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chapter 6

chapter 6. Manual Therapy Techniques. 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. Massage.

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chapter 6

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  1. chapter6 Manual Therapy Techniques

  2. 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.

  3. 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)

  4. Massage (continued) • Indications • Precautions • Contraindications • Application

  5. Figure 6.1

  6. Figure 6.2

  7. Figure 6.3

  8. Myofascial Release • Related to massage • Various techniques with many different names • Pressure and tissue stretch used to obtain desired results

  9. 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

  10. 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

  11. Figure 6.4 Pathology of Myofascial Restriction

  12. Myofascial Release Techniques • Various strokes: J-stroke, oscillation, wringing, stripping, arm pull, leg pull, longitudinal release • Precautions • Contraindications • Possible neurogenic responses

  13. Figure 6.5

  14. Figure 6.6a Alternative Myofascial Release Applications

  15. Figure 6.6b Alternative Myofascial Release Applications

  16. Figure 6.6c Alternative Myofascial Release Applications

  17. Figure 6.7 J-Stroke

  18. Figure 6.8 Oscillation

  19. Figure 6.9 Wringing

  20. Figure 6.10 Stripping

  21. Figure 6.11 Arm Pull

  22. 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

  23. 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

  24. Figure 6.15 Effect of Trigger Point Release on Neural Pathways

  25. Trigger Point Treatment • Ice- or spray-and-stretch • Ischemic compression • Both followed by gentle stretches • In some cases injections by physician

  26. Figure 6.14 Ice-and-Stretch Technique

  27. Joint Mobilization • Purposes: • Relieve pain • Restore joint mobility • Various techniques • Arthrokinematics • Roll • Slide (glide) • Spin • Compression and distraction

  28. Figure 6.18a Joint Surfaces of Ovoid and Sellar Joints

  29. Figure 6.18b Joint Surfaces of Ovoid and Sellar Joints

  30. Figure 6.19 Roll

  31. Figure 6.20 Slide

  32. Figure 6.21 Spin

  33. Figure 6.22 Compression

  34. Figure 6.23 Distraction

  35. Figure 6.24a Rules for Concave and Convex Joint Surfaces

  36. Figure 6.24b Rules for Convexand Concave Joint Surfaces

  37. Figure 6.25a Grades of Movement in a Normal and a Restricted Joint

  38. Figure 6.25b Grades of Movement in a Normal and a Restricted Joint

  39. Figure 6.26 Sustained Versus Oscillation Mobilization

  40. Figure 6.27 Movement Diagram

  41. Figure 6.28a Pain and Resistance on Movement Diagrams

  42. Figure 6.28b Pain and Resistance on Movement Diagrams

  43. Figure 6.28c Pain and Resistance on Movement Diagrams

  44. Figure 6.28d Pain and Resistance on Movement Diagrams

  45. Figure 6.28e Pain and Resistance on Movement Diagrams

  46. Figure 6.29 Direction of Force Application

  47. Joint Mobilization • Indications • Contraindications • Precautions

  48. Neural Mobilization • Used as a last resort • Used with caution • Susceptible sites of neurofascial restriction • Symptoms • Treatment

  49. Figure 6.30 Passive Neck Flexion

  50. Figure 6.31 Straight-Leg Raise

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