Manual Therapy Flashcards by Tori Chatman

Manual Therapy

-skilled hand mmts and passive mmts of joints

-improved tissue exttensibility, ROM, relaxation, pain, restrictions

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Mobilizations

-passive
-rhythmic, repetitive mmt
-varied amplitudes
-high tolerance
-Restore full, painfree joint motion

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Manipulations

-passive
-single, quick, decisive mmts
-small amplitude
-important set up
-Restore full, painfree joint motion
-faster, not always safe

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Biomechanical Method

-biomechanical theory to assess abnormalities
-athrokinematic principals
-anatomical causes for presentation

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Patient-Based Response Method

-pain reproduction and reduction w/ mmt
-does not rely on biomechanical
-findings to determine Tx

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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

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Biomechanical Effects of Manual Therapy

-Improved movement
-Improved position

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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

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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

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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

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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

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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

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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

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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

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Grade I Oscillatory Mobilization Grades

-small amplitude
-0-25%
-beginning of available joint play
-Pain
-acute stage

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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

1. Baseline Assessment -pain, s/s, ROM, Strength 2. Determine Grade -impairment, stage, irritability 3. Contraindications and Precautions 4. Take up Slack -assess joint play 5. Arthrokinemattics and Pt Position 6. Only 1 Surface Moves 7. 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 1. Know joint surface shape 2. Determine hand placement 3.Grade Motion compared to other side and expected motion 4. Assess Pain/no pain and mobility

Joint Distractions

-improve all motions available to the joint