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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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chapter6 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 • 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)
Massage (continued) • Indications • Precautions • Contraindications • Application
Myofascial Release • Related to massage • Various techniques with many different names • Pressure and tissue stretch used to obtain desired results
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
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
Myofascial Release Techniques • Various strokes: J-stroke, oscillation, wringing, stripping, arm pull, leg pull, longitudinal release • Precautions • Contraindications • Possible neurogenic responses
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
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
Figure 6.15 Effect of Trigger Point Release on Neural Pathways
Trigger Point Treatment • Ice- or spray-and-stretch • Ischemic compression • Both followed by gentle stretches • In some cases injections by physician
Joint Mobilization • Purposes: • Relieve pain • Restore joint mobility • Various techniques • Arthrokinematics • Roll • Slide (glide) • Spin • Compression and distraction
Figure 6.25a Grades of Movement in a Normal and a Restricted Joint
Figure 6.25b Grades of Movement in a Normal and a Restricted Joint
Joint Mobilization • Indications • Contraindications • Precautions
Neural Mobilization • Used as a last resort • Used with caution • Susceptible sites of neurofascial restriction • Symptoms • Treatment