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For the purposes of this article, "manipulation/mobilization" is an externally applied mechanical measure. "Manipulation/adjustment" of a joint is defined as a passively applied movement of low amplitude and low or high-velocity thrust which moves the joint into the paraphysiological range. Manipulation is a passive dynamic thrust that causes cavitation or gapping and attempts to restore the manipulated joint's range of motion and neurophysiological function. Manipulation commences where mobilization ends.
Mobilization is a non-thrust, manual therapy. It involves passive movement of a joint within its physiologic range of motion. This is approximately equivalent of the normal range of motion a joint can be taken through by intrinsic musculature. Active range of motion is motion which patients can accomplish by themselves. Mobilization is passive movement within the physiologic joint space administered by a clinician for the purpose of increasing overall range of joint motion.
Figure 1 graphically demonstrates the varying degrees of motion between the two techniques, and their specific classifications.
Stage 1 The active range of movement (motion produced by muscular action).
Stage 2 The passive range of movement (motion produced by traction or springing the jointjoint play, up to the elastic barrier of resistance). Characterizes mobilization.
Stage 3 The paraphysiological range of movement (motion beyond the elastic barrier of resistance up to the limit of anatomical integrity produced by manipulation/adjustment and frequently accompanied by an audible release). Characterizes manipulation/adjustment.
Stage 4 The pathological movement (motion beyond the limit of normal anatomical integrity, which damages ligaments and capsule, resulting in joint hypermobility).
Manipulation/adjustment that is too forceful may move the joint beyond the limit of anatomical integrity, creating or perpetuating joint instability.
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General Authority: SDCL 36-5-1, 36-5-4, 36-5-15.2(1)(3).
Law Implemented: SDCL 36-5-1, 36-5-4, 36-5-15.2(1)(3).
Meridel I. Gatterman, "Complications of and Contraindications to Spinal Manipulative Therapy," chap. 4 in Chiropractic Management of Spine Related Disorders, ed. Meridel I. Gatterman (Baltimore: Williams & Wilkins, 1990), 49, fig. 3.1.