Theory Flashcards
What are the aims of Tx for Constipation?
1) Reduce stress
2) Decrease SNS firing
3) Decrease pain
4) Address contributing postural imbalances
5) Decrease hypertonicity and trigger points in lumbar spine muscles and glutes
6) Decrease congestion in the abdomen
7) Increase circulation to the abdomen
8) Decrease trigger points and hypertonicity in iliopsoas if present
9) Move fecal matter
10) Maintain ROM
What order/direction do you move fecal matter during Constipation Tx?
- Apply slow, short fingertip kneading to colon from sigmoid colon - superiorly along descending colon, to splenic flexure - across transverse colon to hepatic flexure and inferiorly to cecum
- Same techniques are then applied proximal to distal colon
- ALWAYS apply clockwise direction
What is the purpose of the Rebound test? When would you use it?
Purpose: Rule in/out appendicitis
Use: Someone has abdominal pain
Causes of Constipation?
- Longer transit time than average of fecal movement through the intestine (average 24-48hrs)
- More water is absorbed from stool the longer it is present in the intestine, causes it to become more solid (unable to pass)
Predisposing Factors (Causes) of Constipation?
- Poor diet (low fibre)
- Sedentary lifestyle
- Stress
- Resisting urge to defecate
- Postural imbalance
- Surgery
- Medications
- Pregnancy
- Poor muscle control
- GI conditions (IBS)
Signs and Symptoms of Constipation?
1) Straining, and pain or discomfort may be experienced when passing stools
2) Infrequent bowel movements occur. 1/day to 3/week is considered within normal limits.
3) Hard stool, “rabbit” or “pellet” stools- may be interspersed with softer stools or diarrhea, referred to as IBS.
4) Abdominal pain, cramps or discomfort intermittently
5) Low back pain or discomfort can result. Stimulation of the rectum from the presence of fecal matter can cause pain referral to the sacrum
6) Bloating and flatulence
7) Hemorrhoids can result from straining due to large or hard stools
8) A bad taste in the mouth, bad breath (halitosis), nausea, and lack of appetite can result due to the slowing of gastric emptying
9) Headaches, nausea, irritability, and malaise seem to result reflexively from dissention of the rectal wall
Pathway of fecal matter through the large intestine? Time frame it takes to transmit?
- Normal: average time is 24-28 hrs and the normal limits are 1/day to 3 times a week
- Starts at: Cecum -> Transverse Colon -> Splenic Flexure -> Descending Colon -> Sigmoid Colon -> Colon
What is IBS?
Irritable bowel syndrome - a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities.
Home care for Constipation?
1) Epsom salts bath
2) Self massage / cool wash to abdomen
3) Refer to naturopath or nutritionist for diet counselling
4) Stretch / strengthen affected postural muscles
5) Diaphragmatic breathing
6) Place footstool in front of toilet to increase flexion of hips and help with the bearing down during defecation
Postural changes that can occur during Pregnancy?
1) Ligamentous laxity
2) Anterior carriage of weight shifts the center of gravity upward and forward
3) Hyperlordosis & Kyphosis due to weight shifting
4) Anterior pelvic tilt external rotation of the hips and hyperextension of the knees and possible Pes planus. Ant Pelvic tilt - Gluteal muscles, piriformis, quadriceps and iliotibial band will shorten.
5) External rotation of the hips may cause lengthening of the adductors
6) Enlarged breast can cause shoulder to rotate anteriorly
7) Anterior head carriage - shorten the posterior cervical, upper trapezius, scalene and sternocleidomastoid muscles.
8) Compensatory posture of the upper back and winging of scapula - lengthening of the selecta characters, rhomboids, middle and lower trapezius.
9) Pronation of the feet
- lengthening of tibialis anterior muscles and medial head of gastrocnemius.
Symptoms of Pregnancy
1) Nausea and vomiting
2) Frequent urination
3) Blood pressure often falls in early pregnancy
4) Breast changes
5) Musculoskeletal changes
6) Taste and smell altered
7) Mood swings
8) Edema primarily in the legs
9) Hypertension / preeclampsia
10) Supine hypotension
11) Shortness of breath
12) Back aches associated with Hyperlordosis or Hyperkyphosis
13) Abdominal pain
14) Diastasis symphysis pubis
15) Varicose veins
16) Hemorrhoids
17) Pigmentation such as butterfly mask
18) Stretch marks
19) Nosebleeds, gum bleeding, and nasal congestion
20) Headaches
21) Emotional changes
22) Gestational diabetes
23) Ketoacidosis
24) Compression syndromes
25) Sacroiliac sprain
26) Leg cramps
27) Pelvic discomfort
28) Fatigue/ insomnia and restlessness
Techniques that are appropriate in 3rd trimester of Pregnancy
All techniques are appropriate for a client in their third trimester of pregnancy monitor for ominous signs and treat within the client’s pain tolerance.
