Manual Therapy Concepts and History

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Questions and Answers

What is the primary characteristic of manual therapy as defined in the provided text?

  • It is characterized by the application of externally generated force via the hands. (correct)
  • It primarily focuses on pharmacological interventions for pain management.
  • It relies on patient-generated movements to restore function.
  • It involves the use of electrical modalities to stimulate tissue healing.

Historically, 'bone setters' in various cultures such as Nepal, Russia, and Norway are an example of what?

  • Ancient physicians focused on pharmacological treatments for bone diseases.
  • Early practitioners of surgical orthopedic procedures.
  • A precursor to modern physiotherapy employing manual therapy techniques. (correct)
  • Traditional healers who primarily used herbal remedies.

Which historical figure is specifically mentioned as utilizing manipulation and traction as therapeutic techniques?

  • Hippocrates (correct)
  • Adam Squires
  • Kerry
  • Andrew Taylor Still

During the 16th to 19th centuries, what was a common trend among physicians regarding manual therapy?

<p>They frequently referenced Hippocrates in their writings on manipulation. (A)</p> Signup and view all the answers

What was Andrew Taylor Still's core belief regarding manipulation when he established the American Osteopathic College in 1892?

<p>Manipulation could cure diseases by improving the function of the 'disturbed artery'. (C)</p> Signup and view all the answers

Which of the following is categorized as a touch-based intervention within the realm of manual therapy?

<p>Joint manipulation (A)</p> Signup and view all the answers

According to the definition provided, what is the intended outcome of applying externally generated force in manual therapy?

<p>To achieve a therapeutic intent. (C)</p> Signup and view all the answers

While the mechanisms of pain relief are not detailed, what can be inferred as the overall goal of manual therapy based on its definition and historical context?

<p>To achieve pain relief and improve function through physical intervention. (B)</p> Signup and view all the answers

What effect do opioids have on neuronal signaling?

<p>Decrease temporal and spatial summation. (A)</p> Signup and view all the answers

The dorsal horn's activity is reduced as part of a pain modulation mechanism. Which pathway is primarily responsible for this reduction?

<p>Descending inhibitory pathways. (C)</p> Signup and view all the answers

Daniel David Palmer's primary contribution to manual therapy is best described as the development of:

<p>chiropractic medicine based on vertebral subluxation affecting nerve impulses. (C)</p> Signup and view all the answers

According to the Gate Control Theory of Pain, what spinal cord mechanism is associated with a 'closed gate' and reduced pain perception?

<p>Decreased activity in the dorsal horn. (B)</p> Signup and view all the answers

In the context of pain modulation, what is the outcome of decreased activity in pain processing regions of the brain?

<p>Reduced pain perception. (C)</p> Signup and view all the answers

James Henry Cyriax is credited with establishing a systematic approach to diagnosis in orthopedic medicine through:

<p>introducing 'selective tissue tension testing' for logical differential diagnosis. (D)</p> Signup and view all the answers

Maitland's significant contribution to manual therapy involved:

<p>promoting mobilization as a gentler alternative to manipulation and developing a grading system. (B)</p> Signup and view all the answers

Which term describes the movement occurring between joint surfaces, such as roll, slide, and spin?

<p>Arthrokinematics. (A)</p> Signup and view all the answers

The International Federation for Orthopedic Manual Therapy (IFOMT) was established in:

<ol start="1970"> <li>(A)</li> </ol> Signup and view all the answers

Flexion, extension, abduction, and adduction are examples of movements described by which kinematic term?

<p>Osteokinematics. (B)</p> Signup and view all the answers

What is the primary purpose of combining rolling, sliding, and spinning motions at joints?

<p>To produce desired limb or trunk movements. (C)</p> Signup and view all the answers

Achieving the credential FAAOMPT is possible after completing:

<p>an accredited Orthopedic Manual Physical Therapy (OMPT) fellowship. (D)</p> Signup and view all the answers

According to the provided information, the fundamental mechanism initiating the effects of manual therapy is:

<p>a mechanical force triggering neurophysiological responses. (A)</p> Signup and view all the answers

How do arthrokinematics and osteokinematics relate to each other in joint movement?

