1] Advanced Manual Therapy Techniques Flashcards Preview

MSK III P3 Fall > 1] Advanced Manual Therapy Techniques > Flashcards

Flashcards in 1] Advanced Manual Therapy Techniques Deck (48):
1

HVLA thrusts are often accompanied by

Cavitations

2

3 types of pain

Acute, subacute, chronic

3

What is expected motion loss in a patient with restricted capsular mobility atthe Left L2/L3facet?

Capsular restriction at lumbar limits upslides and gapping.

Left L2/L3 facet would be restricted in flexion, right SB and left rotation.

4

Absolute contraindications for manips in lumbar

Bone weakening patho
Neurological symptoms
Vascular issues
Severe pain that wont let them get into position
Lack of patient consent

5

Neuro sx that are absolute contraindications

Cord compression
Cervical myelopathy
Nerve root compression with increasing neuro deficits
Cauda equina compression

6

Vascular issues that are absolute contraindications

CAD or vertebrobasilar insufficiency
Aortic aneurysms
Blood disorder (hemophilia)
Using anticoagulants

7

Relative contraindications for lumbar manips

History of intervertebral disc injury
Pregnancy
Ligamentous laxity/hypermobility
Advantaged DJD
Vertigo
Psychological dependence on joint manip

8

Some transient adverse effects that might happen after manip

Increased local pain or discomfort
Stiffness
Headache
Tired/fatigue
Radiating pain
DNV
Tinnitus

9

Serious adverse effects after manip

HNP
Fractures
Vertebral artery dissection
CVA
Cauda equina syndrome
Spinal cord compression
Death

10

3 effects of manual therapy

Psychological
Mechanical
Neurophysiological

11

What is a psychological effect of manual therapy?

We have found their pain and can reproduce it so this strengthens the THERAPEUTIC ALLIANCE - possible placebo effect

12

Mechanical effects of MT

Stretching
Snap intra-articular adhesions
Release entrapped meniscoid tissue within facets
Increase ROM

13

What are some neurophysiological effects of MT?

Endogenous pain relief
Less muscles guarding and inhibition and sensitivity to pain

14

Mid cervical flexion

Both facets upslide

15

Mid cervical extension

Both facets downslide

16

Mid cervical right SB

L facet upslide
R facet downslide

17

Left sidebend mid cervical motion

Left downslide
Right upslide

18

Mid cervical right rotation

Left upslide
Right downslide

19

Mid cervical left rotation

Left downslide
Right upslide

20

Lumbar flexion

Both facets upslide

21

Lumbar extension

Both facets downslide

22

Lumbar right SB

Left up
Right down

23

Left SB

Left down
Right up

24

Lumbar right rotation

Left compress
Right gap

25

Lumbar left rotation

Left gap
Right compress

26

Coupled motion of Upper cervical spine

Rotation and SB happen in opposite directions

27

Coupled motions of mid cervical

Rotation and SB occur to SAME side

28

Coupled motion of thoracic and lumbar

In neutral/extended: rotation and SB in opposite directions

In flexed: rotation and SB happen in same direction

29

How do you do facet apposition locking

Put the spine in position thats opposite to the normal coupled motions

30

How would you lock mid cervical coupled motions?

SB and rotate to opposite side

31

When SB and rotation happen to the opposite sides like in neutral position of lumbar and thoracic, how do you lock?

Put them in SB and rotation to the same side

32

What conditions do you screen for during the interview

CAD
VBI
Cauda equina compression

33

What 3 conditions do you want to rule out before doing manips?

Cervical arterial dysfunction
Cervical instability
CES

34

Signs and Sx of cervical arterial dysfunction

Occipital and one sided headache
Ataxia
Ptosis
Facial palsy
5 D’s
3 Ns

35

What are the 5 D’s

Dizzy
Drop attacks
Diploplia
Dysarthria
Dysphagia

36

What are the 3 N’s

Numbness
Nausea
Nystagmus

37

Meta analysis by Mitchell noted significant decreased blood flow in VA with ?

Contralaterla end range rotation

38

Risk factors for craniocervical artery dissection

Recent minor trauma
HTN
Hypercholesterolemia
Smoking
TIA/CVA
Vertigo
Paresthesia

39

In pts with cervical instability, you want to rule out?

RA
Down’s syndrome
S/p trauma or falls

40

What would a pt with cervical instability say?

That they cant hold their head up or that they feel the need to wear a collar

41

Other signs and Sx of cervical instability

Bilateral paraesthesias
Weakness
Other signs of cord compression
Midline muscle guarding or tender

42

3 tests for cervical instability

Canadian c spine rules for fracture
Sharp-purser for transverse lig
Alar ligament stress test

43

What do you do if they are + for cervical instability through testing

Refer to imaging

44

Causes for cauda equina syndrome

HNP
Trauma
Tumor
Fracture
Stenosis
Infection

45

Signs and symptoms of cauda equina syndrome

LBP
Urinary incontinence or retention
Fecal retention/incontinence
Paresthesias in saddle distribution
Motor or sensory loss in B/LLEs
Gait Dysfunction

46

If CES suspected

Immediately refer for medical work up/imaging

47

Lumbar manip CPR guidelines (5)

Symptoms less than 16 days
No Sx below knee
FABQ work subscale less than 19
Hip IR more than 35 deg atleast 1 side
1 hypomobility lumbar segment

48

Recommendations for neck pain with mobility deficits

Acute: should thoracic manip and may cervical manip/mob - weak evidence

Subacute: may thoracic manip and cervical manip/mob- weak evidence

Chronic: multimodal approach - mod evidence