Autor: Bartosz Szafran
How do the manipulations taught at FRSc differ from other schools, why and when do we use them?
Manipulations of the peripheral joints and the spinal joints are part of the whole FRS concept. This is probably the most important and biggest (maybe) difference.
We use these techniques most often when we recognize a specific type of disorder in a patient related to the course of the muscle chains (Syncinetic Chains) defined in the Concept.
This diagnosis is always preceded by an appropriate interview with the patient, in accordance with general medical practice and the determinants typical of FRSc. Manipulations are most often performed away from the place where the patient feels their pain.
The very concept of Synkinetic Chains is a certain way of describing the functional connections in our musculoskeletal system, developed based on the observations of Radek Składowski. We develop this topic a lot during the training in Manual Medicine according to FRSc. Simply put, it is a complex description of biomechanical-functional relationships that can have a mutual, indirect or direct influence on each other. We analyze many functional movement patterns, such as the gait cycle, the action of sitting, maintaining a standing position, breathing, performing a squat, etc. We take into account various inconspicuous movements, which during a thorough analysis turn out to have a common denominator, which is information flowing from our central nervous system to individual movement units, the activation of which in total allows for the performance of complex, or even global movements of the entire body. These are not only bone connections. Not only muscle connections. These are any type of structure that will allow the patient to move as ergonomically and smoothly as possible. A perfect example would be the co-movements in the structures of the spine accompanying the alternating work of the lower and upper limbs during walking.
By analyzing the course of co-tensions in the patient's body, we can sometimes solve the problem with one manipulation and/or direct further therapy to the right track. Here, the patient will come to our aid, describing the pain in various ways:
• local?
• local responsive/non-responsive to movement?
• morning or evening?
• does it pull, burn, radiate, go numb?
• wakes you up at night?
Many of these descriptions almost immediately rule out the possibility of performing manipulation in the painful area or segment. That is why we then return to the knowledge of chain relationships and look for the best distal solution, which may turn out to be crucial.
• Can't you manipulate C2? Look at the TH9 segment or the Sacrum
• The interview excludes the possibility of TH12/L1 manipulation? Focus on C1 or C5
• Recurrent sciatica-like pain? Consider manipulation/mobilization of the knee and ankle complex
• Patient reports 2-3 recurring problems? Look for a segment that intersects synkinetic pathways.
These are, of course, only examples that we can experience in office work.
That is why we always intertwine manipulations with other techniques during therapy. Thanks to this:
• they can be a typical GAME CHANGER,
• they can open up therapy and make other techniques more effective,
• used at the end of therapy will consolidate the effects of the therapy.
1. Are FRSc manipulations short-lever manipulations (HVLA)? 🤔
The abbreviation HVLA in its expansion is: High Velocity Low Amplitude. The explanation of this acronym describes almost every principle of well-executed manipulation. Correct manipulation should be performed with high acceleration and low amplitude. If we decided to perform Low Velocity Low Amplitude manipulations, it would no longer be manipulation, but rather mobilization.
So yes, we do and teach manipulations that meet the HVLA criteria.
2. Do you teach short or long lever manipulation?
We always emphasize the importance of maximally "selecting" a given segment for manipulation. The better this skill, the better. The goal of each manipulation is to create a so-called NOTCH PHENOMENON in a specific place, i.e. a place where forces accumulate. All this is to ensure that the technique is as targeted as possible. Unfortunately, if you already work with patients, you know well that sometimes it is simply impossible or difficult. Therefore:
A/ we show which segments of the spine to focus on so that the key one is easier to manipulate,
B/ we explain that sometimes during the first visits it is SIMPLY impossible to manipulate a specific segment because the patient's body does not allow us to do so (return to sub-point "A"),
C/ in the case of a highly mobile patient, sometimes you need to find "THIS ONE" that will be crucial. Unfortunately, when positioning the patient for the technique, nearby segments without impulse produce cavitation sounds. Is this a mistake? Not necessarily.
So yes, we use as many SHORT LEVERS as possible.
3. Is Manipulations in FRSc Chiropractic?
Let's go back to the basics and quickly recall what we have already described in part 1 of the article. Spine and peripheral joint manipulations in FRSc are performed:
A/ Not in all, but only in selected situations and patient problems.
B/ At a specific time during the visit – at the beginning, middle or at the very end. It is possible that we will repeat the technique at the next visit. We always follow the patient's CURRENT DESCRIPTION OF PAIN and the remaining parts of the interview and examination, which may change at each visit.
C/ Sometimes it is not the manipulation of the spine, but the manipulation/mobilization of the peripheral joints that will bring us the greatest breakthrough in therapy.
D/ Due to the fact that we look at the patient through the prism of the 5 Regulators, manipulations are interwoven with other techniques and we are unable to separate them from each other. They are a great addition that we use often and willingly.
Many "dry" techniques in their execution are the same or very similar to those known from chiropractic concepts. Manipulation instructors are not, however, certified chiropractors educated according to specific standards by authorized entities. Therefore, during training you will never hear from us the statement that we teach Chiropractic. Chiropractic is a completely separate philosophy of looking at and understanding the patient's body. So the context of using these techniques in FRSc and in Chiropractic may be different. In FRSc we most often treat manipulations as a COMPLEMENT to the remaining active and passive work with the patient.