Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 4 , Pages 316-329 , May 2006

Manual Forces Applied During Posterior-to-Anterior Spinal Mobilization: A Review of the Evidence

  • Suzanne J. Snodgrass, MMedSc(Physio)

      Affiliations

    • Lecturer, Discipline of Physiotherapy, The University of Newcastle, Callaghan, NSW, Australia
    • Corresponding Author InformationSubmit requests for reprints to: Suzanne J. Snodgrass, MMedSc(Physio), Discipline of Physiotherapy, The University of Newcastle, Box 24, Hunter Bldg, Callaghan, NSW 2308, Australia
    • ,
  • Darren A. Rivett, PhD

      Affiliations

    • Associate Professor, Head, Discipline of Physiotherapy, The University of Newcastle, Callaghan, NSW, Australia
    • ,
  • Val J. Robertson, PhD

      Affiliations

    • Professor of Allied Health, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia

Received 31 May 2005 ,Revised 19 August 2005

References 

  1. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004;4:335–356
  2. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22:2128–2156
  3. Koes BW, Assendelft WJJ, van der Heijden GJM, Bouter LM. Spinal manipulation for low back pain: an updated systematic review of randomized clinical trials. Spine. 1996;21:2860–2873
  4. Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, et al. Manipulation and mobilisation for mechanical neck disorders. 2002, Issue 3. Art. No.: CD004249. DOI: 10.1002/14651858.CD004249.pub2.
  5. Korthals-de Bos IBC, Hoving JL, van Tulder MW, Rutten-van Molken MPM, Ader HJ, de Vet HCW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003;326:911–916
  6. Hurley DA, McDonough SM, Baxter GD, Dempster M, Moore AP. A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain. Man Ther. 2005;10:61–67
  7. Kotoulas M. The use and misuse of the terms “manipulation” and “mobilization” in the literature establishing their efficacy in the treatment of lumbar spine disorders. Physiother Can. 2002;54:53–61
  8. Chiradejnant A, Latimer J, Maher CG. Forces applied during manual therapy to patients with low back pain. J Manipulative Physiol Ther. 2002;25:362–369
  9. Harms MC, Bader DL. Variability of forces applied by experienced therapists during spinal mobilization. Clin Biomech. 1997;12:393–399
  10. Simmonds MJ, Kumar S, Lechelt E. Use of a spinal model to quantify the forces and motion that occur during therapists' tests of spinal motion. Phys Ther. 1995;75:212–222
  11. Scaringe JG, Kawaoka C. Mobilization techniques. In:  Haldeman S editors. Principles and practice of chiropractic. 3rd ed.. New York: McGraw-Hill; 2005;p. 767–785
  12. Maitland GD, Banks K, English K, Hengeveld E. Maitland's vertebral manipulation. 6th ed.. Oxford: Butterworth-Heinemann; 2001;
  13. Jull G. Use of high and low velocity manipulative therapy procedures by Australian manipulative physiotherapists. Aust J Physiother. 2002;48:189–193
  14. Magarey ME, Rebbeck T, Coughlan B, Grimmer K, Rivett DA, Refshauge KM. Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Man Ther. 2004;9:95–108
  15. Snodgrass SJ, Rivett DA, Chiarelli P, Bates AM, Rowe LJ. Factors related to thumb pain in physiotherapists. Aust J Physiother. 2003;49:243–250
  16. Snodgrass SJ, Rivett DA. Thumb pain in physiotherapists: potential risk factors and proposed prevention strategies. J Man Manip Ther. 2002;10:205–216
  17. Cook C, Turney L, Ramirez L, Miles A, Haas S, Karakostas T. Predictive factors in poor inter-rater reliability among physical therapists. J Man Manip Ther. 2002;10:200–205
  18. Harms MC, Innes SM, Bader DL. Forces measured during spinal manipulative procedures in two age groups. Rheumatology (Oxford). 1999;38:267–274
  19. Matyas TA, Bach TM. The reliability of selected techniques in clinical arthrometrics. Aust J Physiother. 1985;31:175–199
  20. Petty NJ, Bach TM, Cheek L. Accuracy of feedback during training of passive accessory intervertebral movements. J Man Manip Ther. 2001;9:99–108
  21. Lee M, Moseley A, Refshauge K. Effect of feedback on learning a vertebral joint mobilization skill. Phys Ther. 1990;70:97–104
  22. Lee RYW, McGregor AH, Bull AMJ, Wragg P. Dynamic response of the cervical spine to posteroanterior mobilisation. Clin Biomech. 2005;20:228–231
  23. Conradie M, Smit E, Louw M, Prinsloo M, Loubser L, Wilsdorf A. Do experienced physiotherapists apply equal magnitude of force during a grade I central PA mobilisation on the cervical spine. S Afr J Physiother. 2004;60:18–25
