PT 621 exam 1
deformation curve related to patient education
- guide patient toward activities that keep her out of microfailure - educate on how to avoid excessive load and deformation
components of subjective examination
- health screening/subjective exam - preliminary assessment statement - preliminary identification as appropriate for physical therapy
symptoms modulation clinical findings
- high disability - volatile symptom status - high-moderate pain - new or recurrent symptoms - AROM is limited/painful - increased sensitivity
intervention phase I: hemostasis
- highly irritable - difficulty finding positions of comfort - impaired ROM
importance of goals
- identify expected outcomes - assessing effectiveness of interventions
importance of patient goals
- identify expected outcomes of interventions - assess effectiveness of interventions
open kinetic chain exercises at the knee
- increased tibial translation - more rectus femoris muscle activity - less patellofemoral compressive forces - increased shear forces - less co-contraction
treatment for subacute lbp with mobility deficits
- mobilization/manipulation focused on improving mobility mid to end range
movement control clinical findings
- moderate disability - stable symptom status - moderate-low pain - AROM may be full with aberrant movements - impaired flexibility, activation, control
what ICF category does spondylolisthesis or lumbar instability likely fit?
- movement coordination impairment
apophyseal injuries
- muscle and tendon grwoth lag behind quickly growing bone creating tension at the apophysis leading to apophysitis or apophyseal avulsion ex. osgood schlatter disease or sever's disease
muscle strength changes with age
- muscle development in children correlates with acquisition of motor skills - increased muscle strength leads to coordination and increase muscle mass - gross and fine motor skills become refined during school ages
contraindications for stabilization classification
- negative prone instability treatment - absent aberrant movements - FABQPA <9 - no hypermobility with lumbar spring testing ??
neuropathic sensitization lbp with leg pain
- neuropathic pain with sensory sensitization such as allodynia, hyperalgesia, paroxysmal pain
thrust vs no thrust
- no difference between side lying and supine thrust techniques - mobilization does not equal manipulation
CPR for manipulation
- no symptoms distal to the knee - recent onset of symptoms <16 days - low FABQW score <19 - hypomobility of the lumbar spine - hip IR rotation >35 degrees (at least 1 hip)
signs and symptoms of lbp with radiating pain
- numbness and or tingle into LE within dermatomal pattern - weakness into LE within myotomal pattern - pain in low back or buttock region and or LE
distinguishing features of acute lbp with mobility deficits
- restricted ROM and segmental mobility - symptoms reproduced with provocation of involved segments
acute lbp with movement coordination impairments distinguishing feature
- restricted initial to mid range ROM and segmental mobility - flexion and ext
subacute lbp with movement coordination impairments distinguishing feature
- restricted mid range that worsens with end range - while performing self car/home management
intervention phase III: proliferation
- restrictions of capsule improved but remain - strength impairments - flexibility impairments
traction criteria
- signs and symptoms of nerve root compression - no movements centralize symptoms
benefits of TAR over arthrodesis
- similar revision rates - decreased in salvage procedures - ROM may be improved - smaller rate of degenerative joint changes in adjacent joints - high functional outcomes
what intervention could be used if 15sec single leg balance with eyes open and trendelenburg noted
- single leg balance 30-60 sec holds - 30 secs head turns - compliant surface
proprioception receptors are located in
- skin - joint capsule - ligaments - skeletal muscle - musculo- tendinous junctions ^ injury to any of these affect proprioception
EdUReP: reload
- specific exercises for condition - parameters: reps, sets, frequency - reloading may be painful but still helpful/not harmful
which treatment category do patients with lbp with movement coordination impairments likely fit?
- stabilizaiton
onset of LBP with mobility deficits
- strain - unguarded movement - awkward movement/position
functional optimization treatments
- strength and conditioning exercises - work or sport specific tasks - aerobic exercises - general fitness exercises = maximize performance
spondylolysis causes
- stress fracture from repetitive trauma (young athletes) - congenital due to failure of ossification of pars interarticularis
indications for specific exercise as treatment
- strong preference for sitting or walking - centralization with motion testing - peripheralization in direction opposite of centralization
rationale for manual therapy for movement control
- structural and psychosocial variables can degrade movement control - nerves, joint, and soft tissue can affect local mobility --> global stability
conditions in pediatrics
stress fracture growth asymmetry epiphyseal fracture/displacement osteoarthritic ligamentous sprains/avulsions osteochondritis dissecans apophysitis avulsion fractures osteochondrosis - avascular necrosis dif
type I avulsion injury
stretch?
occupation/roles of a child
student peer sibling explorer
structure of PT exam
subjective objective assessment plan
subjective impatient post operative PT
subjective: chart review patient interview discharge planning
subjective home health PT
subjective: intake review - precautions, what interventions has she been doing patient interview home/living arrangement assessment- getting dressed, showering
3 components of the assessment
summary statement diagnosis potential to benefit from physical therapy
triage by rehabilitation provider determining the appropriate rehabilitation approach
symptoms modulation movement control functional optimization
sets and reps for movement re-education
takes 100-150 reps to improve neural patterns - consider environment, feedback, practice schedule, dosage, and motivation
hindfoot complex
talocalcaneal, talonavicular, calcaneocuboid
midfoot
tarsal-tarsal, tarsal MT joints and first ray
why does nadine jones have pain on the medial and lateral sides with post tib dysfunction
tension on the medial side and compression on the right side cause pain
how do you know if you chose the correct treatment
test --> treat --> re-test
what serves as the reference for direction of tested motion?/ what determines the assessment/treatment plane
the convave surface of joint determines joint plane of motion - assessment/treatment motion should be parallel to concave surface
joint mobility assessments at the knee
tibiofemoral traction tibiofemoral PA glide tibiofemoral AP glide patellar superior glide patellar inferior glide
differential diagnosis age 4-10
transient synovitis legg-calve-perthes disease discoid lateral meniscus sever disease growing pains
PCL injury MOI
traumatic hyperflexion
plan SOAP
treatment and follow-up
true or false: significant decrease in recurrence of LBP if patients are taught MC exercises during the first onset of acute pain
true
classification of physeal fractures
types I Straight across II Above III Lower or beLow IV Two or Through V ERasure of growth plate or cRush
ACL sprain MOI
valgus knee force, hyperextension, rotation - deceleration, cutting, landings - 70% non-contact
ROM findings: AROM < PROM =
weakended musculature - due to disuse, lack of neuromuscular control, lack of neural input (neuropathy), pain
strengthen if
weakness (assess AROM << PROM)
PILL response
when applying mobilization with movement, to determine if appropriate we should see PILL response P = pain free I = instant result LL= long lasting - if not achieved vary glide parameters
ottawa ankle rules
x rays are required if there is pain in the malleolar region and any of the following - bone tenderness at any of the four areas - inability to weight bear four steps both immediately and in the ER
assessment SOAP
your interpretation of the data
X BW running
~4.5+ times BW
general STM principles
- superficial layers treated before deeper - force applied in direction of maximal restriction - choice of technique is dependent on: extent of restriction, amount of discomfort, degree of irritability
