PTH 661 Week 1 Information

Why develop manual therapy skills?

Better differentiation of normal vs. pathological mechanics and to help diagnose sources of dysfunction

What is manual therapy?

Any skilled manual therapeutic intervention that a patient receives to modulate pain, increase ROM, reduce soft tissue inflammation, promote relaxation, improve tissue extensibility, increase stability, facilitate tissue recruitment and movement, and/or to improve function/quality of life

What is the Cyriax Approach?

Identifies biomechanical source of soft tissue lesion and pathological structure

If pain occurs with PROM, what does this suggest?

Noncontractile, inert lesion

If pain occurs with AROM, what does this suggest?

Contractile lesion

What is a soft end-feel?

Tissue on one side of the joint compresses tissue on the other normally

What is a hard end-feel?

Abrupt stop caused by bone-to-bone contact normally

What is an elastic end-feel?

Stretching of joint capsule normally or abnormally if early in range

What is a springy end-feel?

Rebound-type sensation indicating the presence of an internal derangement, such as a piece of intra-articular cartilage caught between two bony surfaces

What is a spasm end-feel?

A protective, involuntary mechanism to guard against painful motion indicating severe arthritis, displacement, or joint destruction

What is an empty end-feel?

Pain or fear of pain causes patient to resist further motion and request that the examiner ceases the test without perception of tissue tension

What is a neurogenic hypertonic end-feel?

Cogwheel rigidity as the joint is moved noted in the presence of a central nervous system disorder or it suggests emotional overlay

Capsular pattern for the glenohumeral joint?

Lateral rotation, abduction, and medial rotation

What is the Maitland approach?

Treatment application is based on comparable sign and whether presentation is pain/symptom dominant or stiffness dominant

What does SINSS mean?

Severity, irritability, nature, stage, stability

What does R1 mean?

Initial onset of resistance

What does R2 mean?

Final onset of resistance

What does P1 mean?

First onset of pain

What does P2 mean?

Final onset of pain

Pain dominant characteristics?

Afraid to move; resting, early, & mid-range pain. Pain is described as diffuse or burning (>5/10) and is slow to reduce. Often presents with spasms and repeated movements aggravate pain

Stiffness dominant characteristics?

Limited range. Pain is often end-range only. Pain is described as localized and stiff (<5/10) and lasts for a short duration. Spasms are not usually present and repeated movement increases ROM

Describe grade I Maitland

Small amplitude, stopping short of any stiffness barrier/spasm

Describe grade II Maitland

Large amplitude, stopping short of any stiffness barrier/spasm

Describe grade III Maitland

Larger amplitude, into and through resistance (50% of R1-R2)

Describe grade IV Maitland

Small amplitude into and through resistance (50% of R1-R2)

Describe grade V Maitland

Specific manipulation at the end-range barrier, high velocity, low amplitude

What is the Kaltenborn approach?

Based on the concave-convex theory and knowledge of open- and close-packed positions

Where is the treatment plane with Kaltenborn?

Always parallel to the concave side of the joint

Convex moving on fixed concave = ?

Roll and glide in opposite directions

Concave moving on fixed convex = ?

Roll and glide in the same direction

What is grade I Kaltenborn?

Low amplitude, no stress on capsule, equalizes forces acting on joint (joint surfaces unweighted, bunch up skin)

What is grade II Kaltenborn?

Distraction to tighten the tissues around the joint, “taking up the slack of the capsule”

What is grade III Kaltenborn?

Stretch, place a stretch on the joint capsule and on surrounding periarticular structures

What happens in the transition zone of grade II Kaltenborn?

Tissue tightens

Purpose of grade I Kaltenborn?

Relieve pain and relax tissue tone; facilitate gliding movements

Purpose of grade II Kaltenborn?

Test joint play traction/glide movements; relieve pain within the slack zone; and to relax, increase, or maintain motion

How long does a grade II Kaltenborn cycle last?

3-5 seconds

Purpose of grade III Kaltenborn?

To test joint play end-feel; increase mobility and joint play via stretch-mobilization treatments; manipulative thrust

How long are grade III Kaltenborn cycles?

7-60 seconds

What is Mobilization with Movement (MWM)/Mulligan?

Combines passive accessory mobilization with active or passive physiological movement at a specific joint; it helps correct positional faults to restore normal, pain-free ROM

What does manipulation mean?

High velocity, low amplitude passive movement to the joint which a patient is unable to prevent

What is a mobilization?

Low velocity, variable amplitude passive movement to a joint which a patient is able to prevent

What is an open-packed (resting position)?

The position of the joint where you’ll get the greatest degree of mobility between articular surfaces; least congruent and most lax

What is a close-packed (non-resting position)?

