Podcast
Questions and Answers
A patient presents with a chronic muscle strain. Which of the following best describes the initial step in applying strain-counterstrain technique?
A patient presents with a chronic muscle strain. Which of the following best describes the initial step in applying strain-counterstrain technique?
- Apply deep massage to the antagonistic muscle.
- Slowly stretch the affected muscle to its full length.
- Place the affected muscle in a position of maximal shortening. (correct)
- Instruct the patient to actively contract the affected muscle against resistance.
When performing joint mobilization within the context of physical medicine, which principle is most critical for ensuring patient safety and comfort?
When performing joint mobilization within the context of physical medicine, which principle is most critical for ensuring patient safety and comfort?
- Focusing solely on the area of pain, regardless of compensatory changes.
- Using forceful, rapid movements to break adhesions.
- Applying the mobilization beyond the joint's anatomical end range.
- Ensuring the movement is a passive therapeutic movement up to, but not exceeding, the anatomic end range of joint movement. (correct)
A patient is being treated for a muscle spasm using myofascial release. What physiological effect is the treatment primarily targeting?
A patient is being treated for a muscle spasm using myofascial release. What physiological effect is the treatment primarily targeting?
- Stimulating the production of synovial fluid in adjacent joints.
- Reducing muscle spasm and fascial restrictions. (correct)
- Increasing bone density at the site of the spasm.
- Strengthening the muscle fibers directly involved in the spasm.
In the context of trigger point pathophysiology, what is thought to initiate the cascade of events leading to a trigger point formation?
In the context of trigger point pathophysiology, what is thought to initiate the cascade of events leading to a trigger point formation?
What is the primary goal of applying traction/distraction in physical medicine?
What is the primary goal of applying traction/distraction in physical medicine?
A patient with chronic lower back pain is undergoing massage therapy. When applying the general principles of massage, which approach is MOST appropriate?
A patient with chronic lower back pain is undergoing massage therapy. When applying the general principles of massage, which approach is MOST appropriate?
A patient presents with edema following an ankle sprain. Which massage technique is MOST suitable for reducing fluid accumulation in the affected area?
A patient presents with edema following an ankle sprain. Which massage technique is MOST suitable for reducing fluid accumulation in the affected area?
In a patient with tight iliotibial band (ITB), which massage technique would be MOST effective for warming and softening the superficial fascia before applying deeper, more specific treatments?
In a patient with tight iliotibial band (ITB), which massage technique would be MOST effective for warming and softening the superficial fascia before applying deeper, more specific treatments?
A patient complains of muscle hypertonicity. Which massage technique would be MOST appropriate to decrease muscle tone via spindle cells and Golgi tendon receptors?
A patient complains of muscle hypertonicity. Which massage technique would be MOST appropriate to decrease muscle tone via spindle cells and Golgi tendon receptors?
During a massage session, a therapist aims to increase local circulation and encourage the absorption of exudates in an area of chronic tendinopathy. Which massage technique is MOST appropriate?
During a massage session, a therapist aims to increase local circulation and encourage the absorption of exudates in an area of chronic tendinopathy. Which massage technique is MOST appropriate?
A 34-year-old female with a high-stress job presents with frequent headaches and suspected TMJ dysfunction. Palpation reveals hypertonicity in the masseter and temporalis muscles. Which of the following manual therapy techniques would be MOST appropriate to initially address the muscular component of her TMJ dysfunction?
A 34-year-old female with a high-stress job presents with frequent headaches and suspected TMJ dysfunction. Palpation reveals hypertonicity in the masseter and temporalis muscles. Which of the following manual therapy techniques would be MOST appropriate to initially address the muscular component of her TMJ dysfunction?
When performing a TMJ distraction technique, which hand placement is MOST appropriate for mobilizing the TMJ?
When performing a TMJ distraction technique, which hand placement is MOST appropriate for mobilizing the TMJ?
When performing an anterior glide of the TMJ, what is the PRIMARY direction of force applied by the mobilizing hand?
When performing an anterior glide of the TMJ, what is the PRIMARY direction of force applied by the mobilizing hand?
During a lateral break manipulation of the cervical spine, after proper positioning and skin slack removal, what is the MOST appropriate Line of Drive (LOD) to deliver the thrust?
