Musculoskeletal Unit

Question 1

Contraindications for Manual Therapy

Answer 1

• neoplastic disease
• cauda equina s/sx
• spinal cord s/sx
• non-mechanical causes
• vertebrobasilar ischemia
• craniovertebral transverse II instability
• 1st and 2nd lumbar nerve root palsy
• bi-level cervical nerve root signs
• tri-level lumbar nerve root signs
• sign of the buttock
• empty end-feel
• adverse joint environment (spasm)
• fracture or dislocation
• bone disease
• acute rheumatoid arthritic episode
• infective arthritis
• emotionally dependent patients
• hemophilia

Question 2

Precautions for Manual Therapy

Answer 2

• RA
• osteoporosis
• neurological signs
• spondylolisthesis
• hypermobility
• acute signs/sx
• pregnancy
• dizziness
• prolonged steroid therapy
• hx of neoplastic disease
• cervical traumatogenesis
• distal pain on movement
• springy end-feel
• paresthesia w/o strong pain
• no local sx
• primary posterolateral protrusions
• joint pain from isometric testing
• spinal fusion

Question 3

Gentle Mobilization

Answer 3

• constant severe pain
• extensive radiation
• pain unrelieved by rest
• severe joint irritability
• pain before resistance is met
• pain simultaneous with meeting resistance
• pain caused by coughing
• severe hypertonicity
• severe joint range limitation
• severe latent pain
• recent neurological deficit
• pain disturbing sleep

Question 4

Vigorous Mobilization/Manipulation

Answer 4

• pain after resistance is met
• stiffness rather than pain
• pain relieved with change or activity or posture or rest
• no radiation of pain
• minimal hypertonicity
• no radiation from spinal movement
• no recent neurological deficit
• negative isometric tests
• intermittent pain