Spinal Manipulation - Coursework Example

Spinal Manipulation College Table of Contents 0 Spinal Manipulation……………………………………………………………………...……3 2.0 Chiropractic approach Vs. Physical Therapy approach………………………………………4 2.1 Relationship between weak transverse abdominis and chronic low back pain………5 2.2 The function of the Transverse Abdominis (TrA)……………...………………………5 2.3 Effectiveness of activating the Transversus Abdominis………………………………6 3.0 The Pressure Biofeedback unit………………………………………………………………..7 4.0 Prevalence of Low Back Pain…………………………………………………………………8 5.0 HVLA techniques (High-Velocity Low-Amplitude Techniques)……………………………9 5.1 Diversified Technique………………………………………………………………..10 5.2 Gonstead adjustment…………………………………………………………………10 5.3 Thompson Terminal Point Technique………………………………………………..10 6.0 Conclusion………………………………………………..………………………………….10 7.0 Reference List……………………………………………………..…………………………11 1.0 Spinal Manipulation Spinal manipulation is a very important element in the fields of chiropractors, osteopaths, medical doctors and physical therapists. The term “manipulation” can be used in two different ways: It can be used to refer to any kind of passive movement that is employed during treatment. It can also be defined as a rapid, unpreventable and small-amplitude movement that does not have to be performed at the range of motion’s limit. (Maitland’s Vertebral Manipulation) Maitland classifies manipulation similar to Grade V mobilization due to its unique biomechanics of low amplitude (HVLA) (2) and high velocity. Manipulation techniques can be grouped into two main subtypes; Thrust manipulation which consists of low amplitude therapeutic movement at end of range motion that also has high velocity; Non thrust manipulation which simply means that which does not make use of thrust (Herkowitz, 2004) Several manipulation techniques also fall under the category of manual therapy. They include mobilization of joints or soft tissue, manipulation of joints, myofascial release and massage. Manual therapy tends to have different definitions depending on the specific profession involved. This is so as to clearly outline what is allowed to within the practitioner’s code of practice (Gibbons, & Tehan, 2010). Physical therapy is defined as the techniques that consist of a wide group of skilled hand movements, including manipulation and mobilization, which is employed by physical therapists to manipulate or mobilize joints and soft tissues for the sole purpose of varying pain; the joint range of Motion (ROM) , eliminating swellings of the soft tissues, restriction or inflammation, inducing relaxation, help in improving non-contractile and contractile tissue extensibility and help in improving pulmonary function (Bailey & Bernstein, 2013). (American Physical Therapy Association’s Guide to Physical Therapist Practice) In the scope of U.S chiropractors, Manual therapy was defined by Gatterman and Hansen (1994) as the procedure through which hands directly handle the body to treat articulations or soft tissues. It can also be defined as the use of a specifically determined manual force to the body so as to improve mobility in certain areas that are restricted; in joints and connective tissues mainly. 2.0 Chiropractic approach Vs. Physical Therapy approach Chiropractic deals with diagnosis, treatment and prevention of mechanical problems in the musculoskeletal system most commonly in the spine under the reasoning that such disorders will lead to disorders affecting a person’s health through the nervous system. It mainly approaches treatment via manual therapy like spine and soft tissue manipulation. Spinal adjustment is the most frequently used method of treatment (Chaitow, 2008). This refers to passive manual maneuvers whereby a three – joint complex is taken past the normal movement range and in the process forming a dynamic thrust that refers to a sudden force that leads to audible releases and seeks to increase the range of motion of a particular joint. In general, spinal manipulative therapy refers to techniques in which hands are utilized to massage, adjust, mobilize, stimulate and manipulate to influence the spine. The guide to physical therapist Practice provides a framework that describes the practice in respect to the various methods used in manual therapy that make use of manipulation and mobilization. These techniques are defined in the guide as using of skilled passive movements to soft tissues and joints that are applied at varying amplitudes and speeds that also makes use of high velocity and small –amplitude therapeutic movement (Chaitow, Franke, & Chaitow, 2013). Over the past two decades, chiropractic organizations have been against physical therapists making use of Thrust Joint Manipulation in their treatments. They hold this position since they claim that they are not properly trained to perform this hence exposing patient to serious injury risks in the course of this manipulation treatment in their hands. The four main branches of physical therapy are: muscle and joint manipulation, therapeutics exercise, hydrotherapy and electrotherapy (Chaitow, 2008). (Mary McMillan, Massage and Therapeutic Exercise) This shows that manipulation has been part of physical therapy ever since the profession’s founding. Physical therapist practice and education mainly rotates around movement analysis and science. Their expertise is grounded in physiology, anatomy, biomechanics, pathology and clinical medicine. This helps in providing of the knowledge base for understanding the contraindications and indications that are associated with manual techniques. 