Chapter 1: Advanced techniques Flashcards Preview

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Flashcards in Chapter 1: Advanced techniques Deck (230):

_____________ - a series of breathing exercises used to help your client relax. These techniques can also be used to help your client work through their pain.

Diaphragmatic Breathing


Complete the Relaxation/Pain control breathing technique.

1. Sit in a comfortable position or lie down.

2. Close your eyes.

3. Place one hand on your chest and one hand on your abdomen.


5. Continue to inhale until your lungs are completely filled. 

4. Inhale in through the nose, the hand on your abdomen should rise first, as you continue to inhale, the hand on your chest should rise second. 


What are the contraindications for breathing technique?


uncontrolled hypertension

renal disease


These techniques encourage lymphatic drainage and reduce certain types of edema. 

Manual Lymph Drainage


How Manual Lymph Drainage techniques is applied?

Techniques are applied uni-directional (towards the heart) rhythmically and segmental starting at the proximal lymph nodes and working in an over-lapping fashion distally, towards the edema site.


Pressure in Manual Lymph Drainage techniques is very light ( __________ )

20 - 40 mmHg


Why very light pressure is applied in Manual Lymph Drainage techniques?

To avoid collapsing the superficial lymph nodes.


Who developed Manual Lymph Drainage techniques and what year?

Emil Vodder 1930’s


In Manual Lymph Drainage techniques, Each manipulation must be repeated how many times?

minimum of 5 to 7 times


It Determine if swelling is acute, subacute or chronic over the affected area.

4 T’s of palpation


When doing Manual Lymph Drainage techniques affected area should be:



____________ are applied using the palmar surface of the hand to the lymphatic nodes of the most proximal part of the limb (or body part) that has edema.



In doing Lymph pump to proximal lymph nodes we can use:

Towel roll


Larger areas proximal to the edema are treated using ____________ . You can use the entire _________ or just the palmar side of the proximal fingers.

stationary circles

palm of the hand


True or False:

a. When you reach the edema, lymph drainage is done using the ulnar border of the hand or the radial border of the thumbs. The movement is always distal.

b. Tissue proximal to the edema is not treated, until the edema site has decreased.



a.When you reach the edema, lymph drainage is done using the ulnar border of the hand or the radial border of the thumbs. The movement is always proximal.

b.Tissue distal to the edema is not treated, until the edema site has decreased.


This technique is performed without oil and is usually performed before any other techniques.

Manual Lymph Drainage


How many minutes 'post massage' is Manual Lymph Drainage techniques can done?

20 - 30 minutes


Why we need to wait 20 - 30 minutes 'post massage' before performing Manual Lymph Drainage?

you have to wait 20 - 30 minutes 'post massage' so that the lymph nodes are no longer collapsed.


Contraindications of Manual Lymph Drainage Techniques.

Recent thrombosis

acute conditions due to bacterial or viral infections, malignant pathologies severe varicose veins.


Once you have performed the Manual Lymph Drainage, then you can apply this technique around the edema site. This technique is called:

Specific swelling technique


True regarding Specific swelling technique. Except:

a. At the swelling site, shave ¼ to 1/8 inches around the periphery of swelling (always finish above). Continue to drain into nearest lymph node using MLD or effleurage. Use reflex moves over injury. Pressure is very light.

b. Repeat MLD technique, drainage and reflex moves until swelling goes down or pain is relieved.

c. With continued treatments as swelling subsides, progress into area of trauma with superficial effleurage. 

Except: b

Correct: Repeat shaving technique, drainage and reflex moves until swelling goes down or pain is relieved.


In Specific swelling technique, with continued treatments as swelling subsides, progress into area of trauma with ______________ .

superficial effleurage


In Specific swelling technique: Once client can tolerate __________ , then progress to large and small kneading and eventually frictions (only performed in chronic stage). Pressure in this stage can be increased.

deep effleurage


________________ - are sensory organs located in the muscle tendon. It increases in concentration, the closer the tendon is to the muscle. They determine the amount of tension put on a tendon and use a protective reflex to prevent muscular injury.

Golgi Tendon Organ (GTO)


This reflex is activated when muscle tension is placed on the tendon. In order to prevent what the GTO perceives as danger of a tendon rupture, it has to stop a muscle contraction. It does this by controlling nerve firing, causing the muscle to relax.

protective reflex


This concept is used by the Massage Therapist to release muscle tone when ‘on site’ massage is too painful. It is most effective in muscles, where tendons are easily palpable.

Golgi Tendon Organ (GTO)


Regarding how to perform Golgi Tendon Organ (GTO) technique: True or False

a. Use reinforced thumb or fingers. A transverse stretch or direct compression is applied to the tendon for a minimum of 30 seconds or until the muscle relaxes.

b. The tendon may be bowed in an ‘S’ or ‘C’ shape. Pressure is moderate to deep.



