OBM

Joint capsule or Ligament restriction OR hypermobility (Laxity)

Restriction - goal = increase joint mobility

  • all CT techniques, hydrotherapy, joint mobilization

Laxity - goal = increase joint integrity and stability

  • DO NOT attempt to decrease the mm tension across the joint

  • functional instability - general massage techniques facilitates awareness of movement and posture

  • therapeutic exercise

Lymphedema - after mastectomy, 50% axillary lymph nodes removed, chronic arm-hand edema

Ax

  • gross edema, pitting from shoulder to arm,

  • measure: girth

  • muscle strength test: 3/5 shoulder, elbow, wrist

  • ROM whole affected limb

ADL

  • unable to comb hair with affected arm

  • difficulty dressing and perform self-care

  • unable to reach object above shoulder

  • unable to carry object in affected hand

Goal

  • decrease edema and increase lymphatic drainage

  • increase ROM

  • increase muscle strength to 5/5 throughout

  • functional outcome -

      • able to carry a 10lb object and ambulate 100 feet

      • able to perform self-care, dressing, bathing, toileting, without adaptive equipment

      • able to reach object 2ft above shoulder

      • able to lift 1lb object from overhead shelf

      • social - increase social interaction with fewer complaints of self-consciousness regarding the appearance of the arm

Techniques

  • superficial effleurage, then SLD

  • contralateral quadrant first --> proximal area of the affected quadrant --> axillary, intercostal and parasternal --> distally into the affected arm & alternate back and forth between proximal and distal segments

  • passive ROM

  • functional activities, strengthening


LBP

Symptoms & signs & findings

  • tight mm & achiness in low back

  • refer to buttocks and leg

  • posture - hyperlordotic

  • resting m tension - increased m resting tension in quatratus lumborum, gluteals, piriformis, lumbar erector spinae, rectus femoris, psoas, iliacus, TFL

  • ROM - lumbar ROM WNL, rightness @ end of range for flexion

  • TP - QL, gluteals, piriformis

ADL functional limitation

  • unable to sit for greater than 30 min without discomfot. pain is distracting and patient needs to focus on work/schedule to meet deadline

Goal

      • lengthen shortened hip flexors, lumbar erector spinae, gluteal mm to facilitate deceased lordosis,

      • decrease resting mm tension

      • tight muscles - increased muscle extensibility

      • tp - aleviate tp in QL, lumbar erector spinae, gluteals, pififormis, rectus femoris, TFL and iliopsoas

      • inprove ease of movement

Techniques

  • superficial effleurage & petrissage to lumbar, anterior thigh, gluteal region

  • lengthening strokes to tight/shortened mm associated with hyperlordosis including rectus femoris, QL, TFL and lumbar erector spinae

  • direct fasia applied to thoracolumbar fascia

  • tp release with specific compression to alleviated tp followed by cross-fiber strokes and passive stretching for mm

  • rhythmic moilization to reduce muscle tone and improve neuromuscular patterning

  • age, pain tolerance allow- specific compression of iliopsoas with voluntary/active release ( kneading along medial iliac crest and sink fingers deep onto iliacus, then push medially to reach psoas major. client flex hip to soften tissue and slowly lower the thigh while maintaining compression

  • passive/PNF stretch

  • hydrotherapy

  • education on sitting posture & progressive muscle relaxation

Muscle spasm

spasmodic torticollis, athletic performance, nutritional deficiency

aggrevating factors: exposure to cold, dehydration, TP, postural imbalance

  • extreme spasm: do not stretch, use relaxation techniques, away from the site of spasm

  • on site of spasm:

    • PNF of agonist contract to stretch mm,

    • specific compression & cross fiber petrissage on the attachedments of the mm, combine with active movements within pain tolerance. (voluntary/active release)

    • muscle approximation

    • superficial reflex/stroke, fine vibration on site

    • gentle petrissage

    • genle stretching

    • PNF active contract/hold relax

    • strain-counterstrain or positional release***

    • hydrotherapy based on clinical response

    • strengthening antagonist mm

  • Connective tissure techniques:skin rolling, myofascial release, direct fascia, + rythmic mobilization to enhance movemnet pattern (shoulder, arm, thigh)

  • joint mobilization

  • hydrotherapy local heat before ct techniques

Postural impairments

goal :improve postural alignment; improve extensibility of mm and fascia, improve balance of agonist/antagonist mm function


