Crest Physical Therapy is a Manual Therapy based rehabilitation practice.
At the time of initial evaluation, the therapist usually performs a full assessment of the medical history of the patient. This includes a physical assessment of the blood and nerve supply in the area, as well as a bone and muscle assessment in order to decide if there is an increased risk of complications from the use of our joint pain manual therapy management techniques. Depending on the results of that assessment and each individual patient’s particular situation, the therapist may perform some or a combination of the following types of manual physical therapy:
Soft Tissue Mobilization
It is important to recognize how the role of muscles and their attachments around the joints work in concert with each other to allow the joints of the body to function in harmony. To facilitate and decrease muscle tension, the therapist at times must address the function of the joints in the region, but many times the spasm will continue to be present. In such cases, muscle tension should be addressed or the joint dysfunction may return. The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue (called ‘myofascial adhesions’) such as scar tissue from an injury, move tissue fluids, and relax muscle tension. This procedure consists of rhythmic stretching and deep pressure, and is commonly applied to the musculature surrounding. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area, with an attempt to restore normal texture to tissue and reduce associated pain.
This technique focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful tender-points. The therapist finds the patient’s positions of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which, asymptomatic strain is induced through mild stretching. The patient is then slowly brought out of this position, allowing the body to reset its muscle to a normal level of tension. This normal tension in the muscle sets the stage for healing. This technique is gentle enough to use with acute problems or problems that are too delicate to treat with other procedures.
Joint mobilizations are manual techniques that a therapist will apply to the surface of the joints that are restricted. These techniques are applied to loosen up the restricted joint and increase its range of motion. These manual applications are applied within the comfort range of the patient; however, if the therapist has to reach the end range of the motion, these mobilizations can be painful.
Muscle Energy Techniques
Muscle energy techniques (METs) are designed to treat restricted joints and shortened soft tissue structures. These techniques involve the patient in that they must participate in the actual treatment by contracting a particular muscle or set of muscles in concert with the therapist applying manual resistance techniques. This resistance by the therapist is the key to the treatment. The counter force is applied for a 3-5 second period, after which the therapist takes the joint to its new barrier and repeats the procedure. These techniques can be repeated 2 or 3 times with moderate force from both participants.
High Velocity, Low Amplitude Thrusting (HVLAT):
HVLAT technique is a more aggressive manual treatment technique that has a primary purpose to restore the gliding motion of joints and enable them to move freely. This technique involves taking the joint to its restricted barrier and then applying an isolated force to reduce this restriction. When properly applied, this technique can increase mobility and decrease muscle tone about the joint.
Patients Responsibility to Maintain an Improved Quality of Life with Maximum Function
The primary purpose of physical therapy is to maximize the level of function of a patient. Research has provided us with an improved understanding that the most effective way to treat a patient’s musculoskeletal pathology is to utilize our manual techniques in concert with a strong exercise program. It is critical that the patient actively participate in the rehabilitation process by utilizing these exercises at home and following proper postural techniques for all joints. Exercise techniques involve stretching and strengthening exercises to low impact aerobic conditioning. The goal is to maintain the correct level and type of activity to prevent the dysfunction and pain from returning. We want to empower the patient with the proper tools to address their injuries.
© 2014 Crest Physical Therapy