Treatments Flashcards
soft tissue, McKenzie, POE, ultrasound, TENS, ice/heat, PPIVM/PAIVMs, exercise
What are the techniques of soft tissue management? x3
- massage
- myofascial release
- trigger point therapy
What are the contraindications to soft tissue therapy?
- active infections
- skin conditions
- open wounds
- haemorrhagic problems
- inadequate circulatory problems
- acute inflammation at site
- febrile conditions (related to a fever)
- myositis ossifications (calcium/ bone deposits in muscle)
- altered skin sensitisation
- tumours at site
- recent Ca treatment
- over active bone growth areas
What are the types of massage and ST management? x5 (x3/x2)
- effleurage
- petrissage
- tapotement
- trigger point release
- myofascial release
*use of medium e.g. wax
What is effleurage? used for? physiological effects x5 ? techniques of contact x5 ?
USED for: introduces touch to the client > putting Pt at ease > eases in > warms the tissue > relaxing muscle
+ increased venous flow
+ increased lymphatic flow
+ reduction in oedema
+ reduces pain
+ decrease anxiety > promote relaxation
- light and slow ~ soothing, relaxing > good for lymphatic drainage
- medium pressure and faster > increased circulation, relaxation
- CONACTS; 1. single hand, 2. single reinforced, 3. double hand, 4. double alternating, 5. forearm
What is petrissage? used for? effects x7 ? types of technique x5 ?
USED for: deeper tissues for mobilising fluids > stretching muscle fibres > inducing relaxation
+ loosens adhesions of muscle fibres and connective tissues
+ improves extensibility of tissue
+ improves muscle tone
+ reduce pain
+ increase circulation
+ reduce build up of metabolites (substances produced in metabolism)
+ decrease fibrous thickening
TYPES:
1. kneading; palm, thumbs/fingertips, knuckle, forearm
2. skin rolling
3. thumb circles
4. picking up (of muscle body)
5. wringing
What is tapotement? used for? effects x5 ? types of technique x2 ?
- drumming brisk hand movements on broad areas USED for invigorating or stimulatory effects
+ stimulates muscle
+ helps improve muscle tone
+ increase blood flow/circulation
+ reduce pain
+ preparation to exercise
TYPES:
1. hacking > lateral edge of hand; hands relaxed, fingers staring in an open position, coming together when making contact with Pt
2. cupping > hands in cupped position; wrists loose, capture the air
- fast and rhythmic - easier to perform on opposite side to body you stand from
What is myofascial release? used for? movements x3 ?
myofascial pain - inflammation of muscles and fascia (thin, connective tissue surrounding muscle)
USED: to assess site of myofascial thickening and reduce fascial glide using direction of greatest restriction
motions of technique to test restriction: (planes)
- assessing if the tissues have the ability to translate… move as far in plane as can without sliding hand
1. forward and back ~ superiorly and inferiorly
2. side to side ~ medially and laterally
3. rotation ~ rotationally
~ assess freedom of movement between each side, repro. of symptoms or tensions
~ can hold to pressure in the most restricted direction to release OR is less irritable hold in two directions i.e. down and lateral OR three directions i.e. down, lateral and rotation (can leads to more symptoms)
~ add mobilisation - e.g. quad: Pt on sat on end of plinth legs free > apply the pressure while PT slowly moves leg into flexion and back
DIRECT M.R: - high pressure
- use hand to ‘block’ surface of body, sink in, take up slack of fascia, drag fascia across, very slow movement, exit gracefully
INDIRECT M.R: - gentle
- lightly contact, move hands away from each other, slow stretch until restriction, maintain for 60-120s, sustained pressure over time
What are myofascial TRIGGER POINTS? types? x4 how to perform? look for?
- TPs are hyperirritable spots in muscle or fascia
- felt as a nodule or band
- palpation reproduces Pts pain > can evoke a twitch response and referred pain which usually responds with a pain pattern distant from the spot ~ the referral
- primary or central ~ serve local and referred pain, located centre of muscle belly
- secondary or satellite ~ caused in response to existing ‘central TP’, in surrounding muscle, spontaneously release when central is healed
- active ~ any point causing tenderness and referred pain on palpation, can cause autonomic symptoms; redness, sweating, dizziness
- latent ~ no evoked pain spontaneously, local and referred pain only occurs with strong pressure
- muscle length tests to find restriction
- palpate to find TP > apply pressure until discomfort (8/10)
- maintain pressure until pain lowers to 4/10, asking Pt for feedback
- reapply pressure and repeat 3-4x or when tension has reduced
*referred pain? twitch response? muscle length change?
What is the McKenzie method? value? when to use? goal?
- McKenzie/mechanical therapy ~ a system of diagnosis and treatment for spinal and extremity musculoskeletal disorders
value:
+ control/reduction of symptoms
+ benefit QOL during healing
+ focus on controlling recurrence
+ focuses on Pt empowerment and self treatment approach
USE:
- intra-disc displacement > no herniation > USE
- disc protrusion > material beyond IVDS > USE
- disc extrusion > herniation > potentially NOT? > surgery? multi therapy approach?
GOAL:
- CENTRALISATION of symptoms back to spine and reduce the peripheralization of pain in the extremities > move pain from distal areas to proximal areas (spine) > avoid peripheralization to abolish pain
What is a red flag before completing McKenzie Rx?
- cauda equina
What is the process of the McKenzie method?
- ASSESSMENT > detailed Hx, aggs and eases, movement assessment > specific repeated or sustained movements > determine effect of symptoms (e.g. standing flexion/extension, knees to chest, cobra - loaded or unloaded, therapist or patient directed)
- CLASSIFICATION
- postural syndrome > prolonged stretch or load of soft tissues, c/o intermittent pain associated with postures
- dysfunction > ligaments or tissues chronically shortened, decreasing ROM, intermitted pain when shortened structures are stressed
- derangement > disc prolapse or herniation - TREATMENT > finding a repeated or sustained movement that reduces or eliminates symptoms, MAINTAIN this, RESTORE function, eventually pain provoking movements become pain free
- PREVENTION > of recurrence, education and encouragement, exercise regularly and self care
How to assess DEARANGEMENT in MK?
*derangement - disc prolapse or herniation
Ax - does the Pt…
- centralisation?
- peripheralization? - pain in extremities
- lateral shift?
>contra-lateral shift ~ move to opposite side of pain, shift away from painful side
>ipsilateral shift ~ move towards the painful side - deviation?
>flex or extent / drift left or right - lordosis?
> reduced (red), accentuated (acc) - flexion / extension in standing (FIS/EIS)
- repeated x10
- shift > hold Pts shoulders and ask to align pelvis under shoulders
How to treat derangement using McKenzie?
- repeated or sustained movements/positions in accordance with Ax findings > use in Rx
- if Pt unable to reduce > therapist can assist before handing responsibility back over
- follow principle of FORCE PROGRESSION:
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