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Modulating Pain with Thrust Manipulation: The Big, The Small, How to Tackle Them All
AAOMPT Symposium Oct 25, 2015: Stacy Soappman & Ann Porter Hoke 1
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Stacy Soappman, PT, DSc, COMT, FAAOMPT
Ann Porter Hoke PT, DPT, OCS, FCAMPT, FAAOMPT
AAOMPT Symposium, Louisville KY, October 25, 20151
… Over a span of 75 years, myfather, the late James MennellMD, and I have tried toencourage the use ofmanipulative therapeutictechniques … to allow thepainless restoration offunctional movements veryreadily and comfortably… .”
1984 letter to the Journal of the Royal Society of Medicine19, Dr. John McM. Mennell
… I encourage you to teach others well andmodify as necessary for the individualpractitioner so these techniques are safe andcomfortable, and so even the small therapistwith small hands can do them well.
1984 letter to the Journal of the Royal Society of Medicine19, Dr. John McM. Mennell
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Modulating Pain with Thrust Manipulation: The Big, The Small, How to Tackle Them All
AAOMPT Symposium Oct 25, 2015: Stacy Soappman & Ann Porter Hoke 2
• Spinal manipulation, one of the oldest forms of therapy for back pain
• There has been an escalation of clinical and basic science research on manipulative therapy, which has shown that there is a scientific basis for the treatment of back pain by manipulation.
Kirkaldy-Willis & Cassidy 1985
• A significant effect of spinal manipulation on increasing pain pressure threshold at the remote sites of stimulus application supporting a potential central nervous system mechanism
Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis.” Coronado, Bialosky et al. 2012
Skilled clinical interventions involve domains of cognitive, affective and psychomotor concepts.
• 8 homogenous skill sets associated with OMPT proficiency:
• Manual joint assessment• Proficiency of fine sensorimotor characteristics• Manual patient management• Bilateral hand-eye coordination• Manual gross characteristics of upper extremity• Manual gross characteristics of lower extremity• Control of self and patient movement• Discriminate touch
Sizer et al. A Delphi Study – consensus of manual therapy educators (2007)
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Modulating Pain with Thrust Manipulation: The Big, The Small, How to Tackle Them All
AAOMPT Symposium Oct 25, 2015: Stacy Soappman & Ann Porter Hoke 4
• If you cannot get your arms to the back of their lower neck — then grasp onto their forearms but be careful to grip across and/or support their wrists
• Squeeze their thorax and avoid cervical flexion
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Modulating Pain with Thrust Manipulation: The Big, The Small, How to Tackle Them All
AAOMPT Symposium Oct 25, 2015: Stacy Soappman & Ann Porter Hoke 7
• Patient assists with a hip/bridge lift which will provide better upper thoracic transverse process contact and easier to generate a pre-manip loading force