Principles of Intervention CH 10 Part II SOFT TISSUE LESIONS.
-
Upload
aldous-cole -
Category
Documents
-
view
215 -
download
0
Transcript of Principles of Intervention CH 10 Part II SOFT TISSUE LESIONS.
Chronic Pain Syndrome
• A state that persists longer than 6 months
• Pain cannot be linked to a source of irritation• Functional limitations and disability include– Physical– Emotional– psychosocial parameters
Impairments
• Inflammation, pain, edema, muscle spasm• Impaired movement• Joint effusion • Decreased use of associated areas
Educate the patient.
• Anticipated recovery time• How to protect the part while maintaining
appropriate functional activities.
Maintain integrity and function of associated area.
• Active-assistive• Free• Resistive• Aerobic• Assistive devices
Precautions:
• Rest and movement• Increased pain • Increased inflammation
Contraindications:• Stretching and resistance exercises
Impairments
• Pain at the end of available ROM• Decreasing edema• Decreasing joint effusion• Contractures and adhesions • Muscle weakness • Decreased functional use of the part and
associated areas
Soft tissue, muscle, and/or joint mobility
• Passive• Active assistive• Active ROM • Mobility of scar• Mobility of related structures
Neuromuscular control, muscle endurance, and strength in involved and related muscles
• Multiple-angle isometric• AROM• Stabilization exercises• Isotonic exercises• Progress resistance
Integrity and function of associated areas
• Strengthening • Stabilizing exercises• Low-intensity functional activities
Impairments
• Contractures and adhesions• Muscle weakness• Poor endurance• Poor neuromuscular control• Decreased usage
Educate the patient.
• Safe progressions of exercises• Monitor• Avoid re-injuring the part• Safe body mechanics• Ergonomic counseling
Increase soft tissue, muscle and/or joint mobility.
• Stretching• Joint mobilization• Cross-fiber massage• Neuromuscular inhibition
Improve neuromuscular control, strength, muscle endurance.
• Submaximal to maximal resistance• Specificity of exercise • Multiplane motions• Complex motions• Functional activities• Safe biomechanics
Progress functional activities.
• Supportive and/or assistive devices• Functional training• Progressive strengthening exercises• advanced training activities
Tissue Response—Chronic Inflammation
• Injured • Repetitively stressed • Inflammatory process • New immature collagen• Weakening of the tissue• Limitation of motion
Etiology
• Overuse, repetitive strain• Trauma• Re-injury of an “old scar.” • Contractures or poor mobility
Impairments
• Pain of varying degrees:– After doing repetitive activities– When doing repetitive activities– When attempting to do activities– Continued and unremitting
• Contractures or adhesions• Muscle weakness• Poor muscular endurance• Imbalance in length and strength• Decreased functional use of the region• Faulty position or movement pattern
Acute Stage
• 1. Educate the patient.
• 2. Promote healing; decrease pain and inflammation.
• 3. Maintain integrity and mobility of involved tissue.
• 4. Develop support in related regions.
• 1. cause of chronic irritation and to avoid stressing the part
• Adapt the environment to decrease tissue stress.
• Home exercise program to reinforce therapeutic interventions.
• 2. PRICE• 3. Non-stressful passive
movement, massage, and muscle setting within limits of pain.
• 4. Posture training.• Stabilization exercises
MANAGEMENT GUIDELINES—Chronic Inflammation/Cumulative Trauma Syndromes:
Controlled Motion and Return to Function Phases• 1. Educate the patient.
• 2. Develop strong, mobile scar.• 3. Develop a balance in length
and strength of the muscles.
• 4. Progress functional independence.
• 5. Analyze job/activity.
• 1. Ergonomic counseling in ways to prevent recurrence.
• Home instruction in safe progression of stretching and strengthening exercises.
• Instruction on signs of too much stress• 2. Friction massage.• Soft tissue mobilization.• 3. Correct cause of faulty muscle and joint
mechanics with appropriately graded stretching and strengthening exercises.
• 4. Train muscles to function according to demand; provide alternatives or support if it cannot.
• Train coordination and timing.• Develop endurance.• 5. Adapt home, work, sport environment/tools.