Mod. 9-11: Traction, Compression, Man. Therapy Flashcards
Traction Indications:
spinal disc bulge/herniation*
narrowing of IV foramen*
nerve root impingement*
joint hypomobility
mm guarding
mm spasm
osteophyte/bone spurs
spinal ligament/CT contractures
subacute/chronic pain
subacute/chronic joint inflammation
Traction Contraindications:
acute strain/sprain*
acute inflammation*
fracture or dislocation*
vertebral joint instability*
peripheralization of symptoms*
movement-exacerbating symptoms
pregnancy (lumbar)
spinal infection of bone/joint
spine malignancy/tumor
meningitis
severe HTN or cardiovasc. disease
rheumatoid arthritis
aortic aneurysm
osteoporosis
hiatal hernia
cardiopulm problems
positive Alar ligament test or vertebral artery test (cervical)
Traction Physio Effects:
decrease disc protrusion
decrease pain
increase joint mobility
increase mm relaxation
increase ST extensibility
promote arterial, venous & lymphatic flow
Traction effect on facet joints:
widens IV foramen
exchange synovial fluid
joint mobilization
Traction effect on muscles
increase spinal mm extensibility
mm relaxation
Traction effect on ligaments
viscoelasticity
low load/long duration
Traction effect on nervous system
relieves nerve pressure
facilitates blood flow
Traction effect on bone
stress can increase bone density (Wolff’s Law)
Traction effect on IV discs
decrease size of herniated disc material via pressure gradient
Traction effect on pain/inflammation
reduce pressure on inflamed joint surface
mechanical stimuli for gate control
Lumbar spine traction: initial/subacute phase-
force,
hold/relax,
time
29-44 lbs
static
5-10 min
Lumbar spine traction: joint distraction
force,
hold/relax,
time
50% of body weight (min. 50 lbs)
15 sec/15 sec
20-30 min
Lumbar spine traction: disc/ST stretch
force,
hold/relax,
time
25% body weight
60 sec/20 sec
20-30 min
Lumbar spine traction: mm spasm-
force,
hold/relax,
time
25% body weight
5 sec/5 sec
20-30 min
Cervical spine traction: initial/subacute phase-
force,
hold/relax,
time
7-9 lbs
static
5-10 min
Cervical spine traction: joint distraction-
force,
hold/relax,
time
7% body weight (< 30 lbs)
15 sec/15 sec
20-30 min
Cervical spine traction: disc/ST stretch-
force,
hold/relax,
time
11-15 lbs
60-sec/20sec
20-30 min
Cervical spine traction: mm spasm-
force,
hold/relax,
time
11-15 lbs
5 sec/5sec
20-30 min
use what type of exercise for posterolateral herniated discs?
extension-based; prone positioning
peripheralization vs. centralization of symptoms
P: when symptoms follow nerve pathway to periphery (inc. compression and worsened nerve function)
C: symptoms move back to localized origin
Lumbar spine traction: high angle of pull targets ___
low angle of pull targets ___
high: L1/L2
low: L3-L5
Cervical spine traction (supine):
0-5* flex targets ___
10-20* flex targets ___
25-35 * flex targets ___
0-5: C1/C2
10-20: C3/-C5
25-35*: C6/C7
Compression Indications:
edema
lymphedema
hypertrophic scarring
stasis ulcer
new residual limb
DVT risk (post-op)
Compression Contraindications
DVT
heart failure
infection of treated area (cellulitis)
pulmonary edema
circulatory obstruction (lymphatic or venous return)
acute/unstable fracture
malignant area
peripheral artery disease (arterial ulcer)
Compression physiological effects:
control peripheral edema (promote fluid circulation proximally)
manage scar formation (collagen balance, reshape tissue)
promote lymphatic & venous return (improve circulation & oxygenation, dec. ulcer)
shaping residual limb (dec. size & edema)
prevent DVT (improve venous flow)
intermittent compression: LE pressure
40-80 mm Hg or diastolic BP
-pick the lower
intermittent compression: UE pressure
30-60 mm Hg or diastolic BP
-pick the lower
intermittent compression parameters:
on/off time (2)
tx time
total sessions
3:1 or 4:1
30 min to 4 hrs
3x/wk to 4x/day
compression garments: pressure for DVT prevention
16-18 mm Hg
compression garments: pressure for scar formation
20-30 mm Hg
compression garments: pressure for edema control (amb)
30-40 mm Hg
compression garments: pressure for edema control (non-amb)
60-70 mm Hg
pressure exerted by a fluid, which is determined by BP & gravity
hydrostatic pressure
pressure determined by concentration of plasma proteins inside & outside the vessel
osmotic pressure
3 causes of edema
venous /lymphatic obstruction or insufficiency
increased capillary permeability
increased plasma volume (Na & water retention)
qualities of hypertrophic scar
not pliable, rigid, raised appearance, excess/abnormal collagen, defined shape, hyperproliferation
pressure exerted with activity or rest when elastic compression bandage is put on stretch
resting pressure
pressure exerted only with activity of muscle contracting against inelastic compression bandage
working pressure
type of bandage with great resting pressure and little working pressure
max 60-70 mm Hg
long-stretch bandage
type of bandage with low resting pressure and high working pressure
requires ambulating muscles
short stretch bandage
what are antiembolism stockings or TED hose used for?
