Final Flashcards
Purpose of inflammatory aka acute phase
- Defend against foreign intruders
- remove damaged tissue and debris
- immobilize area
Joint effusion
Contained by joint capsule and feels like a waterballon.
Moves when palpated then returns
Edema
Fluid in interstitial space and dents/pits when pushed
Circumference measurement is reasonably accurate
PRICES
Protect Rest Ice Compress Elevate Support
Compression
Decreases edema and bleeding and provides mechanical support
External compression procedure
Wrap distal to proximal
May add U or J shaped felt pad to increase
Internal compression
Compresses lymph vessels and veins
Done through muscle contractions, ROM, pumping ankles, writing alphabet and isometrics
Purpose of external compression
- Pushes flood toward the heart (therapeutic and prophylactic for DVTs and VTE)
- pushes arterial blood into extremity
Intermittent compression
Acute or chronic edema
Mechanical device used that inflates to compress part
Ex: intermittent sequential graded compression (3 parts) that’s repeated hours per day
Compression gradient in compression garments
Increasing compression as continues dismally
What can intermittent compression be combined with
Cooling
Effects of elevation
- gravity augments (increases) lymph flow
- elevation above heart significantly reduces edema in 20 minutes
Forms of “support” in PRICES
- nutritional
- education
- referral for emotional support
- bracing, taping, crutches, canes etc
What is taping and bracing good for?
Acute support
Bracing may inhibit muscle action
Ex: hamstring inhibition with knee bracing
Ambulatory aids
Support/assist when patient cannot walk or put weight on one extremity
-still maintain partial weight bearing but gives local rest to a lower extremity
Fitting of crutches
Positions, arm brace, hand brace
- 6 inches lateral to foot and 2 inches in front of shoe
- arm brace 1-2” below anterior axillary fold
- hand brace elbow flexed at 30 degrees
Improper use/fit of crutches may lead to what
-abnormal stress causing: Lumbar/pelvic subluxation Low back strain Hip strain Crutch palsy (axillary N/vessels-numbness)
Walking with crutches: non-weight bearing vs. partial weight bearing
Non weight bearing: tripod gait
Partial weight bearing: tripod or four point gait
Tripod gait: non-weight bearing
Affected foot fully elevated
Tips move 12-15” in front and swing both legs between crutches and land on healthy foot
Tripod gait: swing-to gait vs. swing-through gait
Swing-to: easier and less coordination
Swing-through: faster, more coordination
Tripod gait: partial weight bearing
Aka four point gait
Affected leg and crutches move forward together
Up and down stairs gait options
Tripod gait and handrail gait
Handrail gait for up stairs
Safer
Both crutches under one arm opposite to the side of the railing and on the affected side if possible.
“The good go up the bad go down”
Unaffected leg steps up followed by the crutches and involved leg
Handrail gait down stairs
Crutches opposite of railing on affected side.
Crutches go down first, then affected leg, then unaffected leg
Tripod stair gait up stairs
Without railing
Step up with unaffected then crutches and affected leg
Tripod stair gait down stairs
Without railing
Crutches and affected leg step first, then unaffected leg follows
Fitting of cane
Length at superior aspect of greater trochanter (of femur)
Use of cane
Cane is used on opposite side of involvement
Moves WITH involved side
Braces for scoliosis
TLSO
-thoracolumbosacral orthosis
CTLSO
-cervicothoracolumbosacral orthosis
Boston brace aka and for?
TLSO-thoracolumbosacral orthosis
Aka under arm brace
Scoliosis
Worn under clothing at least 23 hours a day
For thoracolumbar curves
Milwaukee brace aka and for what
CTLSO-cervicothoracolumbosacral orthosis
For thoracic curves-scoliosis
Includes a neck ring
Worn 23 hours a day
What curves are the boston and Milwaukee braces used for?
Boston: thoraolumbar curves (TLSO)
Milwaukee: thoracic curves (CTLS)
Charleston bending brace
Night brace only used when sleeping
Molded to patient while they are in side flexion to give added pressure
Scoliosis
Braces for spinal fractures
Jewett brace TLSO Extension Voigt-Bahler Knight-Taylor Williams Lennox-Hill
Trochanteric/SI Belts
Support SI joints and pelvis by forcing closure
Used in pregnant/post-partum females with SI joint pain
Causes gapping of SI joints if worn over trochanter
Lumbar supports-thoughtsn
Weak evidence that they prevent re-injury.
Cause increased intrabdominal pressure leading to higher BP and HR. Requires screening for cardiac risk
Should be considered temporary
Knee braces for ACL tears
- pt feels more stable even though not objectively more stable
- doesn’t protect from injury
- bracing slows hamstring reflexes while elastic taping increases
- protects from lateral blows
Knee bracing-neoprene sleeve
- Keep muscles and joints warm
- no injury prevention
- improve proprioception in patients with deficits
Hamstring reflex in brace vs. elastic taping
Brace: decreases
Elastic taping: increases
Cho-Pat use at knee
So good schlatter’s
Cho-pat for elbow
Epicondylitis
Walking boot indications
Fracture
Severe strain
Post surgery
Description of walking boot
Full immobilization and weight bearing
Ankle stirrup inhibits/allows what Motion’s
Allows flexion/extension
No: inversion/version
Orthopedic (fracture) shoe
For fractured toes
Protects from re-injury/aggrevation
Has rigid sole
Plantar fasciitis supports
- thermoskin plantar FXT night splint
- passive night splint
- Strassburg sock
Brace for metatarsalgia
Use a almond shaped bad under the metatarsal heads
Cervical pillows
Little research
- positive results on pain
- mild traction of neck
- should have firm support of curve and doesn’t force flexion or extension
Philadelphia collar
Rigid
Prevent motion
Stabilizes
Some distraction
(C-collar)
Soft cervical collar
Limits cervical motion
No rotation
Used post strain/sprain injuries
Wrist brace name and use?
