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Ortho 3 > Grimsby > Flashcards

Grimsby Flashcards

0
Q

What do you have to understand?

A
  • Anatomy
  • Pathology
  • Biomechanics
  • Histology
  • Traumatology
  • Neurology
  • Exercise Physiology
  • Examination
  • Treatment (Manual Therapy and Exercise Prescription)
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1
Q

OGI - What is unique to this approach? (4)

A
  • Manual therapy lesion
  • Tissue specific diagnosis
  • Scientific understanding of all of the sciences in relation to MSK management.
  • Exercise dosage and prescription.
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2
Q

History

A
  • In the 1970’s we integrated advanced biomechanics
  • In the 1980’s we added current pain concepts
  • In the 1990’s we added relevant histology for specific tissue repair
  • In the 2000’s we integrated nutrition and supplements
  • Through the last 10 years we added: pharmacology, electro-neuro-myography, clinical psychology, imagery, diagnostic methodology, >60 dissertations supporting our curricular evidence.
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3
Q

EBP

A

Today it is the gold standard for credentialed, “evidence based” therapy.

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4
Q

OGI Program Series

A
  • 1 to 5 day weekend courses
  • Manual therapy clinical certification
  • Orthopedic clinical residency
  • Manual therapy fellowship
  • Advanced clinical specialist - Ph.D
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5
Q

Examination

A
  1. Initial Observation
  2. History/Interview
  3. Structural Inspection
  4. Active Movements
  5. Passive Movements
  6. Resisted Movements X 3 (3 position testing)
  7. Palpation
  8. Neurological Examination (after AROM)
  9. Specific Mobility Tests and Positional Faults
  10. Specific Regional Tests (special tests -1st)
  11. Additional Test (MRI, x-ray, etc.)
  12. Correlation
  13. Treatment
  14. Prognosis
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6
Q

Cyriax Differential Diagnosis

A

A. Provoked Tissue - Normal Tissue = Pathological Tissue

B. Pathological Tissue - Contraindications = Treatment

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7
Q

Compare and Analyze Movements - Active and Passive

A
  • Active Movements: Test all anatomical structures
  • Passive Movements: Test all “inert” structures (nerve, ligaments, capsules, bursa, bone, blood vessels, connective tissue).
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8
Q

Arthrogenic vs. Soft Tissue Lesion

A
  1. Active and passive motion is restricted and/or painful in the same direction. –> Arthrogenic Lesion
  2. Active and passive motion is restricted and/or painful in the opposite direction. –> Soft Tissue Lesion
  3. Test restricted motion in 3 different positions of the joint to evaluate entrapments. –> Soft Tissue Lesion
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9
Q

SBR increases pain

A
  • Compromise foramen R
  • Increase of disc protrusion
  • Incarcerated capsule
  • Facet entrapment syndrome
  • Painful inf. facet capsule
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10
Q

SBL increases pain

A
  • Protrusion in n. root axilla
  • Adhesion about a root
  • Painful superior facet
  • Tender muscles
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11
Q

RL increases pain

A
  • Incarcerated capsule
  • Compromise neural foramen
  • Increase disc protrusion
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12
Q

RR increases pain

A
  • Facet capsule stretch

- Protrusion in a n. root axilla

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13
Q

SBL and RR increases pain

A

-Facet capsular stretch

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14
Q

SBL and RL increase pain

A
  • Incarcerated capsule

- Facet capsule stretch

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15
Q

SBL relieves pain

A

-Neural compromise

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16
Q

SBR eases pain

A

-Protrusion in n. root axilla

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17
Q

What are the SOURCES of pain in the neck?

A
  • muscle spasm
  • ligaments
  • disc
  • facet joint
  • bone
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18
Q

Need to differentiate between these:

A
  • Cervical disc
  • Facet entrapment
  • Facet arthritis
  • Nerve root compression
  • Uncovertebral pathology
  • Ligamentous strain
  • Capsulitis
  • Whiplash associated disorder
  • Muscle strain
  • Trigger points/chronic tension
  • Upper cervical vs. lower cervical
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19
Q

Key Tool for Grimsby

A

The Diagnostic Pyramid

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20
Q

Manual Therapy Lesion

A
  1. Collagen trauma
  2. Receptor damage
  3. Reduced muscle fiber recruitment
  4. Tonic fiber atrophy
  5. Reduced anti-gravity stability
  6. Motion around non-physiologic axis
  7. Trauma/Acute locking
  8. Pain/guarding
21
Q

Grading Joint Mobility

A

Kaltenborn’s
0 = Ankylosed; surgery, no PT treatment
1 = Considerable Limitation; articulation, avoid exercise
2 = Slight Limitation; articulation, manipulation, self mobilization exercise
3 = Normal; no treatment needed
4 = Slight Increase; postural correction, check for hypomobility, ADL and ANL, taping, self stabilization exercises
5 = Considerable Increase; postural correction, check for hypomobility, ADL and ANL, taping, collars and corsets, dry needling, sclerosing injections
6 = Pathologically Unstable; surgery, no PT treatment

