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Manual Therapy Techniques
chapter 6 Manual Therapy Techniques
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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.
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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)
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Massage (continued) Indications Precautions Contraindications
Application
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Figure 6.1
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Figure 6.2
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Figure 6.3
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Myofascial Release Related to massage
Various techniques with many different names Pressure and tissue stretch used to obtain desired results
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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
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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
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Figure 6.4 Pathology of Myofascial Restriction
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Myofascial Release Techniques
Various strokes: J-stroke, oscillation, wringing, stripping, arm pull, leg pull, longitudinal release Precautions Contraindications Possible neurogenic responses
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Figure 6.5
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Figure 6.6a Alternative Myofascial Release Applications
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Figure 6.6b Alternative Myofascial Release Applications
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Figure 6.6c Alternative Myofascial Release Applications
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Figure 6.7 J-Stroke
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Figure 6.8 Oscillation
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Figure 6.9 Wringing
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Figure 6.10 Stripping
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Figure 6.11 Arm Pull
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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
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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
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Figure 6.15 Effect of Trigger Point Release on Neural Pathways
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Trigger Point Treatment
Ice- or spray-and-stretch Ischemic compression Both followed by gentle stretches In some cases injections by physician
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Figure 6.14 Ice-and-Stretch Technique
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Joint Mobilization Purposes: Various techniques Arthrokinematics
Relieve pain Restore joint mobility Various techniques Arthrokinematics Roll Slide (glide) Spin Compression and distraction
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Figure 6.18a Joint Surfaces of Ovoid and Sellar Joints
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Figure 6.18b Joint Surfaces of Ovoid and Sellar Joints
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Figure 6.19 Roll
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Figure 6.20 Slide
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Figure 6.21 Spin
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Figure 6.22 Compression
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Figure 6.23 Distraction
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Figure 6.24a Rules for Concave and Convex Joint Surfaces
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Figure 6.24b Rules for Convex and Concave Joint Surfaces
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Figure 6.25a Grades of Movement in a Normal and a Restricted Joint
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Figure 6.25b Grades of Movement in a Normal and a Restricted Joint
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Figure 6.26 Sustained Versus Oscillation Mobilization
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Figure 6.27 Movement Diagram
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Figure 6.28a Pain and Resistance on Movement Diagrams
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Figure 6.28b Pain and Resistance on Movement Diagrams
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Figure 6.28c Pain and Resistance on Movement Diagrams
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Figure 6.28d Pain and Resistance on Movement Diagrams
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Figure 6.28e Pain and Resistance on Movement Diagrams
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Figure 6.29 Direction of Force Application
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Joint Mobilization Indications Contraindications Precautions
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Neural Mobilization Used as a last resort Used with caution
Susceptible sites of neurofascial restriction Symptoms Treatment
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Figure 6.30 Passive Neck Flexion
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Figure 6.31 Straight-Leg Raise
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Figure 6.32 Prone Knee Bend
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Figure 6.33a Slump Test
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Figure 6.33b Slump Test 53
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Figure 6.34a Upper-Limb Tension Test
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Figure 6.34b Upper-Limb Tension Test
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Figure 6.34c Upper-Limb Tension Test
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Figure 6.35a Upper-Limb Tension Test 2a
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Figure 6.35b Upper-Limb Tension Test 2a
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Figure 6.36a Upper-Limb Tension Test 2b
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Figure 6.36b Upper-Limb Tension Test 2b
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Figure 6.37a Upper-Limb Tension Test 3
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Figure 6.37b Upper-Limb Tension Test 3
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Figure 6.38a Self-Mobilization
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Figure 6.38b Self-Mobilization
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Figure 6.38c Self-Mobilization
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Figure 6.38d Self-Mobilization
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Figure 6.38e Self-Mobilization
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Figure 6.38f Self-Mobilization
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Figure 6.38g Self-Mobilization
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