__Manipulation_of_the_Spine__Thorax_and_Pelvis__An_Osteopathic_Perspective

l HVLA thrust techniques - pelvis ,--~---- SUMMARY Sacrococcygeal joint Coccyx anterior Patient side-lying Thrust posteriorly • Contact points: -Anterior aspect of the coccyx -Posterior aspect of the coccyx • Applicators: -Lubricated index finger of operator's gloved right hand -Thumb of operator's gloved right hand • Patient positioning: Left lateral position with flexion of the hips. knees and spine • Operator stance: Behind the patient • Palpation of contact points.: Place the index finger of right hand against the anal margin (Fig. C.S.1 A). Insert your right index finger into the anal canal in a cephalic and anterior direction (Fig. C.S.1 B). The palpating index finger identifies the sacrum and coccyx through the posterior wall of the rectum. Place the distal phalanx of the right index finger against the anterior surface of the coccyx. Identify the posterior aspect of the coccyx between the buttocks. The coccyx is now gently held between your right index finger internally and thumb externally (Fig. C.S.1 C) • Fixation of contact points: Keep right index finger on the anterior aspect of the coccyx while applying pressure against the posterior aspect of the coccyx with your right thumb • Adjustments to achieve appropriate pre-thrust tension • Immediately pre-thrust: Relax and adjust your balance • Delivering the thrust: The direction of thrust is towards you in a curved plane (Fig. C.S.2) 258

References References dysfunction. I Manipulati\\~ 1'h)'Siol Tiler 1967; 259 10:164_171. Alderink CI. '11M: sacroiliac loinl; review of anatomy, mechanics, and function. I Orthop I' Dreyfuss 1', Dr~r S, Griffin I, Hoffman I, Sports Ph)'S'lher 1991; 13:71-84. Walsh N. l>OSith~ sacroiliac: Kreenlng tests in 2 Bcm;ml TN, cassidy ID. The sacroiliac joint asymptomatic adults. Spine 1994; s)'ndrOl'ne - pathoph)'siolom~ diagnosis and 19:1138-1143. JrnIn~ment. In: PryrtlO)'eI\" JW, ed. The Aduh Spine: Prin<iph:5 and Pl'3etKe. New York,. NY: 20 Dreyfuss I~ Michaelsen M. PalIZa K. MeLan)' I, Ra\\w Press; 1991:2107-2130. Bogduk N. The value of medical history and 3 Walker IM_ 'Ibe sacroiliac. taint: a aitic:al review. physical examination in diagnosing sacroiliac 1'tI>'S Ther 1992; 72:903-916. joint pain. Spine 1996; 21:2594-2602- • Dreyfuss I~ Cole AI. Pauza K. Sacroiliac joint 21 Herzog W. Read ... Conway P. Shaw L. McEwen injection techniques. 1'tl)'S Mec:I RehabiL CLin M. ReliabiLity of motion palpation procedures Nooh Am 1995; 6(4):785-813. to detect sacro-iliac: joint fwlttons. I S Cibulka M. Understanding sacroiliac joint Manipulam'\\' Physioll'her 1986; 11:151-157. [I)()\\'Cment as a guide to the managemenl of a 22 laslett\"'l Williams M. The reliability of patient v.;th unilateral low back pain. Man Ther 2002; 7(4 ):21 S-221. selected pain ptO\\'OCation tests for sacroiliac joint padlology. Spine 1994; 19:1243-1249. • Brolinson P, Ko7.aJ A. Obor G. sacroiliac joint dysfunction in athletes. Olrr Spons MOO Rep 23 Deunm ILJM Van. Patijn I, OckhU)'Sefl AI... 2003; 2(1):47-56. \\'Orunan BI. The value of some dinicall£SlS of the sacro-iliac joint. Man t.Ied 1990; 5:96-99. 7 Grieve C. The saociliac joinL Physiotherapy 1976; 62:384-400. 24 Riddk D, Frebu~ I. E\\'a!uation oi till\" presern of sacroiliac joint region d)'Sfunction 8 WeismanteJ A. Evaluation and tIeaLment of mins a combination of tests; A multiCf'nter sacroiliac joint problems. I Am I'II)'S Ther ASliOC intertesler reliabilily Sluef)'. 1\"h)'S Ther 2002; 1976; 3(1):1-9. 62(8):7n-781. 9 Mitchell F. The Muscle F.nttgy Manual, Vol I. 2S Young S. Aprill C Laslen \"'l Correlation of Ease lansing.. MI; MEl\" Prt'SS; 1995. c1inkal examination chaf3C\\er1.sco with three sources of chronic low back pain. SpilW 2003; 10 DonT'igny RL Function and pathomechania of 3(6):460-465. the sac.roiliac joint. PI!)'S 'fher 1985; 65:35-43. 