Manual Therapy - exam 1 Flashcards
Are most manual therapies passive or active exercises?
passive - has limitations
(active = exercise)
can progress these to active treatments
how is manual therapy similar to modalities?
many are overstated and/or unsupported claims of benefit
why does it seem like the treatment actually works when the fix wasn’t really from the treatment?
many conditions can purely improve with time alone
why are manual therapies difficult to blind clinicians and patients to techniques?
the patient knows that a manual therapy technique is being done on the vs not knowing what is happening in ROM
what is the actual benefit occurs when laying hands on patient? not just the placebo effect
actual beneficial neurophysiological changes occur
what are 2 things that manual therapy lack?
- lack of clearly defined techniques - every therapist does something different
- lack of agreement on most beneficial technique
true or false. low back pain should be treated the same for every patient presenting with those symptoms
false
- common area that this happens on is SI joint
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?
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
what are best evidence practices to consider first?
consider patient preferences and beliefs
level of clinical skill
EBP - when available, always use this first
sound anatomy, physiology, and biomechanics
what are proposed benefits of transverse friction massage?
improved P!
extensibility
tissue integrity
* mainly used on tendons
what is the MOA of transverse friction massage?
unclear
in a systematic review for transverse friction massage, is there support or not support for use of this technique?
no support
what are proposed benefits for myofascial release?
improve inefficient movement and posture
cellular turnover
disease
P!
*targets fascia
what does myofascial release lack?
- scientific support - mostly anecdotal (brings back to placebo effect)
- current evidence is not sufficient to use with persistent MSK P!
what are proposed benefits of soft tissue mobilization?
improved P!, circulation and relaxation
what does the evidence say about using soft tissue mobilization as an effective treatment for low back pain?
very little confidence
low to very low quality evidence to help LBP and function, if so only short term
what is the proposed benefit for instrumented assisted soft tissue mobilization? (Graston/ASTYM)
use of tools to scrape tissue and improve P!, circulation and tissue healing
why is there a high risk of bias using ASTYM/Graston?
huge conflict of interest because the company paid for the research
- no statistically meaningful benefit on P!, ROM, or function
what are proposed benefits for acupressure?
help P! and function of vital organs
improve circulation and energy flow along meridians
why wouldn’t you know if acupressure is actually working or not?
you can’t measure the energy flow
what are proposed benefits of muscle energy (similar to stretching)?
normalize the neuromuscular system after being “scarred” by P! and impairment
restore symmetrical position and/or motion
what is the MOA for muscle energy?
unknown for P! control
refuted and unsubstantiated muscle relaxation and inhibition
what is muscle energy most likely to increase?
tolerance to stretch
what does the systematic review say about muscle energy?
more likely that other treatment/variables influenced the outcomes rather than the muscle energy treatment
what are proposed benefits of strain counter strain?
use of passively shortened positioning to improve trigger points and function
what is the MOA of strain counter strain?
undetermined and untested
why is the use of manual palpation for trigger points unreliable?
there is a lack of consistency amongst therapists when finding trigger points
what are proposed benefits of craniosacral therapy?
improving craniosacral motion improves health
based on assumption cranial and sacral bone movement occurs through respiration and influences neurological system and health
what does the research say about craniosacral therapy?
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
what does the research say about dry needling?
low to moderate quality evidence for MSK P! and function
mixed risk of bias
is dry needling more or less effective than modalities, massage and stretching?
more effective
when using dry needling to treat headaches, can you use it as a stand alone Rx?
not recommended - should be used with more JMs amd exercise
true or false. majority of studies indicates NO effect on force production
true
what is the MOA for PNF?
unknown currently
likely due to improving tolerance to movement and/or P! modulation
(similar to ME and stretching)
in PNF, what do you do to get best results?
contract relax
perform right after exercise
10 sec muscle action
<60% max voluntary contraction
repeat up to 5x
true or false. PNF is better for extremities than spine
true
what does the evidence say in a meta-analysis for PNF with LBP?
low quality evidence
weak rec. for P!, disability, ROM in short term
true or false. PNF is better when combined with JM –> then stretching, rest, modalities, PROM
true
does PNF have mostly good quality studies?
yes
what is thrust manipulation?
high velocity, low amplitude therapeutic movements within or at end range of motion
when performing joint mobilizations/manual therapy techniques, in TN what must you make sure not to do?
do NOT perform beyond the joint’s normal range of motion
previously joint mobilizations was thought to improve motion. current knowledge says ____
you get neurophysiological benefits from biomechanical influences - not fully understood but supported with research
what is the P!-spasm-P! cycle?
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
what does joint mobilizations do as a neuromuscular response at rest?
decreases protective muscle activity at rest by reducing nociceptive input –> disrupts P!-spasm-P! cycle
what happens in the spinal stretch reflex pathway of P!-spasm-P! cycle?
same as P!-spasm-P! cycle but using higher brain centers with motion
- increased motor neuron activation, increased m. spindle activation, increased muscle recruitment
how does joint mobilization decrease excessive muscle recruitment with motion?
reverse P!-spasm-P! cycle
reduce nociceptive input
diminish motor neurons and muscle spindle activity
what does joint mobilization do for the autonomic nervous system?
stimulates mechanoreceptors and preganglionic cells then sends signals to the hypothalamus
acts as a natural opioid releaser, anti-inflammatory and tissue healing hormones released
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?
larger myelinated fibers are stimulated thru mechanoreceptors stimulation by JM and override P! signals of smaller P! carrying fibers
joint mobilization __increase/decrease__ temporal summation and reorganizes homunculus. explain how this happens.
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
where is joint mobilization most useful?
spine
in acute neck P! conditions, what is the meta-analysis for JM?
low-quality evidence that cervical manipulation is more effective than thoracic manipulation
in acute and sub acute neck P! conditions, what does the research state about JM?
moderate quality evidence for cervical and thoracic manipulation
very low-quality evidence for one direction of mobilization over another
in acute and persistent conditions, what does the research say about JM?
moderate to high quality evidence for manipulation
what does the research state about persistent neck P! and function in regards to JM?
low to moderate quality of evidence of a small effect with mobilization and manipulation
greatest effect when combined with exercise
low risk of bias
what does the clinical prediction rule predict? Which MT technique is the only one that this applies to?
predicts successful cervical and thoracic manipulation with neck P!
which groups is manipulation most effective for?
sub groups
– CPR for lumbar rotation or SI distraction manipulation for LBP
– added benefit when used with exercise
what does JM NOT do?
- 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
when would short term benefits of JM/MT be OK ?
can be ok if it brings patient to active exercises quicker
overall, manual therapy gives mostly ____ ______ evidence with _____, _______ ______ benefits, if any
low quality
small, short term
most benefits on subjective variables
true or false. generally, MT techniques have conclusive and known MOAs
false
HIGH research bias effects MT. as a result, what would most likely be causing the small, short term benefits?
other variables
which manual therapy technique has the best support?
JM
more mod-high quality studies and evidence
greater effect when combined with exercise
least research bias
CAPTE requires JM for all DPT programs
behind JM, what other two MT are next best supported?
PNF
dry needling
what should you consider when using manual therapy?
multiple influences on both the patient and the provider
what is the essential goal with manual therapies?
to get to active exercises sooner and more often
what would our best intervention be in terms of MT?
immediately capitalize on improved P! with progressive medical exercise therapy
