SMT-1 Manual, pgs 45-56 Flashcards
- How is C-Fiber comparable to wind up?
Wind up results from tonic C-Fiber input and is an example of central sensitization that occurs in the dorsal horn cells.
- Can wind up be measured?
No, but thermal stimulus is an indirect measure.
- Biolosky et al 2008 divided 60 non-LBP subjects into what 3 groups?
- What was each group told?
- Pos expectation group told SMT was very effective, expect heat pain perception to be reduced.
- Neg expectation group told SMT was ineffective and expect heat pain perception to increase.
- Neutral expectation group told SMT effects are unknown for treating LBP and heat pain perception.
- According to Biolosky et al 2008, how is C-Fiber pain assessed?
- What were the results?
- What does this suggest?
It is assessed at the plantar foot, 10 heat pulses, at a rate of 0-100.
- Pos group had significant dec in LBP, 7.7/100
- Neg group had significant inc in LBP, 6.98/100
Hypoalgesia associated c SMT may be influenced by expectation.
- How did Bishop et al 2011 measure regional pain modulation p HVLAT?
Subjects rated 1st pain Abeta fibers and 2nd pain c-fiber, 0-100 from thermal stimuli on volar forearm and upper calf, then thenar eminence and medial longitudinal arch.
- What were the interventions for Bishop et al 2011?
- Results?
- Changes in thermal stimuli ratings?
- Upper Tx HVLAT supine
- Cx ext DNF c CCFT
- Control group rested supine for 5min
- resulted in no significant changes for any group
- no significant changes in thermal stimuli ratings
- Bishop et al 2011: What group experienced dec in TSS (secondary) pain?
- What does this prove?
- Tx HVLAT experienced significant reduction in pain greater than Cx ext or control group
- Immediate inhibition dec TSS p SMT, but only proven in healthy adults
- Have the mechanisms behind SMT really been proven?
Bialosky et al 2009 says they have not been established.
- Bialosky et al 2009: are biomechanical effects assessment reliable?
No
- What do joint techniques lack?
Precision, because forces are dissipated over a large area.
- Are nerve biased techniques specific to a single nerve?
No
- Does the choice of technique affect the outcome?
No
- Have lasting structural changes been identified?
No
- Have existing studies directly observed the central or peripheral nervous system?
No
- Stimulation of dPAG following SMT was suggested by whom?
Wright 1995
- Who suggested the lessening of TSS dorsal horn cells following SMT?
George et al 2006
- What 3 categories does Bialosky et al 2009 use for neurophysiological mechanisms of SMT?
Peripheral Mechanisms, Spinal Mechanisms, Supraspinal Mechanisms
- What are peripheral mechanisms of SMT?
MSK injuries produce an inflammatory response in the periphery which influence both healing and pain processing. SMT changes blood levels of inflammatory products such as SubP, serotonin, B-endorphins (descending pain inhibitory systems)
- For spinal mechanisms
- Who suggested SMT may exert an effect on the spinal cord by a counter irritant to modulate pain?
Boal & Gillette 2004
- Who speculated SMT bombards the CNS c sensory input from the muscle and joint proprioceptors?
Pickar & King 2006
- How does SMT indirectly implicate a spinal cord mediated effect?
Hypoalgesia, afferent discharge, dec motorneuron, pool activity, changes in muscle activity.
- Who found direct support for supraspinal mechanism of SMT?
Malisza et al 2003
- Oliphant et al 2002 found what ratio of worsening of Lx spine c SMT?
1 / 3,700,000
- Absolute contraindications for SMT:
- Vascular
- Bone
- Neurological
- Vascular - CAD, aneurism greater than 5cm
- Bone - tumor, osteomalacia, long-term corticosteroid use, fracture
- Neurological - cauda equina, Cx myelopathy
- Relative Contraindications for SMT:
- Disk herniation or prolapse
- Pregnancy
- Osteoporosis, RA
- Spondylolysis, lolisthesis
- Advanced DDD
- 49-63% of people never had significant bout of LBP yet show HNP on MRI (1,500 hospital employees in Boston)
- Force required to break the “fixation” of a joint p it is focused in Cx spine? Tx/Lx spine?
150 Newtons
500 Newtons
- What is preferred, a momentum induced technique or a combined leverage technique? How is the preferred technique defined?
