3-Manual Therapies

Question 1

Explain the belief system of Manual therapies

Answer 1

• body is a unit unto itself where structure and function are interrelated
• disease can occur when the normal adaptability is disrupted
• reverse structural imbalances to optimize the body’s ability to self-correct to repair itself

Question 2

List the 11 concepts common to all bodywork manual therapies

Answer 2

1. Bilateral symmetry
2. Gravity
3. Tensegrity
4. Postural maintenance and coordinated movement
5. Connective tisues (fascia)
6. Segmentation (functional spinal unit)
7. Reflexes and autonomic nervous system
8. Pain, guarding, muscle spasm and facilitation
9. Compensation and decompensation
10. Range of motion and barrier concepts
11. Active/passive and direct/indirect

Question 3

Explain the bilateral symmetry concept

Answer 3

we can divide our body into right and left, front and back, or top and bottom halves

Question 4

Explain the Gravity concept

Answer 4

We are all affected by the pull of the earth on our bodies

Question 5

Explain the Tensegrity concept

Answer 5

our body systems maximize the balance between compression and tension forces to maintain balance and minimize our energy expenditure

Question 6

Explain the Postural maintenance and coordinated movement concept

Answer 6

• as we are 2-legged creatures we have gained advantages (using our hands for tools), while losing others (we are less stable than 4-legged creatures);
• our motor system acts with our equilibrial triad (proprioceptive, vestibular, and visual systems) to allow balanced posture with proper head alignment, and coordinated movement

Question 7

Explain the Connective tissue concept

Answer 7

• the connective tissue, both deep and superficial, that surrounds and gives form to the tissues and organs of the body;
• see what happens when you pull on your “fascial sweater”

Question 8

Explain the Segmentation concept

Answer 8

• each one of our individual spinal nerves and all of the tissues (e.g., muscles and fascia) that it innervates
• each spinal nerve is associated with a spinal vertebrae. For example, the spinal nerve originating from the first thoracic vertebrae (T1) will relate to the tissues along the dermatome (e.g., segment) running down the arm.

Question 9

Explain the Reflexes and autonomic nervous system concept

Answer 9

• with reflexes our bodies respond automatically to sensory stimuli through the central nervous system (CNS) and movement occurs through the motor neurons;
• our autonomic nervous system is responsible for unconscious control of visceral organs such as the heart, glands, and digestive organs;
• stimulation of our musculoskeletal system (e.g., somatic system) can positively affect the visceral system

Question 10

Explain the pain, guarding, muscle spasm, and facilitation concept

Answer 10

• when we experience tissue damage, we feel this negative stimulus in the form of pain;
• when we damage a bone, joint, or ligament, our surrounding muscles contract reflexively to create a natural “splint.” This is referred to as guarding;
• when our muscles guard too much these muscles can start to spasm;
• over time this muscle spasm can cause our motor neurons to become more sensitive, therefore our capacity for activity becomes reduced. This is referred to as facilitation

Question 11

Describe the Compensationa and decompensation concept

Answer 11

• our bodies (e.g., muscles, joints) shift along our spine to enable us to maintain a horizontal visual sightline. This is referred to as compensation;
• as we age, changes in body tissues occur (e.g., tissue damage or failure). This is referred to as decompensation and usually results in pain

Question 12

Describe the Range of motion and barrier concepts

Answer 12

• each joint in our body has a normal amount of motion associated with it, measured in degrees;
• a barrier is anything that stops the normal motion of our body. This can be related to pain around a joint, or due to an anatomical structure (e.g., ligament)

Question 13

Explain the Active/passive and direct/indirect concept

Answer 13

• two approaches when used for manual therapy;
• are you actively participating in your treatment (e.g., lifting your leg yourself), or are you passive (e.g., the treating practitioner is lifting your leg);
• direct and indirect refers to the motion barrier previously mentioned and the approach that is used. The affected joint can either move towards the motion barrier (direct) or away from the barrier (indirect)

Question 14

What is massage?

Answer 14

• The scientific manipulation of the soft tissues of the body
• a healing art, an act of physical caring, and a way of communicating without words

Question 15

What is the history of massage and its research?

