5 minutes: breath of arrival and attendance 50 minutes ... · musculoskeletal conditions list...
TRANSCRIPT
Lesson Plan: Musculoskeletal Pathology
5 minutes: Breath of Arrival and Attendance
50 minutes: Musculoskeletal Pathology
Classroom Rules Punctuality- everybody's time is precious:
Be ready to learn by 9:00, we'll have you out of here by 1:30
Tardiness: arriving late, late return after breaks, leaving early
The following are not allowed:
Bare feet
Side talking
Lying down
Inappropriate clothing
Food or drink except water
Phones in classrooms, clinic or bathrooms
You will receive one verbal warning, then you'll have to leave the room.
Musculoskeletal Conditions List (Werner Page 61)
Muscle Disorders Muscular dystrophy Spasms Cramps Strains
Bone Disorders Osteosarcoma Osgood-Schlatter Osteoporosis Hyperkyphosis Hyperlordosis Scoliosis Rotoscoliosis
Musculoskeletal Conditions List (Werner Page 61)
Joint Disorders Adhesive Capsulitis Baker cysts Gout Dislocations Subluxations Dysplasia Joint replacement surgery Lyme disease
Osteoarthritis Patellofemoral syndrome Spondylolisthesis Spondylosis Sprains Temporomandibular joint
dysfunction
Musculoskeletal Conditions List (Werner Page 61)
Fascial Disorders Compartment syndrome Dupuytren contracture Ganglion cyst Hammertoe Hernia Plantar fasciitis Pes planus Pes cavus
Neuromuscular Disorders Carpal tunnel syndrome Disc disease
Herniation Degenerative disc
disease Internal disc disruption
Myofascial pain syndrome Thoracic outlet syndrome
Musculoskeletal Conditions List (Werner Page 61)
Other Connective Tissue Disorders Bunions Bursitis Shin splints Tendinitis Tendinosis Tenosynovitis De Quervain tenosynovitis Whiplash
Spasms and Cramps
Spasms Involuntary contraction of skeletal muscle. Low-grade and long- lasting.
Cramps (AKA: charley horse) Involuntary contraction of skeletal muscle. Strong, painful, and short-lived.
Spasms and Cramps
Etiology Nutrition deficiency Ischemia Vigorous exercise Splinting Underlying conditions
Spasms and Cramps
Treatment Massage (circulation, attachment sites, and stretching) Heat Ice Ointments creating hot and cold sensations
Medications Analgesics Muscle relaxants (if severe)
Spasms and Cramps
Massage
Avoid direct and aggressive bodywork to the muscle bellies
Consider underlying conditions if cramping is frequent
Painkillers and relaxants can mask pain and stretch limitations
If splinting is due to injury, wait for acute stage to pass
Spasms and Cramps
Pain-spasm-ischemia cycle Chronic contraction of a muscle begins a cycle of decreased oxygen supply, pain, and spasm.
Strains
Signs and Symptoms Local pain Stiffness Pain on resisted movement or passive stretching No palpable heat or swelling unless severe.
Strains
Treatment Accurate diagnosis PRICES (to control inflammation) Rehabilitation (realign scar tissue) Exercise, cross-fiber and linear friction, and passive stretching Prevent further injury Lymphatic drainage (limits edema) Avoid vigorous deep massage to a new or acute injury
Medications NSAIDS (for pain and inflammation)
Sprains
Sprains Tears to ligaments.
Etiology Not warming up results in a sudden snap Prolonged but extreme stretch after activity
Sprains
Acute Stage Inflammation (including loss of function) Pain with passive stretches Duration of 24-48 hours Common sprains are anterior talofibular and sacroiliac ligaments
Sub-acute Stage Inflammation (with regaining function)
Sprains
Treatment RICE (limits edema and tissue damage) Moving the joint within range of pain tolerance ASAP Lymphatic massage during acute stage Linear and cross-fiber friction when sub-acute and post-acute May be a bone fracture if the “sprain” is not much better within a few
days.
Medications NSAIDs (for pain and inflammation)
Osteoporosis
Osteoporosis Loss of bone mass and density.
Osteopenia Pathological thinning of bones. Precursor to osteoporosis.