During a lateral break manipulation of the cervical spine, after proper positioning and skin slack removal, what is the MOST appropriate Line of Drive (LOD) to deliver the thrust?
In a rotational cervical manipulation, what are the components for joint locking?
In a rotational cervical manipulation, what are the components for joint locking?
When performing a glenohumeral (GH) distraction technique, which of the following best describes the direction in which the humeral head should be moved?
When performing a glenohumeral (GH) distraction technique, which of the following best describes the direction in which the humeral head should be moved?
A patient presents with limited shoulder flexion and pain. When performing a glenohumeral posterior glide, which hand placement and direction of force application is MOST appropriate?
A patient presents with limited shoulder flexion and pain. When performing a glenohumeral posterior glide, which hand placement and direction of force application is MOST appropriate?
A patient is positioned side-lying for scapulothoracic joint mobilization. To perform a superior glide, where should the clinician place their hands and in which direction should the scapula be moved?
A patient is positioned side-lying for scapulothoracic joint mobilization. To perform a superior glide, where should the clinician place their hands and in which direction should the scapula be moved?
When performing a sternocostal anterior glide, which of the following hand placements and actions is MOST appropriate to improve movement and reduce pain?
When performing a sternocostal anterior glide, which of the following hand placements and actions is MOST appropriate to improve movement and reduce pain?
During an acromioclavicular (AC) joint assessment, a patient demonstrates restricted posterior glide. What is the MOST appropriate hand placement and direction of force application to address this restriction?
During an acromioclavicular (AC) joint assessment, a patient demonstrates restricted posterior glide. What is the MOST appropriate hand placement and direction of force application to address this restriction?
When performing a humeroulnar joint distraction, which of the following patient positions and hand placements is MOST appropriate?
When performing a humeroulnar joint distraction, which of the following patient positions and hand placements is MOST appropriate?
A patient exhibits restricted supination. Which mobilization technique would MOST effectively target improved range of motion for this movement?
A patient exhibits restricted supination. Which mobilization technique would MOST effectively target improved range of motion for this movement?
Which of the following hand placements and procedural steps BEST describes the application of a posterior glide to the radiocarpal joint?
Which of the following hand placements and procedural steps BEST describes the application of a posterior glide to the radiocarpal joint?
A patient presents with limited abduction of the index finger. To address this restriction with joint mobilization, which intermetacarpal glide is MOST appropriate?
A patient presents with limited abduction of the index finger. To address this restriction with joint mobilization, which intermetacarpal glide is MOST appropriate?
When assessing a patient with suspected lateral epicondylalgia (LE), which of the following findings would MOST strongly indicate the presence of this condition?
When assessing a patient with suspected lateral epicondylalgia (LE), which of the following findings would MOST strongly indicate the presence of this condition?
Flashcards
Joint Mobilization
Joint Mobilization
A passive therapeutic movement within the anatomic end range of joint movement, restoring ROM and addressing compensatory stress.
Graded Mobilization/Oscillation
Graded Mobilization/Oscillation
Gently taking a joint to its end range or point of pain, holding against resistance until release, and repeating with optional movement.
Stretching
Stretching
A continuous process of lengthening tissue, holding for 8-12 seconds, and progressively stretching in a rhythmic fashion.
Active Myofascial Release
Active Myofascial Release
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Proprioceptive Neuromuscular Facilitation (PNF)
Proprioceptive Neuromuscular Facilitation (PNF)
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Effleurage
Effleurage
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Petrissage
Petrissage
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Roulomont
Roulomont
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Tapotement
Tapotement
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Friction Massage
Friction Massage
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Lateral Temporomandibular Ligament
Lateral Temporomandibular Ligament
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Side Gliding (TMJ)
Side Gliding (TMJ)
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TMJ Distraction
TMJ Distraction
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Upper C-Spine Primary Motions
Upper C-Spine Primary Motions
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TMJ Anterior Glide
TMJ Anterior Glide
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Glenohumeral Joint
Glenohumeral Joint
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Adhesive Capsulitis
Adhesive Capsulitis
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Impingement Syndrome
Impingement Syndrome
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GH - Distraction
GH - Distraction
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GH - Posterolateral Glide
GH - Posterolateral Glide
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Lateral Epicondylalgia
Lateral Epicondylalgia
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Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome (CTS)
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Elbow Joint
Elbow Joint
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Wrist and Hand
Wrist and Hand
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Humeroulnar Mobilizations
Humeroulnar Mobilizations
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Study Notes
Context
- A 38 year old male has numbness and tingling in his fingers.