Answer 15

• Beneficial effects of touch well established through anecdotal evidence and scientific study, throughout history into the modern day
• massage recorded as being used as far back as 3000 years ago

Question 16

List the 5 basic techniques of massage

Answer 16

1. Effleurage
2. Petrissage
3. Friction
4. Tapotement
5. Vibration

Question 17

Effleurage

Answer 17

• a gliding stroke applying light to moderate pressure
• aiding in lymphatic and venous blood drainage as well as arterial blood supply to a tissue

Question 18

Petrissage

Answer 18

• more aggressive stroke with the thumb and fingers working together to lift and knead the tissues
• aiding in lymphatic and venous blood drainage from the muscles and to break up scar tissue adhesions

Question 19

Friction

Answer 19

• most deeply applied technique using circular or back-and-forth movement
• creates heat in the tissue and breaks up larger scar tissue adhesions

Question 20

Tapotement

Answer 20

• uses rapid, repeating blows with cupped hands, of varying strength
• stimulates arterial circulation to the targeted tissue

Question 21

Vibration

Answer 21

• uses a brisk snapping or strumming (like a guitar string) across tissues to achieve a light, quivering effect
• this technique most commonly uses a mechanical device to achieve the desired effect

Question 22

Within the 5 massage techniques, it has been suggested the skill set of bodywork therapists could be categorized into ____ components which cover ____ core skills and “serve as the building blocks of all techniques that are utilized by the various massage applications” around the world

Answer 22

8

26

Question 23

Swedish Massage

Answer 23

• What most people envision in our Western culture
• Most common form of massage in the US
• Created 150 years ago
• Blends ancient Asian massage with Western understanding of anatomy and physiology
• Primarily used for full body massage to relieve muscle tension and promote relaxation, along with improving circulation and joint range of motion

Question 24

Lymph drainage

Answer 24

• Lymph (clear fluid) is mostly comprised of white blood cells (integral to immune system function)
• Several lymphatic pumps that enable to travel through the body as needed
• Using a very light pressure, encourages built up lymph, to empty into the lymph capillary in order to travel to larger vessels and further along into the circulatory system
• “rhythmic short stroke that creates a pulling action on the skin and superficial fascia, which is then abruptly released”
• Extremely useful in reducing edema in post-surgical and post-trauma patients

Question 25

Myofascial release

Answer 25

• gentle, whole body therapy that deals with the connective tissue
• fascia is interconnected with every other part of the body,
• when “injury, inflammation, or physical or emotional trauma occurs, the fascia can become tight and cause pain and/or restricted ROM”
• normally soft and mobile, abnormal tissue may be hot, hard, sensitive, maybe even stringy or crunchy
• Using gentle pressure, the practitioner moves the fascia either towards or away from the restriction until a release or softening of the tissue is felt
• break up the collagen fibers that make up the fascia

Question 26

Neuromuscular therapy

Answer 26

• trigger point therapy
• Concentrated areas of soft tissue in the body that are characterized by pain, tightness, and tenderness and usually develop because of referral pain, or pain from another source of the body
• Once located, apply pressure until a degree of resistance is felt
• Held for 8-12s, during which time the patient will most likely feel an increase in pain followed by the sensation of this pain fading away
• European and American versions of this technique, and while there are similarities and subtle differences

Question 27

Rolfing

Answer 27

• Structural integration,
• Interaction between the body (fascial system) and the gravitational pull of the Earth
• good posture is balance with the Earth and using a minimum of our baseline energy to keep healthy
• When our fascia shortens or binds up due to “injury, bad posture, emotional problems or genetic weaknesses”, our body uses more of our baseline energy and has less for other activities
• stretch the fascia to release patterns of tension throughout the body while asking patients to breathe deeply and visualize the lengthening of the fascia
• series of sessions in order to allow the practitioner to focus on a particular fascial pattern and to allow the body time to readjust to ‘new normal’
• return to state of correct alignment

Question 28

Shiatsu massage

Answer 28

• Japanese, shiatsu means finger (shi) pressure (atsu)
• Similarly to TCM, based on the thought that illness causes blockages in the free flow of ki (life energy) along the meridian pathways
• Pressure applied for 1-30s to specific acupressure points using the fingers, palms, elbows, knees, feet of the practitioner
• Many variations in treatment styles.
• “Japanese adaptation of acupressure”

Question 29

Sports massage

Answer 29

• incorporates different massage styles to enhance performance and skill in a particular sport and aid in the prevention and recovery from injury
• use deeper, more vigorous strokes and focus on the parts of the body that are likely to be stressed by a particular sport, as opposed to the body as a whole
• know the biomechanics of the sport in question and to tailor the massage depending on whether it is before or after the athletic event
• More recently, athletes and therapists have been using elastic tape in order to aid lymphatic and blood flow movement post-massage

