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    Manual Therapy 6

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    induwasal
    The document provides guidelines for selecting manual therapy techniques for the lumbar spine, outlining 5 groups of patients based on their presentation of pain and stiffness. It discusses evaluating range of motion, pain response, and underlying pathology to determine the appropriate techniques such as mobilization, manipulation, or traction. The goal is to apply techniques in a safe and effective manner based on each patient's individual clinical presentation and stage of recovery.

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    Manual Therapy 6

    Uploaded by

    induwasal
    100 views26 pages
    The document provides guidelines for selecting manual therapy techniques for the lumbar spine, outlining 5 groups of patients based on their presentation of pain and stiffness. It discusses evaluating range of motion, pain response, and underlying pathology to determine the appropriate techniques such as mobilization, manipulation, or traction. The goal is to apply techniques in a safe and effective manner based on each patient's individual clinical presentation and stage of recovery.

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    The document provides guidelines for selecting manual therapy techniques for the lumbar spine, outlining 5 groups of patients based on their presentation of pain and stiffness. It discusses evaluating range of motion, pain response, and underlying pathology to determine the appropriate techniques such as mobilization, manipulation, or traction. The goal is to apply techniques in a safe and effective manner based on each patient's individual clinical presentation and stage of recovery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    100 views26 pages

    Manual Therapy 6

    Uploaded by

    induwasal
    The document provides guidelines for selecting manual therapy techniques for the lumbar spine, outlining 5 groups of patients based on their presentation of pain and stiffness. It discusses evaluating range of motion, pain response, and underlying pathology to determine the appropriate techniques such as mobilization, manipulation, or traction. The goal is to apply techniques in a safe and effective manner based on each patient's individual clinical presentation and stage of recovery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    MANUAL THERAPY LUMBER SPINE SELECTION OF THE TECHNEQUES

    Prepared by: MUHAMMAD IBRAHIM KHAN


    BS.PT(Pak), MS.PT(Pak), NCC(AKUH)

    OBJECTIVES
    Selection of techniques Order of efficacy of techniques Ground the theory in reality Application of techniques How do you do what you should do

    QUOTE FROM MAITLAND

    Manipulative physiotherapy is not only a matter of learning and applying techniques. It is a matter of knowing WHEN and HOW to use WHICH technique, how to ADAPT the technique to a particular situation of the patient

    SEQUENCE OF SELECTING TECHNIQUES


    Also known as the order of efficacy. Determines which technique is used when. Indicates the progression from one technique to the next

    MOBILIZING TECHNIQUES AND THERE USES IN LUMBER SPINE


    PA(C VP) Bilateral distributed symptoms when there are bony changes from any cause, it is useful as rotation technique. PA(UVP) unilateral distributed symptoms, (direct the push downward on the site of pain) Transverse vertebral pressure unilateral distributed symptoms, useful in the upper lumber region than lower lumber region (direct the push toward the side of pain. Rotation first technique used, unilaterally distributed symptoms, (rotate the pelvis fwd. on the side of pain)

    MOBILIZING TECHNIQUES AND THERE USES IN LUMBER SPINE


    LONGITUDINAL MOVEMENTS two legs, bilateral distributed symptoms of lower lumber in origin one leg, of unilateral distributed symptoms of the lower lumber in origin. FLEXION bilateral distributed symptoms of chronic in nature, flexion dysfunction TRACTION gradual onset of symptoms , and pain is not aggravated by active movements INTERMITTENT TRACTION gross radiological degenerative changes SLR unilateral limitation of the SLR with out extreme pain, for symptoms of chronic or stable nerve root sumtoms

    LUMBAR REGION
    UNILATERAL PAIN Rotation= PA(UVP) UPPER LUMBER Transvers Traction LOWER LUMBER Traction longitudinal BILATERALSYMPTOMS PA(CVP) Rotation UPPER LUMBER Transverse Traction LOWER LUMBER Traction longitudinal

    GUIDELINES FOR THE SELECTION OF TECHNIQUE


    Cause and effect rule is used. Based on current knowledge of the pathological disorder and structures of the vertebral column. Diagnosis closely related to the history. History signs and symptoms

    ASPECTS OF KNOWLEDGE OF PATHOLOGY


    1. Movements and the related range/pain response. 2. Pain-sensitive Structures and their patterns. 3. The pathological disorders and injury.

