MANUAL THERAPYCREDIT HOURS 3(2-1)

COURSE DESCRIPTION
This course provides review of all Manual Therapy techniques, covering spine, peripheral joint
mobilizations, Temporo-Mandibular joint, advanced myofascial trigger point therapy, Proprioceptive
training, muscle energy techniques, strain counter strain techniques, neuromobilization combination
techniques and mobilization, manipulation techniques.

LEARNING OBJECTIVES
 Discuss various concepts of manual therapy techniques
 Discuss principles of manual therapy
 Demonstrate skills in application of manual therapy techniques

COURSE CONTENTS
FOUNDATION CONCEPTS TO MANUAL THERAPY
OMT KALTENBORN-EVJENTH CONCEPT
 History
 Special features
 Overview.

PRINCIPLES
SPINAL MOVEMENT
 The mobile segment
 Spinal range of movement
 Joint positioning for evaluation and treatment
 Three-dimensional joint positioning
 Resting position
 Actual resting position
 Non resting positions
 Joint locking
 Bone and joint movement
 Rotations of a vertebral bone
 Standard bone movements
 Combined bone movements
 Coupled movements
 Non coupled movements
 Joint roll-gliding associated with bone rotations
 Joint roll-gliding
 Abnormal roll-gliding
 Translation of vertebral bone
 Joint play associated with bone translation.

TRANSLATORIC JOINT PLAY

 The Kaltenbom Treatment Plane
 Translatoric Joint Play Movements
 Determining the direction of restricted gliding
 Glide test
 Kaltenbom Convex-Concave Rule
 Grades of translatoric movement
 Normal grades of translatoric movement (Grades I - III)
 Palpating resistance to normal movement
 Pathological grades of translatoric movement
 Using translatoric grades of movement.
TESTS OF FUNCTION
 Principles of function testing
 Assessing quantity of movement
 Measuring rotatoric movement with a device
 Manual grading of rotatoric movement ( - scale)
 Assessing quality of movement
 Quality of movement to the first stop
 End-feel: Quality of movement after the first stop
 Elements of function testing
 Active and passive rotatoric movements
 Testing rotatoric movement
 Localization tests
 Differentiating articular from extra-articular dysfunction
 Differentiating muscle shortening from muscle spasm
 Translatoric joint play tests
 Resisted movements
 Passive soft tissue movements
 Additional tests.

OMT EVALUATION
 Goals of the OMT evaluation
 Physical diagnosis
 Indications and contraindications
 Measuring progress
 Elements of the OMT evaluation
 Screening exam
 Detailed exam
 History
 inspection
 Tests of function
 Palpation
 Neurologic and vascular tests
 Medical diagnostic studies
 Diagnosis and trial treatment.

SPINAL JOINT MOBILIZATION

 Goals of joint mobilization
 Mobilization techniques
 Pain relief mobilization
 Pain-relief traction mobilization (Grade I -IISZ)
 Vibrations and oscillations
 Relaxation mobilization
 Relaxation-traction mobilization (Grade I -II)
 Stretch mobilization
 Stretch-traction mobilization (Grade III)
 Stretch-glide mobilization (Grade /)
 Manipulation
 If traction exacerbates symptoms
 A voiding high-risk manual treatment
 Rotation mobilization
 Joint compression.
OMT TREATMENT
 Elements of OMT
 Treatment to relieve symptoms
 Immobilization
 Thermo-Hydro-Electric (T-H-E) therapy
 Pain-relief mobilization
 Special procedures for pain relief
 Treatment to increase mobility
 Soft tissue mobilization
 Passive soft tissue mobilization
 Active-facilitated soft tissue mobilization
 Muscle stretching principles
 Joint mobilization to increase mobility
 Neural tissue mobilization
 Specialized exercise to increase mobility
 Treatment to limit movement
 To inform, instruct and train
 Research.

SPINAL SYNDROMES
 Notes on spinal syndromes
 Cervical syndromes
 Thoracic syndromes
 Lumbar syndromes
 Neurologic evaluation of nerve root syndromes
 Sensory innervation of the skin
 Sensory innervation of deep structures
 Motor innervation
 Common nerve root syndromes.

MANUAL THERAPY ASSESSMENT

 The Maitland‘s and Mulligan concept
 Subjective examination
 Physical examination
 Examination of the temporomandibular joint
 Examination of the upper cervical spine
 Examination of the cervicothoracic spine
 Examination of the thoracic spine
 Examination of the lumbar spine.

THE SUBJECTIVE EXAMINATION STEP BY STEP

 Introduction
 Body chart
 Behavior of symptoms
 Special questions
 History of the present condition (HPC)
 Past medical history (PM H)
 Social and family history (SH, FH)
 Plan of the physical examination
 Case scenarios
 Counterfeit clinical presentations.
PHYSICAL EXAMINATION STEP- BY-STEP
 Introduction
 Observation
 Joint tests
 Muscle tests
 Neurological tests
 Special tests
 Functional ability
 Palpation
 Accessory movements
 Completion of the physical examination.

