Joined: November 15, 2003
A confusion in terminology here. From where I stand, a manipulation is a Gr 5 thrust, and that is all it is. A mobilisation is from 1-4; this has been carefully distinguished for the last 30 years in our part of the world. I agree - mobilisations can be very effective, almost instantaneous relief...but we still do not know why. So, although the evidence is there that they work, there is no evidence that I know of or PT schools know of, as to why. I think every PT would mobilise (passively) but not all do manips. That is usually their choice; because ther are other ways as well.
Thanks for your response. I realize that there may be some degree of disagreement in terms here. For the sake of my comments mobilization and manipulation are synonymous, with both meaning to apply a skilled passive movement to a target tissue. If you prefer to seperate the terms that is fine with me. I don't disagree that it is not clear what the mechanism of action is for a grade 5 thrust but of course that doesn't mean we shouldn't utilize it. We do it precicely because it is effective, and safe. I do not at all begrudge those who don't thrust manipulate and I hope they have solid support in the science for what they do. I'm just saying we need to make this and I'll speak directly to grade 5 thrust a standard routine part of our capabilities beginning at the entry level.
Joined: January 31, 2005
Tim- Excellent post, thoroughly agree.
All- I think as a group we may be getting sidelined again with being overly concerned with why something works and what it is doing physiologically; less concerned with what outcomes it can achieve.
I use mobs all the time for lots of joints. After a study of thoughts posted here and research elsewhere, I am quite certain that I haven't the faintest idea exactly what is going on. I am sure there are lots of tissues involved and even quite likely a neurological basis for the improvement as well. I'm also quite certain that I don't care why it works. My only mission is to find the fastest way to acheive the best outcome with the patient sitting in front of me. Right now, mobilizations (in conjunction with exercise) have more evidence supporting their use than almost any other treatment available, for a wide variety of problems. What could any possible rationale be for not using something proven effective?
Others have made interesting points about tissues affected and other mechanisms to explain the improvement. That's cool for future research directions, as well as discussions over frosty beverages, but just does not pass the common sense test as far as day-to-day treatment goes.
Who knows, maybe in 20 years we will all be laughing about how we used mobilizations and manipulations on our client's joints all the time, because newer methods work better. But until such methods arrive, proven by outcome measures, I will just keep movin it, and movin' on...
Joined: September 15, 2004
Well said Jason. I fit the same pattern of treatment. I have been in the field for over 30 years and you are right. I look back at what we used to do and laugh but it was the best we knew at the time. I just hope newer grads don't get caught up in the research and not what gets results.
Joined: August 25, 2000
What Nari posted is whats being currently taught in PT schools, at least the ones that students who come here talk about. Maybe one day there will do enough studies to show what it really happening when they are performed.
Joined: November 15, 2003
Good thoughts; as long as it is acknowledged that we do not really know why mobilisations gr 1-V work. A neuromodular component is most likely, and probably the main one; but they do work, so what the heck. Movement is movement. What I do object to is any practice which consists just of passive mobilisations, exercises and hot pack and see yuh next time...which is precisely what happened when we all fell in love with Maitland in 1983 (and earlier). but I don't think that is happening anymore...
Joined: February 6, 2004
From: New York, NY 10028
Jason, I agree with the active movement therapy. I have been changing the way I approach a patient who needs to be "mobilized". i.e. stiff joints, restricted movement. In that regard, I find the Shirley Sahrmann info is good but a large part of my training and current beliefs are that a person needs to be guided, moved, mobilized by own hands. I have returned to look at the Mulligan courses I have taken. I use alot of his techniques currently but still feel that my tool box lacks for good mobilization with active movement. Having a patient move either with your guidance or putting them in a corrective position will have so many more systemic effects than just a straight p/a will. Other thoughts? Erica
[QUOTE]What I do object to is any practice which consists just of passive mobilisations[/QUOTE]I can't agree with this statement since the patient may listen (aware of, discoevring how it is functioning...) to his body while we are moving it (for him)!