Podcast
Questions and Answers
What is a core element of the definition of manual therapy?
What is a core element of the definition of manual therapy?
Which historical figure is significantly associated with the development of osteopathic medicine and its emphasis on manipulation?
Which historical figure is significantly associated with the development of osteopathic medicine and its emphasis on manipulation?
Who, besides physicians, practiced manual therapy historically?
Who, besides physicians, practiced manual therapy historically?
In what time period did physicians begin documenting manipulation techniques in textbooks, often citing Hippocrates?
In what time period did physicians begin documenting manipulation techniques in textbooks, often citing Hippocrates?
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What did Andrew Taylor Still believe manipulation could achieve?
What did Andrew Taylor Still believe manipulation could achieve?
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What effect does decreased activity at the dorsal horn have on pain perception?
What effect does decreased activity at the dorsal horn have on pain perception?
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When a convex surface moves on a concave surface, how do the roll and glide movements relate to each other?
When a convex surface moves on a concave surface, how do the roll and glide movements relate to each other?
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Which mechanism is NOT involved in reducing the perception of pain?
Which mechanism is NOT involved in reducing the perception of pain?
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Which of the following is NOT a contraindication for joint mobilization?
Which of the following is NOT a contraindication for joint mobilization?
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Which joint movement is described as the movement around the joint surfaces?
Which joint movement is described as the movement around the joint surfaces?
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What is the primary focus of joint mobilizations in therapy?
What is the primary focus of joint mobilizations in therapy?
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What are the movements involved in osteokinematics?
What are the movements involved in osteokinematics?
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Which of the following correctly describes the gate control theory of pain?
Which of the following correctly describes the gate control theory of pain?
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Which of the following conditions makes joint mobilization a precaution rather than a contraindication?
Which of the following conditions makes joint mobilization a precaution rather than a contraindication?
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What grading system is used to categorize mobilization techniques according to Maitland?
What grading system is used to categorize mobilization techniques according to Maitland?
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What is the primary purpose of Grade I mobilization?
What is the primary purpose of Grade I mobilization?
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Which grade of mobilization is characterized by a large amplitude oscillation up to and through tissue resistance?
Which grade of mobilization is characterized by a large amplitude oscillation up to and through tissue resistance?
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In the context of mobilization and manipulation, how does the class differentiate between the two techniques?
In the context of mobilization and manipulation, how does the class differentiate between the two techniques?
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According to Maitland, how is manipulation defined?
According to Maitland, how is manipulation defined?
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Which technique is most often directed to the spine, but can also be used for peripheral joints?
Which technique is most often directed to the spine, but can also be used for peripheral joints?
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Which mobilization grade is associated with small amplitude movements at and through tissue resistance?
Which mobilization grade is associated with small amplitude movements at and through tissue resistance?
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What is a key component of the Guide to Physical Therapist Practice's definition of mobilization/manipulation?
What is a key component of the Guide to Physical Therapist Practice's definition of mobilization/manipulation?
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Which grade of mobilization is most appropriate for moderate to low irritability with the aim of capsular stretch?
Which grade of mobilization is most appropriate for moderate to low irritability with the aim of capsular stretch?
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Who is credited with developing chiropractic medicine?
Who is credited with developing chiropractic medicine?
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What is the core principle of chiropractic medicine?
What is the core principle of chiropractic medicine?
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James Henry Cyriax is known for which contribution to orthopedic medicine?
James Henry Cyriax is known for which contribution to orthopedic medicine?
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What did Maitland contribute to the field of manual therapy?
What did Maitland contribute to the field of manual therapy?
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When was the International Federation for Orthopedic Manual Therapy (IFOMT) established?
When was the International Federation for Orthopedic Manual Therapy (IFOMT) established?
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What credential can be earned upon completing an accredited OMPT fellowship?
What credential can be earned upon completing an accredited OMPT fellowship?
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What is a key finding regarding the transient biomechanical effects of manual therapy?
What is a key finding regarding the transient biomechanical effects of manual therapy?
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How does manual therapy influence cytokines and endogenous opioids?
How does manual therapy influence cytokines and endogenous opioids?
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Study Notes
Introduction to Manual Therapy
- Manual therapy is a deliberate application of force on body tissue, typically with the hands, for a therapeutic purpose. (Kerry 2024)
- It involves touch-based interventions, including mobilization, manipulation, soft tissue mobilization, and neurodynamic movements.