<p>Arthrokinematics is a component of osteokinematic movements. (A)</p> Signup and view all the answers

Transient biomechanical effects of manual therapy are primarily evidenced by:

<p>short-term improvements in joint mobility. (A)</p> Signup and view all the answers

Which of the following is an example of an arthrokinematic movement?

<p>Femoral head spinning in the acetabulum during hip rotation. (B)</p> Signup and view all the answers

Based on the text, what is the current understanding regarding lasting joint position change after manual therapy?

<p>Evidence does not support lasting changes in joint position. (B)</p> Signup and view all the answers

If a patient is experiencing reduced pain sensation due to the activation of descending inhibitory pathways, which of the following mechanisms is most likely involved at the dorsal horn?

<p>Decreased activity of neurons transmitting pain signals. (C)</p> Signup and view all the answers

Manual therapy's effect on cytokines in the periphery is described as:

<p>decreasing cytokines, which are inflammatory chemicals released following injury. (C)</p> Signup and view all the answers

The release of endogenous opioids following manual therapy contributes to pain reduction by:

<p>decreasing nerve ending sensitivity and nociceptive load to the brain. (C)</p> Signup and view all the answers

Which mobilization grade, according to the provided information, is characterized by large amplitude oscillations performed up to the point of tissue resistance?

<p>Grade III (C)</p> Signup and view all the answers

According to Cyriax's definition provided, what is the primary characteristic of manipulation?

<p>A passive movement performed at a joint with therapeutic intent, using manual methods. (B)</p> Signup and view all the answers

In the context of this class, how is 'mobilization' distinct from 'manipulation' based on the descriptions provided?

<p>Mobilization is considered a low speed, oscillatory movement, while manipulation is defined as a high velocity, low amplitude thrust technique. (D)</p> Signup and view all the answers

According to Maitland's definition, which characteristic is essential for a movement to be considered manipulation?

<p>It must be a small amplitude, rapid movement that the patient cannot prevent. (D)</p> Signup and view all the answers

Which of the following is NOT explicitly stated as an objective of the module on manual therapy, according to the provided information?

<p>Analyzing the biomechanical effects of manual therapy on articular cartilage. (D)</p> Signup and view all the answers

In arthrokinematics, if a convex joint surface moves on a concave joint surface, in which direction does the glide occur relative to the roll?

<p>Opposite direction (A)</p> Signup and view all the answers

According to the principles of joint mobilization, which component of joint arthrokinematics is primarily targeted to improve motion and reduce pain?

<p>Glide/slide (B)</p> Signup and view all the answers

The convex-concave rules of arthrokinematics are best described as:

<p>General rules that may not always apply due to other factors (C)</p> Signup and view all the answers

Which of the following is an indication for joint mobilization?

<p>Muscle guarding/spasm (C)</p> Signup and view all the answers

Which condition is a contraindication for joint mobilization, particularly manipulation techniques?

<p>Osteoporosis (A)</p> Signup and view all the answers

Long-term corticosteroid use is listed as a precaution for joint mobilization because it can lead to:

<p>Weakened connective tissue (A)</p> Signup and view all the answers

According to the provided definition, joint mobilization is characterized by being:

<p>Passive and applied by a skilled therapist (B)</p> Signup and view all the answers

In the Maitland grading system for mobilization, Grade V is also known as:

<p>High-velocity, low-amplitude thrust (HVLAT) (B)</p> Signup and view all the answers

A patient presents with pain and limited range of motion due to joint stiffness, but also exhibits hyperalgesia. Considering the indications and precautions, which approach is MOST appropriate?

<p>Proceed with gentle mobilization techniques as tolerated, respecting the hyperalgesia. (A)</p> Signup and view all the answers

Which of the following is NOT explicitly listed as a contraindication for joint mobilization in the provided text?

<p>Acute inflammation (B)</p> Signup and view all the answers

Flashcards

Manual Therapy

The use of hands to apply force to the body, aiming to improve function and relieve pain.

Joint Mobilization

A type of touch-based intervention that aims to improve joint movement and flexibility.

Joint Manipulation

A type of touch-based intervention where a quick, forceful thrust is delivered to the joint.

Soft Tissue Mobilization

A type of manual therapy focusing on the muscles, tendons, ligaments, and fascia.

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Neurodynamic Movements

A type of manual therapy that involves moving the nerves to improve their function.

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Osteopathic Principle

The idea that manipulating joints can improve blood flow and therefore improve health.

