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Treatment Techniques

Colour-coded cards for fast visual recall

🤲

Massage

Manual Soft Tissue Therapy
  • Increases local circulation & lymphatic drainage
  • Reduces muscle tension & spasm
  • Promotes relaxation & parasympathetic response
  • Decreases pain via gate control mechanism
  • Improves tissue extensibility & flexibility
  • Techniques: effleurage, petrissage, friction, tapotement
🔄

Mobilisation

Passive Joint Movement
  • Restores joint range of motion
  • Reduces joint stiffness & capsular tightness
  • Stimulates mechanoreceptors → pain inhibition
  • Improves synovial fluid distribution
  • Grades I–IV (Maitland) for varying resistance
  • Safe for acute & chronic presentations
💪

MET

Muscle Energy Technique
  • Uses patient's own muscle contraction
  • Post-isometric relaxation → increased ROM
  • Reciprocal inhibition of antagonist muscles
  • Corrects somatic dysfunction & asymmetry
  • Low force – suitable for acute presentations
  • 3–5 repetitions at 20–30% effort, 5–7 sec hold
⚡

HVT

High Velocity Thrust
  • High-speed, low-amplitude manipulative thrust
  • Audible cavitation (joint "crack") common
  • Rapid neurological inhibition of pain
  • Restores joint play & end-feel
  • Requires thorough pre-screening (VBI, red flags)
  • Contraindicated: osteoporosis, instability, malignancy
🌿

Functional Release

Indirect Positional Technique
  • Moves tissue toward ease (not restriction)
  • Reduces afferent nociceptive input
  • Gentle – ideal for acute, elderly, post-surgical
  • Facilitates inherent tissue motion
  • Holds position until release/softening felt
  • Addresses fascial & myofascial restrictions
🎯

Counter Strain

Strain–Counterstrain (SCS)
  • Identifies tender points (TPs) on body
  • Positions body to reduce TP tenderness by 70%+
  • Hold position 90 seconds, then slowly return
  • Resets aberrant proprioceptive activity
  • Very gentle – no direct pressure on lesion
  • Effective for acute muscle guarding & spasm
🎀

Soft Tissue Release

Active & Passive STR
  • Combines stretch with direct tissue pressure
  • Breaks down adhesions & scar tissue
  • Active STR: patient moves while pressure applied
  • Passive STR: therapist controls movement
  • Targets specific muscle fibres & fascial planes
  • Highly effective for chronic overuse injuries

🧠 Cranial Nerves

All 12 cranial nerves — type and key function

🎵 Mnemonic — Nerve Names (I–XII)

"On Old Olympic Towering Tops A Finn And German Viewed Some Hops"

Olfactory · Optic · Oculomotor · Trochlear · Trigeminal · Abducens · Facial · Auditory/Vestibulocochlear · Glossopharyngeal · Vagus · Spinal Accessory · Hypoglossal

🔑 Type Mnemonic: "Some Say Marry Money But My Brother Says Big Brains Matter More" → S S M M S M S S B S M M (Sensory / Motor)
#NameTypeKey Function
IOlfactorySSmell
IIOpticSVision
IIIOculomotorMEye movement (SR, IR, MR, IO), pupil constriction, eyelid elevation
IVTrochlearMEye movement – superior oblique (downward & inward gaze)
VTrigeminalSMFacial sensation (V1 ophthalmic, V2 maxillary, V3 mandibular); mastication
VIAbducensMLateral eye movement – lateral rectus
VIIFacialSMFacial expression, taste (anterior 2/3 tongue), lacrimation, salivation
VIIIVestibulocochlearSHearing (cochlear) & balance/vestibular function
IXGlossopharyngealSMTaste (posterior 1/3 tongue), swallowing, carotid body/sinus, parotid gland
XVagusSMParasympathetic to thorax/abdomen, swallowing, phonation, heart rate
XISpinal AccessoryMSCM & trapezius – head turning, shoulder elevation
XIIHypoglossalMTongue movement – intrinsic & extrinsic muscles

📍 Assessment Referral Patterns

Common pain referral chains by body region

🔵 Cervical / Neck

Neck→Shoulder→Arm
C3–C4→Trapezius / Shoulder tip
C5–C6→Lateral arm / thumb
C7–C8→Medial arm / little finger

🟡 Thoracic / Mid-Back

T1–T4→Chest / Anterior shoulder
T4–T6→Interscapular region
T10–T12→Lower abdomen / groin

🟠 Lumbar / LSP

L1–L2→Groin / anterior thigh
L3–L4→Anterior knee / medial leg
L5→Lateral leg / dorsum foot
S1→Posterior leg / lateral foot

🟣 Hip & Pelvis

Hip→LSP / Pelvis→Groin
SIJ→Buttock→Posterior thigh
Piriformis→Sciatic distribution

🟢 Shoulder

Shoulder→Neck→Upper arm
Rotator cuff→Deltoid insertion
AC joint→C3–C4 dermatome

🔴 Visceral Referral

Heart→Left arm / jaw / chest
Liver/GB→Right shoulder tip
Kidney→Loin / groin / testis
Appendix→Periumbilical → RIF

🚨 Red Flags & Neuro Indicators

When to perform neurological assessment & consider urgent referral

🚩

Red Flag Screening

Spinal Red Flags

  • Age <20 or >55 with new back pain
  • Constant, progressive, non-mechanical pain
  • Thoracic pain (unexplained)
  • Previous history of carcinoma
  • Systemic steroids / immunosuppression
  • Unexplained weight loss
  • Widespread neurological symptoms
  • Structural deformity

Cauda Equina Syndrome

  • Bladder / bowel dysfunction
  • Saddle anaesthesia (perineal region)
  • Bilateral leg weakness / numbness
  • Progressive neurological deficit
  • Sexual dysfunction
  • ⚡ EMERGENCY – immediate referral

Cervical Artery Dysfunction

  • 5 D's + 3 N's: Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks
  • Nausea, Numbness (face/limbs), Nystagmus
  • Ataxia / loss of coordination
  • Headache – sudden onset / thunderclap
  • Contraindication to cervical HVT

Inflammatory / Systemic

  • Morning stiffness >45 minutes
  • Peripheral joint swelling / warmth
  • Skin rash (psoriasis, butterfly rash)
  • Iritis / uveitis
  • Fever / night sweats
  • Positive family history of inflammatory arthritis

⚡ Perform Neurological Assessment When:

  • Radicular pain pattern present (dermatomal distribution)
  • Patient reports pins & needles, numbness, or weakness in limb
  • Reflexes appear asymmetrical or absent on clinical observation
  • History of trauma, disc prolapse, or spinal stenosis
  • Symptoms worsen with Valsalva manoeuvre (cough/sneeze)
Dermatomes Myotomes Reflexes (DTR) Sensation Testing Upper Motor Neuron Signs Babinski Sign Clonus
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