W5 Flashcards
Reduce Pain Treatment Options
- Advice and Education
- Removal from aggravating activities/relative rest
- Technique correction
- Deload/protect tissue: Taping, bracing, walking aids
- Joint passive accessory or passive physiological mobilisation techniques
- Mobilizations with movement
- Massage
- Electrophysical devices: interferential, therapeutic ultrasound, TENS
- Ice
Restore ROM Goals
restore pre-injury joint motion
Restore ROM
Involves: Stretching, PROM, AROM, AAROM,
Manual Therapy.
* Will stimulate mechanoreceptors which inhibit
nociceptive stimulation leading to decreasing pain.
* Will promote synovial fluid secretion leading to
increased ROM.
Restore ROM Manual Therapy
- Passive Physiological Movement (PPM’s)
- Passive Accessory Movements
- Mobilisation with movements
- Soft tissue techniques
Progression Markers for phase 2 (next to strength training) of rehabilitation
- FULL passive and active extension ROM
- Flexion ROM > 120°
- High level quadriceps recruitment
- Minimal to no effusion
- NO active quadriceps lag
- Nil joint/articular related pain
- “Normal Gait Pattern”
Muscle Conditioning goal
address examined strength deficits in trunk and lower extremity muscle groups. no open chains prior to 6 weeks post graft
Important points for post surgical ligament reconstruction ACLR
- If hamstring graft no resisted hamstring work for 6 weeks due to healing hamstring
graft site. - Must ensure attention given to progressive hamstring rehab in this population due to
dynamic restraint to anterior tibial translation
Important points for post surgical ligament reconstructionin PCLR
- no resisted hamstring work until instructed as early tension will stretch graft.
Muscle Conditioning Hamstring Injuries
- Be specific to the muscle involved, usually biceps femoris
- Be specific to the muscle action required
- Emphasis on eccentric muscle contractions
- Recommend exercises that load the hip and knee simultaneously
- L-protocol – the extender, the diver and the glider
Functional Activity Progression goals
Regain efficiency of multi-joint movement patterns
eg strengthening and activation patterns in functional positiong, lower kinetic chain control, proprioception based experience
Non-operative ACL management
“Cross ACL Bracing Protocol”
1-4 wks - Locked 90˚ NWB with crutches.
5-6 wks Week 5= 60˚-90˚ Week 6= 45˚-90˚
w77= 30˚-FULL FLEXION (WBAT)
Week 8= 20˚-FULL FLEXION˚ (Full WB)
Week 9= 10˚-FULL FLEXION
Patellofemoral Pain Syndrome (PFPS)
- Treatment should follow the evidence but always reflect the findings of your assessment:
o Reduce pain
o Address local factors
o Address remote factors - Manage training/activity load
Reduce Pain treatment options
- Removal from aggravating activities
- Ice
- Taping – medial tilt/glide/rotation and/or fat pad deload
- PF passive accessory mobilisation techniques Gr 1 and 2
- Address tight lateral structures (soft tissue release, manual therapy)
- Acupuncture
PFPS Neuromuscular control/Muscle Conditioning for Quadriceps and Hip Muscle Strengthening:
supports the use of combining hip and knee muscle
strengthening intervention as being superior to quadriceps muscle strengthening alone in
regards to pain and function in the short, medium and long term
PFPS muscle conditioning
Addressing kinetic chain
* Trunk muscle strengthening to address lumbar spine hypermobility
* Consider foot muscle strengthening to address foot and ankle hypermobility.
Patient-specific advice and education re lack of knowledge
- Clear, lay terms used to describe the potential mechanisms leading to the onset of PFPS in
each patient. - Concise instruction regarding activity modification.
- Manage patient expectations and create clear patients centred goals
- Empower patient to engage in active management rather than rely on passive treatment
current evidence. - Consider psychosocial influences on rehabilitation (self efficacy, motivation, fear avoidant
behaviours).
Osteoarthritis Conservative treatment:
e.g. medication, education, physiotherapy, exercise, weight management
* Joint replacement surgery in more severe cases
Physiotherapy for OA
- EDUCATION ++
- Activity/load modification
- Should be developed based on IMPAIRMENTS found in history & physical examination
- Individualised treatment for each patient
- Need to take into account patient’s goals and work/leisure activities
Six recommendations from the expert panel continued from 2016:
- Exercise therapy is recommended to reduce pain in the short, medium and long term and
improve function in the medium and long term. - Combining hip and knee exercises is recommended to reduce pain and improve function in the short, medium and long term and this combination should be used in preference to knee exercises alone.
- Combined interventions are recommended to reduce pain in adults with patellofemoral pain the short and medium term.
- Foot orthoses are recommended to reduce pain in the short term.
- Patellofemoral, knee and lumbar mobilisations are not recommend (in isolation)
- Electrophysical agents are not recommended.
PFPS Consensus Statement 2018 PFPS Consensus Statement 2018
- Use of patellar taping/bracing (should be in combination with exercise)
- Use of acupuncture/dry needling
- Use of manual soft tissue techniques
- Use of blood flow restriction training
- Use of gait re-training
what is the GLA:D program
v* Developed in Denmark for patients with knee and hip OA
* Education and supervised exercise delivered by trained physiotherapists
GLA:D program outcomes
- Reduced pain and use of pain medications
- Improved quality of life
- Improved physical function and ability
- Reduced time off work
Other Important Points
- Encourage general exercise/activity (multi-factorial benefits)
- Encourage weight management
OA weight management
- Obesity increases risk of development and progression of lower limb OA
- Can have cycle of pain causing ↓ activity resulting in ↑ weight and increased knee
pain - Physical activity combined with diet best outcomes in QoL, pain
- Even small weight loss beneficial in reducing pain
