Maitland’s Concepts Selected Pages from Yearlong Course Theory Manual Yearlong Course Theory Manual Australian Musculoskeletal Physical Therapy 2011 T 1

  • Published on
    22-Mar-2018

  • View
    213

  • Download
    1

Transcript

<ul><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 1 </p><p>Theory Manual Contents (add a T in front of page number) Abbreviations and Symbols ................................................................................................................2 </p><p>Maitlands Concepts ..........................................................................................................................4 </p><p>Standards for Intermediate level Manual Physical Therapy Practice ....................................................7 </p><p>Components of the Subjective Evaluation ......................................................................................... 10 </p><p>Subjective Exam Form ...................................................................................................................... 13 </p><p>SINSS ............................................................................................................................................... 15 </p><p>SINSS Worksheet ............................................................................................................................. 22 </p><p>Contraindications and Precautions ................................................................................................... 24 </p><p>Components of the Objective Examination ....................................................................................... 27 </p><p>Comparable Sign .............................................................................................................................. 29 </p><p>Movement Diagrams ........................................................................................................................ 30 </p><p>Grades of Movement ....................................................................................................................... 32 </p><p>Clearing ........................................................................................................................................... 34 </p><p>Planning the Objective Examination ................................................................................................. 40 </p><p>Manual Therapy Treatment Selection Part 1 ..................................................................................... 45 </p><p>Re-assessment ................................................................................................................................. 56 </p><p>Clinical Reasoning ............................................................................................................................ 61 </p><p>Neurodynamics ................................................................................................................................ 68 </p><p>Manual Therapy Treatment Selection Part 2 ..................................................................................... 78 </p><p>Mechanisms of Pain ......................................................................................................................... 83 </p><p>Progression of Treatment ................................................................................................................. 98 </p><p>Errors in Clinical Reasoning ............................................................................................................ 100 </p><p>Screening for Non-Neuromusculoskeletal Disease ........................................................................... 102 </p><p>Clinical Patterns: The Characteristics of Common Presentations ..................................................... 107 </p><p>Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 3 </p><p>Abbreviation Meaning </p><p>Rot Rotation </p><p>RTS Return to sleep </p><p>SG Side glide (AKA shift correction) </p><p>STFJ Superior tibiofibular joint </p><p>SRUJ Superior radioulnar joint. </p><p>Tx Thoracic </p><p>TFJ Tibiofemoral joint </p><p>ULNT Upper limb neurodynamic test </p><p>2/12 2 months </p><p>2/52 2 weeks </p><p> Full active movement no pain overpressure applied (e.g. F: OP PCx) </p><p> Full APM no pain OP pain free resistance normal. (also used as all clear for complete subjective and objective exam sections) </p><p> Right Rot. The side the arrow is on is the direction of Rot. Used upside </p><p>down by some people </p><p>LF </p><p> Unilateral posteroanterior (UPA) pressure performed on the right sideT6 </p><p> Unilateral posteroanterior over TP performed on the right </p><p> Unilateral posteroanterior over the right rib angle </p><p> Anteroposterior (AP) </p><p> Posteroanterior pressure (PA AKA central PA in spine) </p><p> Unilateral anteroposterior pressue (UAP) </p><p> Combined AP/PA </p><p> (med) Medial glide </p><p> (lat) Lateral glide </p><p> Transverse pressure in the spine </p><p> (caud) Longitudinal caudad glide. Manual traction in the lumbar spine </p><p> (ceph) Longitudinal cephalad glide. Manual traction in the cervical spine. </p><p>Shift/deviation denoted on the body chart. </p><p> Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 7 </p><p>Standards for Intermediate level Manual Physical Therapy Practice </p><p> Introduction </p><p>Physical Therapy School educates PTs in the knowledge and </p><p>practical skills required to practice Physical Therapy across a </p><p>wide variety of disciplines. The depth of manual physical </p><p>therapy training in PT school is highly variable creating the </p><p>need for post-graduate manual therapy programs. These post-</p><p>graduate programs could be at the intermediate level, such as </p><p>this yearlong course, or at the advanced level, like the Kaiser </p><p>Permanente Fellowship Program or the Masters in Manipulative </p><p>Therapy programs offered in the UK and Australia. </p><p>Currently, there is considerable variation in the specifics of </p><p>orthopedic practice among physical therapists. In our opinion, </p><p>to be successful in Manual Therapy, Orthopedic and Sports </p><p>Physical Therapy therapists need to maintain practice standards </p><p>that are above those seen in many PT clinics. The following </p><p>section is to help yearlong students recognize what it takes to be </p><p>successful in Manual Therapy. Hopefully, all of you are </p><p>already meeting or exceeding the following standards. Students </p><p>are expected to acquire the knowledge and skills necessary to </p><p>meet each of the standards prior to the end of the course. </p><p>Standards for Intermediate level Manual Physical Therapy Practice: </p><p>Therapeutic Philosophy and Beliefs </p><p>1) Therapists should accept responsibility for the management of each patients problem. </p><p>2) Therapists should attempt to exhaust all possible Manual Therapy and Physical Therapy options prior to concluding one-on-one PT can no longer help. </p><p>3) For Physical Therapy to be effective the Physical Therapist needs to spend time directly evaluating, treating and educating each client. </p><p>4) Therapists should believe that every client can benefit from skilled Manual Therapy/Physical Therapy (except those individuals with non-musculoskeletal disorders). </p><p>5) Doing the very best you can possibly do for each client will result in maximum patient improvement and therapist growth. The quality of how you practice is the primary determinant </p><p>of how well you advance clinically. </p><p>6) The patient is always given the benefit of the doubt. </p><p>7) Failure for a patient to improve should force you to reflect on your knowledge and skill, and the quality of care you have been providing. </p><p>Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 10 </p><p>Components of the Subjective Evaluation </p><p>Category/Order Information Gathered Common Questions Information Used For </p><p>Main Complaint/Kind of disorder </p><p>* Reason for patient seeking help. * Pain, stiffness, giving way, instability, weakness, loss of function, Post-trauma (injury/surgery). </p><p>* As far as you are concerned, what do you feel, is you main problem, (at this stage)? </p><p>* Function limitations. * Management * Nature </p><p>Patient Profile/Functional Loss </p><p>* Age, marital status, living situation, kids, work, exercise etc. * Normal activity level. * Begin to appreciate emotional demands of the patient. * Current functional limitation (ADL, work, sport, exercise etc) </p><p>* How do you keep your self busy? * Do you live alone? * Is there anything it stops you from doing? </p><p>* Function limitations * Contributing factors * Management * Severity * Prognosis </p><p>Body Chart/Area and type of Symptoms </p><p>* Map all areas of symptoms. Label by numbers or code, E.g. P1, P2 or P-Lx, P-Leg. * Palpate to confirm exact location of symptoms. * Label the worst area according to the patient. * For all areas label I/M vs Const, description, depth and severity. * Clear adjacent areas. * Ask about N/T. * Try to establish relationships between the symptoms. </p><p>* Show me where the worst area is? * Do you get anything here? * Do you get any numbness or tingling? * Is it there all the time or does it come and go? * Is it deep down or on the surface? * How would you describe it? * Is it mild, moderate or severe? * On a scale of 0-10. Zero being no pain and 10 being the most pain you can imagine feeling, how much is it when it is at its worst? * Are they related? * Do they come