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Manual Therapy and the Canine Thoracic Spine MANUAL THERAPY LITERATURE

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Manual Therapy and the Canine Thoracic Spine MANUAL THERAPY LITERATURE Manual Therapy and the Canine Thoracic Spine MANUAL THERAPY LITERATURE Manual Therapy REVIEW and the Canine Thoracic Spine The Canine Spine: Laurie Edge-Hughes Advanced Assessment & Treatment BScPT, MAnimSt (Animal Physio), CAFCI, CCRT Techniques The Canine Fitness Centre Ltd www.CanineFitness.com Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT Four Leg Rehab Inc www.FourLeg.com IntroducNon Mobilizaon • FuncNon = Mobility with Stability Form Closure: . Mobilizaon or manipulaon aimed at restoring mobility and/or correcNon of osseous alignment. • The Integrated Approach . “If eXercise is prescribed first, without firstly restoring – Form Closure joint mobility, the paent’s pain and dysfuncNon o\en – Force Closure gets worse.” (Lee & Lee 2004) – Motor Control & Timing Mobilizaon . The gentle coaXing of movement by passive • Manual Therapies rhythmical oscillaons – Mobilizaon & TracNon... ▪ To treat sNffness Disturbed Harmony by Giorgio Vaselli ▪ To treat pain (rather than sNffness) Maitland et al 2005 Copyright Laurie Edge-Hughes, 2013 1 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • Maitland’s Mobilizaon Grading Scale • Maitland’s Mobilizaon Grading Scale • Grade 1: Gentlest. Performed with pressures so light and amplitudes so Nny as may be considered ineffecNve. Used when pain and more parNcularly mm spasms are easily evoked by very __________________________Available range_____________________________ gentle passive movement. Beginning R.O.M. Anatomical Barrier • Grade 2: Large amplitude in painless part of joint’s range. Where in _______________Grade 1 the range is guided by pain and spasm so as to avoid both. ______________________________Grade 2 • Grade 3: Big amplitude movement and done to ‘knock’ at the limit ______________Grade 3____________ of range. Used when pain is felt at the limit of range and is Grade 4____________ moderate and is not associated with spasm. • Grade 4: Tiny amplitude: performed with joint at maXimal stretch Grade 5________> and used only when eXaminaon finds the range to be almost full, Grades 1 & 2 have a neuromodulatory / pain relieving effect Grades 2 & 3 have a vascular effect not protected by muscle spasm, and when there is very lidle pain. Grades 3 & 4 have a mobilizing effect • Grade 5: manipulaon: An eXtension of grade 4 – the joint is Grade 5 is a manipulation suddenly moved through a very small amplitude, but at high velocity before paent is aware of it. Maitland et al 2005 Maitland 1966 Neutral AXis Mobilizaon Flexion • Methodology: Extension – Minimal Symptoms Anatomical Barrier ElasNc Barrier • Staccato technique (like plucking a violin) – Moderate Symptoms Physiologic Zone Anatomical Barrier • Staccato technique (like playing staccato Elasc Zone ElasNc Barrier notes with a bow on the violin strings) – Severe Symptoms Elasc Zone • Oscillatory movements of smooth and even nature (a movement with unperceivable changes in direcNon) Maitland et al 2005 Copyright Laurie Edge-Hughes, 2013 2 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • Passive Accessory vs. Passive Physiological Mov’ts • Passive & AcNve Movements – Preservaon of full ROM PAIVMs (Passive Accessory PPIVMS (Passive Physiological – Preservaon of strength and fleXibility of Intervertebral Movements) Intervertebral Movements) periarNcular Nssue Usually the first choice for manual Use if irritable to touch, or if treatment worsened aer palpaon, or if neurologic signs • Physiological Movements ParNcularly useful when loss of ParNcularly useful when loss of – AcNve or passive FUNCTIONAL movements moNon in eXtension (? Canine moNon in fleXion (? Canine • Accessory Movements applicaon or not?) applicaon or not?) – Conjunct movements Eg: Dorso-ventral (PA) pressures, Eg: Large movements – fleXion, Maitland et al 2005; TracNon, Transverse pressures. eXtension, side bending, rotaon. • Both are used to mobilize joints Björnsdóttir & Kumar 1997 Maitland et al 2005 Mobilizaon Mobilizaon • Selecon of techniques • SelecNon of techniques based on PATHOLOGY – To OPEN a facet joint – Acute pain or Nerve root symptoms • Rotate or Side bend AWAY from the side of pain • Stac tracNon – gentle • Dorso-Ventral Pressures ON the side of pain – Chronic Nerve root symptoms • Transverse Pressures TOWARDS the side of pain • – To CLOSE a facet joint Central D-V pressure, rotaons, tracNon • Opposite of above – Discogenic signs • And if using a D-V pressure – direct the pressure medially • Generalized rotaon • Rule of thumb… – Facet joint signs – Try OPENING first! • Localized rotaon – OsteoarthriNs • Large movements throughout range (accessory & physiologic) Maitland et al 2005 Maitland et al 2005 Copyright Laurie