Manipulation of the Spine, Thorax and Pelvis: An Osteopathic Perspective Second Edition

259 Pages·2006·28.61 MB·English

by  Peter Gibbons MB BS DO DM-Smed MHSc

Peter Gibbons
Philip Tehan
Foreword by
Philip EGreenman
CHURCHILL
UvrNGSTONE
EUEVlER
Manipulation of the
Spine, Thorax and Pelvis
An Osteopathic Perspective
With accompanying CD-ROM SECOND EDITION
Peter Gibbons
MBBS 00DM-SMed MHSc
AssociateProfessor. OsteopathicMedidne.
Victoria University, Melbourne. Australia
Philip Tehan
00DipPhysk>MHSc
Senior lecturer,OsteopathicMedidne. School ofHealthSciences.
Victoria University,Melbourne. Australia
Forewordby
Philip E. Greenman00FAAO
EmeritusProfessor, DepartmentofOsteopathicManipulativeMedicine;
Emeritus Professor. DepartmentofPhysical Medicineand Rehabilitation,
Michigan StateUniversityCollegeofOsteopathicMedicine.Michigan.USA
Photographsby
TimTurner
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UVINGSTONE
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Contents
TheCD-ROMaccompanyingthistextindudesvideosequencesofallthetechniquesdescribedin
PartBandthefirstfourtechniquesdescribedinPartC.Theseareindicatedinthetextbythe
following symbol .Tolookatthevideoforagiventechnique.clid.ontherelevanticon inthe
contentslistontheCD-AOM.
TheCD-ROMisdesignedtobeusedinconjunctionwiththetextandnotasastand-aloneproduct.
Foreword ix
Preface xi
Acknowledgements xiii
PA1?fA HVLA thrust techniques - an osteopathic perspective 1
1 Introduction 3
2 Osteopathicphilosophyandtechnique 5
3 Kinematicsandcoupled motionofthespine 9
4 Spinal positioning and locking 17
5 Safetyand I-M.Athrusttechniques='--'2::S'--' _
6 RationalefortheuseofHVLAthrusttechnques 45'-___ _ __
7 Validationofclinical practicebyresearch 55
PART B HVLA thrusttechniques - spine and thorax 65
SeCflON 1 Cervical and cervkothoracicspine 69
1.1 Atlanto-ocdpitaljoint(O-Cl:contad pointonocdput;chinhold; patientsupine;
--anteriorand sup-erio-rthrustinacurved pl-an-e -71
1.2 Atlanto-occipitaljointCo-O: contact pointonatlas;chin hokI; patientsupine;
anteriorandsuperiorthrustIn acurved plane 77
1.3 Atlanto-axlal jointCl-2: chin hold; patient supine; rotation thrust 81
~ttan~~xial jointCl-2:cradle hold; patie~supine; rotationthrust 85
~~rvical spine0-7:up-slopegliding;chin hold; patient supine 89
1.6 Cervicalspine0-7: up-slopegliding;chin hold; patient supine-
--==var'i-a-tio..n:..9:3-----
J.7 Cervical spine0-7:up-slopegliding;cradle hold patient supine 97
1.8 Cervicalspine0-7: up-slopegliding;cradlehold; patient supine; reversed
primaryandsecondary leverage 101
1.9 Cervical spineC2-7: up-slopegliding; patient sitting;operatorstanding
v
infront 107 -----
Manipulation ofthe spine, thorax and pelvis
1.10 CeNfcat spine0-7: u~slopegliding; patientsitting;operatorstanding
totheside 111
J.U Cervical spine 0-7:down-slopegliding;chin ~d;patientsupine 115
J.12 Cervical spineC2-7:down-sk>pegliding;cradle hokI;patient supine 121
J.13 Cervical spineC2-7:down-slopegliding;patient sitting;operatorstanding
totheside 127
'-:----:::::-=-
,.14 Cervkothoracic spine0-1'3: rotation gliding;patient prone;operator
atsideofcouch 131
1.15 Cervicothoracic spine0-D: rotation gliding; patientprone;operator
at headofcouch 135
':-_------,-----,-----
1.16 Cervicothoracicspine0-1'3: rotation gliding; patientprone;operator
at head ofcouch - variation 139
/.17 Cervicothoradcspine0-D: sidebending gliding;patientsitting ---,'_4~3 _
1.18 Cervicothoradc spine0-D: sidebending gliding;patient sitting;
ligamentous myofasdal tension locklng,---~'4~7,--- _
1.19 Cervicothoradcspine0-D: sidebending gliding; patientside-lying,,-_',,5::',-_~