Question 30

Tui na

Answer 30

• one of the four main branches of Traditional Chinese Medicine
• more than 4000 years old
• precursor to all modern day massage treatments
• performed by a TCM physician
• treat specific illnesses, musculoskeletal problems, address emotional and spiritual issues, and to build up general health and strength
• assess and treat the flow of Qi for any blockages along any of the 12 meridians within the body

Question 31

Infant Massage

Answer 31

• enjoy the touch of massage
• produces weight gains in premature infants, reduces complications in drug-addicted babies, and aids mothers with postpartum depression
• reduces pain from inoculations, teething and constipation, reduces colic crying spells, induces sleep, and improves bonding between parent and child

Question 32

List the general/systemic massage therapy contraindications

Answer 32

1. Viral
2. Bacterial
3. Skin
4. Diabetes with heart or kidney disease
5. Undiagnosed mole, lump, headache
6. Severe hypertension
7. Fever
8. High risk pregnancy
9. Acute pneumonia

Question 33

List the local area massage therapy contraindications

Answer 33

1. Contagious conditions
2. Rheumatoid arthritis
3. Metastic cancer
4. Acute diarrhea, colits, crohn’s
5. Severe unexplained internal pain
6. Fundal, dermatitis
7. Open wounds

Question 34

List the medical conditions that require adaptation of the standard massage therapy treatment but are not contraindicated completely

Answer 34

1. AIDS
2. ALS
3. Asthma, chronic emphysema
4. Cancer
5. MS
6. Parkinsons
7. Artherosclerosis
8. Hypertension
9. Hypotension
10. angina
11. Osteoporosis
12. disk herniation
13. joint mobilizations during pregnancy
14. IBS
15. Hernia
16. Seizure disorders

Question 35

What is reflexology?

Answer 35

• based on the premise that there are reflex points in the hands, feet, and ears corresponding via nerve pathways of the nervous system (Western Medicine) and/or meridians (Eastern Medicine) to every part, organ, and gland of the body
• thought that there are zones and reflexes in the body that correspond or connect to other parts, glands, or organs of the entire body
• When a reflex is manipulated through systematic pressure, it reduces stress in the body by activating the para-sympathetic (i.e., relaxation) nervous system in an attempt to return to homeostasis (i.e., natural functioning)
• para-sympathetic system allows endorphins (i.e., natural pain-killers) to be released, relaxation of the nervous system, and increased blood and lymphatic circulation, which in turn results in increases in oxygen and immune levels

Question 36

What is conventional zone theory?

Answer 36

• CZT
• body is divided into 10 vertical zones (5 on each side of the body), from the tips of your fingers and toes up to the top of your head
• zones numbered from the innermost region of the body (1) to the outermost (5), on either side
• Anything within this zone is connected
• pressure applied in that zone, every gland, organ, or other structure in that zone will be stimulated
• Body is also divided into 5 transverse (horizontal) zones; the pelvic area, lower abdominal area, upper abdominal area, thoracic area, and head area
• Zones in the right hand or foot correspond to the right side of the body, same with left
• Brain (e.g., stroke symptoms), the opposite is true

Question 37

What is Osteopathy?

Answer 37

• applies the knowledge of the structure (anatomy) and function (physiology) of the body, to all diseases, disorders and dysfunctions
• based on the following principles:
  
  • human is a dynamic functional unit, whose state of health is influenced by the body, mind, and spirit;
  • body possesses self-regulatory mechanisms and is naturally self-healing;
  • structure and function are interrelated at all levels of the body

Question 38

Describe the history of Osteopathic medicine

Answer 38

• Began as a branch among other common medical practices in the 1800s when Dr. Andrew Taylor Still (M.D./D.O.) founded the first college of Osteopathy in the US, in 1892

Question 39

Describe Osteopathic practitcioners in the US

Answer 39

• contemporary Doctors of Osteopathic (DO) Medicine are fully licensed physicians
• provide a full range of services, from prescribing drugs to performing surgery, and they use the latest medical tools
• DOs are also trained to:
  