Cock-up splint
For sprain and CTS
Effects of massage
- increase blood flow and disperses waste
- dilation of lymphatics
- sedation
- muscle relaxation
- removal of lactic acid
- loosens adhesions and soften scars
Indications for massage
- adhesions
- circulatory stasis
- congestion
- edema/joint swelling
- myalgia/trigger points
- tension HA
- postexertion fatigue/stiffness
Contraindications to massage
- arteriosclerosis
- thrombus/embolism
- varicosities
- acute phlebitis
- cellulitis
- synovitis
- abcess/skin infection
- acute inflammatory conditions
Effleurage
Long stroking motions done with palm of hand or flats of fingers
Parallel with fibers
Petrissage
Kneading muscle
Pulling tissue up with fingers: squeeze, pinch, rolling
Tapotement/percussion
Rapid blows Tapping: tips of fingers Hacking: ulnar boarder of hand Slapping: fingers Cupping: cupped hands
Manual vibration
Perpendicular to orientation of muscle fibers
-distal to proximal
Mechanical vibration
G5, genie rub, thumper
High frequency vibration uses
Analgesia Decrease trigger points Pre-exercise warm up Relax spasticity Superficial circulation
Low frequency vibration uses
- decrease congestion/edema/stasis
- milk tissue
- postural drainage
Times for vibration of:
Trigger points:
Muscle relaxation:
Postural drainage:
Body relaxation:
Trigger points: 1 min/spot
Muscle relaxation: 10min
Postural drainage: 15min
Body relaxation: 5min
Cross friction massage
Over ligaments, tendons, muscles
- loosen scar tissue/adhesions
- aid in absorption of local edema/effusion
- mobilize ligaments/tendons/scars
- restore mobility/extensibility
Duration of cross-friction massage
7-10 minutes or until numb. No lotion
Trigger point therapy
Focus on hyerirratibility in muscle/fascia
Rope sign and twitch sign. What and indicate what type of massage
Indicate: trigger point needed
Rope sign: taught band of fibers causing hyper-excitability in surrounding muscles (twitch sign)
Ischemic compression-trigger point
Digital pressure for one minute of series of 7-10seconds
Stripping-trigger point
Sliding along tissue with increasing pressure, pause over trigger point then continue
Spray and stretch (Travell)-trigger point
Vapocoolant spray combined with stretching
Myofascial release
Pressure to tendons, ligaments, fascia and nerve while actively pr passively moving the tissue
ART benefits
- restore strength, flexibility, motion to soft tissues
- release entrapped nerves, circulatory and lymphatics
Concentrates on tissue texture, tension, movement and function
Rolfing
“Balance body within a gravitational field”
Alter a person’s posture and structure with deep massage
Instrument assisted soft tissue mobilization
Allow deeper pressure and less stress on doc’s hands
T-bar FAKTR Graston -localized inflammatory reaction to speed healing -break scars and loosen adhesions
IASTM
Graston technique
Ligaments 43% stronger 4wks post MCL injury, but no difference at 12 weeks
-ligaments had better collagen bundle formation and orientation
FAKTR-PM stand for?
Functional and kinetic treatment with rehab, provocation and motion
F: treat during function, not just static
K: assess and use entire kinetic chain
T: soft-tissue techniques
R: incorporate resistance and proprioceptive
P: produce pain and treat
M: treat with option if more painful
Indication for FAKTR: PM
- Tendinopathies
- Fascial syndromes (ITB, trigger finger)
- Entrapment syndromes
- Ligament pain (sprains)
- Scar tissue/adhesions
- Edema
FAKTR-PM. R examples
Rehab—incorporate resistance and proprioception
Ex: oscillation/vibration and unstable surfaces
SASTM?
Sound assisted soft tissue mobilization
Traction types
Manual
Positional
Mechanical
Inversion
Positional traction
- Knee to chest
- side lying on a roll to open an IVF
Inversion traction
NOT RECOMMENDED
Contraindicated for: Heart disease HTN Glaucoma Sinus infections Asthma Migraines Detached retina
Benefits of spinal traction
Spinal column elongation
Enlarge IVF
Increase diffusion of nutrient to disc
Release pressure on NR
Indications for spinal traction
Neck and low back disorders
- disc
- NR impingement
- joint hypomobility
- arthritis of facets
Contraindications to traction
- infection/tumor
- fracture
- severe herniation
- hypermobility
- VBAI
- spinal stenosis
- osteoporosis
- Aortic aneurysm
- abdominal hernia
- HTN
- pregnancy-lumbar only
Risks of traction
-increase pain
-history of spinal surgery
-spondylosis/spondylistesis
-HTN/respiratory disorders
-dentures (C only)
TMD (C-only)
Instructions of mechanical traction-lumbar
Pelvic and thoracic harnesses Hips/knees flexed Force= 30-60% body weight Angle pull= 0-30 degrees 10-30 minutes
Cervical traction
Over-the-door pulley system
Mechanical
Head/neck angle=0 degrees
10-30% body weight
10-30 mint
Injury taping with keywords: basket weave with stirrups and heel lock?
Ankle injury taping
Ankle injury taping key words
Closed basket weave with stirrups and heel lock
Key words for foot taping plantar fasciitis
1st metatarsals around calcaneous and anchoring
What are you taping for with taping 1st metatarsal through the 5th with anchoring
Plantar fasciitis
