Principles And Effectiveness Of Manual Therapy

Question 1

What is the primary theory proposed by the theorist Cyriax?

Answer 1

Pain is due to a lesion and treatment must reach the lesion

Evaluation involves searching for the type of tissue causing the complaint.

Question 2

What are the key components of Cyriax’s evaluation process?

Answer 2

Search for the type of tissue causing the complaint

Employs strong movements including manipulation to return ROM.

Question 3

What approach did Kaltenborn develop from?

Answer 3

Cyriax’s approach

Treatment focuses on the joint capsule.

Question 4

What techniques does Kaltenborn use to increase joint mobility?

Answer 4

Traction and joint glide

Focuses on the lesion found in evaluation.

Question 5

What is the focus of Maitland’s treatment approach?

Answer 5

Treats the symptom without confusion over diagnostic terminology

Examination focuses on function and study of all anatomical structures.

Question 6

How does Maitland classify problems during examination?

Answer 6

Grouped into PAIN/stiff and Stiff/pain

Problems may change from one group to the other.

Question 7

What types of joint motion does Maitland utilize in treatment?

Answer 7

Grades of motion, glide, and traction

Focuses on function and symptom treatment.

Question 8

What evaluation tool did Mennell develop?

Answer 8

Joint play evaluation

Used as an evaluation tool for joint dysfunction.

Question 9

What does Mennell’s approach to treatment involve?

Answer 9

Joint mobilization to treat joint dysfunction

Muscle pain is generally not assessed.

Question 10

What is the assessment focus in Mennell’s theory?

Answer 10

To rule out contraindications to mobilization

Treatment involves sharp thrust to return normal range.

Question 11

What is the purpose of the sharp thrust in Mennell’s treatment?

Answer 11

To return normal range

Includes muscle reeducation to maintain new range.

Question 12

Manual therapy revolution - What does the mechanisms of manual therapy suggests in the case of treatment of msk pain?

Answer 12

• That a mechanical force from MT initiates a cascade of neurophysiological responses from peripheral and central nervous system => responsible for the clinical outcomes

Question 13

What is MT according the the comprehensive model?

Answer 13

= an effective treatment contributing to the recovery of functional capabilities
- Should include a multimodal approach targeting the functional recovery of the paient.

Question 14

What does a multimodal approach includes? What is best for the care of patient?

Answer 14

• Psychological and psychosocial aspect of the patient’s pain
• Physical management

=> Current evidence is suggesting that a
multimodal approach, including manual therapy, exercise and education, seems to provide better outcomes than manual therapy alone.

Question 15

Definition of MT according to the MT revolution

Answer 15

Manual therapy (MT) is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems, which is utilized with the intent to create beneficial changes in some
aspect of the patient pain experience.

Question 16

On what is based the processed of MT?

Answer 16

• On clinical reasoning to enhance patient management for musculoskeletal pain
  by influencing factors from a multidimensional perspective that have potential to positively impact clinical outcomes.

Question 17

What factors influence the process of MT?

Answer 17

The influence of biomechanical, neurophysiological, psychological and nonspecific patient factors as treatment mediators and/or moderators provides additional information related to the process and potential mechanisms by which MT may be
effective.

Question 18

End feel - What it is ?

Answer 18

The endpoint/barrier of the ROM of a joint can be described as ‘end-feel’.
- When a joint is actively or passively brought to its physiological limit, there is usually a definite, but not abrupt end-feel.

Question 19

End feel - When do we feel it?

Answer 19

During joint mobilisation

Question 20

End feel - What we should feel

Answer 20

When a joint is actively or passively brought to its physiological limit, there is usually a definite, but not abrupt end-feel.
- When the joint is brought to its anatomical limit, there is a stiffer sensation.
- However, if there is a restriction in the normal ROM of a joint, then there is a pathological barrier evident in active or
passive movement.

Question 21

What do tissue adaptations result in according to kinesiological relationships?

Answer 21

Definable patterns

These patterns are related to the prevailing movement direction and associated pain.

Question 22

What effect does the prevailing movement direction have on pain?

Answer 22

Induces pain related to impairments in the neuromusculoskeletal systems

This relationship contributes to a cycle of pain and movement adaptation.

Question 23

What is the consequence of severe pain on movement?

Answer 23

Further adaptation of movement

This can lead to a cycle of increased pain and altered movement patterns.

Question 24

What is the ‘Path of Least Resistance for Motion’?

Answer 24

A concept indicating that movement will occur in the direction that requires the least effort

This concept is crucial for understanding movement system impairment.

Question 25

Define Relative Flexibility.

Answer 25

Two forms: intra-joint and inter-joint

Intra-joint refers to motion occurring more readily in one or two directions, while inter-joint refers to motion occurring more readily at one joint than another.

Question 26

What is intra-joint relative flexibility?

Answer 26

Accessory motion occurs more readily in 1 or 2 directions and exceeds the optimal range of motion

This often occurs with greater frequency of occurrences.

Question 27

What is inter-joint relative flexibility?

Answer 27

Motion occurs at one joint more readily than at another contiguous joint

For example, motion may occur more readily at the lumbar spine than at the hips.

Question 28

What is the effect of hypertrophy of muscle on relative muscle stiffness?

Answer 28

Increases the passive stiffness

This can lead to differences in muscle stiffness on either side of a joint.

Question 29

Define relative muscle stiffness.

Answer 29

The change in tension/unit change in length in two springs of different stiffness

The least stiff spring elongates more than the stiffer spring when tension is applied.

Question 30

What happens when there is impaired relative stiffness?

Answer 30

Movement compensation occurs before reaching the limits of muscle length

This indicates that the flexibility of the spinal segment is more critical than muscle stiffness.

Question 31

What are the syndromes identified in Movement System Impairment Syndromes of the lumbar spine?

Answer 31

Flexion; flexion-rotation; extension; extension-rotation; rotation (primary & secondary)

Each syndrome is associated with specific movement impairments and pain.

Question 32

What criteria is used to identify Movement System Impairment Syndromes?

Answer 32

Identified with movement exam, alignment/direction that is impaired and causes pain

Pain is decreased or eliminated when movement is corrected.

Question 33

True or False: The presence of a muscle guarantees its appropriate use.

Answer 33

False

Just because a muscle is present does not mean it is being effectively utilized.

Question 34

Fill in the blank: ‘You get what you ______.’

Answer 34

train

This emphasizes the importance of training methods on movement patterns.

Question 35

What is the most important factor in optimal relative stiffness?

Answer 35

Flexibility of spinal segment

This is more critical than the stiffness or shortness of muscles.