Spinal Mobilisations - contraindications??

[Emmkam]

Hi there
What are the contraindications and precautions for spinal mobs???

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[Physio_de]

hi!
spinal mobilisation should not be done to the following:
- patients with rheumatoid arhtritis (esp. cervical spine)
- osteoporosis
- presence of hypermobility
- presence of bony block
- presence of malignancy
- fresh\healing fractures
- caution in application for pregnant women
- hiatal hernia
- cardiac problems
**complete contraindication for acute cervical neck injuries and injury to stabilizing soft tissues.

[Emmkam]

Thanks alot
Mangaed to find some more on tinernet:-

Inflammatory infections, viral conditions
Severe scoliosis
VBI (high grade mobs)
Ankylosing spond
Severe pain

[ginger]

Mobs?, depends on wether the therapist is using maitland style mobs, or CM

if Cm , then

" patients with rheumatoid arhtritis (esp. cervical spine"
caution only when undergoing highly irritable states, otherwise OK.

"osteoporosis"
No problem.

"presence of hypermobility"
I have never seen this in 20 plus years of looking for it. In spinal pain conditions I am inclined to say this does not exist.


"presence of bony block"
same story here.

"presence of malignancy"
fair enough , but how you gonna know, most times you will not.

"fresh\healing fractures"
depends on how close to the joint you are mobilising and how recent.

"caution in application for pregnant women"
Why?, if they can lie down and be adequately supported and comfortable , cm will be of benefit and totally safe

"hiatal hernia"
I suspect the writer here was referring to Hiatus hernia, in which case they can be mobilised in a sitting and or a side lying position.

"cardiac problems"
one needs the patient to have a beating heart, if it has stopped , discontinue mobs.

"**complete contraindication for acute cervical neck injuries and injury to stabilizing soft tissues."
Nonsense.

"Inflammatory infections, viral conditions "
who wrote this, are you kidding me?

"Severe scoliosis
VBI (high grade mobs)
Ankylosing spond
Severe pain"

Whoever is threatened by the majority of these conditions and refuses to use gentle mobs in these circumstances , is either untrained in their use , or entirely devoid of skill . sensitivity, or common sense.

[Emmkam]

I was referring to Maitland mobilisations but hey dont shoot the untrained student physio messenger - sources were taken from the internet!!!
And one with ample amounts of skill and practice would not really be asking the question in the first place would they?

[ginger]

emmkam forgive my little rant , I have been teaching mobilisations and related matters for many years. I often find , amongst the physios and others who have maitland as their central theme, may not appreciate the full range of conditions and situations where Continuous Mobilisation will be of value.
CM is gentle , safe and the most effective way to restore normal unprotected mobility to facet joints. Because this method works so well , I have explored it's use across a very broad range of patient presentations and see it as the method of choice most of the time.
Further information on Cm can be found in abundance of the RE site.
Cheers

[alophysio]

Never seen hypermobility or a bony block?

If the joint is infected for some reason, you wouldn't go there.

Otherwise the above is true for any good mobilisations, not just CMs

[ginger]

that's correct, in spinal conditions , because the ubiquitous nature of a protective muscular splint , hypermobility would only be possible were this not to occur. I have yet to come across a living human being where complaints of either referred events from the spine , or pain and dysfunction immediate to the spine was occurring , where protective responses where not easily observed. As for the so called "bony block", in similar circumstances this interpretation of a powerful contracture may be made . I am yet to observe such a state which could objectively be described as bony block . I work mostly in an outpatient setting where infections of joints are extremely rare indeed ( none in twenty years plus ) worthy of genuine caution should the therapist have reason to suspect same however.

[alophysio]

I have only seen one infected facet joint in my time - it is rare.

For your hypermobility patients, what is your plan of attack... i am assuming you use CMs to deal with the protective muscular spasm (which probably works via a neurophysiological effect or ischaemic pressure trying to get through all that bulk to the joint).

But once you relieve their protective strategy, they will still have the underlying hypermobility. If you don't change their stabilisation strategy, they will end up with the pain again in the same way with the same protective muscular spasm...do you have a different view/philosophy on this?

