Direct Methods

MFR CI

NO ABS CONTRAINDICATIONS relative CI: sprain, strain, fracture, infxn, DVT (on anticoags), osteoporosis, aortic aneurysm

soft tissue

direct technique monitoring tissue response and motion changed by palpation involved lateral and linear stretching, deep pressure, traction and/or separation of muscle attachments

palpating myofascial restriction

direction of underlying force will be easier to palpate your finger across

soft tissue activating forces and elements

directly applied to muscle/fascia and affect associated neural/vascular elements and also improvement of articular motion

in a patient with a full ROM, the neutral (midline) point is the same as in dysfunction

false. a new midline would be established, as midline is defined as literally the middle of the range of PHYSIOLOGIC motion

MET CI

fracture,dislocation,devere joint instability; patients w poor vitality or comprehension relative CI: mod/sev muscle spasms, severe osteoporosis, severe illness

what is direct technique

positioning patient directly TOWARDS direction of restrictive barrier (towards pain)

what are the activating forces in indirect method

Intrinsic forces- 2nd tenet of bodys ability to heal self also respiratory forces

lumbosacral region and fascia

LS spine plays huge role in maintaining posture, but alone not enough. thoracolumbar fascia critical part of myofascial girdle surrounding lower portion of torso, important in posture, load transfer, and respiration

myofascial release

MFR apply compresion forces into affected fascia direct release=once barrier engaged, fascia responds w decreased resistance=motion resumes

HVLA contraindication

a ton of abs CIs: Joint instability Severe osteoporosis Metastasis in the region to be treated OA with ankylosis Severe discogenic spondylosis with ankylosis Osteomyelitis in region to be treated Infection in area to be treated Joint replacement in area to be treated Severe disk herniation with radiculopathy

considerations in direct technique

acute disruptions of tissues (tears, sprains, fractures) may further be damaged using this. could also INCREASE pain and thus CI'd if patient has severe pain

articulatory tech CI

acute sprain strain fracture, dislocation joint instability acute inflam joint disease metastasis in area

post isometric relaxation

after muscle contraction there is a brief refractory period, so less contraction=ability to move slightly and temporarily increase muscle length

reciprocal inhibition

agonist/antagonist muscles simultaneously ex: bicep flexion, tricep relaxes

isolytic

physician resistance greater

soft tissue indications

basically anything for relaxing muscle/fascia tension also to improve movement of fluids=improve local& systemic immune response can also result in normalized tone by stimulating stretch receptors to contract in hypotonic muscles (this is why it says soft tissue not just for tight muscles on ppt)

isotonic

physician resistance less = patient wins

articulatory technique

low velocity technique w high ROM

normal vs abnormal "end feel"

normal= u can gradually increase tension at end of rom abnormal= abrupt stop/firm, hard at end. indicates pathology

soft tissue techniques

parallel traction (stretching) perpendicular traction (kneading) inhibitory (constant) pressure- requires monitoring for tissue changes transverse tissue technique=break cross fiber adhesion

isometric muscle energy

physician force equals pts counterforce w no net motion during contraction

HVLA

rapid therapeutic force, brief duration, short distance anatomic range.

articulatory tech indications

restricted motion w joint and/or myofascial SD circulatory and/or lymphatic congestion

what techniques are direct techniques

soft tissue direct myofascial release (theres also an indirect) articulatory muscle energy HVLA (thrust)

fascial creep

sometimes fascial barrier moves due to unique qualities of fascia

sibson's fascia

traverses thoracic inlet twice before emptying into left major duct the right only traverses thoracic inlet once

Muscle energy technique

use active forces (patient will cooperate) golgi tendon reflex is normally neutral at neutral position, but in dysfunction, reflex position detects neutral in contracted state. MET opposes patient active force, and bring patient towards restriction pt to re-establish neutral position