1. Musculoskeletal PT

2. Objectives Give an example of each of the following musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition. Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination Define and give examples of the various tests and measures used in a musculoskeletal PT examination Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT

3. Focus on Function Musculoskeletal PT What are the functional limitations……or “dysfunctions” Often caused by: Muscle or bone structural imbalances Birth defects Surgery Degenerative changes in body

4. Musculoskeletal Dysfunctions Can result in: Pain Swelling Edema Effusion Stiffness Muscle weakness Loss of range of motion (ROM) Active ROM Passive ROM

5. Musculoskeletal System Includes Bones Soft Tissue Muscle Tendon Joint capsule Ligaments Bursae Fascia

6. Common Musculoskeletal Conditions Overuse injuries Traumatic Injuries Surgical Conditions Medical Conditions

7. Overuse Injuries Repeated stress to soft tissue and bone Bursitis Tendonitis Nerve entrapment Stress fracture

8. Traumatic Injuries Bone and soft tissue can be damaged through a direct blow or excessive stretch Fracture - bone Sprain - ligaments AND tendons Strain - muscle

9. Traumatic Injuries Strains and sprains follow a traditional injury grading scale: Grade I Fibers stretched with micro-tears No laxity compared to non-injured side Grade II Fibers stretched with micro-tears Slight increase in laxity compared to non-injured side Grade III Full tear of ligament or muscle Requires surgical repair

10. Surgical Conditions Common surgical conditions may require PT to rehabilitate Total joint replacement Amputation Ligament reconstruction Ex: ACL Tendon and/or joint repair Ex: Rotator cuff repair

11. General Medical Conditions General medical conditions may affect the musculoskeletal system Rheumatoid arthritis Cancer Multiple sclerosis HIV or AIDS Fibromyalgia Systemic sepsis

12. A Brief Review: PT Exam includes: Patient History Systems review Tests and measures

13. Patient History Typical questions included in medical history in a musculoskeletal PT exam Why are you here at PT today? When did the problem begin? What is your primary problem? What provokes or relieves your symptoms? Medications, or past medical conditions?

14. Tests and Measures Used in Musculoskeletal PT Pain scale Range of Motion Strength Manual muscle testing Flexibility Functional Tests Bed mobility Transfers Activities of Daily Living (ADL’s) (page 148) Special Tests

15. Physical Agents Body tissue is injured Inflammatory process Repair process Typical physical agents used in musculoskeletal PT may include: Thermal agents Electrical stimulation

16. Thermal Agents (p.152) Superficial Heat Increased blood flow Decreased pain Increased healing and delivery of nutrients Deep heat Same as above Cold Same as above BUT has decreased blood flow properties as well Electrical Stimulation Decreased pain Decreased edema/effusion Muscle re-education Decreased muscle spasticity Promotes wound healing

17. Manual Techniques Soft Tissue mobilization Decrease pain and/or swelling Relax muscle or fascia tension Improve ROM Examples: Massage Trigger point release Joint mobilization

18. Therapeutic Exercise ROM exercise AAROM vs AROM Resisted exercise Muscular strength vs. muscular endurance Isometric – without movement at joint Isotonic – movement occurring at joints Concentric contraction Eccentric contraction Isokinetic – movement at constant speed

19. Therapeutic Exercise Balance and coordination proprioception Cardiovascular endurance Aquatic therapy Functional exercises – combination Open chain – end segment is free to move Kicking leg out while sitting on a chair Closed chain – movement at 1 joint affects another Performing a squat Home exercise program Patient education

20. Now you Should be able to: Give an example of each of the following musculoskeletal conditions: (1) overuse injury, (2) traumatic injury, (3) surgical condition, and (4) general medical condition. Understand why it is important to ask, and be able to provide several questions involved in a good musculoskeletal PT examination Define and give examples of the various tests and measures used in a musculoskeletal PT examination Identify, and be able to describe the objective of physical agents, manual techniques, and therapeutic exercise used in musculoskeletal PT

21. Questions??