lumbar nerve root remote/referral to hip L1-L2 L3-L4 L5-S1
L1-L2: anteriorly L3-L4: laterally L5-S1: posteriorly
6 ICF classifications for LBP
LBP with mobility deficits LBP with radiating or referred pain LBP with movement coordination impairments LBP with related cognitive and affective tendencies LBP with related generalized apin
candidates for TAR should have
adequate vascualr flow to extremity adequate soft tissue envelope around the ankle to allow for wound healing and initiation of physical therapy and ankle ROM exercises post op
hemostasis timing
after injury up to 6-8 hrs; lasts up to 2 days
inflammation timing
after injury up to 7-10 hrs; peaks in 2-3 hrs
characteristics of lumbar stenosis
age of 65 relief of pain with sitting pain with standing and walking wide based gait
open packed position of ankle
all positions that are not a closed packed position
forefoot position
angle of forefoot vs angle of calcaneus - neutral varus or valgus
compensations for weak hip abductors
contralateral pelvic drop ipsilateral trunk lean
main? function of posterior tibialis
controls pronation and provides supination
lateral shift correction as treatment
correct shift before assessing sagittal plane motion
objective SOAP
data that you obtain through direct observation
subjective of SOAP
data you obtain through patient report (or family)
range of motion in newborns is _________ and range of motion in children is ________ in comparison with adults
decreased (newborn contractures), increased
STM if
decreased flexibility
spondyloysis
defect or weakening of pars interarticularis without any forward slippage - occurs in 5% of adult population, mainly at L5/S1
plastic region
deformation is permanent; failure point
medial ankle ligaments
deltoid ligament
maitlands 4 grades
developed the 4 point scale to describe the amount of movement and number of oscillations used during manual joint testing and treatment grade I: small amplitude at begining of movement grade II: large amplitude movement performed with free range but not moving into any resistance grade III: large amplitude movement performed up to the limits of the perceived range grade IV: small aplitude movement performed at the limit of the perceived range
pathoanatomical/ICF --> treatment based classification: disc stenosis radiating mobility deficits instability
disc = extension stenosis = flexion radiating = traction mobility deficits = manipulation instability = stabilization
lateral shift is associated with what pathoanatomical structures
discs
closed kinetic chain
distal segment is fixed and proximal segment moves - more co-contraction of various muscle groups
2 questions to screen for depression
during the past month, have you been bothered by feeling down, depressed or hopeless? during the past month, have you often been bothered by little interest or pleasure in doing things?
early, mid, and late treatment dosing of EdUReP model
early: even division of 4 components mid: mostly reloading late: mostly prevention
home health goals and planning
education length of need for home health safety begin process of rehab toward long term goals modification of exercise program
impatient PT goals and planning
education safety discharge goals begin process of rehab to individuals long term goals
what is considered an abnormal end feel
end feel that is different from the normal occurring end feel for the joint and when it occurs at a different point in the range than is normal
forefoot valgus
eversion of forefoot - lateral forefoot is higher = not normal
impairment goals
expected improvements in impairments - related to activity goals
nerve compression position with stenosis
extension > ipsilateral side bend > ipsilateral rotation
avulsion injuries
happen at bony attachment of ligament, tendon, joint capsule from its point of attachment to bone - more common in pediatrics due to maturing structures/skeleton - grades based on severity of separation from the bones (types I-IV)
stages of tissue healing
hemostasis inflammation proliferation remodeling
what is manipulation
high velocity low amplitude thrust aka grade V mobilization, spinal reposition maneuver, graded passive mobilization- local V
manipulation
high velocity thrust close to end range of motion - repeat twice and reassess in standing and walking
scoring of FPI
highly supinated: -5 to -12 supinated: -1 to -4 normal: 0 to +5 pronated: +6 to +9 highly pronated: +10
posterior THR precaution
hip flexion past 90 avoid IR avoid add across midline
mechanical stresses at the hip
hip handles tensile, torsional, and compressive loading
common MOI for ankle fracture
impact (fall) with forced DF
impairment improvement
impairment changes after treatment
interventions are driving by...
impairments with consideration to irritability
depression is associated with
increased pain intensity, disability, medication use, unemployment
tendinitis
inflammation of a tendon and myotendinous junction - microscopic tearing - resulting from tissue failure vs direct trauma - vascualr activation, inflammatory response
summary statement
introductory sentence(s) that briefly describe patient and summarize the background information
forefoot varus
inversion of forefoot when subtalar joint in neutral - medial forefoot is higher = normal
arthrokinematics
joint movement - motion occurring at the joint surfaces; roll, glide, spin
for the hypermobile joint, the stop will occur ________ and the end feel will feel _______
later; the same or less firm
tendinosis
painful degradation of collagen fibers - collagen fiber disorientation, focal necrosis - 1/3 population >35 y/o
elastic region
part of the curve before failure (microfailure) begins
type II avulsion injury
partial tear
3 levels of goals
participation goals activity goals impairment goals
interventions for hypomobility with medial glide & lateral tilt with hypomobility into medial tilit
patellar joint mobs - medial glide - medial tilt
ACL surgical options
patellar tendon graft (anterior knee pain) hamstring graft (strength deficits up to 10%) allograft procedure (high failure in youth)
supination is associated with ______ at the hip and knee
ER
EdUReP model for tendinopathy
Educate Unload Reload Prevent
pronation of the foot is associated with ______ at the hip and knee
IR
Grade I (Kaltenborn)
"loosening" movement is an extremely small traction froce that produces no appreciable increase in joint separation. GradeI traction nullifies the normal compressive forces acting on the joint
Grade III (Kaltenborn)
"stretching" movement is applied after the slack has been taken up and all tissues become taut
Grade II (Kaltenborn)
"tightening" movement first takes up slack in the tissue surrounding the joint and then tightens the tissues
effeurage STM
"tough lightly" - used to warm up tissue, lymphatic drainage, relaxation - apply distal to proximal (follows lymphatic drainage)
direct method to assess joint mobility
(glide testing) - passive translatoric gliding movements are applied in all possible directions to determine joint-gliding restrictions - preferred method as it gives the most information about the degree and nature of restriction - relies on end feel
close packed position
(only 1 closed packed position for a joint) - maximal tautness of major ligaments - maximal surface congruity - minimal joint volume - maximal stability of the joint - movement toward close packed position involve an element of compression
resting position
(only 1 resting position) - slackening of major ligaments - minimal surface congruity - minimal joint surface contact - maximal joint volume - minimal stability of the joint - movements toward open packed position involve an element of distraction
lbp with related cognitive or affective tendencies categorized by one or more of the following:
- 2 positive responses to primary care evaluation of mental disorders for depressive symptoms - high scores on FABQ questionaire and behavior consistent with excessive anxiety or fear - high scores on pain catastrophizing scale and cognitive processes consistent with helplessness, rumination or pessimism about lbp
signs and symptoms of lumbar instability
