Contraindications Flashcards
List 2 Supine contraindications
Mid-late stage pregnancy.
Acute disc herniation.
List 3 flexion contraindications
Disc herniation.
Osteoporosis.
Mid-late stage pregnancy.
List 3 extension contraindications
Stenosis.
Spondylolithesis.
Facet joint syndrome.
List 3 lateral flexion contraindications
Stenosis.
Facet Joint syndrome.
Osteoporosis
List 4 lower extremity precautions
Pelvic instability.
Osteitis Pubis.
Total hip joint replacement.
Trochanteric Bursitis.
List 3 upper extremity precautions
Thoracic Outlet Syndrome.
Shoulder impingement.
Carpel Tunnel syndrome.
List 3 Inversion precautions
Hypertension.
Glaucoma.
Gastric reflux.
Why is it advised to not lie in supine if a client is in mid-late stage pregnancy
The weight of the uterus can put pressure on the inferior vena cava, reducing cardiac output and impeding blood flow to mother and child.
What is supine hypotension
When uterus compresses vena cava of pregnant woman leading to reduced cardiac output and impeding blood flow.
What is the nucleus pulpous
The soft, gelatinous, central portion of an intervertebral disc
What are the symptoms of an acute disc herniation
Local back pain.
Pressure on nerve roots producing neural symptoms in extremities
What is an acute disc herniation
When the nucleus pulposus bulges or squeezes through a tear in the intervertebral disc
Why should you avoid supine with an acute disc herniation
It aggravates symptoms of back pain and neural symptoms
What is a disc herniation
A slipped disc, where the soft tissue in between the vertebra is pushed out of place. Tissue can slip forward, right or left.
How is disc trauma most likely to occur
Unsupported forward bending.
Rotation in the lumbar spine.
Lifting heavy loads without adequate support.
Name the contraindication with disc herniation
Flexion
What causes osteoporosis
Demineralization of the bone tissue, leading to bone fragility.
Why should clients with osteoporosis avoid spine flexion
It puts excessive pressure on the anterior vertebral bodies which may lead to compression fractures on the spine.
What movements should be avoided with osteoporosis
Spine flexion. End-range side bending and rotation (lateral flexion)
What is osteopenia
Mildly reduced bone mass and precursor of osteoporosis
Why is flexion and long lever loading a contraindication for mid-late stage pregnancy
Can cause bulging of rectus abdomens which cause diastasic recti to develop leading to lumbar instability, severely an abdominal hernia.
What is diastasic recti
Separation of the rectus abdomens along the line of the line alba
What is stenosis
Narrowing of the spinal canal or intervertebral foramen (pressure on the spinal cord/nerves from your spinal cord to your muscles)
What movement aggravates stenosis
Extension through stenotic segments, and lateral flexion
Symptoms of stenosis
back pain, tingling, motor deficits, intermittent pain in one or both legs
What is spondylolithesis
A defect in the vertebral arch (vertebra is displaced/shifts anteriorly) putting pressure on the spinal cord and nerve roots at that level
At which section of the spine does spondylolithesis typically occur
Between the inferior and superior facets, most often L5-S1 or L4-L5
Describe the symptoms of spondylolithesis
Lower back pain and/or neurological damage affecting the spinal cord, nerve roots and the lower extremities
What movement aggravates spondylolithesis
Extension of the affected segments
What is facet joint syndrome
Hypomobility or locking of a facet joint on one side of the spine e.g. cricked neck. Degenerative change to cartilage inside the facet joint, can become inflamed
Symptoms of facet joint syndrome
Low back pain, possibly neural symptoms
What movement is contraindicated for facet joint syndrome
Extension and lateral flexion towards the affected side
Give 2 examples of pelvic instability
Sacroiliac joint dysfunction, pubis symphysis separation
What is pelvic instability
Instability of the joints around the pelvis
Which clients is pelvic instability commonly seen in
Pre and post natal due to production of the hormone relaxin
What does the hormone relaxin do in the body
Induces increased joint laxity in the pelvis
What movement is contraindicated for pelvic instability
Hypo or hyper mobility at any one joint in the pelvis will be aggravated by single-leg weight bearing and asymmetrical movements e.g. side lying
What is osteitis pubis
Painful inflammation of the pubic bones near the midline
What is the common cause of osteitis pubis
Results from repetitive activities which cause movement at the pubic symphysis e.g. running, kicking
What movement contraindicates osteitis pubis
Overload of the adductor muscles and the superficial abdominals can contribute to symptoms. Avoid single leg weight bearing, asymmetrical leg movements and bilateral adductor resistance if they aggravate symptoms
What is total hip joint replacement
Hip replacement surgery involves replacing the femoral head with a metal ball. A lateral approach to the hip joint is taken which results in trauma to the lateral stabilisers of the hip joint, especially the hip abductors
Name a common post-operative complication with total hip joint replacement
Hip joint dislocation
Contraindications of total hip joint replacement
Avoid hip flexion over 90 degrees, adduction and internal rotation (occurring separately or together) of the leg
What is trochanteric bursitis
Painful inflammation of the bursa (fluid filled sac which protects against friction and pressure) which lies between the greater trochanter of the femur and the iliotibial band
