Practical Flashcards
Order of Practical
Introduce
Explain procedure
Contraindications
Permission
Position/Draping
Set Up
Treatment
Check in w/ Pt
Check Skin
Clean Up
Containdications for Massage
-skin infections/open
-thrombosis/embolism or phlebitis, severe varicose veins
-new tendon transplant
-fracture/non union
-acute inflammation
-cellulitis
-synovitis
-absesses
-cancer
-fever
Rules of Massage
-table height (knuckles at table)
-build trust before touching
-draping
-position
-continuous muscle contact
-distal to procimal towards heart
-not over bones
Order of Massage
-skin rolling (no lotion)
-Light effleurage
-Deep effleurage
-Petrissage
-Friction (or other technique)
-petrissage
-Deep effleurage
-light effleurage
Skin Rolling
-evalutes skinn conectivity and underlying restrictions
-no lotion
-lifting skin
Light Effleurage
-warm up and cool down
-light, continuous pressure
-get used to contact
Deep Effleurage
-medium, continuous pressure distal (light) to heart (deeper)
-promotes relaxation
-decreases pain
-searching for spasms
Petrissage
-kneading, deeper
-grasp and lift muscle and skin toward heart
-push waste to increase lymphatic and venous return
-loosen tissue and increase elasticity
Effect:
-spreads fibers
-tension of connective tissue
-proprioceptive input
-reduce collagen cross-linking
Friction
-deep, circular or transverse mmts
-no skin mmt, move underlying tissues
-where a trigger point, adhesion or scar is felt
-realign collagen fibers
Transverse Friction
-intense perpendicular to tendon
-should be painful, explain
-used for chronic tendon inflammation
Trigger Point Massage
-related to acupressure
-find point until pain or jump sign
-press on point and maintain pressure (will increase pain then lessen)
Myofascial Release
-mid pressure and stretch
-move in direction of restriction
-superficial to deep
-relieves soft tissue from abnormal grip of tight fascia
Active Release Technique
-deep tissue to break down fibrotic adhesions that restrict movement and scar tissue
-apply pressure in direction of fibers while pt actively elongates muscle
ROM Contraindications
-disruptive to healing process (precautions)
-response or condition is life threatening
Russian Currents
-muscle strengthening*
-muscle re-education*
-increasing ROM
-Slow atrophy
-Edema control (via muscle)
-2,000-10,00z frequency
-burst mode
-fast oscillating AC current, burst
Interferential Currents
-IFC
-pain control*
-muscle stimulation
-2 bipolar configurations (relief where they cross)
-4000-4100Hz frequencies
-120usec pulse width
Sweep Mode: frequencies modulated to avoid accommodation
Scan Mode: amplitude can be modulated
-for poorly localized pain
Target Mode: move with finger
High-Volt Pulsed Current
-HVPC
-reducing edema
-muscle pump 1:1
-wound healing
-twin peaked monophasic
-unequal electrodes, small over treatment
Transcutaneous Electrical Nerve Stimulation: Conventional
-TENS
-acute pain relief; surgical, labor*
-gate control theory; A-Beta*
-asymmetric biphasic
-tingle with no contraction*
Settings:
-75-150msec Duration/Width
-80-125pps Frequency
-continuous*
- Starting: 100p/100f*
-30mins, til pain is gone*
Iontophoresis
-low volt, continuous direct current
-drive ions into body
-medicine
-less than 30min on big machines
-longer with home devices
Doses:
-40mA-min= 4.0 current x 10min
-40mA-min= 2.0 current x 20min
Meds:
-Acetate, -, calcium depositis
-Dexamethasone, -, tendonitis/bursitis
-Lidocaine, +, trigeminal neuralgia