- 20-40 yr olds - needs to change position often (increased time in position = pain) - may have directional preference toward flexion, but end ranges hurt - inconsistent hypomobility - not correlated with radiographs
open packed position
- Any position but "close-packed" - Joint surfaces do not fit congruently - Also referred to as loose-packed position
possible consequences of excessive pronation
- CCJ, midfoot will alter mechanics of extrinsic and intrinsic muscle function - lose windlass effect - abnormal pronation allows 1st ray to remain in DF, 1st MTP will not move into DF - instability in late stance
pre treatment assessment before manipulation at ankle
- DF end feel knee extended and flexed - weight bearing DF measurement ( contribution of multiple joints) - pain: VAS and location - functional reach measurement: 1) DF measure in standing, floor, and fibula (in degrees); 2) anterior reach in length
what are the hallmarks of clinical presentation of hip OA
- groin/thigh pain - morning stiffness - difficulty with transitional movements - antalgic gait - painful WB - avoid motion
contraindications for specific exercise as treatment
- LBP only - no distal symptoms - status quo will all movement s (flexion or extension doesnt help)
conservative management for post traumatic OA
- Medication - Patient education - Shoe modification - Bracing - Stretching - Mobilization - Strengthening - Symptom management
rehabilitation management clinical findings
- Medium to high psychosocial risk status - Low psychosocial risk status with predominantly leg pain - Minor or controlled medical comorbidities
what intervention could be used for a postive thomas test
- STM to rectus femoris ITB/TFL - stretching: manual and self stretch
early PT intervention for LBP is related with decreased risk of what
- advanced imaging - additional MD visits - surgery - injections - opiod medications decreases total cost of care
correction of lateral shift should:
- affect intensity of symptoms - cause centralization or lessening of peripheral symptoms
denervation lbp with leg pain
- arising from significant axonal compromise with marked sensory and/or motor deficits
maitlands joint mobilization
- both rotational and translational movement - oscillatory manner (one or two to three applications per second) - "feels for" abnormal resistance to motion and carefully monitors any symptoms reported by the patient
management and prognosis of discoid meniscus
- can be asymptomatic - surgical intervention for torn/unstable menisci
serious adverse events to manipulation
- cervical: death, spinal cord compression, vertebral artery dissection - T/s: compression fracture, rib fracture, rotator cuff tear, pneumothorax - l/s: fracture, HNP, cauda equina
what happens if we dont get a cavitation?
- check for procedure error /clean up technique - modify patient position - try three times; move it and move on
hip strengthening exercises
- clams - standing resisted hip abduction - RDL - fire hydrant - prone hip extension - lateral sidestep walk
EdUReP: prevent
- conditioning, changing mechaniscs - increasing ROM, strength, balance - education
fear-avoidance based therapy strategies
- de-emphazised anatomical correlations - encouraged patients to take an active role - educated that LBP is a condition, not a disease - performed a graded exercise program
closed kinetic chain exercises at the knee
- decreased tibial translation - more vastus medialis and lateralis muscle activity - greater patellofemoral compressive forces - more co-contraction - compression of meniscus and articular cartilage
what is osteoarthritis
- degenerative joint diseases - injury/deteriation to articular cartilage - demasked collagen fibers --> fissures --> subchondral sclerosis --> exposed bone
elements of diagnostic statement
- differential diagnosis - nature and location of pathology; health condition - classification - determination of etiology; anaylsis of causal factors - relation to activity limitations and participation - anlysis of functional consequences of condition and how it interfering with participation
components of intervention
- directed toward body structure and function impairment - directed toward activity limitations - directed toward participation restrictions
directional preference
- direction of spinal movement or posture that produces centralization - direction that decreases pain intensity without pain changing location or increased in previously limited motion
treatments for symptoms modulation
- directional preference exercises - manipulation/mobilization - traction - active rest = modulate symptoms
what can cause nerve root inflammation
- disc disorder with nerve irritation - stenosis with nerve irritation - nerve irritation from local tissue inflammation
how should we reload the post tib?
- eccentrically - closed chain inversion - low arch = use shoes - exercise should be guided by symptoms and technique
possible interventions for ankle sprain
- edema management (manual & modalities) - improve ROM (joint accessory motion, STM, motor re-education) - improve strength - pain control - improve balance/proprioception - improve movement patterns
EdUReP: education
- educate patient on their conditions, timing of injury, reason for exercise/rest, long term effect, time duration
implementation of care types
- education - manual therapy - therapeutic exercise - assistive devices - home program
Kaltenborn Joint Mobilization
- emphasis on straight line movement within a joint; "translatoric" - emphasis on end feel testing - sustained holds - glides are often repeated several times using different speeds of movement during testing
gillet march test
- evaluate mobility of SIJ via hip flexion - PSIS should move inferiorly before the sacrum moves - "+" = PSIS does not end inferior to sacral sulcus
forward bend test
- evaluate mobility of SIJ via lumbar flexion - "+" = if sacrum and PSIS move at the same time vs independently - sacrum --> innominate
sacral rotation test
- evaluate mobility of SIJ via lumbar side bend - should see ipsilateral sacral sulcus deepen as patient side bends - "+" = sulcus fails to deepend
abnormal foot pronations defined
- excessive pronation in an expected phase of gait or pronation occurring in the wrong phase of gait
common sources of LBP
- facet joints - nerve roots - outer layer of annulus fobrosis - vertebral periosteum - ligaments - muscles
how can you control excessive foot pronation
- footwear - taping of arch - foot orthoses (over the counter or custom)
differential diagnosis at foot/ankle
- fracture - subtalar sprain - peroneal tendon injury (tendon vs retinaculum) - achilles rupture/tendinopathy - osteochondral lesion (shows up later) - fifth MT fracture (avulsion vs jones fracture) - midfoot sprain (cuboid positional fault) - fracture anterior (calcaneal process) - plantar fasciitis - posterior tibial tendon dysfunction - ankle sprain (ligaments) - arthritis of joints
intervention phase IV: remodeling
- functional limitations resolving - strength impairments improving but remain - underlying pathology considerations
mobilization with movement glide parameters
- glide mobilization in one direction - repeat 10-15 times - repeat this two to three times
how to avoid adverse events with manipulation
- good and complete medical history - detailed subjective interview - alertness with red flag signs - careful screen of ligament instability, VBI - choose right patient
gluteal muscle function and contribution to injury/apin
- greater posture sway - ITB syndrome - posterior tibial tendon dysfunction - total knee arthoplasty - total hip arthroplasty - patellofemoral pain syndrome
contraindications for STM
- infection - acute inflammatory process - acute circulatory condition - inflammatory skin condition - obstructive edema - acute rheumatologic conditions - hypersensitivity of skin - suture/hemorrhage sites - fractures - hypermobility - deep vein thrombosis - constant, severe pain - extensive radiation of pain - advanced diabetes - rheumatoid arthritis (when exacerbated) - presence of neurological signs (watch for increase) osteoporosis (cautious of pressure)
onset of radiating pain
- insidious with gradual buildup - injury or trauma usually associated with flexion& rotation, axial load/compression
What do we base exercise selection on?
