Which of the following is a precaution to thrust joint manipulation?

• A. Active spondyloarthropathies
• B. Hyper-mobility
• C. Upper motor neuron lesion
• D. Vertebral bone disease

Answer: (B)

Thrust manipulation carries risk when the joint can’t safely control a sudden high-velocity impulse. In joints that are hypermobile, ligamentous laxity means there’s already excessive motion at the segment. Introducing a thrust could push the joint beyond its safe end range, increasing the chances of ligament or facet injury, cartilage damage, or neural irritation. Because of this instability, thrust manipulation is avoided or modified in patients with hypermobility.

The other choices point to concerns that would generally lead to avoiding thrust for different reasons (active inflammation in a spondyloarthropathy, weakened bone in vertebral disease, or a neurological condition indicated by an upper motor neuron lesion), but the specific precaution most directly tied to the risk of an excessive, uncontrolled joint movement is hypermobility.