Compression applied to the part of the tendon adjacent to the _________________ , will give best results due to the greatest concentration of GTO.

muscle-tendon junction


This technique may be uncomfortable for client. Prior to perform Golgi Tendon Organ (GTO) we should first:

Remind client of pain scale and breathing, to decrease the perception of pain.


List are contraindication of Golgi Tendon Organ (GTO) Technique. Except:

a. Edema surrounding tendon

b. Hypotonic or atrophy muscles

c. Cough

d. Pathologies of connective tissue which may include shortening of tissue, adhesions causing binding, pulling and restricting movement and joint laxity.

e. Skin lesions

Except: c


This technique can be used to reduce tone in a muscle, when direct work to the muscle belly is too painful.

Origin and Insertion Technique


What we use in doing Origin and Insertion Technique?

the thumb or finger kneading


In Origin and Insertion Technique, the therapist covers the origin of the muscle to be treated and performs a series of _______ , with fiber strokes ( _______ ).


+ signs


In Origin and Insertion Technique: work cross-fiber, with fiber on the ___________ until the tissue releases. Then move slightly along the origin ________ the muscle belly and repeat the technique.

same location



Rate and pressure in Origin and Insertion Technique are:



Origin and Insertion Technique stimulates receptors in the muscle-tendon junction which reflexively reduces nerve firing and helps to relax the muscle belly. This receptors are called:

sensory receptors


Contraindications for Origin and Insertion Technique:

a. Edema surrounding tendon

b. Hypotonic or atrophy muscles

c. Pathologies of connective tissue which may include shortening of tissue, adhesions causing binding, pulling and restricting movement and joint laxity.

d. Skin lesions


True or False:

Both GTO and O&I can be painful if client’s muscles are in spasm. Use a lower pain scale (3).



This technique uses the reflex effect of muscle spindles to reduce the overall tone of a muscle.

Muscle Approximation


___________ - are sensory organs located throughout a skeletal muscle. They monitor the length of the muscle and the rate at which this length changes, preventing injury from over-stretching.

Muscle spindles


By approximating the ends of the muscle, the stretch on the muscle spindle is ________ thus _______ the muscle tone.




Complete the Muscle Approximation technique.

1. Using hands, the origin and insertion of a muscle is grasped and slowly and forcibly drawn together.

2. You grasp the muscle by compressing the origin and insertion onto bony structures below or by using the pincer grasp.

3. You hold the position until the muscle relaxes.


5. Your hands do not slide over the skin.

4. Usually hold for 30 - 60 seconds depending on the severity of the spasm or hypertonicity.


This technique helps to mobilize the thorax.

Rib Springing/Rib Compression - breathing against resistance


The chosen portion of the rib cage is held by the therapist’s hands while the client _______ .



In Rib Springing/Rib Compression technique: The therapist applies a compressive force against the ________ .

rib cage


The procedure of inhaling of client against resistance and exhaling, is performed a total of ________ .

three times


When the client has inhaled half way on the third inhale, What will the therapist do?

the therapist quickly, yet smoothly, releases the compressive force.


In Rib Springing/Rib Compression technique: The technique has been done correctly. If the client has:

an audible intake of breath


Contraindications of Rib Springing/Rib Compression technique: 

Acute injury dislocated / broken ribs inflammation of costal cartilage osteoporosis.


True or False:

In Rib Springing/Rib Compression technique:

Remember to have the client put some effort into inhaling, as it will increase the contraction of the intercostal muscles and thus help to increase the muscle effectiveness in mobilizing the thorax. Can perform rib springing more than 3 times in one treatment. 



Correct: . Do NOT perform rib springing more than 3 times in one treatment.


This technique is used during abdominal massage or when the client has a respiratory problem.

Diaphragm Release


What is the position of the client in doing the technique of Diaphragm Release?

Supine position with abdominal drape


In Diaphragm Release, As the client breathes out and the diaphragm contracts and rises to push CO2 out of the lungs. The therapist will:

follow it with the tips of fingers, pad of the thumb and/or ulnar border of the hand until the exhalation is finished.


Client will have trouble breathing in, against resistance. After about ________ , release your pressure and allow them to breathe in fully. This helps to reduce any restrictions and encourage the _______ to work better and expand ________ and increase O2 intake.

3 - 4 seconds


chest area


These are passive movements (PROM) performed by the therapist to rhythmically mobilize joints. The amplitude of the rocking and shaking movements are gradually increased. The rocking and shaking movements can be maintained for several minutes and gradually decreased.

