Physical Therapy Manual Techniques Quiz

Manual Therapy Overview

• This presentation covers manual therapy, its definition, history, mechanisms, and techniques.
• Manual therapy is the deliberate application of external force on body tissue using hands. The intent is therapeutic.
• The history of manual therapy dates back thousands of years, including "bone setters" in various cultures (Nepal, Russia, Norway, etc.).
• Key figures like Hippocrates are referenced in historical records.
• The 16th-19th centuries saw physicians documenting manipulation in textbooks.
• In 1892, Andrew Taylor Still established the American Osteopathic College, believing in the curative power of manipulation to improve function, particularly of disturbed arteries.
• Daniel David Palmer developed Chiropractic Medicine, focusing on vertebral subluxations and nerve impulses.
• James Henry Cyriax (1954) developed a method for logical, clinically reasoned differential diagnosis, including "selective tissue tension testing".
• In 1970, the International Federation for Orthopedic Manual Therapy (IFOMT) was established.
• The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) formed in 1992. Completing an accredited OMPT fellowship leads to the FAAOMPT credential, which is recognized as an integral part of the Physical Therapy scope of practice.

Mechanisms of Manual Therapy

• Manual therapy mechanisms are complex, encompassing several physiological responses to a mechanical force.
• The initial stimulus is a mechanical force.
• The mechanism leads to neurophysiological responses that contribute to the outcomes associated with manual therapy.
• Various factors influence outcomes including transient biomechanical effects, decreased cytokines, opioid release, and neurophysiological effects.
• Understanding this complex chain of neural events is crucial to comprehending the effects of manual therapy.
• Transient biomechanical effects are often noticed, in terms of joint mobility changes, but lasting joint position changes are less evident. Technique choice does not seem to make a major difference in outcomes.
• Decreased cytokines and endogenous opioid release in the periphery play a significant therapeutic role.
• Neuron activation, spatial summation, and temporal summation are all parts of this complex response.
• Opioid receptors have a significant role in pain modulation.
• Decreased activity in the dorsal horn, either through descending inhibitory pathways, or by way of "gate control" theory, is also important.
• Activation of pain processing regions of the brain is also reduced with manual therapy.

Joint Kinematics

• Joint motion combines rolling, sliding, and spinning.
• Arthrokinematics describes the movements that occur at joint surfaces.
• Osteokinematics describes bone movement around a joint (e.g., flexion, extension).
• The convex-concave rule governs movement. Convex surfaces moving on concave surfaces exhibit opposite glide and roll. A concave surface over a convex surface will experience the same direction of glide and roll.
• The direction of glide is less important than the mechanical stimulus in achieving outcomes.

Joint Mobilization & Manipulation

• Mobilization techniques are passive, skilled methods on joints and related soft tissues. Varying speeds and amplitudes are used.
• Maitland developed a grading system (Grades I-V) for mobilization.
• Grade V mobilization/manipulation involves high velocity, low amplitude thrust (HVLAT).
• Kaltenborn also developed grading systems.
• Understanding the different grades of mobilization helps describe what is occurring during the treatment.

Indications, Contraindications and Precautions

• Indications for manual therapy include pain, muscle guarding/spasm, ROM limitations, and functional immobility
• Contraindications include malignancy, osteopenia/osteoporosis, unhealed fractures/fusions, acute injuries with uncertain severity of damage, patient refusal.
• Precautions include hyperalgesia/allodynia, hypermobility, weakened connective tissues, long-term corticosteroid use, immediate post-surgery, disuse, and rheumatoid arthritis.

Questions

• The presentation concludes with a call for questions from the audience.