NPTE - MSK Interventions

Manual therapy goals

Improve joint mobility

Reduce p!

Promote tissue healing

Types of manual therapy

Joint mobs

Soft tissue mob

Myofascial release

Grades of Joint Mobs

Grades I-II: pain relief

Grades III-IV: improve ROM

Goals of STM

Reduce mm tension

Improve circulation

Goals of Myofascial release

Address fascial restrictions

Chronic p!

When is manual therapy indicated?

Capsular restrictions

Mm guarding

What are some contraindications for manual therapy?

Hypermobile joints

Fxs

Active inflammation

Therex goals

Restore function, strength, endurance, mobility, and balance

Types of therex

ROM

Stretching

Strengthening

NM re-ed

What are the types of ROM exercises?

PROM —> AAROM —> AROM

Stretching Dosage

Static: hold 30-60s, 2-3x/d

What is a contraindication for stretching?

Acute injury phase

Types of Strengthening exercises

Isometric —> isotonic —> isokinetic

When to emphasize isometrics?

Early rehab - avoids joint shear

Types of NM Re-ed

PNF

Balance

Proprioception

When is therex indicated?

All phases of healing!

What are the goals of modalities?

P! relief

Tissue healing

Reduce inflammation

What are some common modalities?

Cryotherapy

Thermotherapy

US

E-stim (TENS/NMES/IFC)

Iontophoresis

When to use cryotherapy?

Acute phase

Decreases edema/p!

When to use thermotherapy?

Subacute/chronic phase

Increases tissue extensibility

Types of US and when to use them?

Thermal (continuous): increases tissue temp

Non-thermal (pulsed): increases healing

When to use e-stim?

P! control

Mm re-ed

Edema control

When to use iontophoresis?

Deliver meds (dexamethasone for inflammation)

Contraindications for modalities

Over malignancy

Pacemakers

DVT

Impaired sensation

Goals of gait training and ftnal mobility

Restore I and safe mobility

Things to consider with gait training and ftnal mobility:

ADs

WB status

Surface/speed/balance progression

ADs (most —> least support)

walker, crutch, cane

WB status

NWB —> PWB —> WBAT —> FWB

Interventions to include in ftnal mobility and gait training for return to ftn stage

Stair training

Uneven terrain

Dual-tasking

Goals of motor control/proprioception training

Improve coordination, balance, and mvmt efficiency

examples of motor control/proprioception training

Balance boards, BOSU, SLS

Perturbation training (joint instability [ankle/knee])

CC functional retraining

When to use motor control/proprioception training?

Post-injury

Post-surgery

Fall prevention

Goals of bracing and orthotics

Support

Alignment

Offloading

Examples of orthotics

Foot and ankle alignment (pes planus, plantar fasciitis)

Examples of bracing

ACL

Scoliosis

Post-op

Examples of taping

Patellar tracking

Joint support (McConnell taping, Kinesiotape)

Pt ed examples

Posture and body mechanics

Activity modification

HEP compliance

P! science and expectations

When is pt ed especially important?

Chronic p!

Postural dysftn

Tendinopathy

Acute (inflammatory) Phase of tissue healing

0-7d

Protect, reduce p! and inflammation

RICE, isometrics, PROM

Subacute (Repair) phase of tissue healing

1-3wks

Restore motion, gentle strengthening

AROM, low-load stretching, STM

Chronic (Remodeling) phase of tissue healing

>3wks

Strengthen, return to ftn

Functional training, resistive ex

Red flags and contraindications to intervention

High fever, unexplained swelling/redness: refer out

Signs of DVT (Wells score): refer before mob

Severe osteoporosis: avoid high-impact/aggressive mobs

Unstable vitals/post-op precautions

Tips for boards

Don’t stretch acutely inflamed tissues

CC > OC for joint stability (esp knees)

Isometric holds are SAFE and useful early post-op

In tendinopathy, eccentric exercises are the gold standard

Don’t use modalities as the only intervention - must combine with exercise/ed