Maitland_s_Peripheral_Manipulation_compressed

Principles of selection and progression of mobil ization / manipu lation techniques 203 c S2 (IV+) D II I R' (strength) Y2 I P' (minor intensity) :z:. II AI \">C5D5 Y. Y2 3f4 P1 R 1 S1 B (f) 5° knee extension A Muscle spasm, restriction of knee extension and pain Figure 8.49 Muscle spasm, restriction of knee extension and pain. Figure 8.48 Posteroanterior movement of the first Spasm as a response to quick movements at carpometacarpal joint. the limit of a mildly aching, stiffjoint • as a response to quick movements at the limit of a Spasm may present in patients witll mildly or inter­ mildly aching, stiff joint mittently aching joints. On examination one or more movements may be slightly stiff and painful, such as • as the limiting factor of the available range. knee extension (Fig. 8.49). If passive movements are examined at the usual speed, part of the abnormal find­ Handling spasm ings may be missed. However, if quick, sharp move­ ments are used at the limlt of the range, slight muscle Muscle spasm may be caused unnecessarily during spasm may be felt as a response to the test movement. When this response occurs, the treatment movement treatment of painful joints, if the painful joint is badly must be performed so that it almost produces this response. The further away the treatment movement is positioned or carelessly held by the physiotherapist or from producing this response, the less likely is the treat­ moved unevenly, roughly or without due respect for ment to be successful. pain during treatment. To avoid such situations, care­ ful positioning of the patient, competent handling and Spasm as a limiting factor of the available range well-controlled techniques are essential requirements. Muscle spasm (or holding) in group 3 patients may be Spasm as a response to movement the factor limlting range. This type of spasm occurs at the limlt of the available range, is very strong and occu­ When muscle spasm occurs as a constant minimum pies only a small part of the range. By treating the pain response to movement no attempt should be made to of a stiff/painful joint and assessing its effects, such thrust forcibly through the spasm. In treatment the treatment will give a good indication of the behaviour spasm is best influenced by tiny (grade IV) amplitude of the patient's pain and will also show the degree of movements that gently nudge at the muscle spasm, irritability of the joint disorder. However, when such gradually attempting to move further into the range. If spasm is the dominant sign that can be found on exam­ there is no inlprovement, nudging movements should ination of the joint movements, treatment of pain alone is unlikely to help and therefore movement through be used in an accessory movement that is slightly range to spasm is likely to be more effective, i.e. the joint should be moved through a physiological range restricted by spasm. If this is not effective, the opposite up to the point where spasm starts and there perform movement to the physiological movement most very small amplitude movements (grade IV) in con­ restricted should be used with grade IV movements at junction with active relaxation techniques. the limit of this range. Oscillatory movement is not always desirable Joints which exhibit this kind of spasm are often slow (because of irritability or latent exacerbation) and con­ to respond to treatment and do not readily respond to trolled, sustained stretching techniques may be more relaxation techniques either. valuable. This applies to treating painful joints whose