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Joint Kinematics

The movements of a joint during motion, described as roll and slide actions.

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Convex/Concave Rule

A set of rules that describe how the convex and concave surfaces of a joint move relative to each other.

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Chiropractic Medicine

A field in medicine that focuses on the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system, primarily through manual techniques.

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Subluxation

A misalignment of a vertebra that can affect nerve impulses, leading to various symptoms.

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Textbook of Orthopedic Medicine, Volume I

A foundational textbook in orthopedic medicine that introduced a structured approach to diagnosis.

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Selective Tissue Tension Testing

A specific technique used in orthopedic medicine for diagnosis that assesses the tension of different tissues to identify the source of pain.

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Mobilization

Manual therapy technique involving gentle, controlled movements to restore joint mobility and reduce pain.

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Maitland Grades

A system of graded movements used in mobilization, ranging from small, passive movements to forceful manipulations.

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International Federation for Orthopedic Manual Therapy (IFOMT)

An international organization dedicated to promoting and developing orthopedic manual therapy.

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American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)

A professional organization for physical therapists specializing in orthopedic manual therapy in the United States.

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FAAOMPT

The credential awarded to physical therapists who complete an accredited fellowship in orthopedic manual therapy.

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Mechanisms of Manual Therapy

The effects of manual therapy on the body, including biomechanical changes, the release of neurochemicals, and the reduction of inflammation.

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Temporal and Spatial Summation

The combined effect of multiple signals arriving at a neuron, resulting in a stronger or weaker response.

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Temporal Summation

A type of neuron activation where multiple signals arrive at the neuron in a short period of time, increasing the overall signal strength.

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Spatial Summation

A type of neuron activation where multiple signals arrive at the neuron from different locations, increasing the overall signal strength.

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Opioid Receptors

Specific receptors in the nervous system that bind to opioids, leading to pain relief and other effects.

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Dorsal Horn

The area of the spinal cord that receives sensory information from the body, including pain.

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Gate Control Theory of Pain

A theory that explains how pain signals are modulated in the spinal cord, involving a 'gate' that can open or close to allow or block pain signals.

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Osteokinematics

The movement of bones around a joint, such as flexion, extension, abduction, etc.

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Arthrokinematics

The movement of joint surfaces relative to each other, including rolling, sliding, and spinning.

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Pain Processing Regions

Areas of the brain responsible for processing pain signals.

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Convex on Concave Rule

When a convex joint surface moves on a concave joint surface, the roll and glide movements occur in opposite directions. Imagine a ball rolling on a flat surface, the ball rolls forward and glides backward.

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Concave on Convex Rule

When a concave joint surface moves on a convex joint surface, the roll and glide movements occur in the same direction. Imagine a cup moving on a ball - they move in the same direction.

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Joint Mobilization Focus

Joint mobilization techniques primarily focus on the gliding or sliding movement of the joint surfaces to improve mobility and reduce pain.

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Convex/Concave Rules: Not Absolute

While the convex/concave rules provide a general guideline, the direction of the glide during mobilization is less important than the mechanical stimulus applied to the joint.

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Maitland Grading System

A graded system developed by Maitland to classify joint mobilization techniques based on the amplitude and speed of movement. Grades I-IV represent different levels of force and movement, while Grade V involves a high-velocity, low-amplitude thrust.

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Grade V Mobilization (Manipulation)

A specific joint mobilization technique involving a forceful, quick movement to restore joint motion. It's considered a high-velocity, low-amplitude thrust (HVLAT).

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Indications for Joint Mobilization

Pain, muscle guarding, limited range of motion, and functional limitations are common indications for using joint mobilization techniques.

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Contraindications for Joint Mobilization

Conditions such as malignancy, osteoporosis, unhealed fractures, acute injury with uncertain severity, and patient refusal are contraindications for joint mobilization.

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Precautions for Joint Mobilization

Situations like hyperalgesia, hypermobility, weakened connective tissue, long-term corticosteroid use, post-surgery, disuse, and rheumatoid arthritis require caution when using joint mobilization techniques.

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Study Notes

Introduction to Manual Therapy

  • Manual therapy is the deliberate application of external force to body tissues, typically via the hands, with therapeutic intent.
  • The use of manual therapy dates thousands of years back, with early practitioners known as "bone setters".
  • Hippocrates, and other physicians, frequently referenced manual manipulation in their works.

