Manual Therapy Overview
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Questions and Answers

What is the primary focus of joint mobilizations in arthrokinematics?

  • Flexion
  • Glide/Slide (correct)
  • Roll
  • Rotation
  • Which rule applies when there is convex moving on concave surfaces?

  • Roll and glide are opposite (correct)
  • Flexion and extension are the same
  • Roll and glide are the same
  • Flexion and extension are opposite
  • Which condition is a contraindication for joint mobilization?

  • Muscle spasm
  • Acute injury with uncertain severity (correct)
  • Range of Motion (ROM) limitations
  • Long-term corticosteroid use
  • What is a precaution to consider during joint mobilization?

    <p>Hypermobility (D)</p> Signup and view all the answers

    According to Maitland's grading system, what does Grade V mobilization refer to?

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

    What is the primary therapeutic intent of manual therapy?

    <p>Application of externally generated force (B)</p> Signup and view all the answers

    Which of the following accurately represents the historical contribution of Hippocrates to manual therapy?

    <p>Pioneering work in manipulation and traction (C)</p> Signup and view all the answers

    What significant development in manual therapy history occurred in 1892?

    <p>Establishment of the American Osteopathic College (A)</p> Signup and view all the answers

    Which statement about joint kinematics is emphasized in the context of manual therapy?

    <p>Emphasis on roll/slide movements and convex/concave rules (D)</p> Signup and view all the answers

    What is NOT one of the types of interventions mentioned in manual therapy?

    <p>Joint stabilization surgery (B)</p> Signup and view all the answers

    What role do opioid receptors play in the modulation of pain?

    <p>They activate descending inhibitory pathways decreasing pain. (B)</p> Signup and view all the answers

    Which mechanism is associated with decreased activity in the dorsal horn?

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

    Which of the following best describes osteokinematics?

    <p>Movement of bones around a joint such as flexion and extension. (B)</p> Signup and view all the answers

    How is decreased pain perception related to the gate control theory?

    <p>The gate closes, preventing pain signals from reaching higher brain centers. (B)</p> Signup and view all the answers

    Which of the following describes the role of temporal and spatial summation in neuronal activation?

    <p>They enhance the combined effects of multiple synaptic inputs. (A)</p> Signup and view all the answers

    Who developed chiropractic medicine?

    <p>Daniel David Palmer (B)</p> Signup and view all the answers

    What is selective tissue tension testing?

    <p>A method for logical, clinically reasoned differential diagnosis (C)</p> Signup and view all the answers

    What did Maitland contribute to manual therapy?

    <p>Popularized the use of mobilization as an alternative to manipulation (C)</p> Signup and view all the answers

    What was established in 1970 in the field of manual therapy?

    <p>International Federation for Orthopedic Manual Therapy (C)</p> Signup and view all the answers

    Which effect of manual therapy involves short-term joint mobility improvement?

    <p>Transient biomechanical effects (B)</p> Signup and view all the answers

    How do endogenous opioids affect pain processing?

    <p>They decrease nerve ending sensitivity and nociceptive load (A)</p> Signup and view all the answers

    What is necessary to initiate a chain of neurophysiological responses in manual therapy?

    <p>Mechanical force (B)</p> Signup and view all the answers

    What evidence exists for lasting joint position change in manual therapy?

    <p>No evidence (C)</p> Signup and view all the answers

    What characterizes a Grade II mobilization?

    <p>Large amplitude oscillation within available motion (D)</p> Signup and view all the answers

    Which grade of mobilization is associated with theoretically achieving capsular stretch?

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

    Which description best matches Maitland's definition of manipulation?

    <p>A small amplitude, rapid movement not prevented by the patient (D)</p> Signup and view all the answers

    According to the Guide to Physical Therapist Practice, what does manipulation involve?

    <p>A continuum of passive movements of varying speeds and amplitudes (A)</p> Signup and view all the answers

    What is the main clinical application difference between mobilization and manipulation according to the class description?

    <p>Mobilization is for low speed, oscillatory movements, while manipulation is for high velocity, low amplitude thrusts (D)</p> Signup and view all the answers

    Which grade of mobilization is typically used for patients with high symptom irritability?

    <p>Grade I and II (A)</p> Signup and view all the answers

    What is a common misconception regarding the interchangeability of mobilization and manipulation?

    <p>They are used interchangeably but differ in speed and amplitude (D)</p> Signup and view all the answers

    In what scenario is Grade IV mobilization typically applied?

    <p>Small amplitude at and through tissue resistance (A)</p> Signup and view all the answers

    Flashcards

    Joint Kinematics

    The combined movements of rolling, sliding, and spinning that occur at a joint to produce limb or trunk movement.

