Articular dysfunction patterns in patients with mechanical neck pain: A clinical algorithm to guide specific mobilization and manipulation techniques

Abstract

In view of a didactical approach for teaching cervical mobilization and manipulation techniques to students as well as their use in daily practice, it is mandatory to acquire sound clinical reasoning to optimally apply advanced technical skills. The aim of this Masterclass is to present a clinical algorithm to guide (novice) therapists in their clinical reasoning to identify patients who are likely to respond to mobilization and/or manipulation. The presented clinical reasoning process is situated within the context of pain mechanisms and is narrowed to and applicable in patients with a dominant input pain mechanism. Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities.

Head-Trunk Kinematics During High-Velocity–Low-Amplitude Manipulation of the Cervical Spine in Asymptomatic Subjects: Helical Axis Computation and Anatomic Motion Modeling

“…In this study, cervical segments to be manipulated were chosen according to manual assessment relying on practitioner palpation for determining segmental motion restriction as generally defined and recommended in clinical practice and guidelines. 34,35 Validation of such an assessment procedure is to be found elsewhere for symptomatic subjects. 36,37 The number of HVLA manipulations depended on the number of mobility restrictions found by the practitioner to be consistent with clinical practice.…”

Articular dysfunction patterns in patients with mechanical low back pain: A clinical algorithm to guide specific mobilization and manipulation techniques

“…The reader is referred to several more thorough accounts where the reference framework is delineated in more detail (Danneels et al, 2011;Dewitte et al, 2014). Even though minor symptoms coming from muscular or neurological structures might be present in patients suffering from mechanical LBP, the dominant pain source should be articular to justify the use of specific mobilizations and/or manipulations.…”

“…As most manual therapists use the manipulative approach as a progression of localized mobilization techniques, the techniques will only be described in terms of manipulations, bearing in mind that these can also be applied as mobilization techniques (Dewitte et al, 2014).…”

“…Both focus and locking techniques are frequently used with different strategies to enhance safety and limit ROM during the thrust phase (Dewitte et al, 2014). Locking techniques will often be the first choice in cases with relative contra-indications on a segment caudal or cranial of the affected level.…”

“…Consequently, the absence of a universally accepted gold standard to diagnose facet joint origin challenges the clinician to recognize patterns and link them to treatment techniques. Similar to a recent published Masterclass on cervical dysfunction patterns (Dewitte et al, 2014), this issue presents a clinical algorithm for guiding therapists in their clinical reasoning to identify patients with predominantly mechanical nociceptive pain probably arising from articular structures, who are likely to respond to mobilization and/or manipulation.…”