Q4 Notes

Type

Cause

Pathology Example

Best Response

Motor Tone

Tonic low-level muscle conntraction

Spasms / Cramps

Neuromuscular Techniques

Muscle Tone

Fluid / Fascia Firmness

Frozen shoulder / Compartment Syndrome

Myofascial / Lymphatic Techniques

Muscle Type

Function

Fiber Type

Characteristics

Postural

Hold body upright

Type l

High endurance, rich in mitchondria

Phasic

Enable movement

Type ll

Powerful but fatigues quickly

Direct

Cold to the head

Constricts vessels, reduces pressure

Contrast (Alternate)

Hot/cold to head

Decongests + pain relief

Derivative/Retrostatic

Hot to feet + Cold to neck

Draws blood away from head

Collateral

Hot to face (maxillary artery)

Pulls blood from deeper brain arteries

Arterial Trunk

Ice to carotid (one side only)

Reduces blood flow to head

Spinal Cord Reflex

Cold to palms

Reflexively reduces head congestion

Thin

Avoid cold; use short, mild cold treatments after heat

Large/Stocky

Avoid heat

Athletic

Tolerate hot/cold treatments better

Children & Elderly

Short treatments; moderate temperatures

Healthy Individuals

Tolerate a range of therapies

Skin Tolerance

0 - 44°C

Normal Body Temperature

Torso: 32-35°C; Extremities: 26-27°C

Contrast Treatments

Gradually change temperature extremes

Optimal Immersion Temp

36 - 38°C

Cold Application

Minimum 10°C below skin temperature

Short Cold

10-30 seconds (up to 60 seconds for retro-static effect)

Prolonged Cold

15 minutes to 2 hours (for derivation)

Hot Treatments

20-30 minutes (up to 2 hours with blankets)

Post-Hot Treatments

Short cold application afterward

Condition

Category

Details

Degenerative Disc Disease

General Patogenesis

• Loss of vertebral disc height (normal with aging)

• Intervertebral discs undergo wear and tear

• Most affected areas: Lumbar and Cervical spine

  • Especially L4/L5 and L5/S1

• Bulging and tears in annulus fibrosus

• Alignment changes in facet joints

• Formation of osteophytes (bone spurs)

Thinning Disc Changes

• Nucleus pulposus changes from hydrophilic gel → fibrous (dries out)

• Disc flattens → disc space narrows

• Bulging/tearing triggers pain via nerve root branches

Pain Presentation

• Pain may come from:

  • Disc

  • Facet joints

• Causes:

  • Localized back pain

  • Referred pain to:

    • Buttocks

    • Legs (radiating low back pain)

Description of Degenrative Disc Disease

• Narrowing of intervertebral foramen due to disc compression

• Less space for nerve roots

• DDD tends to occur earlier in cervical spine

Age-Related Disc Changes

• 20s: Early changes in lumbar discs

• 30s: Facet joint degeneration begins (increased stress)

• Possible:

  • Synovitis (synovial membrane inflammation)

  • Joint effusion (swelling)

• 40s: Osteophyte formation (limits motion)

• 40s–50s:

  • Discs still absorb water

  • Nucleus becomes increasingly fibrous

Condition

Category

Details

Disc Herniation

Types of Herniation

• Protrusion

• Prolapse

• Extrusion

• Sequestration

Common Features

• Pain & Inflammation of Nerve Root

• Weakness starts Posteriolaterally

• Lumbar: May lose back pain but worsen neurologically

Demographics

• Between Ages 30-45

• Rare <50 due to nucleus fibrosis

• Common in Males

Signs & Symptoms

• nerve root irritation and produces low back pain that radiates down buttock to below the knee (SCIATICA)

• Numbness, tingling and weakness

• Positive straight leg test

• Pain lasting < 1 month • Worse with activities that increase intradiscal pressure:

