Essentials of Spinal Manual Therapy
This document discusses various manual therapy techniques for treating spinal issues. It begins with a brief history of spinal manipulation approaches from ancient times to modern developers. It then advises assessing the patient to determine the nature and origin of their pain before selecting a treatment approach. Common pain classifications and red/yellow flags are outlined. The document recommends choosing mobilization, manipulation, or McKenzie techniques depending on the case. Specific tips are provided for applying Mulligan techniques and adjusting force, level, angle, pressure and side based on the patient's response. Guidance is given on treating in weight-bearing versus non-weight-bearing positions and incorporating active movement. The summary concludes with safety reminders.
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Essentials of Spinal Manual Therapy
- 1. Essentials of Spinal Manual Therapy Prof. Satyen Bhattacharyya Associate Professor BIMLS, Burdwan Chief Physio – Fit O Fine Physiotherapy Solutions
- 2. House of thoughts or confusion? • Which one to select? • Should we assess first? • Should we apply only one house of thoughts? • Or we should combine and deliver? • Hippocrates (460 BC – 370 BC) • Cato, Galen • Bone setter • Hutton’s manipulation • D.D.Palmer, B.J.Palmer • A.G.Timbrell Fisher • James Cyriax • John Mennel • F.M.Kaltenborn • G. Maitland • R. McKenzie • B.R.Mulligan
- 3. Then what to choose? Go by choose your treatment according to that before that know the biomechanics
- 4. Assessing and Decision making • PAIN is your fiend • Nature of pain will describe about pathology • Types of Pain by origin – by receptors- local(intact outer annulus fibrosus) referred (herniated disc) thermal radicular (herniated disc) chemical (organ ref. pain) central (intact outer annulus fibrosus) mechanical(structural changes/positional fault etc)
- 5. once it’s diagnose with chemical pain or else treat
- 6. • YELLOW FLAGS • Osteopenia • Hypermobility • Pregnancy • Patient on anti-coagulant • Acute arthritis of any type • RED FLAGS • Osteoporosis • Active inflammation • Infection • Tumor • Tuberculosis • Metabolic bone diseases • Myelopathies • Neurological deficit • Unstable joint fracture, non united fracture • Unwilling pt/intolerant pt • Undiagnosed pain
- 7. Mobilization Therapist overpressure Patient overpressure Patient generated Manipulation Totally Independent 70% Totally dependent Can apply Mulligan, Maitland McKenzie is the best option here
- 8. • Apply mulligan to get immediate effect. • How will you know that mulligan is indicated? Pain should decrease & increase ROM Change your FLAPS Force Level Angle Pressure Side
- 9. Try to Treat in weight bearing position as patient complaints of pain in loaded only When to treat not loaded? Joint is inflamed or the SIN (severity, irritability & nature of pain) is high
- 10. Active movement followed by passive overpressure • To be done if it is not painful. • To be given when you find out new P1 & R1 • Should be given by patient himself(best option) otherwise by therapist • If new P1 & R1 is not achieved then follow FLAPS NO PAIN NO GAIN THEORY DOESN’T WORK HERE, IT SHOULD BE ALWAYS PAIN FREE WAY
- 11. • DON’T TRY IN HUMAN BEING, THEY ARE NOT DALL – BE SURE • DON’T HARM THE PATIENT • DON’T BE OVER ENTHUSIASTIC • TRY TO KEP THE PATIENT INDEPENDENT(SELF EXERCISES)
Editor's Notes
- 1.Hutton technique Kessler 110 page lt hand side below HVT towards the direction of motion
- Patient generated force is ext, fle, eis, fis, reis, rfis, etc. patient overpressure is breath out and do the movt and fix towel in the back and do the extension etc