Intro to Manual Therapy Flashcards
a passive mvmt performed by PT at various speeds and amplitudes
mobilization/manipulation
4 types of mobilization/manipulation
- oscillatory
- sustained
- manip
- mob w/ mvmt
3 types of passive ST mob
friction massage
Instrument assisted STM (grastin)
positional release
3 types of active ST mob
contract-relax
reciprocal inhibition
muscle energy
what is the purpose of neural tissue mob
improve mobility of dura mater, n roots or peripheral n
what are the 4 functional classificaitons of synovial joints
- unmodified ovoid
- modified ovoid
- unmodified sellar
- modified sellar
how many DOF does an unmodified ovoid joint have?
list some examples
3DoF
- ball and socket, triaxial
- hip and shoulder
how many DoF does a modified ovoid have?
examples
2 DoF
- ellipsoid, biaxial
- MCP joints
How many DoF does an unmodified sellar joint have
examples?
2 DoF
saddle, biaxial
1st CMC
how many DoF does a modified sellar joint have?
examples?
1 DoF
hinge, uniaxial
IP and elbow joint
what are the 2 types of accessory motions
component and articular/arthrokinematic
motions accompany active motion but not under voluntary comtrol
component/coupled motion
motions that occur b/w joint surfaces
articular/arthrokinematic/accessory motions
new points on one joint surface meet new points on another surface when joint surfaces are incongruent
roll
one bone segment rotates around a fixed axis
spin
one joint surface moves across another so the same point on one surface always contacts a new point on the other surface
glide/slide
2 joint surfaces approximate each other
compression
2 joint surfaces are separated
distraction
position when the peri-articular structures are most lax and allowing the greatest motion
resting / open-packed position
what do we use the open-packed position for
- evaluate joint play and end feel
- relaxation, stretch and joint mob
joint position when the capsule and ligaments are the tightest with maximal contact b/w joint surfaces
close-packed position
what do we use close-packed position for
stabilize the joint, test ligament integrity
a plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface
treatment plane
traction and compression is applied in a direction that is ______ to the treatment plane
perpendicular
glides are performed in a direction that is _________ to the treatment plane
paraller
what 2 effects are we attempting to generate when we mobilize or manipulate
- neurophysiological effects
- mechanical effects
5 indications of joint mob/manip
- decrease pain, m guarding/spasm
- reversible joint hypomobility
- positional fault (sublux)
- progressive limitation
- functional immobility
what is the #1 contraindication of manual therapy
pt denies treatment
what 2 end feels can not have manual therapy
empty end feel
spasm end feel
caution or contraindication for manual therapy?
- bone disease
- acute RA episode
- joint effusion
- active inflammation
contraindication
lumbar root signs of ______ or cervical root signs of ____ are contraindications to manual therapy
lumbar >/= 3
Cervical >/= 2
what ligament instability is a contraindication to manual therapy
craniovertebral (transverse) ligament
what end feel is a caution to manual therapy
springy
caution or contraindication to manual therapy?
- paresthesia with strong pain
- no local symptoms
- primary posterolateral protrusion
- joint pain from isometric testing
caution
caution or contraindication to manual therapy?
- osteoporosis
- neurological signs
- spondylolisthesis
- acute signs and symptoms
- pregnancy
cautions
is repeated steroid use a contraindication or a caution to manual therapy
caution - weakens the CNT
how do we describe joint mobilization/manipulation?
7 categories
- type of mobilization
- grade of mobilization
- location in range of available mvmt
- direction of force
- target of force
- pt and PT position
- duration of mobilization
what are the 3 types of mobilizations?
what does this refer to?
