Manual Therapy Flashcards by Heather Stephens

Which type of manual therapy is described as needing speed and the patient cannot stop movement?

a. spinal manipulation
b. spinal mobilization
c. none of the above
d. all of the above

spinal manipulation

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Which type of manual therapy is described as oscillations, varying amplitudes, the patient can stop movement?

a. spinal manipulation
b. spinal mobilization
c. none of the above
d. all of the above

spinal mobilization

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What are the 3 mechanisms of manual therapy?

mechanical
neurophysiological
placebo

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This mechanism of manual therapy is moving a joint which creates a mechanical stimulus stimulating the tissue, decreasing spasm and increasing ROM

a. mechanical
b. neurophysiological
c. placebo
d. none of the above

mechanical

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This mechanism of manual therapy is the effect on the brain

a. mechanical
b. neurophysiological
c. placebo
d. none of the above

neurophysiological

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This mechanism is something that influences what the patient feels/thinks about what were doing

a. mechanical
b. neurophysiological
c. placebo
d. none of the above

placebo

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What are the mechanisms of manual therapy?

create space
stretch collagen/off set load
gate control 
blood flow 
locked joint 
disc pressure 
plasticity 
placebo 
neuromuscular effect 
graded exposure 
patient expectations 
range of motion 
money/cost

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This mechanism of manual therapy takes tension or stress/strain off of a particular tissue that you are targeting with therapy

a. create space
b. stretch collagen/offset load
c. blood flow
d. plasticity

stretch collagen/offset load

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This mechanism is of manual therapy is concluded as the local dorsal horn mediated inhibition of c-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects

a. create space
b. gate control
c. blood flow
d. locked joint

gate control

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Manual therapy _ blood flow which is good for _ nerve sensitivity

increases

decreasing

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Patients are able to identify where the therapist is manually pressing improves

homonculus

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biological plasticity has both a _ effect and _

mechanical

neuroplasticity

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_ can enhance with identification

plasticity

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Placebo can show induced biological changes in

CNS activation
opioid pathways
dopamine production

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Placebo can show induced psychological responses in

expectation of benefit
conditioning/learning effect
negative effect

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Manual therapy gives an immediate _ effect

hypoalgesia

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this is defined as the thinking underlying clinical practice

clinical reasoning

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Clinical reasoning incorporates recognizing

_ and _-testing

pattern recognition

hypothesis-testing

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Predisposing physical, psychosocial and environmental circumstances is a

a. clinical pattern
b. common error of clinical reasoning

clinical pattern

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An overemphasis on findings which support existing hypothesis is a

a. clinical pattern
b. common error of clinical reasoning

common error of clinical reasoning

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It is important to ignore findings that do not support the favored hypothesis (true/false)

false

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This is defined as the awareness and ability to think about your thinking

a. clinical reasoning
b. metacognition
c. error of clinical reasoning
d. none of the above

metacognition

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Patients want to know

what is wrong with me?
how long will it take?
what can I do for it?
what can you do for it?

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reasoning categories of clinical reasoning

sources 
prognosis 
management 
pathobiology
contributing factors
dysfunction
precautions

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With the prognosis, it is important to focus on a. pain b. function c. none of the above d. both

function

Improve _ and _ will come down

``` function pain ```

the more complex the pain, the more likely a multidisciplinary approach is needed (true/false)

true

The pain, action programs, and stress regulation is the a. output b. input c. processing d. none of the above

output

The various biological systems protect a. output dominant b. input dominant c. processing dominant d. none of the above

output dominant

Sensory and cognitive is a part of a. output b. input c. processing d. none of the above

processing

CNS, brain, central sensitization, hyperalgesia, allodynia are a. output dominant b. input dominant c. processing dominant d. none of the above

processing dominant

The tissue sampling, environment, nociception, peripheral nerve are categorized as a. output b. input c. processing d. none of the above

input

What are contributing factors of clinical reasoning to be aware of?

yellow flags | outside factors that influence their pain experience

This concept is defined as open mindedness, mental agility, mental discipline linked with a logical and methodical process of assessing cause and effect

Maitland concept

The central theme of the Maitland concept is to have a positive personal commitment to understand what the patient is enduring (true/false)

true

Maitland concept puts an empahsis on

