Week 8 (Manual Therapy)

Question 1

Manual therapy techniques

Answer 1

Joint mobilisations
Soft tissue massage/therapy
Myofascial release
Trigger point therapy

Question 2

Manual therapy can reduce pain through what mechanisms

Answer 2

Neurophysiological mechanisms
Relieve muscle spasm/improve muscle relaxation
Facilitate tissue healing

Question 3

Manual therapy can reduce stiffness through what mechanisms

Answer 3

Increase joint ROM
Reduce reflex muscle facilitations
Facilitate movement (due to pain relief/muscle relaxation)
Increase tissue extensibility

Question 4

What grade and amplitude to give to someone in pain only?

Answer 4

1-3 (usually grade 2)

Largest possible

Question 5

What grade to give someone in primarily pain with little stiffness?

Answer 5

Grade 2-3

Largest possible

Question 6

What grade to give someone who is primarily stiff with some pain?

Answer 6

Grade 3

Large or small

Question 7

What grade to give someone who is stiff only?

Answer 7

Grade 3-5

Large or small

Question 8

Grade 1 of joint mobilisation

Answer 8

Small amplitude movement performed at beginning of range

Question 9

Grade 2 of joint mobilisation

Answer 9

Large amplitude movement performed within free range not moving into any resistance or stiffness

Question 10

Grade 3 of joint mobilisation

Answer 10

Large amplitude movement performed up to the limit of range

Question 11

Grade 4 of joint mobilisation

Answer 11

Small amplitude movement performed at the limit of range

Question 12

What is a clinical indicator to do a joint mobilisation?

Answer 12

Non-contractile structures contributing to pain or restricting physiological or accessory movements

Question 13

Contraindications to joint mobilisation

Answer 13

• Local malignancy
• Local bony infection
• Fracture/risk of fracture
• Spinal cord compression
• Cauda equina syndrome
• Active inflammatory arthritis

Question 14

Treatment parameters of joint mobilisation

Answer 14

Grade 1-2 mobilisations typically slow for about 30 seconds per rep
Grade 3-4 mobilisations typically faster for about 45-60 seconds per rep

Question 15

Soft tissue techniques

Answer 15

Soft tissue massage
Myofascial release
Trigger point therapy

Question 16

Effleurage massages aim to

Answer 16

• Assist lymphatic drainage such as in chronic oedema to help move fluid around to drain to the lymphatic system
• Desensitise patient to your touch
• Influence muscle tone

Question 17

Petrissage massage aims to

Answer 17

• Stimulate flow of venous and lymphatic fluid

- Increase tissue mobility

Question 18

Myofascial release mechanism

Answer 18

Potentially rupture the abnormal cross-linkages between collagen fibres, stimulate fibroblasts synthesis of collagen and increase inter-fibre distance

Question 19

Trigger point therapy mechanism

Answer 19

Equalising sarcomere length by pressure, needle, stretch or contraction

Question 20

Contraindications and precautions to soft tissue techniques

Answer 20

• Malignancy
• Systemic or localised infection
• Acute circulatory condition
• Fracture/risk of fracture
• Open wounds
• Skin conditions
• Haematoma
• Active inflammatory arthritis