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Andrew Taylor Still

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Person: "The Lightened Bone Setter"

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Andrew Taylor Still

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Person: Ideas of manipulations came from having chronic headaches

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Andrew Taylor Still

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Person: Established the American Osteopathic College in Kirksville, Missouri

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Andrew Taylor Still

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Person: Theory of the Disturbed Artery (Obstructed blood flow could lead to disease or deformity -> Law of the Artery)

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Daniel David Palmer

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Person: Became a "natural healer", began as a magnetic healer

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Daniel David Palmer

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Person: Chiropractic healing using thrust technique on spinous process out of alignment -> Harvey Lillard no longer deaf (vertebrae out of alignment puts pressure on nerves and therefore affecting visceral function leading to disease)

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BJ Palmer (son of Daniel David Palmer)

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Person: enabled the profession to survive into the 20th century

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John Mennell

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Professional altruism (his teaching was not confined to any one profession but to all who had the education and training to learn effective and safe manipulation techniques)

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John Mennell

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Instrumental in founding North American Academy of Manipulative Medicine

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John Mennell

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Person: Crucial testimony in the anti-trust court proceedings against the AMA to help end the AMA campaign to contain and eliminate chiropractic

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John Mennell

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Person: "The Musculoskeletal System: Differential Diagnosis from Symptoms to Physical Signs"

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James Cyriax

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Person: Selective Tissue Tension Testing (method of logical, clinically reasoned, differential diagnosis)

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James Cyriax

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Person: Textbook of Orthopedic Medicine, Volume 1 irrevocably changed the way orthopedic manual PT's thought, taught, and practiced

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Freddy Kaltenborn

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Person: Use of arthrokinematics and osteokinematics for both assessment and treatment

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Freddy Kaltenborn

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Teaching based on emergent biomechanics of MacConaill, regaining motion through focusing on motion at the joint surfaces

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Stanley Paris

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Founded St. Augustine University

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Stanley Paris

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Heart and voice of rapidly emerging physical therapy specialization

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Robin McKenzie

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Accidently cured one of his chronic patients -> safe and effective treatment of LBP

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Robin McKenzie

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Defined the major contraindication to manipulation of lumbar spine: deviation with neurological symptoms

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Robin McKenzie

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Showed us that manual techniques are often not the only, or even the most appropriate approaches to correct a lumbar dysfunction

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Geoff Maitland

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Introduced ideas on how gentle oscillation techniques could be used prior to manipulation to more accurately attain the motion barrier

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Geoff Maitland

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With assistance from Jenny Hickling, movement diagrams were introduced to quantify concept of motion barriers

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International Federation for Orthopedic Manual Therapy (IFOMT)

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McKenzie, Paris, Kaltenborn, Maitland, and Grieve worked together to create this. It encouraged, through reccomendation of standards and setting of examinations, and expansion of influence of OMT throughout the world.

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Chiropractor

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Which profession manipulates due to subluxation, when joint is out of place?

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Chiropractor

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What profession focuses on adjustment and maintenance?

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Osteopathic

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What profession manipulates with positional fault (locked joint or joint incorrectly positioned)?

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Osteopathic

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What profession focuses on thrust manipulation and muscle energy?

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PT

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What professional manipulates with hypomobile joint, pain modulation, movement dysfunction?

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PT

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What profession focuses on manipulation, mobilization, oscillation, muscle energy, soft tissue mobilization?

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Non-thrust manipulation

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Slow and controlled mobilization is called?

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Thrust manipulation

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High velocity and low amplitude movements within or at end range of motion are called?

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Segmental Mobility Testing

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What is arthrokinematic assessment in the spine called?

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Convex femoral head moving on concave acetabulum Flexion: posterior and inferior glide Extension: Anterior glide

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Directions of glide for flexion and extension of hip (OKC)

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Convex femoral head moving on concave acetabulum ABD: inferior glide ADD: lateral glide

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Directions of glide for abd/add of hip (OKC)

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Convex femoral head moving on concave acetabulum ER: anterior glide IR: posterior glide

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Directions of glide for ER/IR of hip (OKC)

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Concave tibia moving on convex femur Flexion: posterior glide Extension: anterior glide

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Directions of glide for flex/ext of knee (OKC)

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patella moving on femur Flexion: inferior glide Extension: superior glide

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Direction of glide for flex/ext of PFJ (OKC)

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Convex talus moving on concave tibia DF: posterior glide PF: anterior glide

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Direction of glide for DF/PF of talocrural? (OKC)

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30 degrees flexion and abduction, slight ER

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Loose packed position of hip joint?

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25 degrees of flexion

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Loose packed position of knee joint?

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10 degrees PF

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Loose packed position of talocrural?