Rhythmic Mobilizations


The speed of the movements in performing Rhythmic Mobilizations depends on:

patient’s body



Range Of Motion



In Rhythmic Mobilizations, The treatment will be more effective if :

you have the client breathe deeply.


What is the effect of Rhythmic Mobilizations?

help relax a patient who has trouble loosening up

assess any restrictions of motion or holding patterns

help reduce muscle hypertonicity.


Test for fascial restrictions. Assessment methods include slow skin rolling, fascial glide and positional testing. This step is done in what technique?

Myofascial Release Technique


True or False:

In Myofascial Release Technique, The client is position only in supine position. True or False:


Correct: client is place in best position for ease of technique and comfort for both of you. Take your time and change position if needed.


________ is connective tissue in the body. It is collagen and elastin fibres in ground substance, woven together like a sweater. 



Fascia is also known as:

“organizer” of the body


What are the Three Fascial Layers?

a) Subcutaneous/superficial -> living body- suit; surrounds whole body.

b) Subserous -> fascial “bags” that your organs develop inside.

c) Deep -> around muscle groups, individual muscles – periosteum (around bones).


What is the load capacity of Fascia?

Some fascia has a load capacity of about 2000lbs/sq inch.


In Myofascial Release Technique: When the technique is too deep and too quick it leads to:

autonomic exhaustion


What are the signs of autonomic exhaustion?

1. Tearing of eyes (can be emotional)

2. Shaking/tremors

3. Skin pallor or extreme hyperemia or grayish tone

4. Nausea

5. Sweating

6. Change in mood , STOP TREATMENT!!!!


“The body will mold itself based on the forces applied to it” therefore, with fascial restrictions, putting unnatural forces on the body, the body will mold to the new and usually less beneficial posture position-MFR can change this.

Wolff’s Law


As the therapist, if the technique is too painful for you, you should:



What are the contraindications of Myofascial Release Technique?

Acute circulatory conditions

Malignancy Cellulitis

Systemic or local infection


Advanced diabetes


Fascia is generally oriented in a longitudinal direction. What are the 5 areas where fascia forms a web-like diaphragm?

1. Pelvic diaphragm

2. Thoracic diaphragm

3. Cervical regions (either thoracic inlet or outlet)

4. Hyoid diaphragm

5. Occipital diaphragm


The actual technique Myofascial Release is divided into two:

direct and indirect


The direct technique takes the fascia towards the restriction or adhesion. Some direct techniques are:

Skin rolling

Crossed-hand fascial stretch

Fascial spreading

Cutting technique

Fascial torquing





___________ : The thumbs are placed on the skin next to each other, while the fingers grasp the skin, forming a line. The fingers are pulled towards the thumbs, raising the skin between them, from the underlying layer. The thumbs are slowly pushed away from the therapist over the skin, engaging the tissue.

Skin rolling


If oil is used in skin rolling this technique is called:

petrissage technique


________________ : The therapist’s forearms are held parallel to each other with the elbows at 90 degrees of flexion. The palms of the hands contact the client's skin with the hands positioned so that the fingers are pointing away from each other. The heels of the hands are a few inches apart.

Crossed-hands fascial stretch


_____________ : The fingertips or thumbs of both hands may be used for this technique; it is important to hold the fingers of one hand together for support. The fingertips are placed on the skin at the required depth, then moved apart to take up the slack.

Fascial spreading


_________ : The therapist’s fingers are held together for support and then placed on the skin at the required depth. The terminal phalanges are slightly flexed; the tissue is engaged by pulling towards the therapist. To treat, the fingertips, especially the middle fingertip, are pulled through the tissue towards the therapist, in a cutting motion (Ebner, 1980).

Cutting technique


______________ : The tissue is raised between fingertips and thumbs of both hands, to take up the slack, then pulled further off the underlying surface and twisted to engage it.

Fascial torquing


_______________ - The usual concepts of engaging, then holding the technique to release are followed. If the same thumb position is used on a tendon, it is called S-bowing Golgi tendon organ release.

S-bowing fascial technique


__________________: The thumbs are placed on the skin next to each other while thefingers grasp the skin forming a line. The fingers are pulled towards the therapist, with the little and ring fingers moving more than the index and middle fingers; at the same time the thumbs are pushed away from the therapist. This distorts the fascia into a C-shape which is engaged and held to release.

C-bowing fascial technique


If the same finger and thumb positions are used on a tendon, it is called:


Golgi tendon organ release


_________ : This is the deepest, most destructive direct fascial technique. It is used selectively after more superficial fascial techniques have been used, applied in an organized manner in lines or rows.



What is the Effect Direct fascial techniques?

