Manual Therapy and Neuroprovocation

Question 1

what are the contraindications to manual therapy?

Answer 1

systemic or localized infection
febrile state
acute circulatory condition
malignancy
open wound or sutures over tx site
recent fracture
hematoma
advanced DM
hypersensitive skin
inappropriate end-feel
RA (during exacerbation)
cellulitis
constant, severe pain
extensive radiation of pain
ANY CONDITION NOT FULLY EVALUATED

Question 2

which impairment and end feel should a grade I-II mob be done for?

Answer 2

pain
capsular end-feel

Question 3

which impairment and end feel should a grade III-IV mob be done for?

Answer 3

joint adhesions
early capsular end-feel (hypomobility)

Question 4

which manual techniques are recommended for acute stage (<3 days)?

Answer 4

MET strongly indicated
grade I-II joint mobs
HLAT rarely indicated

Question 5

which manual techniques are recommended for sub-acute stage (3 days - 3 months)?

Answer 5

MET strongly indicated
grades II-III joint mobs
HVLAT mod-strongly indicated if MET unsuccessful

Question 6

which manual techniques are recommended for chronic stage (<3 months)?

Answer 6

MET used to prepare tissue for HVLAT & prevent recurrence
grades II-IV mobs
HVLAT strongly indicated if MET ineffective

Question 7

which direction should the joint be pushed during a mob?

Answer 7

in the direction of the joint’s glide

Question 8

grade 1 mob:
amplitude
% tissue resistance

Answer 8

small amp
~25%
no pressure at joint

Question 9

grade 3 mob:
amplitude
% tissue resistance

Answer 9

large amp
last 50% (50-100%)

Question 9

grade 2 mob:
amplitude
% tissue resistance

Answer 9

large amp
mid 50% (25-75%)
no plastic changes
turn on mechanoreceptors

Question 10

grade 4 mob:
amplitude
% tissue resistance

Answer 10

small amp
last 25% (75-100%)

Question 11

grade 5 mob:
amplitude
% tissue resistance

Answer 11

quick movement that exceeds resistance
high velocity low amplitude thrust

Question 12

osteokinematics can be _____
arthrokinematics can be ____

Answer 12

osteo - seen
arthro - felt

Question 13

who developed sustained hold joint mobs?

Answer 13

Freddy Kaltenborn

Question 14

who developed graded oscillations?

Answer 14

Maitland

Question 15

what are the biomechanical effects of manual therapy?

Answer 15

improved movement
improved position

Question 16

what are the neurophysiological effects of manual therapy?

Answer 16

SC
central mediated
peripheral inflammatory

Question 17

T/F: manual effects last 20-30 mins only and should be backed up with exercises

Answer 17

T

Question 18

which mechanisms is triggered by manual at the CNS?

Answer 18

gate-control theory

Question 19

what are the PNS effect of manual?

Answer 19

decreased inflammatory mediators at local site

Question 20

what are the SC effect of manual?

Answer 20

inhibit pain receptors
non-localized/non-specific effects on vitals
decrease mm hypertonicity

Question 21

what are the autonomic effect of manual?

Answer 21

changes in HR, BP, RR, and skinconductance

Question 22

what is the only active form of manual?

Answer 22

muscle energy techniques

Question 23

what are normal end-feels?

Answer 23

bony
elastic
soft tissue approximation
capsular

Question 24

what are abnormal end-feels?

Answer 24

springy
boggy
spasm
empty

Question 25

meniscus or disc issue will have a ___ end-feel

Answer 25

springy

Question 26

viscous fluid in joint will have ___ end-feel

Answer 26

boggy

Question 27

reflexive and repeated mm contraction in response to irritation of nociception will have a ___ end-feel

Answer 27

spasm

Question 28

an empty end feel is produced solely by

Answer 28

pain

Question 29

pain dominant condition –> ____ mobs

Answer 29

oscillatory grades I-II

Question 30

stiff dominant condition –> ____ mobs

Answer 30

sustained grade or oscillatory grades III-IV

Question 31

indication for manual therapy

Answer 31

mild MSK pain
MSK condition with low irritability
intermittent MSK pain
pain that is relived or provoked with specific motions or positions
pain related to changes in sitting or standing postures

Question 32

what are the 3 objectives of manual therapy?

Answer 32

reduction of pain
alternation of stiffness
patient education

Question 33

what 3 factors determine the appropriate grade of manual?

Answer 33

type of impairment
stage of condition
irritability of symptoms

Question 34

what are the 3 tension sites where dura is tethered to bony canal?

Answer 34

C6
T6
L4

Question 35

what are the sites of nerve & nerve root vulnerability?

Answer 35

tunnels
branches
hard interfaces (on bone, through fascia)
proximity to surface
adherence to interfacing structures

Question 36

proposed mechanisms of adverse neural tension

Answer 36

posture
direct trauma
extremes of motion
electrical injury
compression

Question 37

what are the 3 signs of a positive neurodynamic mobility exam?

Answer 37

1) reproduction of pt’s symptoms (concordant pain)
2) Movement of distant component alters pt response (sensitization)
3) side-to-side differences

Question 38

repetitive _____ strains may have a relationship with adverse neural tension of the sciatic nerve (slump test)

Answer 38

hamstring

Question 39

if the wrist is flexed in the ULTT, which nerve is biased?

Answer 39

radial

Question 40

if the elbow is flexed in the ULTT, which nerve is biased?

Answer 40

ulnar

Question 41

contras for neurodynamic moblizations

Answer 41

recent repaired peripheral nerve
malignancy
active inflammatory conditions
acute inflammatory demyelinating diseases

Question 42

what should be treated 1st before neural tension?

Answer 42

pain and mobility deficits