C&T Passive Treatment

• Manual Therapy - Passive treatment desired effects:

  • reduce pain - mechanically induced analgesia
  • neurophysiology effect and hypoalgesiac effect
  • peripheral mechanism
  • spinal cord mechanism
  • supraspinal mechanism
  • reduce hypomobility - biomechanical effect
  • transient and not long lasting
  • indicated: presents with a lack of range or length or periarticular tissue that are a barrier to recovery
  • move joint to affect muscle and/or nerve tissue
• Manual Therapy - Passive treatment desired effects:

  • always respect SIN when choosing treatment technique
  • this will help determine starting position, duration, speed and repetitions of treatment
  • if a pt has high SIN:
  • position away from direction of aggravation
  • small amplitudes, out of resistance, shorter sets and less reps
  • if a pt has low SIN:
  • progress position towards direction of restriction or discomfort
  • high amplitudes, into resistance longer sets and more reps
• Manual Therapy Techniques

  • passive asscessory intevertebral movement (PAIVM)
  • cervical spine
  • central PA
  • unilateral PA
  • thoracic spine
  • central PA
  • unilateral PA
  • transverse
  • SNAG
  • 1st rib caudal mobilisation
  • cervical lateral glide
• Manual Therapy - Cervical Spine - Central PA:

  • indications
  • localised treatment to specific levels for pain modulation or to improve mobility
  • improvement shown during examination using these techniques
  • pts in prone, place towel under forehead and pillow under chest
  • therapist position: standing at top of bed
  • hand position: use thumbs with fingers resting around neck, apply force through thumbs directly onto spinous process
  • lean forward to make sure youre over the level and that youre in the line of movement and make sure to have bed low enough, allows you use body weight to apply force
• Manual Therapy - Cervical Spine - Unilateral PA:

  • indications
  • localised treatment to specific levels for pain modulation or to improve mobility
  • improvement shown during examination using these techniques
  • pt in prone, towel under foreahead and pillow under chest
  • therapist at top of the bed
  • use thumbs, fingers resting around the neck, the articular pillar is directly laterally off the spinous process of the level
  • apply force through thumbs through articular pillar
  • lean forward so you're over the level and that youre in the line of movement, make sure bed is low to use your body weight
• Manual Therapy - Thoracic Spine - Central PA:

  • indications
  • localised treatment to specific levels for pain modulation or to improve mobility
  • improvement shown during examination using these techniques
  • pt in prone, towel under forehead, pillow under chest
  • therapist standing at top of bed for upper thoracic and to side for mid to lower
  • hand position: use pisiform grip
  • make sure to have to bed low enough, allows you to use your bodyweight to apply the force
• Manual Therapy - Unilateral PA at rib angle:

  • indications:
  • localised treatment to specific levels for pain modulation or to improve mobility
  • improvement shown during examination using these techniques
  • examination identified involvement of the costotransverse joints/rib angle on passive accessory assessment
  • pts in prone
  • therapist stand to side of pt in step stance position, once transverse process is found, go slightly lateral
  • use of thumb pads reinforcing bottom thumb with top one
  • ensure bed is low enough to have your sternum over your hand
• Manual Therapy - Unilateral PA at rib angle:

  • indications:
  • localised treatment to specific levels for pain modulation or to improve mobility
  • improvement shown during examination using these techniques
  • theoretical bias towards rotation movements
  • pt in prone, bed needs to be up high, xyphoid process level
  • therapist to side of pt in step stance position, once youve found target spinous process, go lateral onto side of spinous
  • use of thumb pads reinforcing bottom thumb with top on
  • make sure to have bed high enough
• Manual Therapy - Passive Accessory - Caudal pressure onto 1st rib:

  • indications:
  • theoretical mobilisation to increase vertical diameter of thoracic outlet
  • pt in prone or supine
  • be gentle here are lots of sensitive structures, ribs not easy to find
  • therapist stands at top of the bed, find superior border of upper traps, come anterior and push back the muscle tissue away, direct pressure in a inferior direction
  • use thumb pads, reinforcing bottom thumb with top one
  • ensure beds at belly button height
• Manual Therapy - SNAG:

  • indications:
  • theoretical mobilisation for pain relief into a functional movement
  • technique combines accessory movement with active physiological movements
  • pain should ease with repeated movements, cease if no change or pain increases
  • pts seated or standing - ensure safety
  • isolate level to be mobilised and apply pressure with both thumbs together - can be done unilaterally on the articular pillar on one side or one thumb on each side of a level
  • apply glide in direction plane of facet
  • pt moves into flexion/side flexion/rotation
  • 7 repetitions
• Manual Therapy - Cervical lateral glides:

  • indications:
  • pt with neural tissue pain without conduction issue
  • positive provocation test
  • pt in supine, make sure head is well supported with a pillow or towel
• Manual Therapy - Cervical lateral glides:

  • therapist position:
  • stand at top of plinth facing down to pts feet
  • stabilise shoulder by placing the heel of your palm onto the spine of the scapular on the side youre wanting to perform treatment on
  • this arms forearms blocks head from rotating/side flex
  • other and reaches under neck onto side you want to treat with your finger tips hooking onto transverse and unilateral of target level
  • glide is applied away from side of discomfort e.g. symptoms on the right, glide is from right to left
  • progress by moving arm into provocative position