``` clinical reasoning detail approach to the patient signs and symptoms technique ```

Maitland concept of assessment

continuous analytical before, during, and after treatment be open-minded, non-judgmental

How long do you treat a patient before you see results?

dont see within 4-6 treatments - may be missing something

optimum improvement per session means pushing them harder when something is working for treatment (true/false)

false

Objective measures a. sign b. symptoms c. comparative sign d. none of the above

sign

patient subjective reporting a. sign b. symptoms c. comparative sign d. none of the above

symptom

passive or active movement is _

physiological movement

spin, roll, glide of the articular surfaces a. active physiological movement b. passive physiological movement c. accessory movement d. comparative sign

accessory movement

Measurements of progress, identifiable, what they have trouble doing functionally a. sign b. symptoms c. comparative sign d. none of the above

comparative sign

``` What is normally seen with screening for red flags? spinal movement is _ associated _ _ _ _ _ onset of symptoms ```

unaffected by spinal movement associated symptoms (heartburn) past medical history insidious onset of symptoms

A patient is unaffected by spinal movement, has associated symptoms, PMH. onset of symptoms is insidious. These characteristics can be categorized as a. yellow flags b. red flags c. cancer d. systemic issues

red flags

A patient has a PMH of cancer, failure to improve within 1 month of tx, under the age of 20, family history or sudden explained weight loss can be classified as a. yellow flags b. red flags c. cancer d. systemic issues

cancer

A patient has a PMH of cancer, failure to improve within 1 month of tx, over the age of 50, family history or sudden explained weight loss can be classified as a. yellow flags b. red flags c. cancer d. systemic issues

cancer

Risk factors for cancer

age > 50 y/o age < 20 y/o personal history of cancer

Symptom location for pain in patients older than 50 a. UE b. long bones of extremities c. axial skeleton d. LE

axial skeleton

Symptom location for pain in patients under the age of 20 a. UE b. long bones of extremities c. axial skeleton d. LE

long bones of extremities

A symptom description of initial ache that progresses to constant, sharp, incapacitating can be classified as a. systemic issues b. yellow flag c. red flag d. cancer

cancer

Pain that is related to cancer is a. traumatic b. gradual c. insidious d. none of the above

insidious

A patient is aggravated by loading their bones through weight-bearing activities and unloading alleviates pain, this can be

cancer

Night pain is a red flag (true/false)

true

What can also be causing night pain?

neuropathic pain

When you wouldn't/shouldnt use a physical test or technique under any circumstances a. precaution b. contraindication c. red flag d. none of the above

contraindication

Depending upon the skill, experience and training of the practitioner, type of test or technique selected, the amount of leverage and force used, and the age, general health and physical condition of the patient a. precaution b. contraindication c. red flag d. none of the above

precaution

It is safe to be aggressive with strength of the technique and not reassess (true/false)

false

safety in manual therapy should be | gradual/quick

gradual | continually assessed

MT contraindications of bony issues

``` tumor infection metabolic congential iatrogenic inflammatory traumatic ```

MT neurological contraindications

cervical myelopathy cord compression cauda equina syndrome nerve root compression with increasing neurological deficit

