Test 2: Manual Therapy

Question 1

The emphasis on manual therapy/motor learning is on

Answer 1

preliminary need for postural control

Question 2

Motor development- Process by which a person _____

Answer 2

acquires skills and movement patterns

Question 3

Typical order of motor development

Answer 3

• Cephalocaudal
• proximal -> distal
• Gross -> Fine

Question 4

Three stages of motor learning process

Answer 4

Cognitive – Determining what should be done
Fixation – Fine Tuning
Autonomous – Mastery

Question 5

Bimanual or B/L UE Training protocols can include

Answer 5

Repetitive reaching with hand fixed Isolated muscle repetitive training
Whole arm functioning
Can combine with rhythmic auditory cues & repetitive reaching with hand fixed activities

Question 6

Bimanual or B/L UE Training protocols can be used with

Answer 6

Stroke survivors or those with moderate -> severe motor impairments

Question 7

Physical Agent Modalities (PAMS)

Electrical Stimulation often used with those who have impaired _____

Answer 7

motor function

Question 8

Activation of desired muscle(s) is mandated ___ to e-stim being applied for motor response

Answer 8

prior

Question 9

Manual Therapy is defined as

Answer 9

Defined as a clinical approach utilizing skilled, specific hands-on techniques used to diagnose and treat soft tissue and joint restrictions for the purpose of:

Question 10

Causes of soft tissue restriction

Answer 10

Trauma – past or present
Habitual Patterns - Develop abnormal movement or holding patterns
Posture – becomes a habit
Inflammation
Immobilization
Strain from over exercising – eventual soft tissue breakdown
Imbalances– Leg length discrepancies

Question 11

Effects of Restricted Mobility

Answer 11

Disuse atrophy – fibrotic changes in tissue Loss of sarcomeres – shortened range
Decreased ROM
Adhesions of fascial elements
Degeneration of cartilage – wear away prematurely
Loss of ground substance – loss of lubrication
Decreased nutrition and blood supply to the tissues
Weak muscle through ROM
Joint restrictions
Bony structure changes (Wolf’s Law)

Question 12

Tissue restrictions __ show up on standardized tests

Answer 12

do NOT

Question 13

Retrograde Massage works from ___ to ____

Answer 13

distal to proximal

Question 14

Retrograde assists with improving circulation and movement of _____ back toward the lymph nodes for drainage and towards the heart

Answer 14

extra-cellular fluid

Question 15

Key points of retrograde massage: use _____ pressure

Answer 15

firm but gentle pressure

Question 16

Key points of retrograde massage: ____ the extremity you are working on

Answer 16

elevate

Question 17

Key points of retrograde massage: always use _____

Answer 17

lotion

Question 18

Key points of retrograde massage: Use ___ and __ strokes

Answer 18

Slow and long

Question 19

Key points of retrograde massage: Do the massage ____ times per day

Answer 19

Several

Question 20

What is a Trigger Point (TrP)?
Latent Trigger Points
More common than active
Restrict motion and cause stiffness but are not painful until palpated

Answer 20

A discrete, focal, hyperirritable spot that is located in a taut band of skeletal muscle

Question 21

Trigger points can produce pain ___ or _____

Answer 21

locally or in a referred pattern

Question 22

Are latent or active trigger points more common?

Answer 22

latent

Question 23

Which kind of trigger points restrict motion and cause stiffness but are not painful until palpated

Answer 23

Latent

Question 24

Which kind of trigger point is always tender, prevents full ROM and weakens the muscle
Patient c/o pain that may also radiate (referred pain)

Answer 24

Active

Question 25

Palpation of Trigger points may also produce a _____ which is a - Contraction of the fibers in response to stimulation of the same trigger point or nearby trigger point

Answer 25

“Local Twitch Response”

Question 26

How do we get TrP?

Answer 26

``` Poor Posture Leaving muscles in a shortened position Attempting to contract muscles in a shortened position Muscle overload Repetitive Sustained Nerve Compression ```

Question 27

Trigger Point Release Direct downward pressure perpendicularly with maximum pressure over the area that is hyperirritable for ___ seconds

Answer 27

90

Question 28

CFM TECHNIQUE With deep pressure over the area in need, the therapist can use ______ to massage perpendicularly or “across the grain” of the direction of the tissue fibers

Answer 28

one to two fingers

Question 29

Do you use lotion with cross-friction massage?

Answer 29

No

Question 30

For acute injury CFM lasts how long?

Answer 30

1-2 minutes

Question 31

For deep structures, CFM lasts how long?

Answer 31

5-10 minutes

Question 32

Key point for CFM: Don't ____, instead, take it with you

Answer 32

Slide over the skin

Question 33

Fascia over time can ___ and ____

Answer 33

tighten and harden

Question 34

Fascial restrictions can have a tensile strength of up to

Answer 34

2000 pounds per square inch

Question 35

What is fascia made of?

Answer 35

Elasto-collagenous complex Collagen – pliable and strong Elastic fibers – allow stretching and recoil Arranged to withstand multidirectional stresses Ground substance- 60-70% water Acts as lubricant and to maintain interfiber distance (adhesions) Glucosaminoglycans (GAG) – (-) charged to repel tissues Hyaluronic acid - lubrication Chondroitin and Sulfate – glue Glucosamine and Chondroitin

Question 36

What is myofascial release?

Answer 36

Very hands on approach Whole body Firm, gentle, sustained pressure into restricted tissues Permanent effects of elongated tissues removing pressure Increases function and mobility and decreasing pain

Question 37

How does myofascial release work?

Answer 37

The piezoelectric effect Applied pressure creates a small electrical charge Tissue under stress has a lower energy potential Less strength and power Myofascial release generates an electrical field Attracts water molecules

Question 38

What does myofascial release feel like?

Answer 38

Potentially a warm or hot sensation Breaking bonds produces heat – CHEMISTRY!!! Stretching that feels like “creeping, bubbles popping, fingers sliding across the skin, tingling, numbness, or buzzing.” Feeling of “therapeutic pain” afterward, different then previous pain Heightened awareness of body

Question 39

Following myofascial release:

Answer 39

``` Drink plenty of fluids Rehydrates tissues and washes chemical irritants released Neuromuscular re-education PNF Functional movements Kinesiotaping Ergonomics Sleeping positions Sit/Stand posture Body mechanics HEP to mobilize tissues released Foam rolls, use of small balls Myofascial stretches ```