Contraindications/ precautions Flashcards
CI for resistance exercises
- If pain is experienced with AROM/PROM exercises
- Acute inflammation - dynamic resistance is CI
- Joint effusion
- Uncontrolled hypertension
- Severe cardiovascular disease or unstable symptoms
- Symptomatic congestive heart failure
- Fracture
- Within 4-6 weeks of a myocardial infarction
- Joint/muscle pain during AROM or muscle testing
- If significant: bony metastasis, osteoporosis, low platelet count (<20,000)
Contraindications to stretching:
o Acute infection/inflammation
o Forcing a joint beyond normal ROM
o Movement restrictions specific to certain surgeries (e.g. Total hip replacement)
o Unhealed fracture
o Joint effusion
o Hematoma
o Sharp or acute joint pain
o Recent corticosteroid injection to the involved tissue
o Hypermobility/instability in direction being stretched
o Bony block limits motion
Precautions to stretching:
Limb soreness >24hrs after stretching
o Osteoporosis
o Newly united fracture
Indications of Serious Spinal Pathology Red Flags
• Presentation age younger than 20 years or onset older than 55
• Violent trauma, such as a fall from a height or car accident
• Constant, progressive, non-mechanical pain
• Thoracic pain
• Previous history of carcinoma, systemic steroids, drug abuse, HIV
• Systemically unwell weight loss
• Persisting severe restriction of flexion in lumbar spine
• Structural deformity
• Investigation
o Elevated ESR
o X-ray vertebral collapse or bone destruction
Indications of Serious Spinal Pathology:
Cauda Equina Syndrome
- Difficulty with urination
- Loss of anal sphincter tone or fecal incontinence
- Saddle anesthesia
- Widespread (more than on nerve root) or progressive motor weakness in the legs
- Gait disturbance
Laminectomy post-op precautions
• Do not sit for more than 20–30 minutes continuously for the first two weeks after surgery.
• Maintain a neutral back when moving from supine to sit and vice versa:
- PT needs to teach proper log roll in and out of bed
- Log rolling ensures the patient gets in/out of bed with a neutral spine
• After surgery, do not lift, push, pull or carry anything that weighs more than 5 to 10 pounds.
• Do not engage in any activity that requires repetitive and/or excessive bending, twisting or reaching in any direction.
• Patients should receive permission from their surgeon before returning to sports and other physical activities.
• It is important that the team is advised right away if the patient experiences new numbness, tingling, or increased weakness as this could be a sign of nerve compression/surgical complications.
CI to Spinal Traction
- Acute sprains or strains.
- Acute inflammation.
- Recent unhealed fractures.
- Vertebral joint instability.
- Any condition in which movement exacerbates existing problem.
- Bone diseases.
- Osteoporosis.
- Local infections in bones or joints.
- Vascular conditions/compromise.
- Recent surgery.
- Pregnant females.
- Severe cardiac or pulmonary problems.
- Malignancy.
- Infectious or inflammatory arthritis.
- Signs or symptoms of spinal cord or cauda equina compression.
- Pain during manual traction/unable to tolerate position.
- Patient has had bad response to manual traction.
CI for Cervical Traction
- Signs and symptoms of vertebral artery compromise.
- Cervical myelopathy.
- Rheumatoid arthritis.
- TMJ dysfunction.
- Glaucoma.
CI for heterotopic ossification:
o Forced stretch
o Massage
o Casting
o Strenuous/resistive exercises
Precautions post fracture
- No stretch or resistive forces around the fracture sit until the bone is radiologically healed.
- Radiologically healed = calcification on x-ray (around 6-8 weeks)
- No excessive joint compression or shear for several weeks after the period of immobilization.
- Use protection, weight bearing cannot begin until fracture is radiologically healed.
Sign of the Buttock
Rheumatic bursitis Osteomyelitis of the upper femur Neoplasm of the upper femur Neoplasm of the ilium fractured sacrum Ischiorectal abscess Septic sacroiliitis Septic bursitis
CI for massage
Autoimmune disease during flare ups Fever Hemorrhage Embolism DVT Flu Migraine headache (Vascular headache that can increase with increased blood flow from massage) Serious psychological diagnosis Recent surgery Acute Rheumatoid Arthritis Sickle cell disease Pneumonia
When not to mobilize a joint
Hypermobility Joint Effusion Inflammation: gentle oscillating or distraction are appropriate Cancer Acute arthritis Fracture or Osteoperosis Dislocation Bone disease Inflammation Empty/bony end feel Anticoagulant/ steroid use Sign of buttock Vertebral artery and insufficiency Craniovertebral ligament instability • Neurological signs/symptoms of a spinal cord injury (spinal mobilization). • Spasm, bony, or empty end feel. • Lack of patient consent. • Infectious arthritis. • Acute arthritis. • Fusion or ankylosis. • Ligament rupture. • Joint effusion. • Vertebral artery insufficiency. • Craniovertebral ligament instability.
Precautions to joint mobilizations:
Impaired/diminished circulation or sensation.
• Hemophiliacs (clotting disorders).
• Poor skin condition.
• Open wounds near area.
• Discomfort in treatment position.
• Marked skeletal deformity.
• Elderly or individuals with weakened connective tissue.
Contraindications to deep tendon friction massage
Infection/ skinbreakdown Inflammatory joint disease Recent local injection Ossification/calcification Bursitis Connective Tissue Disease Neural Irritation Long-term steroid, anticoagulant, or anti-inflammatory drugs
