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Ortho III > Vertebral Manual Therapy > Flashcards

Vertebral Manual Therapy Flashcards

1
Q

Small amplitude oscillation short of resistance (R1)

A

Grade I

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2
Q

large amplitude oscillation near beginning of R1

A

Grade II

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3
Q

a large amplitude oscillation 50% between R1 and R2.

A

Grade III

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4
Q

a small amplitude oscillation performed at the limit of range (R2)

A

Grade IV

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5
Q

A small amplitude, high speed, thrust at the end of available range.

A

Grade V: High Velocity Thrust; also called a manipulation

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6
Q

Physical examination findings related to the chief complaints that are reproduced during an examination/treatment.

A

Comparable Sign

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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

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8
Q

Why make a diagnosis? (2 Main Objectives)

A
  1. 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
  2. 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
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9
Q

Clinical Decision making focuses on:

A
  • Patient’s:
    • comparable sign
    • (symptoms)
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10
Q

Abnormal joint movement (that may be observed or felt)

  • (for example: stiffness, spasm, instability)
A

Joint Sign

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11
Q

Joint sign (felt by therapist) that reproduces the patient’s symptoms

A

Comparable sign

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12
Q

A joint cannot be considered clear or normal unless:

A

firm overpressure can be applied without pathological signs

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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
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14
Q

True or False: Osteokinematic movement cannot occur without appropriate arthrokinematic movement

A

True

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15
Q

What are Mobilizations:

A

Passive Movements:

  • Oscillatory Movements
  • Physiological Movements
  • Accessory Movements
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16
Q

Oscillatory Movements:

A

Consist of the joint’s accessory movements and/or its physiological movements

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17
Q

Physiological Movements:

A

movements which the patient carries out actively

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18
Q

Accessory Movements

A

Movements that are not under voluntary control and can only be produced passively

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19
Q

Passive Physiological Spinal Movements (2 groups)

A
  1. (PPIVM) Passive Physiological Intervertebral Movements
  2. (PAIVM) Passive Accessory Intervertebral Movement
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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
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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
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22
Q

3 Roles of Mobilization:

A
  1. RESTORE JOINT ALIGNMENT to normal positions or pain-free positions
    • allows for a painless full-range movement
  2. STRETCHING a stiff painless joint to restore range
    • use treatment movements that include the spin, roll, and slide normal for that joint
  3. 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
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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
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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
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25
Q

Severe patient condition is indicated by:

A
  • The patient is unable to sustain the position that produces the symptoms
    • no overpressures should be attempted
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26
Q

Irritability

A

The presence of pain on movement

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27
Q

R1

A

Initial Resistance

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28
Q

R2

A

Limit of resistance

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29
Q

P1

A

Onset of pain

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30
Q

P2

A

intensity/ irritability/ nature, and limit of pain

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31
Q

B

A

Physiologic Limit

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32
Q

L

A

Pathologic Limit

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33
Q

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.

A

HISTORY

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34
Q

(Assessment) (Relationship between irritability and pathology) Information can be obtained by:

A
  • 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.
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35
Q

The Maitland treatment approach primarily uses _______ _________ movements to normalize function

A

passive accessory

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36
Q

The primary aim in the examination of a joint movement is to find a __________ ____ in an appropriate joint.

A

comparable sign

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37
Q

Pain Dominant presentation (4 characteristics)

A
  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
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38
Q

Stiffness dominant presentation:

A
  1. Range: limited
  2. Pain: Often end range only
  3. Spasm: seldom present
  4. Repeated movements: often increase the range
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39
Q

A Pain Component at Rest or With Movement:

A
  • pain associated with stiffness/hypomobility
  • often referred to as “intracapsular” pain
  • loose-packed mobilizations achieve relief
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40
Q

A Stiff and Painless Component:

A
  • “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
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41
Q

Grade I and II mobilizations to:

A

Reduce, centralize, and eliminate pain

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42
Q

Grade III and IV mobilizations for:

A
  • produce the pain in the stiff dominated disorder
  • move the pain farther out into range
  • increase range by reducing stiffness
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43
Q

Contraindications to higher grade mobilizations:

A
  • Any active systemic disease - Malignancy - Inflammatory Conditions - Recent Fracture or Non-union - Severe Osteoporosis - Cord Compression - Instability or Excessive Hypermobility - Spondylolisthesis - Gross Foraminal Encroachment
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44
Q

Precautions to higher grades of movement:

A
  • 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
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45
Q

Straight Leg Raise:

  • Hip: Flexion
  • Knee: Extension
  • Ankle:
  • Toes:
A
  • Straight Leg Raise
    • Sciatic Nerve Bias
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46
Q

Straight Leg Raise:

Hip: Flexion and medial rotation

Knee: Extension

Ankle: Plantarflexion

Foot: Inversion

Toes:

A
  • Straight Leg Raising:
    • Common peroneal nerve bias
47
Q

Straight Leg Raise:

Hip: Flexion

Knee: Extension

Ankle: Dorsiflexion

Foot: Eversion

Toes: Extension

A
  • Straight Leg Raise:
    • Tibial Nerve Bias
48
Q

Straight Leg Raise:

Hip: Flexion

Knee: Extension

Ankle: Dorsiflexion

Foot: Inversion

Toes:

A
  • Straight Leg Raise
    • Sural Nerve Bias
49
Q

Unilateral thoracic pain radiating along the line of the rib is usually indicative of pathology affecting the:

A
  • nerve root
50
Q

Deep central back pain radiating through the chest may be indicative of:

A
  • Intervertebral Disc
51
Q

Unilateral thoracic pain radiating horizontally around the chest wall is likely emanating from:

A
  • Unilateral joints:
    • Facet joints
    • Costovertebral Joints
    • Costosternal joints
52
Q

T4 Pathology may produce what type of headache?

