Advanced Osteopathic and Chiropractic Techniques for Manual Therapists. Giles Gyer

of the spine. Unlike a conventional intervention, spinal manipulation is not a curative therapy. The ultimate goal of this therapy is to create the best possible environment for the body’s own self-healing mechanisms. Hence, by affecting visceral function via the ANS and releasing fascial restrictions, therapists of spinal manipulation are actually sending ‘SOS’ signals to the brain and paving the way so that the body can self-heal on its own.

      References

      Bakris, G., Dickholtz Sr, M., Meyer, P.M., Kravitz, G., Avery, E., Miller, M. et al. (2007) ‘Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: A pilot study.’ Journal of Human Hypertension 21(5), 347.

      Benarroch, E.E. (2006) ‘Pain-autonomic interactions.’ Neurological Sciences 27(Suppl. 2), S130–S133. Available at www.ncbi.nlm.nih.gov/pubmed/16688616

      Bolton, P.S. and Budgell, B. (2012) ‘Visceral responses to spinal manipulation.’ Journal of Electromyography and Kinesiology 22(5), 777–784.

      Budgell, B.S. (1999) ‘Spinal manipulative therapy and visceral disorders.’ Chiropractic Journal of Australia 29, 123–128.

      Di Fabio, R.P. (1992) ‘Efficacy of manual therapy.’ Physical Therapy 72(12), 853–864.

      Findley, T., Chaudhry, H., Stecco, A. and Roman, M. (2012) ‘Fascia research – A narrative review.’ Journal of Bodywork and Movement Therapies 16(1), 67–75.

      Hall, H. (2012) ‘Visceral Manipulation Embraced by the APTA.’ Science-Based Medicine. Available at https://sciencebasedmedicine.org/visceral-manipulation-embraced-by-the-apta

      Harper, B., Steinbeck, L. and Aron, A. (2016) ‘The effect of adding Fascial Manipulation® to the physical therapy plan of care for low back pain patients.’ Journal of Bodywork and Movement Therapies 1(20), 148–149.

      Hawk, C., Khorsan, R., Lisi, A.J., Ferrance, R.J. and Evans, M.W. (2007) ‘Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research.’ The Journal of Alternative and Complementary Medicine 13(5), 491–512.

      Ingraham, P. (2017) ‘Spinal nerve roots do not hook up to organs!’ PainScience.com. Available at www.painscience.com/articles/spinal-nerves-and-organs.php

      Jowsey, P. and Perry, J. (2010) ‘Sympathetic nervous system effects in the hands following a grade III postero-anterior rotatory mobilisation technique applied to T4: A randomised, placebo-controlled trial.’ Manual Therapy 15(3), 248–253.

      Moulson, A. and Watson, T. (2006) ‘A preliminary investigation into the relationship between cervical snags and sympathetic nervous system activity in the upper limbs of an asymptomatic population.’ Manual Therapy 11(3), 214–224.

      Oulianova, I. (2011) ‘An Investigation into the Effects of Fascial Manipulation on Dysmenorrhea.’ Doctoral dissertation, RMTBC.

      Padayachy, K., Vawda, G.H.M., Shaik, J. and McCarthy, P.W. (2010) ‘The immediate effect of low back manipulation on serum cortisol levels in adult males with mechanical low back pain.’ Clinical Chiropractic 13(4), 246–252.

      Perry, J., Green, A., Singh, S. and Watson, P. (2011) ‘A preliminary investigation into the magnitude of effect of lumbar extension exercises and a segmental rotatory manipulation on sympathetic nervous system activity.’ Manual Therapy 16(2), 190–195.

      Plaza-Manzano, G., Molina, F., Lomas-Vega, R., Martínez-Amat, A., Achalandabaso, A. and Hita-Contreras, F. (2014) ‘Changes in biochemical markers of pain perception and stress response after spinal manipulation.’ Journal of Orthopaedic & Sports Physical Therapy 44(4), 231–239.

      Sampath, K.K., Mani, R., Cotter, J.D. and Tumilty, S. (2015) ‘Measureable changes in the neuro-endocrinal mechanism following spinal manipulation.’ Medical Hypotheses 85(6), 819–824.

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3

      MOTION PALPATION

      MISCONCEPTIONS

      Introduction

      Spinal motion palpation is an integral diagnostic procedure that has been widely used by manual therapy practitioners to diagnose spinal dysfunction. It is frequently used to locate primary areas of joint restriction, asymmetries in spinal level and intersegmental hypomobility and hypermobility. It helps determine whether a patient needs spinal manipulation, and, if so, where to apply the thrust (Bergmann and Peterson 2010). Motion palpation is also performed to detect functional changes in other regions (e.g., shoulder or hip) related to the spine. In addition, a recent study among physiotherapists in Australia reported that around 98 per cent of the respondents were using manual palpatory tests to take treatment decisions (Abbott et al. 2009).

      Over the last century, various palpatory techniques have been developed to detect different degrees of motion restriction at the spinal level. However, the clinical utility of these palpation techniques in the assessment of spinal dysfunction has been controversial (Walker et al. 2015). Although proponents of manual therapy consider it to be a valid and reliable indicator of spinal abnormalities, a majority of studies have found it to be unreliable due to low indices of agreement (Cooperstein and Young 2016; Haneline et al. 2008; Huijbregts 2002; Walker et al. 2015). Because the reliability of an examination tool is a prerequisite for its clinical utility, the use of motion palpation to guide treatment interventions is questionable.

      This chapter is therefore written to improve our understanding concerning the validity and reliability of spinal motion palpation.

      Intrarater and interrater reliability of motion palpation

      In the context of spinal motion palpation, reliability refers to the degree of consistency in the diagnostic outcomes when it is repeated under identical conditions. Intrarater reliability is the degree of agreement obtained by the same rater across two or more trials using the same procedure. Interrater reliability is the relative consistency of agreement among two or more raters concerning the outcomes of the same procedure (Watkins and Portney 2009).

      Over the past decades, a large body of research has been conducted to determine the reliability of motion palpation. However, the reliability estimates have been reported to vary widely from study to study (Walker et al. 2015). The literature investigating the intrarater reliability using κ values suggested the degree of agreement to be moderate. On the other hand, the interrater reliability of motion palpation has been found to be poor, often the agreement at near chance levels (Haneline et al. 2008). Huijbregts (2002) proposed that this higher intra- than interrater reliability might be due to incorrect detection of the vertebral level by the raters at which motion restriction was identified. Nyberg and Russell Smith (2013) stated that a therapist’s primary focus during motion palpation might also be responsible for the low level of agreement between raters. They suggested that some therapists might solely concentrate on the degree of spinal displacement while others might be more focused on assessing the velocity of the displacement.

      Systematic