Manual Therapy Interventions for the PTA

May2nd 2019

The Physical Therapist Assistant (PTA) degree is a 2 year degree, consisting of in class lecture, hands-on labs and real life experience through clinicals in all settings of physical therapy. PTA’s work in any setting, from acute care in hospitals, to skilled nursing facilities, to outpatient orthopedic settings. The role of the PTA is to follow through the plan of care that is set by the Physical Therapist (PT) during the initial evaluation. The PTA is under the supervision of a PT. That means that any changes that need to be made to the plan of care must come from the PT. That does not mean that a PTA has to ask permission to add in an exercise, or to apply a modality (assuming it is already in the plan of care to do so) but that does mean that the PTA must refer the patient back to the PT if they suspect that there is something else going on with the patient that wasn’t found in the evaluation.

PTA’s must work within their scope of practice and, therefore, are limited on what they can do. However, PTAs aren’t as limited as most people think. It is within the scope of practice for a PTA to run through exercises with a patient, collect objective data measurements, apply modalities such as moist heat, ultrasound, and electrical stimulation, and perform manual therapies. Manual therapy is essentially any “hands on” treatment intervention including soft tissue mobilization, passive stretching, joint mobilization and active assisted facilitated movement. It is very important for the PTA to be competent with performing manual therapy techniques because it is often a large part of the plan of care designed by the PT and in this blog we will describe some of the manual therapy techniques frequently used here at Rocky Mountain Physical Therapy.

Soft tissue mobilization is utilized frequently in physical therapy treatments to decrease pain, increase blood flow, decrease tissue tension and mobilize restrictions in the soft tissue. This can be done passively, where the patient is relaxed and the therapist works on the tissues, or actively, where the patient moves a body part while the therapist applies pressure. This technique requires good communication and trust between the therapist and patient because the patient relies on the therapist to instruct them when and how to move their body part. Another type of soft tissue mobilization is the pin and release method. This is when the therapist puts the tight or restricted muscle in a shortened position, applies direct pressure over the most restricted area and then slowly moves the muscle into a lengthened position. Tight and restricted soft tissues can be painful, limit range of motion and create dysfunction in the surrounding body parts which is why it is so important to address these areas.

Stretching is another important manual therapy technique where the therapist moves the patient into positions to lengthen and elongate muscles. One example of a very effective type of manual stretching is the hold-relax technique. This is where you have the patient hold an isometric contraction against gentle pressure to not move in a certain position then the therapist cues for  relaxation those muscle to then allow the therapist to passively stretch the muscle further causing lengthening of the tight muscle. Static stretching is the most common form of stretching that is used for muscle lengthening due to it being safe and effective. This is where the therapist will passively stretch the muscle of the patient into a comfortable yet challenging position and hold for about thirty seconds. Dynamic stretching is movement based stretching that mimics the movement the person will be doing in the sport or activity. An example of dynamic stretching would be someone that is preparing to play tennis and stretches by performing lunges in different directions and arm swings to loosen up before playing. Stretching before and after exercise will help maintain long term flexibility.

Some patients suffer from nerve pain to travel down the extremity, possibly all the way into the hands or feet. To help relieve nerve pain, a nerve glide can be performed to relieve tension on the nerve coming from the spine. When you perform a tensioning nerve glide, it can elongate a nerve but also decreased neural blood flow and can increase sensitivity. A sliding technique results in greater excursion of the nerve, elongation of a nerve at one joint is counterbalanced by shortening at another joint.Performing nerve glides daily can help reduce nerve pain.

                     Sliding technique                                       Tensioning technique

If you are dealing with any pain, ROM restriction, tight/spasming muscles or want to learn how to make stretching more beneficial for your workouts please make an appointment at any Rocky Mountain Physical Therapy location.