A
  • Cap-type headache
    • (although headaches may also be produced from C1 to C3)
53
Q

Thoracic spine pathology at T1 may produce symptoms in:

A
  • Anterior or posterior arm
54
Q

Thoracic spine pathology at T10-T12 may produce symptoms in:

A
  • The groin and posterior thigh
55
Q

Severe biomechanica lesions of the thoracic spine (such as disc protrusion or dynamic facet defect) frequently involve activities of:

A
  • thoracic rotation and extension
56
Q

Thoracic Vertebral Fractures:

  • most commonly what type?
  • most commonly occur where?
  • Why?
A
  • Compression Fracture
  • At T12
  • Junction between thoracic and lumbar spine and transition point between lumbar lordsis and thoracic kyphosis.
57
Q

Indications for Inspiration Glides RIbs 2-11

A
  • Increase motion into bucket handle inspiration
    • Correction faulty positional space at rib joints
    • Improve periarticular muscle performance
    • Decrease pain
58
Q

Indications for Expiration Glides RIbs 2-11

A
  • Increasing ROM into pump-handle expiration of ribs
    • Increase periarticular muscle performance
    • decrease pain
    • correcting faulty positional rib joint space-impairment
59
Q

What is the PT implication of ribs having low stiffness against superior or inferior loading?

A
  • A force placed too far laterally can easily sprain one or more costovertebral and/or costotransverse joints
.
60
Q

Pain pattern for a mid-thoracic rib subluxation:

A
  • Pain that radiates down the arm laterally
    • aggaravated during inspiration when trunk is flexed
61
Q

Slump Test Variation

  • Cervical Spine: Flexion
  • Thoracic and Lumbar Spine: Flexion (slump)
  • Hip: Flexion (90o+), abduction
  • Knee: Extension
  • Ankle: Dorsiflexion
  • Foot:
  • Toes:
A
  • Slump Test (ST2)
    • Obturator Nerve Bias
62
Q

Long Sitting Slump Test Variation

  • Cervical Spine: Flexion, Rotation
  • Thoracic and Lumbar Spine: Flexion (slump)
  • Hip: Flexion (90o+)
  • Knee: Extension
  • Ankle: Dorsiflexion
  • Foot:
  • Toes:
A
  • Long Sitting Slump Test (ST4)
    • Spinal Cord, cervical and lumbar nerve roots, sciatic nerve
63
Q

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:
A
  • Side Lying Slump Test (ST3)
    • Femoral Nerve Bias
64
Q

Slump Test Variation

  • Cervical Spine: Flexion
  • Thoracic and Lumbar Spine: Flexion (slump)
  • Hip: Flexion 90+ degrees
  • Knee: Extension
  • Ankle: Dorsiflexion
  • Foot:
  • Toes:
A
  • Slump Test (ST1)
    • Spinal Cord
    • Cervical and lumbar nerve roots
    • Sciatic nerve
65
Q

[True/False]

You can use a Grade V manipulation to relieve a muscle in spasm.

A
  • False
    • Never attempt to manipulate (Grade V) a muscle in spasm, gentle passive movements may relieve the spasm.
66
Q

Effects of Rotations (cervical):

A
  • closes same side, opens other side
  • affects upper C-spine more than lower
67
Q

Effects of Lateral Flexion (cervical):

A
  • Closes same side, opens other side
  • Affects lower C-spine more than Upper C-spine
68
Q

A negative (-) finding of the Alar Ligament Stress Test is when:

A
  • The transverse process of C2 rotates opposite the direction of the side bend of the head.
69
Q

What is a positive finding of the Sharp-Purser test and what does it mean?