Edge-Hughes, 2013 3 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • How bloody long do I do the technique(s) for? • Mechanical – TIME – Restoraon of voluntary movement – If Irritable: then 20 – 30 seconds, repeated 1 or 2 Nmes – Aids in carNlage nutriNon – If Non-Irritable: then 1 minute, repeated 4 – 6 Nmes – Aids in intervertebral disc nutriNon – TECHNIQUES PER SESSION – Aids in metabolism of so\ Nssue structures – Add them in, but reassess before and aer each new – Improved rate and quality of tendon repair technique – Zusman 1986; Perform the most effecNve technique (again) last Björnsdóttir & Kumar 1997 Maitland et al 2005 Mobilizaon Mobilizaon • Requirements for a Mechanical Effect • Neurological Effects – RepeNNve passive joint movements (oscillaons) – ReducNon in acute pain need to be carried out at the limit of the joint’s – InhibiNon of refleX muscle contracNons available range in order to achieve a mechanical effect • i.e. Tissues need to be stretched Zusman 1986; Katavich 1998; Björnsdóttir & Kumar 1997; Zusman 1986 Zelle et al 2005 Copyright Laurie Edge-Hughes, 2013 4 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • Neurological Effects: • Neurological effects – RepeNNve (oscillatory) or sustained manual – “cheat sheet” sNmulaon results in a hysteresis effect: • Inhibitory effect on low threshold mechanoreceptors (group I & II) • Inhibitory effect on high threshold nociceptors (group III & IV) • THUS reducing intra-arNcular pressure and peripheral afferent discharge Zusman 1986; Katavich 1998; Conroy & Hayes 1998; Sterling et al 2001 Mobilizaon Mobilizaon Postulated Cellular Level Effects • Postulated Cellular Level Effects . Mechanical / ConnecNve Nssue remodelling – ArNcular CarNlage Changes ▪ Cellular modulaon • Alter joint lubricaon ▪ Release of enzymes to breakdown cross links ▪ Simulaon of fibroblast synthesis of collagen proteoglycans • Enhance carNlage nutriNon ▪ Realignment of old fibres • Movement of joint inclusions ▪ Increase interfibre distance (meniscoids) or loose bodies (carNlage ▪ Increase interfibre lubricaon fibrillaon) ▪ Alignment of new fibres • Shi\ hard fragment of intervertebral ▪ Stretching arNcular capsule / segmental muscles disc ▪ Breaking intra-arNcular adhesions ▪ Vertebral movement Maffey LL 2007 Maffey LL 2007 Copyright Laurie Edge-Hughes, 2013 5 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • Postulated Cellular Level Effects • Postulated Cellular Level Effects – – Neurological effects * Neuromuscular response * • Alter afferent input to effect efferent output – relaX • SNmulaon of Type I and type II mechanoreceptors muscle • Inhibit transmission of nocicepNve impulses • SNmulaon of muscle spindle and golgi tendon organ – • Decrease pain percepNon refleX inhibiNon of segmental muscles • Relieve mechanical irritaon of nervous system • Alter segmental (and more distal) muscle acNvity • AcNvaon of arNcular mechanoreceptors • RefleX muscle response locally and at a distance • SNmulaon of sympatheNc nervous system • Decrease spinal segmental facilitaon * Validated effects Maffey LL 2007 * Validated effects Maffey LL 2007 Mobilizaon Mobilizaon • Postulated Cellular Level Effects • Postulated Cellular Level Effects – Alter Circulaon – Physiological * • Increase supply of materials required for healing • Increase beta-endorphin levels • Remove chemical irritant (hence decreasing nociceptor • Immune system effects sNmulaon) Maffey LL 2007 * Validated effects Maffey LL 2007 Copyright Laurie Edge-Hughes, 2013 6 Manual Therapy and the Canine Thoracic Spine Mobilizaon Mobilizaon • Postulated Cellular Level Effects • Research EXamples - Effects of Mobilizaon – Joint Tissue Response – Improved pressure pain threshold in pts with • Increase capsule elasNcity rheumatoid arthriNs (12 minute P-A pressures) • Improve arNcular carNlage nutriNon (Dhondt et al 1999) • Improve circulaon – Improved pain (VAS) & immediate neck ROM in pts • Restoraon of joint play / accessory glides with mechanical neck pain • Restoraon of passive / acNve movement (Kanlayanaphotoporn et al 2010) • Decreased pain percepNon – A rapid onset analgesic response following joint mobs has been proven in rodent models (Grayson et al 2012) Maffey LL 2007 Mobilizaon Mobilizaon • Research EXamples - Effects of Mobilizaon • Research EXamples - Effects of Mobilizaon – Unilateral neck mobs facilitated acNvaon of deep – DOES NOT Alter sacrum-iIium joint posiNon (on neck fleXor muscle firing & reducNon in superficial roentgen stereophotgrammetric analysis) neck fleXor acNvity. – Manipulaon might influence so\ Nssue structures, (Sterling et al 2001) such as joint capsules, muscles, ligaments, tendons – Improves ROM in the human hip & ankle joints and and postures canine carpus Tullberg et al 1998 (Hoeksma et al 2004; Collins et al 2004; Olson 1987) – Does Not Change vertebral sNffness or have permanent
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