(thrombo-embolic deterrent hose)
prevention of DVT formation
Goals of therapeutic massage (2)
increase blood flow
promote tissue relaxation
Goal of manual therapy: ____
by ____ (2)
restore normal, pain-free movement
by breaking up adhesions
addressing musculoskeletal pain
Manual Therapy Contraindications
malignancy
infection (cellulitis, osteomyelitis)
acute circulatory conditions
rheumatoid arthritis
open wounds/suture sites
acute musculoskeletal trauma (hematoma, sprain, strain)
6 general Physiological effects of Manual Therapy
reflexive (ANS)
analgesic (pain relief- gate control)
circulatory (blood &lymph)
skin (inc. temp & blood flow)
traumatic hyperemia (circulation helps remove by-products & congestion)
what is fascia composed of?
collagen for strength
elastin for elasticity
gelatinous substance
Goal of myofascial release
release fascial adhesions & restrictions
MFR stroke: apply counter pressure w/ heel of hand; stroke at adhesion w/ 2-3 fingers; use torque to break up fascial restriction
J stroke
MFR stroke: apply pressure w/ anchor hand & counter pressure in opposite direction; parallel w/ mm fibers
Vertical Stroke
MFR stroke: apply downward force into mm w/ fingertips; strumming motion perpendicular to mm fibers
Transverse Stroke
MFR stroke: place hands on opposite side of restriction & move them opposite to stretch fascia to point of limitation
Deep Release/
Cross Hand Technique
hyper irritable area of tight mm fibers that form after injuries, overuse or adaptive shortening (knots)
trigger points
Physio Effect of Trigger point release
ischemic compression restricts blood flow w/ sustained direct pressure
release of pressure restores blood flow to area
goals of Transverse Friction Massage
increase mobility/extensibility of tissues
prevent/treat inflammatory scar tissue
Transverse Friction Massage Indications
tendinopathy
chronic-inflamed bursae
tissue adhesions
healed scar tissue
Physio effects of Transverse Friction Massage (2)
restarts inflammatory process of healing
helps realign collagen
Joint Mob Indications
limited passive ROM
limited accessory joint motion
abnormal end feels
pain
when symptoms aggravated by activity are relieved by rest/comfortable positions
Joint Mob Contraindications
joint hypermobility
potential necrosis of ligaments or joint capsule
joint swelling/effusion from trauma or disease
Joint Mob Physio Effects
hydrodynamic (joint lubrication & synovial fluid)
analgesic (pain relief- gate control)
mechanical (stretch restricted tissue)
neural (inc. proprioception, relax tissues)
Maitland Mobilizations: small amplitude oscillations at beginning of range for pain relief
Grade 1
Maitland Mobilizations: large amplitude oscillations at mid-range for pain relief
Grade 2
Maitland Mobilizations: large amplitude oscillations up to end range for mobility
Grade 3
Maitland Mobilizations: small amplitude oscillations up to end range for mobility
Grade 4
Maitland Mobilizations: small amplitude, high velocity thrust manipulations beyond point of limitation for mobility (PT Only)
Grade 5
