Introduction to Spinal Manipulation

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  1. Barriers to Joint Motion
    • Free motion - neutral zone
    • Soft tissue restriction - physiologic barrier
    • Bony restriction - anatomic barrier
  2. Effects of Manipulation: Mechanical
    • Restore normal joint play
    • Stretch tight capsules
    • Stretch adhesions 
    • Rupture adhesions
    • Alter relative positions of articular surfaces
  3. Effects of Manipulation: Neurophysiological
    • 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
  4. Mechanoreceptor-Related Effects of Manipulation
    • 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
  5. Gate Effects of Manipulation
    Stim of large-fiber proprioceptors causes flood of impulses --> closes gate to small-fiber nociceptors
  6. Effects of Manipulation: Psychological
    Laying of hands instills confidence in many people, assurance that they will improve
  7. Indications for Manipulation
    • Joint dysfunction
    • Neurophysiologic effects
  8. Contraindications for Manipulation
    • Deviation int he presence of neurologic signs (sensation, motor weakness, reflex changes)
    • Serious pathology
    • Relative to skill and experience
    • Absence of dysfunction
  9. Contraindications for Spinal Maniuplation
    • Fracture
    • Post-operative
    • Bone disease (osteoporosis, neoplasm, infection)
    • Ligament rupture
    • Acute RA
    • Excessive pain or resistance
    • Empty end feel
  10. Precautions for Spinal Manipulation
    • Pharmacology
    • History of neoplasm
    • Inflammation
    • Age
    • Cachexia
    • Difficulty relaxing
    • Pregnancy
    • BC pills
    • Physique
    • Hunch 
    • Chronic pain, fibromyalgia
    • Emotionally dependent patients
  11. Constrained Joint Motion
    • 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.)
  12. Joint Dysfunction
    Condition referring to abnormal joint mechanics that may or may not be associated w/ symptomatology
  13. Etiology of Joint Dysfunction
    • Trauma (intrinsic or extrinsic)
    • Immobilization
    • Following resolution of a more serious pathological condition
  14. Fryette's Laws of Spinal Motion
    • 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
  15. Somatic Dysfunction: Type I
    • 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
  16. Somatic Dysfunction: Type II
    • 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
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Introduction to Spinal Manipulation
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