Musculoskeletal Manipulation

Aka: Musculoskeletal Manipulation, Osteopathic Manipulative Treatment, Manipulative Therapy, Manipulation Procedure, Chiropractic Manipulation, Spinal Manipulation, Muscle Energy Technique, Muscle Energy Therapy, Counter Strain Therapy

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II. Types

  1. Counter Strain Therapy
    1. Passive shortening of a Muscle until its associated Tender Point softens while being palpated
    2. Joints and Muscles are manipulated away from a restrictive barrier (taut Muscle) toward a less restrictive position
    3. Once Trigger Point pain decreases, position is held for 90 seconds, and then returned to a neutral position
  2. Muscle Energy Technique
    1. Stretches tight Muscles and fascia
    2. Examiner applies counter force against a patient's isometric contraction of involved Muscles
    3. Patient holds each contraction for 3-5 seconds and repeats the maneuver 3-5 times
  3. Soft Tissue Therapy
    1. Fascial tissue is lengthened through manual force
  4. Spinal Manipulation
    1. Manual force applied to spinal joint, moving it at it's end range of motion

III. Indications

  1. Acute Low Back Pain
    1. May offer short term benefit, but no longterm benefit compared with other Low Back Pain Management
    2. Assendelft (2003) Ann Intern Med 138(11): 871-81 [PubMed]
    3. Rubinstein (2012) Cochrane Database Syst Rev (9): CD008880 [PubMed]
    4. Paige (2017) JAMA 317(14): 1451-60 [PubMed]
  2. Chronic Low Back Pain
    1. Offers some benefit in the longterm, but no better than other conservative therapy
      1. Assendelft (2004) Cochrane database Syst Rev (1): CD000447 [PubMed]
  3. Neck Pain
    1. Cervical manipulation or mobilization appears effective in reducing pain in acute and chronic Neck Pain
    2. There are risks to neck manipulation including rare but catastrophic effects (e.g. Vertebrobasilar Dissection)
    3. Gross (2015) Cochrane Database Syst Rev (2): CD004249 [PubMed]
    4. Gross (2010) Cochrane Database Syst Rev (1): CD004249 [PubMed]
    5. Gross (2004) Cochrane Database Syst Rev (1): CD004249 [PubMed]
  4. Chronic cervicogenic Headache or Tension Headache
    1. May be effective, but studies of efficacy to date are small
    2. Cerritelli (2017) J Pain Res 10:601-11 [PubMed]
    3. Bronfort (2004) Cochrane Database Syst Rev (3):CD001878 [PubMed]

IV. Precautions

  1. Chiropractic Manipulation is common in infants and children (2.5 Million in 2007)
    1. Has been used for various complaints beyond musculoskeletal, including respiratory conditions, colic, allergies
    2. Evidence of benefit is poor in this population, and it is not generally recommended
    3. Posadzki (2013) Pediatrics 132(1):140-52 [PubMed]

V. Adverse Effects: Serious or Life Threatening

  1. Vertebrobasilar Dissection (<1 in 20,000)
  2. Lumbar Disk Herniation (<1 in 2 million)
  3. Cauda Equina Syndrome (<1 in 3 million)
  4. Death (<1 in 3 million)
  5. Nielsen (2017) Syst Rev 6(1): 64 [PubMed]
  6. Stevinson (2002) Am J Med 112(7): 566-71 [PubMed]
  7. Vohra (2007) Pediatrics 119(1): e275-83 [PubMed]

VI. References

  1. Smith (2019) Am Fam Physician 99(4): 248-52 [PubMed]

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Related Studies

Ontology: Manipulation of spine (C0086586)

