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Medical Massage 1
Back
| Question | Answer |
|---|---|
| examples of detailed Hx | car accident, work on feet, parents Hx of Ca |
| individuals Hx | how sleep, eating habits, if does yoga or other activities |
| look for | ambulation, gait, posture |
| listen to patient | may tell you something physical or mental |
| psoas | emotion mm, fearful, anxious, ER hips if tight |
| LB strain | muscular |
| LB sprain | ligaments |
| 3 Lumbar Dx | Lumbar facet syndrome, spondylolysis, spondylolisthesis |
| spondylolysis | fx posterior 1 side of vert |
| spondylolisthesis | fx post both sides of vert causing ant slippage |
| contraindication of spondylolysis and spondylolisthesis | lumbar extenstion, prone worse, hyperlordosis |
| men | LBP, security, financial |
| women | UT pain carry load |
| spondylos | vertebrae |
| lysis | breakdown, dissolve |
| olisthesis | slippage sliding down hill |
| C/R | give a little bit |
| functional unit in spine | 3 parts, 2 vert and 1 disc |
| natural splint | mm locks, swelling |
| type of back diagnosis | pelvic tilts, lower cross syndrome, lumbar facet joint syndrome, piriformis syndrome, sacroiliac joint syndrome, sciatica. low back strain or sprain, spondylolisis, spondylolisthesis, trochantaric bursitis |
| COG | hips and pelvis contain |
| iliac bones aka | innominate bones |
| are the iliac and sacral bones immobile | they are held together tightly by do experience small amounts of movement that assist the body in walking and bending |
| what anatomical landmarks must you palpate to accurately pelvic tilts | ASIS, PSIS, iliac crest |
| what do the iliac bones rotate around | the head of the femur |
| what is the result of APT and PPT | postural disorders and mm imbalances |
| APT | ASIS lower than PSIS by 1cm(1/2 inch) or more. most common.could be onsided left or right APT. hyperlordosis, sometimes no symptoms because body compensates for it, can contribute to SIjt dysfunction |
| Left or Right APT | leg length difference |
| hyperlordosis | increased lumbar lordosis, caused from APT |
| muscles imbalances from APT | hypertonic rectus femoris, hypertonic iliopsoas, hypertonic lumbar erectors, overstretched weak abdominals, overstretched HS |
| APT assessment | H-c/o LBP due to hypertonic mm, or facet jt compression, O-hyperlordosis=prominent gluteal region, P=hypertonic mm=ES, QL,Rectus femoris, iliopsoas, R=limted trunk flexion and hip extension due to tight psoas, MRT=no usual findings |
| Special test for APT | Ant innominate rotation test-palp ASIS and PSIS and compare heights. + if ASIS in more that 1cm lower that PSIS.Modified Thomas test-+ if thigh is angles too high indicates tight iliopsoas and if lower leg doesn't hang straight down tight rectus femoris |
| treatment for APT | postural re-ed, massage, stretching, release hypertonic mm, esp lumbar erectors, tx triggerpoints, stretch erectors, iliopsoas and quads, strengthen abs and HS |
| PPT | PSIS is lower than ASIS, caused by poor sitting habits, less common than APT, diminished Lumbar curve=hypolordosis, |
| hypolordosis | dec lumbar curve, puts pressure on intervertebral discs which can lead to degeneration and herniations |
| mm imbalance for PPT | hypertonic HS, hypertonic Abs, hypotonic weak rectus femoris and lumbar ES |
| PPT assessment | H=c/o of LBP or HS tightness, O=hypolordosis, gluteal region appears flattened or tucked under, frequently occurs with kyphosis, P=hypertonic HS or abs, R=tight HS cause pain c hip flexion, MRT-no unusual findings |
| special test PPT | post innominate rotation test, palpate PSIS, and ASIS and compare the heights, +if PSIS is lower than ASIS |
| treatment PPT | postural re-ed, massage and stretch, release hypertonicity of HS and Abs, tx trigger points, stretch HS and Abs, strengthen ES and Quads, ex cobra stretch abs and strengthen ES |
| LPT | one iliac crest lower that the other. cause by either structural or functional disorders. must access accurately for proper tx, LPT can negatively effect SIjt and Lumbar spine |
| skeletal causes of LPT | structural leg length difference, small hemi-pelvis(one innominate bone smaller than the other, scoliosis |
| functional causes of LPT | functional leg length discrepancy, hypertonic QL on higher side or hypertonic iliopsoas on lower side |
| LPT assessment | H=c/o LBP or SI pain, O=1 hip higher, alt gait, shld tilt contralaterally, P=tender & TP's in LB region. if HT QL-high side lumbar mm are hypertonic, low side mm tight overstretched. HT hip flex +thomas test. R=limit lat flex contralaterally c pain SI jt |
| LPT special test | LPT test=compare heights of iliac crest, uneven+lateral tilt, Leg length meas=meas from low side ASIS to ower side of Med Mall, Sup to Sit test= client lies on table, tx legs fully extended, note pos of med mall, +client sits up if one mall moves superior |
| LPT tx | structural=heel lift in short leg, small cushion under short hemipelvis when sitting, functional=release hypertonic mm, trigger point, MFR, stretch short mm |
| lower cross syndrome | postural mm overused or fatigues and become hypertonic, housing MF trigger points. causing inhibition of its antagonist,when phasic mm are inhibited or overused they become weak, causing predictable imbalances UCS and LCS |
| 2 types of skeletal mm | postural or phasic, antagonist to the postural mm are the phasic mm |
| reciprocal inhibition | agonist contract, antagonist relax |
| hypertonic LCS postural mm | ES, QL,Iliopsoas |
| hypotonic LCS phasic mm | Abs, Glut max and med |
