Manual Therapy Flashcards
Which type of manual therapy is described as needing speed and the patient cannot stop movement?
a. spinal manipulation
b. spinal mobilization
c. none of the above
d. all of the above
spinal manipulation
Which type of manual therapy is described as oscillations, varying amplitudes, the patient can stop movement?
a. spinal manipulation
b. spinal mobilization
c. none of the above
d. all of the above
spinal mobilization
What are the 3 mechanisms of manual therapy?
mechanical
neurophysiological
placebo
This mechanism of manual therapy is moving a joint which creates a mechanical stimulus stimulating the tissue, decreasing spasm and increasing ROM
a. mechanical
b. neurophysiological
c. placebo
d. none of the above
mechanical
This mechanism of manual therapy is the effect on the brain
a. mechanical
b. neurophysiological
c. placebo
d. none of the above
neurophysiological
This mechanism is something that influences what the patient feels/thinks about what were doing
a. mechanical
b. neurophysiological
c. placebo
d. none of the above
placebo
What are the mechanisms of manual therapy?
create space stretch collagen/off set load gate control blood flow locked joint disc pressure plasticity placebo neuromuscular effect graded exposure patient expectations range of motion money/cost
This mechanism of manual therapy takes tension or stress/strain off of a particular tissue that you are targeting with therapy
a. create space
b. stretch collagen/offset load
c. blood flow
d. plasticity
stretch collagen/offset load
This mechanism is of manual therapy is concluded as the local dorsal horn mediated inhibition of c-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects
a. create space
b. gate control
c. blood flow
d. locked joint
gate control
Manual therapy _ blood flow which is good for _ nerve sensitivity
increases
decreasing
Patients are able to identify where the therapist is manually pressing improves
homonculus
biological plasticity has both a _ effect and _
mechanical
neuroplasticity
_ can enhance with identification
plasticity
Placebo can show induced biological changes in
CNS activation
opioid pathways
dopamine production
Placebo can show induced psychological responses in
expectation of benefit
conditioning/learning effect
negative effect
Manual therapy gives an immediate _ effect
hypoalgesia
this is defined as the thinking underlying clinical practice
clinical reasoning
Clinical reasoning incorporates recognizing
_ and _-testing
pattern recognition
hypothesis-testing
Predisposing physical, psychosocial and environmental circumstances is a
a. clinical pattern
b. common error of clinical reasoning
clinical pattern
An overemphasis on findings which support existing hypothesis is a
a. clinical pattern
b. common error of clinical reasoning
common error of clinical reasoning
It is important to ignore findings that do not support the favored hypothesis (true/false)
false
This is defined as the awareness and ability to think about your thinking
a. clinical reasoning
b. metacognition
c. error of clinical reasoning
d. none of the above
metacognition
Patients want to know
what is wrong with me?
how long will it take?
what can I do for it?
what can you do for it?
reasoning categories of clinical reasoning
sources prognosis management pathobiology contributing factors dysfunction precautions
With the prognosis, it is important to focus on
a. pain
b. function
c. none of the above
d. both
function
Improve _ and _ will come down
function pain
the more complex the pain, the more likely a multidisciplinary approach is needed (true/false)
true
The pain, action programs, and stress regulation is the
a. output
b. input
c. processing
d. none of the above
output
The various biological systems protect
a. output dominant
b. input dominant
c. processing dominant
d. none of the above
output dominant
Sensory and cognitive is a part of
a. output
b. input
c. processing
d. none of the above
processing
CNS, brain, central sensitization, hyperalgesia, allodynia are
a. output dominant
b. input dominant
c. processing dominant
d. none of the above
processing dominant
The tissue sampling, environment, nociception, peripheral nerve are categorized as
a. output
b. input
c. processing
d. none of the above
input
What are contributing factors of clinical reasoning to be aware of?
