1. Manual Therapy for Athletes
Bryan Bourcier DPT, ATC, COMT, CSCS,

2. Outline Manual Therapy basics Contraindications Indications
Spine Mobilizations for Athletes
Upper extremity Peripheral Mobilization
Lower extremity Peripheral Mobilizations

3. Manual Therapy Basics Grading Mobilizations Comparable Sign
Resistance vs Pain
R1 vs R2
P1 vs P2
Grades of Mobilizations
I – Small amplitude short of resistance
II – large amplitude short of resistance
III – Large amplitude midway between R1 and R2
IV - Small amplitude midway between R1 and R2
V- At R2 High velocity low amplitude
+, ++, -, -- variations
IV++ and III++

4. Contraindications (Red/Yellow
Fracture (red)
Hypermobility / empty end feel (Yellow)
Pregnancy (yellow)
Cord Compression (Red)
Cancer (Red)
Patient comfort (yellow)
Open wounds (yellow)
Fusions (Red and Yellow)
Manipulation into spasm (Red)

5. Indications Stiffness Pain management Scar tissue management
“locking” or “Pinching” (Spine)
Evidence
When combined with exercise, speed up recovery
Not better if used without exercise

6. Common Cervical Spinal Mobilizations for Athletes
Suboccipital Release
Concussions
Traction
MET
Soft tissue

7. What are we treating neck pain and stiffness, headache, dizziness
Concussion
Whiplash
neck pain and stiffness,
headache,
dizziness
fatigue
jaw pain
activity intolerance
postural weakness
visual disturbances
tinnitus
increased symptoms with fatigue
shoulder and arm pain
back pain

8. Subocciptial release Long sustained pressure on suboccipitals.
Can be done unitlaterally
Make sure knees are bent
If too painful, try traction first.

9. Common Cervical Spinal Mobilizations for Athletes
Suboccipital Release
Concussions
Traction – Manual Vs Mechanical
MET – when and when not
Soft tissue – positional release and first rib

10. Common Thoracic Spinal Mobilizations for Athletes
Pistol
Screw

11. Common Lumbar Spinal Mobilizations for Athletes
Rotational Mobilization
Grade I-III
Manipulation
Chicago Roll
Shotgun
SI / IS MET
Leg Pull
A/P

12. Upper extremity Mobilizations
Shoulder
“Fish Flop” (Shoulder pain control)
Elbow
Radial Head
Wrist
Distal Radial ulnar distraction

13. Lower Extremity Hip Knee Ankle Lateral glides (FAI) AP and PA
Extension with ER and IR (post op and Hamstrings)
Ankle
Lateral malleolus glides (Ankle Sprains)