Clinical Reasoning, Manual Therapy and Concept of Healing Flashcards
Subjective Examination (Anamnesis) - Definition
Thorough and detailed subjective history and review of systems. To provide adaptable treatment depending on the patient.
What information must be gathered for a subjective examination?
- Body chart (gender, height, weight, age)
- Location, quality, severity, irritability, and behavior of a patient’s symptoms
- Aggravates/Eases
- Functional incapacity: Professional life, personal life (daily activities/leisure…). What’s the most prominent change due to the pain (blue/black flags).
- Patient’s history of present pain: Nature of injury / pain / problem. How did it happen? Since when? Phase of healing. Acute, subacute, recurrent, chronic? Natural evolution of condition. AM/PM and 24 hour pain.
What questions must be asked at the end of the subjective examination?
Suspicion of a serious condition that needs referral? Suspicion of psychometric factors that might interfere with the treatment outcome?
Objective Examination
- Guided by subjective examination (hypothesis, do the features fit? relevant to present condition).
- Patient centered (concordant sign: pain or symptom for which the patient is seeking physical therapy).
- Screening examination (proximal to site of symptom, link with distal symptom?, A.ROM - overpressure, spring test).
- Region specific examination (narrowing on concordant vs. disconcordant sign, how specific movement affect symptom).
Objective Examination - Tests
A.ROM (physiological movement, quality?, quantity?)
P.ROM (physiological movement, accessory movement, end-feel).
Specific tests (Pain provocation, neurodynamic, muscular, neurological).
Rules of Application of Joint Mobilization Treatment
• Patient should be relaxed
• Explanation of the purpose of the treatment
• Comfortable room temperature with patient properly draped
• Remove watches and jewelry
• Secure ties, belt buckles, etc.
• Start in a resting position and then “chase” end range
• Allow gravity to assist to Avoid muscle guarding
• Large surface area of hand contact (confident, firm and
comfortable hand holds)
• Short lever arms and hands as close to joint as possible
Absolute Contradictions
- Malignancy in area of treatment
- Infectious arthritis
- Metabolic bone disease
- Neoplastic disease
- Fusion or ankyloses
- Osteomyelitis
- Fracture or ligament rupture
- Herniated disc with nerve compression
- Hypermobile joint for grade III and IV
Relative Contradictions
• Excessive pain or swelling • Arthroplasty • Pregnancy • Hypermobility • Spondylolisthesis • Rheumatoid arthritis • Vertebrobasilar insufficiency When in doubt, don´t do it
Manual Therapy - Definition
'’Hands-on’’ treatment. May include joint mobilization, manipulation, muscle stretching, passive movements of affected body part, patient moving body part against resistance to improve muscle activation and timing. Selected specific soft tissue techniques to improve mobility and function of tissue and muscle.
Manual Therapy - James Cyriax
tension techniques, soft-tissue massage
Manual Therapy - Freddy Kaltenborn
techniques incorporate the influence of muscle function
and soft-tissue changes, techniques are eclectic and very specific.
Manual Therapy - Geoffrey Maitland
uses passive accessory movements to restore function,
history of the patient and objective assessment, oscillations
Manual Therapy - James Mennell
joint play is the key, small accessory movements
Manual Therapy - Stanley Paris
incorporates both chiropractic and osteopathic orientations.
Manual Therapy Techniques
- Mobilisation!
- Massage!
- Soft-tissue mobilisation
- Neural mobilisation
- Trigger point release
- Myofascial release
- Proprioceptive neuromuscular facilitation
- Manual resistance
- Stretching
- Stabilisation
Joint Mobilization - Definition
A manual therapy technique.
“skilled” passive movements at the joint complex, applied at varying speeds and amplitudes. May include small amplitude/high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function and/or reduce pain.
What is the goal of joint mobilization?
Restore function and reduce pain.
Joint Mobilization vs. Manipulation
- Joint mobilization is on a continuum with manipulation
- Both involve passive movements
- Mobilization is under patient´s control
- Manipulation is done at a speed where the patient cannot stop the motion (!)
Physiological Joint Motion
Movement that patient can do voluntarily and can be analyzed for quantity, quality and symptom response.
Accessory Motion
Necessary for normal joint motion but cannot be voluntarily performed or controlled.
Roll, spin and slide (convex or concave rule).
Examined passively to assess range and symptom response in the open pack position of a joint.
Primary Healing
Separation of tissue is small, stump ends are close, bridge of cells binds ends together. Example: surgical incision.
Heals faster.
Secondary Healing
Severe wounds, stump ends far apart, cannot be bridged by single cells, production of cells from the bottom. Example: second-degree sprain.
Can we treat patients with inflammation?
Yes! if the patient does not have fever or other symptoms of infection.
Signs of inflammation
Pain, swelling, redness, heat, function reduction.
