Reducing the force & amplitude needed for the ‘Anterior’ thoracic spine manipulation
In this video we discuss a method to reduced both the force, and amplitude necessary to perform the ‘Anterior’ thoracic spinal manipulation.
Whilst many ‘more seasoned’ practitioners of spinal manipulation from the various manual therapy disciplines, may in fact utilize some/all of these concepts, I find through my travels, having taught hundreds of therapists world wide, that these techniques are not emphasized in current manipulation curriculums. This may be due to the current questions posed by manipulation research regarding the specificity of spinal manipulative techniques. Namely that the techniques cannot in fact specify a manipulation to a particular spinal articulation. However, aside from this finding, patient comfort during the performance of the procedure should be taken into account. This becomes of utmost importance with acute cases where muscular guarding/splinting may provide added difficulties to successful completion of the procedure. As I note in many of my seminars, the “1……2……3……JUMP” style manipulation may work for those who are asymptomatic when practicing/training, however it will not be met with gratitude from a patient in considerable pain!
It is my personal belief that we should be employing techniques that minimize both the force and amplitude needed during manipulations. If not only for the benefit of the patient, but also for the long term preservation of the practitioner. The less force we use, the less force we must absorb on our bodies = longevity of practice. It is not difficult to teach an untrained individual to put their fist behind someones back and then jump on them. However to perform the manipulation successfully with minimal force requires more skill and ‘tactile knowledge.’ This is something that in my opinion should be constantly worked on by manual therapists.
For the thoracic ‘anterior’ manipulation of most importance, and what is often ignored, is the function of the hand placed under the patients body. While it is most often taught to be passive during the procedure, I disagree. During the procedure, I actively flex the elbow in order to ‘push’ the contact hand upwards into the spine. This force allows the practitioner to properly sense when the two necessary forces, the contact force via elbow flexion and the downward force of the body, meet. When these forces do meet their individual values are summated (similar to meeting waves) through the spine thus requiring very little thrust force (if at all). Also of importance is the concept of ‘rolling out’ the spine over the lower contact. As can be seen in the video, the practitioner begins movement well behind the contact hand (see red arrow), and then gradually applies force in a progressively downward manner. This allows for maximal joint lock out position so that when the forces ‘meet,’ once again, very little force, and amplitude is needed to complete the manipulation. Also note that the 2nd and 3rd manipulations performed are at lower thoracic segment levels. Notice how the angle of forces is altered accordingly….however the moment of the ‘thrust’ only occurs when the two forces are sensed to meet.
In essence, the treating practitioner is ‘hugging’ the patient firmly throughout the entire procedure allowing them to ‘feel’ for the meeting of the two forces. Contrary to what is often done where the contact hand is placed passively under the patient, the practitioner then rests their other hand on the folded arms of the patient, and then the practitioner ‘jumps’ and lands with a crashing force. A force which may, or may not meet that of the upward force of the lower contact hand.
For a similar post for manipulation of the lumbar spine CLICK HERE