PHT 5321C Manual Therapy - Considerations and End Feel

PHT 5321C Manual Therapy - Considerations and End Feel

Overview of Manual Therapy Interventions

• The presentation will cover the considerations a physical therapist must consider when conducting manual therapy.

• Emphasis will be placed on:

  • Convex-concave rule and its application in manual therapy.

  • Discussion on normal and abnormal end-feels in physiologic and accessory joint motions.

• Benefits of manual therapy include:

  • Normalizing passive accessory motion.

  • Normalizing soft tissue mobility.

  • Reducing pain.

  • Improving function.

Considerations for Manual Therapy Interventions

• There are nine key considerations for physical therapists during manual therapy interventions:

  1. Joint Surface Shape:

  • Shape of joint segment (concave or convex) informs the direction of force application during joint-specific glides and distractions.

  1. Patient's Clinical Presentation:

  • Awareness of the patient's level of irritability and phase of healing of the target tissues can influence:

    • Structures to be treated.

    • Amount and direction of force.

    • Position of the structure.

  1. Closed Packed Position:

  • Techniques should not be performed in a closed packed position, where joint surfaces are maximally congruent and structures taut, resulting in minimal accessory motion.

  • Techniques should only be performed in positions outside of this closed packed position to avoid injury and ensure efficacy.

  1. Understanding the Convex-Concave Rule:

  • When a concave surface moves on a convex surface, roll and glide occur in the same direction.

  • When a convex surface moves on a concave surface, roll and glide occur in opposite directions.

  1. Accessory Motion Testing:

  • Findings from accessory motion testing may influence technique choices, even when they do not align with convex-concave rule.

  • Assess accessory motion immediately after manual therapy techniques for therapeutic outcome evaluation.

  1. Direction of Force Application:

  • Glide techniques are applied parallel to the joint plane.

  • Distraction techniques are applied perpendicular to the joint plane.

  1. Patient Positioning:

  • Position must allow for patient relaxation and provide access to target tissue.

  1. Optimal Therapist Positioning:

  • The therapist should consider body mechanics in relation to the direction and amount of force applied during interventions.

  1. Amount of Force Applied:

  • Based on patient presentation, tissue healing phase, impairments, and the type of barrier encountered.

End Feels

• Important for assessing motion quality and barrier encountered during passive motion testing.

• Normal End-Feels:

  • Hard (bone-to-bone): Examples include elbow extension where olecranon of ulna meets humerus.

  • Soft Tissue Approximation: E.g., calf pressing against thigh during knee flexion.

  • Capsular Stretch (firm): Experienced when capsular structures become taut, such as during passive finger extension or ankle dorsiflexion.

  • Muscle Stretch: Experienced when a muscle is maximally lengthened, as during knee extension with hip flexed.

• Abnormal End-Feels:

  • Springy: Indicates a potential issue, such as a torn meniscus in the knee.

  • Muscle Spasm: Unexpected during testing.

• A normal end-feel can be abnormal if encountered inappropriately, such as a hard end-feel at 20 degrees of flexion instead of full extension.

Implications of End Feels

• Help identify anatomical structures limiting motion and where in the motion spectrum limitations occur.

• Can indicate pathological processes, like a springy end-feel suggesting joint damage.

Conclusion

• Manual therapy requires careful consideration of multiple factors to ensure efficacy and safety.

• Future presentations will focus on a specific manipulation grading system to better inform about force application and expected outcomes in therapy.