Introduction

1 Introduction

Manipulative techniques for the spine, thorax and pelvis are commonly utilized for the treatment of pain and dysfunction. Proficiency in their use requires training, practice and development of palpatory and psychomotor skills. The purpose of this book is to provide a resource that will aid development of the knowledge and skills necessary to perform high-velocity low-amplitude (HVLA) thrust techniques in practice. It is written not just for the novice manipulator but also for any practitioner who uses thrust techniques. While the book presents an osteopathic perspective, it does not promote or endorse any particular treatment model or approach.

The term ‘manipulation’ is often used to describe a range of manual therapy techniques. This text focuses specifically upon HVLA procedures where the practitioner applies a rapid thrust or impulse. The aim of HVLA thrust techniques is to achieve joint cavitation that is accompanied by a ‘popping’ or ‘cracking’ sound. This audible release distinguishes HVLA thrust techniques from other osteopathic manipulative techniques. HVLA thrust techniques are also known by a number of different names, e.g. adjustment, high-velocity thrust, mobilization with impulse and grade V mobilization.

The book is divided into three parts. Part A comprises seven chapters that provide an osteopathic perspective on the use of HVLA thrust techniques and reviews indications, research evidence, kinematics, safety and research.

An overview of the osteopathic philosophy and practice that underpins osteopathic manipulative technique and treatment is presented in Chapter 2. Chapter 3 reviews spinal kinematics and coupled motion of the spine. Practitioners require knowledge of biomechanics and coupled motion characteristics in order to apply the principles of spinal locking used in HVLA thrust techniques. The osteopathic profession has developed a classification of spinal motion. Chapter 4 describes Type 1 and Type 2 movements and the relevance of coupled motion to spinal positioning and joint locking.

Complications of, and contraindications to, HVLA thrust techniques are outlined in Chapter 5. Relative risks of thrust and non-thrust techniques and the use of HVLA thrust techniques in patients with disc lesions are discussed. Pre-manipulative assessment for cervical artery compromise and upper cervical instability is described and the use of testing protocols is reviewed in light of the published literature.

Chapter 6 reviews the literature relating to cavitation, the evidence related to the efficacy of spinal manipulation and outlines a decision-making process that will assist practitioners to determine when a HVLA thrust technique might be used in clinical practice.

Research is necessary to validate the use of osteopathic techniques in clinical practice, including HVLA thrust techniques. Chapter 7 discusses where research should be focused and identifies strategies that can be used by practitioners to classify patients and document patient outcomes.

Part B outlines in detail specific HVLA thrust techniques for the spine, rib cage and pelvis. This part combines photographs and descriptive text that is supported by the video images of HVLA thrust techniques on the accompanying DVD-ROM.

HVLA thrust techniques can be described in terms of bone movement or joint gliding. In this text, all 41 techniques are outlined utilizing the principle of joint gliding. This approach has been shown to be effective in the teaching of HVLA thrust techniques to both undergraduate and postgraduate students.

The text has been designed to provide a logical step-by-step format that has consistency throughout the book. Each technique is described from the moment the patient is positioned on the couch, through a series of steps up to and including segmental localization and delivery of the thrust. Each individual technique is logically organized under a number of specific headings: