A Model for Standardizing Manipulation Terminology in Physical Therapy Practice

Mintken, Paul E.; DeRosa, Carl; Little, Tamara; Smith, Britt

doi:10.2519/jospt.2008.0301

Cited by 67 publications

(33 citation statements)

References 57 publications

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“…13,55 This technique was performed with the patient positioned supine. Using recommended terminology recently proposed by Mintken et al, 44 the therapist (C.S.) used her manipulative hand to stabilize the inferior vertebra of the targeted motion segment and used her body to push down through the patient's arms, performing a high-velocity, low-amplitude thrust.…”

Section: Methodsmentioning

confidence: 99%

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

Sparks

Cleland

Elliott³

et al. 2013

J Orthop Sports Phys Ther

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[ research report ] R ecently, in the physical therapy profession con siderable attention has been devoted to exam ining the effectiveness of spinal manipulation in clinical practice. 9,15,16,24,65 The use of thrust manipulation applied to the thoracic spine has been shown to result in increased range of motion, decreased pain, and improvements in function in subgroups of individuals with mechanical neck and shoulder pain. [13][14][15][16]23,43,62,65 Biomechanical theories to explain the effects of spinal manipulation exist, yet the available data do not sufficiently explain how manipulation results in short-or long-term clinical benefits. 20,34,47,56 Researchers have attempted to identify which combination of clinical signs, symptoms, and other pertinent findings from the examination may predict a favorable response to spinal manipulation. 13,43,57 A validation study of a proposed clinical decision rule to identify patients likely to respond to thoracic manipulation found that subjects with mechanical neck pain improved with T T STUDY DESIGN: Case series. T T OBJECTIVES:To use blood oxygenation leveldependent functional magnetic resonance imaging (fMRI) to determine if supraspinal activation in response to noxious mechanical stimuli varies preand post-thrust manipulation to the thoracic spine. T T BACKGROUND:Recent studies have demonstrated the effectiveness of thoracic thrust manipulation in reducing pain and improving function in some individuals with neck and shoulder pain. However, the mechanisms by which manipulation exerts such effects remain largely unexplained. The use of fMRI in the animal model has revealed a decrease in cortical activity in response to noxious stimuli following manual joint mobilization. Supraspinal mediation contributing to hypoalgesia in humans may be triggered following spinal manipulation. T T METHODS: Ten healthy volunteers (5 women, 5men) between the ages of 23 and 48 years (mean, 31.2 years) were recruited. Subjects underwent fMRI scanning while receiving noxious stimuli applied to the cuticle of the index finger at a rate of 1 Hz for periods of 15 seconds, alternating with periods of 15 seconds without stimuli, for a total duration of 5 minutes. Subjects then received a supine thrust manipulation directed to the midthoracic spine and were immediately returned to the scanner for reimaging with a second delivery of noxious stimuli. An 11-point numeric pain rating scale was administered immediately after the application of noxious stimuli, premanipulation and postmanipulation. Blood oxygenation level-dependent fMRI recorded the cerebral hemodynamic response to the painful stimuli premanipulation and postmanipulation. T T RESULTS:The data indicated a significant reduction in subjects' perception of pain (P<.01), as well as a reduction in cerebral blood flow as measured by the blood oxygenation level-dependent response following manipulation to areas associated with the pain matrix (P<.05). There was a significant relationship between reduced activation in the insular cortex and d...

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Section: Methodsmentioning

confidence: 99%

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

Sparks

Cleland

Elliott³

et al. 2013

J Orthop Sports Phys Ther

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show abstract

“…10 They also underwent screening for upper cervical spine ligamentous instability through the Sharp-Purser test, alar ligament stress test, and transverse ligament test. Exclusion criteria included the following: (1) any contraindication to manipulation (eg, positive extensionrotation test 32 ), (2) whiplash injury, (3) previous cervical surgery, (4) cervical radiculopathy or myelopathy, (5) diagnosis of fibromyalgia, 48 (6) spinal manipulative therapy in the previous 6 months, or (7) younger than 18 or older than 65 years of age. The medical history of each patient was solicited from the primary care physician to assess the presence of exclusion criteria or red flags (eg, infection, osteoporosis).…”

Section: Participantsmentioning

confidence: 99%

“…The therapist, based on pain localization and detection of perceived joint hypomobility, chose the most appropriate cervical segment and attempted to localize the cervical spine thrust manipulation to this level. In the current study, we used the model for describing thrust manipulations proposed by Mintken et al 32 For example, to target the C3-4 level on the right, we used a high-velocity, midrange, left rotational force to the right articular pillar of C3, on the right articular pillar of C4 with the patient in supine, with left rotation and right sidebending.…”

Section: Midcervical Spine Thrust Manipulationmentioning

confidence: 99%

“…A high-velocity, end-range, anterior/posterior thrust applied through the elbows to the upper thoracic spine on the midthoracic spine in cervicothoracic flexion was applied. 32 The patient was supine, with the arms crossed over the chest and the hands placed over the opposite shoulder. The therapist placed his upper chest at the midthoracic spine of the patient and grasped the patient's elbows.…”

Section: Upper Thoracic Spine Thrust Manipulationmentioning

confidence: 99%

See 1 more Smart Citation

Immediate Changes in Widespread Pressure Pain Sensitivity, Neck Pain, and Cervical Range of Motion After Cervical or Thoracic Thrust Manipulation in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Clinical Trial

Martínez-Segura¹,

de-la-Llave-Rincón²,

Ortega‐Santiago³

et al. 2012

J Orthop Sports Phys Ther

126

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“…A cynic might ask how different this is from apprenticing with the sorcerer in the middle ages. As a first step in moving from magician to modern clinician, we recently proposed a nomenclature intended to standardize and clarify the terminology used in describing specific manual therapy techniques, recommending the use of 6 key characteristics 13 In that paper, a key point was made: "In our opinion and for our purpose, the difference between manipulation and mobilization, or between manipulation and another comparable physical therapy intervention rests in how the individual characteristics are modified." 13 The persistent obfuscations appear to be aimed at obscuring the differentiation of ma-…”

mentioning

confidence: 99%