- rate of force
- oscillation, sustained, thrust
small amplitude rhythmic oscillation performed at the beginning of available range
grade 1 oscillation
large amplitude rhythmic oscillations performed within the range, not reaching the limit
grade 2 oscillation
large amplitude rhythmic oscillation performed thru the available range and into the resistance
grade 3 oscillation
small-amplitude rhythmic oscillations performed at the limit of available range and into the resistance
grade 4 oscillation
why do we use grade 1 and 2 oscillation
relieve pain in acute/sub-acute stage
why do we use grade 3 and 4 oscillations
maintain and increase joint mobility
which sustained technique is considered “loosening”
grade 1
small amplitude traction, no stress applied to the capsule, nullifies normal joint compressive force
grade 1 sustained
which sustained technique is considered “tightening or taking up the slack”
grade 2 sustained
enough traction or glide to tighten the tissue around the joint
grade 2 sustained
which sustained technique is considered “stretching”
grade 3
- a large traction or glide places a stretch on the joint structures
grade 3 sustained
why do we use grade 1 sustained technique
- relieve pain with oscillation
- m relaxation
why do we use grade 2 sustained technique
- relieve pain
- m relaxation
** test joint play traction and glide mvmts - increase and maintain joint mobility
why do we use grade 3 sustained technique
- test joint play end-feel
- increase joint play
massive mvmt using physiological or accessory motions
manipulation
2 types of manipulation
thrust and manip under anesthesia
how is a thrust manipulation performed
with high velocity, small amplitude motion
why is manip under anesthesia used?
when pts have contractures or conservative tx fails
in the Kaltenborn convex-concave rule for directions of mobilizations,
convex is in the ______ direction and
concave is int the ______ direction
convex - opposite
concave - same
what is the most important joint mobilization rule?
both pt and PT should be relaxed
9 joint mobilization rules
- pt Supported
- Relaxed
- Stabilize one and Mobilize the other
- Uninvolved comparison
- Stop if painful
- hands close to the joint
- Loose packed position
- work with gravity
which traction/glide is used to assess joint motion
grade 2
what progression of manual therapy is used to relieve pain
- sustained grade 1 or 2 manual traction
OR - grade 1 and 2 short amplitude oscillation
what progression is used to maintain or increase joint motion
grade 2 traction and glide mob in resting –> grade 3 in resting –> grade 3 at end range
simultaneous application of therapist applied accessory mob and pt generated active mvmts
mobilization with mvmt
what type of MWM is used for the spine
SNAGS (sustained natural apophyseal glides)
when is MWM indicated
to increase function and decrease pain
where can SNAGS be applies
cervical, thoracic and lumbar spine
what is the purpose of deep transverse friction
- maintain or restore mobility of CNT
- produce motion of damaged tissue over sm area
what are the 3 desired effects of deep transverse friction
- traumatic hyperemia
- mechanical
- temporary analgesia
what is traumatic hyperemia
- increase in blood flow and reduction of inflammtion/pain
what are the mechanical effects of deep transverse friction
- improve motion b/w fibers
- prevent cross link, stretch apart adhesion
how does deep transveres friction create a temporary analgesia
stimulates type 1 and 2 mechanoreceptors
3 indications of DFM
- acute or subacute partial tears of ligament, tendon or m
- adhesion in ligament or m or b/w tissues
- pre-treatment to manip or strong stretch
7 contraindications of DFM
- hyper-acute inflammation
- recent hematoma
- arterial insufficiency
- bleeders
- multiple injection of cortisone, LT steroid
- open would
- uncontrolled diabetes
how is contractile tissue placed for application of DFM
relaxed
how are tendons and ligaments placed for application of DFM
taut
manual procedure that involves the voluntary contraction of pt m in a precisely controlled direction at various level of intensity against a resistance applied by operator
muscle energy technique
what are the 2 types of MET techniques we use?
- post isometric relaxation
- reciprocal inhibition
for MET contraction, how long do you hold the contraction
8-10 sec
how long should you wait for isometric relaxation of MET
1-2 sec before moving to next barrier
myofascial release technique is a combo of what 3 things?
MET, craniosacral technique and ther ex