2. ~1eijne W, Neerlxts K \\'an. Aufdemkampe C. II Bernard TN, Kir\\.:aldy-WiI1is Wt-l. Recognil'ing Wurff P \\'an der. Intrnexaminer and !ill..\"Cific characterilitia of non~lx-cific low back inteJCX'3lniner rdiabilily of the Gillet tt'Sl.. I pain. Clin Orthop 1987; 217:266-280. Manipulath~ Physiollher 1999; 22(1}:4-9. 12 8ourdillon IF. Da)' I:A, Boohhout MR Spinal 27 Sturcsson B. Uden A. Vlecming A. A Manipulation. 5th oon. Avon: Bath Press; 1995. I'3diosterrometric anal)'Sis of the mO\\'Cments of the sacroiliac. joints during the standing hip 13 Shaw 11_ '111e role of the sacroiliac joint as a nexlon lest. Spine 2000; 25(3):364-368. cause of low back pain and d)'Sfunction. Roo 1nterdi!lCiplillary World Congres.~ on Low Back 28 Vincent-$mith 8, Gibbons P. 1I1t(''r-examincr Pain and itll Relation to the Sacroiliac Joint, and intra-cx:aminer rclial)i1it)' ofpalpatol)' ROllcrda.m: I;CO; 1992. findings for the standing nl.'xion tt'Sl. Man Ther 1999; 4(2):87-93. I' Schw3l\"Zer AC, Aprill CN. Bogduk N. 'Ibe \" O'Haire C. Gibbons I'. Inlel-examiner and sllcroili:tc joint in chronic low bock pain. Spine inlra-examinCf agreernelll for asSC5sing 1995; 20;31-37. sacro·i1iac analomical landmarks ming palpation and observation: A pilot study. Man IS Her:7..Clg W. Oinical Biomechanics of Spinal Ther 2000; 5( I}: 13-20. M:Ulipulation. New '<>rk Churchill 30 Colachis sc. ....'ordcn RF.. Brechtol CO, Snohm Uvingstone; 2000. BR MO\\~ent of the sacroiliac. joint in the adult male: a preliminary repon. Arch ptl)'S I. Maigne IV, AivalikJis A. pf(.fer F. Results of Mcd Rehabil 1963; 44:490-498. sacroiliac joim double block and value of 31 Egund N. Olsson 'Ili. Schmid H, Selvik C. sacroiliac pain provocation tests in 54 patients MO\\-ements in the sacroiliac joints with low back pain. Spine 199G; demonslrated with Roentgen 21:1889-1892. stereophotogr.unmeuy. Acta R.\"ldiol Diagn 1978; 19:833-846. 17 Speed C. ABC of rhcumalology. Low back pain. BMI 2004; 328: 1119-1121. 32 Sture:sson B, Sdvik G, Uden A. MCJ\\IeIT}ents of the sacroiliac joints. A Roent~n 18 Carmichael JP. Intt.'r and intra-examiner rcliabiliry of palpation for sacroiliac joint

Technique failure PART and analysis Techniques in this manual have been • General technique analysis described In a structured format. This format -Incorrect selection of technique allows flexibility so that each technique can -Inadequate localization of forces be modified to suit both the patient and -Ineffective thrust practitioner. • Practitioner and patient variables Competence and expertise in the use of -Patient comfort and cooperation HVLA thrust techniques Increase with practice -Patient positioning -Practitioner comfort and confidence and experience. Development of ahigh level -Practitioner pOSture of skiU in the use of HVLA thrust techniques is • Physical and biomechanical modifying predicated upon critical reflection of performance. When a tM.A thrust technique fact\"\" does not produce cavitation with minimal -Primary leverage force. the practitioner should reflect upon -Secondary leverages how the technique might have been modified -Contact poVlt pressure and improved. Even the experienced -Identif.cation of appropriate pre-thrust practitioner should review each HVlA thrust technique to identify factors that might tension improve technique delivery. -Direction of thrust -Vek>city of thrust Inability La achieve cavitation with minimal -Amplitude of thrust force may arise for a number of reasons and -Force of thrust can be reviewed under three broad headings: -Arrest of technique.

