Professional Documents
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Acute Stage / Inflammatory Stage Subacute Stage / Repair Chronic stage / Remodelling
OTPT 130 : Medical Rehabilitation Lectures 2 University of the Philippines Manila , College of Allied Medical Professions
moro
Dietician
Athlete - Coach
Massage Therapist
Psychologist Others
Podiatrist
SPORTS MEDICINE
The secret of success is to take a broad view of the patient and his or her problem Ask Why has this injury / illness occurred Diagnosis and treatment
SPORTS MEDICINE
Diagnosis Precise anatomical and pathological cause of the presenting problem Presenting problem and cause of the problem History, physical examination and investigation
SPORTS MEDICINE
Treatment Treatment of presenting injury and treatment to correct the cause Combination of different forms of treatment will usually give the best result Evaluate effectiveness of treatment constantly
SPORTS MEDICINE
Meeting Individual Needs Every patient is a unique individual with specific needs Treatment depends on the patients situation, not purely on the diagnosis
SPORTS MEDICINE
Love Thy Sport It is essential to know and love the sport It is essential to be on site
Return to Sport
Skill Aquisition
Proprioception
Strength
Flexibility
BONE
Acute Injuries
Overuse Injuries
Fracture
Perisosteal Contusion
ARTICULAR CARTILAGE
Acute Injuries
Overuse Injuries
JOINT
Acute Injuries
Overuse Injuries
Dislocation Sublaxation
Synovitis Osteoarthritis
LIGAMENT
Acute Injuries Overuse Injuries
Sprain / Tear
Inflammation
MUSCLE
Contusion Cramp
Acute Injuries
Overuse Injuries
Strain / Tear
Chronic Compartment Syndrome Delayed Onset Muscle Syndrome Focal Tissue Thickening / Fibrosis
TENDON
Acute Injuries Overuse Injuries
Tear
Tendinopathy
BURSA
Acute Injuries Overuse Injuries
Traumatic Bursitis
Bursitis
LIGAMENT Sprain
Ankle Anterior Talo Fibular Ligament Inversion
Meniscectomy
Indication for Surgery
A symptomatic (pain and locking), displaced tear of the meniscus sustained by an older, inactive individual associated with pain and locking of the knee A tear extending into the central, less vascular third of the meniscus if not determined repairable when arthroscopically visualized and probed A tear localized to the inner, avascular third of the meniscus
Meniscectomy
Management: Protection Phase Educate the Patient Decrease Inflammation
Meniscectomy
Management: Controlled Motion Phase Attain Full range of motion Start Strengthening Balance and Propriception
Meniscectomy
Management: Controlled Motion Phase Progress strength training Progress Balance and propriception exercises Sports movement and skills
Tendinopathy
Rotator cuff tendinopathy Supraspinatus tendinitis Bicipital tendinitis Cumulative trauma disorder ITB tendinitis Patellar tendinitis Tibialis posterior tendinitis Plantar fasciitis
Tendinopathy
Rotator cuff tendinopathy
Primary
Due to anatomic abnormalities
Osteophytes Type III Acromion process
Secondary
Excessive load on the shoulder due to
impaired scapulohumeral rhythm Joint instability Muscle imbalance
Tendinopathy
Rotator cuff tendinopathy Clinical features Pain with overhead activity or movement Painful arc 60-120 degrees of abd. Abduction less than 90 degrees are usually pain free Pain and tenderness in the supraspinatus muscle particularly at the insertion Pain with excessive shoulder flexion
Tendinopathy
Bicipital Tendinitis Long head of the biceps susceptible to overuse injury Occurs with individuals performing high volume of weight training Referred pain and rotator cuff tendinopathy can produce pain in the biceps
Symptoms
Local tendernes s of the biceps tendon Muscle tightness Chronic intermusc ular and fascial thickening Pain on
Tendinopathy
Acute
Subacute
Chronic
Mobility/Strength
Tendinopathy
Cumulative Trauma Disorders Chronic Inflammation repetitious movements over a prolonged period of time originating from the body part results in microtrauma of the area
Pain is the primary Manifestation Characterized by increased collagen production and resorption of mature collagen Efforts to stretch the inflamed tissue perpetuate the irritation
Tendinopathy
Tennis elbow
Typical Movements flexion and extension of the elbow
Typical Job Activities small parts assembly hammering meat cutting playing tennis bowling
Tendinopathy
Tennis Elbow Pain at the site radiating to the lateral epicondyle ECRB + Supinator ROM Complete Weak grasp
Golfers Elbow Pain at site reproduced by resisted wrist flexion, pronation, grasping
Tendinopathy
Tennis and Golfers Elbow Treatment is consistent with stages Ergonomic modifications
Tendinopathy
De Quervains Disease Stenosing tenosynovitis APL and EPB tendon
Tendinopathy
De Quervains
Typical Movements Typical Job Activities combined forceful gripping and sawing use of pliers hand twisting turning" control such as on a motorcycle inserting screws in holes forceful hand wringing
Tendinopathy
Management Guidelines Acute Control of inflammation Focus on non-stressful activities / non-stressful intensities Subacute and Chronic Exercise programs with controlled stress(until CT can withstand the stress) Identify the cause of faulty muscle and joint mechanics
Tendinopathy
OT Pallative treatment
Tendinopathy
ITB tendinitis ITB Friction syndrome Pain at insertion (Gerdys Tubercle) Treatment consistent with stages
Tendinopathy
Patellar Tendinitis Jumpers knee Inferior pole of the patella Sinding Larsen Johansson Osteochondritis of proximal attachment Osteochondritis Dissecans Partial to complete avulsion of TT
Tendinopathy
Tib Post Pain in the navicular bone Resisted ankle inversion Achilles tendinitis Pain in calcaneus Plantarflexion Plantar fasciitis Pain in plantar aspect Rule out heel spurs
Tendinopathy
Acute
Chronic
Achilles Tendinitis
Plantar Fasciitis
Bursitis
Ischiogluteal bursitis Weavers bottom Prepatellar bursitis Housemaids knee Subacromial / Subdeltoid bursae Olecranon Bursitis Miners Elbow
Bursitis
Clinical Feature Pain present in all motions Leads to secondary complications (wekaness, LOM) Continued use willl lead to erosion, rupture, adhesive pericapsulitis
MUSCLE STRAINS
Maximum Protection Phase -No stretching -No strengthening -Protect healing muscle -Mobilize unimmobilized areas
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Moderate Protection Phase -Strengthening -Isometrics as tolerated isotonic -Core -Start stretching, massage Minimum Protection Phase Strengthening isotonic eccentrics Stretching calf, hamstrings and quads