- irritability - Pt goals - stage of healing - research!
intervention phase II: inflammation
- irritability - capsular restrictions in specific areas of capsule - muscle length - muscle length impairments
3 classifications (diagnosis)at the knee
- knee pain with mobility deficits - knee pain with muscle performance deficits - knee stability + movement coordination impairments
contraindications to ankle manipulation
- lack of diagnosis - patient positioning cannot be achieved because of pain and or resistance - lack of patient consent or understanding of the technique - age related contraindications (children without skeletal maturity and older persons with fragile neuromusculoskeletal system) - bone pathology including osteoporosis, long term corticosteroid use, osteomalacia, history of bone metastases - infection, dysplasia, trauma (fracture, dislocation), degenerative changes - RA - signs of peripheral nerve pathology - pulse-less foot - peripheral edema - open wound - pregnancy depending on stage
possible treatment for LBP with related LE pain
- lateral shift correction - repeated extension - mobilization into extension specific exercise extension!
signs and symptoms of movement coordination impairments
- lbp and associated lower extremity pain - restricted lumbar ROM and segmental mobility - movement coordination impairments of lumbopelvic region - diminished trunk or pelvic region strength and endurance - lumbar segmental hypermobility may be present - mobility deficits of thorax and lumbopelvic/hip region
acetabular contact during walking
- least during swing - greatest during single limb = most compressive forces
a dysfunctional joint often demonstrates (3):
- less quantity of movement - change in quality of movement (increased resistance to a movement within the available range) - more abrupt completion of movement with a firmer end feel
components of prognosis
- level of optimal improvement possible - time to achieve - guides plan of care, provides specific interventions and treatment that will be used - frequency and number of visits - patient educaiton/responsibility
what could be injured in a sprain
- ligaments (ex. ATFL, CFL, PTFL) - joint capsule - tendons (ex. peroneals) - bones (avulsion fracture) - cartilage (intra articular)
manual exam for LBP with mobility deficits
- limited segmental mobility - soft tissue palpation revealing restriction/guarding - limited excursion LE muscle length tests - symptoms reproduction with provocation of lower thoracic, lumbar or SI segments
common adverse events to manipulation
- local discomfort in area of treatment - pain in other areas - fatigue or HA - nausea, dizziness
characteristics of patient with LBP with mobility deficts
- local non radiating pain - referral into buttock or thigh - symptoms reproduction with end range motion and provacation of l/s, thorax, pelvis, or hip, SIJ - presence of lumbar, thoracic, pelvic, or hip segmental motion deficits
functional optimization clinical findings
- low disability - controlled symptom status - low to absent pain - aggravated by movement system fatigue - impaired endurance, power, strength
generalized guidelines for LBP (3)
- low stress aerobic exercises and gneral muscle reconditioning after two weeks - advice to remain as active as possible within limits of their pain - reminder that most persons with LBP return to full work capacity
esstential difference between the kaltenborn and maitland approach
- maitland was strongly influenced by neurophysiologic mechanisms for modulating pain = oscillatory - kaltenborn was influenced by joint based mechanical approaches = stretch
prognosis for those with LBP
- majority recover within 6 weeks; beyond 6 weeks improvements slows - even at one year, some patients have low to moderate levels of pain and disability
4 classifications for treatment based approach to LBP
- manipulation - stabilization - specific exercise: extension, flexion, lateral shift - traction
placebo effect of manipulation
- manipulation has better effect than sham but not statistically significant - better doctor-patient encounter improves outcomes
standing extension in individuals in the specific exercise: extension classification
- may be limited and aggravating due to compressive forces while standings - use extension in prone to concentrate bending movements in low back
symptoms patterns with radiating pain
- mechanical or inflammatory - stage of healing important to consider
cognitive ability considerations when working with kids
- meet the child at their age appropriate level - adapt instructions and interventions
regional precautions to manipulation
- mobility issues of the three joints of the ankle 1. inferior tibiofibular joint 2. superior tibiofibular joint 3. talocrural joint - stability of joints post fracture (dont do it) or post ligamentous injury(be cautious)
what to "move on to" if manipulation doesnt work
- mobilization - STM - exercise: strengthen, stretch, body mechanics/postural correction
treatment for acute lbp with mobility deficits
- mobilization/manipulation focused on improving mobility and reducing pain
knee osteoarthritis signs and symptoms
- older individual - joint hypomobility and limited ROM - pain with motion and compression - morning stiffness and after being in a static position - muscle weakness - crepitus, grinding, deep, achy pain
specifc exercise: flexion criteria
- older than 50 y/o - directional preference for flexion - imaging evidence of lumbar spinal stenosis
fundamental characteristics of well written functional goals
- outcomes, not processes - concrete - measure-able and testable - predictive but not aspirational - determined in collaboration with patient and family
3 aspect of inflammation
- pain - decreased ROM - muscle weakness; decreased motor output
reasons for impaired movement
- pain - neuromuscular - ROM - habit - structural deformity
indications to ankle manipulation
- pain felt at anterior ankle - restriction of talocrurual dorsiflexion in standing
distinguishing features of subacute lbp with mobility deficits
- pain occurs mid to end range - symptoms reproduced with provocation of involved segments
radicular symptoms
- pain radiating along the dermatome of a nerve due to inflammation or other irritation of the nerve root
spondylolisthesis signs and symptoms
- pain with extension - may cause nerve compression - may have palpable step off
indications for joint mobilization
- painful restriction of accessory joint motion with loss of rotational motions - inadequate ROM with capsular end feel of the joint
treatment strategies based on irritability level moderate irritability
- patient education - activity modification - short duration (5-15secs); passive, AAROM to AROM - low to high grade mobilization - basic functional activities
treatment strategies based on irritability level low irritability
- patient education - high grade mobilization - low to high resistance end range strengthening - end range & overpressure, increased duration and cyclic loading - high demand functional activities
treatment strategies based on irritability level high irritability
- patient education - low grade mobilization - activity modification - shorter duration ROM/stretch (1-5secs); pain free, passive AAROM
interventions for lbp with radiating pain
- patient education regarding positions that reduce strain or compression - manual or mechanical traction - manual therapy to tissues adjacent to involved nerves or nerve roots that exhibit mobility deficits - neural mobility exercises in pain free ranges
