Universitat Internacional de Catalunya

Manual Therapy for the Lower Extremities

Manual Therapy for the Lower Extremities
7
13882
1
First semester
OB
Main language of instruction: Spanish

Other languages of instruction: Catalan, English

Teaching staff


Dra. PÉREZ GUILLÉN, Silvia - sperezgu@uic.es

Introduction

This subject includes practical and theoretical content related to the development and application of manual therapy techniques for the lower extremity. The student will learn and improve abilities and skills to evaluate and treat joint, neural and muscular dysfunctions located in the lower extremity. The course includes both manual and instrumental assessment and treatment methodologies.

Pre-course requirements

No prerequisites are specified.

Objectives

  1. To know the pathology and pathogenesis of the mechanical dysfunction of the osteo-arthro-neuro-myofascial system.
  2. To establish the objectives of treatment in OMPT and the different strategies and treatment modalities generally used in OMPT.
  3. To demonstrate palpatory skills in the identification of the different structures of the lower extremity.
  4. To carry out an inspection of the lower extremity under load, both statically and dynamically, and interpret the findings.
  5. To perform and interpret the clinical tests necessary to assess the specific function of the physiological and anatomical joints of the lower extremity {active and passive rotatory movements, translational movements of joint play, resisted movements, passive soft tissue movements [physiological and accessory movement, muscle and compartmental play)].
  6. To execute treatment techniques according to the therapeutic objective of pain modulation or function improvement.
  7. To know the clinical presentation of the most typical syndromes and clinical categories of the lower extremity.

Competences/Learning outcomes of the degree programme

General and basic competencies:

  • CB7: To develop the skills to apply the knowledge acquired and their ability to solve problems in new or little-known environments within broader (or multidisciplinary) contexts related to their area of study.
  • CB8: To have the skills to integrate knowledge and face the complexity of formulating judgments based on information that, being incomplete or limited, includes reflections on the social and ethical responsibilities linked to the application of their knowledge and judgments.
  • CB9: To have the skills to communicate their conclusions as well as the knowledge and ultimate reasons that support them, aimed at specialized and non-specialized audiences in a clear and unambiguous way.
  • CB10: To have the ability to develop learning skills that allow them to continue studying in a way that will be largely self-directed or autonomous.
  • CG2: To know how to effectively manage professional and clinical situations that require the integration of knowledge of biomedical, clinical and behavioral sciences in the area of specialization of Manual Orthopedic Physiotherapy.
  • CG3: Knowing how to carry out specific evaluation and treatment procedures for arthro-neuro-muscular dysfunctions, establishing a diagnosis of Orthopedic Manual Physiotherapy based on the findings.

Transversal competencies:

  • CT1: Being able to communicate effectively and to carry out an anamnesis, an evaluation and treatment of arthro-neuro-muscular dysfunctions, in interpersonal relationships so that they lead to enhancing the health status of the patient/user and the collaboration of the multidisciplinary team.

Specific competencies:

  • CE1: To determine and apply the most appropriate treatment, taking into account the indications, contraindications, precautions and effects of Manual Orthopedic Physiotherapy in the framework of the management of pain mechanisms and dysfunctions of the arthro-neuro-muscular system.
  • CE4: To have the ability to specifically execute the principles of mobilization, manipulation, motor learning, exercise physiology, ergonomic strategies, among other therapeutic modalities, for the treatment of pain and function of the arthro-neuromuscular system specifically, such as multimodal elements of the therapeutic approach of Orthopedic Manual Physiotherapy.

Learning outcomes of the subject

Students will:

  • Learn about the origins and evolution of OMPT.
  • Demonstrate advanced knowledge of the principles and fundamentals of the different Manual Therapy methodologies.
  • Demonstrate advanced and specialized knowledge of the specific anatomy, physiology, and biomechanics of the musculoskeletal, neurological, vascular, and lymphatic systems of the lower extremity.
  • Learn the pathology and pathogenesis of the mechanical dysfunction of the osteo-arthro-neuro-myofascial system.
  • Establish the objectives of treatment in OMPT and the different strategies and treatment modalities generally used in OMPT.
  • Demonstrate palpatory skills in identifying the different structures of the lower extremity.
  • Perform an inspection of the lower extremity under load, both statically and dynamically, and interpret the findings.
  • Demonstrate advanced knowledge and abilities and skills in performing and interpreting the clinical tests necessary to assess the specific function of the physiological and anatomical joints of the lower extremity {active and passive rotatory movements, translatory movements of joint play, resisted movements, passive movements of soft tissue [physiological and accessory movement (muscular play and compartmental play)].
  • Demonstrate advanced knowledge and abilities and skills in the execution of treatment techniques according to the therapeutic objective of pain modulation or function improvement.
  • Demonstrate critical awareness of the need and importance of specificity in the execution of the evaluation and treatment of osteo-arthro-neuro-myofascial dysfunctions of the lower extremity.
  • Demonstrate advanced knowledge of the clinical presentation of the most typical syndromes and clinical categories of the lower extremity, as well as specific abilities and skills in their evaluation and treatment.

