Manual Tehniques Flashcards Preview

631: Clinical Management of the Musculoskeletal System I > Manual Tehniques > Flashcards

Flashcards in Manual Tehniques Deck (66)

What are 7 types of manual therapy?

- Myofascial release (MFR)
- Positional release techniques
- Neurodynamic mobilization techniques
- Manually resisted exercise
- Proprioceptive neuromuscular facilitation (PNF)
- Joint mobilization
- Manipulation


The decision about which approach or technique to use has traditionally been based on what 3 things?

- The clinician’s beliefs
- Level of expertise
- Clinical decision-making processes


The key to a great patient rehabilitation program is what?

the combination of manual techniques with other interventions such as progressive therapeutic exercise, NMR, therapeutic activities, modalities, and patient education about body mechanics, positions and postures


What are the 12 criteria for the correct application of manual therapy techniques?

- Knowledge of the relative shapes of the joint surfaces
- Convex/Concave rules
- Duration, type and irritability of symptoms
- Patient and clinician position
- Position of joint to be treated (open-packed)
- Clinician’s hand placement
- Specificity (the exactness of the procedure based on its intent)
- Direction and type of force
- Amount of force
- Reinforcement of any gains made
- Reassessment is an integral part of any intervention, but especially MT
- Assess the patient prior to the MT, perform the MT, then reassess post-MT to look for objective gains


The indication for selection of manual technique is based on what?

the duration of symptoms


When are muscle energy techniques strongly indicated?

During the acute and subacute phases


What types of mobilizations should be used during the acute phase? Subacute phase? Chronic phase?

Acute: grade I and II
Subacute: grade II and III
Chronic: III and IV


When are joint manipulations (grade V) indicated?

In the subacute and chronic phases if MET is ineffective


Repeated cross-grain massage that is applied to muscle, tendons, tendon sheaths and ligaments can be defined as what?

Transverse Friction Massage (TFM)


Transverse friction massage is utilized before performing a manipulation or a strong stretch for what reason?

To desensitize and soften the tissues


How does transverse friction massage relieve pain?

It stimulates type I and II mechanoreceptors and produces presynaptic anesthesia


If TFM is too vigorous in the acute stage what will occur?

the stimulation of nociceptors will override the effect of the mechanoreceptors, causing the pain to increase


How does transverse friction massage decrease scar tissue?

It assists with the orientation of the collagen in the appropriate lines of stress, and also helps to produce hypertrophy of the new collagen


During what stage of healing should TFM be applied and why?

In the early stages of a subacute lesion, so as not to damage the granulation tissue


What should the rate of TFM be?

at two to three cycles per second, applied in a rhythmical manner


A series of techniques designed to release restrictions in the myofascial tissue can be defined as what?

Myofascial Release (MFR)


What is Myofascial Release (MFR) used for?

the treatment of soft-tissue dysfunction


According to the myofascial theory what is the significance of the collagen, elastin, and gel in fascia?

- collagen provides strength to the fascia
- elastin gives it its elastic properties
- gel functions to absorb the compressive forces of movement


What are the 3 types of fascia? Describe each...

- superficial: lies directly below the dermis
- deep: surrounds and infuses into the muscle bone, nerve, blood vessels, and organs to the cellular level
- deepest: consists of the dura of the CNS


The theory of MFR is based on what?

the principle that trauma or structural abnormalities may create inappropriate fascial strain, because of an inability of the fascial to absorb or distribute the forces


What is the purpose of MFR techniques?

to apply a gentle sustained pressure to the fascia, in order to release fascial restrictions thereby restoring normal pain-free function


What are the 4 types of MFR?

- J-stroke
- Vertical stroke
- Transverse stroke
- Cross-hands technique


What is the goal of the J-stroke?

to increase skin mobility


What is the goal of the vertical stroke?

to open up the length of vertically oriented superficial fascia


What is the goal of the cross-hands technique?

The release of deep fascial tissues


What is soft-tissue mobilization recommended for?

to reduce muscle spasm and promote pain reduction


How does ischemic compression work?

A constant, consistent pressure (8-12 seconds) over the trigger point deprives if of oxygen, rendering them inactive and breaking the cycle of pain-spasm


Defined general massage

the systematic, therapeutic, and functional stroking and kneading of the body


How does deep massage increase circulation and skin temperature?

capillary dilation


What are the 4 types of general massage?

- Effleurage
- Stroking
- Petrissage
- Strumming


How does acupressure work?

Manual pressure over acupuncture points can strengthen, disperse or calm Qi, which enables a smooth flow


When acupressure is applied correctly, the patient is to experience a sensation known as what?

‘teh chi’ which can be defined as a subjective feeling of fullness, numbness, tingling and warmth with some local soreness and a feeling of distension around the acupuncture point


What are METs?

Muscle energy techniques

Which combine passive mobilization, muscle reeducation, and therapeutic exercise


What can METs be used to do?

