23029 - ADVANCED SKELETON MUSCLE PHYSIOTHERAPY

Subject type: Mandatory

Coordinator: Esther Wall Gimeno

Trimester: Third term

Credits: 4

To be able to take this subject, it will be necessary to have passed the Musculoskeletal Physiotherapy I and II subjects, as well as the Musculoskeletal Pathology subject.

Spinal pain is one of the main causes of sick leave and disability in our society. For this reason, it is necessary to have specific training aimed at acquiring skills that allow the correct evaluation and application of therapeutic procedures aimed at the prevention and treatment of spinal pathologies and dysfunctions.

This subject presents three distinct blocks that give an analytical and global approach to the therapeutic approach of physiotherapy in spinal pathologies and injuries. The general objective of the subject is for students to develop the procedural skills necessary to be able to correctly apply the analytical techniques of mobilization in the different segments of the spine. Likewise, they will also integrate active and proprioceptive work, basic for vertebral segmental stabilization and the treatment of vertebral pain. In a complementary and integrated way, the evaluation and treatment will also be considered through the mobilization of the neuromeningeal system in relation to those clinical entities in which symptoms occur due to involvement of the nervous system.

In the teaching and teaching of this subject, the perspective of gender and sex will be considered with respect to the differences that may be related to the expression of the mobility-flexibility of the spinal segments depending on the sex.

  This subject has methodological and digital resources to make it possible to continue it in a non-face-to-face mode if necessary for reasons related to Covid-19. In this way, the achievement of the knowledge and skills specified in this teaching plan will be facilitated

- Identifies the main treatments used in physiotherapy interventions for each of the clinical specialties. Classifying them according to their effects and importance and establishing the order of priority in their therapeutic application.

- Analyze the effects produced by the interventions. It evaluates benefits and risks and establishes an intervention criterion based on the priorities and effects pursued.

- Establishes the intervention protocol based on the joint negotiation between therapist and patient.

- Apply technologies for patient assessment. It incorporates new measuring instruments that facilitate the objectification of interventions. Participates in the validation of assessment tools for incorporation into clinical practice.

- Carry out the diagnosis of specific physiotherapy for each of the clinical specialties in order to determine the dysfunctions and disabilities that will require a specific physiotherapy intervention.

- Applies advanced manual and instrumental techniques for the treatment of musculoskeletal dysfunctions. Evaluation of results and adverse effects.

Manual spinal therapy:

1. Pelvic girdle:
1.1. Biomechanics of sacroiliac joints
1.2. Sacroiliac pathomechanics
1.3. Functional assessment of sacroiliac mobility 
1.4. Manual techniques of passive sacroiliac mobilization
1.5. Additional orthopedic clinical tests

2. Lumbar spine:
2.1. Lumbar spine biomechanics
2.2. Lumbar pathomechanics
2.3. Functional assessment of lumbar mobility
2.4. Manual soft tissue treatment techniques
2.5. Manual techniques of passive lumbar mobilization
2.6. Additional orthopedic clinical tests

3. Thoracic spine:
3.1. Spine biomechanics
3.2. Dorsal pathomechanics
3.3. Functional assessment of thoracic mobility
3.4. Manual treatment techniques in soft tissues
3.5. Manual techniques of passive thoracic mobilization

4. Cervical spine
4.1. Cervical spine biomechanics
4.2. Cervical pathomechanics
4.3. Functional assessment of cervical mobility 
4.4. Manual soft tissue treatment techniques
4.5. Manual techniques of passive cervical mobilization
4.6. Additional orthopedic clinical tests

Active spinal therapy:

1. Body Consciousness

2. Therapeutic Exercise of the Spine

3. Active techniques of muscular self-inhibition of the rachis

4. Active Work with Fitball

Neurodynamics:

1. Introduction to the anatomy, physiology, pathophysiology, mechanics and pathomechanics of nervous tissue.

2. Concept of neural mechanosensitivity and more prevalent clinical pictures related to the peripheral nervous system.

3. Assessment, treatment and self-treatment techniques.

Teaching methodologies:

MD1. Expository method or master class: transmit knowledge and activate the student's cognitive processes through unidirectional learning.

MD2. Case study: acquiring learning through the analysis of real or simulated cases.

MD3. Solving exercises and problems: exercising, rehearsing and putting into practice previous knowledge.

MD4. Problem-based learning: developing active knowledge through problem-solving.

MD5. Project-oriented learning: carrying out a project to solve a problem, applying acquired skills and knowledge.

MD6. Cooperative learning: fostering active and meaningful knowledge in a cooperative way.

This subject will be evaluated following the indicators detailed in the following table:

The following assessment activities are proposed for each of the three practical blocks that make up the subject:

Seminar on Manual Therapy of the Spinal Cord

• Electronic portfolio: individual submission of a document in concept map format of the subject's contents (40% of the block grade).
• Exam: individual delivery in video format of a practical assessment or therapeutic procedure related to the contents of the subject (60% of the grade for this block).

