Intro To MSK Flashcards
What is the (Massage Therapy Act, 1991) Scope of Practice?
The assessment of soft tissues & joints of body & treatment & prevention of physical dysfunction & pain of soft tissues & joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain.
What are the 3 main treatment priorities?
- Decrease pain
- Normalize ROM
- Improve function (Strength/Endurance)
What are Causes (Specific impairment) for Pain?
• Mechanical (stretch or compression)
• Inflammation
• Referral (TrP, Neurological)
• Psychosomatic
What is the Assessment for Mechanical (stretch or compression) Pain?
Postural assessment, AF, PR, mm length testing, palpation
What is the Assessment for Inflammation pain?
Case history, observation, palpation
What is the Assessment for Referral (TrP, Neurological) Pain?
TrP: referral patterns, palpation, mm length strength tests Neurological: Dermatomes, Nerve tension tests, tinnel’s, TOS tests, palpation
What is the Assessment for Psychosomatic Pain?
Physical findings don’t match
What is the Treatment Option for Mechanical (stretch or compression) Pain?
Massage, heat, stretch
What is the Treatment Option for Inflammation Pain?
Lymph drainage/superficial fluid techs, rhythmich techs (gentle), low grade join play, hydrotherapy, positioning
What is the Treatment Option for Referral (TrP, Neurological) Pain?
TrP: Petrissage, heat, stretch, PIR, acupuncture
Neurological: Massage, MF techs (Nerve mobilization), acupuncture, spine joint mobes if nerve root implicated
What are the Causes (Specific impairment) for Hypomobility?
• 5MRT (tone/TrP)
• Myofascial (muscular) extensibility
• Adhesions/ Scarring
• Periarticular adhesions/ contracture
• Swelling
• Pain
• Weakness/ Inhibition
What is the Assessment for 5MRT (tone/TrP) Hypomobility?
Passive ROM, mm length testing, palpation, visual observation, ‘stiffness’ may be described
What is the Assessment for Myofascial (muscular) extensibility Hypomobility?
Passive ROM, mm length testing, palpation, visual observation, ‘stiffness’ may be described
What is the Assessment for Adhesions/ Scarring Hypomobility?
Passive ROM, mm length testing, palpation, visual observation, ‘stiffness’ may be described
What is the Assessment for Periarticular adhesions/ contracture Hypomobility?
ROM (active/passive), early capsular end feel, postural deviation
What is the Assessment for Swelling Hypomobility?
Observation, palpation
What is the Assessment for Pain Hypomobility?
Subjective data, provocation tests
What is the Assessment for Weakness/ Inhibition Hypomobility?
Postural observation confirmed with mm strength testing
What is the Treatment Option for 5MRT (tone/TrP) Hypomobility?
Neuromuscular techniques, heat, joint play, stretch, PIR
What is the Treatment Option for Myofascial (muscular) extensibility Hypomobility?
Myofascial techs, heat, stretch
What is the Treatment Option for Adhesions/ Scarring Hypomobility?
Myofascial techniques (including frictions*), heat, stretch
What is the Treatment Option for Periarticular adhesions/contracture Hypomobility?
High grade joint play
What is the Treatment Option for Swelling Hypomobility?
Superficial fluid techniques, LD, hydrotherapy, low grade joint play, positioning
What is the Treatment Option for Pain Hypomobility?
Treat primary dysfunction
What is the Treatment Option for Weakness/ Inhibition Hypomobility?
Weakness: Therapeutic exercise
Inhibition: Tapotement, TherEx, Electroacupuncture
What are Causes (Specific impairment) for Hypermobility?
• Trauma/ Pathology
• Tissue laxity
• Weakness/ Inhibition
What is the Assessment for Trauma/Pathology Hypermobility?
Diagnosis/Clinical impression
What is the Assessment for Tissue laxity Hypermobility?
Postural assessment, ROM (active/passive), mm length tests, special tests
What is the Assessment for Weakness/Inhibition Hypermobility?
Postural observation confirmed with mm strength testing
What is the Treatments for Trauma/Pathology Hypermobility?
Treat presenting impairments (modify as needed)
What is the Treatment for Tissue laxity Hypermobility?
TherE to strengthen supporting structures
What is the Treatment for Weakness/ Inhibition Hypermobility?
