The twisted ribbon analogy and why laughter is the best remedy

Last week I was treating a patient with whom I share a sense of humour.  we were chatting away as I do, when it is appropriate (don't worry I won't force you to chat if you would rather not!) and I kept making her laugh.  At the time I was setting her up for a series of 'lumbar rolls', these are 'manipulations' where we lie the patient on the side and twist and flex them so that the point of tension lies at the segment we wish to manipulate.  I always think of it like a ribbon, if you put one twist in a ribbon you can twist it from the top or bottom and move the point where it twists round itself up and down the length of the ribbon.  Now imagine I can also flex your back in such a way that in that direction of motion the forces are focused at the same point.  I can then compress through the area and further focus the forces to the one joint.   At this point the normal technique would be for me to drop slightly and use gravity to deliver a small impulse which would be enough to manipulate the joint and achieve the desired outcome, resetting local muscle tone so the joint moves more normally and often with the pop or click of cavitation and any potential benefits that may confer.  Except in this case, every time I set the joint, either before or after I added the compression, Ms X would laugh and the joint would release and cavitate.  The involuntary tightening of the abdominal muscles and the movement associated with that, coupled with the increased intra-abdominal pressure were working to act as extra levers and were enough to initiate the process in a gentle and enjoyable way.  Sadly I don't think I can be reliably funny enough to make this a part of my everyday practice but it does go to show how effectively some techniques minimise the force required to perform a manoeuvre and how a good set up can increase the probability of success.

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