PTE 722: exam 3

traction therapy

applying a gentle, controlled force to the spine to reduce pressure on vertebral discs and relieve pain

list the types of lumbar traction therapies.

• mechanical

• positional

• auto-traction

• manual

• inversion

• gravity

list the type of cervical traction therapies.

• mechanical

• manual

• wall mounted or “over the door” units

what are the two types of mechanical traction?

1. static

2. intermittent

what % of body weight is a good starting point for a traction weight?

7%

T or F: traction causes vertebral separation which can result in an increase in height if forces are great enough to overcome the forces of friction and gravity. (Dr. Robinson question)

T

describe the changes seen with 7%, 25%, and 50% of weight in joint distraction.

7% body weight to distract the cervical vertebrae

25% body weight to increase length of spine

50% body weight to distract lumbar zygapophyseal joints

what are the effects of spinal traction?

• reduction of disc protrusion

• soft tissue stretching

• muscle relaxation

• joint mobilization

• patient immobilization

what are the five clinical indications for the use of spinal traction?

1. disc bulge or herniation

2. nerve root impingement

3. joint hypo-mobility

4. subacute joint inflammation

5. paraspinal muscle spasm

what are the contraindications for spinal traction?

• acute injury or inflammation

• joint hyper-mobility or instability

• traction causes peripheralization of symptoms

• uncontrolled hypertension

• where motion is contraindicated

which populations should avoid using traciton?

downs syndrome, osteoporosis, rheumatoid arthritis, and pregnancy

what are the precautions for spinal traction?

• structural diseases affecting the spine

• when pressure from the belts may be hazardous

• displacement of annular fragment

• medial disc protrusion

• claustrophobia

• patient who cannot tolerate position

• disorientation

• TMJ issues or dentures

T or F: traction therapy as a single treatment for LBP will show great improvement for patients.

F; need other therapy modalities and treatments to go along with it

• even for sciatic issues

symptoms generally fail to improve after traction if ____ disc herniations are present or if theres _____ of disc material

1. large

2. calcification

what type of patients may benefit from mechanical traction?

patients with leg symptoms, signs of nerve root compression, and either peripheralization with extension movements or a straight leg raise

how can a therapist mobilize a specific spinal level?

using positional traction or manual therapy techniques

what type of traction is recommended for an initial treatment ?

low-load traction

hydrotherapy

a therapeutic technique that uses water's properties like buoyancy and temperature to promote healing and well-being, often for pain relief, muscle relaxation, and improving circulation

why would a therapist use hydrotherapy?

• superficial heating or cooling

• water exercise

• pain control

• edema control

• wound care

how can hydrotherapy be applied?

through immersion (whirlpool, aquatic activities, contrast bath) and/or non-immersion (pulsavac, neg pressure wound therapy)

what are the physical properties of hydrotherapy?

• buoyancy

• resistance

• specific heat and thermal conductivity

• hydrostatic pressure

buoyancy

upward force on an object immersed in a fluid that is equal to the weight of the fluid it displaces, enabling it to float or to appear ligther

resistance

a force counter to the direction of movement

T or F: the resistance to a body’s movement in water is proportional to the relative speed of the body, the water’s motion, and the frontal areas of the body in contact with the water.

T

hydrostatic pressure

pressure exerted by a fluid on a body immersed in the fluid

what is pascal’s law?

fluid exerts equal pressure on all surfaces of a body at rest at a given depth; pressure increases in proportion to the depth of the fluid

what is the mode of heat transfer when in water?

convection and conduction

T or F: when swimming, a fast moving body results in high resistance and a slow moving body results in moderate resistance.

T

what are the physiological effects of hydrotherapy?

• cleansing

• musculoskeletal

• cardiovascular: good for venous return

• respiratory: increases work of breathing

• renal: increased urine production

• psychological: relaxing or invigorating

buoyancy decreases weight bearing meaning the deeper you are in water, the lighter you feel. what are the percentages of body weight associated with the varying water depths?

