week 9 - manual therapy

Question 1

What is the aim of manual therapy?

Answer 1

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

Question 2

How long is the benefit of manual therapy?

Answer 2

short term benefit only

Question 3

What structures do passive movements help?

Answer 3

joint or muscle

Question 4

What structures do joint mobilisation (accessory) help?

Answer 4

joint

Question 5

What structures do soft tissue massage/mobilisation/trigger points help?

Answer 5

soft tissues

Question 6

What does hands on facilitation help with?

Answer 6

proprioception

Question 7

How does manual therapy reduce pain?

Answer 7

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

Question 8

How does manual therapy increase movement?

Answer 8

graded exposure to painful activity
increase neural activity/stimulus
increase confidence and self-efficacy
reduced pain = patient able to move more

Question 9

How does manual therapy increase confidence/ reassurance?

Answer 9

reduced threat response
trust from therapist

Question 10

How does manual therapy increase proprioceptive/joint position sense?

Answer 10

stimulation of sensory nerves
stimulation of mechanoreceptors

Question 11

What is a passive movement?

Answer 11

a physiological movement performed at a joint by an external force, with the patient completely relaxed

Question 12

What is an indication for passive movements?

Answer 12

increase joint ROM or muscle length if patient not able to this for themselves

Question 13

What is a joint mobilisation (accessory)?

Answer 13

a passive movement (performed by a therapist) of one joint surface relative to another
described as slide, glide and roll

Question 14

What is an indication for joint mobilisation?

Answer 14

a joint (reduced ROM) problem

Question 15

What is a grade 1 joint mobilisation?

Answer 15

small amplitude of movement, not into resistance

Question 16

What is a grade 2 joint mobilisation?

Answer 16

large amplitude of movement, not into resistance

Question 17

What is a grade 3 joint mobilisation?

Answer 17

large amplitude of movement, into resistance

Question 18

What is a grade 4 joint mobilisation?

Answer 18

small amplitude of movement, into resistance

Question 19

What is a grade 5 joint mobilisation?

Answer 19

manipulation

Question 20

What is a potential problem with manual therapy?

Answer 20

reliability poor (inter and intra)

Question 21

What is a massage?

Answer 21

the mobilisation of soft tissue, usually using the therapists hands, fingers, thumb and forearms, elbows or tools

Question 22

Where is a trigger point aimed?

Answer 22

at a specific spot with in the muscle tissue (typically termed ‘muscle knot’)

Question 23

Why use soft tissue massage, mobilisation or trigger points?

Answer 23

physiological effects same as joint mobilisations
may also increase blood flow and reduce subjective feeling of DOM’s after exercise

Question 24

What is effluage?

Answer 24

long stroking movements

Question 25

What is petrisage?

Answer 25

stretching, needing and picking up

Question 26

What are some contra-indications of manual therapy?

Answer 26

infection local tumour acute inflammatory process within 24 hours of muscle tear fractures/dislocations acute flare up of rheumatoid arthritis

Question 27

What are some precautions of manual therapy?

Answer 27

joint instability hypermobility sero-negative arthropathies high severity/high irritability diabetes reduced sensation

Question 28

Which types of patients is manual therapy particularly useful for?

Answer 28

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

Question 29

Which type of patients is manual therapy not particularly useful for?

Answer 29

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)