If pregnant client at your client has sudden rise in blood pressure, what would be the appropriate course of action?
Send them to their doctor. Do not treat this client.
Aim of Tx in 3rd trimester of Pregnancy
1) Monitor blood pressure
2) Decrease sympathetic nervous system firing
3) Decrease physical discomfort and trigger points
4) Decrease edema
5) Decrease the breast discomfort
6) Decrease constipation
7) Treat conditions that arise (carpal tunnel, IT band tightness, low back pain)
8) Maintain circulation and tissue health
9) Provide emotional support, education, referral
monitor for ominous signs
What is Preeclampsia?
- A cardiovascular crisis
- A- toxemia related condition, although no toxin causes preeclampsia
- It may present as early as 20th week of pregnancy
What are the signs of Preeclampsia?
1) Spiking blood pressure
2) Edematous weight gain over 2 pounds a week
3) Proteinuria (Presence of protein in the urine)
* Any two of the three symptoms are indication of preeclampsia*
What is Postpartum Depression?
Postpartum depression is going from extreme happiness to sadness without explanation.
CI’s associated with pregnancy
1st Trimester:
1) Abdominal and sacral massage only have light strokes or not at all ( especially if risk of miscarriage is present)
2) Deep massage and fascial CI in low back (lumbar)
2nd/3rd Trimester:
1) Carefully positioned on back to avoid compression of aorta and inferior vena cava
1) Care taken over abdomen during entire pregnancy
2) After 4 months, general/gentle is usually enjoyable for baby and mother
3) Fascial should be assessed for any stabilizing structure of posture before using
4) Aggressive joint play avoided over entire body, due to joint laxity during and 6 months after delivery
5) Decrease pressure over varicose veins
6) Change in blood pressure, combined with preeclampsia symptoms
7) Diabetes - snacks, juice should be eaten prior to tx to maintain blood sugar
8) Heartburn 2 hours should elapse after a meal before tx
Tx for client with Frozen Shoulder in (Acute) freezing stage?
1) Decrease pain with cool/cold hydrotherapy, reflex techniques, grade 1 joint play FDB
2) Eliminate metabolites and localized swelling with Swedish and manual drainage techniques
3) Reduce muscle spasms to compensating muscles of the shoulder, back and anterior chest with hydrotherapy and soothing, effleurage and petrissage
4) Maintain range of motion with low-grade joint play to affected joint and Joint play to joints above and below the GH joint. Mid-range passive movement
5) Address distal musculature with gentle muscle squeezing and stroking without increasing venous and lymphatic return that make congest the site
6) Treat opposite limb, back, anterior chest and neck for compensation
Treatment for Frozen Shoulder (Subacute) stage?
EARLY:
1) Cold hydro
2) Vibrations
3) Shaving
4) Compensatory structure
LATE:
1) DMH
2) Low grade joint play into higher grades
3) Frictions
4) Triggerpoint
5) Adhesions
6) Gentle stretching (pendulum swings)
Tx for Frozen Shoulder in chronic stage (Thawing)?
1) DMH
2) High grade joint play
3) Stretching
4) Strengthening
5) Frictioning
6) Triggerpoints
Triggerpoint in which muscle can cause Frozen Shoulder?
Subscapularis
Capsular pattern associated with GH joint? Significance to Frozen Shoulder?
1) restriction in movement due to increased fluid
2) low grade joint play only
3) may not always be capsular pattern, cuz only part of the capsule may be involved
4) joint mice may be present ( floating cartilage)
5) use end feel to assess normal ROM
Homecare exercise for Frozen Shoulder?
1) Pendulum swings
2) Wall crawl
3) Wall-walking / washing
4) Wand exercises
5) Strengthening of back, shoulder, chest and neck muscles
6) Passive stretching of rotator cuff muscles, chest, neck muscles
7) Increase range of motion first then strengthen
Special tests that could be positive for Frozen Shoulder?
