1] Advanced Manual Therapy Techniques Flashcards
HVLA thrusts are often accompanied by
Cavitations
3 types of pain
Acute, subacute, chronic
What is expected motion loss in a patient with restricted capsular mobility atthe Left L2/L3facet?
Capsular restriction at lumbar limits upslides and gapping.
Left L2/L3 facet would be restricted in flexion, right SB and left rotation.
Absolute contraindications for manips in lumbar
Bone weakening patho Neurological symptoms Vascular issues Severe pain that wont let them get into position Lack of patient consent
Neuro sx that are absolute contraindications
Cord compression
Cervical myelopathy
Nerve root compression with increasing neuro deficits
Cauda equina compression
Vascular issues that are absolute contraindications
CAD or vertebrobasilar insufficiency
Aortic aneurysms
Blood disorder (hemophilia)
Using anticoagulants
Relative contraindications for lumbar manips
History of intervertebral disc injury Pregnancy Ligamentous laxity/hypermobility Advantaged DJD Vertigo Psychological dependence on joint manip
Some transient adverse effects that might happen after manip
Increased local pain or discomfort Stiffness Headache Tired/fatigue Radiating pain DNV Tinnitus
Serious adverse effects after manip
HNP Fractures Vertebral artery dissection CVA Cauda equina syndrome Spinal cord compression Death
3 effects of manual therapy
Psychological
Mechanical
Neurophysiological
What is a psychological effect of manual therapy?
We have found their pain and can reproduce it so this strengthens the THERAPEUTIC ALLIANCE - possible placebo effect
Mechanical effects of MT
Stretching
Snap intra-articular adhesions
Release entrapped meniscoid tissue within facets
Increase ROM
What are some neurophysiological effects of MT?
Endogenous pain relief
Less muscles guarding and inhibition and sensitivity to pain
Mid cervical flexion
Both facets upslide
Mid cervical extension
Both facets downslide
Mid cervical right SB
L facet upslide
R facet downslide
Left sidebend mid cervical motion
Left downslide
Right upslide
Mid cervical right rotation
Left upslide
Right downslide
Mid cervical left rotation
Left downslide
Right upslide
Lumbar flexion
Both facets upslide
Lumbar extension
Both facets downslide
Lumbar right SB
Left up
Right down
Left SB
Left down
Right up
Lumbar right rotation
Left compress
Right gap
Lumbar left rotation
Left gap
Right compress
Coupled motion of Upper cervical spine
Rotation and SB happen in opposite directions
Coupled motions of mid cervical
Rotation and SB occur to SAME side
Coupled motion of thoracic and lumbar
In neutral/extended: rotation and SB in opposite directions
In flexed: rotation and SB happen in same direction
How do you do facet apposition locking
Put the spine in position thats opposite to the normal coupled motions
How would you lock mid cervical coupled motions?
SB and rotate to opposite side
When SB and rotation happen to the opposite sides like in neutral position of lumbar and thoracic, how do you lock?
Put them in SB and rotation to the same side
What conditions do you screen for during the interview
CAD
VBI
Cauda equina compression
What 3 conditions do you want to rule out before doing manips?
Cervical arterial dysfunction
Cervical instability
CES
Signs and Sx of cervical arterial dysfunction
Occipital and one sided headache Ataxia Ptosis Facial palsy 5 D’s 3 Ns
What are the 5 D’s
Dizzy Drop attacks Diploplia Dysarthria Dysphagia
What are the 3 N’s
Numbness
Nausea
Nystagmus
Meta analysis by Mitchell noted significant decreased blood flow in VA with ?
Contralaterla end range rotation
Risk factors for craniocervical artery dissection
Recent minor trauma HTN Hypercholesterolemia Smoking TIA/CVA Vertigo Paresthesia
In pts with cervical instability, you want to rule out?
RA
Down’s syndrome
S/p trauma or falls
What would a pt with cervical instability say?
That they cant hold their head up or that they feel the need to wear a collar
Other signs and Sx of cervical instability
Bilateral paraesthesias
Weakness
Other signs of cord compression
Midline muscle guarding or tender
3 tests for cervical instability
Canadian c spine rules for fracture
Sharp-purser for transverse lig
Alar ligament stress test
What do you do if they are + for cervical instability through testing
Refer to imaging
Causes for cauda equina syndrome
HNP Trauma Tumor Fracture Stenosis Infection
Signs and symptoms of cauda equina syndrome
LBP Urinary incontinence or retention Fecal retention/incontinence Paresthesias in saddle distribution Motor or sensory loss in B/LLEs Gait Dysfunction
If CES suspected
Immediately refer for medical work up/imaging
Lumbar manip CPR guidelines (5)
Symptoms less than 16 days No Sx below knee FABQ work subscale less than 19 Hip IR more than 35 deg atleast 1 side 1 hypomobility lumbar segment
Recommendations for neck pain with mobility deficits
Acute: should thoracic manip and may cervical manip/mob - weak evidence
Subacute: may thoracic manip and cervical manip/mob- weak evidence
Chronic: multimodal approach - mod evidence