Technique failure and analysis Box 0..2 Practitfon« and patient van.bles ......_-Box 0.3 Physk.aI and biome<hwlkal - Common fautts Common hutts • Patient not comfortabty positioned • Insufficient primary leverage • Patient not relaxed • Rough patient handling • Too much secondary Ie\\.lefage - Ioddng • Rushing techntque • Poor practitioner posture often resorts from the over-aPPlication of • lack of practitioner confidence secondary leverages.. This can occur dlKing Checklist the build-up of IeYerages or at the point d Patient comfort and CoopBation Dependent upon: thrust • Confidence and trust In practitioner • Patte-nt experience of prevJous successful • loss of contact point pressure immediately pre-thru<t HVLA thrust technique • Slow, firm and gentle patient handling • Not identifying appropriate pre-thrust • Confident and reassuring approach by tension and leverage prior to thfUSt - if in doubt about optimum pre-thl1JSt tension\" practitioner attempt multi~ light thrusts • E>cplanatlon of technique and Informed • Incorrect direction of thrust - the thrust coo\"\"', should be In a direction that is comfortable for the patient Multiple light thrusts • Optimal patient positioning can assist in the identification of the PDtknt positioning appropriate direction of thrust Dependent upon: • Insufficient velocity of thrust • Appropriate positioning to match patient's • Too much am~itude- this is often a physkal and medical condition consequence of too much force and/or • COl'J'eCI identification of primary leverage poor control and secondary Ieo.Ierages • Pai......free positioning • Too much force • Appropriate use of pillows and treatment • Insuffident arrest of technique - this is couch adjustment often a consequence of poor practitioner coordination and control ProctitioMr comfort ond confidence Dependent upon: Checklist • Establishing a working diagnosis • Primary leverage • Secondary leverages • Selecting a technique to match patient's physical and medical condition • Contact point pressure • Confidence that the technique will improve • Identification of appropriate pre-thrust and not worsen the patient's symptoms tension • Previous e)(perlence and success with the • Direction of thrust seleded HVLA thrust technique • VelocJty of thrust • Optimal practitioner posture • Amplitude of thrust • Force of thrust Proctitioner postu~ • Arrest of technique Dependent upon: • Using as wide a base as possible • Not relying sok!fy upon arm strength and speed • Using your body where possib~ to generate thrust force • Not stooping or bending over the patient • Keeping your own spine erect • Optimal treatment couch height 263

