Technique Mechanisms

Question 1

HVLA mechanism

Answer 1

PRRR

• reflex muscle relaxation (decrease hypertonicity via golgi tendon organ inhibitor of motor neuron)
• pain modulation (reprogramming of central
  nervous system at the dorsal horn)
• release or endorphins (reduce pain perception)
• restore bony alignment (increase ROM)

Question 2

Articulation mechanism

Answer 2

Artie - HIS

• hypoalgesia (via immediate reduction in pain sensitivity via descending central inhibition and spinal mechanisms)
• improved fluid drainage (speculative drainage in and around the joint)
• stretch capsule and connective tissues (around the joint to improve mobility - speculative)

Question 3

MET mechanism

Answer 3

Remember: You just MET Sophie - ‘Sophie Is Fake In Reality’

• Stretch connective and contractile issues (resulting in viscoelastic properties that elongate the tissues. More permanent plastic changes may occur following microtearing of collagen fibers, thus remodeling to a new length)
• Inhibition of pain (reducing concentrations of pro-inflammatory cytokines which reduce sensitization of peripheral nociceptors OR activation of local mechanoreceptors can cause inhibition of nociceptive signals at the spinal cord level and inhibition of centrally mediated nociception)
• Fluid drainage (muscle contraction influencing interstitial fluid collection and lymphatic flow)
• Improvement of proprioception and motor control (stimulates joint proprioceptors to allow the central nervous system to normalize proprioceptive and motor control for the region in patients with pain)
• Reflex muscle relaxation (losing credibility but suggests that the stimulation of golgi tendon organ inhibits the alpha motor neurons, resulting in increased ROM and tissue texture changes)

Question 4

Soft Tissue Technique Mechanisms

Answer 4

PISRR

• Promotion of healing and repair (via the graded stress, promoting alignment of collagen fibers for optimum tissue strength)
• Increase fluid drainage (by changing tissue pressure gradients through manual pressure, resulting in increased venous and lymphatic flow)
• Stretching shortened tissues (with effects mainly on stretch tolerance and pain rather than lasting plastic changes)
• Reflex muscle relaxation (via stimulation of muscle and tendon receptors)
• Reducing pain (via two likely mechanisms: increased drainage leading to clearing of pain-causing metabolites, and central neurological changes by modulating pain at dorsal horn of spinal cord and activating central descending pain inhibitory pathways)

Question 5

Indirect Techniques Mechanisms

Answer 5

Not Not Fine

• Nociceptive model (placing a patient into a point of ease or balance, the afferent information is decreased, resulting in normalized motor activity and reduced pain)
• Neurological model (decreased abnormal afferent information sent from mechanoreceptors including muscle spindles and golgi tendon organs, resulting in rescued muscle guarding and tone)
• Fibroblast response (impact fibroblasts resulting in decreased inflammatory response, leading to decreased inflammation and pain)