M3 Reading Guide

Question 1

What are the two most serious adverse events related to spinal manipulation?

Answer 1

• CES

- CAD

Question 2

how does the risk of these events (CES/CAD) compare to the risk associated with medication use?

Answer 2

• HVLAT risk is significantly less
• NSAIDS for OA is 100-400x more risky than cervical manip
• Lumbar manip up to 150000x safer

Question 3

Do the effects of spinal manipulation rely on careful detection of a segmental movement deficit?

Answer 3

• successful outcome linked to correctly identifying individuals who are responder to manipulation
• NOT accurate localization of dysfunctional segments

Question 4

How large is the placebo effect of spinal manipulation?

Answer 4

Placebo accounts for 10-25% of the benefits of spinal manip

Question 5

How does the addition of exercise affect outcomes in patients being treated using spinal manipulation?

Answer 5

• manip alon: 45% chance of success

- if 4/5 CPR factors present AND manipulation with exercise used, success rose to 95%

Question 6

What are the six key exam findings that help a therapist recognize when a patient might benefit from spinal manipulation?

Answer 6

1. No sx distal to knee
2. Recent onset
3. Low FABQ
4. Hypomobility of L-spine
5. Hip IR over 35˚ for at least 1 hip (measured prone)
6. Regional deficits

Question 7

Recent onset =

Answer 7

less than 16 days

Question 8

CPR: Hypomobility of L-spine

Answer 8

• Lumbar AROM limited
• End-range pain (increased but no worse with repeated movement)
• PAIVM or PPIVM segmental hypomobility of lower thoracic, lumbar, SI regions

Question 9

In addition to IR over 35˚ as part of the CPR, what else must be considered?

Answer 9

10˚ difference in IR between hips

Question 10

CPR: regional deficits

Answer 10

• mobility
• muscle performance/length
• activity limitations

Question 11

List the specific treatment options for a patient in the Manipulation & Mobilization Subgroup.

Answer 11

a. Lumbopelvic mobilization or manipulation
b. Muscle energy technique
c. Active ROM (anterior/posterior pelvic tilt - supine or quadruped, 10 reps, 3 to 4 x daily)
d. AROM and stabilization exercises
e. A/PROM to augment mob/manip
f. Address regional and fxl deficits