Subject Index Abbrevialion.~ used: HVlA == high-velocity ION-amplitude Page refl,.'Il:lll:el followed by 'r or 't' rde!\" 10 figura and tables/boxOO material rcsp«tiwly A Biopsych06OCiaJ model 61 265 Biplanar Tadi08J\"3phic studies, 11-12 Alar Hll\"mcnc atlanlOoaxial stability. 33 c 5tfC$ tcs!. 35-37, 36[. 37[ Cada\\uresearch. 11-13 Apoph}'Sial joiOl Caudil ..quina syndrome. 28 cavitation, 47 <:aviation _ joint cavitation trophism (fattt) roupl«1 motion. 13-14 CnmrOYa.!CUlar /ICddenl, 25. 30 low back pain. 14 Cavialspinc (0·7). 17-19 Articular uopism. 233 dUn hold. 691 Asymmcuy, 6 A3ymplOnlallc 50nUtic dysfuncUoo. 6 coupkd motion, 11-12. 17-19 ALlanlo-aml joint (CI-2) cradle hold, 70( ccMcaJ rotation. 17 down~ glidi~ chin hold. 81-84 coupled motion. 17 dUn hold. IIS-119 cTadle hold,. 85-88 cradic hold, 121 -125 IIVlA thrusl t('Chniques, 81-88 hypermobility, )) patienl sillinf,. 127-130 instability. 33-31 Atlanlo-d\"'11tal interval. imagir'lg. 34 raut ClppOIilion locking. 18-1 ') AtlanlO«eipital joinl (CO-Cl) IIVLA thrust tcchniques. 89-130 contact point on ~lIas, 71-80 COIll~CI poinl on OCcipUI. 71-15 il'l$labUily jft upPer ttrviGtI instability coupled motion. 17 manipulalkJn fnce!. Opposilion, 17-18 JIVU, thl'llStlechniqu('S, 71-80 rompllCll!Onll. 25 AXel of motion, 9-10, 10/ vt'ncbrobasilar irusufticic.'flC)' (VBI), 30 AxialI0f<1ue. 13 rOUlion. 19(. 29{ Axillary hoJd. 205 sidcbendins. 12 B UI)oI;lol'H~ gliding dun hold. tl9-,)6 Back l>ain _low back ~in cradle hold, 97-100.101-105 Bed re5l, DCC'ilii\\'l:, 1 Opet<llOr 31 side. 111-114 Ilioeocrgy lreaunent model, 46 Iliom«hanks 0!>Cf310r in front. 107-110 modifying factors, 2631 patient lilting. 107-114 $pinal motion. 9 podtioning. 1'Jj IrnlmCrlI model, 45-46 m~~10I-105 \\1!I'tcbr.tl arltfy rd;ui()nl;mp, 28{. 30 _ abo \\o'eItOOrobasib.r anel)' diMoection; \\~Iar insufficiency (VBI) wri5l position. 70f Cm.icoIhontdc spine (Cl~13) txtmsiongiiding.lS')-l62 facet oppOlitton kJcking. 18-19 rotation gliding

Manipulation of the spine, thorax and pelvis openuor at head, 135-138 H orlel,uor at head, variation, 139-142 ope....tor at skit\", 131-134 Haod pa;:ition. thoracic: and ribcage lupinl\" teehniqut'S, sldeberKling gliding 165 ligamemoUll m)Ofil!cia1 tensMJo lockil* 147-150, Headache. spinal mallipulaciYe therap)', 48 155-158 High-\\'do61y kJw-amplilude (IIVIA) thrust techniques paticm sidc-tyi~ l51-158 patient siniJ'G 143-150 aim, 47 Chin hold. 69f, 81-84 anaiysb, 261-263 Oneradiogrnphy, 34 aLiarnoaxial join.. 81-88 Clinicoll dcci5kJn makiJ'G- 49-50, 491 Compre5lSion. 67 aLianlo-ocdpital join.. n-80 Computoo lOmognphy (CT), 34 C'.onglrilill cnvicallnMability, 33 av'il,nion., 46-47 Conjunct roUtion, 10, 13 ~Ied molion, 9-16 arvicothoradcspine.131-162 axes; of molion. 9-10 complotio... 25-27 axiallOUtion. 12 biplanar radiognplUc studies, 11-12 causes, 27 conjunct rotation, 10, 13 dassi6cuion. 26-27 muscular 3Oivity, 14 inciderlct\", 25-26 neutral/o:tention pos.itiooiJ'G- 20 rontnindiationl, 27 po51U11! and posicioni\"1\\o 19 diK hrnliation. 