![Definition
ï” Orthopaedic Manual Therapy
[Inscoe et al 1995]
âąA 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](https://image.slidesharecdn.com/omtlecture1-240612114558-a06efede/85/OMT-lecture-1-pptx-for-Physiotherapiststudent-2-320.jpg)
![Structural Anatomy: Revision âmuscle
system
ï”Muscles:
ï”Origin & Insertion
ï”Action vs. Function
ï”Mobilisers vs. Stabilisers [fibre type
and recruitment pattern]
ï”Function vs. dysfunction](https://image.slidesharecdn.com/omtlecture1-240612114558-a06efede/85/OMT-lecture-1-pptx-for-Physiotherapiststudent-6-320.jpg)
![What we [and ageing] do to our bodies!!](https://image.slidesharecdn.com/omtlecture1-240612114558-a06efede/85/OMT-lecture-1-pptx-for-Physiotherapiststudent-12-320.jpg)
![A Movement-System Balance
ï” Mottram & Comerford [âŠ.2007]
ï” Control of
ï”Direction [Control the âgiveâ and move the
ârestrictionâ - Local & Global stabilisers]
ï”Correct translation [low threshold activation local
stabilisers â stiffness to control abnormal
translation]
ï”Through range [Especially global stabilisers inner
ROM]
ï”Extensibility [Global mobilisers = its more than
length of ms, does pt have active control to control
proximal extensibility = no give, as muscle
lengthens.](https://image.slidesharecdn.com/omtlecture1-240612114558-a06efede/85/OMT-lecture-1-pptx-for-Physiotherapiststudent-14-320.jpg)
![Connective tissue mobilisation
ï” Transverse frictions [Cyriax, 1984; Kesson & Atkins, 1998]](https://image.slidesharecdn.com/omtlecture1-240612114558-a06efede/85/OMT-lecture-1-pptx-for-Physiotherapiststudent-31-320.jpg)
OMT lecture 1.pptx for Physiotherapiststudent
- 1. Orthopaedic Manual Therapy (OMT) S. Himalowa LAMU
- 2. Definition ï” Orthopaedic Manual Therapy [Inscoe et al 1995] âąA 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 âskeletal system ï” Peripheral joints and vertebral column ï” What is a joint ï” Type of joints ï” Joint planes ï” Loose-Packed and Close-Packed Position of joints ï” Capsular pattern of joints ï” Physiological/Osteokinematic vs. Accessory/Arthrokinematic movt of joints
- 6. Structural Anatomy: Revision âmuscle system ï”Muscles: ï”Origin & Insertion ï”Action vs. Function ï”Mobilisers vs. Stabilisers [fibre type and recruitment pattern] ï”Function vs. dysfunction
- 8. Structural Anatomy: Revision -Peripheral neural system ï”Nerve roots = plexi =peripheral nerves ï”Anatomical relation to joints/muscles ï”Function and dysfunction
- 10. Functional Anatomy ï” Movement = the main function of the NMS system! ï” Active physiological movement ï” Passive physiological movement ï” Resisted isometric contraction ï” Passive accessory movement ï” Close-chain and open-chain movement ï” Biomechanical rhythm of movement
- 11. What we need for functional movement?
- 12. What we [and ageing] do to our bodies!!
- 13. A Movement System Balance involves White and Sahrmann 1994 ï” Maintenance of precise movement of the moving parts of a joint around an axis ï”Correct muscle length ï”Correct muscle control ï”Correct relative stiffness of both contractile and non-contractile tissues ï”Correct kinetics (forces of motion)
- 14. A Movement-System Balance ï” Mottram & Comerford [âŠ.2007] ï” Control of ï”Direction [Control the âgiveâ and move the ârestrictionâ - Local & Global stabilisers] ï”Correct translation [low threshold activation local stabilisers â stiffness to control abnormal translation] ï”Through range [Especially global stabilisers inner ROM] ï”Extensibility [Global mobilisers = its more than length of ms, does pt have active control to control proximal extensibility = no give, as muscle lengthens.
- 15. Connective Tissue ï” Cartilage, disc, menisci ï” Capsules, ligaments, tendons ï” Fascia layers/sleeves surrounding ï”Muscles ï”Neural tissue ï”Adipose tissue ï”Vascular & lymphatic structures ï” Almost ALL soft tissue, but inner bone
- 16. E.g. of Joints: Held together by CT
- 17. E.g. of Muscles = (Contractile tissue)Covered with connective tissue
- 18. 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
- 19. Connective tissue: Classification ï”Dense regular CT â Tendons, ligaments ï”Dense irregular CT â Aponeurosis, capsules, fascial sheeths, periosteum
- 20. Connective tissue Mechanical properties ï” VISCOSITY; the ability to dampen shearing/tensile forces ï” ELASTICITY; the ability to return to original state after deformation = VISCO-ELASTICITY=
- 21. Connective tissue Mechanical properties ï” Load: deformation depends on; Time Magnitude Rate Temperature
- 22. CT: Mechanical properties Elastic and Plastic Deformation
- 23. Dysfunction of CT ï” Effected by injury ï” Effected by immobilisation ï¶ Ultimately form A functional scar
- 24. Effects of immobilisation on CT (Hendricks, 1995) ï” Loss of tensile strength: 33% -39 % in 8 weeks ï” Still debate on what causes stiffness? ï” Loss of proteoglycons and water leading to loss of space between collagen fibres & increased friction forming adhesion ï” 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
- 25. Connective Tissue Effect of Immobilisation ï” Changes begin 4-6 days post-immobilisation ï” Increase in CT ratio & collagen concentration ï” Decrease in water & proteoglycon content ï” Dysorganisation of parallel fibre arrangement & spacing ï” Decrease in mobility ï” Decrease in tensile strength & ability to absorb energy
- 26. Effect of Injury Healing in Terms of CT Changes 1. Inflammatory Phase ï” Revascularisation (weak blood network) ï” Formation of weak Type III fibrin - scaffolding 2. Fibroblastic Phase- ï” Collagen formation: Type I is laid down by fibroblasts & replaces Type III ï” Cross-linkage increase 3. Remodelling Phase ï” Maturation & Arrangement ï” Synthesis-lysis balance, excess collagen remodelled by fibroclasts
- 27. Factors influencing healing time ï”Type of injury ï”Type of tissues involved ï”General health of the patient ï”Physical demands needed from the tissue ï”Events occurring during course of recovery ï”Age
- 28. INJURED CONNEECTIVE TISSUES ï”A FUNCTIONAL SCAR = as close as possible to the mother tissue: ï”Length and elasticity ï”Tensile strength ï”Mobility
- 29. Transverse vs. longitudinal mobilisation techniques of CT structures in formation of Functional Scar
- 30. So: Why OMT for NMS movement dysfunction? ï”Relieve pain ï”Restore function of structure = pain-free movement ï”Rehabilitate normal function = movement ï”Rehabilitate participation in activity= movement
- 31. Connective tissue mobilisation ï” Transverse frictions [Cyriax, 1984; Kesson & Atkins, 1998]
- 32. Connective tissue mobilisation ï” Myofascial release
- 33. Connective tissue mobilisation ï” Lengthening by movement & stretching, SSTM techs (Hunter 1994;1998)
- 34. Ref ï” Cyriax, 1984; Kesson & Atkins, 1998 ï” Diener I, University Stellenbosch & Western Cape 2010. ï” Hendricks, 1995 ï” Hunter 1994;1998 ï” Inscoe et al 1995 ï” Mottram & Comerford 2007 ï” White and Sahrmann 1994