1) Apley’s stratch
2) Frozen shoulder PR abduction test
3) Anterior & Lateral spinous challenge: reveal vertebral hypomobility
4) 1st rib mobilization, sternoclavicular joint play show hypomobility
Describe hyperextension (head on collision) injury in CS?
1) Reverse of rear-impact; torso accelerates backwards and the neck hyperflex is first, then hyperextends
2) A person may be able to see impending collision and brace for the impact
3) Seat belts, airbags, headrests, and front and crumple zones all help reduce injuries
Describe hyperflexion (rear end collision) injury in CS?
Phase 1 (60ms):
- Back seat pushes torso as vehicle moves forward
- Torso compressed into seat and carried forward along with vehicle
- Head stays fixed in place (inertia)
- Torso then moves upward (compressing CS)
- Cervical discs may be injured
Phase 2 (120ms):
- Vehicle/torso reach peak forward position
- Seat begins to recoil back
- Head/neck stay in place as torso moves forward (causing hyperextension of neck)
- Anterior neck muscles overstretched
- Facet joints, TMJ injured
Phase 3 (160ms): -Head/neck at peak forward position, vehicle/torso slowing down
Phase 4 (280ms):
- Head/torso full deceleration
- Seatbelt restrains torso while head/neck continue to flex forward (hyperflexion)
- Greatest stress placed on muscles, discs, ligaments in lower CS/upper TS (injuring tissues)
- C5-C7 most affected
Which muscles commonly strained in hyperextension Whiplash?
Muscles of anterior neck:
- SCM
- Mylohyoid
- Omohyoid
- Supra/Infrahyoid
- Platysma
Techniques for Acute Stage Whiplash?
- Cold hydro
- MLD before any compensatory work to decrease edema
- Treat trunk, shoulder girdle, uninjured limbs to reduce H+ and increase drainage
- Muscles of respiration treated with apical breathing
- Effleurage and slow petrissage
- QTF 0-1, isometric agonist contraction, gentle vibrations and effleurage to antagonist
- GTO and O&I on affected muscle
- Isometric agonist contraction in higher grades if tolerated (don’t remove spasm)
- Other on-site work CI’d
- Stroking/squeezing on head, muscles of mastication and dital arm
Difficulty swallowing is associated with TP in which muscle with Whiplash?
TP in SCM, may also cause deafness, dizziness, headache, memory loss, TMJ pain, TOS and tinnitus
What are various factors that can influence whiplash when driving?
1) Head position: compressive stress on ipsilateral facet joints turned to the side, compress nerve roots
2) Seatbelt: contribute to neck injury, low back pain and bruising to chest
3) Headrest position: if too low may further extend CS
4) Seatback position: too far inclined, headrest can’t reduce injury
5) Stature: shorter than 5 feet are 40% less likely to sustain neck injury, more likely to have cervical injury from shoulder harness
Various grades from Quebec task force for WAD?
Grade 0:
No complaint about neck
No physical signs of injury
Grade 1:
Neck has pain, stiffness or tenderness.
No physical signs are serious enough to cause spasm
Grade 2:
Neck has pain, stiffness or tenderness
Musculoskeletal signs of decreased ROM and point tender
Injury of muscle, tendon, ligament and joint capsule can cause spasm
Grade 3:
Neck pain, stiffness or tenderness
Neurological signs including decreased tendon reflex and weakness
Injury of muscle, injury to neurological system due to mechanical injury or inflammation
Grade 4:
Neck complaint and fracture or dislocation
Special test for Whiplash?
Vertebral Artery Test
Passively takes clients head into extension/side flexion
Dizziness indicates vertebral arteries are compressed
Compression Test
Client’s head rotated and head is pressed straight down
Pain radiates into arm indicated compressed nerve root
Distraction Test
Hand under client’s chin, other under occiput. Slowly lifting clients head
Pain relief indicates nerve root compression
Swallowing Test
SCM grasped at site of potential TP, client swallows.
