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FALL2 MSK > LECTURE 1B: MANUAL THERAPY > Flashcards

LECTURE 1B: MANUAL THERAPY Flashcards

1
Q

What are manual therapy techniques for?

A

*help with pain
*decrease restrictions

skilled passive/hand movements of joints/soft tissue that….
*help with ROM, tissue extensibility, relaxing, mobilization of soft tissue/joints, decrease swelling and inflammation

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2
Q

passive technique designed to restore full painless JOINT FUNCTION
using rhythmic, repetitive, passive movements

A

mobilization

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3
Q

accurately localized/globally applied single, quick, decisive movement of SMALL AMPLITUDE, following careful positioning of patient

A

manipulation

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4
Q

manually assisted method of stretching/mobilization where patient actively uses his/her muscles, on request, while maintaining targeted preposition against distinctly executed counterforce

A

muscle energy technique

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5
Q

passive technique that consists of rhythmic, repetitive passive movement to patient’s tolerance in voluntary and/or accessory ranges, performed with active movement of the patient at the same region

A

passive mobilization with an active movement

(ART, MWM)

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6
Q

what is a mobilization?

A

passive technique
rhythmic, repetitive movements
varied amplitudes
WITHIN PATIENT TOLERANCE

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7
Q

what is a manipulation?

A

passive technique
single, quick, decisive movements
small amplitude
careful patient set up, but *not always safe on patient

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8
Q

difference between mob and manip

A
  1. mob is rhythmic/repetitive vs. manip: single, quick/decisive movement
  2. mob: varied amp, manip: small amp
  3. mob: takes longer to reach goal of full ROM, manip: not always safe
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9
Q

What is the biomechanical/pathological method?

A

WORKS WELL FOR Surgical patients
1. biomechanical theories assess abnormalities
2. treatments target arthrokinematic principles
3. relationship btwn anatomy and pathology to determine whats wrong

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10
Q

What is the patient based response method of manual therapy?

A
  1. addresses pain repro and reduction with movement
  2. does not rely on biomechanical model for diagnosis
  3. rely on assessment findings to determine treatment
  4. treatment techniques are similar to assessment method (reproduce patient’s pain, then apply movement to increase ROM and/or decrease symptoms)
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11
Q

what is the hybrid method of manual therapy assessment?

A

use both biomechanical AND patient response

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12
Q

what are the 2 mechanical hypothesized effects of manual therapy?

A
  1. improved movement
  2. improved position
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13
Q

What are neurophysiological effects of manual therapy?

A
  1. ANS: HR, BP, skin conductance
  2. SC: inhibit pain receptors (non-localized effect on vitals and muscle relaxing)
  3. CNS: altered pain, inhibits mechanical nociception through gate control theory
  4. PNS: decreased inflammatory mediators at local site
  5. temporal: lasts 20-30 min-need to back up with exercises to maintain/improve motion and strength
  6. placebo
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14
Q

Reinforce manual therapy with exercises since gains only last how long?

A

20 min-48 hours

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15
Q

manipulation is a passive technique ___normal range of motion

mobilization is a passive technique or combined passive/active ___normal range of motion

A

manip: BEYOND
mob: WITHIN

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16
Q

active assisted technique within or beyond normal ROM

A

muscle energy technique

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17
Q

knee extension is a ___ end feel

A

hard capsular end feel

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18
Q

elbow extension is a ____ end feel

A

hard bony end feel

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19
Q

wrist flexion and finger flexion: ___ end feel

A

elastic (mm-tendon unit)

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20
Q

elbow flexion in muscle-y people end feel

A

soft tissue approximation

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21
Q

wrist flexion end feel

A

soft capsular

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22
Q

elbow flexion end feel in supination

A

medium capsular end feel

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23
Q

knee flexion/extension with displaced meniscus is what kind of end feel

A

springy
(rebounding intra-articular meniscus or disk)

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24
Q

hemarthrosis at knee is what kind of end feel?

A

boggy (viscous fluid within joint)

