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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Understand the history and evolution of thrust manipulation among disparate professions.

  • Understand the role thrust manipulation plays in physical therapists' management of musculoskeletal disorders

  • Identify patients with low back pain who are likely to respond to thrust manipulation.

  • Explain the risks associated with cervical spine manipulation.

  • Articulate best-evidence strategies for screening for vertebrobasilar insufficiency.

  • Understand the appropriate medical screening procedures to perform prior to administering manipulation to the cervical spine.

  • Articulate best-evidence strategies for screening for upper cervical spine instability.

  • Understand the appropriate physical examination screening procedures to perform prior to administering manipulation to the cervical spine.

  • Summarize the body of evidence that supports cervical thrust and nonthrust manipulation for individuals with neck pain.

  • Identify individuals with neck pain who are likely to respond to cervical spine thrust manipulation.

  • Identify individuals with neck pain who are likely to respond to thoracic spine thrust manipulation.

  • Summarize the supportive evidence for thrust manipulation for osteoarthritis of the hip.

  • Summarize the supportive evidence for glenohumeral translational manipulation under anesthesia for adhesive capsulitis.

  • Describe the appropriate procedures to conduct prior to glenohumeral manipulation under anesthesia.

  • Describe the postmanipulative care required following glenohumeral translational manipulation under anesthesia.

  • Summarize the supportive evidence for manipulation of the wrist for lateral epicondylalgia.

  • Describe the performance of the following techniques:

    • Supine lumbosacral regional thrust manipulation.

    • Side-lying lumbar thrust manipulation.

    • Seated cervicothoracic thrust manipulation.

    • Supine thoracic flexion/opening thrust manipulation.

    • Cervical flexion/opening thrust manipulation.

    • Hip joint distraction thrust manipulation.

    • Inferior glenohumeral manipulation.

    • Posterior glenohumeral manipulation.

    • Wrist/scaphoid extension thrust manipulation.

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INTRODUCTION

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Operational Definitions

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There is considerable variability within physical therapy literature and practice regarding the terminology used to describe manipulative techniques. For the purposes of this chapter and text, mobilization refers to Grade I to IV nonthrust techniques, while manipulation refers to "high velocity, low amplitude thrust movements within or at the end range of motion."1 In the literature and in practice, these terms may be used interchangeably (Box 18-1).

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Box 18-1 Quick Notes! MANIPULATION

Manipulation is:

a high-velocity, low amplitude thrust movement within or at the end range of motion.

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This chapter is not intended to be comprehensive but rather to provide the reader an evidence-based perspective of the role of thrust manipulation in the management of several musculoskeletal diagnoses commonly encountered by physical therapists. Detailed descriptions of the manipulative techniques used in the reviewed studies are provided. Every effort is made to describe the techniques in the manner in which they were performed in their respective studies. Based on the ever-evolving nature of evidence in this area of study, the reader is encouraged to consult the literature for the current best evidence. This chapter intends to highlight several of the important studies performed in this area; however, new evidence has emerged since the writing of this chapter.

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