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DPT MSK - fall 22 > Manual Therapy - exam 1 > Flashcards

Manual Therapy - exam 1 Flashcards

1
Q

Are most manual therapies passive or active exercises?

A

passive - has limitations
(active = exercise)
can progress these to active treatments

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2
Q

how is manual therapy similar to modalities?

A

many are overstated and/or unsupported claims of benefit

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3
Q

why does it seem like the treatment actually works when the fix wasn’t really from the treatment?

A

many conditions can purely improve with time alone

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4
Q

why are manual therapies difficult to blind clinicians and patients to techniques?

A

the patient knows that a manual therapy technique is being done on the vs not knowing what is happening in ROM

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5
Q

what is the actual benefit occurs when laying hands on patient? not just the placebo effect

A

actual beneficial neurophysiological changes occur

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6
Q

what are 2 things that manual therapy lack?

A
  1. lack of clearly defined techniques - every therapist does something different
  2. lack of agreement on most beneficial technique
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7
Q

true or false. low back pain should be treated the same for every patient presenting with those symptoms

A

false
- common area that this happens on is SI joint

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8
Q

63% of 30-80 year olds have asymptomatic disc changes. Why should you not treat every low back pain as disc change given this information?

A

many people have disc changes as part of aging without causing pain therefore the pain they are coming in for may not necessarily be due to disc changes
- normal age related changes can be greater than the reasons for symptoms

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9
Q

what are best evidence practices to consider first?

A

consider patient preferences and beliefs
level of clinical skill
EBP - when available, always use this first
sound anatomy, physiology, and biomechanics

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10
Q

what are proposed benefits of transverse friction massage?

A

improved P!
extensibility
tissue integrity
* mainly used on tendons

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11
Q

what is the MOA of transverse friction massage?

A

unclear

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12
Q

in a systematic review for transverse friction massage, is there support or not support for use of this technique?

A

no support

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13
Q

what are proposed benefits for myofascial release?

A

improve inefficient movement and posture
cellular turnover
disease
P!

*targets fascia

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14
Q

what does myofascial release lack?

A
  • scientific support - mostly anecdotal (brings back to placebo effect)
  • current evidence is not sufficient to use with persistent MSK P!
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15
Q

what are proposed benefits of soft tissue mobilization?

A

improved P!, circulation and relaxation

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16
Q

what does the evidence say about using soft tissue mobilization as an effective treatment for low back pain?

A

very little confidence
low to very low quality evidence to help LBP and function, if so only short term

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17
Q

what is the proposed benefit for instrumented assisted soft tissue mobilization? (Graston/ASTYM)

A

use of tools to scrape tissue and improve P!, circulation and tissue healing

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18
Q

why is there a high risk of bias using ASTYM/Graston?

A

huge conflict of interest because the company paid for the research
- no statistically meaningful benefit on P!, ROM, or function

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19
Q

what are proposed benefits for acupressure?

A

help P! and function of vital organs
improve circulation and energy flow along meridians

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20
Q

why wouldn’t you know if acupressure is actually working or not?

A

you can’t measure the energy flow

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21
Q

what are proposed benefits of muscle energy (similar to stretching)?

A

normalize the neuromuscular system after being “scarred” by P! and impairment
restore symmetrical position and/or motion

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22
Q

what is the MOA for muscle energy?

A

unknown for P! control
refuted and unsubstantiated muscle relaxation and inhibition

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23
Q

what is muscle energy most likely to increase?

A

tolerance to stretch

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24
Q

what does the systematic review say about muscle energy?

A

more likely that other treatment/variables influenced the outcomes rather than the muscle energy treatment

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25
Q

what are proposed benefits of strain counter strain?

A

use of passively shortened positioning to improve trigger points and function

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26
Q

what is the MOA of strain counter strain?

A

undetermined and untested

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27
Q

why is the use of manual palpation for trigger points unreliable?

A

there is a lack of consistency amongst therapists when finding trigger points

28
Q

what are proposed benefits of craniosacral therapy?

A

improving craniosacral motion improves health
based on assumption cranial and sacral bone movement occurs through respiration and influences neurological system and health

29
Q

what does the research say about craniosacral therapy?

A

reliability of feeling cranial movement ranges from worse than chance to fair
- one study found small to medium effects on P! only immediately after Rx BUT high bias and other variables most likely influenced outcomes

30
Q

what does the research say about dry needling?

A

low to moderate quality evidence for MSK P! and function
mixed risk of bias

31
Q

is dry needling more or less effective than modalities, massage and stretching?

A

more effective

32
Q

when using dry needling to treat headaches, can you use it as a stand alone Rx?

A

not recommended - should be used with more JMs amd exercise

33
Q

true or false. majority of studies indicates NO effect on force production

A

true

34
Q

what is the MOA for PNF?

A

unknown currently
likely due to improving tolerance to movement and/or P! modulation
(similar to ME and stretching)

35
Q

in PNF, what do you do to get best results?

