Brighton Polytechnic Eastbourne

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1 Brighton Polytechnic Eastbourne Welkin Library Please return this book to the library on or before the last date stamped below

2 An Introduction to Medical Manipulation

3 An Introduction to Medical Manipulation John K. Paterson, MB. BS. MRCGP currently Vice-President and Han. Secretary of the British Association of Manipulative Medicine and member of the Scientific Advisory Committee of the International Federation of Manual Medicine and Loic Burn, BA. MRCS. LRCP. DPhysMed currently President of the British Association of Manipulative Medicine. Han. Secretary of the Scientific Section of the British League against Rheumatism and member of Council of the Back Pain Association ~~ M.TP PRESS LIM.ITED ~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP LA CASTER I BOSTON I THE HAG E / DORDRECHT

4 Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data Paterson, John K. An introduction to medical manipulation. 1. Manipulation (Therapeutics) I. Title II. Burn, Loic 615.8'2 RM724 Published in the USA by MTPPress A division of Kluwer Boston Inc 190 Old Derby Street Hingham, MA 02043, USA Library of Congress Cataloging in Publication Data Paterson, John K., An introduction to medical manipulation. Bibliography: p. Includes index. 1. Manipulation (Therapeutics) I. Burn, Loic, II. Title. [DNLM: 1. Joint Diseasestherapy. 2. Manipulation, Orthopedic. 3. Muscular Diseases-therapy. 4. Pain-therapy. 5. Spinal Diseases therapy. WE 725 P296i] RM724.P ' Copyright 1985 MTP Press Limited Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. Typeset and printed by Butler & Tanner Ltd, Frome and London. ISBN-13: e-isbn-13: DOl: /

5 Contents Preface Foreword by Professor B. Wyke ix x 1 General Considerations 1 Orthopaedic neurology 1 - how manipulation works Orthopaedic neurology 2 - a review of current ideas relating to manipulation 5 Spinal mobility and its relevance to manipulation 7 Incidence and aetiology of low back pain in general terms 8 Referred pain, referred tenderness and back pain syndromes 11 Trigger points 13 Some psychological aspects of vertebral pain 14 Indications, contra indications and dangers 16 Clinical history and data recording 19 Local examination 32 Conventional radiology 34 Posture and prophylaxis 36 Spondylolisthesis and spinal stenosis 40 Rheumatology and orthopaedics 42 Lay manipulators 45 Drug treatment of musculoskeletal problems 47 Collars and corsets 49 Traction 50 Exercise and exercises 52 Vertebral injections 54 Electro-acupuncture and transcutaneous electrical nerve stimulation 56 Rhizotomy and rhizolysis 59 Sclerosant therapy 60 Assessment of results and the associated difficulties 61 v

6 CONTENTS The British Association of Manipulative Medicine, the International Federation of Manual Medicine, the British League Against Rheumatism and the Back Pain Association 67 Conclusion 69 2 The cervical spine 71 Functional anatomy 71 Symptomatology 75 Brachial and thoracic radiation 78 Examination 80 Conventional radiology 82 Injections 84 3 The thoracic spine 86 Functional anatomy 86 Symptomatology 87 Examination 89 Conventional radiology 91 Injections 91 4 The lumbar spine 94 Functional anatomy 94 A classification of low back pain 97 Examination 103 Conventional radiology 105 Lumbar injections 107 The pelvis 111 The intervertebral disc Peripheral joints 117 The shoulder 117 The elbow, wrist and hand 121 The hip 124 The knee and ankle 127 The foot 129 vi