Transcutaneous Electrical Nerve Stimulation: Low-Frequency/Acupuncture/Motor-Level
-TENS
-chronic pain relief*
-Descending Pain control theory: modulation; enkephalin*
-asymmetric biphasic
-tingle AND contraction*
Settings:
-100-600msec Duration/Width
-<20pps Frequency
-Duty cycle: 30-60s*
- Starting: 180p/18f*
-15-60min*
-over motor point
Transcutaneous Electrical Nerve Stimulation: Noxious- Level
-TENS
-hyperstimulation analgesia
-chronic pain relief*
-Endogenous opiate pain control theory*
-asymmetric biphasic
-high intensity to noxious level; muscle contraction acceptable*
Settings:
-100-1000msec Duration/Width
-1-5pps Frequency
-Duty cycle: 30-45s
- Starting: 250p/2f*
-15-60min*
-over trigger point, until pain is no longer percieved
Transcutaneous Electrical Nerve Stimulation: Brief Intense
-TENS
-fast pain relief during procedure*
-Descending: peripheral and central anagelsia theory*
-asymmetric biphasic
-muscle fasciculation to sustain contraction*
Settings:
-100-600msec Duration/Width
-100 pps Frequency
-Duty cycle: 30-45s
- Starting: 250p/100f*
-15min*
-around wound
Premodulated (Bipolar)
-2 currents switch within the device
-only 2 electrodes
-pain control
-muscle stimulation/reeducation
-slow atrophy
-2 bipolar configurations (relief where they cross)
-duty 10:10, ramp 1-2s, 10-20min
-200-400usec pulse width
E-Stim Contraindications
-pacemaker/defib
-internal stimulators
-chest or heart area
-carotid
-thrombosis/vascular or arterial disease
-confusion
-seizure
-infection
-open wounds (unless treatin)
-cancer
-pregnancy
-high level SCI
Muscle Re-education
-Russian, NMES
-following surgery
-CNS inhibition of muscle
-improve motor control
-200-600 usec/ 35-55 pulse
-15min
-Duty 1:1
Muscle Pump Contractions
-HVPC, Russian, NMES
-increase circulation
-mimic normal contractions
-200-600usec/ 35-55 pulse
-comfortable muscle contraction
-20-30min
-duty 1:1
-elevatte the body part (can use AROM)
Edema Control
-HVPC
-elevate extremity*
-space electrodes far apart*
-negative polarity distal to swelling*
-driving forve to move plasma away
-30min
-best results immediately after injury
-80-120Hz/ low frequency*
-intensity as needed >60*
Muscle Strengthening
-Russian, NMES
-200-600usec/ 50-85pps
-gradual ramp
-duty 1:5
-to muscle fatigue 60% MVIC
-pt working with estim
Increasing ROM
-Russian, NMES
-200-600usec/ 35-55pps
-strong contraction
-interrupted current with gradual ramp
-antagonist muscles to joint contracture
-90min
-duty 1:1
-pt passive
Denervated Muscle
-lost peripheral nerve supply
-if reinnervation doesnt occur in 2 years connective tive replaces contractile elements so recovery not possible
-1st week <1ms duration
-2 weeks >10ms duration
-NMES
Slow Muscle Atrophy
-Russian, MNES, HVPC
-200-600usec/ 50-86pps
-15-20mins
-duty 1:5
-to muscle fatigue
-pt working with estim
IONTO Indications
-analgesia
-bone spurs
-ulcers
-edema reduction
-fungal infections
-sweating
-muscle spasms
-tendonitis
IONTO Contraindications
-estim rules
-impaired skin sensation
-allergy
-recent scar
-broken skin
-metal
Ultrasound Contraindications
-active bleeding
-decreased sensation to temp
-decrease circulation
-DVT
-infecion
-malignancy
-breast implants
-carotid
-epiphyseal plates in young
-heart, eyes, genitalia
-cement or plastic
-pelvic and thrunk of pregnant
-pacemaker
-vascular insufficiency
ERA
-effective radiating area
-energy output is greatest at center, small than transducer
Treatment area= 2-3x ERA
Non-Thermal Ultrasound
Acute Injury, Edema, Healing Ultrasound
-superficial and deep (3-1MHz)
