Manual therapy Flashcards
manual therapy definition
manual therapy techniques consist of a broad group of skilled hand movements, including but not limited to mobilization and manipulation, used by the PT to mobilize or manipulate soft tissues and joints for the purpose of:
- modulating pain
- increasing joint ROM
- reducing or eliminating soft tissue swelling, inflammation or restriction
- inducing relaxation
- improving contractile and noncontractile tissue extensibility
- improving pulmonary function
these interventions involve a variety of techniques such as the application of graded forces
types of joint movement
osteokinematic
arthrokinematic
Osteokinematic joint movement
- movement of the bones
- clinically described reference cardinal planes
- flexion, abduction, IR, nutation (rotation of the pelvis)
- under control of the pt
- typical stretching/strengthening motions
- combined into functional patterns
arthrokinematic joint movement
- movement of the joint partners
- described one partner on the other
- roll, glide, compression, distraction
- not under voluntary control of the pt
- not functional:
- restoration of arthrokinematics should NOT be the only thing you do
- critical for normal motion so critical for function
normal movement
For normal movement, both osteokinematic and arthrokinematic motion have to be normal
Goal of ther ex: restore normal osteokinematic motion and function
-generally active tx
Goal of manual therapy seeks to restore normal arthrokinematic motion
- generally passive tx
- many exceptions, but a good way to start thinking about it
manual therapy approaches
- dizzying array of names and theoretical constructs: quality varies
- most have their own “lingo”
- most have little or no evidence backing them up
Examples:
- Cyriax
- Kaltenborn
- Maitland
- Mulligan
- Paris
- McKenzie
- Chiropractic
- Osteopathic
- Trigger point
- Strain/conterstrain
- MFR
- muscle energy
- positional release therapy
- neural tension
how to decide which path to choose?
- levels of evidence
- quality of theoretical construct
- appropriateness of technique to sPT
- APTA and CAPTE recommendations and requirements
joint mobilization
- continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including small amplitude/high velocity therapeutic movement
- most often done to increase joint mobility by increasing joint play (arthrokinematic motion)
- glides and distraction are most common
Kaltenborn’s mobilization technique grades
HOLDS
1: 0-25% available joint play
2: 0-full available joint play
3: 0-past available joint play and tissue resistance
Maitland’s mobilization technique grades
OSCILLATES
1: 0-25% available joint play
2: 25-75% available joint play
3: 50-100% available joint play
4: 75-100% available joint play/tissue resistance
5: HVLA: high velocity low amplitude thrust, starts at end range; pt can’t splint
1+2 gets pt to move jt, mostly for pain relief, stimulation, relaxation, get synovial fluid moving. neuro effect w/ some muscular
*1-4: 2 minute oscillations, non-aggressiveaggressive, pt can splint
tissue resistance end feel
- endfeel is felt by the examiner; quality of motion felt as joint is moved through resistance (beyond “first stop”)
- endfeels exist in osteokinematic and arthrokinematic (joint play) motions
- when painfree PROM is not >AROM, endfeel will be abnormal (capsular, empty)
Kaltenborn endfeels
FIRM: capsular or ligamentous stretch (GH ER)
HARD: bone meets bone (elbow extension)
SOFT: tissue approximation or tissue stretch (knee flexion)
Cyriax endfeel
BONY: abrupt stop to motion (elbow ext)
CAPSULAR: immediate stop with some give (GH ER)
TISSUE APPROXIMATION: soft tissue compression (knee flexion)
EMPTY: severe pain limits motion
SPRINGY BLOCK: rebound felt at end range (meniscal block, labral tear)
SPASM: muscle splint, usually involuntary
theoretical effects of mobilization
1: decrease pain
- stimulate synovial fluid production
- improve synovial fluid circulation
- release pinched painful structures
- stimulation of large diameter fibers (Gate theory)
- psychological/placebo effects of touch
2: increase ROM
- rupture joint adhesions
- stretch periarticular structures
- decrease muscle spasm
- improve joint alignment
- restore arthrokinematic motion
mobilization technique variables
joint position:
- close vs loose packed
- neutral vs end range
- straight vs out of plane
- addition of other planar motions?
**choice of technique and variables is determined by pt response model.
do the RIGHT things WELL!
