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64 Cards in this Set
- Front
- Back
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State the APTA Guide's definition of manipulation. |
-"a manual therapy technique comprised of a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude high velocity therapeutic movement"
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State Dr. Paris' definition of manipulation.
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-"skilled passive movement to a joint"
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When was manipulation established in contemporary medicine?
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-1870
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Who was Wharton Hood?
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-1871 published "On Bone Setting", 1st book published by an orthodox medical practitioner
-believed "snapping" was breaking of adhesions |
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Who was Andrew Taylor Still?
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-founded osteopathy 1874
-believed normalization of mechanically locked joints improved disease conditions -"law of the artery" founder |
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What composes the osteopathic concept?
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-the body as a unit
-structure and function are reciprocally related -body possesses self regulatory mechanisms |
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Who was Daniel David Palmer?
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-founder of Chiropractic 1895
-admitted existence of manipulation prior to founding chiropractic |
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Briefly state the "law of the nerve."
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-vertebrae may sublux and impinge other structures, causing corresponding structures to function abnormally; adjustment of subluxation restores normal innervation and function
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Who was James Cyriax?
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-published theories on medical practice in 1948
-wrote "Textbook of Orthopedic Medicine" -popularized the term "end-feel" -proponent of physiotherapists practicing manipulation |
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Define End-Feel, according to Cyriax.
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-sense of resistance felt in all joints at end range
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Who was John Mennell?
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-published "Joint Pain" in 1960
-joint pathology and pain arise from synovial joints and not the disc -may have been 1st person to use term "Joint Play" |
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Define Joint Play.
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-the quality of motion in a joint or mechanical structure that provides for tolerance to aberrant motion
-"wiggle or slack" present in biomechanical structures |
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Who was Freddy Kaltenborn?
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-published "Extremity Joint Manipulation" in 1961
-1st to relate manipulation to arthrokinematics |
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Who was Geoffrey Maitland?
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-published "Vertebral Manipulation" in 1964
-used oscillatory motions to treat reproducible signs -identified painful active or passive movements, oscillated the joint, and tested again -also wrote "Peripheral Manipulation" |
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Who were Melzack and Wall?
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-proposed the "Gate Control" theory of pain in 1966
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Who is Robin McKenzie?
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-popularized "spinal extension" in the late 1970's to treat low back pain
-believe centralization of pain following repeated extension was due to reduction of disc protrusion |
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Discuss the Chiropractic manipulation philosophy.
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-based on relieving nerve root pressure
-non-specific resulting in multiple cracks -achieve neurophysiological and chemical effects |
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Discuss Maitlands manipulation philosophy.
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-based on relieving pain
-oscillations are used to eliminate reproducible signs -specific techniques |
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Discuss Maigne's manipulation philosophy.
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-must produce no pain
-direction of manipulation is the direction of least restriction -specific techniques |
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Discuss McKenzie's manipulation philosophy.
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-repetitive motion is used for centralization of pain
-many interpret this as disc centralization |
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Discuss Mennell's manipulation philosophy.
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-normalize joint mobility
-emphasizes "joint play" -extremities are specific, spine less so |
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Discuss Kaltenborn's manipulation philosophy.
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-emphasis on arthrokinematics
-focus on concave-convex relationship -specific and eclectic techniques |
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Discuss Paris' manipulation philosophy.
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-emphasis on restoring normal arthrokinematics, especially component motion and joint play.
-pain is de-emphasized -specific and eclectic techniques |
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Discuss Mulligan's manipulation philosophy.
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-promotes natural facet glides by assisting the motion performed by the patient, usually in weight bearing.
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List the positive findings consistent with Hicks Preliminary Stabilization Prediction Rule.
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-positive prone instability test
-aberrant movement present -average SLR >91 -age < 40 y.o. = success of 67% for patients w/ 3 of 4 variables |
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State the clinical prediction rule for manipulation according to Flynn et al.
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- symptoms < 16 days
-FABQ < 19 -Hip IR > 35 deg. -hypomobile PA lumbar mobility -symptoms proximal to knee = 4 of 5 variables pts respond well to manipulation |
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Discuss the findings of the O'Sullivan article (1997)
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-reduced pain intensity and Oswestry scores in spondylolysis and spondylolisthesis pts following a 10 week rx program of abdominal stabilization and education regarding stabilization during activity
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Discuss the findings of Daneels et al (2001) in regards to chronic low back pain.
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-decreased amount of type II muscle fibers
-concentric-static hold-eccentric exercises increase cross sectional girth -no static hold = no significant growth |
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Discuss the conclusion of Hides et al (1996) in regards to the multifidus as a stabilizer.
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-multifidus recovery is not spontaneous
-subjects receiving stabilization restored multifidus thickness -control received meds and education and lost multifidus girth |
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Discuss 2 articles contributing to use of stabilization for treatment of low back pain.
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Hides = multifidus suffers reflex inhibition w/ LBP and recovery is not spontaneous
Hodges = multifidus bulk can be restored with stabilization exercises |
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What are the four treatment classification groups for LBP according to Fritz? What patient types belong in each classification?
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-manipulation = strain/sprain, hypomobility, SI
-stabilization = instability, spondy -specific exercise = mckenzie disc -traction = non-mckenzie nerve roots |
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Discuss the findings of Linstrom et al (1992)
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-graded activity and behavioral approach (Rehab Approach) has been shown to cause 5 week earlier return to work and 8 week combined difference in sick leave
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Discuss research supporting the use of PIVM in the spine evaluation.
