If you have not yet read Part 1 of this series, we suggest you give it a look.
Physiotherapists explore patient generated forces before considering therapist overpressure or manipulation. In many cases, chiropractors start with manipulation.
Tissue injury is at risk when manipulation is applied early in the treatment process. The sharp sudden thrust force of manipulation renders the body unable to protect itself. This means that the body’s inbuilt protective reflexes are unable to respond fast enough to prevent any potentially excessive and dangerous soft tissue loading. Therefore, the risk of tissue overload increases with manipulation techniques.
The sudden forces of manipulation are also often painful and can aggravate other adverse symptoms such as dizziness in the neck or spasm in the lower back. Upper neck manipulations also have an inherent risk of stroke and even death. Arteries traversing the neck may be inadvertently stressed during the application of these manipulation techniques (Ernst, 2007).
If soft tissue is deconditioned and unknowingly weak, gradual loading with repeated patient generated movements will safely test its integrity while simultaneously encouraging tissue strengthening over time. This system of progressive loading of soft tissue provides a fool proof way of building strength and encouraging movement that is safe and effective.
As already mentioned in Part 1, physios generally use slower, gradual and more sustained forces. Once the tissue responds to a certain level of force with improvements in movement and pain reduction, the force application will be maintained and repeated over multiple cycles until no further progress is achieved. This can be done over consecutive treatments to ensure the tissue is loaded safely.
Under the guidance of physiotherapists, patients learn how best to apply repeated movements in specific directions to improve movement and reduce pain. This creates independence in self-management and reduces the reliance on health care practitioners. This saves untold amounts of money and time both for patients and therapists.
Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med. 2007;100(7):330–338. doi:10.1177/014107680710000716
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