Manipulation is a treatment modality used for the management of spinal disorders (pain and hypomobility
). Its use dates back to ancient Greece and China. Generally defined as “Passive technique performed to a joint at high speed low amplitude thrust that is beyond patient’s voluntary control, usually accompanied by a clicking sound or a pop in the joint (cavitation), aiming at increasing mobility and/ or reducing pain.”. The proposed effects can be divided into 3 main categories: biomechanical, neurophysiological and psychological. Biomechanical effects: • Restoration of tissue extensibility and ROM of hypo- mobile joint (increase range of motion). • Elongation of connective tissue (collagen fibers). • Disruption of cross linkage between collagen fibers. • Stretching of capsular adhesions. • Release entrapment of joint meniscoids. • Correction of positional faults. Neurophysiological: • Reduction of pain perception; local and regional pain inhibition (hypoalgesia). • Release of endogenous opiates • Mechanoreceptors activation. • Trigger descending pain inhibitory pathways of CNS. • Sympathetic nervous system response. • Peripheral/spinal cord mechanism at dorsal horn. • Influence on muscle activation (neuromuscular response). • Inhibition of global/superficial muscle tone. • Facilitation of local/deep muscle activation. Psychological: • Placebo effect. • Influence of therapist instruction/interactions. • Influence of patient expectations.
Thank you for your tremendous efforts in this wonderful piece of work. Be proud of the fact that you have the ability to rise above any situation and deliver the best no matter what the circumstances could be. small charcoal grill Excellent article!