a contraindication if poorly thought out or not guided by a physician or doctor of physical therapy. Improper treatment plans can be ineffective for the client at the least, and at worst increase the pain or dysfunction (Wedge, 2022). The assessment tests provided in this course are commonly used by physicians and doctors of physical therapy but can be used by any manual therapist. They will help narrow the focus of treatment and identify the source or sources of pain or dysfunction and whether those dysfunctions are structural or functional in nature. Keep in mind that although any therapist who does not hold a medical degree cannot diagnose, these tests can help them determine what they can and cannot treat as well as advise a client when a referral to another health practitioner is appropriate. This course is designed to help manual therapists gain insight into the value of assessments during the course of treatment planning as well as assessing clients post-treatment. properly characterize an area as inflamed. Do not apply heat to inflamed tissue. ● ASIS : Anterior superior iliac spine (of the pelvis). ● AIIS : Anterior inferior iliac spine (of the pelvis). ● PSIS : Posterior superior iliac spine (of the pelvis). ● PIIS : Posterior inferior iliac spine (of the pelvis). ● Traction : Pulling a limb or the head away from the torso. ● Flexion : Decreasing the angle between two body parts. ● Extension : Increasing the angle between two body parts. ● Rotation : Turning a body part away from or toward the mid-line. ● Abduction : Moving a limb away from the mid-line. ● Adduction : Moving a limb toward the mid-line.
This level of treatment planning requires assessment skills not often taught in some manual therapy schools. Before conducting soft-tissue assessments, a knowledge of kinesiology—skeletal muscles and their actions on the skeleton—is of the utmost importance. This allows a manual therapist to assess tissues accurately and immediately in a clinical setting and requires a commitment to learning and practice (Wedge, 2022). The benefit of assessment skills are twofold: First, addressing a client’s pain and dysfunction quickly; and second, the therapist may provide psychological comfort by letting a client know why they have pain or dysfunction. While effective treatment relies on applying suitable techniques that fit the client’s goals, it is important to let a client know when their injury involves something a manual therapist can only treat minimally at best, such as a meniscus tear. Understand that manual therapy itself can be Glossary of terms Many manual therapists are well-versed in the terminology related to anatomical movements. It is helpful to review, though, the most common anatomical terms and acronyms before continuing. The following list includes terms encountered throughout this course, followed by their meaning (Cael, 2022): ● ROM : Range of motion. ● Hypermobility : Mobility beyond the normal ROM. ● Hypomobility : Mobility beneath the normal ROM. ● Hypertonicity : Increased muscle tension. ● Hypotonicity : Decreased or flaccid muscle tension. ● Inflammation : The body’s first response to physical injury. Symptoms include swelling, heat, loss of function, redness, and/or pain. Two symptoms must be present to
MANUAL TECHNIQUES
There are several massage techniques common to almost all massage modalities that can be of use to any manual therapist. These include all of the classic Swedish massage techniques such as effleurage, petrissage, friction, vibration, and tapotement. Other techniques that can Cross fiber friction This technique can loosen hypertonic muscles by realigning their fibers, reducing scar tissue that may affect a client’s ROM, or initiating the repair of damaged ligaments. To perform this technique, apply medium to firm pressure (always within a client’s pain tolerance) with the thumbs or fingertips at either the belly or tendonous attachment of a muscle, at a site of scar tissue formation, or at the site of ligament damage. Move quickly back and forth perpendicular to the affected tissue fibers; here, a knowledge of specific muscles and the direction of their fibers is helpful. (Note that a circular motion may also be worked in for variety, though you should always start and Directional massage This technique is similar to the myofascial release technique described subsequently except that it is applied to muscle fibers instead of the body’s connective tissue (or fascia), is deeper, and is most effective during the acute phase of a muscle’s injury (24 to 48 hours after the initial injury) between applications of ice to reduce inflammation. Without using any lubricant, this technique begins by placing fingers or thumbs in line with a muscle’s fibers near one of the muscle’s attachments with light to medium pressure. Once the fingers or thumbs have made contact with the muscle tissue, the therapist uses short 1-inch-deep strokes to push the muscle toward the other attachment. The therapist should be sure to check in with or monitor their client to
be commonly employed include the various methods of tissue compression and stretching. The following are some techniques that can be very useful in treating a client’s pain or dysfunction when other techniques or medical devices are ineffective. finish with the perpendicular movement.) Cross fiber friction is generally one of the more uncomfortable techniques for clients and commonly results in soreness or inflammation of the targeted area. However, this is necessary to help initiate the healing process, and the inflammation should be short- lived. Icing the targeted area before the end of a treatment session can help reduce prolonged inflammation. Make a note not to use cross fiber friction if inflammation is already present at the injury site. It is important to let a client who is unfamiliar with this technique know why it is being used, that it may be uncomfortable, and what the intended result from its use may be (Hendrickson, 2020). see if they are experiencing any sharp pain; if so, refrain from using this technique. If the client is not experiencing sharp pain, the therapist can continue by slowly lifting the fingers or thumbs out of the muscle and repositioning them 1 inch closer toward the other attachment and repeating the technique until reaching the other end of the muscle. The length of the muscle will dictate how many strokes are needed to go from one end to the other, but generally speaking there should be at least three. On occasion, this technique is more effective in one direction rather than the other. If there is no reduction in a muscle’s hypertonicity using this technique in one direction, attempt it in the opposite direction (Hendrickson, 2020).
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