Mobilisation & Manual Therapy Flashcards
Do all impairments respond to manual therapy?
No
What are the different types of treatment modalities?
- advice & education
- therapeutic exercise
- EPA
- manual therapy
- physical devices
- predisposing risk factors
What should Goal setting always be with?
the patient
What should goal setting focus on?
function
What format should the goals be in?
SMART
What techniques does manual therapy include?
- jt mobs
- jt manipulation
- ND mob
- soft tissue massage
What movements does manual therapy include?
accessory & physiological movement
What does manual therapy match?
the patients needs and problems & not the technique which matches the technique/ approach
What is a mobilisation technique?
a passive mvmt technique applied to a spinal/ peripheral jt performed within control of patient
What does mobilisation include?
assessment & treatment
Which movements does mobilisation include?
physiological/ accessory
- oscillatory small/large amplitude
- sustained stretching +/- oscillations at limit of range
What is a manipulation?
sudden movement/ thrust performed at the limit of joint range such that patient is unable to prevent movement
- high velocity
- small amp
MOBILISATION
What do the oscillations/ sustained stretches consist of?
Physiological & accessory movement
Whats a physiological movement in mobs?
movements that a person can carry out actively
e.g. ankle DF
Whats an accessory movement in mobs?
movements that a person cannot perform independently but are necessary for joint movement
- roll, spin, slide/glide
- distraction, compression
e.g. anteroposterior glide of talus during ankle DF
What are the different ways of application for Mobs?
- accessory movement in neutral/ any physiological position
- accessory & physiological movement
- accessory movement in fctnal/ WB positions
- combo of physiological movements
- accessory/ physiological movement in conjunction with ND test position
What is the rationale for selection/ progression?
- know what symptoms are
- know the provocative/ asterisk signs
- know the effects of the manual therapy techniques (reduce pain etc)
- know how to modify these techniques for prog & reg
- available ‘tool box’ of techniques to use
- consider how they integrate with other treatment modalities
- perform the technique & re-assess
Contraindications & precautions for mobs
- whenever urgent med referral needed
- post fracture - until its united
- inflammatory jt diseases
- total jt replacements
- when manual therapy is aggravating the condition
- patient’s current and past history/ general health requires further investigation
What are the 6 principles of mobilisation?
- direction
- patient position
- therapist position
- localisation of forces
- application of force: Grades, rhythm
- dosage parameters
What direction should you mobilise the jt in?
perpendicular to jt
What is the patient position of rmobs?
relaxed
What is the therapist position for mobs?
90 to jt & ensure you are comfortable
DIRECTION OF MOBS
What are the 3 types of joint play?
- gliding
- traction
- compression
What is ‘joint play’?
small movements within a synovial joint that are independent of voluntary muscle contraction
What is a ‘gliding’ force?
Translatoric bone movement parallel to the treatment plane
What is a ‘traction’?
bone movement at a right angle to and away from the treatment plane = traction (separation) of jt surfaces
What is a ‘compression’?
bone movement at a right angle to and towards the treatment plane = compression of jt surfaces
PRINCIPLES OF MOBILISATION - GLIDING
What is the rule called which describes the gliding directional movement?
Convex-concave rule
What happens to the convex joint surface in the convex-concave rule?
move in opposite direction to the direction of restricted mvmt of the distal aspect of the bone (concave = fixed)
What happens to the concave jt mvmt surface in the convex-concave rule?
move in the same direction e.g. tibia condyles glide anteriorly for restricted knee extension
PRINCIPLES OF MOBILISATION
What is the patient position in mobilisation? (4)
- completely relaxed
- may be selected to replicate functional position of pain
- neutral position if pain = main problem
- at limit of range if aiming to stretch structures/ manage stiffness
What is the therapist position in mobilisation? (6)
- afford complete control of position
- forces can be applied in direction required
- optimal base of support
- comfortable & allow minimal effort
- make use of mechanical advantage of levers
- prevent movement beyond established point
Where should the localisation of forces occur?
- how should you hold patient?
confident, comfy grasp
What do you stabilise when mobilising?
where required e.g. tibia
Where should the applied line of force match?
direction intended
How many grades of mobilisation are there?
V
Grade I mobilisation:
small amplitude movement at the beginning of available range
Grade II mob:
large amplitude within a resistance-free part of available range
Grade III:
large amp performed into resistance / up to limit of available range
Grade IV:
small amp performed into resistance / up to limit of available range (EOR available)
Grade V (manipulation):
small amp movement at EOR
What impairments do use grades I and II mobilisation levels for?
pain
What impairments do you use grade III mob for?
pain & stiffness
What impairment do you use grade IV mob for?
stiffness
DOSAGE
Grade I/II dosage parameters:
< 2 mins 1-2 x / session
DOSAGE
Grade III/IV parameters:
quicker rhythm
- several mins
- several x / session
How can you progress your mobilisation technique?
- repeat tech
- alter a component of technique
- add in new techniques
- change the technique (add Fx)
- manipulate @EOR
- stop Rx
What is a mobilisation with movement (MWM)?
application of a sustained passive accessory force to a joint while the patient actively performs a task that was previously identified as being problematic. e.g. squat with patella medial glide
What is the response acronym for a MWM?
PILL
PILL
“P”
pain- free application of mobilisation &movement components
PILL
“I”
instant result at time of application
PILL
“L L”
Long Lasting effects beyond the techniques application
PILL
“L L”
Long Lasting effects beyond the techniques application
what is the order of application of a MWM?
Glide, move, unmove, unglide
What is the volume/dosage of a MWM influenced by?
condition, response & sustainability of response
What is the dosage of a MWM?
6-10 reps
1-3 sets
What do you do in the rest period of a MWM?
re-assess with functionals
How can you progress a MWM?
- increase force
- increase difficulty/ level of physiological movement e.g. NWB –FWB
- increase frequency/ sets
What does an AP talar glide speed up?
recovery rate
What does the AP talar glide improve and when?
DF earlier in treatment
What does an AP talar glide MWM influence?
ROM rather than pain
What are the adverse effects of manual therapy?
- predominantly related to manipulations
- similar to those of exercise e.g. soreness
- risk of major adverse event = very low
- risk should be weighed against patient-perceived benefit and alternative Rx
When do most adverse effects of manual therapy occur?
within 24 hours and resolve in 72 hours
