Transcript MANUAL THERAPY IN ATHLETICS

MANUAL THERAPY
IN ATHLETICS
Joel Harman D.C., Cert. MDT, CKTP
Manchester Family Chiropractic
OBJECTIVES
• Learn and get a hands-on understanding of joint mechanics in
the shoulder, and thoracic spine.
• Learn basic movement patterns that will help guide treatment.
• Palpate, palpate, palpate.
• Learn mobilisation techniques for the shoulder, and thoracic
spine.
• Leave with an integrated approach to handling common and
difficult dysfunctions.
GOALS
• Learn to palpate the junctional areas of the spine and
shoulder.
• Learn how to functionally assess the musculoskeletal
system to locate primary areas of dysfunction.
• Learn to manually treat these findings.
• Learn how to teach the patient how to reinforce your
treatment actively.
WE ARE WHAT WE
REPEATEDLY DO.
EXCELLENCE, THEN, IS
NOT AN ACT, BUT A HABIT.
- ARISTOTLE
10,000 HOURS
The hand is the greatest diagnostic and therapeutic tool
that has ever been, or will be, invented.
- Karel Lewit
Orthopedic Testing
• Active Compression Test (O’Brien’s)
• Apprehension Test
• Sulcus Sign
• Hawkin’s
• Neer’s
• Drop Arm
• Empty Can
• Speed’s
• Yergason’s
Functional Testing
• Arm Abduction (Janda)
• Push-Up Test (Janda)
• T4 Extension
• Wall Angels
• Internal/External Rotation
Look for Texas-sized deficits!
ARM ABDUCTION
• Fail if during the
"setting phase," first 60
degrees, the shoulder
blade elevates
PUSH-UP TEST
Fail if:
• Scapulae retract
• Scapulae wing
• Scapulae shrug
T4 Extension Test
• Failure to approximate
forearm to wall.
• Thoraco-lumbar
extension.
WALL ANGELS
Fail if:
• Pain during movement
• Inability to perform
without thoracic spine
coming off wall
Maitland 5-Grade Mobilisation
Classification System
Resting
Position
Point of
Limitation
Anatomic
Limit
• Grade I: Small amplitude
•
I
•
II
•
III
•
IV
V
movement performed at
beginning of ROM
Grade II: Large amplitude
not reaching end of ROM
Grade III: Large amplitude
reaching the limited ROM
Grade IV: Small amplitude at
end of limited ROM
Grade V: Small amplitude
and high velocity at end of
limited ROM (manipulation)
Grade III-V End Range Mobilisation Techniques
are used for increasing Range of Motion
(Maitland, 1977)
Shoulder Mobilisations
• Glenohumeral Mobs
• AP
• PA
• FLEXION
• ABDUCTION (INF GLIDE)
• EXT. ROT
• INT. ROT
• LONG-AXIS
DISTRACTION
• AC Accessory Mobs
AC Joint Caudal Glide
Clavicle Rotation
• Scapular Mobilisations
• Elevation/Depression
• Protraction/Retraction
• External/Internal Rotation
AP GLIDE
• Position pt. supine with
humerus to be mobilized at
the edge of the table
• Therapist to stabilize the
pt.’s distal extremity, while
placing other hand over the
anterior proximal humerus
• Therapist then provides a
force in an A-P direction,
starting with grade 1 and
working up to grade 4 as pt.
tolerates
• Parameters: 8-10 reps (at
each grade) – hold each
mob for 3 seconds
AP GLIDE (ALTERNATIVE)
PA GLIDE
• Pt. lies prone with arm to be
mobilized toward the edge of the
table in 90 degrees of abduction (off
the table), elbow flexed with some
glenohumeral internal rotation.
• PT grasps the pt.’s distal humerus,
allowing forearm to hang down
toward the ground. Heel of proximal
hand is placed against the posterior
humeral head with elbow locked.