  • Teach patients how to prevent illness and injury by maintaining a healthy lifestyle;
  • Look at the whole person to reach a diagnosis without focusing just on symptoms;
  • Help the body to heal itself;
  • Believe that all parts of the body work together and influence one another (i.e., specifically the nervous system and the musculoskeletal system);
  • Perform osteopathic manipulative treatment (OMT), a hands-on approach to diagnosing, treating, and preventing illness or injury.
• in all 50 States have the same practice rights as MDs”
• both DOs and MDs practice together in facilities to enhance the state of care available

Question 40

Describe osteopathic practicioners in Canada

Answer 40

• Despite a variety of business websites promoting training and certification in osteopathy within Canada, there are no government recognized or accredited colleges of osteopathy of Canada. Only those graduates from American colleges of osteopathic medicine accredited by the Canadian and American Osteopathic Associations are eligible for licensure in Canada
• there are unqualified and non-licensed practitioners presenting themselves as Osteopaths or ‘Osteopathic Practitioners,’” practicing outside of legislation in Canada
• Ontario Association of Osteopathic Manual Practitioners have formal recognition of the practice of osteopathic manual therapy, as a component of osteopathic health care
• Osteopathic Manual Practitioners have extensive education, training and a Diploma in traditional manual osteopathic practice
• Practitioners assess and treat patients using only manual techniques; they are not physicians and they cannot prescribe medication or perform surgery

Question 41

List the manual techniques that an osteopathic health care practitioner would utilize when treating a patient

Answer 41

1. Soft Tissue Manipulation and Lymphatic Treatments
2. High-velocity low-amplitude thrust
3. Articulatory technique
4. Muscle energy technique
5. Counterstrain technique
6. Myofascial Release
7. Cranial Osteopathy
8. Visceral Manipulation

Question 42

Soft Tissue Manipulation and Lymphatic Treatments

Answer 42

similar to massage, the focus is on relaxing the tone and lengthening muscle and fascial connective tissue, which in turn creates improved blood and lymphatic flow

Question 43

High-velocity low-amplitude thrust

Answer 43

a very rapid (high-velocity), yet extremely small (low-amplitude) movement
resets the joint position and muscle tension levels, which improves blood flow and neural issues

Question 44

Articulatory technique

Answer 44

moving two joint surfaces together or a body part through the restricted range of motion in a gentle, repetitive fashion, until the barrier is released or diminished

Question 45

Muscle energy technique

Answer 45

the patient uses effort (e.g., voluntarily contracts a muscle) during a treatment;
this is followed by the practitioner using the body reflexes to help illicit change (e.g., gentle stretching after muscle contraction)

Question 46

Counterstrain technique

Answer 46

also known as positional release therapy, this technique uses the reflex system to reduce pain
the dysfunctional joint or tissue is positioned to a point away from the restrictive barrier (i.e., a point of balance where pain eases)
this point is held for 90 seconds before release

Question 47

Myofascial Release

Answer 47

similar to myofascial techniques mentioned earlier in this module, changes in muscle length are attempted

Question 48

Cranial Osteopathy

Answer 48

very light pressure focused on the skull or sacrum as this is where the dura mater (i.e., tubes that hold cerebral-spinal fluid) attach;
a restoration of balance to the circulation of the blood and other body fluids, by treating the body’s inherent biorhythm, which practitioners trained in this technique can feel;
commonly used as a treatment for headaches, ear, and TMJ issues

Question 49

Visceral Manipulation

Answer 49

practitioners gently move the visceral structures themselves and the fascia that surrounds them to restore full movement;
while only gentle pressure is felt, corrections can improve the mobility of an organ, improve blood flow, and help an organ function more effectively

Question 50

Describe chiropractic

Answer 50

• Originating in the US in the 1900s, focuses on the relationship between the body’s structure (i.e., mainly the spine) and its functioning
• DCs primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body’s natural ability to heal itself
• 3rd largest independent health profession in the Western world
• 90% of patients come with neuromusculosketal complaints (e.g., back and neck pain, headaches), the conditions for which spinal adjustment/manipulation is most effective
• drug-free, manual approach to health care that covers patient assessment, diagnosis, and treatment for disorders related to the spine, pelvis, extremity joints, and their effect on the nervous system
• unique position of having scaled many walls of the health care establishment…while at the same time maintaining strong roots in the CAM community with a philosophy that emphasized healing without drugs

