Chapter 10 - Manual Techniques Flashcards
Where are the first written records of manual therapy?
Ancient China
Physician originated techniques include…
Cyriax, Mennell, and Osteopathic techniques
Physical therapy originated techniques include…
Maitland, Kaltenborn, and McKenzie
What are the subsets of Manual Therapy?
MFR, positional release techniques, neurodynamic mobilization techniques, manually resisted exercise, PNF, joint mobilization, manipulation
How is the manual technique chosen?
The clinician’s beliefs, their level of expertise and clinical decision-making processes
Concerns with efficacy of manual techniques include…
- technique selection is typically made on ad hoc basis
- strong placebo effect associated with laying on hands
- many M/S conditions are self-limiting
- difficulty of blinding clinicians and subjects
- clear cut definitions as to when a test is superior to another
- overreliance on MT techniques to improve patients status is a passive approach
What is the key to a great rehabilitation program?
The combination of manual techniques with other interventions
List the criteria for the correct application of manual therapy techniques
- knowledge of joint surfaces
- convex/concave rules
- duration, type, irritability of symptoms
- patient and clinician position
- position of joint to be treated
- clinician hand placement
- specificity
- duration and type of force
- amount of force
- reinforcement of any gains made
- reassessment
- assess patient prior to MT, perform MT, then re-assess
Use of Muscle Energy Techniques in 3 Stages of Healing
Acute = strongly indicated Subacute = strongly indicated Chronic = used to prepare tissue for manipulation and to prevent recurrent dysfunction
Use of Joint Mobilizations in 3 Stages of Healing
Acute = Grades I and II Subacte = Grades II and III Chronic = Grades III and IV
Use of Joint Manipulation in 3 Stages of Healing
Acute = rarely indicated Subacute = moderate to strong indication if MET ineffective Chronic = strong indication if MET is ineffective
Indications for Manual Therapy
Mild M/S pain
Nonirritable M/S condition
Intermittent M/S pain
Pain that is relieved by rest
Pain that is relieved or provoked by a particular motion or position
Pain that is altered by changes related to sitting or standing
What is TFM?
Repeated cross-grain massage applied to muscle, tendons, tendon sheaths and ligaments
When is TFM indicated?
Acute or subacute ligament tendon or muscle injuries
Chronically inflamed bursae
Adhesions in ligament or muscle or between tissues
When is TFM contraindicated?
Acute inflammation Hematomas Debilitated or open skin Peripheral nerves Diminished sensation
How does TFM aid in pain relief?
Stimulates type I and II mechanoreceptors which produce a presynaptic anesthesia (CAREFUL: too much during acute phase can trigger nociceptors instead, increasing pain)
How does TFM aid in decreasing scar tissue?
Helps to orient the collagen in the appropriate lines of stress. It also helps produce hypertrophy of the new collagen (light TFM applied in subacute stage to protect granulation tissue)
What is the rate and amplitude for TFM application?
Rate = 2-3 cycles per second, applied in rhythmical manner Amplitude = sufficient to cover all the affected tissue
What are the three types of fascia?
Superficial = just below the dermis Deep = surrounds/infused with muscle, bone, nerve, blood vessels, organs Deepest = dura of CNS/brain
What are techniques used for MFR?
J-Stroke (to increase skin mobility)
Vertical Stroke (to open length of vertical fascia)
Transverse Stroke
Cross-Hands Technique (for deep fascia release)
How is STM performed?
Superficial layers are treated prior to deep layers, and force is applied in the direction of maximum restriction
What is STM useful for?
Reducing muscle spasms and promoting pain reduction
How is sustained pressure performed?
Force applied to center, exact depth, direction and angle of maximal restriction. Apply clockwise/counterclockwise force while maintaing pressure.
How does ischemic compression work?
Works by depriving trigger points of oxygen with a constant pressure for 8 - 12 seconds, rendering them inactive which breaks the pain-spasm cycle
What is the basis of acupressure?
Based on shiatsu and acupuncture. A manual pressure over acupuncture points improves flow of body’s Qi.
Teh Chi
Subjective feeling of fullness, numbness, tingling and warmth with some local soreness and a feeling of distension around acupuncture point
What are METs a combination of?
Passive mobilizations, muscle reeducation and therapeutic exercise
What are METs used to treat?
Joint mobilization, strengthening muscle and stretching muscle/fascia
Strain-Counterstrain
Moving into direction of restriction and holding for 90-120 seconds
Functional Techniques
Moving into the opposite direction of the restriction
Craniosacral Therapy
Idea that misalignments, immobility, restrictions of cranial sutures and tension of intracranial meninges impact health of an individual
Evidence-based indications for Joint Mobilizations
- increased joint ROM
- decrease pain
- promote muscle relaxation
- improve muscle performance
Benefits of Joint Mobilizations
- restore articular relationship
- decrease pain
- decrease muscle guarding
- lengthen the tissue around a joint
- N/M influences on muscle tone
- increase proprioceptive awareness
Kaltenborn Technique
3 grades of traction
Grade I = Piccolo (loose), no separation of surface
Grade II = Slack, separates surfaces
Grade III = Stretch, stretched joint capsule to increase mobility
Maitland/Australian Techniques
5 grades of mobilization
Grade I = small amplitude technique beginning ROM
Grade II = large amplitude in middle ROM
Grade III = large amplitude end ROM
Grade IV = small amplitude end ROM
Grade V = movement exceeding resistance barrier (high-velocity thrust)
High-Velocity Thrust Technique
Fast impulse of small amplitude force beyond end-feel, can be applied perpendicular or parallel
Contraindications to Locking Techniques
Patient can’t relax, pediatric, PMH of: bone-weaking conditions, conditions creating hypomobility, condition involving joint fusion, condition involving chemo/radiation
Contract-Relax
Bring into end ROM, isometric contraction of muscle being stretched for 2-5 seconds, relax, new ROM
Agonist Contraction
Move limb into gentle stretch and ask patient to contract opposite muscle being stretched, hold 2-5 seconds, repeat 2-4 times
