Front Matter

Chapter 6 Manual Therapy 125

be identified and addressed for long‐standing
resolution of the problem.
For example, upper trapezius or scalene
muscle pain is a common complaint in human
medicine. On evaluation, tenderness, trigger
points, and decreased flexibility are noted. Is
this an isolated muscle strain or is something
else causing the muscles to react? In humans,
a forward head posture commonly results in
upper trapezius and scalene overuse and pain.
If this is the case, local treatment of the muscles
will not resolve the issue. The root of the prob­
lem must be addressed. The effective treatment
must involve changing the gravitational effect
on these muscles. This can be accomplished
with postural correction and exercise. A canine
example is the patient with a suspected iliop­
soas strain. Is this an isolated muscle strain or is
the root of the problem elsewhere? Due to its
attachments on the spine, the iliopsoas muscle
can become activated with thoracolumbar

dysfunction. If that is the case, local treatment

of the iliopsoas muscle will provide temporary

relief at best. The spinal dysfunction must be

addressed in order for full resolution of the

iliopsoas pain.

There are a few contraindications to soft tis­

sue mobilization. Patients with mast cell

tumors, phlebitis, or infectious/parasitic der­

matitis in the affected area should not be treated

with this technique. With these precautions in

mind, the therapist can determine the best tech­

niques to apply to the patient, based upon the

indicated treatment goals.

Range of motion (ROM)

Normal range of motion (ROM) is required for

normal function. When ROM is compromised,

the body naturally compensates by increasing

movement at another segment. Thus, hypomo­

bility at one segment may result in hypermo­

bility at an adjacent segment. Hypermobility

can lead to abnormal localized stress, causing

pain and, eventually, laxity. Although there

are numerous effective options for treating

hypomobility, hypermobility can be difficult to

stabilize, often requiring splinting or surgery.

Therefore, it is important to thoroughly assess

ROM and treat accordingly to establish normal

mechanics of the joint and soft tissues. Normal

ROM varies considerably among breeds and is

affected by age and other factors. Norms for

average ROM for all joints have not been well

established for the canine population; there­

fore, comparison with the contralateral side is

required.

Passive ROM (PROM)

PROM is used as an assessment tool as well as

a treatment technique. PROM is passive,

osteokinematic movement of bony segments

around a joint axis performed by the thera­

pist. The patient is noncontributory. Normally

PROM is slightly greater than active range of

motion (AROM) because each joint has a small

amount of involuntary, end‐range joint play

motion that the therapist can create with over­

pressure (Norkin & White, 1985). Joint PROM

is the ability of the joint to move through its

normal ROM without restriction of muscles that

Table 6.2 Treatment guidelines by goal

Goals Techniques

Increase circulation Effleurage, petrissage,

tapotement

Decrease swelling Effleurage; lymphatic

drainage

Increase soft tissue

extensibility

Effleurage, petrissage,

cross‐friction massage,

positional release, trigger

point release, MFR

Reduce adhesions Cross‐friction massage

Increase scar mobility Cross‐friction massage, MFR

Eliminate trigger or

tender points

Trigger point release,

positional release, ischemic

compression

Promote tendon and

ligament healing

Cross‐friction massage

Increase ROM All of the above

Decrease pain Effleurage, petrissage,

cross‐fiber massage, trigger

point release, MFR,

ischemic compression

Decrease muscle

spasm

Ischemic compression,

effleurage, petrissage,

tapotement

MFR, myofascial release; ROM, range of movement.