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Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis
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Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Joint manipulations for the lumbar spine, sacroiliac joint, and pubic symphysis. Types of manipulations, manipulations vs. mobilizations of the spine, lumbar spine, SI joint, and pubic symphysis. Optimal intervention for anterior pelvic tilt, low back pain, inadequate forward lean, asymmetrical weight shift, sacroiliac joint dysfunction, knee bow in, knee bow out, and hip symmetry. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of lumbar spine, SIJ, and pubic symphysis manips.

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Course Description: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis Joint Manipulation

Introduction

This course describes joint manipulation techniques for the lumbar spine, sacroiliac joint (SIJ), and pubic symphysis. Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion; specifically glide). Research does imply that manipulations affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the lumbar spine (low back), SIJ, and the pubic symphysis (lumbopelvic manipulations), improve spine range of motion (ROM), improve lumbopelvic alignment, and potentially reduce hip dysfunction. For example, research has demonstrated a correlation between asymmetrical SIJ stiffness, asymmetrical hip range of motion, and a correlation between low back pain, and future lower extremity injury. These techniques may also be used in an integrated approach for improving lumbopelvic hip complex dysfunction (LPHCD) and lower extremity dysfunction (LED) including sacroiliac joint pain (SIJD), lumbar radiculopathy, iliotibial band syndrome (ITBS), femoroacetabular impingement (FAI), patellofemoral pain syndrome (PFPS), etc. Additionally, due to the relationship between lumbopelvic alignment and hip mobility, and the relationship between hip mobility and ankle motion during gait, these techniques may aid in the treatment of pes planus, Achilles tendinopathy, and plantar fasciitis.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

Additional Joint Mobilization Courses

For an introduction to joint mobilizations and manipulations:

Pre-approved credits for:

Pre-approved for Continuing Education Credits for:

This Course Includes:

  • AI Tutor
  • Study Guide
  • Text and Illustrations
  • Audio Voice-over
  • Research Review
  • Technique Videos
  • Sample Routine
  • Practice Exam
  • Pre-approved Final Exam

Course Study Guide: Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Introduction

Research Summary

Research Corner: Lumbar Spine Manipulation
7 Sub Sections

Research Corner: Sacroiliac Joint
6 Sub Sections

Pubic Symphysis Manipulation

Video Demonstration
3 Sub Sections

Sample Intervention: Left Asymmetrical Weight Shift

Bibliography

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    • Clinical Predication Rule
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    • Comparing Manipulations to Medical Care
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    • Comparing Interventions
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    • Combination of Treatments
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    • Mobilization versus Manipulation
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    • Manipulation and Performance
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    • Manipulations and Kinematics:
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    • Analgesia
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    • Stretch Reflex/H-Reflex
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  82. Dishman, J. D., Burke, J. R., & Dougherty, P. (2018). Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study. Journal of manipulative and physiological therapeutics, 41(5), 363-371.
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  84. Dishman, J. D., Cunningham, B. M., & Burke, J. (2002). Comparison of tibial nerve H-reflex excitability after cervical and lumbar spine manipulation. Journal of manipulative and physiological therapeutics, 25(5), 318-325.
  85. Dishman, J. D., & Burke, J. (2003). Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study. The spine journal, 3(3), 204-212.
  86. Colloca, C. J., Keller, T. S., & Gunzburg, R. (2004). Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy. Journal of manipulative and physiological therapeutics, 27(1), 1-15.
  87. Cao, D. Y., Reed, W. R., Long, C. R., Kawchuk, G. N., & Pickar, J. G. (2013). Effects of thrust amplitude and duration of high-velocity, low-amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement. Journal of manipulative and physiological therapeutics, 36(2), 68-77.
  88. Sung, P. S., Kang, Y. M., & Pickar, J. G. (2005). Effect of spinal manipulation duration on low threshold mechanoreceptors in lumbar paraspinal muscles: a preliminary report. Spine, 30(1), 115-122.
  89. Pickar, J. G., & Kang, Y. M. (2006). Paraspinal muscle spindle responses to the duration of a spinal manipulation under force control. Journal of manipulative and physiological therapeutics, 29(1), 22-31.
  90. Floman, Y., Liram, N., & Gilai, A. N. (1997). Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation. European Spine Journal, 6(6), 398-401.
    • Transcranial Magnetic Stimulation
  91. Dishman, J. D., Ball, K. A., & Burke, J. (2002). First prize central motor excitability changes after spinal manipulation: a transcranial magnetic stimulation study. Journal of manipulative and physiological therapeutics, 25(1), 1-9.
  92. Dishman, J. D., Greco, D. S., & Burke, J. R. (2008). Motor-evoked potentials recorded from lumbar erector spinae muscles: a study of corticospinal excitability changes associated with spinal manipulation. Journal of manipulative and physiological therapeutics, 31(4), 258-270.
  93. Fryer, G., & Pearce, A. J. (2012). The effect of lumbosacral manipulation on corticospinal and spinal reflex excitability on asymptomatic participants. Journal of manipulative and Physiological Therapeutics, 35(2), 86-93.
    • Sympatho-excitatory Effects
  94. Perry, J., Green, A., Singh, S., & Watson, P. (2015). A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP. Manual therapy, 20(6), 861-867.
  95. Perry, J., Green, A., Singh, S., & Watson, P. (2011). A preliminary investigation into the magnitude of effect of lumbar extension exercises and a segmental rotatory manipulation on sympathetic nervous system activity. Manual therapy, 16(2), 190-195.
  96. Roy, R. A., Boucher, J. P., & Comtois, A. S. (2009). Heart rate variability modulation after manipulation in pain-free patients vs patients in pain. Journal of manipulative and physiological therapeutics, 32(4), 277-286.
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    • Manipulations and Core Muscle Activity
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    • Combination of Manipulation and Other Techniques
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    • Systemic Changes
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    • Reflex
  215. Lelic, D., Niazi, I. K., Holt, K., Jochumsen, M., Dremstrup, K., Yielder, P., … & Haavik, H. (2016). Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: A brain source localization study. Neural plasticity, 2016.
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    • Muscle Activity
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  224. Marshall, P., & Murphy, B. (2006). The effect of sacroiliac joint manipulation on feed-forward activation times of the deep abdominal musculature. Journal of manipulative and physiological therapeutics, 29(3), 196-202.
  225. Barbosa, A. W. C., Silva, A. M., Silva, A. F., Martins, F. L. M., & Barbosa, M. C. S. A. (2014). Immediate improvements in activation amplitude levels of the deep abdominal muscle following a sacroiliac joint manipulation during rapid upper limb movement. Journal of bodywork and movement therapies, 18(4), 626-632.
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  227. Suter, E., McMorland, G., Herzog, W., & Bray, R. (2000). Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 23(2), 76-80.
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  231. Pollard, H., & Ward, G. (1998). The effect of upper cervical or sacroiliac manipulation on hip flexion range of motion. Journal of manipulative and physiological therapeutics, 21(9), 611-616.
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    • Pubic Symphysis
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    • Additional Studies
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