Musculoskeletal-Basic Treatment Principles

kms013's version from 2016-01-27 21:46


Question Answer
what do we treat?Passive strucutre, active structures, NM control
Person comes in with abnormal movent system, fxl limitations and decr acti, we....find which link is the weak link
When movment system-- when something isn't moving....get it moving!
if stuck,...unstuck it
if moves too much...stabilize it
if tight..stretch it
if weak...strengthen it
if dones't com on when you want it to....turn it on (via practice lots of reps) and isometrics
contraindications for therapeutic interventionsSC injurys (myelopathy), recent trauma where fractures haven't been ruled out, unstable segments suspected, serious p! that can't be expaliend mechanically,e specially p! that awaknes someone, agressive manual therapy if p! has ankylosing spondylitis, no position/mvt decr/centralizes p! or incr'd peripherization; pt is rigid w any attempt to correct, surgical protocol, unstable co-morbidiites
where do we start with treatment? At this point, you complted eval and come up with dx; what determines where your tx starts?1. classification (being able to classify your pt by there s/s helps to guid us in determing which txt iterventions would most likely be successful)and severity of symptoms/staging (being able to determine the severity of pts sx/condition to be able to best determine where/how to best begin our tx POC
If someone is losy gosey, give them a ______ programstability
if someone is stuck, give ________ program mobility
severity of symptoms/staging....if someone is 10/10 p!, will that help where they start tx that day?yes- if in lots of p!, don't do alot that day
someone in not bad p!...assess that they are able to do it, and get to gettin!
Stage/severity of sx: 3 phasesacute inflammatory stage, subactue stage, chronic stage
if to get it to calm down
if it calms down, we gear up interventions
if chronic stage...emphasis on returning pt to high level demand act; prgress to high level , return to work/play, enduranc
if someone comes in w RCT for 8 wk what stage are they at?if they first come in, they always start at stage 1 (because we haven't seen them before)
Stage 1 of SED principleinability to perform basic mechnical fx
SEDseverity, ease, duration principle
Stage 2unable to carry out adls
stage 3endurance; can perform adls
General tx progressionmobility- stability- stabilaity with mvt- stab w fxl activites
pt education happens....thorughout tx progression
The general treatmnet progression will be the sequence...FOR ALL JOINTS!
Kinesthetic/posture awarenes goal1. develop proprioception of "neutral spine/midrange (understanding p! free poistioning--diff for everyone!) 2. safe and fxl mvmt (slow/steady wins the race...neural spine/midrange (p! free range) --> full/fxl ranges) 3. NM/postural control (ability to maintain neutral/P1 Free postiion, proper body/lifting mechanics, ergoniomics (computer, driving, texting)
Clinical Pearl: Practice doesn't make perfect (p!- free)...(P! free) perfect practice makes perfect (p! free):)
How do we work on mobility?jt mobility
if something doesn't work the way you want it, its....jt itsef or soft tissue that crosses the jt
joint mobsjot mobs include--(PROM, jt mobs, jt manipulation)..... 2. Soft tissue restriction--soft tissue mobs (myofascial release, trigger point releases) manual stretching (PNF contract/relax, hold/relax) self-stretch/myofascial release
our most effective tools are......our hands (manual therapy) and brains (teach the pt how to do it themselves)
which comes first: stability or mobility?Mobility before stability
Manual therapy (PROM) Goals:to maintian existing ROM of jt, to promote jt lubrication (WD40) 3. to provide appropriate tissue tension (promote healing)
what postion is pt in in manual therapywhatever allows them to relax
what are the keys to manual therapy?1. getting the pt to completely relax (many have to do STM prior to PROM/jt mbos if mus tension is preventing effective manual itnerventions) 2. addition distraction helps (incr ROM, decr p!/mm guarding
Clinical pearl: why is manual therapy (PROM) a good time to get to know your pt?distracts them to get them to relax
empty end feel means....we have something to work on
in order to get full _____kinematics, need full _______ kinematicsosteo, arthro
Manual therapy: Jt mobs vs. manip...t/f...jt mobs is the same as jt manip?both; depending on if state allows it or not, use one or the other:
How are jt mobs/manip different?every jt has a limit to how far they will move; jt mobs-- passive treatment technique in which examier applies forecs to move pts body part or jts w/o assistance from pt who remains relaxed (a manual therapy technique comprising a continuum of skilled passive movemnt to the jt complex tht are appleid at varying sppeds nad amplitudes that may includ small-amplitud/high velocity therapeutic mvmt (manipulation) witht he intnet to restore optimal motion, fx, and or to decr p!
