1 Rehabilitation of Common Musculoskeletal Disorders 新光醫院 復健科 謝霖芬 醫師

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3 Classification of Common Musculoskeletal Disorders 4 Soft tissue lesion – Muscle: strain, myofacial pain sydrome – Tendon: tendinitis, tear – Ligament: sprain, rupture – Bursa: bursitis – Cartilage: degeneration, herniation, injury 4 Bone and joint lesion – Arthritis – Fracture and/or dislocation

4 Muscle strain 4 Damage to the musle fibers 4 Due to overstretch or too much contraction 4 Classification: 1st, 2nd, and 3rd degree

5 Myofacial pain syndrome 4 Local and referred pain patterns 4 Muscle stiffness and shortening 4 Taut bands in muscle 4 Presence of trigger points 4 Local twitch response or jump sign 4 Autonomic dysfunction

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7 Tendinitis or tendosynovitis 4 Local pain & tenderness 4 Resisted isometric contraction induces pain 4 Tendon stretch induces pain 4 May have local swelling or crepitus 4 May have tendon shortening or adherence (triggering)

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9 Bursitis 4 Pain on motion and at rest 4 Local tenderness and/or swelling 4 Regional loss of active movement

10 Arthritis: joint inflammation 4 Local findings – redness, swelling, heat, tenderness 4 Impairment of joint function – ROM restriction – Impairment of force transmission

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12 Major Problems of Musculoskeletal Disorders 4 Pain 4 Contracture 4 Muscle weakness, atrophy 4 Instability 4 Functional impairment

13 Definition of Pain (IASP) 4 “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” – Acute pain vs chronic pain – Individual variations – Psychological factors

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15 Quantitation of Pain 4 Visual analogue scale (VAS) – 10cm line 4 Likert scale

16 Pain Generator 4 Bone 4 Joint 4 Muscle 4 Tendon 4 Ligament 4 Nerve 4 Vessel

17 Contracture 4 Arthrogenic: arthritis, capsular fibrosis 4 Myogenic: trauma, inflammation, degeneration 4 Other soft tissue: tendinitis, ligamentous tear 4 Mixed  Most common cause: lack of joint mobilization throught full alowable range

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19 Muscle weakness or atrophy 4 Disuse 4 Pain inhibition 4 Muscle or tendon lesions 4 Neuropathy 4 Side effect of drugs

20 Instability 4 Bone and cartilage damage 4 Muscle atrophy 4 Relative lengthening of tendon, ligament

21 Evaluation of Musculoskeletal Disorders 4 History taking 4 Physical examination 4 Special examinations

22 History Taking 4 Location 4 Disease duration 4 Cause 4 Course 4 Severity 4 Factors relieving or worsening the symptom 4 Other sensory complaints

23 Physical Examination 4 Inspection: redness, swelling, atrophy, ecchymosis, discoloration, deformity, physical defect 4 Palpation: tenderness, local heat or coldness, swelling, atrophy, mass, local defect 4 Neurological examination: sensory, motor, DTRs 4 Check ROM, joint stability, soft tissue flexibility 4 Special tests:

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31 Special Examinations 4 Conventional radiography 4 Ultrasound 4 Computed tomography 4 Magnetic resonance imaging 4 Bone scan 4 Arthrography 4 Arthroscopy 4 EMG & NCS 4 Motion analysis (gait laboratory)

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38 Goals of Rehabilitation 4 4 Symptom relief 4 4 Mobility and strength 4 4 Sense of self-worth 4 4 Maximal functional ability 4 4 Maximal independence

39 Therapeutic Exercise 4 Mobility exercise 4 Strengthening exercise 4 Aerobic exercise 4 Recreational exercise

40 Mobility Exercise 4 Range of motion – active – active-assistive – passive 4 Stretching – ballistic – PNF (proprioceptive neuromuscular facilitation) – static 4 Joint mobilization

41 Strengthening Exercise 4 Isometric - same length 4 Isotonic - same load 4 Isokinetic -same speed

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45 Aerobic Exercise 4 Mode: swimming, bicycle, walking 4 Frequency: 3-5 times/week 4 Duration: min 4 Intensity: – 55-90% maximal HR – 40-85% HR reserve – 40-85% VO 2 reserve – RPE (rate of perceived exertion).

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48 Purposes of Orthoses (splints) 4 Unweigh joints 4 Stabilize joints 4 Decrease joint motion 4 Improve joint function

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51 Basic function of assistive devices 4 Compensate for lost function 4 Alleviate joint stress 4 Decrease energy demands 4 Increase safety

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55 Treatment and Rehabilitation of Common Musculoskeletal Disorders 4 Acute stage 4 Subacute stage 4 Chronic stage

56 Acute Stage 4 PRICE 4 Physical agents: TENS, low power laser 4 Medications: NSAIDs, analgesics 4 Local steroid injection (c or s xylocain) 4 Local xylocain injection 4 Acupuncture` 4 Manipulation 4 Therapeutic exercise: – ROM exercise – Isometric exercise

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58 Hyperstimulation Analgesia

59 Subacute Stage 4 Heat or cold therapy 4 Hydrotherapy(contrast bath) 4 Local massage 4 ROM exercise 4 Strengthening exercise – isometric, isotonic, isokinetic 4 Other physical agents

60 Chronic Stage 4 Heat therapy 4 Hydrotherapy (Spa therapy) 4 Stretch exercise 4 Strengthening exercise 4 Aerobic exercise 4 Mobilization and manipulation 4 Other physical agents (USD, SWD, TENS)

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62 Patient Physician Nurse Orthotist OT PT Bioengineer Family Social worker Psychologist Pedorthist