Download Spinal Manual Therapy PP-DPT

Orthopedic Manual Therapy Assessment
By
Dr.Asghar Khan,
Director/Associate professor(RCRS)
 Manual
therapy can be define as;
A quite communication between the therapist
hands and the damage tissues of the
individual how to promote healing by using
manual force accurately determined and
specifically directed to words the damage
tissue of the body.
Damage tissue repair process
 Adaptation process due to tissue damage.
 Repair and adaptation are multidimensional
process:

a)
b)
c)
A cycle of damage and repair with in the tissue.
Adaptive motor changes in the
neurological/neuromuscular dimension
Adaptive behavioral responses in the
psychological/psychomotor dimension.
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Tissue dimension
Neurological dimension
Psychological dimension
 How
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Manual Force Can Influence The Tissues?
Assist tissue repair
Assist fluid flow
Assist tissue adaptations
 The
Manual Therapist aims to influence the
three areas of neurology;
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The motor system(Neuromuscular)
Pain mechanism
Autonomic system at the spinal reflex level.

Touch is a potent stimulus for psychological
processes that may result in a wide spectrum
of physiological responses affecting every
system in the body.
 “Every
manual therapist is a pain
management unit”.(Lederman E. second edition-2005)
 “Manual Therapy, in its many forms, is
probably the major method, after medication,
for the relief of musculoskeletal pain”.(Lederman E.
second edition-2005)
a)
b)
c)
In the tissue level by direct mechanical
stimulation of the damage area.
In the neurological dimension by the
activation of gating mechanism.
In the psychological dimension by
psychodynamic emotive influences of touch.
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A process where by mechanical signals are
converted into biochemical signals in the
target cells.
Fibroblasts and muscle cells are highly
responsive to mechanical stimulation (also
called mechanocytes).

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Two major forms of loading:
Tension Loading
Compression Loading
A physiological mechanism facilitates the formation
and drainage of synovial fluid in the joint by
movement(Passive or Active)
 Components:

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A fluctuating intra articular pressure
An increased synovial blood flow
Facilitate drainage into the lymphatics
Increase intra-articular pressure → Produces an outflow
Decrease intra-articular pressure →Increases influx into the
joint cavity
Passive movement → Decrease pressure
Active movement → Increase pressure
The rate at which fluids move in and out of the joint →
Clearance rate
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All decision-making models are deigned to
provide clinicians with information that
targets a “threshold effect "toward decision
making.
A decision based on the threshold approach
is sometimes refereed as categorical
reasoning.
Hypothetical-Deductive Model
Heuristic Model
Mixed Model
•
•
•
Hypothetical-deductive decision making involves
the development of hypothesis during the clinical
examination, and the refuting or acceptance of
that hypothesis that occurs during the process of
the examination.
The process is considered a bottom-up
approch,as it allows any pertinent findings to be
a qualifier during the decision-making process.
A pathognomonic diagnosis involves a decision
based on a sign or symptom that is so
characteristic of a disease or outcome that the
decision is made on the spot.

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Heuristic decision making involves pattern
recognition and the ability to lump useful
finding into coherent groups.
In essence, clinical gestalt is pattern
recognition and is characterized as a heuristic
approach to decision making.
This process is considered top down.

The mixed model involves decision-making
elements of hypotheticaldeductive,heuristic,and pathognomonic.
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The mainstay of the osteopathic diagnosis of
somatic dysfunction.
The diagnosis triad identifies the three key
components of a somatic dysfunction:
A- asymmetry
R-range of motion
T-tissue texture abnormality
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In the late 1980s,Physical Therapists at
Southside Hospital in Bay Shore,NY,under the
direction of Jeffrey Ellis elaborated on the ART
diagnostic triad by adding C,Hand S.
C-Chief Complaint
H-History
A- asymmetry
R-range of motion
T-tissue texture abnormality
S.special tests
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O-Onset; sudden or insidious onset
P-pain ; better or worse with activities
Q-Quality; Nature of the symptoms
R-Radiating; Dermatomes to be involved
S-Severity; Intensity (0 to 10)
T-Timing; consistant,intermittent and
occasional
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Neurologic Origin;Burning,shooting and
piercing.
Somatic Origin;Deep,aching and vague
Vascular origin; Throbbing and pulsing
Techniques that engages the motion barrier
directly is referred to as direct technique.
(Myofasicial release, Joint mobilization etc)
• Manipulative Therapy, which moves away
from the motion barrier in the direction of
“ease” in the tissues comprises those
techniques that are known as indirect
technique.
(Positional Release, strain/counterstained)
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Reduction of the derangement
Maintenance of the reduction for healing to
occur
Recovery of function
Prevention of recurrence