Page 30 - BackSpace October 2017

Review
Spine and Joint Articulation for Manual Therapists
Giles Gyer, Ben Calvert-Painter, Jimmy Michael
Handspring 2016 ISBN 978-1-909141-31-5
THREE EXPERIENCED manual therapists (osteopaths) have written this text with
the aim of providing access and insight into the theory and practical application of articulation and mobilisation techniques. They meet their objective in relation to the spinal/pelvic region and the extremity joints. The black and white illustrations are of high quality, and the book is well-written, but the references are dated and
the inclusion of related anatomy and muscle charts detracts. The volume would make a good reference text for practitioners to review their examination and joint assessment techniques and an entry level reference for undergraduates in the initial years of their studies.
The basis of the articulation techniques described comes from Maitland (1986).
The book concentrates on Grades 1 – 4
which are mainly mobilisation techniques
or pre-high velocity low amplitude (HVLA) techniques. Grade 5, which is defined as
the HVLA, is not included and my concern
is that the definition of this grade suggests that this technique takes the joint into the pathological limit of movement. However, the chiropractic adjustment/manipulation HVLA technique takes the joint to the end range of joint movement to restore joint play without exceeding the anatomical limits of the joint.
The glossary at the beginning of the book is a useful addition. A few entries are somewhat confusing as the definitions of ‘articulation’ and ‘osteokinematics’ appear to overlap. There are also a few terms that creep into the text, such
as ‘plastic phase of deformation’, which are not well defined. ‘Articulation’ would appear to be equivalent to the chiropractic adjustment or HLVA thrust technique, characteristic of a joint manipulation procedure.
The description of movement and stress and movement and tissue repair in Chapter 1 is comprehensive and well-referenced. However, many of the concepts underpinning the effects of joint manipulation are theoretical in nature and are not derived from clinical observation. The remainder of the chapter provides a good overview of the structure of synovial joints and surrounding soft tissues including tendons and
ligaments. The explanation of the neurological effects of articulation is standard, referring to mechanoreceptor stimulation and the resultant hypoalgesic effects. The main gap, however, is that the authors have failed to include some
of the more recent research that has outlined the effect of spinal manipulation on joint stiffness, muscle spindles and intervertebral disc hydration. They also say there is no definitive evidence for the optimum duration, frequency or amplitude for articulation techniques. However, a number of recent studies have identified ideal treatment frequency with good clinical outcomes on particular patient groups with chronic back pain.
Chapter 2 provides a very good overview of all the types of joints in the body including fibrous, cartilaginous and synovial joints. The planes and directions of movement are also presented in graphic form using a range of illustrations.
Chapter 3 presents the absolute and relative contra-indications that practitioners should consider before undertaking articulation techniques. There is a useful discussion of
the risk-to-benefit concept. The chapter
also introduces the five ‘flag’ system for musculoskeletal disorders and outlines the importance of history taking. The authors also attempt to include patient-reported outcome measures but refer only to the Fear Avoidance Questionnaire, which is only one of a number of well-supported validated questionnaires that they could have included in this section.
Chapter 4 presents a comprehensive overview of therapist posture and stance. It outlines
the importance of the therapist’s posture to maximise therapeutic skills and minimise mechanical stress on the therapist. The advice and skills presented in this chapter include treatment posture, patient posture, head position, table height and the importance of breathing, which are fundamental skills for students when beginning to learn manual skills and also a good review for those engaged in manual therapy.
Section 2 of the book covers the articulation techniques for all regions of the spine including the rib cage and pelvis/hip. This section also
covers the articulation techniques for the shoulder, elbow, wrist/hand, knee and ankle/ foot. Each section follows a common format including an introduction, anatomy of the region or joint, epidemiology, examination, red flags, passive range of motion techniques and finally the articulation techniques for
that region of the spine or extremity joint. The various conditions for each region are encapsulated in a chart form including the relevant examination procedures for spine
and extremity joints. The illustrations are generally good and the description of each procedure easy to follow. However, the section of each chapter covering the spinal, rib cage and hip pelvis articulation techniques is not
as comprehensive as I would expect and the authors are only able to demonstrate the practitioner-patient position in a static fashion. These skills are illustrated well, but don’t add to existing textbooks covering the same material.
The section covering the shoulder joint provides a good review of a number of assessment and mobilisation techniques for a complex clinical presentation. The illustrations, using a graded non HVLA approach, are sensible considering that the shoulder is inherently unstable and capable of movement in all planes of motion. The inclusion of scapulothoracic articulations is also sound
as this part of the shoulder complex is often overlooked clinically.
David Byfield
Head of Clinical Services Welsh Institute of Chiropractic University of South Wales
30 BACKspace www.chiropractic-ecu.org October 2017