Mobilization/manipulation including grade V thrust

Question 1

Joint injury can result in what

Answer 1

• dysfunction
• effects of sprains and strains
• inststability
• OA

Question 2

dysfunctions within a joint present as

Answer 2

• decreases in motion
• increases in motion
• presence of aberrant movements

Question 3

Passive intervertebral mobility grading system

Answer 3

• 0: ankylosed/no movement
• 1: consideratble restriction; significant decrease range
• 2: slight restriction; limited in extected range
• 3: normal
• 4: slight increase
• 5: considerable increase
• 6: unstable

Question 4

Mobilization indications

Answer 4

• to relieve pain
• graded oscillations/mobilizations Grades I, II = firing of articular mechanorecptors
• Increase ROM: higher grade mobilizations
• tranditional stretching: TERT

Question 5

Grade 5 thurst indications

Answer 5

• capsular restriction
• adhesions limiting ROM
• loose body in joint
• stuck joint surfaces
• sensitive structure impingement

Question 6

Contraindications for mobilization/manipulation

Answer 6

• grad 1 and 2 = few; not stressing the tissue
• higher grades: disease (osteoporosis/cancer), long term corticosteriod use, likelihood of causeing osseous or ligmentous damage

Question 7

Thrust precuations

Answer 7

• Very stiff joints/severe capsular restrictions
• for C/S - vertebral arteries

Question 8

Thrust adverse reactions

Answer 8

• increase in pain, swelling, guarding
• decrease in mobility/ROM

Question 9

reason for thrust adverse reaction

Answer 9

• thrust manipulatoin not indicated: too acute, too restricted, patient selection
• technique is too forceful

Question 10

Effects of mobilization/manipulation

Psychologic, Mechanical, Chemical, Neurophysiology

Answer 10

Psychological

• skilled eval, caring hands
• feel like you are helping them

Mechanical effects:

• stretch capsular restrictions
• snap adhesions
• move a loose body
• free stuck surfaces
• release sensitive structures

chemical:

• release endorphins

Neurophysiological effects:

• firing of articular mechanorecptors
• stimulate A alpha and A beta nerve fibers
• synpase with inhibitory interneuron at spinal cord level
• inhibitory effects on transmission of pain from C and A delta at spinal cord level

Question 11

Negative effects of manipulation

Answer 11

• if hypermobile = make it worse
• stress disc
• dependency from the fix of immediate relief
• chronic self manipulation

Question 12

Notes on how to manipulate a joint

Answer 12

• high velocity stiffens the tissue; adhesions do better with thrust
• do not heat tissues before a thrust
• before thrust accumulate the forces by getting ligamentous tension, facet/articular opposition
• severe capsular restrictions do better with joint mobilization

Question 13

Criteria for L/S thrust manipulation

Answer 13

• Duration of LBP <16 days
• no symptoms distal to the knee
• FABQ lower score <19 points
• spine mobility testing - at least one hypomobile L/S segment
• at least one hip with 35ºof IR
• *with 4/5 met above = 95% probability of achieving a positive outcome from manipulation
• if 3/5 met = 68% of sucess*

Question 14

Risks of lumbar spine manipulation grade V thrust

Answer 14

• impossible to determine exact risk of spinal manipulation for L/S
• under-reported in peer reviewed literature all disciplines only 1/10 cases reported
• cauda equina syndrome is most serious risk of L/S manipulation

Question 15

Red flags screen

manipulation

Answer 15

• significant trauma, pain, inflammation Fx
• Hx o CA patient over 50 years old
• unexplained weight loss
• unrelenting night pain
• pain worse with lying down
• osteoporosis, loss of bone or ligamentous integrity
• steriod use