Manual Therapy Flashcards by Owen Honroth

manual therapy should be done

with other evidence based treatments

part of the plan as well as active exercises and education

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high irritability and MT appropriate

low-intensity JT mob
pain free accessory ranges

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MT and moderate irritability appropriateness

mod intensity JT mob
progressing amplitude and duration into tissue resistance without producing symptoms

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MT and low irritability appropriateness

end-range jt mobilization
high amp and long duration into tissue resistance

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role of MT

improve body/structure impairment
psychosocial context

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bone disorder contraindications of MT

recent fracture
osteopenia/perosis
suspected fx

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vascular contraindications of MT

hematoma
clotting disorders
anomalies/vessel path changes

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active infection contraindications of MT

acute local infection
bacterial infection
RA
systemic infection

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collagen disorders contraindications of MT

RA
EDS
Marfans
congenital abnormalities

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skin condition contraindications of MT

sutures
open wound
hypersensitivity of skin

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accessory contraindications of MT

advanced diabetes
congenital disorders
malignancy
severe joint disease

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biomechanical effects of MT

improved mvmt
improved position

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neurophysiological effects of MT

spinal cord mediated
central mediated
peripheral inflammatory

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spinal cord mediated effects of MT include

hypoalgesia
sympathoexcitatory
muscle reflexogenic

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central mediated effects of MT include

alterations in pain “experience”

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soft tissue/joint mobilization effects

decrease afferent nociceptive info
peripheral gating
promote peripheral blood flow
non-specific treatment effects

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manipulation effects

descending pain inhibition
promote PSNS activity
peripheral gating
decreased motor pool excitability, resting muscle activity, muscle spindle activity

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autonomic response in spinal cord to MT

skin temp
skin conduction
cortisol levels
heart rate

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neuromuscular response in spinal cord to MT

motorneuron pool
afferent discharge
muscle activity

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pain inhibition is facilitated by

decreased pain sensitivity
enhanced pain inhibition
decreased pain facilitation

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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 placed between 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