Treatment algorithms Flashcards
Treatment Plan (Local: Move it, Find it, Control it and Remote): Acute Irritable Neck pain
LOCAL
Movement - Promote movement into directional preference
* Exercises to decrease & centralise pain
* Manual therapy maybe as well – general passive physiological techniques
Movement - Strategies to minimise peripheralising movements
* Task modification
* Education on load management
Muscle performance - Improve local muscle performance
Find It
* Precise mvt into non-provocative direction -Directional preference
Control It
* Control exercises under provocative load
* Improve capacity of the muscles that prevent provocative mvt
Sensorimotor control
* Balance exercises
* Joint position training
* Oculomotor exercises
REMOTE
Optimise thoracic spine function
* Promote thoracic movement into provocative directions (Manual therapy, Home exercises and stretches)
* Improve capacity of thoracic muscles to work independently into provocative direction
Address scapula mechanics so as to optimise cervical loading
* Muscle extensibility
* Muscle recruitment
* Thoracic spine function
* Consider scapula taping
Treatment Plan (Local: Move it, Find it, Control it, Load it and Remote): Impaired Mobility
LOCAL
Movement - Promote movement into provocative direction (Manual therapy, Home exercises and stretches)
Muscle performance - Improve local muscle performance
Find It
* Precise mvt into provocative direction
Control It
* control exercise under non-provocative load
* Improve capacity of the muscles that produce provocative mvt
Load It
* Loading programme that reflects functional problems
* Integrates with remote issues
* Targets scapula and thoracic impairments
Sensorimotor control
* Balance exercises
* Joint position training
* Oculomotor exercises
REMOTE
Optimise thoracic spine function
* Promote thoracic movement into non-provocative direction (Manual therapy, Home exercises and stretches)
* Improve capacity of thoracic muscles to work independently into non-provocative direction
Address scapula mechanics so as to optimise cervical loading
* Muscle extensibility
* Muscle recruitment
* Thoracic spine function
Treatment Plan (Local: Move it, Find it, Control it, Load it and Remote): Impaired Control
LOCAL
Movement - Promote movement into non-provocative direction (Manual therapy, Home exercises and stretches)
Muscle performance - Improve local muscle performance
Find It
* Precise mvt into the non-provocative direction
Control It
* Control exercises under provocative load
* Improve capacity of the muscles that prevent provocative mvt
Load It
* Loading programme that reflects functional problems
* Integrates with remote issues
* Targets scapula and thoracic impairments
Sensorimotor control
* Balance exercises
* Joint position training
* Oculomotor exercises
REMOTE
Optimise thoracic spine function
* Promote thoracic movement into provocative direction (Manual therapy, Home exercises and stretches)
* Improve capacity of thoracic muscles to work independently into provocative direction
Address scapula mechanics so as to optimise cervical loading
* Muscle extensibility
* Muscle recruitment
* Thoracic spine function
Treatment Plan (Local: Move it, Find it, Control it, Load it and Remote): Radicular pain with radiculopathy
LOCAL – unload the nerve
Movement - Promote movement into IVF opening
* Without loading nerve adversely or worsening disc pathology
* Manual therapy, home exercises and stretches
Muscle Performance - Control IVF closing load
FIND IT
* Precise movement into IVF opening directions
CONTROL IT
* Control exercises under IVF closing load
* Stay away from outer range control
LOAD IT
* Loading programme that reflects functional problems
* Integrates with remote issues
* Targets scapula and thoracic impairments
REMOTE
Take IVF closing load out of cervical spine
* Promote thoracic extension and ipsilateral rotation / side bending movement
* Improve capacity of thoracic muscles to work independently into these directions
Improve remote neurodynamics
* Improve sliding remotely
o Open remote tunnels through which neural tissue passes
o Thoracic outlet mainly
* Unload tension remotely
o Promote scapula elevation and lateral rotation
o Promote thoracic extension movement & muscle function
Treatment Plan (Local: Move it, Find it, Control it, Load it and Remote): Radicular pain with radiculopathy
LOCAL - optimise neural mechanics and load tolerance
Movement – Improve sliding by opening space around nerve
Promote movement into IVF opening
* Manual therapy, home exercises and stretches
* Progress to same techniques with static longitudinal neural load
* Add neural movement to IVF opening techniques (MWM)
* Sliding neural mobilisation exercises
Movement - Minimise tensioning
Tensioning mobilisations exercises (progression from sliding exercises)
Muscle Performance - Improve sliding by minimising closing around nerve
FIND IT
* Precise movement into IVF opening directions
CONTROL IT
* Control exercises under IVF closing load
* Stay away from outer range control
LOAD IT
* Loading programme that reflects functional problems
* Integrates with remote issues
* Targets scapula and thoracic impairments
REMOTE
Take IVF closing load out of cervical spine
* Promote thoracic extension and ipsilateral rotation / side bending movement
* Improve capacity of thoracic muscles to work independently into these directions
Improve remote neurodynamics
* Improve sliding remotely
o Open remote tunnels through which neural tissue passes
o Thoracic outlet mainly
* Unload tension remotely
o Promote scapula elevation and lateral rotation
o Promote thoracic extension movement & muscle function
Treatment Plan - General Function: Acute severe irritable
- discourage bed rest
- encourage general exercise within tolerance
- encourage gentle and graded increase in activity levels
- advice re strategies to temporarily reduce mechanical load
- postural and ergonomic advice appropriate for level of severity
Treatment Plan - General Function: Mobility and Control (7)
- advice on load management - chunks of activity instead of long bouts
- discourage excessive sedentary behaviour
- prescribe a progressive general exercise program - dependent on life expectations (suitable and achievable)
- sporting technique modification and manual handling advice
- sleep hygiene if indicated
- lifestyle counselling if indicated
- management of relevant co-morbidities within scope - ref to other HCP if outside scope
Treatment plan - Tissue sensitivity: Acute severe, mobility and control (3)
Good explanation and reassurance
Time contingent medications from GP
Neuromuscular massage techniques
* feels safe to move - dont make it the primary rx
Treatment - Psychological
Provide them with a clear explanation of their problem that
* Emphasises the low chance of a serious medical condition
* Emphasises the high likelihood of a favourable outcome
* Describes the problem in non-threatening reversible terms
* An emphasises on function over structure
* Provides a sensible and plausible rationale for reactivation
* Disavows pathoanatomical models of pain
* Emphasise the strength and robustness of the spine
* Provides a holistic biopsychosocial view of their problem
* Enriches their understanding of pain as protection not damage
Provide them with a clear and comprehensive treatment plan that
* Is explicitly active and encourages self-management
* Discourages excessive caution and protection
* Emphasises the importance of moving and loading
* Addresses non-somatic factors
* Encourages helpful behaviours and coping strategies
* Explore accident related stress response if WAD
Treatment plan: tissue sensitivity for radicular pain with/without radiculopathy
- Explanation and reassurance (done above)
- Medications from GP (limited efficacy)
- Epidural Injections (limited efficacy – some harm)
- Candidate for Surgery if conservative Rx fails
Treatment plan: Thoracic outlet - movement and muscle function
Aim = open space around nerve
MOVEMENT
- Promote thoracic extension
- Improve extensibility of scalenes
- Improve subclavius extensibility
- Promote caudal mobility of Rib 1
- Improve extensibility of pec minor
MUSCLE FUNCTION
* Improve thoracic extensor capacity
o Activation
o Strength
* Decrease use of scalenes
o Improve DNF function
o Breathing training
* Improve upper traps capacity
o Train elevation/LR synergy (less levator scap + rhomboid minor because they close)
o Load it up