A

contract relax

perform right after exercise
10 sec muscle action
<60% max voluntary contraction
repeat up to 5x

36
Q

true or false. PNF is better for extremities than spine

A

true

37
Q

what does the evidence say in a meta-analysis for PNF with LBP?

A

low quality evidence
weak rec. for P!, disability, ROM in short term

38
Q

true or false. PNF is better when combined with JM –> then stretching, rest, modalities, PROM

A

true

39
Q

does PNF have mostly good quality studies?

A

yes

40
Q

what is thrust manipulation?

A

high velocity, low amplitude therapeutic movements within or at end range of motion

41
Q

when performing joint mobilizations/manual therapy techniques, in TN what must you make sure not to do?

A

do NOT perform beyond the joint’s normal range of motion

42
Q

previously joint mobilizations was thought to improve motion. current knowledge says ____

A

you get neurophysiological benefits from biomechanical influences - not fully understood but supported with research

43
Q

what is the P!-spasm-P! cycle?

A

you have nociceptive input –> motor neuron response –> muscle spindle stays tight –> increases protective response (guarding)

this means the muscle spindle has hyperactivity response as a protective response because the muscle is lengthening (eccentric)

this cycle keeps going and PTs can break it up

44
Q

what does joint mobilizations do as a neuromuscular response at rest?

A

decreases protective muscle activity at rest by reducing nociceptive input –> disrupts P!-spasm-P! cycle

45
Q

what happens in the spinal stretch reflex pathway of P!-spasm-P! cycle?

A

same as P!-spasm-P! cycle but using higher brain centers with motion
- increased motor neuron activation, increased m. spindle activation, increased muscle recruitment

46
Q

how does joint mobilization decrease excessive muscle recruitment with motion?

A

reverse P!-spasm-P! cycle
reduce nociceptive input
diminish motor neurons and muscle spindle activity

47
Q

what does joint mobilization do for the autonomic nervous system?

A

stimulates mechanoreceptors and preganglionic cells then sends signals to the hypothalamus
acts as a natural opioid releaser, anti-inflammatory and tissue healing hormones released

48
Q

segmental inhibition is based on gait control theory of P!. An example would be when you hit your elbow on a hard surface and immediately rub that hurt area. How does JM play into segmental inhibition?

A

larger myelinated fibers are stimulated thru mechanoreceptors stimulation by JM and override P! signals of smaller P! carrying fibers

49
Q

joint mobilization __increase/decrease__ temporal summation and reorganizes homunculus. explain how this happens.

A

temporal summation - increased and misprocessing P! perception due to persistent P! perceptions and increased dorsal horn excitability

homunculus - areas of brain dedicated to bodily perception
–> knee hurts, area of brain/homunculus focused on it more

50
Q

where is joint mobilization most useful?

A

spine

51
Q

in acute neck P! conditions, what is the meta-analysis for JM?

A

low-quality evidence that cervical manipulation is more effective than thoracic manipulation

52
Q

in acute and sub acute neck P! conditions, what does the research state about JM?

A

moderate quality evidence for cervical and thoracic manipulation
very low-quality evidence for one direction of mobilization over another

53
Q

in acute and persistent conditions, what does the research say about JM?

A

moderate to high quality evidence for manipulation

54
Q

what does the research state about persistent neck P! and function in regards to JM?

A

low to moderate quality of evidence of a small effect with mobilization and manipulation
greatest effect when combined with exercise
low risk of bias

55
Q

what does the clinical prediction rule predict? Which MT technique is the only one that this applies to?

A

predicts successful cervical and thoracic manipulation with neck P!

56
Q

which groups is manipulation most effective for?

A

sub groups
– CPR for lumbar rotation or SI distraction manipulation for LBP
– added benefit when used with exercise

57
Q

what does JM NOT do?

A
  • individually change health overall
  • create long term benefits
  • joint movement occurs but no lasting change in isolation - motion needs to be actively used with exercise
  • no studies indicate dependence is a consequence of JM
58
Q

when would short term benefits of JM/MT be OK ?

A

can be ok if it brings patient to active exercises quicker

59
Q

overall, manual therapy gives mostly ____ ______ evidence with _____, _______ ______ benefits, if any

A

low quality
small, short term

most benefits on subjective variables

60
Q

true or false. generally, MT techniques have conclusive and known MOAs

A

false

61
Q

HIGH research bias effects MT. as a result, what would most likely be causing the small, short term benefits?

A

other variables

62
Q

which manual therapy technique has the best support?

A

JM
more mod-high quality studies and evidence
greater effect when combined with exercise
least research bias
CAPTE requires JM for all DPT programs

63
Q

behind JM, what other two MT are next best supported?

A

PNF
dry needling

64
Q

what should you consider when using manual therapy?

A

multiple influences on both the patient and the provider

65
Q

what is the essential goal with manual therapies?

A

to get to active exercises sooner and more often

66
Q

what would our best intervention be in terms of MT?

A

immediately capitalize on improved P! with progressive medical exercise therapy

DPT MSK - fall 22 (18 decks)

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