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Rehab Topic Rehabilitation Biopsychosocial Lewit & Soft tissue Models of Functional Neuro- Ergonomics
Introduction model Janda therapy Rehabilitation Assessment dynamics
Stages of (FMS, MAT) ICA Rehab
Rehabilitation Submission

Record & Assess your Assess and Complete the Assess your Complete a Record submit Record &
In Class submit a link partner using record your table to partner using Functional a link for a submit link for a
Activity for a Patient Biopsychosocial partner doing compare and a long and Assessment student patient
ICA educational assessment Janda hip contrast; short PARQ on your educational educational
Video / tools for their extension, Effleurage, form. Submit partner and video Video /
infographic risk of red or Hip abduction, Petrissage, in ICA attach Demonstrating infographic etc.
etc. of Tissue yellow flags for Trunk curl up, Tapotement, appendix. score sheet in UL nerve of
Sparing chronic / patient Cervical Manual and ICA appendix. tension tests, ergonomic
(sit/stand, care. flexion, push mechanical SLR and its assessment
getting in and up OR vibration differentiators, and advice for
out of bed, Shoulder Cross LL nerve your partners
ADLs tasks abduction friction tension tests or workstation,
etc.) using hudl massage, similar etc. seated
apps (or Trigger point posture, ADLs
similar). work, posture, job
scraping site posture
techniques, environment,
Spinal sleeping
traction. posture etc.
Tutor
signature and
date
 Useful on which Useful on which Tissues? Useful at which stage? (acute, Useful for which intensity?
Conditions? sub-acute, severe) (superficial, deep)
Effleurage Oedema Superficial tissues Acute Mild in general – also customised
lymphatic drainage Fascial layers Sub-acute to individual patients
Muscle relaxation Trigger points Chronic
removal and resynthesis of Severe
lactic acid Debilitating
Tension headaches End stage of cancer once
circulatory stasis approved by GP
myalgia / trigger points
superficial adhesion
post exertion fatigue /
stiffness

Petrissage Muscle relaxation Superficial and Intermediate Acute (Superficial) Mild to Severe (Deep layers)
removal and resynthesis of Sub-acute (Superficial to
lactic acid moderate)
Tension headaches Chronic (Superficial to Deep)
circulatory stasis Severe (Superficial)
myalgia / trigger points Debilitating (Superficial)
superficial adhesion End stage of cancer once
post exertion fatigue / approved by GP (Superficial)
stiffness

Tapotement Lung fluid drainage Thoracic spine Acute Mild to severe

Cystic fibrosis Sub-acute
Asthma (after an episode) Chronic
Other breathing issues
Cross friction Tendinopathy Ligaments Acute (sparingly) Mild to severe
Strains Tendons Sub-acute (Superficial to
Sprains Muscles moderate)
 Scar tissue Chronic (Superficial to Deep)
Trigger points
Trigger point – focal area Trigger points Muscles acute Mild to severe (superficial and
of tightness in a muscle Tendinopathies Tendons?? Sub-acute deep)
Headaches Fascia Chronic
Tight muscles
Contractures
Sprains/strains
Tears?

Scraping – instrument Tendinopathy Fascia Acute (sparingly) Mild to severe

assisted cross friction Strains Muscles Sub-acute (Superficial to
Sprains Tendon moderate)
Scar tissue Scar tissue Chronic (Superficial to Deep)
Trigger points
Manual and mechanical Muscle relaxation Muscle Acute (mindful of nociceptive Severe – depending on structure
vibration removal and resynthesis of Tendon stimulus) being invaded.
lactic acid Trigger point Sub-acute
Tension headaches Chronic
circulatory stasis
myalgia / trigger points
superficial adhesion
post exertion fatigue /
stiffness
 Approach (therapy,
advise, treatment)
Paul Hodges
Karel Lewit MRT:
1. Proprioceptive
Neuromuscular
Facilitation a) Hold–relax
b) Contract–relax c)
Rhythmic stabilization
2. Muscle energy
procedures
3. Post-isometric
relaxation
4. Post-facilitation stretch
Core principles / values Utility for common Amount or level of
conditions supporting research
Neuromotor control of Spinal control – lower back
movement and stability and pelvic pain
changes with pain. The
effect of pain on motor
control and possible
mechanisms.
Manipulation treatment Reduction of skin
does not change the tenderness
Reduction of connective
shape or position of a
tissue pain
structure, but it could
Release myofascial
change the function of
pressure
the MSK system.
Shifting and stretching
Frequently used muscles fascia
will have a roundness of Relaxation of hypertonic or
shape and or convexity overactive muscle
between origin and
insertion
Less used or atrophied
muscles will have a
hollowness or concavity
of a shape
Observation of muscle
form by looking at the
topography of the body,
notice asymmetries and
decreased development
areas
 Observing muscles can
tell you a lot about how a
person moves and where
pain might be or develop.
Vladimir Janda Movement Patterns: Movement patterns Functional assessment of
rather than individual movements
 Hip Extension muscles and looked  Upper cross
 Hip Adduction globally rather than syndrome
 Hip Abduction locally for the causes of  Lower cross
 Trunk Curl-up muscle dysfunction syndrome
 Cervical flexion  Inner cross
 Push-up syndrome
 Shoulder Looks into Phasic and
 Layer syndrome
abduction tonic Muscles
Pavel Koler Prague school –
neurodevelopmental
aspects of motor control.

The importance of the

diaphragm in the stability
of the spine.
Stuart McGill Dynamic Neuromuscular Injury – failure of tissue Lower back pain
Stabilization when load exceeds
tolerance/strength of
McGill ‘big 3’ - curl up; tissue
bird/dog; side bridge
Stability through stiffness
– motor control increases
stability
Robin Mackenzie 1. flexion in standing Mechanical pain may Identify causes of low
2. repeated flexion in develop from postural back pain, disc pathology
standing stressed, joint in postural syndromes,
3. extension in standing derangement or by pathology from muscles,
4. repeated extension in dysfunction
standing
5. side gliding in standing
6. repeated side gliding in
standing
7. flexion in lying
8. repeated flexion in
lying
9. extension in lying
10. repeated extension in
lying
McKenzie believes that
almost all low back pain is
aggravated and
perpetuated, if not
caused, by poor sitting
postures in both
sedentary and manual
workers
Physicians should exclude
serious and unsuitable
pathologies from being
treated by mechanical
therapy. McKenzie feels
the therapist should
confine themselves to
diagnosing MSK
mechanical lesions – this
is where chiros differ
from therapists
Spinal pain of mechanical
origin can be classified
into
1. Postural
syndrome
2. Dysfunction
syndrome
3. Derangement
syndrome
Movement of the
vertebral column, the
nucleus can alter its
ligaments, disc, apophyseal
joints and fascia due to
adaptive shortening of
muscles in dysfunction
syndrome and internal
derangement of the disc,
alteration in the position of
the fluid in the nucleus and
the surrounding annulus,
disturbing the resting
position of the above and
below vertebrae in
derangement syndrome.
Movements are chosen to
decrease mechanical
deformation by reducing
the derangement.
The movements will
gradually stretch and
lengthen contracted soft
tissues, eventually
reducing mechanical
deformation
 shape and with sustained
positions or repeated
movements will
eventually alter its
position.

Gray Cook FMS The whole is greater than Non acute

the sum of its parts.
SFMA
“Movement patterns are
purposeful combinations
of mobile and stable
segments working in
coordinated harmony to
produce efficient and
effective movement
sequences”

Screening helps us
identify what we want to
change, improve or
rehabilitate.

Screening may be
predictive of injury