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) A cycle of damage and repair with in the tissue. b) Adaptive motor changes in the neurological/neuromuscular dimension c) Adaptive behavioral responses in the psychological/psychomotor dimension.

 Tissue dimension  Neurological dimension  Psychological dimension

 How 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;  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) In the tissue level by direct mechanical stimulation of the damage area. b) In the neurological dimension by the activation of gating mechanism. c) In the psychological dimension by psychodynamic emotive influences of touch.

 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).

 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:  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

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.

 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 hypothetical- deductive,heuristic,and pathognomonic.

 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

 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

 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

 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)

 Reduction of the derangement  Maintenance of the reduction for healing to occur  Recovery of function  Prevention of recurrence