Biomedical subjects
Publications and source records attributed to S V Paris.
The author asserts that if an instability is of any consequence, then it can be detected during the physical examination by a trained observer. Radiographs, which display full-range or even paradoxical movements, do not represent true functional movements. If the instability cannot be seen or palpated there is a serious question as to whether it exists. Hypermobility can also be detected and differentiated from instability.
In this article I have attempted to give an overview of the current aspects of anatomy relevant to understanding low back function and pain. Generally, anatomy, neuroanatomy, and mechanics of the spine are not well understood by those who examine and treat these structures. It is hoped that an improved understanding will enhance both evaluation and patient care.
Spinal manipulative therapy is growing in popularity and acceptance, as judged by the increasing number of practitioners in physical therapy and medicine and by the results of clinical trials. Manipulation is the skilled, gentle, passive movement of a joint (or spinal segment) either within or beyond its active range of motion. This definition is broad enough to encompass a great variety of techniques, ranging from the more traditional thrust to oscillation and distraction. Manipulation is rendered effective by a combination of mechanical, neurophysiologic, and biomechanical mechanisms.
Reliable measurements are prerequisite to the successful conduct of outcome studies. In a study of the performance of physical therapists (n = 5) in evaluating passive mobility of the vertebral column with normal subjects (n = 5), several sources of measurement variability were assessed: the reliability within and between therapists, the criteria for grading, and the subjects themselves. Intratherapist reliability was found to be dependable; intertherapist reliability was not. Problems that merit further study were identified as idiosyncratic behaviors that may develop with experience, subject characteristics, and the instrument itself. Periodic assessment of the reliability of therapists in performing evaluations is recommended because of its importance to therapeutic programming.
This article presents spinal dysfunction (as opposed to disease) as being an altered state of mechanics demonstrating either an aberrant motion or an increase or decrease from the expected range. Examination techniques, including passive intervertebral motion testing, are outlined, as is the grading system for recording results. Mobilizations and positional distraction are advocated for treating restricted range, and the neurophysiological and mechanical effects are explained along with their indications and contraindications. Pain is presented as a misleading symptom that cannot be relied upon to monitor the results of treatment. The author considers that exercise routines have no place in the treatment of spinal dysfunction, although selected exercises may be given for the patient's particular requirements. Walking is advocated to maintain mobility and function, but running, cycling, and swimming are generally discouraged.
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