2.1 Relationship between weak transverse abdominis and chronic low back pain In the treatment of low back pains, many physical therapists concentrate on the strengthening of the transversus abdominis muscle for improvement of stability. This is frequently used in treatments with a broad number of patients. 2.2 The function of the Transverse Abdominis (TrA) Its main purpose is to offer stability to the low back and pelvis prior to body movements. Rehabilitation through therapy is mainly used to restore motor control of this important stabilizing muscle. Various books point to the most effective means of dealing with low back pains through the strengthening of deep abdominal muscles to achieve a more improved motor control. It has been discovered that TrA is normally activated with arm movements in lower back pain movement patients. 2.3 Effectiveness of activating the Transversus Abdominis Studies have shown that during a willing recruitment task involving the TrA, induced pain was seen to reduce the activity of the transverses abdominis. It has also been seen that a muscle’s role as an antagonist or agonist tends to be altered by pain in order to control its movement and protect tit by use of the pain adaptation model. Many previous studies have also shown that chronic lower back pains tend to reduce the thickness of the transverses abdominis. This will often lead to delay in the muscle’s timing. The optimal muscle activation is also changed rendering ineffective in the presence of pain exercises that activate muscles. There has not been concrete data that prove the fact that the spine is les controlled when the activation of the transverses abdominis is changed. There has also been no proof that changed timing of the transverses abdominis results in poor core stability (Tollison, Satterthwaite, & Tollison, 2001). Independent studies have shown that almost 40% of individuals who are pain free do not possess the feed forward responses in almost two thirds of trials involving bilateral arm tasks. This only serves to prove that low back pain possess a multimodal and complex challenge to diagnose and also treat. A study was also conducted that disapproved the notion that lower back pain patients tend to be unstable. The study in fact found out that lower back pain patients tend to exhibit much more increases stability (Bailey & Bernstein, 2013). It should be noted that even in instances whereby we feel that the LBP patient is unstable; there is no particular method of diagnosing this. Special tests that were aimed at achieving specifically this have come out to be inconclusive hence not applicable. It has however been observed that physical application of force over certain lumbar spine segments is useful in the quest to identify the particular segment that has been impaired. The prone instability test is also a common test but also ends up offering inconclusive diagnostic values. Musculoskeletal specialists possess significant knowledge and have to play a crucial role in low back pain management (Lewit, 2010). The best approach is to teach these patients on methods they can use to independently control their symptoms. The method of activating transverse abdominis with the aim of improving stability when regular aches arise does not seem to be working. Towell rolls, foam rolls or any other methods can also be used in giving relief, regaining joint motion and also making sure an exercise program is much more advantageous to the patient. Statistics show that lower back pain has a 70% chance of re-occurring and this shows that most of the methods employed to deal with this problem are not appropriate/ effective (Brotzman, Manske, & Daugherty, 2011). Involving the transversus abdominus as a main organ in the treatment procedure seems to be the right thing to do but it is not a conclusive means of dealing with lower back pains. The medical professionals need to actively incorporate education and pain relieving exercises so as to achieve optimal muscle activation. 3.0 The Pressure Biofeedback unit This instrument is used so as to provide critical information that ensures precision and quality in muscle testing and exercise performance. This allows the medical professional handling the patient to determine whether the patient is capable of selectively maintaining and isolating contractions of the cervical core stabilization muscles. It uses a standard measuring range of 0-200mmHg analog pressure which ideally has an accuracy of +/- 3mmHg pressure (Seffinger, & Hruby, 2007). The unit that has been designed by physical therapists takes readings of changing pressure in a pressure cell that has been filled by air. This is important since it allows detection of spinal movements during the exercise. It is made up of a gauge/filtration bulb that is connected to a pressurized cell. 4.0 Prevalence of Low Back Pain Lower Back Pain (LBP) is quite common in many western nations including the United States. It affects about 20 % of the U.S Population and the figure is even higher in the working class adult population whose prevalence