Manual Therapy History – Flashcards
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Hippocrates used manual traction in treatment of
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spinal deformities
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in 1800's bonesetters developed practice consisting of
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Joint mobs and manipulation techniques
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Andrew Taylor Still founded
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Osteopathic Medicine in 1874
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Daniel David Palmer founded
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Chiropractic - in 1895
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Physiotherapy was founded in
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1899 in England
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Manual therapy is an important component of intervention for ______ and _____ disorders
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orthopaedic and neurologic
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Significant contributors to Manual Therapy Philosophies include
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Cyriax, Mennel, Osteopathic philosophies, Maitland, Kaltenborn & Mackenzie
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Subsets of Manual Therapy
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joint & soft tissue mob myofascial/positional release neurodynamic mobs proprioceptive neuromuscular techniques manual resistive exercise
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James Cyriax
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1950 - ortho pain has anatomic source - tx directed at this differentiates contractile/non contractile lesions *identify anatomic structure associated w/lesion*
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Cyriax Treatment
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FIMEP Friction massage injection Manipulation/manual exercise & modalities patient education
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Mennel
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Ortho 1980s Loss of normal joint play can lead to dysfunction -> dysfunction is sign of serious pathologic process or joint joint manipulation can restore normal joint play
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Mennel Treatment
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MEP Manual/manipulation Exercise/modalities Patient Ed
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Osteopathic philosophy
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Andrew Taylor Still 1874 body = complete unit neuromuscular system connect to other systems abnormality in structure can = abnormality in function *somatic dysfunction* exam focuses on asymmetry, restrictions & palpation of soft tissue changes eval interpretation is position or regional fault, segmental or multisegmental
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Osteopathic Treatment
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MMMSEP Manual/manip Muscle Energy Myofascial technique Strain/counterstrain Exercise Patient Ed
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Maitland (australian approach)
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Physiotherapist communicate w/patient theoretical & clinical thinking: clinical reasoning *assess & Reassess & uses SINSS* focuses more on pain strong emphasis in passive movement testing (grades 1-5) Differential assessment Eval findings = diagnosis
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Maitland Treatment
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TTEAMP Treating pain/stiffness Traction Exercises that reproduce clinical tx adverse neurodynamic mobs mobs/manip Patient Education
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Kaltenborn (Norwegian)
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biomechanical assessment pain, joint dysfunction & soft tissue change focus on regaining motion through movement
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Kaltenborn Treatment
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METSP Mobs/manip Exercise (emphasized PNF) Traction/Distraction Soft tissue mob Patient Ed
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McKenzie
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Physiotherapist lifestyle factors of sitting posture, loss of extension range - frequency of lumbar flexion - pain contributor patient involvement in self management/tx Emphasizes active no passive movement intervertebral disc common pain generator *use of REPEATED movements* Diagnosis is a syndrome v structure Postural, Dysfunction, Derangement
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McKenzie treatment
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SEMP Self tx w/REPEATED active movements Exercise w/pain reducing movements mobs/manip Patient Ed & self tx
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Mulligan
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Mobs w/movement *MWM* mobs applied parallel to plane of motion and sustained throughout the movement until joint returns to its starting point intention of producing *no pain* when applied
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Shirley Sahrmann
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movement impairment resolve underlying movement imbalances label & treat abnormal movement pattern as a diagnosis
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Stanley Paris
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Joint injuries = dysfunction GOAL = correct dysfunction rather than pain major difference from Maitland who focuses on pain
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Stanley Paris Treatment
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MP Mobs/manip Patient Education
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1/2 of the joint should be ___ and the other half ____ During manual therapy techniques
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1/2 stabilized, 1/2 mobilized
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Slow stretches for ____ capsular restrictions, Fast Oscillations for _____ restrictions
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Large Small/minor
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ABSOLUTE Contraindications to manual therapy
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Acute Circulatory condition Advanced Diabetes Bacterial infection Cauda equina lesions Cellulitis Constant - severe pain Hematoma Hypersensitivity of skin Inappropriate end feel Malignancy Open Wound in area S&S of SC involvement Systemic or localized infection (osteomyelitis)
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Relative Contraindications (Dependent on pt) for manual therapy
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Dizziness Hypermobility Joint effusion/inflammat. Neurologic signs Osteoporosis Pregnancy RA Steroid or anti-coagulant therapy
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Definition: Physiological Movements
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voluntary movement that can be performed actively
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Definition: Accessory Movements
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movements that are necessary for normal ROM that CANNOT be actively performed (joint play - motions between jt surfaces include distraction, compression, sliding, spinning, rolling)
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Definition: Compression
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Decrease in joint space of opposing joint surfaces Accessory motion when muscle contracts- provides stability normal intermittent comp. loads help move synovial fluid & maintain cartilage health High compressive loads may lead to articular cartilage changes & degeneration
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Definition: Joint Mobs Grade I-IV
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passive technique applied to joints using physiological or accessory motions -- at speed pt can stop
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Definition: joint manipulation Grade V
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passive technique - articular capsule is stretched w/a quick thrust to the joint Hi velocity - short amplitude motion @ end of joint ROM pt cannot stop motion
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Definition: Open packed
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slackening of major ligaments of the joint minimal jt surface contact max distraction of the joint surface max joint volume
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Definition: Closed pack position
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max congruency max tautness of major ligaments max stability min joint volume
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Definition: Anatomic limit
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determined by configuration of the joint surfaces and surrounding soft tissues
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Definition: point of limitation
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point in range that is short of anatomic limit and is reduced by either pain or tissue resistance
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Grade I
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Small amplitude movement at beginning of range
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Grade II
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Large amplitude movement within available range - resistance free
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Grade III
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Large amplitude into resistance
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Grade IV
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Small amplitude into resistance
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Grade V
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small amplitude, hi velocity thrust at end of available range past available ROM
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If pain is experience BEFORE tissue resistances Grade ____ and ____ are appropriate mobs
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I and II
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Indications for joint mobs
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pain control (I and II grades) - muscle guarding and spasms Joint hypomobility -stretching a stiff joint to restore range -stretching to lengthen contracted or fibrosed muscle tissue
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Rhythm of mobs
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varies but usually 3-6 sets of oscillations, 20-60 seconds for resistance. 1-2 min for pain smooth and regular continue until you feel a change then reassess
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Direction of movement of mobs
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either parallel or perpendicular to tx plane. tx plane - lies on articulating surface perpendicular to line from center of opposite articulating surface
