Spinal PA movements behave ‘as if’ there are limitations of local segmental mobility and are large enough to be perceivable by manual palpation: A synthesis of the literature

Abstract

Implications for clinical practice and teaching include the need to attend to the stiffness of PA movements at lower levels of force than those typically described. The authors recommend a three tiered approach to assessment of PA movements which may assist in both clinical practice and teaching manual therapy skills.

Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment

“…The current study investigated segmental mobility of the cervical spine using vertebral kinematics during AROM. Another way of evaluating segmental mobility is using translational passive movements such as posterior-anterior (PA) movements where increased stiffness in PA movements is consistent with decreased mobility in the underlying motion segment (Tuttle & Hazle, 2018). The results of several studies using PA movements have been comparable to the results in the current study.…”

“…The location that was deemed to be hypomobile and contributing to the participant's symptoms was determined using a tiered approach (Tuttle & Hazle, 2018). Briefly a 'first pass' using either posterior-anterior (PA) or anterior-posterior (AP) movements was used to select the motion segments which were potentially symptomatic.…”

An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

“…The ability of patients to perceive and report changes in pain location and intensity occurring during treatment has been clearly demonstrated in the literature on centralisation (May, Runge and Aina, 2018;Yarznbowicz et al, 2018) The ability of clinicians to perceive differences in stiffness within a treatment session is less clearly established. There is evidence that differences in PA stiffness related to symptoms are greater than the approximately 10% differences needed to be palpable by manual palpation (Tuttle and Hazle, 2018). Active myofascial trigger points have been found to be 13% stiffer than corresponding asymptomatic locations and are described as demonstrating a palpable 'release' during treatment (Arokoski et al, 2005).…”

“…Active myofascial trigger points have been found to be 13% stiffer than corresponding asymptomatic locations and are described as demonstrating a palpable 'release' during treatment (Arokoski et al, 2005). Although not conclusive, the literature therefore suggests that differences in stiffness occurring in clinical practice are likely to be large enough to be perceivable (Tuttle and Hazle, 2018).…”

“…Many students indicated that they had found the rule-based approach confusing and the Reflection in Interaction Approach conceptually simpler and more accessible even if they could not yet perceive the level of differences in spinal mobility that would be needed to fully apply the principles. More detailed descriptions of aspects of the approaches used in teaching manual therapy skills are provided elsewhere (Tuttle and Bialocerkowski 2017;Tuttle, Evans, Bialocerkowski, 2015;Tuttle and Hazle, 2018).…”