Musculoskeletal PT

Objectives Give an example of each of the following

musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition.

Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination

Define and give examples of the various tests and measures used in a musculoskeletal PT examination

Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT

Focus on Function Musculoskeletal PT

What are the functional limitations……or “dysfunctions”

Often caused by: Muscle or bone structural imbalances Birth defects Surgery Degenerative changes in body

Musculoskeletal Dysfunctions Can result in:

Pain Swelling

Edema Effusion

Stiffness Muscle weakness Loss of range of motion (ROM)

Active ROM Passive ROM

Musculoskeletal System Includes

Bones Soft Tissue

Muscle Tendon Joint capsule Ligaments Bursae Fascia

Common Musculoskeletal Conditions Overuse injuries Traumatic Injuries Surgical Conditions Medical Conditions

Overuse Injuries Repeated stress to soft tissue and

bone Bursitis Tendonitis Nerve entrapment Stress fracture

Traumatic Injuries Bone and soft tissue can be

damaged through a direct blow or excessive stretch Fracture - bone Sprain - ligaments AND tendons Strain - muscle

Traumatic Injuries Strains and sprains follow a traditional

injury grading scale: Grade I

Fibers stretched with micro-tears No laxity compared to non-injured side

Grade II Fibers stretched with micro-tears Slight increase in laxity compared to non-injured

side Grade III

Full tear of ligament or muscle Requires surgical repair

Surgical Conditions Common surgical conditions may

require PT to rehabilitate Total joint replacement Amputation Ligament reconstruction

Ex: ACL Tendon and/or joint repair

Ex: Rotator cuff repair

General Medical Conditions General medical conditions may

affect the musculoskeletal system Rheumatoid arthritis Cancer Multiple sclerosis HIV or AIDS Fibromyalgia Systemic sepsis

A Brief Review: PT Exam includes:

Patient History Systems review Tests and measures

Patient History Typical questions included in medical

history in a musculoskeletal PT exam Why are you here at PT today? When did the problem begin? What is your primary problem? What provokes or relieves your

symptoms? Medications, or past medical conditions?

Tests and Measures Used in Musculoskeletal PT Pain scale Range of Motion Strength

Manual muscle testing Flexibility Functional Tests

Bed mobility Transfers Activities of Daily Living (ADL’s) (page 148)

Special Tests

Physical Agents Body tissue is injured

Inflammatory process Repair process

Typical physical agents used in musculoskeletal PT may include: Thermal agents Electrical stimulation

Thermal Agents (p.152) Superficial Heat

Increased blood flow Decreased pain Increased healing and

delivery of nutrients Deep heat

Same as above Cold

Same as above BUT has decreased blood flow properties as well

Electrical Stimulation Decreased pain Decreased

edema/effusion Muscle re-education Decreased muscle

spasticity Promotes wound

healing

Manual Techniques Soft Tissue mobilization

Decrease pain and/or swelling Relax muscle or fascia tension Improve ROM Examples:

Massage Trigger point release

Joint mobilization

Therapeutic Exercise ROM exercise

AAROM vs AROM Resisted exercise

Muscular strength vs. muscular endurance Isometric – without movement at joint Isotonic – movement occurring at joints

Concentric contraction Eccentric contraction

Isokinetic – movement at constant speed

Therapeutic Exercise Balance and coordination

proprioception Cardiovascular endurance Aquatic therapy Functional exercises – combination

Open chain – end segment is free to move Kicking leg out while sitting on a chair

Closed chain – movement at 1 joint affects another Performing a squat

Home exercise program Patient education

Now you Should be able to: Give an example of each of the following

musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition.

Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination

Define and give examples of the various tests and measures used in a musculoskeletal PT examination

Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT

Questions??