A
  • 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
Q

Neck related disorders are more common in (men vs. women):

A
  • Women
    • prevalence increases after 50 yrs of age
71
Q

Upper Cervical vs. Lower Cervical division components:

A
  • Upper Cervical: C1, C2
  • Lower Cervical: C3-C7
72
Q

Features of atlanto-occipital joint:

A
  • 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
Q

Features of atlanto-axial joint:

A
  • 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
Q

Primary restraint mechanism to prevent anterior sheer force of C1 on C2:

A
  • Transverse Ligament
75
Q

Limits contralateral lateral flexion and rotation movement of the occiput on the cervical spine:

A
  • Alar Ligament
76
Q

Resting Position of Cervical Spine:

A
  • Midway between flexion and extension
77
Q

Close Packed Position of the Cervical Spine:

A
  • Full extension
78
Q

Capsular Pattern of the Cervical Spine:

A
  • Side Flexion and rotation equally limited; extension
79
Q

Facet Opening

A
  • 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
Q

Facet Closing

A
  • 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
Q
  • Facet Gapping
A
  • Refers to the separation or distraction (traction) of the joint surfaces in a perpendicular direction
82
Q

Arthrokinematic Movement in the cervical spine: Convex-Concave Rule

A
  • 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
Q
A
84
Q

Mobilization [Maitland Definition]

A
  • 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
Q

Contraindications to mobilization [11]

A
  • 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
Q

Central Posterior-Anterior (CPA) indications:

A
  • Best used for central & bilateral symptoms
    • Indicated when pain/ protective spasm is present in same direction
87
Q

Unilateral Posterior Anterior UPA indications:

A
  • 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
Q

Characteristics of Low Back Pain (Burton et al. 2009):

A
  • Localized pain and discomfort
    • Below costal margin and above the inferior gluteal fold
  • May or may not have leg pain
89
Q

Unilateral Anterior-Posterior (UAP) Indications:

A
  • Anterolateral signs & symptoms
    • Often has an effect on Neurodynamics
    • Carpal Tunnel Syndrome
    • Spondylolisthesis or intradiscal disorder
90
Q

Transverse Glides indication:

A
  • Unilateral pain
    • usually push towards side of pain
    • provides a rotational component to the segment
    • used to centralize symptoms
91
Q

Lateral Glide (Side Bending) indications

A
  • 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
Q

Greatest stresses on the vertebral artery occur in these locations [3]:

A
  • C6-where it enters the transverse process
  • Between C1 and C2
  • Between C1 and the entry of the arteries into the skull
93
Q

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:

A
  1. History (subjective examination)
  2. Physical (objective) examination
  3. During treatment of the cervical spine
  4. Following treatment.
94
Q

Risk Factors For Symptoms Related To Vertebrobasilar Insufficiency (Barker et al 2000)

A
  • 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
Q

Precautions to Lumbar (vertebral) manual therapy related to nociception:

A
  • Pain occurs in a ‘stimulus-response relationship’
    • Hx and pain relationship
  • As pain reduces, function normalizes over time
96
Q

Contraindications to vertebral manual therapy (lumbar):

A
  • No stimulus-response relationship to pain
  • Pain and activity intolerance seem to last longer than normal healing processes
97
Q

[True/False]

You can rule out the sacral plexus as a source of pathology if symptoms radiate below the knee.

A
  • True
    • don’t need to look at lower nerve roots in this situation
98
Q

Specific Precautions to Examination and Treatment of the Sacroiliac and Pelvis:

A
  • Sexual dysfunction
  • Urinary frequency changes
    • Urinary incontinence developed over a relatively short period of time, may be indicative of a cauda equina lesion.
99
Q

Add end-range overpressure to active test movements if:

A
  • FULL active movements are pain-free
100
Q

The least threatening of the tension tests is:

A
  • Passive Neck Flexion
    • therefore should be executed first.
101
Q

The prone knee bend only needs to be performed when:

A
  • a patient experiences neurological symptoms into the anterior thigh.
102
Q

If the comparable sign (CS) was not elicited in active or passive physiological flexion, extension, lateral flexion, or rotation…..

A
  • …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
Q

Stability of the pelvic girdle is acheived through:

A
  • Symphisis Pubis and the SI joints
104
Q

Primary stabilizers of the pelvic girdle:

A
  • local muscles of the transversus abdominis
  • multifidi
  • Diaphragm
  • pelvic floor muscles
  • synergistic active timed co-contraction of these muscles produces stability
105
Q

Factors that help produce dynamic stability and force closure of the pelvic girdle:

A
  • A strong ligamentous system
  • The wedge shape of the sacrum
  • Various muscle groups and fasciae crossing over the pelvic girdle
106
Q

Force closure occurs by:

A
  • 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
Q

Nutation (of the sacrum) is:

A
  • anterior sacral on iliac rotation
  • posterior iliac on sacral rotation
    • or both motions occurring simultaneously
108
Q

Counternutation is:

A
  • Posterior sacral on iliac rotation
  • Anterior iliac on sacral rotation
  • or, both motions occurring simultaneously
109
Q

Gaenslen’s Test can indicate the presence or absence of:

A
  • SIJ lesion
  • Pubic symphysis instability
  • Hip pathology,
  • L4 nerve root lesion.
  • It can also stress the femoral nerve.
110
Q

Mandibular deviation on opening:

A
  • The mandible often deviates toward the affected side due to muscle spasm or mechanical locking due to a displaced meniscus.
111
Q

Indications for temporomandibular anterior glide:

A
  • 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
Q

Componenents of clinical reasoning (5):

A
  • The Nature Or Kind Of Disorder
  • The Areas Of Symptoms
  • The Behavior Of The Symptoms
  • Present History
  • Past History
113
Q

Factors relating to treatment by passive movement:

A
  • 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”

Ortho III (4 decks)

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