Phys Med Rehab

Whiplash

Torticollis

Manual Therapy Acute - reduce pain by decreasing SNS firing. Light effleurage --> relax and lymph drainage Sub-acute - golgi tendon release on affected muscle, address trigger points with stripping/compression Chronic - long axis traction of upper cervicals in slight extension. Joint play techniques. Begin on side not in spasm. Golgi tendon release on SCM. Strokes that increase circulation and flush out metabolites are important Massage anterior chest and address trigger points in all muscles.

Hyperkyphosis

TOS

Frozen Shoulder Dislocation

Tendonitis

Carpal Tunnel Syndrome

Hyperlordosis

Degenerative Disk Disease - Cervical

Degenerative Disk Disease - Lumbar

Hydrotherapy Physical Modalities Acute: Ice massage (10-15 min). Ice TENS - pain relief, reduce pack (10-15 min every 1-2 hrs) spasm Sub-Acute: Ice after activity. Heat Laser, US - pain relief & added when acute signs are gone. facilitate healing Alternating hot and cold packs/immersion baths (3:1 ratio) Chronic: Hot pack (10-15 min). How Cold for analgesiawith ROM exercises US - aid stretching and tub/bath/showers Heat used with trigger points to improve circulation increase circulation and flush out TENS - pain metabolites Hot pre-treatment on anterior chest. TENS - pain relief, reduce Cool to stimulate traps, rhomboids, spasm erector spinae.

Patient Education Relaxation - stress relief Healthy posture normally slight extension, pillowing

Exercise prescription Subacute: Rotation/side flexion on pillow, Side flexion/rotation upright (chronic - add hand for resistance)

Posture - sleeping, reading

Education, Ergonomics, Exercise. Sitting posture: use postural muscles, no back support - ball! Passive range of motion and joint play for shoulder girdle Do not place deep moist heat over TENS - pain relief, reduce Limit aggravating and clavicle. Trigger points on forearm muscles of nexk of anterior chest if client has HT spasm activites. Modify sleep affected side. Massage scalenes, pec minor. or atherosclerosis of neck. Laser, US - pain relief & position (especially neck Moist heat over scalenes/pecs. facilitate healing pillow - neutral!) Contrast hydro to improve circulation.

Horizontal arm retractions and open doorway stretches. T spine extension over a ball.

Trigger points

Sleep with affected shoulder up - on side. Avoid movement which causes dislocation. May need to use tape or brace Rest. Modify sport or occupational activities.

Pain-free passive pendulum exercise Maintain ROM.

Posture - as close to neutral as possible. Support elbow. Frequent breaks. Stretch.

Wrist flexion and extension stretches --> weight (hammer exercises - ulnar and radial deviation, pronation and supination) Posterior pelvic tilt - flatten low back into the floor and hold for 15 sec. Gluts strengthened in prone with hip extensions hold 15 sec Positional traction: patient rests head on small towel and puts neck in flexion and side bending away from painful side.

Acute - RICE and lymphatic drainage. Sub-acute and chronic - address adhesions and trigger points Acute - Golgi tendon release and gentle joint play. Early sub-acute - lymph drainage Chronic - Friction - 90 degrees to tendon. Stretch and ice after. Acute - address proximal tissues and joints Chronic - massage pronator teres and flexor and extensor muscles (efffleurage and drainage). Trigger points. Do not compress median nerve.

Ice affected shoulder, heat compensating structures. same

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Contrast to flush out build up of same metabolic waste Heat before frictions or after treating trigger points

Myofascial release on hip flexors (crossed arms, supine Pre-treatment heat on rectus femoris same with pillows under knees) - can pre-heat the area. Ulnar and lumbar fascia. Cool for gluts and border stripping of rectus, adductors. Massage iliacus, hamstrings. psoas major. Begin with anterior thorax if there is postural dysfunction. Fascial/swedish techniques for SCM, pectoralis, intercostals and scalenes. Mobilization for hypomobile vertebrae. Brisk, stimulating work on scapular retractors.