MT vascular contraindications

diagnosed with vertebrobasilar insufficiency aortic aneurysm bleeding disorder

MT contraindications: lack of

not examining someone | lack of pt consent

``` adverse reaction to previous MT disc herniation or prolapse pregnancy spondylolisthesis psychological dependence upon manipulative techniques ligamentous laxity a. MT contraindications b. MT precaution ```

MT precautions

How should you make MT safer?

appropriate training thorough history and exam clinical reasoning skills graded mobilization

Fear and anxiety, family concerns, failed treatment, persistent pain, job issues, different explanations fall under a. cancer screening b. yellow flags c. red flags d. contraindications

yellow flags

_ flags enter into the system during the processing stage

yellow

Emotions, behaviors, family, work, compensation can be a. red flags b. yellow flags c. precautions d. contraindications

yellow flags

fear of increased pain, depression, irritability, anxiety, and stress are a. yellow flags b. red flags c. warning signs d. patterns

yellow flags | emotions

behaviors of extended rest, poor compliance, extreme pain ratings, excessive reliance on aids/devices, sleep disturbance, high intake of alcohol or medication, work

yellow flags

overprotective and punitive responses from family

yellow flags

manual work, work history, belief that work is harmful, unhappy at work, low educational background, working shifts, negative previous experiences at work with LBP

yellow flags

lack of financial incentive to return to work, extended time off work, number of claims, previous history of LBP

compensation | yellow flags

conflicting diagnosis, passive treatments, number of health care providers, lack of satisfaction

yellow flags

tools for screening yellow flags

FABQ Tampa Scale of Kinesiophobia pain catastrophization scale Orebo musculoskeltal pain screening questionnaire Keele STarT back screening tool Acute low back pain screening (ALBPS) questionnaire

SINS stands for

severity irritability nature stage

A finding of debilitating, high-intensity pain a. severity b. irritability c. nature d. stage

severity

A finding of small movement causes a lot of pain and take awhile to subside a. severity b. irritability c. nature d. stage

irritability

A finding of deep, burning, type of pathology a. severity b. irritability c. nature d. stage

nature

SINS plus includes

stability

SPINS includes

pain mechanism

What are the categories of a subjective exam?

``` kind of disorder history site of symptoms behavior of symptoms special questions ```

This part of the subjective exam is the main problem which can typically be pain, limited movement, limited ROM, weakness, numbness, decreased function a. history b. kind of disorder c. site of symptoms d. behavior of symptoms

kind of disorder

the kind of disorder is from the (patient/therapist) perspective

patient

What do you need to get from the subjective history part?

onset of disorder progression diagnosis, tx and effect previous history

How and when did this start? What kind of symptoms were present when it started? Did any of the symptoms spread anywhere else? How long did it take for the symptoms to come on? What were you doing around the time of the onset? What do you think happened? Why do you think you hurt? these questions help you determine a. type of disorder b. onset of disorder c. progression of disorder d. diagnosis

onset of disorder

``` Is it getting better, worse or the same? If (better, worse or the same) in which way? these questions help you determine a. type of disorder b. onset of disorder c. progression of disorder d. diagnosis ```

progression of the disorder

What information do you need to get from the site of symptoms?

area depth nature correlation

The nature of the site of symptoms can tell you

constant vs intermittent | variable vs non variable

You should target each symptom they mark on the body chart (true/false)

false | prioritize

If their body map is intact and sharp, what should you do for treatment? a. pain science b. mobilization c. traditional manual therapy d. don't treat

manual therapy

If their body map is smudged, what should you do for treatment? a. pain science b. mobilization c. traditional manual therapy d. don't treat

pain science

Aggs, eases, SINS, latency and daily pattern describe a. site of symptoms b. depth of symptoms c. nature of diagnosis d. behavior of symptoms

behavior of symptoms

What do you need to ask for special questions?

review of systems cancer screen inflammation vertebrobasilar insufficiency

What do you need to consider with vertebrobasilar insufficiency?

5 D's and 3 N's

5 D's for vertebrobasilar insufficiency

