Manual Medicine - Joint Manipulation

Articular Thrust Technique

Related Authors: Andrew Tayor Still MD/DO, James Cyiax MD, David Palmer DC

"Manipulation techniques have existed since ancient times and can be found in different forms of medicine. The defining characteristic of osteopathic medicine lies in the concept of philosophy whereby these manipulations are performed.

Principles: The High Velocity manipulation at high speed and low amplitude (H.V.L.A.) Technique is aimed at taking articular mobility beyond the motor barrier, thus immediately freeing the articulation and its movement.

Method: The right "thrust", corrective and not painful, depends on correct selection of the following characteristics: force, force direction, point of application of force, speed, amplitude, contact point, pressure, traction, compression, stabilisation of the segment, the respiratory stage, leverage, moment, fulcrum, start and stop, and the state of relaxation of both patient and operator.

Indications: Cases of articular hypomobility and the physiology disorders correlated to them."
Source

Mechanism of Action

J Manipulative Physiol Ther. 2003 May;26(4):220-5.Somatovisceral response following osteopathic HVLAT: a pilot study on the effect of unilateral lumbosacral high-velocity low-amplitude thrust technique on the cutaneous blood flow in the lower limb.
J Manipulative Physiol Ther. 2002 May;25(4):251-62.Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories.
Spine J. 2005 May-Jun;5(3):277-90. Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.
Am J Phys Med Rehabil. 2005 Apr;84(4):251-7.Manual treatment effects to the upper cervical apophysial joints before, during, and after endotracheal anesthesia: a placebo-controlled comparison.
Int J Mol Med. 2004 Sep;14(3):443-9.Nitric oxide as a possible mechanism for understanding the therapeutic effects of osteopathic manipulative medicine (Review).
J Manipulative Physiol Ther. 2007 Oct;30(8):578-83.Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects.
J Manipulative Physiol Ther. 2008 Feb;31(2):115-26.
Altered sensorimotor integration with cervical spine manipulation.

Reviews/Trails/Studies

Spine J. 2004 May-Jun;4(3):335-56.Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.
BMC Musculoskelet Disord. 2005 Aug 4;6:43.Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials.
Spine. 2003 Jul 1;28(13):1355-62.Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.
Fam Pract. 2003 Dec;20(6):662-9.Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care.
Cochrane Database Syst Rev. 2004;(3):CD001878.Non-invasive physical treatments for chronic/recurrent headache.
Spine. 2004 Jul 15;29(14):1541-8.A Cochrane review of manipulation and mobilization for mechanical neck disorders.
BMC Musculoskelet Disord. 2005 Aug 4;6:43.Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials.
Lancet. 2007 Nov 10;370(9599):1638-43.Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial.
The Spine Journal Jan-Feb 2008 Interventional Review -Spinal manipulation and mobilization Full Text + Links PDF (239 K)
Critically Appraised Topics -from evidenceinmotion.com
LBP: Spinal manipulation & interferential current
LBP: Spinal manipulation clinical prediction rule (Validation)

Side Effects

J R Soc Med. 2007 Jul;100(7):330-8.Adverse effects of spinal manipulation: a systematic review.
Pediatrics. 2007 Jan;119(1):e275-83. Epub 2006 Dec 18.Adverse events associated with pediatric spinal manipulation: a systematic review.
J Am Osteopath Assoc. 2007 Sep;107(9):411-3.Trauma-induced pneumothorax after "bear-hug back crack" home remedy: attempted spinal manipulation by a layperson.
Spine. 2008 Feb 15;33(4 Suppl):S176-83.Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.
Spine. 2008 Feb 15;33(4 Suppl):S176-83.
Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.

Question/Refute

Cochrane Database Syst Rev. 2004;(1):CD000447.
Spinal manipulative therapy for low back pain.
Cochrane Database Syst Rev. 2006 Jul 19;3:CD002119.
Spinal manipulation for primary and secondary dysmenorrhoea.
Clin J Pain. 2006 Mar-Apr;22(3):278-85.
Are manual therapies effective in reducing pain from tension-type headache?: a systematic review.
Spine. 2001 Apr 1;26(7):788-97; discussion 798-9.
A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.
Spine. 2003 Jul 1;28(13):1355-62.
Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.