Risk Factors

• Lifting items that are too heavy & twisitng

• Repeated Injuries

Acute Lumbar Lesions

• Sudden onset of back pain, progressing to primarily leg pain

• Pain qualities: sharp, deep, or aching

• Local tenderness on palpation

• Hypertonicity in:

  • Quadratus Lumborum (QL)

  • Erector Spinae

• Do not release protective muscle spasm

• Use bolsters to prevent lumbar hyperextension (reduces aggravation)

Acute Neck Lesions

• Referred pain & paresthesia:

  • Across shoulder

  • Down affected arm

  • Follows specific dermatomal pattern

• Pain qualities: sharp, deep, aching

• Worsens with weight bearing (e.g., carrying a bag or purse)

Condition

Description

Types (if applicable)

Signs & Symptoms

Risk Factors

Spondylosis

• Age-related degenerative arthritis of vertebrae, discs, facet joints, and spinal ligaments

• Most common in the cervical spine (neck)

• Often affects adults over 50 years old

• Stiff spine

• Disc thinning

• Osteophyte (bone spur) formation on vertebral bodies and facet joints

• Nerve compression → shooting pain, tingling, numbness, muscle weakness

• Headaches at the occiput (back of head)

• Muscle spasms

• Pain is chronic and progressively worsening

• Ligament laxity or vertebral misalignment

• Increased shearing and compressive forces on joints

• May cause calcification of ligaments

• More frequent/severe in older adults

Lumbar Spinal Stenosis

• Narrowing of spinal canal in the lumbar region causing nerve root compression

• Common cause of low back pain in people over 50 years old

• Low back pain with lumbosacral radiculopathy

• Pain worsens with:

  • Walking

  • Standing

  • Bending backward or hyperextension

• Pain improves with:

  • Sitting

• Nerve symptoms: tingling, numbness, weakness, pins & needles, shooting pain

• Common in older adults

• Often coexists with spondylosis

Spondylolysis

• Stress fracture or defect in the pars interarticularis of the vertebral arch

• Often leads to anterior slippage of vertebra

• Most common at L5, but can occur in cervical spine

• May be asymptomatic or chronic low back pain

• Often worsens with extension-based activities

• More common in young athletes (gymnastics, football)

• Repetitive hyperextension stress on the spine

Spondylolithesis

• Structural instability where one vertebra slips anteriorly over the one below (usually L5/S1)

• Involves tiny or large fractures in the vertebra

• Can be congenital, degenerative, traumatic, or pathological

• Congenital – malformed facets, worsened by activity

• Pars Defect – fracture at pars interarticularis

• Degenerative – facet arthritis + ligament laxity

• Traumatic – rare; from acute injury

• Pathologic – due to disease (tumor, infection, surgery)

• Chronic low back pain

• May have palpable step deformity (prominent spinous process)

• Limited forward flexion

• Nerve symptoms if spinal canal is narrowed

• Athletes or individuals with prior spinal degeneration

• Pain worsens with activity or prolonged standing

Cauda Equina Syndrome

• Compression of nerve roots at lower spinal canal (usually S1 and below)

• Considered a surgical emergency

• Severe low back pain

• Saddle anesthesia (numbness in buttocks, inner thighs)

• Bowel/bladder dysfunction (incontinence or retention)

• Motor weakness in lower limbs

• Abnormal reflexes (ankle/knee)

• Straight Leg Raise test positive

• Inability to heel or toe walk

Caused by large disc herniation, tumor, trauma, or spinal stenosis

Ankylosing Spondylitis

• Chronic, progressive autoimmune condition affecting the spine and SI joints

• Leads to spinal inflammation and stiffness

• Inflammatory flares alternate with remission

• Name breakdown:

  • Ankylosing = stiffness

  • Spondylitis = spinal inflammation

• Chronic low back pain and stiffness, worse in the morning

• Pain improves with activity

• Thoracic kyphosis, forward head posture

• Stiffness in SI joints, neck, and lower back

• Restricted breathing in advanced stages

• Onset: 20–40 years old

• Male > Female

• General contraindication during flares (due to fatigue, illness, fever)

