Mišično-skeletna fizioterapija 3 / Musculoskeletal physiotherapy 3 Fizioterapija 2013, letnik 21, suppl 1 Manualna terapija in drugi fizioterapevtski postopki na področju glave Blanka Koščak Tivadar, dipl. fiziot. Mediko d.o.o., Višnja Gora, Slovenija Korespondenca/Correspondence: blanka@fizioterapija-mediko.si Uvod: Fizioterapevti skrbimo za vzpostavljanje, vzdrževanje in krepitev zdravja in funkcionalnosti gibalnega sistema pri ljudeh. Večina se ukvarja z udi in trupom. H gibalnemu sistemu spada tudi glava, sicer le z eno premično kostjo, a z veliko mišicami in patološkimi stanji (1, 2). Namen prispevka je pregled najpogostejših okvar gibalnega sistema na področju glave in fizioterapevtskih postopkov za njihovo odpravljanje. Metode: Narejen je bil pregled strokovne literature, predvsem s področja manualne terapije. Pregledana so patološka stanja na glavi oziroma težave, ki se na glavi izražajo kot prenesena bolečina. Zaradi obširnosti so predstavljeni le največkrat uporabljeni postopki fizioterapije na področju glave. To so mobilizacija fascij (3), terapevtska obravnava miofascialnih prožilnih točk (4, 5), sklepna mobilizacija (7), metoda Cyriax (8) in proprioceptivna nevromuskularna facilitacija (7). Rezultati: Za obravnavo čeljustnega sklepa ter mišic na glavi in sprednjem delu vratu je veliko primernih tehnik manualne terapije in kinezioterapije, ki ponujajo dobre rezultate. Večina tehnik ima specifične teste, s katerimi se ocenjuje predvsem kakovost izvedenih gibov oziroma se ugotavlja simetrija mišične kontrakcije ali simetrija sklepnega gibanja. Pri čeljustnem sklepu so postopki usmerjeni v mobilizacijo sklepa, mišične tehnike pa večinoma v relaksacijo oziroma okrepitev za ponovno pridobitev simetrije. V vseh primerih je potrebna aktivna udeležba pacientov pri zdravljenju, ki obsega izvajanje vaj in terapijo doma. Z aktivno udeležbo pacienti tudi prevzamejo odgovornost za svoje zdravje. Zaključki: Za celovit pristop obravnave pacientov je treba obravnavati tudi glavo. Večina terapevtskih postopkov zahteva dodatno učenje, širino znanja in individualni, celostni pristop k pacientu. Dobra fizioterapija ni terapija le dela telesa. Že Hipokrat je navajal: »Delu nikoli ne more biti dobro, če celoti ni dobro.« Ključne besede: glava, manualna terapija, fizioterapija, čeljustni sklep, bolečina. Mišično-skeletna fizioterapija 3 / Musculoskeletal physiotherapy 3 Fizioterapija 2013, letnik 21, suppl 1 Manual therapy and other physiotherapeutic methods on region of the head Background: The purpose of physiotherapy is to maintain, regain and improve health and functionality of human locomotion system. Most physiotherapists perform their work on trunk and extremities and not on head region that also belongs to the locomotion system. It truly has only one mobile joint, but also a lot of muscles and a lot of pathological conditions (1, 2). The aim of the present study is to describe the most common head pathologies and physiotherapeutic methods of diminishing them. Methods: The source was professional literature on manual therapy. The main emphasis was given to pathological circumstances and conditions on the head itself and on the head as a referred pain. Due to so many methods, only the most common ones are described. Those methods are fascial mobilization (3), miofascial techniques (4, 5), joint mobilization (6), Cyriax method (7) and proprioceptive neuromuscular facilitation (8). Results: There are a lot of good manual and kinesio therapeutic techniques for temporomandibular joint, head muscles and muscles on the frontal side of the neck. Most of them have their own tests for movement evaluation, mostly for quality of movement and symmetry of muscles contraction. In the treatment of temporomandibular joint there are mainly mobilization techniques and in muscles pathology relaxing techniques or techniques of improving muscle strength and regaining muscle symmetry. Patient’s activities at home, such as exercises and home therapy are expected. The role of an active patient is an important factor of its own health responsibility. Conclusions: Considering holistic approach, the therapy of head is necessary to be a part of physiotherapy. Most methods can be learned in additional courses and require widespread knowledge and individual approach to a patient. Good physiotherapy is not only a therapy of a certain part of the body. Hippocrates said: »A Part can never be well unless the whole is well«. Keywords: head, manual therapy, physiotherapy, temporomandibular joint, pain. Literatura/References: 1. Jakovljević M, Hlebš S (2002). Manualno testiranje mišic. Ljubljana: Univerza v Ljubljani, 155–68. 2. Head pain. http://round-earth.com/HeadPainIntro.html. <5. 1. 2013> 3. Stecco L (2004). Fascial manipulation for musculosceletal pain. Padova: Piccin, 77–91. 4. Alvarez DJ, Rockwell PG (2002). Trigger points: Diagnosis and management. Michingan: American Family Physican. http://www.aafp.org/afp/2002/0215/p653.html. <5. 1. 2013>. 5. Manuelle trigerpunkttherapie TP3 (2004). Neobjavljeno delo. 6. Technique highlight: TMJ Manual Techniques. http://www.themanualtherapist.com/2012/02/technique- highlight-tmj. <5. 1. 2013> 7. Cyriax J (1982).Text book of ortopedic medicine 8th ed. London. Bailliere Tindal, 70–7. 8. Adler SS, Becker D, Buck M (2003). Pnf in practice. 2nd ed. Verlag: Springer, 365–85.