• submerged to waist level: 40-50% of BW

• submerged to chest level: 25-30% of BW

• submerged to neck level: ~10% of BW

what are the two musculoskeletal effects of hydrotherapy?

1. resistance provides force for strengthening

2. hydrostatic pressure increase resting muscle blood flow by 100-225%

water can simultaneously strengthen _________________ unlike many land-based exercises.

both sides of a muscle pair

what are the cardiovascular effects with immersion to the neck?

• central blood volume increased by ~60%

• cardiac volume and output increases by ~30%

• less heart rate response to exercise

• use perceived exertion to guide exercise

what are the contraindications/precautions for hydrotherapy (local immersion)?

• maceration around a wound

• bleeding

• impaired thermal sensation in the immersed area

• infection in the immersed area

• confusion or impaired cognition

• recent skin grafts

T or F: pregnant women can receive hydrotherapy in a full body immersion in hot water, because it’s practically like taking a bath which is okay.

F lol; also MS patients should not be immersed in hot water

what are the contraindications/precautions for hydrotherapy (full body immersion)?

• cardiac instability

• infections conditions

• bowl incontinenece

• severe epilepsy

• suicidal patients

• confusion or disorientation

• alcohol ingestion by patient

what are the adverse effects of hydrotherapy?

• drowning

• burns, fainting, or bleeding

• hyponatremia

• infection

• aggravation of edema

• asthma exacerbation

hydrotherapy chart

what are the steps for whirlpool applicaition?

1. fill the tank with appropriate temp water

2. allow the patient to undress the area to be treated maintaining modesty

3. remove wound dressings if any are present and if they are east to remove without causing pain or damaging the tissue

4. position the patient comfortably, with the affected area immersed in water

5. adjust the direction and aeration of the turbine

6. turn on on the turbine

7. stay with the patient throughout the hydrotherapy treatment and monitor the patient’s vitals before, during, and after

8. When the treatment is completed, remove the limb from the water, dry the intact skin thoroughly, and inspect the treated area.

9. Keep the patient covered or wrapped after treatment to avoid chilling.

10. If the whirlpool is being used for the treatment of an open wound, a clean, pressurized rinse is recommended after the whirlpool to remove bacteria more effectively.

11. Reapply wound dressings if open wounds are present.

12. Drain, rinse, and clean the whirlpool according to the directions given in the section on safety issues regarding hydrotherapy.

whirlpools are generally applied for _____ mins.

10-30 mins

water exercise/ aquatic therapy chart

compression therapy

application of a mechanical force that increases the external pressure on the body or body part

• static or intermittent

T or F: intermittent compression allows for application of force sequentially (distal to proximal) or throughout the entire limb at one time.

T

edema

the accumulation of excess fluids in the spaces between cells of tissues, known as interstitial space

what are the two types of edema?

1. lymphatics edema: plasma proteins in the tissues stagnate owing to mechanical insufficiency of lymphatic drainage

2. venous edema: results from increased capillary pressure and venous obstruction

what’s the difference between hydrostatic pressure and osmotic pressure?

plasma proteins flow out of vessels due to hydrostatic pressure, but flow into vessels due to osmotic pressure

why do proteins and their products accumulate in the tissue space?

when the lymphatic system is incompetent, obstructed, or surgically obliterated

when are the two instances where edema occurs?

1. an imbalance of the affected pressures across the capillary membrane

2. obstruction to the venous or lymphatic flow

what are the effects of external compression?

• improved venous and lymphatic circulation

• limits the shape and size of tissues

• increased tissue temp

T or F: both static and intermittent compression can increase circulation and both increase hydrostatic pressure in the interstitial space

T

what are the causes of edma?

• trauma

• lymphatic and/or venous compromis or insufficiency

• congestive heart failure, liver failure, acute renal disease, diabetic glomerulonephritis, malnutrition, and radiation injury

• infection

if a patient suffers from congestive heart failure, where might a therapist find the edema formation?

lower extremities (ankles, foot, knee)

what causes venous insufficiency?

