A Revised Definition of Manipulation

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 2005 (Jan);   28 (1):   68–72 ~ Full-Text

Howard Vernon, DC, PhD, John Mrozek, DC

In 1976, Sandoz (1) published an important article entitled “Some physical mechanisms and effects of spinal adjustments.” In this article, Sandoz published a figure which was meant to describe the nature of joint manipulation with respect to where, in the total arc of the motion of a joint, manipulation was proposed to take place. Sandoz's figure is shown in Fig 1. The figure was particularly effective in identifying several phases of a joint's total motion, starting with the active range, defined as the range capable of being voluntarily produced by a person with their own motor power. Sandoz postulated that a further movement could be produced passively, either by the person themselves or by an external agent (ie, therapist), where ‘passive’ implied the imposition of externally applied force.

The outer margins of the figure represent the anatomic limit of motion of a joint, beyond which injury would occur to any of the holding elements and, with severe enough force, to the bony elements themselves. Active and passive motions are clearly shown to be less than, that is, within, the anatomic limit.

Sandoz postulated the presence of a “paraphysiological space,” beyond the passive range, but less than the anatomic limit. It was “into” this space that he postulated that a manipulation occurred. This “space” was described by others as a “zone of end-play,”2 the “barrier,”3 or “the capsular pattern.”4 All of these terms are based on the notion that, at the end of “normal motion,” there exists a zone of elasticity in the joint which can be decreased in a joint which has lost some of its flexibility. The clinical term for this state has, as well, been given various names by all the schools of manipulation. Chiropractors have used the terms “subluxation” and “fixation”5: osteopaths use the term “somatic dysfunction”; medical and physiotherapeutic specialists use terms such as “dysfunction,” “barrier,” and “loss of end-play.” All of these terms contain the notion of “hypomobility.” We propose that the generic term for this problem is “joint dysfunction.”

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