Direct fascial techniques increase the excursion and flexibility of fascia by moving it towards, then beyond, the restriction.


Contraindications of Direct fascial techniques:

acute injury

hypotonic or atonic muscles

fragile skin

skin lesions and recent incisions

painful conditions

anticoagulant medication.


_______________ - is moving away from the restriction, or put another way, going into the direction of ease (the way the tissues want to go). This technique basically unhooks tissues.

The indirect technique


Statement regarding indirect Fascial techniques: True or False.

1. indirect Fascial techniquesare done with little or no lubricant, within client pain tolerances.

2. The appropriate level of fascia is reached by applying pressure to the tissue.

3. Placing a stretch on the fascia, will take the elastic slack out of the tissue.

4. Remember when addressing different tissues, the therapist must change their focus to the appropriate tissue.



This technique is specifically intended to disrupt and break down existing and forming adhesions in muscles, tendons and ligaments, using compression and motion.

Cross Fiber Frictions


Cross Fiber Frictions technique is same as:

Frictions/cross-fibre frictions/Cyriax’s technique


It can be used to test tendons, muscles and ligaments for adhesions and restrictions.

Palpation and ROM


What is needed prior to Friction Therapy?

consent to treat client with this technique


In Cross Fiber Frictions:

Friction for _________ , tenderness should decrease (if tenderness does not decrease but increases, the technique should be ___________ ).

1-2 minutes



Frictions are performed as follows: Except

1. Friction - Drain

2. Friction - Stretch

3. Friction - Drain

4. Stretch - Ice

Except: 4


What is the duration of Cross Fiber Frictions?

Depending on the client’s pain tolerance, frictions can be applied initially, with less pressure and for short periods over several sessions.


Statement are General Principles of what therapy?

a. As much as possible, healing needs to happen in the presence of movement.

b. Scar tissue is a normal part of the healing process but will be more mobile and provide less restriction, when it forms with movement.

c. Scar tissue that forms when there is immobility which then adhere to structures and restricting movement.

d. Scar tissue that forms along axis of stress, which equals decrease in movement. 

Movement Therapy


What are the Primary types of movement?

1) Flexion, forward and lateral (spine)

2) Extension

3) Abduction

4) Adduction

5) Rotation, internal (medial) and external (lateral)

6) Dorsiflexion and plantarflexion (foot)

7) Inversion (supination) and eversion (pronation)

8) Pronation and supination (forearm)


What are the categories of movement therapy?

Passive Active ROM

Active Resisted (AR)


__________ - Range of motion performed by someone other than the client (no muscular contraction performed by client). These exercises mobilize joints without soft tissue contraction.



____________ - Performed by the therapist, no strain or stress on affected part. First form of exercise in rehabilitation process. where in the joint is taken to the point of resistance. .

Passive relaxed


Effects Passive relaxed movement:

  • Joint mobility is maintained (even if muscles are not moving).
  • Adhesions are prevented.
  • Muscles do not become shortened because they are being moved to normal, or near normal lengths.
  • Increased lymph and venous flow, increased O2 supply, increase waste removal
  • .Rhythmic movement is soothing to increase PNS firing.


Passive relaxed movement can be use for:

  • Good for bed-ridden people.
  • Acute or early recovery clients.
  • Clients with flaccid/spastic paralysis.
  • Clients with physical challenges (stimulates proprioceptors). 


What are contraindications of Passive relaxed movement?

Joint diseases

Local CI’s to massage

Any changes, where there are permanent changes in the joint.


______________ - the joint is challenged beyond the initial point of resistance. Used when an abundance of scar tissue needs to be broken down.

Passive forced (chronic)


Effects of Passive forced. Except:

a. Stretches joint ligaments, capsules, muscle and tendons

b. Stretches scar tissue

c. Decrease tone

d. Increase synovial fluid in the joint

e. Increase ROM

Except: c

Correct: Increase tone


A technique that cannot be use if the client has had any surgery to repair the joint (purposeful restriction).

Passive forced (chronic)


What are the uses of passive force technique?

Rehab of conditions restricted joint movement (e.g. frozen shoulder) Burn victims


___________ - involves same degree of muscle activity by client.

Active ROM


__________ - any movement where the client freely moves a joint without assistance, or resistance.

Active Free (AF)


_____________ - free movement within current ROM (pain free) always preceeded by Passive Relax & Active Assisted


Active free mobility


_____________ - Free movement with a component of stretch.

Active free flexibility


Contraindications of Active Free ROM:

High fever

Acute inflammation

Infective synovitis/bursitis

Local recent trauma


When assisting active free technnique as home care it is important to remember that it should be:

specific simple and clearly understood with clear progression expectations frequency and reps.


