phys med wk 1 Flashcards
OHIPMNRS
observe
history
inspection
palpation
motion
neurovascular
referred pain
special tests
history of phys med
all the way back to 400BCE with Hippocrates…
when did manual therapy become a controlled act
under the RHPA 1991
mechanics
A branch of applied mathematics that looks at forces
and their effects when producing motion
biomechanics
The application of mechanical laws to living structures, more specifically to the locomotor system of the human body
The interrelations of the skeleton, muscles, and joint. Where BONES are the levers, LIGAMENTS form the hinges (Surround joint), and MUSCLES provide forces, moving the levers around the joint.
forces have 2 things
directionality and magnitude
what is a mobilization
A form of a non-thrust technique, typically applied within the PHYSIOLOGIC range of joint motion, but not passed the ELASTIC BARRIER.
passive (patient doesnt do anything)
controlled depth (amplitude) and rate
what velocity for joint mobilization
low velocity
They may be applied with fast or slow repetitions (Oscillations) and various depth (Grades 1-4) but always low velocity
grades for jont mobilization
1-4
cavitations “pop” in mobilizations?
sometimes
Although joint mobilizations (Grades 1-4) are not commonly associated with joint cavitation, deep mobilization may induce cavitation.
how many times to apply motion in mobilization
Movement applied singularly or repetitively within or at the physiologic range of joint motion, without imparting a thrust or impulse
what are the 7 goals of mobilizations
- Restore ROM of a joint
- Pain reduction
- Reduce muscle spasms (stretching hypertonic muscles) thus
inducing relaxation - Stimulate synovial fluid production (joint nutrition)
- Increase local blood flow
- Relieve nerve compression/irritated sympathetic chain
ganglia - Restore joint mechanics
how can mobilizations help reduced pain and improve proprioceptive function
- The vibratory nature of the oscillations being applied are thought to activate sensory mechanoreceptors that may help to reduce pain and improve proprioceptive function*
what are the clinical indications for mobilizations
- Joint Pain/Stiffness (Kinetic Chain/Muscle Compensation)
- Decreased ROM during Sub-Acute/Chronic stages of injury
- Decreased muscular function
- Headaches
- Joint Hypomobility
- Myofascial Restrictions/Pain
- When THRUST Manipulations are contraindicated or not
advisable due to harm to the patient - When practitioner is unable to produce a thrusting force
that is capable of producing a joint cavitation
physiologic barrier
Where the END of AROM of a joint takes place due to muscle/fascial tension
elastic limit
Felt as an elastic resistance at the end of PROM
end feel
The sensation that the practitioner feels in the joint as it
reaches the end of ROM (Normal and Abnormal End Feels)
joint play
SMALL movements that are independent of voluntary muscle contraction. Measuring less than 1/8 inch in any plane, these movements provide roll, glide, spin, and distraction combinations to aid in smooth joint motion.
AROM
Patient is moving the body part by themselves
PROM
Without any help from patient, the practitioner moves the joint. Due to relaxed nature of patient, this type of motion is usually greater then AROM.
paraphysiological space
An area where there is increased movement within the joints elastic barrier after a cavitation. Does NOT pass anatomical Limit
anatomical limit
Where anatomy limits motion of the joint. Moving beyond this limit will result in tissue damage (Sprain, Strain, Fracture)
what has greater ROM active or passive
passive
grade 1 mobilization
- Near beginning of range (beginning to mid)
- A slow, small-amplitude (rhythmic oscillations
grade 2 mobilization
- Within Mid Range (no stiffness or resistance) * A slow, larger amplitude rhythmic oscillations * Area free of stiffness or muscle spasm
grade 3 mobilization
- Within Mid Range to Elastic Barrier
- A slow, large amplitude rhythmic oscillations. * Moving into stiffness or muscle spasm
grade 4 mobilization
- Within Deep Range to Elastic Barrier
- A slow, small amplitude rhythmic oscillations * Stretches into stiffness of muscle spasm
grade 1 through 4 mobilization
Grade 1:
* Near beginning of range (beginning to mid)
* A slow, small-amplitude (rhythmic oscillations
Grade 2:
* Within Mid Range (no stiffness or resistance) * A slow, larger amplitude rhythmic oscillations * Area free of stiffness or muscle spasm
Grade 3:
* Within Mid Range to Elastic Barrier
* A slow, large amplitude rhythmic oscillations. * Moving into stiffness or muscle spasm
Grade 4:
* Within Deep Range to Elastic Barrier
* A slow, small amplitude rhythmic oscillations * Stretches into stiffness of muscle spasm
grade 5 manipulation is a…
controlled act
grade 5 manipulation
- End of Elastic Barrier
- Creating the paraphysiolocial space
- High velocity, Low amplitude THRUST
- Popping or Cavitation is often heard (Nitrogen gas released from synovial
fluid within joint cavity)
what is the velocity and amplitude of manipulation
High velocity, Low amplitude THRUST
why is there a cavitation or cracking noise
The best evidence suggests that this noise occurs as the volume oft he intra- articular space increases, and synovial fluid changes from a liquid to a gaseous state
This increase in intra-articular space might explain the temporary increase in range of motion that occurs after manipulation techniques.Since the gas takes time to reabsorb, joints are not likely to crack again immediately after
having been cracked
grade 1-2 used for
Used more as warming up tissue or assessment Helps to reduce pain and irritability
grade 3-4 used for
Used more to stretch the joint capsule and passive tissues that support and stabilize the joint
Helps to increase range of motion
Generalized Graded Oscillatory Mobilization Procedure for Grade 3-4
- Take the joint to tension (engage barrier or point of pain). This involves firm pressure until resistance is felt. However, it is important to avoid using heavy forces that might create reactive muscle spasm.