Momentum induced technique is preferred. It is performed by placing as little tension as possible through adjacent segments, but target segment is at the point of max focus of forces.
- How long is the post cavitation refractory period? (How long until you can successfully manipulate a joint again?)
15-30min.
- Did Cascioli et al 2003 find evidence of gas in the joint space or increased zygopophysial space p Cx HVLAT?
No. Not even c traction and traction-free post-HVLAT Cx scans/films.
- What is capsular detonization theory?
Sandoz 1969 provided an explanation for post-cavitation refractory period due to overstretch beyond a point of collagen fibers in the articular capsule. Unable to re-cavitate until a return to original length.
- What are the Travell & Simons TrP diagnostic criteria?
- presence of palpable taut band
- hypersensitive tender spot in the taut band
- local twitch response from snapping palpation of taut band
- pt recognition of referred pain as familiar
- What did Fernandez de las Penas et al 2005 test regarding TrPs?
They studied the relationship between TrPs in upper trapezius and joint dysfunction in C3-4 in 150 pts c mechanical neck pain.
- Was Fernandez de las Penas et al 2005 a double blind study?
Yes.
- In Fernandez de las Penas et al 2005 what did each PT examine?
They examined the TrPs in upper trapezius and joint dysfunction in C2-7 c lateral glides.
- In Fernandez de las Penas et al 2005 what were the overall results?
84% had TrPs.
- In Fernandez de las Penas et al 2005 what percent were latent TrPs
56% were latent TrPs.
- In Fernandez de las Penas et al 2005 what percent were active TrPs?
28% were active TrPs.
- In Fernandez de las Penas et al 2005 what percent were ipsilateral joint dysfunction?
97% were ipsilateral joint dysfunction.
- In Fernandez de las Penas et al 2005 what was the significant relationship (P-value)?
P = 0.03
- In Fernandez de las Penas et al 2005 what percent were dysfunction at C3?
61%
- In Fernandez de las Penas et al 2005 what percent were dysfunction at C4?
74%
- Does Fernandez de las Penas et al 2005 conclude that TrP causes joint dysfunction or joint dysfunction causes TrP?
Both.
- What was the purpose of Indahl et al 1997 regarding paraspinals and facet joints?
To explain nerve pathway interactions between intervertebral discs, facet joints, and paraspinal muscles.
- How did Indahl et al 1997 determine a connection between the multifidus and the facet joint?
They stimulated posterolateral annulus of L3-4 before and after a saline injection into the facet joint.
- What were the time frames Indahl et al 1997 used for stimulation of the annulus after saline injections?
30sec, 1, 2, 5, 20, 25, and 30min.
- Did Indahl et al 1997 record a change in EMG activity of multifidus and longissimus at L4-5?
Yes. 74% had reduction in MUAP of Lx Multifidus within 30sec of saline injection. Most had a reduction of MUAP within 30sec or 5min.
- Why did Indahl et al 1997 find a change in EMG activity?
The annulus, ZJ capsule, ligaments, and paraspinals have an innervation network that is likely part of a proprioceptive system whcih recruits muscles for motion/stabilization.
- According to Indahl et al 1997, what is the motion and stabilization of the spine based on?
It is based on a complex reflex activation system which involves proprioceptive nerve endings in the annulus fibrosis and facet joints.
- Indahl et al 1997 concludes the saline injection is related to what?
It is related to a STRETCH REFLEX from the capsule that excites INHIBITORY interneurons, which INHIBIT the motor neurons, which DECREASE the muscle response.
- According to Indahl et al 1997, how does HVLAT alleviate muscle spasm?
HVLAT causes a stretch reflex on the ZJ capsule, which causes an INHIBITORY action on muscle spasms.
- Does HVLAT correct positional faults?
No credible evidence exists to say that it does.
- Who validated the Cx lateral glide test?
Fernando de las Penas et al 2005.
- How did Fernando de las Penas et al 2005 validate the Cx lateral glide test?
- N = 25 pts
- 2 AP Cx Xrays at max R/L lateral flex
- Compared blinded results of PT using C3-7 Cx lateral glide to dx hypomobile segment
- Joint dysfunction most common at C3-4
- Was pain used to determine dysfunction in Fernando de las Penas et al 2005?
No.
