lecture 7 - principles of manual therapy

Question 1

manual therapy

Answer 1

• joint mobilisations and manipulation
• soft tissue massage/therapy
• myofascial release
• trigger point therapy

Question 2

Why use manual therapy

Answer 2

1. reduce pain
   - neurophysiological mechanisms
   - receive muscle spasm/improve muscle relaxation
   - facilitate tissue healing
2. reduce stiffness
   - increase joint ROM
   - reduce reflex muscle facilitations
   - increase tissue extensibility
   - facilitate movement

Question 3

Potential mechanisms

Answer 3

Biomechanical - restore normal joint movement and muscle recruitment patterns

Neuromuscular - Decreased Motor Neurone excitability, muscle spasm, ischemia

Neurophysiological - Activate descending inhibition from brain (release inhibitory transmitters)

Question 4

Joint mobilisation

Answer 4

Passive physiological (PPM) and accessory (PAM)

Question 5

Grades of mobilisation

Answer 5

I - small amplitude movement performed at beginning of range

II - Large amplitude movement performed within free range not moving into any resistance or stiffness

III - large amplitude movement performed up to the limit of range

IV - small amplitude movement performed at the limit of range

V - High velocity, small amplitude movement performed at the limit of range

Question 6

Joint mobilisation in spine

Answer 6

PA on spinous process or transverse process

• thumbs Gr I-II
• Pisiform Gr III-IV

Question 7

Joint manipulation

Answer 7

Grade V - high velocity, low amplitude thrust

- sudden movement or thrust of small amplitude performed at high speed at the end of joint range

Question 8

Soft-tissue techniques

Answer 8

1. Soft tissue massage
2. Myofascial release
3. Trigger point therapy

Question 9

Effleurage

Answer 9

Stroking form of massage that can be superficial or deep

Question 10

Petrissage

Answer 10

Can be kneading, picking up, wringing, and rolling techniques

Question 11

Myofascia

Answer 11

collagenous-based soft tissue that covers, separates and protects skeletal muscle

Fibroblasts respond to pressure and tension in the myofascia by laying down collagenous fibres in the direction of strain

Question 12

Myofascial release

Answer 12

Position: target tissue in a position of stretch

Technique: apply tensile force with the thumb, fingers, knuckles, forearm in direction of tissue restrictions

Question 13

Possible mechanisms of myofascial release

Answer 13

Potentially rupture the abnormal cross-linkages between collagen fibres

Stimulate fibroblast synthesis of collagen and increase inter-fibre distance

Question 14

Myofascial trigger points

Answer 14

Hyper-irritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to the characteristic referred pain, motor dysfunction, and autonomic phenomena

Question 15

Treatment for trigger points

Answer 15

• pressure-release tecnique
• contract-relax with pressure
• self treatment
• dry needling
• vapocoolant spray + stretch