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MUSC 206 > Mobilisation & Manual Therapy > Flashcards

Mobilisation & Manual Therapy Flashcards

1
Q

Do all impairments respond to manual therapy?

A

No

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2
Q

What are the different types of treatment modalities?

A
  1. advice & education
  2. therapeutic exercise
  3. EPA
  4. manual therapy
  5. physical devices
  6. predisposing risk factors
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3
Q

What should Goal setting always be with?

A

the patient

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4
Q

What should goal setting focus on?

A

function

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5
Q

What format should the goals be in?

A

SMART

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6
Q

What techniques does manual therapy include?

A
  1. jt mobs
  2. jt manipulation
  3. ND mob
  4. soft tissue massage
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7
Q

What movements does manual therapy include?

A

accessory & physiological movement

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8
Q

What does manual therapy match?

A

the patients needs and problems & not the technique which matches the technique/ approach

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9
Q

What is a mobilisation technique?

A

a passive mvmt technique applied to a spinal/ peripheral jt performed within control of patient

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10
Q

What does mobilisation include?

A

assessment & treatment

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11
Q

Which movements does mobilisation include?

A

physiological/ accessory
- oscillatory small/large amplitude
- sustained stretching +/- oscillations at limit of range

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12
Q

What is a manipulation?

A

sudden movement/ thrust performed at the limit of joint range such that patient is unable to prevent movement
- high velocity
- small amp

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13
Q

MOBILISATION
What do the oscillations/ sustained stretches consist of?

A

Physiological & accessory movement

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14
Q

Whats a physiological movement in mobs?

A

movements that a person can carry out actively
e.g. ankle DF

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15
Q

Whats an accessory movement in mobs?

A

movements that a person cannot perform independently but are necessary for joint movement
- roll, spin, slide/glide
- distraction, compression
e.g. anteroposterior glide of talus during ankle DF

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16
Q

What are the different ways of application for Mobs?

A
  1. accessory movement in neutral/ any physiological position
  2. accessory & physiological movement
  3. accessory movement in fctnal/ WB positions
  4. combo of physiological movements
  5. accessory/ physiological movement in conjunction with ND test position
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17
Q

What is the rationale for selection/ progression?

A
  • know what symptoms are
  • know the provocative/ asterisk signs
  • know the effects of the manual therapy techniques (reduce pain etc)
  • know how to modify these techniques for prog & reg
  • available ‘tool box’ of techniques to use
  • consider how they integrate with other treatment modalities
  • perform the technique & re-assess
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18
Q

Contraindications & precautions for mobs

A
  • whenever urgent med referral needed
  • post fracture - until its united
  • inflammatory jt diseases
  • total jt replacements
  • when manual therapy is aggravating the condition
  • patient’s current and past history/ general health requires further investigation
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19
Q

What are the 6 principles of mobilisation?

A
  1. direction
  2. patient position
  3. therapist position
  4. localisation of forces
  5. application of force: Grades, rhythm
  6. dosage parameters
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20
Q

What direction should you mobilise the jt in?

A

perpendicular to jt

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21
Q

What is the patient position of rmobs?

A

relaxed

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22
Q

What is the therapist position for mobs?

A

90 to jt & ensure you are comfortable

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23
Q

DIRECTION OF MOBS
What are the 3 types of joint play?

A
  1. gliding
  2. traction
  3. compression
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24
Q

What is ‘joint play’?

A

small movements within a synovial joint that are independent of voluntary muscle contraction

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25
Q

What is a ‘gliding’ force?

A

Translatoric bone movement parallel to the treatment plane

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26
Q

What is a ‘traction’?

A

bone movement at a right angle to and away from the treatment plane = traction (separation) of jt surfaces

27
Q

What is a ‘compression’?

A

bone movement at a right angle to and towards the treatment plane = compression of jt surfaces

28
Q

PRINCIPLES OF MOBILISATION - GLIDING
What is the rule called which describes the gliding directional movement?

