The Unwritten Chapter: Thrust Manipulation | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

The Unwritten Chapter: Thrust Manipulation

In my thrust manipulation courses, whether it's con-ed, fellowship, or DPT students, I say there are more indications for thrust manipulation other than to improve pain and ROM.
  • it's awesome
I learned the effects of manipulation from Dr. Stanley Paris:

1) Chemical 2) Neurological 3) Physical 4) Psychological

It's the 4th item that makes it very powerful. Hearing the cavitation or click sometimes works much better than giving any amount of amazing patient education, explanation, or well prescribed exercise. I had a patient today who after 20 minutes of soft tissue work to her cervical spine, upper traps, and first rib mobilizations, said "Is that it?" She still c/o tension in her upper traps and had a loss of cervical extension. Next, I did a sitting upper thoracic thrust, and after hearing the multiple cavitations, she felt much better. That is a huge psychological effect. I have not normally heard "WOW, that deep cervical flexor exercise over the pressure cuff is AMAZING!" Or, "WOW, that cervical retraction with my own generated overpressure, is AMAZING!" I don't mean to take away from the effectiveness of either proven treatment, they just lack that BAM!
  • the patient just knows they need it
Some people are very in tuned to their bodies and what they need. I teach one of the indications for manipulation is a patient just feeling "like it needs to go." Obviously you are still going to evaluate them for ROM, PIVM, repeated motions, etc... but I do often check the area that "feels locked," especially if it is an acute facet lock... just the type that needs a HVLA. In acute conditions, it has been shown in recent research that a lumbar derangement syndrome classification also meets the CPR for lumbar HVLA. I'm sure if it were studied, the same would be true for cervical derangement and HVLA. Both respond to end range, and once motion is restored in the acute condition, function is often restored very quickly. As some patients are unwilling to push past the point of pain with repeated motions, I often manipulate them, improving the pain free range, thus making them more compliant with their HEP.

My only video of my current 54 that has over 10,000 views. You can even hear a volunteer gasping at the end.

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