Manual Therapy

Question 1

When is manual therapy in the spine indicated? (3)

Answer 1

(1) mechanical dysfunctions present
(2) motion limitations/restrictions present
(3) requirements for clinical prediction rule (CPR) for manipulation met

Question 2

What are the criteria for the clinical prediction rule (CPR) for manipulation for LBP? (5)

Answer 2

(1) no symptoms distal to knee
(2) less than 16 days duration
(3) FABQ < 19
(4) hypomobility of lumbar spine (1+ segment)
(5) hip IR > 35 degrees

Question 3

What are the requirements for a treatable dysfunction? (3)

(hint: ART)

Answer 3

A: asymmetry of position or motion

R: range of motion restriction

T: tissue texture abnormalities (i.e. increased tone, increased histamine response, or tenderness)

Question 4

What are the contraindications to manual therapy in the spine? (8)

Answer 4

(1) inflammatory arthritis (i.e. RA, etc.)
(2) Down’s syndrome
(3) osteoporosis
(4) spine infections
(5) fractures
(6) cancer/metastases to the spine
(7) vertebral artery compromise
(8) anticoagulation therapy

Question 5

What are the precautions to manual therapy? (6)

Answer 5

(1) spondylolisthesis (avoid affected segment but look for dysfunctions above/below)
(2) hypermobility (look for dysfunctional segments elsewhere)
(3) pregnancy and immediately postpartum
(4) anticoagulation therapy
(5) trauma not medically evaluated
(6) anxiety/fear

Question 6

Which of Fayette’s Laws does the cervical spine follow? Why?

Answer 6

Law II because the cervical facets are always engaged in neutral due to the orientation of the facets

Question 7

What would “muscle banding” imply?

Answer 7

That there is dysfunction at that level

Question 8

T/F: A reduced lumbar lordosis is common

Answer 8

True

Question 9

T/F: An excess of mid thoracic kyphosis in common

Answer 9

False, lack of mid thoracic kyphosis is common

Question 10

What are “key” areas or transition zones to observe AROM in? (3)

Answer 10

thoracolumbar, cervical thoracic, and lumbosacral junctions

Question 11

What part of the spine does a hip drop isolate motion in?

Answer 11

lower lumbar spine, specifically at L5

Question 12

What part of the spine does a hip hike isolate motion to?

Answer 12

thoracolumbar junction/upper lumbar

Question 13

During manual therapy, lever arm should be [short/long] and contacts should be [narrow/broad].

Answer 13

During manual therapy, lever arm should be short and contacts should be broad.

Question 14

What are muscle energy techniques (MET)?

Answer 14

They are using muscle contractions to increase ROM, muscle length or strength, or lymphatics at a joint via isometric relaxation or reciprocal inhibition

Question 15

What to muscle energy techniques (MET) target? (2)

Answer 15

golgi tendon organs and muscle spindles

Question 16

What is an ERS?

Answer 16

ERS = extended, rotated, and side bent

They are limited in flexion and rotation + side bending to the opposite side

Question 17

When is the transverse process more prominent in an ERS?

Answer 17

flexion

Question 18

What is an FRS?

Answer 18

FRS = flexed, rotated, side bent

They are limited in extension and rotation + side bending to the opposite direction

Question 19

When is the transverse process more prominent in an FRS?

Answer 19

extension

Question 20

When an ERS is identified in flexion, the transverse process will be more prominent on the [same/opposite] side of the dysfunction.

Answer 20

same side

Question 21

When an FRS is identified in extension, the transverse process will be more prominent on the [same/opposite] side of the dysfunction.

Answer 21

opposite side

Question 22

In an ERS, the facet on the same side will not [open/close].

Answer 22

open

Question 23

In an FRS, the facet on the opposite side will not [open/close]

Answer 23

close

Question 24

Where would a Type I (neutral type) of muscle energy dysfunction be found?

Answer 24

flexion, extension, and neutral at multiple levels (i.e. L1-L4)

Question 25

Where would a Type II (non-neutral type) of muscle energy dysfunction be found?

Answer 25

flexion or extension at single level (i.e. L5)

Question 26

With a Type I (neutral type) of muscle energy dysfunction, what motion would be restricted? By what muscles?

Answer 26

motion restricted in opposite directions

muscles = long restrictors (longissimus, quadratus, etc.)

Question 27

With a Type II (non-neutral type) of muscle energy dysfunction, what motion would be restricted? By what muscles?

Answer 27

ERS/FRS

muscles = short restrictors (multifidus/rotatores, etc.)

Question 28

With a Type I (neutral type) of muscle energy dysfunction, when is it treated?

Answer 28

last

Question 29

With a Type II (non-neutral type) of muscle energy dysfunction, when is it treated?

Answer 29

first

Question 30

What do muscle energy techniques do for ERS and FRS dysfunctions?

Answer 30

They restore mobility and reset the afferent pathways to short rotators

Question 31

Where can you have ERSs and FRSs? (3)

Answer 31

(1) multiple levels
(2) bilaterally
(3) both an ERS and FRS at same level

Question 32

During muscle energy treatments, what are the basics? (4)

Answer 32

(1) position segment in flexion/extension until motion stops, then let off a little
(2) then have them contract into side/bending against resistance (3-7 seconds @ 40% MVIC)
(3) relax, and move further into side bending until motion stops and let off a little
(4) REPEAT