OMT lecture 1.pptx for Physiotherapiststudent

Orthopedic manual therapy

1. Orthopaedic Manual Therapy (OMT) S. Himalowa LAMU

2. Definition Orthopaedic Manual Therapy [Inscoe et al 1995] •A systematic method of evaluating & treating dysfunctions of the NMS system through application of specific manual techniques in order to relieve pain, increase or decrease mobility & normalise general function

3. Interrelationship of the systems of the body Muscle system Articular system Neural system

4. Structural Anatomy: Revision –skeletal system Peripheral joints and vertebral column What is a joint Type of joints Joint planes Loose-Packed and Close-Packed Position of joints Capsular pattern of joints Physiological/ Osteokinematic vs . Accessory/ Arthrokinematic movt of joints

5. Structural Anatomy: Revision –muscle system Muscles: Origin & Insertion Action vs. Function Mobilisers vs. Stabilisers [fibre type and recruitment pattern] Function vs. dysfunction

6. Structural Anatomy: Revision -Peripheral neural system Nerve roots = plexi =peripheral nerves Anatomical relation to joints/muscles Function and dysfunction

7. Functional Anatomy Movement = the main function of the NMS system! Active physiological movement Passive physiological movement Resisted isometric contraction Passive accessory movement Close-chain and open-chain movement Biomechanical rhythm of movement

8. What we need for functional movement?

9. What we [and ageing] do to our bodies!!

10. Functional Anatomy Alignment Posture and effect on NMS system What is good posture? Congenital mal-alignment: Coxa vara /valgus; genu varum /valgus etc

11. Posture/function = Structure

12. A Movement System Balance involves White and Sahrmann 1994 Maintenance of precise movement of the moving parts of a joint around an axis Correct muscle length Correct muscle control Correct relative stiffness of both contractile and non-contractile tissues Correct kinetics (forces of motion)

13. A Movement-System Balance Mottram & Comerford [….2007 ] Control of Direction [Control the ‘give’ and move the ‘restriction’ - Local & Global stabilisers] Correct translation [low threshold activation local stabilisers ↑ stiffness to control abnormal translation] Through range [Especially global stabilisers inner ROM] Extensibility [Global mobilisers = its more than length of ms , does pt have active control to control proximal extensibility = no give, as muscle lengthens.

14. Connective Tissue Cartilage, disc, menisci Capsules, ligaments, tendons Fascia layers/sleeves surrounding Muscles Neural tissue Adipose tissue Vascular & lymphatic structures Almost ALL soft tissue, but inner bone

15. E.g. of Joints: Held together by CT

16. E.g. of Muscles = (Contractile tissue)Covered with connective tissue

17. E.g. of Neural tissue: Conductive tissue Covered and lined with connective tissue Key A=axon BV=blood vessel E= endonerium EE&IE= epinerium M= mesonerium P= perinerium

18. Connective tissue: Classification Dense regular CT – Tendons, ligaments Dense irregular CT – Aponeurosis, capsules, fascial sheeths , periosteum

19. Connective tissue Mechanical properties VISCOSITY; the ability to dampen shearing/tensile forces ELASTICITY; the ability to return to original state after deformation = VISCO-ELASTICITY=

20. Connective tissue Mechanical properties Load : deformation depends on; Time Magnitude Rate Temperature

21. CT: Mechanical properties Elastic and Plastic Deformation

22. Dysfunction of CT Effected by injury Effected by immobilisation Ultimately form A functional scar

23. Effects of immobilisation on CT ( Hendricks, 1995 ) Loss of tensile strength: 33% -39 % in 8 weeks Still debate on what causes stiffness? Loss of proteoglycons and water leading to loss of space between collagen fibres & increased friction forming adhesion Loss of proteoglycons & water from matrix leading to reduction in critical space & more cross links formed WITHOUT MOTION CT LOOSES ABILITY TO MAINTAIN BIOMECHANICAL COMPOSITION OF MATRIX AND BIOMECHANICAL CHARACTERISTICS OF NORMAL TISSUE

24. Connective Tissue Effect of Immobilisation Changes begin 4-6 days post-immobilisation Increase in CT ratio & collagen concentration Decrease in water & proteoglycon content Dysorganisation of parallel fibre arrangement & spacing Decrease in mobility Decrease in tensile strength & ability to absorb energy

25. Effect of Injury Healing in Terms of CT Changes Inflammatory Phase Revascularisation (weak blood network) Formation of weak Type III fibrin - scaffolding Fibroblastic Phase- Collagen formation: Type I is laid down by fibroblasts & replaces Type III Cross-linkage increase Remodelling Phase Maturation & Arrangement Synthesis- lysis balance, excess collagen remodelled by fibroclasts

26. Factors influencing healing time Type of injury Type of tissues involved General health of the patient Physical demands needed from the tissue Events occurring during course of recovery Age

27. INJURED CONNEECTIVE TISSUES A FUNCTIONAL SCAR = as close as possible to the mother tissue: Length and elasticity Tensile strength Mobility

28. Transverse vs. longitudinal mobilisation techniques of CT structures in formation of Functional Scar

29. So: Why OMT for NMS movement dysfunction? Relieve pain Restore function of structure = pain-free movement Rehabilitate normal function = movement Rehabilitate participation in activity= movement

30. Connective tissue mobilisation Transverse frictions [Cyriax, 1984; Kesson & Atkins, 1998]

31. Connective tissue mobilisation Myofascial release

32. Connective tissue mobilisation Lengthening by movement & stretching, SSTM techs (Hunter 1994;1998)

33. Ref Cyriax, 1984; Kesson & Atkins, 1998 Diener I, University Stellenbosch & Western Cape 2010. Hendricks, 1995 Hunter 1994;1998 Inscoe et al 1995 Mottram & Comerford 2007 White and Sahrmann 1994