History of Manual Therapy

Transcription

1 Manual Therapy: Mobilization, manipulation of soft tissues, massage A systematic method of evaluating and treating dysfunctions of the neuromusculoskeletal system in order to relieve pain, increase or decrease mobility, and in general normalize function

2 History of Manual Therapy Hippocrates ( BC) Galen ( AD) Bone-setter (England):.Stiffness and pain in joints were immobilized for a long period of time after fractures, dislocations, or sprains.stiffness and pain resulting from disuse after soft tissue injuries.internal deragements after rupture of the meniscus.subluxations of small bones of the hands and feet.ganglion development around the wrist.treatment of neck and back disorders Graham ( ) Massage: any procedure done by the hands (friction & manipulation)

3 William Merrell ( ) A scientific mode of treating certain forms of disease by scientific manipulation, including passive range of motion, mobilization, and manipulation

4 Osteopaths: Andrew Taylor Still ( ) The body as a unit had the ability to fight off all disease and that the cause of all disease was mechanical pressure on blood vessels and nerves produced by dislocated bone, abnormal ligaments, or contracted muscles in the back(osteopathic lesion)

5 Chiropractors: Daniel David Palmer ( ): To put bones back into place.straights:.mixers:

6 Medical Manipulators for Mennell: Physical therapist NAAMM merged with AAOM (American Association of Orthopaedics Medicine) Cyriax

7 Practice of Manual Medicine the functional capacity of the human organism dynamic processes of disease musculoskeletal system comprises over 60% of the human organism Structural diagnosis to evaluate the musculoskeletal system for its particular disease and dysfunctions to evaluate the somatic manifestations of disease and derangement of the internal viscera. to increase mobility in restricted areas of l k l l

8 Goals of Manipulation To restore maximal, pain-free movement of the musculoskeletal system in postural balance (1983)

9 Concepts

10 A. Holism: the musculoskeletal system deserves thoughtful and complete evaluation (treat patients, not to treat disease

11 B. Neurological control: (fig) somaticosomatic reflex pathways viscerovisceral reflex arc sympathetic reflex pathways ANS a) parasympathetic b) sympathetic

12 B. Circulatory function 1. Arterial system 2. venous system 3. lymphatic system 4. muscular activity 5. diaphragm C. Energy expenditure: musculoskeletal activity

13 D. Self-regulation: 1. homeostatic mechanism 2. iatrogenic disease

14 Manipulable lesion osteopathic lesion, chiropractic subluxation, joint blockage, loss of joint play, joint dysfunction current somatic dysfunction

15 Manipulable lesion A. defined as impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic, and neural elements B. emphasized is on altered function of the musculoskeletal system C. The art of structural diagnosis is to define the presence of somatic dysfunction(s) and determine any significance to the patient s complaint or disease process presenting at the time.

16 Diagnostic triad for somatic dysfunction ART through observation or palpation 1. A: Asymmetry 2. R: Range of motion of a joint, several joints or regions of musculoskeletal system a) Active or passive movement b) Hypermobility or Hypomobility 3. T: Tissue texture abnormality of soft tissue of the musculoskeletal system for location, status (acute, or chronic), prognosis, treatment response

17 Relief of nerve-root pressurereacting only to the spine A. Specific- chiropractors recommend the movement of one specific vertebra on another. B. Nonspecific- Cyriax recommends general manipulation with traction

18 Relief of pain- relating to the spine or extremities A. Graded oscillations- Maitland believes in mobilizations subthreshold to pain B. Contrary movement- Mainge recommends therapeutic movement in a direction exactly opposite to that which cause pain

19 Normalization of joint mobilityrelating to the spine or extremities A. Osteopathy- osteopaths advocate specific techniques for mobilizing the spine and extremities B. Treatment of stiffness- & Kaltenborn advocates the use of arthrokinematic principles to regain mobility without regard to pain C. Paris: a concept of facet disorder as the primary cause of spine dysfunction D. The cause of the dysfunction and treatment of pain

20 Joint mobilization Passive exercise Physiologic movement: the creation of motion within a joint by an outside force taking the body part through all or part of its range of motion Accessory movement: movement that occurs between the articulating surfaces of a joint that is involved in a physiological motion, either active or passive.

21 Accessory movement glide, spine, roll Accessory movement cannot be produced actively Component motion: the motion occurring in a related joint that allows the primary joint to function normally

22 Joint play: the motion that occurs within the joint but only as a response to an outside force and not as a result of voluntary movement

23 Joint Mobilization: the attempt to improve joint mobility or decrease pain originating in joint structure by the use of selected grades of accessory movement

24 Classification of synovial joints Simple: one joint space with two surfaces ( one concave and one convex) and a single capsule (metacarpophalangeal joint) Compound: one joint has more than two joint articulating surfaces within a single capsule (elbow) Complex: an anatomically compound joint with meniscus or intracapsulaar disk (knee)