Uses of Active Free - Conditions of sluggish circulation

Conditions of sluggish circulation

•Chronically stiff joint

•Shortened muscles (stretching)

•Overall fitness and tone, improve rate of healing

•Increase co-ordination and balance


_______________ - therapist helps the client through a movement and may actually take the joint beyond what the client could do alone (early sub-acute).

Active Assisted (AA)


In Active Assisted (AA), It is required by the therapist to perform or complete the full movement when assisting client.

external force


False statements regarding Active Assisted. Except:

a. Client must be relaxed and comfortable and know the expected action of the muscle and joint that is being moved (show yourself or do passive first).

b. Movement should be fast and smooth, with therapist taking the client through it.

c. Therapist always assist the client to take the joint to end of pain free range.

d. As muscle strength increases, assistance required increases.

Except: a


What are the Effects of Active assisted?

•Aid for co-ordinated movement

•Joint mobility is maintained and even increased

•Optimal muscle is maintained

•Muscle memory is maintained


Give two uses of active assisted:

Client with muscle atrophy, after cast removal (or to re-establish neural pathways)

Effective for clients with weakened muscle conditions (disuse)


___________ - (chronic) movement by the client, against some kind of resistance. Performed for strengthening purposes.

Active Resisted (AR)


In Active Resisted (AR), exercise by the client against ________ greater than _______ .




In Active Resisted (AR): After the pain is gone and mobility is restored, What is the percentage of ROM is required before strengthening should take place?

80% of ROM


In Active Resisted (AR): Joint is unstable or hyper mobile - ___________

strengthen first


Types of resistance that can be used in active resisted:

Types of resistance are water bottles, therapist or client assist. Anything to give some resistance other than gravity.


In Active Resisted (AR): More weight with fewer reps to increased __________ .



In Active Resisted (AR): More reps with less weight to increased ___________ .



All are effects of Active Resisted (AR). Except

a. Increase in muscle size, strength and endurance

b. Joint mobility is maintained and even increased

c. Increase blood and lymph flow d. Improves overall fitness

Except: b


Give three uses of Active Resisted (AR).

Strengthen weak structures

Increase endurance

Rehab atrophied structures (casted structures)


_________ - are contractile tissue and have the ability to contract and relax.

Muscle fibres


What are non-contractile tissue?

Tendons, ligaments, fascia, joint capsules and skin


What is the main source of resistance, to passive stretching?

non-contractile tissues


When non-contractile tissue is stretched, the wavy collagen fibres that make up the tissue straighten out. This is called the __________.

elastic range


True or False:

If the stretch is past the elastic range, cross-links and bonds between collagen fibres break and there is a release of heat (plastic range). If the stretch is released here, the tissue is permanently stretched.



____________ - If the tissue is taken beyond the normal ROM of a joint and associated soft tissue, the result is hypermobility.



What are the Three Categories of Stretching?

1. PNF – Proprioceptive neuromuscular facilitations

2. Passive stretching

3. Self stretching


True or False:

If there are shortened muscle and connective tissue - this results in tight muscle. Usually due to muscle inactivity and results in increased ROM. The muscle usually becomes weakened.



It is done before any stretch to warm up the tissue.

Active Free ROM or hot hydrotherapy


When doing stretch, stretch is always:

slow, gentle and sustained


__________ and _________ - hold stretch for 30-60 seconds

Passive stretching



Stretch must be held for a prolonged length of time, to break collagen fibre bonds.

Active inhibition


What are the Two types of Active inhibition?

a) Autogenic inhibition

b) Reciprocal inhibition


What are two ways in Autogenic inhibition?

Hold - Relax

Contract - Relax


In Hold - Relax, client then isometrically (joint does not move) contracts the mm against resistance for 7 to 10 seconds. While in Contract - Relax:

Client concentrically (contracts while mm shortens) contract the tight mm against resistance for 7 to 10 seconds.


Statements are same with Hold - Relax and Contract - Relax. Except:

a. End with 30 second stretch.

b. Repeat technique 3x in total.

c. Mobilization technique lengthens (stretches) tight muscle (pain-free) hold for 30 seconds.

d. When muscle fatigues, client relaxes muscle.

Except: d

In Contract - Relax: When mm is fatigued, M.T. moves mm to new ROM.


The use of Hold-relax lengthens soft tissue, when pain and restricted ranges are present. While the use of Contract-Relax:

lengthen soft tissue, when no pain is present.


True or False:

Another use of Contract-Relax is to lengthen soft tissue, to decrease mm tone and symptoms of trigger points and to re-align individual muscle fibres. 



_______________ - The agonist is always the contracting muscle. The antagonist is the opposite-opposing muscle which is forced to relax and stretch to allow the agonist to contract.

