Term
| Most common orthopedic injury in geriatrics |
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Definition
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Term
| Hip fractures are attributed to what? |
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Definition
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Term
| How are hip fractures described |
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Definition
Location:
Femoral neck (intercapsular)
Intertrochanteric fracture (extracapsular)
Sub trochanteric fracture (proximal femur) |
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Term
| Surgical Intervention of Hip Fractures |
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Definition
ORIF
Hemireplacement
Total Hip Replacement
Arthoplasty |
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Term
| Physical therapy intervention of Hip fracture is based on: |
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Definition
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Term
| 3 main complications of hip fractures |
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Definition
Malunion
Delayed Union
Nonunion Avascular Necrosis (AVN) |
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Term
Post Op management of Hip Fractures
Acute Setting |
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Definition
Get pt up an moving to prevent effects of prolonged bed best & thrombus
Protect surgical stabilized fracture
Teach moving safely in bed
Transfer w/ correct WB status
Ambulation with assistive device
Edema control
Bed positioning
Deep breathing exercises |
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Term
| Does ORIF allow for early portected weight bearing |
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Definition
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Term
| Who decides weight bearing status |
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Definition
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Term
| Rehabilitation after hip fracture |
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Definition
Avoid torque through the affected limb - loosens fixation device
Bone heals 8-12 weeks |
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Term
| Max protection phase for hip fracture |
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Definition
Exercises begin day after surgery
Ankle Pumps to prevent venous thrombosis
Begin submaximal muscle setting exercises for gluteus maximus, adductors, abductors, quadriceps & hamstrings
Achieve 80 - 90 degrees of hip flexion by 2-4 weeks using AA heel slides
Progress to Active-Assisted and active ROM exercise to maintain mobility and prevent contracture |
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Term
| Progressive Hip Ex weeks 2-5 |
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Definition
Add active supine/prone exercises for flexion, extension, abduction & adduction
Add sitting terminal extension
Pelvic tilts & Single Knee to Chest (SKC) with uninvolved to prevent LB tightness
Prone hip flexor stretch
When pain decreases do standing flexion, abduction, extension exercises in standing on uninvolved leg (without resistance) |
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Term
| Precaution for Hip post surgery |
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Definition
NO ABD/ADD ISOMETRICS FOR SUBTROCHANTERIC FRACTURE
AVOID 4 - 8 WEEKS 2E TO MEDIAL CORTEX RECONSTRUCTION Strengthen scapular depressors, triceps and uninvolved lower extremity for using Assistive device |
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Term
| Mod protection phase hip fracture |
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Definition
6 weeks = soft tissue healed
Continue with active exercises
Stretch heel cord (gastrocnemius) using a towel stretch
Stretch hip flexors using Thomas test position
Stretch hamstrings with sitting hamstring stretch
Bike Ergometer |
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Term
| Late Healing phase hip fracture |
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Definition
8 - 12 weeks some degree of bone healing has occurred = PWB (use support)
Improve standing balance and postural stability
Improve strength of lower extremities for functional activities
Improve cardiorespiratory endurance
Treadmill to normalize gait
Heel raises
Partial wall squats
When full weight bearing is OK use closed chain exercise to improve strength, endurance, stability, and balance |
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Term
| Resistive ex with HIp fractures |
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Definition
DO NOT ADD RESISTIVE HIP EXERCISE WITH WEIGHTS UNTIL MD OK BONE HEALING COMPLETE 8-12 weeks
May take 6 MONTHS
Open chain hip extension and abduction with elastic resistance for ambulation |
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Term
| Signs of Possible Failure of Hip ORIF |
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Definition
Severe groin pain that increases with WB
A positive Trendelenburg sign that does not resolve with Glut Med strengthening exercise
Persistent external rotation of operated limb
Progressive limb length shortening |
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Term
| Most common arthritc disease of the Hip joint |
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Definition
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Term
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Definition
| Degenerative changes and breakdown of articular cartilage and osteophyte at joint margins |
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Term
| Common impairments with OI |
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Definition
Stiffness after rest
Limited internal rotation
No extension past neutral
Hip flexion limited to 90 degrees
Limited hip extension preventing full knee extension when standing
Limited hip extension leading to increased extension forces on lumbar spine and pain
Antalgic gait with a compensated gluteus medius limp
Impaired balance and postural control
Pain experienced in the groin and referred along the anterior thigh and knee in L3 dermatome |
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Term
| Functional limitations with OI |
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Definition
Difficulty putting on pants, socks, hose
Difficulty rising from chair, climbing stairs, squatting, weight bearing activities |
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Term
|
Definition
Instruct in importance of frequently moving hip through ROM throughout day
Perform ROM in pool to decrease weight bearing stress on joint
Non-impact activities, swimming, water aerobics, stationary bicycling (light resistance) |
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Term
|
Definition
DECREASE PAIN DURING WEIGHT BEARING ACTIVITIES:
Assistive devices for ambulation (cane)
DECREASE PAIN AT REST
Rocking chair to provide Grade I or II oscillations to lower extremity |
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Term
| Late subacute and chronic phase with OI |
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Definition
To increase range of motion do stretching (therapist assisted and self-stretching)
To increase joint play do mobilization of hip (Distraction of hip joint)
Work on increasing hip extension ROM & internal rotation
To progress strength and functional use of supporting muscles |
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Term
|
Definition
Begin with isometric, progress to isotonic resistance (keep resistance LIGHT) Especially gluteus maximus, medius, and rotators.
