Manipulation

How does the stress strain curve work?

- get creep out of joint - improve range - then exercise for patient to maintain the ROM

What are the effects of manipulation?

1. Psychological 2. Neurophysiological 3. Biomechanical 4. Chemical

CPR for manipulation on patients with LBP

<16 days of pain duration No symptoms distal to knee FABQ < 19 greater than or equal to 1 hypomobile segment in the lumbar spine greater than or equal to 1 hip with 35 degrees of IR ROM 4/5 of the above indicate patients more likely to benefit from spinal manipulation

What are the Maitland Grades?

Grade 1 - beginning range small amp Grade 2 beginning to mid range large amp Grade 3 mid range to end range large amp Grade 4 end range long amp

What grades are for pain?

Grades I-IV

What grades are biomechanical effects?

Grades III and IV and thrust

Define manipulation

Manual therapy technique comprised of a continuum of the skilled passive movement to the joints and/or related to soft tissues that are applied at various speeds and amplitudes; including a small amplitude high velocity therapeutic moment

Results of the thrust vs. non-thrust study

People who satisfy a prescriptive CPR for lumbar spinal manipulation benefit as much from non-thrust manipulation driven by the physical therapist's clinical reasoning as from thrust manipulation

Describe biomechanical effects

Stretch restrictions in the capsule to restore fiber glide and ability to elongate Stretch or snap adhesions between capsule and bone ends (reflex inhibition?) Stress strain curve

Describe the stress strain curve

Toe, elastic, plastic, ultimate stress, necking, ultimate failure

What happens to a joint?

collagen fibers floating in protein molecules (GAGs) loose from immobility lose water adhesions hypomobility

What is the pop?

gas (nitrogen) released from the synovial fluid inside the capsule due to negative pressure gas stretches out the joint capsule the distended joint capsule stimulates type III mechanorecpetors stimulates descending pathways inhibit muscles and decreases tension

Elaborate on neurophysiological effects

gate control muscle inhibition movement and nutrition

What is movement/nutrition?

improve blood flow and wash away chemical irritants restore more normal movement supply nutrition for healing

Describe chemical effects

probable release of endorphin in the brain acting as pain killers descending pathways in the periaqueductal gray ma block pain at the dorsal horn

What is gate control?

stimulation of A beta fibers blocks nociception signals of the A delta and C fibers at the dorsal horn spinal cord decides if pain signals are blocked or if they continue onto the brain

What is muscle inhibition?

stretching the capsules fire type III mechanoreceptors and GTO of attaching muscles such as the multifidus cervical spine, thus causing a reflex inhibition of muscle tone and neighboring muscles

Elaborate on physiological effects

touch - caring intelligent hands, induced movement, pop or snap