week 9 - manual therapy Flashcards
What is the aim of manual therapy?
reduce pain
increase movement
increase patient confidence, reassurance or reduce fear avoidance
increase proprioception/joint position sense
some therapists use it as a ‘way in’ to allow the patient to exercise or do longer term treatment modalities
How long is the benefit of manual therapy?
short term benefit only
What structures do passive movements help?
joint or muscle
What structures do joint mobilisation (accessory) help?
joint
What structures do soft tissue massage/mobilisation/trigger points help?
soft tissues
What does hands on facilitation help with?
proprioception
How does manual therapy reduce pain?
Neuromodulation
reduced sensitivity and threshold level for pain signal
central changes within the brain, endorphins
stimulation of sympathetic nervous system
pain gate theory
psychological/placebo/therapist effect
How does manual therapy increase movement?
graded exposure to painful activity
increase neural activity/stimulus
increase confidence and self-efficacy
reduced pain = patient able to move more
How does manual therapy increase confidence/ reassurance?
reduced threat response
trust from therapist
How does manual therapy increase proprioceptive/joint position sense?
stimulation of sensory nerves
stimulation of mechanoreceptors
What is a passive movement?
a physiological movement performed at a joint by an external force, with the patient completely relaxed
What is an indication for passive movements?
increase joint ROM or muscle length if patient not able to this for themselves
What is a joint mobilisation (accessory)?
a passive movement (performed by a therapist) of one joint surface relative to another
described as slide, glide and roll
What is an indication for joint mobilisation?
a joint (reduced ROM) problem
What is a grade 1 joint mobilisation?
small amplitude of movement, not into resistance
What is a grade 2 joint mobilisation?
large amplitude of movement, not into resistance
What is a grade 3 joint mobilisation?
large amplitude of movement, into resistance
What is a grade 4 joint mobilisation?
small amplitude of movement, into resistance
What is a grade 5 joint mobilisation?
manipulation
What is a potential problem with manual therapy?
reliability poor (inter and intra)
What is a massage?
the mobilisation of soft tissue, usually using the therapists hands, fingers, thumb and forearms, elbows or tools
Where is a trigger point aimed?
at a specific spot with in the muscle tissue (typically termed ‘muscle knot’)
Why use soft tissue massage, mobilisation or trigger points?
physiological effects same as joint mobilisations
may also increase blood flow and reduce subjective feeling of DOM’s after exercise
What is effluage?
long stroking movements
What is petrisage?
stretching, needing and picking up
What are some contra-indications of manual therapy?
infection
local tumour
acute inflammatory process
within 24 hours of muscle tear
fractures/dislocations
acute flare up of rheumatoid arthritis
What are some precautions of manual therapy?
joint instability
hypermobility
sero-negative arthropathies
high severity/high irritability
diabetes
reduced sensation
Which types of patients is manual therapy particularly useful for?
patients lacking confidence or self-efficacy to move
can be useful to build rapport and trust
distraction/talk about other physiological issues
patients who believe manual therapy will help
Which type of patients is manual therapy not particularly useful for?
contra-indications
patients who are particularly passive in their treatment
persistent pain
some yellow, blue, black flag patients
hyperalgesia or allodynia (increased pain or sensitivity to a non-painful stimulus)