-non-thermal and pulsed
-20% Duty Cycle
-1 Intensity/ 8-10mins
Mid Thermal Ultrasound
Subacute Injury or Hematoma Ultrasound
-increase 1deg C
-continuous
Superficial (3MHz)
-0.5 in/ 3 mins
Deep (1MHz)
-1 in/ 5min
Moderate Thermal Ultrasound
-chronic injury, inflammation, pain, trigger points
-increase 2 degree C
-continuous
Superficial (3MHz)
-0.5 in/ 6min
Deep (1MHz)
-1 in/ 10min
-1.5 in/ 6min
-2 in/ 5min
Vigorous Thermal Ultrasound
-stretching collagen, joint contractures
-increase 4 deg C
-continuous
Superficial (3MHz)
-1 in/ 6min
Deep (1MHz)
-2 in/ 10 min
Ultrasound Frequency
0.75-3MHz
-tissue depth
1Mhz= greater depth, 5cm
3MHz= superficial 1-3cm
Higher frequency= faster heating= shorter treatment
D1 UE
-putting a seatbelt on
Flexion: reaching for seatbelt
-Shoulder: add, ER
-Scap: UR, abd
-Forearm: sup
-Wrist: flex, rad dev
-Fingers: flx, add
Extension: buckling it
-Shoulder: abd, IR
-Scap: DR, add
-Forearm: pronation
-Wrist: ext, ulnar dev
-Fingers: ext, abd
D2 UE
-Sword and waiter
Flexion: waiter holding a tray
-Shoulder: flx, abd, ER
-Scap: elevat, UR, abd
-Forearm: sup
-Wrist: ext, rad dev
-Fingers: ext, abd
Extension: reaching for sword
-Shoulder: ext, add, IR
-Scap: depress, DR, add
-Forearm: pronation
-Wrist: flex, ular dev
-Fingers: flx, add
D1 LE
-hacky sack and ballet
Flexion: hackey sack
-Hip: flx, ER, add
-Knee: flx
-Ankle: DF, inv
-Toes: extension
Extension: Ballet
-Hip: ext, ITR, abd
-Knee: ext
-Ankle: PF, ev
-Toes: flx
D2 LE
-dog peeing and curtsey
Flexion: dog peeing
-Hip: flx, IR, abd
-Knee: flx
-Ankle: DF, ev
-Toes: extension
Extension: curtsey
-Hip: ext, ER, add
-Knee: ext
-Ankle: PF, inv
-Toes: flx
Rhythmic Initiation
-PT guiding through ROM
-for pts with difficulting initiating
-improves controlled mmts
-AROM, PROM, AAROM
Repeated Contractions
-jerking motions
-PT stretches in jerks pt while going through the RROM
-strengthens weak agonists
-need AROM and RROM
Slow Reversal
-kind of reversal of antagonist
-function changes in agonist to antagonist mmt
-contant resistance applied through ROM
-strong concentric of agonist followed by less strong eccentric of antagonist
Slow Reversal Hold
-kind of reversal of antagonist
-function changes in agonist to antagonist mmt
-contant resistance applied through ROM with isometric hold at end of range
-better detection of joint/space tension
Alternating Isometrics
-most common
-isometric hold of agonist then antagonist
-alternatting resistance to opposite muscles
-no ROM, inproves stabilization
Rhythmic Stabilization
-isometric hold of agonist AND antagonist (co-contraation)
-simultaneous multidirectional resistance to opposite muscles
-no ROM, inproves rotary stabilization
Stretching Time
10-30s hold
Stretch: Upper Traps
Postition: Supine
Stabilize: Shoulder
Movement: LSB, flexion away
Home:
-flex head and rotate away with one hand
Stretch: Levator
Postition: Supine
Stabilize: Shoulder
Movement: Flex, LSB, Rotate away
Home:
-flexion and rotation away with one hand
-ipsi scap upward rotation and depression with other hannd
Stretch: SCM
Postition: Sitting up
Stabilize: Clavicular head
Movement:
-Stand behind pt
-Pt actively Ext, LSB away and Rotate toward
Stretch: Suboccipital
Postition: Supine
Stabilize: C2
Movement:
-lumbrical hold on C2
-Stabilize head @ shoulder
-touch chin
-slowly move back into stretch
Home:
-chin tuck with one hand
-slight flx of head with other hand
Hold-Relax
-stretch msucle and maintain stretch
-isometrically contract against stetch
- Stretch muscle