yellow flags
outside factors that influence their pain experience
This concept is defined as open mindedness, mental agility, mental discipline linked with a logical and methodical process of assessing cause and effect
Maitland concept
The central theme of the Maitland concept is to have a positive personal commitment to understand what the patient is enduring (true/false)
true
Maitland concept puts an empahsis on
clinical reasoning detail approach to the patient signs and symptoms technique
Maitland concept of assessment
continuous
analytical
before, during, and after treatment
be open-minded, non-judgmental
How long do you treat a patient before you see results?
dont see within 4-6 treatments - may be missing something
optimum improvement per session means pushing them harder when something is working for treatment (true/false)
false
Objective measures
a. sign
b. symptoms
c. comparative sign
d. none of the above
sign
patient subjective reporting
a. sign
b. symptoms
c. comparative sign
d. none of the above
symptom
passive or active movement is _
physiological movement
spin, roll, glide of the articular surfaces
a. active physiological movement
b. passive physiological movement
c. accessory movement
d. comparative sign
accessory movement
Measurements of progress, identifiable, what they have trouble doing functionally
a. sign
b. symptoms
c. comparative sign
d. none of the above
comparative sign
What is normally seen with screening for red flags? spinal movement is _ associated _ _ _ _ _ onset of symptoms
unaffected by spinal movement
associated symptoms (heartburn)
past medical history
insidious onset of symptoms
A patient is unaffected by spinal movement, has associated symptoms, PMH. onset of symptoms is insidious. These characteristics can be categorized as
a. yellow flags
b. red flags
c. cancer
d. systemic issues
red flags
A patient has a PMH of cancer, failure to improve within 1 month of tx, under the age of 20, family history or sudden explained weight loss can be classified as
a. yellow flags
b. red flags
c. cancer
d. systemic issues
cancer
A patient has a PMH of cancer, failure to improve within 1 month of tx, over the age of 50, family history or sudden explained weight loss can be classified as
a. yellow flags
b. red flags
c. cancer
d. systemic issues
cancer
Risk factors for cancer
age > 50 y/o
age < 20 y/o
personal history of cancer
Symptom location for pain in patients older than 50
a. UE
b. long bones of extremities
c. axial skeleton
d. LE
axial skeleton
Symptom location for pain in patients under the age of 20
a. UE
b. long bones of extremities
c. axial skeleton
d. LE
long bones of extremities
A symptom description of initial ache that progresses to constant, sharp, incapacitating can be classified as
a. systemic issues
b. yellow flag
c. red flag
d. cancer
cancer
Pain that is related to cancer is
a. traumatic
b. gradual
c. insidious
d. none of the above
insidious
A patient is aggravated by loading their bones through weight-bearing activities and unloading alleviates pain, this can be
cancer
Night pain is a red flag (true/false)
true
What can also be causing night pain?
neuropathic pain
When you wouldn’t/shouldnt use a physical test or technique under any circumstances
a. precaution
b. contraindication
c. red flag
d. none of the above
contraindication
Depending upon the skill, experience and training of the practitioner, type of test or technique selected, the amount of leverage and force used, and the age, general health and physical condition of the patient
a. precaution
b. contraindication
c. red flag
d. none of the above
precaution
It is safe to be aggressive with strength of the technique and not reassess (true/false)
false
safety in manual therapy should be
gradual/quick
gradual
continually assessed
MT contraindications of bony issues
tumor infection metabolic congential iatrogenic inflammatory traumatic
MT neurological contraindications
cervical myelopathy
cord compression
cauda equina syndrome
nerve root compression with increasing neurological deficit
MT vascular contraindications
diagnosed with vertebrobasilar insufficiency
aortic aneurysm
bleeding disorder
MT contraindications: lack of
not examining someone
lack of pt consent
adverse reaction to previous MT disc herniation or prolapse pregnancy spondylolisthesis psychological dependence upon manipulative techniques ligamentous laxity a. MT contraindications b. MT precaution
MT precautions
How should you make MT safer?
