Manipulation is a treatment modality used for the management of spinal disorders (pain and hypomobility). Its use dates back to ancient Greece and China. Generally defined as “Passive technique performed to a joint at high speed low amplitude thrust that is beyond patient’s voluntary control, usually accompanied by a clicking sound or a pop in the joint (cavitation), aiming at increasing mobility and/ or reducing pain.”.
The proposed effects can be divided into 3 main categories: biomechanical, neurophysiological and psychological.
• Restoration of tissue extensibility and ROM of hypo- mobile joint (increase range of motion).
• Elongation of connective tissue (collagen fibers).
• Disruption of cross linkage between collagen fibers.
• Stretching of capsular adhesions.
• Release entrapment of joint meniscoids.
• Correction of positional faults.
• Reduction of pain perception; local and regional pain inhibition (hypoalgesia).
• Release of endogenous opiates
• Mechanoreceptors activation.
• Trigger descending pain inhibitory pathways of CNS.
• Sympathetic nervous system response.
• Peripheral/spinal cord mechanism at dorsal horn.
• Influence on muscle activation (neuromuscular response).
• Inhibition of global/superficial muscle tone.
• Facilitation of local/deep muscle activation.
• Placebo effect.
• Influence of therapist instruction/interactions.
• Influence of patient expectations.