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25
recent trauma, hypermobility, grade 2 muscle tears will result in what kind of end feel?
spasm! reflex mm contraction due to nociceptor irritation
26
acute sub-deltoid bursitis or sign of buttock end feel
EMPTY PAIN
27
If someone has an empty end feel (pain), what technique?
NONE
28
if end feel is spasm, what technique?
NONE
29
If end feel is capsular, and impairment is pain, what technique should be done?
oscillation mobs 1-2
29
If end feel is early capsular, and impairment is adhesions, what technique?
sustained mob (3) oscillation mob (3-4)
30
If end feel is early elastic, and impairment is muscle adhesions, what technique
passive stretchingI
31
If impairment is bone, end feel is bony, technique?
NONE
32
joint pain less than 3 days old: what manual technique should you use?
Grade 1-2 (acute!) mobilization or MET (not HVLAT)
33
injury is 3 days-3 months old...what manual technique should you use?
MET! Grade 2-3 joint mobs If MET doesn't work, then use HVLAT (mod-strong indication)
34
If injury is chronic (over 3 months), what manual technique should you use?
grade 3-4 joint mob MET!!! and also HVLAT HVLAT: strong indication if MET doesn't work
35
grade 1 joint mobilization
small amplitude (0-25%) *motion from 0 to 1st tissue resistance USE WITH PAIN
36
grade 2 joint mobilization
*large amplitude (25-75% or mid-50%) *in middle of joint play: get mechanoreceptors to turn on, calm Nervous system down!*
37
grade 3 joint mobilization
*large amplitude (50-100%) *end of joint play to 2nd tissue resistance!
38
grade 4 joint mobilization
*small amplitude (75-100%) at end of joint play to tissue resistance PAIN CANNOT BE THE ISSUE
39
grade 5/HVLT
quick movement exceeding 2nd tissue resistance!
40
joint sustained mobilizations
grade 1: loosen *no stress on capsule grade 2: take up slack *distraction force to separate joint surfaces grade 3: stretch *large distraction force to stretch capsule and soft tissue
41
when should you do a sustained joint mob?
hypomobility! 6+ seconds of hold, release partially, repeat as tolerated
42
pain dominant condition of joint hypomobility: which grades?
oscillatory grade 1 and 2 to DECREASE PAIN
43
stiff dominant condition of joint hypomobility: which grades?
grade 3-4 OR sustained grades to INCREASE MOBILITY
44
target specified HVLAT is designed for what?
apply passive/assisted mvmt towards 1 specific functional unit *1 spinal segment or joint
45
how should you position the joint in target specified HVLAT?
pre-position to allow PT to feel 2nd tissue resistance point with combo of mid-range positions
46
generalized HVLAT is designed for what?
isolate a thrust to a specified REGION (multiple spinal segments) *less pre-positioning, force directed through long level arms
47
soft tissue mobilizations address what structures?
muscles tendons ligaments fascia veins/lymph structures
48
what is the goal of soft tissue mobilization?
increase tissue length break up scar tissue and adhesions remodel collagen fibers increase circulation, venous function, lymph function, DECREASE PAIN
49
manual therapy indications
MSK pain mild, low irritability, pain with motion, relieved with rest...
50
when should you NOT PERFORM MANUAL THERAPY?
1. infection (local or systemic) RA, osteomyelitis, fever, cellulitis 2. acute circulatory condition 3. tumor (constant, severe pain) 4. hematoma=bruise 5. recent fracture 6. open wound/sutures 7. advanced DM 8. skin is super sensitive 9. inappropriate end feel 10. extensive pain radiating
50
when should you also not do manual therapy? precautions
1. RA 2. joint inflammation 3. neuro signs 4. osteoporosis 5. pregnancy 6. dizziness 7. steroids/anti-coag therapy
51
3 goals of manual therapy treatment
PAIN, MOBILITY, FUNCTION 1. reduce pain 2. increase mobility -return normal mobility -correct weak/imbalance mm -stabilize -restore control of mvmt 3. education: prevent reoccurence, restore well being/confidence
52
how should you choose the appropriate treatment?
1. impairment 2. end feel 3. stage of condition 4. irritability
53
What is adverse neural tension?
abnormal response from nervous system (when squashed, stretched, cut, tissue adhesions) *LIMITS RANGE of nerve *SYMPTOMS through available range
54
3 tension sites on spinal cord where dura is tethered to a bony canal
C6 T6 L4
55
proposed mechanisms of nerve injury
1. posture (shortening) 2. direct trauma (adhesions/damage) 3. extreme motions (traction) 4. electrical injury (1/4 electrocuted pts) 5. compression (mm contraction, tight fascia, neoplasms, bony protuberances)
56
If you suspect nerve involvement *pain, paresthesias, spasms then do these tests...
Nerve tissue provocation tests NTPT
57
3 signs of a positive neural tension provocation test
1. reproduce symptoms 2. change distant body part 3. differences L vs R
58
What are the 3 upper limb tension tests?
1. ULTT median 2. ULTT radial (pronation, wrist flexion) 3. ULTT ulnar
59
DF, eversion and toe extension is SLR sensitizer of what nerve
tibial nerve
59
DF, inversion is SLR sensitizer for what nerve
SURAL
60
PF, inversion is SLR sensitizer for what nerve?
common fibular nerve
61
what are contras for neurodynamic mobs?
1. recent nerve repair 2. tumor 3. active inflammatory conditions 4. neuro: acute inflammatory demyelinating diseases
62
other contras for neurodynamic mob
1. irritable conditions 2. spinal cord signs 3. nerve root signs 4. severe night pain 5. recent anesthesia, parasthesias 6. mechanical spine pain with peripheralization of symptoms

FALL2 MSK (18 decks)

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