Objectives
- Understand the definition and brief history of manual therapy in treating orthopedic conditions.
- Understand the current evidence on how manual therapy relieves pain.
- Review joint kinematics, emphasizing roll/slide movements and convex/concave rules.
- Define joint mobilization and manipulation.
History of Manual Therapy
- Evidence for manual therapy dates back thousands of years, including practitioners known as "bone setters" in various cultures (Nepal, Russia, Norway, etc.).
- Hippocrates described manipulation and traction techniques in the 16th-19th centuries.
- Multiple physicians in textbooks referenced Hippocrates' work.
- In 1892, Andrew Taylor Still established the American Osteopathic College, believing manipulation could cure disease by improving blood flow to the "disturbed artery".
- Daniel David Palmer developed chiropractic medicine, focusing on vertebral subluxations affecting nerve impulses and leading to disease.
- James Henry Cyriax published a textbook of orthopedic medicine in 1954, creating a logical and clinically reasoned method for differential diagnosis, known as "selective tissue tension testing."
- Maitland popularized mobilizations as an alternative to manipulation, developing grades I-V for mobilization.
- The International Federation for Orthopedic Manual Therapy (IFOMT) was established in 1970, and the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) in 1992.
- Manual therapy is now recognized as an integral part of physical therapy.
Mechanisms of Manual Therapy
- Manual therapy involves a chain of neurophysiological responses initiated by a mechanical force.
- This can result in transient biomechanical effects, including short-term improvements in joint mobility.
- There's no evidence for long-lasting positional changes resulting from manual therapy.
- The precision of specific techniques is limited, as force is dissipated over a large area, with poor validity and reliability in palpating specific structures.
- The choice of technique doesn't seem to significantly affect outcomes for most patients.
- Finding patients who respond to manual therapy is more important than the technique used.
- Manual therapy can reduce cytokines and release opioids (beta-endorphin, serotonin, cannabinoids) in the periphery. This has the effect of decreasing nerve ending sensitivity and nociceptive load in the pain processing regions of the brain, leading to less temporal and spatial summation.
- Neuron activation occurs reducing activity in the dorsal horn.
- This occurs through descending inhibitory pathways and through the gate control theory, which reduces activity in pain processing regions of the brain.
What Manual Therapy Can and Cannot Do
- Can: Transient biomechanical effects, decrease activation of supraspinal regions, reduce cytokines, release endogenous cannabinoids, decreased spinal activity, and increased dopamine production.
- Cannot: Detect the precise cause of pain, lengthen all tissues, adjust joints, fully restore normal function.
Joint Kinematics
- Joint motion combines rolling, sliding, and spinning to produce movement.
- Arthrokinematics describes movements at joint surfaces (roll, slide/glide, spin), differentiating from osteokinematics (bone movement).
- Convex moving on concave; roll and glide are opposite.
- Concave moving on convex; roll and glide are the same.
Joint Mobilization
- Mobilization focuses on the glide/slide portions of joint arthrokinematics to improve motion and modulate pain.
- Convex/concave rules are not always strictly followed.
- The direction of glide is less important than the mechanical stimulus.
Indications, Contraindications, and Precautions
- Indications*: Pain, muscle guarding/spasm, ROM limitations, functional immobility
- Contraindications*: Malignancy, osteopenia/osteoporosis, manipulation on unhealed fractures/fusions, acute injury with uncertain severity of damage, patient refusal
- Precautions*: Hyperalgesia/Allodynia, hypermobility, weakened connective tissue, long-term corticosteroid use, immediately after surgery, disuse, Rheumatoid arthritis
Manipulation
- Cyriax defines manipulation as passive joint movement with a therapeutic purpose, using the hands.
- Maitland defines manipulation as a small amplitude, high-velocity movement, often at the limit of range of motion.
- Mobilization and manipulation are sometimes used interchangeably. Manipulation is often used for high-velocity low-amplitude thrusts (particularly in relation to the spine).
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Description
This quiz covers the essentials of manual therapy, including its definition, history, and therapeutic applications for orthopedic conditions. You'll explore evidence supporting its effectiveness and review key concepts like joint mobilization and manipulation. Test your knowledge on the principles of manual therapy and its historical significance.
