Vertebral Manual Therapy Flashcards
1
Q
Small amplitude oscillation short of resistance (R1)
A
Grade I
2
Q
large amplitude oscillation near beginning of R1
A
Grade II
3
Q
a large amplitude oscillation 50% between R1 and R2.
A
Grade III
4
Q
a small amplitude oscillation performed at the limit of range (R2)
A
Grade IV
5
Q
A small amplitude, high speed, thrust at the end of available range.
A
Grade V: High Velocity Thrust; also called a manipulation
6
Q
Physical examination findings related to the chief complaints that are reproduced during an examination/treatment.
A
Comparable Sign
7
Q
A manual therapy technique used to selectively influence the joint soft tissues depending on the technique or direction of translation
A
Joint Mobilization
8
Q
Why make a diagnosis? (2 Main Objectives)
A
- To be able to EXPLAIN to the patient what is happening in their joints and thereby:
- (a) produce relief through reassurance
- (b) empower them to manage their symptoms
- To be able to PREDICT:
- (a) what will happen to the affected part
- (b) the risk of future problems in other places
- (c) useful treatment
9
Q
Clinical Decision making focuses on:
A
- Patient’s:
- comparable sign
- (symptoms)
10
Q
Abnormal joint movement (that may be observed or felt)
- (for example: stiffness, spasm, instability)
A
Joint Sign
11
Q
Joint sign (felt by therapist) that reproduces the patient’s symptoms
A
Comparable sign
12
Q
A joint cannot be considered clear or normal unless:
A
firm overpressure can be applied without pathological signs
13
Q
Physical joint signs found on examination of an abnormal synovial joint and its supportive structures will consist of:
A
- pain
- pain at rest or with movement
- stiffness
- muscle spasm
14
Q
True or False: Osteokinematic movement cannot occur without appropriate arthrokinematic movement
A
True
15
Q
What are Mobilizations:
A
Passive Movements:
- Oscillatory Movements
- Physiological Movements
- Accessory Movements
16
Q
Oscillatory Movements:
A
Consist of the joint’s accessory movements and/or its physiological movements
17
Q
Physiological Movements:
A
movements which the patient carries out actively
18
Q
Accessory Movements
A
Movements that are not under voluntary control and can only be produced passively
19
Q
Passive Physiological Spinal Movements (2 groups)
A
- (PPIVM) Passive Physiological Intervertebral Movements
- (PAIVM) Passive Accessory Intervertebral Movement
20
Q
Passive Physiological Intervertebral Movements (PPIVMS)
A
- Examines the movement at each segmental level of the spine
- useful adjunct to identify segmental hypomobility or hypermobility
21
Q
Passive Accessory Intervertebral Movement (PAIVMs)
A
- Gentle movements that can help direct the therapist to identify:
- Location, Nature, Severity or Irritability of symptoms
- check for hyper/hypomobility, instability, spasm
22
Q
3 Roles of Mobilization:
A
-
RESTORE JOINT ALIGNMENT to normal positions or pain-free positions
- allows for a painless full-range movement
-
STRETCHING a stiff painless joint to restore range
- use treatment movements that include the spin, roll, and slide normal for that joint
-
RELIEVE PAIN by using special passive movement techniques
- Mobilization and manipulation show to best effective when directed at mechanical problems
- If the mechanical treatment eliminates the mechanical irritating cause, the patient loses his pain
23
Q
CONDITIONS REQUIRING SPECIAL CARE (5)
A
- Severe pain
- Irritable conditions
- Acute nerve root pain/irritation
- Peripheralization
- Any patient’s condition which is worsening
24
Q
Non-severe patient condition is indicated by:
A
- The patient is able to sustain a position that reproduces the symptoms
- overpressures can be applied in this case
25
Severe patient condition is indicated by:
* The patient is unable to sustain the position that produces the symptoms
* no overpressures should be attempted
26
Irritability
The presence of pain on movement
27
R1
Initial Resistance
28
R2
Limit of resistance
29
P1
Onset of pain
30
P2
intensity/ irritability/ nature, and limit of pain
31
B
Physiologic Limit
32
L
Pathologic Limit
33
The ______ of the patient’s condition will indicate the diagnosis and also provide facts on which the prognosis and possibility of recurrence can be assessed.
