Manipulation Indications, Contraindications

MANIPULATION involves twisting the neck or back to the end of the range, then giving a sudden thrust. This procedure is often accompanied by a pop or clicks which is the result of the release of pressure in the joint, similar to cracking one’s knuckles. Sometimes a manipulation may have a lasting effect, but often it is temporary. Manipulation is particularly difficult to perform if the patient has a severe? muscle spasm? or is anxious. Under these circumstances, pain or injury may be worsened by this procedure as the patient is unable to control the movement, or to stop it once it’s started, and spasmed or tight muscles may be torn.

MOBILISATION consists of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual vertebrae?. They are applied at various locations on each of the affected vertebrae, and at various angles, directed at relieving restriction in movement at any particular level of the spine. Mobilization stretches stiff joints to restore range. It also relieves pain by using special techniques. For example, it is especially effective with arthritic joints.

Spinal manipulative therapy (SMT) involves high-velocity low-amplitude (HVLA) forces to spinal segments and supporting soft tissues. The result is thought to have local biomechanical effects (e.g., facet joint gapping, stretching of soft tissues) that stimulate a cascade of peripheral and central events resulting in pain relief and improved spine related function. The exact mechanism of action of spinal manipulation is unclear, although multiple potential mechanisms have been observed. The clinical? effect is the likely sum of improved joint biomechanics and multiple peripheral and central nervous system mechanisms.

Types of Manipulation

Spinal Manipulation (High-Velocity Low-Amplitude Thrust) – The most frequently used chiropractic technique, spinal manipulation, is the traditional high-velocity low-amplitude (HVLA) thrust. The manipulation often results in an audible “pop,” as chiropractors use their hands to apply a controlled sudden force to a joint while the body is positioned in a specific way.

Spinal Mobilization (Low-Force or Gentle Chiropractic Techniques) – Some conditions (such as osteoporosis?), pathology, the patient’s size, patient comfort, or patient preference, may require a gentler approach generally referred to as spinal mobilization. In addition, some patients and/or clinicians prefer mild? spinal mobilization techniques that do not involve twisting of the body or a forceful thrust.

Most Common Manipulation Techniques

• Lying – Predators are constantly lying about practically everything in their life. They do this to wrong-foot their victim and confuse them. Lying is one of the manipulation techniques psychopaths typically use because they have no qualms about it.
• Not telling the whole story – This is different from lying as a predator will often keep a key part of the story to themselves in order to put their victim at a disadvantage.
• Frequent mood swings – Never knowing what mood your partner is going to be in when you get home, whether they’ll be happy or angry is a very useful tool for the predator. It keeps their victim off balance and makes them more malleable.
• Love-bombing and devaluation – Narcissists typically use love bombing as a manipulation tactic, they will go on a charm offensive and get you hooked into thinking this is the best relationship ever, then they’ll drop you like a ton of bricks without explanation.
• Punishment – This can include anything from constant nagging, shouting, the silent treatment, physical violence, and mental abuse.
• Denial – Often the simplest way a predator will manipulate a person is by denying the thing they are accused of ever happening.
• Spinning the truth – How many times have politicians twisted the facts to suit themselves? This spinning of the truth is often used to disguise bad behavior by predators such as sociopaths.
• Minimizing – Where a predator will try and play down their actions as not important or damaging and shift the blame onto the victim for overreacting.
• Plays the victim – The manipulator will themselves take on the role of the victim in order to gain sympathy and compassion from those around them. We as humans are naturally drawn to helping people when they are suffering.
• Targets the victim – When a manipulator accuses the victim of wrongdoing, they are making the victim defend themselves whilst the predator is able to mask their own manipulation techniques. The focus is on the victim, not the accuser.
• Positive reinforcement – This includes buying expensive presents, praising them, giving money, constantly apologizing for their behavior, excessive charm and paying lots of attention.
• Moves the goal posts – You might think you know where you stand with a person, but if they are constantly moving the goal posts in order to confuse you, then it’s likely you’re dealing with a predator.
• Diversion – Diverting the conversation away from the perpetrator’s actions and moving the conversation onto a different topic is a typical way predators manipulate their victims.
• Sarcasm – A predator will often be sarcastic about their victim in front of others. They do this to lower the self-esteem of the victim and to show others how powerful they are.
• Guilt tripping – Someone who manipulates will often guilt trip their victim by saying that they don’t care about them, or that they are selfish or their life is easy. It all helps to keep that person confused and anxious.
• Flattery – Using charm, praise or flattering the victim is one way of gaining that person’s trust. The victim is naturally happy to receive such compliments but in doing so lowers their guard.
• Playing the innocent card – A true manipulator will feign utmost shock? and confusion? at being accused of any wrongdoing. Their surprise is so convincing that the victim may question their own judgment.
• Over the top aggression – Manipulators often use rage and aggression to shock their victim into submission. The anger is also a tool to shut down any further conversation on the topic as the victim is scared but focused now on controlling the anger, not the original topic.
• Isolation – It is far easier to keep a person under control if they are isolated from family members and friends who could shed some light and truth on the situation.
• Feigns love and empathy – Predators such as psychopaths and sociopaths do not know how to love someone other than themselves, and cannot feel empathy, but they can pretend to in order to inveigle others into their lives. If you watch out for the above manipulation techniques, you can keep yourself out of a predator’s clutches.

Indications of Manipulation

Skilled movements to mobilize or manipulate soft tissues and joints for the purpose of

• Modulating pain, increasing the range of motion, reducing or eliminating soft tissue swelling?, inflammation? or restriction.
• Inducing relaxation
• Improving contractile and non-contractile tissue extensibility
• Improving pulmonary function
• Efficiency and ease of delivery
• Provide a reduction of neurophysiological tone and rigidity? in the treatment area 
• Back pain
• Neck pain
• Reduced range of movement
• Joint stiffness

Contraindications of Manipulation

• Direct manipulation (eg, high-velocity/low-amplitude) is contraindicated? in those cases and, additionally, in the presence of
• Spinal deformity
• Systemic? anticoagulation treatment
• Severe diabetes? or atherosclerotic disease
• Degenerative joint disease
• Vertebral-basilar disease or insufficiency
• Spondyloarthropathies
• Ligamentous joint instability or congenital? joint laxity
• Aseptic necrosis
• Local aneurysm
• Osteoporosis
• Acute? disk herniation
• Osteomalacia

References