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631: Clinical Management of the Musculoskeletal System I > Manual Tehniques > Flashcards

Manual Tehniques Flashcards

1
Q

What are 7 types of manual therapy?

A
  • Myofascial release (MFR)
  • Positional release techniques
  • Neurodynamic mobilization techniques
  • Manually resisted exercise
  • Proprioceptive neuromuscular facilitation (PNF)
  • Joint mobilization
  • Manipulation
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2
Q

The decision about which approach or technique to use has traditionally been based on what 3 things?

A
  • The clinician’s beliefs
  • Level of expertise
  • Clinical decision-making processes
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3
Q

The key to a great patient rehabilitation program is what?

A

the combination of manual techniques with other interventions such as progressive therapeutic exercise, NMR, therapeutic activities, modalities, and patient education about body mechanics, positions and postures

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4
Q

What are the 12 criteria for the correct application of manual therapy techniques?

A
  • Knowledge of the relative shapes of the joint surfaces
  • Convex/Concave rules
  • Duration, type and irritability of symptoms
  • Patient and clinician position
  • Position of joint to be treated (open-packed)
  • Clinician’s hand placement
  • Specificity (the exactness of the procedure based on its intent)
  • Direction and type of force
  • Amount of force
  • Reinforcement of any gains made
  • Reassessment is an integral part of any intervention, but especially MT
  • Assess the patient prior to the MT, perform the MT, then reassess post-MT to look for objective gains
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5
Q

The indication for selection of manual technique is based on what?

A

the duration of symptoms

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6
Q

When are muscle energy techniques strongly indicated?

A

During the acute and subacute phases

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7
Q

What types of mobilizations should be used during the acute phase? Subacute phase? Chronic phase?

A

Acute: grade I and II
Subacute: grade II and III
Chronic: III and IV

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8
Q

When are joint manipulations (grade V) indicated?

A

In the subacute and chronic phases if MET is ineffective

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9
Q

Repeated cross-grain massage that is applied to muscle, tendons, tendon sheaths and ligaments can be defined as what?

A

Transverse Friction Massage (TFM)

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10
Q

Transverse friction massage is utilized before performing a manipulation or a strong stretch for what reason?

A

To desensitize and soften the tissues

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11
Q

How does transverse friction massage relieve pain?

A

It stimulates type I and II mechanoreceptors and produces presynaptic anesthesia

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12
Q

If TFM is too vigorous in the acute stage what will occur?

A

the stimulation of nociceptors will override the effect of the mechanoreceptors, causing the pain to increase

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13
Q

How does transverse friction massage decrease scar tissue?

A

It assists with the orientation of the collagen in the appropriate lines of stress, and also helps to produce hypertrophy of the new collagen

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14
Q

During what stage of healing should TFM be applied and why?

A

In the early stages of a subacute lesion, so as not to damage the granulation tissue

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15
Q

What should the rate of TFM be?

A

at two to three cycles per second, applied in a rhythmical manner

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16
Q

A series of techniques designed to release restrictions in the myofascial tissue can be defined as what?

A

Myofascial Release (MFR)

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17
Q

What is Myofascial Release (MFR) used for?

A

the treatment of soft-tissue dysfunction

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18
Q

According to the myofascial theory what is the significance of the collagen, elastin, and gel in fascia?

A
  • collagen provides strength to the fascia
  • elastin gives it its elastic properties
  • gel functions to absorb the compressive forces of movement
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19
Q

What are the 3 types of fascia? Describe each…

A
  • superficial: lies directly below the dermis
  • deep: surrounds and infuses into the muscle bone, nerve, blood vessels, and organs to the cellular level
  • deepest: consists of the dura of the CNS
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20
Q

The theory of MFR is based on what?

A

the principle that trauma or structural abnormalities may create inappropriate fascial strain, because of an inability of the fascial to absorb or distribute the forces

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21
Q

What is the purpose of MFR techniques?

A

to apply a gentle sustained pressure to the fascia, in order to release fascial restrictions thereby restoring normal pain-free function

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22
Q

What are the 4 types of MFR?

A
  • J-stroke
  • Vertical stroke
  • Transverse stroke
  • Cross-hands technique
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23
Q

What is the goal of the J-stroke?

A

to increase skin mobility

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24
Q

What is the goal of the vertical stroke?

A

to open up the length of vertically oriented superficial fascia

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25
Q

What is the goal of the cross-hands technique?

A

The release of deep fascial tissues

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26
Q

What is soft-tissue mobilization recommended for?

A

to reduce muscle spasm and promote pain reduction

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27
Q

How does ischemic compression work?

A

A constant, consistent pressure (8-12 seconds) over the trigger point deprives if of oxygen, rendering them inactive and breaking the cycle of pain-spasm

28
Q

Defined general massage

A

the systematic, therapeutic, and functional stroking and kneading of the body

29
Q

How does deep massage increase circulation and skin temperature?

A

capillary dilation

30
Q

What are the 4 types of general massage?

A
  • Effleurage
  • Stroking
  • Petrissage
  • Strumming
31
Q

How does acupressure work?

A

Manual pressure over acupuncture points can strengthen, disperse or calm Qi, which enables a smooth flow

32
Q

When acupressure is applied correctly, the patient is to experience a sensation known as what?

A

‘teh chi’ which can be defined as a subjective feeling of fullness, numbness, tingling and warmth with some local soreness and a feeling of distension around the acupuncture point

33
Q

What are METs?

A

Muscle energy techniques

Which combine passive mobilization, muscle reeducation, and therapeutic exercise

34
Q

What can METs be used to do?

A
  • Mobilize joints
  • Strengthen weakened muscle
  • Stretch muscles and fascia
35
Q

MET is a _____ effort in a ______ direction, commencing from a ______ position

A

controlled

controlled

controlled

36
Q

What is the intent of MET?