HISTORY
34
(Assessment) (Relationship between irritability and pathology) Information can be obtained by:
* _RANGE OF MOVEMENT_ in a joint
* _IRRITABILITY_
* The presence of pain on movement
* _"ENDFEEL"_ produced by gently forcing the joint to the end of its range.
35
The Maitland treatment approach primarily uses _______ \_\_\_\_\_\_\_\_\_ movements to normalize function
passive accessory
36
The primary aim in the examination of a joint movement is to find a __________ \_\_\_\_ in an appropriate joint.
comparable sign
37
Pain Dominant presentation (4 characteristics)
1. _Range_: often afraid to move
2. _Pain_: Resting, early, and midrange
3. _Spasm_: usually present
4. _Repeated movements_: aggravate pain unless preferred direction is used
38
Stiffness dominant presentation:
1. _Range_: limited
2. _Pain_: Often end range only
3. _Spasm_: seldom present
4. _Repeated movements_: often increase the range
39
A Pain Component at Rest or With Movement:
* pain associated with stiffness/hypomobility
* often referred to as “intracapsular” pain
* loose-packed mobilizations achieve relief
40
A Stiff and Painless Component:
* “periarticular” or “end-range” pain
* end range (closed packed) mobilizations and manipulation can achieve relief
* a reduction of deformation is the key
* increase range to restore function
41
Grade I and II mobilizations to:
Reduce, centralize, and eliminate pain
42
Grade III and IV mobilizations for:
* produce the pain in the stiff dominated disorder
* move the pain farther out into range
* increase range by reducing stiffness
43
Contraindications to higher grade mobilizations:
- Any active systemic disease - Malignancy - Inflammatory Conditions - Recent Fracture or Non-union - Severe Osteoporosis - Cord Compression - Instability or Excessive Hypermobility - Spondylolisthesis - Gross Foraminal Encroachment
44
Precautions to higher grades of movement:
* Acute Nerve Root Irritation or Compression
* Recent Whiplash
* Last trimester of pregnancy (unless acute locked joint)
* Fusions (at same level)
* Psychogenic disorders
* Children/Teenagers prior to puberty
* Practitioner lack of ability, skills, or training
* Undiagnosed pain
* When the S/E and P/E don’t agree
45
Straight Leg Raise:
* Hip: Flexion
* Knee: Extension
* Ankle:
* Toes:
* Straight Leg Raise
* Sciatic Nerve Bias
46
Straight Leg Raise:
Hip: Flexion and medial rotation
Knee: Extension
Ankle: Plantarflexion
Foot: Inversion
Toes:
* Straight Leg Raising:
* Common peroneal nerve bias
47
Straight Leg Raise:
Hip: Flexion
Knee: Extension
Ankle: Dorsiflexion
Foot: Eversion
Toes: Extension
* Straight Leg Raise:
* Tibial Nerve Bias
48
Straight Leg Raise:
Hip: Flexion
Knee: Extension
Ankle: Dorsiflexion
Foot: Inversion
Toes:
* Straight Leg Raise
* Sural Nerve Bias
49
Unilateral thoracic pain radiating along the line of the rib is usually indicative of pathology affecting the:
* nerve root
50
Deep central back pain radiating through the chest may be indicative of:
* Intervertebral Disc
51
Unilateral thoracic pain radiating horizontally around the chest wall is likely emanating from:
* Unilateral joints:
* Facet joints
* Costovertebral Joints
* Costosternal joints
52
T4 Pathology may produce what type of headache?
