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S6- MSK 2 > Week 6- Lower Leg Interventions > Flashcards

Week 6- Lower Leg Interventions Flashcards

1
Q

PART 1: INTRODUCTION AND LAS

A

PART 1: INTRODUCTION AND LAS

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2
Q

What interventions can be used for primary and secondary prevention of lateral ankle sprain (LAS)?

A

-Bracing and balance training exercises.

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3
Q

What interventions can be used for management of acute LAS?

A
  • External supports w/ progressive WB.
  • Ther-Ex including AROM, stretching, neuromuscular training, postural re-ed, balance.
  • RTW/RTS programs to lessen activity and participation restrictions.
  • Physical agents.
  • Manual therapy (mobs/manips, STM)
  • Nonsteroidal anti-inflammatory medication.
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4
Q

Which physical agent should NOT be used post LAS?

A

-Ultrasound

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5
Q

What interventions can be used for management of chronic LAS?

A
  • Proprioceptive and neuromuscular Ther-Ex for stability.
  • Manual therapy (mobs/manips, WB/NWB MWM.
  • Dry needling.
  • Combined treatments.
  • Address psychological factors.
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6
Q

What should NOT be used as a stand-alone intervention in chronic LAS?

A

-External supports

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7
Q

Is there a concensus on surgical management for chronic ankle instability?

A

NO

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8
Q

PART 2: ANKLE IMPINGEMENT SYNDROMES

A

PART 2: ANKLE IMPINGEMENT SYNDROMES

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9
Q

What impairments do we want to address?

A
  • Acute management

- Balance/coordination training & other muscle performance exercises.

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10
Q

Can we use manual therapy with ankle impingement syndromes?

A

Yes, but wont affect any structural abnormality (osteophyte/scar tissue formation).

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11
Q
  • When is surgical management of ankle impingement syndromes used?
  • What is a common surgery performed for ankle impingement syndrome?
A
  • Failure of positive response to conservative interventions x6 months following injury.
  • Arthroscopic debridement
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12
Q

PART 3: ACHILLES TENDINOPATHY

A

PART 3: ACHILLES TENDINOPATHY

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13
Q

What interventions can be used for management of Achilles Tendinopathy?

A
  • Activity modification (complete rest not indicated).
  • Exercise (eccentric, heavy load, slow speed) (2x/week)
  • Iontophoresis
  • Low level laser therapy and orthoses (contradictory evidence exists)
  • Stretching
  • Manual therapy (F)
  • Dry needling (F)
  • Rigid taping rather than elastic tape (F)
  • Heel lifts (contradictory evidence exists)
  • Night splints
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14
Q

What did Beyer study conclude about eccentric and heavy slow resistance exercise?

A

-12-week eccentric exercise and heavy slow resistance programs yielded improvements in tissue quality, pain, and function.

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15
Q

When is iontophoresis most recommended for Achilles Tendinopathy?

A

-Acute

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16
Q

Achilles Tendon Rupture (Repair):

  • Commonly NWB with crutches for ___ weeks.
  • If casted, commonly __-__ weeks.
A
  • 4 weeks

- 6-8 weeks

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17
Q

PART 4: POST TIB TENDINOPATHY

A

PART 4: POST TIB TENDINOPATHY

18
Q

Exercises should be aimed with loading and parallel organization of fibers, what exercises are used for this?

A

Eccentric

19
Q

Why is a shoe insert used for Post Tib Tendinopathy?

A

-To diminish mechanical loading on Post Tib tendon by raising the floor to the patient’s foot.

20
Q

With Post Tib Tendinopathy we want to address contributors to excessive _______/___ which could be related to hip/knee and foot/ankle strength.

A

-pronation/IR

21
Q

PART 5: PLANTAR FASCIITIS

A

PART 5: PLANTAR FASCIITIS

22
Q

There is (E) grade evidence that what patient education can be important in treating Plantar Fasciitis?

A
  • Diet and exercise w/ other education (referral to nutritionist) strategies to address patient’s BMI.
  • Results in less stress on plantar fasciitis.
23
Q

What interventions can be used for management of acute LAS?

A
  • Pt education (weight)
  • Manual therapy (mobs/manips, STM)
  • Gastroc/soleus stretching
  • Taping
  • Foot orthoses
  • Night splints
  • Laser therapy/phonophoresis
  • Rocker-bottom shoe
  • Strengthening and dry needling (F)
24
Q

What is gastroc/soleus stretching aimed at helping in patients with Plantar Fasciitis?

A

-Provides short-term (1 week - 4 months) pain relief

25
Q

What are both taping and foot orthoses aimed at treating with Plantar Fasciitis?

A

-Used for anti-pronation and pain reduction with improved function.

26
Q

How does a rocker-bottom shoe work?

A

-Toe/heel tapered up allowing for shoe to continue further as tibia advances, which diminished the amount of DF necessary for patient.

27
Q

PART 6: SHOE INSERTS AND METATARSALGIA

A

PART 6: SHOE INSERTS AND METATARSALGIA

28
Q

What is the most common orthotics?

A

-semi-rigid

29
Q

What are some common things to address metatarsalgia?

A
  • Matatarsal pads
  • Avoid high heels
  • Orthotics to address pes cavus
  • Address triceps surae length
30
Q

PART 7: GENERAL EXERCISE

A

PART 7: GENERAL EXERCISE

31
Q

Strengthening

A
  • Eccentrics

- Progressive resistance

32
Q

Neuromuscular

A
  • Balance
  • Proprioception
  • Coordination
33
Q

PART 8: MANUAL THERAPY

A

PART 8: MANUAL THERAPY

34
Q

What is the CPR for manual therapy and exercise?

A
  • Symptoms worse when standing
  • Symptoms worse in evening
  • Navicular drop 5.0mm
  • Distal tib-fib joint hypomobility
35
Q

The CPR for manual therapy and exercise is for dramatic _____-term effect.

A

-short-term effect

36
Q

Cosby et al found what?

A

-Single “bout” of oscillatory AP and PA talocrural mobs following acute inversion sprain showed decrease in pain, but no change in DF ROM, posterior talar translation, and self-reported function.

37
Q

Beazell et al found what?

A

-For subjects with CAI, no significant difference between proximal/distal tib-fib manips compared to no interventions.

38
Q

Vicenzino et al found what?

A

-For subjects with recurrent inversion sprains, MWM with posterior talocrural mobs resulted in greater posterior talar translation and DF ROM.

39
Q

What are the oscillation and sustained hold mobilizations we can perform at the lower leg?

A

Tib-Fib Joint
-AP and PA glides at proximal/distal joints

Talocrural Joint

  • AP/PA glides
  • Distraction

Subtalar Joint
-Medial/lateral glides

MTP/IP Joints

  • Dorsal and Plantar glides
  • Distraction glide
40
Q

What are the joint manipulations we can perform at the lower leg?

A
  • Talocrural Distraction Manipulation

- Cuboid Whip

41
Q

What are some other manual therapy interventions we can perform at the lower leg?

A
  • Posterior Talocrural MWM

- “Muscle Flow” STM triceps surae

S6- MSK 2 (21 decks)

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