appropriate training
thorough history and exam
clinical reasoning skills
graded mobilization
Fear and anxiety, family concerns, failed treatment, persistent pain, job issues, different explanations fall under
a. cancer screening
b. yellow flags
c. red flags
d. contraindications
yellow flags
_ flags enter into the system during the processing stage
yellow
Emotions, behaviors, family, work, compensation can be
a. red flags
b. yellow flags
c. precautions
d. contraindications
yellow flags
fear of increased pain, depression, irritability, anxiety, and stress are
a. yellow flags
b. red flags
c. warning signs
d. patterns
yellow flags
emotions
behaviors of extended rest, poor compliance, extreme pain ratings, excessive reliance on aids/devices, sleep disturbance, high intake of alcohol or medication, work
yellow flags
overprotective and punitive responses from family
yellow flags
manual work, work history, belief that work is harmful, unhappy at work, low educational background, working shifts, negative previous experiences at work with LBP
yellow flags
lack of financial incentive to return to work, extended time off work, number of claims, previous history of LBP
compensation
yellow flags
conflicting diagnosis, passive treatments, number of health care providers, lack of satisfaction
yellow flags
tools for screening yellow flags
FABQ
Tampa Scale of Kinesiophobia
pain catastrophization scale
Orebo musculoskeltal pain screening questionnaire
Keele STarT back screening tool
Acute low back pain screening (ALBPS) questionnaire
SINS stands for
severity
irritability
nature
stage
A finding of debilitating, high-intensity pain
a. severity
b. irritability
c. nature
d. stage
severity
A finding of small movement causes a lot of pain and take awhile to subside
a. severity
b. irritability
c. nature
d. stage
irritability
A finding of deep, burning, type of pathology
a. severity
b. irritability
c. nature
d. stage
nature
SINS plus includes
stability
SPINS includes
pain mechanism
What are the categories of a subjective exam?
kind of disorder history site of symptoms behavior of symptoms special questions
This part of the subjective exam is the main problem which can typically be pain, limited movement, limited ROM, weakness, numbness, decreased function
a. history
b. kind of disorder
c. site of symptoms
d. behavior of symptoms
kind of disorder
the kind of disorder is from the (patient/therapist) perspective
patient
What do you need to get from the subjective history part?
onset of disorder
progression
diagnosis, tx and effect
previous history
How and when did this start?
What kind of symptoms were present when it started?
Did any of the symptoms spread anywhere else?
How long did it take for the symptoms to come on?
What were you doing around the time of the onset?
What do you think happened?
Why do you think you hurt?
these questions help you determine
a. type of disorder
b. onset of disorder
c. progression of disorder
d. diagnosis
onset of disorder
Is it getting better, worse or the same? If (better, worse or the same) in which way? these questions help you determine a. type of disorder b. onset of disorder c. progression of disorder d. diagnosis
progression of the disorder
What information do you need to get from the site of symptoms?
area
depth
nature
correlation
The nature of the site of symptoms can tell you
constant vs intermittent
variable vs non variable
You should target each symptom they mark on the body chart (true/false)
false
prioritize
If their body map is intact and sharp, what should you do for treatment?
a. pain science
b. mobilization
c. traditional manual therapy
d. don’t treat
manual therapy
If their body map is smudged, what should you do for treatment?
a. pain science
b. mobilization
c. traditional manual therapy
d. don’t treat
pain science
Aggs, eases, SINS, latency and daily pattern describe
a. site of symptoms
b. depth of symptoms
c. nature of diagnosis
d. behavior of symptoms
behavior of symptoms
What do you need to ask for special questions?
review of systems
cancer screen
inflammation
vertebrobasilar insufficiency
What do you need to consider with vertebrobasilar insufficiency?