* Cap-type headache
* (although headaches may also be produced from C1 to C3)
53
Thoracic spine pathology at T1 may produce symptoms in:
* Anterior or posterior arm
54
Thoracic spine pathology at T10-T12 may produce symptoms in:
* The groin and posterior thigh
55
Severe biomechanica lesions of the thoracic spine (such as disc protrusion or dynamic facet defect) frequently involve activities of:
* thoracic rotation and extension
56
Thoracic Vertebral Fractures:
* most commonly what type?
* most commonly occur where?
* Why?
* Compression Fracture
* At T12
* Junction between thoracic and lumbar spine and transition point between lumbar lordsis and thoracic kyphosis.
57
Indications for Inspiration Glides RIbs 2-11
* Increase motion into bucket handle inspiration
* Correction faulty positional space at rib joints
* Improve periarticular muscle performance
* Decrease pain
58
Indications for Expiration Glides RIbs 2-11
* Increasing ROM into pump-handle expiration of ribs
* Increase periarticular muscle performance
* decrease pain
* correcting faulty positional rib joint space-impairment
59
What is the PT implication of ribs having low stiffness against superior or inferior loading?
* A force placed too far laterally can easily sprain one or more costovertebral and/or costotransverse joints
.
60
Pain pattern for a mid-thoracic rib subluxation:
* Pain that radiates down the arm laterally
* aggaravated during inspiration when trunk is flexed
61
_Slump Test Variation_
* Cervical Spine: Flexion
* Thoracic and Lumbar Spine: Flexion (slump)
* Hip: Flexion (90o+), abduction
* Knee: Extension
* Ankle: Dorsiflexion
* Foot:
* Toes:
* Slump Test (ST2)
* Obturator Nerve Bias
62
_Long Sitting Slump Test Variation_
* Cervical Spine: Flexion, Rotation
* Thoracic and Lumbar Spine: Flexion (slump)
* Hip: Flexion (90o+)
* Knee: Extension
* Ankle: Dorsiflexion
* Foot:
* Toes:
* Long Sitting Slump Test (ST4)
* Spinal Cord, cervical and lumbar nerve roots, sciatic nerve
63
_Side Lying Slump Test Variation_
* Cervical Spine: Flexion
* Thoracic and Lumbar Spine: Flexion (slump)
* Hip: Flexion (20o)/(Hip in Extension?)
* Knee: Flexion
* Ankle: Plantar Flexion
* Foot:
* Toes:
* Side Lying Slump Test (ST3)
* Femoral Nerve Bias
64
_Slump Test Variation_
* Cervical Spine: Flexion
* Thoracic and Lumbar Spine: Flexion (slump)
* Hip: Flexion 90+ degrees
* Knee: Extension
* Ankle: Dorsiflexion
* Foot:
* Toes:
* Slump Test (ST1)
* Spinal Cord
* Cervical and lumbar nerve roots
* Sciatic nerve
65
[True/False]
## Footnote
You can use a Grade V manipulation to relieve a muscle in spasm.
* False
* Never attempt to manipulate (Grade V) a muscle in spasm, gentle passive movements may relieve the spasm.
66
Effects of Rotations (cervical):
* closes same side, opens other side
* affects upper C-spine more than lower
67
Effects of Lateral Flexion (cervical):
* Closes same side, opens other side
* Affects lower C-spine more than Upper C-spine
68
A negative (-) finding of the Alar Ligament Stress Test is when:
* The transverse process of C2 rotates opposite the direction of the side bend of the head.
69
What is a positive finding of the Sharp-Purser test and what does it mean?