Reciprocal inhibition


Contracting muscle is called:

the agonist


Relaxing and stretching muscle is called:

the antagonist


True or False:

Reciprocal inhibition: When we perform agonist contraction stretching, the agonist is the unaffected mm and the antagonist is the affected mm. It is the antagonist (affected mm) you want to stretch,therefore, you contract the agonist (unaffected mm). 



Similar statements regarding Agonist Contraction Hold relax and Contract relax. Except:

a. The therapist slowly and smoothly lengthens the tight mm (antagonist) to a comfortable position.

b. The client then contracts (isometrically) the agonist muscle (unaffected) mm against resistance.

c. The contraction is held for 7 to 10 seconds.

d. Technique is repeated 3x in total.

e. End with a 30 second stretch of antagonist.

Except: b

In Contract relax/Agonist Contraction, The client then contracts (concentrically) the agonist muscle (unaffected) mm against resistance.


What is the use of Hold relax/Agonist contraction?

Use agonist contraction to lengthen soft tissue, when tightness, pain and spasm are present.


What is the use Contract relax/Agonist Contraction?

Use for stretching tight muscles and strengthening weak muscles


True or False

Agonist contraction can be used by itself. Rhythmical stabilization uses both autogenic & reciprocal inhibition. 



Techniques used to lengthen contractile and non-contractile.

Passive Stretching


Technique done before passive stretching of any muscles.

Active Free ROM

AI technique, or use heat on affected muscle.


___________ - is applied to restricted ROM which increases range. ______________ - is applied within unrestricted available range.

Passive stretch

Passive relaxed ROM


Passive stretching is performed by the _______. They controls the direction, duration, speed and force of stretch.

Massage Therapist


Stretching that performed by client.

Self Stretching


True or False.

Passive stretching and Self Stretching. Stretch is held for 30 to 60 seconds and repeated several times. 



Use to lengthen soft tissue, to decrease mm tone and symptoms of T.P. and to re-align individual mm fibres.To gain mm length with this technique we use isometric contraction followed by relaxation and gentle stretch, using 20% of client’s strength.

Post - Isometric Relaxation (PIR)


Post - Isometric Relaxation (PIR) is repeated ______ times and ends with ____ second stretch.

3 to 5 times

30 second stretch


_____________ - are most useful when stretching the head and trunk.

Eye movements


Statements are True regarding Post - Isometric Relaxation (PIR). Except:

a. Flexion, extension and rotation of the head and neck, are facilitated by eye movements. Side bending is not affected by the addition of eye movements.

b. Client then concentrically contracts mm against resistance 7 to 10 seconds.

c. M.T. slowly, passively stretches the mm to the barrier (pain-free range) holds stretch for 30 seconds.

d. Stretch is not forced.

e. Client then relaxes mm and exhales. f. M.T. stretches mm but stops at new barrier before pain.

Except: b

Correct: Client then isometrically contracts mm against resistance 7 to 10 seconds.


What are the two Components of Joint Mobilization?

Physiological Movements

Accessory Movements


Physiological movements is also known as ______________ . Which describes the movement that occurs between two bones.

osteokinematic movements


_____________ - refer to the cardinal movements of the different body regions.Motion occurs via a concentric or eccentric muscle contraction, as the bone moves away from the anatomical position.

Physiological movements


The physiologic movements consist of:





What is used to measure physiological movements? 



True or False

Physiological movement are considered the basic, single-plane motions that are specific to a joint. It should be noted that in real life, movement does not occur in a single plane fashion only. Many variations of movement occur, at one time, during joint motion. 



Accessory movements are also known as ________________ . It describes the movement that occurs between joint surfaces.

arthrokinematic motions


____________ - refers to the way that one articulating joint surface moves in relation to another. normally occur in conjunction with physiological movements. 

Accessory movements


True or False

In Accessory movements: A person cannot actively perform these movements, separated from the physiologic movements. An internal force must produce these movements. Involve a short lever arm of action. 


Correct: An external force must produce these movements.


What is used to measure accessory movements?

There is no tool with graded increments that can measure accessory movements. They are “measured” by comparison of joint motion, with the contralateral joint and with an “expected” degree of movement. “Measurement” results from practice over time and skill development.


Accessory movements is consist of :

Spin, Roll, Slide, Rolling, and gliding


_______ – movement occurring around a stationary longitudinal axis in a clockwise or a counterclockwise direction (like a spinning top). One point on one joint surface, makes contact with one point, on another joint surface.



_______ – movement occurring when a series of points on one joint surface comes in contact with a series of points, on another joint surface. The action can be considered equivalent to a car tire rolling down the road or a rocking chair rolling back and forth on the floor, as it moves. Occurs in the same direction, as the movement of the bone.



