THER2050 midterm OP (official)

first thing to do upon entering exam room

sanitize; check pillowing; supine: knees and head, prone: knees & abdomen, side-lying: head, torso, legs

elevate site of injury (acute to late-sub)

goals in acute

protect injury, control inflammation & SNS firing, maintain safe ROM and spasm

goals in early subacute

decrease inflammation & SNS firing, begin to decrease spasm, maintain ROM, decrease TPs

late subacute goals

progressively increase ROM & strength, gentle stretching, decrease TPs & adhesions, control inflammation & SNS firing

chronic goals

return to function, decrease adhesions & hypertonicity

sprain is an injury to

ligament

grades of sprains

gr 1 - minor, joint is stable, mild local pain

gr 2 - variable, active instability, stable PR

gr 3 - rupture, unstable, spasmatic

anterior tibiofibular ligament O+I and function

anterior lateral malleolus (fibula) to neck of talus. resists inversion & plantarflexion

tibial (medial) collateral ligament attachments & function

medial femoral epicondyle to medial condyle & superomedial surface of tibia; resists valgus force

fibular (lateral) collateral ligament attachments & function

lateral femoral epicondyle to lateral fibular head; resists varus force

anterior cruciate ligament attachment & function

ant intercondylar area of tibia to posteromedial lateral femoral condyle; resists hyperextension of knee joint / ant displacement of tibia on femur

posterior cruciate ligament attachments & function

posterior intercondylar area of tib to anterolateral surface of medial femoral condyle; limits hyperflexion of knee jt/ post. displacement of tibia on

dislocation is an injury in which

joint surfaces lose normal anatomical contact (also involves ligament sprain)

strain is an injury to

muscle / tendon

contusion is what type of injury

crush injury to muscle involving hematoma

no deep / aggressive techniques in acute because

can further destabilize unstable joint, decrease protective spasm, and easily overstress fragile tissue

no deep / aggressive techs in early subacute injury

can easily stress fragile healing tissue

no aggressive stretching in late subacute because

tissue is immature and can easily reinjury BUT gentle stretch can help realign fibers

no major CI in chronic (unless on meds / residual inflammation) but be cautious of

overstressing tissue, progressing too quickly, or working into pain

treatment for any acute injury

DDB - pump terminus - undrape - nodal pumping - gentle long stroke eff proximal to injury - palmar knead - redrape - gentle compressions proximal

how to perform DDB

inhale to first to abdomen, second to lat rib, third to chest; exhale in same order (abd - lat ribs - upper chest)

how to perform nodal pumping

slow, rhythmic, light pumping to lymph nodes proximal to injury

early subacute (moderate protection): sprain / dislocation treatment

DDB - sweeping proximal and distal (no circulatory work distal) - undrape - eff - palmar knead - PROM proximal jts not crossing injury / m.m setting - work out

how to perform PROM

stabilize proximal, move distal; 5-10 reps in all indicated directions

how to perform muscle setting

reps: 7-10, set 3-5, duration: 5-7s

early subacute contusion / strain treatment

nodal pumping - stroke prox + distal - undrape - gentle eff to knuckle knead (proximal) - mid-range PROM (do not disturb tissue / hematome)

late subacute sprain / dislocation treatment

work entire structure eff to specific knead - fascia assess + stretch - gr 2 joint mob opposite injury direction OR PROM all joints - work out

late subacute strain / contusion treatment

work full limb, eff to specific kneading - PROM affected jt - gentle frictions

how to perform frictions

warm to strip - stretch - remove oil, apply tech until change - stretch - ice

how to perform static stretch

stabilize; lengthen 15-30s, repeat 3x (one set for OP)

how to perform hydrotherapy

perform patch test - apply cold until numbness (5-10m) and hot until tissue is warm & red (10m)

how to perform fascial work

warm to knead - stretch - assess fascia - apply tech until softening - sooth

chronic sprain treatment

work entire structure to specific strip and rhythmic rocking / shaking; fascia assess + stretch - HR

how to perform PNF

first barrier - contraction 5-10s - second barrier - repeat to 3rd barrier

how to perform PIR

isometric minimal contraction of the m.m you want to reduce tone in

chronic dislocaion treatment

swedish entire structure to specific strip & rhythmic techs; TP release + gr I/II joint mobs in direction of injury

chronic contusion / strain treatment

swedish entire structure to specific strip & rhythmic techs; TP release & HR

how to perform Gr I/II joint mobs

positioning in trimester 1 (12-24 weeks) & CI

any positioning; avoid abdomen / low back / sacrum, avoid techs that alter BP

2nd trimester (24-28 weeks) positioning & CI

supine / semi seated (prop under R hip), L sidelying to decrease compression on venous return; no prone; avoid heavy techs on abd/low back/sacrum; avoid techs that alter BP

3rd trimester CI & postiion

semi seated (may / not need R hip prop) / sidelying; no supine / prone; no techs that affect BP

1st trimester treatment

compressions + stroking - warm hydro + local lymph sweep

2nd trimester treatment

short stroking + compressions h- TP release + PROM all joints

how to perform TP release

warm to strip - apply strip or static pressure in lengthened position - hold stretch if available / AROM agter

3rd trimester treatment

short strokes + compressions - TP strip + PROM all joints

before leaving OP, what tasks are important

instruct client no getting off the table and ask if they need assistance; remind about possible dizziness / lightheadedness