- The symptom are worse at night.
- The diagnoses to consider relates to the elbow, wrist and hand.
Learning Outcomes
- Apply stretching, PNF, and traction techniques for common conditions of the elbow, wrist, and hand.
- Assess and treat common trigger points in the elbow, wrist and hand.
- Apply appropriate draping and patient/practitioner setup for elbow wrist and hand presentations.
- Integrate appropriate manual therapies into a comprehensive treatment plan based on patient presentation in the elbow, wrist and hand.
Elbow Anatomy
- The elbow contains the humeroradial joint and humeroulnar joint
- It also contains the radioulnar joint
Wrist & Hand Anatomy
- Key entities: Capitate, Hamate, Pisiform, Triquetrum, Lunate, Ulna, Phalanges, Metacarpals, Trapezoid, Trapezium Scaphoid & Radius
Elbow Biomechanics:
- The elbow is a modified hinge joint.
- Humerus articulates with the radius and ulna at the compound paracondylar joint, which has two distinct facets.
- Primary elbow movements are flexion, extension, supination, and pronation
Wrist and Hand Biomechanics
- Complex movements are made via the distal radio ulnar, radiocarpal, and mid carpal joints.
- Metacarpals glide on one another, causing an arch with the 3rd metacarpal as the axis.
- The thumb and fingers allow a variety of functional hand movements.
Condition Review
- Lateral epicondylalgia.
- Carpal Tunnel Syndrome.
- Decreased MCP ROM
Lateral epicondylalgia
- Inflammation and pain may occur as the extensors rub against the lateral epicondyle and radial head during contraction.
- Microtears can be produced in the tendon and may start to pull away from the periosteum.
- Pain can be experienced locally and may extend down the forearm following the extensors.
Carpal Tunnel Syndrome
- Compression of the median nerve happens through the flexor retinaculum or transverse carpal ligament.
- It worsens over time and could lead to permanent disfunction of the hand.
- Causes may include genetics, repetitive hand use, extreme wrist flexion or extension over time, pregnancy, and other health conditions.
Decreased MCP ROM
- Reduced mobility and ROM happens after MCP fracture; arthritis can also reduce mobility.
Humeroulnar Mobilizations
- Purpose is to examine for the humeroulnar joint impairment.
- Increase accessory motion and ROM and decrease pain.
Humeroulnar Distraction (4-1) Setup
- Patient is supine.
- The HU joint is in resting position (conservative) or near restricted ROM (aggressive).
- Clinician stands at the patient’s hip, facing the joint.
- The patient’s upper arms rests on table, and the forearm rests on the shoulder.
- Stabilizing hand holds the anterior distal humerus.
- Mobilizing hand is placed on the anterior proximal ulna without contacting the radius.
Humeroulnar Distraction (4-1) Procedure
- Stabilizing hand holds the humerus against the TX table.
- Mobilizing hand moves the proximal ulna in a direction perpendicular to the ulnar joint surface.
Humeroulnar Medial Glide (4-2) Setup
- Patient supine, HU joint in resting position (conservative) or near restricted ROM (aggressive).
- The clinician stands between the patient’s arm and trunk.
- The patient’s forearm is held between the upper arm and trunk.
- Stabilizing hand holds the medial distal humerus and mobilizing hand is placed on the lateral proximal radius.
Humeroulnar Medial Glide (4-2) Procedure
- Apply a grade 1 traction to the joint.
- Stabilizing hand holds the humerus in position. Mobilizing hand moves the proximal ulna in a medial direction (indirectly through the radius) while guiding motion with your trunk.
Humeroulnar Lateral Glide (4-3) Setup
Patient is supine, HU joint in resting position (conservative) or near restricted ROM (aggressive). Clinician stands at the patient’s side. Patient’s forearm is held between the upper arm and trunk. Stabilizing hand holds the lateral distal humerus. Mobilizing hand is placed on the medial proximal ulna.
Humeroulnar Lateral Glide (4-3) Procedure
- Apply a grade 1 traction to the joint.
- Stabilizing hand holds the humerus in position.
