Manual Therapy (Pod med)

Question 1

What’s the two main mechanism of action of manual therapy:

1?

2?

Answer 1

1. Promotion of healing tissue

• Superficial fluid techniques (efflurage)
• Specific Soft Tissue Mobilisation

2. Improvement in tissue extensibility

• Neuromuscular techniques
• Connective Tissue techniques

Question 2

What are the indications for manual therapy?

1?

2?

3?

4?

5?

Answer 2

1. Pain
2. Effusion
3. Muscle spasm
4. Reduced muscle extensibility
5. Reduced connective tissue extensibility (scar)
6. Reduced Muscle Integrity

Question 3

What are the contraindication or precautions for manual therapy?

Answer 3

1. Diabetes
2. Blood disorders
3. Anticoaugulant medication
4. Infection
5. Thrombosis
6. Malignancy
7. Vascular insifficinecy
8. Cellulitis
9. Fever
10. Poor skin condition
11. Open wound
12. Loss of sensation

Question 4

What are the endageroud sites?

Answer 4

1. Throat/Thrachea
2. Ant/Post neck
3. Kidney
4. Popliteal fossa area
5. Femoral triangle (Nerve, artery, vein)

Question 5

What are some of the effect of STM and massage?

1. M
2. P
3. P
4. R
5. PNI

Answer 5

1. Mechanical: physically moving the tissue
2. Reflex: Change mediated by nervous system, sedation and arousal of mechanoreceptors
3. Physcological: thoughts, emotions, behaviours
4. Physiological: Change in biological process
5. Psychoimmunological, decrease in stress hormone

Question 6

What are general practice guidlines for manual therapy?

1?

2?

3?

4?

5?

Answer 6

1. Locate the tissues: Assess during treatment /Palpate
2. Observe pt
3. Penetrate deeper through repetition
4. Rate = 1/depth
5. Adjust technique to :

Patient needs

Region and condition

Question 7

1. What is the Efflurage technique?
2. Which stage of healing?
3. Promote?
4. Indicated in ?
5. Remove?

Answer 7

1. Superficial fluid technique
2. Early stages of healing (0-3days)
3. the resorption of inflammatory exudate
4. the presence of swelling / effusion/ inflammation
5. chemical inflammatory mediators that are pain sensitizing (prostaglandins)  decrease pain and sensitivity to movement

Question 8

What are some clinical examples for Effluerage?

1?

2?

3?

Answer 8

1. Acute ankle sprain
2. Hamstring strain (day 0-3)
3. Removing excess fluid post cellulitis/ would infection

Question 9

What are some of the function for specific soft tissue mobilisation?

1. Which stage of healing?
2. Controlled graded loading to promote ?
3. Promote ?
4. Prevent?
5. Stimulate the proliferation of?
6. Type III collagen is replaced by?

Answer 9

1. Later stage of healing (7-10 days)
2. Collagen synthesis
3. Promote Collagen alingment and links within the tissue
4. Prevent inappropriate crosslink between the tissue layers
5. Fibroblast
6. strong type I

Question 10

Explain the deep transverse friction mobilisation:

Answer 10

Small amplitude, specfic, repetitive, non-gliding technique on the superficial tissue surface

Movement is between tissue layers to prevent/break down inappropriate cross-link regenerates in muscle or tendon

Causes hyperaemia

Breaks down adhesions

Stimulates mechanoreceptors (analgesic effects)

Promote collagen orientation

Question 11

What are some clinical examples for Deep transverse frictions:

Answer 11

Accessory SSTM:

Achilles Tendonopathies

Patella Tendon

Deep Transverse Frictions: Plantar Fascia Anterior Talofibular ligament

Question 12

1. When is the neuromuscular techniques indicated?
2. What are the stages of healing?
3. What the intend of treatment?

Answer 12

1. Indicated when an impaired movement is present, limited by an active myofascial restriction
2. 10 days- 4 weeks
3. Intent of treatment not to produce a longer bit of tissue but to induce muscle relaxation

Question 13

What are the different NMT techniques:

1?

2?

3?

Answer 13

1. Kneading
2. Stripping
3. Myofascial trigger point release

Question 14

What is the kneading technique?

Answer 14

Repetitive compression, shear & release of a muscle with varying degrees of drag, lift and glide

Picking up, wringing and squeezing

Used on large muscles that can be easily lifted (eg. Calf, quads)

Question 15

What is the Stirpping technique?

Answer 15

Deep, slow and very specific glidng techniqe along the line of the muscle

“Deep Effleurage”

Deep enough to engage muscle but should cause minimal pain

Hand contact needs to be soft and broad

Question 16

Trigger Point Release:

Answer 16

TrP is a focus region of hyperirratability within a muscle

‘Knot’ or MTrP develops as a characteristic clinical presentation

Taut ropey band of muscle fibers

Initially can illicit pain and a twitch response on palpation

Latent response- Tender on palpation yet no symptoms

Active response- reproduces the patient symptoms , especially referred pain

Question 17

What the technique for Myofascial trigger point release?

Answer 17

Technique:

Direct pressure for flat muscles or pincer grip when the muscle can be picked up

Put muscle under slight stretch

Find the ropey fibres via gentle pressure and cross fibre movement

Apply pressure until symptoms are reproduced

Hold until pain decreases

Increase pressure as pain decreases and stops

Re-assess muscle length, pain and function

Acupuncture and dry needling

Question 18

Connective tissue techniques:

Answer 18

Engages connective tissue and attempt to lengthen and remodel the tissue

Passive myofascial restriction

Movement impairment secondary to a passive limitation of movement (eg, ITB)

Deep Tissue Massage:

Consent is crucial – can be painful and has potential to cause slight skin discoluration

Deep, slow, gliding technique that applied moderate tensile load on the passive elements of muscle

Used in combination with joint positioning to place maximal tensile load on the tissues

Proceed the techniques with some lighter NMT techniques

Gradually increase pressure, with constant re-assessment of symptoms (ie. Pain)