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MUP > W8 > Flashcards

W8 Flashcards

1
Q

What is vertebral manual therapy

A

Manual technique applied to nerve, muscle, fascia or joint
Low velocity = mobe
High velocity = manip

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2
Q

Who were prominent 20th century PTs

A

Grieve, Maitland, Paris, McKenzie, Kaltenborn/Evjenth, Janda, Sahrmann

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3
Q

What did Maitland do

A

Aussie PT, developed system for Ax and Rx of MSK disorders
Focus on presenting symptoms and physical signs rather than being based on a biomechanical or pathological model
Treatment emphasis on manual therapy

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4
Q

What is a passive mobilisation

A

Any manual therapy directed at joint dysfunction that does not involve a high velocity thrust

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5
Q

When would you perform mobilisation

A

To improve vertebral motion both specific and generalised
Where motion loss is related to the presenting symptoms
To unload a symptomatic (adjacent) area
To affect to pathology/pathobiology -> open a compromised IVF, to affect IVD, to influence tissue healing
To alter CNS pain processing
- enhance descending pain inhibition
- alter spinal cord processing
- affect supraspinal pain processing

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6
Q

What are the variables in vertebral mobilisation

A

accessory/physiological/combined (what really happens?)
midline vs unilateral (for PA pressures)
specific/generalised
large/short amplitude
into resistance/short of resistance
long lever/short lever

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7
Q

What does the type of mobe you choose depend on

A

Aims of treatment
Likely pathology
Symptom mechanisms
Examination findings
Reassessment findings
Therapist expectations / expertise
Patient expectations
Contraindications and precautions

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8
Q

What are the grades of movement

A

Grade I: small amplitude short of resistance
Grade II: large amplitude short of resistance
Grade III: Large amplitude into resistance
Grade IV: small amplitude into resistance

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9
Q

What are the contraindications to vertebral mobilisation

A
  1. Conditions requiring medical evaluation and Mx
    * Possible malignancy – primary or secondary
    * Infective conditions, eg: osteomyelitis, TB, bacterial
    * Spinal cord compression
    * Cauda equina compression
    * Likely fracture
  2. Conditions with increased risk of complications or exacerbation
    * Severe pain, pregnancy, acute nerve root pain/irritation, worsening conditions, mechanical instability (spondyloses), osteoporosis
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10
Q

What should you do with different movement restrictions

A

Generalised restriction = generalised technique = physiological or accessory @ multiple levels
Specific restriction = specific technique = accessory and localised physiological

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11
Q

What to do when primary concern is pain relief

A

Try to increase ROM IF you think pain is due to stiffness
Alteration of pathology
Pain gating
Affect central pain processing by using placebos, expectation, using larger amplitudes and lower grades
Desensitising the neural system

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12
Q

What is involved in tissue lengthening

A

Muscles -> soft tissue release
creep deformation of ligaments
– elongation of ligament with sustained force
– gradual rearrangement of collagen fibres, proteoglycans and water within the ligament
– upon release of force ligament may not immediately return to initial length
stretching beyond plastic limit
post immobilisation you are aiming at prevention of recurrence / breaking down of adhesions

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13
Q

What is involved in afferent mediated responses

A

from pressure, touch, strain, motion receptors in skin, joints, muscle fascia
– carried to dorsal horn in fast, wide diameter afferent neurons (A beta)
inhibition of muscle activity
pain gating
stimulation of endogenous opiates
increased awareness at cortical level

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14
Q

What is placebo or expectation effect

A

not purely psychological: physiological, behavioural and subjective effects
likely to be modulated in part by endogenous opioids - reversed by naloxone
not a fixed effect
no particular personality type
inextricably linked with specific mode of treatment
effect of past treatment important
consider nocebo effect

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15
Q

What is fluid mechanics

A

restoration of blood flow / venous drainage
* removal of metabolites
improvement of tissue nutrition
* cartilage
* disc
alteration of viscosity of synovial fluid
alignment of collagen post injury
normalisation of axoplasmic flow in nerves (??)

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16
Q

SE of SIJ

A
  • The area of pain
  • Pregnancy
  • Trauma (indirect or direct)
  • Asymmetrical stress
  • Weight bearing
  • Pain on striding and moving from supine to standing
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17
Q

OE of SIJ

A

Positional tests = Standing, sitting, supine-long sitting test
Movement tests = standing flexion test, hip knee flexion test, sitting flexion test
Pain provocation = iliac compression, iliac distraction, pelvic torsion, posterior shear, sacral PA, active sLR, palpation of long dorsal ligament

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18
Q

Iliac compression and distraction

A

Iliac compression
- Medial to lateral force applied to ASISs
Iliac distraction
- Lateral to medial force applied to ASISs

looking for laxity not pain

19
Q

Pelvic torsion test

A

Pelvic torsion
- One hip in flexion while pushing other hip into extension
- Does this produce pain?
- Performed on both sides
- Can do one leg off bed one leg on

20
Q

Posterior shear test

A
  • Hip in 90˚ flexion
  • PT applies AP force directly in line with femur so ligaments relax
  • Does this produce symptoms?
  • Performed on both sides
  • Can bring into slight adduction
21
Q

SIJ Treatment

A
  • Address muscle system impairments at both local and global hip level
  • Address Lx/LL impairments
  • Address positional faults/compensations
  • SIJ belt used for stability
22
Q