* Positive Findings: demonstration of a sliding motion of the head backwards in relation to the spine of the axis
* Indicates that a subluxation of the atlas on the axis has been reduced
* Implicates dysfunction of the Transverse Ligament
70
Neck related disorders are more common in (men vs. women):
* Women
* prevalence increases after 50 yrs of age
71
Upper Cervical vs. Lower Cervical division components:
* Upper Cervical: C1, C2
* Lower Cervical: C3-C7
72
Features of atlanto-occipital joint:
* Condyloid
* Contributes to half of total neck flexion and extension
* Common cause of headaches
* Common cause chronic upper neck pain 2o to muscle tension
73
Features of atlanto-axial joint:
* Synovial Joint (diarthrodial)
* Pivot joint
* Dens and atlas articulation
* 1st intervertebral joint
* Permit rotation of the skull
* ½ total rotation of the neck comes from this joint
74
Primary restraint mechanism to prevent anterior sheer force of C1 on C2:
* Transverse Ligament
75
Limits contralateral lateral flexion and rotation movement of the occiput on the cervical spine:
* Alar Ligament
76
Resting Position of Cervical Spine:
* Midway between flexion and extension
77
Close Packed Position of the Cervical Spine:
* Full extension
78
Capsular Pattern of the Cervical Spine:
* Side Flexion and rotation equally limited; extension
79
Facet Opening
* Refers to the anterior and superior glide of the inferior articular process of the superior vertebra on the superior articular process of the vertebra below
80
Facet Closing
* Refers to the posterior and inferior glide of the inferior articular process of the superior vertebra on the superior articular process of the vertebra below
81
* Facet Gapping
* Refers to the separation or distraction (traction) of the joint surfaces in a perpendicular direction
82
Arthrokinematic Movement in the cervical spine: Convex-Concave Rule
* C0-C1 Motion Segment
* The occipital condyles (convex surface) move on the concave surface of the atlas
* C2-C7 Motion Segment
* concave surface (superior vertebra) moving on a convex one (inferior vertebra)
* Superior component: rotation & translation in same direction
* Inferior component: rotates & translates in opposite direction
83
84
Mobilization [Maitland Definition]
* Passive movement that is performed with a rhythm and a grade in a manner in which the patient is unable to prevent the technique from being performed
85
Contraindications to mobilization [11]
* Bone disease/malignancy
* Pregnancy
* Vertebral artery insufficiency
* Active ankylosing spondylitis
* Rheumatoid arthritis
* Spondylolisthesis
* Gross foramina encroachment and/or ANR compression
* Instability of the spine
* Recent whiplash
* Undiagnosed pain (psychological pain where signs do not match symptoms
* Long-term steroid use (affects ligament laxity)
86
Central Posterior-Anterior (CPA) indications:
* Best used for central & bilateral symptoms
* Indicated when pain/ protective spasm is present in same direction
87
Unilateral Posterior Anterior UPA indications:
* Best used for unilateral pain:
* Symptoms on the side of the pain
* Force directed against an articular process
* Important technique for upper cervical disorders
* same side symptoms
* assess bilaterally, levels above and below on both sides of the motion segment
88
Characteristics of Low Back Pain (Burton et al. 2009):
* Localized pain and discomfort
* Below costal margin and above the inferior gluteal fold
* May or may not have leg pain
89
Unilateral Anterior-Posterior (UAP) Indications:
* Anterolateral signs & symptoms
* Often has an effect on Neurodynamics
* Carpal Tunnel Syndrome
* Spondylolisthesis or intradiscal disorder
90
Transverse Glides indication:
* Unilateral pain
* usually push towards side of pain
* provides a rotational component to the segment
* used to centralize symptoms
91
Lateral Glide (Side Bending) indications
* Best used for unilateral distribution of pain
* Pain is diffused over a region of the spine
* closure/compression on one side with opening on the other
92
Greatest stresses on the vertebral artery occur in these locations [3]:
* C6-where it enters the transverse process
* Between C1 and C2
* Between C1 and the entry of the arteries into the skull
93
Assessment for the presence of symptoms and signs associated with VBI occurs at these four stages in the management of a patient with an upper quadrant disorder:
