Maitland Concept MSKP 2 PDF

MAITLAND CONCEPT MSKP 2 Elena Cabezas Yagüe  G.D. MAITLAND (1924-2010) Always known for his humility and kindness, as well as his willingness to share and learn from others Adelaide, Australia (1924-2019). 1949. Gr...

MAITLAND CONCEPT MSKP 2 Elena Cabezas Yagüe  G.D. MAITLAND (1924-2010) Always known for his humility and kindness, as well as his willingness to share and learn from others Adelaide, Australia (1924-2019). 1949. Graduated as a physiotherapist. He practices in private practice. Academic Tutor at PT School South Australia. Interest in the use of passive joint mobilization techniques and in the comprehensive clinical assessment and evaluation of patients with neuromusculoskeletal problems. 1974. Co-founder IFOMPT (International Federation of Orthopedic Manipulative Therapists) - Paris, Mckenzie, Grieve, Kaltenborn Creator of the Maitland Concept® (Stoddard, Cyriax, Grieve)  MAITLAND CONCEPT PRINCIPLES CONCEPT Importance of the patient's clinical picture Examination and treatment of Generation of verifiable hypotheses neuromusculoskeletal disorders with Normalize Directions of Motion passive movements based on the Promote Function & Participation conceptual model of the Patient Responsibility SEMIPERMEABLE BRICK WALL Differentiation Effective Communication, Therapy, Didactics  SEMIPERMEABLE BRICK WALL Theoretical side Clinical side Speculative Not speculative Belief History Anatomy Known Phisiology Unknown Biomechanics Symptoms Hypothesis Pathology Speculation Signs Diagnosis 2024 4  MAITLAND CONCEPT TECHNIQUE Interrogation, Inspection, Functional Demonstration, Active Movements, Screening, Neurological and METHOD Neurodynamic Examination, Instability test Guided actions using hypotheses obtained from Motion Diagrams subjective examination, planning, physical examination, rehearsal treatment and continuous re-evaluation PAIVMs, PPIVMs Nerve mobilizations Documentation & Data Gathering Oscillatory passive mobilizations Muscle and proprioceptive reconditioning Automobilizations Any other.....  THEORETICAL CLINICAL 1.Contraindications and precautions Anatomy 2.2. Pathological mechanisms Biomechanics 3.3. Source/Area Inervation 1. Main problem 4.4. ICF Clinical presentation: 2. Body chart 5.5. Contributing Factors Impigement Frozen shoulder 6.6. Yellow Flags ACJ origin pain 3. Behaviour … 7.7. Handling 4. History 8.8. Prognosis Hipothesis categories 5. Special questions  ACTIVITY 1. List the eight categories of hypotheses 2. List three reasons why the hypothesis categories are fundamental for the clinical reasoning 3. Which factors determine a risk situation for manual therapy? 20XX 7  THEORETICAL CLINICAL Disability degree (ICF) 1. Main problem Individual experience of Captures the nature of complaints the disease from the patient's point of view It must be quoted and recorded in the patient's words  Main symptom THEORETICAL CLINICAL -No., colors -Types of Symptoms Characteristics x Symptom: -Frequency -Depth -Description -Intensity Symptoms source Relationship/absence between Sx ICTs, other regions Precautions and 2. Body chart All up-to-date information contraindications Every symptom is recorded Disability degree No. 1 is the main problem Record on body map adding description of the (ICF) symptom (acute, dull, intermittent, variable, deep...)  