  24. Smit E, Conradie M, Wessels J, Witbooi I, Otto R. Measurement of the magnitude of force applied by students when learning a mobilisation technique. S Afr J Physiother. 2003;59:3–8
  25. Langshaw M. Cervical spine mobilisation: the effect of experience and subject on dose. Undergraduate honours thesis, 2001 Sydney; The University of Sydney; 2001.
  26. Threlkeld JA. The effects of manual therapy on connective tissue. Phys Ther. 1992;72:893–902
  27. Bjornsdottir SV, Kumar S. Posteroanterior motion test of a lumbar vertebra: accuracy of perception. Disabil Rehabil. 2003;25:170–178
  28. Snodgrass SJ, Factors related to thumb pain in physiotherapists [Masters thesis]. NSW, Australia; The University of Newcastle; 2003.
  29. Hardy GL, Napier JK. Inter and intratherapist reliability of passive accessory movement technique. NZ J Physiother. 1991;19:22–24
  30. Watson MJ, Burnett M. Equipment to evaluate the ability of physiotherapists to perform graded postero-anterior central vertebral pressure type passive movements of the spine by thumb pressure. Physiotherapy. 1990;76:611–614
  31. Chester R, Swift L, Watson MJ. An evaluation of therapist's ability to perform graded mobilization on a simulated spine. Physiother Theory Pract. 2003;19:23–34
  32. Kulig K, Landel R, Powers CM. Assessment of lumbar spine kinematics using dynamic MRI: a proposed mechanism of sagittal plane motion induced by manual posterior-to-anterior mobilization. J Orthop Sports Phys Ther. 2004;34:57–64
  33. McGregor AH, Wragg P, Gedroye WMW. Can interventional MRI provide an insight into the mechanics of a posterior-anterior mobilisation?. Clin Biomech. 2001;16:926–929
  34. McGregor AH, Bull AMJ, Lee R, Wragg P. Dynamic response of the human spine to anteroposterior mobilisation manual therapy: an interventional magnetic resonance imaging study. Physiotherapy. 2004;90:165–166
  35. Viner A, Lee M. Direction of manual force applied during assessment of stiffness in the lumbosacral spine. J Manipulative Physiol Ther. 1995;18:441–447
  36. Lee M, Svensson NL. Effect of loading frequency on response of the spine to lumbar posteroanterior forces. J Manipulative Physiol Ther. 1993;16:439–446
  37. Chiradejnant A, Maher CG, Latimer J. Development of an instrumented couch to measure forces during manual physiotherapy treatment. Man Ther. 2001;6:229–234
  38. Petty NJ. Principles of joint treatment. In: Principles of neuromusculoskeletal treatment and management: a guide for therapists. Edinburgh: Churchill Livingstone; 2004;p. 116–118
  39. Shirley D. Manual therapy and tissue stiffness. In:  Boyling JD,  Jull GA,  Twomey LT editor. Grieve's modern manual therapy. 3rd ed.. Edinburgh: Churchill Livingstone; 2004;p. 381–390
  40. Latimer J, Lee M, Goodsell M, Maher CG, Wilkinson BN, Adams R. Instrumented measurement of spinal stiffness. Man Ther. 1996;1:204–209
  41. Lee M, Evans J. Load-displacement-time characteristics of the spine under posteroanterior mobilisation. Aust J Physiother. 1992;38:115–123
  42. Edmondston SJ, Allison GT, Gregg CD, Purden SM, Svansson GR, Watson AE. Effect of position on the posteroanterior stiffness of the lumbar spine. Man Ther. 1998;3:21–26
  43. Latimer J, Goodsell MM, Lee M, Maher CG, Wilkinson BN, Moran CC. Evaluation of a new device for measuring responses to posteroanterior forces in a patient population: Part 1. Reliability testing. Phys Ther. 1996;76:158–165
  44. Latimer J, Lee M, Adams R, Moran CM. An investigation of the relationship between low back pain and lumbar posteroanterior stiffness. J Manipulative Physiol Ther. 1996;19:587–591
  45. Nicholson LL, Maher CG, Adams R. Hand contact area, force applied and early non-linear stiffness (toe) in a manual stiffness discrimination task. Man Ther. 1998;3:212–219
  46. Nicholson LL, Maher CG, Adams R, Phan-Thein N. Stiffness properties of the human lumbar spine: a lumped parameter model. Clin Biomech. 2001;16:285–292
  47. Shirley D, Ellis E, Lee M. The response of posteroanterior lumbar stiffness to repeated loading. Man Ther. 2002;7:19–25
  48. Caling B, Lee M. Effect of direction of applied mobilization force on the posteroanterior response in the lumbar spine. J Manipulative Physiol Ther. 2001;24:71–78
  49. Chansirinukor W, Lee M, Latimer J. Contribution of pelvic rotation to lumbar posteroanterior movement. Man Ther. 2001;6:242–249
