Manual Therapies

Question 1

what is manual therapy

Answer 1

Physical treatment (usually with hands) to address musculoskeletal pain.

Question 2

What falls under manual therapy (5)

Answer 2

massage, passive ROM, stretching, joint mobilization, joint manipulation

Question 3

What is massage?

Answer 3

The rubbing and kneading of muscles and joints of the body with the hands, especially to relieve tension or pain

Question 4

What are the direct therapeutic benefits of massage? (4)

Answer 4

Decreases muscle tone, increases muscle pliability (decrease pain), increased venous return, increased lymphatic flow

Question 5

T/F massage will increase lactic acid clearance decreasing pain and allowing for muscle recovery

Answer 5

True

Question 6

Which autonomic nervous system does massage activate?

Answer 6

Parasympathetic NS and vagal nerve stimulate. Decreases stress hormones.

Question 7

What are some indications for massage therapy (4)

Answer 7

Swelling and edema, osteoarthritis, chronic pain, cancer pain, trigger points

Question 8

What are contraindications for massage therapy

Answer 8

Cutaneous disease, shock, fever, acute incision, aggressive demeanor.

Question 9

What is Effleurage

Answer 9

Rhythmic stroking- mild/moderate pressure. Gain patient confidence

Question 10

What is petrissage/kneading

Answer 10

Skin rolling, wringing, or squeezing. Breaks up adhesions and knots

Question 11

Describe Tapotement

Answer 11

Rhythmic percussion. Edge of hand or cupped hand technique. Good for athletic warm up.

Question 12

T/F Tapotement can be used as parasympathetic NS stimulation.

Answer 12

True- if done for longer periods of time.

Question 13

Describe friction massage

Answer 13

Soft tissue manipulation primarily fingers and thumbs are used. Used around joints and tendons, trigger points, adhesions and to break up scar tissues.

Question 14

What are myofascial trigger points (MTPs)

Answer 14

hyperirritable spots, usually within a taut band of skeletal muscle which is painful on compression and can give rise to characteristic referred pain, motor dysfunction and autonomic phenomena.

Question 15

how you do treat MTP

Answer 15

2 finger rule- 2 fingers on top of 2 fingers thumb over thumb and press for 20-30 seconds repeat 2-3 times.

Question 16

Where can MTPs be located

Answer 16

within belly, origin or insertion of a muscle. known to cause decreased changes in ROM, muscle weakness and postural imbalance.

Question 17

T/F Patient will not develop gait changes when they have MTPs

Answer 17

False- they will develop gait pattern changes to function without pain.

Question 18

Describe vibration

Answer 18

Trembling movements. use hands or fingers. Relaxation prior to deeper massage techniques.

Question 19

what is the general massage approach

Answer 19

Warm up with effleurage and petrissage (use to check the body). Continue with petrissage. Use deeper techniques if needed. +/-PROM. 10-15 min. Finish with effleurage.

Question 20

What is passive range of motion

Answer 20

An outside force, causes movement of joint. It is usually the maximum range of motion. PROM is non-voluntary.

Question 21

What are the benefits of PROM (4)

Answer 21

promotes joint health. Decreases/prevents adhesions, decreases edema. Decrease inflammatory process

Question 22

What are some indications of PROM

Answer 22

Post-surgical, no active/voluntary limb use (plegic), osteoarthritis.

Question 23

What is the general approach to PROM therapy

Answer 23

Massage warm up. Isolate each joint. move it in comfortable range 10-20 reps. 2-3x/day.

Question 24

How do you isolate each joint in PROM

Answer 24

Supporting hands cranial and caudal to the joint. Hold joint straight at P normal plane.

Question 25

How do you do PROM bicycling

Answer 25

Move the entire limb (all joints) at the same time through full range of motion.

Question 26

what is the difference between gait patterning and bicycling

Answer 26

Gait patterning is done in standing position. Stimulates proprioceptive receptors.

Question 27

What is Stretching

Answer 27

Requires putting a body part in a certain position that’ll serve in the lengthening and elongation of the muscle or muscle groups and thus enhancing its flexibility and elasticity.

Question 28

What are the benefits of strentching

Answer 28

Elongates muscles, improves contracture, restores full ROM, improves comfort during activity.

Question 29

What is a consideration when it come to stretching.

Answer 29

Need to know your end points to prevent pain to Patient. Can be more difficult with chronic diseases that cause tightness

Question 30

What is joint mobilization

Answer 30

A manual therapy technique which can help temporarily reduce pain, improve joint function and increases ROM around the joint.

Question 31

What are the types of mobilization (2) and describe their motion

Answer 31

Physiologic- motion that mimics voluntary movements
Accessory- motion that could not be accomplished by voluntary movement.

Question 32

What are joint end feels

Answer 32

Type of sensation or feeling that examiner feels when the joint is at the end of its avaialbe PROM.

Question 33

What is a normal end feel

Answer 33

When the joint has full ROM and the range is stopped by the anatomy of the joint.
Can be due to soft tissue, muscle anatomy or bone on bone

Question 34

What is an abnormal end feel

Answer 34

When the range of the joint is less or greater than normal and is painful. Or when a structure other than the normal anatomy of the joint stops the motion.

Question 35

What are the types of abnormal end feels (4)

Answer 35

Soft- soft tissue edema
Firm- increased muscle tone (ex CCL tear)
Hard- osteoarthritis (poping and crackling present)
Empty- acute joint inflammation- cant move it at all

Question 36

T/F there are grades of mobilization

Answer 36

True. There are 4 grades and start with grade 1: small osolations of the joint. 2: wider but not ROM 4: right at edge of ROM but small osolations again