These muscle improve stability and balance when performing weight bearing activities
IF ANY EXERCISE EXACERBATE THE JOINT SYMPTOMS, REDUCE THE INTENSITY |
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Term
|
Definition
Help patient establish a balance between activity and rest
Learn the importance of minimizing stressful deforming forces on joint
Maintain muscle strength and flexibility in hip region
Use pool for exercises
Develop postural awareness and balance |
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Term
|
Definition
Pain over lateral hip when ITB rubs over greater trochanter
Discomfort standing asymmetrically for long periods (mothers with baby on hip) |
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Term
| PSOAS BURSITIS = Iliopectinal bursitis |
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Definition
iliopectinal bursa lies deep to tendon of iliopsoas,
Aggrevated by activities requiring excessive hip flexion |
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Term
| PSOAS BURSITIS = Iliopectinal bursitis |
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Definition
iliopectinal bursa lies deep to tendon of iliopsoas,
Aggrevated by activities requiring excessive hip flexion |
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Term
| ISCHIOGLUTEAL BURSITIS = Ischial bursitis (Tailor's bottom) |
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Definition
| Pain underlying gluteus maximus caused by extended periods of sitting |
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Term
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Definition
| overuse of any muscle in the hip |
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Term
| Common impiarments with overuse syndromes |
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Definition
Pain when involved muscle contracts or when repeat prolonged activity
Shorter stance on painful side = decreased ambulation
Imbalances in muscle flexibility and strength
Decrease muscular endurance
Inability to do the provoking activity |
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Term
| Management of acute symptoms of overuse syndromes |
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Definition
AVOID ACTIVITY CAUSING PAIN
RICE = Rest, Ice, Compression, Elevation
Control inflammation & Promote healing
Pt Education & cooperation are necessary to reduce repetitive trauma |
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Term
| Management of overuse syndromes in subacute phase |
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Definition
Remodel scar in muscle by applying cross fiber massage
Multiple angle isometric in pain free position
Stretch the injured muscle (therapist assisted and self-stretch)
Develop alignment of pelvis
Strengthen weak muscle of hip because imbalance muscle contribute to overuse compensation
Progress to low intensity isotonic resistance |
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Term
| Management of overuse syndromes in chronic phase |
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Definition
Closed chain and functional activities
Balance activities and endurance activities |
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Term
| Muscle Strain (muscle pull) |
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Definition
Poor flexibility & fatigue, sudden fall
Common problems include hip flexor, adductor, rectus femoris, and hamstrings
Injuries to the hamstring can be caused by sudden forceful contraction
or
By decelerating the lower leg against the concentric contraction of the quadriceps during running as the hamstrings contract eccentrically |
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Term
| Max protection phase of muscle strain |
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Definition
RICE
Avoid motions that interfere with the healing process i.e. full knee extension with trunk flexion
Rest involved tissue without stressing it
Put pillows under knee to reduce stress to hamstrings
(NOT concerned with contracture, need healing) |
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Term
| Mod protection phase for muscle strain |
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Definition
Begins GENTLE stretching to influence direction of immature collagen fibers beg
Active knee extension and flexion (pain-free) |
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Term
| Minimal protection phase in muscle strain |
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Definition
Stress flexibility of hamstrings
Strengthen hamstrings = scooting exercise, resistive leg curls
To improve function of hip = hip bridges |
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Term
| Indications for proximal femoral osteotomy |
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Definition
Degenerative joint disease (DJD) is extensive and result in pain
Associated with subchondral bone erosion
Purpose = changes shaft of femur so healthy cartilage is exposed to improve joint surface congruity |
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Term
| Max protect phase of proximal femoral osteotomy |
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Definition
Protected weight bearing NWB, TDWB, PWB with walker or crutches 8 to 12 weeks
Muscle setting = glut sets, quad sets
Gentle active hip ROM exercise allowed from first day after surgery
AVOID UNWANTED FORCES ON JOINT - ambulation on underwater treadmill |
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Term
| Mod protection phase for proximal femorla osteotomy |
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Definition
When X-ray show secure bone healing begin isotonic exercises using a wall pulley
Knee extension, leg curls, standing hip abduction, adduction, flexion and extension |
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Term
| Min protection phase for proximal femoral osteotomy |
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Definition
Extreme caution must be used with closed chain strengthening exercise due to compressive loads with contribute to cartilage degeneration
DO ONLY IF HAVE NO PAIN
Leg press, mini squats, step-up, treadmill |
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Term
| Classification of pelvic fractures |
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Definition
STABLE
= Avulsion-type fractures of ASIS, AIIS, IT, Iliac crest
UNSTABLE
= Rotationally or vertical unstable
= life threatening injury due to blood supply in area |
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Term
| Treatment of stable pelvic fractures |
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Definition
RICE
Protected weight bearing with crutches
Avoid premature stretching which may delay bony union (usually 6 weeks) |
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Term
| Treatment of unstable pelvis fractures |
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Definition
EIGHT (8) WEEKS NON-WEIGHT BEARING
Use Tilt Table for upright position
THE PTA MUST CLOSELY SUPERVISE ALL VITAL SIGNS BEFORE, DURING AND AFTER REHAB
Active Ankle pump, gentle knee motion, and limited hip motion
Once fracture healed need program of full body general strength and endurance training
Due to long immobilization |
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Term
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Definition
Describes the lateral tracking that the quadriceps muscles and patellar tendon have on the patella
Angle is formed by two intersecting lines
1) tibial tubercle through mid patella
2) ASIS to mid patella
Normal = 15 degrees
Females have larger Q angle due to wider pelvis |
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Term
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Definition
LATERAL FORCES
Iliotibial band and lateral retinaculum
Vastus lateralis
MEDIAL FORCES
Medial retinaculum
Vastus medialis oblique |
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Term
|
Definition
1. Increased Q angle, wide pelvis
2. Genu valgum
3. Femoral anteversion
4. Pronated feet
5. Tight ITB
6. Tight Hamstrings
7. Tight Gastrocnemius (result in pronation of foot when ankle dorsiflexion)
8. Weak VMO |
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Term
|
Definition
Femoral anteversion
External tibial torsion
Genu valgum
Foot pronation
Tight ITB
Abnormal patellar tracking
Difficulty firing the quadriceps |
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Term
| Anterior knee pain is related to |
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Definition
| imbalance of soft tissues alignment the patella in the trochlear groove and influencing patellar tracking. |
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Term
| Causes of Patellofemoral Pain |
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Definition
Weak or overstretched medial structures = Inadequate medial stabilizers
Abnormal Q angle
Shallow trochlear groove
Patella alta
Tight ITB
Forceful quadriceps contraction while foot is planted and femur externally rotating and knee is flexed |
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Term
| Common impairments with patellofemoral pain |
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Definition
Weak VMO (poor timing or recruitment)
Overstretch medial retinaculum
Resticted lateral lateral structures (IT band or lateral retinaculum)
Decreased medial gliding of patella
Pronated foot
Tight gastrocnemius or hamstrings
Patellar crepitus, swelling or locking |
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Term
| Commonn functional limitation with pattelofemoral pain |
