Manual therapy techniques

Question 1

Central PA LS

Unilateral PA LS

Answer 1

• palpate appropriate level of Lumbar spine e.g. L4
• pisiform grip press down on spinous process
• grades 1 - 4
• find space in between two spinous processes and move a thumbs length to the appropriate side
• use thumbs back to back and push down through grades

Question 2

Passive physiological rotation LS

Answer 2

• lie on non painful side with knees over edge of bed
• flex patients hip and palpate l3/4
• stand behind patient with hand on the pelvis
• push in line with femur rotating the spine

1. oscillations
2. bring arm back and larger amplitude
3. bring bottom shoulder out/more rotation
4. extend upper leg, hold pec major, small pushes

Question 3

Hip Caudad and cephalad

Answer 3

Grade 1/2

• supine lying with knee flexed
• physios knee under patients knee
• hand on bottom of femur
• pull femur distally

Grade 3/4
- hip flexed 
- interlock fingers 
- hands on top of thigh near groin area 
hug leg and pull

Question 4

Passive physiological medial rotation of hip

Answer 4

Grade 1/2

• supine lying, knee under patients knee
• hand above and below knee
• rotate knee inwards

Grade 3/4

• prone lying, knee 90 degree flexion
• rotate knee outwards to test resistance then apply block
• one hand on front of leg and one on heel
• pull towards block

Question 5

Knee - AP on tibia

Answer 5

• supine lying with towel under leg
• hands just below joint line
• press down on tibia

Grade 3/4
- same technique with knee flexed

Question 6

Knee - PA on tibia

Answer 6

• prone lying, towel under femur
• hands on joint line (back of knee)
• push down through grades

Question 7

Knee - Patellofemoral caudad

Answer 7

• supine lying, towel under knee
• stand facing direction of push
• hands in diamond shape
• glide patella towards feet
  (opposite for cephalad)

Question 8

Knee - patellofemoral medial/lateral glide

Answer 8

• supine lying
• hand on either side of knee and thumbs on patella
• glide medially or laterally

Question 9

Ankle - Passive physiological movements of inferior tibiofibular

PF/DF AP/PA

Answer 9

PF/DF

• hand on tibiofibular joint
• other hand on bottom of foot
• move in direction of movement

PA
- prone lying, knee flexed 90 degrees 
- hand on fibula to stabilise
- elbows facing out  
- push malleolus from heel to toe 
AP - toe to heel

Question 10

Ankle Talocrural AP/PA

Answer 10

prone lying, 90 degrees flexion
AP
- hands on distal tibia fibula
- web of hand against talus 
- push posteriorly

PA

• swap hands over
• push calcaneus

Question 11

Ankle: subtalar medial and lateral

Answer 11

• Side lying, hand on proximal part of leg
• push down on calcaneus
• medial flip patient over and repeat