Question 51

Describethe chiropractic manual adjustment

Answer 51

• a manipulation or mobilization of the spine
• necessary due to a functional problem related to a spinal joint (e.g., a facet joint ‘sticking’) and the structures associated with the joint such as the muscles, tendons, ligaments, and nerves
• resulting dysfunction can then manifest itself in various ways (e.g., pain, inflammation, restricted movement)
• popping sound can be heard (result of a change of pressure within the joint resulting in gas bubbles being released) -not painful (
• You should also note that chiropractors work on the context of the body as a whole (source of pain should be sought along the path of the nerves leading to and from the site of the symptoms

Question 52

List the core chiropractic principles

Answer 52

1. Structure and function exist in intimate relation with one another;
2. Structural distortions can cause functional abnormalities;
3. Vertebral subluxation is a significant form of structural distortion and dysfunction and leads to a variety of functional abnormalities;
4. The nervous system occupies a preeminent role in the restoration and maintenance of proper bodily function;
5. Subluxation influences bodily function primarily through neurological means;
6. The chiropractic adjustment is a specific and definitive method for the reduction or correction of the vertebral subluxation.

Question 53

List the main theories on why chiropractic works

Answer 53

1. Bone-Out-of-Place Theory
2. Motion Theory and Segmental Dysfunction
3. Segmental Facilitation

Question 54

Describe the Bone-Out-of-Place Theory for why chiropractic works

Answer 54

• moving misaligned vertebrae back into line relieves pressure caused by direct bony impingement on spinal nerves;
• the first chiropractic theory now thought to be too simplistic in scope

Question 55

Describe the Motion Theory and Segmental Dysfunction theory on why chiropractic works

Answer 55

• a loss of proper spinal mobility, as opposed to misalignment, is the cause of vertebral subluxations
• there is always more than one vertebrae involved, as there is a relationship between at least two articulating joint surfaces;
• ideally a joint functions in between the two extremes for balance or dysfunctions will occur within the segment;
• currently the most accepted chiropractic theory

Question 56

Describe the Segmental Facilitation theory on why chiropractic works

Answer 56

• the stimulus threshold in a particular spinal cord segment (i.e., nerve) has been reduced, and the spinal cord is highly excitable;
• therefore a smaller stimulus (i.e., hypersensitivity) will trigger excessive impulse firing in the segment and may be detrimental to the body as a whole;
• for example, if the segment that innervates the stomach becomes facilitated, the stomach becomes hypersensitive. Mildly irritating foods may cause disproportionate stomach dysfunctions such as pain, food allergies, or intolerances and if allowed to continue, gastritis or ulceration may follow

Question 57

Describe the Research behind chiropractic

Answer 57

• Not until the 1990s that the scientific literature began to report findings on chiropractic treatments
• number of research studies are outlined that support the use of chiropractic therapy to aid various health issues, such as headaches and low back pain
• randomized controlled trials for chiropractic treatments as well as systematic reviews/meta-analysis
• Past media attention on the rare reports of complications (i.e., a stroke) after a chiropractic neck adjustment, although the cause of the stroke was unclear.
• 2007 study of treatment outcomes for 19,722 chiropractic patients in the United Kingdom concluded that minor side effects (such as temporary soreness) after cervical spine manipulation were relatively common, but that the risk of a serious adverse event was “low to very low” immediately or up to 7 days after treatment”
• Ontario 2008 study analyzed 818 cases (9 years of hospitalization records) of vertebrobasilar artery (VBA) stroke (arteries that supply blood to the back of the brain) - link between visits to a health care practitioner and subsequent VBA stroke, but there was no evidence that visiting a chiropractor was more risky than visiting their family doctor. The association between health care visits and VBA stroke to the likelihood that people with VBA dissection (torn arteries) seek care for related headache and neck pain before their stroke”

Question 58

Describe the chiropractic profession

Answer 58

• 2 branches of practitioners, traditionalists and modernists.
• Both agree that spinal adjustments are the main feature of their treatment
• Traditionalists seek to treat the cause and not the symptom,
• Modernists
  
  • treat both the cause and the symptom
  • enlist a broader scope and use other tools such as electrical modalities (e.g., TENS machine), nutritional regimens and supplementation, and techniques such as hands-on muscle therapies and acupuncture to aid in their treatment.
• Chiropractic is a regulated health profession recognized by law in all Canadian provinces and American states
• must undergo a four-year, full-time Doctor of Chiropractic (DC) degree program after previously completing three years of university
• US also
• requirement to successfully undertake national examinations