vertebral manipulation

hi
what's the role of grade five manipulation?
has anyone used vertebral manipulation in grade five on cervical spine?
what is the best position for it?
if done Wrong can it cause paraplegia?
i have done my bechelor an year back am i eligible for applying grade 5 manipulation techniques?

thanks
hira !!

Hi hera,

G-V is a very sensitive technique used by many manual tharapists/ chiropractors and osteopaths. HVLAT/G-V's has many roles in terms of its mechanical/neurophysiological/chemical and psycological effects. It is one of the most researched techique used by the professionals, However there is still contravorsy about its efficacy. The evedince also suggests that cervical HVLAT can cause a stroke (VBI). At the same time there is no law restricting general physios from doing a HVLAT, But one should always keep in mind the adverse effects of the technique if it is not done correctly. So it is always better to get trained to do it and should know exatactly why and when to do the technique.Hope this helped you...:)

tanx..
naveen

When you do it like in the action movies, your patient will have a paraplegia!:eek:

So I also suggest to get trained before you try it out on your patients.:cool:

About the position: it depends on the level (C1, C2, ...) and the side (left, right). So this means it is specific for each patïent and you must 'feel it'.

thanks naveen and adriaan
so far i haven't tried it i have seen it done..but
yeah it efficacy has a question mark

to add to these.. i had seen a patient with a lesion(hypoxic) in the brainstem secondary to a sham cervical treatment by a neighbour... the patient was a pharmacist by profession, and after the manipulation by the neighbour.. he is lying down as a useless vegetable with only life and nothing else, cervical grade V has its uses too but the adverse effects outweigh the use if not used properly...

hi
do some reading,authors:Levitt, Maigne, Maitland,Kaltenborn, Hartmann,Ackermann, Cyriax etc.

all the best

The potential risks of cervical manipulation are well documented, and their use is controversial. However, the same risks are not present with lumbar and thoracic manipulation.
In recent times the use of manipulation for the management of acute back pain has acquired an emerging evidence base (UK BEAM trial;work of Julie Fritz and colleagues), and this would justify greater use of this technique in physiotherapy. Like the other comments above, however I would recommend good quality training, both in the technique and in the clinical reasoning around its application. No point in knowing how to do something if you dont know when and to whom!!

words of wisdom!!!!

Hello

The adverse effects of C/S manipualtion is well documented and you have an approximate 1 in 50 000 chance of doing something serious such as causing paraplegia or a stroke (look at the anatomy of the vertebral artery as it courses up the C/S). The chances of doing something serious is greatly increased without thourough training as you are likely to use a much to high application of force. Your chances of making someones neck pain is also very high.

The evidence is also very limited for C/S manipulation. That said I do appreciate that in some patients it may be warranted.

Personally I don't ever do C/S manips. I feel that the area is very easily mobilised as it is very small and there is good evidence supporting this technique that has considerably less risk.

I think as a clinician you should always use a more effective and considerably less dangerous technique. It is simple.

The T/S and the L/S are much less dangerous areas to manip and the evidence base for these areas is starting to become a little more positive. I do manip these areas however I am well trained in doing this and I wouldn't even attempt it without proper taining. You can still cause serious damage mostly in the form of quadraplegia, however very unlikely (1/ approx 400 000).

If I were interested I would consider extending your training through an advanced diplpoma or masters or some form of appropriate training. There are famous cases of therapsits being held accountable for a manip going wrong.

Cheers

hira,
G V manip is a valuable tech to Rx diff conditions if used discriminately & with appropriated protocol. Dx shld be accurate, clear pt for absolute and relative contraindications of G V, use prediction rule for tech to be effective, & apply only & when 100% confident with pt safety and tech efficacy. i do manip and i like its immediate dramatic results. but beleive me we are obssesed with myth of manip and its cracking sound, otherwise there are so many other manual mob techs which can yeild equally excellent immediate results. if one can get same results without chalanging pt's safety, why G V be carried out? G V should be the last option on table. Can be 1st option if 100 % or more confident with its all aspects.
G V HVLT can only be performed by a practioner having advance training in this area in form of degree prog or state approved certification. practicing G V manip on pts without training in this area is not ethical and not allowed.
hope it answers your questions.

hijump -
If your questions regarding Grade V mobilization are directed at a patient with neck pain, you may want to consider these references, all of which document the benefit of thoracic spine manipulation for the treatments of patients with neck pain. It is a very safe region of the spine to perform a thrust technique on, and anecdotaly I've found it an "easier" technique to perform.

LinksFernández-de-las-Peñas C, Palomeque-del-Cerro L, Rodríguez-Blanco C, Gómez-Conesa A, Miangolarra-Page JC.

Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series.
J Manipulative Physiol Ther. 2007 May;30(4):312-20.
PMID: 17509440 [PubMed - indexed for MEDLINE]

Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD.

Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial.
Phys Ther. 2007 Apr;87(4):431-40. Epub 2007 Mar 6.
PMID: 17341509 [PubMed - indexed for MEDLINE]

Cleland JA, Childs JD, Fritz JM, Whitman JM, Eberhart SL.

Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education.
Phys Ther. 2007 Jan;87(1):9-23. Epub 2006 Dec 1.
PMID: 17142640 [PubMed - indexed for MEDLINE]

thanks everyone !!
i am too late to respond .....cat had my tongue
:p

Ciao everyone!
I've been doing a cervical manipulation seminar last week end.
I'm attending a master degree in manual therapy, but i didn't feel confidence enought to do at least a thrust, even if the pre-manipulating position was correctly done.
Do you think that the practice of this kind of tecniques requests a very hard training period? And the training should be practiced only between collegues?

hey Alessia
yes i think first we should practice on each other rather than applying directly on the patient. practice makes the man perfect my boss used to do it very well but being a man he was able to lift and position the patient far better than me !! :)
and thrust in my personal view should be avoided because even if our positioning is fine the patient may get paniced and move or tilt head....that can cause serious issue.
grade 4 is good so its better to give under than over does :)


where have you done your masters from?
how many years are there in masters degree programme?:)
see ya

Hi!
i agree with you about the 4 grade... mobilization is enought for now,even if training in how to find the barrier is a correct way to improve my finger sensibility...i think!
I'm doing my master in Italy,in a city of the north called Padova. Have you ever been in Italy? It lasts 2 years, and allowed to get OMT...Orthopaedic Manipulative Therapist;) what i attempt to do!
Ciao

havent been to italy yet :)
but its one of the dream destinations :P
we have DPT degree only for this time in our country
i liked that OMT hmmm
i am going to apply for US Ai hope i'll find something like that there :)

take care
good luck :)

hi , cn anyone give me some information regarding universities in australia giving diploma in manual therapy.

hi im 3rd diploma in physio so i have used this technique to my fellow housemates to relief their back pain cause of prolonge sitting is it ok cause they said it relief them and im confident of what i do couse i never make a mistakes before so is there any other manipulation technique that i can learn to apply at the upper and lower limb i have juz learned to use at vertebral only.

the maitland's techniques are non weight bearing manipulation
and the muligan's are in weight bearing positions

i am unable to get hand placement in muligan's techniques
anyone who used it ......please can you tell which in more affective and widely used now a days?