Random SMT-1 Flashcards
Lateral Glide Test?
Fernandez-de-las-Penas (2005) did study of 25 patients with neck pain. Took 2 AP cervical x-rays on each patient at maximum right and left lateral flexion and compared with PT doing lateral glide testing from C3-C7. Didn’t use pain. Measured distance between hypomobile transverse processes and subadjacent TP. Intervertebral radiologic motion at hypomobile side was 3.44 mm less than contralateral side at dysfunctional segments. 1st study providing evidence that lateral glide is comparable with radiologic assessment for diagnosis of hypomobility (C3-C7).
Types of stances?
- Diagonal
- Pulling
- Parallel
Travell and Simons TrP Diagnostic Criteria?
- Presence of palpable taut band
- Hypersensitive tender spot in taut band
- LTR provoked by snapping palpation of taut band
- Reproduction of typical referred pain pattern with TrP compression
- Patient recognition of referred pain as familiar.
Is pain needed to identify dysfunctional joint?
Jull (1994). Tested PT’s ability to differentiate painful and non-painful cervical segments without subject feedback. Did manual exam of C0/C1 through C6/C7 with PAIVM and PPIVM. In 90% of cases when therapist rated joints as normal the subjects agreed they were painless. 94% agreement between examiner and subjects for most symptomatic joints. In majority of cases an experienced manual therapist doesn’t need patient verbal report to differentiate normal painless joints and symptomatic dysfunctional joints.
Z-Joint and LM Connection?
Indahl (1997) stimulated L3/L4 annulus of 23 pigs before and after saline injection of facet joint. MUAP (motor unit AP) recorded with needle EMG for multifidi and longissimus at L4 and L5 levels. Electrical stimulation of nerve fibers of annulus elicited reflex contraction in LM/longissimus but introduction of 1 mL saline into lumbar facets caused immediate (<5 min) reduction in LM and longissimus EMG activity. Found 74% reduction in MUAP of multifidi within 30 sec of injection. The outer annulus of disc, Z-joint capsules, ligaments, and paraspinal muscles have innervation network that is probably part of a proprioceptive system that recruits muscles for stabilization of motion segments. Injection most likely was related to stretch reflex in capsule that excited inhibitory interneurons which inhibited motor neurons and decreased muscle response. HVLAT of facet joints may cause stretch reflex to capsule, contributing to inhibitory action on muscle spasm.
Diagonal stance?
- Used in 90% of techniques
- Feet pointing to head of table for lumbar roll or diagonally for cervical
- Keep head over pelvis to keep center of gravity over you to keep you in control of your posture.
Types of barriers?
- Normal joint barrier
- anatomical/physiological end range of joint, solid discomfort - Lesion joint barrier
- point less than normal range, get pain and/or resistance - Manufactured joint barrier
- discomfort, not pain. Crisp/firm with different quality of resistance. Barrier is drawn back behind point of lesion. This the the barrier we create and manipulate.
Correction of positional faults?
Level of evidence for clinical efficacy of MWM treatments is low. It has been hypothesized that it reduces minor positional faults but little evidence to support this, mostly case studies/series.
Free play?
Don’t over lock, just focus to the level. Hold away from 100% (97%) tension so tissues don’t resist. Using multiple levers draws barrier back into mid-range of joint, thus safer and more comfortable.
Building a barrier?
Keep testing the primary lever. Add secondary levers as necessary until primary lever is firm/crisp. The secondary levers will make primary lever get smaller in amplitude.
Reasons for applying thrust?
- Facilitate movement
- Pain relief (manipulation induced analgesia, non-opiod mechanism, serotonergic & noradrenergic pathways, stimulate dPAG for descending inhibition)
- Increased circulation (sympathetic and parasympathetic effects on vasculature; sympathoexcitatory [decreased skin temperature and increased skin conductance])
- Immediate neurophysiological Reflex Response (Immediate muscle relaxation of paravertebral - probably resets muscle spindles)
- Immediate increase in strength (Suter and McMorland 2002; Liebler 2001)
- Less time/work
Effects of HVLAT (Quick)?
- Mechanical
- Biochemical
- Neurophysiologic
- Hypoalgesic
Inter-examiner reliability to detect upper cervical joint dysfunction?
Jull (1997). 20 patients with history of neck pain and headaches, plus 20 with no such complaints. PT required to do manual exam of C0/C1 through C2/C3 and used pain provocation and joint motion to identify level of joint dysfunction. “Excellent to complete inter-examiner agreement” whether dysfunction was present. C1/C2 (19/20) was most common dysfunctional segment followed by C2/C3 (9/20) and C0/C1 (6/20).
Reliability of Cervical PPIVM’s?
Smedmark (2000) had 2 PT’s look at PPIVM’s of C2-C3 in lateral flexion, 1st rib depression, C7-T1 flex/ext, and C1/C2 rotation for those with neck pain. 77% agreement with “fair to moderate” inter-examiner reliability. Showed high % agreement between examiners but kappa coefficients were only fair to moderate, could be due to too small of sample (61 patients).
TrP’s and HVLAT?
Fernandez-de-las-Penas (2005) looked at relationship between TrP’s in upper trap and presence of C3 and/or C4 joint dysfunction in those with neck pain. Took 150 patients and one examiner looked at TrP’s and another did lateral glide test. 97% of subjects had cervical joint dysfunction ipsilateral to TrP. Found significant relationship between TrP’s in upper trap and joint dysfunction at C3 and/or C4 (84% had TrP’s, 74% dysfunction at C4 and 61% at C3). Abnormal sensory input from joint dysfunction can reflexively activate TrP or increased tension from TrP can stress joint.