Syllabus

  1. History and development of Orthopedic Manual Therapy
  2. OMPT Principles
    1. Anatomical joint and physiological joint
    2. Joint positions
    3. Physiological and pathological osteokinematics and arthrokinematics
    4. Translational movements of joint play (traction, compression and glidings)
    5. Concave-convex rule
    6. Physiological and pathological grades of movement
  3. Scheme of evaluation and treatment in OMPT
  4. Functional anatomy and biomechanics of the ankle, knee and hip regions
  5. Structural and functional palpation of the ankle, knee and hip regions
  6. Static and dynamic inspection of the lower extremity
  7. Functional evaluation of the lower extremity
  8. Treatment techniques for the lower extremity according to therapeutic objective:
    1. Symptom relief: pain modulation techniques, clinical neurodynamics, functional taping.
    2. To increase joint mobility: slow joint mobilization of traction and sliding and joint manipulation.
    3. To increase muscle mobility: dry needling, diacutaneous fibrolysis, functional massage and muscle stretching.
    4. To decrease mobility: passive stabilization and mobilization of adjacent regions.
  9. Evaluation and treatment of the most frequent clinical presentations (clinical subgroups) of the lower extremity:
    1. Ankle region:
      1. Acute and chronic ankle instability
      2. Tarsal tunnel syndrome
      3. Achilles tendinopathy and flexor hallucis longus tendinopathy
      4. Dysfunctions associated with poor load management: plantar fasciopathy, hallux valgus, Morton's neuroma, tibial periostitis.
      5. Soleus and gastrocnemius muscle tears
    2. Knee region
      1. Acute knee instability
      2. Patellofemoral pain syndrome
      3. Patellar tendinopathy
      4. Knee osteoarthritis
      5. Meniscal injuries
      6. Rectus femoris and hamstring muscle tears
    3. Hip region:
      1. Hip osteoarthritis
      2. Trochanteric bursitis
      3. Hip instability (femoro-acetabular syndrome)

Teaching and learning activities

In person



  • TC (Theoretical classes): The teacher is the one who exposes in a systematic and orderly manner the information corresponding to the different subjects and the student has a role mainly as a receiver. The scenario in which the teacher transmits knowledge is the classroom and he does it to the entire group of students. The theoretical class format allows the introduction of group activities in the classroom and the development of strategies that encourage the active participation of students.
  • PC (Practical classes):  It includes any type of classroom and/or laboratory practice (practices among students, case studies, problems, activities in the computer room, search for information,...)
  • SLA (Self-learning activities: These activities are designed so that the student solves problems on their own with the help of the material provided and the information from the face-to-face activities and/or available in the virtual environment in which the online subjects are developed.
  • SIS (Student independent study): It is a process aimed at the formation of an autonomous student capable of learning to learn; It consists of developing study skills, establishing educational goals and objectives based on the recognition of the weaknesses and strengths of the individual, which will respond to the needs and expectations of each one. It implies the possibility that each student makes their own decisions in relation to the organization of their time and their learning pace, which is why it requires a high degree of responsibility to make the most of resources.Includes study of contents related to "theoretical classes" and "practices" (studying exams, carrying out individual and group theoretical work, library work, complementary reading, etc.).
  • MC (Master Class): Transmission of knowledge and activation of cognitive processes in the student.
  • CL (Cooperative learning): Development of active and significant learning cooperatively.
  • FL (Flipped learning): Systems based on new technologies as basic knowledge tools outside the classroom, so that when students arrive to class they put their ideas and impressions together, giving teachers the opportunity to personalize their instruction according to the needs of each one.
  • PBL (Problem based learning): Development of active learning through problem solving.
  • RP (Role playing): Transfer to the classroom of situations typical of reality that will serve the student to apply them in their future life.

Evaluation systems and criteria

In person



  • Theoretical evaluation: 10%
  • Practical evaluation: 25%
  • Oral evaluation: 5%
  • Narrative report: 20%
  • Self-assessment: 20%
  • Co-assessment: 20%

The grading system will be used in accordance with current legislation.

