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MSK III P3 Fall > 1] Advanced Manual Therapy Techniques > Flashcards

1] Advanced Manual Therapy Techniques Flashcards

1
Q

HVLA thrusts are often accompanied by

A

Cavitations

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2
Q

3 types of pain

A

Acute, subacute, chronic

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3
Q

What is expected motion loss in a patient with restricted capsular mobility atthe Left L2/L3facet?

A

Capsular restriction at lumbar limits upslides and gapping.

Left L2/L3 facet would be restricted in flexion, right SB and left rotation.

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4
Q

Absolute contraindications for manips in lumbar

A 
Bone weakening patho
Neurological symptoms
Vascular issues
Severe pain that wont let them get into position
Lack of patient consent
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5
Q

Neuro sx that are absolute contraindications

A

Cord compression
Cervical myelopathy
Nerve root compression with increasing neuro deficits
Cauda equina compression

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6
Q

Vascular issues that are absolute contraindications

A

CAD or vertebrobasilar insufficiency
Aortic aneurysms
Blood disorder (hemophilia)
Using anticoagulants

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7
Q

Relative contraindications for lumbar manips

A 
History of intervertebral disc injury
Pregnancy 
Ligamentous laxity/hypermobility 
Advantaged DJD
Vertigo 
Psychological dependence on joint manip
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8
Q

Some transient adverse effects that might happen after manip

A 
Increased local pain or discomfort 
Stiffness
Headache
Tired/fatigue
Radiating pain
DNV
Tinnitus
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9
Q

Serious adverse effects after manip

A 
HNP
Fractures 
Vertebral artery dissection
CVA
Cauda equina syndrome
Spinal cord compression
Death
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10
Q

3 effects of manual therapy

A

Psychological
Mechanical
Neurophysiological

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11
Q

What is a psychological effect of manual therapy?

A

We have found their pain and can reproduce it so this strengthens the THERAPEUTIC ALLIANCE - possible placebo effect

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12
Q

Mechanical effects of MT

A

Stretching
Snap intra-articular adhesions
Release entrapped meniscoid tissue within facets
Increase ROM

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13
Q

What are some neurophysiological effects of MT?

A

Endogenous pain relief

Less muscles guarding and inhibition and sensitivity to pain

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14
Q

Mid cervical flexion

A

Both facets upslide

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15
Q

Mid cervical extension

A

Both facets downslide

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16
Q

Mid cervical right SB

A

L facet upslide

R facet downslide

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17
Q

Left sidebend mid cervical motion

A

Left downslide

Right upslide

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18
Q

Mid cervical right rotation

A

Left upslide

Right downslide

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19
Q

Mid cervical left rotation

A

Left downslide

Right upslide

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20
Q

Lumbar flexion

A

Both facets upslide

21
Q

Lumbar extension

A

Both facets downslide

22
Q

Lumbar right SB

A

Left up

Right down

23
Q

Left SB

A

Left down

Right up

24
Q

Lumbar right rotation

A

Left compress

Right gap

25
Q

Lumbar left rotation

A

Left gap

Right compress

26
Q

Coupled motion of Upper cervical spine

A

Rotation and SB happen in opposite directions

27
Q

Coupled motions of mid cervical

A

Rotation and SB occur to SAME side

28
Q

Coupled motion of thoracic and lumbar

A

In neutral/extended: rotation and SB in opposite directions

In flexed: rotation and SB happen in same direction

29
Q

How do you do facet apposition locking

A

Put the spine in position thats opposite to the normal coupled motions

30
Q

How would you lock mid cervical coupled motions?

A

SB and rotate to opposite side

31
Q

When SB and rotation happen to the opposite sides like in neutral position of lumbar and thoracic, how do you lock?

A

Put them in SB and rotation to the same side

32
Q

What conditions do you screen for during the interview

A

CAD
VBI
Cauda equina compression

33
Q

What 3 conditions do you want to rule out before doing manips?

A

Cervical arterial dysfunction
Cervical instability
CES

34
Q

Signs and Sx of cervical arterial dysfunction

A 
Occipital and one sided headache
Ataxia
Ptosis
Facial palsy 
5 D’s 
3 Ns
35
Q

What are the 5 D’s

A 
Dizzy
Drop attacks
Diploplia 
Dysarthria 
Dysphagia
36
Q

What are the 3 N’s

A

Numbness
Nausea
Nystagmus

37
Q

Meta analysis by Mitchell noted significant decreased blood flow in VA with ?

A

Contralaterla end range rotation

38
Q

Risk factors for craniocervical artery dissection

A 
Recent minor trauma 
HTN
Hypercholesterolemia 
Smoking
TIA/CVA
Vertigo 
Paresthesia
39
Q

In pts with cervical instability, you want to rule out?

A

RA
Down’s syndrome
S/p trauma or falls

40
Q

What would a pt with cervical instability say?

A

That they cant hold their head up or that they feel the need to wear a collar

41
Q

Other signs and Sx of cervical instability

A

Bilateral paraesthesias
Weakness
Other signs of cord compression
Midline muscle guarding or tender

42
Q

3 tests for cervical instability

A

Canadian c spine rules for fracture
Sharp-purser for transverse lig
Alar ligament stress test

43
Q

What do you do if they are + for cervical instability through testing

A

Refer to imaging

44
Q

Causes for cauda equina syndrome

A 
HNP
Trauma
Tumor
Fracture
Stenosis 
Infection
45
Q

Signs and symptoms of cauda equina syndrome

A 
LBP
Urinary incontinence or retention 
Fecal retention/incontinence
Paresthesias in saddle distribution
 Motor or sensory loss in B/LLEs
Gait Dysfunction
46
Q

If CES suspected

A

Immediately refer for medical work up/imaging

47
Q

Lumbar manip CPR guidelines (5)

A 
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
48
Q

Recommendations for neck pain with mobility deficits

A

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

MSK III P3 Fall (19 decks)

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