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convex humeral head moving on concave glenoid fossa Flexion: inferior and posterior Extension: anterior

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Direction of glide for glenohumeral flexion/extension? (OKC)

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convex humeral head moving on concave glenoid fossa ABD: inferior

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Direction of glide for glenohumeral abd? (OKC)

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convex humeral head moving on concave glenoid fossa Hor ADD: posterior

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Direction of glide for glenohumeral horizontal ADD? (OKC)

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convex humeral head moving on concave glenoid fossa ER: anterior glide IR: posterior glide

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Direction of glide for glenohumeral ER/IR? (OKC)

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23-55 degrees abduction in the scapular plane

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Loose packed position of gleohumeral joint

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concave radius moving on convex capitulum Flexion: anterior glide Extension: posterior glide

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Direction of glide for radius on humerus (capitulum) flex/ext? (OKC)

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convex radius moving on concave radial notch of ulna Supination: anterior glide Pronation: posterior glide

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Direction of glide for radius on ulna (proximal) supination/pronation? (OKC)

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concave ulna moving on trochlea (humerus) Flexion: anterior glide Extension: posterior glide

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Direction of glide for ulna on humerus flexion/extension? (OKC)

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70 degrees flexion and 10 degrees supination

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Loose packed position of ulna on humerus

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concave radius moving on ulna supination: posterior pronation: anterior

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Direction of glide for radius on ulna (distal) with supination/pronation in OKC?

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convex carpals moving on concave radius flexion: posterior Extension: anterior

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direction of glide for carpals on radius flexion/extension in OKC?

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neutral with slight ulnar deviation

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loosed packed position for carpals on radius?

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concave phalange moving on convex metacarpal

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direction of glide for MCP with flex/ext in OKC?

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(1) ROM loss differentiation (2) assessment of arthrokinematics: hyper vs hypo vs normal (grading) (3) guides the choice of intervention (4) reproduction of symptoms and implication of concordant pain source

answer

Purpose of joint play assessment?

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Toe region Elastic region Plastic region

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Stress/strain curve: name the regions in order

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between end of elastic/beginning of plastic regions

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Stress/strain curve: where is the yield point?

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end of plastic region

answer

Stress/strain curve: where is the failure point?

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Maitland's point R1 is onset of resistance: start of the elastic region Corresponds to Grade 1 or Grade II

answer

What does R1 correspond to?

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Maitland's point R2 is end point of resistance at end range: end of the available range where the plastic region begins but short of failure Corresponds to Grade III or Grade IV

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What does R2 correspond to?

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Malignancy Vertebrobasilar Insufficiency (5 D's) Instability/hyperlaxity (RA or upper cervical/DS) Cord/Cauda Equina signs (ataxic gait, difficulty balance, gross weakness of extremities, bowel and bladder) Declining neurological status

answer

List absolute contraindications to joint play assessment:

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Diplopia Dysarthria Dysphagia Dizziness Drop attack

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What are the 5 D's of vertebrobasilar insufficiency

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scoliosis skeletal abnormality (osteoporosis) pregnancy (spine) patient apprehension/guarding anti-coagulants prolonged corticosteroid use: weakens articular tissue

answer

List relative countraindications/precautions

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small amplitude motion, short of R1 point and remains in Toe region purpose: pain modulation

answer

Grade 1 Maitland

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higher amplitude, slightly into the elastic region purpose: pain modulation

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Grade 2 Maitland

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higher amplitude, moving into plastic region and then out of it purpose: increase ROM

answer

Grade 3 Maitland

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Remaining in plastic region purpose: increase ROM

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Grade 4 Maitland

question

high velocity thrust manipulation

answer

Grade 5 Maitland

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un-weight joint surfaces

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Grade 1 Kaltenborn

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slack is taken up to the end range (tests joint)

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Grade 2 Kaltenborn

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at end range tissue is stretched

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Grade 3 Kaltenborn

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Maitland: oscillations (grade 1-5) Kaltenborn: sustained/distraction techniques (grade 1-3)

answer

Difference between Maitland and Kaltenborn?

question

improve tissue extensibility reduction of intra-articular pathology disruption of adhesions nutritional neurophysiological psychological

answer

6 benefits of joint mobilization/manipulation

question

spinal cord mechanisms: Gate theory supraspinal mechanisms: descending pain inhibition from dPAG decrease paraspinal activity and increase activation of lumbar multifudus sympathoexcitatory responses

answer

Examples of neurophysiological?

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function: static and dynamic changes in joint position location: superficial capsule (stimulated early in the range) fired by: oscillations or stretch

answer

Mechanoreceptors (C-fibers) - located in joints of the extremity and the spine including the periphery of disc and fibrocartilage Type 1 fiber type function: location: fired by:

