Exam 2: Mob/Manip Class Notes

Question 1

What are the key exam findings for the manip + mob category?

Answer 1

• no sx distal to knee
• recent onset
• low FABQ
• L-spine hypomobility
• Hip IR over 35˚ for at least 1 hip
• regional deficits

Question 2

If there were sx distal to knee, why would you not think mob/manip was appropriate?

Answer 2

more likely to be radiculopathy

Question 3

Why is recent onset a key finding for mob/manip?

Answer 3

• People who respond to manipulation tend to not have had the problem for very long
• Often just woke up with pain, not sure why or how it happened

Question 4

mob/manip: l-spine hypomobility

Answer 4

End-range pain (as opposed to mid-range)

Question 5

Regional deficits of someone in the mob/manip category

Answer 5

• mobility
• muscle performance/length
• activity limitations

Question 6

What are the absolute contraindications for mob/manip?

Answer 6

• malignancy of region of interest
• radiculopathy involving more than one nerve root on ONE side
• medically unstable
• anticoagulent meds
• vascular disorders in the region, clotting disorders
• spinal fusion
• bone disease
• red flags
• rheumatoid collagen necrosis
• vertebrobasilar insufficiency
• CES
• spondylolisthesis or other segmental instability
• deteriorating CNS pathology
• undiagnosed pain
• clinician lack of ability
• myelopathy with s/s of SC involvement
• inflammatory arthritis
• unstable upper c-spine

Question 7

What is “undiagnosed pain”?

Answer 7

• can’t figure out what’s going on

- Level 1 screening: if you suspect LBP with possible serious pathology, don’t manipulate!

Question 8

comparable sign =

Answer 8

movement that reproduces their symptoms/is limited

Question 9

In the lumbar spine, the comparable sign is almost always:

Answer 9

flexion reproduces sx

Question 10

If you decide to do a mobilization, how should you approach it initially?

Answer 10

do 1 set (~60s), GIII (monitoring sx)

Question 11

Mobs: for stiffness

Answer 11

60s sets

Question 12

Mobs: for pain

Answer 12

~30s sets more appropriate

Question 13

Procedure for mob/manip

Answer 13

1. Baseline/resting pain rating (in standing)
2. Baseline comparable sign (pain and mobility)
3. If you decide to do a manipulation, do it
4. Reassess comparable sign (pain and mobility)
5. Document final comparable sign and educate pt regarding possible soreness

Question 14

If you performed mobs, what should you do after comparable sign is assessed?

Answer 14

repeat 2 more sets

Question 15

After a mob/manip, what must you make sure to tell your pt?

Answer 15

• monitor their sx

- that you will ask them about them when they come back