chapter 6 Manual Therapy Techniques Manual Therapy Handson

chapter 6 Manual Therapy Techniques

Manual Therapy • Hands-on technique is used to evaluate, treat, and improve a patient’s status. • Art and skill are involved. • Practice is required. • Objective evidence-based analysis of effectiveness is difficult.

Massage • Systematic and scientific manipulation of soft tissue for remedial or restorative purposes • Effects – Physiological – Mechanical • Types – Effleurage (see figure 6. 1) – Pétrissage (see figure 6. 2) – Friction (see figure 6. 3) (continued)

Massage (continued) • • Indications Precautions Contraindications Application

Figure 6. 1

Figure 6. 2

Figure 6. 3

Myofascial Release • Related to massage • Various techniques with many different names • Pressure and tissue stretch used to obtain desired results

Fascia • • Surrounds all tissue Superficial layer Deep layer Subserous fascia: not affected by manual treatment • Contains elastin, collagen, cellular components, ground substance • Has high tensile strength, can be deformed

Fascia Pathology • Results from acute or chronic deformation forces • Alters function • May cause pain, deformation, loss of motion, reduced function • Changes posture • Requires neuromotor readjustment • Increases risk of injury

Figure 6. 4 Pathology of Myofascial Restriction

Myofascial Release Techniques • Various strokes: J-stroke, oscillation, wringing, stripping, arm pull, leg pull, longitudinal release • Precautions • Contraindications • Possible neurogenic responses

Figure 6. 5

Figure 6. 6 a Alternative Myofascial Release Applications

Figure 6. 6 b Alternative Myofascial Release Applications

Figure 6. 6 c Alternative Myofascial Release Applications

Figure 6. 7 J-Stroke

Figure 6. 8 Oscillation

Figure 6. 9 Wringing

Figure 6. 10 Stripping

Figure 6. 11 Arm Pull

Myofascial Trigger Points • Based primarily on work by Simons and Travell • A trigger point is a focus of hyperirritability that refers pain and occasional autonomic reaction. • Taut band with a central nodule • Active trigger point: refers pain without activity • Latent trigger point: refers pain only when palpated

Trigger Points • Do not follow neurological patterns • Do not have same type of pain as neurologically-based pain • Dull ache of various intensities • Specific referral pattern • Increase in pain with activity or irritation • Relief provided by short periods of rest, heat

Figure 6. 15 Effect of Trigger Point Release on Neural Pathways

Trigger Point Treatment • • Ice- or spray-and-stretch Ischemic compression Both followed by gentle stretches In some cases injections by physician

Figure 6. 14 Ice-and-Stretch Technique

Joint Mobilization • Purposes: – Relieve pain – Restore joint mobility • Various techniques • Arthrokinematics – – Roll Slide (glide) Spin Compression and distraction

Figure 6. 18 a Joint Surfaces of Ovoid and Sellar Joints

Figure 6. 18 b Joint Surfaces of Ovoid and Sellar Joints

Figure 6. 19 Roll

Figure 6. 20 Slide

Figure 6. 21 Spin

Figure 6. 22 Compression

Figure 6. 23 Distraction

Figure 6. 24 a Rules for Concave and Convex Joint Surfaces

Figure 6. 24 b Rules for Convex and Concave Joint Surfaces

Figure 6. 25 a Grades of Movement in a Normal and a Restricted Joint

Figure 6. 25 b Grades of Movement in a Normal and a Restricted Joint

Figure 6. 26 Sustained Versus Oscillation Mobilization

Figure 6. 27 Movement Diagram

Figure 6. 28 a Pain and Resistance on Movement Diagrams

Figure 6. 28 b Pain and Resistance on Movement Diagrams

Figure 6. 28 c Pain and Resistance on Movement Diagrams

Figure 6. 28 d Pain and Resistance on Movement Diagrams

Figure 6. 28 e Pain and Resistance on Movement Diagrams

Figure 6. 29 Direction of Force Application

Joint Mobilization • Indications • Contraindications • Precautions

Neural Mobilization • • • Used as a last resort Used with caution Susceptible sites of neurofascial restriction Symptoms Treatment

Figure 6. 30 Passive Neck Flexion

Figure 6. 31 Straight-Leg Raise

Figure 6. 32 Prone Knee Bend

Figure 6. 33 a Slump Test

Figure 6. 33 b Slump Test

Figure 6. 34 a Upper-Limb Tension Test

Figure 6. 34 b Upper-Limb Tension Test

Figure 6. 34 c Upper-Limb Tension Test

Figure 6. 35 a Upper-Limb Tension Test 2 a

Figure 6. 35 b Upper-Limb Tension Test 2 a

Figure 6. 36 a Upper-Limb Tension Test 2 b

Figure 6. 36 b Upper-Limb Tension Test 2 b

Figure 6. 37 a Upper-Limb Tension Test 3

Figure 6. 37 b Upper-Limb Tension Test 3

Figure 6. 38 a Self-Mobilization

Figure 6. 38 b Self-Mobilization

Figure 6. 38 c Self-Mobilization

Figure 6. 38 d Self-Mobilization

Figure 6. 38 e Self-Mobilization

Figure 6. 38 f Self-Mobilization

Figure 6. 38 g Self-Mobilization