28 radiographk studJto$, 12-13 fail~ 261-263 ra.earch. 12-14 indication.. 451 .\\l~ot<Jgr.lmmetry,12 IUrMM sphw. 217-228 type 1 Jl\\O\\lU11ellts, 10, ItI. 17 lumboaaaJ joir-., 229-236 type 2 mo~.~mml5, III. 17 patient variaIHa. 2631 Cndle hokt atlanto-axial joint (Cl.2), 85-88 ph)'!Oiai aod biom«hanbl modifying fanon. 2631 ctrVical spiM (0-7), 70{. 97-100, 101-IOS, rncthioner variables, 2631 121-125 prNhrust checklist, 67, 238 rational(' of lR. 45-53 o ribs, 189-204 sacKlCOCC)pJ joint. 255-258 Depn:ssiOI\\ Anxiely and POliti\\1: Oullook Scale sacroiliac joh.. 239-254 (DAPOS),61 safety issues. 25-43 short le\\~, 17 Disc dt.'gener,lIion. 14 spinal poKitioning and loc:klJ'G- 17-24 Disc herniation, 28 thoracic spilll\". 167-188 Di.ma-l & Risk ASK$Smcnl Method (DRAM), 61 thorarolwnbar spilll\". 209-216 Diu:in~ 29, 291 transimt 51(\\(' dT«a, 26-27 Down's syndrome. 34 validation by rl.'l('3fCh. 55-63 E Holds Elbow hold, 205 axillary, 205 Evidence Basal Mt.'dicine (I:BM), 47-49 chin hold, 69f, 81-84 Examiner reliability, 5-6 cradle $N craclJ(' hold elbow, 205-207 10Wl..'f body, 205-207 p«IOra!, 205-206 sid('lying tcchniqucs. 205-207 Ullp('!' arm, 205-206 UI)perbody, 163-164,205-207 266 F Iliac ct'C!>t symmetry, 237 Imaging ta:hnkjUl'S Face1 appositionlockil\"G 17-27,67 cervieothoradc ,;pine. 18-19 cwilalion du(' 10 tlVLA, 47 flexion posilionhJ&. 23 cervical inllabillty, 34 tTUflk flf'.xKm, 21f Inflammalory cervlcal instability, 33 F~ lI'ophism, \\'CI1l.'br,'\" coupled molion. 13-14 Infonnation e::xchinse 38 ..w.xion positioning,. 9, 20, 23, Df Informed consctll. 37-38, 38f Instability $N I4)peJ (UViQ1 illSlability Fryt'lta law, 9-14 Inter- and intra.etaminer reliability, 5-6

J Index = Joint cavitation. 46-47, 66 MallUillthcr.apy approaches. 48 267 failure to achieve. 261 MetxarpopNl.lllfPl joint avtution. 46--47 pelvis, 237 Miaotra~, cumulative. 45 Muscle cnogy technique (MET), 9 Joint 'cJa(king.' 47 MUK\\.l!ar activity, 14 K N Kinematics, ofspine, 9-16 \"'\"man! pulation lee ~bD biom«haria; coupled motMln complicilliom. 25-26 L efI1acy, 48 p.1Iin. 48 Ul;iU'lcnlOUS myoWciaI tension. 17 __ b «'IVkaJ spirx (0-7) low bad( pain Nt.'Opl.lst:ic ~I ill$labiliry. 33 acute 14,48 NeurologicallIUlmftU rnode:l. 46 apoph)'$I~1 joint lrophism, 14 chronic, 14,48 NcurOYa!lCUlar compromisr, 25 clinical trials, 48 Neuualfextenskm ~tioning, 20-22, 21/. 22f coupled motion. 14 Ncutnl\\ sideblendlng, 11 racet trophism. 13-14 Non-neulr.l.l sidebendh1!,. II manipulalion. ~ ,lnal'.$lht$ia. 28 rating. 58-61 NWllcricai rating scale, 60, flJf sacroiliac joiN. 237-238 __ ~lso lumbar spine IU-I.5) N)'Sl:agJJ1us, 34 l.ower body holds, 205-207 I.umbar 'Pine (1.1-LS) o axillary hold. 205 elbow hold. 205 Odontoid process incompetentt. 33 racet appO!;ilion locking. 19-21 ()ppo5ituidcbendillfl,. 19, l'lf Rexion pcw;itioning, rotation g1ldil\"G 221-224 HVlA thrust tochniq.M:s. 217-228 cervical rolation. 