A

Convex-concave rule

29
Q

What happens to the convex joint surface in the convex-concave rule?

A

move in opposite direction to the direction of restricted mvmt of the distal aspect of the bone (concave = fixed)

30
Q

What happens to the concave jt mvmt surface in the convex-concave rule?

A

move in the same direction e.g. tibia condyles glide anteriorly for restricted knee extension

31
Q

PRINCIPLES OF MOBILISATION
What is the patient position in mobilisation? (4)

A
  1. completely relaxed
  2. may be selected to replicate functional position of pain
  3. neutral position if pain = main problem
  4. at limit of range if aiming to stretch structures/ manage stiffness
32
Q

What is the therapist position in mobilisation? (6)

A
  • afford complete control of position
  • forces can be applied in direction required
  • optimal base of support
  • comfortable & allow minimal effort
  • make use of mechanical advantage of levers
  • prevent movement beyond established point
33
Q

Where should the localisation of forces occur?
- how should you hold patient?

A

confident, comfy grasp

34
Q

What do you stabilise when mobilising?

A

where required e.g. tibia

35
Q

Where should the applied line of force match?

A

direction intended

36
Q

How many grades of mobilisation are there?

A

V

37
Q

Grade I mobilisation:

A

small amplitude movement at the beginning of available range

38
Q

Grade II mob:

A

large amplitude within a resistance-free part of available range

39
Q

Grade III:

A

large amp performed into resistance / up to limit of available range

40
Q

Grade IV:

A

small amp performed into resistance / up to limit of available range (EOR available)

41
Q

Grade V (manipulation):

A

small amp movement at EOR

42
Q

What impairments do use grades I and II mobilisation levels for?

A

pain

43
Q

What impairments do you use grade III mob for?

A

pain & stiffness

44
Q

What impairment do you use grade IV mob for?

A

stiffness

45
Q

DOSAGE
Grade I/II dosage parameters:

A

< 2 mins 1-2 x / session

46
Q

DOSAGE
Grade III/IV parameters:

A

quicker rhythm
- several mins
- several x / session

47
Q

How can you progress your mobilisation technique?

A
  • repeat tech
  • alter a component of technique
  • add in new techniques
  • change the technique (add Fx)
  • manipulate @EOR
  • stop Rx
48
Q

What is a mobilisation with movement (MWM)?

A

application of a sustained passive accessory force to a joint while the patient actively performs a task that was previously identified as being problematic. e.g. squat with patella medial glide

49
Q

What is the response acronym for a MWM?

A

PILL

50
Q

PILL
“P”

A

pain- free application of mobilisation &movement components

51
Q

PILL
“I”

A

instant result at time of application

52
Q

PILL
“L L”

A

Long Lasting effects beyond the techniques application

53
Q

PILL
“L L”

A

Long Lasting effects beyond the techniques application

54
Q

what is the order of application of a MWM?

A

Glide, move, unmove, unglide

55
Q

What is the volume/dosage of a MWM influenced by?

A

condition, response & sustainability of response

56
Q

What is the dosage of a MWM?

A

6-10 reps
1-3 sets

57
Q

What do you do in the rest period of a MWM?

A

re-assess with functionals

58
Q

How can you progress a MWM?

A
  • increase force
  • increase difficulty/ level of physiological movement e.g. NWB –FWB
  • increase frequency/ sets
59
Q

What does an AP talar glide speed up?

A

recovery rate

60
Q

What does the AP talar glide improve and when?

A

DF earlier in treatment

61
Q

What does an AP talar glide MWM influence?

A

ROM rather than pain

62
Q

What are the adverse effects of manual therapy?

A
  • predominantly related to manipulations
  • similar to those of exercise e.g. soreness
  • risk of major adverse event = very low
  • risk should be weighed against patient-perceived benefit and alternative Rx
63
Q

When do most adverse effects of manual therapy occur?

A

within 24 hours and resolve in 72 hours

MUSC 206 (5 decks)

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