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Musculoskeletal Physiotherapy 3 > Week 6 : Manipulation > Flashcards

Week 6 : Manipulation Flashcards

1
Q

definition of manipulation

A

skilled therapeutic use of a passive movement designed to restore motion/function

High velocity, small amplitude movement often associated with an audible crack/click

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2
Q

what is a cavitation

A

crack/click/pop

the audible release is caused by a cavitation process whereby a sudden decrease in intracapsular pressure causes dissolved gasses in the synovial fluid to be released into the joint cavity

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3
Q

Gas remains in the joint for how long after manipulation

A

20-30mins

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4
Q

What is the affect on the joint post cavitation

A

the force displacement changes and the ROM of the joint is increased

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5
Q

The gases released from the synovial fluid make up what percentage of the joint volume and consist of what

A

15% synovial fluid

80%Co2

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6
Q

Grade V HVT define

A

Manipulation is defined as a form of manual therapy, which involves movement of a joint passed its usual end of range of motion (physiological), but not passed it’s anatomic range of motion

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7
Q

Type of manipulation

A 
general (regional) 
indirect
non - contact
long lever
soft tissue 
mobilisation 
localised (specific) 
direct 
contact 
short lever
joint 
HVT grade V
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8
Q

indications for manipulation

A

only after thorough clinical assessment
grade V HVT should be primarily considered as a progression of mobilisation to a grade V
in some cases, can be considered as first treatment of choice. for example an acute locked back/neck or thoracic spine manipulation

  • Spinal motion restriction/dysfunction (of mechanical origin)
  • Responded to mechanical treatment and Rx has plateaued with mobilisations
  • Shorter pain duration (<12 weeks) = more evidence
  • No contraindications to manipulation
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9
Q

absolute contraindications to manipulation

A 
neoplasia: benign or malignant 
active infection or inflammation 
RA
neurologic changes 
cord compression 
cauda equina compression 
instability following trauma
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10
Q

Relative contraindications to manipulation

A 
VBI
spondylolisthesis 
anticoagulation drugs 
Hx of stroke 
drop attacks
Osteoporosis 
Bone maldevelopment 
marked foraminal encroachment 
severe disc protrusion 
acute nerve irritation
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11
Q

Care contraindications

A 
pregnancy 
dizziness
elderly patient 
trivial back pain 
psychogenic pain 
undiagnosed pain 
severe pain 
hypermobility 
post laminectomy 
post spinal fusion
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12
Q

Use of a HVLA technique requires looking for signs of specific spinal dysfunction
ARTT

A

A relates to asymmetry (facet on palpation)
R relates to range of motion
T relates to tissue texture changes
T relates to tissue tenderness

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13
Q

Method of manipulation

A

localise thrust to a single facet jt
spinal segments above and below should be locked
Short, Sharp thrust given (speed and direction more important than force)

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14
Q

Mechanical effect of manipulation

A

effects on motion segments (disk/facet/muscle)

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15
Q

Neurophysiological effect of manipulation

A

effects on pain mechanisms

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16
Q

Effect of manipulation is either on the

A

mechanical
or
neurophysiological

17
Q

How does manipulation increase range of motion

A

stretching of capsular/ligamentous adhesions, scar tissue
Reflex inhibition of muscle spasm/increased tone
Unlocking of entrapped meniscus (synovial folds)
Reduction in intra-articular pressure
Enhancement of joint nutrition/hydrodynamics

18
Q

previous theories

- four main hypotheses for lesions that respond to Manipulation

A

1 - release of entrapped synovial folds or plica
2 - relaxation of hypertonic muscle by sudden stretching
3- disruption of articular or periarticular adhesions
4- unbuckling of motion segments that have undergone disproportionate displacements

19
Q

4th theory - unbuckling of motion segments that have undergone disproportionate displacements

A

Vague heading refers to either realignment of the joint ‘subluxation’, ‘realignment’ or ‘replacement’
The theory is the oldest and possibly due to the audible ‘clicking’
The profession of the “Bone setters”

20
Q

manipulation and the effect on muscle spindles

A

Changes in paraspinal muscle activity noted after SMT

Suggested that it is as a result of stimulation of muscle spindles (Ia fibres)

Decreased muscle tonicity and increased ROM seen after SMT

21
Q

neurologically based mechanisms of manipulation

A

– Pain gate-control theory (via stimulation of large diameter sensory mechanoreceptors)
– decrease in joint afferent activity (via stimulation of muscle spindles and decrease in GT activity)
– descending pain inhibitory systems (via PAG and DAG) / similar to mechanisms for TENS
– autonomic nervous system effects – increase in pain threshold levels

22
Q

psychological benefits of manipulation

A

unknown mechanisms behind the perceived influence but appears to be related to the audible “click”

23
Q

mechanisms of HVT manipulation

A
  • The precise mechanism(s) whereby manipulation decreases pain is still unclear
  • Proposed mechanisms may be selective to the source of the pain which remains difficult to isolate
24
Q

efficacy of manipulation

A

• Acute low back pain
– moderate evidence of the short term efficacy
• SMT
– inconclusive evidence for long-term efficacy
• Chronic low back pain
– moderate evidence of the short term efficacy
• SMT +MOB
– inconclusive evidence for long-term efficacy

25
Q

side effects/complications

A

benign transient muscle and joint soreness

how to make it feel better

  • massage
  • heat
  • gentle mobilisations
  • pain killers
  • support
26
Q

reversible serious complications associated with manipulation

A 
vertigo/dizziness (cspine) 
rib fracture (Tx)
Progression of neurological deficits 
TIA (Cx) 
misdiagnosis - cancer
27
Q

Irreversible complications associated with manipulations

A

cauda equina syndrome (1/100 million)
Cerebrovascular injuries/paralysis (1/1million)
Death

28
Q

Monitor for red flags

A 
cauda equina compression 
persistent or progressive neuro deficit 
intractable pain 
serious spine pathology 
inflammatory disorders (ankylosing spondylitis &amp; related disorders)
29
Q

Practicum

A 
Lumbar spine rotation (million dollar roll)
Thoracic spine (PA thrust + crossed pisiform) 
Cervical spine (mid cervical upslope) 
Talocrural joint (longitudinal) 
Wrist (capitate flick)

Musculoskeletal Physiotherapy 3 (9 decks)

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