Condition

Cause

Location

Key Features

Spondylosis

Degeneration w/ Age

Cervical & Lumbar

Disc thinning, osteophytes, nerve compression

Spondylolysis

Stress Fracture of Pars

Lumbar (L5)

Pars defect, possible slippage risk

Spondylolisthesis

Vertebral Slippage

Mainly L5/S1

Vertebra slips forward, limited flexion

Ankylosing Spondylitis

Autoimmune Inflammation

Spine & SI Joints

Stiffness, fusion, kyphosis

Condition

Description / Types / Details / etc/

Demographics

Signs & Symptoms

Risk Factors / Worsening Factors

Myasthenia Gravis

• Weaknes & fatigue of muscles of voluntary control

• Caused by a breakdown in comunication between nerves & muscles

• More Common in Women >20 & Men <60

• Weakness of eye muscke, double vision, trouble swallowing

• Difficulty chewing, talking, shortness of breath, weakness

• Worsens with activity

• Better with rest & cold

• Fatigue

• Illness / Infection

• Surgeru

• Stress

• Pregnancy

• Menstruation

Carpal Tunnel Syndrome

• Compressive neuropathy where the median nerve is trapped under the transverse carpal ligament among carpal bones

• Changes in hand/fingers (1st, 2nd, 3rd, and half of 4th digit)

• Increased congestion and edema raises pressure, reducing nerve nutrition

• Common in adults of working age

• More frequent in females, especially during pregnancy (due to hypervolemia)

• Repetitive wrist use

• Pain, numbness, tingling (paresthesia) in median nerve distribution

• Weakness and clumsiness of hand

• Nocturnal awakening due to symptoms

• Symptoms may worsen with wrist use

• Overuse of wrist (computer work, vibratory tools, paintbrush use, upholstery, musicians, assembly line work, massage therapists)

• Pregnancy (fluid retention)

• Edema in carpal tunnel

• Subluxation of carpal bones

• Fibrotic buildup due to repetitive use

• Neck injuries or other nerve impairments (degenerative disc disease, disc herniation)

• Thoracic outlet syndrome (nerve entrapment higher up)

• Double/multiple crush syndrome (nerve irritation at multiple sites)

• Wrist injuries, osteoarthritis, rheumatoid arthritis, tendinosis, sprains

Thoracic Outlet Syndrome

• Neurovascular entrapment of brachial plexus nerves and/or blood vessels supplying the arm

• Compression can occur in 3 places:

  1. Between anterior and medial scalene muscles

  2. Between clavicle and first rib

  3. Under the coracoid process

• Repetivive arm / shoulder movements

• Nerve Irritation

• Vascuar Signs: Fullness, cold, color / temperature difference between arms

• Worse at night

• Muscular Imbalance

• Excessive Connective Tissue

• Cervical Rib (Extra Rib at C7)

Sciatica

• Pain starts in buttocks, runs down one or both legs

• Caused by nerve irritation or pressure in lower back

• Common causes: herniated disc, spinal stenosis (bone spur), or tight piriformis muscle

• Piriformis muscle runs from sacrum to greater trochanter, crossing the sciatic nerve

• Tight piriformis can compress sciatic nerve

• Shooting, burning pain down back of leg(s)

• Numbness and tingling in buttocks and leg(s)

• Tenderness in buttock muscles

• Difficulty sitting comfortably; pain worsens the longer sitting continues

• Sedentary lifestyle

• Obesity

• Age

• Diabete

Headaches

• Tension Headache: Bone-Bone contact between occipital condyles & facets of C1; entrapment of occipital nerve

• Bilateral pain

• “Tight Band Feeling”

• Soft Tissue Injury

• Muscle Tightness

• Trigger Points

• TMJ

Migraine

• Hyperexcitability in pain-sensitive nerves

• With Aura (20%)

• Without Aura (80%)

