What is manipulation?

Manipulation is a "hands-on" treatment using a high velocity, low amplitude, controlled movement (thrust or distraction technique) applied to a specific joint with the intention of restoring movement of that joint, thereby improving its function and reducing pain.

Physiotherapists do manipulate!!!

Manipulation is part of the physiotherapy Scope of Practice. It is a controlled act that cannot be delegated. Many physiotherapists have post graduate education and certification in manipulative therapy.

Philosophy

In our practice, the application of manipulation to the spine is the final act in a series of techniques and thought processes. A differential diagnosis examination, followed by an indepth biomechanical assessment, must always precede the decision to manipulate.

Safety Tests

Patient safety is the primary consideration!! Thorough and proper screening of patients before and after treatment will minimize the risk of injury. Objective tests include the assessment of:

1. ligamentous stability
2. joint stability
3. vascular competence

Reasons to Manipulate

• considered only in the absence of contra-indications
• joint subluxation/dysfunction
  • non-capsular pattern of restriction
  • unidirectional restriction
  • jammed end-feel
• last few degrees of range limited and unobtainable by mobilization
• mobilization produces unacceptable levels of post-treatment soreness

In our practice, we do not encourage manipulation on an ongoing basis - it is to free a stuck (or jammed) joint safely, when other approaches don't or can't work. Repetitive manipulation should not be necessary. It may encourage segmental hypermobility or instability.

Some Reasons NOT to Manipulate

• bone disease eg. osteoporosis, Paget’s
• systemic inflammatory disorders
  eg. rheumatoid arthritis, Ankylosing Spondylitis
• moderate to severe osteoarthritis
• neoplastic disease - past or present
• infective arthritis
• children under 18 years of age
• history of trauma eg. under 6 wks post car-accident
• blood clotting disorders
• congenital abnormalities
• fracture or dislocation
• non-mechanical causes
• empty end-feel
• adverse joint environment (spasm)
• vertebrobasilar ischaemia or history of same
• craniovertebral transverse, or alar ligament instability
• bi-level cervical root signs
• tri-level lumbar root signs
• bilateral LE neuralgia
• cauda equina signs and/or symptoms
• 1st and 2nd lumbar root palsy
• signs and symptoms of radiculopathy
• spinal cord signs and/or symptoms
• sign of the Buttock present
• emotionally dependent patients

For physicians wishing to have their patients evaluated for the appropriateness of spinal manipulation, using up-to-date evidence based practice, please consider direct referrals to our:

Clinical Associates for Spinal Manipulation:

Martin Blaser   B.A./B.P.H.E., B.Sc.(P.T.), G.I.M.S.

• Credentialed by examination in spinal manipulative therapy by Jim Meadows, F.C.A.M.T.

James Baggs  B.Sc.(P.T.), C.A.F.C.I.

• Credentialed by examination in spinal manipulative therapy by Jim Meadows, F.C.A.M.T.