Manual Therapy

Question 1

What is manual therapy?

Answer 1

Mainly used to treat movement related disorders.

Question 2

What is grade 1 in manual therapy and when used?

Answer 2

What? Small amplitude movement, nese the start of range soft resistance.
Used?- Not ROM pain predominany conditions, oscillatory effect is claimed to dilute chemical soup (chemical mediators, histamine, substance P).

Question 3

What is grade 2 in manual therapy and when is it used?

Answer 3

What? - Large amplitude movement, carries well into the range, soft resistance.
Used- pain dominant presentations, oscilatory effect dilute chemical soup (chemical mediators, histamine, substance P)

Question 4

What is grade 3 manual therapy and when is it used ?

Answer 4

What- large amplitude, performed from the onset of resitance to the end of available range, where abouts grade 3 is performed depends on pain responde/muscle spasm, plastic range on stress/strain curve.
Used- help with ROM, pain and resistance (via neurophysiological mechanisms)

Question 5

What is grade 4 in manual therapy and when is it used?

Answer 5

What? - small amplitude movement, stretches well into firm resistance or muscle spasm towards the end of available range.
Used- Treat pain and resistance (via neurophysiological mechanisms), end range resistance.

Question 6

What is low dosage of manual therapy and when used?

Answer 6

Use when pain limiting, high SIN and indications of active pathophysiology, mobilise in symptom free, comfortable posistion, smooth slow osvillations (1 cycle per 2 seconds) or short duration (intervals of 30 seconds), primary to achieve neural/reflex desensitation.

Question 7

What is high dosage of manual therapy and when is it used?

Answer 7

Pathomechanics/maintained pain due to resistance, mobilise in best posistion to apply forces appropriately and into resistance, uses alternating oscillations for longer duration (intervals of 60 seconds), achieves neural/reflex desensitation and possible mechanical effects. Less irritable.

Question 8

What are the contraindications of manual therapy?

Answer 8

1. Malignancy
2. Metabolic bone disease (steroids, anticoagulants)
3. Recent fractures
4. Joint instability/severe sprains
5. Inflammatory arthropathy
6. Severe unremitting pain
7. Rapidly worsening condition
8. Spinal mobilisations dont do if: cord signs, vertebrobasilar insufficiency, severe nerve root symptoms

Question 9

What are the precautions of manual therapy?

Answer 9

High SIN factor, long standing deformity, severe degenerative conditions, pregnancy- no probe lying able to do on shoulder/elbow.

Question 10

What are the benefits/physiological effects of manual therapy? (8)

Answer 10

1. Decrease spasm
2. Increase joint mobility
3. Stimulation of mechanoreceptors to decrease pain through pain gate, opioid system.
4. Maintain/Increase ROM
5. Reduce soft-tissue inflammation
6. Induce relaxation
7. Reduce muscle tension
8. Education- that can do some movement and can be in some pain.
9. Improve remodeling, repair and cross-linking during healing.
10. Improve the transfer of fluids across joint surface.
11. Stimulate the movement of synovial fluid
12. Stretching a joint to restore ROM

Question 11

How else is pain reduced in manual therapy?

Answer 11

Activates the descending pain inhibitory system.
Periaqueductal grey matter stimulated by manual therapy release endogenous opioids down.
Sensory input from manual therapy activates A Beta fibres that inhibit nociceptive input from A delta and C afferent fibres.

Question 12

What dosage/ duration for manual therapy?

Answer 12

Acute- 30-40 seconds 2 sets

Chronic- 1 minutes plus 3 sets