Seminar on Active Spinal Therapy

• Electronic portfolio: resolution of a clinical case with delivery to the virtual classroom in video format (40% of the grade for this blog).
• Final exam: completion of an individual practical final test (60% of the grade for this block).

Neurodynamics Seminar

• Electronic portfolio: resolution of a clinical case delivered in the subject's virtual classroom in video format (40% of the grade for this blog).
• Exam: Completion of an individual theoretical test (60% of the grade for this block).

In order to pass the subject, it will be an essential requirement to pass each of the three seminars that make up the subject independently with a grade equal to or higher than 5. In this case, the average of the grades obtained between the three seminars, taking into account the specific weighting that each of them represents on the final mark of the subject.

Manual Therapy Seminar: weighs 37,5% of the subject's final grade.

Active Therapy Seminar weighs 37,5% of the subject's final grade.

Neurodynamics Seminar: weighs 25% of the subject's final grade.

Recovery conditions:

Students who have not passed the subject in the ordinary call, may opt for recovery considering that a final practical exam will be held in the three seminars. In no case, the activities related to the portfolio can be recovered.

Assistance and Rules of Conduct

Attending class without respecting the basic rules of hygiene and uniform dress may be sanctioned. Given the situation caused by the pandemic, the indications related to safety and protection in the practical spaces, collected in a document from the School and which will be available to the students in the virtual classroom, must be considered and respected. All the teaching staff will be aware of this information and will ensure its compliance. During the practices in class and especially during the assessment tests, students may not wear objects that could interfere with the execution of the techniques, such as rings, watches, bracelets, long earrings, etc. Likewise, hand hygiene will be essential, with short, clean, unpainted nails. Given the practical nature of the classes and in order to facilitate and correctly perform the manual palpation procedures and the execution of the evaluation tests, it will be necessary to wear appropriate clothing such as shorts and a top, considering that in many situations the anatomical region evaluated must be stripped of clothing to be able to observe and palpate the anatomical reliefs.

It is an essential requirement to attend 80% of each of the practical blocks. Failure to comply with this requirement will result in the subject being suspended and having to be taken again next year.

Specific criteria of the grade Not Presented

This situation will be considered when the student has not attended the assessment activities related to the "exam" assessment indicator of one of the subject's seminars.

Maitland GD, Hengeveld E, Banks K, Englisg K. Maitland´s vertebral manipulation. 7th .: Ed Elsevier; 2005.

Souchard P. Global Postural Reeducation. The RPG method. Barcelona: Elsevier-Masson; 2012.

Myers, TW. Anatomical pathways. 2nd edition. Barcelona: Elsevier Masson; 2010.

Tixa, S. Atlas of palpatory anatomy of neck, trunk and upper extremity. Manual surface research. Barcelona: Ed. Masson; 2000.

Calais-Germain B. Breathing. Anatomy of movement. Volume IV. 1st edition. Barcelona: The Books of the March Hare.

Pilat, A. Myofascial Therapies: Myofascial Induction. 1st edition. Madrid: McGraw-Hill- inter-American of Spain; 2003.

Carlos López Cubas. Neurodynamics in clinical practice. 2nd edition. Madrid: Wolters Kluwer Health; 2022. 

David S. Butler. Mobilization of the nervous system. 2nd edition. Madrid: Paidotribo; 2009

M. Shacklock. Clinical neurodynamics: a new system in musculoskeletal treatment. 1st edition. Madrid: LTC; 2007

Cook, C. Hegedus, E. Orthopedic physical examination tests: an evidence-based approach. England: Ed. Pearson; 2014

Bienfait, M. Postural Reeducation through manual therapies. 3rd edition. Barcelona: Paidotribo; 2005.

Denys-Struyf, G. The Handbook of the Mezierist. 3rd edition. Barcelona: Paidotribo; 2004.

Rodrigo, C. Miralles, M. Clinical biomechanics of the locomotor system. Barcelona: ed. Masson, 1998.

Kaltenborn, FM Manual physiotherapy extremities. Madrid: Mc Graw-Hill Interamericana; 1999.

Busquet, L. The muscular chains. Volume I. 6ª edition. Barcelona: Paidotribo; 2002.

Genot, Neiger, Pierron, Péninou. Kinesioterapia.Tomos I, II, III, IV. Madrid: Ed. Panamericana; 1988.

Gomariz, JR. Stretching muscle chains. Barcelona: Ed. The March hare; 2005.

Igual, C .; Muñoz, E .; Aramburu, C .; General physiotherapy: kinesitherapy. Madrid: Ed. Synthesis, 1999.

Kapandji, IA Notebooks of joint physiology III. 6th edition. Barcelona: Ed.Panamericana; 2006.

R. Torres Cueco. The cervical spine: clinical syndromes and their manipulative treatment. 1st edition. Madrid: Médica Panamericana; 2008