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Definition
Pain with stairs
Poor knee control
Pain with walking or running
Pain and stiffness with prolonged flexed knee postures, i.e. sitting, squatting |
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Term
| Max protect with patellofemoral pain |
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Definition
Joint effusion inhibit the quadriceps
RICE
Reduce irritation forces
Patella taping or bracing |
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Term
| Subacute with patellofemoral phase |
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Definition
Patellar medial mobilization
Stretching ITB
Stretch gastroc/hamstrings
Train and strengthen knee in non-weight bearing position
AVOID RANGE WHERE PAIN IS FELT |
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Term
| VMO emphasis with patellofemoral pain |
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Definition
Quad sets with knee in various position (use ES or biofeedback)
Progress to partial weight bearing positions
Mini-squats are effective in causing a greater VMO:VL ratio than quad sets
Avoid activities where knee is flexed > 60 degrees 2° to high patellar compression loads |
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Term
| Patient education with patellofemoral pain |
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Definition
Avoid activities that provoke the symptoms
Avoid stair climbing
Avoid sitting with knees flexed excessively |
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Term
|
Definition
Chronic irritation of synovial tissue around patella
Pain medial to patella |
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Term
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Definition
Irritation of infrapatellar fat pad from overuse or trauma
See Anterior knee pain |
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Term
| Iliotibial band friction syndrome |
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Definition
| Irritation over the lateral femoral condyle |
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Term
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Definition
Irritation from prolonged kneeling
Pain over patellar tendon |
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Term
| Tight medial or lateral retinacula |
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Definition
| Increased direct contact of the patella in the trochlear groove |
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Term
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Definition
Refers to softening of cartilaginous surface of patella
May be caused from trauma, surgery, prolonged & repeated stresses, or lack of normal stress such as prolonged periods of mobilization |
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Term
| Nonoperative management in acute with patellofemoral pain |
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Definition
RICE
Muscle setting exercises in pain -free positions (multiple angle isometrics) |
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Term
| Nonoperative management in subacute with patellofemoral pain |
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Definition
Strengthen VMO (use biofeedback & specific exercise to isolate VMO)
Stretch ITB, hamstrings, gastrocnemius
Avoid stair climbing until muscles strengthened to a level where they can do pain-free
Avoid excessive knee flexion
Correct foot pronation (do Posterior Tibialis exercise) (get foot orthotics) |
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Term
| Management of chronic patellofemoral pain |
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Definition
| Use light weights, high repetition and avoid flexion greater than 90 degrees |
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Term
| Functional Activities with patellofemoral pain |
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Definition
Step ups
Lunges
Treadmill
Activity specific drills for return to desired activity |
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Term
|
Definition
When the knee is in full extension, the patella is superior to the trochlear groove
By 15 degrees, the inferior border of the patella begins to articulate with the superior aspect of the groove
As the knee flexes, the patella slides distally in the groove & more surface area comes in contact
As the knee flexes past 90 degrees, the quadriceps tendon comes into contact with the trochlear groove as the patella slide inferiorly |
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Term
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Definition
In full extension there is no contact of the patella with the trochlear groove
& line of pull of patellar tendon almost parallel = very small resultant compressive load
Compression to the posterior aspect of patella against femur rise rapidly between 30 and 60 degrees of knee flexion |
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Term
| Patellar compression forces |
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Definition
In close chain squatting, the joint reaction forces continue to rise until 90 degrees
Compressions rises to greater than three time body weight during stair climbing
Eight time body weight during deep knee (deep squats) activities
Obesity - for every one pound of body weight lose, lose 4 pounds of pressure off patella |
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Term
| PATELLAR SUBLUXATION or PATELLAR DISLOCATION |
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Definition
| Lateral movement of patella out of trochlear groove |
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Term
| Indications for Lateral Retinacular Release |
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Definition
Impairment of the patella caused by lateral dislocation
Chronic patellofemoral pain |
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Term
| Max Protection Phase for lateral retinacular release |
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Definition
Two weeks to allow for healing of incision
Muscle setting exercise for quadriceps, hamstrings and adductors
Cryocuff to decrease swelling & pain |
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Term
| Moderate Protection phase for lateral retinacular phase (3 -4 weeks) |
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Definition
Active knee motion - use stationary bicycling with light resistance
Multiple angle isometrics
Open chain knee exercises
Closed chain exercises - mini squats, partial lunges, step-ups
AVOID ALL EXERCISES THAT CAUSE COMPRESSIVE FORCES ON PATELLA |
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Term
|
Definition
| Foot planted , femur is rotated internally, knee flexed = compression and shear force tears meniscus |
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Term
| Surgical repair of meniscal tears |
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Definition
1. MENISCAL REPAIR = suture the torn meniscus together if tear in the red-on-red zone (peripheral tear)
2. MENISCECTOMY = Remove torn tissue because not viable |
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Term
Max protect after meniscal repair
(1st four weeks) |
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Definition
Immediately after surgery:
Patient immobilized in full extension to protect sutured cartilage. Ambulates w/crutches PWB
Flexion limited to 50-90
Isometric submaximal quadriceps and hamstring setting
Maintain hip musculature: SLR in supine, prone & sidelying
ROM using heel slides, supine gravity assisted knee flexion , patellar glides |
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Term
Mod protection phase for meniscal repair
(5 - 16 wks) |
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Definition
Progressive strengthening exercise for quads, hamstring, SLR, hip add & hip abd , & hip ext exercises
FULL WEIGHT BEARING NOT ALLOWED FOR 6 - 8 WEEKS
CLOSED CHAIN ACTIVITIES IN FWB NOT ALLOWED TILL FWB |
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Term
| Management after meniscectomy |
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Definition
Early weight bearing to full weight bearing as pain allows
Progressive strengthening exercise for quads, hamstring, SLR, hip add & hip abd , & hip extension exercises |
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Term
| Rheumatoid Arthritis (RA) |
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Definition
Hands & feet involved first
See swollen joints
Limited motion develops
When knees become involved, a genu valgum deformity develops |
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Term
| Osteoarthritis (DJD) (OA) |
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Definition
Pain, muscle weakness, joint limitations
Genu varum develops in the knees |
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Term
| Common impairments with knee arthritis |
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Definition
Knee loss usually more for flexion than extension
When joint is swollen, joint assumes a position of 25 degrees of flexion
Pain in knee can cause extensor (quadriceps) lag with active knee extension
Decrease mechanical advantage
Decrease physiologic advantage |
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Term
| Acute ot advance stages of knee arthritis |
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Definition
Pain on motion, during gait, with weight bearing activities
Difficulty arising from a chair or commode, descending stairs or squatting |