Actually, according to RD 1.125/2003 del 5 de septiembre.

  • 0-4,9 Fail.
  • 5,0-6,9 Pass.
  • 7,0-8,9 Notable.
  • 9,0-10 Outstanding.

The Honor Roll mention may be awarded to students who have obtained a grade equal to or greater than 9.0. Their number may not exceed 5% of the students enrolled in a subject in the corresponding academic year, unless the number of students enrolled is less than 20, in which case a single Honors may be awarded.

Bibliography and resources

  • Freddy M. Kaltenborn. Movilización Manual de las Articulaciones. Volumen I Extremidades. 7ª Ed. Zaragoza. OMT España; 2011.
  • Freddy M. Kaltenborn. Fisioterapia Manual. Volumen III Manipulación – Tracción de las extremidades y la columna. 1ª Ed. Zaragoza. OMT España; 2009.
  • M. Tricás, César Hidalgo, Orosia Lucha, Olaf Evjenth. Estiramiento y Autoestiramiento muscular en Fisioterapia OMT. Volumen I: Extremidades. OMT-España, 2012.
  • G. Bucher-Dollenz, R. Wiesner, R. Blake, E. Hengeveld, P. Jeangros, V. Schöb Mezzanotte, H. Stam, H. von Piekartz, P. Westerhuis  El Concepto Maitland. Su aplicación en Fisioterapia Panamericana, 2010.
  • Renate Wiesner, dipl. Physiotherapeutin HF, Fachlehrerin Manuelle Therapie, OMT SVOMP, Teacher IMTA Ejercicios de fisioterapia Thieme 2009
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  • Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: Introduction, and mind-body exercise programs ∗. Clin Rehabil. 2017;31(5):582–95.
  • Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: Strengthening exercise programs. Clin Rehabil. 2017;31(5):596–611.
  • Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: Aerobic exercise programs ∗. Clin Rehabil. 2017;31(5):612–24.
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  • Ceballos-Laita L, Jiménez-del-Barrio S, Marín-Zurdo J, Moreno-Calvo A, Marín-Boné J, Albarova-Corral MI, et al. Effects of dry needling in HIP muscles in patients with HIP osteoarthritis: A randomized controlled trial. Musculoskelet Sci Pract [Internet]. 2019;43:76–82. Available from: http://dx.doi.org/10.1016/j.msksp.2019.07.006
  • Cibulka MT, Bloom NJ, Enseki KR, Macdonald CW, Woehrle J, McDonough CM. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. J Orthop Sports Phys Ther. 2017;47(6):A1–37.
  • Estébanez-de-Miguel E, Caudevilla-Polo S, González-Rueda V, Bueno-Gracia E, Pérez-Bellmunt A, López-de-Celis C. Ultrasound measurement of the effects of high, medium and low hip long-axis distraction mobilization forces on the joint space width and its correlation with the joint strain. Musculoskelet Sci Pract. 2020;50(March):1–5.
  • Estébanez-de-Miguel E, López-de-Celis C, Caudevilla-Polo S, González-Rueda V, Bueno-Gracia E, Pérez-Bellmunt A. The effect of high, medium and low mobilization forces applied during a hip long-axis distraction mobilization on the strain on the inferior ilio-femoral ligament and psoas muscle: A cadaveric study. Musculoskelet Sci Pract. 2020;47(March):3–7.
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  • Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54(6):572–88.
  • Lee P, Nixion A, Chandratreya A, Murray J. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain. Surg J. 2017;03(01):e9–16.
  • Logerstedt DS, Scalzitti D, Risberg MA, Engebretsen L, Webster KE, Feller J, et al. Knee stability and movement coordination impairments: Knee ligament sprain revision 2017. J Orthop Sports Phys Ther. 2017;47(11):A1–47.
  • Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: Structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32(30):7411–31.
  • Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: Clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther. 2015;45(11):887–98.
  • Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, et al. Heel pain - Plantar fasciitis: Revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1–33.
  • Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures of the Foot and Ankle in Athletes. Sports Health. 2014;6(6):481–91.
  • McKay J, Maffulli N, Aicale R, Taunton J. Iliotibial band syndrome rehabilitation in female runners: A pilot randomized study. J Orthop Surg Res. 2020;15(1):1–8.
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  • Rutland M, O’Connell D, Brismée J-M, Sizer P, Apte G, O’Connell J. Evidence-supported rehabilitation of patellar tendinopathy. N Am J Sports Phys Ther [Internet]. 2010;5(3):166–78. 
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