Intro Flashcards
Assessment of joint mechanical capacity is not dictated by the _____, but is performed ______ to assess the surrounding connective tissue which typically limits joint mobility.
Angles of the articular surfaces, but is performed three dimensionally
Efficient motor control requires: efficient ____
Efficient mechanical capacity and neuromuscular function
Efficient motor control requires: the presence of an ____
An integrated sensory and motor homunculus which can effectively recognize sensory input and activate effective motor output for any given automatic or volitional movement
Efficient motor control requires: the presence of _____
Corefirst strategies (proper synergistic activation of local and global muscles) to promote smooth and coordinated patterns of movement
Efficient motor control allows for___
Anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) to best adapt to external input or control intentional movement
What are the physical effects in the loss cycle?
Shock
- sleep and appetite disturbance
- numbness
- irritability
What are the integration factors in the loss cycle?
“Acceptance”
Positive feelings
Lessons learned
Future planning
What are the mental effects in the loss cycle?
“Disorganization “
Depression
Social withdrawal, isolation
Feeling of going crazy
Suicidal ideas
Hopelessness
What are the emotional effects of the loss cycle?
“Distress”
Flood of feelings
Anger
Sadness
Fear
Difficulty coping
Helplessness, why me?
What are the interventions in the loss cycle for the physical effects?
Release of physical tension, normalize breathing patterns
Introduce loss cycle
Goal is patient safety
What are the interventions in the loss cycle for emotional effects?
Encourage expression of feelings into words
Pain diary/med monitor
Goal is support and understanding for patient’s emotional hurt
What are the interventions in the loss cycle for mental effects?
Engage pt support system
Set clear limits, contract, if needed, on specific issues
Provide information sources
Goal is to assist pt to be active “within” current limits
The acute pain experience should be a ____ process
Self-limiting
Pain should stop when it no longer has _____
Biological value
In a sustained pain experience, _____ , and the pain experience becomes protracted.
Acute processes fail to cycle down
When the nervous system and immune system fail to cycle down, _____
Inflammation becomes systemic.
Brain hypersensitivity (a central, ____ ____ _____) can generate pain without any input from the body
Glial immune process
Chronic hormone and immune activity can lead to ______ and that can cause pain
Auto-immune responses in the body
Down regulating chronic central and systemic inflammation requires a multi system approach and includes:
Re-educating the brain on pain process.
Regulating stress.
Replenishing nutrients.
Enhancing antioxidant and anti-inflammatory nutrition.
Restoring hormonal balance
Achieving sleep
Healing the GI system
RESTORING EFFICIENCY THROUGHOUT THE BODYS STRUCTURES AND FUNCTIONS
Nutrition of the disc is gained through _____
Fluid imbibition
Dropping a leg off the side of the chair assists the pelvis to assume and maintain a neutral position by _____, and helps to distribute weight into the base of support.
Using the tension of the hip flexors to support the spine
What are some acute strategies for treating through the basic FM principles?
Gentle gentle oscillations to soft tissues and articulations in NWB
Tone reduction (relaxation and gentle MTT)
Decrease inflammation, swelling, edema - modalities and ice
STM to associated soft tissue restriction
Note if pain is related to associated dysfunction
STM shortened range
Train in self-care and pain reducing exercise
What are some subacute strategies to apply for basic FM treatment principles?
Decrease tone and inflammation, improve soft tissue and articular mobility.
More aggressive STM and more directed. Progress shortened to lengthened.
Promote healing, initiate rehab, exercises and training in efficient posture and movement.
What are some strategies for FM treatment in sustained pain situations?
Decrease tone, inflammation and central sensitization.
STM to area and all associated areas, more toward lengthened range.
Treat compensations - progress to weight bearing postures.
Aggressive rehab and training in full return to work and activity.
In preparation for treatment, what factors need to be considered for positioning?
Irritability of symptoms, type of dysfunction and tenderness of tissues palpated. Begin in shortened range and progress to mid and lengthened ranges.
When is vertical compression contraindicated in sitting?
Pt is highly irritable to loading.
Increase in painful symptoms with just placing hands on shoulders.
Do not add more force after beginning to produce symptoms or after segmental displacement occurs.
Anyone with delayed onset of symptoms after being treated (subjective evaluation).
Symptoms, fracture, etc. of upper quadrant may be exacerbated with application of vertical pressure.
When is VCT contraindicated/use precaution in standing?
Same as sitting as well as:
Acute lumbar shift (derangement) - correct derangement first.
LE dysfunction may be exacerbated by compression.
When is EFT contraindicated/use precaution?
UE problem - elbow/shoulder fracture or pain which may be exacerbated by compression.
TOS symptoms which are increased by minor elbow flexion resistance.
Irritable cervical symptoms
When is LPM contraindicated/should use precaution?
Highly irritable pt - or if increased symptoms are experienced.
Pt must be supported or test avoided if marked balance disturbance exists.
If mild VCT increased symptoms, only test in corrected position.
List the contraindications for superficial fascia:
Finger glide through friable or irritable skin such as fresh incision, burn, grafted area, psoriasis and elderly; easy bruising of PVD or enervated regions. Skin glide often can be done in these cases, except with recent skin graft.
When should you use caution with treating bony contours of the iliac crest?
Hypermobile innominate into anterior torsion
Acute nerve root pain or clinical nerve pain may be exacerbated with firm pressure to iliac crest.
When should you use caution with treating bony contours of sacral sulcus?
Hypermobility of sacrum. Use less force and cascade of techniques.
When should you use caution with bony contours of 12th rib?
Steroid use, osteoporosis, fracture.
Patients with kidney and spleen problems and all transplant patients.
Unstable thoracic lumbar region.
When should you use caution with associated oscillations?
Vestibular symptoms or vertigo.
Caution with hyper mobility.
Contraindicated on side of nerve root pain.
Caution with highly irritable articular or myofascial structure in region used for oscillation.
When should you use caution with treating bony contours of groove of spine?
Suspect or confirmed fracture of spine; work superior to inferior direction first to avoid lymph stains in upper thoracic region.
Osteoporosis.
Caution to maintain neutral during Rx of: acute hypermobile segment or acute nerve root
What are the 5 concepts related to sustained pressure for skin/superficial fascia mobilization?
Pressure - fingertips/thumbs, medial border middle finger tip
Tension - specific direction of restriction
Therapist’s body position - in line with restriction
Maintain pressure on the same layer - follow path of release
Re-evaluate for remaining tissue restrictions
In both shortening and lengthening tissues for skin/superficial fascia, the specific direction is identified by the _______.
enhanced release of the tissues
Who influenced the unlocking spiral technique?
G. Johnson (1981)
When do you begin to use unlocking spiral?
When a restriction is not responding to the sustained pressure technique and Assisting Hand tissue lengthening/shortening.
When an unlocking spiral has been used but the restriction has not resolved, what should be done next?
Repeat the technique with unlocking spiral in direction of greatest tension.