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Term
|
Definition
Pain on motion, during gait, with weight bearing activities
Difficulty arising from a chair or commode, descending stairs or squatting |
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Term
| Protection phase for knee arthritis |
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Definition
Control pain - use modalities
Minimize stiffness - do Grade 1 or 2 distractions (Grade 3 is contraindicated)
Minimize atrophy - Do muscle setting techniques (open & closed chain)
Protect the joint - use assistive device
Prevent deformity - Bed positioning to avoid flexion contracture
Functional adaptations (elev commodes) |
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Term
| Subacute and chronic phase of knee arthritis |
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Definition
Decrease effects of stiffness from inactivity
Instruct pt to perform active ROM exercise
Decrease pain from mechanical stress
Use assistive device
Increase ROM
Joint mobilization to patella & knee
Passive stretching
Increase strength of knee muscles |
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Term
| Precautions with kne arthitis |
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Definition
Strong muscle contractions may exacerbate joint symptoms - do light resistance
Resistance in mid-range tend to increase patellofemoral pain due to compressive forces on patellas
Only do exercise in pain free arc for hamstrings and quadriceps
Bent leg raises in varying degree of knee flexion |
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Term
| exercise with Osteoarthritis of the knee |
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Definition
Develop patella balance = strengthen VMO
Stretch ITB
Patient Education: Alternate Activity & Rest
Functional training:
Bicycle with high seat for full extension, use light resistance
Swimming |
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Term
| Surgical treatment with patella fractures |
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Definition
MD use ORIF with wiring if displaced
Immobilized till bone heals and NWB approx. 6 weeks
See pt in long leg brace |
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Term
PT treatment for patella fracture
ACUTE |
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Definition
| Glut sets, ankle pumps, ice for edema/pain control |
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Term
PT treatment for patellar fractures
SUBACUTE |
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Definition
Once bone healing starts to take place - begin AROM QS, SAQ, SLR
Maintain patellar mobility = mobilization
Maintain flexion ROM (passive stretching)
Force of muscle contraction can separate fracture site - no heavy resistive ext ex |
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Term
PT treatment for patellar fractures
LATE |
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Definition
Bone healed
Quadriceps, hamstrings, hip, calf strengthening exercises
Care must be taken to avoid aggressive knee extension exercise - avoid slow speed isokinetic
Progress to CKC activities for strengthening and proprioception |
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|
Term
PT treatment with Tibial plateau fx
ACUTE |
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Definition
Do exercises with immobilizer on
= QS, 4-way SLR (hip flex, abd, add, ext) |
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|
Term
PT treatment with tibial plateau fx
SUBACUTE |
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Definition
| Knee flexion exercises & ROM |
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Term
PT Treatment with tibial plateau fx
CHRONIC |
|
Definition
May be 10-12 weeks later
Bone healing must be verified by x-ray
Advanced strengthening
Functional CKC exercises (balance board, wall squats, leg presses, trampoline) |
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|
Term
| Classification of ankle sprains |
|
Definition
Grade I - mild sprain
Grade II - partially torn ligament
Grade III - complete tear or rupture of a ligament |
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|
Term
| Classification of gare III ankle sprains |
|
Definition
First degree - single ligament rupture (anterior talofibular)
Second degree - double ligament rupture (ATF & fibulocalcaneal)
Third degree - all three lateral ligament completely torn (ATF, FC, & posterior talofibular) |
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Term
|
Definition
Pain with weight bearing
Use assistive device
Immobilize ankle to prevent further injury and instability (Air cast) |
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|
Term
PT treatment of ankle sprains
MAX PROTECT |
|
Definition
Treat for pain and swelling - RICE
Do muscle setting techniques
Do isometric exercise for DF & Eversion
Avoid PF & INV = mechanism of injury
Do exercises for knee & hip |
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|
Term
PT treatment of ankle sprains
MOD PROTECT |
|
Definition
Begins when pt can WB without pain and swelling decreased
Continue to provide ankle protection (remove for RX)
Cross fiber massage to ligaments (lateral)
Joint distraction techniques
AROM to resistive exercises with Theraband
Stretch gastrocnemius with towel stretch
Balance activities for proprioception, i.e. sitting BAPS progressed to standing |
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|
Term
PT Treatment of ankle sprains
MIN PROTECT |
|
Definition
Approx 4-8 weeks later
Mobilization to increase DF & Eversion
NO Anterior Glide (don’t need more ROM PF)
Increase strength of peroneals = trampoline side-to-side
Training to improve proprioceptive feedback for ankle stability
= jumping drills, Fig 8 running
Can start on trampoline |
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Term
| Return to sport ankle sprain |
|
Definition
Continue to wear protective bracing to protect from further re-injury for at least 6 months
Emphasis proper shoe fit - may need orthotic if pronated foot |
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Term
| Rupture of achilles tendon |
|
Definition
Occurs with excessive sudden plantarflexion
Seen often with 25 - 50 y/o
PT Test: Thompson test
Pt prone, squeeze muscle belly of gastroc, if no PF observed = ruptured Achilles tendon |
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Term
| Non-surgical tx of achilles tendon rupture |
|
Definition
Patient casted
NO ACTIVE PLANTAR FLEXION TILL TENDON HEALS
Do activities & exercises for uninvolved side, i.e. single leg bicycle with toe clip Surgically suture tendon together
Immobilized up to 8 weeks |
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Term
| After immobilization of achilles tendon rupture |
|
Definition
Protect graft 1st 4 weeks or may rupture with forceful PF or DF
HP/US to increase flexibility of gastroc - do GENTLE stretching
Ice WP/Ice for swelling
Begin gentle Active DF & PF exercises (very slow process to regain full DF) |
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Term
| Mod protec of achilles tendon rupture |
|
Definition
Bicycle (keep seat low to avoid excessive PF or DF)
Resistive Theraband PF & DF
Seated BAPS, calf raises |
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Term
| MIn protect of achilles tendon rupture |
|
Definition
Begin WB plantar flexion when strengthening improved
Can begin jogging when gastroc strength is 70% of uninvolved (Use isokinetic testing) |
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|
Term
|
Definition
Inflammation of plantar aponeurosis from repetitive microtrauma
Often occurs from running and competitive sports participation
Often pt has excessive pronation |
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|
Term
| Symptoms of plantar faciitis |
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Definition
Pain along medial border of the calcaneus on the plantar surface
Increase in pain when foot hits floor, ie. step out of bed
Increase pain when toes extended due to increase tension on fascia, i.e. push off |
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Term
| Conservative tx for plantar faciitis |
|
Definition
Eliminate all factors causing inflammation - avoid activity that causes pain
Use ice & iontophoresis to decrease inflammation
Gentle stretch to plantar fascia, including toe flexors
Strengthen toe flexor intrinsic muscle, i.e. towel curl , marble pick-up exercise
Aerobic exercises in a pool or bicycle
Correct pronation - may need orthosis |
|
|
Term
|
Definition
Overuse of anterior tibialis muscle
= mircrotears of AT & irritation of the interosseus membrane (attachment) |
|
|
Term
| TENDINITIS OR TENOSYNOVITIS |
|
Definition
Tendons of the extrinsic muscles of the foot may become irritated as they cross over the ankle or where they attach in the foot
Pain occurs following repetitive activity |
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|
Term
| Tx of Tendinitis or tenosynovitis |
|
Definition
Stop running/long walking
RICE
Stretch gastrocnemius
Foor orthosis to correct pronation |
|
|
Term
|
Definition
Overuse of anterior tibialis muscle
= mircrotears of AT & irritation of the interosseus membrane (attachment)
Symptoms: Pain along anterior lateral proximal two-thirds of the tibia
Pain increases with active DF & passive PF |
|
|
Term
|
Definition
Stop activity that increases pain
RICE
Stretch anterior tibialis
Muscle sets in pain-free range |
|
|
Term
Tx of Shin splints
SUB ACUTE |
|
Definition
Strengthen inversion muscles (AT&PT) Isometric to AROM to resistance ex.
