Manual Therapy Techniques

1
Manual Therapy Techniques

• Chapter 6

2
Sports massage

• Systematic manipulation of soft tissue
• Stimulates relaxation and blood vessel dilation
• Reduces edema and improve tissue mobility
• No conclusive evidence of effectiveness
• Hoffa massage traditional strokes
• Effleurage, petrissage, percussion/tapotement,
  vibration
• Friction massage increase inflammatory response

• Acupressure massage of trigger points
• Indications
• Contraindications
• Precautions
• Application

3
Myofascial release

• Fascia is found around muscles and other tissues
• Superficial layer skin undersurface where
  edema accumulates
• Deep layer around muscle, tendon, joints,
  ligaments, bone
• Subserous fascia around internal organs (not
  treated)
• Techniques
• Trigger point examination
• Trigger point ice treatment
• Trigger point ischemic compression
• Trigger point stripping/Rolfing
• Application
• daily sessions 3-5 min.
• Each stroke lasts about 90sec.

4
Mobilization and Traction

• Slow, passive movements of articulating surfaces
• Used to
• Regain AROM PROM
• Realign a joint
• Regain normal force distributions
• Reduce pain

5
Physiologic vs. Accessory Motion

• Physiologic
• Osteokinematic
• Results from muscle contractions that move joints
• Occurs in cardinal planes
• Measured in degrees

• Accessory
• Manner in which articulating surfaces move in
  relation to one another
• Accompanies physiologic motion
• Measured in mm
• Roll
• Slide/glide
• Spin
• Compression
• distraction

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Accessory Motion

• Spin occurs around stationary axis
• Radial head during pronation/supination
• Roll series of points on one surface contacts
  another series of points
• Femoral condyles rolling over tibial plateau

• Glide translation one point comes in contact
  with a series of points
• Anterior drawer
• Pure gliding occurs in surfaces are congruent
• Use concave-convex rule

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Concave-Convex Rule

• If the concave joint surface is moving on a
  stationary convex surface, gliding will occur in
  the same direction as the rolling motion
• If the convex segment moves, the treatment plane
  is fixed
• Glide in the direction opposite the restriction
• If the convex surface is moving on a stationary
  concave surface, gliding will occur in an
  opposite direction to rolling
• If the concave segment moves, the treatment plane
  moves with it
• Glide in the same direction as the restriction

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Joint Positions

• Resting position
• Joint capsule and ligaments are most relaxed
• Maximum jt. Play
• Testing position
• Close-packed
• Maximum contact
• No jt. Play
• Capsule ligaments tight

• Loose-packed
• Articulating surfaces are maximally separated
• Mobilization and traction done here
• Improves fluid flow and reduces muscle spasm

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Treatment Techniques

• Treat hypomobile joints with mobilization and
  traction
• Treat hypermobile joints with strengthening,
  stability exercises, and taping/bracing
• Treatment plane falls ? to axis of rotation in
  convex surface to center or concave surface
• Use translational movement
• Mobilization parallel to tx plane
• Traction perpendicular to tx plane

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Mobilization Grades

• Mobilization used to break adhesions and
  stretch
• Use 3-6 sets of oscillations lasting between
  20-60 seconds (1-3 oscillations per second)
• Treat pain first (everyday ok), then stiffness
  (3-4x/week)

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Joint Traction

• Traction pull one segment to separate surfaces
• Use 10 second intermittent grades I and II, then
  distract to grade III and release
• Should be used in conjunction with mobilization

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Contraindications

• Inflammatory arthritis
• Malignancy
• Bone disease
• Neurological involvement
• Bone fracture
• Congenital bone deformities
• Vascular disorders of vertebral artery