Comps2

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Author:
barbostick
ID:
138961
Filename:
Comps2
Updated:
2012-03-02 16:11:24
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Soma Comps Comps2
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Description:
Study guide for second round of comps
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  1. 3 specific contraindications for DDD
    • 1- Do not remove protective spasming with acute disc lesion.
    • 2- If no position can be found that alleviates symptoms, refer before starting treatmentprotocols.
    • 3- No range of motion should increase nerve pain sensation.
  2. Three other questions for DDD
    • 1- Bending/twisting/lifting as part of job
    • 2- Do you work out? If so what type of exercises do you do? (muscle imbalances)
    • 3- Do you have a history of back injuries?
  3. Treatment for DDD
    • Resting
    • Stroking/general warming
    • Light cervical traction
    • Joint mobilizations- don’t go into overpressure!
    • Fascial work
    • Slightly stronger cervical traction
    • Clearing
    • Deeper warming
    • Trigger points
    • Stretching
    • Superficial work
    • More traction
    • Reset muscles with resisted in each direction except flexion
    • Close
  4. Homework suggestion for DDD
    Proper pillowing
  5. Three other questions for whiplash
    • 1- What position was your head in when you were injured?
    • 2- Where was your car hit- direction of impact (if MVA)?
    • 3- Any headache or pain in the neck, back, shoulder or jaw before impact?
    • 4- Is this an insurance claim
  6. Two specific contraindications for whiplash
    • 1- Don’t remove protective spasms
    • 2- Avoid extreme stretches to cervical muscles, especially SCM, in acute & subacute stages
  7. Two tests to rule out/confirm DDD
    • 1- Spurling’s Test
    • 2- Distraction Test
  8. Tx goals for DDD
    • 1- Create space between vertebrae
    • 2- Relieve pain
  9. Two tests for whiplash
    • 1- AROM- reduced cervical movement
    • 2- Resisted testing- (all but acute) for possible muscle strain
  10. Three goals for whiplash tx
    • 1- Reduce hypertonicity, pain & inflammation
    • 2- Increase ROM
    • 3- Treat compensating structures and related injuries
  11. Tx for whiplash
    • Supine
    • Resting
    • Lymphatic drainage to clavicle, back- front chain, side chain, water wheel
    • Joint mobilizations
    • Indirect fascial work
    • Dry warming- compressions
    • clearing
    • Swedish- lotion
    • Full palm effleurage
    • prayer palms cup shoulder and pull
    • pincer SCM
    • shoulder work on back to c7
    • compressions
    • MFR
    • Swedish
    • muscle stripping
    • trigger point work
    • Stretch
    • work to close
    • reactivate spasming
  12. Use of hydro for whiplash
    Cold in acute stage to injured areas
  13. Three other questions for shoulder tendonitis
    • 1- Any inflammation in the area lately? (Red, hot, swollen?)
    • 2- Does it hurt when you raise your arm from your side?
    • 3- Any weakness with any activity?
  14. Specific contraindications for shoulder tendonitis
    • 1- No cyriax friction if on anti-inflammatories or blood thinners
    • 2- No cyriax friction if in acute/subacute phase
  15. Two possible causes for shoulder tendonitis
    • 1- Overuse injury- shoulder tendonitis
    • 2- Subacromial bursa
  16. Two shoulder tendonitis tests
    • 1- Empty Can
    • 2- TOS tests to rule out- Military Brace, Wright’s Hyperabduction, etc.
  17. Goals for shoulder tendonitis tx
    • 1- Bring in controlled inflammatory response to trigger the healing process
    • 2- Mobilize scar tissue
  18. Shoulder tendonitis tx
    • Resting
    • Dry warming
    • Joint mobilizations
    • Fascial work
    • Clearing
    • Deeper warming
    • Specific work to identified muscles
    • Stretches muscles post-specific work
    • Cyriax Friction
    • (5-20 mins or until the area goes numb. Strokes are applied non-stop in a bilateral cross-fiber direction.)- cross/cross/long 30-45 seconds each, three cycles minimum
    • Infra- Cross-fiber direction is perpendicular to the lateral spine of the scapula
    • Supra- Cross-fiber direction is parallel to clavicle with proper arm positioning (most likely)
    • Subscap- Cross-fiber friction is parallel to humerusGeneral/superficial work
    • Ice massage
  19. Stretches for shoulder tendonitis
    • Supra- hold hand behind back
    • Infra- crossover
    • Subscap- half "I believe I can fly"
  20. Homework for shoulder tendonitis
    Ice after activities that aggravate tendon
  21. Three additional questions for TOS
    • 1- Recent pregnancy?
    • 2- Use of crutches?
    • 3- Do you carry a bag on your shoulders?
  22. Two specific contraindications for TOS
    1- Refer out if significant loss of hand strength
  23. Two possible causes- TOS
    • 1- TOS
    • 2- CTS
  24. TOS tests
    • Adsons,
    • reverse Adsons,
    • Wright’s hyperabduction to find impingement
  25. Two goals for TOS tx
    • 1- Reduce pain, parasthesia in hand
    • 2- Decrease tension/ increase space in brachial plexus
  26. Tx for TOS
    • Resting
    • Dry warming
    • Joint mobilizations
    • Fascial work
    • Clearing
    • Deeper warming
    • Specific work to identified muscles- Anterior/Middle Scalene; Pectoralis Minor
    • Remember to address areas of the arm/ hand that are symptomatic-
    • General work
    • Stretches muscles post-specific work
    • Works into hand!
