Manual Therapy Flashcards
Manual Therapy
-skilled hand mmts and passive mmts of joints
-improved tissue exttensibility, ROM, relaxation, pain, restrictions
Mobilizations
-passive
-rhythmic, repetitive mmt
-varied amplitudes
-high tolerance
-Restore full, painfree joint motion
Manipulations
-passive
-single, quick, decisive mmts
-small amplitude
-important set up
-Restore full, painfree joint motion
-faster, not always safe
Biomechanical Method
-biomechanical theory to assess abnormalities
-athrokinematic principals
-anatomical causes for presentation
Patient-Based Response Method
-pain reproduction and reduction w/ mmt
-does not rely on biomechanical
-findings to determine Tx
Manual Therapy Terminology
-Rate of force
-Location in Range: availability of segment
-Direction of force
-Targe of force: PT applied force
-Relative structural mmt
-Pt Position
Biomechanical Effects of Manual Therapy
-Improved movement
-Improved position
Neurophysiological Effects of Manual Therapy
ANS: change in vitals, skin conductance
Spinal Cord: inhibit pain receptors, decreased hypertonicity
CNS: altered pain experience in brain, inhibits mechanical nociception (gate control)
PNS: decreased inflammatory mediators
Temporal: last 20-30min, need to supplement with exercise to maintain effects
Placebo
Muscle Energy Technique
-active assits technique within or beyond normal ROM
-against PT counterforce
-less agressive and most tolerated
-RROM
ex: Pelvic SIJ Dysfuction: Alternating Add/Abd isometrtic holds
Normal End Feels
Bony/Hard: bone on bone
-elbow ext
-hard ending
-no joint play
Elastic: muscle tendon unit
-stretches with recoil
-wrist flextion causing finger flexion
-muscle adhesions= passive stretch
Soft: soft tissue
-elbow flexion
Capsular: produced by capsule or ligaments
-with pain= 1-2 Oscillation
-Adhesions= 3 sustained and 3-4 oscillation mobilization
Abnormal End Feels
Springy: articular surface
-rebound sensation
-knee flexion with displaced meninscus
Boggy: viscous fluid in joint
-squishy sensation
-blood in joint or sepsis
Spasm: reactive muscle reaction
-unyielding spasm
-recent trauma or tear
-no joint play
Empty: pain stops you
-no joint play if with assessment
Acute Stage of Healing
-inflammatory
-pain early in ROM
-0-10 (or 3) days
-chemicals irritate nerve endings
PT:
-prevent negative effects of rest
-reduce inflammation, edema, pain
-protect area
Teqniques:
-soft tissue/estim/US
-joint mobilizations (I-II)
-Muscle Energy Tecniques
Subacute Stage of Healing
-proliferation and repair
-pain at endfeel
-2 days - 3 months
-growth of capillaries, collagen formation, wound is covered, granulation tissue
PT:
-mobilize scar
-promote healing and function (PROM>AAROM>AROM)
-develop neurmuscular control
-pt education about 6w healing
Manual Therapy Teqniques:
-soft tissue/estim/stretch
-joint mobilizations (II-III)
-MET
-HVLAT if MET not successful
Chronic Stage of Healing
-maturation and remodeling
-pain at overpressure
-12 days -1+ yr
-new collagen (type 2) to align with stress
-scar formation
PT:
-return to function
-increase tensile quality of scar
- develop functional independence
-mobilize scar
-improve neurmuscular control
Manual Therapy Teqniques:
-soft tissue/estim/strength
-joint mobilizations (III-IV)
-MET to prepare for HVLAT
-HVLAT Strong indication
Grade I Oscillatory Mobilization Grades
-small amplitude
-0-25%
-beginning of available joint play
-Pain
-acute stage
Grade II Oscillatory Mobilization Grades
-large amplitude
-25-75%
-middle joint play
-acute and sub acute stage
-pain
Grade III Oscillatory Mobilization Grades
-large amplitude
-50-100%
-end of joint play
-joint adhesions
-Subacute and chronic stages
Grade IV Oscillatory Mobilization Grades
-small amplitude
-75-100%
-end of joint play
-intense
-joint adhesion
-chronic stage
Grade V Oscillatory Mobilization Grades
-high velocity low amplitude thrust
-quick movement that exceeds resistance
-100+%
-Subacute to chronic stages
Grade I Sustained Mobilization Grades
-loosen to neutralize joint pressure
-no stress on capsule
-decrease compression
-used with gliding motion
Grade II Sustained Mobilization Grades
-take up slack to separate joint surfaces
-eliminate joint play
-determine joint sensitivity
Grade III Sustained Mobilization Grades
-stretch
-large distraction w/ 6 sec hold
-increase mobility
-treat hypomobility
-joint adhesions
Oscillatory Joint Mobilizations
-pain dominant
-III-IV for stiffness
Sustained Joint Mobilizations
-stiff dominant
High Velocity Low Amplitude Thrust Manipulations
Target-Specified:
-localized
-movement toward 1 specific functional unit
-at or slightly past 2nd ttissue resistance
-pre-position joint before
Generalized
-isolate thrust to region
-at or slightly past 2nd ttissue resistance
-less pre-positioning
Indications for Manual Therapy
-MSK pain
-MSK condition w/ low irrittability (relieved at rest)
-pain changes with movements
Contraindications for Manual Therapy
-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated
Precautions for Manual Therapy
-Joint effusion or inflammation
-RA (non-exacerbation)
-Osteoporosis
-Pregnancy (over spine)
-Dizziness
-Steroid or anti-coagulant
Examination to Treatment w/ Mobilizations
- Baseline Assessment
-pain, s/s, ROM, Strength - Determine Grade
-impairment, stage, irritability - Contraindications and Precautions
- Take up Slack
-assess joint play - Arthrokinemattics and Pt Position
- Only 1 Surface Moves
- Re-assess after Treatment
-pain, s/s, ROM, Strength
Convex on Concave
-roll and glide in opposite direction
-pt move with glide
Concave on convex
-roll in glide in same direction
-pt move with glide
Joint Play
-Hypomobile, Normal, Hypermobile
-Only skip if they have normal, pain free motion
- Know joint surface shape
- Determine hand placement
3.Grade Motion compared to other side and expected motion - Assess Pain/no pain and mobility
Joint Distractions
-improve all motions available to the joint
