Critical Thinking

The Tools We Use: Part 2

In my last article, I presented several videos and asked you if “they make sense”.  Below I have posted several explanations of these tools (from originators/educators/researchers on each approach) and I want you to re-consider, “does the tool NOW make sense”?     Again, I ask the polls are completed by licensed Physical Therapists.

Graston Technique (quoted from www.grastontechnique.com):

Graston Technique® is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.

Originally developed by athletes, Graston Technique® is an interdisciplinary treatment used by more than 16,775 clinicians worldwide—including physical and occupational therapists, hand therapists, chiropractors, and athletic trainers.

GT is utilized at some 1,760 outpatient facilities and 43 industrial sites, by more than 260 professional and amateur sports organizations, and is part of the curriculum at 57 respected colleges and universities.

Outpatient Facilities
Companies/Industry
Colleges and Universities
Sports Organizations

For the clinician:
  • Provides improved diagnostic treatment
  • Detects major and minor fibrotic changes
  • Reduces manual stress; provides hand and joint conservation
  • Increases patient satisfaction by achieving notably better outcomes
  • Expands business and revenue opportunities
For the patient:
  • Decreases overall time of treatment
  • Fosters faster rehabilitation/recovery
  • Reduces need for anti-inflammatory medication
  • Resolves chronic conditions thought to be permanent
For employers and the healthcare industry:
  • Allows patients to remain on the job
  • Reduces the need for splints, braces and job-site modifications
  • Contributes to reduction of labor and healthcare costs, direct and indirect

Trigger Point Dry Needling (quoted from http://www.kinetacore.com)

Dry Needling is a general term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle in the area of the body, which produces pain and typically contains a Trigger Point. There is no injectable solution and typically the needle that is used is very thin. Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the discomfort can vary drastically. Usually a healthy muscle feels very little discomfort upon insertion of the needle; however, if the muscle is sensitive and shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp — which is often referred to as a ‘twitch response.

The twitch response also has a biochemical characteristic to it which likely affects the reaction of the muscle, symptoms and response of the tissue. Along with the health of the tissue, the expertise of the practitioner can also attribute to the variation of discomfort and outcome. The patient may only feel the cramping sensation locally or they may feel a referral of pain and/or similar symptoms for which they are seeking treatment. A reproduction of their pain can be a helpful diagnostic indicator of the cause of the patient’s symptoms. Patients soon learn to recognize and even welcome this sensation, as it results in deactivating the trigger point, reducing pain and restoring normal length and function of the involved muscle. Typically, positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, overall health of the patient, and experience level of the practitioner.

Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

Cervical Spine Thrust Manipulation (quote below from Di Fabio RP. Manipulation of the Cervical Spine: Risks and Benefits. Physical Therapy 1999; 79: 50-65)

Manipulation of the spine (MTS) is a form of manual therapy that is used in an effort to reduce pain and improve range of motion.1  The use of manipulation of the spine to treat patients with pain involves a high-velocity thrust that is exerted through either a long or short lever-arm.2–6 The “long-lever” techniques move many vertebral articulations simultaneously (eg, rotary manipulation of the thoracolumbar spine),7–9 whereas the “short-lever” techniques involve a low-amplitude thrust that is directed at a specific level of the vertebral column. Manipulation of the spine differs from mobilization of the spine because, theoretically, during manipulation of the spine, the rate of vertebral joint displacement does not allow the patient to prevent joint movement.10 Mobilization of the cervical spine involves low-velocity (nonthrust) passive motion that can be stopped by the patient.10 The speed of the technique (not necessarily the amount of force), therefore, differentiates manipulation from mobilization. Manipulation of the spine has been used in the treatment of patients with head and neck disorders, including neck pain and stiffness, muscle-tension headache, and migraine.11

Joint Mobilization (quoted from http://www.ozpt.com/res2.php)

Joint mobilization (also known as non thrust manipulation) is a commonly used treatment for patients with a variety of neuromusculoskeletal disorders (Maitland 1985). The efficacy of mobilization in the treatment of both hypomobility and pain has been documented for many years in both peripheral and spinal conditions alike. This commentary deals primarily with the mechanisms of Pain Modulation and Pain Reduction effects of mobilization as demonstrated by various research studies.

 Hypoalgesic Response

Numerous authors have documented the potent Hypoalgesic (pain reduction) response to mobilization in symptomatic populations, the so called “neurophysiological effect”.

This effect has been shown in:

  • Elbow pain (Vicenzino et al 1998)
  • Cervical Pain (Sterling et al 2009)
  • Knee OA (Moss et al 2007)
  • Shoulder Pain (Teys et al 2008)

 How Pain is Modulated: Two Neurophysiological Theories

 Two different, yet complementary theories, have been developed to describe the neurophysiological effect.  The two theories suggest different neurological pathways that may inhibit pain perception, thereby providing relief and/or modulation following mobilization. One is the “Gate Control” Theory and the other is “Descending Inhibition via the dPAG”. Some debate exists in the literature regarding exactly which mechanism of pain modulation is responsible for pain reduction following mobilization (Gate Control or dPEG Inhibition).

 It is possible, if not probable, that both mechanisms work together interdependently to modulate pain. The exact nature of this interplay remains unclear at this time.

Neural Mobilization (quote from McKeon MM, Yancosek KE. Neural gliding techniques for the treatment of carpal tunnel syndrome: a systematic review. J of Sport Rehab 2008; 17: 324-341.)

Sometimes referred to as “neural flossing” or “neurodynamic mobilization,” the technique of neural gliding is movement based and attempts to take the nerve throughout the available range of motion,  potentially affecting the nerve both mechanically and physiologically.23,24 Neural  gliding may improve the actual excursion of the nerve, decreasing adhesions and  reducing symptoms by allowing the nerve to move freely. This technique may also  help to oxygenate the nerve, decreasing ischemic pain.

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Categories: Critical Thinking

5 replies »

  1. You should do the same poll for DNM and Simple contact. Ask if it makes sense? Do another poll on asking if this poll makes sense as well?

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