Spinal Thrust Techniques: Manipulation and Safety

what grade of mobilization is a trust?

grade 5

what is the definition of a grade 5 mobilization?

manipulation or thrust, high velocity, low amplitude (HVLA) beyond end range

4 contraindications to thrust techniques

- bony compromise

- neurological signs/symptoms

- vascular issues

- lack of patient consent/communication

what are examples of bony compromise?

fracture, metastases, osteoporosis, osteomyelitis, long-term corticosteroid use, RA

what are examples of vascular issues?

aortic aneurysm, diagnosed VBI, hemophilia/bleeding disorders

6 precautions for thrust techniques

- Adverse reaction to previous manual therapy

- Disc herniation

- Pregnancy

- Spondylolisthesis

- Ligamentous laxity

- Psychological dependence on manipulation

what cervical motions cut off blood supply to the brain, therefore should be avoided while doing thrusts?

rotation and extension

4 serious, non-reversible impairments for thrusts

- death

- CVA/stroke

- spinal cord compression

- cauda equina injury

3 reversible impairments for thrusts

- disc injury

- nerve root compression

- fracture

what group of people have a higher likelihood of a serious side effect from thrusts, increasing their risk of injury?

people with underlying health problems

it is critical for PTs to ____/____ patients and for patients to accurately share their ____ _____

assess/screen ; health information

10 transient impairments that usually go away within 24 hours

- *Local pain or discomfort

- *Headaches

- *Stiffness

- Tiredness

- Radiating pain or discomfort

- Paresthesia

- Dizziness

- Nausea

- Hot skin

- Fainting

when do most side effects begin within? when do they disappear?

4 hours ; 24 hours

what gender is more at risk for side effects?

women

how often is manipulation utilized?

EXTREMELY low

what is the number 1 reason manipulation is under-utilized?

anxiety about complications

what are the 2 most common causes of complications?

- incorrect patient selection

- errors in technique

what are examples of incorrect patient selection?

- Lack if awareness of possible complications

- Inadequate physical therapist evaluation

- Lack of patient consent

- Patient unable to relax

what are examples of errors in technique?

- Excessive force

- Excessive amplitude

- Excessive leverage

- Poor positioning of the patient or PT

- Lack of patient feedback

- Lack of training

The estimated risk of cauda equina syndrome as a complication of lumbar manipulation is estimated to be less than ___ case per _____ _____ manipulations

1 case per 100 million

5 factors related to lack of improvement =

- longer duration of symptoms

- no stiffness in lumbar spine/decreased ROM

- symptoms extending to buttocks/leg

- little discrepancy in hip IR - 35 degrees (L to R)

- generally reduced hip ROM