Lecture 6

Question 2

Whats more correct the biomechnical model or the neurophysiological?

Answer 2

neurophysiological

Question 3

Define regional interdependence

Answer 3

If i treat one area it will have an affect on another area

usually if you treat something more proximal it will help the distal

Question 4

Does manipulation create a long standing change in the persons anatomical structure?

Answer 4

No

Question 5

When we do manipulation do we get a biomechnical change or a neurophysiological change?

Answer 5

Neurophysiological (there isnt actually an anatomical change)

Question 6

What is complex interactions of both the peripheral and central NS which comprise the patients pain experience

Answer 6

neurophysiological

Question 7

KNOW: Mobilization is essentially a reset switch

When I do mobilization I am reseting the brain by showing it that that area can move (motion is lotion)

Tell patient its a reset to your NS to help everything calm down and let them move better

Question 8

Does foam rolling break down the tissue (whats its mechnism)

Answer 8

No it doesnt break down tissue. Were just stretching the NS tissue showing it that it can move. This will let the brain / area not be so gaurded and let you relax

Question 9

KNOW: Neurophysiologic effects of manipulation

Decrease pain pressure threshold (decreasing the amount of pain felt in that area)

Decrease temporal summation: I think basically once you manipulate you decrease the AP’s from the pain nerves from happening as much?

Decrease pain

Decrease Thermal pain sensitivity: decrease the amount someone feels hot or cold (can decrease hyperactivity in that area through manipulation)

Question 10

What does manipulation do to thermal pain sensitivity

Answer 10

Decrease it

EX: Think grandpa having OA in knee saying “I can feel it getting cold outside”. This is an example of being over sensitive to temperature - with manipulation we can decrease this hypersentivity

Question 11

Are pts with chronic pain more or less senstive to hot and cold? Why?

How do we help this?

Answer 11

More sensitive

Because those nerve channels are used to just staying open. They’re used to being flooded with pain signals so when they sense something else (i.e., hot and cold) they are also ready to project that to the brain

We help this by using manipulation. With manipulation we effectively shut off some of the nerves (making them less sensitive) and that will lead to them sensing less hot and cold

Question 12

Is manipulation short or long term effects

Question 13

How does manipulation effect temporal summation? (give mechanism by which it does this)

Answer 13

Decreases it.

Essentially temporal summation is those nerves sensing things constantly (lots of times pain). We can manipulate which will calm those nerves down decreasing that temporal summation.

(These nerves no longer generate that action potential as much)

Question 14

What does manipulation do to pain pressure threshold (amount of pain felt in that area).

Answer 14

Decreases it

Question 15

What does manipulation do to pain?

Answer 15

Decreases it

Question 16

Patient presents with lots of pain on arrivial to clinic. Would I satrt with exercise or mannual therapy / manipulation

Answer 16

Mannual therapy / manipulation to calm it down then move into exercise

Question 17

KNOW: We do mannual therapy to reduce pain so that we can do exercise

Question 18

KNOW: Mannual therapy / manipulation show improved ROM / Improved function

Question 19

Would you do manual therapy on smoeone with worsening neurological function?

Answer 19

No

Question 20

Would you do manual therapy on someone with unremitting, severe, non-mechanical pain?

Answer 20

No

They already shouldnt be in PT if its not mechanical pain

Question 21

Would you do manual therapy on someone with multi-level nereve root pathology?

Answer 21

No

Question 22

Would you do manual therapy on someone with unremitting night pain?

Answer 22

No, red flag for cancer

Question 23

Would you do manual therapy on someone with unimaged / unaddressed recent trauma?

Answer 23

No

Question 24

Would you do manual therapy with someone who has UMN lesions?

Answer 24

No

Question 25

Would you do manual therapy on someone w/ SC damage?

Answer 25

No

Question 26

KNOW: Precaustions for manual therapy:
* Local infection
* Inflammaroy disease
* Active Cancer
* Hx of cancer
* Long-term steriod use
* Osteoporosis
* Cervical anomalies
* Throat infections in children
* Systemically unwell
* Hypermobility syndromes - Do EX / Stabilization first - in response to having a hypermobile segment the body responds by making a hypo mobile segment underneath - this would be an example of when it is okay to manip a pt like this
* Connective tissue disease
* 1st suddent episode before 18 or after 55
* Recent manipulation by another healthcare provider

Why do something risky when theres lots of other interventions you can take advantage of

Question 27

What makes disc issues worse, flexion or extension

Answer 27

Flexion makes disc issues worse (closing down on them)

Question 28

Whats more dangerous manipulation or EX?

Answer 28

EX

Question 29

Patient comes in with ehlers danlos syndrome. The report lower back pain that is not abnormal. You determine it to be muscular in origin and want to losen them up with manual therapy/manip before they hop into exercise. Should you do this, why or why not?

Answer 29

Elhers dalos is a hypermobility syndrome which is typically a precaution to manual therapy/moanip. However, hypermobility disorders often present with a hypermobile segment then the body creates a hypomobile segment above and beneath that one. Since this patient has normal back pain (not new onset) and you have deemed it mechanical, it would be appropriate to losen up the hypomobile segments with manip/manula therapy and then hop into exercise with a more loosened / less painful back.