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