22
Q

Mobilization Methods

A

-Mobilization = movements which increase mobility. They can be:
1. Passive Movements:
A. Articulation = rhythmically repeated, passive joint movements
1) Distraction = separation of joint surface
2) Glide = translation of joint surfaces
B. Manipulation = high velocity, short amplitude thrust at end of range
2. Active Movements:
A. Self Mobilization = rhythmically repeated active joint movements

23
Q

Guidelines for Choice of Articulation

A
  1. Where in the body is the problem?
  2. Which mechanoreceptor has the highest density in that area?
  3. What is its adaptation period?
  4. Which technique does that indicate, stretch or oscillation?
  5. Where in range?
  6. Which direction?
  7. Is the problem acute or chronic?
24
Q

History of Exercise Therapy

A
  • De Lorme & Watkins (1951) - progressive resisted exercise
  • Knight (1985) - daily adjustable progressive resistance exercise (DAPRE)
  • Odvar Holten (1965) - ‘The Holten Curve’ and ‘Medical Exercise Therapy’ (MET)
  • Ola Grimsby (1995) - ‘Scientific Therapeutic Exercise Progression’ (S.T.E.P.)
25
Q

Medical Exercise Therapy

A
  • Medical Exercise Therapy (MET) is an active rehabilitation system based on more than 30 years of clinical experience and research.
  • Local and global exercises.
  • Active graded exercise program treating pain, decreased motion, increase endurance and strength as well as improving activities of daily living.
  • The system accommodates for treating athletes and ordinary patients with tolerance for loading and to normalize muscle imbalance and coordination.
26
Q

MET - repetitions

A
  • During this hour most patients who are in an early phase of the treatment, are able to do seven to nine different graded exercises doing three sets of thirty repetitions, up to one thousand repetitions during one treatment session.
  • The high number of repetitions are aimed at treating the pain experience and to increase range of motion.
27
Q

STEP - Scientific Therapeutic Exercise Progression - Phase I

A
  • Phase I - pain free phase focuses on coordinated mobility and stability around physiological axes throughout the ROM.
  • Goals - increase circulation to the tonic system, prevent atrophy, increase protein synthesis, and reduce the level of metabolites.
28
Q

STEP - Phase II

A
  • Phase II - Restoration of function phase which focuses on increasing tissue tolerance to levels corresponding to the demands of ADL’s.
  • Goals - Restore and enhance function. Strength, endurance, ROM, speed, WB capability, and coordination. Optimum stimulus for regeneration of each specific tissue.
29
Q

STEP - The Progression

A
  1. To increase the tissue tolerance to ADL’s
  2. Functional Qualities - elements in active movement that contains the optimal stimulus for tissue improvements, maintenance and regeneration
  3. Motion around a physiologic axis - arthrokinematic exercise - tonic muscle - coordination and endurance vs. osteokinematic exercise - phasic muscles - power/strength
30
Q

Goals for Dosage and Selection of Exercise

A
  1. Reconditioning - Endurance and Strength
  2. Stabilize a Hypermobility
  3. Mobilize a Hypomobility
  4. Coordination/balance/skill
  5. Selective Tissue Training - OSR
  6. Cardiopulmonary Reconditioning
  7. Neuro-physiologic Pain Control - Dorsal Horn inhibition, high frequency afferent - Spinothalamic tract, Opiate System, Endorphin Release, decrease a sympathetic overflow
  8. Decrease disability behaviors - psychological functions ***This could be the most important reason.
31
Q

Functional Qualities

A
  • Power-Heavy resistance/few reps
  • Strength
  • Volume
  • Speed
  • Coordination
  • Endurance-light resistance/many reps
32
Q

Holten Curve

A
  • RM: Resistance Maximum - the amount of weight that can be overcome one time with a group of muscle. DeLorme and Watkins
  • Exercise with 30 reps at 60% 1 RM can cause increased blood flow to the muscle.
  • Minimal strength gains begin at 47% 1 RM.
  • Muscles in atrophy should not exceed 30-40% 1 RM initially.
  • Initial strength gains are due to improved neurology, not to muscle hypertrophy. Approximately 6 weeks before hypertrophy begins.
  • How to calculate 1 RM.
33
Q

Bone - Optimal Stimulus for Regeneration/Normal Healing Times

A
  • OSR - Biomechanical Energy in the Line of Stress without shearing
  • Healing Time - 4-6 weeks UE; 6-8 weeks LE
34
Q