Objectives of Manual Therapy

  • Understanding the definition and brief history of manual therapy in orthopedic conditions.
  • Understanding the current evidence on the mechanisms of pain relief during manual therapy treatment.
  • Reviewing joint kinematics with emphasis on roll/slide movements and convex/concave rules.
  • Understanding the differences between joint mobilization and joint manipulation.

Mechanisms of Manual Therapy

  • Mechanical force initiates a chain of neurophysiological responses, leading to outcomes associated with manual therapy.
  • Manual therapy can result in transient improvements in joint mobility, but typically do not produce lasting change in joint position.
  • Force is dissipated across a large area, making specific structures difficult to target effectively, also showing low reliability during palpation.
  • Cytokine levels decrease, initiating the release of endogenous opioids (endorphins, serotonin, cannabinoids).
  • This can reduce sensitivity in nerve endings, decreasing pain processing in the brain.
  • Decreased activity at the dorsal horn, via descending inhibitory pathways or changes in pain processing regions in the brain, reduces neuronal activation. This includes decreasing activation in the dorsal horn, and pain processing regions.

Definitions

  • Definition of Manual Therapy: "The deliberate application of externally generated force upon body tissue, typically via the hands, with therapeutic intent".
  • Touch-based interventions: Include mobilization, manipulation, soft tissue mobilization, and neurodynamic movements.

History

  • Andrew Taylor Still: Founded the American Osteopathic College in 1892, believed manipulation improved the function of the disturbed artery.
  • Daniel David Palmer: Developed Chiropractic Medicine, focusing on vertebrae misalignment (subluxation) affecting nerve impulses, and leads to disease. 
  • James Henry Cyriax: Published a textbook on orthopedic medicine in 1954, laying out a method for logical, clinically reasoned diagnosis.
  • Maitland: Popularized mobilization as an alternative to manipulation. Developed grades of mobilization.
  • The evolution of Manual Therapy is associated with different practitioners and philosophies.

History of International Organizations

  • International Federation of Orthopedic Manual Therapy (IFOMT) was established in 1970, and the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) was established in 1992.
  • Successfully completing the OMPT fellowship allows practitioners to obtain the credential FAAOMPT.
  • Manual therapy is now an integral part of physical therapy practice.

Indications, Contraindications & Precautions in Manual Therapy

  • Indications:*
  • Pain
  • Muscle guarding/spasm
  • ROM limitations
  • Functional Immobility
  • Contraindications:*
  • Malignancy
  • Osteopenia/Osteoporosis
  • Unhealed fracture/unhealed fusion
  • Acute injury related to severity of damage.  
  • Patient refusal
  • Precautions:*
  • Hyperalgesia/Allodynia
  • Hypermobility
  • Weakened connective tissues
  • History of long-term corticosteroid use
  • Immediately after surgery
  • Disuse
  • Rheumatoid Arthritis

Joint Kinematics

  • Motions at joints combine rolling, sliding, and/or spinning, to generate desired limb or trunk movements.
  • Arthrokinematics describes the movement at joint surfaces.
  • Osteokinematics refers to bone movements.

Arthrokinematic Rules

  • Convex moving on concave: Opposite roll and glide.
  • Concave moving on convex: Same roll and glide.

Joint Mobilization

  • Mobilization techniques primarily focus on the glide/slide motion at a joint, to improve mobility and modulate pain.
  • The direction of glide is less important than the mechanical stimulus.
  • Previous discussion in this study guide can help to understand the fundamental principles of joint mobilization.

Manipulation

  • Cyriax defines Manipulation as a method to provide passive joint movement with therapeutic intent.
  • Maitland defines Manipulation as a short-amplitude, rapid movement that is performed at a joint. A joint movement the patient cannot prevent from taking place.
  • Manipulation can be used interchangeably with mobilization but usually refers to high velocity, low amplitude techniques applied to joints.
  • Manipulation techniques are often used for the spine, and other peripheral joints.

Grades of Mobilization

  • Maitland Grades I-IV: Passive movement techniques at a joint, designed to vary in speed and amplitude, with Grade V being considered manipulation.
  • Kaltenborn Grades: Also grades of mobilization, where the practitioner will focus on available joint play and tissue resistance.

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