0
Q
Introduction
A
A manual therapy approach
-Hands-on
-Indications, contraindications, and precautions
-Graded oscillatory movements to assess and treat
Assessment
-Active, with overpressure as needed
-Passive physiological (~3 oscillations at each segment of increasing depth)
-Accessory (as above)
Treatment
-Joint mobilization: grades I - IV
-Joint manipulation: grade V (thrust; HVLA)
1
Q
Maitland Key Concepts
A
Reproducible Signs and Symptoms Graded Oscillatory Movements Commitment to the Patient Skilled Communication Clinical Reasoning Manual Therapy Assessment
2
Q
Geoff D. Maitland
A
(1924-2010)
- Australian physiotherapist
- Vertebral Manipulation (book 1964, 2014 - 8th edition)
- Peripheral Manipulation (book 1970, 2013 - 5th edition)
- lateral thinker
3
Q
Commitment to the Patient
A
- Non-judgmental (believe the patient)
- Learn the patient’s plight
- Compassion
- Humility
4
Q
Skilled Communication
A
- Misunderstandings are common
- Really listen (don’t just hear) - Verbal and Non-verbal (tone, body language, eye-contact)
- Clarify
- Effective questioning
5
Q
Communication Guidelines
A
- Never assume
- Reticent vs. garrulous
- Latching on to key words
- Immediate - response, convert statement of fact into comparisons, non-verbal responses
- Suggestive (biased) questions - “right?”
- Short word: “Worse?” “This vs. that?” “Same?”
- Asking vs. telling (pt. doesn’t like being told what to do, make it their idea)
6
Q
Treatment Philosophy
A
- Direct your treatment towards reproducible signs and symptoms (ex. pain, stiffness, spasm) rather than patho-anatomical or biomechanical diagnostic titles.
- Avoids confusion over labels (black box analogy).
- Diagnosis may present different, so need different treatment (stage, symptoms, movement impairment, tissues/pain generator)
7
Q
Manual Therapy Approaches
A
Pain Approaches -Maitland -McKenzie -Mulligan Biomechanical Approaches -Norwegian (Kaltenborn and Evjenth) -Paris -Osteopathic -Grimsby
8
Q
Active ROM, with Overpressure prn
A
Typical (spine) -Flexion (forward bend, FB) -Extension (backward bend, BB) -Side flexion R/L (side bend, SB) -Rotation R/L Patient specific (ex. golf downswing) Combined as needed (ex. quadrant)
9
Q
Passive Physiological (PPIVMs)
A
- Passive Physiological Inter0vertebral Movements
- FB, BB, SB R/L, and rotation R/L
- Used to assess and treat
10
Q
Accessory (PAIVMs)
A
- Passive Accessory Inter-Vertebral Movements
- CPA, UPA, Transverse, and UAP
- Used to assess and treat
11
Q
Accessory (PAIVMs) - Specific Techniques
A
- CPA - central PA pressures on SP
- UPA - unilateral PA pressures:
- -C-spine - lamina
- -T-spine - facet, TP, rib angle
- -L-spine - facet, TP
- Transverse - L to R (vice versa) pressures on side of SP
- UAP - cervical or lumbar
12
Q
PAVIMs - Variations
A
- Angles (ex. UPA directed 30 degrees medially; or directed cephalic)
- Joint position (ex. neutral vs. non-neutral)
- Patient position (ex. prone, supine, sit, side-lying)
- Combined techniques (ex. C7/T1 SB L PPIVMs combined with a L to R transverse PAIVM at C7)
13
Q
Assessment - What is it?
A
- Assessment is the careful study of pain, stiffness, and/or muscle spasm behavior with movement.
- -Detailed
- -Precise
- -Continual
- Assessment derives effective management.
- -Assessment is primary
- -Techniques are secondary - but important
14
Q
Comparable Sign
A
- An abnormal movement that most reproduces the patient’s chief complaint.
- -Benchmark for reassessment.
- -Serves as a guide to manage treatment.
- Joint sign - abnormal movement that may or may not be related to the patient’s chief complaint.
15
Q
Assessment - What do I look for?
A
- Comparable sign (reproduction of S&S)
- Quality (willingness to move, smoothness)
- Quantity
- Behavior and location of movement barriers
- End-feel
16
Q
Movement Barriers (3)
A
Pain -P1 - Onset of pain or pain begins to increase -P2 - Pain limits (L) further movement Resistance -R1 - Onset of resistance -R2 - Resistance limits (L) further movement Spasm -S1 - Onset of spasm -S2 - Spasm limits (L) further movement
17
Q
Movement Diagram
A
- Starting point of movement (often neutral)
- Expected normal amount of motion
- Amount of pain, resistance, or spasm that limits further motion (P2, R2, S2)
- Observed limitation of ROM (by P2, R2, S2)
- Full range for a hyper-mobile joint
- Note: Many possibilities exist for the behavior of pain and resistance (i.e. shapes of the curves and locations of the barriers (P1, P2, R1, R2, S1, S2))
18
Q
Continual Assessment
A
Initial -Baseline -Hypothesis generation Ongoing, re-assessment -Before, during, and after a technique -Start and end of each treatment session Reflective -Looking back over several sessions -Comparison with patient perspective Analytical -Accept, reject, modify initial hypothesis -Modes of thinking (discussed later)
19
Q
Graded Oscillatory Movements
A
For pain (neuro-physiological effects) -Grade I --Small amplitude, short of pain barriers --Just enough to bend the legs of a fly -Grade II -Larger amplitude, short of pain barriers For stiffness -Grade III --Larger amplitude, into barriers --May specify III- or III+ -Grade IV --Smaller amplitude, into barriers (or end range) --May specify IV- or IV+
20
Q
Accessory (PAIVMs) Techniques - Therapist’s Hands
A
- Thumbs (tips or pads)
- Thumb on thumb
- Pisiform-hamate
21
Q
Technique Basics
A
- Patient and therapist comfortable (relaxed)
- Posture and line of force
- Hands - soft
- Arms - relaxed, stiff springs
- Force - from body (not hands or arms)
- Take up soft tissue slack
- 2-3 oscillations of increasing depth (assessment)
- -Too deep: crashes through barriers (miss them)
- -Too fast: just feels like shaking
- -Too slow: will not appreciate motion
- -Approximately 1-3 cycles/second
Ortho 3
flashcards
Decks in class (4)
# Cards
