Comprehensive Notes on Various Musculoskeletal Conditions and Treatments

Delayed Onset Muscle Soreness (DOMS)

• DOMS is caused by microscopic muscle tears during exercise or strenuous activity.

• Discomfort can last from a few hours to 3 days.

Muscle Energy Technique (MET)

• The client relaxes for a few seconds between contractions.

• The procedure is repeated 3-5 times.

• Involves the client's active participation through gentle muscle contractions against a counterforce applied by the therapist.

• Used to lengthen shortened muscles and improve joint mobility.

• Helps restore normal muscle function and reduce muscle imbalances.

• Can be applied to various muscles and joints throughout the body.

Ulnar Nerve

• Located between the medial epicondyle and olecranon process.

• The nerve runs under the medial epicondyle, referred to as the "funny bone".

• Bumping the nerve causes a tingling sensation because it lies close to the skin.

• Responsible for sensation in the fourth and fifth fingers.

• Controls several muscles in the forearm and hand, affecting grip strength and fine motor skills.

• Vulnerable to compression or entrapment, leading to ulnar nerve entrapment or cubital tunnel syndrome.

Patellofemoral Pain Syndrome (PFPS)

• Characterized by pain in the front of the knee around the kneecap.

• Also known as "runner's knee".

• Common in people who engage in sports.

• Cause: Muscular imbalance in the quadriceps, leading to poor patellar tracking in the trochlear groove and patellar misalignment.

• Aggravated by activities such as running, squatting, and climbing stairs.

• May also be associated with factors like overuse, trauma, or biomechanical abnormalities.

• Treatment often involves exercises to strengthen the quadriceps and improve patellar tracking.

Knee Pain

• ITBS (Iliotibial Band Syndrome): Pain on the side of the knee associated with the IT band.

• LCL (Lateral Collateral Ligament) Injury: Pain on the outer side of the knee.

• Torn Meniscus: Pain on the inside, outside, or back of the knee.

Torn Meniscus

• Common knee injury involving damage to the knee cartilage, often due to twisting or heavy lifting.

• Symptoms:

  • Pain

  • Swelling

  • Stiffness

  • Difficulty moving the knee

  • Knee locking or blocking

• Treatment:

  • Rest

  • Ice

  • Physical therapy

  • Surgery (depending on severity)

• Consult a healthcare professional for diagnosis and treatment.

• Can occur during sports activities, especially those involving sudden stops, turns, and pivots.

• The medial meniscus and lateral meniscus are the two main meniscal structures in the knee.

• Diagnosis often involves physical examination and imaging tests such as MRI.

Sweeping Cross Fiber to the Quadriceps

• Uses superficial to moderate pressure.

• Reduces tension in the quadriceps muscle group.

• Similar to effleurage, with a gliding stroke.

• Aids in tissue fluid flow.

• Warms soft tissue and enhances pliability.

• Helps reduce the pull on the medial and lateral retinaculum.

• Stroke travels diagonally across the fibers of the muscle group.

• Performed before other techniques to reduce initial tension.

• Applied in a rhythmic manner to promote relaxation and increase circulation.

• Can address adhesions and trigger points within the quadriceps muscles.

Posture and Muscle Imbalance

• Pectoralis major and Latissimus dorsi can slump the shoulders forward (rounded shoulders).

• These muscles can cause internal rotation of the arm (palms facing the front of the thigh).

• If the client's palms are facing the sides of the leg, the slump is likely a spinal curve issue.

• Upper and lower crossed syndromes can contribute to postural imbalances.

• Strengthening weakened muscles and stretching tight muscles can help correct these imbalances.

Stages of Injury

• Stage 1:

  • Inflammation

  • Edema

  • Hemorrhage

• Stage 2:

  • Fibrosis

  • Cuff tendinitis

• Stage 3:

  • Bony changes (spurs)

• Stages 1 & 2 are reversible and may be treated with conservative treatments.

• Stage 3 requires surgical intervention.

• Each stage has specific characteristics and requires corresponding treatment approaches.

• Proper management in the early stages can prevent progression to more severe chronic conditions.

Amputation

• Surgical removal of all or part of a limb or extremity (arm, leg, hand, foot).

• Typically performed when a body part is too sick or injured to be saved.

• Common causes: trauma, disease, or infection.

• Can significantly impact a person's physical function, mobility, and quality of life.

• Rehabilitation and prosthetic training are essential for regaining independence and function after amputation.

Working Unaffected Limb

• Studies show that working the unaffected limb can send similar neurological impulses to the injured side.

• Doctor's approval: working the affected side manually can help move blood and lymph towards the heart to improve circulation.

• Helps maintain muscle strength and prevent atrophy in the injured limb.

• Enhances overall recovery and functional outcomes.

Piriformis Syndrome

• Medical examination (with x-rays) ruled out intervertebral disc pathology or spinal degeneration

• Sciatica-type pain with a knot in the buttock region.

• The piriformis muscle in the buttock tightens, swells, or spasms, compressing the sciatic nerve.

• Therapist should avoid putting much pressure on the area due to tenderness.

• Muscle Energy Technique (MET) stretching is the best option.

• Nerve strokes or feathering are used for relaxation but have no effect on the musculoskeletal system.

• Symptoms may include pain, numbness, and tingling radiating down the leg.

• Differential diagnosis is important to rule out other conditions that can mimic sciatica.

Piriformis Syndrome - Avoid and Manage

• Avoid prolonged sitting and running uphill and downhill (aggravates symptoms).

• Tennis ball rolling can help loosen and release the tightness in the piriformis.

• Instructions for tennis ball use: Sit or lie on the floor, place the tennis ball under the affected buttock, and slowly shift the body weight over the ball until the tender spot. Hold until the muscle releases.

• Stretching and strengthening exercises targeting the hip and pelvic muscles are beneficial.

Leg Length Discrepancies

• Distort the client's stride length.

• Assessment: Have the client lay on the treatment table and pull both legs and lay them back on the table.

• Visual overview: look to see that the malleoli are not parallel and one heel will be further down (longer) than the other.

• Can lead to compensatory changes in posture and gait patterns.

• May contribute to lower back pain, hip pain, and knee pain.

• Management strategies include shoe lifts, stretching, and strengthening exercises.