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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
Q

recent trauma, hypermobility, grade 2 muscle tears will result in what kind of end feel?

A

spasm!
reflex mm contraction due to nociceptor irritation

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26
Q

acute sub-deltoid bursitis or sign of buttock end feel

A

EMPTY PAIN

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27
Q

If someone has an empty end feel (pain), what technique?

A

NONE

28
Q

if end feel is spasm, what technique?

A

NONE

29
Q

If end feel is capsular, and impairment is pain, what technique should be done?

A

oscillation mobs 1-2

29
Q

If end feel is early capsular, and impairment is adhesions, what technique?

A

sustained mob (3)
oscillation mob (3-4)

30
Q

If end feel is early elastic, and impairment is muscle adhesions, what technique

A

passive stretchingI

31
Q

If impairment is bone, end feel is bony, technique?

A

NONE

32
Q

joint pain less than 3 days old:
what manual technique should you use?

A

Grade 1-2 (acute!) mobilization or MET (not HVLAT)

33
Q

injury is 3 days-3 months old…what manual technique should you use?

A

MET!
Grade 2-3 joint mobs
If MET doesn’t work, then use HVLAT (mod-strong indication)

34
Q

If injury is chronic (over 3 months), what manual technique should you use?

A

grade 3-4 joint mob
MET!!! and also HVLAT
HVLAT: strong indication if MET doesn’t work

35
Q

grade 1 joint mobilization

A

small amplitude (0-25%)
*motion from 0 to 1st tissue resistance

USE WITH PAIN

36
Q

grade 2 joint mobilization

A

*large amplitude (25-75% or mid-50%)
in middle of joint play: get mechanoreceptors to turn on, calm Nervous system down!

37
Q

grade 3 joint mobilization

A

*large amplitude (50-100%)
*end of joint play to 2nd tissue resistance!

38
Q

grade 4 joint mobilization

A

*small amplitude (75-100%)
at end of joint play to tissue resistance

PAIN CANNOT BE THE ISSUE

39
Q

grade 5/HVLT

A

quick movement exceeding 2nd tissue resistance!

40
Q

joint sustained mobilizations

A

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
Q

when should you do a sustained joint mob?

A

hypomobility!
6+ seconds of hold, release partially, repeat as tolerated

42
Q

pain dominant condition of joint hypomobility: which grades?

A

oscillatory grade 1 and 2 to DECREASE PAIN

43
Q

stiff dominant condition of joint hypomobility: which grades?

A

grade 3-4 OR sustained grades to INCREASE MOBILITY

44
Q

target specified HVLAT
is designed for what?

A

apply passive/assisted mvmt towards 1 specific functional unit
*1 spinal segment or joint

45
Q

how should you position the joint in target specified HVLAT?

A

pre-position to allow PT to feel 2nd tissue resistance point with combo of mid-range positions

46
Q

generalized HVLAT is designed for what?

A

isolate a thrust to a specified REGION (multiple spinal segments)
*less pre-positioning, force directed through long level arms

47
Q

soft tissue mobilizations address what structures?

A

muscles
tendons
ligaments
fascia
veins/lymph structures

48
Q

what is the goal of soft tissue mobilization?

A

increase tissue length
break up scar tissue and adhesions
remodel collagen fibers
increase circulation, venous function, lymph function, DECREASE PAIN

49
Q

manual therapy indications

A

MSK pain mild, low irritability, pain with motion, relieved with rest…

50
Q

when should you NOT PERFORM MANUAL THERAPY?

A
  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
Q

when should you also not do manual therapy? precautions

A
  1. RA
  2. joint inflammation
  3. neuro signs
  4. osteoporosis
  5. pregnancy
  6. dizziness
  7. steroids/anti-coag therapy
51
Q

3 goals of manual therapy treatment

A

PAIN, MOBILITY, FUNCTION
1. reduce pain
2. increase mobility
-return normal mobility
-correct weak/imbalance mm
-stabilize
-restore control of mvmt

  1. education: prevent reoccurence, restore well being/confidence
52
Q

how should you choose the appropriate treatment?

A
  1. impairment
  2. end feel
  3. stage of condition
  4. irritability
53
Q

What is adverse neural tension?

A

abnormal response from nervous system (when squashed, stretched, cut, tissue adhesions)
*LIMITS RANGE of nerve
*SYMPTOMS through available range

54
Q

3 tension sites on spinal cord where dura is tethered to a bony canal

A

C6
T6
L4

55
Q

proposed mechanisms of nerve injury

A
  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
Q

If you suspect nerve involvement
*pain, paresthesias, spasms
then do these tests…

A

Nerve tissue provocation tests NTPT

57
Q

3 signs of a positive neural tension provocation test

A
  1. reproduce symptoms
  2. change distant body part
  3. differences L vs R
58
Q

What are the 3 upper limb tension tests?

A
  1. ULTT median
  2. ULTT radial (pronation, wrist flexion)
  3. ULTT ulnar
59
Q

DF, eversion and toe extension is SLR sensitizer of what nerve

A

tibial nerve

59
Q

DF, inversion is SLR sensitizer for what nerve

A

SURAL

60
Q

PF, inversion is SLR sensitizer for what nerve?

A

common fibular nerve

61
Q

what are contras for neurodynamic mobs?

A
  1. recent nerve repair
  2. tumor
  3. active inflammatory conditions
  4. neuro: acute inflammatory demyelinating diseases
62
Q

other contras for neurodynamic mob

A
  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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