    • Closes with general/superficial work
  27. TOS hydro
    • Ice on shoulder if acute
    • Heat on shoulder for chronic
  28. Homework for TOS
    • 1- Encourage client to use a pillow that keeps their cervical spine straight when theysleep
    • 2- Strengthen and or stretch any muscles they take the head off the plumb line
  29. Three questions for ITB contracture
    • 1- Do you run or cycle?
    • 2- Do you sit all day?
    • 3- Have you been told you have flat feet?
  30. Two guesses- ITB contracture
    • 1- ITB Contracture
    • 2- Vastus lateralis tp/ strain
  31. ITB contracture tests
    • 1- Modified Ober’s
    • 2- Resisted knee extension (rule out vastus lateralis)
    • 3- Modified Thomas’ (rule out tight rec fem)
  32. Tx goals for ITB contracture
    • 1- Remove IT Band from vastus lateralis
    • 2- Reduce pain when active
  33. ITB Contracture tx
    • Resting
    • Joint mobilizations- fully clothed; afterwards ask for pants off
    • Put most of sheet to side working on, undrape leg
    • Ct hold both ends of sheet and goes sideline.
    • Roll sheet to keep in place
    • Bolster medial knee
    • Clearing- ASIS horseshoe
    • Compressions & squeeze kneading
    • MFR down- superior to inferior, with last one from greater trochanter all the way down
    • Compressions, squeeze kneading, picking up
    • Swedish- ITB, glut max & TFL
    • Trigger point work to glut max, vastus lateralis at sides of ITB, and thunderbolt
    • Pry apart posterior edge of ITB, thumb tips friction up and down between ITB & vastus lateralis to separate.
    • Bolster out
    • Supine
    • Knee release- sunburst- think of knee as sun & mfr in 8 directions around
    • Thumb on patella & drag with other thumb
    • Redress & stretch
  34. ITB contracture stretch
    Speed skater’s stretch
  35. ITB contracture homework
    Ice after aggravating activity
  36. Questions for CTS
    • 1- Ever been diagnosed with RA?
    • 2- Recent pregnancy?
    • 3- Does the pain wake you up in the middle of the night?
  37. Specific contraindications for CTS
    • 1- No local massage 10 days after steroid injection
    • 2- No deep friction with RA in affected hand
    • 3- No distal work if in acute stage
  38. Tests for CTS
    • 1- Phalen’s/ Reverse Phalen’s
    • 2- Tennis Elbow Test to rule out lateral epicondylitis
  39. CTS goals
    • 1- Decrease compression on median nerve
    • 2- Reduce fascial restrictions
  40. Tx for CTS
    • Resting
    • Work proximal arm first
    • Dry warming
    • Joint mobilizations- elbow and wrist
    • Fascial work- slacken pin & stretch (all four sides), wringing
    • Compressions
    • Clearing on interosseus membrane
    • Swedish- Deeper warming
    • Muscle stripping (flexors, pronator teres)
    • Trigger point work
    • Friction flexor retinaculum- plus signs
    • Swedish (include hand!)
    • Stretches muscles post-specific work
    • Closes with general/superficial work
  41. Stretch for CTS
    Pull palm down & stretch flexors then extensors
  42. Homework for CTS
    Ice
  43. Questions for piriformis syndrome
    • 1- Have you seen a doctor for this?
    • 2- Have you been officially diagnosed?
    • 3- When you’re sitting, where is your wallet?
  44. Contra for piriformis syndrome
    • 1- No direct compression of sciatic nerve
    • 2- No massage within 10 days of cortisol shot
  45. Guesses of pain for piriformis syndrome
    • 1- Piriformis syndrome
    • 2- Glut max strain, tight hamstrings, DDD of lumbar spine
  46. Tests for piriformis syndrome
    • 1- Pace abduction
    • 2- Straight leg raise with braggard’s sign
    • 3- Kemps to rule out thoracic impingement
  47. Goals for piriformis syndrome tx
    • 1- Relieve tps in piriformis, QF, gluts
    • 2- Reduce the tension in the lower back
  48. Tx for piriformis syndrome
    • Prone
    • Resting
    • Dry warming
    • Compressions to gluts, sacrum, down posterior thigh
    • Joint mobilizations- bend knee, lateral & medial hip rotation, hip extension, traction
    • Fascial work
    • Clearing- “double horseshoe” iliac crest, lateral border, greater trochanter
    • Put client in figure 4
    • Swedish- deeper warming to hamstrings, glut max
    • Therapist can sit- dig in to hamstrings
    • Muscle stripping to glut max (cross table), piriformis (most likely at O/I)
    • Stretch/smooth
    • Closes with general/superficial work
  49. Stretch & homework for piriformis syndrome
    • Figure four stretch- seated, ankle on knee, bend forward
    • Sit on tennis ball and roll around after a hot shower

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