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MANIPULATION TECHNIQUE FOR THE LOWER BACK By G. D, MAITLAND, Adelaide, South Australia. Introduction. The title “Manipulation” in many ways isa rather uniortunate one, in that it seems to deter many patients, doctors, and physio- therapists, from using this method of treat- ment. IH scems that many people consider manipulation means being manhandied roughly whereas it is only im a small per- centage of cases that strong movements are needed and even with these the patients have gradually been worked up to it. Tt has paid dividends to ask a doctor whom you know would not accept manipulations to call it “passive movements”, After all that is what manipulation is. Some people feel that, if manipulation is suggested as a form of treatment for a patient, the physiotherapist 1º “manipulation happy”, but it is quite an eye-opener to see how some symptoms can be rclieved by manipulation. Unfortunately the discussion tonight will have to be Emited to the lumbar spine, even though the thoracic and cervical regions have possibly the more interesting range of symptoms ; time will not allow for a reason- able coverage of thoracic and cervical spine manipulations. However, the basic prin- ciples of examination and assessment are the same at afl levels though the manipu- lations in the different areas vary. Principles of Treatment. The hasic essential of this method cf treatment is the continual assessment of the patient's symptoms (that is, what they fcel) and signs (that is, limita- tions to movement which are used as a guide) not only at each visit but at each session. Tt is only by this means that you can tell whether the manipulation being used is the correct one. No patient can be harmed provided that the first time each manipulation is used it is used gently, that continual assessment between the mancuvres is maintained, and that a manipulation is stopped when it tends to increase the symptoms. Marked sciatic scoliosis or lumbar kyphosis or neurological changes need be no bar to treatment by manipulation if carried out thus. There have been several books written on the “art” of manipulation, This word “art” is very well chosen becanse there is a high degree of “feel” in carrving out any of the manipulations. Tt is very much like changing gears in a car. You cannot see the various sized cogs and the manner in which they mesh together, yet 1f you are a good driver you “feel” the gears through the gear lever. If you do not “feel” the gears and just push the lever through its movements 136 you mect with varying degrees of success or failure, and the same applies to manipu- lation. You just can't choose the manipu- lation which suits the symptoms and then push your way through it, you must “feel” your way through it. Time and time again Figure É you will find that this is the difference between success and failure. To illustrate this point, there was a patient who had gluteal pain who after manipulation gained complete relief which wauld last a full day, but the symptoms would recur overnight. He wanted his friend to learn the manipu- lation so that he could be made pain free
