Muscolino Notes
Muscolino Notes
Muscolino Notes
Table of contents
What is COMT ?
Assessment
COMT treatment techniques
Hydrotherapy
Soft tissue manipulation
Stretching
Joint mobilization
What is COMT?
What does “clinical” mean?
What does “orthopedic” mean?
Why “manual therapy”?
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Alternative?
What are the demographics?
80%... 60%...
Musculoskeletal niche
Muscle doctor?
PT /DC/DO/Fitness trainer
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Technique seminars
T his is not a branded technique seminar that claims to
miraculously cure every condition with which the client
presents.
This webinar…
T his webinar is about using critical thinking skills to
creatively apply fundamentally sound orthopedic
treatment approaches for your clients’ musculoskeletal
conditions.
Assessment
“Never treat without a diagnosis.”
“Never treat without an assessment.”
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How do we assess?
Verbal history
Physical exam (assessment tests)
Range of motion
Special orthopedic assessment tests
Palpation (static and motion)
Response to treatment
Verbal history
Where does it hurt?
When did it begin?
Was there a precipitating trauma?
What is the quality of the pain?
What is the severity of the pain (0 – 10 scale)
Does it refer?
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Response to examination
A healthy tissue should be able to receive this stress
without pain (or other symptoms)…
Physical exam…
Range of motion – challenges motion
T ight antagonists?
Fascial adhesions?
Healthy joint surfaces?
Palpation…
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Muscle palpation
Understand – critically think! Apply guidelines…
Know actions
Know the action(s) to make it engage.
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When do we assess?
Always… whenever we are observing or touching the
client…
Formulating an assessment
Cookbook vs. critical thinking
Assessment example
Active ROM
Passive ROM
Manual resistance
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Treatment planning
Frequency:
“Wow! T his client comes in EVERY week! ”
“T his client only comes in ONCE a week?!”
Rehabilitation strategy…
PT /DC/fitness training, etc.
Effect of frequency
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Hydrotherapy
Heat / ice
Look at the mechanism(s)
Heat – vasodilation & relaxation
Ice – vasoconstriction & anesthetic
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Body mechanics
Stretching
Stretching is essentially a mechanical process
Multiplane stretching
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Advanced stretching
techniques
Pin and stretch
Why?
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CR stretching mechanism
Stated basis is the Golgi tendon organ (GT O) reflex
When a muscle contracts, it pulls on its tendons,
stretching the GT Os, resulting in inhibition/relaxation of
the muscle (and its synergists).
CR stretching protocol
T herapists brings the target tissue to tension
Client (isometrically) contracts against the resistance of
the therapist
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Beginning CR technique
T issue brought to tension
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CR first repetition
Resistance Stretch
CR second repetition
Resistance Stretch
CR third repetition
Resistance Stretch
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AC stretching mechanism
Basis is the reciprocal inhibition (RI) reflex
When a muscle contracts, the antagonist musculature
on the “other side” of the joint must lengthen.
AC stretching protocol
Client actively moves into the stretch (our target
musculature is the antagonist of the motion)
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AC technique
T herapist augments
Client actively moves stretch
AC technique cont’d
Client returned to starting position
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CRAC stretching
Perform CR and AC sequentially
Mechanism(s)…
Breathing protocol…
CRAC technique
Resistance Client actively moves
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Muscles
Joints
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Joint mobilization
Joint mobilization is essentially a specific form of pin
and stretch
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Motion palpation…
Joint mobilization
Place pin Bring to tension
Contact
Index finger contact Finger pads contact
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Joint mobilization
contraindications
Contraindications for joint mobilization of the spine are
effectively the same as for stretching:
anything that would cause nerve impingement
Pathologic disc
Marked/severe osteoarthritic bone spurs
Order of techniques
T here is no right or wrong…
A good guideline/default is:
Soft tissue manipulation
Heat
Stretching
Joint mobilization
Modifications…
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Photo credits
COMT Certification
Workshops:
COMT: Neck
COMT: Low Back and Pelvis
COMT: Upper Extremity
COMT: Lower Extremity
COMT: Spinal Joint Mobilization
Distance learning modules
www.learnmuscles.com
Contact Information:
[email protected]
www.learnmuscles.com
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