- INFORMATION REGARDING JOINT MOBILIZATION
WHAT IS IT?
Manual joint mobilizations are techniques used by specially trained physiotherapists to restore the normal position / movement of one or more joints to decrease pain +/- hypertonus of muscles. It is done on the joints of the spine ( spinal joint mobilization) or the joints of the arms/ legs ( peripheral joint mobilization).
The force applied by the physiotherapist may go beyond the Currently available movement of that joint(s) but it does not take the tissues beyond their normal integrity or beyond the normal
physical limits of that joint. The mobilization may be done close to the barrier of restriction of motion, or far away from it, or anywhere in between depending on the goal I.e. Pain modulation
vs restoration of full motion.
JOINT MOBILIZATIONS SHOULD NOT BE CONFUSED WITH JOINT MANIPULATIONS OR CHIROPRACTIC ADJUSTMENT.
Manual joint mobilization techniques involve either large or small amplitude rhythmic or sustained pressure to the bone in the direction desired to restore joint mobility and / or reduce pain.
ANTICIPATED BENEFITS:
There is usually significant relief of mechanical pain/ hypertonus after the mobilization and very often full range of motion (ROM) will be restored and the joint will rest in its normal anatomical position. The joint, muscles and associated soft tissues then perform with greater mechanical efficiency because of the better motion & alignment.
Because joint mobilizations stimulate nerve endings that modulate pain, the mobilization can be used exclusively for temporarily, successfully diminishing pain in an acutely painful joint.
WHY DOES THE PHYSIOTHERAPIST WANT TO USE IT?
Prior to using the joint mobilization technique(s), the physiotherapist has carefully considered the integrity of your bones, nerves, soft tissues, your circulation, your overall health and the stage of healing of your tissues if injured, in order to ensure safety and effectiveness of the technique(s).
Considering this information, your physiotherapist may choose joint mobilizations over alternative treatments / techniques because it has been deemed the safest, most effective treatment for your current situation.
WHAT ARE SOME ALTERNATIVE TREATMENTS/TECHNIQUES?
Active or passive exercises or stretching may be considered alternatives to joint mobilization.
CONTRAINDICATIONS / PRECAUTIONS:
It’s very important that you inform the physiotherapist (Mary Brannagan) of any direct physical treatment to the same area being addressed by another practitioner ( Physio, Chiro, Osteopath,
other) as this may cause latent adverse reaction from their treatment, or an increased risk to adverse reaction to this intended treatments with Mary.
Any recent joint treatments to the intended area of treatment received by another practitioner within the last 6 weeks (especially the neck) needs to be discussed with Mary Brannagan to
ensure safety above all else.
Conditions such as: pregnancy, recent birth, cancer within last 5 years, circulatory disease / compromise, osetopenia / osteoporosis, collagen disease, soft tissue laxity, current or past prednisone use, use of blood thinners, or use of medications that may compromise the integrity of your tissues thereby potentially increasing the risk of tissue damage with this treatment.
Some of these may be absolute contraindications, while others may be relative contraindications depending on your specific situation.
DISADVANTAGES / POTENTIAL SIDE EFFECTS / ADVERSE REACTIONS:
Sometimes the reduced force or speed used in the joint mobilization is insufficient to restore full range of motion and therefore mechanical efficiency and / or pain relief may not be realized.
Because I have to hold on to the bones adjacent to the intended joint in order to deliver the force, sometimes this can be tender / painful.
The most common adverse side effect is soreness during, and / or after the treatment, although most people feel relief rather than pain after the joint mobilizations.
If the above-mentioned precautions / contraindications are not adhered to, tissue bleeding, fracture, or with spinal joint mobilizations the added risk of disc or nerve injury or stroke may
occur in very rare instances.
WHAT ARE MY OBLIGATIONS WITH THIS TREATMENT?
