Intro to Manual Therapy

Question 1

a passive mvmt performed by PT at various speeds and amplitudes

Answer 1

mobilization/manipulation

Question 2

4 types of mobilization/manipulation

Answer 2

• oscillatory
• sustained
• manip
• mob w/ mvmt

Question 3

3 types of passive ST mob

Answer 3

friction massage
Instrument assisted STM (grastin)
positional release

Question 4

3 types of active ST mob

Answer 4

contract-relax
reciprocal inhibition
muscle energy

Question 5

what is the purpose of neural tissue mob

Answer 5

improve mobility of dura mater, n roots or peripheral n

Question 6

what are the 4 functional classificaitons of synovial joints

Answer 6

• unmodified ovoid
• modified ovoid
• unmodified sellar
• modified sellar

Question 7

how many DOF does an unmodified ovoid joint have?
list some examples

Answer 7

3DoF
- ball and socket, triaxial
- hip and shoulder

Question 8

how many DoF does a modified ovoid have?
examples

Answer 8

2 DoF
- ellipsoid, biaxial
- MCP joints

Question 9

How many DoF does an unmodified sellar joint have
examples?

Answer 9

2 DoF
saddle, biaxial
1st CMC

Question 10

how many DoF does a modified sellar joint have?
examples?

Answer 10

1 DoF
hinge, uniaxial
IP and elbow joint

Question 11

what are the 2 types of accessory motions

Answer 11

component and articular/arthrokinematic

Question 12

motions accompany active motion but not under voluntary comtrol

Answer 12

component/coupled motion

Question 13

motions that occur b/w joint surfaces

Answer 13

articular/arthrokinematic/accessory motions

Question 14

new points on one joint surface meet new points on another surface when joint surfaces are incongruent

Answer 14

roll

Question 15

one bone segment rotates around a fixed axis

Answer 15

spin

Question 16

one joint surface moves across another so the same point on one surface always contacts a new point on the other surface

Answer 16

glide/slide

Question 17

2 joint surfaces approximate each other

Answer 17

compression

Question 18

2 joint surfaces are separated

Answer 18

distraction

Question 19

position when the peri-articular structures are most lax and allowing the greatest motion

Answer 19

resting / open-packed position

Question 20

what do we use the open-packed position for

Answer 20

• evaluate joint play and end feel
• relaxation, stretch and joint mob

Question 21

joint position when the capsule and ligaments are the tightest with maximal contact b/w joint surfaces

Answer 21

close-packed position

Question 22

what do we use close-packed position for

Answer 22

stabilize the joint, test ligament integrity

Question 23

a plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface

Answer 23

treatment plane

Question 24

traction and compression is applied in a direction that is ______ to the treatment plane

Answer 24

perpendicular

Question 25

glides are performed in a direction that is _________ to the treatment plane

Answer 25

paraller

Question 26

what 2 effects are we attempting to generate when we mobilize or manipulate

Answer 26

- neurophysiological effects - mechanical effects

Question 27

5 indications of joint mob/manip

Answer 27

- decrease pain, m guarding/spasm - reversible joint hypomobility - positional fault (sublux) - progressive limitation - functional immobility

Question 28

what is the #1 contraindication of manual therapy

Answer 28

pt denies treatment

Question 29

what 2 end feels can not have manual therapy

Answer 29

empty end feel spasm end feel

Question 30

caution or contraindication for manual therapy? - bone disease - acute RA episode - joint effusion - active inflammation

Answer 30

contraindication

Question 31

lumbar root signs of ______ or cervical root signs of ____ are contraindications to manual therapy

Answer 31

lumbar >/= 3 Cervical >/= 2

Question 32

what ligament instability is a contraindication to manual therapy

Answer 32

craniovertebral (transverse) ligament

Question 33

what end feel is a caution to manual therapy

Answer 33

springy

Question 34

caution or contraindication to manual therapy? - paresthesia with strong pain - no local symptoms - primary posterolateral protrusion - joint pain from isometric testing

Answer 34

caution

Question 35

caution or contraindication to manual therapy? - osteoporosis - neurological signs - spondylolisthesis - acute signs and symptoms - pregnancy

Answer 35

cautions

Question 36

is repeated steroid use a contraindication or a caution to manual therapy

Answer 36

caution - weakens the CNT

Question 37

how do we describe joint mobilization/manipulation? 7 categories

Answer 37

- type of mobilization - grade of mobilization - location in range of available mvmt - direction of force - target of force - pt and PT position - duration of mobilization

Question 38

what are the 3 types of mobilizations? what does this refer to?