    1. MOVEMENTS
    Range of movement of the spine and each segment. Differentiation from top-down or bottom-up movement should be considered. Range/pain response to movement must be considered. Stretching or compression. Point in the range pain occurs. Local or referred pain provoked.

    PAIN-SENSITIVE STRUCTURES AND THEIR RESPONSE


    Joint structures.
    Intervertebral disc, ligaments, facet joints, bones, blood vessels, tendons, muscles fascia and aponeuroses.

    Pain-sensitive structures
    In the CANAL and the IV FORAMEN The dura, nerve root sleeves, nerve roots and their rootlets

    THE INTERVERTEBRAL DISC

    HERNIATING IV DISC
    Herniating nuclear material causes a bulge in the annulus If spinal stenosis is present symptoms may travel down the leg Pain and pins and needles are common. Level of pain determined by the level of irritation. Distal pain usually not greater than the central pain.

    DURA AND NERVE ROOTS


    Dural signs - distal pain is not greater than the central pain. Root sleeve pain - referred to foot Pins and needles present Nerve root - symptoms in the distal part of the dermatome. Testing structures that cause pain can differentiate causes of the pain - disc versus nerve root irritation.

    STABILITY ISSUES
    Stability of the disorder has an influence on the intensity of assessment and treatment. No clear sign patterns of pain for old herniated disc/nerve root situations. Relationship between structures must be considered. Joint structure involvement - through range and end range pain described DIAGNOSIS

    ASPECTS OF PAIN THAT INFLUENCE SELECTION

    SELECTION OF THE TECHNIQUE


    Decide whether you want to mobilize or manipulate. Identify the direction of the movement. Identify the position in which the directed movement would be performed. Identify the manner of the technique. Consider the duration of the treatment

    GROUP 1 PAIN
    Patients have severe pain limiting movement. Accessory movements in the part of the range that is completely pain free. Positioned in a painless position and large amplitude movements used. The rhythm should be smooth and slow. Physiological movements should not provoke symptoms. Progress into a controlled degree of discomfort.

    PAIN-MOTION SEQUENCE
    Pain before restriction of motion Indicative of an active and often acute lesion such as a sprain or strain Treat with protection, rest, ice, compression, elevation as indicated Mobilization is contraindicated Pain at the point of restricted motion Indicative of sub-acute stage of recovery Continue modalities with cautious and progressive movement and mobilization as indicated

    PAIN-MOTION SEQUENCE
    Restriction of motion before pain
    Indicative of chronic dysfunction and lack of recovery Modalities as needed and motion and mobilization are indicated

    Pain without restriction


    Usually indicative of impingement type syndromes Can occur with tumors and/or vascular disorders Exercise and modalities are the treatment of choice for impingement syndromes

    GROUP 2 PAIN WITH STIFFNESS


    Largest and most challenging group to treat. Movement will be stiff and will elicit pain. Need to identify the dominant factor - pain or stiffness. Graphically portrayed by movement diagrams. Initially only accessory or physiological movements are used - not both. Decide on whether to use accessory or physiological movements

    GROUP 3 STIFFNESS
    Stiffness limits normal function - not pain. Use two kinds of stretching movements - alternating from one side to the other. Physiological movement with end range stretching. Followed by Accessory movements in the same direction.

    GROUP 4 MOMENTARY PAIN


    Pain occurs unexpectedly as a sudden ONSET. Always associated with movement. Technique selection depends on the movements which elicited pain. Identify the combined movement that causes pain and treat using the appropriate accessory movement. Technique is nearly always a strong grade IV followed by gentle grade III movements

    GROUP 5 ARTHRITIC FACET JOINT


    Pain through-range occurs. Treated in the same way as for Group 1 - Pain. Decision should be made as to whether to treat this type of pain as a normal orthopedic joint or as a spinal problem. If treating by mobilization this may not succeed and manipulation may be required at the faulty level

    DISC OR NERVE ROOT


    If severe enough surgery may be indicated. Less severe symptoms do not prevent light work. Chronic remnants of nerve-root symptoms. Position of ease may be necessary and movements should provide ease as well. Select appropriate technique according to the order of efficacy.

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