You have to inform Mary Brannagan of:
– Any treatments provided by other practitioners to the area(s) Mary Brannagan is treating
– Your complete medical history ( especially conditions such as pregnancy / recent birth, circulatory compromise, decreased bony integrity, cancer within the last 5 years, any collagen disease or infection
– Complete medication list especially blood thinners, present or past use of steroids /prednisone
– Concerns or questions you may have as they arise.
– Report any adverse reactions to Mary Brannagan as you notice them.
– Terminate this treatment at any time you wish, with no adverse effect to your future treatment.
2.INFORMATION REGARDING PERIPHERAL JOINT MANIPULATION
WHAT IS IT?
Joint manipulation is a hand’s on technique used by specially trained physiotherapists which involves the skillful movement beyond its current limit of active motion which is still within the joint’s normal anatomical limits (tissues are not forced beyond their normal physiological limits).
This movement, is a localized, small amplitude, high speed, controlled thrust that often causes an audible click which is usually painless.
Peripheral joint manipulation then, is manipulation of a peripheral joint ( a joint in the arm/ wrist / hand or leg / ankle / foot.)
ANTICIPATED BENEFITS
Potential benefits include but are not limited to restored joint motion / normal resting position, pain relief and improved mobility and function. It is usually an immediate improvement in 1 treatment.
WHY DOES THE PHYSIOTHERAPIST WANT TO USE IT?
Prior to using this technique, the physiotherapist has carefully considered your medical history; medication list; current health status; the state of your nervous system; soft tissue & bony
integrity; circulatory status and your current stage of healing and has concluded that this is the best technique to restore joint mobility for the overall goal of maximizing functional recovery.
Considering this information, your physiotherapist may choose joint manipulation over alternative treatments / techniques because it has been deemed the safest, most effective treatment for your current situation. Additionally, a peripheral joint manipulation when the joint is not amenable to joint mobilization or exercises / stretching or these techniques have been tried and failed.
WHAT ARE SOME ALTERNATIVE TREATMENTS/TECHNIQUES?
Active or passive exercises, stretching or joint mobilizations may be considered alternatives to joint manipulation.
CONTRAINDICATIONS / PRECAUTIONS:
Patients with excessive laxity of tissues ( in the direction of the intended manipulation) or generalized tissue laxity due to injury or illness or congenital / medical predisposition are not candidates for peripheral joint manipulation.
It is not safe to use peripheral joint manipulation in patients that have significantly impaired circulation / sensation, or decreased integrity of bone / soft tissues.
It is not safe to manipulate through a joint that is unstable ( from fracture or soft tissue damage) or an area of infection, malignancy or acute inflammation.
POTENTIAL SIDE EFFECTS / ADVERSE REACTIONS:
The risks of adverse reaction to peripheral joint manipulation are rare and include but are not limited to tenderness during the treatment, soreness after the treatment, numbness, nerve injury,
fracture, or soft tissue damage. Most patients however feel no ill effects and feel significant improvement after the treatment.
WHAT ARE MY OBLIGATIONS WITH THIS TREATMENT?
You have to inform Mary Brannagan of:
– Any treatments provided by other practitioners to the area(s) Mary Brannagan is treating
– Your complete medical history ( especially conditions such as pregnancy / recent birth, circulatory compromise, decreased bony integrity, cancer within the last 5 years, any collagen disease or infection
– Complete medication list especially blood thinners, present or past use of steroids /prednisone
– Concerns or questions you may have as they arise.
– Report any adverse reactions to Mary Brannagan as you notice them.
– Terminate this treatment at any time you wish, with no adverse effect to your future treatment.
3.INFORMATION / INFORMED CONSENT TO ORTHOPAEDIC MANUAL PHYSIOTHERAPY –
THORACIC SPINE, RIB, LUMBAR SPINE, AND SACROILIAC AND PELVIC MANIPULATION AND MANUAL THERAPY
I understand that manipulation (including spinal and peripheral joints) is a skillful passive high velocity, low amplitude, minimal force thrust movement of as joint beyond its physiological limit of motion but inside the limits of its anatomical integrity for the purpose of restoring motion and function.
