Manual Therapy for Athletes
Bryan Bourcier DPT, ATC, COMT, CSCS,
Outline
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Manual Therapy basics
Contraindications
Indications
Spine Mobilizations for Athletes
Upper extremity Peripheral Mobilization
Lower extremity Peripheral Mobilizations
Manual Therapy Basics
• Grading Mobilizations
• Comparable Sign
• Resistance vs Pain
– R1 vs R2
– P1 vs P2
• Grades of Mobilizations
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I – Small amplitude short of resistance
II – large amplitude short of resistance
III – Large amplitude midway between R1 and R2
IV - Small amplitude midway between R1 and R2
V- At R2 High velocity low amplitude
• +, ++, -, -- variations
• IV++ and III++
Contraindications (Red/Yellow
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Fracture (red)
Hypermobility / empty end feel (Yellow)
Pregnancy (yellow)
Cord Compression (Red)
Cancer (Red)
Patient comfort (yellow)
Open wounds (yellow)
Fusions (Red and Yellow)
Manipulation into spasm (Red)
Indications
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Stiffness
Pain management
Scar tissue management
“locking” or “Pinching” (Spine)
Evidence
– When combined with exercise, speed up recovery
– Not better if used without exercise
Common Cervical Spinal Mobilizations
for Athletes
• Suboccipital Release
– Concussions
• Traction
• MET
• Soft tissue
What are we treating
Concussion
Whiplash
•neck pain and stiffness,
•headache,
•dizziness
•fatigue
•jaw pain
•activity intolerance
•postural weakness
•visual disturbances
•tinnitus
•increased symptoms with fatigue
•neck pain and stiffness,
•headache,
•shoulder and arm pain
•dizziness
•fatigue
•activity intolerance
•jaw pain
•postural weakness
•visual disturbances
•tinnitus
•back pain
•increased symptoms with fatigue
Subocciptial release
• Long sustained
pressure on
suboccipitals.
– Can be done
unitlaterally
– Make sure knees are
bent
– If too painful, try
traction first.
Common Cervical Spinal Mobilizations
for Athletes
• Suboccipital Release
– Concussions
• Traction – Manual Vs Mechanical
• MET – when and when not
• Soft tissue – positional release and first rib
Common Thoracic Spinal Mobilizations
for Athletes
• Pistol
• Screw
Common Lumbar Spinal Mobilizations
for Athletes
• Rotational Mobilization
– Grade I-III
– Manipulation
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Chicago Roll
Shotgun
SI / IS MET
Leg Pull
A/P
Upper extremity Mobilizations
• Shoulder
– “Fish Flop” (Shoulder pain control)
• Elbow
– Radial Head
• Wrist
– Distal Radial ulnar distraction
Lower Extremity
• Hip
– Lateral glides (FAI)
– AP and PA
• Knee
– Extension with ER and IR (post op and Hamstrings)
• Ankle
– Lateral malleolus glides (Ankle Sprains)