1. History (subjective examination)
2. Physical (objective) examination
3. During treatment of the cervical spine
4. Following treatment.
94
Risk Factors For Symptoms Related To Vertebrobasilar Insufficiency (Barker et al 2000)
* Drop attacks, blackouts, loss of consciousness
* Nausea, vomiting and general unwell feelings
* Dizziness or vertigo
* particularly if associated with head positioning
* Disturbances of vision (e.g. decreased, blurred, diplopia)
* Unsteadiness of gait (ataxia) and general feeling of weakness
* Tingling or numbness (especially dysaesthesia, i.e. tingling around the lips, hemianaesthesia or any alteration in facial sensation)
* Difficulty in speaking (dysarthria) or swallowing
* Hearing disturbance (e.g. tinnitus, deafness)
* Headache
* Past history of trauma
* Cardiac disease, vascular disease, altered blood pressure, previous cerebrovascular accident or transient ischemic attacks
* Blood clotting disorders
* Anticoagulant therapy
* Oral contraceptives
* Long-term use of steroids
* A history of smoking
* Immediately post partum
95
Precautions to Lumbar (vertebral) manual therapy related to nociception:
* Pain occurs in a ‘stimulus-response relationship’
* Hx and pain relationship
* As pain reduces, function normalizes over time
96
Contraindications to vertebral manual therapy (lumbar):
* No stimulus-response relationship to pain
* Pain and activity intolerance seem to last longer than normal healing processes
97
[True/False]
You can rule out the sacral plexus as a source of pathology if symptoms radiate below the knee.
* True
* don't need to look at lower nerve roots in this situation
98
Specific Precautions to Examination and Treatment of the Sacroiliac and Pelvis:
* Sexual dysfunction
* Urinary frequency changes
* Urinary incontinence developed over a relatively short period of time, may be indicative of a cauda equina lesion.
99
Add end-range overpressure to active test movements if:
* FULL active movements are pain-free
100
The least threatening of the tension tests is:
* Passive Neck Flexion
* therefore should be executed first.
101
The prone knee bend only needs to be performed when:
* a patient experiences neurological symptoms into the anterior thigh.
102
If the comparable sign (CS) was not elicited in active or passive physiological flexion, extension, lateral flexion, or rotation…..
* ...the examiner needs to try the quadrant test.
* This is a combination movement that consists of 3 separate motions: extension, side-bending, and rotation.
* “super closed-packed position”
103
Stability of the pelvic girdle is acheived through:
* Symphisis Pubis and the SI joints
104
Primary stabilizers of the pelvic girdle:
* local muscles of the transversus abdominis
* multifidi
* Diaphragm
* pelvic floor muscles
* synergistic active timed co-contraction of these muscles produces stability
105
Factors that help produce dynamic stability and force closure of the pelvic girdle:
* A strong ligamentous system
* The wedge shape of the sacrum
* Various muscle groups and fasciae crossing over the pelvic girdle
106
Force closure occurs by:
* nutation movement of the sacrum in relation to the innominates (friction)
* compression generated by the myofascial structures
* Prevents shear forces and tolerance to vertical loading
107
Nutation (of the sacrum) is:
* anterior sacral on iliac rotation
* posterior iliac on sacral rotation
* or both motions occurring simultaneously
108
Counternutation is:
* Posterior sacral on iliac rotation
* Anterior iliac on sacral rotation
* or, both motions occurring simultaneously
109
Gaenslen's Test can indicate the presence or absence of:
* SIJ lesion
* Pubic symphysis instability
* Hip pathology,
* L4 nerve root lesion.
* It can also stress the femoral nerve.
110
Mandibular deviation on opening:
* The mandible often deviates toward the affected side due to muscle spasm or mechanical locking due to a displaced meniscus.
111
Indications for temporomandibular anterior glide:
* Restrictions in mandibular depression, protrusion and contralateral lateral deviation of the TMJ.
* Movement consists of slight downward distraction force followed by anterior gliding force applied through the thumb.
112
Componenents of clinical reasoning (5):
* The Nature Or Kind Of Disorder
* The Areas Of Symptoms
* The Behavior Of The Symptoms
* Present History
* Past History
113
Factors relating to treatment by passive movement:
* used to increase mobility of joints
* used to decrease pain
* performed at a speed in which it is not possible for patient to prevent the movement
* may be "gentle-smooth" or "stretching"