I understand that there are risks associated with thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and manual therapy techniques used by physiotherapists who are Fellows of the Canadian Academy of Manipulative Physiotherapy, including:
Thoracic Spine and Rib Manipulation and Manual Therapy Risks:
1. Exacerbation and aggravation of symptoms including increased pain and stiffness;
2. Muscle or ligament strains or sprains;
3. Muscle spasms;
4. Bruising;
5. Rib injury including rib fractures;
6. Spinal disc injury including disc herniation and bulges;
7. Fractures;
8. Spinal cord injury or myelopathy;
9. Pneumothorax.
Lumbar Spine and Sacroiliac and Pelvic Manipulation and Manual Therapy Risks:
1. Exacerbation and aggravation of symptoms including increased pain and stiffness;
2. Muscle or ligament strains or sprains;
3. Muscle spasms;
4. Bruising;
5. Spinal disc injury including disc herniation and bulges;
6. Fractures;
7. Spinal cord injury or myelopathy;
8. Cauda Equina Syndrome or symptoms including loss of bowel and bladder control;
9. Neurological injury or impairment including radiculopathy, paraesthesia, numbness, tingling, pins and needles, and radiating pain in a lower extremity;
10. Paraparesis;
11. Paraplegia.
I acknowledge I have informed my physiotherapist of:
1. All my health issues and concerns (past and present) including malignant and inflammatory diseases, suspected fractures, osteoporosis, and mental disorders;
2. All medication I am currently taking or have been prescribed including steroids and anti-clotting agents (anticoagulants);
3. All other medical professionals or treatment providers that I am currently seeing.
I acknowledge I have discussed with my physiotherapist:
1. The nature and purpose of thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and manual therapy techniques;.
2.The anticipated benefits of thoracic spine, rib, lumbar spine, and sacroiliac and
pelvic manipulation and manual therapy techniques including reducing pain and
restoring movement and function to joints;
3. Alternative treatment options that are available;
4. The history of my medical condition at issue, diagnosis regarding my medical ondition, and treatment recommendations for my medical condition;
5. Consequences of not undertaking thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and manual therapy techniques;
6. The common and significant risks and possible complications of thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and manual therapy techniques;
7. Serious risks and possible complications, even if unlikely;
8. Special risks and possible complications, that although uncommon, may have particular relevance to me; and
9. Any questions that I may have.
I acknowledge that all my questions have been satisfactorily answered.
I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained.
I acknowledge that I have the right to refuse thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and manual therapy techniques, regardless of the consequences and regardless how beneficial or necessary such treatment may be.
I consent to and authorize my physiotherapist to perform thoracic spine, rib, lumbar spine, and sacroiliac and pelvic manipulation and
manual therapy techniques on me, and agree to proceed with such treatment.
This consent applies to all my current and future treatment.
I acknowledge that I have the right to withdraw my consent and stop treatment at any time.
4.INFORMATION / INFORMED CONSENT TO ORTHOPAEDIC MANUAL PHYSIOTHERAPY –
CERVICAL SPINE MANIPULATION AND MANUAL THERAPY
I understand that manipulation (including spinal and peripheral joints) is a skillful passive high velocity, low amplitude, minimal force thrust movement of as joint beyond its physiological limit of motion but inside the limits of its anatomical integrity for the purpose of restoring motion and function.