What is the result of a “pure” rolling action?

A “pure” rolling action would result in one joint surface rolling off the other. 


_______ – occurs when a specific point on one moving joint surface contacts a series of points on another stationary surface. This is also known as “translation” of the joint surfaces. The action can be considered equivalent to a car tire “skidding” on the road or a rocking chair moving across a floor without any rocking motion.



Slide is also known as:

“translation” of the joint surfaces


True about Slide. Except:

a. The direction of the gliding action depends on the shape of the articulating surface of the bone that is moving; that is, whether it is concave or convex.

b. A “pure” glide occur both joint surfaces are completely congruent which essentially .

c. For pure glide to occur, both joint surfaces would have to be completely flat or perfectly curved. This does not occur; thus, gliding occurs with a rolling action.

Except: b 


_______________ - occur together during joint movement. Because of the shape of the articulating surface, rolling and gliding do not always occur in a similar proportion, nor do they always occur in the same direction.

Rolling and gliding


Rolling and gliding: True or False.

The more congruent the joint surfaces, the more gliding will occur. The more incongruent the joint surfaces, the more rolling action will occur.



The shape of the articular surfaces of the bones determines the direction of glide during joint movement. This rule is the best way to determine the direction of the glide of a moving bone.

Concave-Convex Rule


When a concave joint surface moves upon a stationary convex surface, the slide will occur in the same direction as the bone movement. In these cases, glide occurs in the same direction as the roll.

Concave-Convex Rule #1


When a convex joint surface moves upon a stationary concave surface, the slide will occur in the opposite direction of the bone movement. In these cases, glide occurs in the direction opposite to the roll.

Concave-Convex Rule #2


In Concave-Convex Rule #1: During treatment, sliding forces of the concave joint surface upon the convex joint surface should be in the same direction as the restricted movement. What is it in Rule # 2 during treatment?

Concave-Convex Rule #2 During treatment, sliding forces of the convex joint surface upon the concave joint surface should be in the direction opposite to the restricted movement.


What is the hand placement in Joint Mobilization during treatment?

The therapist’s hands should be placed within a close proximity to the joint. 


What are the types of Joint Mobilization Techniques?

glides and tractions


_________________- is performed parallel to the treatment plane. It refers to asliding motion that occurs between the two articulating surfaces involved. Glides can be performed along several directions: anterior-posterior, medial-lateral and superior-inferior. Many other techniques, such as rotations and pronation, are derived from the glide.

glide joint mobilization technique


__________________ - is performed perpendicular to the treatment plane. It requires that the involved articulating surfaces be separated from each other during the mobilization

distraction (traction) joint mobilization


Traction techniques that follow along the central axis of the long bone are sometimes called _____________ .

long axis traction


When performing Joint Mobilization Techniques there should be:

no swinging or arcing of one joint surface, as it lays on the other.


Techniques that involve separation of the joint surfaces not in the direction of the long axis of the bone, will be referred to as ________ .



What condition will results from swinging or arcing of one joint surface as it lays on the other ?

excessive joint compression


What are the effects of joint motion?

Stimulates biologic activity by moving synovial fluid, nourishing cartilage and intra- articular fibrocartilage of menisci.

Maintaining extensibility and tensile strength of joint tissues.


What are the causes Immobilization?

Fibrofatty proliferation


Biomechanical changes in Connective Tissue (CT)

Joint contracture and weakening


Limitations of Joint Mobilization Techniques: Except.

a. Cannot make changes in inflammatory diseases like R.A or SLE or inflammatory stages of injury.

b. if the client has had any surgery to repair the joint (purposeful restriction).

c. Skill of the therapist’s evaluation and treatment.

d. If the joint play cannot be restored through mobilization, or the pain persists, then the joint dysfunction may warrant chiropractic adjustment.

Except: b


What are the three general contraindications of Joint mobilization techniques?

a) Inflammatory disease

b) Hypermobility

c) Joint effusion


What are the precautions with the use of joint mobilization techniques?



Bone disease


New/weak connective tissue

Joint replacement

Excessive pain


The point where further stretch cannot be applied by joint mobilization is called the _______________ . 

physiological barrier


This is the first barrier that the therapist will come across, which refers to the point where the first resistance to movement is met. This is the point at which the “slack has been taken up”. From this point, a stretch is applied on the tissues involved.

elastic barrier


Joint Mobilization Techniques: True or False

Working between the elastic barrier and the physiological is the ideal range for increasing range of motion.



__________________ - is the point where joint manipulations, or grade V movements are performed. The joint can be taken to this position only by high velocity movements. 