Begin with hip flexors if hyperlordosis. Trigger points on iliopsoas, TFL, QL and gluts. To decrease posterior pelvic tilt: hip extensions (leg off table) Acute: passive positioning (pillows) - reduce sx. Posterior protrusion: lumbar extension most comfortable (no pillows). Anterior: relieved by flexion (with pillows)

Heat on shortened tissues. Cold to reduce pain and spacm

Lumbar posture - step up when standing

Neck stretches for scalenes. Doorway stretch for pec minor. Strengthen upper traps, levator scap with shoulder elevation.

Acute - stretch --> isometric --> isotonic

Diaphragmatic breathing. NONE on acute - do not Pain-free range of penetrate deep enough. motion. Correct lifting Same in sub-acute/chronic procedures and posture. Positional traction: lying prone Orthotics may be useful. on a kitchen table and let legs hand. Swimming. Lumbar extension: standing, cat strech, supermans

Long axis traction. Joint play techniques.

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During flare ups: cold Between: hot (e.g. paraffin wax)

US, Laser

Moist heat over affected buttock. If edema: cool towel. Contrast after treatment to flush metabolites and increase circulation.

same

OA

During flare up: relax and treat other areas. Between flare ups: rhthymic techniques (rocking and shaking). Treat compensatory structures for hypertonicity and trigger points. Avoid compression of sciatic nerve. Massage is very effective: address lumbar and pelvic girdle. Leg should not be placed in excessive external rotation. Trigger Piriformis Syndrome points in glut max, med and min. RA

IT Band Syndrome

Diaphragmatic breathing. Deeper fascial techniques interspersed with effleurage and lighter techniques. TFL treated specifically for hypertonicity, adhering or trigger points.

same Pre-treatment heat, such as a hydrocollator. Following fascial work, cool or contrast to increase circulation.

RICE following injury. Lymphatic drainage used on affected leg proximal to knee to reduce edema. Gluts, proximal hams and quads are treated with Swedish techniques. Cruciate injury same

Meniscus injury

Patellofemoral Syndrome

Pes Planus

Weight bearing on locked knee is avoided. Primary focus is same as cruitate, treat compensating structures and proximal lymphatic drainage. Gentle passive relaxed ROM into pain-free extension. Fascial techniques on IT band and hamstrings. Deep moist heat to IT band and Hypomobile joints such as hip and ankle are lateral retinaculum or contrast to manipulated. Effleurage to entire leg and thigh to encourage local circulation increase venous return and flush metabolites Fascial techniques NOT used on medial border of plantar Contrast foot baths. Deep moist heat surface since these tissues are stretched. Fascial tech to to gastrocs and peroneals before gastrocs, soleus, peroneii. Frictions appropriate on stretching. achilles and peroneal tendons.

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Diaphragmatic breathing. Gravity-reduced exercise such Avoid motions that agg as swimming. Pain free joint. Self-massage. stretching and ROM --> Rest. isometric --> isotonic. Hip exercises on floor then standing. Then with hands for resistance. Rest. Stretch. Strenthen - maintain strength to prevent injury. Aerobic conditioning. Frequent breaks and Stretch - seated piriformis then changes in position. Brief lying figure 4. walk or stretching every hour. Pillow between knees when sleeping on side. Side lying position with IT wall stretch - affected side pillows under knees against wall and affected leg (sleep on unaffected behind. side) Frequent stretching if sitting for long periods. Minimize activities that shorten IT band Avoid quad exercise with ACL. Avoid hamstring with PCL. ACL - strengthen hamstrings active assisted. First heel into table and then standing + RICE. Find position of relief. Don't over do it!! weights. After ACL heals, then quads on extended leg (knee When swelling diminishes, exercise can into table). begin Quads and ham straight leg raises can begin in first weel. Step up and step down and stationary bike work. Self-mobilization of SLR to strengthen vastus patella in medial medialis obliquus. Isometric direction. Orthotics for adduction (use feet to adduct). foot pronation. Step up with injured leg, down with non-injured. Wear shoes or sandals Inversion, dorsiflexion and with arch support and adduction to strengthen tibialis avoid walking on bare anterior - using theraband. feet. Orthotics. Strengthen intrinsic foot muscles by scrunching towels.