Tuesday, September 8, 2009

Summer 2009

Osteopath Med Prim Care. 2009 Aug 27;3(1):7. [Epub ahead of print]
Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment.
Mil Med. 2009 Jul;174(7):750-6.
Comparison of short-term response to two spinal manipulation techniques for patients with low back pain in a military beneficiary population.

From: Geneva Foundation for Medical Education and Research
WHO Collaborating Centre in Education and Research in Human Reproduction - Link

Spinal manipulation
Cochrane Library - Spinal manipulation for primary and secondary dysmenorrhoea [2009]
National Center for Complementary and Alternative Medicine - Spinal Manipulation for Low-Back Pain [2008]
Child care - Spinal manipulation
Pediatrics - Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review [2007]
Multiple indications - Spinal manipulation
Journal of the Royal Society of Medicine - A systematic review of systematic reviews of spinal manipulation [2006]
Musculoskeletal diseases - Spinal manipulation
Cochrane Library - Spinal manipulative therapy for low back pain [2009]
Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies [2003]
Australian Family Physician - Neck related causes of headache [2005]
BMC Complementary and Alternative Medicine - Content validity of manual spinal palpatory exams - A systematic review [2003]
Family Practice - Does spinal manipulation have specific treatment effects? [2000]
Medical Journal of Australia - Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001 [2002]
Stroke - Life-Threatening Complications of Spinal Manipulation [2001]
Safety - Spinal manipulation
Adverse effects of spinal manipulation: a systematic review [2007]

Sunday, February 15, 2009

Spring 2009

BMJ. 2004 Dec 11;329(7479):1381. Epub 2004 Nov 19.
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.
Man Ther. 2003 Feb;8(1):46-51.
Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations.
J Orthop Sports Phys Ther. 2009 Jan;39(1):4-11.The change in the diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization compared to prone lying.

Sunday, October 19, 2008

October 2008

Pain. 2008 Sep 4.
Which subgroups of patients with non-specific neck pain are more likely to benefit from spinal manipulation therapy, physiotherapy, or usual care?

Wednesday, September 10, 2008

September 2008

Med Hypotheses. 2008 Aug 22. [Epub ahead of print]
Hypothesis: Upregulation of a muscle-specific isoform of insulin-like growth factor-1 (IGF-1) by spinal manipulation.
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):461-4.
Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks?
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):447-54.
Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence.
J Orthop Sports Phys Ther. 2008 Mar;38(3):A1-6. Epub 2008 Feb 29.
AAOMPT clinical guidelines: A model for standardizing manipulation terminology in physical therapy practice.

Monday, July 7, 2008

July 2008

Ann Readapt Med Phys. 2008 May 28.
Vertebrobasilar ischemia after cervical spine manipulation: A case report.
Spine. 2008 Jun 1;33(13):1451-8.
Predictors of a favorable outcome in patients treated by chiropractors for neck pain.

Wednesday, June 18, 2008

June 2008

J Manipulative Physiol Ther. 2008 Mar;31(3):199-203.
The refractory period of the audible "crack" after lumbar manipulation: a preliminary study.
Am Surg. 2008 May;74(5):428-9.
Boerhaave's syndrome following chiropractic manipulation.
J Manipulative Physiol Ther. 2008 Mar;31(3):237-46.
Prospective case series on the effects of lumbosacral manipulation on dysmenorrhea.
J Manipulative Physiol Ther. 2008 Mar;31(3):172-83.
Predictors for immediate and global responses to chiropractic manipulation of the cervical spine.
Clin Rehabil. 2008 Jun;22(6):529-41.
Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study.

Friday, May 2, 2008

May 2008

Osteopath Med Prim Care. 2008 Apr 25;2(1):5 [Epub ahead of print]
OSTEOPAThic Health outcomes In Chronic low back pain: The OSTEOPATHIC Trial.
Eur Spine J. 2008 Apr 22
Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial.
Spine. 2008 Apr 15;33(8):914-8.
The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review.
J Manipulative Physiol Ther. 2008 Feb;31(2):115-26.
Altered sensorimotor integration with cervical spine manipulation.
BMC Musculoskelet Disord. 2008 Feb 11;9:19.
The influence of expectation on spinal manipulation induced hypoalgesia: an experimental study in normal subjects.
J Manipulative Physiol Ther. 2008 Mar;31(3):172-83.
Predictors for immediate and global responses to chiropractic manipulation of the cervical spine.