Weakness: TherEx
Inhibition: Tapotement, TherEx, Electroacupuncture
What are the 4 Big/Common Modifiers?
- Compromised Cardiovascular Health
- Diabetes
- CT disorders
- Medications
What are modifications for Compromised Cardiovascular Health?
• consider positioning (limiting time in prone, tx in sidelying or semifowler’s)
• hydro modifications (ie. modifying temperature, duration of tx, local instead of general applications)
• shorter/local strokes instead of sweeping fluid techniques to limit stress on CV system
• delayed/compromised healing - consider impact on stages of healing & response to treatment
What are modifications for Diabetes?
• tissue fragility
• altered sensation
• delayed/compromised healing
• with long term patients, cardiovascular health needs to be considered
What are modifications for CT disorders?
• tissue fragility
What are modifications for Medications?
• implications for patient feedback, tissue fragility
What are Treatment Planning Considerations for Functional presentations and the aging body?
• Tissues can be altered with manual therapy & remedial exercise to improve function/mechanics.
• When patients present with functional impairments, treatment goals should be to normalize tissues & optimize function. There can & should be defined treatment plan resulting in full resolution & discharge of patient.
What are Treatment Planning Considerations for Structural presentations and the aging body?
• There are permanent changes to tissues that cannot be altered with manual therapy.
• Treatment goals shift to managing symptoms & maintaining tissue health/mobility. Treatment planning for structural presentations tend to be long term/ongoing ‘maintenance’ treatments as opposed to ‘fixing’ functional problem.
What happens to soft tissues and joints as we age?
Soft tissues & joints slowly degenerate, often presenting as osteoarthritis (OA), disc degenerations, tendinopathies, etc.
What are conditions like osteoarthritis & tendinopathies considered to be?
They are considered chronic & sometimes structural impairments.
Can conditions like OA & tendinopathies typically be ‘fixed’?
No, they often cannot be ‘fixed’ & require long-term management.
What is the focus of long-term treatment plans for patients with degenerative conditions?
The focus is on managing symptoms & maintaining functionality as much as possible.
Why is it important to have conversations about degenerative conditions with patients?
Helps manage patient expectations & makes treatment planning discussions easier.
Can massage therapy still benefit patients with chronic degenerative conditions?
Yes, massage therapy can play significant role in their long-term health, wellness, & functionality, even if conditions cannot be fixed.
What is the traditional way we learn a muscle’s action in anatomy?
Based on a proximal attachment fixed joint position.
What is the functional reality of muscle actions in the lower extremity?
We live in a distal attachment fixed scenario, such as when our feet are on the ground during standing or gait.
Why is it important to consider the interdependent nature of joints in the body?
No joint functions in isolation, especially in a distal attachment fixed scenario like during gait.
What is an example of joint interdependence in the lower extremity?
During a squat, hip flexion, knee flexion, & dorsiflexion of the talocrural joint cannot be isolated; the joints function as a chain.
What should be considered when assessing impaired function at one joint?
The impact on the rest of the chain – particularly the joints above & below.
What balance does every joint require to allow for efficient movement?
Every joint requires a balance of stability & mobility.
What determines a joint’s primary need for stability or mobility?
Factors like the number of planes it moves in, its articulation, & its static/dynamic stabilizers (ligaments, muscles).
How do joints alternate in their primary needs to allow efficient movement?
Joints typically alternate between mobility & stability to allow a large range of motion (ROM) while maintaining control.
What happens if a joint’s primary need (stability or mobility) is not fulfilled?
It can lead to inefficiency in movement or dysfunction in the joints above & below it.
What happens if a mobile joint loses mobility due to postural dysfunction, injury, etc.?
The brain will compensate by gaining mobility at another joint, often a stable joint, above or below.
Why is compensatory movement at a stable joint problematic when a mobile joint loses mobility?
Stable joints are not designed for mobility, so compensatory movement can lead to dysfunction & stress on those joints.
hat happens if a stable joint lacks stability?
There will be a lack of control during movement, & compensatory actions may occur at the affected joint or at a joint above or below.
What can be stressed if a stable joint experiences excessive movement?
Inert structures, like ligaments or menisci, are likely to be stressed, which can lead to injury.
How does the brain compensate for a lack of stability in a joint?