1.20 Cervicothorack spine0-D: sidebending gliding; patient side-lying;
ligamentousmyofasdaltensionlocking 155
-- - ----
1.21 CervkothoradcspineO-D: extensiongliding; patientsitting;
ligamentous myofasdal tension locking 159
S£Cl10N 2 Thoracicspineand ribcage 163
2.1 ThoracicspineT4-9:extension gliding; patientsitting;ligamentousmyofascial
tension locking 167
2.2 ThoracicspineT4-9:flexion gliding; patientsupine; ligamentous rnyofascial
tension locking:c-"'-7''-----,-_
2.3 ThoracicspineT4-9: rotationgliding; patientsupine; ligamentous myofasdal
tension locking 177
2.4 Thoracic spineT4-9: rotation gliding; patientprone;short levertechnique 183
2.5 Ribs R1-3: patient prone;gliding thrust 189
- -
2.6 Ribs R4-1O: patientsupine;glidingthrust;ligamentous myofasdal
tension locking 193
2.7 3ibs A4-10: patient prone;gliding thrust 197
2.8 Ribs R4-10:patientsitting;gliding thrust 201
SEcnON3 lumbar andthoracolumbarspine 205
3.1 Thoracolumbarspinen o-t.1: neutral positioning;patientside-.Mng;rotation
gliding thrust 209
---
3.2 Thoraco'umbarspineT1o-t2:flexion positioning; patientside-lying; rotation
gliding thrust 213
-
Contents
3.3 LumbarspineL1-5:neutral positioning; patientside-lying; rotation
gliding thrust 217
3.4 Lumbarspine L1-5:flexion positioning; patientside-lying; rotation
glidingthrust 221
3.5 Lumbarspinell-5: neutral positioning;patientsitting; rotation
gliding thrust 225
3.6 Lumbosacraljoint l5-51: neutral positioning; patient side-tying;thrustdirection
isdependent uponapophysialjoint plane 229
3.7 Lumbosacraljointl5-S1:flexion positioning; patient side-lying;thrustdirection
__i::'.:d",ependent uponapophysialjoint plane 233
PART C HVLAthrusttechniques- pelvis 237
1 Sacroiliacjointleftinnominate posterior; patient prone; ligamentousmyofascial
tension locking 239
2 Sacroiliacjoint right innominateposterior.patientsK:le-.Jying 243
3 Sacroiliacjointleftinnominateanterior;patientsupine'---:-24_7 _
4 Sacroiliacjointsacral baseanterior;patient side-tying 251
5 Sacrococcygealjointcoccyxanterior; patientside-iying --=:25::5'--- _
References 259
PAKT 0 Technique failure and analysis 261
Index 265
vii
Foreword
This second edition builds upon the expanded reference lisL Couplingofspinal
strengths ofthe firsL The aumors focus motion continues to bedifficult to
upon high-velocity low-amplitude (HVLA) understand and current research has cast
thrust technique. Itcontinues to beone of some doubtsabout some ofme original
the mOSt widelyused forms of meoret.ical const.ruets.Theauthors h3Vl"
manipulation by many health care cogentlybridged the original concepts with
professions.The book is again divided into me results ofcurrent research. aidingme
four parts: (A) HVlA thrust techniques. an reader's understandingofcomplex concepts
osteopathic perspective; (8) HVl.A thruM and preparing theirundemanding for me
techniques. spine and thorax; (C) HVLA technique chapters that follow.
thrust techniques. pelvis; and (D) technique Chaptet" 5 on Safety and high-velocity
failwe and analysis. low-amplitude techniques brings an update
It is in the first section that the aumors to an area ofcontroversy.Theauthors have
have added much to this volume. and the expanded the references by 63 new
profession's understanding. oftwo very citations.. bringing newdarity to the
important areas. namely in spinal concerns previously expressed about the
biomechanics and coupled motion ofthe safetyofHVLA. They conclude that the risk
spine. and in the area ofsafety and the is extremelylow but that the key to
prevention ofcomplications. prevemion ofcomplications is adequate
In Chapter 2, the authors have added to training and experience.
