Lec.4 Manual Therapy.pdf

Manual Therapy Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Joint mobilization techniques Include a broad spectrum, from the general passive motions performed in the physiologic cardinal planes at any point in the range, to the semispecific and specific accessory (arthrokinematic) joint glides, or j...

Manual Therapy Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Joint mobilization techniques Include a broad spectrum, from the general passive motions performed in the physiologic cardinal planes at any point in the range, to the semispecific and specific accessory (arthrokinematic) joint glides, or joint distractions, initiated from the open-packed position of the joint. Considered to be the “cornerstone” of most rehabilitation programs, these techniques can be used to improve tissue extensibility, increase range of motion (ROM), induce relaxation, mobilize/manipulate soft tissue and joints, modulate pain, and to reduce swelling and inflammation. Grading systems Different grading systems exist for joint mobilizations include those for traction, sustained holds, and oscillatory techniques; however, the most widespread system is that used for describing the oscillatory technique proposed by Maitland: Grade I—slow, small amplitude movements performed at the beginning of the range (pain relieving) Grade II—slow, large amplitude movements performed that do not reach the limit of the range (pain relieving) Grade III—slow, large amplitude movements performed up to the limit of the range (stretch) Grading systems Grade IV—slow, small amplitude movements performed at the limit of the range (stretch) Grade V—high velocity, small amplitude (thrust) movements performed beyond the pathologic limit. (Joint Manipulation or HVLA) A joint mobilization should begin with a distraction technique. This is a perpendicular movement to the treatment plane. This separates the joint surfaces and makes joint mobilizations much more comfortable. Should perform a distraction prior to performing a joint glide. Although Grade V or joint manipulation techniques share similarities with Grade IV in terms of amplitude and direction, it is the velocity at which the technique is employed that sets them apart. 1. Joint mobilization Joint mobilization is a manual therapy technique in which the therapist manually applies pressure to a joint to help improve that joint's mobility and range of motion. It is used to treat patients experiencing stiffness or pain in their joints. For example, a patient with golfer's elbow or tendinitis in their shoulder may benefit from the relief that joint mobilization offers. 2. Soft tissue mobilization • Soft tissue mobilization is a manual therapy technique in which the therapist physically stretches and applies pressure to the muscles and ligaments. • Soft tissue mobilization breaks up the muscle tissue, which can help relieve tension and reduce inflammation. • It can also improve flexibility, so much so that it's often used to restore mobility in joints that lost mobility. 3. Strain-counterstrain therapy • Strain-counterstrain therapy, often called positional release therapy, is a type of manual therapy designed in which the therapist holds your body in a series of strategic positions for 90-second intervals. • It's beneficial because it allows the sensory receptors within the muscle to relax in a position that's both comfortable and natural. • It's a gentle but effective technique for relieving tension in the muscles. 4. Myofascial release Myofascial release therapy is a manual therapy technique that specifically targets the fascia, which is the thick tissue that coats all the bones and muscles in our body. The physical therapist feels around for stiff or tight spots in the fascia and manually manipulates them to restore pliability. This technique relieves the joints and muscles of any pressure placed on them. It is repeated on each trigger point until the therapist can no longer identify any tension in the body. It is often used to treat back pain, sciatica and other forms of chronic pain. 5. Instrument-assisted soft tissue mobilization (IASTM) Instrument-assisted soft tissue mobilization (IASTM) is a manual therapy technique that involves the use of tools (instruments) to mobilize the muscles and joints. These tools vary in shape and size but are contoured to various parts of the body, giving the physical therapist extra leverage with which to apply pressure to the body. 6. Dry needling • Dry needling is a physical therapy modality that involves the use of thin needles inserted into the skin to break up stiff sections of muscle fiber called trigger points. • The goal is to relieve muscle tension, decrease pain, increase blood flow and restore mobility. • Dry needling sounds like acupuncture but it is in fact very different. Whereas acupuncture aims to short-circuit pain patterns, dry needling targets muscles currently experiencing pain. • Like other manual therapy techniques, it is most effective when used as part of a larger treatment plan that involves therapeutic exercise and other forms of treatment. 7. Active Release Techniques (ART) • Active Release Techniques (ART) is a branded, proprietary manual therapy technique performed at some physical therapy clinics. • During an ART session, the therapist applies heavy pressure on soft tissue that has been altered in shape or size by a repetitive strain injury or repeated acute injuries. • Simultaneously, the patient is instructed to move in specific ways that stretch the soft tissue. • It is used to treat many different types of chronic pain.