nmt200 physical medicine wk1

OHIPMNRS Model

• A musculoskeletal assessment approach that guides treatment for a presenting musculoskeletal concern.
• Used to help determine if a mobilization is needed, and which to perform.

History and Evidence for Manual Therapy

• Hippocrates, 400 BCE, described using gravity to manipulate the spine to help treat scoliosis.
• Friar Thomas, 1656, wrote "The Complete Bone Setter", describing manipulation in the treatment of spinal curvatures.
• Manual therapy fell out of favor in the 18th century, possibly due to indiscriminate use and dangers involved.
• By the 19th century, "Bone Setters" gained popularity again, but physicians dismissed their success as luck.
• By the late 19th century, manipulation became more mainstream, with papers and books explaining the procedure and benefits.
• Now, manipulation of bones is practiced by Osteopaths, Physiotherapists, Chiropractors, Naturopaths, and Registered Massage Therapists.
• It is a CONTROLLED ACT under the RHPA 1991.

Fundamental Concepts

• Mechanics: The study of forces and their effects on motion.
• Biomechanics: The application of mechanical laws to living structures, especially the human body's locomotor system.
• • Considers the interaction of the skeleton, muscles, and joints.
• • Bones act as levers, ligaments act as hinges, and muscles provide the forces.
• • Manipulative forces take into account joint mechanics and structure, analyzing the effects of forces on the body.

Joint Mobilization

• A non-thrust technique applied within the physiological range of joint motion, but not exceeding the elastic barrier.
• Passive rhythmic graded movements with controlled depth and rate.
• May be applied with fast or slow repetitions (Oscillations) and various depths (Grades 1-4), but always low velocity.
• Movement applied singularly or repetitively, without imparting a thrust or impulse.

Goals/Benefits of Mobilizations

• Restore range of motion (ROM) of a joint.
• Reduce pain.
• Reduce muscle spasms by stretching hypertonic muscles.
• Stimulate synovial fluid production.
• Increase local blood flow.
• Relieve nerve compression and irritated sympathetic chain ganglia.

Types of Mobilizations

• Antero-Posterior Glide (AP Glide)
• Posterior-Anterior Glide (PA Glide)
• Inferior Glide
• Superior Glide
• Medial Glide
• Lateral Glide

Joint Manipulation (Grade 5 Mobilization)

• Thrust technique that takes the joint PAST its physiological ROM without exceeding the anatomical limit.
• Characterized by a low-amplitude, high-velocity thrust, typically producing an audible crack or pop (cavitation).
• A CONTROLLED ACT under the RHPA.

Controlled Act: Manipulation under RHPA 1991

• Moving the joints of the spine beyond the individual's usual physiological range of motion using a FAST, LOW amplitude thrust is a CONTROLLED ACT.
• To perform manipulation as treatment, one must be a member in good standing of a REGULATED HEALTH PROFESSION that has manipulation within its scope of practice.

Naturopaths and Manipulation

• CONO Standard of Practice: Manipulation.
• Naturopaths must perform manipulation safely effectively, and competently.
• Members must conduct an assessment and formulate a diagnosis before performing manipulation, and reassess the patient's progress and response to treatment regularly.

Stretch Techniques

• Gastrocnemius Stretch:
• • Patient stands facing a wall with their feet shoulder width apart.
• • One leg is straight behind the other, with their heel in contact with the floor and the toes pointing straight ahead.
• • Patient leans forward, keeping their back straight, until they feel a stretch in the calf.
• • Hold for 30-60 seconds.
• Soleus Stretch:
• • Patient lies prone on the treatment table with one knee flexed to 90 degrees.
• • The clinician dorsiflexes the foot as far as possible.
• • The clinician supports the bent leg with one hand and wraps the other around the heel with the forearm resting against the sole of the foot.
• • Patient relaxes and inhales deeply while maintaining the foot in the starting position.
• • On exhale, the clinician eases into the soleus stretch.
• • Hold for 30-60 seconds.
• Tibialis Anterior Stretch:
• • Patient lies supine on the table with the ankle plantarflexed.
• • The clinician cups the heel with one hand and holds the top of the foot with the other hand.
• • Patient relaxes and inhales deeply while maintaining the foot in the starting position.
• • On exhale, the clinician eases into the tibialis anterior stretch.
• • Hold for 30-60 seconds.
• Peroneal Stretch (Evertors):
• • Patient lies supine on the table with the ankle inverted, keeping the ankle in neutral relative to dorsiflexion or plantarflexion.
• • Clinician grasps the lower leg with one hand to stabilize it, and places the other hand against the lateral side of the foot.
• • Patient relaxes and inhales deeply while maintaining the foot in the starting position.
• • On exhale, the clinician eases into the peroneal stretch.
• • Hold for 30-60 seconds.
• Tibialis Posterior Stretch (Invertor):
• • Patient lies supine on the table with the ankle everted, keeping the ankle in neutral relative to dorsiflexion or plantarflexion.
• • Clinician grasps the lower leg with one hand to stabilize it, and places the other hand against the medial side of the foot.
• • Patient relaxes and inhales deeply while maintaining the foot in the starting position.
• • On exhale, the clinician eases into the tibialis posterior stretch.
• • Hold for 30-60 seconds.