  50. Chansirinukor W, Lee M, Latimer J. Contribution of ribcage movement to thoracolumbar posteroanterior stiffness. J Manipulative Physiol Ther. 2003;26:176–183
  51. Lee M, Steven GP, Crosbie J, Higgs JED. Towards a theory of lumbar mobilisation—the relationship between applied force and movements of the spine. Man Ther. 1996;2:67–75
  52. Chester R, Watson MJ. A newly developed spinal simulator. Man Ther. 2000;5:234–242
  53. Watson MJ, Burnett M, Dickens W. Experiment in recording passive spinal movement. Physiotherapy. 1989;75:747–749
  54. Petty NJ, Messenger N. Can the force platform be used to measure the forces applied during a PA mobilisation of the lumber spine?. J Man Manip Ther. 1996;4:70–76
  55. Herzog W, Conway PJ, Kawchuk GN, Zhang Y, Hasler EM. Forces exerted during spinal manipulative therapy. Spine. 1993;18:1206–1212
  56. Herzog W. Biomechanical studies of spinal manipulative therapy. J Can Chiropr Assoc. 1991;35:156–165
  57. Harms MC, Milton AM, Cusick G, Bader DL. Instrumentation of a mobilization couch for dynamic load measurement. J Med Eng Technol. 1995;19:119–122
  58. Triano J, Schultz AB. Loads transmitted during lumbosacral spinal manipulative therapy. Spine. 1997;22:1955–1964
  59. Maher CG, Adams R. A comparison of pisiform and thumb grips in stiffness assessment. Phys Ther. 1996;76:41–48
  60. Downey B, Taylor NF, Niere K. Can manipulative physiotherapists agree on which lumbar level to treat based on palpation?. Physiotherapy. 2003;89:74–81
  61. Harlick J, Milosavljevic S, Milburn P. Is lumbar spinal palpation a valid clinical procedure?. In:  Singer KP editors. Proceedings of the 7th Scientific Conference of the IFOMT, Perth, Australia: International Federation of Orthopaedic Manipulative Therapists. 2000;p. 201–205
  62. Simmonds MJ, Kumar S. Health care ergonomics: Part II. Location of body structures by palpation—a reliability study. Int J Ind Ergon. 1993;11:135–143
  63. McKenzie AM, Taylor NF. Can physiotherapists locate lumbar spinal levels by palpation?. Physiotherapy. 1997;83:235–239
  64. Lucchetti CA. Palpation of the C7 vertebral spinous process. An inter- and intra-examiner reliability and accuracy study. [Thesis submitted for BSc Chiropractic] Bournemouth, UK: Anglo-European College of Chiropractic; 1992.
  65. Latimer J, Lee M, Adams R. The effect of training with feedback on physiotherapy students' ability to judge lumbar stiffness. Man Ther. 1996;1:266–270
  66. Lee M, Liversidge K. Posteroanterior stiffness at three locations in the lumbar spine. J Manipulative Physiol Ther. 1994;17:511–516
  67. Lee M, Steven GP, Crosbie J, Higgs RJED. Variations in the posteroanterior stiffness in the thoracolumbar spine: preliminary observations and proposed mechanisms. Phys Ther. 1998;78:1277–1287
  68. Chiradejnant A, Maher CG, Latimer J. Objective manual assessment of lumbar posteroanterior stiffness is now possible. J Manipulative Physiol Ther. 2003;26:34–39
  69. Lee M, Gal J, Herzog W. Biomechanics of manual therapy. In:  Dvir Z editors. Clin Biomech, New York: Churchill Livingstone; 2000;p. 209–238
  70. Lee M, Latimer J, Maher CG. Normal response to large posteroanterior lumbar loads—a case study approach. J Manipulative Physiol Ther. 1997;20:369–371
  71. Latimer J, Lee M, Adams RD. The effects of high and low loading forces on measured values of lumbar stiffness. J Manipulative Physiol Ther. 1998;21:157–163
  72. Allison GT, Edmonston SJ, Roe CP, Reid SE, Toy DA, Lundgren HE. Influence of load orientation on the posteroanterior stiffness of the lumbar spine. J Manipulative Physiol Ther. 1998;21:534–538
  73. Shirley D, Hodges PW, Eriksson AEM, Gandevia SC. Spinal stiffness changes throughout the respiratory cycle. J Appl Physiol. 2003;95:1467–1475
  74. Lee M, Esler M-A, Mildren J, Herbert R. Effect of extensor muscle activation on the response to lumbar posteroanterior forces. Clin Biomech. 1993;8:115–119
  75. Maher CG, Latimer J, Holland MJ. Plinth padding confounds measures of posteroanterior spinal stiffness. Man Ther. 1999;4:145–150
  76. Maher CG, Adams RD, Shields RK. Reliability of pain and stiffness assessments in clinical manual lumbar spine examination. Phys Ther. 1994;74:801–809
  77. Maher CG, Adams RD. Stiffness judgments affected by visual occlusion. J Manipulative Physiol Ther. 1996;19:250–256

PII: S0161-4754(06)00050-9

doi: 10.1016/j.jmpt.2006.03.006

Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 4 , Pages 316-329 , May 2006

Article Tools

* Image Usage & Resolution