Introduction to Spinal Manipulation

• Free motion - neutral zone
• Soft tissue restriction - physiologic barrier
• Bony restriction - anatomic barrier

• Restore normal joint play
• Stretch tight capsules
• Stretch adhesions 
• Rupture adhesions
• Alter relative positions of articular surfaces

• The motions produced result in firing of sensory receptors which may provide pain relief and decreased resting tone 
• Two mechanisms = Mechanoreceptors and Gate Control Theory

• Type I and II: activated by grade I and II oscillations
• Reduces pain and muscle guarding
• Repeated gentle motions tend to reduce pain

Type III: activated by grade V manipulations --> provides reflex muscle relaxation

Stim of large-fiber proprioceptors causes flood of impulses --> closes gate to small-fiber nociceptors

Laying of hands instills confidence in many people, assurance that they will improve

• Joint dysfunction
• Neurophysiologic effects

• Deviation int he presence of neurologic signs (sensation, motor weakness, reflex changes)
• Serious pathology
• Relative to skill and experience
• Absence of dysfunction

• Fracture
• Post-operative
• Bone disease (osteoporosis, neoplasm, infection)
• Ligament rupture
• Acute RA
• Excessive pain or resistance
• Empty end feel

• Pharmacology
• History of neoplasm
• Inflammation
• Age
• Cachexia
• Difficulty relaxing
• Pregnancy
• BC pills
• Physique
• Hunch 
• Chronic pain, fibromyalgia
• Emotionally dependent patients

• If you take up slack in one direction at a joint, you affect the others
• If you block one movement, you affect others
• This occurs in the presence of pathological conditions and physical constraints (clothing, shoes, etc.)

Condition referring to abnormal joint mechanics that may or may not be associated w/ symptomatology

• Trauma (intrinsic or extrinsic)
• Immobilization
• Following resolution of a more serious pathological condition

• Law 1: if the A-P curve of the spine is in a neutral or mid-range position, side bending & rotation occur to opposite sides
• Law 2: If the A-P curve of the spine is in a non-neutral (flexed or extended) position, side bending & rotation occur to same sides
• Law 3: If a segment is moved into one of the cardinal planes of motion, the available motion in the other 2 planes is reduced

• Multisegmental
• Found in neutral spine position
• Improved in flexion and extension
• Positional asymmetry in accordance w/ Law I
• SB & ROT occur to opposite sides
• i.e. scoliotic curve

• Usually affects a single joint
• May be present in neutral spine position
• More pronounced in either flexion or extension
• Positional asymmetry in accordance w/ Law II
• SB & ROT occur to same side
• 4 potential diagnoses for single-quadrant limitation of segmental motion, named for resultant position of superior vertebra relative to inferior vertebra (ERSL, ERSR, FRSL, FRSR)
• i.e. intrinsic or extrinsic trauma