General Treatment Flashcards
Mobs, ST, etc.
Soft Tissue Techniques
- Relaxation: breathing, progressive muscle relaxation, mindfulness, autogenic
- Stretching: do not do it… infections unhealed #, joint effusion, recent injection in area, in direction of hyper mobility, movement restrictions specific to certain surgeries
- Massage: do not do if… autoimmune flare ups, fever, hemorrhage, embolism, DVT, flu, migraine headache, serious psych diagnosis, recent surgery, acute RA, sickle cell disease
- Massage types: elleurage, nerve stroking, petrissage (lifting, squeezing and releasing tissue)
Joint Mobiliation Set Up
- Is it safe to mobilize?
- Treatment grade
- Direction of movement
- Patient set up
- Perform treatment
- Vocalize your treatment grade and prescription
- Re-assess
Joint Types
- Hinge: 1 plane (elbow)
- Pivot: limited to rotation (AA joint, proximal rad-ulnar)
- Planar: slide or side and rotation (AC joint, Z joints)
- Condyloid: biplanar, motion in two planes, typically flx/ex and add/abd (knee, TMJ)
- Ellipsoid: biplanar (radial carpa; articulation of the wrist)
- Saddle: biplanar, no rotation but allows flex/ex/abd/add (CM of thumb, sternoclavicular)
- Ball and socket: triplanar (shoulder, hip)W
When to mobilize?
- Pain, muscle guarding, spasm
- Reversible joint hypo mobility
- Positional faults
- Progressive limited
- Functional immobility
When NOT to mobilize?
- Hyper mobility
- Joint effusion
- Inflammation
- Cancer
- Acute arthritis
- Fracture or osteoporosis
- Bone disease
- Empty/bony end feel
- Anticoagulant/steriod use
- Sign of buttock
- Vertebral artery insufficiency
- Craniocertebral ligament instability
Choosing grades for mobilizations
P +++ - no mob
P > R - oscillation or grade 1(acute, irritable)
P = R - grade 1 or 2 (subacute, chronic)
R > P - grade 3 or 4 (chronic)
R, no P - grade 4 or 5 (stiff non-irritable)
Concave-convex rule
If convex surface is stationary and concave surface moves… motion is in the same direction
If convex surface moves and concave is stationary… motion is in opposite direction
Distraction use
- Unweight joint surfaces
- Relieve pressure on the intra-articular surface
- Stretch joint capsule
Postier glide of the shoulder use
- Limited ER or extenstion
Performing Treatment Grade
Grade 1: small amplitude at beinning of range
Grade 2: large amplitude within range, no reaching tissue stretch
Grade 3: large amplitude up to limit of available motion and stressed into tissue resistance
Grade 4: small amplitude at limit of available motion and stressed into resistance
Grade 5: small amplitude, high velocity thrust technique at the limit of available motion.
End Feels
- Capsular: slight give, leather like (frozen shoulder)
- Bone-to-bone: passive range, bone on bone (extension of the elbow - normal)
- Empty end-feel: lack of stoppage or pain that stops movement (shoulder impingement causing pain)
- Springy block end-feel: rebound movement felt at the end range of passive motion (locking of the knee)
- Spasm end feel: involunatry muscle spasm that causes resistance
- Soft tissue approximation: soft tissue of to body segments that prevents further passive range (knee flexion, elbow flexion)
Deep Tendon Friction Massage
- Break adhesion and align collagen
- Prevent scar adhesion
- Mechanoreceptor stimulation to decrease pain
- Contraindications: infection, skin breakdown, inflammatory joint diseases, recent local injection, ossification/calcification, bursitis
Active and Passive Insufficiency
Active Insufficiency: muscle crosses two or more joints and muscle produces same movement at all joints and reached a shortened position that it no longer has the ability to develop more effective tension (grip weakness when the wrist is flexed)
Passice Insufficiency: when lengthening of a muscle presents further movement at a joint that the muscles crosses over (knee flexed will get move DF)
Contractures: Dupuytren’s
- One or more small nodules form in the palm
- Curled fingers - one of more fingers flexed
- Ring and little finger most commonly affected
- Risk factors: common in northern european and Scandinavians, runs in family, increase with age
- Treatment: splinting, education on progression, surgery if severe.
Planes and Axis
- Sagittal: Mediolateral = FLEX/EX
- Frontal (coronal): anteroposterior = ABD/ADD
- Transverse (axial): longitudinal = rotation
