Principles of Neuromuscular Treatment

Question 1

What are the 6 stages in managing pathology?

Answer 1

1) Diagnosis
2) Stage and SIN
3) Dominant Pain mechanism
4) Patient’s problems
5) Tissue healing
6) Yellow flags, psychosocial

Question 2

What are the 5 pillars of symptom management?

Answer 2

1. Advice and education
2. Symptom control
3. Build capacity
4. Return to function
5. Monitor, Reflect, Adapt

Question 3

What evidence supports that client/patient centered care improves outcomes?

Answer 3

1) Improved outcome in heart failure populations and neurorehabilitation setting.
2) Improves patient satisfaction and long-term self-management

3) Superior outcomes compared to standard physiotherapy

Question 4

What 4 questions do you need to know for a client-focused approach?

Answer 4

1. Why are they here?
2. What are their goals?
3. What are their expectations?
4. Psychosocial influences?

Question 5

What are 5 potential areas you can discuss in the “Advice and Education” pillar?

Answer 5

1. Explain what is wrong and what the patient can expect
2. Address fears and unhelpful beliefs
3. Relative rest, encouragement of early (safe) return to activity
4. Discuss likely frequency / duration of treatment, self-management plan
5. Discuss patient goals, treatment options, and encourage shared decisions.

Question 6

In the “Symptom control” pillar, what 4 things do you want to cover?

Answer 6

1. Ask about pain control
2. Possible use of passive modalities
3. Consider analgesics
4. Other strategies (sleep hygiene, manual therapy)

Question 7

What are two different types of manual therapy?

List the two main mechanisms for their therapeutic effect?

Answer 7

1. Soft tissue treatment technique
   • Massage
   • Trigger point release
2. Passive joint techniques
   • Joint mobilization
   • Joint manipulation

Therapeutic effects
• Mechanical stimulus
• Neurophysiological (hypoalgesia effect)

Question 8

With mechanical stimulus therapy, what do you need to take into consideration?

Answer 8

Biomechanical effects are transient.
Main goal is to reduce stiffness when it is a barrier to recovery.
NEVER do in isolation, always pair with active treatment.

Question 9

What is the hypoalgesic effect, and 3 explanations of it’s mechanism?

Answer 9

The hypoalgesic effect is the reduction in pain symptoms following

1. Peripheral mechansims
2. Spinal cord mechanisms
3. Supraspinal mechanisms

Question 10

What is a peripheral mechanism of the hypoalgesic effect?

Answer 10

Potential interaction with the peripheral nervous system
Alters inflammatory mediators
Reduces pain sensitivity

Question 11

What is the spinal cord mechanism of the hypoalgesic effect?

Answer 11

Pain gate theory - proprioception and cutaneous mechanoreception interfere with incoming nociception in the dorsal horn.

Question 12

What is the supraspinal mechanism of the analgesic effect?

Answer 12

Descending top-down control of pain in the nervous system from the PAG, ACC, and RVM. Affected by attention and emotional control

Question 13

When applying manual therapy, what is the difference between accessory mobilization and physiological mobilisation?

Answer 13

Active accessory mobilization - inducing a movment that the individual cannot do themselves.

Physiological mobilization - Inducing a movement that the individual can do themselves.

Question 14

What are 4 ways to modify applied manual therapy techniques?

Answer 14

1. Amplitude and rhythm
2. Duration and repetitions
3. Direction
4. Patient position

Question 15

What are some contraindications/precautions to manual therapy?

Answer 15

Ø Active Cancer
Ø Osteoporosis
Ø Rheumatoid arthritis
Ø Active inflammatory or
infective arthritis
Ø TB
Ø Unremitting night
pain/unexplained weight
loss
Ø Long-term corticosteroid
or anticoagulant
medications
Ø Pregnancy
Ø Delayed or non union of
#
Ø Hyper mobility
Ø Acute trauma (fractures,
open wounds, sprains)
Ø Congenital or acquired
malformations
Ø Acute inflammation
Ø Hemarthrosis
Ø DVT
Ø Disc herniation

Question 16

What do you want to address in the “building capacity” pillar?

Answer 16

Address:
Restrictions in joint movement
Strength deficit
Control/balance/proprioception

Question 17

What principles do you consider for buildling capacities?

Answer 17

FITT
Specificity
Overload
Progression

Question 18

List the different types of load on the body

Answer 18

Tensile
Friction/Shear
Compressive
Combination
Internal: How the individual perceives load/effort
External load: Objective measurement of training capacity.

Question 19

What 4 things should you consider in the “Return to function” pillar?

Answer 19

1. Advanced rehab
2. Functional/sports specific exercises
3. Increase load
4. Consider appropriate level and time for return to function (particularly with high performance activities)

Question 20

What are some activity or sport-specific questions for return to function?

Answer 20

• Position played and demands of that role
• Playing history - games missed due to injury
• Training history - preseason vs season
• Recent and chronic loading history
• Any note in loss of function or performance (pre- and post-injury)
• Equipment used and any recent changes
• Skill level
• Competition phases: where are they in their year and what is coming up?