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function: only respond to changes in motion signaling acceleration or deceleration (Grade IV oscillation) location: deep capsule fired by: oscillations

answer

Mechanoreceptors (C-fibers) - located in joints of the extremity and the spine including the periphery of disc and fibrocartilage Type 2 fiber type function: location: fired by:

question

function: EXCITATORY: active at extremes of joint motion (increasing multifidus activity, increasing excitation in corticospinal tract thus generating a muscle contraction) INHIBITORY: inhibition of muscles that are associated with increased tonic activity (inhibiting paraspinal activity) location: capsule, ligament, and muscle fired by: thrust or sustained stretch pressure

answer

Mechanoreceptors (C-fibers) - located in joints of the extremity and the spine including the periphery of disc and fibrocartilage Type 3 fiber type function: location: fired by:

question

function: nociceptive location: all tissue Fired by: injury and inflammation

answer

Mechanoreceptors (C-fibers) - located in joints of the extremity and the spine including the periphery of disc and fibrocartilage Type 4 fiber type function: location: fired by:

question

flexion, internal rotation, horizontal adduction

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Glenohumeral Posterior glide required for

question

Posterior instability

answer

Precaution for posterior glide

question

flexion, scaption, abduction

answer

Inferior glide required for

question

slowly apply distraction force as technique may identify inferior GH instability/hyperlaxity or MDI (multi-directional instability

answer

Precaution for inferior glide

question

inferior GH instability/hyperlaxity of MDI

answer

Precaution for inferior glide with scapular stablization

question

120 shoulder flexion 70 IR 135 Horizontal adduction

answer

Normal ROM values associated with posterior glenohumeral glide

question

120 shoulder flexion scaption 90-120 abduction

answer

Normal ROM values associated with inferior glenohumeral glide

question

flexion (80) Supination (80-90)

answer

Normal ROM values associated with anterior proximal radius glide

question

extension (70) pronation (80-90)

answer

Normal ROM values associated with posterior proximal radius glide

question

TFCC injuries/sprain/tear

answer

Precaution for distal ulna anterior movement

question

RA

answer

Precaution for metacarpophalangeal anterior/posterior glide

question

90 MCP flexion

answer

Normal ROM values associated with anterior glide of MCP

question

45 MCP extension

answer

Normal ROM values associated with posterior glide of MCP

question

posterior/lateral approach hip arthroplasty

answer

precaution for posterior glide of hip

question

anterior approach hip arthroplasty or a labral repair in the acute or sub-acute stage

answer

precaution for anterior glide of hip

question

120 hip flexion 45 internal rotation

answer

Normal ROM values associated with posterior glide of hip

question

30 hip extension 45 external rotation

answer

Normal ROM values associated with anterior glide of hip

question

Hip arthoplasty (when using this specific technique for posterior approach)

answer

precaution for inferior glide of hip

question

120 hip flexion 45 abduction

answer

Normal ROM values associated with inferior glide of hip

question

Acture ACL reconstrcution and distal realignment procedures

answer

Precaution for anterior glide of knee

question

Acute or sub-acute PCL reconstruction or TRUE meniscal repairs

answer

Precaution for posterior glide of knee

question

0-10 knee extension

answer

Normal ROM values associated with anterior glide of knee

question

135 knee flexion

answer

Normal ROM values associated with posterior glide of knee

question

Avoid lateral glides with lateral patellar instability or following patellar stabilization procedures designed to limit lateral glide

answer

Precaution for patellofemoral glide

question

Medial glide

answer

What is often restricted with patellofemoral disorders

question

20 planter flexion

answer

Normal ROM values associated with anterior glide of talocrural

question

50 dorsiflexion

answer

Normal ROM values associated with posterior glide of talocrural

question

cancer site, osteoporosis, corticosteroid use

answer

precaution for thoracic and lumbar P->A glide

question

site of cancer, Trisomy 21, RA, s/p laminoplasty, osteoporosis, corticosteriod use

answer

precaution for cervical P->A glide

question

1. desensitization 2. Breaking up of aberrant cross linkage (scar tissue) 3. Promoting an inflammatory response to stimulate phagocytotic activity/healing-fibrin 4. Mechanical stimulation of collagen synthesis (mechanotransduction)

answer

Indications for CFM

question

1. Grade 3-4 tenderness 2 Bone pathology (excluding periostiitis) 3. Thinning of stratum corneal layer of skin 4. prescription of anticoagulation medications 5. over ecchymosis or abnormal skin conditions such as purpura 6. overt pain behavior or an irritable patient 7. Do not use over sutures, staples, or other primary closure methods

answer

Countraindication/precautions for CFM

question

Until pt perceives: 1 - decreased tenderness 2 - numbness 3 - up to 2-5 minutes

answer

Duration of CFM treatment

question

Grade 0 tenderness normal scar lack of progress over 2-3 consecutive sessions

answer

Discontinuation of CFM

question

1) increased blood flow and tissue temperature of area treated -> mechanical stimulation of tissue results in production of histamine (vasodilator), thereby increasing blood flow to area 2) improved soft tissue mobility/decreased soft-tissue restrictions 3) resolution of muscle guarding 4) placebo effect of "hands on" contact

answer

Effects of soft tissue mobilization

question

dysfunction is identified and correlated through impairments such as AROM, joint assessment, or soft tissue palpation (e.g. tenderness/guarding) intervention is performed to achieve a measureable outcome (e.g. increased AROM)

answer

soft tissue mobilization is most effective and appropriate when:

question

increase mobility of upper cervical extensors, relax sub-occipital musculature, and to reduce cervical headaches

answer

purpose of OA release

question

rectus capitis posterior major and minor obliquus capitis superior and inferior

answer

what muscles are targeted in OA release

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