Manipulation is a treatment modality used for the management of spinal disorders (pain and hypomobility). Its use dates back to ancient Greece and China. Generally defined as “Passive technique performed to a joint at high speed low amplitude thrust that is beyond patient’s voluntary control, usually accompanied by a clicking sound or a pop in the joint (cavitation), aiming at increasing mobility and/ or reducing pain.”. The proposed effects can be divided into 3 main categories: biomechanical, neurophysiological and psychological. Biomechanical effects: • Restoration of tissue extensibility and ROM of hypo- mobile joint (increase range of motion). • Elongation of connective tissue (collagen fibers). • Disruption of cross linkage between collagen fibers. • Stretching of capsular adhesions. • Release entrapment of joint meniscoids. • Correction of positional faults. Neurophysiological: • Reduction of pain perception; local and regional pain inhibition (hypoalgesia). • Release of endogenous opiates • Mechanoreceptors activation. • Trigger descending pain inhibitory pathways of CNS. • Sympathetic nervous system response. • Peripheral/spinal cord mechanism at dorsal horn. • Influence on muscle activation (neuromuscular response). • Inhibition of global/superficial muscle tone. • Facilitation of local/deep muscle activation. Psychological: • Placebo effect. • Influence of therapist instruction/interactions. • Influence of patient expectations.