5 D’s
and
3 N’s
5 D’s for vertebrobasilar insufficiency
dizziness diplopia dysphagia drop attacks dysarthria
And vertebrobasilar insufficiency
ataxia
3 N’s for vertebrobasilar insufficiency
nystagmus
numbness
nausea
Outcome measures used for subjective examing
function
fear
pain catastrophization
5 reasons to do a physical exam
confirm subjective hypothesis/diagnosis find comparative signs choose techniques and treatment determine pts movement limits determine pits willingness to move
Determining if the symptoms are peripherally or centrally initiated
a. sources of symptoms
b. mechanism of symptoms
c. site of symptoms
d. diagnosis
mechanism of symptoms
The possible structures at fault and determining what should be examined on day 1
a. sources of symptoms
b. mechanism of symptoms
c. site of symptoms
d. diagnosis
sources of symptoms
For planning the physical exam consider
mechanism of symptoms sources of symptoms when to limit the exam if you should do a neuro eval comparative signs
Limits of physical exam
point of onset
partial reproduction
total reproduction
production of referred symptoms
Let the patient demonstrate the aggravating movements (true/false)
true
Non-verbal cues are irrelevant, dont tell you anything (true/false)
false
When looking at the patient move, what should you be looking for?
distortion of the movement quality speed, rhythm, willingness to move, ROM where movement occurs limits status of ceased movement
Consider what concepts for planning the treatment
patient symptoms pathology goals and objectives prognosis techniques available
Joint positioning mid ROM, large amplitude, grade 2 will treat
a. stiffness
b. pain
c. impaired function
d. ROM
pain
Joint positioning end ROM, small amplitude, grade 4 will treat
a. stiffness
b. pain
c. impaired function
d. ROM
stiffness
This grade is a small amplitude, beginning of the ROM
a. grade I
b. grade II
c. grade III
d. grade IV
grade I
This grade is a large amplitdue, beginning to mid ROM, free of resistance
a. grade I
b. grade II
c. grade III
d. grade IV
grade II
This grade is a large amplitdue, mid to end ROM, into resistance, stiffness
a. grade I
b. grade II
c. grade III
d. grade IV
grade III
This grade is small amplitude, stretching into stiffness
a. grade I
b. grade II
c. grade III
d. grade IV
grade IV
According to the Maitland concept, what rhythm should you use to treat pain?
a. fast
b. aggressive and slow
c. smooth and even
d. increase as you go
smooth and even
According to the Maitland concept, what rhythm should you use to treat stiffness?
a. staccato
b. aggressive and slow
c. smooth and even
d. increase as you go
staccato
According to the Maitland concept, how should you advance a technique?
increase amplitdue move into some discomfort increase speed, maintain smoothness slight staccato oscillations place the joint on a stretch before mobilizing
With muscle spams, you should oscillate (true/false)
false
To treat pain according to maitland concept use a
a. comfortable position, comfortable technique, small amplitude, slow speed, smooth rhythm, and long duration
b. end ROM position, firm technique, large amplitude, small amplitude in between, quicker speed, staccato rhythm, short duration
c. comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration
d. end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration
comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration
To treat stiffness according to maitland concept
a. comfortable position, comfortable technique, small amplitude, slow speed, smooth rhythm, and long duration
b. end ROM position, firm technique, large amplitude, small amplitude in between, quicker speed, staccato rhythm, short duration
c. comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration
d. end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration
end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration
The tissues, environment, nociception, and peripheral nerve are what part of the pain process?
a. input
b. output
c. processing
d. psychological
input
The CNS, brain, central sensization, hyperalgesia, allodynia symptoms is part off which system with pain?
