Final - History of Mobilization

Question 1

Oldest statue or illustration of a manipulation

Answer 1

2500 BC Thailand

Question 2

Hippocrates

Answer 2

father of western medicine

massage is an effective therapy for treating injuries

Question 3

Galen

Answer 3

Greek physician
Influenced by Hippocrates
Treated Gibbus Deformity and Scoliosis

Question 4

Bonesetters

Answer 4

Practitioner of joint manipulation

Reduce joint dislocations and “re-set” bone fractures

Question 5

Sir Percival Pott

Answer 5

condemned traction and manipulation as useless and dangerous

Question 6

James Mennell

Answer 6

• Manipulation is best served by PTs

- used radiology to see what techniques achieved

Question 7

Thomas Marlin

Answer 7

• first published practitioner of specific joint manipulation
• Had sound understanding of the word arthrokinematics
• paid close attention to facet/joint planes

Question 8

James Cyriax

Answer 8

• UK
• laid claim to founding orthopedic medicine
• techniques use great force

Question 9

Cyriax’s Theory

Answer 9

• If back pain comes on rapidly and does not radiate down the leg, it is a torn disc that needs to be manipulated back into place
• if pain comes on gradually or radiates, it is a disc protrusion and needs to be suck back with manual or mechanical traction

Question 10

Freddy Kaltenborn, PT

Answer 10

• Father of Manual Therapy
• developed Kaltenborn-Evjenth approach
• emphasis on restoring the gliding component of the normal joint roll-gliding movement

Question 11

Geoff Maitland, PT

Answer 11

• approach focused on structured clinical reasoning, taking a thorough history in order to establish a comparable sign, focuses on pain
• comparable sign = pain or other symptoms reproduced upon physical exam that is indicated by the patient as their reason for seeking PT

Question 12

Mariano Rocabado

Answer 12

focused on the oral/facial system

Question 13

Robert Elvey

Answer 13

introduced neural tension concepts

Question 14

Brian Mulligan

Answer 14

Developed mobilization/manipulation with movement

Question 15

David Butler

Answer 15

further progressed neural tension techniques and restoring neurodynamic function

Question 16

Stanley Paris, PT

Answer 16

• voice of manual therapy
• Fonded IFOMPT and AAOMPT
  0-6 PIVM grading system

Question 17

APTA Definition of manual therapy

Answer 17

skilled hand movements intended to improve tissue extensibility, increase ROM, induce relaxation, mobilize or manipulate soft tissue and joints, modulate pain, and reduce soft tissue swelling, inflammation or restriction

Question 18

What constitutes manual therapy?

Answer 18

Massage
manual lymphatic drainage
manual traction
mobilization/manipulation
neural mobilization
joint stabilization
sef mobilization exercises
PROM

Question 19

APTA definition of Manipulation

Answer 19

Meaning a skilled passive movement to a joint and related soft tissues which includes both thrust and non-thrust

Question 20

Thrust definition

Answer 20

high velocity, low amplitude therapeutic movements within or at end ROM

Question 21

Do practice guidelines support the use of manipulation for acute and chronic LBP?

Answer 21

yes

Question 22

Manual therapy vs. no manual therapy

Answer 22

• improved outcome score
• improved pain score
• decreased cost of EOC
• improved neurophysiological effect of multifidus

Question 23

thrust manipulation vs mobilization

Answer 23

• no significant change in outcome/pain scores

- decreased sessions, decreased cost, decreased duration –> increased overall efficiency

Question 24

Does technique matter as much as we think?

Answer 24

no

the thrust itself may be all that is needed due to the effects of manipulation

Question 25

barriers that exist to mobilization/manipulation

Answer 25

- other health care professions dont always recognize PTs can perform manips - fear by PTs to learn manips/not trained - many people are involved for this to be the most effective (rapid scheduling is critical)

Question 26

Clinical Prediction Rule - LBP

Answer 26

- Duration of symptoms < 16 days - FABQ work sub scale 18 or less - Symptoms not distal to the knee - At least one hip internal rotation PROM > 35 - Hypomobility at one or more lumbar levels with spring testing

Question 27

Psychological Effects of Manips

Answer 27

- Laying on of skilled hands - Placebo - Demonstrates that movement is not painful - An immediate sound - "crack or pop" - immediate relaxation of tight musculature

Question 28

Mechanical Effects of Manips

Answer 28

- Reposition vertebra and joints - Stretch out or snap adhesions - Restore fiber glide within the capsule

Question 29

Neurological Effects of Manips

Answer 29

- Increases inflow of sensory information to the central nervous system - muscle spindle afferents are stimulated by spinal manipulation - smaller diameter sensory nerve fibers are likely activated - numerous studies show that spinal manipulation increases pain tolerance or its threshold

Question 30

Biochemical Effects of Manips

Answer 30

- very little is known about the chemical effects - however, clinically evident that when the spine is subjected to a series of manips at non symptomatic levels on normal subjects, they report "that feels good" lol - endorphin/enkephalin release

Question 31

Are thrust and non-thrust manips included in PT licensure exam?

Answer 31

Yep

Question 32

Is there evidence of higher claims losses due to PTs utilizing manipulative procedures?

Answer 32

nope

Question 33

What has excessive use of imaging been cited to do?

Answer 33

cause escalating health care costs

Question 34

Benefits of manips outweighs the risks as long as ...

Answer 34

clinical decision making is based on thorough examination and evidence based impairment based approach - screen for red flags - consider contraindications - modify techniques when appropriate

Question 35

Subjective indications for manips

Answer 35

- short duration of episodic pain - minor triggers - mild to mod pain intensity - mild to mod pain referral - maintains function although it may be modified

Question 36

objective indications for manips

Answer 36

- ROM limitation proportional to the pain intensity - no neurological signs or symptoms/mild referral - unidirectional restriction - joint hypomobility or restriction - jammed or pathomechanical end feel with joint glides - last few degrees of range limited or unobtainable by mobilization

Question 37

Contraindications of Manips

Answer 37

- local infection - inflammatory disease - active cancer - long term steroid use - osteoporosis - systemically unwell - hypermobility syndromes - connective tissue disease - RA/systemic arthritis - cervical anomalies - throat infections in children - recent manipulation by another health professional

Question 38

more contraindications for manips

Answer 38

- uncontrolled diabetes - cauda equina - pregnancy - bleeding disorders - unwilling patient - empty end feel - multi-level nerve root pathology - worsening neurological function - unremitting, severe, non-mechanical pain - unremitting night pain - relevant recent trauma - UMN lesion - spinal cord damage - symptom fabrication or severe amplification - hx or cancer

Question 39

risk factors associated with an increased risk of either internal carotid or vertebrobasilar arterial pathology

Answer 39

- past history of trauma to c spine/ cervical vessels - history of migraine type headache - hypertension - hypercholesterolemia/ hyperlipidemia - cardiac disease, vascular disease, previous CVA, TIA - diabetes mellitus - blood clotting disorder - anticoagulant therapy - long term use of steroids - hx of smoking - recent infection - immediately post partum - trivial head or neck trauma - absence of plausible mechanical explanation for the patients symptoms

Question 40

risk factors associated with the potential for bony or ligamentous compromise of the upper cervical spine

Answer 40

- hx of trauma - throat infection - congenital collagenous compromise - inflammatory arthrities - recent neck/head/dental surgery

Question 41

informed consent

Answer 41

- recommended that the disclosed of information and the obtaining of IC be recorded in pt's record - recommended to document each time pt receives a manipulation