Manual Therapy and Neuroprovocation Flashcards
what are the contraindications to manual therapy?
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
which impairment and end feel should a grade I-II mob be done for?
pain
capsular end-feel
which impairment and end feel should a grade III-IV mob be done for?
joint adhesions
early capsular end-feel (hypomobility)
which manual techniques are recommended for acute stage (<3 days)?
MET strongly indicated
grade I-II joint mobs
HLAT rarely indicated
which manual techniques are recommended for sub-acute stage (3 days - 3 months)?
MET strongly indicated
grades II-III joint mobs
HVLAT mod-strongly indicated if MET unsuccessful
which manual techniques are recommended for chronic stage (<3 months)?
MET used to prepare tissue for HVLAT & prevent recurrence
grades II-IV mobs
HVLAT strongly indicated if MET ineffective
which direction should the joint be pushed during a mob?
in the direction of the joint’s glide
grade 1 mob:
amplitude
% tissue resistance
small amp
~25%
no pressure at joint
grade 3 mob:
amplitude
% tissue resistance
large amp
last 50% (50-100%)
grade 2 mob:
amplitude
% tissue resistance
large amp
mid 50% (25-75%)
no plastic changes
turn on mechanoreceptors
grade 4 mob:
amplitude
% tissue resistance
small amp
last 25% (75-100%)
grade 5 mob:
amplitude
% tissue resistance
quick movement that exceeds resistance
high velocity low amplitude thrust
osteokinematics can be _____
arthrokinematics can be ____
osteo - seen
arthro - felt
who developed sustained hold joint mobs?
Freddy Kaltenborn
who developed graded oscillations?
Maitland
what are the biomechanical effects of manual therapy?
improved movement
improved position
what are the neurophysiological effects of manual therapy?
SC
central mediated
peripheral inflammatory
T/F: manual effects last 20-30 mins only and should be backed up with exercises
T
which mechanisms is triggered by manual at the CNS?
gate-control theory
what are the PNS effect of manual?
decreased inflammatory mediators at local site
what are the SC effect of manual?
inhibit pain receptors
non-localized/non-specific effects on vitals
decrease mm hypertonicity
what are the autonomic effect of manual?
changes in HR, BP, RR, and skinconductance
what is the only active form of manual?
muscle energy techniques
what are normal end-feels?
bony
elastic
soft tissue approximation
capsular
what are abnormal end-feels?
springy
boggy
spasm
empty
meniscus or disc issue will have a ___ end-feel
springy
viscous fluid in joint will have ___ end-feel
boggy
reflexive and repeated mm contraction in response to irritation of nociception will have a ___ end-feel
spasm
an empty end feel is produced solely by
pain
pain dominant condition –> ____ mobs
oscillatory grades I-II
stiff dominant condition –> ____ mobs
sustained grade or oscillatory grades III-IV
indication for manual therapy
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
what are the 3 objectives of manual therapy?
reduction of pain
alternation of stiffness
patient education
what 3 factors determine the appropriate grade of manual?
type of impairment
stage of condition
irritability of symptoms
what are the 3 tension sites where dura is tethered to bony canal?
C6
T6
L4
what are the sites of nerve & nerve root vulnerability?
tunnels
branches
hard interfaces (on bone, through fascia)
proximity to surface
adherence to interfacing structures
proposed mechanisms of adverse neural tension
posture
direct trauma
extremes of motion
electrical injury
compression
what are the 3 signs of a positive neurodynamic mobility exam?
1) reproduction of pt’s symptoms (concordant pain)
2) Movement of distant component alters pt response (sensitization)
3) side-to-side differences
repetitive _____ strains may have a relationship with adverse neural tension of the sciatic nerve (slump test)
hamstring
if the wrist is flexed in the ULTT, which nerve is biased?
radial
if the elbow is flexed in the ULTT, which nerve is biased?
ulnar
contras for neurodynamic moblizations
recent repaired peripheral nerve
malignancy
active inflammatory conditions
acute inflammatory demyelinating diseases
what should be treated 1st before neural tension?
pain and mobility deficits
