treatment principles Flashcards
key questions to ask for intervention planning?
What is the stage of healing?
How long do you have to treat the patient?
What does the patient do for activities?
How compliant is the patient?
How much skilled physiotherapy is needed?
What needs to be taught to prevent recurrence?
Are any referrals needed?
What has worked for other patients with similar problems? Are there any precautions?
What is your skill level?
what is often associated with soft tissue damage?
pain, inflammation and edema
what are pain and edema part of?
part of the healing process
what clinical findings are associated to pain and inflammation?
Swelling
◦ Redness
◦ Heat
◦ Impairment or loss of function
◦ Pain at rest or with active movement or when specific stress is applied to the injured structure ◦ Pain if severe enough can result in muscle guarding and loss of function
◦ With PROM pain is reported before tissue resistance is felt by the clinician
what is the objective of pain?
serves as a protective mechanism
what are the goals of the inital intervention phase in acute lesions?
Decrease pain - Avoid painful positions
◦ Control edema and inflammation
◦ Protect the damaged structures from further damage
◦ While attempting to increase function – Improve ROM (may require education)
◦ Reduce muscle atrophy through gentle isometric setting
◦ Maintain aerobic fitness
what is PRICEMEM
Protection ◦ Rest ◦ Ice ◦ Compression ◦ Elevation ◦ Manual therapy ◦ Early motion ◦ Medications
what needs to be avoided with protection associated with pain and inflammation?
excessive tissue loading must be avoided (crutches, slings, splints)
what do we need to be weary of of rest associated to pain and inflammation?
absence from abuse vs absence from activity – prolonged immobilization can have a detrimental effect on muscles, ligaments, bones, collagen, and joint surfaces
when is ice used in pain and inflammation?
until swelling has decreased
what can be used to provide compression to pain and swollen area?
elastic bandage
what is the aim of elevation of the extremity that is swollen and painful?
aids in venous return and helps minimize swelling
when should elevation and compression be used to control swellling and pain?
used until the swelling has completely disappeared
what is manual therapy in the control of pain and inflammation?
controlled application of a variety of manual techniques have therapeutic benefits
how can manual therapy help control pain and inflammation?
Stimulation of the large-fiber joint afferents of the joint capsule, soft tissue, and jointcartilage which aids in pain reduction
◦ Stimulation o fendorphins–pain reduction
◦ Decrease on intra-articular pressure–pain reduction
◦ Mechanical effect–increases joint mobility
◦ Remodeling of local connective
tissue
◦ Increase of
the gliding of tendons within theirs heaths
◦ Increase in
joint lubrication
how can early motion help control pain and inflammation?
reduce muscle atrophy
◦ maintain joint function
◦ prevent ligamentous creeping
◦ reduce the chance of excessives carring
◦ enhanced cartilage nutrition and vascularization–early recovery and enhanced comfort
◦ ROMexercises–passive or active–while protecting the healing tissue
how can meds help reduce pain and inflammation?
can help with healing process
NSAIDS can control inflammation
corticosteroid injections can serve to decrease pain at the site of inflammation (requires education as it decreases symptoms but won’t heal)
interventions to promote and progress healing inflammation
PRICEMEM
electrotherapeuthic and physical modalities to help contrpl pain swellin, however heat and US are introduced once the acute stage is done
manual therapy such as masse or mobilization.
Tissue repair can be viewed as an adaptive life process in response to what?
intrinsic and extrinsic stimuli
promotion and progression of tissue repair involves a delciate balance between what?
protection and application of controlled functional stresses to the damaged structure
does physical therapy accelerate the healing process?
no, but With correct education and supervision it can ensure that the healing process is not delayed or disrupted and that it occurs in an optimal environment
the rehabilitation procedures used to assist with repair differ depending on
Type of tissue involved
◦ Extent of the damage
◦ Stage of healing
clinical findings associated with the promotion and progress during the proliferative phase
◦ Decrease in pain and swelling
◦ Increase in pain-free active and passive ROM
◦ During PROM pain and tissue resistance occur at the same time
◦ ROM still not WNL – stress applied to the injured structure still produces pain, but less
intervention goal for proliferative healing phase?
Protect the forming collagen, direct its orientation to be parallel to the lines of force it must withstand, and prevent cross-linking and scar contracture
◦ Make scar strong and flexible
how to intervene in the case of a proliferative phase of healing?
- progressive increase in movement; aim to have full ROM in 3-4 weeks
- Progress from PROM –> AAROM –> AROM
- Strengthening move away from isometric
- as ROM and joint play increase, concentric exercises are initatied
- manual therapy to mobilize the joint, transverse frictions fro scar healing
what happens in the even of an overly aggressive approach in the proliferative phase of healing
result in delay or disruption in the repair process through an increase in the stimulation of the inflammatory chemical irritants and exudates
when is pain generally felt during the remodeling phase of healing?
Pain typically felt at the end of range with PROM, after the tissue resistance has been encountered
interventions executed by the PT to promote healing in the remodeling phase?
- apply SAID principles
- exercises should include OC (non weight bearing) or CC (weight bearing)
- concentric and eccentric contractions
- functional and sport specific exercises
- manual therapy; joint mobilization, passive stretch and myofasical release
how can a pt’s functional status be improved or maintained?
by strength, endurance and flexibility exercises
how should the exercises be in the aim to strengthen or increase flexibility?
reate exercises that are safe yet challenging, progressive, systematic,proprioceptively enriched, activity specific and based on evidence based science
why is it important to work on proprioception
knowing where limbs are in space
for balance
avoid falls
what is the goal in correcting posture in pt, especially if cause of symptoms
Alleviate symptoms
◦ Educate pt against habitual abuse
what interventions are executed by the PT when assessing and correcting posture
◦ restoration of normal length of the muscles
◦ Strengthening of the muscles that have become inhibited and weak
◦ Establishing optimal motor patterns to secure the best possible protection to the joints and surrounding soft tissues
what does CKC?
when the distal aspect of the limb pushes onto something
why is CKC commonly used?
replicated functional tasks
enhance joint congruency
decrease shearing force
what is an advantage of OKC rather than CKC
better muscle isolation
what are CKC exercises used to help?
Are used to help reinforce the synchronization of the necessary muscle-firing patterns for both antagonist and agonist ms groups used during stabilization and ambulation
what is open kinetic chain
distal end of the limb is free to move
what is neuromuscular reeducation?
method of training the enhancement of unconscious motor responses, by stimulating both afferent signs signals and central mechanisms responsible for dynamic control`
what are the goals of incorporating NMR?
improve the ability of the nervous system to generate a fast and optimal muscle-firing pattern ◦ Increase joint stability
◦ Decrease joint forces
◦ Relearn movement patterns and skills
when should NMR be added in rehab?
Initiated as early as possible in the rehab process
what is the ultimate goal in improving functional outcome of the patient?
- restore pt confience
- improve fct without harming healing structures
- begin with simple tasks and progress to complex one
- SAID principle to meet specific vocational demands, ADLs or recreation
help pt maintain or improve overall fitness what shoulld try to maintain what
cardiovascular endurance
what is one of the most important aspect of pt treatment
pt education in any treatment intervention
what should be aborded in pt education
- things that can be controlled and changed
- educate about the pt condition so they understand their own role in the rehab process
- discuss strategies to adopt and discuss goals of treatment
what is the ultimate goal of the PT in terms of treatment?
safely return a pt to their preinjury state with as little risk of reinjury as possible
what type of approach is used in the case of a chronic injury or pain?
biopsychosocial approach
