Mechanisms of Action of Manipulative Therapy Bill Vicenzino Professor in Sports Physiotherapy Head of Division of Physiotherapy UUUUUUUUUUUUUUUUUUUUUnnnnnnnnnnnnnniiiiiiiiiiivvvvvvvvvvvvvvvvvvvveeeeeeeeeeeeeeeeeeeeeerrrrrrrrrrrrrrrrrrsssssssssssssssssssssiiiiiiiiiiiiitttttttttttttttttyyyyyyyyyyyyyyyyyyyy ooff QQQuuuuuuuuuuuuuuuuuueeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeennnnnnnnnnnssssssssssssssssslllllllllllllllaaaaaaaaaaaaaaaaaaannnnnnnnnnnnnnnnnnnddddddddddddddddddd http://www.optp.com/ www.us.elsevierhealth.com Manipulation 1.  Low Velocity Techniques (cid:2) (cid:3) Passive Mob –  Under control of client –  Passive ± active or functional components* –  Includes soft tissue, joints, nerual … 2.  High Velocity Thrust Techniques –  Beyond control of client –  Small amplitude (ie, HVLA) What is the major difference between mobilisation and HVT? Indicates successfu l manipulation! Significance to mechanism of action? Brodeur R 1995 The audible release associated with joint manipulation JMPT 18: 155-64 Audible release caused through cavitation mechanism that is responsible for: Initiating reflex effects Producing forces in target tissues without damaging muscle Does it work? Or What is its clinical efficacy? Gross et al (2010) Manipulation or Mobilization for Neck Pain: Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD004249.pub3 Gross et al (2010) Manipulation or Mobilization for Neck Pain: Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD004249.pub3 Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. Journal of Orthopaedic & Sports Physical Therapy. 2007 Mar;37(3):100-7. Spinal manual therapy appears efficacious …in short to mid term