TECHNIQUES
TECHNIQUE PRINCIPLES
 Learning manual techniques
 Applying manual techniques
 Objective
 Starting position
 Patient's position
 Therapist's position
 Hand placement and fixation/stabilization
 Grip
 Therapist 's stable hand
 Therapist's moving hand
 Procedure
 Joint pre-positioning
 Mobilization technique
 Symbols
 Recording
 Identifying an intervertebral segment
 The Star Diagram.

PELVIS
 Functional anatomy and movement
 Notes on evaluation and treatment
 Pelvis tests and mobilizations
LUMBAR SPINE
 Functional anatomy and movement
 Notes on evaluation and treatment
 Lumbar tests and mobilizations

THORACIC SPINE AND RIBS

 Functional anatomy and movement
 Notes on evaluation and treatment
 Thoracic tests and mobilizations.

CERVICAL SPINE
 Functional anatomy and movement
 Notes on evaluation and treatment
 Cervical tests and mobilizations.

UPPER CERVICAL SPINE

 Functional anatomy and movement
 Notes on evaluation and treatment
 Upper cervical tests and mobilizations.

JAW
 Functional anatomy and movement
 Jaw examination scheme
 Jaw tests and mobilizations.

SPINAL MOBILIZATIONS
THE CERVICAL AND UPPER THORACIC SPINES
 NAGS
 REVERSE NAGS
 SNAGS
 SELF SNAGS
 Spinal Mobilization with arm Movement
 Other mobilization with movement techniques (MWMS) for the Cervical and Upper Thoracic
Spines.

THE UPPER CERVICAL SPINE SPECIAL TECHNIQUES

 The acute Wry Neck
 Headaches
 Vertigo, Nausea and other vertebral artery Signs.

THE LUMBAR SPINE

 SNAGS
 SELF SNAGS

THE SACROILIAC JOINTS (S/I) JOINTS

THE THORACIC SPINE
THE RIB CAGE

PERIPERAL JOINT MOBILIZATION TECNIQUES

INTEGRATIVE MANUAL THERAPY
 Postural Compensations of the spine
 Muscle Energy and 'Beyond' Technique for the spine
 Treatment of spine Hypertonicity for Synergic Pattern
 Release with Strain and Counter strain Technique
 Myofascial Release
 Tendon Release Therapy for Treatment of Tendon Tissue Tension with Advanced Strain and
Counter strain Technique
 Ligaments: a Tensile Force Guidance System: Treatment with Ligament Fiber Therapy
 Procedures and Protocols to correct spinal Dysfunction with Integrative Manual Therapy.

LAB WORK
In the laboratory sessions, Supervised evaluation and manual therapy treatment techniques will be
demonstrated and practiced, including joint and soft-tissue mobilization, manipulations, and posture and
movement retraining in the physiotherapy clinic/Ward and Orthopaedic clinic/Ward, Indoor as well as
outdoor. Various reflective case studies related to manual therapy of the spine and TM joint will be
assigned to the students.
Note: The students are expected to make a record of his/her achievements in the log book. The log
book is a collection of evidence that learning has taken place. It is a reflective record of achievements.
The log book shall also contain a record of the procedures which student would have
performed/observed
RECOMMENDED BOOKS
1. Manual Mobilization of the Joints TheKaltenborn Method of Joint. Examination and Treatment
Volume I, The Extremities By: Freddy M. Kaltenbom in collaboration with Olaf Evjenth,
TraudiBaldauf. Kaltenbom, Dennis Morgan, and Eileen Vollowitz,OPTP Minneapolis, Minnesota,
USA.
2. Manual Therapy By: Ola Grimsby, the Ola Grimsby institute San Diego.
3. Integrative Manual therapy for the upper and lower extremities By: Sharon weiselfish, North
Atlantic books Berkeley, California.
4. Orthopedic manual therapy an evidence-based approach by: Chad Cook.
5. Orthopaedic Manual Therapy Diagnosis Spine and Temporomandibular Joints By: Aad van der.
6. Translatoric Spinal Manipulation By: John R. Krauss, Olaf Evjenth, and Doug Creighton John R.
Krauss A Lakeview Media L. L.C. Publication.
7. euromusculoskeletal Examination and Assessment A Handbook for Therapists.
8. By: Nicola J Petty, Ann P Moore &G D Maitland, Second Edition Churchill Livingstone.
9. Myofascial Manipulation Theory and Clinical Application, Second Edition By: Robert I. Cantu,
Alan J. Grodin an Aspen Publication Aspen Publishers, Inc. Gaithersburg, Maryland 2001.
10. Maitland's Vertebral Manipulation Seventh Edition By: Geoffrey D. Maitland.
11. Musculoskeletal manual medicine, diagnosis and treatment by Jiri Dovark, Vaclav Dovark,
Werneir Schneider etc.
Manual therapy, NAGS, SNAGS, MWMS etcby Brian R Mulligan fifth edition.