17-18 \\ower bod)' holds. 205- 2C11 Ollteopathk tlI'atmenl, 5-8 manipulation, 47 neutr.1I plXitioning. roullkJn gIldillfl, manipulati,t' tochniques, 7-8, 7. philOllOphy, 5-8, 5f p.1Itimt ~ 217-220 trealment models, 45-4(, patient siuillfl,. 225-228 Oswcslfy toW' Back Disability Questionnaire, 59-60 pectoral hoKI, 205 Outcome mCZl.uemefll, 58-61 siddlendi\"& 12~13 spinallockillfl,. 19-21 p upper ann hold. 205 uppet'\" body holds, 205-207 ..Pain Lumbar zygapoph)'Seal joint cavitation. 47 low back 5« kJw back pain Lumbosacral joint (15-51) \"\"\"- plO\\'OCal.ion. somalic dysfurxtion, 6 nexion positioning. 233-236 ratitlg r.ca1f'S, 58-61. 60f spinal, 49, 56, 58-61 HVIA thrust I«hni~ 22?-236 Palpation. diagnostic neuual ~tloning. 229-232 classification puIJ)CI5CS. 56 M .....intra·inter C%iUJliner rdiabiUty, 5-6 Magnetic resonance imaging (MID), 34. 47 spine. '.I Manipul~tioll Pa~34 efficacy, 48 evidence hierarchy, 47-48 Patient genenl anaesthesia, 28 clasliification. 56-58 validation apptoachf'S, 45-46 po5itioning. HLVA thrust techniques. 163-164 jl'JI! o15D spt!Cifi£. tec:hniqurs Idualion, 67 \\'3riables, 2631 PccIOfaI hold, 205 Pt!1~ 237-238 pre·thrust checklist. 238 ~ also saaocoo:ygcal join~ .sacroiliac joim

Manipulation of the spine, thorax and pelvis 268 t'hysical modifying faclOf$, 2631 Sidebendill@ PhysiQI therapy dlagnl;Jlliis classification. S8I ceMcal spine, 9.17-19 I !\"islolgril>. 70, 70f limits. 18, 19[ I'oMUI<l!/stf\\lClural treatment rntXIeI. 45-46 Si,inal rotational rl/!Iationdtip. 10-14 Pr..etitione.. \\~riabl(S, II\\'LA th~t tcchniqtJf':S. thor.Jcic and lumbar splOl'.. 19-20 2631 Sidetying l«hniques. body holds. 205-207 lJore.manlpulAthor 8SCSSmern. \\61cbrobiUilar Somatic dysfunction insufficimcy (VBI). 31-33. 31t. 37/ asymmetl)'. 6-7 Pre-thrust tcmion. 67. 2631 asymptoma!ic, 6 l~haviOUlallrcatmerlt model, 46 ddinil ion. 5 Q diagnosis. 5-7, 61. 49. 49[ QuebcI: Back r;.in Disability SoIk. 60 mt«:Jpalhk manipuJathor techniqua. 7-8 Queba: wIOorl:':, 7. 56-57 ranse of motm 7 Q\"csdonnairQ, JMin ratios. 58-61 l)'TTIplom reproduction,. 6 tissue lendet-nmI. 6 R 1is6ue texture changel, 7 UellJnftlt apPfoachel, 71 RAnSi!' of motion. 7 Res.earch, 55-63 Spinal toni comprcssm 34 Spinal disordm c:oupkd mocion. 12-14 aetivity-relaloo. d-.lOOtion, 57t \"ou\"tc'O\"li5n6e meawremalt. 58-61 ~ic tenninoklgy. 56 rationale. 55-56 Qul'b«Touk Foret da55ifia.tion.. 7. 56-58 lhnapeutic objoo.i\\a. 7 Rt:5piralOl)'/cimJlalOl)' treatmet1l modd 46 SpiNI klc:king, 17-24. 67 IigiUllen~ myo(-.:ial tm5ion\" 17 Rarophal)'llg,tal irllammatory processes. 34 Spinal manipulative Ihtrapy, 48 Kheumatokl anhritil,. 33-34, 34f dUe: haniatK>n\" 28 Ribs Spinal pain contraindicalions,. 4') IlVlA thrusl techniques, 189-204 dia8'JO'is issua,. 56 RI-3, patienl prone, 189-192 rating. 