Intro to Manual Therapy (Exam 1)

What are the most distinguishing points that define orthopedic manual therapy?

Advanced Subspeciality, Clinical Judgement, Examination Expertise, Treatment Exepertise, Patient-Centered Longterm Mindset

How was manual therapy thought of prior to the 2000’s?

Being anecdotal, not scientifically proven to be efficacious

Passive Physiologic Movements

Movements that can be measured using a goniometer, also used in identifying Capsular Pattern

Passive Accessory Movements

Smaller movements that occur along with passive physiologic movements, cannot be measured by a goniometer, attributed to joint play

Pain Provocation/Symptom Change Test

Passive movement used to stress or unload a structure, determining mechanosensitivity mechanically, may not be informative of a problem

Muscle Length Tests

Determination of muscle-tendon unit length, not a basis for diagnosis, often includes normal ranges

Stability Tests

Passive movement to stress a specific joint’s stabilizing structures, may or may not be provocative of pain

What kinds of movements would be considered Passive Physiologic Movements?

Rolls, Spins, Glides (Osteokinematics including induced Arthrokinematics)

What two factors can limit Passive Physiologic Movements?

Muscle Tendon Units, Articular/Periarticular Structures

What single factor usually limits Passive Accessory Movements?

Articular/Periarticular Structures

What two things are Passive Accessory Movement useful for as a clinician?

Evaluation and Treatment

Active manual examinations include what types of movement?

Composite, Joint Physiologic

Passive manual examinations include what types of movement?

Osteokinematic, Arthrokinematic

What is the only way to assess arthrokinematic motion?

Manual Testing

If physiologic motion is normal…

Then osteokinematics and arthrokinematics can be assumed to also be normal

If physiologic motion is reduced…

Then osteokinematics could be hindered, including or NOT including loss of arthrokinematics

Arthrokinematic motion is an indicator of a joint’s…

Health

Is the correlation between arthrokinematics and osteokinematics direct in EVERY joint?

No

Compression

Decrease in space between joint surfaces, decrease in joint volume, ADDITION of stability, not truly arthrokinematic

Distraction

Increase in joint space, increase in joint volume, tensioning of capsule and accessory ligaments, ONLY FROM EXTERNAL FORCES

What are the two things to look for as you examine passive movement?

Amount of movement, and Quality of resistance over the course of the movement (including end-feel)

End-Feel

Quality of resistance during and at the end of of available motion

Normal Capsule/Ligament

Firm end-feel with small elastic yield (leathery)

Shortened Capsule/Ligament

Very firm end-feel, with little to no elastic yield

Elongated Capsule/Ligament

Soft end-feel, less resilient with greater yield (more sliding/gliding of the joint)

Soft Tissue Interposition

Soft end-feel due to visible barrier of the body

Bone to Bone

Hard end-feel

Edema/Effusion

Soft, boggy end-feel

Pain

Empty end-feel

What condition is classified as having the most mobility?

Unstable

What condition is classified as having the least mobility?

Ankylosed

What condition is associated with having the least amount of end-feel?

Unstable

What condition is associated with having the most amount of end-feel?

Ankylosed

R1

Initial Resistance

R2

End Resistance

What are the two things that generally cause hypomobility?

Shortened muscles/MTUs, and Loss of articular/periarticular tissue length or extensibility leading to loss of osteokinematics and arthrokinematics

Hypermobility

Excessive osteokinematic motion ONLY

Instability

Excessive osteokinematic motion with excessive translatory non-physiologic motion

Concave moving on Convex

Glide in same direction

Convex moving on Concave

Glide in opposite direction

Loosed Packed Joint Position

Least tension of capsule/periarticular tissue, maximal joint volume, greatest ability for glide

Closed Packed Position

Maximal joint congruency/bony stability, maximal tightness of ligament/capsule, least availability for glide

What joints are you most likely to see in a Close Packed position?

Glenohumeral and Acetabulofemoral

Capsular Pattern

Pattern of motion loss due to shortening of the joint capsule, indicates that the entire joint is involved

Selective Tissue Tension Tests

Making a tissue do its principal function

How are contractile tissues tested?

Isometric Contraction

Why are isometric contractions used for testing contractile tissues?

Joints remain still, isolating the muscles/MTUs themselves for analysis

How are noncontractile tissues tested?

Passive Motion

Why are passive motions used to test noncontractile tissues?

They apply tension to the rigid structure, causing them to rotate/translate for analysis

What kinds of manipulations are considered to be oscillatory/stretching?

Non-Thrust

What kinds of manipulations are considered to be high velocity, small amplitude thrusts to go through a motional barrier?

Thrust

Grade 1 Mobilization

Passive movement of joint below its midrange

Grade 2 Mobilization

Larger passive movement of joint to its midrange

Grade 3 Mobilization

Passive movement of joint from its midrange to end-range

Grade 4 Mobilization

Oscillatory movement at the end range of a joint

Grade 5 Mobilization

Thrust Manipulation

If a patient is hypomobile, the Available Motion barrier will shift …

Leftward

If a patient is hypermobile, the Available Motion barrier will shift …

Rightward

Cavitation

Collapse of gas bubble causing shockwave

Tribonucleation

Creation of small gas bubbles by breaking or making contact between two solid surfaces immersed in liquid containing dissolved gas

Do Cavitation or Tribonucleation indicate effectiveness of manual therapy treatment?

No

What part of the neurophysiological effects of manual therapy can also be called “circuit breaking”?

Reduction of Temporal Summation

Manual therapy has been studied and proven to help with reducing what?

Immediate pain sensation, blunting ascending signals, and nociception in the spinal cord and its peripheral nerves

What is the difference between pain and nociception?

Pain occurs only in the brain, its subjective. Nociception is the neural detection of harmful or potentially harmful stimuli.

Where is nociplastic pain occurring in a patient?

Central Mechanisms

What can exist without conscious experience of pain?

Peripheral Nociception

What kind of patient presentation would be resultant in a high level of mechanosensitivity, as well as joint limitation?

Pain Dominant

What kind of patient presentation would be resultant in a low level of mechanosensitivity, as well as pain not being as easily provoked?

Stiffness Dominant

Indications

High probability of beneficial use in treatment

Contraindications

Probability of negative result/harming patient

Precautions/Cautions

May or may not contribute to positive or negative outcomes, dependent on the patient themselves and not their condition

What kind of relationship does Manual Therapy have with Active Exercise in patients?

Synergistic