Basic Principles Flashcards by Megan Musa

What is orthopedic manual therapy?

The practice and utilization of skilled hand movements intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction.

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What is clinical reasoning?

Process by which the therapist, while interacting with the patient and significant others, structures meaning, goals, and health management strategies based on clinical data, client choices, professional judgment/knowledge.

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What are clinical prediction rules?

Algorithmic decision tools designed to aid clinicians in determining a diagnosis, prognosis, or likely response to an intervention

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What are clinical practice guidelines?

Systematically developed guide to assist the clinician and patient decisions about appropriate health care for specific clinical circumstances

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What is regional interdependence?

Musculoskeletal concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.

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True or false; somatic impairments are mechanical in nature and can be traced to non-systemic causes

True

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____________is a pathological condition or abnormal entity with
a characteristic group of signs and symptoms affecting
the body from either known or unknown etiology

Disease

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What are the features of disease?

➢ Symptoms not worsened with activity; not improved with rest 
➢ Pain comes and goes like spasms 
➢ Disproportionate pain 
➢ Severe night pain 
➢ Systemic signs and symptoms

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What makes weight loss concerning?

More than 15% of body weight
Less than a 3 month period
Unintentional

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evidence-based medicine avoids practice lacking…

reliability, validity, and efficacy.

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Which source defines pain as…

“A disturbed sensation that causes suffering or distress”
-?

PT Guide

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Which source defines pain as…

“A unpleasant psychophysiological experience, triggered by activation of the normally quiescent nociceptive afferent system”
-?

Makofsky

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Which source defines pain as…

“Pain is an unpleasant feeling that is felt somewhere in the body and urges us to protect that body part”
-?

Butler and Mosely

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What is dermatomal pain?

Painful lesions pf skin and superficial fascia

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What is somatic pain?

Mechanical strains/ sprains of musculoskeletal structures
Symptoms describes as being proximal, deep, achy, stiff, sore (etc)
Associated signs of somatic impairment, including misalignment, hypomobility, and tissue texture abnormality

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What is neurogenic pain?

Inflammation of neural tissue usually due to compression
Symptoms described as being distal, sharp, shooting, burning, (etc)
Associated signs of peripheral neuropathy, including weakness, sensory loss, atrophy, hyporeflexia (etc)

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What is Viscogenic pain?

Pathological lesions of visceral structures
Symptoms of systemic disease described as intense, constant, worse at night, not relieved by rest nor worsened by activity, throbbing, etc.
Associated signs of systemic disease, including edema, clubbing, skin rash, pallor, hair loss, unexplained weight loss/ gain, nausea, anorexia, fatigue, night sweats, fever, etc.

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What are somatoform disorders?

Physical symptoms in the absence of organic causes with evidence of psychological involvement

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True or false; Deep somatic pain is commonly perceived at the level of
impairment

False- rarely, secondary to nerve convergence

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What are the two types of complex regional pain syndrome?

1- (RSD)- multiple regions

2-(causalgia)- single nerve root/ nerve distribution that is hyper sensitive

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Normally, peripheral nociceptive and/or peripheral neurogenic stimulation is sensed and relayed to …

the spinal cord and CNS for processing.

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What happens to the sensation of pain during central sensation processing?

Central processing is amplified, prolonged, and/or altered resulting in lower sensory activation thresholds.

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True or false; Central processing becomes influenced by thoughts,
perception, understanding, and emotions regarding pain.

True

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What are neuro tags?

(In this context specifically) When different parts of the brain become activated by memories of the pain or time of injury

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What are the abnormalities associated with cardiac-adrenal-pain syndrome?

* Hypertension >130/90 = 60 * Heart Rate > 84 = 46 * High Serum Cortisol (>20ug/dl) = 28 * High Erythrocyte Sedimentation Rate (ESR) (>20mm/hr) = 30

Which system of manual therapy has an Emphasis on treatment of specific impairments consistent with traditional manual therapy thinking. It includes osteopathic Rx?

Mechanism based

Which system of manual therapy is based on thee syndromes dictating Rx?

McKenzie

Which system of manual therapy is based on muscle imbalances (tonics vs phasics) ?

Janda

Which system of manual therapy is based on movement impairment syndrome?

Sahrmann

Which system of manual therapy utilizes a cluster of signs and symptoms to classify patients into subgroups with specific implications for management? It includes McKenzie, mobilization/manipulation, and stabilization.

Treatment based

What are McKenzie's 3 syndromes?

Postural syndrome Dysfunction syndrome Derangement syndrome

What is postural syndrome?

1. Normal healthy tissues 2. Pain is induced by static loading at end range and not by movement 3. Pain is never referred and never constant

What is dysfunction syndrome?

1. Shortened soft tissues have reduced elasticity 2. Pain occurs at end range when shortened structures are places under tension 3. Pain is never felt during movement and is never referred

True or false; Dysfunction syndrome is often found in young adults

False, it's an accumulation of postural syndromes with age

What is derangement syndrome?

1. Misalignment of intervertebral disc material (annulus or nucleus) causing blockage 2. Symptoms are made worse or better by specific movements and can be referred distally and tend to be constant and often severe 3. The patient may present with acute spinal deformity of sudden onset (e.g., kyphosis, torticollis, or lateral shift), which is often improved dramatically with manual therapy/ therapeutic exercise

What is a mobilization?

A manual therapy technique comprising of a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes

What is a manipulation?

a small amplitude/high velocity therapeutic movement.

True or false; an indirect technique is a mobilization that is performed against the restrictive barrier resulting in mechanical changes in the tissues

False- that's direct

What is a direct technique?

A mobilization that is performed against the restrictive barrier resulting in mechanical changes in the tissues

True or false; an indirect technique is a mobilization that is performed away from the restrictive barrier resulting in neuromuscular changes in the tissues.