• lack of physical activity

• dysfunction of venous valves due to degeneration

• mechanical obstruction of the veins by a tumor or inflammation

what is the most common cause of venous insufficiency?

inflammation of the veins (phlebitis)

what type of edema results in a glossy, shiny appearance to the skin?

venous edema

lymphedema

the lymphatic system is compromised resulting in the proteins will progressively accumulate in the interstitial fluid causing an imbalance in capillary dynamics resulting edema

T or F: edema is typically characterized by a pitting quality.

F; lymphedema

what are the adverse consequences of edema?

• subcutaneous tissue fibrosis

• hard induration of the skin

• increased risk of infection

• increased risk of bacterial growth

what are the 5 protocols of the assessment of edema?

1. accurate baseline and follow-up girth measurements are critical in evaluating the patient with edema

2. same landmarks must be used each time

3. same person should take the measurements

4. measurements should be taken at the same time each day

5. use the same tool every time

what are some treatment options of edema?

• elevation

• electrical stimulation at a low pulse rate (produces a pumping effects and increased venous return)

• massaging distal to proximal

• active exercise combine with elevation

• non-mechanical and mechanical compression devices

T or F: air pressures of 20-50 mmHg for the UE and 30-70 mmHg for the LE are recommended starting points for compression therapy in the treatment of edema.

T

what is the total treatment time for edema?

varies from 10-60 mins

what are some contraindications for external compression?

• heart failure or pulmonary edema

• recent or acute DVT, thrombophlebitis, or pulmonary embolism

• obstructed lymphatic or venous return

• severe peripheral arterial disease and/or ulcers due to arterial insufficiency

• severe hypoproteinemia

• acute trauma or fracture

what are the precautions for external compression?

• impaired sensation or mentation

• uncontrolled hypertension

• cancer

• stroke or significant vascular insufficiency

too much pressure can cause the compression device to act as a _______ which could lead to tissue death

tourniquet

what are the two ACSM recommendations for resistance training?

1. 1-3 sets per exercise of 8-12 reps at 70-85% of 1RM for novice

2. 3-6 sets of 1-12 repetitions with 70-100% 1RM for advanced

what is blood flow restriction therapy (BFR)?

the brief and intermittent occlusion of arterial and venous blood flow using a tourniquet while at rest or while exercising

why would a therapist want to utilize BFR?

patient can exercise using significantly less loads and still achieve significant gains in muscle strength and size

• decreases load with increase hypertrophy

T or F: BFR attempts to mimic the hypoxic environment of high intensity exercise, tricking the body to use anaerobic systems instead of aerobic.

T

what are the chances of clotting and hemodynamics when using BFR?

clotting: research shows no increase in signs for clotting (acutely or chronically)

hemodynamics: BP, HR, and CO increase but not as much as with HIIT

what is exertional rhabdomyolysis?

the breakdown of skeletal muscle due to excessive physical training; injury causes the release of cellular contents into the bloodstream

what is ischemic-reperfusion injury?

tissue damage occurring due to the influx of blood flow following a period of ischemia

what are the adverse effects of BFR?

• numbness

• dizziness

• subcutaneous hemorrhage

• rhabdomyolysis

what are some precautions of BFR?

• poor circulation

• obesity/loose skin

• diabetes

• tumors

• hypertension/congestive heart failure

• renal compromise

what are some contraindications of BFR?

• acidosis

• cancer

• those with dialysis ports

• open wounds or fractures

• pregnancy

• severe hypertension or clotting risks

what are the three typical applications of BFR?

1. cell swelling

2. endurance

3. metabolite build-up

what are the benefits of cell swelling (BFR)?

increase protein synthesis and suppress proteolysis

• cell swelling occurs due to a plasma fluid shift into the muscle

T or F: cell swelling is best used as BFR to long-term patients in an outpatient clinic.

F; best used for very acute patients

what are the guidelines for cell swelling (BFR)?