- Mobilizing hand moves the proximal ulna in a lateral direction while guiding motion with your trunk.
Humeroradial Mobilizations
- Purpose is to examine for the humeroradial joint impairment.
- Increases accessory motion and ROM and decrease pain.
Humeroradial Distraction (4-6) Setup
- Patient is supine, HR joint in resting position (conservative) or near restricted ROM (aggressive).
- The Clinician stands at the patient’s side facing the joint.
- Stabilizing hand holds the anterior distal humerus.
- Mobilizing hand is placed on the medial proximal radius, contact with the ulna is avoided.
Humeroradial Distraction (4-6) Procedure
- Stabilizing hand holds the humerus in position.
- Mobilizing hand moves the radial head distally and perpendicular to the radial joint surface.
Humeroradial Posterior Glide (4-8) Setup
Patient is supine with the shoulder in medial rotation. The HR joint is in resting position (conservative) or nearing restricted ROM (aggressive). Clinician stands at the patient’s side facing the joint. Stabilizing hand holds the posterior distal humerus. Mobilizing hand is placed on the anterior proximal radius.
Humeroradial Posterior Glide (4-8) Procedure
- Apply a grade 1 traction to the joint.
- Stabilizing hand holds the humerus in position.
- Mobilizing hand glides the proximal radius in a posterior direction.
Humeroradial Anterior Glide (4-9) Setup
- Patient is supine with the shoulder in medial rotation.
- The HR joint is in resting position (conservative) or nearing restricted ROM (aggressive).
- Clinician stands at the patient’s side facing the joint.
- Stabilizing hand holds the anterior distal humerus.
- Mobilizing hand is placed on the posterior proximal radius.
Humeroradial Anterior Glide (4-9) Procedure
- Apply a grade 1 traction to the joint.
- Stabilizing hand holds the humerus in position.
- Mobilizing hand glides the proximal radius in an anterior direction.
Radio Ulnar Mobilizations
Purpose is to examine radio ulnar joint impairment. Increases accessory motion and ROM and decrease pain.
Posterior Glide of Proximal Radius (4-10) Setup
- Patient is supine with the forearm resting on the TX table.
- The proximal RU joint is in resting position(conservative) or near restricted ROM (aggressive).
- Clinician stands at the patient’s side facing the joint.
- Stabilizing hand holds the posterior proximal ulna.
- Mobilizing hand is placed on the anterior radial head.
Posterior Glide of Proximal Radius (4-10) Procedure
- Stabilizing hand holds the ulna in position and mobilizing hand glides the radial head posteriorly.
Anterior Glide of Proximal Radius (4-11) Setup
The patient is supine with the forearm resting on the TX table. Proximal RU joint is in resting position (conservative) or near restricted ROM (aggressive_. Clinician stands at patient’s side facing the joint.Stabilizing hand holds the anterior proximal ulna.Mobilizing hand is placed on the posterior radial head.
Anterior Glide of Proximal Radius (4-11) Procedure
The stabilizing hand holds the ulna in position, while the mobilizing hand glides the radial head anteriorly.
Posterior Glide of Distal Radius (4-12) Setup
Patient is sitting with the forearm resting on the TX table. The distal RU joint is in resting position (conservative) or near restricted ROM (aggressive). Clinician stands at the patient’s side facing the joint. The stabilizing hand holds the posterior distal ulna. Mobilizing hand is placed on the anterior distal radius.
Posterior Glide of Distal Radius (4-12) Procedure
Stabilizing hand holds the ulna in position, while the mobilizing hand glides the radial head posteriorly.
Anterior Glide of Distal Radius (4-13) Setup
The Patient is supine with the forearm resting on the TX table. Distal RU joint is in resting position (conservative) or nearing restricted ROM (aggressive). Clinician stands at the patient’s side facing the joint. Stabilizing hand holds the anterior distal ulna. Mobilizing hand is placed on the posterior distal radius.
Anterior Glide of Distal Radius (4-13) Procedure
- Stabilizing hand holds the ulna in position, while the mobilizing hand glides the distal radius anteriorly.
Wrist Mobilizations
- Purpose is to examine for ulnocarpal and rardiocarpal joint impairment, increase accessory motion and ROM, and decrease pain.
Distraction (5-1) Setup
- Patient is sitting with the anterior forearm on TX table and hand off the table.