Collagen

A
  • Type 1 - primarily capsule, ligament, tendon, connective tissue of muscle, nerves, blood vessels
  • OSR - modified tension in the Line of Stress
  • Healing Time - 6-8 weeks, skin/subcutaneous 7-10 days
  • Type 2 - primarily articular cartilage and fibro cartilage
  • OSR - compression, decompression and gliding
  • Healing Time - hyaline articular cartilage 4-6 months secondary healing with fibro cartilage; fibro cartilage 3-4 months - meniscus regeneration
35
Q

Muscle

A
  • Muscle - not just static biomechanical structures - neurophysiologically controlled from local reflexive activity - gamma bias, muscle spindles, GTO - and upper motor neuron influence.
  • OSR - modified tension in the line of stress - dosage for functional quality. 2-4 weeks - do not forget CT takes 6-8 weeks.
36
Q

Effects of Immobilization - The Injury Disguised

A
  • Movement is critical to tissue health
  • Immobilization is destructive
  • Examples:
  • Overuse injuries - tissue is only stimulated in a limited ROM, thus outer ROM is immobilized
  • This area is under stimulated and undernourished
  • No different than immobilization by splinting, casting, etc.
37
Q

Treatment is only as Good as Your Evaluation

A
  • Tissue Specific Diagnosis
  • Cyriax equation to derive inert or contractile lesion
  • Determine the cause of weakness - inhibition vs. atrophy
  • Examples - compression when decompression is needed
  • Over tensioning connective tissue
38
Q

Information Needed for Exercise Selection

A
  1. Tissues involved - variables for Healing Time - degree of injury, vascularity.
  2. Optimal Stimulus
  3. Correct Dosage for that tissue
  4. Proper nutrition to the tissues - circulation/vascularity and nutrients, hormones and enzymes.
  5. Reactive capacity of the individual - age, complicating factors - diabetes, other disease processes, smoker, etc.
39
Q

Localize the Effect with:

A
  • Tools: apparatus, bolsters, wedges, pillows, tables

- Skills: artificial locking, ligamentous locking, joint locking, coordinative locking

40
Q

Hypomobility Progression - 1st

A

-Many resps
-Low speed
-Minimal resistance
-Outer ROM
Goals:
-Increase endurance
-Increase circulation
-Increase exercise ability
-Avoid over exertion

41
Q

Hypomobility Progression - 2nd

A

-Increase reps
-Increase speed
-Do not increase resistance
Goals:
-Further increase endurance and fast coordination

42
Q

Hypomobility Progression - 3rd

A

-Stabilizing exercises in the gained ROM - concentric and eccentric
Goals:
-To increase strength in the gained ROM

43
Q

Hypomobility Progression - 4th

A

-Coordination tonic and phasic function throughout physiologic ROM
Goals:
-Functional stability

44
Q

Hypermobility Progression - 1st

A

-Many reps
-Low speed
-Minimal resistance
-Beginning to mid range of motion
Goals:
-Increase endurance
-Increase circulation
-Increase exercise ability
-Avoid over exertion

45
Q

Hypermobility Progression - 2nd

A

-Increase reps
-Include isometric contractions in inner ROM
Goals:
-To increase strength and increased sensitivity to stretch.

46
Q

Hypermobility Progression - 3rd

A

-Sub maximal (80% 1RM) resistance - concentric and eccentric
-Include isometric contractions in the full ROM except the outer ROM
Goals:
-To further increase dynamic stability

47
Q

Hypermobility Progression - 4th

A

-Coordinate tonic and phasic function throughout the physiologic ROM
Goal:
-Functional stability

48
Q

Important Concept

A

“Prior to attempting to rehabilitate muscle function, it is essential to first minimize the effects of pain and any reflex inhibition of the muscles concerned. In addition, the effect of any tight opposing structures needs to be assessed and treated appropriately.’

49
Q

Cervical Examination

A

Differentiation in:

  • cervical disc - compression, shearing, flexion
  • facet entrapment - rotation, sidebending, extension to the side of pain, palpation, pain the same active or passive
  • facet arthritis - rotation, sidebending, extension to the side of pain, crepitus
  • nerve root compression - Spurling’s, neurologic exam, relief with traction, positive upper limb tension test
  • uncovertebral pathology - sidebending to the painful side
  • ligamentous strain - symptoms with stretch/stress of the ligament
  • capsulitis - rotation, sidebending, flexion away from the side of pain, palpation, resisted testing
  • muscular - pain with resistance in 3 positions, pain to palpation, pain with stretch
50
Q

Exercise Prescription - What do I need to consider?

A
  • What is the tissue in lesion?
  • What are the causative factors?
  • Do I need to stabilize or mobilize?
  • What exercise mobilize or stabilize the tissue in lesion?
  • How do I progress/translate this into function?

Ortho 3 (4 decks)

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