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-fair intratester reliability, poor intertester reliability
-Pain w/ PA mobility testing is more reliable than graded motion -PA mobility testing has been shown to assist in predicting who will benefit from manipulation vs. stabilization |
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According to Broadhurst et al. (1998) which SI provocation tests have high predictive value?
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-FABER
-posterior shear -resisted hip ABduction |
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According to Laslett et al. (1994) which SI provocation tests are reliable?
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-SI gapping and compression
-Posterior shear -posterior torsion |
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What are the effects of immobilization on muscle at 2,4,6,and 8 weeks?
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2= atrophy, hyperemia
4= considerable atrophy 6= considerable atrophy 8= less hyperemia, thickening |
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What are the effects of immobilization on synovium at 2,4,6,and 8 weeks?
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2= increase synovial fluid and BV proliferation
4= marked increase in synovial cells, hyperemia, pannus over non contact cartilage 6= less hyperemia, fibroblasts and collagen give fibrotic appearance 8= .... |
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What are the effects of immobilization on cartilage at 2,4,6,and 8 weeks?
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2= appearance normal
4= loss of luster and color, softening, pannus growth up to contact area 6= ulcerated, peripheral defects fill w/ fibrous tissue 8= exostosis and deep ulceration, bone denuded in non-contact area |
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What are the effects of immobilization on capsule at 2,4,6,and 8 weeks?
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2= normal
4= normal 6= increased thickness 8= increased thickness |
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What are the effects of immobilization on ROM at 2,4,6,and 8 weeks?
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2= 75% lost 10% of ROM
4= 50% partial loss, 50% total loss 6= 20% partial loss, 80% complete loss |
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What are the effects of immobilization on adhesions at 2,4,6,and 8 weeks?
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2= none
4= none 6= none 8= began to appear |
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What are the general tissue responses to immobilization?
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-loss of GAGS
-increase crosslink formation -poor collagen orientation -fatty fibrous infiltration of edematous areas -pannus formation inside jts -general atrophy of all tissue types |
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What are the general effects on muscle, ligament and capsule as a result of immobilization?
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-capsular contractures
-ligament shortening -muscle incompetence |
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List the UE dermatomes.
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C4 = upper trap area
C5 = lateral shoulder C6 = thumb C7 = middle finger C8 = ulnar border T1 = medial forearm T2 = medial upper arm |
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List the UE myotomes.
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C4 = upper traps
C5 = biceps C6 = wrist extensors C7 = triceps/wrist flexors C8 = thumb extensors T1 = intrinsics |
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List the UE reflexes.
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C5/6 = biceps
C5/6 = brachioradialis C7 = triceps |
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List the LE dermatomes.
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L2 = groin
L3 = medial thigh L4 = distal lateral thigh and medial shank L5 = lat thigh, lat shank, dorsum/plantar foot S1 = lateral posterior leg, lateral foot S2 = medial posterior leg |
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List the LE myotomes
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L1/2 = psoas
L3 = quads L4 = tib anterior L5 = EHL S1 = FHL S2 = hamstrings |
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List the LE reflexes
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L3/4 = patellar tendon
S1 = achilles tendon |
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List, in order of greatest reliability, the components of neurovascular assessment according to Paris.
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-Muscle weakness
-neural tension -skin sensation -reflexes (unreliable) |
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List "Red Flags" indicating a non-musculoskeletal problem may be present.
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-bizarre/unusual history
-night pain -pain not relieved by rest or aggravated by movement -change in B&B function -throbbing and burning pain -chest pain -pains in shoulder nape, sternum, T-L junction |
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What are the results of restricted motion according to Paris?
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-collagen contraction, binding and proliferation
-loss of segmental flexibility and function -reduced disc nutrition -synovia degeneration -disuse of support muscles -adjacent hypermobilities may occur |
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What are the effects of hypermobility/instability on supporting tissues?
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-increased ligamentous stress and sensitivity
-altered NM control -fatigue fx of bone -weakness of annulus fibrosus |
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How does hypermobility/instability cause pain?
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-muscle involuntary guarding
-muscle chemical guarding -muscle shortening |
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What are the 7 reasons backward bending may relieve pain according to Paris?
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1= gate control theory
2= elevates water content of the disc which reduces its irritability 3= mobilizes the facet joint 4= promotes circulation 5= relieves fear of mvmt 6= neural tension is reduced 7= over time, GAGs are lost from disc and it begins to shrink |
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What are the 3 aspects of pain?
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-physical
-rational -emotional |
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What are the clinical signs of instability?
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-history/demo of tissue relaxation and creep
-increased muscle tone in standing -presence of step -disappearance of tone or step in lying -juddering w/ FB -grade 5 or 6 on PIVM -radiological studies of FB and BB (EXCESSIVE TRANSLATION) -segment tenderness - |
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What muscles attach to the occiput?
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-upper trapezius
-splenius capitis -semispinalis capitis -rectus capitis major -rectus capitis minor -obliquus capitis superior -longus capitis -SCOM |
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What are the components of pain?
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-physiological
-perceptual -affective -cognitive -behavioral |
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How do we evaluate pain?
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-body chart
-McGill pain questionnaire -history questions regarding behavior -provocation/palpation |
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What is the effect of speed of loading?
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-stiffness increases with loading rate, failure occurs at higher stresses and lower strains
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What is the effect of temperature on tissues?
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-less stiff at higher temperatures, resulting in failure at higher strain and lower stress
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What is creep?
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-progressive deformation of a structure under a constant load
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What is stress relaxation?
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-decrease in stress of a structure in presence of a constant strain
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