• Throbing Pain

• Unilateral

• Hypersensivity to Senses

• Hormonal Shifts

• Food Sensitivities

Fibromyalgia

• Painful, non-articular rehumatic disorder / neurological / hormonal disorder

• Gentle pressure at specific “tender points”

• Affects fibrous connective tissue

• Onset age of 25-50

• Female > Male

• Tender points

• Fatigue

• Poor Stamina

• Pain

• Digestive Discomfort

• Sensitivty Amplification

Myofascial Pain Syndrome

• Development of multiple trigger points

• Begins as microscopic injuries to individual muscle fibers & descend into injury-pain-spasm-ischemia cycle

• Taut Bands & Nodules

• Predictable Trigger Point Map

• Referred Pain Pattern

• Regional Pain

Condition

Description

Demographic

Signs & Symptoms

Risk Factors

Scleroderma

• Autoimmune disease causing collagen to build-up & harden

• Autoimmune attack on linings; inflammation stimulated by fibroblasts

• When the edema subsides, scar tissue remains for years

• Tight, hard skin

• Changes in pigmentation

• Weak muscles & swollen tendons

• Skin Ulcers

• Hair Loss

Ehlers-Danlos Syndrome

• Genetic condition affecting connecitve tissue

• Causes hypermobility of the joints

• Loose Joints

• Highly elastic skin

• Easily bruisable

• Redundaant skin folds on eyes

• Muscle Pain

• Muscle Fatigue

• Benign growth on pressure areas

Compartment Syndrome

• Pressure builds inside a closed fascial compartment.

• Can lead to muscle and nerve cell starvation and death.

• Two types:

  • Acute Compartment Syndrome – medical emergency.

  • Chronic Compartment Syndrome – typically exercise-induced and less severe.

• Acute: Anyone with traumatic injuries (common in young adults or athletes).

• Chronic: Common in athletes, especially runners or those doing repetitive leg activity.

• Out of proportion pain to the actual injury

• Tight and burning

• Hot to touch

• Pain, cramping, weakness

• Acute:

  • Fractures

  • Crush injuries

  • Burns

  • Snake/insect bites

  • Complications from surgery

• Chronic:

  • Repetitive stress or athletic activity

  • Poor footwear or biomechanics

  • Muscle hypertrophy without sufficient fascial expansion

Dupuytren Contracture (Palmar Fasciitis)

• Idiopathic thickening and shortening of the palmar fascia.

• Leads to progressive loss of finger extension.

• Causes fingers (commonly the ring and little fingers) to bend permanently toward the palm.

• Proliferation Phase

  • Myofibroblasts multiply

  • Nodule forms at the base of the ring finger (palmar side)

• Involutional Phase

  • Cord of tissue develops distally toward the PIP joints

• Residual Phase

  • Cord tightens

  • Finger(s) bend permanently (flexion contracture)

• Middle-aged to older white men

• Of Northern European descent

• Mildly tender or painless lump near the base of the ring finger

• Palpable cord in the palm

• Inability to fully straighten one or more fingers

• Range from mild contracture to severe finger deformity

• In very severe cases:

  • Compression of nerves and blood vessels

  • Hand function can be significantly impaired

• Repetitive physical labor (especially with vibration)

• Smoking

• Alcohol use

• Diabetes (Type 1 and 2)

• Genetic predisposition

Ganglion Cysts

• Small connective tissue pouches filled with viscous fluid that grow on joint capsules

• Related to degeneration of fascia

• Women > Men

• Children & Young Adults

• Small or Large Soft Lesion

• Gradual or sudden onset

Bursitis

• Bursae: Small synovial fluid-filled sacs that reduce friction between tendons and bones.

• Bursitis: Inflammation of a bursa.

  • Caused by irritation, leading to cell proliferation and excess fluid.

  • Results in pain, swelling, and limited range of motion (ROM).