Correct abnormal foot alignment - orthosis
Patient Education
Stretching before activity
Warm-up
Foot support
Allow recovery time for high intensity work outs to recover from microtrauma |
|
|
Term
| Types of foot/ankle fractures |
|
Definition
Lateral malleolar fractures
Medial malleolar fractures
Trimalleolar fractures
Pott’s Fracture = general term for fracture of 1 or more malleolei |
|
|
Term
| Surgical tx of ankle/foot fx |
|
Definition
In many cases the fractures will be repaired with an ORIF
Pt in semi-rigid splint for 2 weeks
Removed to allow for active DF & PF ROM exercises
No inversion or eversion exercises are performed = Mechanism of Injury
A walking cast is applied once surgical wounds are closed |
|
|
Term
| PT treatment of ankle/foot fx |
|
Definition
After cast removed:
Begin isometric exercises
ROM exercises - use stationary bicycle
Strengthening exercises
Precaution: Watch for signs of possible hardware loosening
= increase pain, swelling, crepitus, decrease motion
- STOP exercise & inform PT |
|
|
Term
|
Definition
Fall from a height and land on feet = compression of calcaneus from the talus
Usually casted or ORIF and immobilized |
|
|
Term
Tx of calcaneal fx
MAX PROTECT |
|
Definition
| Multi-angle isometric plantar flexion and progressed to full ROM with min resistance |
|
|
Term
Tx of calcaneal fx
MOD PROTECT |
|
Definition
Long sitting resistive plantar flexion with Theraband
Prone with knee flexed plantar flexion with weight for soleus |
|
|
Term
|
Definition
Falling from a height and landing on feet in a crouched position
Produces axial compression load between talus and the calcaneus |
|
|
Term
|
Definition
Casted and immobilized for 3 months
Because of the long duration of immobilization and non-weight bearing status:
OA is a common complication
Do strengthening exercises, bicycling 1 legged, aerobic exercise while immobilized for uninvolved side |
|
|
Term
Tx for Talus fx
MAX PROTECT |
|
Definition
Begin gentle ROM exercises once cast is removed
Control swelling and pain |
|
|
Term
Tx of Talus fx
MOD-MIN PROTECT |
|
Definition
| Progress to resistive exercises and CKC |
|
|
Term
| Plane of the scapula (POS) |
|
Definition
Scaption
30 degrees anterior to frontal plane
Do exercises in this plane |
|
|
Term
| SUBACROMIAL ROTATOR IMPINGEMENT |
|
Definition
| A common cause of pain and dysfunction for persons who do repetitive overhead lifting |
|
|
Term
| Intrinsic factors with Subacromial rotator impingement |
|
Definition
Due to bony changes or enlarged tissues i.e.
Flat vs curved/hooked acrominon
Bone spurs inferiorly on acromion
Thickened bursae due to chronic inflammation |
|
|
Term
| Extrinsic factors with Subacromial rotator impingement |
|
Definition
Causes a decrease in the suprahumeral space which causes compression:
Poor position scapula with humeral movement
Patient with forward shoulder & protracted scapula
= weakness scapula muscles
= tight pectoralis minor/major
Tight posterior capsule due to position of humerus
Humeral head elevates and see decrease subacromional space
= humeral head not depress with elevation
= weakness External rotators muscles
= impinge on supraspinatus = pain
Impingment syndrome can lead to RC tears due to poor blood supply to supraspinatus (watershed/critical zone) |
|
|
Term
|
Definition
| Mechanical compression of supraspinatus under acromion > 90 degrees |
|
|
Term
|
Definition
Describes symptoms from faulty mechanics
Due to hypermobility or instability of GH
Hypermobility causes problems:
Impingement
Subluxation
RC tenditinis
Tendon rupture |
|
|
Term
| Symptoms of Rotator impingement |
|
Definition
Pain with overhead reaching
A painful arc with abduction between 60 - 120 º
Pain with resisted internal rotation at 90 º flexion (Hawkins Test)
Pain w/palpation anterior & inferior to acromion with hand behind the back
Avoid all exercises that elicits pain |
|
|
Term
| Common impairments of rotator impingement |
|
Definition
Poor posture
thoracic kyphosis
rounded shoulders with internal rotation
tight internal rotators, weak external rotators
Protracted & anteriorly tipped scapula
Tight pec minor, levator scapula,
Faulty scapulohumeral rhythm
Scapular elevation with humeral elevation |
|
|
Term
|
Definition
RC no longer able to provide dynamic stabilization
No longer provide compressive and translational forces to control normal joint mechanics
Tissue in subacrominal space become impinged |
|
|
Term
| GENERAL TREATMENT PRINCIPLES FOR IMPINGMENT |
|
Definition
Stretch pectoralis major, pectoralis minor
Do scapula stabilization exercises for:
Middle, lower trapezius
Serratus anterior
Rhomboids
Do rotator cuff strengthening exercises
Infraspinatus, Teres minor = external rotation
Supraspinatus = weak due to injury |
|
|
Term
| Non-Operative Impingement Rehabilitation Exercises |
|
Definition
Wall push-ups
Prone extension
Sidelying external rotation
Scaption
Prone horizontal abduction with ER |
|
|
Term
| If pt has a full thickness tear |
|
Definition
Pt will not be able to actively abduct arm but has full passive abduction
See pt hunching shoulder to abduct shoulder, using deltoid muscle
Resisted abduction is weak
Resisted external rotation is weak |
|
|
Term
Rotator Cuff Surgery
“Mini-Open” |
|
Definition
Deltoid is longitudinally split
Repair made using arthroscopic approach
Most common procedure used for medium to large tears
Use abduction orthosis 3 – 6 weeks
Position improve blood flow to area
Decreases stress on repaired tendons
Maximum protection phase last 4 weeks |
|
|
Term
| Surgery for Massive Tears |
|
Definition
Use Open Procedure
For Massive Tears (>5cm)
See an anterolateral incision
The deltoid muscle is detached and reflected to get to the rotator cuff muscles
***Because of this, no ACTIVE flexion is allowed for 6 weeks to allow healing of deltoid
Abduction orthosis for 4-8 weeks
Maximum protection phase last 6 - 8 weeks |
|
|
Term
Rotator Cuff Management
MAX PROTECT (0-6 wks) |
|
Definition
RX: Remove splint for exercise
PROM in pain-free range, usually 90-120 degrees
Codman's pendulum exercise for gentle distraction (no wt)
AAROM doing gear shift, rope and pulley flexion, wand exercise for external rotation ROM
Submaximal isometric exercise with arm in abduction (use large towel roll or bolster) (not till 6 wk for massive tear) for Shoulder IR, ER, Flexion, Abduction
Scapular mobilization
Isometric scapula exercises using submaximal manual resistance |
|
|
Term
Rotator Cuff Management
MOD PROTECT (6-12 wks) |
|
Definition
See atrophy of external rotators
*** Must strengthen before do flexion and abduction
From isometric exercises, can now begin active external rotation exercise and progress to light resistance using theraband or dumbbells.