Definition (MSH) Adjustment and manipulation of the vertebral column.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D020393
ICD10 1386 , 48600-00
SnomedCT 44275008, 178809009, 225511007
English Manipulation of spine NOS, Manip of vertebrae - non-surg, Manipulation of spine, Manipulation of back, NOS, Manipulation, Spinal, Spinal Manipulation, Manipulation of spine (procedure), Manipulation of spine NOS (regime/therapy), Manipulation of spine (regime/therapy), Spinal manipulation, Spine manipulation, manipulation spinal, manipulation spine, spinal manipulation, manipulations spinal, spine manipulation, Manipulation of spine NOS (procedure), Manipulation of the vertebrae - non-surgical, Manipulation of the vertebrae, Manipulation of the vertebrae - non-surgical (procedure), Manipulation of vertebral column, Manipulation of spine, NOS, Manipulation of vertebral column, NOS
Italian Manipolazione vertebrale, Manipolazione della colonna vertebrale, Manipolazione spinale
Dutch wervelkolom manipulatie, manipulatie van wervelkolom, spinale manipulatie, Manipulatie, spinale
German Wirbelsaeulenmanipulation, Manipulation der Wirbelsaeule, Manipulation, spinale, Spinale Manipulation
Spanish Manipulación de columna vertebral, manipulación de la columna vertebral (procedimiento), manipulación de la columna vertebral (régimen/tratamiento), manipulación de la columna vertebral, SAI (régimen/tratamiento), manipulación de la columna vertebral, SAI, manipulación de la columna vertebral, SAI (procedimiento), manipulación de la columna vertebral, manipulación de vértebras - no quirúrgica, manipulación vertebral no quirúrgica (procedimiento), manipulación vertebral no quirúrgica, Manipulación de la columna vertebral, Manipulación Espinal
Japanese 脊椎徒手整復, ｾｷﾂｲﾄｼｭｾｲﾌｸ, マニピュレーション-脊椎, 腰椎マニピュレーション, マニピュレーション-脊柱, 脊柱マニピュレーション, マニピュレーション-腰椎, マニピュレーション-頸椎, 頸椎マニピュレーション, 脊椎マニピュレーション
Swedish Manipulation, ryggrad
Czech manipulace spinální, manipulace páteřní, Manipulace s páteří, Manipulace páteře, Páteřní manipulace
Finnish Selän manipulaatiohoito
Russian SPINAL'NAIA MANIPULIATSIIA, MANIPULIATSIIA NA SHEINYKH POZVONKAKH, MANIPULIATSIIA SPINAL'NAIA, POZVONOCHNIK, MANIPULIATSIIA, МАНИПУЛЯЦИЯ НА ШЕЙНЫХ ПОЗВОНКАХ, МАНИПУЛЯЦИЯ СПИНАЛЬНАЯ, ПОЗВОНОЧНИК, МАНИПУЛЯЦИЯ, СПИНАЛЬНАЯ МАНИПУЛЯЦИЯ
French Manipulation des vertèbres, Manipulation rachidienne, Manipulation spinale, Manipulation du rachis, Manipulation vertébrale
Polish Leczenie manualne kręgosłupa, Zabiegi manualne na kręgosłupie, Terapia manualna kręgosłupa
Hungarian Gerinc manipulatio, Gerinc manipulációja, Gerincmanipulatio
Norwegian Manipulasjon av ryggraden, Spinal manipulasjon, Manipulasjon av ryggsøylen, Manipulasjon av virvelsøylen, Manipulasjon av columna vertebralis
Portuguese Manipulação da coluna vertebral, Manipulação da Coluna
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Chiropractic manipulation (C0600577)