every session note should include
- patient self report - changes in patient status as they relate to plan of care - interventions, including frequency, intensity and duration - progress toward goals
HVLA and transverse abdominis and multifidus contraction
- patients with lbp who met CPR for lumbar manipulation showed increased TrA and multifidus muscle thickness immediately post-manipulation - increased thickness = increased recruitment
strumming STM
- perform perpendicular to muscle belly - improve muscle length
referred symptoms
- phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury origin
CPR for stabilization treatment classification
- positive prone instability test - aberrant movements present (- younger than age 40 & SLR >90)
rehabilitation continuum
- pre operative care - inpatient post operative day one - skilled nursing facility/ acute rehab - home health - outpatient facility
sub groups of patients most likely to benefit from traction characterized by
- presence of leg symptoms - signs of nerve root compression - peripheralization with extension movements - crossed straight leg raise
roles of PT with LBP
- prevent recurrence - prevent acute eposodes from developing into chronic conditions
diagnosis defintion
- process and label - investigation or analysis of the cause or nature of a condition, situation or problem - statement or conclusion from such an analysis typically recognizable label
plan of care should include
- proposed frequency and duration of visits - planned date for re-evaluation and or anticipated date of discharge - coordination and communication interventions - patient related instruction interventions - treatment (procedural) interventions - documentation of informed consent
positional fault concept
- proposed injuries or sprains might result in a minor "positional fault" to a joint causing restriction in physiological movement - normal joints facilitate free but controlled movement while simultaneously minimizing the compressive forces generated by that movement - normal proprioceptive feedback maintains balance in a joint - alterations would change joint position or tracking during movement and would provoke symptoms of pain, stiffness or weakness in the patient
sacroiliac joint assessment
- provocation tests (laslett cluster) - palpation of bony/ligament landmarks for posture and pain - movement tests to identify side of dysfunction
what intervention could be used if poor eccentric control was noted bilaterally during desecnt
- quad muscle performance - PF muscle performance - glute muscle performance - movement coordination training
post operative management of discoid meniscus
- range of motion is key! -- extension - edema management - pain management - normalization of gait - prevention of secondary impairments due to asymmetries, compensatory strategies - functional activities, sport specific, access to school/home - strengthening and stretching
components of initial evaluation documentation (5)
- reason for referral - activities - impairments - assessment - goals - plan of care
contraindications for manipulation
- symptoms below the knee - increasing episodic frequency - peripheralization with motion testing - no pain with mobility testing - lack of consent - lack of appropriate diagnosis - children and geriatrics - bone pathology: fracture, infection, tumor, osteoporosis - ligament instability, pregnancy - RA, down syndrome - VBI, abdominal aortic aneurysms - bleeding datheses
specific exercise: extension criteria
- symptoms distal to buttock - symptoms centralize with lumbar extension - symptoms peripheralize with lumbar flexion - directional preference for extension
what can you do for a high severity/high irritability patient who cannot do lots of exercise
- taping or bacing - modalities: ice, heat, NMES, TENS, ultrasound
what intervention could be used for observed pronation lasting through terminal stance left to right
- taping or orthotics to support arch and cedrease pronation
components of objective examination
- task/movement analysis - hypothesis of key impairments - tests and measures - final assessment statement and goals
characterisitics of patients with unclear classificaiton
- tend to be less affected by their back pain;lower levels of disability, fewer fear avoidance beleifs - longer duration of back pain
treatment for stabilization classification
- training transverse abdominis and/or lumbar multifidi = motor control training is superior to general exercise in patients with recurrent or chronic BLP
what predicts better outcomes after an ankle fracture?
- unimalleolar fracture had better outcomes than bimalleolar and trimalleolar (distal post tib) - increased DF ROM after cast removal had better outcomes - age was not a predictor
specific exercise: lateral shift criteria
- visible frontal plane deviation of the shoulder relative to the pelvis - directional preference for lateral translation movements of the pelvis
considerations for HEP for children
- who is responsible? - fit the family's schedule into exercises: ex heel raises while brushing teeth
LBp with related (referred) LE pain symptoms pattern
- worse with sustained flexed postures - centralized and diminished with repeated movements = extension - can see lateral shift, reduced lordosis, limited extension mobility
chronic lbp with movement coordination impairments distinguishing feature
- worsens with sustained end range movements or positions - while performing community/work-related recreational or occupational activities
progress note
- written periodically and should summarize what is in the session notes emphasis on: - progress toward goals - evidence that skilled intervention has been required to achieve goals - revision of plan of care as necessary - justification for continued therapy
stabilization criteria
- younger than 40 - greater general flexibility (postpartum, average SLR ROM >90) - instability catch or aberrant movements during lumbar flexion and extension ROM - positive findings for prone instability test - postpartum: + psoterior pelvic pain with ASLP, pain provacation with palpation of long dorsal sacroiliac ligament/ pubic symphysis
windlass effect
-as you go into extension at MTP, it pulls on aponeurosis (plantar fascia) which pushes tarsal bones up -high arches = pes cavus
effects of immobilization
-cartilage degeneration (thinning or softening) -decreased mechanical and structural properties of ligaments; disorganized cellular and fibrillary alignment, weakening of insertion sites -decreased bone mineral density -weakness/atrophy of muscles; decreased strength and increased fatigue - increase scar tissue - adhesion between synovial folds in joint
self care management clinical findings
-low psychosocial risk status -predominantly axial low back pain -minor or controlled medical comorbidities
medical management clinical findings
-red flags -medical comorbidities precluding rehab -leg pain with progressive neurologic deficits
movement control treatments
-sensorimotor exercises -stabilization exercises -flexibility exercises = improve quality of movement
STM techniques
-sustained pressure -effleurage -strumming -petrissage
considerations when foot pronation is excessive
1. hypomobility of foot and ankle segment (ankle, STJ) 2. hypermobility of foot and ankle segment (TNJ, CCJ) 3. weakness of perimalleolar muscles 4. combination of all of the above
proliferation timing
1 day after injury up to 6 weeks - peaks in 2-3 weeks
3 answers to "is physical therapy appropriate?"