True

What is an indirect technique?

A mobilization that is performed away from the restrictive barrier resulting in neuromuscular changes in the tissues.

How is tissue reactivity described?

It is described as: 1. High = Pain limits motion 2. Moderate = Pain/stiffness occur together 3. Low = Tissue stiffness limits motion

The state of tissue _________ and _________ is in most cases correlated to the inflammatory process.

Reactivity and irritability

How is soft tissue tenderness graded?

* Grade 0 – no tenderness to palpation * Grade 1 – tenderness without grimace/flinch * Grade 2 – tenderness with grimace/flinch * Grade 3 – tenderness with withdrawal (jump sign) * Grade 4 – withdrawal from non-noxious stimuli

What are the contraindications to manual therapy?

1. Malignancy 2. Osteomyelitis 3. Fractures 4. Joint Instability (subluxations, dislocations) 5. Ligamentous ruptures 6. Fever 7. Joint Inflammation (systemic or somatic) 8. Depleted general health

What are the 3 zones of the stress strain curve?

1. Neutral = laxity 2. Elastic = resistance (border positions) 3. Plastic = micro-failure

What are the 3 components of the stabilization mechanism?

1. Passive – osseous/articular (Form Closure) 2. Active – muscular/fascial (Force Closure) 3. Neural Control – sensorimotor control

What is the rule of superior motion?

Motion of a single vertebra is described relative to the vertebra below regardless of whether the motion occurs from above down or below up

True or false; Motion of a single vertebra is described relative to the vertebra above regardless of whether the motion occurs from above down or below up

False, below

What is the rule of vertebral body motion?

It is the direction of the vertebral body and not the spinous process that determines the direction of vertebral motion

For spinal movement, Roll-Gliding occurs between __________ during all active and passive rotations

incongruent curved joint surfaces

Occurs when a new point on one surface always comes into contact with a new point on the other surface

Roll

Occurs when one point on one surface always comes into contact with a new point on the other surface

Glide

Which axis do flexion and extension rotate/ roll around?

Which axis does side bending rotate/ roll around?

Which axis does axial rotation rotate/ roll around?

Which actions rotate/ roll around the X-axis?

Flexion/ extension

Which actions rotate/ roll around the Z-axis?

Side bending

Which actions rotate/ roll around the Y-axis?

Axial rotation

Which movements translate/ glaide along the X-axis?

Side bending (medial and lateral)

Which movements translate/ glaide along the Z-axis?

Flexion extension (anterior/ posterior)

Which movements translate/ glaide along the Y-axis?

Cranial and caudal

Which direction do the facet joints move during flexion?

Cranially

Which direction do the facet joints move during extension?

Caudally

If I side bend to the left, what will happen to my facets?

The left translates caudally | The right translates cranially

Which spinal segments follow the convex rule?

CO- C1- C2

True or false; C2 on C3 is the last spinal segment to follow the convex rule

False

Which spinal segments follow a concave rule?

C2-C3 to L5-S1

True or false; CO-C2 are convex joints

False- planar, but they follow the convex rule

True or false; C2-S1 are concave joints

False- planar, but they follow the concave rule

True or false; during T6- T7 Extension, T6 rolls anteriorly over T7 around the X-axis

False- posteriorly around the X axis

True or false; during T6- T7 Extension, T6 glides posteriorly over T7 along the Y-axis

False- Z-axis

True or false; during T6- T7 Extension, T7 glides anteriorly relative to T6 along the Z-axis

True

What are fyette's rules of spinal mechanics?

1. When the spine is in neutral, side bending in one direction will be accompanied by rotation in the opposite direction. 2. When the spine is flexed or extended (non-neutral), side bending to one side will be accompanied by rotation to the same side. 3. When motion is introduced in one plane it will reduce motion in all others.

What are Makofsky's endfeels?

1. Normal: healthy tissue yield at end-range associated with normal joint mobility 2. Stiff: decreased tissue yield at end-range associated with hypo-mobility 3. Loose: increased tissue yield at end-range associated with hyper-mobility

As per Maitland, what is a Grade 1 mobe?

Grade 1: Small amplitude movement performed at the beginning of the available range. (Resistance-free)

As per Maitland, what is a Grade 2 mobe?

Grade 2: Large amplitude movement performed within a resistance-free part of the available range.

As per Maitland, what is a Grade 3 mobe?

Grade 3: Large amplitude performed into resistance or up to the limit of available range. (Grade 3 is 50% of R1 {1st resistance} - R2 {restrictive barrier limit})

As per Maitland, what is a Grade 4 mobe?

Grade 4: Small amplitude performed into resistance or up to the limit of the available range. (Grade 4 is 50% of R1 {1st resistance} - R2 {restrictive barrier limit})

As per Maitland, what is a Grade 5 mobe?

Grade 5 : Small amplitude high velocity general movement performed usually, but not always, at end of available range

Grade 1 mobes have a _____ amplitude and a ______ frequency

Small amp | High frequency

Grade 2 mobes have a _____ amplitude and ______ frequency

Large amplitude | Low frequency

Which has a large amplitude; Grade 3 or Grade 4 mobes?

Grade 3

What's another word for a grade 5 mobe?

Thrust

Where do Grade 3-- and Grade 4-- end?

First onset of R1

Where do Grade 3- and Grade 4- end?

25% of the way between R1 and R2

Where do Grade 3+ and Grade 4+ end?

75% of the way between R1 and R2

Where do Grade 3++ and Grade 4++ end?

End of available ROM

What is R2?

End of available ROM

What is the OMT treatment sequence?

○ Reduce reactivity ○ Restore myofascial length and extensibility ○ Normalize joint mobility ○ Achieve optimal alignment (i.e., posture correction) ○ Address strength and motor control issues