Week 6- Lower Leg Interventions Flashcards
PART 1: INTRODUCTION AND LAS
PART 1: INTRODUCTION AND LAS
What interventions can be used for primary and secondary prevention of lateral ankle sprain (LAS)?
-Bracing and balance training exercises.
What interventions can be used for management of acute LAS?
- 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.
Which physical agent should NOT be used post LAS?
-Ultrasound
What interventions can be used for management of chronic LAS?
- Proprioceptive and neuromuscular Ther-Ex for stability.
- Manual therapy (mobs/manips, WB/NWB MWM.
- Dry needling.
- Combined treatments.
- Address psychological factors.
What should NOT be used as a stand-alone intervention in chronic LAS?
-External supports
Is there a concensus on surgical management for chronic ankle instability?
NO
PART 2: ANKLE IMPINGEMENT SYNDROMES
PART 2: ANKLE IMPINGEMENT SYNDROMES
What impairments do we want to address?
- Acute management
- Balance/coordination training & other muscle performance exercises.
Can we use manual therapy with ankle impingement syndromes?
Yes, but wont affect any structural abnormality (osteophyte/scar tissue formation).
- When is surgical management of ankle impingement syndromes used?
- What is a common surgery performed for ankle impingement syndrome?
- Failure of positive response to conservative interventions x6 months following injury.
- Arthroscopic debridement
PART 3: ACHILLES TENDINOPATHY
PART 3: ACHILLES TENDINOPATHY
What interventions can be used for management of Achilles Tendinopathy?
- 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
What did Beyer study conclude about eccentric and heavy slow resistance exercise?
-12-week eccentric exercise and heavy slow resistance programs yielded improvements in tissue quality, pain, and function.
When is iontophoresis most recommended for Achilles Tendinopathy?
-Acute
Achilles Tendon Rupture (Repair):
- Commonly NWB with crutches for ___ weeks.
- If casted, commonly __-__ weeks.
- 4 weeks
- 6-8 weeks
PART 4: POST TIB TENDINOPATHY
PART 4: POST TIB TENDINOPATHY
Exercises should be aimed with loading and parallel organization of fibers, what exercises are used for this?
Eccentric
Why is a shoe insert used for Post Tib Tendinopathy?
-To diminish mechanical loading on Post Tib tendon by raising the floor to the patient’s foot.
With Post Tib Tendinopathy we want to address contributors to excessive _______/___ which could be related to hip/knee and foot/ankle strength.
-pronation/IR
PART 5: PLANTAR FASCIITIS
PART 5: PLANTAR FASCIITIS
There is (E) grade evidence that what patient education can be important in treating Plantar Fasciitis?
- Diet and exercise w/ other education (referral to nutritionist) strategies to address patient’s BMI.
- Results in less stress on plantar fasciitis.
What interventions can be used for management of acute LAS?
- 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)
What is gastroc/soleus stretching aimed at helping in patients with Plantar Fasciitis?
-Provides short-term (1 week - 4 months) pain relief
What are both taping and foot orthoses aimed at treating with Plantar Fasciitis?
-Used for anti-pronation and pain reduction with improved function.
How does a rocker-bottom shoe work?
-Toe/heel tapered up allowing for shoe to continue further as tibia advances, which diminished the amount of DF necessary for patient.
PART 6: SHOE INSERTS AND METATARSALGIA
PART 6: SHOE INSERTS AND METATARSALGIA
What is the most common orthotics?
-semi-rigid
What are some common things to address metatarsalgia?
- Matatarsal pads
- Avoid high heels
- Orthotics to address pes cavus
- Address triceps surae length
PART 7: GENERAL EXERCISE
PART 7: GENERAL EXERCISE
Strengthening
- Eccentrics
- Progressive resistance
Neuromuscular
- Balance
- Proprioception
- Coordination
PART 8: MANUAL THERAPY
PART 8: MANUAL THERAPY
What is the CPR for manual therapy and exercise?
- Symptoms worse when standing
- Symptoms worse in evening
- Navicular drop 5.0mm
- Distal tib-fib joint hypomobility
The CPR for manual therapy and exercise is for dramatic _____-term effect.
-short-term effect
Cosby et al found what?
-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.
Beazell et al found what?
-For subjects with CAI, no significant difference between proximal/distal tib-fib manips compared to no interventions.
Vicenzino et al found what?
-For subjects with recurrent inversion sprains, MWM with posterior talocrural mobs resulted in greater posterior talar translation and DF ROM.
What are the oscillation and sustained hold mobilizations we can perform at the lower leg?
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
What are the joint manipulations we can perform at the lower leg?
- Talocrural Distraction Manipulation
- Cuboid Whip
What are some other manual therapy interventions we can perform at the lower leg?
- Posterior Talocrural MWM
- “Muscle Flow” STM triceps surae