• Housemaid’s Knee – Prepatellar bursa

• Student’s Elbow – Olecranon bursa

• Weaver’s Bottom – Ischial bursa

• Trochanteric Bursitis – Lateral hip

• Subacromial Bursitis – Shoulder

• Calcaneal Bursitis – Heel

• Septic Bursitis – Infection in the bursa (commonly superficial ones like elbow or knee)

• Physically active individuals

• People with physically demanding jobs (e.g. kneeling, lifting heavy loads)

• Older adults (degenerative changes)

• Those with inflammatory conditions

• Pain with active (AROM) and passive (PROM) movement

• Limited ROM due to muscle splinting (protective contraction)

• Localized swelling and heat (especially in septic bursitis)

• Pain increases with joint use or pressure

• Repetitive stress or overuse

• Occupations requiring:

  • Kneeling (e.g. floor layers, cleaners)

  • Carrying heavy objects

• Pre-existing inflammatory conditions:

  • Rheumatoid arthritis

  • Gout

  • Tendon injuries

• Direct trauma or prolonged pressure on joints

Illiotibial Band Syndrome

• Inflammation & pain where ITB crosses lateral femoral condyle (friction)

• Positive Noble’s Test

• High-Activity

• Those with issues in Gait

• Ache, burning, or sharp pain

• Local pain to lateral knee or radiation up lateral thight

Pes Planus (Flat Feet)

• Loss of medial, lateral, and transverse arches

• Often lacks spring, flexibility, and shock absorption

• Young Children

• Visible absence of arch when standing

• May cause pain if associated with abnormal bone structure

• Congenital deformities (bone shape, ligament strength)

• Foot trauma (esp. to calcaneus or talus)

• Malunion fractures

• Unsupportive footwear

• Muscle imbalance: deep flexors, evertors, weak ligaments

Pes Cavus (Caved Feet)

• Overly high and rigid arch

• Arch does not flatten with each step (reduced shock absorption)

• Associated with Neuormuscular Disorders

• Rigid, high arch with lateral foot pain

• Extensive callusing

• Ankle instability

• Same as Above

Plantar Fascititis

• Pain at the plantar fascia (bottom of foot)

• Likely due to degeneration (not inflammation) → correctly called plantar fasciosis

• Breakdown of collagen fibers in fascia

• Women > Men

Classic pain pattern:

• Sharp, bruised pain on plantar surface (anterior to calcaneus or in arch)

• Worst with first steps after immobility (e.g. getting out of bed)

• Pain subsides with movement, returns with fatigue or prolonged standing

• Excessive running, especially in old/worn-out shoes

• Obesity / Overweight

• Sudden increase in activity levels

• Unequal leg length

• Flat/pronated feet

• Jammed arches

• Tight calf muscles

• May occur as a complication of:

  • Gout

  • Rheumatoid arthritis

  • Diabetes

Hammer Toe

• Deformity affecting 2nd toe

• Muscle and tendon imbalance causes:

  • Hyperextension at MTP & DIP

  • Hyperflexion at PIP

• Over time, muscles, tendons, and fascia shorten, becoming fixed

• Visible toe deformity

• Involuntary muscle contraction

• Pain from friction (shoes)

• Corns and calluses, especially on dorsal PIP joint

• Becomes increasingly rigid over time if untreated

• Contracture of soft tissues

• Often associated with:

  • Bunions

  • Pes cavus (high arches)

• Ill-fitting footwear:

  • High heels

  • Shoes that crowd toes or cause toe to curl

• Trauma

• Underlying conditions:

  • Diabetes

  • Rheumatoid arthritis (RA)

  • Osteoarthritis (OA)

Bunion

• Deformity where the big toe (1st phalanx) is pushed laterally, toward the other toes

• Joint capsule stretches

• Bursa forms at irritated medial MTP joint

• Callus develops over the protrusion

• A similar issue at the little toe = “bunionette” or Tailor’s bunion

• 10x more commen in Women

• Visible bump on the medial side of the 1st MTP joint

• Covered with callus

• Area may be:

  • Red, hot, painful if bursa is inflamed

• Painful to walk, especially in tight shoes