Osteoporosis
Etiology Endocrine imbalances Poor metabolism of calcium Nutritional deficiency
Non-controllable risk factors Smaller stature, white and Asian females with a family history
Osteoporosis
Signs and symptoms No signs in early stages. Test regularly if high-risk Fractures Hyperkyphosis Chronic or acute back pain
Osteoporosis
Treatment Light pressure massage to increase movement and decrease pain Pharmaceutical intervention Weight-bearing exercise Dietary adjustments Pressure light enough to prevent fractures Positioning and bolstering for comfort
Postural Deviations
Hyperkyphosis (AKA: humpback) Overdeveloped thoracic curve due to muscular imbalance or osteoporosis of ankylosing spondylitis.
Postural Deviations
Scoliosis Lateral curvature of the spinal column in a C or S shape.
Rotoscoliosis Lateral curvature and twist of the spinal column.
Postural Deviations
Etiology Functional (soft tissue tension) Structural (bony distortion)
Congenital Cerebral palsy Polio Muscular dystrophy Osteogenesis imperfecta Spina bifida
Postural Deviations
Signs and symptoms Muscle tension Nerve impingement Chronic ache Loss of range of motion Impaired rib movement Cardiac and respiratory problems
Postural Deviations
Treatment Osteopathy, chiropractic, physical therapy, and exercise therapy
Massage If hyperkyphosis is due to osteoporosis, use light pressure If lung or cardiac function is impaired, consult a doctor
Joint Disruptions
Subluxation Bones are out of best alignment, but the joint capsule is intact.
Joint is functional, but lacks full range of motion.
Joint Disruptions
Dysplasia A congenital anomaly involving the formation of an abnormal acetabulum or femoral head.
Joint Disruptions
Signs and symptoms Acute, traumatic cause:
Pain, swelling, damage, bleeding, fractures, damaged tissues, nerves, ligaments, muscles, and tendons.
Chronic, progressive cause: Low-level pain Referred pain due to nerve root pressure
Joint Disruptions
Medications NSAIDs (for acute pain and inflammation)
Massage Massage locally contraindicated if acute. If sub-acute or chronic, respect the limitations of range of motion. Massage adjoining tissues to manage pain, and improve tissue
function.
Osteoarthritis
Osteoarthritis (AKA: degenerative joint disorder) Joint inflammation due to wear and tear of articular cartilage. Most common form of arthritis.
Osteoarthritis
Etiology Aging Weight-bearing stress Repetitive movements Inflammation and damage at synovial joints (especially weight-
bearing)
Osteoarthritis
Triggers and factors Old age and overweight History of trauma or surgery Repetitive pounding stress Hormonal imbalances and nutritional deficiencies
Osteoarthritis Treatment
Counterirritant ointment Exercise
Medications NSAIDs (for pain) Steroidal anti-inflammatories
Massage Acute inflammation contraindicates massage that promotes local
circulation Do not focus specifically on the affected joints
Tendinopathies Tendinopathy Umbrella term that covers injury and damage to tendons
and tenosynovial sheaths.
Tendinopathies Tendinitis (AKA: acute tendinopathy ) Acute injury of tendons.
Inflammation, edema, and pain sheaths. Less common.
Tendinopathies Tendinosis Long term degeneration of tendons involving no inflammation,
collagen degeneration, and loss of weight-bearing capacity.
Tendinopathies Tenosynovitis Irritation developing where tendons slide through their
synovial sheaths. Characterized by crepitus (gritty sensation during movement).
Tendinopathies DeQuervain tenosynovitis Tenosynovitis specifically of the abductor and
extensor pollicis tendons.
Tendinopathies Intrinsic factors
Direct or shearing forces through tendon Overuse without recovery time Poor flexibility Underlying disease History of corticosteroid injections
Tendinopathies Extrinsic factors
Training errors Problems with equipment Fall or blow (trauma) that damages from the outside
Tendinopathies Medications
NSAIDs (for pain) Steroid injection (may be appropriate in some circumstances)
Massage Acute injuries with inflammation locally contraindicate deep massage Lymphatic work may be helpful Linear and cross fiber friction promote scar maturation