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Musculoskeletal PT
Objectives Give an example of each of the following
musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition.
Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination
Define and give examples of the various tests and measures used in a musculoskeletal PT examination
Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT
Focus on Function Musculoskeletal PT
What are the functional limitations……or “dysfunctions”
Often caused by: Muscle or bone structural imbalances Birth defects Surgery Degenerative changes in body
Musculoskeletal Dysfunctions Can result in:
Pain Swelling
Edema Effusion
Stiffness Muscle weakness Loss of range of motion (ROM)
Active ROM Passive ROM
Musculoskeletal System Includes
Bones Soft Tissue
Muscle Tendon Joint capsule Ligaments Bursae Fascia
Common Musculoskeletal Conditions Overuse injuries Traumatic Injuries Surgical Conditions Medical Conditions
Overuse Injuries Repeated stress to soft tissue and
bone Bursitis Tendonitis Nerve entrapment Stress fracture
Traumatic Injuries Bone and soft tissue can be
damaged through a direct blow or excessive stretch Fracture - bone Sprain - ligaments AND tendons Strain - muscle
Traumatic Injuries Strains and sprains follow a traditional
injury grading scale: Grade I
Fibers stretched with micro-tears No laxity compared to non-injured side
Grade II Fibers stretched with micro-tears Slight increase in laxity compared to non-injured
side Grade III
Full tear of ligament or muscle Requires surgical repair
Surgical Conditions Common surgical conditions may
require PT to rehabilitate Total joint replacement Amputation Ligament reconstruction
Ex: ACL Tendon and/or joint repair
Ex: Rotator cuff repair
General Medical Conditions General medical conditions may
affect the musculoskeletal system Rheumatoid arthritis Cancer Multiple sclerosis HIV or AIDS Fibromyalgia Systemic sepsis
A Brief Review: PT Exam includes:
Patient History Systems review Tests and measures
Patient History Typical questions included in medical
history in a musculoskeletal PT exam Why are you here at PT today? When did the problem begin? What is your primary problem? What provokes or relieves your
symptoms? Medications, or past medical conditions?
Tests and Measures Used in Musculoskeletal PT Pain scale Range of Motion Strength
Manual muscle testing Flexibility Functional Tests
Bed mobility Transfers Activities of Daily Living (ADL’s) (page 148)
Special Tests
Physical Agents Body tissue is injured
Inflammatory process Repair process
Typical physical agents used in musculoskeletal PT may include: Thermal agents Electrical stimulation
Thermal Agents (p.152) Superficial Heat
Increased blood flow Decreased pain Increased healing and
delivery of nutrients Deep heat
Same as above Cold
Same as above BUT has decreased blood flow properties as well
Electrical Stimulation Decreased pain Decreased
edema/effusion Muscle re-education Decreased muscle
spasticity Promotes wound
healing
Manual Techniques Soft Tissue mobilization
Decrease pain and/or swelling Relax muscle or fascia tension Improve ROM Examples:
Massage Trigger point release
Joint mobilization
Therapeutic Exercise ROM exercise
AAROM vs AROM Resisted exercise
Muscular strength vs. muscular endurance Isometric – without movement at joint Isotonic – movement occurring at joints
Concentric contraction Eccentric contraction
Isokinetic – movement at constant speed
Therapeutic Exercise Balance and coordination
proprioception Cardiovascular endurance Aquatic therapy Functional exercises – combination
Open chain – end segment is free to move Kicking leg out while sitting on a chair
Closed chain – movement at 1 joint affects another Performing a squat
Home exercise program Patient education
Now you Should be able to: Give an example of each of the following
musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition.
Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination
Define and give examples of the various tests and measures used in a musculoskeletal PT examination
Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT
Questions??