Lecture 4

Question 1

A patient presents with limited ROM and neck pain at the end ranges of AROM and PROM. What am I thinking is wrong with them

Answer 1

Neck pain w/ mobility deficit

NOTE: They would also feel stiff / pain with PIVM testing (im pushing and litteraly hitting stiffness / pain)

Might also have neck muscle weaknes as well

Question 2

KNOW: If i can poke something central and it brings on something distal that should really make me think that the pain is coming from that central area

Question 3

If there are no red flags in the neck do we need imaging?

Answer 3

No

It might even make things worse. Imagine they had arthritits int heir neck and didnt even know it. The neck pain that just started to days ago is not because of that but now they’re thinking about it.

Question 4

Why would you do throacic manipulation of someone with acute neck pain with mobility deficits instead of cervical manipulation?

Answer 4

Because they proably don’t want you touching their painful area, so if you can mobilize a lower segment is might free up the higher one.

Note, this neck pain has stiffness and pain and this intervention might address both of those. (think stiff neck being unlocked) –> this is why acute is so good. Manipulation = great for a quick fix in the acute phase

Question 5

Is manipulation/mobilization a good fix for acute or chronic issues? Why?

Answer 5

Acute

Because you can just pop it back into place and quickly fix the issue. But if its chronic they might’ve been babying the area and caused all kinds of other problems.

However, it can be used for both - just a quicker fix for acute

Question 6

KNOW: ROM / Isometrics are absic pain inhibitors. Typically done w/ acute patients

Question 7

A patient with subacute neck pain w/ mobility deficits comes into your clinic. He resieves cervical and thoracic manipulation. Would adding ROM and isometric exercise or adding cervicothoracic edurance exercise be a better bet ofr his plan of care? Why?

Answer 7

Cervicothorcic endurance exercise. Doing the ROM / isometric isnt bad for reducing pain to satrt the exercise, we really want to get that exercise in because thats the best way to see results.

ROM / Isometric are basic pain inhibitors (good for acute).

NOTE: for chronic he added “supervised exercises” I’m not sure why its specifically endurance for sub acute

Question 8

Should chronic neck pain patients be coached to stay active?

Answer 8

Yes

Question 9

Is patient education an intervention for acute, subacute, or chorinic neck pain w/ mobility deficits?

Answer 9

All

Question 10

Is thoracic / cervical manipulation an intervention for acute, subacute, or chronic neck pain patients w/ mobility deficits?

Answer 10

All

Question 11

Which two grades of mobilization / manipulation are oscillatory (going up and down)

Answer 11

1 and 4

Question 12

are slow or fast ossilatory forces more tollerable for pts?

Answer 12

Slower (Push longer, take a second - dont rhythmically do it super fast)

Question 13

What does a grade 1 mobilization/manipulation look like?

Answer 13

Small amplitude rhythmic oscillating mobilization near starting position of range (basically saying press up and down fast but not deep at all)

Question 14

Explain a grade 2 mobilization / manipulation

Do we push into muscle stifness here?

Answer 14

Large amplitude rhythmic oscillating mobilization in mid range of movement (not pushing terrible long but pushing for a longer amount of time)

NOTE: we don’t want to go into stifness or msucle guarding here

Question 15

What is a grade 3 mobilization / manipulation?

Do we move into muscle stiffness / muscle gaurding

Answer 15

Lrage amplitude w/ rhythmic oscillating mobilization in mid-range of movement up to limit of range and movving into stifness / muscle guarding

Yes

Question 16

Explain a grade 4 mobilization / manipulation?

Do we move into muscle guarding / stifness here

Answer 16

SMALL amplitude (lots of little pushes) rhythmic oscillating mobilization at end-range of movement

Just like grade 3 we move into muscle stiffness / guarding.

Question 17

KNOW: A grade 5 mobilization / manipulation is high velocity low amplitude thrust - within or at end of range of motion

Question 18

What is normal oscilation frequency for non thrust manipulation?

What is the duration?

Answer 18

2 Hz / sec (120 / min)

30-60 seconds

Question 19

another name for muscle energy techniques (MET) is

Answer 19

Isometrics contractions (pushing into resistance)

Question 20

What is direct isometric manipulation?

Answer 20

Toward the resistance (pushing into pain)

EX: if your neck hurts you turn to the point of pain (directly to pain), back off a little then push into that direction of pain

Question 21

What is indirect isometrics

Answer 21

Going away from pain and holding isometrically

“since your neck pain is on your left im going to have you turn to your right (away from pain). Turn to right and resist isometrically (therpaist)

Question 22

For a patient w/ high irritability do we utilize direct or indirect isometrics? (test)

Answer 22

Indirect - we don’t want to push them directly into that pain causing a flare up.

NOTE: Muscle spindles on the opposite (with pain) are still firing w/ sensing this stretch - letting the muscles on the opposite side still get some action without flaring them up.

Question 23

KNOW: 50% of rotation comes form C1-3

Question 24

Does stretching deform muscle (making physiological changes)

Answer 24

No, its a neurological inhibition (stretching golig tendon / muscle fiber to relax everything back and getting it moving again)

Question 25

KNOW: so you everything you do manual theraoy wirse, we should follow up with some exercise to maintain those gains

For instance w/ the neck isometric example. We could follow up those neck isometrics (that loosened his neck up) with arc like movement. Go to pain on painful side then go into full ROM on opposite side. This is tehcnically an exercise we can pick for this scenerio

Question 26

how often shoulder strecthing be done?

Answer 26

2-3 times per week (minimum)

Question 27

How intense should streches be?

Answer 27

result in feeling tightness or slight discomfert

Question 28

How long should stretches be held

Answer 28

10-30 seconds

Question 29

How much strteching should we due per exercise? How much can we split it up

Answer 29

60 seconds fo total stretching for each stretching exercise by means of repetition of exercises two to four times (meaning we could split it up and do 15 seconds per exercise 4 times)

Question 30

KNOW: Hurt does not = harm w/ stretching and pain does not = damage