Manual Therapy for Athletes

Bryan Bourcier DPT, ATC, COMT, CSCS,

Outline

• Manual Therapy basics• Contraindications• Indications• Spine Mobilizations for Athletes• Upper extremity Peripheral Mobilization • Lower extremity Peripheral Mobilizations

Manual Therapy Basics• Grading Mobilizations • Comparable Sign• Resistance vs Pain

– R1 vs R2– P1 vs P2

• Grades of Mobilizations– I – Small amplitude short of resistance – II – large amplitude short of resistance– III – Large amplitude midway between R1 and R2– IV - Small amplitude midway between R1 and R2– V- At R2 High velocity low amplitude

• +, ++, -, -- variations• IV++ and III++

Contraindications (Red/Yellow

• Fracture (red)• Hypermobility / empty end feel (Yellow)• Pregnancy (yellow)• Cord Compression (Red)• Cancer (Red)• Patient comfort (yellow) • Open wounds (yellow)• Fusions (Red and Yellow) • Manipulation into spasm (Red)

Indications

• Stiffness• Pain management • Scar tissue management• “locking” or “Pinching” (Spine)• Evidence– When combined with exercise, speed up recovery– Not better if used without exercise

Common Cervical Spinal Mobilizations for Athletes

• Suboccipital Release– Concussions

• Traction• MET • Soft tissue

What are we treatingConcussion Whiplash

•neck pain and stiffness,•headache, •dizziness •fatigue •jaw pain •activity intolerance•postural weakness•visual disturbances •tinnitus•increased symptoms with fatigue

•neck pain and stiffness,•headache, •shoulder and arm pain•dizziness •fatigue •activity intolerance•jaw pain •postural weakness•visual disturbances •tinnitus•back pain•increased symptoms with fatigue

Subocciptial release

• Long sustained pressure on suboccipitals.– Can be done

unitlaterally– Make sure knees are

bent– If too painful, try

traction first.

Common Cervical Spinal Mobilizations for Athletes

• Suboccipital Release– Concussions

• Traction – Manual Vs Mechanical• MET – when and when not• Soft tissue – positional release and first rib

Common Thoracic Spinal Mobilizations for Athletes

• Pistol• Screw

Common Lumbar Spinal Mobilizations for Athletes

• Rotational Mobilization– Grade I-III– Manipulation

• Chicago Roll• Shotgun• SI / IS MET• Leg Pull • A/P

Upper extremity Mobilizations

• Shoulder– “Fish Flop” (Shoulder pain control)

• Elbow– Radial Head

• Wrist – Distal Radial ulnar distraction

Lower Extremity

• Hip– Lateral glides (FAI)– AP and PA

• Knee – Extension with ER and IR (post op and Hamstrings)

• Ankle – Lateral malleolus glides (Ankle Sprains)