Definition (MSH) Procedures used by chiropractors to treat neuromusculoskeletal complaints.
Definition (SCTSPA) Manipulación efectuada por un quiropráctico
Definition (SNOMEDCT_US) A manipulation done by a chiropractor
Concepts Therapeutic or Preventive Procedure (T061)
MSH D026882
SnomedCT 46947000
English Chiropractic Manipulation, Manipulation, Chiropractic, Chiropractic manipulation, adjustment chiropractic, chiropractic manipulation, chiropractic adjustment, chiropractic manipulations, adjustments chiropractic, Chiropractic manipulation (procedure), Chiropractic manipulation, NOS
Swedish Manipulation, kiropraktisk
Czech páteř - napravení chiropraktické, manipulace chiropraktická
Finnish Kiropraktinen manipulaatio
Russian KHIROPRAKTICHESKIE MANIPULIATSII, KHIROPRAKTICHESKIE MANIPULIATSII NA POZVONOCHNIKE, ХИРОПРАКТИЧЕСКИЕ МАНИПУЛЯЦИИ, ХИРОПРАКТИЧЕСКИЕ МАНИПУЛЯЦИИ НА ПОЗВОНОЧНИКЕ
Japanese 脊椎調整-カイロプラクティック, カイロプラクティックアジャストメント, カイロプラクティックマニピュレーション, マニピュレーション-カイロプラクティック
Polish Nastawianie kręgosłupa, Manualne leczenie kręgosłupa, Manipulacje chiropraktyczne, Kręgarstwo
French Manipulation de chiropractie, Manipulation chiropractique, Manipulation de chiropraxie
Norwegian Kiropraktisk manipulasjon, Manipulasjon, kiropraktisk
Portuguese Alinhamento Postural Quiroprático, Correção Postural, Manipulação Quiroprática
Spanish manipulación quiropráctica (procedimiento), manipulación quiropráctica, Manipulación Quiropráctica
German Chiropraktisches Adjustieren, Manipulation, chiropraktische, Wirbelsäulenadjustierung, chiropraktische
Italian Manipolazione chiropratica
Dutch Chiropractie, Chiropractische correctie, Wervelkolomcorrectie, chiropractische
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Manipulation procedure (C0947647)

Definition (SCTSPA) Acción de hábil destreza manual aplicada directamente sobre una parte corporal
Definition (SNOMEDCT_US) Skilled dextrous action of the hands directly applied to a body part
Definition (NCI) Move, treat, or operate with the hands or by mechanical means, especially in a skillful manner.
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 182552004, 150708005, 19207007, 129408000
English Manipulation procedure, Manipulations NOS, Manipulate, Manipulative, Manipulation NOS, manipulation procedure, manipulation, Manipulations NOS (procedure), Manipulations NOS (regime/therapy), Manipulation, Manipulative procedure, Manipulation - action, Manipulation (procedure), Manipulation - action (qualifier value), Manipulation, NOS
Spanish manipulación - acción, Manipulación NEOM, manipulaciones, SAI, manipulaciones, SAI (procedimiento), Manipulations NOS, manipulaciones, SAI (régimen/tratamiento), manipulación (acción), manipulación (procedimiento), manipulación - acción (calificador), manipulación, procedimiento manipulativo, procedimiento por manipulación, Manipulación
Italian Manipolazione, Manipolazione NAS
Dutch manipulatie NAO, manipulatie
French Manipulation SAI, Manipulation
German Manipulation NNB, Manipulation
Portuguese Manipulação NE, Manipulação
Japanese 用手操作ＮＯＳ, 用手操作, ﾖｳｼｭｿｳｻNOS, ﾖｳｼｭｿｳｻ
Czech Manipulace NOS, Manipulace
Hungarian Manipuláció k.m.n., Manipuláció
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Musculoskeletal Manipulations (C0949741)