Pain/difficulting swallowing can indicate TP’s in SCM or cervical pathologies
Strength Test
Test to assess motor weakness
Spurlings
Carefully presses head down in neutral, extended, extended/rotated to tested side
Pain radiating into arm toward side of bent head indicates nerve root pressure
1st Rib Mobility
Adson’s
Palpate radial pulse. Client rotates head toward test shoulder, extends head back while shoulder is laterally rotated and extended. Client takes deep breath
If radial pulse disappears positive for TOS
Wright’s
Palpate radial pulse. Client’s arm is hyperabducted. Tested seated, then supine. Take deep breath and rotate head and neck while arm is brought over the head
Disappearance of pulse or tingling numbness in upper limb indicates TOS
3 Knuckle Test (for TMJ)
Length Test
May reveal shortness due to scar tissue
Various types of Dislocation?
1) Posterior Dislocation
2) Anterior Dislocation
3) Inferior Dislocation
Special test for Dislocation?
1) AF apprehension test
2) ROM testing
3) Apley’s scratch test
4) AC shear test
What similarities does tx of dislocation have with severe sprain?
- Do not treat to affected area (Don’t want to remove protective spasm)
Health history questions for dislocation?
1) Any medication being used, anti-inflammatories, etc
2) Any contributing conditions
3) History of recurrent dislocation
4) When did it occur
5) What was done at time of injury - what position were they in
6) Have they seen a Dr
7) Any pins, screw, surgery done to area
8) If pain is sharp indicates acute injury
What direction is most common for patella to dislocate?
Laterally
- Injury involves external rotation of tibia and foot when knee is flexed
What happens to muscles surrounding joint after dislocation during healing? (Acute, Subacute, Chronic)
Acute:
Protective mm spasm present in mm crossing affected joint
Heat present over injured joint
Subacute:
Tone of the mm crossing joint changes from spasmodic in the early subacute stage to tightness and hypertonic in the late subacute.
TP’s are now present in these mm
Chronic:
Adhesions are local to joint capsule
Hypertonicity and TP are present local to injured joints and in compensator mm.
Disuse atrophy may be present
Steps to safely asses client’s ROM, joint stability, strength after dislocation?
1) Main goal in assessing a dislocated joint before treatment is to determine if joint is stable or unstable
2) If the AF apprehension test is positive (unstable) no PR testing performed. Continue only with AR isometric testing
3) If any joint instability is present during any AF or PR tests - refer back to AR isometric test and do not continue with further PR testing
View chart in LP 21 pg. 9 Easiest explanation
Homecare for Dislocation?
1) Hydro
2) Self massage
3) Remex
4) Encourage activity
Acute: Maintain ROM
Early Subacute: Increase strength
Late Subacute: Increase strength
Chronic: Strengthen Muscle
Muscles associated with TMJ?
1) Medial Pterygoids: elevate Jaw
2) Lateral Pterygoids: pulls disco anteriorly to allow for jaw movement
3) Temporalis: elevate Jaw
4) Masseter: elevate Jaw
5) Supra & Infra Hyoid: depress Jaw (with Digastric)
Signs/Symptoms of TMJ?
Stage 1
-Disc slightly anterior and medial on mandibular condyle
-Inconsistent click (possible)
Mild/No pain
Stage 2
- Disc anterior and medial
- Reciprocal click present (early opening and late closing)
- Severe consistent pain
Stage 3
- Reciprocal consistent click (later on opening and earlier on closing)
- Most painful stage
Stage 4
- Click rare (disc no longer relocates)
- No pain
What would cause mandible to deviate to right when opening the mouth? NOT SURE IF THIS IS RIGHT ANSWER
1) Lateral deviation may be due to TP’s in Masseter, Temporalis and Post. Digastric on side the mandible deviates towards (in this case the right side)
2) Lateral deviation may also be due to TP’s in Lateral Pterygoid on side it moves away from (in this case the left side)
3) Also may be indicative of Capsular Restriction? (pg. 9 TMJ LP)
What is capsular pattern of restriction for TMJ?
- This would indicate that there is a C-Shaped wobble
- Capsular Source - mandible deviated to side that is restricted
- Restriction to the right side in Capsular
Contributing factors for TMJ?
- Predisposition: can be intrinsic (genetic development of mm, ligaments and bones) OR extrinsic (trauma to the neck, face, or jaw)
- Tissue alteration: can occur to the dental and neuromuscular structures.
- Stress: results in increased tone of the muscles of mastication due to jaw clenching, bruxism, or habits such as gum chewing.