- Mobilize joints
- Strengthen weakened muscle
- Stretch muscles and fascia


MET is a _____ effort in a ______ direction, commencing from a ______ position





What is the intent of MET?

to treat somatic dysfunctions by restoring the muscles around a joint to their normal state, via stretching or strengthening the agonist and antagonist


What is strain-counterstrain?

A passive positional technique used in the treatment of musculoskeletal pain, related somatic dysfunction, and improvement of blood flow


How does strain-counterstrain improve blood flow?

through a circulatory flushing of previously ischemic tissues


Describe the process of strain-counterstrain

The effected limb is placed in a position that causes increased tension and held there for 90-120 seconds before it is slowly returned to the normal position


What is the difference between functional techniques and strain-counterstrain?

Functional techniques move the joint away from rather the restriction, while strain-counterstrain moves the joint into the restriction


Once the patient is positioned correctly, what are the 2 forms of functional techniques the clinician can use?

- Active in which the clinician initiates movement along the path of least resistance until the restrictive barrier is no longer detectable and normal motion is regained
- Passive in which the joint is "unwound" through sequential releases of the treated joint to the point of full soft-tissue release, until the restrictive barrier is no longer detectable and normal motion is regained


In what position must joint mobilizations be performed?

In the open-packed position


What are the 4 indications for joint mobilizations?

- Increased joint ROM
- Decrease pain
- Promote muscle relaxation
- Improve muscle performance


What are the 6 benefits of joint mobilizations?

- Restore the articular relationship within a joint
- Decrease pain
- Decrease muscle guarding
- Lengthen the tissue around a joint
- Neuromuscular influence on muscle tone
- Increase proprioceptive awareness


What does the Kaltenborn technique refer joint play as?



Describe the 3 grades of Kaltenborn techniques

- Grade I: Piccolo (loosen) involves traction force that neutralizes pressure in the joint to reduce the compressive forces on the articular surfaces
- Grade II: Slack, in which the joint surfaces are separated which eliminate the play in the joint capsule
- Grade III: Stretch involves the stretching of the joint capsule/tissues to increase mobility


Which grade of Kaltenborn technique should be used to treat joint hypomobility?

Grade III to stretch the joint capsule


What is the type of joint mobilization we use in class? Describe the 5 various grades

Australian Techniques
- Grade I: small amplitude technique performed at the beginning of the available ROM
- Grade II: large amplitude technique performed in the middle of the ROM
- Grade III: large amplitude movement at the end of the ROM
- Grade IV: a small amplitude movement at the end of ROM
- Grade V: a movement that exceeds the resistance barrier


What are grade I and II joint mobilizations used for?

acutely for pain relief


What are grade III and IV joint mobilizations used for?

to reduce restriction of movement by activating inhibitory joint and muscle spindle receptros


In which direction should joint mobilizations be applied?

Either parallel or perpendicular to the joint


If a large improvement occurs following joint mobilization, what should be done next?

Intervention should be discontinued for the day


What is essential after mobilization or high-velocity thrust techniques?

Muscle reeducation


Describe Mobilizations with Movements (MWM)

A technique that combines a sustained manual gliding force with concurrent physiologic motion of the joint with the intent of causing a repositioning of so-called bony positional faults


What are the 2 types of locking techniques?

- locking from above
- locking from below


How are adjacent joints positioned in both locking techniques?

at the end of the available ROM


What does Proprioceptive Neuromuscular Facilitation (PNF) promote?

The response of the neuromuscular mechanism through stimulation of the proprioceptor


What are the 7 types of PNF?

- Contract-Relax
- Agonist Contraction
- Contract-Relax-Agonist-Contraction
- Rhythmic Initiation
- Repeated Contraction
- Stabilizing Reversal
- Rhythmic Stabilization


When is rhythmic initiation used?

In patients who are unable to initiate movement in order to teach them a specific movement pattern


When is repeated contraction used?

In patients who have weakness and to correct imbalances that occur within the ROM


Describe how repeated contraction PNF techniques work

The patient is asked to push repeatedly by using the agonist concentrically and eccentrically against maximal resistance, until fatigue occurs


What are the 2 things stabilizing reversal PNF techniques are used for?

- Developing AROM of the agonists
- Developing the normal reciprocal timing between the antagonists and agonists that occurs during functional movements


Describe how stabilizing reversal PNF techniques work

The patient is asked to concentrically contract the agonist followed immediately by a concentric contraction of the antagonist. In which the initial agonist push contraction facilitates the pull contraction of the antagonist.


How does the rhythmic stabilization PNF technique work?

There is co-contraction of agonists and antagonists which results in an increase in the holding power to a point where the position cannot be broken. A “hold” command is always given to the patient prior to resisting movement


What are the 5 goals of rhythmic stabilization?

- Improve stability around a joint
- Increase positional neuromuscular awareness
- Improve posture and balance
- Enhance strength in the functional range
- Enhance stretch in the functional range


What are chop and lift PNF patterns?

Applications of the UE diagonal that involve the use of both UEs
- One UE is performing D1
- One UE is performing D2
Both UEs move into flexion or extension while using spiral and diagonal movements that cross the midline