week 9 - manual therapy Flashcards

1
Q

What is the aim of manual therapy?

A

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

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2
Q

How long is the benefit of manual therapy?

A

short term benefit only

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3
Q

What structures do passive movements help?

A

joint or muscle

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4
Q

What structures do joint mobilisation (accessory) help?

A

joint

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5
Q

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

A

soft tissues

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6
Q

What does hands on facilitation help with?

A

proprioception

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7
Q

How does manual therapy reduce pain?

A

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

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8
Q

How does manual therapy increase movement?

A

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

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9
Q

How does manual therapy increase confidence/ reassurance?

A

reduced threat response
trust from therapist

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10
Q

How does manual therapy increase proprioceptive/joint position sense?

A

stimulation of sensory nerves
stimulation of mechanoreceptors

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11
Q

What is a passive movement?

A

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

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12
Q

What is an indication for passive movements?

A

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

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13
Q

What is a joint mobilisation (accessory)?

A

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

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14
Q

What is an indication for joint mobilisation?

A

a joint (reduced ROM) problem

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15
Q

What is a grade 1 joint mobilisation?

A

small amplitude of movement, not into resistance

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16
Q

What is a grade 2 joint mobilisation?

A

large amplitude of movement, not into resistance

17
Q

What is a grade 3 joint mobilisation?

A

large amplitude of movement, into resistance

18
Q

What is a grade 4 joint mobilisation?

A

small amplitude of movement, into resistance

19
Q

What is a grade 5 joint mobilisation?

A

manipulation

20
Q

What is a potential problem with manual therapy?

A

reliability poor (inter and intra)

21
Q

What is a massage?

A

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

22
Q

Where is a trigger point aimed?

A

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

23
Q

Why use soft tissue massage, mobilisation or trigger points?

A

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

24
Q

What is effluage?

A

long stroking movements

25
Q

What is petrisage?

A

stretching, needing and picking up

26
Q

What are some contra-indications of manual therapy?

A

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

27
Q

What are some precautions of manual therapy?

A

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

28
Q

Which types of patients is manual therapy particularly useful for?

A

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

29
Q

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

A

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)