Thursday Thoughts: Stiffness vs Laxity

Back when I was in fellowship and OMPT training, we tried to be as "specific" with our joint manipulations as possible.

After all, we had to target the hypomobile segment and not the adjacent hypermobile segments. Yes, I believed I could do that for over a decade after that training. You see, people confuse getting results after being taught a particular assessment, technique, and mechanism with the validity of the technique, and the purported mechanism. Those of us performing "specific" manipulation thought that repeated end range loading would promote hypermobility along with repeated manipulation without stabilization.

Have you ever made an endomorph an ectomorph? 

If we cannot deform fascia without superhuman force, and most losses of range of motion are due to a change in stretch perception, we also cannot make someone who is generally stiff (higher tone, less mobility) into someone who scores 9/9 on a Beighton Hypermobility Scale.

In general, you can give your gymnast and ballet dancer stabilization exercises, but you are probably just affecting motor control and perceived threat to a movement or activity, not making them more "stiff."

Since we get results with general mobilization and "specific" mobilization, and those results are also easily obtained with repeated motion, don't worry about targeting specific segments, unless the patient really believes a certain segment needs to "go." Getting that particular cavitation will probably be better than using repeated motions in that case, feeding into their expectations.

The bottom line is that your mobilizations and thrust manipulation should be comfortable; forget about being specific, at least 6 vertebrae are moving with each technique. Use manual therapy techniques to modulate threat. A patient can then move to end range to keep up the neurophysiologic effects you got from the treatment. Don't worry about "promoting hypermobility," unless you are superhumanly strong. If someone is adverse to manual therapy, repeated motions work well, and if they are still weak after pain is modulated, then you start with strengthening.

Keeping it Eclectic...