Manual Therapy for Athletes Bryan Bourcier DPT, ATC, COMT, CSCS,

Outline 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 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 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 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 neck pain and stiffness, headache, dizziness Concussion Whiplash neck pain and stiffness, headache, dizziness fatigue jaw pain activity intolerance postural weakness visual disturbances tinnitus increased symptoms with fatigue shoulder and arm pain back pain

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 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 Knee Ankle Lateral glides (FAI) AP and PA Extension with ER and IR (post op and Hamstrings) Ankle Lateral malleolus glides (Ankle Sprains)