The brain may use the muscular system to create stability, leading to muscle & fascia shortening to limit excessive movement.
What is an example of a compensatory pattern due to glute med weakness?
A patient may develop a Trendelenburg gait with contralateral hip drop, resulting in pelvic instability.
How can pelvic instability due to glute med weakness affect the knee?
Pelvic instability can cause excessive movement at the knee (a stable joint), potentially damaging inert structures or predisposing them to injury.
What muscle is often recruited by the nervous system to compensate for glute med weakness?
The iliopsoas is commonly recruited to stabilize the hip, which can lead to trigger points, strain, & mechanical pain in the lumbar spine.
Why is it important to look beyond the location of pain in patients?
Pain is not always located where the dysfunction or the root cause of the dysfunction is.
What is the primary treatment goal for patients experiencing pain?
The number one priority is to alleviate pain.
Why is treating only the tissue impairments at the location of pain often insufficient for long-term relief?
If there is an underlying stability or mobility issue causing dysfunction, treating the pain alone won’t address the root cause & may not lead to long-term relief.
What types of assessments should be used to identify the root cause of dysfunction?
Regional postural scan, movement screening, length testing, strength testing, & functional/special tests.
What does a comprehensive assessment help with when creating a treatment plan?
It helps form both short- & long-term goals & creates an effective treatment plan.
How can assessments influence active care programs?
They provide insight into the type of active care program that should be implemented, either under supervision or in collaboration with other healthcare professionals.
How can we achieve efficient movement in one plane of motion?
By controlling movement in the other two planes of motion.
What is an example of a sagittal plane movement, & which planes must be controlled for efficiency?
Gait is a sagittal plane movement (flexion & extension), & the transverse and coronal planes (rotation, abduction/adduction) must be controlled.
What forces act on the body during single-limb stance?
Gravity pulls us into flexion, adduction, & internal rotation.
Which muscles are important for maintaining an upright posture during single-limb stance?
The trunk & lower limb musculature, especially the posterior chain, resist flexion, adduction, & internal rotation.
What are examples of coronal or transverse plane deviations at different joints in the lower extremity?
Hip: Lateral pelvic shift or contralateral hip drop
Knee: Valgus stress
Lower extremity: Internal rotation
Ankle: Overpronation
Why are movement inefficiencies in the coronal & transverse planes particularly damaging for certain joints?
The more stable a joint needs to be & the fewer planes it allows movement in, the more damaging inefficiencies in movement can be.
What approach should be taken in treatment planning for patients with movement inefficiencies?
A local, regional, & spinal segmental approach, with thorough intake & assessment to identify contributing factors.
Why is specificity important in treatment planning?
Specificity in assessment & intake leads to successful treatment planning & helps achieve the patient’s goals & desired clinical outcomes.
How does massage therapy contribute to the healing process?
Massage therapy can affect multiple levels of the healing process, touching on local, regional, & systemic factors.
What does local treatment focus on?
Local treatment focuses on specific tissues, including inert and contractile tissues, nerve pathways, & circulatory pathways.
What tissues are involved in regional treatment?
Regional treatment includes joints above & below the local treatment site, agonist-antagonist muscles, synergists, & associated nerve & circulatory pathways.
What is spinal segmental treatment?
Spinal segmental treatment involves addressing the spinal segments related to the local & regional tissues, stimulating the circulatory & nervous system pathways (dermatome, myotome, sclerotome) to enhance treatment effectiveness.
Which spinal segments correspond to the head, neck, shoulder, & upper extremity in the paravertebral reflex sympathetic vascular areas?
T1-T6.
Which spinal segments correspond to the middle trunk somatic tissues & all visceral territory?
T1-L2.
Which spinal segments correspond to the pelvic girdle & lower extremity?
T10-L2.
Which spinal segments correspond to the heart, lungs, & upper respiratory airways in the paravertebral reflex sympathetic visceral areas?
T1-T5.
Which spinal segments correspond to the liver, gallbladder, stomach, spleen, and pancreas?
T6-T10.
Which spinal segments correspond to the adrenal medulla?
T8-L1.
Which spinal segments correspond to the kidneys?
T10-T11.
Which spinal segments correspond to the adrenal glands, small intestine, ascending & transverse colon, & bladder?
T10-L2.