Contraindications of trochanteric bursitis
Side lying
Symptoms of trochanteric bursitis
Lack of balance, thigh bone won’t fit congruently, pain/tenderness in hip joint
What is thoracic outlet syndrome
Collective term for number of conditions attributed to compromise of the blood vessels or nerve fibres at any point between the base of the neck and the armpit
List 4 lower extremity contraindications
Pelvic instability, osteitis pubis, total hip joint replacement, trochanteric bursitis
List 3 lateral flexion contraindications
Stenosis, facet joint syndrome, osteoporosis
List 3 extension contraindications
Stenosis, spondylolithesis, facet joint syndrome
List 3 flexion contraindications
Disc herniation, osteoporosis, mid-late stage pregnancy
List 2 supine contraindications
Mid-late stage pregnancy, acute disc herniation
List 3 upper extremity contraindications
Thoracic outlet syndrome, shoulder impingement, carpal tunnel syndrome
Symptoms of thoracic outlet syndrome
Accessory breathing, pain, weakness, tingling and numbness in hand and arm, head forward posture
Which fitness screening would someone with thoracic outlet syndrome possibly struggle with
goalpost
What movement contraindicates thoracic outlet syndrome
Exercises that causes excessive scapular depression e.g. push-up if shoulders collapse down
What is a shoulder impingement
The head of the humerus compresses the supraspinatus tendon, infraspinatus tendon or subacromial bursa against the coracoacromial arch of the scapula leading to localised pain in the shoulder, referred to as pain in the lateral arm and weakness in upper extremity
Symptoms of shoulder impingement
Pain in lateral arm and weakness in upper extremity
Movements that contraindicate shoulder impingement
Elevation, internal rotation and horizontal adduction
What is carpal tunnel syndrome
Nerve entrapment syndrome, entrapment of the median nerve at the wrist
Symptoms of carpel tunnel syndrome
Numbness and pain in the hand, especially at night. Sensory loss and wasting in the hand.
Movements that contraindicate carpel tunnel syndrome
Upper extremity weight bearing may aggravate symptoms and grip may be compromised
List 3 inversion contraindications
Hypertension, glaucoma, gastric reflux
What is hypertension
High blood pressure
Movements that contraindicate hypertension
Positions that increase the blood pressure to the head and neck regions such as inverted positions or positions where the head is below the level of the heart
What is glaucoma
Elevated pressure within the eye due to an obstruction of the outflow of the fluid circulating in the chambers of the eye. The pressure may kill cells in the optic nerve, which can lead to gradual vision loss
Movement contraindications for glaucoma
Inverted positions
What is gastric reflux / gastroesophageal reflux disease
The backwards flow of stomach acid contents into the oesophagus. An injury in the oesophagus that develops from chronic exposure of the oesophagus to acid coming up from the stomach
Symptoms of gastric reflux
Heartburn, discomfort behind the sternum
Movement contraindications for clients with gastric reflux
Inversion
Suggestions to reduce the risk of gastric reflux
Avoid food consumption 2 hours before exercise, monitor supine positions and avoid inverted positions
What is osteoarthritis
Damage to the joint cartilage allowing bone to rub on bone. Pain and inflammation around the joints results in loss of range of motion and function. Additional bony outgrowths (osteophytes) may form at the margins of affected joints. Affects the weight-bearing joints.
Helpful exercise for osteoarthritis and precautions
Maintain strength and mobility around the joint, however excessive work/movement may aggravate symptoms and acutely inflamed joints may require rest
What is rheumatoid arthritis
Immune-mediated condition. Erosion of the joint cartilages leads to arthritis involving many joints in the body, especially hands and feet. Often progressive and chronic
How can a client manage rheumatoid arthritis and their precautions
Maintain strength and mobility around joint. Acutely inflamed joints require rest
Movement contraindications for rheumatoid arthritis
Upper extremity weight bearing may have to be avoided if wrists are affected. Grip may be compromised making exercises holding straps, bars or handles difficult
What is adverse neural tension
Trauma to tissue around the nerves leading to scar tissue formation which pins down the nerve at that level. Most commonly associated with the sciatica nerve (from the buttocks down each leg)
Movement contraindications of adverse neural tension
Stretching, movement associated with sciatica nerve: long sit position, dorsiflexing the ankles, fully flexing the spine. Any combination of spine flexion, knee extension and ankle dorsiflexion
Why is stretching of the affected area for someone with adverse neural tension a negative
Stretching can produce neurological symptoms including numbness, tingling, burning or dural headaches
Give 3 examples of neurological diseases
Parkinsons, ALS, Multiple sclerosis
Give 3 examples of neurological trauma someone might be recovering from
Cerebral vascular accident, spinal cord trauma, head trauma
What should you be cautious of with a patient who has neurological disease or is recovering from neurological trauma
Be cautious they don’t exercise to the point of fatigue or over-heating, it may have adverse effects on the improvement of their function