Definition (MSH) Various manipulations of body tissues, muscles and bones by hands or equipment to improve health and circulation, relieve fatigue, promote healing.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D026201
Czech muskuloskeletální manipulace
Finnish Manipulaatiohoidot
Russian KOSTNO-MYSHECHNYE LECHEBNYE MANIPULIATSII, MYSHECHNO-KOSTNYE LECHEBNYE MANIPULIATSII, MYSHECHNO-SKELETNYE LECHEBNYE MANIPULIATSII, MANIPULIATSII MYSHECHNO-SKELETNYE, MANIPULIATSIONNAIA TERAPIIA, КОСТНО-МЫШЕЧНЫЕ ЛЕЧЕБНЫЕ МАНИПУЛЯЦИИ, МАНИПУЛЯЦИИ МЫШЕЧНО-СКЕЛЕТНЫЕ, МАНИПУЛЯЦИОННАЯ ТЕРАПИЯ, МЫШЕЧНО-КОСТНЫЕ ЛЕЧЕБНЫЕ МАНИПУЛЯЦИИ, МЫШЕЧНО-СКЕЛЕТНЫЕ ЛЕЧЕБНЫЕ МАНИПУЛЯЦИИ
Japanese 筋骨格系マニピュレーション, マニピュレーション-筋骨格系
French Manipulations de l'appareil locomoteur
Croatian Not Translated[Musculoskeletal Manipulations]
Swedish Muskuloskeletala manipulationer
Polish Manipulacje mięśniowo-szkieletowe
Portuguese Manipulações Musculosqueléticas, Manipulações Musculoesqueléticas
English Manipulations, Musculoskeletal, Musculoskeletal Manipulations
Norwegian Muskel-skjelettmanipulasjonsbehandlinger
German Manipulationen, muskuloskelettale, Muskuloskelettale Manipulationen
Italian Manipolazioni muscoloscheletriche
Dutch Therapie, manuele
Spanish Manipulaciones Musculoesqueléticas
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Osteopathic manipulation (procedure) (C0949744)

Definition (SCTSPA) Manipulación efectuada por un osteópata
Definition (SNOMEDCT_US) A manipulation done by an osteopath
Definition (MSH) Musculoskeletal manipulation based on the principles of OSTEOPATHIC MEDICINE developed in 1874 by Dr Andrew Taylor Still.
Definition (AOT) see:http://www.nlm.nih.gov/mesh/MBrowser.html
Concepts Therapeutic or Preventive Procedure (T061)
MSH D026301
ICD9 93.6
SnomedCT 150705008, 16992002
CPT 98925, 98928, 98927, 98929, 98926, 1013559
English Manipulation, Osteopathic, Osteopathic Manipulation, osteopathic manipulative treatment (OMT), osteopathic manipulative treatment (OMT) (treatment), Treatment, Osteopathic Manipulative, Osteopathic Manipulative Treatments, Treatments, Osteopathic Manipulative, Osteopathic Manipulative Treatment, osteopathic manipulative therapy, osteopathic manipulation, Osteopathic manipulative treatment (OMT), Osteopathic manipulation, Osteopathic manipulative therapy, Osteopathic manipulation (procedure), Osteopathic manipulation, NOS, Osteopathic manipulative therapy, NOS, Osteopathic services, Osteopathic manipulative treatment
Swedish Manipulation, osteopatisk
Czech manipulace osteopatická
Finnish Osteopaattinen manipulaatiohoito
Russian OSTEOPATICHESKAIA MANIPULIATSIIA, ОСТЕОПАТИЧЕСКАЯ МАНИПУЛЯЦИЯ
French Traitement par manipulation ostéopathique, Manipulation ostéopathique
Italian Trattamento manipolativo osteopatico, Manipolazione osteopatica
Polish Osteopatyczne leczenie manipulacyjne, Manipulacje osteopatyczne, Zabiegi osteopatyczne
Japanese オステオパシックマニピュレーション, オステオパチー(治療), オステオパシー(治療)
Norwegian Osteopatisk manipulasjon, Manipulasjon, osteopatisk
Spanish manipulación osteopática (procedimiento), manipulación osteopática, terapia de manipulación osteopática, Manipulación Osteopática
German Osteophathische Manipulation, Manipulation, osteophathische
Dutch Manupulatie, osteopathische, Osteopathische manipulatie
Portuguese Manipulação Osteopática
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: counter strain therapy (C2015276)

Concepts Therapeutic or Preventive Procedure (T061)
English OMT counter strain, counter strain therapy, counter strain therapy (treatment)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: muscle energy therapy (C2015513)

Concepts Therapeutic or Preventive Procedure (T061)
English OMT muscle energy, muscle energy therapy, muscle energy therapy (treatment)
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Procedure

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