Week 4 Flashcards
richards splint/zimmer splint (EPD) are used for:
- during phase 1 rehab programs (0-2 weeks)
- patella dislocation
- ACL rupture
motion limiting brace is used for:
– during phase 1 rehab programs (0-2 weeks)
- common for grade 2 MCL tears
rigid taping techniques for the knee
- Box deload taping.
- Medial Collateral Ligament taping
- Patellofemoral joint taping
- medial tilt tape, medial glide tape
- Fat pad / patella tendon deloading
patella dislocation phase 1
POLICE, maintain knee extension, control swelling and pain, exercises targeting VMO.
patella dislocation phase 2
2-6 weeks
- increase ROM and strength, VMO progression, exercises and functional tasts. ensure pain free exercises
acute condition of knee and application of forces - pain only
Grade I: small amplitude movement at
beginning of the available range
Grade II: large amplitude movement within a resistance-free part of available range
dosage: 1-2 sets of 30 seconds to a minute dependent on pain
acute condition of the knee and application of forces - pain and stiffness
Grade III: large amplitude movement performed into resistance or up to the limit of avaliable range
dosage: 2-3 sets or > of 1 min or > dependent on changes in tissue resistance and/or pain
overuse/chronic condition of the knee and application of forces - stiffness
Grade IV: small amplitude movement performed into resistance or up to limit of available range
dosage: 2-3 sets or > of
1 min or > dependent on changes in tissue resistance and/or pain
overuse/chronic condition of the knee and application of forces - stiffness (locked joint)
Grade V: small amplitude, high velocity movement at end of available range (not taught in PHTY 206)
passive physiological treatment techniques for the knee - OA and end range knee extension stiffness
TFJ extension through grades (III - IV)
TFJ extension (Gr III only)
TFJ extension Gr IV
TFJ flexion (Gr III)
TFJ flexion (Gr IV)
Clinical Application: Osteoarthritis, end range knee flexion stiffness+/- pain
passive accessory treatment techniques for the knee
TFJ AP (grades I-IV)
TFJ PA (grades I-IV)
TFJ < medial in a degree of flexion/extension
TFJ > lateral in a degree of flexion/extension
Clinical Application: Medial or lateral knee pain and decreased ROM of flexion or extension
PILL
Pain free, Instant, Long Lasting
passive accessory treatment techniques for the superior tibiofibular joint
STFJ AP (Grades I-IV)
STFJ PA (Grades I-IV)
Clinical Application: STFJ pain +/- stiffness eg: post immobilization.
passive accessory treatment techniques for the patellofemoral joint
- Medial patella tilt in neutral and relevant flexion angle (supine)
- Medial patella glide in neutral and relevant flexion angle (supine) (Grades I-IV)
Clinical Application: Patellofemoral maltracking and pain, PFPS
Cephalad/caudad longitudinal glides (Grades I-IV)
Distraction (Grade IV)
Clinical Application: PF stiffness +/- pain e.g., post immobilization, chronic knee swelling, post TKR
Manual therapy treatment techniques to improve knee flexion:
- PP knee Flexion Gr 3 and/or 4
- PAM of tibia AP in neutral, Gr 1 and 2 if pain is limiting range.
- PAM of tibia AP in flexion range close to the onset of symptoms, Gr 3 and 4
- PAM PF caudad glide, any grade
- Massage techniques for improving range of quadriceps muscle group length.
Manual therapy treatment techniques to improve knee extension:
- PP knee Extension Gr 3 and/or 4
- PAM of tibia PA in neutral, Gr 1 and 2 if pain is limiting range.
- PAM of tibia PA in extension range close to the onset of symptoms, Gr 3 and 4
- PAM PF cephalad glide, any grade
- Massage techniques for improving range of hamstrings and gastroc-soleus muscle groups length.