58-61 R4-IO Spine blomuhania, 9 patiClll prone, 197-200 coupling behaviour, 19 patient sitting. 201-204 HVlA thrust teChniques. 66-67 patient supine.. 193-196 mobilily. 12-13 Koemgm stercophOlogrnmmelric analysis\". pelvi$. m0\\1?ITICI1t jtIE \",enebral molion palpatory ~ment. 9 237 pOlIitionlng. 10-11. 17-24 Roland-Morris tow Back Pain Disability QiH'stionnaire. _ Ollso specifIC rqJtm$/ioinLS Standardised testing. 6 59-60 SI:-'RTacronym, diagnosi5, (>-7. 49. 491 SteroophOlogrnmml'lry. 12, 237 s Stroke. 25. 30 StfUCIl.lralJp06lul'1l1 trelllmt:nt model, 45-46 SocnxOCC)'lpl joint. 255-258 Symptom reproduction. 6 Sa<:roi1iac ;OInt somatic dysfunction, 6 SynO'llial joint cavitation, 47 1m innominate antcnOf. 247-250 T left innominate I'll»terior, 239-242 lOw back pain, 237 l:-'RT acronym, diagnosis. 6. 49 manil>utation. cavitAtion. 47 Techniques mobility, 237 pre-lhrust checklist. 238 analysis, 2621 right innominate posteri(W, 243-246 failure. 261-263 HVlA _ high-\\Uocity lOw-amplitude (HVL\\) Ihrust romq;en steroophOlogrammelric analysis, 237 tochniqllC$ sacral base anterior, 251-254 Safety L'lSues. 25-43 ~263t Sciatica. 14 Scoliotic cun~ 10 manipulation jtIE manipulation Self raling scalC5, 60 Sharp-Purser te5ot. 35-37

Index thlU!ll, 2631 Upper ann hold, 205 5te /lJso 5~jflC joinu/spirlQ/ regiom Upper body holds, 163-164. 205-207 'Iboracic spine (T4-T9) Upper body positioning. lhor.Jcic spine and ribagc coupled motion. II, 19-20 l-fVlA thJUlillcchniqoes. 163-164 elCtension g:iding. 167-17'0 Uppe- «JVia1 inwbility. 33-38 facet apposition locking.. 19-21, 21! flexion gliding. 171-175 symptoms, 33-JS UVlA thrust l«;hni~ 167-188 1C50. 35-37 opeIaIor hand position. ) 65 rotation ~kling v palient prone, 183-188 \\bbal r;Jling lIOle. 60. 611 patient supine. 177_183 \\\\>nd)ral arwy spinalloddng. 19-21 upper body posilioning. 163-164 «fVica1 roution, 29/ Thoracolumbar spille' (TIo-l.2) -'.~ ~inr rmtionship. 2S{ fIerion positioning. 213-216 \\'Cnd>n!moc.ion\" 9-15 Ilftltral positioni~ 200-212 Thrusllcchniqua. 26Jf coupled mocion _ coupled motion 'rlS5UC tendn\"1lCSll,. 6, 60. 611 £acd uophism. 13-14 Tissue II'XtUrt: chang,es. 7 Tr;u1S\\'et'5I.' allanl~llig.1mml roUtion, 9 sidebmdi~ 10-15 atlanto-Mial subiliry, 33 Vcrtebrobasilar anery diss«tioo. 25-26, 261 incompc'lcncr.. 33 \\'t:ncbrobasilar insufficinJcy (VBI), 28-33 SU'e5lI te5l, 3S/ TreauT'lcm nlOde\\l, 45-46 ~~29 Tronk rotation ~ClI examination, 29-31 Ouion position. 20. 2Jf prf'-manipula(i\\-~~ 31-33. 31/. 32{ KreUling lt51$, 30 m.'uuaJ/cxICJ'llIion pOSition,. 20, 21( S)'TnplOffiS, 29 Type I movernmU. 10. III. 17, 18f \\rlSU<l1 analosut: IClIa. 60, 60f Type 2 ll'lO\\'e!I!t:IlIS w llallnJ/cxtmsion JXl5ilionh~ 22/ Whiplam iU50Ciatcd dillordcn,. 57-58 u Wrist atcllll)oo grip, 70, 70f Unil..od Ki\"bodorn llack Pain l:Xen::ise and Manipul,lloo (UK 1lt'..AM) crial. 48 Wrist pl)'ition. 70, 70f 269