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Questions and Answers
What is the primary focus of joint mobilizations in arthrokinematics?
What is the primary focus of joint mobilizations in arthrokinematics?
Which rule applies when there is convex moving on concave surfaces?
Which rule applies when there is convex moving on concave surfaces?
Which condition is a contraindication for joint mobilization?
Which condition is a contraindication for joint mobilization?
What is a precaution to consider during joint mobilization?
What is a precaution to consider during joint mobilization?
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According to Maitland's grading system, what does Grade V mobilization refer to?
According to Maitland's grading system, what does Grade V mobilization refer to?
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What is the primary therapeutic intent of manual therapy?
What is the primary therapeutic intent of manual therapy?
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Which of the following accurately represents the historical contribution of Hippocrates to manual therapy?
Which of the following accurately represents the historical contribution of Hippocrates to manual therapy?
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What significant development in manual therapy history occurred in 1892?
What significant development in manual therapy history occurred in 1892?
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Which statement about joint kinematics is emphasized in the context of manual therapy?
Which statement about joint kinematics is emphasized in the context of manual therapy?
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What is NOT one of the types of interventions mentioned in manual therapy?
What is NOT one of the types of interventions mentioned in manual therapy?
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What role do opioid receptors play in the modulation of pain?
What role do opioid receptors play in the modulation of pain?
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Which mechanism is associated with decreased activity in the dorsal horn?
Which mechanism is associated with decreased activity in the dorsal horn?
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Which of the following best describes osteokinematics?
Which of the following best describes osteokinematics?
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How is decreased pain perception related to the gate control theory?
How is decreased pain perception related to the gate control theory?
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Which of the following describes the role of temporal and spatial summation in neuronal activation?
Which of the following describes the role of temporal and spatial summation in neuronal activation?
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Who developed chiropractic medicine?
Who developed chiropractic medicine?
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What is selective tissue tension testing?
What is selective tissue tension testing?
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What did Maitland contribute to manual therapy?
What did Maitland contribute to manual therapy?
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What was established in 1970 in the field of manual therapy?
What was established in 1970 in the field of manual therapy?
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Which effect of manual therapy involves short-term joint mobility improvement?
Which effect of manual therapy involves short-term joint mobility improvement?
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How do endogenous opioids affect pain processing?
How do endogenous opioids affect pain processing?
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What is necessary to initiate a chain of neurophysiological responses in manual therapy?
What is necessary to initiate a chain of neurophysiological responses in manual therapy?
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What evidence exists for lasting joint position change in manual therapy?
What evidence exists for lasting joint position change in manual therapy?
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What characterizes a Grade II mobilization?
What characterizes a Grade II mobilization?
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Which grade of mobilization is associated with theoretically achieving capsular stretch?
Which grade of mobilization is associated with theoretically achieving capsular stretch?
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Which description best matches Maitland's definition of manipulation?
Which description best matches Maitland's definition of manipulation?
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According to the Guide to Physical Therapist Practice, what does manipulation involve?
According to the Guide to Physical Therapist Practice, what does manipulation involve?
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What is the main clinical application difference between mobilization and manipulation according to the class description?
What is the main clinical application difference between mobilization and manipulation according to the class description?
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Which grade of mobilization is typically used for patients with high symptom irritability?
Which grade of mobilization is typically used for patients with high symptom irritability?
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What is a common misconception regarding the interchangeability of mobilization and manipulation?
What is a common misconception regarding the interchangeability of mobilization and manipulation?
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In what scenario is Grade IV mobilization typically applied?
In what scenario is Grade IV mobilization typically applied?
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Flashcards
Joint Kinematics
Joint Kinematics
The combined movements of rolling, sliding, and spinning that occur at a joint to produce limb or trunk movement.
Arthrokinematics
Arthrokinematics
The specific movements occurring at the joint surfaces. Examples include rolling, sliding, and spinning.
Osteokinematics
Osteokinematics
The movement of bones around a joint. Examples include flexion, extension, abduction, etc.
Manual Therapy
Manual Therapy
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Joint Mobilization
Joint Mobilization
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Joint Manipulation
Joint Manipulation
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Soft Tissue Mobilization
Soft Tissue Mobilization
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Neurodynamic Movements
Neurodynamic Movements
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Convex on Concave Rule
Convex on Concave Rule
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Concave on Convex Rule
Concave on Convex Rule
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Indications for Joint Mobilization
Indications for Joint Mobilization
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Contraindications for Joint Mobilization
Contraindications for Joint Mobilization
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Daniel David Palmer
Daniel David Palmer
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James Henry Cyriax
James Henry Cyriax
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Geoffrey Maitland
Geoffrey Maitland
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International Federation for Orthopedic Manual Therapy (IFOMT)
International Federation for Orthopedic Manual Therapy (IFOMT)
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American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)
American Academy of Orthopaedic Manual Physical Therapists (AAOMPT)
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How does Manual Therapy work?
How does Manual Therapy work?
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Transient Biomechanical Effects of Manual Therapy
Transient Biomechanical Effects of Manual Therapy
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Pain relief mechanisms of Manual Therapy
Pain relief mechanisms of Manual Therapy
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Mobilization
Mobilization
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Manipulation
Manipulation
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Grade I Mobilization
Grade I Mobilization
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Grade II Mobilization
Grade II Mobilization
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Grade III Mobilization
Grade III Mobilization
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Grade IV Mobilization
Grade IV Mobilization
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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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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.