OMM REHABILITATION OF THE EXTREMITIES – Flashcards

Goals to restore function, ADLs, mobility, quality of life Achieved through modalities, manual therapies (OMT!), bracing, exercises, patient education

Proper phases in order for best outcome: 1 decrease pain/swelling, 2 restore ROM and normal arthrokinematics, 3 strength training, 4 neuromuscular control and proprioceptive training, 5 functional or sport specific training

Heat - Superficial heat: hydrocollator packs, heating pads, fluidotherapy, paraffin baths - Deep heat: Ultrasound, hydrotherapy, whirlpool, contrast baths Cold - Cold packs, ice massage, cold water immersion, vapocoolant spray Electrotherapy - Neuromuscular electrical stimulation, transcutaneous electrical stim (TENS), interferential current therapy, iontophoresis

*Manual therapy: soft tissue and ME at this stage will give up most "bang for buck" * Joint mobilization - Gentle ROM, stretch, HVLA (PT not allowed to do - Grade 5 mobilization ie HVLA) Muscle Energy Counterstrain MFR Soft tissue Active release technique (ART) Massage Traction

ROM Strengthening Proprioception Functional activities Home Exercise Program

Dx: Low back pain Rx: Evaluate and treat

Need pt name/date, write PT (gross movement, usually lower extremity) vs OT (more task orientated, usually upper extremity) - Write Dx, therapist needs to know - What precautions that should be taken - Frequency of visits/tx duration - Tx type: modalities, manual therapy, exercise, special equipment or bracing, etc - Pt education, home exercise plan - Goals of pt: helps everyone know what pt is hoping to gain/how hard to push

Physical Therapy 2-3x/week for 8 weeks Modalities, manual therapy Core strength, pelvic girdle stability HEP

*Exercise is KEY* - Successful therapeutic interventions will not be able to sustain themselves over prolonged time - Compensation and chronic injury patterns will induce a reversal to the "original" pathological condition - Exercise, including muscular and fascial retraining is essential to maintain the new changes

Excessive inversion on plantar flexed ankle (Supination/inversion most unstable position of ankle. Dorsiflexion/eversion most stable position) Ligaments involved - *Anterior talofibular (ATF)-MOST COMMON* - Calcaneofibular (CF) - Posterior talofibular (PTF)

Grade 1 (mild) Stretch/minor ATF tear Grade 2 (moderate) Partial/complete tear Of ATF, stretch CF Grade 3 (severe) Complete rupture ATF & CF, partial PTF tear

1) Inspection, palpation, neurovascular exam 2) Ligament testing - Anterior drawer: ATFL --> Positive if >5mm anterior displacement - Talar tilt: CFL, apply inversion stress to ankle --> Positive if >10° side to side difference 2) Adjacent joints above/below (knee and foot) 3) X-ray used to r/o fracture - Ottawa ankle rules to determine when XR warranted - Pain at malleolar regions, inability to bear weight, midfoot pain, tenderness at navicular or head of 5th metatarsal

1) PRICE (pain reduction/restore ROM) - Lace-up brace, aircast, cane/crutches (to offload and protect joint) - Ice, compressive garments, elevation (to decrease swelling) - AROM/PROM: ankle alphabets/circles, gastroc/soleus stretches 2) Therapeutic Modalities - Ice, Ice , MORE ICE; 20 min max q1h - NSAIDS...controversial for ligament healing 3) Therapeutic exercises (ROM, Strength, Proprioception, Function/Sport Specific Techniques) - ROM-Strengthening - Using resistance bands, dorsiflexors and everters most important muscle group to strengthen (Controls excessive inversion/plantarflexion leading to recurrent sprain) 4) Once ROM/Strength improved - Proprioception, function and sport specific techniques --> Single leg stance activities on various surfaces with eyes open/closed 5) Specialized Treatments for Ankle reabilitation 6) Supportive bracing Tape and/or lace up brace 7) HEP - Starts DAY 1! - Good education critical for compliance - PRICE, ROM, balance and single leg activities (ie washing dishes, brushing teeth) progress to uneven surfaces/eyes closed

