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Principles Of Technique


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Published in: Spiritual

Principles Of Technique

  1. 1. Principles of Methods of Mobilization Treatment Readings Chapter 7 -Maitland Text
  2. 2. Factors that Govern Passive Movement Techniques. <ul><li>Relaxed Patient-avoid strain on pt. </li></ul><ul><li>Avoid a tight grip /patient comfort </li></ul><ul><li>Stabilization /hold around the joint so as to feel movement. </li></ul><ul><li>Pt has confidence that the joint will not be hurt </li></ul><ul><li>Good therapist position including the ability to control movement. Ref : Maitland </li></ul>
  3. 3. Outline of the Method of Mobilization Techniques <ul><li>Selection of mobilization techniques are chosen after examination and assessment have taken place. </li></ul><ul><li>Eight Principles </li></ul><ul><ul><li>Direction of movements </li></ul></ul><ul><ul><li>Desired effect of technique </li></ul></ul><ul><ul><li>Patient’s starting position </li></ul></ul><ul><ul><li>Therapist starting position </li></ul></ul><ul><ul><li>Method of localization of forces </li></ul></ul><ul><ul><li>Method of application of forces </li></ul></ul><ul><ul><li>Expected response to treatment </li></ul></ul><ul><ul><li>Progression of techniques </li></ul></ul>
  4. 4. Eight Principles Direction <ul><li>Techniques are aimed to return movement - impaired direction </li></ul><ul><ul><li>Example: limited shoulder flexion </li></ul></ul><ul><ul><ul><li>Technique </li></ul></ul></ul><ul><ul><ul><ul><li>Passive Accessory - inferior glide </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Physiological movement in flexion </li></ul></ul></ul></ul>
  5. 5. Eight Principles Patient’s Starting Position <ul><li>Position for desired effect </li></ul><ul><ul><li>Supine- TX joint in neutral position- pain free position </li></ul></ul><ul><ul><li>Side Lying- when joint is very painful </li></ul></ul><ul><ul><li>Prone -Best way to treat some stiff joints </li></ul></ul><ul><ul><li>Sitting or standing -reproducing the functional or weight bearing positions in which the techniques can be effective. </li></ul></ul>
  6. 6. Eight Principles Patient’s Starting Position What is the desired treatment effect? To relive pain Stretch for stiffness
  7. 7. Therapist Staring Position Guidelines Therapist has to have complete control It necessary to be in a position so that forces are applied in direction of restriction Be sure to use all mechanical advantage
  8. 8. Localization of Force Principals Avoid tight grip Grip enough to perform the movement safely Have good control be able to assess movement as it occurs Remember comfort of grip and the location of forces may be dictated by the patient Example: response to movement pain
  9. 9. Application of forces general principles Therapist arms and body should be the prime movers which deliver the passive movement to the patient’s body part ( Maitland ) Hands act as sensing agent for movement.
  10. 10. Grades Of Movement Grades of Passive movement can be used to denote the position in the available range and the amplitude at which the technique of passive movement is being performed.
  11. 11. Movement Grades Using the diagram <ul><li>AB=the passive movement direction ( Physiological /accessory combined ) </li></ul><ul><li>AC= quantity,quality,nature & intensity(pain/resistance/spasm) </li></ul><ul><li>CD=line represents the max resistance encountered </li></ul><ul><li>BD= end of average range </li></ul><ul><li>R1= onset of resistance </li></ul><ul><li>R2= Quality or quantity of resistance which act to limit ROM </li></ul><ul><li>Movement grades can be used to guide your treatment </li></ul>
  12. 12. Rhythms of Movements Joints can moved in many different ways <ul><li>Stationary holding </li></ul><ul><li>Slow smooth movements </li></ul><ul><li>Staccato type rhythm </li></ul><ul><li>Manipulation (thrust speed) </li></ul>
  13. 13. Rhythms of Movements <ul><li>Joints that are painful is best treated by with grades that are slow even. </li></ul><ul><li>Joints that are stiff many do better with sharp staccato rhythms </li></ul>
  14. 14. Direction Speed of Movement <ul><li>When performing oscillatory movement in treatment , the treating direction of that movement is most commonly performed at a speed that is faster than the retreating movement. </li></ul><ul><li>e.g. wrist extension- demonstrate. </li></ul><ul><li>Need to choose one of the least painful directions for the treatment movement to began with </li></ul>
  15. 15. Using Stationary Holding <ul><li>Used when attempting to increase ROM of a stiff and painful joint at it limit. </li></ul><ul><li>Movement should be applied slowly within the available range up to the point when pain becomes a limiting factor. </li></ul><ul><li>How long to hold? </li></ul><ul><li>Until the pain subsides after which a further slow stretch is added to gain more range. </li></ul>
  16. 16. Oscillations <ul><li>Back and forth movements </li></ul><ul><li>Timing or rhythm should be steady avoid choppiness in technique. </li></ul><ul><li>The number of oscillations given during treatment is the last consideration </li></ul><ul><ul><li>When joint is irritable small movements may be best. Less oscillation </li></ul></ul>
  17. 17. Compression/ Distraction <ul><li>Distraction best used when joint is painful or irritable. </li></ul><ul><li>Compression can be used in chronic problems like the hip. </li></ul><ul><ul><li>E.g helps to improve lying on the effected hip </li></ul></ul>
  18. 18. When -Which -Why In choosing grades and rhythms <ul><li>Very irritable disorder-pain constant 7 sever (6 to 10) </li></ul><ul><ul><li>Gentle techniques : G I,II,III ( grades need to be painless: can use large Amp. If permitted. ) </li></ul></ul><ul><ul><li>Rhythm needs to be smooth in performing oscillations </li></ul></ul><ul><ul><li>Accessory movements are better choice than physiological. Ref Maitland </li></ul></ul>
  19. 19. In choosing grades and rhythms <ul><li>End of Range pain vs. through -range pain - [chronic aching] </li></ul><ul><ul><li>Small Grade IV is better </li></ul></ul><ul><ul><li>Use both accessory and Physiological movements </li></ul></ul>
  20. 20. In choosing grades and rhythms <ul><li>Muscle spasm </li></ul><ul><li>Move the joint into the range where spasm comes into play </li></ul><ul><li>Then use a sustained stretch w/o oscillations </li></ul><ul><li>When pain lowers resume the stretch. </li></ul><ul><li>If spasm does not let go use small oscillations </li></ul>
  21. 21. When to Use Grades <ul><li>Through-range of pain </li></ul><ul><li>Intra-articular Pathology </li></ul><ul><li>End of range Pain </li></ul><ul><li>Grades I,II to III </li></ul><ul><li>Grades II to III </li></ul><ul><li>Grades II,III &IV </li></ul>
  22. 22. Where does MMT fit within the Guide to PT Practice? <ul><li>Section 4D-Impairment/Connective Tissue Dysfunction </li></ul><ul><li>Section 4E,4F,4G,4H,4I,4J Impaired Joint Mobility & Impaired Motor Function </li></ul><ul><li>Procedural Intervention </li></ul><ul><ul><li>Manual Therapy Techniques </li></ul></ul>