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Author:
jessiekate22
ID:
158567
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Exam
Updated:
2012-06-13 09:04:49
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Week Twelve
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Treatment principles
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  1. Passive joint mobs speed
    • - they are done within the control of the pt- can be prevented by the pt
    • - gentle oscillatory movements applied anywhere in range or sustained end-range stretches
    • Grade 1-4
  2. What are paasive mobs beneficial?
    • - restricted passive jt for stiffness eg hypomobilt- restore ROM
    • - pain reproduced on passive jt movement
    • - pt collaboartion in decision making (edu and obtain consent)
    • - used torelieve pain or ROM
  3. Treatment
    • 1. examine pt * = worse pain and what u reasess
    • 2. treat tech
    • 3. reasses = sub and obj thing. Reassess signs and symptoms
  4. THings you need to consider when treating
    • - progression of the disorder
    • - stage of disorder
    • - degree of stability of the disorder
    • - degre of stability
    • - irritability of the disorder
  5. Dosage for non- irritable pt
    • - select grade into R and possible P (treat R)
    • - 2-5 reps (guided by reassessment)
    • - long reps 30-60 sec
    • - may perform into provocative position or direction
    • - more rapid rhythm: 2-3 oscillation per sec
    • - treat 2-3 times a week
  6. Dosages of a highly irritable
    • - treating pain. Want to touch pain not go into it
    • - grade short of R1
    • - 1-2 reps
    • -short reps 20-30 sec
    • - may select tech to ease resting pain ie easing postion or direction eg traction
    • - slow, smooth rhythm: 1/2 - 1 oscil per sec
    • - treated daily or 3x/ week
  7. Things you need to consider when selecting treatment
    • - impairment of nerve conduction
    • - know pathology or syndrome (PF syndrome)
    • - stretch or compressive component
    • - movement impairment evident.. CJS- found in assessment movt impairment that is what you will use in treatment
  8. Comparable jt sign (CJS)
    • - passive movement which reproduces pts pain and is restricted in range
    • - want this to corresponf with history ie function and with other physical examinations ie active movemets
    • - consider the movement diagram in selecting the grade
  9. Grades of movement
    • 1- small amplitude movement at beginning of range rage
    • 2- large amplitude within resitance- free range
    • 3- large ampl movement into resistance and end range
    • $- small amp movement into resistance and to end range
  10. Treatement selection considerations
    • - effects of past treatment
    • - unilater vs central pain in the spine
    • - biomechanics and coupling of movemnts
    • - precautions and contraindications
  11. Precautions for mobs
    • - hypermobile
    • -undaignosed pain (mechanical) eg weight loss
    • - psychogenic pain
    • - provocation of severe pain
    • - protective spasm (dont push thru)
    • - anticoagulant medication (bruisin)
    • - post spinal surgery eg fusion dont treat in the first 6 weeks
    • - VBI rare
    • - radiological changes
    • - neurological changes- decreased conduction
  12. ontraindications of mobs- likely harms
    • - neoplastic disease (malig or benign)
    • - inflam disease (RA, ank spond) in anflam stage
    • - infective conditions (eg osteomyelitis)
    • - bone disease and fractures (eg OP)
    • - jt instability (aim to stabilise)
    • - cord or cauda equina lesions
    • weakened tissues may be disrupted with PJM. Be aware of non-mechanical and constitutional symptoms
  13. Treatment selections; Considerations
    • - research evidence
    • - past clinical experience
    • - ease and control of performance
    • - reassessment after physical examination
  14. Reassessment: AIMS
    • - to establish appropriateness of RX
    • - to confirm source of symptoms
    • - to determine when RX needs to be progressed
    • - to demonstrate to patient an improvement in their condition (assists complance)
    • - to enhance learning/ reasoning
  15. When do you reassess?
    • - after key physical examination components (PAIVMS)
    • - whilst performing technique
    • - following first Rx repetition
    • - following completeion of technique
    • - on presentation day 2 better?
  16. Treatment progression
    • SAME: cosider further Ax or increase grade/ reps or add home exercise or add technique
    • Better: repeat Rx
    • Worse: derease grade/ reps or discard tech (still good news source is comfirmed
  17. Treatment progression
    • - if non- irritable add tech rapidly eg 2-4 tech concurrently
    • - if irritable better change technique 1-2
    • - only make one Rx change per session as effects may be delayed ( also enhance learning) you dont know what is making them better/ worse
    • One tech on the first day
  18. Cerival unilateral pain / stiffness treatment options
    • Rotation (rotate head away from side of pain: opening)
    • PA unilat pressure(on side of pain: closing) no neuro or referred P
    • Transverse (push towards side of pain: opening) (low C/S) make sure arms are para to ground
    • Lateral flexion (Flex away from side of pain: opening )
  19. Cervical bilateral pain treatmetn options
    • PA central pressure(not if severe symptoms)
    • Traction ( if any neurological symptoms, severe arm pain) (low cerv spine: in flexion)
  20. Lumbar spine unilateral pian/ stiff treatment options
    • Rotation (pain side up and rotate pelvis forward)
    • PA unilateral (on side of pain) – normal back pain not highly irritable
    • Transverse (push towards side of pain)(upper L/S)
  21. Lumbar spine bilateral pain treatment
    • PA central pressure
    • Traction- referred pain

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