THEORETICAL CLINICAL Pathobiological mechanisms Precautions and contraindications Treatment 3. Behaviour - Assessment of symptoms, rest, activities, etc - Functional limitations assessment Biomechanics - Severity and irritability assessment - Patient Coping Information Clinical presentation - Reach /pick up objects overhead - Ironing - Clean windows /mirrors - Hold objects frontwards - Sleep on that side or the opposite side - Fasten bra - Putting on /taking off jacket - Rubbing back in the shower - Combing/ drying hair - Grabbing seat belt to fasten it (driver’s side) - Gear change - Driving 20XX Presentación de lanzamiento 13 BODY MAP AND BEHAVIOR ACCORDING TO PAIN PICTURE NOCICEPTIVE PAIN NEUROPATHIC PAIN NOCIPLASTIC PAIN Located Large/wide location Multisite Clean Body chart +Acute distally Widespread Predictable Relatively predictable Unpredictable Intermittent Variable - Constant Not constant Acute, Subacute Acute with Chronic background  PAIN PICTURE TYPE NOCICEPTIVE PAIN NEUROPATIC PAIN NOCIPLASTIC PAIN 32 yo. assisstant 48 yo. computer scientist 64 yo. housekeeper Throbbing neck pain Pain in calf (dog bites and Generalized pain tingling) and sometimes slightly Hurts if Rot in low back Chronic pain At rest better although Night pain awakes, mornings not Doesn't know what makes it better or morning stiffness good worse. It goes by days Tissue damage, 7 days No improvement with NSAIDs No stimulus-response relationship Improves with NSAIDs Psychosocial factors (chronic fatigue, sleep disturbances, FM...)  THEORETICAL CLINICAL Categories of Contributing factors Use New Use Precautions and Misuse About contraindications 4. History Usage Abuse Assessment of the phase and stability of Non-Use the problem Forecast/prognosis Do the findings fit? Do disability or symptom severity have a logical relationship?  C/O: HISTORY Longitudinal Approach to Patient Symptoms and Disorder Patterns related to natural healing, inflammatory, degenerative condition... Treatment Prognosis Guide New use Beginning? Trauma & Characteristics Overuse Misuse Insidious Abuse Desuse Current phase? Acute (3 to 6 months) Stability? Has it improved? STABLE (Predictable Evolution) Progression? Has it gotten worse? UNSTABLE (Unpredictable evolution) Logical variation? 17 THEORETICAL CLINICAL Precautions and contraindications 5. Special questions Contributing factors Red flags Non-mechanical nature Precautions in Exploration or Treatment  GOALS Verify or revise the hypotheses of the C/O Collect new data to generate more hypotheses ACUTE IRRITABLE UNSTABLE CAREFUL PHYSICAL EXAMINATION and Tx PHYSICAL EXAMINATION & Tx CHRONIC CAN BE MORE INTENSE NO IRRITABLE STABLE  GOALS Reproduce the patient's symptoms or comparable signs (if SYMPTOM allows) Finding the Source of Symptoms / Cause of Source / Contributing Factors Examine and annotate ROM, symptom response, and quality of movement Discard normal structures. Identify contraindications or confirm precautions Relevant findings marked with…  CHECK LIST 8. Neurodynamic tests 1. PP (current symptoms) 9. Physiological Passive Movements (PPIVM) 2. Remark (with correction) 10. Soft tissue palpation 3. Functional Demonstration 11. Accessory Passive Movements (PAIVM) 4. Re-evaluate P/E plan 12. Initial treatment 5. Active Movements 13. Reevaluate 6. Testing if necessary 14. Screening of other structures 7. Additional Tests 15. Patient Instructions 1. PP Symptoms at the time of P/E What and how severe are the symptoms at this very moment? Pain scales MILD MODERATE INTENSE 2. Observation General Posture Protective Posture Correction 3. Functional Demonstration and Differentiation Analyze how posture affects the patient Initial observation of the most affected mov direction * 4. Reevaluate P/E Plan 5. Active Movements Assess range, quality of movement, and behavior of symptoms Motion is corrected if necessary and annotate response F Abd Stabilized position RE F horizontal And horizontal Hand back 6. Testing if necessary Hand back with overpressure Only if the patient's symptoms cannot be Extension and Internal Rotation reproduced with previous tests and there are no contraindications  7. Additional Tests Neurological Exam Vascular Examination Muscle Function and Length Test Instability test  8. Neurodynamic tests 9. Passive Physiological Intervertebral Movements(PPIVM) Used to value passive mobility as a valuation