Manual Therapy Flashcards
Purpose of Manual Therapy
- pain control
- increase ROM
- decrease soft tissue inflammation
PPM’s vs. PAM’s
-what are they limited by?
passive physiologic movements (osteokinematics)
-limited by: soft tissue > joint capsule > joint play
Passive accessory movements (arthrokinematics)
- roll & glide; distraction/compression
- limited by: capsule, ligaments, bony congruency & menisci
Mobilization vs. Manipulation
mobilization - technique where patient has ability to prevent movement
- PPM’s & PAM’s
- less vigorous
manipulation - technique performed at a speed beyond the patient’s control; can break adhesions & remove loose bodies
- Grade V mobilizations
- more vigorous & requires more skill
Absolute Contraindications for Manual Therapy
- Malignancy
- Certain neurological conditions
- Vascular conditions (wounds, arterial insufficiency, Hx. of anticoagulation therapy)
- Bone diseases (fracture, spondylolisthesis)
- Inflammatory conditions (RA (active), ankylosing spondylitis)
- Infection
- Acute symptomatic disc herneation
- Undiagnosed pain
Relative Contraindications for Manual Therapy
- Osteoporosis
- RA (when not active)
- hypermobility & instability
- pregnancy
- previous malignant disease
- protective spasm
- acute trauma
- psychological pain
- severe nerve root pain
- steroid or anticoagulant use
Precautions to Manual Therapy
- recent trauma
- ligament injury
- Post-op
- Empty end feel or muscle spasm
- acute inflammation
Indications for Manual Therapy
- mild or moderate pain of musculoskeletal origin
- joint hypomobility
- non/mild/mod severity
- subacute remodeling phase
- acute spinal pain w/o neurological symptoms
Kaltenborn Distraction Grades
Grade I - just enough force to unload the joint surfaces but not enough to separate them
Grade II - enough force to separate the joint surfaces; “taking up the slack” & to eliminate joint play
Grade III - max force distraction that provides ligament & capsule stretch
Maitland’s Accessory Glide Grades
Grade I - small amplitude in resistance free range (first 25%)
Grade II - large amplitude in resistance free range (first 50%)
Grade III - large amplitude against resistance (last 50%)
Grade IV - small amplitude against resistance (last 25%)
Grade V = manipulation - high velocity, small amplitude, thrust movement at the mid or end range
Manual Technique Selection by?
- Stage of healing
2. level of irritability (agg & easing factors)
Technique for pain & resistance?
Grade III Distraction & mobilizations
Technique for muscle restriction
Muscle stretching (hold/relax)
Technique for joint restriction
PPM, Grade III or IV mobilization and/or manipulation
Technique for capsular restriction
Grade IV mobilization, prolonged stretch, distraction w/ or w/o movement
(NO MANIP)
Technique for hypomobility or pain through ROM
PPM - Osteokinematic motions
Dosage for Distractions
For pain - 10-20sec static hold x5 (grade I or II)
For stretching - 30-60sec static hold x5 (grade II or III)
GH Inferior Glide Thrust Manipulation
Pt. sitting shoulder elevated to 90deg & neutral rotation
Clinician stand in front of patient & fully support arm w/ other hand on superior aspect of humeral head.
Ask patient to slightly lean to opposite side, perform inferior glide to end point, if no pain perform high velocity, low amplitude thrust straight down
GH Posterior Glide Thrust Manipulation
Pt. supine w/ arm relaxed in 60deg abduction and neutral rotation
Clinician fully support arm w/ thigh & other hand on anterior portion of humeral head
Apply distraction force by pushing arm against the medial aspect of thigh, then apply posterior glide to end feel, if no pain perform a high velocity low amplitude thrust straight down
SC & AC Distraction
Have client sit on table w/ shoulders relaxed
Clinician support middle thoracic spine with one leg & hold onto anterior shoulders.
Ask the patient to inhale –> pull shoulders back –> exhale & repeat 3 times
RCI Distraction
**for frozen shoulder specifically
Rotator cuff interval contracture - tissue btwn anterior supraspinatus tendon edge & upper subscapularis border - restricts ER w/ the arm at side and prevents inferior translation
Patient supine, arm by side & ER’d & perform inferior distraction
Neurophysiological Theory of Why/how MT works
- Descending pain inhibitory system
- Gate control theory
- Release of endogenous opioid
- Change in reflex excitability to decrease tone
Mechanical Theory of why/how MT works
- Loosen up and free entrapped/torn menisci
- Mechanical disruption of intra-articular adhesions
- Stretching of joint capsule
Psychological theory of why MT works
PLACEBO affect is huge!!
