Manual Therapy Flashcards
manual therapy should be done
with other evidence based treatments
part of the plan as well as active exercises and education
high irritability and MT appropriate
low-intensity JT mob
pain free accessory ranges
MT and moderate irritability appropriateness
mod intensity JT mob
progressing amplitude and duration into tissue resistance without producing symptoms
MT and low irritability appropriateness
end-range jt mobilization
high amp and long duration into tissue resistance
role of MT
improve body/structure impairment
psychosocial context
bone disorder contraindications of MT
recent fracture
osteopenia/perosis
suspected fx
vascular contraindications of MT
hematoma
clotting disorders
anomalies/vessel path changes
active infection contraindications of MT
acute local infection
bacterial infection
RA
systemic infection
collagen disorders contraindications of MT
RA
EDS
Marfans
congenital abnormalities
skin condition contraindications of MT
sutures
open wound
hypersensitivity of skin
accessory contraindications of MT
advanced diabetes
congenital disorders
malignancy
severe joint disease
biomechanical effects of MT
improved mvmt
improved position
neurophysiological effects of MT
spinal cord mediated
central mediated
peripheral inflammatory
spinal cord mediated effects of MT include
hypoalgesia
sympathoexcitatory
muscle reflexogenic
central mediated effects of MT include
alterations in pain “experience”
soft tissue/joint mobilization effects
decrease afferent nociceptive info
peripheral gating
promote peripheral blood flow
non-specific treatment effects
manipulation effects
descending pain inhibition
promote PSNS activity
peripheral gating
decreased motor pool excitability, resting muscle activity, muscle spindle activity
autonomic response in spinal cord to MT
skin temp
skin conduction
cortisol levels
heart rate
neuromuscular response in spinal cord to MT
motorneuron pool
afferent discharge
muscle activity
pain inhibition is facilitated by
decreased pain sensitivity
enhanced pain inhibition
decreased pain facilitation
mobilization definiton
passive technique for restoration of full painless joint function by rhythmic, repeated passive movements within patient’s range
manipulation definition
accurately localized/global applied single, quick and small amplitude in proper patient positioning
muscle energy technique definiton
manually assisted method of stretching where patient actively uses muscles on request while maintaining position against a counterforce
role of static stretching
placing a muscle at its maximal length and holding it for a sustained period of time
improve ROM when no joint involvement
PNF techniques
active muscle contractions into stretching
reciprocal inhibition
dynamic stretching done to
improve functional performance
loaded ROM
performing ROM with a load
- improved collagen deformity
decreased gaurding
grade 1 mobilization
small amplitude
early ROM
grade 1 mobs are done for
pain
grade 2 mobilizations
large amplitude
mid range of movement
grade 2 mobilizations are done for
pain
grade 3 mobilizations
large amplitude
point of limitation in ROM
grade 3 mobilizations are done for
increased ROM
grade 4 mobilizations
small amplitude
end ROM
grade 4 mobilizations are done for
motion
grade 5 mobilizations
small amplitude
quick thrust at end ROM
grade 5 mobilizations are done for
pain
how long does it take to deform collagen
15 sec minimum
what mobilization grades are done at open packed positions
1,2
testing ranges
what mobilization grades are done at closed packed positions
3,4,5
where you do interventions
for grade 5 mobilizations, what is the protocol for doing them
1-2 times
- pop of joint is not necessary (cavitation)
purpose of muscle energy techniques
lengthen shortened muscles
mobilize area with limited mvmt
strengthen muscles
reduce edema
autogenic inhibition
focus on agonist muscles
GTO activation relaxed muscles being stretched
major difference between autogenic and reciprocal inhibition
auto = agonists
recipro = antagonist
post-isometric relaxation goal
reduce hypertonicity
technique of post-isometric relaxaion
Take up muscle slack to point of resistance.
Ask patient to hold isometric contraction for 5-10 seconds.
Patient then relaxes and slack of muscle is taken up to new barrier.
Process is repeated 2-3 times.
post-facilitation stretch goal
reduce hypertonicity
post-facilitation stretch techniques
Shortened muscle is placedbetween a fully relaxed and fully stretched state.
Patient maximally contracts muscle against PT’s force for 5-10 seconds.
Patient relaxes as PT provides quick, static stretch to new barrier, holding for 10 seconds.
Patient relaxes for 20 seconds, and the process begins again for 3-5 reps.
mobilization with movement
concurrent application of sustained accessory mobilization applied by therapist with active movement of patient to end range
- passive overpressure applied
NAGS vs SNAGS vs MWMS
NAGS - natural apophyseal glides
SNAGS - sustained natural apophyseal glides
MWMS - mobilization with movements
