Manual therapy lecture 1.pdf

Manual therapy (lecture (lecture-1) 1)
Sixth Semester
Mujeeb Ur Ur Rahman
Assistant Assistant Professor
IPM&R(KMU).
IPM&R(KMU).
03/09/2012

History:
Manual therapy
�� Manipulative therapy is probably probably as old as the history history of of humankind.
Throughout that history there have have been been healers who knew how to to reposition joints, and the
spine.
� In the 5th � In the 5 century, Hippocrates, founder of European medicine, listed rachiotherapy as a
th century, Hippocrates, founder of European medicine, listed rachiotherapy as a
further fundamental element of medicine medicine alongside surgery and medicinal therapy.
�� Hippocrates, associated vertebral displacement with:
pharyngitis, laryngitis, bronchial bronchial asthma, tuberculosis of the the lungs, nephritis and cystitis,
inadequate gonadal development, constipation, enuresis, enuresis, etc.
�� Advancement in in medicine (primitive) and surgery surgery left manipulative manipulative therapy far behind.
Pharmaceutical industry’s role… unequal unequal attention to medicine, medicine, surgery surgery and manual techniques.
This remained remained the situation until into the second half half of of the the nineteenth century.
�� The physician Galen (Claudius Galenos, 131-202 A.D.) Galen Galen wrote commentaries on
Hippocrates' work including that on joints. Galen's Galen's own manipulations were inspired by
Hippocrates.
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�� The The medical canon of of A Vicenna, an Arab doctor (980- 1037), also contains illustrations of
Hippocrates' and Galen's back treatments. This canon was was reprinted several times in Latin until
1608, reflecting many centuries of continued interest in in these techniques.
�� Similar illustrations show up in the medical book of of the Italian doctor Vidius Vidio (1500-
1569).
�� Later these same methods are illustrated illustrated with the inclusion inclusion of aa traction table in the works of
the French French Ambroise Pare (1550) and the German Scultetus (1700).
�� Manipulative techniques were were reintroduced to traditional medicine in the the nineteenth century
by the the American physician Andrew Taylor Taylor Still Still (1828-1917).
�� In 1874 he founded the School of Osteopathy in in Kirksville, U.S.A.
�� Still’s Still’s students brought the approach to Europe, where where they founded the British School of
Osteopathy in 1917 and later established the London London College of Osteopathy.
Osteopathy.
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�� 1895, DD Palmer founded the chiropractic school in in Davenport.
According According to to his own account, he witnessed manipulation being practiced practiced by a physician
named of Atkinson. Other sources say that that he he himself received received treatment from Still.
�� Euro physicians initially rejected rejected the concept.
discovery of herniated herniated disc was responsible responsible for for their their interest in man-therapy.
JA Mennell Prof. of physiotherapy main proponent of manual therapy.
Cyriax his successor, a passionate proponent of Man-therapy and an excellent clinician.
(Textbook of of Orthopaedic medicine).
�� The story of Nordic System approach to manual therapy begins in the 1940 by Freddy kaltenborn (
Norwegian Physical Therapist)
�� He developed the Nordic OMT system with the collaboration of Dr.Mennell and Dr.Cyriax.
�� Kaltenborn used to treat treat soldiers disabled during the world war in Germany Germany in 1945.
�� His major contributions was the use of biomechanical biomechanical principles in patient evaluation and
treatment. treatment.
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�� This included translatoric joint joint play movements, the integration of traction and translatoric
gliding into into manual manual evaluation and treatment maneuvers, the concave-convex rule, grades of
movement including both hypo- and and hypermobility, hypermobility, and and pre-positioning pre-positioning methods for traction
and gliding.
�� He also introduced the concepts of self-treatment, ergonomic principles applied to to protect the
therapist , , and and trail treatment.
�� Maitland’s (Our focus).
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Manipulation & Mobilization:
�� Mobilization:
Passive Passive joint joint movement for increasing ROM or decreasing pain.
�� Applied to joints & related soft tissues at at varying speeds & amplitudes using
or accessory motions
physiologic physiologic
�� Force is light light enough that patient can stop the the movement.
�� Manipulation:
�� Passive joint joint movement for increasing joint mobility
�� Incorporates Incorporates a sudden, forceful thrust thrust that is beyond the patient’s patient’s control.
�� Self Mobilization:
Mobilization:
Self-stretching techniques that that specifically use use joint traction traction or glides that direct the the stretch force
to to the joint joint capsule.
�� Mobilization with Movement:
Concurrent application of a sustained accessory mobilization applied by a clinician & an
active active physiologic physiologic movement to to end end range range applied applied by the patient. patient.
Applied in in a pain-free direction.