Continue scapula exercises, i.e ball exercise on table/ wall, kneeling with wobble board
Strengthen serratus anterior, Upper, Middle, and Lower Trapezius, Rhomboids
Do prone scapular retractions with weights to strengthen middle trap, etc. |
|
|
Term
Rotator Cuff Management
MIN PROTECT (12-21 wks) |
|
Definition
Once the patient can demonstrate increased motion without symptoms, pt ready for progression of strengthening exercises with increased intensity and resistance.
Do open and closed chain exercises for flexion, scaption, horizontal abduction with ER, press-ups, rowing, push-ups with a plus (push up with scapular protraction)
Gradually increase speed and intensity of exercise for return to work.
Use caution for repetitive shoulder abduction and flexion above 90 degrees |
|
|
Term
|
Definition
Dense adhesions and capsular restriction = restricted motion especially abduction due to restriction of axillary fold
Primary cause = chronic inflammation |
|
|
Term
| Symptoms of adhesive capsulitis |
|
Definition
Pain and muscle guarding limiting motion
Pain may radiate below elbow
Difficulty sleeping
Pain with motion
Substitutes scapular motions with shoulder motion
= elevates scapula with abduction
Decrease ROM (especially External Rotation and Abduction)
Limitation: Unable to reach behind back (IR & Add), or overhead
Functional limitation: problem putting on coat, bra (behind back activities),combing hair, dishes to cupboard (overhead activities) |
|
|
Term
|
Definition
Control pain: Cold, massage, E-Stim
Elevate if edema in hand
Grade I or II joint mobilization
Add caudal glides when pain decreases
PROM (pain-free range only)
Muscle setting
Scapula, Shoulder, Elbow muscles
AROM elbow wrist (patient education - do to keep mobile) |
|
|
Term
Adhesive Capsulitis
SUBACUTE |
|
Definition
Increase joint mobility = use caudal glide if humerus in cranial position
Codman's Exercise (forward bent or prone)
Self mobilizations
Self stretches
Stretch tight structures = pec minor, pec major
AAROM exercises (wand, cane, pulley)
Strengthen External rotators
Scapular stabilization exercises
(usually see excessive scapula mobility & faulty scapula movements = poor scapulohumeral rhythm)
Teach voluntary humeral depression = patient pushes arm caudally against resistance to elbow = stimulates lower trapezius
Progress to abduction |
|
|
Term
| Exercise Progression for adhesive capsulitis |
|
Definition
Scapula and shoulder AROM
ER/IR exercises with towel roll under axilla to avoid watershed zone
Return to functional activities:
Isokinetic ER & IR in the plane of the scapula (scaption) |
|
|
Term
| Anterior dislocation of shoulder |
|
Definition
Most common dislocation of shoulder
Due to ligamentous and capsular laxity with movement of abduction & ER & extension
See weakness of subscapularis, glenohumeral ligaments, long head of biceps |
|
|
Term
| Common impairments with anterior shoulder dislocation |
|
Definition
Pain and muscle guarding, inflammation
If traumatic dislocation see soft tissue damage, bleeding, inflammation
Restricted ability with horizontal abduction activities = combing back of hair
Restricted ability such as pitching, swimming, tennis serve, spiking
MD do Closed Reduction
Immobilize limb in sling 3-4 weeks |
|
|
Term
| Acute tx of anterior dislocation |
|
Definition
Remove sling to exercise
Do muscles sets
*** Only do ER ROM with arm at side
PROM
***Limit ER to 50 degrees |
|
|
Term
| subacute tx of anterior dislocation |
|
Definition
***ANTERIOR GLIDE mobilization is CONTRAINDICATED
Stretch ER with arm in resting position (NOT 90 degrees)
Strengthen Internal Rotators and adductors
These muscles support anterior capsule & provide eccentric control with ER and abduction
Closed chain exercises |
|
|
Term
| ACROMIOCLAVICULAR SPRAINS (AC) |
|
Definition
| Result of fall on outstretched arm or fall on acromion) |
|
|
Term
| Classification of AC tears: |
|
Definition
Grade I - partial tear acromioclavicular ligament
Grade II- rupture AC ligament, partial coracoacromial ligament
Grade III- both AC & CC complete tear |
|
|
Term
|
Definition
Ice, compression, protect joint
Resume activities after 2 weeks |
|
|
Term
Grade II rehab
MAX protect |
|
Definition
Ice, US, TENS
Submaximal exercises
AAROM = rope & pulley |
|
|
Term
MOD Protect phase
AC tears |
|
Definition
*** Avoid downward displacement of scapula = NO caudle glide to scapula
*** No distraction of humerus = NO mobilization
Active shoulder motions - flexion, abduction, shrugs (limit eccentric lowering to neutral)
Scapular stabilization exercises
Strengthen deltoid & Rotator cuff muscles |
|
|
Term
|
Definition
Dislocation between acromion & clavicle
Operative: MD do surgery using pins or screws (ORIF)
Non-operative: Pt immobilized in sling 8 - 10 weeks
Rehab: Similar to Grade II after immobilization period |
|
|
Term
Lateral Epicondylitis
ACUTE tx |
|
Definition
Ice massage, rest, avoid wrist extension
Cock-up splint = early protected movement
NOT long term immobilization = scarring = decrease motion wrist and hand
Relative rest = remove to do controlled pain-free exercises
Iontophoresis
Submaximal isometrics
Patient Education: Avoid extension motions to avoid stresses |
|
|
Term
Lateral Epicondylitis
SUBACUTE tx |
|
Definition
Ultrasound
Stretch wrist extensors (wrist flex/elbow ext)
Progress to eccentric wrist extension exercise (encourage SLOW eccentric contraction)
Prevents injury = lengthen with increase resistance with eccentric wrist motions
Hammer exercise for pronation/supination, UD, RD |
|
|
Term
|
Definition
Not as common as lateral epicondylitis
Rehab parallels lateral epicondylitis
Focus on wrist flexor eccentric exercises and stretches
Patient Education: Avoid flexion and pronation (lifting, twisting, pulling motions) |
|
|
Term
|
Definition
| Entrapment of Median nerve through Carpal Tunnel |
|
|
Term
|
Definition
Decrease opposition & flexion
Pinch grip (tip to tip)
Opposition (tip#1 to tip #5)
Pad to side grip
Difficulty typing, fine tool manipulation |
|
|
Term
| Non-operative management of CTS |
|
Definition
Adapt environment (modify)
Wrist splint (0 - 20 degrees extension) to support wrist from provoking activity
Mobilize carpals & transverse carpal ligament
Hold pisiform & triquetrum and alternate glide
Stretch adductor pollicis, wrist ROM
Strengthen thumb muscles
Grip, Pinch exercises
Exercise with wrist in functional position (slight extension of wrist) |
|
|
Term
| Operative management of CTS |
|
Definition
MD cut transverse carpal ligament
Immobilized 7 - 14 days
DO AROM all other joints (especially shoulder)
After 14 days: Scar management =cross friction massage
AROM exercises |
|
|
Term
|
Definition
Pt fall on outstretched arm (out of tree, jungle gym)
Immobilization (length of time depends of severity) |
|
|
Term
|
Definition
Type I (non-displaced) = 5 days to 4 weeks
Type II (displaced) = ORIF
Type III = excision of radial head = comminuted fracture of entire head |
|
|
Term
|
Definition
Do hand, wrist, shoulder exercises (part still immobilized - Ex for surrounding jts)
Problems :
contracture occur = flexion contracture = many months to gain full extension
arthrofibrosis = problems pronation/supination
Do joint mobilization once stable when bone union occurs |
|
|
Term
|
Definition
vertebrae
ribs
sternum
clavicle
scapula (attached to the humerus) |
|
|
Term
| contents of the Bony Thorax |
|
Definition
vertebrae
ribs
sternum
clavicle
scapula (attached to the humerus) |
|
|
Term
| Jts of the cervical-thoracic spine |
|
Definition
Costovertebral
Costotransverse
Sternocostal
Facet joints
Intervertebral joints |
|
|
Term
|
Definition
Forms a closed chain
Results in more restricted motion than in other parts of the spinal column.
