Joint manipulation

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of osteopathic medicine and chiropractic medicine. In the context of healthcare, joint manipulation is performed by several professional groups. In North America and Europe, joint manipulation is most commonly performed by chiropractors (estimated to perform over 90% of all manipulative treatments), American-trained osteopathic physicians, occupational therapists, physiotherapists, and European osteopaths. When applied to joints in the spine, it is referred to as spinal manipulation. Manipulation is known by several other names. Historically, general practitioners and orthopaedic surgeons have used the term "manipulation". Chiropractors refer to manipulation of a spinal joint as an 'adjustment'. Following the labelling system developed by Geoffery Maitland, manipulation is synonymous with Grade V mobilization, a term commonly used by physical therapists. Because of its distinct biomechanics (see section below), the term high velocity low amplitude (HVLA) thrust is often used interchangeably with manipulation. Manipulation can be distinguished from other manual therapy interventions such as joint mobilization by its biomechanics, both kinetics and kinematics. Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase. Evans and Breen added a fourth 'orientation' phase to describe the period during which the patient is oriented into the appropriate position in preparation for the prethrust phase. When individual peripheral synovial joints are manipulated, the distinct force-time phases that occur during spinal manipulation are not as evident.