why does it matter (the diff b/w jt mob and manip?)Statewise it might matter, but in the clinic, not really
Jot mobs
2 types of mobs1. physiological mvmt (passive mvmt of bones which the pt could carry out activiely-- this is pts HEP)2. accessory mvmt (passive mvmt at jt surfcaes which the pt cannot isolate, but which can b performed by an examiner (these are clincial jt mobs)
Manipulationhigh velocity/small amplitude
IFOMPT Definitonrestore optimal
Other ways you will hear/see jt mobs differentiated from manipulation: thrust manip, non thrust manipulation
thrust manip vs non thrust manipulationThrust: used to describe interventions described as manip by IFOMPT; non thrust manip: synonymous with the term mobilization as proposed by IFOMPT
is cracking knuckles bad for younot specifically; release of gas
Whats the difference b/w someone cracking their neck and you doing it for you? WHy would we choose to do jt mob on someone?bc we want jt to movment and this is quickest way; so when they are cracking someone, they are pivoting certain spot; we are isolating certain segment in the clinic and they can't do
Jt mob grading scalegrade 1 ( small amp, early range) grade 2 (lg amp, midrange) grade III (Large amp, point of limitation in range) grade IV (small amplitude, end range), Grade V (small amplitude, quick thrust at end range of mvmt --thrust manipulation)
Grade I and II you are not even........getting to end range
the only way you stretch tissue is to......challenge it
manipulation fallls (on the grap)...go to end range...and past
if we go to end range, why do we follow up with IV?from a maintence standpoint; want to stretch it after
I and IV a range ...I is at beginning range, IV is at end range
assessments are a ________ glidesustained
Assessment is when you .... and the only wy to get there is towant to see what end range is at jt...push it as far as it can go
if someone is in p! you....stop. your assessments can wait
Jt mobs basci principles: Indications are....P! (grade I/II and hypomobility (grade II, IV)
Jt mobs basci principles: Tx variables:Positioning- place jt in resting postion to start, well supported, relaxed; drection of mob- use concave convex rule (concave- with motion, convex, opposite motion); mob (sustaiend (assessment) vs oscilatory (tx), hands as close to jt surf as possible,
Manual therapysoft tissue mobPURPOSE?to incr soft tissue mobility by decr mm tesntion, myofascial restrictions, trigger pts
effective techniques:STM/DTM (petrassage, effleurage), myofascial release, cross-friction massage, trigger pt release IASTM (instrument assisted STM)
Manyal therapy - flexibility (stretching) PURPOSEto improve jt mob by improv ST extensibilty of soft tissue that crosesses the jt
focus area of flexibilityManual stretching (must follow STM work, should follow any/all manual work, ease into it), self stretching, self myofacial realease)....self stretch and myofascial are pt (considered manual theray bc you're going ot use your hands to show them how to do it properly
stabilization purpose:1. local (segmental stabilty) ---> global stability (making sure the small guys are doing their job --stabilize each egment--- so the big boys can do their job (move the body) 2. mm balance (make sure thes mall guys are holding up their end of bargain and big guys aren't doing too much
the body is an amazing short term compensator...but not meant to do it long term
if its moving too much.........stabilize it
Stability is when movers and stabilizers...act together
nM control influence ons tability:Normal: brain things about moving body and stabilizers automitically engage in anticipation of mvmt) impaired (firing pattern/strenght of stabilizers is off and movers start movming limb/body before stabiliers have engaged thus allowing abnomrla mvmt of the spine)
Feed forward control and spinal stability:the CNS activates the stabilizers in anticipation of the load imposed by limb mvt (ie the movers) to maintain stability of the spine
Stabilzation with mvt; purposeonce pt has established NM control of neutral spine or midrange (ie they can own it wo p!) its time to progress by adding UE?LE mvmt:
stab. goalbe able to incorporate p! free UE/LE mvmt w/o losing nuetral spine mid range
porgression/regression comes down to 2 uestions...does it hurt to do? Can they do it w good form?
progressionif they can hold/perform ex. for 30-60 sec w no p!, progress.
regressionif p!ful and or cannot maintain bracing in neutral spin (ie Good form)- regress.
stab. w fx: Purposebe able to incorporate fx into our interventions
stab. w/ fx: Goal: be able to incorp. p! fee pt spec. fxl act. w/o losing neutral spine as soon as possible (this will be the only way they will be able to carry over benefits into their daily routine
look at the last 5 or so slides. on PPT!
Wat is a challenge?stretching, strengthening
stretchingmanual (may be uncomfortable but should let up when you let up) self (uncomfortable but not p!ful, discomfort should go away when stretch is finished
strengthingDOMS w/out jt soreness/swelling, exercises should be challenging last 20-25% reps .....stretnght: reps 8-10 should be challenging...endurance: reps 15--20 shoudl be challenging (or go to fatigue)