Important role in ventilation.
Therefore, can use inspiration & expiration to enhance stretching |
|
|
Term
|
Definition
| Follows a course to the brain around and through structures that can impede the flow of blood. |
|
|
Term
| What can impede the flow of blood? |
|
Definition
Muscles around the spine: swelling & spasm
Joints of the spine: inflammation and thickening
Osteophyte formation on vertebrae
Movement: neck rotation with extension |
|
|
Term
| Signs & symptoms of vertebral artery insufficiency |
|
Definition
Dizziness
Diplopia
Dysarthria
Dysphasia
Drop attack |
|
|
Term
| Effects of Poor Alignment |
|
Definition
Total relaxation of muscles
Spinal curves are exaggerated
Passive structural support is required
Over time = end-of-range loading
Increased strain of supporting tissues
Tissues now vulnerable to injury |
|
|
Term
|
Definition
| the lengthening of structures along the longitudinal axis of the body |
|
|
Term
| To correct from poor to optimal requires: |
|
Definition
Craniovertebral flexion
Midcervical flexion to neutral (slight lordosis)
Cervicothoracic extension
Upper thoracic extension to a position of slight kyphosis |
|
|
Term
| Effect of limb muscles on spinal stability |
|
Definition
| The upper extremities provide resistance to the cervical and thoracic spine; therefore, when the limbs move, the spine must stabilize. |
|
|
Term
| Effect of spinal alignment on limb joint mobility |
|
Definition
| Without appropriate spinal and trunk alignment, the extremities cannot perform as intended. The trunk is the base for extremity movement |
|
|
Term
| Effect of breathing on the spine & rib cage |
|
Definition
| With inspiration, the thoracic spine should move toward extension and the rib cage should elevate. |
|
|
Term
| Effect of alignment on muscle function |
|
Definition
| When the spine is in faulty alignment, the action of muscles attached to the spine may be changed from their normal action. |
|
|
Term
Guidelines for Acute (Max Protection Phase)
Cervical-Thoracic |
|
Definition
"Protection Phase"
Establish a position of symptom relief
Flexion bias
Extension bias
Non-weight bearing bias
Decrease pain and inflammation
Patient education |
|
|
Term
Guidelines for Subacute (Moderate Protection Phase)
Cervical-Thoracic |
|
Definition
"Controlled Motion Phase"
Gain control of spinal alignment
Active stabilization exercises in pain free positions
Posture correction
Increase flexibility, strength, & endurance
Relaxation & postural stress relief
Patient education to avoid repeat injury |
|
|
Term
Guidelines for Chronic (Minimum Protection Phase)
Cervical-Thoracic |
|
Definition
Return to Function Phase
Increase flexibility, strength, & endurance
Gain dynamic spinal control in high intensity, prolonged functional activities |
|
|
Term
| Acceleration-Deceleration Injury (whiplash; flexion/extension injury) |
|
Definition
| Most common mechanism of injury is an automobile struck from behind. The head & neck go backward relative to the trunk, then forward with deceleration. |
|
|
Term
| Maximum Protection Phase (A-D Injury) |
|
Definition
Stiffness will occur 24-48 hours after injury
Treatment Focus
Soft collar to remind the wearer to minimize certain movements
Want to decrease movement but decrease the least amount possible – WHY?
Decrease pain –find bias position, relaxation, modalities
Active movement in directions unrelated to mechanism of injury; rotation is often tolerated; muscle setting |
|
|
Term
| Moderate Protection Phase (A-D Injury) |
|
Definition
Larger muscles may not be painful but there may be local areas of tenderness in SCM, suboccipital muscles, and deep anterior muscles
Treatment Focus
Restore flexibility in hypomobile areas: mobilization of spinal segments as needed
Restore optimal posture & begin stabilization |
|
|
Term
| Minimum Protection Phase (A-D Injury) |
|
Definition
There is often adaptive shortening secondary to pain and scar tissue formation.
Treatment Focus
Stretching and other soft tissue work to restore balanced muscle flexibility
Correction of postural deviations
Build endurance in stabilizing muscles |
|
|
Term
| What could cause impingement of the nerve root? |
|
Definition
Change in structures or tissues around the nerve root that press against the nerve or narrow the passage for the nerve.
HNP
Inflammation of tissues secondary to trauma or disease
Facet joint subluxation
RA
Spondylolisthesis
OA, spondylosis, DJD |
|
|
Term
| RA as a Cause of Impingement |
|
Definition
Degenerative changes or inflammation in spinal synovial joints causes impingement of neurological tissues
Degenerative changes results in instability in the spine from necrotic ligaments, bone erosion, and vertebral shifting |
|
|
Term
|
Definition
Treatment
Modalities to relieve pain
Soft collar to provide support
If not in an exacerbation stage, gentle stretching/range of motion in physiologic ranges
Gentle AROM and isometric exercise to tolerance
Traction or joint mobilization can be dangerous and are contraindicated in most cases |
|
|
Term
OA, Spondylosis, DJD
Progression of Change |
|
Definition
Degeneration of the vertebral disc
Hypermobility between vertebrae that causes stress on structures
Stress leads to osteophyte formation (bony outgrowths) with spurs and lipping around the joints edges
Results in hypomobility
Compensatory hypermobility above and below the hypomobile area |
|
|
Term
OA, Spondylosis, DJD
Treatment Focus |
|
Definition
Judicious use of rest and support – keep immobility to a minimum
Address pain and inflammation
Position toward axial extension - allows maximum space between vertebrae.