25 structural forms of jointarticulating surfaces Unmodified ovoid- ball-and-socket articulation, spheroid, (3 axes and 3 degree of freedom) (hip, shoulder) Modified ovoid- ellipsoid and sellar, (2 axes and 2 degree of freedom), (metacarpophalangeal joint) (2 axes and 2 degree of freedom)

26 structural forms of jointarticulating surfaces Unmodified sellarsaddle, the surfaces are convex and concave at right angles (2 axes and 2 degree of freedom)( 1st metacarpal joint) Modified sellar- a hinge, ginglymus, or trochoid joint( one axes, one degree of freedom) (interphalangeal joint, the ulnohumeral joint, and knee)

27 Joint Positions: Congruence Close-packed position: occurs when the joint surface are most congruent a testing position but never used for mobilization because there are no degrees of freedom of movement Loose-packed position: any other position of the joint aside from the closed-packed position. The maximal loose-packed position: resting position (the optimal position for mobilization) elbow flexed to 70 degrees and supination the knee in 30 degrees of flexion with a slight external rotation of the tibia

28 Osteokinematics: the study of movements of the bone Spin: a pure rotation around a mechanical axis, clockwise or counterclockwise, (the head of femur, humerus, and radius), not simultaneous with a spin, transverses the shortest route between two points Swing: any movement other than pure spine pure or cardinal swing impure or arcuate swing

29 Arthrokinematics: the study of the joint Gray s anatomy Gliding (translation): an arc surface simply slides over another surfacewithout adding a component of angulation or rotation Angular movement Circumdution: conical outline Rotation: movement around a longitudinal axis

30 MacConaill and Basmajian Spin: rotation around a stationary mechanical axis Gliding or sliding: one point on a moving surface comes into contact with new points on another surface pure gliding (involuntary motion)(translation or translatory glide Rolling: when new points on one surface come into contact with new points on a second surface Rolling and gliding motion are usually found to

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32 Kaltenborn: more gliding---> nearly congruent more rolling---> nearly incongruent The rolling portion of the combined rollglide movement always follows the direction of the bone movement The gliding portion of the combined rollglide movement

33 Kaltenborn: whether the moving surface is convex or concave If the moving surface is concave---> both the gliding and the bone movement follow the same direction If the moving surface is convex---> the gliding follows the opposite direction

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35 Traction Stage I (grade I): piccolo traction which involves neutralizing pressure in the joint without actually separating the joint surface pain relief and prevent the trauma of grinding when performing mobilization techniques

36 Stage II (grade IV): to separate the joint surfaces and take up the slack in the joint capsule slack : the amount of looseness or play allowed by the capsule and ligaments in a normal joint pain relief

37 Stage III (grade IV+) involves an actual stretching of the soft tissues used to increase the mobility in a hypomobile joint

38 Mobilization Pain relief Grade I-II Traction Vibration and oscillation Relaxation Grade I-II Traction Stretch Grade III Stretch traction Stretch-glide Rotation

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40 Three-dimensional traction: spine, positioned relative to all three cardinal planes (with relative position such as flexion, lateral flexion, and rotation)

41 Translatoric gliding: used to increase mobility in a hypomobile joint, preceded by piccolo traction to eliminate the compressive force

42 Maitland Grade I is a small-amplitude movement conducted from the beginning of the available range of motion Grade II is a large-amplitude movement conducted within the range. It does not reach either end of the range Grade III is a large-amplitude movement that does reach the end of the range of motion Grade IV is a small-amplitude movement conducted at the very end of the range of motion Grade V is a high-velocity thrust of small amplitude at the end of the available range of motion and within is anatomical range. Popping, manipulation

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44 General Rules of Mobilization Techniques The patient must be relaxed The operator must be relaxed Do not move into or through the point of pain When performing any of the joint mobilization techniques, one hand will usually stabilize while the other hand performs the movement The operator must consider

45 General Rules of Mobilization Techniques Direction of movement Velocity of movement slow stretching for large capsular restriction faster oscillation for minor degree of restriction Amplitude of movement: graded according to pain, guarding and degree of restriction

46 General Rules of Mobilization Techniques Compare accessory joint movement to opposite side ( extremity), if necessary, to determine presence or degree of restriction One movement is performed at a time, at one joint at a time Each technique can be used as Examination procedure: slack only to see accessory movement and pain Therapeutic procedure: High-velocity, small-amplitude thrust or graded oscillation Reassessment

47 Indications: Joint dysfunction Restriction of accessory joint motion Capsuloligamentous tightening Internal derangement Reflex muscle guarding bony blockage

48 Contraindication Absolute: bacterial infection, neoplasm, recent fracture Relative Joint effusion or inflammation Arthrosis ( e.g. degenerative joint disease) if acute, or if causing a bony block to movement to be restored) Rheumatoid arthritis Osteoporosis internal derangement General delilitation ( e.g. influenza, pregnancy, chronic disease)

49 To increase proprioceptive input to the spinal cord to inhibit ongoing nociceptive input to anterior horn cells and central receiving area Grade I-II cycles/second

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