1. Yes 2. treat and refer 3. no, refer out
STM uses (7)
1. address tissue restrictions 2. reduce spasm 3. improve lympathic flow/decrease edema 4. reduce pain 5. improve ROM/flexibility 6. increase temperature due to change in peripheral blood flow --> bring nutrients to area 7. improve balance when combined with mobilization
guidelines for mobilization with movement (mulligan)
1. identify aggravating movement 2. select appropriate glide 3. weight bearing or no weight bearing depending on severity, irritability and nature of patient problem 4. glide is sustained throughout the movement until joint returns to starting position; pressure sustained, being aware of minor alterations in treatment plane 5. mobilizations always performed into resistance and without pain 6. immediate relief and improvement in ROM is expected (PILL)
CPG parallels TBC except 3 things:
1. incorporates ICF terminology of body function impairments 2. addresses psychosocial domains by adding cognitive and affective domains, generalized pain 3. assesses level of acuity in terms of duration of symptoms and relationship to movement and pain
stabilization criteria for postpartum
1. posterior pelvic pain provocation test 2. ASLR 3. provocation of long dorsal ligament 4. modified trendelenburg
CPR: individuals who responded better (after manipulation) had three of the following four findings:
1. symptoms are worse when standing 2. symptoms are worse in the evening 3. navicular drop greater than or equal to 5.0mm 4. distal tibiofibular joint hypomobility
6 components of FPI
1. talar head palpation 2. supra and infralateral malleolar curve 3. calcaneal frontal plane position 4. bluge in region of TNJ 5. height and congruence of medial longitudinal arch 6. abduction/adduction of forefoot on the rearfoot
imaging signs of tendonosis
1. tendon enlargement 2. destruction within tendon; white noise 3. fluid at surface of tendon
joint mob treatment procedure for decreasing pain
1. test to determine grade reproducing pain 2. apply sustained/oscillary hold at a grade lesser than that reproducing pain (grade 1 or 2 sustained hold or oscillation) 3. hold for 7-10 secs or oscillate at 2-3 Hz for 40 secs, repeat 3-5 times 4. reassess to determine the grade reproducing pain
maintenance of balance involves integration from 3 systems
1. vestibular 2. visual 3. somatosensory
xBW walking
1.3-5.8
on average, most epiphyseal plates/growth plates close in long bones at ages:
12-15 in girls 15-17 in boys
subacute injury
14 days - 3 months
remodling timing
2-3 days after injury up to 1 year - peaks around 3 months
x BW during standing on 1 leg
2.4-2.6
laslett cluster
3 or more = 94% sensitivity - distraction - thigh thrust - compression - sacral thrust - (gaenslen's)
kaltenborn's three grades
3 point scale to describe amount of movement and percieved resistance during manual joint testing and treatment grade I: "loosening" movement is an extremely small traction froce that produces no appreciable increase in joint separation grade II: tightening grade III: stretchnig
x BW stair climbing
3 x
reps and intensity for power training
3-5 (fast) reps with 85-95% intensity
reps and intensity for strength training
3-5 reps with 85-95% intensity
treatment based classifications and overlap precentages
50% of patients fit into one category 25% fit into more than 1 25% dit not fit into any categroy
outcomes with manipulation for those positive on CPR
50% reduction in ODI treatments and maintained benefit for 6 months
what are range is likely affected?
50-80% >65% y/o have OA virtually 100% >75 years old have some degree of OA
reps and intensity for hypertrophy training
6-12 reps with 67-80% intensity
how long does a typical fracture take to heal?
6-8 weeks
acute injury
<14 days
reps and intensity for endurance training
>12 reps with <66% intensity
chronic injury
>3 months
ABCDE format for patient goals
A- actor; whos in charge of the goal B- behavior; what behavior is happening C- condition; does something specific need to occur D- degree; how much change E- expected time; how long will it take
ABCDE goal format
Actor - identify who Behavior - select expected behavior Conditions - context, circumstances Degrees - quantitative specifications Expected time - time period to achieve goal
neurophysiological responses to manipulation (7)
Change in Nociceptor Afferent System - changes pressure pain threshold; need increased pressure to cause pain Change in Autonomic Nervous System - manipulation increases skin temp, conductance, respiration rate, HR and BP Change in Hoffmann's Reflex - suppression of motor neuron excitability; decrease muscle firing Change in EMG activity - decreased resting emg signal intensity and emg activity in muscle spasm Change in Muscle Performance - increased TA thickness; no change in asymptomatic individuals - modulation of EMG at paraspinals during flexion and extension movement Change of Neuropeptides in Blood Vessels - reduced inflammatory cytokines - increased neurotensin, oxytocin, cortiol (pain modulation and hypoalgesia) Change in Cortical Excitability - changes in corticospinal excitability - changes in functional connectivity: increased activity in area that modulates pain after manipulation to lumbar spine - potentially alter pain hormones
forefoot
MT, MTP joints
objective outpatient PT
Observation/posture Movement analysis Functional analysis AROM/PROM Flexibility Joint accessory motion MMT Palpation Special tests
objective exam includes
Observe posture Movement analysis Functional movement analysis AROM/PROM Flexibility Joint accessory motion MMT Palpation Special tests
peripheralization
Occurs when symptoms increase in distribution - carries a poor prognostic value
physical exam for lbp with radiating pain
Posture Observation - look for increased lumbar and thoracic spinal curves - position of comfort - presence of lateral shift Lumbar Spine ROM - active - response to repeated motion - overpressure as needed Neurological Exam - manual muscle test - sensation - DTR - nerve tension: SLP, slump
key impairments to look for
ROM strength alignment sensory other systems (GP, GI, integumentary) pain edema balance impaired gait
what special tests to preform for osteoarthritis
ROM with overpressure, distraction (should provide relief), walk on heels (increases compression)
patellofemoral pain syndrome MOI
overuse - mal alignment of patella and femur = decreased contact area with increased mechanical stress
SOAP notes format
S: subjective O: objective A: assessment P: plan
open kinetic chain
When the distal end of an extremity is not fixed to any surface, allowing any one joint in the extremity to move or function separately without necessitating movement of other joints in the extremity. - better muscle isoloation
discoid meniscus
congenital deformity - 1.5-15% of pedicatrics presents at 7-8 y/o - lateral meniscus is irregularly shapes, impeding on intra articular space
can weakness influence balance
Yes - hip fatigue results in greater postural changes than from ankle fatigue during single limb stance
salter-harris fracture