Answer 38

- rate of force - oscillation, sustained, thrust

Question 39

small amplitude rhythmic oscillation performed at the beginning of available range

Answer 39

grade 1 oscillation

Question 40

large amplitude rhythmic oscillations performed within the range, not reaching the limit

Answer 40

grade 2 oscillation

Question 41

large amplitude rhythmic oscillation performed thru the available range and into the resistance

Answer 41

grade 3 oscillation

Question 42

small-amplitude rhythmic oscillations performed at the limit of available range and into the resistance

Answer 42

grade 4 oscillation

Question 43

why do we use grade 1 and 2 oscillation

Answer 43

relieve pain in acute/sub-acute stage

Question 44

why do we use grade 3 and 4 oscillations

Answer 44

maintain and increase joint mobility

Question 45

which sustained technique is considered "loosening"

Answer 45

grade 1

Question 46

small amplitude traction, no stress applied to the capsule, nullifies normal joint compressive force

Answer 46

grade 1 sustained

Question 47

which sustained technique is considered "tightening or taking up the slack"

Answer 47

grade 2 sustained

Question 48

enough traction or glide to tighten the tissue around the joint

Answer 48

grade 2 sustained

Question 49

which sustained technique is considered "stretching"

Answer 49

grade 3

Question 50

- a large traction or glide places a stretch on the joint structures

Answer 50

grade 3 sustained

Question 51

why do we use grade 1 sustained technique

Answer 51

- relieve pain with oscillation - m relaxation

Question 52

why do we use grade 2 sustained technique

Answer 52

- relieve pain - m relaxation ** test joint play traction and glide mvmts - increase and maintain joint mobility

Question 53

why do we use grade 3 sustained technique

Answer 53

- test joint play end-feel - increase joint play

Question 54

massive mvmt using physiological or accessory motions

Answer 54

manipulation

Question 55

2 types of manipulation

Answer 55

thrust and manip under anesthesia

Question 56

how is a thrust manipulation performed

Answer 56

with high velocity, small amplitude motion

Question 57

why is manip under anesthesia used?

Answer 57

when pts have contractures or conservative tx fails

Question 58

in the Kaltenborn convex-concave rule for directions of mobilizations, convex is in the ______ direction and concave is int the ______ direction

Answer 58

convex - opposite concave - same

Question 59

what is the most important joint mobilization rule?

Answer 59

both pt and PT should be relaxed

Question 60

9 joint mobilization rules

Answer 60

- pt Supported - Relaxed - Stabilize one and Mobilize the other - Uninvolved comparison - Stop if painful - hands close to the joint - Loose packed position - work with gravity

Question 61

which traction/glide is used to assess joint motion

Answer 61

grade 2

Question 62

what progression of manual therapy is used to relieve pain

Answer 62

- sustained grade 1 or 2 manual traction OR - grade 1 and 2 short amplitude oscillation

Question 63

what progression is used to maintain or increase joint motion

Answer 63

grade 2 traction and glide mob in resting --> grade 3 in resting --> grade 3 at end range

Question 64

simultaneous application of therapist applied accessory mob and pt generated active mvmts

Answer 64

mobilization with mvmt

Question 65

what type of MWM is used for the spine

Answer 65

SNAGS (sustained natural apophyseal glides)

Question 66

when is MWM indicated

Answer 66

to increase function and decrease pain

Question 67

where can SNAGS be applies

Answer 67

cervical, thoracic and lumbar spine

Question 68

what is the purpose of deep transverse friction

Answer 68

- maintain or restore mobility of CNT - produce motion of damaged tissue over sm area

Question 69

what are the 3 desired effects of deep transverse friction

Answer 69

- traumatic hyperemia - mechanical - temporary analgesia

Question 70

what is traumatic hyperemia

Answer 70

- increase in blood flow and reduction of inflammtion/pain

Question 71

what are the mechanical effects of deep transverse friction

Answer 71

- improve motion b/w fibers - prevent cross link, stretch apart adhesion

Question 72

how does deep transveres friction create a temporary analgesia

Answer 72

stimulates type 1 and 2 mechanoreceptors

Question 73

3 indications of DFM

Answer 73

- acute or subacute partial tears of ligament, tendon or m - adhesion in ligament or m or b/w tissues - pre-treatment to manip or strong stretch

Question 74

7 contraindications of DFM

Answer 74

- hyper-acute inflammation - recent hematoma - arterial insufficiency - bleeders - multiple injection of cortisone, LT steroid - open would - uncontrolled diabetes

Question 75

how is contractile tissue placed for application of DFM

Answer 75

relaxed

Question 76

how are tendons and ligaments placed for application of DFM

Answer 76

taut

Question 77

manual procedure that involves the voluntary contraction of pt m in a precisely controlled direction at various level of intensity against a resistance applied by operator

Answer 77

muscle energy technique

Question 78

what are the 2 types of MET techniques we use?

Answer 78

- post isometric relaxation - reciprocal inhibition

Question 79

for MET contraction, how long do you hold the contraction

Answer 79

8-10 sec

Question 80

how long should you wait for isometric relaxation of MET

Answer 80

1-2 sec before moving to next barrier

Question 81

myofascial release technique is a combo of what 3 things?

Answer 81

MET, craniosacral technique and ther ex