THEORY REPORT
REAPPRAISAL OF SOME FUNDAMENTAL MANUAL THERAPY CONCEPTS
Hesch J, Hesch Institute, Henderson, NV
Corresponding author: [email protected]
Every profession benefits from periodic appraisal of their foundational concepts. It is encouraging to note fundamental reappraisals of basic tenets such as recent works on evaluating concave-convex rule, and potential belief such as grade V manipulation being superior to grades I-IV mobilization. Other foundational beliefs and scales may be timely for reappraisal. Qualifiers may enhance the traditional joint movement scale. For example Grade I, II hypomobility can include a fixed, immutable hypo and hypermobility such as in the former; from genetics, age, disease, scar tissue, and for the latter etc. Treatable hypomobility may also be due to proximal or distal reflex or biomechanical faults, muscle guarding, etc. Similar rationale may apply to grades IV and V hypermobility. The mobilization scale could include a separate grade for constant force maintained at end of available range for an extended period of time, AKA viscoelastic creep. Non-synovial joints with dense connective tissue such as the SIJ, symphysis pubis, or joints such as the subtalar with an interosseous ligament, or joints with long-lasting restriction may benefit from creep mobilization. Another concept is that of end feel. A recent case presented with a bone on bone end feel of both hips with ten degrees of internal rotation. Initially reluctant, the author ultimately treated it with a gain to 45 degrees within two sessions. A separate topic for exploration would be the limits imposed by language and by categorization, and the value of clarifying terminologies within manual therapy, medicine and the overall clinician-client interaction.
REAPPRAISAL OF SOME FUNDAMENTAL MANUAL THERAPY CONCEPTS
Hesch J, Hesch Institute, Henderson, NV
Corresponding author: [email protected]
Every profession benefits from periodic appraisal of their foundational concepts. It is encouraging to note fundamental reappraisals of basic tenets such as recent works on evaluating concave-convex rule, and potential belief such as grade V manipulation being superior to grades I-IV mobilization. Other foundational beliefs and scales may be timely for reappraisal. Qualifiers may enhance the traditional joint movement scale. For example Grade I, II hypomobility can include a fixed, immutable hypo and hypermobility such as in the former; from genetics, age, disease, scar tissue, and for the latter etc. Treatable hypomobility may also be due to proximal or distal reflex or biomechanical faults, muscle guarding, etc. Similar rationale may apply to grades IV and V hypermobility. The mobilization scale could include a separate grade for constant force maintained at end of available range for an extended period of time, AKA viscoelastic creep. Non-synovial joints with dense connective tissue such as the SIJ, symphysis pubis, or joints such as the subtalar with an interosseous ligament, or joints with long-lasting restriction may benefit from creep mobilization. Another concept is that of end feel. A recent case presented with a bone on bone end feel of both hips with ten degrees of internal rotation. Initially reluctant, the author ultimately treated it with a gain to 45 degrees within two sessions. A separate topic for exploration would be the limits imposed by language and by categorization, and the value of clarifying terminologies within manual therapy, medicine and the overall clinician-client interaction.
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