    Arthrokinematics

    The specific movements occurring at the joint surfaces. Examples include rolling, sliding, and spinning.

    Osteokinematics

    The movement of bones around a joint. Examples include flexion, extension, abduction, etc.

    Manual Therapy

    The deliberate use of hands to apply force to body tissues, with the goal of improving health.

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    Joint Mobilization

    A type of manual therapy that involves gentle movements to improve joint mobility.

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    Joint Manipulation

    A type of manual therapy that involves a quick, forceful movement to restore joint movement.

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    Soft Tissue Mobilization

    Manual therapy techniques used to improve the function of soft tissues, like muscles and fascia.

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    Neurodynamic Movements

    A set of exercises and movements that help to restore the function of the nervous system.

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    Convex on Concave Rule

    When a convex surface moves on a concave surface, the roll and glide directions are opposite.

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    Concave on Convex Rule

    When a concave surface moves on a convex surface, the roll and glide directions are the same.

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    Indications for Joint Mobilization

    Indications for joint mobilization include pain, muscle guarding, restricted range of motion, and functional limitations.

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    Contraindications for Joint Mobilization

    Contraindications for joint mobilization include malignancy, osteopenia/ osteoporosis, unhealed fracture, acute injury with uncertain damage, and patient refusal.

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    Daniel David Palmer

    Developed Chiropractic Medicine. Believed that vertebrae misalignment (subluxation) affects nerve impulses, leading to disease.

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    James Henry Cyriax

    Published "Textbook of Orthopedic Medicine" in 1954. Developed a method for logical, clinically reasoned diagnosis called 'selective tissue tension testing'.

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    Geoffrey Maitland

    Popularized mobilization as an alternative to manipulation. Developed grades for mobilization, I-V, to quantify the intensity of the movement.

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    International Federation for Orthopedic Manual Therapy (IFOMT)

    Established in 1970. A global organization that promotes orthopedic manual therapy education and research.

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    American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)

    Founded in 1992. A U.S. organization focused on advancing orthopedic manual physical therapy.

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    How does Manual Therapy work?

    A mechanical force is applied to trigger a chain of neurophysiological responses, ultimately leading to therapeutic outcomes.

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    Transient Biomechanical Effects of Manual Therapy

    Manual therapy techniques can improve joint mobility temporarily, but do not demonstrably change joint position permanently.

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    Pain relief mechanisms of Manual Therapy

    Manual therapy triggers the release of endogenous opioids (like endorphins) and reduces inflammatory cytokines in the body, decreasing pain perception.

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    Mobilization

    A gentle, rhythmic movement applied to a joint, typically used to reduce pain and improve mobility.

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    Manipulation

    A high-speed, low-amplitude movement applied to a joint, typically used to restore joint motion.

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    Grade I Mobilization

    A type of mobilization that involves a small amplitude oscillation at the beginning of the joint's range of motion.

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    Grade II Mobilization

    A type of mobilization that involves a large amplitude oscillation within the available range of motion.

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    Grade III Mobilization

    A type of mobilization that involves a large amplitude oscillation up to and through the joint's resistance.

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    Grade IV Mobilization

    A type of mobilization that involves a small amplitude oscillation at and through the joint's resistance.

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    Study Notes

    Manual Therapy

    • Manual therapy is the deliberate application of force to body tissue, often with hands, used in treating orthopedic conditions.
    • Key figures in manual therapy history include "bone setters", Hippocrates, and multiple physicians who described manipulation and referenced Hippocrates.
    • Andrew Taylor Still, in 1892, established the American Osteopathic College, believing manipulation improved function of the disturbed artery.
    • Daniel David Palmer developed Chiropractic Medicine, linking vertebral misalignment (subluxation) to nerve impulses and disease.
    • James Henry Cyriax, in 1954, published a textbook of orthopedic medicine, laying out a logical method for differential diagnosis.
    • Maitland popularized mobilization as an alternative to manipulation and developed grades I-V for mobilization.
    • In 1970, the International Federation for Orthopedic Manual Therapy (IFOMT) was established and in 1992 the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) was formed.
    • Manual therapy qualifications often include certifications as a Board Certified specialist in Orthopedic Physical Therapy (or similar).
    • Manual therapy involves touch-based interventions like mobilization, manipulation, soft tissue mobilization, and neurodynamic movements.
    • The mechanisms of manual therapy may include release of endogenous opioids, decreased cytokines, and decreased activity in the dorsal horn via descending inhibitory pathways.
    • The mechanisms summed up to initiate a chain of neurophysiological responses which produce the outcomes of manual therapy.

