Mobes & Manip

Osseous Mobes & Manip Simulated Exam

 

Mobilization – passive movement of a skeletal joint. It is usually aimed at a ‘target’ synovial joint with the aim of achieving a therapeutic effect. When applied to the spine, it is known as spinal mobilization.

Manipulation (adjustment)– a therapeutic procedure utilizing controlled force, leverage, direction, amplitude (depth) and velocity; most commonly applied as a high velocity low amplitude (HVLA) thrust to the spine utilizing parts of the vertebra and contiguous structures as levers to correct articular malposition (subluxations), restrictions of movement or other dysfunctions of the body. It may be accompanied by  a ‘popping’ sound or cavitation as nitrogen gas is released from synovial fluid within the joint cavity (grade 5 mobilization)

Subluxation – a partial dislocation or slight misalignment of tissue – defined by the World Health Organization (WHO) as – “A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity”

Grades of Mobilization & Example

Grade	Definition
1	Slow, small amplitude, rhythmic oscillations at the beginning of available joint   play range (between  initiation of   movement and tissue resistance)
2	Slow, large amplitude, rhythmic oscillations within the midrange of available joint   play range (between  initiation of movement and tissue resistance)
3	Slow, large amplitude, rhythmic oscillations from the middle to the end of   available joint play range (within tissue resistance, and backing out again – below elastic limit)
4	Slow, small amplitude, rhythmic oscillations end of   available joint play range (within tissue resistance, but below elastic   limit)
5	High velocity, low amplitude (HVLA) thrust at the elastic limit (end of PROM)

 

Contraindications

	Misc.	Arthro	Osteo	Neuro	Vascular
Relative	Mild sprain/strain Recent spinal trauma Prior ‘bad experience’ with manip.	Inflammatory arthritis (RA) Ankylosing spondylitis Atlanto-    occipital OA	Hypermobility (mild instability) Benign bone tumor Demineralization (osteopenia, osteoporosis, long-term steroid use) Spondylolisthesis (lumbar) Scheurmann’s disease	Neurologic deficits secondary to discopathy (herniation,   inflammation) Lack of peripheral sensation	Calcified abdominal aneurysm Anticoagulant therapy
Absolute	Lack of consent Intoxication or drug influence Recent surgery	Atlanoaxial instability (Down’s,    Marfan’s) Dislocation	Congenital malformation (posterior arch aplasia) Bone destruction (cancer, avascular necrosis, osteomyelitis, fracture, sever   osteoporosis)	Cauda equina syndrome Recent TIAs or Stroke	Aneurysm VBI signs & symptoms (5ds And 3Ns)

 

5 Ds And 3Ns Contraindications for Cervical manipulation or mobilization
Dizziness (vertigo, giddiness) Drop attacks (loss of consciousness) Diplopia (or other visual disturbances)	Dysarthria Dysphagia Ataxia	Nausea & vomiting Numbness (unilateral) Nystagmus

 

Reference: Vizniak, NA. Physical Medicine. Professional Health Systems Inc. 2014