7 CONTENTS 6 Anatomical illustrations 133 The mobile segment 133 Cervical ligaments - CO-I-2 - sagittal view 134 The vertebral artery Diagnostic techniques 136 Apparent difference in leg length 136 Skin drag 138 Posterior skin rolling 139 Anterior skin rolling 140 Lateral spinous process pressure test 141 Springing 142 Muscle tone test 143 Zygoapophyseal tenderness 144 The bellpush sign of Maigne Manipulative techniques 146 Upper cervical rotation - supine 147 Lower cervical rotation - supine 148 Upper cervical rotation in traction - sitting Upper cervical rotation in traction - sitting Lower cervical rotation - sitting 151 Cervical side-bending 152 Prone cervical rotation - chin pivot 153 Lower cervical rotation - prone 154 Sternal thrust - standing 155 Sternal thrust - sitting 156 Sternal thrust - supine 157 Crossed pisiform thrust Crossed pisiform thrust Knee in back 161 Spinous process rotation 162 Thoracic rotation - sitting 163 Lumbar rotation 164 Lumbosacral - prone Lumbar rotation - sitting 166 Lumbar extension - sitting 167 vii

8 CONTENTS Lumbosacral forward thrust 168 Lumbosacral longitudinal thrust 169 Lumbosacral - prone Million dollar roll Injections 172 Occipital injections 172 Cervical apophyseal injections 173 Thoracic apophyseal joint injections 174 Lumbar apophyseal injections 175 Caudal epidural anaesthesia Back exercises 178 Lying exercise 178 Standing exercise Domiciliary traction 180 Cervical autosuspension 180 Lumbar autosuspension 181 References 183 Index 194 viii

9 Preface We hope that this book will be of interest to all clinicians involved in the treatment of musculoskeletal problems, be they medical, paramedical or lay. It is primarily directed at general practitioners. Musculoskeletal problems constitute the largest single group of conditions met with in general practice. There is at present a lack of teaching of the subject in Britain, in respect of both the nature of these ill-defined conditions and their therapy. With many years' experience of general practice, both of us are fully aware of the scale and importance of these issues. We seek to provide a wide and balanced review of the current state of knowledge in this field, culled from the available literature. A method of clinical examination applicable to this group of conditions is presented. A collection of therapeutic manoeuvres suitable for use in general practice is described, with carefully worded texts, illustrated by photographs and diagrams, together with a variety of injection techniques, similarly illustrated. Drug therapy and other forms of treatment are discussed. We include sections on prophylaxis, together with further topics of relevance to general practice. If the book appears overcritical of some ideas discussed, this is not our intention, but is rather the result of our understanding of the available literature. If we have omitted any relevant evidence, or if our reasoning is faulty, we will be happy to be so advised. We would like to thank Mr Jim Norton, of the British League Against Rheumatism, and Group Captain Cedric Simons, of the Back Pain Association, for vetting that part of our material which pertains to those organizations. Of the many colleagues who have lent help and advice, we wish in particular to thank Dr A. Maxwell Robertson and Professor Robert Maigne. However, our greatest debt of gratitude must be to Professor Barry Wyke, for his encouragement and painstaking criticism, and for doing us the honour of writing a foreword to this book. 14, Wimpole Street, London WIM 7AB. September, 1984 ix John K. Paterson Loic Burn

10 Foreword By Professor Barry Wyke, M.D. Formerly Director of the Neurological Unit, Royal College of Surgeons of England Manipulative therapy is a technology based on the application of manual forces through bodily tissues with the object of relieving a variety of disorders, principally of the musculoskeletal system. It is one of the most ancient of therapies, having been practised (in some form or another) throughout human history; but in spite of this ancient lineage (or perhaps because of it), it has persisted as a largely empirical body of knowlege split into a variety of 'schools', each with its (sometimes fanatical) devotees. This picture is now changing, however, as a result of the application of scientific investigation to the observations and procedures of manipulative therapy; and this book is a welcome British reflection of this change that should assist United Kingdom doctors in understanding the role of manipulative procedures in contemporary clinical practice. This is especially desirable, in that while countries such as Germany, France, Switzerland and The Netherlands each have a well-established medical speciality of Manual Medicine, such is not the case in Great Britain. London, January 1985 BARRyWYKE