Posteroanterior spinal mobilization: state of the art review and discussion

Abstract

Posteroanterior spinal mobilization is a commonly used technique among physical therapists to diagnose and treat lower back pain patients. Human subjects and instruments have been used to test for the reliability of physical therapists' ability to detect intervertebral motion, but studies confirm unreliable testing. Despite documented efficacy of manual treatment the mechanical response to posteroanterior spinal mobilization is not well understood, and this has been emphasized in recent studies. Various modes of instrumental methodology have been used for objective measurements of force application and joint displacement. Some instruments serve to mobilize the spine others serve as measurement tools for mobilization. The literature does not provide a gold standard for the ideal magnitude of force applied or joint displacement. The terminology used in the field of manual therapy is often confusing, and terms need to be defined. A review and discussion is presented here to highlight the issues and gaps.

Device, protocol and measurement of regional spinal stiffness

“…Based on such assessments patients of low back pain are commonly stated to have stiff spines. However, manual clinical assessment of PA stiffness has been demonstrated to be inaccurate (Simmonds et al, 1995;Bjornsdottir and Kumar, 1997) and with poor inter-rater reliability (Shirley et al, 2003;Matyas and Bach, 1985;Maher and Adams, 1994). Latimer et al (1996) reported patients of low back pain had increased PA stiffness.…”

“…This device has been previously used and results published in peer reviewed literature (Simmonds et al, 1995;Bjornsdottir and Kumar, 1997). This electromechanical model was set on an treatment bed (Make: Hill Adjustable) and the loading block of the Therapeutic Spinal Mobilizer (TSM) was aligned over the vertebral spinous process and positioned appropriately to begin mobilization.…”

Interrater Reliability of a Passive Physiological Intervertebral Motion Test in the Mid-Thoracic Spine

“…23 These PPIM motion tests can be used to isolate each segment and to palpate segmental motion in all directions. 24 To perform PPIM motion tests, the evaluator passively moves the spine in a given direction, the spinal segment is palpated, and a judgment is made with respect to the amount of motion and end feel produced at that segment. 23 Mid-thoracic spine segments can demonstrate inconsistency in spinal mechanical behaviors.…”

Assessment of Lumbar Spine Kinematics Using Dynamic MRI: A Proposed Mechanism of Sagittal Plane Motion Induced by Manual Posterior-to-Anterior Mobilization

“…This technique evaluates passive segmental mobility, which is an indirect reflection of the integrity of periarticular structures (ie, disc, capsule, and ligaments). Even though this and other manual therapy methods have been used with varying levels of success to reduce pain and improve mobility, 1,2,7,9,13,15,16 it is unclear how this particular manual technique influences intervertebral motion of the lumbar spine.…”

“…1,2,4,10,12,16 Posterior-toanterior (PA) mobilization is frequently employed to assess spinal mobility, and involves applying a force to a single vertebral spinous process with the individual lying in the prone position. This technique evaluates passive segmental mobility, which is an indirect reflection of the integrity of periarticular structures (ie, disc, capsule, and ligaments).…”