Mob/Manip Class Notes 2

Question 1

What is an important way to maximize the placebo effect of mob/manip?

Answer 1

• appeal to research to give them confidence that you are using solid reasoning for the tx
• tell them 95% of pts benefit from the tx

Question 2

What should you tell a pt to assist with recovery at home?

Answer 2

• they can and should move themselves

- stay active - motion is lotion

Question 3

For pts who are apprehensive of spinal manip as tx, what could you tell them?

Answer 3

• safer than NSAIDs for treating back pain
• Indicate that “I’ve screened YOU specifically and YOU don’t have any of the red flags that would make you not a candidate”
• your l-spine is so strong that there’s no physical way I could apply enough force to cause damage. What I’m going to do is very gentle
• AFFIRMATION OF THEIR CONCERNS!

Question 4

Libby has limited, painful flexion and hypomobility L > R at L4/5 and L5/S1. S&S indicate she belongs in mob/manip classification. Which of the following is the best approach for initial tx?

A. Left SI manip
B. Left sidelying lumbar rotation manip
C. Central PA mob
D. Unilateral PA non-thrust manip

Answer 4

D. Unilateral PA non-thrust manip

Question 5

Even though the manipulation is called an “SI manip”, what should you remember?

Answer 5

• Don’t assume it only affects SI

- very successful manip for LBP

Question 6

Why might an SI manip not be best for a pt’s first visit?

Answer 6

very end range/wide spread

Question 7

Which side should be up in a sidelying lumbar rotation manipulation?

Answer 7

painful side up!

Question 8

How does end range rotation affect the facets?

Answer 8

causes ipsilateral facets to gap (opens up the painful side)

Question 9

What is central PA mob used for?

Answer 9

address flex/ext mobility deficits

Question 10

With an asymmetrical pain distribution, what type of technique would you most likely use?

Answer 10

You would use a unilateral technique

Question 11

non-thrust =

Answer 11

mobilization

Question 12

HVLA =

Answer 12

high velocity low amplitude

Question 13

Assuming you only have time to add one ex to Libby’s tx, which of the following would be the best choice?

A. Muscle energy (shot-gun technique) for flexion deficit
B. Pain-free anterior and posterior tilts
C. ADIM
D. Cat/cow to end-range

Answer 13

B. Pain-free anterior and posterior tilts

Question 14

What is the benefit of using pain-free AP tilts following mobs/manips?

Answer 14

• not placing them at end-range

- focusing on lumbar without incorporating as much thoracic like cat-cow

Question 15

Which of the following patients (all of the following are IR ROM measurements) has the best chance of responding to mobilization/manip, assuming all other signs and symptoms are equal?

A. L 38˚, R 18˚
B. L 38˚, R 41˚
C. L 28˚, R 45˚
D. L 28˚, R 28˚

Answer 15

A. L 38˚, R 18˚

C. L 28˚, R 45˚

Question 16

Which of the following patients (all of the following are IR ROM measurements) has the best chance of responding to mobilization/manip, assuming all other signs and symptoms are equal?

A. L 38˚, R 18˚
B. L 38˚, R 41˚
C. L 28˚, R 45˚
D. L 28˚, R 28˚

In the question above, why is A a correct choice?

Answer 16

20˚ difference

Question 17

Which of the following patients (all of the following are IR ROM measurements) has the best chance of responding to mobilization/manip, assuming all other signs and symptoms are equal?

A. L 38˚, R 18˚
B. L 38˚, R 41˚
C. L 28˚, R 45˚
D. L 28˚, R 28˚

In the question above, why is C a correct choice?

Answer 17

• 17˚ difference

- May rationalize that this option has the greatest hip ROM of 45˚

Question 18

Which of the following patients (all of the following are IR ROM measurements) has the best chance of responding to mobilization/manip, assuming all other signs and symptoms are equal?

A. L 38˚, R 18˚
B. L 38˚, R 41˚
C. L 28˚, R 45˚
D. L 28˚, R 28˚

In the question above, why is B NOT a correct choice?

Answer 18

There is less than 10˚ difference in left to right IR ROM

Question 19

Which of the following patients (all of the following are IR ROM measurements) has the best chance of responding to mobilization/manip, assuming all other signs and symptoms are equal?

A. L 38˚, R 18˚
B. L 38˚, R 41˚
C. L 28˚, R 45˚
D. L 28˚, R 28˚

In the question above, why is D NOT a correct choice?

Answer 19

less than 10˚ difference in left to right IR ROM

Question 20

Shania’s s/s indicate she is appropriate for mobilization/manipulation but she seems anxious about some of the more vigorous exam techniques. She says she’s had relatives joke with her about “pain and torture” being what PT stands for and she keeps asking how much things are going to hurt.

Why would you not start off with grade 1-2?

Answer 20

• These only address pain

- We believe stiffness is the limiting factor

Question 21

Deciding between mobs and manips: Who would you likely choose to use a manipulation on?

Answer 21

• young, active individual who will maintain mobility due to lifestyle and recent onset
• pain seems to be the only thing limiting their mobility

Question 22

Deciding between mobs and manips: Who would you likely choose to use a mobilization on?

Answer 22

• older pt

- sounds like there’s a lot more going on from exam findings

Question 23

Mob/manip: FABQ scores should be

Answer 23

below 19