Paraphysiological barrier


_______________ - is the absolute barrier for joint motion. Any movement or manipulation beyond this point, would result in dislocation of the bones and disruption of the surrounding tissues.

anatomical barrier


_______________ - occurs where the tissue is moved into the intended position and the therapist then performs a rhythmic oscillatory (back and forth) movement at that point.

oscillation movement


Grading system for oscillations, What grade is the statement below?

At this level, no stress is placed on the capsule or the tissues surrounding the joint. The rhythmic oscillations are of small amplitude and are performed at the beginning of range of motion, within the available joint laxity.

Grade I


What are the uses of Grade 1 oscillations?

When spasm and pain limit movement early in the range of motion. If pain is elicited when passive overpressure is applied. To increase movement of synovial fluid within the joint.


What is grade III oscillations?

Grade III: A large amplitude oscillation is performed between the elastic and physiological barriers. It approaches the point of limitation of the tissue but does not go beyond it. 


Graded oscillations used when physiological range of motion is limited in the absence of pain or spasm and to maintain or increase joint range of motion.

Grade IV Oscillations


Graded oscillations used when there is either pain or resistance due to spasm, tension from inert tissue or compression of tissue, that limits the movement near the end of the range.

Grade III Oscillations


Who defined the grading system for oscillations as having four distinct grades?

Maitland (1977)


______________ - means that the tissue is moved into the intended position and the joint is held, without moving, for an intended duration of time.

sustained movement


Who developed the grading system for sustained movements which includes three distinct grades?

Kaltenborn (1989)


Grade of sustained movements. What grade is the statement below?

This is a force placed on the joint that neutralizes the pressure within a joint but it does not involve an actual separation of the joint surfaces. The sustained force is performed at the beginning of available joint laxity. At this level, no stress is placed on the tissues surrounding the joint.

Grade I


Sustained movement: This grade is implemented to “take up the slack” within the tissues surrounding the joint. The joint is taken to the elastic barrier, but not beyond it. The intent is not to stretch the surrounding tissue but to eliminate the “play” in the capsule.

Grade II


Sustained movement grade used with all gliding techniques. To relieve from pain, by decreasing the compressive forces on the joint, during mobilization techniques.

Grade I


Grade of sustained movements. What grade is the statement below?

this technique the therapist then places a stretch on the tissue surrounding the joint by bringing the joint to the physiological barrier.

Grade III


What are the uses of sustained movements grade III technique?

To increase joint mobility by providing stretch on the tissue.

To decrease build up of scar tissue.

It will also stretch the scar tissue already present.


True or False:

Oscillation Grades are smooth and regular, continuous for 1-2 minutes. Sustained grades are several cycles of intermittent distraction, usually 10 seconds 3x with 2-3 seconds rest in between.



Defined as “a hyper irritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful on compression and that can give rise to characteristic referred pain, tenderness and autonomic phenomena.”

Trigger Point


A trigger point that is always tender, that refers pain at rest, that is very painful when compressed and that will activate a characteristic twitch response in the muscle when adequately stimulated.

Active trigger point


“hidden” trigger point that is symptomatically pain free, until palpated. It may still be responsible for referred pain or autonomic phenomena.

Latent trigger point


________ - This is a trigger point that becomes active because it lies in muscle that falls within the referral pattern of another trigger point.



This is a trigger point that becomes active because a synergist or antagonist muscle to that of the primary trigger point is overloaded, due to presence of the primary active trigger point.



____________ - pain that is caused by a trigger point but is felt a distance away from the trigger point.

Referred pain


What are the causes of trigger points?

acute overload



direct trauma



shortened position for a prolonged period indirectly – by other trigger points visceral disease arthritic joints stress


What are the perpetuating factors of trigger points?

mechanical factors

Vocational stresses

Systemic factors

a slight compromise of a muscle’s energy supply


What are the signs and symptoms of trigger points?

Exquisite local tenderness

Pain referral

A palpable taut band of muscle

local twitch response

Jump sign


Phenomena that is characterized with sweating, local vasoconstriction, tearing, increased salivation, pro-prioceptive imbalances. ear ringing, dizziness,paraesthesia/numbness, nausea.

Autonomic Phenomena


Ways in releasing Trigger Points:

spray and stretch injection and stretch PNF (proprioceptive neuromuscular facilitation)

digital ischemic compression (D.I.C.)

deep muscle stripping.


Methods in releasing Trigger Points. Except:

1. deep muscle stripping to find trigger point

2. give 3 signs of confirmation that it is trigger point e.g. twitch and referral hypertonic band

3. release trigger point with 1 of the 3 techniques, that we use to release

4. use grade II oscillations Technique

5. stretch

6. apply heat

Except: 4