- Forward head posture, incorrect swallowing patterns, mouth breathing
Normal AF ROM for TMJ
Depression: 35-50 mm
Lateral deviation: 8-10mm
Protrusion: 5mm
Retrusion:3-4mm
TMJ is secondary concern to what type of WAD?
Rear impact, phase two (120 milliseconds)
Explain palpation of muscles of mastication
Masseter
Between cheek and molars w/ clients teeth gently clenched
Isolate muscle - clench teeth
Medial Pterygoid
Finger on the last molar, slid around to the medial surface of the molar and inferiorly past gum towards the floor of mouth. Finger against inner surface of mandible, finger is slid posteriorly to medial pterygoid
Isolate muscle - resist elevation (closing)
Lateral Pterygoid
Finger between cheek and molars, fingernail against last upper molars. Finger slid superiorly and posteriorly between the maxilla and coronoid process into hollow at roof of cheek
Isolate muscle - resist depression (opening)
Mylohyoid
Finger between lower teeth and tongue. Beginning at incisors, finger slid down the inner surface of mandible to floor of the mouth, posteriorly to last molar where mylohyoid ends
Isolate muscle - resist depression (opening)
3 components present for TMJ to occur?
1) Predisposition
Intrinsic (Genetic development of bones, muscles
Extrinsic (Trauma to neck, face or jaw)
2) Tissue Alteration
Can be skeletal, muscular or dental (tooth loss, hypermobility, spasm, poor posture)
3) Stress
Increased mm tone, due to jaw clenching, chewing gum, etc
Indications of breast massage?
- Congestion, Edema, Lymphedema
- Painful Breast
- Pregnancy, Breast Feeding
- Drainage issues
- PMS
- Breast trauma
- Scar formation
- Post breast cancer discomfort
- Post surgery
- Education regarding self-examination
- Requested by client
- Client seeks assistance in breast monitoring
- Client has goal to become more comfortable with their breasts
CI’s of breast massage?
- Mastitis (active infection or post surgery)
- Local massage to undiagnosed lump
- Local massage to breast abscess
- Forceful attempt to reduce implant related contracture
- Direct pressure on ruptured implant
- Client unable to clarify wishes, or establish comfortable boundaries
- Therapist cannot establish professional environment
- Client/Therapist cannot establish open communication
- Client doesn’t give or withdraws consent
Ominous signs with breast?
1) Nipple retraction (normal after 35, but rapid retraction may be sign of cancer)
2) Nipple discharge that is crystal clear, gray/green or bloody
3) Hard, non-tender lumps
4) Cancerous lumps are usually not painful (pain usually indicates later stage of cancer)
Anatomical boundaries of breast tissue?
Upper: Lower edge of clavicle
Lower: 1” below breast contour, overlying upper fibers of rectus abdominis
Medial: Sternal midline
Lateral: Ant. edge of Latissimus Dorsi with some tissue extending to axilla
Injury to Longus Coli is associated with what condition? What stage of healing is commonly a issue?
Whiplash, longus coli is in usually in chronic spasm in the chronic stage of healing
Right thoracic scoliosis, convex right and concave left. What direction would movement be restricted?
Restriction on convex side - Right side flexion
Convexity is based on position of vertebral body NOT SP's. SP's point to concavity. For example (left curve= right shoulder down, right hip up) - result in hypertonicity of right muscles and restriction of movement in left flexion
Which muscles are short/tight in Hyperkyphosis?
Shoulder protraction: pectoralis major, pectoralis minor, subclavius, serratus anterior and anterior intercostals
Internal rotation of the humerus: subscapularis
Depression of scapula: latissimus dorsi
Anterior head carriage: levator scapulae, upper trapezius, sternocleidomastoid, scalenes and suboccipitals
What muscles are weak/lengthened in Hyperkyphosis?
Shoulder protraction: rhomboids, middle trapezius, thoracic erector spinae
Anterior head carriage: longus colli, longus cervicis, longus capitis, suprahyoids, infrahyoids.
Hyperlordosis - Erector Spinae short or lengthened?
Lumbar is short and tight
Hyperlordosis - QL is short or lengthened?
Short and tight
Hyperlordosis - Multifius is short or lengthened?
Short and tight
Hyperlordosis - Glute Max is short or lengthened?
Stretched and weak
Hyperlordosis - Rectus Abdominus is short or lengthened?
Stretched and weak
Hyperlordosis - Iliopsoas is short or lengthened?
Short and tight