A

to treat somatic dysfunctions by restoring the muscles around a joint to their normal state, via stretching or strengthening the agonist and antagonist

37
Q

What is strain-counterstrain?

A

A passive positional technique used in the treatment of musculoskeletal pain, related somatic dysfunction, and improvement of blood flow

38
Q

How does strain-counterstrain improve blood flow?

A

through a circulatory flushing of previously ischemic tissues

39
Q

Describe the process of strain-counterstrain

A

The effected limb is placed in a position that causes increased tension and held there for 90-120 seconds before it is slowly returned to the normal position

40
Q

What is the difference between functional techniques and strain-counterstrain?

A

Functional techniques move the joint away from rather the restriction, while strain-counterstrain moves the joint into the restriction

41
Q

Once the patient is positioned correctly, what are the 2 forms of functional techniques the clinician can use?

A
  • Active in which the clinician initiates movement along the path of least resistance until the restrictive barrier is no longer detectable and normal motion is regained
  • Passive in which the joint is “unwound” through sequential releases of the treated joint to the point of full soft-tissue release, until the restrictive barrier is no longer detectable and normal motion is regained
42
Q

In what position must joint mobilizations be performed?

A

In the open-packed position

43
Q

What are the 4 indications for joint mobilizations?

A
  • Increased joint ROM
  • Decrease pain
  • Promote muscle relaxation
  • Improve muscle performance
44
Q

What are the 6 benefits of joint mobilizations?

A
  • Restore the articular relationship within a joint
  • Decrease pain
  • Decrease muscle guarding
  • Lengthen the tissue around a joint
  • Neuromuscular influence on muscle tone
  • Increase proprioceptive awareness
45
Q

What does the Kaltenborn technique refer joint play as?

A

“slack”

46
Q

Describe the 3 grades of Kaltenborn techniques

A
  • Grade I: Piccolo (loosen) involves traction force that neutralizes pressure in the joint to reduce the compressive forces on the articular surfaces
  • Grade II: Slack, in which the joint surfaces are separated which eliminate the play in the joint capsule
  • Grade III: Stretch involves the stretching of the joint capsule/tissues to increase mobility
47
Q

Which grade of Kaltenborn technique should be used to treat joint hypomobility?

A

Grade III to stretch the joint capsule

48
Q

What is the type of joint mobilization we use in class? Describe the 5 various grades

A

Australian Techniques

  • Grade I: small amplitude technique performed at the beginning of the available ROM
  • Grade II: large amplitude technique performed in the middle of the ROM
  • Grade III: large amplitude movement at the end of the ROM
  • Grade IV: a small amplitude movement at the end of ROM
  • Grade V: a movement that exceeds the resistance barrier
49
Q

What are grade I and II joint mobilizations used for?

A

acutely for pain relief

50
Q

What are grade III and IV joint mobilizations used for?

A

to reduce restriction of movement by activating inhibitory joint and muscle spindle receptros

51
Q

In which direction should joint mobilizations be applied?

A

Either parallel or perpendicular to the joint

52
Q

If a large improvement occurs following joint mobilization, what should be done next?

A

Intervention should be discontinued for the day

53
Q

What is essential after mobilization or high-velocity thrust techniques?

A

Muscle reeducation

54
Q

DescribeMobilizations with Movements (MWM)

A

A technique that combines a sustained manual gliding force with concurrent physiologic motion of the joint with the intent of causing a repositioning of so-called bony positional faults

55
Q

What are the 2 types of locking techniques?

A
  • locking from above

- locking from below

56
Q

How are adjacent joints positioned in both locking techniques?

A

at the end of the available ROM

57
Q

What doesProprioceptive Neuromuscular Facilitation (PNF)promote?

A

The response of the neuromuscular mechanism through stimulation of the proprioceptor

58
Q

What are the 7 types of PNF?

A
  • Contract-Relax
  • Agonist Contraction
  • Contract-Relax-Agonist-Contraction
  • Rhythmic Initiation
  • Repeated Contraction
  • Stabilizing Reversal
  • Rhythmic Stabilization
59
Q

When is rhythmic initiation used?

A

In patients who are unable to initiate movement in order to teach them a specific movement pattern

60
Q

When is repeated contraction used?

A

In patients who have weakness and to correct imbalances that occur within the ROM

61
Q

Describe how repeated contraction PNF techniques work

A

The patient is asked to push repeatedly by using the agonist concentrically and eccentrically against maximal resistance, until fatigue occurs

62
Q

What are the 2 things stabilizing reversal PNF techniques are used for?

A
  • Developing AROM of the agonists

- Developing the normal reciprocal timing between the antagonists and agonists that occurs during functional movements

63
Q

Describe how stabilizing reversal PNF techniques work

A

The patient is asked to concentrically contract the agonist followed immediately by a concentric contraction of the antagonist. In which the initial agonist push contraction facilitates the pull contraction of the antagonist.

64
Q

How does the rhythmic stabilization PNF technique work?

A

There is co-contraction of agonists and antagonists which results in an increase in the holding power to a point where the position cannot be broken. A “hold” command is always given to the patient prior to resisting movement

65
Q

What are the 5 goals of rhythmic stabilization?

A
  • Improve stability around a joint
  • Increase positional neuromuscular awareness
  • Improve posture and balance
  • Enhance strength in the functional range
  • Enhance stretch in the functional range
66
Q

What are chop and lift PNF patterns?

A

Applications of the UE diagonal that involve the use of both UEs
- One UE is performing D1
- One UE is performing D2
Both UEs move into flexion or extension while using spiral and diagonal movements that cross the midline

631: Clinical Management of the Musculoskeletal System I (19 decks)

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