their diagnosticcriteria for somatic The technique chapters in sections 8 and
dysfunction, with Ssignifyingsymptom C are again comprehensive in their
reproduction. 111e new mnemonic is S-T-A· description ofthe techniques and follow a
R-Twith S for symptom reproduction; Tfor standard step-by-step format for student
tissue tenderness; Afor asymmetry; Rfor learning. Several n~.... techniques are
range ofmotion; andT for tissue texture added.
changes. "llle accurate diagnosis ofsomatic 'nlis second edition continues to add to
dysfunction is critical for me proper the reader's knowledge ofhigh-velocity
application of HVLA thrust techniques. low-amplitude (HVLA) thrust techniques in
Chapler 3 on Kinematics and coupled a dear, conciseand easily readable fashion.
motion ofthe spine has been updated with
the most currelll research and with an Philip E. Greenman
ix
Preface
'Ibissecond edition ofMaFlipulntilm ofthe so that practitioners can use thew
Spine. T11Ora:carul PellJis: An Osteopathic techniquessafelyand in the appropriate
Perspec:titJe has been produced at a time of ci.rcumslances. Since the first edition. there
increasing knowledge related to the use of has been extensive research published
manipulative techniques in clinical practice. within peer-revie\\u1 journals that suppons
Patient safety remains a majorconsideration the use ofa multi-modal approach,
when selectinga tteatmeOl approach.Thrust indudingthe use ofHVLA thrust
techniques have been considered potentially techniques. for the treatment ofspinal pain
more dangerous when compared with other and cervirogenic headache.
osteopathic techniques, particularly relating fur a commonly used treatment
to the cervicaJ spine. Recent research has approach. it issurprising that there are such
questioned the appropriateness ofa number limited resources to support learningand
ofcommonly used venebrobasilar skill refinement in HVLA thrust techniques.
insufficiency protocols and the text has Most ofthe learning ofHVl.A thrust
been updated to embrace current research techniques has been dependent upon
finding<; and recommendations. The personal instruction and demonstration.
evidence base for the use ofspinal 'I'here are still only a handful ofosteopathic
manipulation in patients with disc lesions technique books and manuals and few of
has been included, as the application of these relatesolely to thrust techniques.
thrust techniques in these patients remains 'Ibe material presented in this te:<t was
controversial. developed in response to the learning needs
·11,c move towards an evidence·based ofundergraduate and postgraduate students
and patient-centred approach to healthcare over a 30-year period and has been
requires the modern practitioner to utilize expanded 10 include additional HVLA thrust
the best available evidence 10 inform techniques. Two new techniques based
clinical practice, to be cognizant ofthe legal upon ligamentous myofascial tension, as
and ethical requirements for informed opposed to facet apposition locking. are
consenl and 10 use the appropriate also included.
instnllllems to monitor patient progress. The novice has to acquire basicskills and
·111e second edition has been updated to experienced practitioners should reflea
re(Jea these changing requirements of upon their performance and conslantly
practice. refine each thrust technique. It has been our
Ourgoal remains to present a text that experience thai thestructured step-by-step
will provide the necessary infonnation formal used in the text and the visual
relating 10 all 3SpccL.. ofthe deliveryof reinforcement offered by the accompanying
High-Velocity Low-Amplitude (HVU\) thrust CD-ROM havebeen successful in assisting
lechniques in one comprehensiwvolume. both initial development and subsequent
Manipulation ofthe spine, thorax and pelvis
TE'finement ofthe psychomotorskills include fluoroscopic imagesofspinal
necessaryfor the effeaive deliveryofHVlA coupling in the lumbarspine. 'l1le principles
thrust techniques, Experience has shown ofspinal positioningand locking elaborated
that thevideo images included on the CD in the text are clarifiedby the addition of
ROM ha\'f' proved useful for both students video images on theCD-ROM,
and praaitioners.'l1le second edition CD·
ROM has been updated with the additional Melbourne 2006 PeterGibbons
thrust techniques and has been expanded 10 PhilipTehan
xii
HVLA thrust
PART
techniques - an
osteopathic perspective
I Introduction 3
2 Osteopathk philosophyandtechnique 5
3 Kinematicsand coupledmOlmofthespine 9
4 Spinal positioning and locking 17
5 Safetyandhigh-velocitylow-amplitude(t-MA)thrusttechn~ues 25
6 Rationalefor theuseofhigh-velocityIow-amplitvde (H\IlA)thrust techniques 45
7 Validationofclinical practice byresearch 55