Manipulation

There is much misunderstanding regarding manipulation especially among patients. As physiotherapists we massage, mobilise and manipulate on a graded scale of intensity. Massage, for the purposes of this blog, refers purely to soft tissue techniques, whereas mobilisation and manipulation refer to joint techniques. Mobilisation is graded I-IV concerning depth of movement and amount of force used, this is a general description and there are finer details to each grade. A grade V technique is still a type of mobilisation but is refered to as a manipulation due to the fact that the therapist is taking the joint to the end of range and slightly beyond to act as a release or realigning tool. Now obviously prior to any therapist carrying out this technique a full assessment will have taken place not only physically but also close questioning to ascertain if there are any possible risk factors the present condition, in medical and drug/medication history. The physical exam will show any relative stiffness/excess movement between adjacent joints and highlight any which would be candidates for manipulation relative to the symptoms being suffered. Prior to any manipulation informed consent has to be gained from the patient involved. From my point of view informed means that the patient has had the technique about to take place fully explained including the reason for it and the actual process. This has to include explaining possible risks in a common sense manner. The patient is then placed in the appropriate position to isolate the joint involved and this can include any joint although will most often concern the spine whether cervical, thoracic or lumbar. After the manipulation has taken place all movements and subjective markers are revisited to establish any change in symptoms or movement. Following manipulation if any muscle imbalance remains then it is very likely that with patients habitual patterns of movement will cause the manipulated joint to start to cause future problems, therefore appropriate ongoing progressive exercises to address these imbalances are vital to stop a recurrence of symptoms. The important part of this is to give the patient knowledge to minimise the problem happening again. http://rannoch-physiotherapy.blogspot.com/2009/03/knowledge.html