| SIjt dysfunction | jt misalignment, lig sprain and or irritation of the contact surfaces btw the sacrum and either iliac bone, unequal forces working on the jt, running on uneven surface, awkward sitting, improper shoes, develop gradually, but can be acute from log sprain |
| assessment SIjt | H-pain in lower lumbar, sacral or glut region, may also have pain in groin or post leg.O=none, pelvic alignment. P=tender in lower lumbar, sacral or glut region, active TPs reproduce pain. R=pain with several hip and trunk movements depends on which ST |
| SIjt MRT | pain with resisted ext of the spine, hip flex, ext and lat rotation or abd |
| special test for SIjt | compare results from several tests. tests shoe misalignment or irritation/infalmmation. Ant ligaments are not treatable and no test for post ligament sprain.FABER, Compression Test,Gapping test. Thigh thrust test and Gaenslens Test |
| gapping test | press both ASIS (cross hand) post and lat. pain +either sprain in Ant sacral log or compression of Post SIjt |
| FABER | Flex, Abd, Ext rotate hip, foot rested thigh (fig 4), stabilize ASIS on opposite side, apply mild pressure on med flexed knee. Pain at SIjt + Ant lig sprain or compression of post SIjt. pain in add is add prob, pain in hip is hip prob |
| compression test | client side-lying press the iliac bones toward each other with increasing pressure until mod force is applied.pain +articular dysfunction of SIjt |
| thigh thrust test | affected side hip flex to 90, push thigh post toward table until mod force applied. pain + irritation of SIjt surface |
| Gaenslens test | side lying affect leg on top, lower leg hip flex, stabilize pelvis and hyperextend upper leg. Pain +SIjt irritation |
| SIjt treatment | misalignment=refer out, ant lig sprain=difficult to tx, post lig sprain=deep friction massage to repair lig, mm=HT HS reduce sacral mobility=reduce HT in low back, glut and HS mm. compression, deep long striping, cautious stretch |
| piriformis syndrome | sciatic nn or sup glut nn compressed by piriformis. caused by external source ex wallet, direct blow, SIjt dysfunction, HT piriformis or TPs in piriformis, produces neurological symptoms in glut region or post LE |
| symptoms of Piriformis syndrome | pain, paresthesia, numbness, mm weakness |
| assessment piriformis syndrome | H=LBP, glut region and/or post LE, sharp shooting pain aggrevated by prolonged sitting,O=rarely visible, P=pressure to gluteal region produces symptoms, HT glut and piriformis, R=may be limit IR due to tight piriformis, MRT=pain with resisted ER or Abd |
| Piriformis syndrome test | FAIR=sidelying leg tested higher, edge of table, flex and adduct hip off table past midline, it will IR hip, radiating pain in glut region or down post leg + . Pace Abd Test=sit on side of table both hips abd resist push knees together + pain |
| piriformis syndrome tx | any treatment aggravates nn discontinue, dec HT in glut mm=comression and deep long stripping. dec HT in piriformis mm - facilitated stretch, static compression neat insertion point, TPs, Stretch piriformis |
| sciatica | irritation inflammation of sciatic nn, sharp stabbing or burning radiates into the buttocks and may travel down the leg all the way to the toes. pain is specific and client can trace pain with one finger. vary in intensity but always present.MD care, |
| sciatica etiology | anything that compresses or puts tension on sciatic nn=herniated disc, vert bone spur, lumbar disc degeneration, fetus pressing on nn, impacted feces, overstretch of nn |
| trochanteric bursitis | inflammation of one or both bursar in the hip jt |
| assessment trochanteric bursitis | H=rep hip flexion or direct trauma, lat hip pain with hip flex or ext, O=no visual signs, P=GT is painful, R+pain with hip flex, ext , MRT=usually neg |
| trochanteric bursitis tx | reduce compression on the bursa, do not work directly over bursa, red compression caused by mm tension, HT in TFL and gluts |
| L/S ROM | flex, ext, lat flex, rot |
| functional unit of the spine | to vert and disc btw them |
| what percent of population suffer from lbp | 70 percent |
| is back pain just physical | back pain has strong psychosocial component too |
| non-specific LBP | tissues involved cannot be determined |
| difference in back pain | nueromuscular causes has the same dysfunctional pattern in the back mm as pin from mm strains. mm become HT, |
| DTF in LBP | can cause therapeutic inflammation and back mm react as in injured and brace or protectively spling and spasm |
| TPs in LBP | commonly created in back mm, can become chronic source of pain, referred pain can be deceptive, can refer from distal (soles) or give appearance of different condition |
| LB strains | mm tendon unit, from trauma or repetitive stress weakening mm tendon unit |
| LB sprains | overstretch injury to a ligament, from sudden twist or wrenching of jt beyond normal ROM. stress can weaken ligaments making easier for sprain to occur |
| LB sprain/strain range | Mild first degree to severe third degree where total rupture or avulsion fx |
| DTF LB sprain | used to stimulate ligament healing. in back deep web of ligament can't get to with DTF |
| LB sprain pain | close to spine and aggravated by movement that pull on damaged ligaments |
| LB strain pain | aggravated by movement that stresses mm tendon unit local swelling |
| assessment LB strain/sprain | H=pain may/may not have identifiable trauma, O=strains superficial mm have localized swelling/bruising, P=HT mm near injury, injury palp =pain at injury site, R=pain c movement that stretch injured ST. MRT=pain c resisted contraction of injured mm/tendon |
Created by:
mloft
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