principles of management of overuse/chronic injuries
4 weeks - 12 months
Overuse injuries
An injury of the musculoskeletal system that results from exposure to a repetitive force beyond its abilities to withstand such a force
Overuse injuries: goals of management: non/mild - moderate irritability
➢ Not affecting ADLs
➢ Pain during the activity
➢ Pain may reduce with warming up
➢ Pain may continue during the activity and after stopping the activity
➢ Treat and train while de-loading tissues
over use injuries: goals of management : Moderate - Severe Irritability
➢ Pain is affecting or limiting ADLs
➢ May have constant symptoms
➢ Cease activity that produced/aggravates pain/injury
➢ Attend to pain +/- inflammation as priority
➢ De-load tissues to relieve pain & encourage normal function
training errors
- Excessive volume
- Too high of a training intensity
- Rapid increases in volume/intensity
Late stage rehabilitation
① Time constraints for soft tissue healing
② Pain-free full ROM
③ No persistent swelling
④ Adequate strength & endurance
⑤ Good flexibility
⑥ Good proprioception/balance
⑦ Adequate cardiovascular fitness
⑧ Function/sport specific skills regained
Reinjury risk
- Inadequate rehabilitation
- Build up too quickly
- Inadequate healing time
- Client not listening
- Fitness not fully restored
- Predisposing factors not fully addressed
Previous risk patterns not recognised & managed accordingly (Bittencourt et al, 2016)
What causes tendinopathy?
overuse, altered lower limb function/biomechanics, intrinsic factors
Reactive tendinopathy
- Non-inflammatory
- Occurs with acute tensile or compressive overload- Short-term adaptive thickening of tendon that reduces stress (stress = force/unit area)
Tendon dysrepair
- Worsening pathology
- Attempt at healing
- Chronically overloaded tendon
- Spectrum of ages & load environments
- Thicker
Some reversibility with load management is possible
Degenerative tendinopathy
- Generally older person
- Possible in younger person or elite athlete with chronically overloaded tendon
- One or more focal nodular areas +/- general thickening
- Hx repeated bouts of tendon pain
- Tendon is heterogeneous – degenerative pathology interspersed with other stages of pathology and normal tendon
- Little capacity for reversibility at this stage
“End stage”
Treatment of tendinopathy - reactive tendinopathy and early dysrepair
- patients goals
- Load management (reduction!)
○ Allows tendon time to adapt
○ Cells become less reactive
○ Matrix resumes more normal structure
Reduces pain
- Load management (reduction!)
Late dysrepair/degenerative tendinopathy - treatment
- Load reduction not generally helpful
- Load modification - address contributing factors
- Lower limb biomechanical issues
○ E.g. Ankle joint mobility, muscle length, foot posture - Training & technique factors
○ Volume
○ Technique (running, jumping) - Kinetic chain function
○ Coordination, strength & endurance
Lumbopelvic and hip stability
Isometric exercise - Patellar Tendinopathy (PT)
- Isometric contractions used to reduce pain without a reduction in muscle strength
- Isometrics could be used pre-sport for pain relief without producing fatigue
- Isotonic exercise effective for tendon rehabilitation, not appropriate prior to activity
Mobilisation
Passive movement technique applied to a spinal or peripheral joint performed within control of patient
- Assessment and treatment
- Physiological or Accessory movements
○ Oscillatory small/large amplitude
○ Sustained stretching +/- oscillations at limit of range
Manipulation
- Sudden movement or thrust performed at the limit of joint range such that patient is unable to prevent movement:
○ Treatment only
○ High velocity
○ Small amplitude
Physiological movement:
- Movements that a person can carry out actively
E.g. ankle dorsiflexion
Accessory movement
- Movements that a person cannot perform independently but are necessary for joint movement
○ Roll, spin, slide/glide
○ Distraction, compression- E.g. anteroposterior glide of talus during ankle dorsiflexion
3 types of joint ‘play:
gliding, traction, compression
application of forces - grade I
small amplitude movement at beginning of the available range
application of forces - grade II
- Grade II: large amplitude movement within a resistance-free part of available range
application of forces - grade III
large amplitude movement performed into resistance or up to the limit of available range
application of forces - grade IV
small amplitude movement performed into resistance or up to limit of available range
application of forces - grade V
small amplitude movement at end of available range
Application of forces - rhythm
- Stationary holding (sustained)
- Slow, smooth movement/oscillation
Fast/sharp, staccato movement/oscillation
- Slow, smooth movement/oscillation
Dosage parameters
- Techniques designed to have an immediate modulating effect on severe or irritable movement related pain:
- Grade I or II
- Slow smooth rhythm
- Short duration (< 2 minutes)
- Repeated only 1-2x in a session
- Techniques designed to have an effect on movement related stiffness & pain:
○ Grade III or IV
○ Quicker, sharper staccato rhythm
○ Performed for several minutes
Repeated several times within a session
AP talar glide
- Green, Refshauge, Crosbie, Adams (2001) A RCT of a passive accessory joint mobilization on acute ankle inversion sprains PhysTher 81:984-94.
- speeds up recovery
