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
Precautions to deep tendon massage
Children and elderly
Diabetes
CI for Assisted cough
Ruptured diaphragm
Inferior vena cava filter
Precautions to assited cough
- Bowel obstruction
- Increased ICP
- Gastric reflux
- Fracture • Abdominal aortic aneurysm (AAA)
- Trauma to chest
- Pregnancy
- Gastrotomy
- Recent abdominal surgery
- Cardiac instability
- Fragile or rigid rib cage
- Thorax/spinal trauma
CI and Precautions to
'HAPPIE CRUU' • Hemoptysis • Aneurism • Patient upset/agitated • Pulmonary embolism • Increased intracranial pressure • Esophageal anastomosis
- Congestive heart failure
- Recent laminectomy
- Untreated pneumothorax
- Unstable cardiovascular status
CI for Percussions/vibrations/ rib springing
- Oxygen desaturation.
- Fractured ribs.
- Osteoporosis.
- Burns.
- Unstable head injury.
- Prone to hemorrhage.
- Metastatic bone cancer.
- Increased intracranial pressure.
- Subcutaneous emphysema of neck and thorax.
- Poor/unstable cardiovascular status.
- Recent skin graft.
- Recent bright red hemoptysis.
- Resectable tumor.
- Pneumothorax.
- Pulmonary embolism.
- Recent pacemaker insertion.
- Pain intolerance to treatment.
- Uncontrolled seizures.
Precautions for vibration/percussion/ rib springing
- Bronchospasm.
- Bruising.
- Patient upset/agitated.
- Tube feed - stopped 30 minutes prior to treatment to minimize risk of aspiration, contraindications and precautions.
CI for nasopharangeal suctioning
- Basal skull fracture
- Nasal bleeding or bleeding disorders
- Nasal stenosis
- Nasal infection
- Nasal pathology (e.g. epistaxis, polyps, septal deviation)
- Acute head or facial injury
- Cerebral spinal fluid leakage
- Epiglottitis or croup
- Increased restlessness and agitation
- Cardiovascular instability
Contraindications to cardiopulmonary exercise:
- Acute myocardial infarction.
- Acute DVT.
- ICP > 20 mmHg.
- Aortic aneurysm.
- Unstable angina.
- Uncontrolled systemic hypertension.
- Resting systolic BP (SBP) >200 mm Hg or resting diastolic BP (DBP) > 110 mm Hg that should be. evaluated on a case by-case basis.
- Orthostatic BP drop of >20 mm Hg with symptoms.
- Severe aortic stenosis.
- Acute systemic illness or fever.
- Uncontrolled atrial or ventricular dysrhythmias.
- Uncontrolled sinus tachycardia (>120 beats per minute).
- Uncompensated CHF.
- Third-degree atrioventricular (AV) block without pacemaker.
- Active pericarditis, myocarditis, or endocarditis.
- Recent embolism.
- Thrombophlebitis.
- Resting ST-segment depression or elevation (>2mm).
- Uncontrolled diabetes mellitus.
- Severe orthopaedic conditions that would prohibit exercises.
- Other metabolic conditions such as: acute thyroiditis, hypokalemia, hyperkalemia, or hypovolemia.
Precautions to cardiopulmonary exercise:
- Pulmonary hypertension.
- Bradycardia/Tachycardia.
- Moderate valvular disease.
- Unstable asthma.
- Diabetic patient with autonomic denervation of heart.
CI for exercise TESTING
- A recent significant change in the resting ECG suggesting infarct or other acute cardiac event.
- Recent complicated MI (unless patient is stable and pain free).
- Unstable angina.
- Uncontrolled ventricular arrhythmia.
- Uncontrolled atrial arrhythmia that compromises cardiac function.
- Third degree AV heart block without pacemaker.
- Acute CHF.
- Severe aortic stenosis.
- Suspecting or known dissecting aneurysm.
- Active or suspected pericarditis or myocarditis.
- Thrombophlebitis or intracardiac thrombi.
- Recent systemic or pulmonary embolus.
- Acute infections.
- Significant emotional distress.
Precautions for Exercise TESTING
- Resting diastolic BP > 115 or resting systolic BP > 200.
- Moderate valvular heart disease.
- Known electrolyte abnormalities (hypokalemia, hypomagnesemia).
- Fixed-rate pacemaker (rarely used).
- Frequent or complex ventricular ectopy.
- Ventricular aneurysm.
- Uncontrolled metabolic disease (e.g. DM).
- Chronic infectious disease (e.g. AIDS, hepatitis).
- Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
- Advanced or complicated pregnancy.
Absolute indications to STOP exercice testing:
- A fall of SBP of > 10 mm Hg from baseline blood pressure despite an increase in workload when accompanied by other evidence of ischemia.
- Moderately severe angina.
- Increasing nervous system symptoms (e.g. ataxia, dizziness or near syncope).
- Signs of poor perfusion (cyanosis or pallor).
- Technical difficulties monitoring the ECG or systolic blood pressure.
- Subject’s desire to stop.
- Sustained ventricular tachycardia.
- ST elevation (+1.0 mm) in leads without diagnostic Q-waves.
Relative indications to STOP exercise testing
- A fall of SBP of > 10 mm Hg from baseline blood pressure despite an increase in workload in the absence of other evidence of ischemia.
- ST or QRS changes such as excessive ST depression (>2mm horizontal or down sloping ST-segment depression).
- Arrythmias other than sustained ventricular tachycardia.
- Fatigue, shortness of breath, wheezing, leg cramps, or claudication.
- Development of bundle-branch block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia.
- Increasing chest pain.
- Hypertensive response (SBP of > 250 mmHg and/or DBP of > 115 mmHg).
