Test 2: Manual Therapy Flashcards
The emphasis on manual therapy/motor learning is on
preliminary need for postural control
Motor development- Process by which a person _____
acquires skills and movement patterns
Typical order of motor development
- Cephalocaudal
- proximal -> distal
- Gross -> Fine
Three stages of motor learning process
Cognitive – Determining what should be done
Fixation – Fine Tuning
Autonomous – Mastery
Bimanual or B/L UE Training protocols can include
Repetitive reaching with hand fixed Isolated muscle repetitive training
Whole arm functioning
Can combine with rhythmic auditory cues & repetitive reaching with hand fixed activities
Bimanual or B/L UE Training protocols can be used with
Stroke survivors or those with moderate -> severe motor impairments
Physical Agent Modalities (PAMS)
Electrical Stimulation often used with those who have impaired _____
motor function
Activation of desired muscle(s) is mandated ___ to e-stim being applied for motor response
prior
Manual Therapy is defined as
Defined as a clinical approach utilizing skilled, specific hands-on techniques used to diagnose and treat soft tissue and joint restrictions for the purpose of:
Causes of soft tissue restriction
Trauma – past or present
Habitual Patterns - Develop abnormal movement or holding patterns
Posture – becomes a habit
Inflammation
Immobilization
Strain from over exercising – eventual soft tissue breakdown
Imbalances– Leg length discrepancies
Effects of Restricted Mobility
Disuse atrophy – fibrotic changes in tissue Loss of sarcomeres – shortened range
Decreased ROM
Adhesions of fascial elements
Degeneration of cartilage – wear away prematurely
Loss of ground substance – loss of lubrication
Decreased nutrition and blood supply to the tissues
Weak muscle through ROM
Joint restrictions
Bony structure changes (Wolf’s Law)
Tissue restrictions __ show up on standardized tests
do NOT
Retrograde Massage works from ___ to ____
distal to proximal
Retrograde assists with improving circulation and movement of _____ back toward the lymph nodes for drainage and towards the heart
extra-cellular fluid
Key points of retrograde massage: use _____ pressure
firm but gentle pressure
Key points of retrograde massage: ____ the extremity you are working on
elevate
Key points of retrograde massage: always use _____
lotion
Key points of retrograde massage: Use ___ and __ strokes
Slow and long
Key points of retrograde massage: Do the massage ____ times per day
Several
What is a Trigger Point (TrP)?
Latent Trigger Points
More common than active
Restrict motion and cause stiffness but are not painful until palpated
A discrete, focal, hyperirritable spot that is located in a taut band of skeletal muscle
Trigger points can produce pain ___ or _____
locally or in a referred pattern
Are latent or active trigger points more common?
latent
Which kind of trigger points restrict motion and cause stiffness but are not painful until palpated
Latent
Which kind of trigger point is always tender, prevents full ROM and weakens the muscle
Patient c/o pain that may also radiate (referred pain)
Active
Palpation of Trigger points may also produce a _____ which is a - Contraction of the fibers in response to stimulation of the same trigger point or nearby trigger point
“Local Twitch Response”
How do we get TrP?
Poor Posture Leaving muscles in a shortened position Attempting to contract muscles in a shortened position Muscle overload Repetitive Sustained Nerve Compression
Trigger Point Release
Direct downward pressure perpendicularly with maximum pressure over the area that is hyperirritable for ___ seconds
90
CFM TECHNIQUE With deep pressure over the area in need, the therapist can use ______ to massage perpendicularly or “across the grain” of the direction of the tissue fibers
one to two fingers
Do you use lotion with cross-friction massage?
No
For acute injury CFM lasts how long?
1-2 minutes
For deep structures, CFM lasts how long?
5-10 minutes
Key point for CFM: Don’t ____, instead, take it with you
Slide over the skin
Fascia over time can ___ and ____
tighten and harden
Fascial restrictions can have a tensile strength of up to
2000 pounds per square inch
What is fascia made of?
Elasto-collagenous complex
Collagen – pliable and strong
Elastic fibers – allow stretching and recoil Arranged to withstand multidirectional stresses
Ground substance- 60-70% water Acts as lubricant and to maintain interfiber distance (adhesions)
Glucosaminoglycans (GAG) – (-) charged to repel tissues Hyaluronic acid - lubrication Chondroitin and Sulfate – glue Glucosamine and Chondroitin
What is myofascial release?
Very hands on approach Whole body Firm, gentle, sustained pressure into restricted tissues
Permanent effects of elongated tissues removing pressure Increases function and mobility and decreasing pain
How does myofascial release work?
The piezoelectric effect
Applied pressure creates a small electrical charge
Tissue under stress has a lower energy potential
Less strength and power
Myofascial release generates an electrical field
Attracts water molecules
What does myofascial release feel like?
Potentially a warm or hot sensation
Breaking bonds produces heat – CHEMISTRY!!!
Stretching that feels like “creeping, bubbles popping, fingers sliding across the skin, tingling, numbness, or buzzing.”
Feeling of “therapeutic pain” afterward, different then previous pain
Heightened awareness of body
Following myofascial release:
Drink plenty of fluids Rehydrates tissues and washes chemical irritants released Neuromuscular re-education PNF Functional movements Kinesiotaping Ergonomics Sleeping positions Sit/Stand posture Body mechanics HEP to mobilize tissues released Foam rolls, use of small balls Myofascial stretches