- Radiocarpal (RC) and ulnocarpal (UC) joints are in resting position (conservative) or near restricted ROM (aggressive).
- Clinician stands facing the joint.Stabilizing hand holds the distal radius and distal ulna.
- Mobilizing hand holds the proximal row of carpals.
Distraction (5-1) Procedure
Stabilizing hand holds the radius and ulna on the TX table, while the mobilizing hand moves the proximal row of carpals distally and perpendicular to the joint surface.
Posterior Glide (5-2) Set up
- Patient sits with anterior forearm on TX table and hand off the table.
- RC and UC joints are in resting position (conservative) or near restricted ROM (aggressive).
- Clinician stands facing the joint.
- Stabilizing hand holds the distal radius and distal ulna.
- Mobilizing hand holds the proximal row of carpals.
Posterior Glide (5-2) Procedure
- Apply a grade 1 traction.
- Stabilizing hand holds the radius and ulna on the TX table.
- Mobilizing hand moves the proximal row of carpals posteriorly.
Anterior Glide (5-3) Setup
- Patient sitting with anterior forearm on TX table and hand off the table.
- The radiocarpal(RC) and ulnocarpal (UC) joints are in resting position (conservative) or near restricted ROM (aggressive).
- Clinician stands facing the joint, Stabilizing hand holds the distal radius and distal ulna.
- Mobilizing hand holds the proximal row of carpals.
Anterior Glide (5-3) Procedure
- Apply a grade 1 traction.
- Stabilizing hand holds the radius and ulna on the TX table.
- Mobilizing hand moves the proximal row of carpals anteriorly.
Medial Glide (5-4) Setup
Patient is sitting with the anterior forearm on TX table and hand off the table. Radiocarpal(RC) and ulnocarpal (UC) joints are in resting position (conservative) or near restricted ROM (aggressive). Clinician stands facing the joint. Stabilizing hand holds the distal radius and distal ulna. Mobilizing hand holds the proximal row of carpals.
Medial Glide (5-4) Procedure
- Apply a grade 1 traction.
- Stabilizing hand holds the radius and ulna on the TX table.
- Mobilizing hand moves the proximal row of carpals medially.
Lateral Glide (5-5) Setup
Patient is sitting with the anterior forearm on TX table and hand off the table. The radiocarpal(RC) and ulnocarpal (UC) joints are in resting position (conservative) or near restricted ROM (aggressive). Clinician stands facing the joint. Stabilizing hand holds the distal radius and distal ulna, while the mobilizing hand holds the proximal row of carpals.
Lateral Glide (5-5) Procedure
Apply grade 1 traction. Stabilizing hand holds radius and ulna on TX table. Mobilizing hand moves the proximal row of carpals laterally.
Midcarpal Joints
Setup is exactly the same as the RC and UC mobilizations, except the clinician grips the proximal row and the distal row of carpal bones.
Midcarpal Joint Mobilizations
Distraction (5-11) Posterior Glide (5-12) Anterior Glide (5-13) Medial Glide (5-14) Lateral Glide (5-15)
Intermetacarpal Joints (2-5)
- Stabilize midshaft of one MCP while mobilizing hand grips the other MCP.Apply a grade 1 traction to the joint and mobilize the desired joint in the desired direction. Available mobilizations:
- Posterior glide (5-25)
- Anterior glide (5-26)
1st MCP Joint
- Stabilize the head of the 1st metacarpal, while mobilizing hand grips the proximal 1st phalanx. Available mobilizations:
- Distraction (5-27)
- Medial Glide (5-28)
- Lateral Glide (5-29)
MCP Joints 2-5
- Stabilize the head of the metacarpal, while mobilizing hand grips the proximal phalanx. Available mobilizations:
- Distraction (5-30)
- Posterior Glide (5-31)
- Anterior Glide (5-32)
- Medial Glide (5-33)
- Lateral Glide (5-34)
Interphalangeal Joints
Available mobilizations:
- Distraction (5-35)
- Posterior Glide (5-36)
- Anterior Glide (5-37)
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Description
Study notes covering tension headaches, manual therapies, and joint mobilization techniques in naturopathic treatment. Includes the pathophysiology of trigger points and graded mobilization. Passive therapeutic movement to restore range of motion and improve movement quality.
