Manual Therapy Flashcards
What is manual therapy
PTs movement of soft tissue or joints
What are the 3 general categories of manual therapy
Joint techniques
soft tissue techniques
manual ROM/Stretching techniques
What are joint techniques
PT movements that are performed on the joint
What is an example of a joint technique
mobs
What is soft tissue techniques
performed on soft tissue
what is an example of soft tissues techniques
massage
What is manual ROM/stretching techniques
peformed manually by therapist
How is ROM and stretching performed in manual ROM/stretching techniques
ROM: PROM or AROM with therapist guidance
Stretching: PROM with therapist overpressure
How is manual ROM/stretching techniques peformed
therapists needs to stabilize one side of the joint, control amount of motion, monitor stretch effects during treatment
What is example of manual ROM/stretching techniques
Posterior shoulder stretch with scapular stabilization
What are joint techniques used for
increase joint mobility
what are the main categories of joint techniques
mobilization (non thrust)
mobilization with movement (Mulligan)
manip (thrust)
muscle energy technique (MET)
how is force applied in MET
pts muscle contraction
How is force apply in non thrust manip
passive, variable amplitude, slower velocity
How is force applied in thrust manip
passive, low amplitude, high velocity
What is a non thrust manip
a skilled passive movement perfumed with variable amplitudes and speeds, perfumed slow enough for a patient to stop mobilization
What are non thrust manips (mobilizations) used for
pain and limited motion
What is the mulligan technique
therapist applied mobilization during patient active motion, can also be patient self mobilization technique
What is a pathological barrier
end of available ROM when there is a restriction
what is a phsyiologic barrier
point at which voluntary range of motion of an articulation is limited by soft tissue tension, further motion can be induced into the anatomic barrier
What is anatomic barrier
point at which passive range of motion is limited by bone contour, soft tissues, especially ligaments, or both. the anatomic barriers serves as a final limit to the motion in an articulation, movement past this barrier causes tissue damage
what is a direct technique
movement and force are in the directionof the motion restriction
what is an indirect technique and when is it used
movement and force are both not in the direction of the motion restriction commonly used/indicated in acute phase
what is general technique
force is transmitted to a number of joints
What is specific technique
force is transmitted only one to one joint
what are indications for joint techniques
as prior to improve joint or soft tissue mobility or reduce pain
what are contraindications for joint techniques
fx, infections arthritis, tumor, joint ankylosis, OP, RA, presence of pathologic end feel, lack of diagnosed joint lesion
what are the 10 contraindications for thrust manips
positive vertebral artery test
dizziness
bilateral or multisegment neurologic signs or sx
paralysis in non perisperhal nerve distribution
hyperreflexria,
pathologic reflexes
presence of emotional disorders
anticoagulant meds or steroidal meds for a long time
Are manips successful without a pop
yes
what should you assess for with accessory joint motion testing
- pain before and during testing
- amount of motion
- end feel
- all sections at the joint
- in open packed position
- functional measures
- review of contraindications/precautions
What are the different non thrust manip system types
maitland
kaltenborn
MWM mulligan
self mob
what is matilatnd non thrust manips
graded oscillation techniqeus
what is kaltenborn non thrust manip
sustained translators joint play technique
what is MWM mulligan non thrust manip
sustained accessory mob while the the pt is performing an active physiological movement to end ROM
what is self mob non thrust manip
self stretching techniques that specifically use traction or glides
what are the diferret grades for Maitland approach
Grade 1: small amplitude at begining of range
grade 2: large amplitude near begining of range
grade 3: large amplitude near end of range
grade 4: small amplitude at end or range
what are the grades for kaltenborn
grade I : loosen; no joint separation; only enough traction appleid to nullify the compression on the joint
grade II: tighten; the slack is taken up in the tissue surrounding the joint are tightened
grade III: stretch; after the slack has been taken up more traction force is applied, and tissues are stretched
what are Maitland and kaltenborn systems both used for
examination and treatment
what is the reliability of the examination and treatment using Maitland and kaltenbonr systems
poor
what is the purpose of addressing pain with manual therapy
reduce pain, reduce muscle spasm/guarding, increase muscle relaxation
how to reduce pain neurolligicaly with manual therapy
stimulate pain receptors to inhibit pain trasmnsmission
how to reduce pain mechanically with manual therapy
increase synovial fluid movement and nutrient exchange for joint, particularly articular cartilage
what techniques are used with manual therapy to treat pain
- low grade, small amplitude
- oscillations
- slowly applied mobs
- traction/distraction with or without accessory glides
- direction of mob: determined by pain/relaxation response
what is the joint position for treating pain with manual therapy
open packed or lease provocative joint position
what is the frequency for treating pain with manual therapy
low grade; 30 sec x 2-5 reps; w/ oscillations
or
Maitland I and II for 30 secs x 2-5 reps w/oscillations
what is the purpose of treating limited motion with manual therapy
improve moitn
what techniques are used for treating limited motion with manual therapy
- Hi grade, small or large amplitude
- sustained stretch to hold at ed ROM or oscillations to aid with pain relief
- traction/distraction with or without accessory glides
- direction of mob: determined by convex-convace roll or anatomy/mechnics and or by accessory motion testing findings
what is the guideline for joint position when treating limited motion with manual therapy
Position that is the least painful position to start, progress the position as patient tolerates
what is the frequency for treating limited motion with manual therapy
hi grade; 30 sec x 3-5 reps; sustained stretch
what is the frequency for treating pre conditioning with manual therapy
- hi grade; 30 sec x 1-3 reps; oscillations or sustained stretch
- Kaltenborn II and III, 30 secs x 1-3 reps, oscillations
- Mailtand III and IV, 30 secs x 1-3 reps, oscillations
what are contraindications for manual therapy
hypermobile
joint effusion
inflammation
what are precautions for manual therapy
- execessive pain
- hyper mobility
- diseased joint
- patient with hemiplegia or hemiparisis
- recent fx
- total joint replacement
- recent surgery
- systemic disease
- elderly
what are the guildlines for manual therpay
- determine purpose
- determine techniques to be used based on purpose
- use of heat may be beneficial before starting
- patient posisitoning
- examiner is relaxed
- joint position
- treat only one joint at a time
- no forceful or abnormal movmeents
- compare bilaterally
- movement stopped pain is elicited
where do you want your hands during manual therapy
as close to joint as possible
