Ch 13- Manual Therapy
Treatment plane
A line that passes through the joint and lies at a right angle to line running from axis of rotation to contacting articular surface
What are three precautions in the application of massage?
Both your skin and the patients skin should be clean before application Your hands should be warm and nails trimmed to prevent lacerations or abrasions A lubricant should be used to reduce friction , so less lubricant is used for petrissage and cross-friction techniques, and more is used for effleurage
Explain the convex-on-concave and concave-on-convex rules, identify how they influence joint mobilization, and give an example of each.
Convex-on-concave rule: concave surface is stable and the convex joint slides in the opposite direction of the bone movement. Example: In the hip joint, the femoral head slides opposite to femoral shaft motion Concave-on-convex rule: the convex surface is stable and the concave joint surface slides in the same direction as the bone movement example: glenohumeral articulation: concave glenoid fossa articulates with the convex humeral head
Define the differences between petrissage, effleurage, and friction massage and their most common uses.
Effleurage is a stroking massage used to reduce edema. Petrissage is a lifting or kneading massage that is used to relax tissue and improve blood flow. Friction massage is used to reduce adhesions between tissues. It can also increase blood flow.
T/F: A pathologically shortened muscle has normal myofascia.
False
T/F: Edema typically accumulates in the deep fascia of the body.
False
T/F: Isometric contractions are used for trunk malalignments, whereas isotonic contractions are used for the extremities with muscle energy techniques.
False
T/F: Joint mobilization is usually initiated in a close-packed position to produce the most effective results.
False
T/F: Massage usually feels good but does not produce significant physiological effects or benefits.
False
T/F: Muscle energy techniques use a patient's maximal muscle contractions against a clinician's equivalent force to correct a malalignment.
False
T/F: Normal tissue has occasional tenderness to palpation.
False
T/F: Physiological joint motion cannot be intentionally or voluntarily produced, but it is necessary for normal motion.
False
T/F: Referred trigger point pain commonly follows neurological pathways.
False; does not follow neurological pathways
Define the four grades of joint mobilization and identify their purpose.
Grade I is a small-amplitude motion in the early, nonresistive parts of a joint's motion. Grade II is a large-amplitude motion that stays within the joint's unrestricted portion of motion. Grade III is a large-amplitude motion that enters into the resistive portion of a joint's motion. Grade IV is a small-amplitude motion that enters into the resistive portion of a joint's motion and is more aggressive than the grade III mobilization. Grades I and II are used to reduce pain. Grades III and IV are used to improve joint mobility.
Identify three contraindications for massage.
Infection, malignancies, skin diseases, blood clots, and any irritations or lesions that may spread with direct contact
A _________ trigger point is painful only when it is palpated.
Latent
Muscle energy techniques may be useful to treat malalignments resulting from
Muscle spasm Muscle imbalance Hypomobility
Explain the theory supporting myofascial treatment and its neurological effects.
Myofascial restriction causes autonomic changes to occur. Stimulating muscles and skin with myofascial techniques causes reflex afferent firing. Those afferent sensations are transmitted to the dorsal horn of the spinal cord. The dorsal horn, acting as a computer-like processing center, receives the information and directs it to one or more levels in the central nervous system. Occasionally, the autonomic system is stimulated so the patient experiences symptoms such as increased pulse rate, sweating, and blood pressure changes. Lesser changes such as sensations of burning, tingling, stinging, or local heat can also be reported.
Joint mobilization techniques are used to
Relieve pain, improve range of motion, increase joint accessory and physiological movement
Identify four functions of fascia in the body.
Tissue form Lubrication Nutrition Stability Integrity Function Support
T/F: Afferent pain fibers are inhibitory and excitatory.
True
T/F: An active trigger point is consistently tender and can refer pain when the muscle is either active or inactive.
True
T/F: Myofascia assists in producing muscular strength during eccentric activity.
True
T/F: Myofascia pathology can affect muscle strength performance.
True
T/F: Slide and roll are movements that must occur for most joint motion to occur.
True
T/F: The direction of joint mobilization force is usually applied either perpendicular to the joint plane or parallel to it.
True
Explain what a capsular pattern of movement is and why it is relevant to improving joint motion.
When the capsule is responsible for restricting normal range of motion, a pattern of movement unique to the joint occurs, with a specific sequence of motion loss seen for each joint. When a capsular pattern exists, joint mobilization is strongly indicated, and efforts to gain capsular mobility will be most effective in increasing range of motion.
Capsular pattern
characteristic pattern of decreased movement
Trigger point pain is commonly described as a
dull ache
List three precautions in the use of joint mobilization.
hypermobile joints, malignancy, unhealed fractures, excessive pain, recent total joint replacements.
resting position
joint capsule is loosest
Close-packed position
joint capsule is tightest
Identify three precautions for myofascial treatment techniques.
new scars (new tissue is fragile bc of its reduced tensile strength); complex regional pain syndrome (reflex sympathetic dystrophy); need to avoid bruising (results in additional scar tissue formation); need to instruct the patient to inform you of any sensations beyond the normal ones of some pain, tingling, burning, or warmth.