I understand that there are risks associated with cervical spine manipulation and manual therapy techniques used by physiotherapists who are Fellows of the Canadian Academy of Manipulative Physiotherapy, including:
1. Exacerbation and aggravation of symptoms including increased pain and stiffness;
2. Muscle or ligament strains or sprains;
3. Muscle spasms;
4. Bruising;
5. Dizziness or vertigo;
6. Vertebral artery dissection;
7. Spinal disc injury including disc herniation and bulges;
8. Fractures;
9. Spinal cord injury , myelopathy , central cord syndrome, or quadriplegia;
10. Neurological injury or impairment including radiculopathy, paraesthesia, numbness, tingling, pins and needles, and radiating pain in an upper extremity;
11. Stroke;
12. Death.
I acknowledge I have informed my physiotherapist of:
1. All my health issues and concerns (past and present) including malignant and inflammatory diseases, suspected fractures, osteoporosis, and mental disorders;
2. All medication I am currently taking or have been prescribed including steroids and anti-clotting agents (anticoagulants);
3. All other medical professionals or treatment providers that I am currently seeing.
I acknowledge I have discussed with my physiotherapist:
1. The nature and purpose of cervical spine manipulation and manual therapy techniques;
2. The anticipated benefits of cervical spine manipulation and manual therapy techniques including
reducing pain and restoring movement and function to joints;
3. Alternative treatment options that are available;
4. The history of my medical condition at issue, diagnosis regarding my medical condition, and treatment recommendations for my medical condition;
5. Consequences of not undertaking cervical spine manipulation and manual therapy techniques;
6. The common and significant risks and possible complications of cervical spine manipulation and manual therapy techniques;
7. Serious risks and possible complications, even if unlikely;
8. Special risks and possible complications, that although uncommon, may have particular relevance to me;
9. Any questions that I may have.
I acknowledge that all my questions have been satisfactorily answered.
I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained.
I acknowledge that I have the right to refuse cervical spine manipulation and manual therapy techniques, regardless of the consequences and regardless how beneficial or necessary such
treatment may be.
I consent to and authorize my physiotherapist to perform
cervical spine manipulation and manual therapy techniques on me, and agree to proceed with such treatment.
This consent applies to all my current and future treatment.
I acknowledge that I have the right to withdraw my consent and stop treatment at any time.
5.INFORMATION / INFORMED CONSENT FOR DRY NEEDLING & ACUPUNCTURE
Dry needling and/or acupuncture is helpful for reducing painfully shortened bands of muscle and for restoring normal tone to muscles thus improving mobility of your joints directly or by making it easier
for your physiotherapist (PT) to manually restore your joint mobility. Acupuncture is used to help with certain pain syndromes.
These treatments use a fine acupuncture needle that is inserted either into the trigger point of a muscle to facilitate its release or into a specific acupuncture point. You may experience a muscle
twitch and/or deep muscular ache when the needle is inserted into the muscle; this is a normal response to this technique. Dry needling and acupuncture are valuable treatments for musculoskeletal problems but like any medical procedure, there are possible complications.
While these complications are rare in occurrence, they need to be considered prior to giving consent to the procedure.
POSSIBLE RISKS ASSOCIATED WITH TREATMENT
• Dry needling may cause post treatment soreness lasting one to two days, followed by an improvement in the overall pain state. If you experience significant post-treatment soreness, topical application of heat is recommended and gentle range of motion of the sore area.
• A needle may be placed inadvertently in a capillary or vein, which will subsequently cause a small painless bruise. Your PT will notify you should this occur during your treatment.
• Any time a needle is used there is a risk of infection. To reduce this risk your PT will clean the area with stanhexadine and use sterile disposable acupuncture needles. Please contact your PT if anything that may seem like an infection occurs.
• When a needle is inserted near the chest wall there is a rare possibility of it creating a pneumothorax (air in the chest cavity). This complication is not fatal and is readily reversible. The PT reduces the risk by only inserting the needle over bony points and/or lifting the muscle away from the chest surface and inserting the needle parallel to the chest.
Patients are required to inform their PT if they are pregnant, use blood thinners, have been exposed to blood diseases such as Hepatitis or HIV, or have any conditions that increase bleeding prior to treatment. In addition, all surgeries should be reported.