This document discusses principles and techniques for manual therapy examinations and treatments. It describes the central themes of listening to the patient, understanding verbal and non-verbal communication, and building trust. It emphasizes keeping theoretical knowledge separate from clinical evidence when examining patients. Examination techniques discussed include range of motion tests, accessory movements, and compression tests to identify pain sources. Treatment techniques focus on physiological and accessory movements at varying amplitudes, ranges, and force levels to address pain, stiffness, and spasms. The importance of ongoing assessment and modifying techniques based on a patient's response is stressed.

2. Central theme or core
Particular mode of thinking
Examination
Techniques
recording

3. THE CENTRAL THEME OR CORE
•Making sense of the information the patient
provides
•Listening and believing the patient without any
prejudging
•using the patient own terminology
•Having skill in understanding and using verbal and
non verbal communication
•Encouraging a feeling of confidence and trust in us
the clinicians

4. THE THINKING MODE IS THE STRENTH OF THE CONCEPT
AND THE SECURITY AND THE THERAPIST
THEORETIC
AL
CLINICAL
PATHOLOGY
NEUROPHYSI
OLOGY
ANATOMY
DIAGNOSIS HISTORY
SYMPTOMS
SIGNS

5.  It’s a symbolic permeable brick wall which guides therapists
in their mode of thinking
By this mode of thinking therapist can keep their thoughts
reflections, impressions, hypothesis and knowledge in two
separate compartments
One compartment contains all theoretical information,known
and speculative including the precautions and contraindications.
 The other compartment should contain all the
clinical evidence
The main core of this mode of thinking states that we must not
get diverted by the theoretical aspects of the patient disorder
because there are enormous events which we do not know

6.  SUBJECTIVE
 OBJECTIVE

7. ACCESSORY MOVEMENTS
COMBINED MOVEMENTS
COMPRESSION TESTS
FUNCTIONAL REDUCING MOVEMENTS
INJURING MOVEMENT
DIFFERENTIATION
RANGE AND PAIN RESPONSE
EFFECT OF OVER PRESSURE

8.  Examined in loose pack position
At the end of limited ranges or
In painful positions of a free range of movement
It is closely related to patient symptoms

9. Combining accessory test
movement to the physiological
movement is special

10. TO know the origin of patient symptoms from joint surface
abnormality compression performed in following circumstances
 when usual test movements do not show patient symptoms
,compression applied through range assessing the smoothness and
matching pain response
If pain response much greater than when surfaces compressed,the
indication is that the disorder associated wih [joint surface
abnormality]
NOTE Common joints require examination by compression are
Tarsometatarsal joint of big toe
Patellofemral jint
Carpometacarpal joint of the thumb
The hip and
The glenohumeral joint

11. Specially when pain rather than
stiffness is the disability .
Subject demonstrates the
particular movement.

12. Used when a passive test
movement causing
simultaneous movement of at
least two joints, reproduces a
patient symptoms

13. To note whether it is [through range pain or end
range pain ]
Does the behavior of the pain with the movement
match the behavior of the resistance with that same
movement within its available range?
 NEVER THINK OF RANGE WITHOUT
THINKING OF PAIN
 NEVER THINK OF PAIN WITHOUT
THINKING OF RANGE

14. Normal if a very firm pressure can be applied
without provoking anything more than the expected
normal stretch response.
When the stretch response is normal and the
overpressure is with adequate firmness the
movement recorded with two ticks.
1 TICK over pressure is applied and the range is
normal
2 TICK stretch response to over pressure has been
normal.

15. To draw a diagram representing the
findings on examining a particular
movement forces he clinician to
analyse the relationship of pain
stiffness muscle spasm which may
be present

16. Proving or assessing the
value of a technique in
the treatment

17. Analytical assessment used during a
treatment programme and at the completion of
programme .
The mental process involves .
 Vertical thinking.
Lateral thinking.
Inductive thinking.
Deductive thinking.

18. The basic treatment techniques must include every
movement of which the joint is capable[Both
Physiological movements and accessory movements
] and possible combination of them.
The techniques are never ending and NEVER
should have ending.
The clinicians mind must always be open ; the
teacher must never be dogmatic.

19. The techniques are never ending
and NEVER should have an ending
The clinicians mind must always be
open

20. Physiological movementsaccessory
movementscombinations
Small amplitudelarge amplitudesustained
Early in range late in rangewithin range
Smoothlystaccatosustained
Without compression with compression
Short of discomfortinto discomfort into pain
Short of resistanceinto resistance respecting
paininto resistanceup to bite

21. Pain [at rest or with movement ]
Stiffness [due to contracted structure or adhesion
Muscle spasm
the above may occur in combinations
Eg painless spasm painful and stiff joint

22. Treatment for pain treatment for stiff treatment for pain and
stiff
group 1 group 2 group 3
pain and stiff stiff and pain

23. The joint is placed in pain free position .
The accessory movements started of large amplitude without
discomfort
If discomfort persists then mild distraction applied while
performing the technique
If improvement occurs the amplitude of movements is
increased and move to range that is painful
Continue to grade 3
At stage where grade 3+without discomfort occurs grade 2
will start.this results in improvement of about 60percent.
Gradually amplitude increase till grade 3+physiological
movement performed without pain .

24. Joint is taken to physiological limit of range
Grade 4 is given for nearly2 minutes.
Started from 4 increase to 4+ and even
4++strength
Holding at limit therapist performs accessory
movements at grade 4
Physiotherapist repeats the above movements 3 or
4 times
If technique produce soreness then relieve it by
performing physiological movements

25. Patient opinion of effect of treatment [a
comparison statement]
Execute treatment plans by planning and reasoning
process which has to be recorded.
The treatment and effect record next .it involves
treatment technique ,its grade ,its rhythm and its
symptomatic response.
Commit thoughts about how the treatment
techniques need to be modified next .

26. N. SAI PRIYANKA