Week 1- Lecture 2 Principles of Treatment prescription for Musculoskeletal pain disorders

Question 1

List the components of a subjective examination

Answer 1

Body diagram

• Area of symptoms
• other related areas
• Areas of paresthesia

Consistancy of pain
Nature of pain. How would you describe it?
Depth of pain 
Severity of pain
Does it radiate out
Pain relationships

HPC
PMH- related to pain
Social history
Aggravating and easing factors
24 hour behaviour
X-rays/ investigations
Medications
General health (GH)
unexplained weight loss
Pyschosocial factors - what you you think is causing the pain

Question 2

Physical examination sequence

Answer 2

 Observation
 Functional Testing
 Screening of other joints
 ROM
 Physiological
 AROM +/- OP
 PROM
 PAMs/passive accessory movements(if indicated

 Palpation
 Orthopaedic/special tests(FADIR /FABER)
 Test of the muscular system
- Resisted tests
- Muscle length
- Muscle performance/MMT
 Motor control (loading & mvmt control)
 Neuro Exam
 NTPT’s

Question 3

Treatment vs Management

START OF LECTURE 2 week 1

Answer 3

Treatment: Specific intervention performed by the clinician, passive in nature(hands on)

• Passive joint mobilisation
• EPA modalities
• HR, rythmic initations
• Taping

Managment(Mx): Specific or general action or activity performed by patient under the direction on prescription of the clinician

• Excercise presciption
• Posture reeducation
• Provision of external support eg brace

Question 4

Physiotherapy indications

Answer 4

If non mechanical & serious/systemic pathology have been excluded (NO RED FLAGS)

If the disorder is likely to be favourably influenced by physiotherapy

Question 5

In what circumstances would you focus more on the symptoms vs contributing factors? and converse

Answer 5

Acute tissue injury
- Focus more of the signs and symptoms which relate to the acute inflammatory process
egMx of pain and swelling

Non-Acute injury or Absence of significant tissue injury
-Focus on the cause
eg underlying impairments of MSK function
eg biopsychosocial factors

Question 6

General Mx plan and advice that should be included as part of physiotherapy intervention

Answer 6

Support and reassurance
Information on prognosis
Provide an explanation
Develop and discuss a treatment plan

Promote usual activity incl work ADL’s hobbies
(w modification)
-increase activity levels based on time vs pain especially with non acute disorders
Promote self efficacy and self Mx

Question 7

Key treatment objectives for
Movement impairment disorders
(Hypomobility)

Answer 7

• Passive accessory(or physiological)movement techniques
• Active /AA mobility excercises w passive over pressure
• Techniques aimed at reducing tone,co-contraction or loss of length
• Address associated or secondary strength/endurance
• Address psychosocial, behavioural or lifestyle issues.

Question 8

What are indications for PAMS

Answer 8

–Loss of joint ROM due to joint hypomobility
Patient can’t independently restore ROM due to pain or loss of tissue compliance

• Physiological Mvmnt limited by resistance(R2) not Pain
• Associated PAM is limited by resistance(R2) not pain

Question 9

Why do we use PAMS

Answer 9

Usually more COMFORTABLE than physiological mobilization

PAMS treatment should not be painful unless some was demonstrated in Ax.

Question 10

Describe the Grades of mobilisation

as it relates to the treatment of joint movement restriction

Answer 10

GRADE 1
Small amplitude applied at beginning of avaliable range
GRADE 2
Large amplitude ossilation applied at beginning of ROM to middle ROM
GRADE 3
Large amplitude ossillation applied at the movement barrier
GRADE 4
Small amplitude ossilation applied at the movement barrier

Question 11

PAMS reasessment

Answer 11

Reasess AROM after each set
Reasess mvmt most likely to improve first
Always ask resting pain proir to reasessing AROM
Looking for changes in range, quality, area pain,functional test

Question 12

List some soft tissue treatment techniques for the treatement of hypotonicity that may contribute to movement impairment

Answer 12

Trigger point release(TP)
-TP pressure with muscle on slight stretch if tolerated
Myofascial release(MFR)
-Longitudinal massage strokes
Massaging tequniques
HR tequniques
HEP: Passive stretches,heat, foam roller

Question 13

Key treatment objectives for
Motor control Impairment
(muscle imbalance) disorders

Answer 13

Aim: normalise suboptimal postures,loading strategies,movement control & or muscle imbalances

• improve proprioceptive/kinasthetic awareness
• Integrate newly established MC into aggravating movement/activitites/functional tasks
• Restore mms balance