Increase strength and endurance in stabilizing muscles, to patient tolerance.
Teach patient to avoid destructive movements and positions.
avoid backward bending & backward bending with rotation for these motions narrow the foramen even more. |
|
|
Term
| Maximum – Moderate Protection (Vertebral Compression Fx – Osteoporosis) |
|
Definition
Maximum – Moderate Protection (Vertebral Compression Fx – Osteoporosis)
Initiate isometric contraction of cervical and thoracic spine extensors
Progress to active exercises as tolerated
Teach patient to avoid destructive movements and positions.
avoid forward bending, side bending, and rotation for these motions increase anterior loads on vertebrae |
|
|
Term
| Minimum Protection Phase (Vertebral Compression Fx – Osteoporosis) |
|
Definition
Improve flexibility – site specific to restore normal alignment
Increase strength and endurance in stabilizing muscles – progress to weight bearing positions and exercise
Restore normal body alignment – posture awareness, flexibility, strength, and endurance
Improve patient’s balance and gait
Continue patient education for good body mechanics during ADL’s |
|
|
Term
|
Definition
Decrease inflammation if present
Patient education to modify or eliminate provoking postures or positions and to modify functional activities such as sleeping positions & working postures
Correct faulty respiratory patterns
Stress reduction
Increase flexibility in tight structures – what were some of those?
Increase strength and endurance in postural muscles to allow for optimum alignment of cervical and thoracic areas with good axial extension |
|
|
Term
Ligaments in spine
Anterior to posterior |
|
Definition
1 - anterior longitudinal ligament (anterior to vertebral bodies & intervertebral discs)
2 - posterior longitudinal ligament (posterior to vertebral bodies & IVD)
3- ligamentum flavum (between lamina)
4 - interspinous ligament (between spinous process)
5 - supraspinous ligament (above spinous process) |
|
|
Term
| What ligament limits flexion of spine? |
|
Definition
| Supraspinous and Interspinous ligament |
|
|
Term
| What ligament limits extension in the spine? |
|
Definition
| Anterior longitudinal ligament |
|
|
Term
| What bony structure limits extension of the spine? |
|
Definition
| Shape & slant of spinous process |
|
|
Term
| What dynamic structure limits extension of the spine? |
|
Definition
|
|
Term
| What ligament limits lateral flexion of the spine? |
|
Definition
|
|
Term
| What bony structure limits lateral flexion of the spine? |
|
Definition
|
|
Term
| What dynamic structure limits lateral flexion in the spine? |
|
Definition
| Quadratus lumborum (in frontal plane) |
|
|
Term
| What limits rotation of the spine? |
|
Definition
1) The annulus fibrosus
2) The facets of L1-L4 |
|
|
Term
|
Definition
Transmit forces
Equalize stress
Promotes movement |
|
|
Term
|
Definition
Standing = 100% of Body Weight
Supine = 25%
Sidelying = 75%
Standing & bending forward = 150%
Bending forward in flexed posture & lifting = 275% |
|
|
Term
|
Definition
The layers of the annulus are strained and tightly packed together in posterolateral corner
Radial fissure develop and nuclear material migrated down the fissures.
If outer layer of annulus rupture, the nuclear material extrudes through the fissures.
Results in disk protrusion (HNP) |
|
|
Term
| Asymmetrical forward flexion |
|
Definition
Asymmetrical forward flexion distorts nucleus toward contralateral corner
Posterior longitudinal ligament in center
Annulus weaken with loading - see posterolateral tear
Breakdown of annulus with repetitive loading or trauma |
|
|
Term
| Classification of Protrusions |
|
Definition
1. Prolapse
2. Extrusion
3. Sequestration |
|
|
Term
|
Definition
Use Extension Bias = PT evaluation determined pt SX lessened
[CENTRALIZE vs PERIPHERALIZE]
In positions of extension (lordosis)
= SX can usually be controlled with extension exercises
= SX relieved by moving fluid anterior to reverse stasis |
|
|
Term
|
Definition
1) Rest interspersed with controlled movement, i.e. walking (avoid sitting first few days)
Walking promotes lumbar extension and stimulates fluid mechanics to help reduce swelling,
i.e. compression, decompression
2) Traction - limited to 10 minutes due to imbibition phenomenon
3) Passive positioning = extension position
= McKenzie exercises (considered a First-Aid Ex)
Begin prone with 1-pillow under abdomen (if pt slightly flexed, not tolerate increase extension)
Then remove pillow to increase extension
Do 5 minutes a day, 6 to 8 times/day |
|
|
Term
|
Definition
1) Teach gentle pelvic tilts (APT/PPT supine/prone in pain-free ranges)
Be aware how far rock pelvis without SX & end in APT = extension
2) Walking or swimming
3) Passive SLR to mobilize sciatic nerve
4) Teach pt how to set abdominal and back muscles while performing simple extremity motions = dynamic stabilization |
|
|
Term
| Acute tx of spinal muscle strains/sprains |
|
Definition
1) To decrease inflammation - appropriate modalities, massage
2) Avoid symptom provoking stress to allow healing
If flexion increases symptoms - don't do
If extension increases symptoms - don't do
3) May see lumbar corset
Remove after healing so pt not become dependent and strengthen patient's natural corset
abdominals (TA, IO, EO)
4) Identify functional position which decreases symptoms for several days
(usually in it's shortened position)
5) Begin muscle setting in this position with no increase in symptoms |
|
|
Term
| Subacute tx of spinal muscle sprains/strains |
|
Definition
Patient lies prone or supine (depends on bias) and begins gentle pelvic tilts to decrease fluid stasis
Progress pelvic tilts to sitting then standing
Begin prone/supine stabilization exercises
Correct muscle imbalances = do exercises
Correct areas of inflexibility = do stretching |
|
|
Term
| Chronic tx for spinal muscle sprains/strains |
|
Definition
Identify postural problems
Identify the mechanism or activity that caused injury
Modify environment to eliminate potential for repeating problem
8 times more likely to reinjure after back injury (see same pt over & over in rehab)
Progress level of function to increase strength and stabilization
Continue home exercises and techniques to prevent further problem |
|
|
Term
|
Definition
Williams Flexion Exercises
Increase intervertebral space for nerve root
Traction
Gentle pelvic motions of slow down process of DJD
Dynamic stabilization exercises |
|
|
Term
|
Definition
Manage fractures with lumbar corset
Avoid extension = increases anterior shear of vertebrae
Provide dynamic support for spine with activity = Exercise abdominals
Do stabilization exercises
Stretching for LE |
|
|
Term
|
Definition
Do Williams Flexion Exercises
Patient ambulates with forward flexion posture to reduce leg and back pain (appropriate for DX)
Avoid Extension |
|
|