When are neurodynamics used

A

Used to assess mobility and extensibility of nerves and related structures
When symptoms are thought to be neurogenic
When mechanics of injury or aggs suggest peripheral nerve involvements
If symptoms are not responding to typical MSK treatment
To exclude altered neurodynamics as a source of pain
To clarify source/mechanism of symptoms
To use as an outcome measure
To justify use of an active or passive treatment technique

23
Q

What are precautions to neurodynamic tests

A

Where are peripheral and central NS sensitisation likely
Where likely pathology will be aggravated by the postures or movements required for the tests
Where the tests are unlikely to provide interpretable or useful clinical

24
Q

What is structural differentiation

A

A movement that will help to differentiate between neural and MSK sources of symptoms
Selectivity alters strain on neural structures -> leads to increased/decreased symptoms and/or ROM
Distal symptoms = proximal SM
Proximal symptoms = distal SM

25
Q

What does a negative test indicate

A

Differentiating test makes no difference to the pt.
The pathology is a normal MSK response

26
Q

What does a positive test indicate

A

Differentiating test alters symptoms and/or movement
It is a neurogenic response which can be further divided into normal and abnormal

27
Q

What are normal neurogenic responses

A

Differentiated as neural
Similar to normal responses in terms of ROM and symptoms
Reasonably symmetrical issue
Does not reproduce patients symptoms

28
Q

What are abnormal neurogenic responses

A

Differentiated as neural
Reduced ROM compared with unaffected side
Symptom location and quality is different on unaffected side
Clinical reasoning is essential to determine the significance of findings

29
Q

Why might you get a positive test

A

Interruption of intraneural blood flow, neural inflammation, increased mechanosensitive, muscle responses, extra neural scaring, mechanical interface dysfunction

30
Q

When to perform passive neurodynamic techniques

A

When there is little to no chance of causing symptom flare up
When there is little chance of aggravating existing pathology or causing new pathology to nerve or MSK
When technique is likely to improve CNS function
When treatment for MSK impairment is not having the desired affect

31
Q

Passive neck flexion neurodynamic test

A

Perform passive neck flexion in supine
Thought to move dura and SC in head direction
Possible movement of nerve roots
Normal response = neck tightness

32
Q

SLR neurodynamic test

A

Sensitising tests = DF, Hip IR, HIP Flex
Biases
- Common peroneal = PF, inversion
- Tibial = DF, eversion
- Sural = DF, inversion
- Can also add adduction
Normal response = calf/hamstring tightness

33
Q

Prone knee bend

A

Pt. in prone and brings foot to bum with OP applied by PT
Assesses L2-4 (femoral nerve roots)
Normal response = anterior thigh tightness

34
Q

Slump

A

Pt. sitting and asked to ‘slump’ therapist applies pressure over head and pt. is asked to lift leg
Does this produce your symptoms? Raise your head, does it go away?
Normal response = mid Tx pain, hamstring and calf tightness
Differentiating movements = Cx flex, knee ext, ankle DF

35
Q

LL dermatomes

A

L1 Upper anterior thigh
L2 Anterior/medial aspect of mid-thigh
L3 Medial knee
L4 Medial malleolus (incl medial shin/foot)
L5 Lateral leg / sole of foot
S1 Lateral border of foot / posterolateral leg

36
Q

LL myotomes

A

L2 = hip flexion, L3 = knee extension, L4 = ankle dorsiflexion, L5 = big toe extension, S1 = ankle PF, SL calf raises to fatigue

37
Q

LL Deep tendon reflexes

A
  • L3 = knee jerk in supine with pt. resting on therapist knee, hammer strikes patella tendon and is repeated until consistent result is obtained
  • S1 = calf jerk, foot in DF, knee and hip in slight flexion, tendon hammer strikes Achilles tendon, Both repeated on other side
38
Q

Base UL Neurodynamic Test

A
  1. Start shoulder 90 abduction & ER 90, forearm supination
  2. Apply wrist /finger E
  3. extend elbow
    Sensitising = Cx LF
39
Q

Ulna neurodynamic test

A
  1. Elbow flexion and pronation
  2. wrist E
  3. abduct shoulder using therapist thigh
    Sensitising = Cx LF
40
Q

Radial neurodynamic test

A
  1. Shoulder 45 abduction
  2. Full IR + pronation
  3. Elbow extension
  4. Wrist flexion
  5. Shoulder abduction
    Sensitising = Cx LF, or scap elevation
41
Q

Median neurodynamic test

A
  1. Shoulder 45 abduction
  2. Full ER + supination
  3. Elbow extension
  4. Wrist extension
  5. Shoulder abduction
    Sensitising = Cx LF, or scap elevation
42
Q

UL dermatomes

A

C5 Lateral elbow and forearm
C6 Palmar surface of thumb
C7 Palmar surface of middle finger
C8 Ulnar border of hand and little finger
T1 Medial elbow and forearm

43
Q

UL myotomes

A

C5 = shoulder abduction break test
C6 = elbow flexion/wrist extension in supination
C7 = elbow extension in midprone
C8 = thumb extension
T1 = finger abduction

44
Q

UL deep tendon reflexes

A
  • C6 = biceps reflex, PT thumb on tendon, strike bicep tendon via their own thumb. Repeated until consistent result obtained
  • C7 = triceps, tendon on triceps tendon above elbow

MUP (12 decks)

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