    Objectives

    • Understand the definition and brief history of manual therapy in treating orthopedic conditions
    • Understand the evidence for the mechanisms of pain relief when utilizing manual therapy
    • Review joint kinematics with an emphasis on roll/slide movements and convex/concave rules
    • Understand the definitions of joint mobilization and manipulation.

    Definition

    • The deliberate application of externally generated force upon body tissue, typically via the hands, with therapeutic intent

    History

    • Evidence of manual therapy dates back thousands of years
    • Various cultures such as Nepal, Russia, and Norway used "bone setters".
    • Hippocrates documented manipulation and traction

    Mechanism

    • What has been your experience with manual therapy?
    • What have you heard described to patients?
    • What do you believe is happening?
    • Previous diagram summed up: "a mechanical force is necessary to initiate a chain of neurophysiological responses which produce the outcomes associated with MT (manual therapy)".

    Transient Biomechanical Effects

    • Evidence for short-term improvement in joint mobility
    • Limited evidence of lasting joint position change
    • Specific techniques lack precision
    • Force is dissipated across a large area
    • Palpation of specific structures has questionable validity and reliability
    • The choice of technique seems less important than finding a patient who responds positively.

    Decreased Cytokines, Release of endogenous opioids

    • Cytokines are inflammatory substances released after injury
    • Endogenous opioids like beta-endorphin, serotonin, and cannabinoids are released.
    • These opioids decrease nerve ending sensitivity and the nerve load on pain processing regions.
    • This results in decreased temporal and spatial summation.

    Neuron Activation

    • Neuron activation involves several stages:
    • Peak action potential
    • Repolarization
    • Threshold of excitation
    • Hyperpolarization
    • Resting potential

    Opioid Receptors

    • Opioid neurons contain endorphins and are affected by morphine
    • Presynaptic and postsynaptic opioid receptors affect pathways like the primary pain pathways.

    Decreased Activity at the Dorsal Horn

    • Spinal cord activity and decreased activity at the dorsal horn are aspects of manual therapy's mechanism.

    Decreased Activation of Pain Processing Regions

    • Pain processing occurs in several brain regions.
    • These include somatosensory cortex, insular cortex, thalamus, hippocampus, prefrontal cortex, anterior cingulate cortex, amygdala, and others.

    What Manual Therapy CAN and CAN'T Do

    • Manual therapy CAN produce transient biomechanical effects supporting improved mobility, decrease activation of the spinal areas for central pain processing, and decrease cytokines.
    • Manual therapy CAN NOT precisely locate the "cause" of pain, lengthen all specific tissues, or adjust every joint that needs manual therapy.

    Joint Kinematics

    • Movement at joints involves combined motions.
    • Arthrokinematics describes the relative motions of joint surfaces.
    • Osteokinematics describes the overall bone movement around the joint.
    • Possible movements include the roll, slide/glide, and spin.

    Arthrokinematic Rules

    • Convex moving on concave (one rounded bone surface moves on another concave surface, and the roll and glide are opposite directions)
    • Concave moving on convex(one concave bone surface moved on another convex surface, and the glide and roll are the same direction)

    Joint Mobilization

    • Mobilizations generally focus on glide/slide aspects of joint arthrokinematics to improve motion and pain modulation.
    • Correct direction of glide may be less important than the mechanical stimulus.

    Indications

    • Pain, muscle guarding/spasm, ROM limitations, and functional immobility.

    Contraindications

    • Malignancy, osteopenia/osteoporosis, unhealed fractures/fusions, acute injuries with unknown severity, and patient refusal.

    Precautions

    • Hyperalgesia/allodynia, hypermobility, weakened connective tissue, recent corticosteroid use, recent surgery, disuse, and rheumatoid arthritis.

    Mobilization

    • Skilled passive manual therapy techniques to joints and related soft tissues.
    • Maitland developed a grading system that uses different speeds and amplitudes.

    Grades of Mobilization

    • Includes low and large amplitude oscillation and movement with different degrees of pain modulation and tissue irritability.

    Manipulation

    • Defined as passive movement at a joint using hands or tools focused on the therapeutic purpose
    • Maitland defines it as a small amplitude rapid movement of a joint, allowing less control from the patient

    Questions

    • Questions are presented, but no answers are given.

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    Manual Therapy Intro PDF

    Description

    Explore the history and practices of manual therapy in this quiz. Learn about key figures like Hippocrates, Andrew Taylor Still, and Daniel David Palmer, and their contributions to the field. Understand various techniques and the evolution of orthopedic manual therapy.

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