Lecture 10 Flashcards
Clinical presentation of a patient with a joint disorder
impaired mobility
impaired muscle performance
impaired balance
functional limitations
Arthritis
inflammation in a joint
Arthrosis
limitation of a joint w/o inflammation
Characteristics of Osteoarthritis
Usually after the age of 40
develops slowly over many years
caused by trauma, genetics, disease, mechanical stress
asymmetrical
Appearance of OA on radiographs
sclerosis
decreased joint space
osteophyte formation
bone cysts
Varus OA
decreased medial joint space
Valgus OA
decreased space laterally in joint
Most common sites of OA
Cervical and lumbar spine
DIP, 1st CMC, shoulder
hip, knee, 1st MTP
OA Joint symptoms
stiff joints after sleeping or immobility, pain with weight bearing, crepitus, decreased ROM
OA Systemic Symptoms
none
Early Stages of OA Interventions
correct body mechanics and movement patterns, focus on proection
Late stages of OA interventions
assistive devices and splints
General interventions of OA
resistance exercises, usually isometrics
stretching/joint mob
Balance
cardio (no impact or twisting)
Characteristics of Rheumatoid Arthritis
chronic, progressive, autoimmune
onset is 16-50 years of age
sudden onset; episodes last months to years
unknown cause
starts as inflammation of synovial joint and then changes the structure of cartilage and bone
Joint symptoms of RA
redness, warmth, swelling
nodules
stiffness in the morning, increased pain with activity
Systemic symptoms of RA
general malaise, fatigue, loss of appetite, weight loss, fever
other symptoms within other systems like ocular, respiratory, etc
Location of RA
MCP, PIP, wrists, cervical spine, MTP, talonavicular, ankle, hip, knee, shoulder
can be multiple, bilateral, symmetrical
RA nodules
extra-articular manifestations of RA
25% frequency
extensor surfaces of tendons/joints causes irritation, nodule forms
also can form in subcutaneous tissues, pads of toes/heels, viscera
Interventions for RA during Active inflammatory period
joint protection
energy conservation
exercise, functional training, gentle isometrics to prevent atrophy. Decrease time but increase frequency
NO stretching of joints
Precautions of RA
steroid use, lead to osteoporosis
ligament laxity
respect fatigue
cardio exercise may be limited with fatigue
Contraindication of RA
no stretching or mobilization of swollen joints when in a flare up phase
RA interventions during subacute/chronic stages
joint protection and activity modification
flexibility and strength
cardiovascular endurance
adaptive equipment
Risk factors for primary osteoporosis
Comes on its own
postmenopausal
caucasian or asian
family history
low body weight
no PA
diet low in vitamin D and calcium
smoking
Risk factors for secondary osteoporosis
develops due to another problem
GI disease, Crone’s
hyperthyroidism
chronic renal failure
RA
Prevention of Osteoporosis
diet rich in viramin D and calcium
heavy weight bearing exercise
no smoking, limited alcohol
PA helps to remodel bones
Interventions for Osteoporosis
Aerobic training, 5x or more a week, moderate
Resistance, 2-3x week, focus on fatiguing
Functional, balance training
Precautions Osteoporosis
any exercise that produces flexion and rotation of spine
balance exercises if balance is impaired
STAYING SAFE NOT SEDENTARY
Contraindications Osteoporosis
vertebral compression fracture history must avoid flexion and rotation of spine
NEMEX Training program
for patients with hip or knee OA
aims to improve senory and motor control, achieving functional stability
improves pain, physical function and PA, increases quality of life
GLA:D and NEMEX
60 min program
warming up, circuit, cool down
role models are more experienced pts. quality is emphasized
Good alignment
knee over toe not knee medial to toe
Circuit portions
core stability
postural orientation
lower extremity muscle strength
functional exercises
1-2 exercises per area, performed 2-3 sets, 10-15 reps
How to increase difficulty
Progression
varying # of, direction, velocity of movements
increasing load
changing support surface
Core stability Level 1
Pelvic lift w/flex knees, short lever arm. both legs loaded
Sit-ups, flex knees, both legs on ball, arms at sides, short lever arm
Core stability Level 2
Pelvic lift w/semi flexed knees, long lever arm, both legs loaded
Sit-ups: flex knees, both legs on ball, arms over chest (medium lever arm)
Core Stability Level 3
Pelvic-lift as level 2, alternate load
Situps: flexed knees, both legs on ball, hands behind neck (long lever arm)
Postural Orientation Level 1
Slide forward/backward: standing, one leg
Slide sideways: standing, one leg
Postural Orientation Level 2
Slide forwards/backwards: as level one, on uneven surface
Slide sideways: same
Postural Orientation Level 3
Forward lunge: standing, take large step forward and then return
Sideways lunge: standing position, take a large step sideways and then return
Lower extremity Level 1
Hip ab/adductors: standing on one leg, rubberband other leg. Pull in and out
Knee ext/flexors: Sitting, rubber band around one foot. Pull forward/backwards
Lower extremity Level 2
As level one, but with increased resistance in rubberband
Lower extremity Level 3
Hip ab/adductors: Level 2 and uneven surface
Knee ext/flexors: Increasing resistance
Functional Exercises Level 1
Chair stands: load on both legs, slight hand support. start in seated.
Stair climbingL step up and step down on low step, with or without hand support
Functional Exercise Level 2
Chair stands: without hand support
Stair: medium step, with or without hand support
Functional Exercise Level 3
Chair: one foot in front of the other, with/without slight hand support
Stair: high step board
Cooling Down
walking forward and backwards
mobility exercises in lower extremity
stretching exercises for 10 min
