Manual Therapy Techniques 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 6.6a Alternative Myofascial Release Applications

Figure 6.6b Alternative Myofascial Release Applications 15

Figure 6.6c Alternative Myofascial Release Applications 16

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: Various techniques Arthrokinematics Relieve pain Restore joint mobility Various techniques Arthrokinematics Roll Slide (glide) Spin Compression and distraction

Figure 6.18a Joint Surfaces of Ovoid and Sellar Joints

Figure 6.18b Joint Surfaces of Ovoid and Sellar Joints 29

Figure 6.19 Roll

Figure 6.20 Slide

Figure 6.21 Spin

Figure 6.22 Compression

Figure 6.23 Distraction

Figure 6.24a Rules for Concave and Convex Joint Surfaces

Figure 6.24b Rules for Convex and Concave Joint Surfaces 36

Figure 6.25a Grades of Movement in a Normal and a Restricted Joint

Figure 6.25b Grades of Movement in a Normal and a Restricted Joint

Figure 6.26 Sustained Versus Oscillation Mobilization

Figure 6.27 Movement Diagram

Figure 6.28a Pain and Resistance on Movement Diagrams

Figure 6.28b Pain and Resistance on Movement Diagrams 42

Figure 6.28c Pain and Resistance on Movement Diagrams 43

Figure 6.28d Pain and Resistance on Movement Diagrams 44

Figure 6.28e Pain and Resistance on Movement Diagrams 45

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 6.33a Slump Test

Figure 6.33b Slump Test 53

Figure 6.34a Upper-Limb Tension Test

Figure 6.34b Upper-Limb Tension Test 55

Figure 6.34c Upper-Limb Tension Test 56

Figure 6.35a Upper-Limb Tension Test 2a

Figure 6.35b Upper-Limb Tension Test 2a 58

Figure 6.36a Upper-Limb Tension Test 2b

Figure 6.36b Upper-Limb Tension Test 2b 60

Figure 6.37a Upper-Limb Tension Test 3

Figure 6.37b Upper-Limb Tension Test 3 62

Figure 6.38a Self-Mobilization

Figure 6.38b Self-Mobilization

Figure 6.38c Self-Mobilization

Figure 6.38d Self-Mobilization

Figure 6.38e Self-Mobilization

Figure 6.38f Self-Mobilization

Figure 6.38g Self-Mobilization