Principles of Intervention CH 10 Part II

SOFT TISSUE LESIONS

Chronic Pain Syndrome

• A state that persists longer than 6 months

• Pain cannot be linked to a source of irritation• Functional limitations and disability include– Physical– Emotional– psychosocial parameters

Impairments

• Inflammation, pain, edema, muscle spasm• Impaired movement• Joint effusion • Decreased use of associated areas

Educate the patient.

• Anticipated recovery time• How to protect the part while maintaining

appropriate functional activities.

Control pain, edema, spasm

• PRICE• 48 hours• Grade I joint oscillations

Maintain soft tissue and joint integrity and mobility

• Passive movements• Muscle setting • EMS

Reduce joint swelling if symptoms are present

• Medical intervention• Protection (splint, cast)

Maintain integrity and function of associated area.

• Active-assistive• Free• Resistive• Aerobic• Assistive devices

Precautions:

• Rest and movement• Increased pain • Increased inflammation

Contraindications:• Stretching and resistance exercises

MANAGEMENT DURINGTHE ACUTE STAGE/PROTECTION

PHASE/CONTROLLED MOTION PHASE

Impairments

• Pain at the end of available ROM• Decreasing edema• Decreasing joint effusion• Contractures and adhesions • Muscle weakness • Decreased functional use of the part and

associated areas

Educate the patient.

Promote healing

• Assistive devices• Splints • Tape • Wrap

Soft tissue, muscle, and/or joint mobility

• Passive• Active assistive• Active ROM • Mobility of scar• Mobility of related structures

Neuromuscular control, muscle endurance, and strength in involved and related muscles

• Multiple-angle isometric• AROM• Stabilization exercises• Isotonic exercises• Progress resistance

Integrity and function of associated areas

• Strengthening • Stabilizing exercises• Low-intensity functional activities

Precautions:

• Resting pain• Fatigue• Weakness• Spasm

Impairments

• Contractures and adhesions• Muscle weakness• Poor endurance• Poor neuromuscular control• Decreased usage

Educate the patient.

• Safe progressions of exercises• Monitor• Avoid re-injuring the part• Safe body mechanics• Ergonomic counseling

Increase soft tissue, muscle and/or joint mobility.

• Stretching• Joint mobilization• Cross-fiber massage• Neuromuscular inhibition

Improve neuromuscular control, strength, muscle endurance.

• Submaximal to maximal resistance• Specificity of exercise • Multiplane motions• Complex motions• Functional activities• Safe biomechanics

Improve cardiovascular endurance

• Progress aerobic exercises using safe activities

Progress functional activities.

• Supportive and/or assistive devices• Functional training• Progressive strengthening exercises• advanced training activities

CUMULATIVE TRAUMA—CHRONIC RECURRING PAIN

GHURKI TRUST TEACHING HOSPITAL

Tissue Response—Chronic Inflammation

• Injured • Repetitively stressed • Inflammatory process • New immature collagen• Weakening of the tissue• Limitation of motion

Etiology

• Overuse, repetitive strain• Trauma• Re-injury of an “old scar.” • Contractures or poor mobility

MANAGEMENT GUIDELINES: CUMULATIVE TRAUMA

GHURKI TRUST TEACHING HOSPITAL

Impairments

• Pain of varying degrees:– After doing repetitive activities– When doing repetitive activities– When attempting to do activities– Continued and unremitting

• Contractures or adhesions• Muscle weakness• Poor muscular endurance• Imbalance in length and strength• Decreased functional use of the region• Faulty position or movement pattern

Acute Stage

• 1. Educate the patient.

• 2. Promote healing; decrease pain and inflammation.

• 3. Maintain integrity and mobility of involved tissue.

• 4. Develop support in related regions.

• 1. cause of chronic irritation and to avoid stressing the part

• Adapt the environment to decrease tissue stress.

• Home exercise program to reinforce therapeutic interventions.

• 2. PRICE• 3. Non-stressful passive

movement, massage, and muscle setting within limits of pain.

• 4. Posture training.• Stabilization exercises

MANAGEMENT GUIDELINES—Chronic Inflammation/Cumulative Trauma Syndromes:

Controlled Motion and Return to Function Phases• 1. Educate the patient.

• 2. Develop strong, mobile scar.• 3. Develop a balance in length

and strength of the muscles.

• 4. Progress functional independence.

• 5. Analyze job/activity.

• 1. Ergonomic counseling in ways to prevent recurrence.

• Home instruction in safe progression of stretching and strengthening exercises.

• Instruction on signs of too much stress• 2. Friction massage.• Soft tissue mobilization.• 3. Correct cause of faulty muscle and joint

mechanics with appropriately graded stretching and strengthening exercises.

• 4. Train muscles to function according to demand; provide alternatives or support if it cannot.

• Train coordination and timing.• Develop endurance.• 5. Adapt home, work, sport environment/tools.

Precaution

• Progressive loss of range of motion • Emphasize stabilizing the part • Safe adaptive patterns of motion