Spinal Manipulation TechniquesSpinal Manipulation Techniques is an ancient healing art practiced by a wide variety of cultures. The earliest known recorded reference to spinal manipulation is found in a Chinese document dated to approximately 2700 BC.
But what exactly is spinal manipulation?
Indeed, there is much confusion regarding the term spinal manipulation. The term has been used to connote anything from the gentle stroking of the paraspinal soft tissues all the way up to a “gross assault” upon the articulations of an unconscious patient. Medical manipulators Bourdillon, Day and Bookhout state, “There is still disagreement as to the breadth of the meaning of the word manipulation. In Europe the term is used, in this context, almost solely for procedures involving a high velocity, low amplitude, thrusting movement. In North America it is used in a much wider sense, to include any active or passive movement initiated, assisted or resisted by the operator. This includes treatments sometimes listed as articulation, mobilization, isometric and isotonic techniques, myofascial, functional or indirect and even craniosacral techniques.”
Doctors of chiropractic utilize a wide variety of methods to induce controlled, forced movements of spinal joints in the treatment of the neuro-musculoskeletal dysfunction syndromes with which their patients present. Although using many different methods, the high velocity, short amplitude thrust, referred to above, is the method of manipulation most commonly used by doctors of chiropractic. Two specific descriptions of the controlled, high velocity, short amplitude thrust have been proposed by chiropractors and physiotherapists. These descriptions are presented below.
Paraphysiologic Joint Space Manipulation
Chiropractic manipulators Haldeman and Kirkaldy-Willis and Cassidy have described a model of the high velocity, short amplitude thrusting movements used by chiropractors which they refer to as the paraphysiologic joint space manipulation. In this model of synovial joint manipulation three ranges of motion are discussed—the active range of motion, the passive range of motion, and the paraphysiologic range of motion of the involved joint(s).
The active range of motion is defined as that range in which the muscles acting over the joint can produce movement. The passive range of motion is that range through which the joints can be moved by an external force acting on the joints.
For example, using the intrinsic muscles of your forearm and hand flex and extend your right index finger maximally. This action would induce the maximum active range of motion of your right first metacarpophalangeal joint. Next, extend your right first metacarpophalangeal joint maximally. Then, with your left hand gently force your right index finger further into extension. The additional extension you are able to induce beyond the active maximal extension of your right first metacarpophalangeal joint is the additional passive range of motion allowed by the joint tendons and ligaments.
The paraphysiological range of motion is the small amount of additional movement that may be passively forced beyond the maximal passive range of motion, but just short of the limits of the anatomical integrity of the joint (i.e. just before the joint would become dislocated).