CHAPTER 6
Manual Therapy Techniques
I.
Definition and basic principles of manual therapy
A. Definition:
B.
Subjective in nature –
C.
Treatment application principles -
II.
Critical analysis: using evaluation and assessment techniques
A. Abilities required to perform effective manual therapy
1.
2.
3.
4.
B. Critical analysis and assessment with
III.
Massage
A. Definition:
B. Reflex physiological and mechanical effects of massage
1.
2.
3.
4.
5.
C.
Types of massage –
D.
Indications
E.
Contraindications
F.
Precautions
G.
Principles of application
IV.
Myofascial release
A. Definition and basic principles
1. Definition:
2. Used to
3. Related techniques:
a.
b.
c.
4. Use of physiological components of
B. Physiological basis
1. Fascia
a.
b.
c.
Effects of injury on fascia
d. Biomechanical impact of fascia
2. Nonacute biomechanical forces
3. Acute biomechanical forces
C.
Basic understandings/concepts
1. The term myofascial release:
2. Palpation:
3. Move from
4.
D.
Treatment guidelines
1. Treatment time =
2. Avoid
3.
4. Apply myofascial release with
E. Myofascial release strokes
1.
2.
3.
4.
5.
F.
Precautions
G.
Contraindications
V.
Myofascial trigger points
A. Definition of trigger point
1. Definition:
2. Can be located in
3. Taut band of
4.
5. The focal point appears as
6. Pressure on the nodule can cause
7. Active trigger points
8. Latent trigger points
B. Trigger point characteristics
1.
2. Pressure on the trigger point can cause referred pain
3. The more irritable the trigger point,
4.
5.
6.
C.
D.
E.
Each muscle has characteristic
Pain is aggravated by
Eased by short rest periods, heat with slow and sustained
stretches, short-term low-level activity, and specific trigger
point release techniques
Causes of trigger points
1.
2.
3.
4.
Trigger point examination
1. Causes of pain
2. Trigger point pain-referral chart
3. Compression test 4.
Trigger point treatment
1.
a.
Theory of effectiveness
2.
3.
4.
F.
VI.
5.
Precautions with trigger point release
Muscle energy
A. Definition:
B. Muscle energy theory
1. Malalignments of the body occur when the body becomes
imbalanced from muscle spasm, overpowering of weak
muscles by stronger ones, or restricted mobility
2. Muscle contraction can be
3.
4.
5.
6. Patient education
C.
Components of muscle energy technique
1. Perform thorough evaluation to determine
2. Determine
3. The patient's segment is placed in a position at
4.
5.
The patient contracts the muscle while the rehabilitation
clinician offers
Muscle contraction is
6.
Patient relaxes completely and the segment is
7.
VII.
Joint mobilization
A. Definition of joint mobilization
1. Passive movement of a joint in either
2.
3.
Is frequently performed by rehabilitation clinician
4.
Table 6.1 delineates the different mobilization approaches
B.
C.
D.
Joint motion
1. Physiological
2. Accessory
a.
b.
Arthrokinematics
1.
2.
3.
4.
5.
6. Joint surface and shape determine arthrokinematic motions
Concave and convex rules
1. One joint surface is stationary and the other is mobile
2. Convex joint surfaces slide in the direction
3.
E.
F.
Concave joint surfaces slide in the
Capsular patterns of joint motion
1. When motion loss is caused by capsular tightness,
2.
3.
Each joint has its own
If reduced motion is not in a capsular pattern,
4.
If a capsular pattern of motion is present,
Effects of joint mobilization
1. Joint mechanoreceptors are
2.
Distraction and gliding can cause
3.
Stretch of the capsule can cause
4.
Cracking noise:
G.
H.
I.
VIII.
Application of joint mobilization
1. Grades of movement
a.
b.
2.
3. Normal joint mobility
4. Close-packed position
5. Loose-packed position
6. Rules of application
Indications
1.
2.
Precautions and contraindications
Neural mobilization
A. Warnings
1. This is the most dangerous of all the manual therapy
techniques!
2. Must be used with care and caution
3. Used as a last resort if other treatments are not successful
4. Consequences of inappropriate application can be severe
B. Nociceptive afferent nerve fibers
1.
2. Nerve fibers are A-delta and C and can become
3.
4.
C.
Result in
5. Trigger the release of
6. C fibers are stimulated by
7. A-delta and C fibers both respond to
8. Both inhibitory and excitatory responses may be triggered
Referred pain
1. Normal neural tissue does
2.
Pathological conditions can produce
3.
4.
5.
6.
D.
E.
F.
G.
Susceptible sites
a.
b.
c.
d.
e.
With injury, fascia can
May be damaged by
Mechanical alterations in one nerve location may
Double-crush syndrome
1.
2. Central lesion should be suspected and ruled out
3. Symptoms are related to
4.
Symptoms of neural pain
1. Often described as
2. Can occur along the nerve's pathway or
3. Can be
4. Sometimes worse during
5. Local neural ischemia:
Neural tests and treatment techniques
1.
2.
3.
4.
5.
6. Can be either direct or indirect in nature; test procedures are
also used as treatment techniques
Neural mobilization treatment application
1. Pretreatment and post-treatment assessment should be
made, using tension tests
2. Use tension tests to identify
3. Monitor symptoms throughout the treatment
4. Avoid
5. A dull constant ache and pins-and-needles sensation should
be
6. Patient should be
H.
I.
7.
Duration, amplitude, and repetitions are determined by
8.
Self-mobilization
Precautions
Contraindications