• frequency: 1-2x per day for duration of immobilization

• restriction time: 5 min intervals

• type: unilateral or bilateral

• sets: 3-5

• rest time: 3-5 mins (between sets)

• pressure: high pressure; 70-100% AOP

• restriction form: continuous

what are the benefits of using endurance BFR?

increases strength, hypertrophy, and VO2 max; skeletal muscle strength increases 7-27%, and shows improvements in aerobic capacity

what are the guidelines for endurance BFR?

• frequency: 2-3x per week (>3 weeks) or 1-2x per day (1-3 weeks)

• intensity: <50% VO2 max or HRR

• type: any training equipment- usually bilateral

• sets and pressure: continuous or intervals 40-80% AOP

• restriction time: 5-20 mins per exercise

what is the metabolite theory- lactate production?

use of anaerobic pathways result in byproducts including hydrogen ions and lactate which creates the “burn”

• BFR limits oxygen to a muscle forcing transistion from aerobic to anaerobic pathways with the same lactate “burn”

describe the impact the metabolite theory has on hormones in the muscles.

accumulating lactate and hydrogen ions release growth hormone → kickstarts collagen synthesis and stimulates insulin-like growth factor → IGF-1 stimulates the transport and fusion of satellite cells into muscle fibers → become myocytes and perfrom functions for repair and growth

what role does BFR have on myostatin?

BFR creates stress, which decreases myostatin bc the body beleives it needs myogenesis

• myostatin: inhibits muscle growth by blocking satellite cell proliferation

summarize the BFR metabolite pathway.

1. lactate

2. growth hormone

3. IGF-1

4. transports satellite cells into muscles

5. inhibits myostatin

6. initiates MTORC1 (mammalian target of rapamycin complex 1)

what are the guidelines for metabolite (BFR)?

• frequency: 2-4x per week

• intensity: 20-35% 1RM
  type: one isolated exercise per muscle

• sets and pressure: 80% LOP for LE and 50% LOP for UE

• reps: 30-15-15-15-15 or until failure

• restriction time: 30-60s between sets with cuff inflated; deflate after exercise is complete

what are other benefits of BFR?

• diminishes pain

• bone remodeling

• proximal strength gains

what are the 3 main theories for proximal strength changes?

1. downstream fatigue: distal musculature fatigue faster and force more use of proximal musculature

2. systemic response: hormones stimulated from intense/stressful exercise are in the circulation

3. back-flow effect: backup of blood proximal to cuff

what are the physiological effects of massage?

reflexive effects: pain, circulation, and metabolism

mechanical effects: muscle and skin

what factors does the duration of massage depend on?

• pathology

• size of area

• age

• condition of patient

describe the direction of force during a massage treatment.

direction of force is generally applied in the direction of the muscle fibers

• for lymphedema: starting proximal to distal- “uncorking effect”

describe the massage’s stroke and pressure during a treatment.

massage stroke should begin at joint or below the joint and finish above the joint

massage pressure should be inline with venous flow and return stroke without pressure

T or F: massage should begin and end with superficial or deep effleurage.

T

what are the two purposes for draping with massage?

1. protect modesty

2. prevent patient from being chilled

what are the hoffa massage treatment techniques?

• effleurage: long, slow stroke with minimal drag

• petrissage: intermittent compressions with grasping and lifting

• tapotement: fast, rhythmic stroke

• vibration: high-frequency shaky hand movements

what are the effects of utilizing effleurage?

• assists circulation

• decreases muscular tension

• can reduce pain

  • sidenote: this assess quality of client’s tissues

what are the two types of effleurage?

1. superficial: applied lightly and feathery with thumbs, fingertips, or palms

2. deep: applied slowly with thumbs, knuckles, heels of hand, interlaced fingers, or forearm

what are the effects of utilizing petrissage?

• improves health of muscle tissue

• superficial technique softens thixotropic fascia (pressure causes redistribution of fluids within connective tissue)

• deep technique deforms deep fascia

what are the three variations of petrissage?

1. deep: focus on intermittent and rhythmic compression

2. wringing: slow application without lifting component

3. skin rolling: lifts superficial fascia to deform and loosen

what are the effects in utilizing tapotement/percussion massage?

• initial response is stimulating

• with longer duration, result is relaxation