- Gait/kinetic chain eval: proximal muscle dysfunction found after unilateral ankle sprain - Core muscle strength and activation: Glut medius/maximus, transversus abdominus, multiplanar/multidirections

PT 2-3x/wk for 8-12 wks Dx: Lateral ankle sprain, Grade 1 Precautions: WBAT/Goals: Return to bball Treatment: - Modalities prn - Therapeutic exercise: A/PROM, stretching to restore DF, balance/proprioceptive training, neuromuscular reeducation, aerobic exercises - Please provide HEP

Follow logical progression Literature supports early/accelerated rehab program for Grade 1-2 sprains Tape or lace up braces recommended after 1st sprain to prevent recurrent sprains Neuromuscular retraining and proprioceptive exercises KEY to successful rehab and future prevention Kinetic chain only as good as weakest link Need to rehab deficits UPSTREAM AND DOWNSTREAM from the hip

Diagnosis OA AC joint Differential Diagnosis: OA GH joint RA Cervical radiculitis Rotator cuff injury Labral tear TOS Adhesive capsulitis

Shoulder Pain With Impingement

Thought to be due to repetitive contact of the RTC tendons with local anatomic structures Shoulder pain worse at night and with overhead activities

Neer's, Hawkins-Kennedy, cross-arm adduction

Evaluate for biomechanical factors: postural assessment (anterior head carriage, kyphosis, scoliosis), ROM (pec minor tightness, GIRD), flexibility, RTC strength (full vs. partial tear), & scapular mechanics (scapular dyskinesia) DON'T Forget to rule out injuries to surrounding areas: neck & upper limb, c-spine ROM, neurological exam MRI/US should be considered if significant RTC tears are suspected

S: Scapular malposition on the rib cage I: Inferior medial border winging from weak middle and lower trapezius muscles C: Coracoid pain and malposition from the attachment of a tight Pectoralis minor muscle pulling on the coracoid K: Scapular dysKinesis from alterations in muscle recruitment patterns The S.I.C.K. scapula is a pneumonic that was developed to help describe a group of findings in the shoulder and scapula

Scapular rehabilitation: strengthening lower trap, middle trap, serratus anterior Normalize resting position - Correct imbalance of scapular stabilizers - Upper/Middle/Lower trap - Serratus anterior

1) Manual Therapy - Stretching the posterior shoulder capsule --> Spencer Technique - Stretching/relaxing the tight muscles that pull the scapula into a different position --> MFR and ST to pec minor and surrounding fascia --> MFR and ART to latissimus and teres in axilla 2) Therapeutic Exercise 3) Remember the order: - ROM/ flexibility - RTC strengthening - scapular strengthening & stabilization 4) Kinetic chain movements, plyometrics, sport specific exercises (athletes) 5) Home Exercise Program 6) Postural training 7) Take home stretches, exercises 8) Activity modification to minimize pain during functional task: - Lift objects close to the body - Only lift light weights &limit lifting to below shoulder level - Do sidestroke or breaststroke when swimming - Throw balls underhand or sidearm - Avoid pushing exercises at the gym --> (eg, pushups, bench press, flys, shoulder press) - Maintain good posture with writing, assembly work, and other tasks by keeping the shoulder blades down and back

Therapeutic Exercise - ROM & Flexibility (Stage II) - Pendulum exercises: if pain free ROM needed - 2 areas responsible for impingement if tight: pec minor and posterior/inferior capsule --> Pec minor stretch --> Cross body adduction

Strengthening of the RTC - Advance based on pain tolerance - Isometric with ext/int rotation - Isotonic strengthening with bands, resistance tubing or dumbbells

PT 2-3x/week for 8-12 weeks Dx: R shoulder pain with AC arthritis, impingement symptoms & scapular dyskinesis Precautions: WBAT/Full pain-free ROM Treatment: - Modalities prn (cryotherapy, moist heat) - Manual therapy: ST mobilization, GH mobilization - Therapeutic Exercise: pain-free ROM, stretching (pec minor), strengthening (scapular stabilizers, RTC) - Specialized treatments: postural training - Please Provide HEP (Patient education)