``` dizziness diplopia dysphagia drop attacks dysarthria ```

And vertebrobasilar insufficiency

ataxia

3 N's for vertebrobasilar insufficiency

nystagmus numbness nausea

Outcome measures used for subjective examing

function fear pain catastrophization

5 reasons to do a physical exam

``` confirm subjective hypothesis/diagnosis find comparative signs choose techniques and treatment determine pts movement limits determine pits willingness to move ```

Determining if the symptoms are peripherally or centrally initiated a. sources of symptoms b. mechanism of symptoms c. site of symptoms d. diagnosis

mechanism of symptoms

The possible structures at fault and determining what should be examined on day 1 a. sources of symptoms b. mechanism of symptoms c. site of symptoms d. diagnosis

sources of symptoms

For planning the physical exam consider

``` mechanism of symptoms sources of symptoms when to limit the exam if you should do a neuro eval comparative signs ```

Limits of physical exam

point of onset partial reproduction total reproduction production of referred symptoms

Let the patient demonstrate the aggravating movements (true/false)

true

Non-verbal cues are irrelevant, dont tell you anything (true/false)

false

When looking at the patient move, what should you be looking for?

``` distortion of the movement quality speed, rhythm, willingness to move, ROM where movement occurs limits status of ceased movement ```

Consider what concepts for planning the treatment

``` patient symptoms pathology goals and objectives prognosis techniques available ```

Joint positioning mid ROM, large amplitude, grade 2 will treat a. stiffness b. pain c. impaired function d. ROM

pain

Joint positioning end ROM, small amplitude, grade 4 will treat a. stiffness b. pain c. impaired function d. ROM

stiffness

This grade is a small amplitude, beginning of the ROM a. grade I b. grade II c. grade III d. grade IV

grade I

This grade is a large amplitdue, beginning to mid ROM, free of resistance a. grade I b. grade II c. grade III d. grade IV

grade II

This grade is a large amplitdue, mid to end ROM, into resistance, stiffness a. grade I b. grade II c. grade III d. grade IV

grade III

This grade is small amplitude, stretching into stiffness a. grade I b. grade II c. grade III d. grade IV

grade IV

According to the Maitland concept, what rhythm should you use to treat pain? a. fast b. aggressive and slow c. smooth and even d. increase as you go

smooth and even

According to the Maitland concept, what rhythm should you use to treat stiffness? a. staccato b. aggressive and slow c. smooth and even d. increase as you go