- Start repetitively and rhythmically mobilize until a release of resistance occurs. Averaging about 120 oscillations per minute for no more than 60 seconds.
- Continue mobilizing until motion is normal (average is 3 to 10 mobilizations sessions).
- Stay just short of reproduction of the symptoms, barely engaging the point of pain and backing away.
If the amplitude is too small, the procedure will be less effective; if the amplitude is too great (going too far into the painful area), the symptoms will be aggravated.
Osteokinematic Movements:
Refers to movements of bony levers in the body that are possible in anatomical planes
arthrokinematics Movements
Refers to movements that occur within the joint or between articular surfaces (Glides, Rolls, Spins)
3 types of joint motion
- glide or slide or transitional
- roll
- spin or rotational
glide/slide/transitional joint motion
When 1 bones articular surface slides on another (Carpal bones slide in relation to eachother when the wrist flexes and extends)
roll joint motion
When 1 bones articular surface roots on another (Tibia rolling on fetus as knee flexes or extends)
spin or rotational joint motion
When the bone moves but the mechanical axis remains stationary (when the humerus rotates or spins during external or internal rotation of the shoulder)
6 types of mobilizations
- Antero-Posterior Glide (AP Glide) 2. Posterior-Anterior Glide (PA Glide) 3. Inferior Glide
- Superior Glide
- Medial Glide
- Lateral Glide
joint manipulation/ grade 5 mobilization? what is the ROM? amplitude and velocity?
A thrust technique, that takes the joint PAST its physiological ROM without exceeding the anatomical limit. Characterized by a Low-Amplitude, High-Velocity thrust usually producing an audible articular crack/pop/cavitation.
A CONTROLLEDACT
RHPA states that joint manipulation is
Moving the joints of the spine beyond the individuals usual physiological range of motion using a FAST, LOW amplitude thrust is a CONTROLLED ACT
therpeutic effects of manipulation
- Reduce joint malpositioning
- Induce local muscle relaxation
- Break soft tissue adhesions
- Stretch ligaments and joint capsules
- Decrease hypo-mobility of joint
- Pain reduction (Widely Accepted evidence based)
- Reduce muscle spasms (stretching hypertonic muscles) thus
inducing relaxation - Stimulate synovial fluid production (joint nutrition)
- Restore ROM of a joint
- Increase local blood flow
- Relieve nerve compression/irritated sympathetic chain ganglia
- Restore joint mechanics/Muscle strength/Posture
clinical indications for manipulations
- Joint Pain/Stiffness (Kinetic Chain/Muscle Compensation) * Decreased ROM during Sub-Acute/Chronic stages of injury * Decreased muscular function
- Headaches
- Joint Hypomobility
- Myofascial Restrictions/Pain
what is a widely accepted and evidence based effect of manipualtion
pain reduction
potential negative effects of manipulation- adequate reactions
(Onset 6-12 hours)
* Localized soreness
* Minor brusing
* Headaches
* Tiredness
* Less than 2 days duration
potential negative effects of manipulation- exceeding reactions
(Onset 6-12 hours)
* Objective worsening of signs and symptoms
* Interferes with work
* Excessive bruising or soreness
* Last more than 2 days in duration
relative vs absolute contraindication
Relative Contraindication
A problem/condition that is identified before the treatment is provided, that unless modified, the application of the treatment has potential to cause harm to patient (inflammatory arthritis, osteoporosis)
Absolute Contraindication
A problem/condition that is identified before the treatment is provided, and WILL cause potential harm if the treatment is applied. Thus treatment is NOT applied (i.e. caudal equine, bone fracture, Down syndrome, RA, meningitis)
cervical contraindications
- Vertigo
- Dizziness
- Nausea
- Vomitting
- Nystagamus
- Numbness
- Diplopia/Vision disturbances
- Dysarthria
- Dysphagia
- Ataxia
- History of Stroke, MI
- Cerebral Artery insufficiency
concentric contraction vs eccentric contraction
The distance that a muscle can maximally shorten (Concentric Contraction) to the point of maximal lengthening (Eccentric Contraction)
normal end feels
Bone to bone: painless end ROM that is hard (elbow extension)
Ligamentous: Painless end ROM that is hard. Limited by
ligamentous tension. (Knee Extension)
Tissue Stretch: Hard or firm feeling that is near the end of ROM but limited by muscle or fascial tension (Cervical Lateral Flexion)
Soft Tissue Approximation: Soft or squeezing feeling that is near the end of ROM but limited by soft tissue compression (Elbow Flexion)
abnormal end feels
Bone to Bone: Painful with a hard feeling at the end or near the end of ROM (Osteophytes, etc)
Muscle Spasm: A guarded or pulling feeling that is protective of injured area (Trauma or instability)
Capsular: Boggy end feel or firm with decreased ROM and pain (Swelling, edema, adhesions, adhesive capsulitis, etc)
Springy Block: A rebound effect/Bouncy or springy in a non capsular pattern (Meniscal tears/derangement)
Empty: Lack of a normal end resistance. Past anatomical barrier (Hyper-mobility, ligament rupture, etc)
normal vs abnormal bone to bone end feel
normal- painless end ROM that is hard (elbow extension)
abnormal- Painful with a hard feeling at the end or near the end of ROM (Osteophytes, etc)
PAR-Q for consent
Procedures: Explaining the treatment that will be provided. In our
case, this would pertain to mobilizations and manipulations
Viable Alternatives: Other treatments that would still benefit the patients presenting concern.
Material Risks: If any, risks to the treatments and common side effects such as soreness, cavitation, etc.
Questions: This allows the patient to ask questions pertaining to that specific procedure.