technique and tto Rate Rom Quality, Resistance, End-Feel & Symptoms They are made to generate * and assess pain and resistance Physiological when pain predominance (to decrease pain->wide mov=>physiological) First option in limbs 10. Soft tissue palpation IMPORTANT Objective: Define the location of symptoms and tissue changes and verify the hypothesis generated 11. Passive Accessory Intervertebral Movements(PAIVM) They are usually started with them in the column or when resistance predominates On the shoulder, perform if you have not noticed any physiological changes (although if you are in very painful pain*, be careful, do not do much more) AP – PA & Transverse 12 & 13. Initial Assessment and Revaluation Depends on C/O and P/E information Importance of Motion Diagram Clinical Groups  14. Screening Evaluate hypotheses if a specific structure is involved in the problem 15. Patient Instructions Warn of possible reactions Instructions to follow Ergonomics Exercise Program  Not the area* If it's the area, Same Too conservative we'll overdo it treatment Normal evolution (as expected) MOVEMENT DIAGRAMS  MOVEMENT DIAGRAMS Allows hypothesis testing Helps choose treatment techniques Define outcome measures for revaluation Helps to communicate 38  MOVEMENT DIAGRAMS HOW CAN I REPRESENT THE MOVEMENT OF MOVEMENTS? Representation of movement, in two dimensions, which includes the factors that appear (or may appear): R: Resistance/STIFFNESS P: Pain S: Spasm It is performed in passive movement (physiological or accessory) Collects subjective data from the physiotherapist and the patient 39 MOVEMENT DIAGRAMS  MOVEMENT DIAGRAMS A: Point of ROM at which you start the movement B: End of normal range 41 C: Maximum of factor under consideration D: Point to complete the movement diagram L: Limit of range/joint play L is at B if normal range is available L is before B if range of movement is restricted L is beyond B if range of movement is greater than normal  MOVEMENT DIAGRAMS C D R2 NORMAL RESPONSE PHYSIOLOGICAL MOVEMENT L A R1 B  MOVEMENT DIAGRAMS C D R2 NORMAL RESPONSE ACCESSORY MOVEMENT L A R1 B  MOVEMENT DIAGRAMS C D R2 ABNORMAL RESPONSE HYPERMOBILITY L A R1 B  HYPOMOBILITY: PAIN PREDOMINANCE C P2 D P? = NO R? = NO GRADES I or II A P1 R1 L B 45 HYPOMOBILITY: PREDOMINANCE OF RESISTANCE WITH HIGH PAIN C P2 D P? = NO R? = YES GRADES III or IV A R1 P1 L B 46 HYPOMOBILITY: RESISTANCE PREDOMINANCE C P2 D P? = NO R? = YES GRADES III+ or IV+ A R1 P1 L B 47  MOVEMENT DIAGRAMS How does a movement diagram change with treatment? L may move closer to B P1 or R1 may move closer to L Decrease in amount of pain at L (therefore L is no longer P2) Behavior of P1 - P2/P' and/or R1 - R2/R' may alter Reactive spasm (S1 - S2) may become less intense &/or harder to provoke Key points: Movement diagrams are NOT scientifically based: ✓ Inter-therapist reliability in detecting R1 or behaviour of resistance through range is POOR ✓ Intra-therapist reliability in detecting R1 or behaviour of resistance through range is MODERATE to GOOD Awesome! for determine relationship between symptoms behavior Useful to put on charts what “are you feeling during examination” 48  MOVEMENT DIAGRAMS How does a movement diagram change with treatment? L may move closer to B P1 or R1 may move closer to L Decrease in amount of pain at L (therefore L is no longer P2) Behavior of P1 - P2/P' and/or R1 - R2/R' may alter Reactive spasm (S1 - S2) may become less intense &/or harder to provoke Key points: Movement diagrams are NOT scientifically based: ✓ Inter-therapist reliability in detecting R1 or behaviour of resistance through range is POOR ✓ Intra-therapist reliability in detecting R1 or behaviour of resistance through range is MODERATE to GOOD Awesome! for determine relationship between symptoms behavior Useful to put on charts what “are you feeling during examination” 49