[Jolene Wium]

Hello, im still a student. I would like to know, how long after a spinal fusion (in the lumbar spine) may you do screw mobs?

[malaa]

osteoporosis,malignancy,cord problems,acute inflammation,recent fracture or soft tissue injury on the overlying area.....

[alophysio]

Hi jolene,

1. What type of fusion - hardware or bone graft
2. Why do you want to do screw mobes? I am assuming Thoracic Spine right?
3. Since everything is all connected, have you considered the consequences of your treatment choices?

e.g.
a. research has shown that discs can refer pain up to 4 levels above and 4 levels below
b. Research has also shown that the target joint to be mobilised is not the only one moving during the technique with the effect of the treatment technique being measured 3 spinal levels away.
c. The erector spinae muscles go from the C/S to the pelvis - their contraction has an effect along the whole course of the muscle
d. the effect of fascia on the muscles, joints, nerves and bones is not to be ignored.
e. The T/S joints, esp the CV joints are very close to the sympathetic tract therefore you can affect visceral function.

i say the above because life (and therefore patients) can't really be boiled down to forumlae like "how long after fusion can you do screw mobs?". It is far better for you to work through logically what you want to do and why and consider the holistic consequences.

And the beauty about your situation is that you are still a student. I wish i had someone tell me that when i was studying!

Just remember, your degree is simply the ticket to commence your journey of learning...graduation is not the end but merely the start of your physio learning. Send money and learn from good educators.

Good luck!

[sharileedahl]

"Screw" mobs? Can someone define that for me? Thanks.

[alophysio]

Hi - usually the T/S rotational manipulative technique. difficult to briefly describe...

[sharileedahl]

So basically with the area above and below the level to be mob'd / manip'd locked with rotation? (Just never heard it described as "screw" mobs)

[alophysio]

You basically choose a level like T5/6. Stand on the left side of the patient. Patient is prone. Put you right hand palm down fingers pointing to the head with the heel of your hand at T5/6, the left hand palm down fingers pointing to the feet at T5/6. Then take up the slack so the right hand will be on T5 TP (supposedly) and the left hand will be on the T6 TP. Then manip - your hands will go on opposite directions.

It is a bastardized description - a lot more art in it than that etc. A common manip technique that is too specific... Can use for mobes as well but there are better ways...

[jesspt]

I have absolutely no idea why this intervention would be contraindicated for this patient, as long as they don't have osteoporosis, osteopenia, etc.

[alophysio]

Hi Jesspt,

i think the original post was by a student physio looking for info on the internet for an assignment...

[sharileedahl]

You basically choose a level like T5/6. Stand on the left side of the patient. Patient is prone. Put you right hand palm down fingers pointing to the head with the heel of your hand at T5/6, the left hand palm down fingers pointing to the feet at T5/6. Then take up the slack so the right hand will be on T5 TP (supposedly) and the left hand will be on the T6 TP. Then manip - your hands will go on opposite directions.

It is a bastardized description - a lot more art in it than that etc. A common manip technique that is too specific... Can use for mobes as well but there are better ways...

Thanks!! Now I know what you're talking about!! I don't usually give it a name but have heard it called "butterfly" mobs. Sounds pretty eh? haha (must be a Canadian thing!)

[alophysio]

butterfly mobes do sound better...

I was once at a loss as to what to do with a patient and i was mumbling to myself (it was in the early years ) and i said "well, i guess i could just screw you"!

Thankfully she didn't jump off the bed and whack me! She had already developed trust in me and just said "i hope that is a technique and not what i think it means!"

Needless to say, i never tell the patient "i am going to screw you" anymore - or at least describe the technique properly!

thanks

[sharileedahl]

HAHA!! That GREAT! LOVE those stories! Makes me feel better for all the times I should have thought things through first before talking out loud!!! (We've all got our embarrassing stories!)

[alophysio]

It is so true - my wife's response wasn't so understanding when i told her the story! She wanted a run down on the technique and why it is called a screw technique!

maybe there should be a thread called "funny stories"! I am currently treating a receptionist at a massage parolour/brothel so she tells us all very funny stories