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LE Treatment

Treatment for Conditions of the Lower Extremity

What is evaluation? A dynamic process in which the PT makes clinical judgments based on data gathered during the examination. "Synthesis of all findings"
Describe the interpretation process of data collected during the examination. After gathering data, the PT must be able to put together a conclusion and make clinical judgments based on findings.
Who can make clinical judgments? PTs are the only professionals allowed to synthesize and make clinical judgments.
What is included in the history portion? Provides a working diagnosis MOI: Traumatic or overuse? Age/work-related?
General causes of patellofemoral pain: Alignment Issues - Structural or Functional
General causes of shin splints: Force attenuation Issues related to the arch of the foot
General causes of Osgood Schlatter Syndrome: Dominant quadriceps (classic diagnosis) Many times the problem is not the quadriceps. Possibility - quads are just being overused b/c other joints/muscles are not functioning correctly. Address problematic structures and treat swelling in quads.
Terrible Triad causes and structures involved. Caused by lateral or torsion force. Structures involved: ACL, MCL, Medial Meniscus
Common cause of lateral ankle sprain. Inversion mechanism
3 Treatments of the Pinball Triad 1. Joint Mobilization 2. Therapeutic Exercises 3. Soft Tissue Mobilization
Increased range of motion without strength = what? Instability - Therefore, the patient must develop strength with new increased range to keep the joint stable
Therapeutic Exercise of the LE. (6 listed) Passive Motion Gravity Neutral Motion Active Motion Active-Assisted Motion Resisted Motion Stretching: nerves, soft tissue, etc. Gain range.
Stretching Techniques of the LE. (4 listed) Static Stretching PNF Stretching Manual Stretching 3D Stretching
Static Stretching Low Load Prolonged Stretch (LLPS) for inert tissues
Creep Elongation of a muscle or joint after placed under static load over time
PNF Stretching and Neurological-Related Components "tricks" PNF: for contractile structures (muscle/tendon) Neurological Components: for stretching muscles - Contract/Relax - Reciprocal Inhibition - Distraction
3D Stretching Customized for individual stretching needs
TERT stands for: Total End Range Time
Optimal Time for TERT Stretching 1 hour per day - can be broken up into two 30 min sessions or four 15 minute sessions.
Describe the contract/relax mechanism. A muscle will fully relax after a complete contraction. A muscle that is not fully relaxed cannot be stretched effectively. In order to completely relax a muscle for stretching, the patient completes a maximal contraction. After a max contraction-stretch.
Describe the mechanism of reciprocal inhibition. The nervous system can cause a muscle to relax when its antagonist is fully contracted (GTOs). Maximal contraction of the antagonist will cause the agonist to more fully relax so inert tissues can be stretched.
Distraction and PNF: Use approximation to facilitate muscle contraction. While performing a PNF pattern, approximation/compression of a jt. will facilitate contraction of surrounding muscles. Distraction of the joint during PNF causes relaxation of muscles around the jt.
Intervention in the Acute/Inflammatory Phase: 4-6 days Patient education - prognosis Control pain,edema, spasm - RICE, Gr. 1 Mobs., Myofascial Release Maintain Tissue Dynamics - PROM/light isometrics, EMS to maintain contractility of the muscles, incr. lymphatic drainage & blood flow (controls pai
Cont. Intervention in the Acute/Inflammatory Phase: Reduce Swelling - monophasics for fluid movement of polar components w/ e-. - Compression - Strict immobilization or relative rest (minimal to prevent adverse affects on tissue dynamics. - HVGS Maintain associated, tissues - exercise & strengthenin
Intervention in Chronic/Remodeling Phase: 3-6 months after subacute depending on severity/vascularity Patient education: safe progression & reinjury avoidance Increase Mobility: Progress stretching, Gr. III - IV joint mobs., soft tissue mobs to reorganize scar tissue
Cont. Intervention in Chronic/Remodeling Phase: Improve control, endurance, strength: Exercise (submaximal/maximal), specificity of training (complexity, speed,integration), cardio endurance, progress functional activity
Types of Medical Management Conservative Surgical: type of procedure, post-surgical precautions, tissue healing times Knoe medications Pt. is currently on
List of possible findings Hypomobility/Hypermobility Weakness Muscle imbalances/Mechanics Length/Tension: active/passive insufficiency Kinetic Chain Refer When Appropriate
Muscles prone to weakness: Peroneals Anterior Tibialis Vastus Medialis/Lateralis Gluteus Max/Med/Min Cores Muscles/Obliques
Cause of patellofemoral syndrome Vastus medialis is not always the cause
Weakness in specific muscles can result in: Muscle imbalances/improper arthrokinematics
Muscles prone to tightness: Triceps Surae Posterior Tibialis Short Hip Adductors Hamstrings Rectus Femoris Iliopsoas Tensor Fascia Latae Piriformis
2 Joint Muscles: Tightness Affects joint mobility and active/passive insufficiency. 2 joint muscles that prone to tightness are prone because they are not regularly used through full range. Normally used in shortened positions.
Common Hip Pathology: Muscles prone to tendinitis or strain Flexors Adductors Hamstrings
Common Hip Pathology: Hip Bursae - Bursitis Trochanteric Psoas Ischioinguinal
Common Hip Pathology: Others Labral Tear: Acetabular Fracture: Femoral neck/Acetabular Arthritis
Common Foot Pathology: Plantar Fascitis Causes Pronation Heel Cord
Jones' Fracture Stress fracture of the 5th metatarsal
Created by: BKBSPT