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�� Physiological Movements: Movements:
�� Movements performed voluntarily. voluntarily.
�� Osteokinametics:
Motion of of the bones.
�� Accessory movements:
Terminologies:
�� Movements within the joint & surrounding tissues that are necessary for normal ROM,
but can not be be voluntarily performed.
Component motions –
Motions Motions that that accompany accompany active motion, motion, but but are are not not under under voluntary voluntary control control i.e. i.e. Upward
rotation of scapula & rotation of clavicle that occur with shoulder flexion.
Joint play – motions that occur within the the joint.
Determined by by joint capsule’s laxity.
�� Can be demonstrated demonstrated passively, but not not performed actively.
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�� Arthrokinematics:
�� Motions of bone surfaces surfaces within the joint.
�� 5 motions motions - Roll, Slide, Spin, Spin, Compression, Distraction.
�� Muscle Energy:
�� use an active contraction of deep deep muscles that attach near the joint & whose line of pull can
cause the desired accessory motion
�� Clinician stabilizes segment on which the distal aspect of of the muscle attaches; attaches; command for for an
isometric contraction of the muscle muscle is given, which causes the accessory movement of the joint.
�� Thrust:
�� High-velocity, short-amplitude motion that the patient can not prevent.
�� Performed at end of pathologic limit of the joint (snap adhesions, stimulate joint receptors).
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�� Concave: Concave:
Hollowed or or rounded rounded inward.
�� Convex:
Curved or rounded outward.
�� Arthrokinematics:
5 types types of of joint arthrokinematics
Roll
Slide
Spin
Compression
Distraction
�� 3 components of joint mobilization mobilization
Roll, Spin, Slide Slide
Joint Joint motion usually often involves involves a combination of rolling, sliding & spinning. spinning.
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Effects of mobilization:
�� Neurophysiological effects
◦ Stimulates mechanoreceptors to �� pain pain
◦ Affect muscle spasm & muscle guarding guarding – – nociceptive stimulation
◦ Increase in in awareness of position & motion because of afferent nerve impulses
�� Nutritional Nutritional effects effects
◦ Distraction or small gliding movements – – cause synovial synovial fluid fluid movement
◦ Movement can improve nutrient exchange exchange due to joint swelling & immobilization
�� Mechanical effects effects –
◦ Improve Improve mobility of hypomobile joints (adhesions & thickened Con Tissue from
immobilization loosens).
◦ Maintains extensibility & & tensile strength of of articular articular tissues
(Cracking noise may sound may be be heard).
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Contra Contra-indications indications for Mob &
�� Should not be used haphazardly
�� Avoid the following:
◦ Inflammatory arthritis
◦ Malignancy
◦ Tuberculosis
◦ Osteoporosis
◦ Ligamentous rupture
◦ Herniated disks with nerve compression
◦ Bone disease.
◦ Neurological involvement
involvement
◦ Bone Bone fracture
◦ Congenital bone deformities
◦ Vascular disorders
Manipulation:
◦◦ Joint effusion effusion
(May use use I & II mobilizations to relieve pain).
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�� Osteoarthritis
�� Pregnancy Pregnancy
�� Flu
�� Total Total joint joint replacement
�� Severe scoliosis
�� Poor general health
�� Patient’s inability to relax
(Psychological)
Precautions:
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Maitland’s Joint Mobilization obilization
Grading:
�� Grading based on amplitude of movement & & where within available ROM the force is
applied.
�� Grade I
◦ Small amplitude rhythmic oscillating movement at the beginning of range of
movement
◦ Manage pain and spasm
�� Grade II
◦ Large amplitude amplitude rhythmic oscillating movement within midrange of movement
◦ Manage pain and spasm
�� Grades Grades I & II – often used before & after treatment with grades III & IV
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�� Grade III
◦ Large amplitude rhythmic oscillating movement up to point of limitation (PL) in range of
movement
◦ Used to gain gain motion within the joint
◦ Stretches capsule & CT structures
�� Grade IV
◦ Small amplitude rhythmic oscillating oscillating movement at very end range of movement
◦ Used to gain gain motion within the joint
�� Used when resistance limits movement movement in absence of pain
�� Grade Grade V V – (thrust technique) - Manipulation
◦ Small Small amplitude, quick thrust at end of range
◦ Accompanied by popping sound (manipulation)
(manipulation)
◦ Velocity vs. force
◦ Requires training.
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�� Grades Grades I and II - primarily used for pain
◦ Pain must be treated prior to stiffness stiffness
◦ Painful conditions can be treated daily
◦ Small amplitude oscillations stimulate stimulate mechanoreceptors mechanoreceptors - limit limit pain perception
�� Grades III and IV - primarily used to increase increase motion
◦ Stiff or hypomobile joints should be treated 3-4 times per week – alternate with active
motion motion exercises
03/09/2012

Thank Thank you.
03/09/2012