a fracture of the epiphyseal plate in children
Wong-Baker FACES scale
a pain assessment tool that asks patients (often children) to select one of several faces indicating expressions that convey a range from no pain through the worst pain
why would the medial forefoot come off the ground with supination
a rigid foot
stress/strain curve
graphical representation of a material's mechanical properties
3 steps of learning for global stability
activation acquisition assimulation
interventions for SIJ dysfunction
active corrections: hip flexors/ext, piriformis, multifidus passive corrections manipulation
injury time based
acute subacute chronic
acute and chronic presentation of ACL sprain
acute: swelling, laxity, pain chronic: unstable joint, loss of function
lateral ankle ligaments
anterior talofibular, calcaneofibular, posterior talofibular
resting position of ankle
approximately 10 degrees PF and midway between maximal inversion and eversion
envelope of function
area under the tissue stress curve - training increases envelope
degenerative joint disease
arthritis of the foot and ankle caused by post traumatic (70%), osteoarthritis, inflammatory (RA = 10-50% or bone cyst)
operative care for OA
arthrodesis (fusion) TAR post operative PT
TAR complications
aseptic loosening malalignment deep infection
overall, interventions must include
assessment sign prescribed intervention parameters ability to describe potential compensations reassessment sign (immediately and long term)
interventions must include (5)
assessment sign prescribed intervention linked to impairment gathered from activity limitations parameters ability to describe to another the potential compensations reassessment sign - same as assessment
interventions for ROM restriction
assistive device strengthening soft tissue mob joint mob
activity limitations with MCL injury
avoid activities causing valgus knee stress: examples - breast stroke - dependent pivot transfers - W sitting
activity limitations with PCL injury
avoid posterior tibial translation: examples - kneeling knee ext ROM - lie prone instead of supine avoid HS activation such as lunges, HS curls, bridges
are these positons the same when the joint is pathological
axis could change --> resting position could change
sites in children that are more suseptible to trauma
bone growth plate epiphysis (articular cartilage) apophysis ischemia
what tissues are more vulnerable to injury in children compared with adults
bone more than ligament and tendon
osteokinematics
bone movement - whole bone moving around a joint axis; measured as angle in degrees
musculoskeletal lbp with leg pain
pain referred from non neural structures such as disc or the facet joints
3 examples of mobility assessments at the foot
calcaneal cuboid, talonavicular, dorsiflexion in STJN flexed and extended
foot posture during pronation
calcaneus = eversion talus = PF/horiz add tibia = IR navicular = pronation (PF?) cuboid = abduct 1st metatarsal = DF (maybe supination)
EdUReP: unloading
can use this time to strengthen surrounding musculature reduce stress by - changing activity, footwear - use of assistive device - bracing/taping - foot orthoses
5 primary end feels
capsular bony soft boggy empty
hip intra articular sources of pain/symptoms/movement dysfunciton
capsule labrum osseous structures
joint mob is
capsule impairment; hypo-mobility
orthostatics
change in vitals with change in position - decrease of systolic BP by 20 mmHG or diastolic BP by 10 mg Hg within 3 minutes of changing position (supine to sitting or sitting to standing)
firm end feel
characteristic of muscular or capsular/ligamentous end feel; firm end feel is variable among individuals depending on factors such as age, size, and extent of degenerative changes
soft end feel
characteristic of soft tissue approximation or soft tissue stretching
patellar tendinopathy
common overuse injury to patellar tendon, resulting in tiny tears. can cause necrotic degenerative change or inflammation in the tendon and pain. (injury common in jumping sports - also called "Jumper's knee")
what shall I do when I forget the angles of these assessment or treatment positions
compare to other side/other positions
type IV avulsion injury
complete tear
type III avulsion injury
completion of tear
indirect method to assess joint mobility
concave-convex rule - based on relationship between normal bone rotations and the gliding component of the corresponding joint movement - it is useful for joints with very limited movement - useful whens severe pain limits movement - useful for early career clinicians
genu varum/valgum 16 yr old female vs male
female slight genu valgum, male slight genu varum
red flags
fever chills night sweats weight loss or gain malaise/fatigue unexplained nausea/vomiting paresthesia shortness of breath dizziness
biomechanical effects of manipulation
fibroud adhesions develop (around facet) --> thrust manipulation separates facet joint --> gapping facet joint breaks up adhesions --> facet joint can move normally - realigns the spine - gapping of facet - reduction of crepitus
kaltenborn described 3 common end feels
firm or capsular hard or bony soft
nerve compression position with disc herniation/ limited nerve mobility
flexion > contralateral side bend > contalateral rotation
intervention for stenosis
flexion! - flexion exercises - manual therapy - body weight support TM
solution to problems with soap notes
focus on goals - functional outcomes documentation - benchmark tasks
how do you measure foot posture
foot posture index (FPI)
neutral forefoot
forefoot perpendicular to calcaneus
what is cavitation
formation of vapor and gas bubbles within fluid through local reduction in pressure, when the collapse of vapor cavities gives rise to noise
two pioneers of joint play testing
freddy kaltenborn and geoffrey maitland
pediatric specific interventions
gaming aquatic functional directed play adpatations in ther ex to make it a game
systemic/visceral sources at the hip
genitourinary - pain during urination, menstrual cycle inguinal hernias - coughing, laughing, sneezing local infection - fever, recent surgery/ illness
what intervention could be used for observed femoral IR in terminal stance and contralateral pelvic drop during stance bilaterally
gluteus medius and maximus muscle performance (ER and ABD) movement coordination training to improve mechanics
from a completed examination we develop what
goals plan of care implementation of treatment
leg alignment 1y, 7m
legs straight
Grade II Sprain/Strain
ligament fibers partially torn - moderate swelling, tenderness and ROM deficits - full weight bearing, may need assistive device - 4-8 weeks till return to normal activities
grade I sprain/strain
ligament fibers stretched - mild swelling tenderness and ROM deficits - full weight bearing - 1-2 weeks till return to normal activities
Grade III sprain/strain
ligament fibers torn with instability - severe swelling, tenderness, and ROM deficits - limited to no ability to ambulate without assistive device - 12-16 weeks till return to normal activities
why would you perform iliopsoas STM?
