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LE Treatment
Treatment for Conditions of the Lower Extremity
| Question | Answer |
|---|---|
| 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
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