Principles of Neuromuscular Treatment Flashcards
What are the 6 stages in managing pathology?
1) Diagnosis
2) Stage and SIN
3) Dominant Pain mechanism
4) Patient’s problems
5) Tissue healing
6) Yellow flags, psychosocial
What are the 5 pillars of symptom management?
- Advice and education
- Symptom control
- Build capacity
- Return to function
- Monitor, Reflect, Adapt
What evidence supports that client/patient centered care improves outcomes?
1) Improved outcome in heart failure populations and neurorehabilitation setting.
2) Improves patient satisfaction and long-term self-management
3) Superior outcomes compared to standard physiotherapy
What 4 questions do you need to know for a client-focused approach?
- Why are they here?
- What are their goals?
- What are their expectations?
- Psychosocial influences?
What are 5 potential areas you can discuss in the “Advice and Education” pillar?
- Explain what is wrong and what the patient can expect
- Address fears and unhelpful beliefs
- Relative rest, encouragement of early (safe) return to activity
- Discuss likely frequency / duration of treatment, self-management plan
- Discuss patient goals, treatment options, and encourage shared decisions.
In the “Symptom control” pillar, what 4 things do you want to cover?
- Ask about pain control
- Possible use of passive modalities
- Consider analgesics
- Other strategies (sleep hygiene, manual therapy)
What are two different types of manual therapy?
List the two main mechanisms for their therapeutic effect?
- Soft tissue treatment technique
• Massage
• Trigger point release - Passive joint techniques
• Joint mobilization
• Joint manipulation
Therapeutic effects
• Mechanical stimulus
• Neurophysiological (hypoalgesia effect)
With mechanical stimulus therapy, what do you need to take into consideration?
Biomechanical effects are transient.
Main goal is to reduce stiffness when it is a barrier to recovery.
NEVER do in isolation, always pair with active treatment.
What is the hypoalgesic effect, and 3 explanations of it’s mechanism?
The hypoalgesic effect is the reduction in pain symptoms following
- Peripheral mechansims
- Spinal cord mechanisms
- Supraspinal mechanisms
What is a peripheral mechanism of the hypoalgesic effect?
Potential interaction with the peripheral nervous system
Alters inflammatory mediators
Reduces pain sensitivity
What is the spinal cord mechanism of the hypoalgesic effect?
Pain gate theory - proprioception and cutaneous mechanoreception interfere with incoming nociception in the dorsal horn.
What is the supraspinal mechanism of the analgesic effect?
Descending top-down control of pain in the nervous system from the PAG, ACC, and RVM. Affected by attention and emotional control
When applying manual therapy, what is the difference between accessory mobilization and physiological mobilisation?
Active accessory mobilization - inducing a movment that the individual cannot do themselves.
Physiological mobilization - Inducing a movement that the individual can do themselves.
What are 4 ways to modify applied manual therapy techniques?
- Amplitude and rhythm
- Duration and repetitions
- Direction
- Patient position
What are some contraindications/precautions to manual therapy?
Ø Active Cancer Ø Osteoporosis Ø Rheumatoid arthritis Ø Active inflammatory or infective arthritis Ø TB Ø Unremitting night pain/unexplained weight loss Ø Long-term corticosteroid or anticoagulant medications Ø Pregnancy Ø Delayed or non union of # Ø Hyper mobility Ø Acute trauma (fractures, open wounds, sprains) Ø Congenital or acquired malformations Ø Acute inflammation Ø Hemarthrosis Ø DVT Ø Disc herniation