limited hip ext, pain with palpation
deformation curve
load vs deformation
tissue stress curve
load vs frequency; tolerance of tissue - increase load, decrease frequency - decreased load, increased frequency
categories of sources of pain and movement dysfunction
local neuro/musculoskeletal (intra or extra articular) remote/referred neuro/musculoskeletal systemic sources
sacroiliac joint disfunction
localized pain and tenderness at the PSIS, ligaments - may radiate to buttock or groin region - more pronounced with single leg standing or landing on one leg
joint mobilization treatment options
low velocity joint mobilization - sustained holds - oscillatory motions high velocity, low amplitude mobilizations mobilization with movement
sustained pressure STM
maintain constant pressure while providing clockwise or counter clockwise force - parallel or perpendicular to restriction - can be used to break up scar tissue
manual treatments for joint limitations
manipulation/mobilization
joint mobilization/manipulation definition
manual therapy technique comprised of a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement
closed packed position of ankle
maximal dorsiflexion
triage by the first contact health care provider
medical management rehabilitation management self care management
leg alignment 6m
minimal genu varum
leg alignment in newborn
moderate genu varum
plan of care
overall goals stated in measurable terms that indicate predicted level of improvement in functioning - general statement of interventions to be used - proposed duration and frequency of service required - anticipated discharge plan
problem with soap notes
overly mechanical often lack focus
functional improvement
movement change after treatment
hip extra articular sources of pain/symptoms/movement dysfunciton
muscles, tendons bursae local peripheral nerves
joint mob treatment aiming at increasing motion
need to know hypomobility is limiting motion, not pain - grade 3 sustained hold or grade 3-4 oscillations - pattern of restriction of a joint (capsular pattern) - history or pain --> pain and restriction --> restriction - capsular end feel
peripheral nerve sensitization lbp with leg pain
nerve trunk inflammation with marked mechanosensitivity - neural mobilization as treatment
manual treatment for positive sensitized neural tension tests (nerve)
neural mobilization
objective impatient post operative PT
objective: vitals post surgical precautions assessment of bed mobility assessment of transfers assessment of gait (assistive devices) UE and LE neurological screen
objective home health PT
objective: vitals demonstrates knowledge of surgical precautions environment precautions and concerns assess bed mobility assessment of transfers assessment of gait, steps/stairs LE, UE neuro screen
acquisition - findings and treatment
observe impaired ability to dissociate or coordinate thoracolumbar and lumbopelvic/hip movements - training to acquire skill of dissociating/coordinating
assimilation - findings and treatment
observe impaired control of multiplanar movements under dynamic loading - assimilate loaded multiplanar movements into ADLs
activation - findings and treatment
observe poor ability to activate individual muscles - training to activate hypoactive muscles
relationship between osteokinematics and arthrokinematics
occur simultaneously directly proportional normal arthrokinematic motion must occur for full range osteokinematic motion to occur - osteokinematic impairment is not always caused by arthrokinematics but impairments with arthrokinematics will cause osteokinematic impairment
hard end feel
occurs when bone or cartilage meet
centralization
occurs when symptoms move from periphery back toward center of spine and overall diminsh in distribution
MCL injury MOI
often accompanied with ACL
differential diagnosis birth to age 5
osteomyelitis spectic arthritis transient synovitis occult fractures kohler syndrome
what are some ways to know you are progressing to next phase of intervention in regards to tissue healing?
patient response - change in response of specific activity - use of self reported outcome measures reassessment! - BSF reassessment - activity level reassessment - patient goals are being achieved
assessment and reassessment with HVLA
patient symptoms and location during tests and measures - ankle DF in STJN with knee extended and flexed to 90 - AP glide of talus with end feel - CKC DF measure
leg alignment 2y, 6m`
physiologic genu valgum
late stage rehab for ACL sprain (knee stability + movement coordination impairments)
plyometrics advanced balance and proprioception agility
activity goals
predicated functional performance skills needed to achieve participation goals
balance definition
process by which the body's COM is controlled with respect to the base of support whether the base of support is stationary or moving - ability to maintain position, voluntarily move, react to preturbation - visual system assists in balance by providing input about head and body in space
participation goals
purpose of physical therapy interventions - specific roles Pt wishes or needs to participate
what special tests do we use to assess PF pain syndrome
quad contraction with inferior or posterior compression
meniscal saucerization with stabilization
repair tears and take out excess middle of meniscus
assistive device used if
restriction is due to pain = offload
subjective outpatient PT
review understanding of precautions review of rehabilitation current concerns symptoms behavior long term goals addressed
apophysis
secondary ossification center and site of tendinous attachment to bone - biomechanically the weakest point of musclulotendonous bone unit during school age-tennage years
end feel definition
sensation perceived by your hands at the limit of available motion
petrissage STM
several subcategories of techniques involving compression of soft tissue structures - includes kneading, rolling, picking up technique - goals: improve areas of muscle fibrosis, mobilize waste products
ROM findings: PROM >/= AROM but < optimal =
shortended musculature - use STM and stretching
glute medius exercise with the most glute med activations
side plank
differential diagnosis age 11-15
slipped capital femoral epiphysis osgood schlatter disease osteochondritis dissecans tarsal coalition freiberg disease accessory navicular
manual treatments for impaired soft tissue compliance
soft tissue mobilization passive stretches
for hypomobile joint, the spot will occur ____ and the end feel will feel _____
sooner; the same or more firm
what is proprioception
specialized variation of the sensory modality of touch - important role is coordinating muscle activity - involves integration of sensory input concerning static joint position. joint movement, velocity of movement, and force of muscle contraction - can be conscious or unconscious
aggravating factors with PF pain syndrome
squatting, kneeling, stretch to the knee extensors, and prolonged sitting
early stage rehab for ACL sprain (knee stability + movement coordination impairments)
stability and movement coordination training - balance proprioceptive training - movement re education (train technique)
diagnosis documentation
state differential diagnosis or health condition and rational - describe patients activity limitations, impairments and participations restrictions
types of stretching
static, dynamic, ballistic, PNF
health conditions that dont fit extension specific exercise
stenosis spondylolisthesis SIJ dysfunction
stimulus and pattern for joint/articular surfaces
stimulus: AROM, PROM, weight bearing/compression, end-feel testing pattern: pain may be deep or poorly localized with compression, gentle motion sometimes reduces pain
stimulus and pattern for muscle pain
stimulus: AROM, muscle contraction pattern: usually localized to damaged area
stimulus and pattern for tendon pain
stimulus: AROM, overstretch, contraction at end range pattern: localized to tendon, myotendinous junction or boney insertion
stimulus and pattern for ligament pain
stimulus: PROM, end range active movements pattern: pain at attachment points, unstable