at the same time? * How is it in the ____ when you get it in the _____? * Do you ever get it in the ____ when you dont have it in the _____? </p><p>* Pathobiological mechanisms * Source of the symptoms * Severity * Nature * Management * Irritability * Prognosis * Establish a baseline </p><p>Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 24 </p><p>Contraindications and Precautions </p><p>Caution with mobilization grade I-IV </p><p>1. The presence of segmental neurological signs (loss of sensation, power and/or reflex). </p><p> Extra care should be taken with movements that close the intervertebral foramina on the painful side (more for </p><p>the cervical spine). </p><p>2. Inflammatory Arthritis (RA, Ank spond, Gout) </p><p> Except in the Acute inflammatory stage </p><p> Treatment into resistance should be avoided in the cervical spine due to painless weakening of its </p><p>ligamentous structures. </p><p>3. Osteoporsis/Osteopenia. Often only suspected due to advanced age (especially menopausal women), post </p><p>radiotherapy, long-term oral steroid or anticoagulant </p><p>therapy. </p><p> Avoid higher grades, long lever arm techniques, axial rotation and localized pressure. </p><p> Must be especially careful in the thoracic spine, ribs, neck of femur or neck of humerus. </p><p>4. Structural Instability. Such as that from spondylolisthesis or recent dislocation. </p><p> Mobilization should not be done in a fashion that may increase instability. Occasionally gentle treatment into </p><p>resistance in the direction of the instability can be useful </p><p>in restoring pain free range. </p><p>5. Hypermobility. </p><p>6. Children and those still growing. Forceful mobilization and long lever techniques may stress the epiphysial plates and </p><p>interfere with normal growth. </p><p>7. Pregnancy. </p><p>8. Signs and symptoms of vertebro-basilar Insufficiency (VBI) or carotid artery compromise. Careful mobilization (except </p><p>rotation) with constant monitoring of VBI symptoms can be </p><p>performed. </p><p> Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 31 </p><p>Compiling a Movement Diagram </p><p>1) Find P1 </p><p>2) Move to the limit. Where in </p><p>range is it? What is it (R, P or </p><p>S)? Qualify the limit. Note that </p><p>in this example the limit is R2. It </p><p>could have easily been P2 or S2. </p><p>3) Map the behavior of pain from </p><p>P1 to the limit. Qualify its </p><p>intensity at the limit. </p><p>4) Map behavior of other </p><p>qualities. </p><p>Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T 40 </p><p>Planning the Objective Examination </p><p>Introduction </p><p>The objective evaluation is a dynamic process. The specific </p><p>techniques used in each evaluation are selected based primarily on </p><p>the information gathered in the subjective examination. The </p><p>subjective presentation of each client will result in an objective </p><p>evaluation that is individual to each client. </p><p>Therefore, there needs to be a planning process to ensure the </p><p>evaluation techniques selected meet the needs determined from the </p><p>subjective examination. As your objective examination progresses </p><p>the plan will be reviewed and modified based upon previously </p><p>gathered info. </p><p>Goals of the Objective Evaluation: </p><p>1. Ensure that Manual/Physical Therapy treatment is safe and indicated </p><p>2. Ensure that the persons problem is musculoskeletal in nature 3. Test hypotheses developed in the subjective exam 4. Develop new hypotheses 5. Locate the most comparable signs 6. Discover treatment techniques 7. Establish a baseline for reassessment </p><p>Factors to consider when planning the OE: </p><p>1. What areas/structures to examine 2. Complete exam or clearing exam of each area 3. What level of symptom reproduction is appropriate 4. Appropriate vigor for the exam 5. How much examination to perform on day 1 6. What follow-up exam is required at future visits 7. Is a neurological exam (or other special tests) indicated 8. Safety </p><p>What Structures to Examine: </p><p>When deciding what structures to examine there a two general rules </p><p>that are useful: </p><p>1. Examine all structures under the area of symptoms, as well as any structure that can refer into the area of symptoms. </p><p>2. Examine joints above and below the involved area </p><p>For the sake of planning it is a good idea to list the musculoskeletal </p><p>structures under the area of symptoms, and the structures (non-</p><p>musculoskeletal structures to be discussed later) that might refer </p><p> Selected Pages from</p><p> Yearlong Course</p><p> Theory Manual</p></li><li><p>AMSPT Yearlong Course Theory Manual </p><p>Australian Musculoskeletal Physical Therapy 2011 T...</p></li></ul>

Recommended

View more >