• PT then provides a P-A force by
moving their body/trunk down
through their locked out elbow,
starting with grade 1 and working up
to grade 4 as pt. tolerates
• Parameters: 8-10 reps (at each
grade) – hold each mob for 3
seconds
FLEXION
ABDUCTION
• Pt. lies supine with side to be
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mobilized towards the edge of the
table, arm abducted off the side of
the table
Pt.’s neck is laterally flexed toward
the side receiving the mob (to
slacken the nerves)
PT stands in lunge position
superiorly to the pt.’s shoulder: one
hand grasps around pt.’s elbow
(holding it in slight flexion), the web
space of the other hand is around
the proximal humerus
PT then provides a force to the
proximal humerus in an inferior
direction, while simultaneously
abducting further starting with grade
1 and working up to grade 4 as pt.
tolerates
Parameters: 8-10 reps (at each
grade) – hold each mob for 3
seconds
EXTERNAL ROTATION
• Pt. lies supine with side to be
mobilized towards the edge of the
table, arm is abducted up to 90
degrees (as pt. can tolerate) and
elbow is flexed to 90 degrees
• Therapist stands facing the pt.’s
head and stabilizes the pt.’s elbow
with one hand, while grasping the
wrist with the other (grasp bony
prominences at the elbow and wrist)
• Therapist slowly externally rotates
the pt.’s shoulder until pt. discomfort
or tissue resistance is met; hold for
3-5 seconds and then back off.
• Repeat up to 30x, and try to move
the shoulder a little further each
time as the tissues relax.
INTERNAL ROTATION
• Pt. lies supine with side to be
mobilized towards the edge of the
table, arm is abducted up to 90
degrees (as pt. can tolerate) and
elbow is flexed to 90 degrees
• Therapist stands facing the pt.’s feet
and stabilizes the pt.’s elbow with
one hand, while grasping the wrist
with the other (grasp bony
prominences at the elbow and wrist)
• Therapist slowly internally rotates
the pt.’s shoulder until pt. discomfort
or tissue resistance is met; hold for
3-5 seconds and then back off.
• Repeat up to 30x, and try to move
the shoulder a little further each
time as the tissues relax.
LONG-AXIS DISTRACTION
• Pt. lies supine with the shoulder to
receive treatment at the edge of the
treatment table
• Therapist stands on the side to
receive treatment, facing towards
the pt.’s head. Stabilize the pt.’s
forearm against the Therapist’s
side. Therapist’s medial arm cups
the middle to proximal humerus and
lateral arm cups laterally around the
humeral head.
• The Therapist gently distracts the
humerus by pulling toward their
body, imparting an oscillatory force
(30-50x) once distracted.
*Note: Make sure the Therapist
moves his/her whole body to provide
the distraction force, do not just pull
with arms
A-C CAUDAL GLIDE
• Pt. positioned supine with
arms at the side
• Therapist sits at the head of
the pt. with both thumbs
positioned over the superior
surface of the distal clavicle,
adjacent to the AC Jt.
• Therapist then provides a
force in an superior to inferior
direction, starting with grade
1 and working up to grade 4
as pt. tolerates
• Parameters: 8-10 reps (at
each grade) – hold each mob
for 3 seconds
CLAVICLE ROTATION
• Pt. positioned supine with arms
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•
•
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at the side
Stand near the pt.’s shoulder,
facing towards the clavicle
Gently grip the middle of the
clavicle using your thumbs on
the inferior surface and
fingertips on the superior
surface
Apply a gentile mobilization
force using a rocking or
“wiggling” motion through
repetitive wrist flexion and
extension to impart rotation of
the clavicle on its long axis
Parameters: 8-10 reps each
grade (up to grade 3)
SCAPULAR ELEVATION/DEPRESSION
• Pt. is sidelying (facing the
Therapist) with shoulder and elbow
flexed and forearm resting on
clinician’s forearm
• Therapist: Lower hand is placed
around the inferior angle of the
scapula with the thumb and
forefinger along lateral and medial
scapula borders. Upper hand
grasps the spine of the scapula,
cupping the heel of the hand
anteriorly over the clavicle
• Mobilize scapula superior and
inferior by using trunk to provide the
key force through the arms. Start
with grade 1 and works up to grade
4 as pt. tolerates
• Parameters: 8-10 reps (at each
grade) – hold each mob for 3
seconds
PROTRACTION
RETRACTION
EXTERNAL/INTERNAL ROTATION
OTHER GOOD THERAPIES
McKenzie Diagnosis and Therapy
Kinesio-Tape
PIR/PNF/SNAGS
QUESTIONS?
REFERENCES
• References
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Boyles RE, Ritland BM, Miracle BM, et al. Man Ther, 2009;14:375-380.
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