staccato

According to the Maitland concept, how should you advance a technique?

``` increase amplitdue move into some discomfort increase speed, maintain smoothness slight staccato oscillations place the joint on a stretch before mobilizing ```

With muscle spams, you should oscillate (true/false)

false

To treat pain according to maitland concept use a a. comfortable position, comfortable technique, small amplitude, slow speed, smooth rhythm, and long duration b. end ROM position, firm technique, large amplitude, small amplitude in between, quicker speed, staccato rhythm, short duration c. comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration d. end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration

comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration

To treat stiffness according to maitland concept a. comfortable position, comfortable technique, small amplitude, slow speed, smooth rhythm, and long duration b. end ROM position, firm technique, large amplitude, small amplitude in between, quicker speed, staccato rhythm, short duration c. comfortable position, comfortable technique, large-amplitude, slow speed, smooth rhythm, short duration d. end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration

end ROM position, firm technique, small amplitude, large amplitude in between, quicker speed, staccato rhythm, expect discomfort, longer duration

The tissues, environment, nociception, and peripheral nerve are what part of the pain process? a. input b. output c. processing d. psychological

input

The CNS, brain, central sensization, hyperalgesia, allodynia symptoms is part off which system with pain? a. input b. output c. processing d. psychological

processing

Pain, sympathetic, motor, immune, adrenaline, cortisol, respiration, language are related to the _ part of pain a. input b. output c. processing d. psychological

output

The primary lesion or dysfunction is located in the spinal cord, brainstem, and cerebral hemispheres affects the _ part of pain a. input b. output c. processing d. psychological

processing

A patient demonstrates disproportionate pain and disproportionate aggravating and easing factors, this is due to the _ part of pain a. input b. output c. processing d. psychological

processing

A patient has diffuse palpation tenderness and nothing eases their pain, it is a _ issue a. input b. output c. processing d. psychological

processing

This type of pain is proportionate, aggravating and easing factors, intermittent sharp, dull ache or throb at rest with no night pain a. peripheral neurogenic b. nociceptive c. processing d. psychological

nociceptive

Pain is dermatomal or cutaneous distribution, positive neurodynamic and palpation with a history of nerve pathology a. peripheral neurogenic b. nociceptive c. processing d. psychological

peripheral neurogenic

Maitland focused on a. pathology b. biopsychosocial c. social issues d. signs and symptoms

signs and symptoms

Loui believed that for collagenous tissues to elongate it takes a. manual therapy b. mobilization c. education d. time and repetition

time and repetition

(small/large) amplitude motions can be seen as a modulation effect on (peripheral/nociceptive) input to CNS

large | nociceptive

(continuous/repetitive) oscillations on a spinal level, often at various angles help _

repetitive | restore body maps in the brain

A cornerstone concept of Maitland is

test and retest

Which system is powerful when it comes to pain?

vision

Hands-on manipulation has been shown to activate the (descending/ascending)

descending inhibitory mechanisms to help modulate acute pain

this model involves exposing a person to a small amount of stimulus for a short amount of time and over time, this exposure is increased a. body maps b. neuroplasticity c. manual therapy d. graded exposure

graded exposure

patient expectations are a _ effect

placebo

changes in the size and shape of the _ _ can correlate with increased pain and disability

body maps

treatments for _ improve SLR

neuroplasticity

reboot of muscles via spinal reflexes; essentially, describes the change in muscle activity seen before & after a manual technique a. neuroplasticity b. placebo c. neuromuscular effect d. manipulation

neuromuscular effect

What was the first school to teach manipulation?

Andrew Taylor Still | osteopathy

Who wrote the four branches of physiotherapy are manipulation of muscle and joints, therapeutic exercise, electrotherapy, hydrotherapy? a. McMillan b. Maitland c. Cyriax d. Mennell

Mary McMillan

Who wrote the textbook of orthopedic medicine? a. Mennell b. Maitland c. Cyriax d. McKenzie

James Henry Cyriax

Who is famous for teaching therapists about manipulation? a. McKenzie b. Maitland c. Cyriax d. Mennell

Cyriax

Who defined joint dysfunction and joint play which cannot be produced by the action of voluntary muscles? a. McKenzie b. Mennell c. Cyriax d. Maitland

John Mennell

Who explained the concept of facilitated segment?

Alan Stoddard

Who came up with the concept of repeated movements being preferred direction, centralization, peripheralization? a. McKenzie b. Maitland c. Cyriax d. Mennell

Robin McKenzie

The ability to respond appropriately to relevant information during a patient encounter? a. clinical reasoning b. reflection in action c. metacognition d. knowing in action

knowing in action

Clinical reasoning is the application of _ _, and _ _ to patient _ on an _ level

relevant knowledge clinical skills management individual

with clinical reasoning, you need to find out if its _ to the patient

relevant

Clinical reasoning is likely more important than the actual treatment itself (true/false)

true

The assessment is the most important part according to the Maitland concept (true/false)

true

This type of pain is proportionate, aggravating and easing factors, intermittent sharp, dull ache or throb at rest a. nociceptive b. peripheral c. processing d. none of the above

nociceptive

This type of pain is no night pain, dysesthesia, burning, shooting or electric a. nociceptive b. peripheral c. processing d. none of the above

nociceptive

This type of pain is dermatomal or cutaneous in distribution, positive neurodynamic and palpation, with a history of nerve pathology or compromise a. nociceptive b. peripheral c. processing d. none of the above

peripheral neurogenic

This type of pain is disproportionate pain, disproportionate aggravating and easing factors, diffuse palpation tenderness, psychosocial issues a. nociceptive b. peripheral c. processing d. none of the above

processing

What is the most important central theme in pain according to the maitland concept?

approach to the patient

Manual Therapy Flashcards

(158 cards)