rate stands at 50% (Benzon, 2014). It is also the most common cause of disability among populations under 45 years of age. Back pain is caused mostly by back overuse, or injury causing damages to joints and muscles. It may also be caused by compression fracture and spinal compression. A survey done amongst adults indicated a general prevalence rate of about 25% with almost half of these affected individuals showing signs of moderate disability and about one in ten showing signs of more serious forms of disability (Dagenais, & Haldeman, 2012). A majority of individuals that suffer from lower back pain do not fully recover as had been earlier on believed. Despite its risk for progression to chronic levels and prevalence there is still lack of evidence of effective treatment strategies for acute lower back pain. 5.0 HVLA techniques (High-Velocity Low-Amplitude Techniques) This is amongst the oldest and most often used chiropractic techniques. Most of the research in this field is focused on examining the efficiency of this form of manipulation of the spine particularly for low back pain. There are several types of HVLA manipulation techniques. I shall focus on the more common techniques that are employed in spinal manipulation. 5.1 Diversified Technique This employs the use of high-velocity low amplitude thrust that has been mostly associated with manual adjustments in chiropractic treatment. Chiropractors apply a brief (low-amplitude), quick (High velocity) thrust on restricted joints normally one joint at a time. The aim of this technique is to be able to restore the correct range of motion in the specific joint. This is achieved by positioning the patient’s body in a certain way so as to achieve the optimum adjustment of the spine (DvořÁk, & Baumgartner, 2008). 5.2 Gonstead adjustment This technique is almost similar to the Diversified technique. The major difference occurs in the process of locating the ailing joint and the details of body positioning. In this technique, the medical professional makes use of specially constructed tables and chairs so as to correctly position the patient. The chest-knee table and the cervical chairs are some of the specialized chairs that are used in this process. This method may also be correctly called the Palmer-Gonstead technique. 5.3 Thompson Terminal Point Technique This also makes use of specialized treatment tables. What sets it apart from the Gonstead adjustment technique is that these tables fall a short distance during an HVLA thrust with the principle that these sudden drops assists in the movements of the joint. This method is frequently used to complement the other more traditional HVLA techniques in the market. With this technique, the normally expected cracking sound may fail to be heard (Tollison, Satterthwaite, & Tollison, 2001). This has led many practitioners in the profession to refer to it as gentle adjustment approach. 6.0 Conclusion During an HVLA manipulation there is often a sound referred to as cavitation that is normally heard. This popping sound is normally caused by a release of gas which occurs when the ailing joint is pushed past its passive range of motion (Bailey & Bernstein, 2013). This is the same mechanism that causes knuckles to crack. There is a section of patients and clinicians that must hear this pop sound in order to be satisfied that the treatment has been a success. There however has been no study that confirms this as a matter of fact. 7.0 Reference List HERKOWITZ, H. N. (2004). The lumbar spine. Philadelphia, Lippincott Williams & Wilkins. GIBBONS, P., & TEHAN, P. (2010). Manipulation of the spine, thorax and pelvis an osteopathic perspective. Edinburgh, Churchill Livingstone/Elsevier. http://site.ebrary.com/id/10554291. CHAITOW, L. (2008). Naturopathic physical medicine: theory and practice for manual therapists and naturopaths. Edinburgh, Churchill Livingstone/Elsevier. WYATT, L. H. (2005). Handbook of clinical chiropractic care. Sudbury, Mass, Jones and Bartlett. CHAITOW, L., FRANKE, H., & CHAITOW, L. (2013). Muscle energy techniques. Edinburgh, Churchill Livingstone/Elsevier. BENZON, H. T. (2014). Practical management of pain. Philadelphia, PA, Elsevier/Saunders. DAGENAIS, S., & HALDEMAN, S. (2012). Evidence-based management of low back pain. St Louis, Mo, Elsevier Mosby. DVOŘÁK, J., & BAUMGARTNER, H. (2008). Musculoskeletal manual medicine diagnosis and treatment. Stuttgart, Thieme. http://site.ebrary.com/id/10587022. BROTZMAN, S. B., MANSKE, R. C., & DAUGHERTY, K. (2011). Clinical orthopaedic rehabilitation: an evidence-based approach. Philadelphia, PA, Elsevier Mosby. SEFFINGER, M. A., & HRUBY, R. J. (2007). Evidence-based manual medicine: a problem oriented approach. Philadelphia, Saunders. BAILEY, A., & BERNSTEIN, C. (2013). Pain in women a clinical guide. New York, NY, Springer. http://www.springerlink.com/openurl.asp?genre=book&isbn=978-1-4419-7112-8. TRIANO, J. J. (1998). Biomechanical analysis of motions and loads during spinal manipulation. Thesis (Ph. D.)--University of Michigan, 1998. TOLLISON, C. D., SATTERTHWAITE, J. R., & TOLLISON, J. W. (2001). Practical pain management. Philadelphia, Pa, Lippincott Williams & Wilkins. LEWIT, K. (2010). Manipulative therapy musculoskeletal medicine. Edinburgh, Churchill Livingstone/Elsevier. http://site.ebrary.com/id/10511824. Read More