- Isometrically Contract same muscle (being stretched)
- Hold and go into further stretch
Contract-Relax
-stretch muscle and maintain stretch
-isotonically contract against stetch, moving
- Stretch muscle
- Isotonically Contract same muscle (being stretched)
- Hold and go into further stretch
Hold-Relax w/ Agonist Contraction
- Stretch muscle
- Isometrically Contract same muscle (being stretched)
- Hold and go into further stretch
- Concentrically contract antagonist (move in opposite direction)
Stretch: Pec Major
Postition: Supine
Stabilize: Anterior shoulder at pec insertion
Movement:
-abduct shoulder while adding pressure to pec insertion
Home: use wall to apply pressure and then rotate away for more stretch
Stretch: Lats/Teres Major
Postition: Supine
Stabilize: Lower ribs and iliac crest (lats), inf angle of scap (teres major)
Movement:
-abduct shoulder while adding pressure on lat/teres major insertion
Home:
-Bilateral: prayer hands with elbows on table and sink down
-Unilateral: place arm up and adducted against wall, rotate torso in opp for more stretch
-Cat stretch with LSB away, ipsi shoulder abducted
Stretch: Quadratus Lumborum
Postition: Side lying
Stabilize: Ribs and iliac crest with forearms
Movement:
-Stand in front of pt
-break the bread
Home:
-cat stretch with LSB away, ipsi shoulder abducted
Stretch: ITB
Postition: Sidelying
Stabilize: Ribs
Movement:
-Stand behind pt
-extend and adduct leg off of table
Home:
-extend and adduct leg off of table
-use roller
also for QL
Stretch: Hip Flexors
Postition: Supine or Prone (eliminates lordosis)
Stabilize: Anterior hip or Posterior hip
Movement:
-Flex contra hip and relax foot on pt
-extend ipsi leg off of table and stretch by pushing (or pull if prone) down on knee
Home:
-flex leg
-Lunge and stretch
also for quads
Stretch: Piriformis
Postition: Supine
Stabilize: opp side flexed hip (still affect though)
Movement:
-Stand on opp side of pt
-Push flexed knee toward pt
Home:
-Supine: hip flexed and cross legs over with pressure
-Supine 2: hip flexed and foot held for stetch
-Prone: hip flexed and knee flexed and use body weight to stretch
Stretch: Hamstrings
Postition: Supine
Stabilize: N/A
Movement:
-Stand in front of pt
-Flex hip with straight leg and push forward
Home: chair, wall, own arm
Home Stretch: Scalene
-Cervical extension, rotation towards, and 1st rib depression
Home Stretch: Biceps
-extension of shoulder with elbow extension
Home Stretch: Triceps
- touch back with hand (simulate washing)
-flx shoulder further
Home Stretch: Wrist Flexors
-stick arm out and extend elbow and wrist
-put more extension force on fingers with other hand
Home Stretch: Wrist Extensors
-stick arm out and extend elbow and flex wrist
-put more flexion force on fingers with other hand
Stretch: Thoracolumbar
Flexion: cat stretch
Extension: Cow stretch
Stretch: Lumbar
Flexion: Supine, knees to chest
Extension: Prone, on elbows and push onto hand
Home Stretch: Adductors
-ipsi side proped up while standing on contra leg
-drop ipsi pelvic for more stretch
or
-crossing legs and stretch
Home Stretch: Gastroc/Soleus
-Long sit with towel behind foott
-stand against a wall tto stick leg out to stretch
Stretching Contraindications
-hypermobile
-hypomobility provides stability
-bony block
-non union fracture
-inflammation
-pain
-tissue trauma
Balance PNF Techniques
shoes on with gait belt
Stability:
-rhythmic stabilization
-alternating isometrics
Enhance Dynamic Balance:
-Isotonic contractions
-Slow and quick reversals