The position of the joint where you’ll get the least amount of mobility between articular surfaces; most congruent and least lax

Open-packed position of the glenohumeral joint?

55 degrees abduction, 30 degrees horizontal adduction, and slight internal rotation

Close-packed position of the glenohumeral joint?

Max abduction and external rotation

Open-packed position of the SC joint?

Anatomical resting; arm resting by side/semi-elevation of shoulder

Close-packed position of the SC joint?

Max elevation or max horizontal adduction

Open-packed position for the AC joint?

Anatomical resting; arm resting by side

Close-packed position for the AC joint?

90 degrees shoulder abduction

What is the rate of force application?

The rate/speed at which the force was applied

What is the location in range of available movement?

Was motion intended to occur only at the beginning of the available range of movement, toward the middle of the available range of movement, or at the end point of the available range of movement

What is the direction of force?

Describes the direction in which the therapist imparts the force

What is the target of force?

Describes the location or specific tissues to which the therapist intended to apply the force

What is the relative structural movement?

Describes which structure or region was intended to remain stable and which structure or region was intended to move; moving structure is named first and the stable segment is named second

What is patient position?

Describes the position of the patient

What are the three R’s?

Reproducible sign, region of origin, and reactivity

What may be a general order to target tissues?

Soft tissue, muscle, joint, nerve

Capsular pattern for AC joint?

Full elevation

Capsular pattern for SC joint?

Full elevation

Open-packed position for scapulo-thoracic joint?

Arm resting by side

What must you do first with muscle and fascial restrictions?

Clear superficial restrictions before moving into deeper structures

What is an indirect technique?

Manual intervention that involve the use of force applied in the opposite direction of the restriction; into the position of ease. Used when direct techniques produce pain or are ineffective

What is a direct technique?

Engages the dysfunctional barrier and applies an activating force that moves through the barrier to reestablish motion. The use of force is applied in the same direction as the restriction

Goal of direct technique?

Reposition barrier closer to the end of normal range

Goal of indirect technique?

Unloads involved tissues and structures to achieve release phenomenon, allowing hypertonic tissues to relax and gain greater ROM beyond original barrier

What is the myotactic reflex arc?

Increased muscle tone due to elevated gamma neuron input

What is strain-counterstrain?

Finding position of comfort (POC) to reduce tender points and improve normalcy of tissue length and function

Indications of indirect strain-counterstrain?

Reduce muscle spasm and edema, improve muscle recruitment and neuromuscular reorganization of an affected tissue

How long do you hold an indirect strain-counterstrain technique?

90 seconds

How long do you hold an indirect strain-counterstrain technique if neuro?

At least 3 minutes

Instructions to indirect strain-counterstrain technique?

Find the most tender point, treat proximal to distal, address anterior TP’s w/flexion, passively move into POC slowly while maintaining light pressure on TP, and apply slow changes in length-tension

Purpose of indirect MFR (fascia/soft tissue release) for the shoulder girdle?

Observed scapular protraction w/postural assessment; noted impairments in HABD during active exam

How long do you hold indirect MFR (fascia/soft tissue release)?

3-5 minutes

Purpose for indirect articular release?

Following soft tissue MFR, corrects for residual joint dysfunction

Purpose for strain-counterstrain for subscapularis?

Postural deviations of shoulder adduction, observed anterior humeral head position, limitations in shoulder ER and abduction, and accessory hypomobility into posterior humeral glide

Purpose for strain-counterstrain for latissimus?

Postural deviations: humeral head position with inferior position, limitations in shoulder flexion

Purpose for pec minor functional positional release?

Postural deviations: anterior scapular tilt; restrictions in shoulder flexion due to limited upward scapular motion

Purpose for STM of pec major and pec minor?

Restrictions in shoulder abduction/ER motion, shoulder flexion/scapulothoracic motion, postural deficits, or TOS

Purpose for STM for subscapularis?

Restricted ER of the shoulder, presence of adhesive capsulitis, recent time spent in a sling

Purpose for STM of the lats?

Restricted abduction, ER, flexion of the shoulder; can also be used for hyperlordosis of trunk or adhesive capsulitis

Purpose of STM of rhomboids?

Elevated tone in scapular retractors; limited upward rotation of scapula during UE elevation

What does dominant sign mean?

Reproducible signs/symptoms

How to find the lesser tubercle most prominantly?

Going into external rotation

True or false: direct techniques move tissues away from the restrictive barrier?

False

During strain-counterstrain, each position is generally held for approximately…?

90 seconds

True or false: indirect MFR shoulder girdle release may be held for several minutes while tissues unwind?

True