a. input
b. output
c. processing
d. psychological
processing
Pain, sympathetic, motor, immune, adrenaline, cortisol, respiration, language are related to the _ part of pain
a. input
b. output
c. processing
d. psychological
output
The primary lesion or dysfunction is located in the spinal cord, brainstem, and cerebral hemispheres affects the _ part of pain
a. input
b. output
c. processing
d. psychological
processing
A patient demonstrates disproportionate pain and disproportionate aggravating and easing factors, this is due to the _ part of pain
a. input
b. output
c. processing
d. psychological
processing
A patient has diffuse palpation tenderness and nothing eases their pain, it is a _ issue
a. input
b. output
c. processing
d. psychological
processing
This type of pain is proportionate, aggravating and easing factors, intermittent sharp, dull ache or throb at rest with no night pain
a. peripheral neurogenic
b. nociceptive
c. processing
d. psychological
nociceptive
Pain is dermatomal or cutaneous distribution, positive neurodynamic and palpation with a history of nerve pathology
a. peripheral neurogenic
b. nociceptive
c. processing
d. psychological
peripheral neurogenic
Maitland focused on
a. pathology
b. biopsychosocial
c. social issues
d. signs and symptoms
signs and symptoms
Loui believed that for collagenous tissues to elongate it takes
a. manual therapy
b. mobilization
c. education
d. time and repetition
time and repetition
(small/large) amplitude motions can be seen as a modulation effect on (peripheral/nociceptive) input to CNS
large
nociceptive
(continuous/repetitive) oscillations on a spinal level, often at various angles help _
repetitive
restore body maps in the brain
A cornerstone concept of Maitland is
test and retest
Which system is powerful when it comes to pain?
vision
Hands-on manipulation has been shown to activate the (descending/ascending)
descending inhibitory mechanisms to help modulate acute pain
this model involves exposing a person to a small amount of stimulus for a short amount of time and over time, this exposure is increased
a. body maps
b. neuroplasticity
c. manual therapy
d. graded exposure
graded exposure
patient expectations are a _ effect
placebo
changes in the size and shape of the _ _ can correlate with increased pain and disability
body maps
treatments for _ improve SLR
neuroplasticity
reboot of muscles via spinal reflexes; essentially, describes the change in muscle activity seen before & after a manual technique
a. neuroplasticity
b. placebo
c. neuromuscular effect
d. manipulation
neuromuscular effect
What was the first school to teach manipulation?
Andrew Taylor Still
osteopathy
Who wrote the four branches of physiotherapy are manipulation of muscle and joints, therapeutic exercise, electrotherapy, hydrotherapy?
a. McMillan
b. Maitland
c. Cyriax
d. Mennell
Mary McMillan
Who wrote the textbook of orthopedic medicine?
a. Mennell
b. Maitland
c. Cyriax
d. McKenzie
James Henry Cyriax
Who is famous for teaching therapists about manipulation?
a. McKenzie
b. Maitland
c. Cyriax
d. Mennell
Cyriax
Who defined joint dysfunction and joint play which cannot be produced by the action of voluntary muscles?
a. McKenzie
b. Mennell
c. Cyriax
d. Maitland
John Mennell
Who explained the concept of facilitated segment?
Alan Stoddard
Who came up with the concept of repeated movements being preferred direction, centralization, peripheralization?
a. McKenzie
b. Maitland
c. Cyriax
d. Mennell
Robin McKenzie
The ability to respond appropriately to relevant information during a patient encounter?
a. clinical reasoning
b. reflection in action
c. metacognition
d. knowing in action
knowing in action
Clinical reasoning is the application of _ _, and _ _ to patient _ on an _ level
relevant knowledge
clinical skills
management
individual
with clinical reasoning, you need to find out if its _ to the patient
relevant
Clinical reasoning is likely more important than the actual treatment itself (true/false)
true
The assessment is the most important part according to the Maitland concept (true/false)
true
This type of pain is proportionate, aggravating and easing factors, intermittent sharp, dull ache or throb at rest
a. nociceptive
b. peripheral
c. processing
d. none of the above
nociceptive
This type of pain is no night pain, dysesthesia, burning, shooting or electric
a. nociceptive
b. peripheral
c. processing
d. none of the above
nociceptive
This type of pain is dermatomal or cutaneous in distribution, positive neurodynamic and palpation, with a history of nerve pathology or compromise
a. nociceptive
b. peripheral
c. processing
d. none of the above
peripheral neurogenic
This type of pain is disproportionate pain, disproportionate aggravating and easing factors, diffuse palpation tenderness, psychosocial issues
a. nociceptive
b. peripheral
c. processing
d. none of the above
processing
What is the most important central theme in pain according to the maitland concept?
approach to the patient
