Passive accessory intervertebral movements

Passive accessory intervertebral movements
Specialty	physical therapy
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Last updated May 01, 2019

Passive accessory intervertebral movements (PAIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland. The purpose of PAIVM is to assess the amount and quality of movement at various intervertebral levels, and to treat pain and stiffness of the cervical and lumbar spine.^[1]

Physical therapy (PT), also known as physiotherapy, is one of the allied health professions that, by using mechanical force and movements, manual therapy, exercise therapy, and electrotherapy, remediates impairments and promotes mobility and function. Physical therapy is used to improve a patient's quality of life through examination, diagnosis, prognosis, physical intervention, and patient education. It is performed by physical therapists.

Technique

During assessment, the aim of PAIVM is to reproduce patient symptoms, and assess the endfeel of cervical movement, quality of resistance, behaviour of pain throughout the range of movement, and observe any muscle spasm. A posterior to anterior force of varying strength is applied by the therapist either centrally onto the spinous process, or unilaterally on either the left or right articular pillar. As a treatment technique, pain is treated by oscillations of small amplitude short of resistance, whilst stiffness is treated by larger amplitudes 50% into resistance.^[1]^[2]

Contraindications

The technique is contraindicated by bone disease, malignancy, pregnancy, vertebral artery insufficiency, active ankylosing spondylitis, rheumatoid arthritis, spinal instability, acute irritation or compression of the nerve root, and recent whiplash.^[1]

Ankylosing spondylitis (AS) is a type of arthritis in which there is long term inflammation of the joints of the spine. Typically the joints where the spine joins the pelvis are also affected. Occasionally other joints such as the shoulders or hips are involved. Eye and bowel problems may also occur. Back pain is a characteristic symptom of AS, and it often comes and goes. Stiffness of the affected joints generally worsens over time.

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.

A nerve root is the initial segment of a nerve leaving the central nervous system. Types include:

Clinical evidence

A 2005 study by Abbott et al. suggested that as an assessment technique, PAIVMs are highly specific, but not sensitive, in the detection of lumbar segmental instability.^[3] A 1993 study by Watson and Trott suggested that PAIVM examinations are reliable when identifying symptomatic vertebral joints when assessing for cervicogenic headache.^[4]

Cervicogenic headache is a type of headache characterised by chronic Hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck.

Related Research Articles

An intervertebral disc lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint, to allow slight movement of the vertebrae, to act as a ligament to hold the vertebrae together, and to function as a shock absorber for the spine.

Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.

Cervical spine disorders are illnesses that affect the cervical spine, which is made up of the upper first seven vertebrae, encasing and shielding the spinal cord. This fragment of the spine starts from the region above the shoulder blades and ends by supporting and connecting the Skull.

Spondylosis degenerative osteoarthritis of the joints between the center of the spinal vertebrae and/or neural foramina

Spondylosis is the degeneration of the spinal column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related wear and tear of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

Degenerative disc disease (DDD) is a medical condition in which there are anatomic changes and a loss of function of varying degrees of one or more intervertebral discs of the spine of sufficient magnitude as to cause symptoms. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the rigid outer shell of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; and/or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.

Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment.

Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together.

Congenital vertebral anomalies are a collection of malformations of the spine. Most around 85% are not clinically significant, but they can cause compression of the spinal cord by deforming the vertebral canal or causing instability. This condition occurs in the womb. Congenital vertebral anomalies include alterations of the shape and number of vertebrae.

Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. This can result in pain, weakness, numbness, or difficulty controlling specific muscles.

A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, such as laminectomy because it leaves more ligaments and muscles attached to the vertebral column intact and it requires removing less bone from the vertebra. As a result, laminotomies typically have a faster recovery time and result in fewer postoperative complications. Nevertheless, possible risks can occur during or after the procedure like infection, hematomas, and dural tears. Laminotomies are commonly performed as treatment for lumbar spinal stenosis and herniated disks. MRI and CT scans are often used pre- and post surgery to determine if the procedure was successful.

Chiropractors primarily use manipulation of the spine as a treatment. It was founded in North America by DD Palmer in the 19th century.

Laminoplasty is an orthopaedic/neurosurgical surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The main purpose of this procedure is to provide relief to patients who may suffer from symptoms of numbness, pain, or weakness in arm movement. The procedure involves cutting the lamina on both sides of the affected vertebrae and then "swinging" the freed flap of bone open thus relieving the pressure on the spinal cord. The spinous process may be removed to allow the lamina bone flap to be swung open. The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place.

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord.

Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible, upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas. There is a concentrated nerve center in this area called the trigeminal nucleus. This major pathway of nerves controls pain signals from the teeth, face, head, and neck, and carries them to the brain. Dentomandibular sensorimotor dysfunction refers to a condition in which an individual experiences chronic pain or stiffness from these nerve inputs as a result of dental force imbalances.

iHunch is a term used to describe the common spinal problem of an excessively kyphotic (hunched) thoracic spine driving neck pain and cervicogenic headache. Other terms include iPosture, forward head posture, poking chin posture, computer neck, text neck and dowager’s hump.

References

1 2 3 Geoffrey Douglas Maitland, Elly Hengeveld, Kevin Banks, Kay English, (2005). Maitland's Vertebral Manipulation, Volume 1. Elsevier Butterworth-Heinemann. ISBN 9780750688062.
↑ Darlene Hertling, Randolph M. Kessler, (2006). Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Lippincott Williams & Wilkins. ISBN 9780781736268.
↑ J Haxby Abbott, Brendan McCane, Peter Herbison, Graeme Moginie, Cathy Chapple, Tracy Hogarty, (2005). Lumbar segmental instability: a criterion-related validity study of manual therapy assessment. BMC Musculoskeletal Disorders, 6:56. doi : 10.1186/1471-2474-6-56
↑ Watson, D. H., Trott, P. H. (1993). Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance Archived 2011-12-16 at the Wayback Machine .. Cephalalgia, 13(4), 272-284.

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[maitland-1] 1 2 3 Geoffrey Douglas Maitland, Elly Hengeveld, Kevin Banks, Kay English, (2005). Maitland's Vertebral Manipulation, Volume 1. Elsevier Butterworth-Heinemann. ISBN 9780750688062.

[2] Darlene Hertling, Randolph M. Kessler, (2006). Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Lippincott Williams & Wilkins. ISBN 9780781736268.

[3] J Haxby Abbott, Brendan McCane, Peter Herbison, Graeme Moginie, Cathy Chapple, Tracy Hogarty, (2005). Lumbar segmental instability: a criterion-related validity study of manual therapy assessment. BMC Musculoskeletal Disorders, 6:56. doi : 10.1186/1471-2474-6-56

[4] Watson, D. H., Trott, P. H. (1993). Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance Archived 2011-12-16 at the Wayback Machine .. Cephalalgia, 13(4), 272-284.