W8 Flashcards
What is vertebral manual therapy
Manual technique applied to nerve, muscle, fascia or joint
Low velocity = mobe
High velocity = manip
Who were prominent 20th century PTs
Grieve, Maitland, Paris, McKenzie, Kaltenborn/Evjenth, Janda, Sahrmann
What did Maitland do
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
What is a passive mobilisation
Any manual therapy directed at joint dysfunction that does not involve a high velocity thrust
When would you perform mobilisation
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
What are the variables in vertebral mobilisation
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
What does the type of mobe you choose depend on
Aims of treatment
Likely pathology
Symptom mechanisms
Examination findings
Reassessment findings
Therapist expectations / expertise
Patient expectations
Contraindications and precautions
What are the grades of movement
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
What are the contraindications to vertebral mobilisation
- 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 - Conditions with increased risk of complications or exacerbation
* Severe pain, pregnancy, acute nerve root pain/irritation, worsening conditions, mechanical instability (spondyloses), osteoporosis
What should you do with different movement restrictions
Generalised restriction = generalised technique = physiological or accessory @ multiple levels
Specific restriction = specific technique = accessory and localised physiological
What to do when primary concern is pain relief
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
What is involved in tissue lengthening
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
What is involved in afferent mediated responses
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
What is placebo or expectation effect
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
What is fluid mechanics
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 (??)
SE of SIJ
- The area of pain
- Pregnancy
- Trauma (indirect or direct)
- Asymmetrical stress
- Weight bearing
- Pain on striding and moving from supine to standing
OE of SIJ
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
Iliac compression and distraction
Iliac compression
- Medial to lateral force applied to ASISs
Iliac distraction
- Lateral to medial force applied to ASISs
looking for laxity not pain
Pelvic torsion test
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
Posterior shear test
- 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
SIJ Treatment
- Address muscle system impairments at both local and global hip level
- Address Lx/LL impairments
- Address positional faults/compensations
- SIJ belt used for stability
When are neurodynamics used
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
What are precautions to neurodynamic tests
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
What is structural differentiation
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
