WEEK 1 - subjective exam and massage Flashcards
what is the purpose of a subjective exam?
to obtain sufficient information about a person symptoms so as to be able to plan an efficient, effective and safe physical exam
identify the components of a subjective exam
- patient info (DOB, gender etc)
- body chart (WOCSNOR)
- behaviour of symptoms
- history of presenting complaint
- special/ screening questions
- past medical history
- social history
- family history
- interests
- patient perspectives
- outcome measures
what is involved in the body chart component of a subjective exam
W – where are main area of symptoms
O – other symptoms related to main area of pain
C – constant / intermittent / variable
S – severity and superficial or deep
N – nature of symptoms
O – other areas of body with symptoms
R- relationship of all symptom areas
what is involved in the behaviour of symptoms component of a subjective exam?
- Aggravating factors -> Include functional activities + pain rating (severity) and time to pain level (gives you clues as to the anatomical structure concerned, the histology and aetiology)
- Easing factors -> include time to settle and pain level once settled (severity) (gives you clues as to if the problem is inflammatory or mechanical in nature + movements or factors that may help during treatment)
- 24 hour pattern
>AM (when wake and get out of bed (GOOB) / how long do the symptoms last?/ can you do anything to ease them?)
>Day (end of day (EOD)
>PM (how long to get to sleep?/ do you wake?/ if you wake how long to get back to sleep?) - Irritability -> how long for pain to come on with aggs, to what pain level and how long for pain to subside with easing factors/ mild/ moderate/ severe
- Status of injury (is condition getting better, staying the same, getting worse?
what is involved in the history of presenting complaint component of a subjective exam?
- Current history (when/how/ what has happened since injury/ any treatment + did it help/no)
- Past history (has this happened before?/when/ how often)
- Past treatment (what type of treatment & who provided?/ what was the treatment?/did it help or not?)
what is involved in the special/ screening questions component of a subjective exam?
- General health (GHx)
- Loss of weight (LOW) and/or history of cancer (Hx Ca)
- Night pain
- Major illness/ injuries/ surgeries
- Current medications
- Corticosteroid use
- Anticoagulants
- Body mass index
- Physical activity (PA) levels
- Imaging (x-ray, CT, MRI, bone scan)
Blood tests
what is involved in the past medical history component of a subjective exam?
- hospitalisations
- chronic conditions
what is involved in the social history component of a subjective exam?
home situation - who they live with, dependent etc
what is involved in the family history component of a subjective exam?
anyone else in family have similar condition
what is involved in the patient perspective component of a subjective exam?
- What do they think is going on?
- what have they been told by others?
- Previous experience with physio?
- Goals?
- Flags
Ø orange - mental health factors
Ø Yellow - psychological factors
Ø Blue - social factors
Ø Black - litigation & threats to financial security
what are the flags that can present in a subjective exam
Ø orange - mental health factors
Ø Yellow - psychological factors
Ø Blue - social factors
Ø Black - litigation & threats to financial security
what is an aggravating factor?
Include functional activities + pain rating (severity) and time to pain level (gives you clues as to the anatomical structure concerned, the histology and aetiology)
what is an easing factor?
include time to settle and pain level once settled (severity) (gives you clues as to if the problem is inflammatory or mechanical in nature + movements or factors that may help during treatment)
define massage
a mechanical stimulation of the tissues by means of rhythmically applied pressure and stretching
why is massage used/ purpose?
- To increase flexibility, coordination, venous return, and blood flow
- To reduce muscle spasm
- To promote relaxation
- To decrease neuromuscular excitability and pain
- To stimulate circulation
- To facilitate healing and restore joint mobility
- To remove lactic acid and oedema
what are the cardiovascular physiological effects of massage?
- Increase blood flow to the area being massaged, histamine release and temperature
- Decreased heart rate, respiratory rate, and blood pressure especially when massage is used for relaxation
what are the neuromuscular physiological effects of massage
- Increase flexibility by stretching muscles and breaking down scar tissue
- Decrease neuromuscular excitability (relaxation) but only during the massage and only to the areas- muscles being massaged
how does massage reduce pain?
- Activate sensory nerves – inhibits pain via spinal gate and the release of
endogenous opiates- Decreasing pressure from swelling, mechanical pain can be reduced
- Interrupting m. spasm, mechanical pain can be reduced
- Reducing oedema, mechanical pain can be reduced
- Increasing b. flow & encouraging waste removal, chemical pain can be reduced
Activates sensory nerves – inhibits pain
what are the psychological implications of massage?
- Reduces patient anxiety, depression, and mental stress
when is massage condraindicated?
- Acute contusions
- Acute inflammatory conditions
- Sever varicose veins
- Open wounds/ abscesses
- Skin infections
- Failed or incomplete fracture healing
Thrombophlebitis and embolisms
what are the 3 stages of massage prepartaion?
- massage media/ lubricant
- setting/ environment
- therapist and client
- therapist: base of support, clothing, hands
- client: informed consent, expose part, client comfort
what are the 6 massage techniques?
stroking
effleurage
petrissage
kneading
tapotement
friction
trigger points
what is stroking?
- Stroking of the skin in any direction with the hand and palm moulding to the contours of the tissue
- Use at beginning and end of massage
- Usually applied parallel to the muscle fibre
Superficial or deep
what is effleurage?
- Stroking – utilizes longitudinal sweeping motion covering large areas of the body
- Long Gliding
- Use at the beginning and end of the massage
- Usually applied in direction of lymphatic flow
- Superficial:
- slow strokes for relaxation
- Deep:
- Elongates muscle fibres
- Stretches fascia
