Manual Therapy

Question 1

Altered joint mechanics can be caused by:

Answer 1

Pain
Muscle guarding
Contractures/adhesions
Aberrant joint motion

Question 2

Billing for manual therapy interventions

Answer 2

In NJ, medicare reimburses for each 15 (8-22) minutes

Question 3

Manual Therapy Techniques

Answer 3

mobilization/manipulation
manual lymphatic drainage
manual traction
one or more regions
each 15 minutes

Question 4

Indications for manual therapy

Answer 4

Pain
Muscle guarding/spasm
Reversible joint hypomobility
Positional faults/subluxations
Diseases that prgressively limit movement
Functional immobility

Question 5

Contraindications

Answer 5

• Hypermobility
• Joint effusion (swelling)
• Inflammation

Question 6

Although inflammation is a contraindication, what technique can be performed?

Answer 6

can apply gentle oscillating techniques that do not stress or stretch the joint capsule; may help block pain transmission

Question 7

Precautions/contraindications

Answer 7

Malignancy
Osteoperosis/post menopausal women
Recent/unheld fracture
Excessive pain
Hypermobility
Joint replacements
Newly formed/weakened connective tissue
Systemic connective tissue diseases such as RA
Elderly individuals w/ weakened connective tissues and diminished circulation

Question 8

Limitations of Joint Mobs/Manipulations

Answer 8

Cannot change disease process
Skill of PT affects outcome
Patients must be properly examined
Must screen for contraindications/precautions
Too much force may cause injury

Question 9

Joint mobilizations techniques

Answer 9

Non-thrust techniques (joint mobilizations)
Oscillations
Sustained
High velocity thrusts (joint manipulation)

Question 10

Non-Thrust Oscillation Joint Play

Grade I

Answer 10

mobilize joint in beginning of range

Question 11

Non-Thrust Oscillation Joint Play

Grade II

Answer 11

mobilize joint in the middle of the range

Question 12

Non-Thrust Oscillation Joint Play

Grades 1 & 2 purpose

Answer 12

designed to relieve pain

Question 13

Non-Thrust Oscillation Joint Play

Grade III

Answer 13

mobilize joint through middle of range and into stretch

Question 14

Non-Thrust Oscillation Joint Play

Grade IV

Answer 14

mobilize joint at end of range and into stretch

Question 15

Non-Thrust Sustained Joint Play

Grade I

Answer 15

similar to oscillaition, beginning of ROM

Question 16

Non-Thrust Sustained Joint Play

Grade II

Answer 16

Goes to end ROM

Question 17

Non-Thrust Sustained Joint Play

Grade III

Answer 17

End of ROM and into stretch

Question 18

Sustained Vs Oscillated

Answer 18

Oscillations-better for pain control
Sustained-better for restoring motion

Question 19

High velocity thrust

Answer 19

• joint is moved to the limit of motion, all slack is taken out of tissue
• quick thrust applied to restricting tissue

Question 20

Amplitude of high velocity thrust

Answer 20

Keep amplitude of the thrust small to prevent damage to unrelated tissues and helps maintain control of the maneuver

Question 21

High velocity thrusts are used for:

Answer 21

Snapping adhesions or to a subluxation or dislocation to reposition joint surfaces

Question 22

Dosage

Pain is experienced before tissue limitation or pain at rest

Answer 22

Use gentle (grade 1) techniques to inhibit pain

Question 23

Dosage

Pain is experienced concurrently with tissue limitation

Answer 23

Treat cautiously-begin with grade II techniques

Question 24

Dosage

Pain is experienced after tissue limitation is met

Answer 24

Can be more aggressive-grades III and IV

Question 25

Neurophysiological Effects

Answer 25

* Stimulates mechanoreceptors, cutaneous recpetors, and muscle receptors * Gate theory * Endorphins These effects can decrease pain/spasm and improve movement

Question 26

Mechanical effects

Answer 26

Plastic deformation Tear adhesions Break cross-linkages of collagen fibers

Question 27

Chemical effects

Answer 27

* release of endogenous hormones * effects fluid dynamics and hydraulics of joints and soft tissues * pyshcological effects

Question 28

Is snap, crackle, pop necessary for effectivness?

Answer 28

Force applied to joint may burst fluid bubbles in the synovium; this sound is not necessary for effectiveness, but may enhance psychological response

Question 29

# Direction and Target of Treatment Force Parallel to the treatment plane

Answer 29

glides

Question 30

# Parallel to the treatment plane Perpindicular to the treatment plane

Answer 30

distractions