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