Stress, sleeping issue

-goal: improve patterns and quality of sleep; improve duration of sleep

- relevance: common symptom of stress, surgeries (before or after), chronic pain, hospitalization, depression, addiction

- techniques

- superficial reflex, superficial fluid, neuromascular, ct, passive movement

- light percussion

- rocking for sedative effective

- sedative massage: slow, rythmic

- head, hand, feet , high tension & highly innervated

- DB, passive movement, manual stretch

Tennis elbow ( lateral epicondylitis)

Symtoms & signs

  • pain at rest or at keyboarding for greater than 10 min without severe pain

  • dropping objects held in hand during work & self-care activities due to pain, feeling of weakness

  • mild swelling after work

  • 8.5/10 pain

  • no ergonomic design or posture awareness

Finding

  • Pain elicited on resisted wrist and finger extension

  • Grip strength:weak grip compared to the unaffected side

  • Palpation:fascial shortening in area of the common extensor origin and forearm musculature

  • posture:kyphotic, forward head posture

ADL limitation

  • Work stask:unable to keyboard for greater than 10 min

  • self-care: compromised ability to perform self-care to pain and weakness

Goal

  • reduce pain and inflammation associated with latereal epicondylitis

  • education on self-care and ergonomics to prevent future exacerbation of this condition

  • normalize fascial extensibility

  • increase strength

Functional outcome

  • Able to keyboard with the use of ergonomic modifications for 1 hour with appropriate stretching and rest periods without pain

  • able to carry 10lb weight in the affected hand for 25 feet without pain or dropping the weight

Techniques

  • petrissage, myofascial release, direct fascia applied to shortened mm related to hyphosis and forward head posture

  • superficial effleurage, petrissage, myofascia release, direct fascia applied to entire forearm, especially mm of the extensor compartment

  • friction to common extensor origin, ice applied to friction site

  • techniques applied to flexors of the affected arm to maintain antagonist balance

  • wrist and hand stretch, strengthening, postural stretch, education, ergonomic examination, education and self-care


Shin splint (tibial stress syndrome)

Findings

Dull aching pain in the front of her lower legs along her shin bones and feelings of weakness, especially when coming downstairs

Achiness on the top of both feet

Ambulation: slow, antalgic gait

■ ROM: within normal limits for the ankle and knee, but patient complains of feeling of tightness during movement

■ Resisted movement: pain on (a) resisted ankle dorsiflexion and eversion and (b) toe extension bilaterally

■ strength: grade 4 ankle dorsiflexors and toe extensors secondary to pain

■ Pain: pain on palpation along the lateral border of the tibia bilat and the dorsum of the foot

■ Resting muscle tension: increased bilaterally at the tibialis anterior and extensor digitorum muscles

■ trigger points: active trigger points in tibialis anterior muscles

Activity Limitations

■ Needs to hold handrail for support when coming downstairs secondary to pain

■ Needs to use arm rests of chairs to rise from a chair

■ Difficulty walking for greater than 30 feet secondary to pain

Goal:

Reduce pain, decrease resting muscle tension, and alleviate trigger points that are contributing to shin and foot

pain.

Functional goal:

Able able to walk up and down stairs without the need of additional support

Able to sit and rise from chair without additional support

Able to walk distances required to participate in usual self-care and recreational activities

Techniques:

■ superficial effleurage and petrissage to help sooth muscles in general at the hips, thighs, and legs, beginning in prone and proceeding in supine.

■ Muscle stripping to the tibialis anterior, extensor digitorum longus, peroneus longus, and peroneus brevis beginning superficially and ending deep.

■ Deep transverse friction is provided to the same areas along with the retinaculum of the ankles and the tendons of the muscles involved.

■ trigger point pressure release to alleviate trigger points followed by cross-fiber strokes and passive stretching for muscles with trigger points.

■ Passive stretching for low leg and foot muscles.

Wellness

CC: Relaxation, maintain good posture, posture awareness, learn self-stretch

Finding

■ Resting muscle tension: within normal limits

■ Posture: no postural malalignment noted

■ Range of motion: full and pain-free active range of motion in upper and lower extremity joints, neck, and back

Goal: the aim of treatment is to increase the patient’s well-being and relax-

ation and to optimize his postural awareness.

Techniques

■ Rhythmic gentle rocking to the whole body

■ Gentle superficial effleurage and broad-contact petrissage to the limbs, back, and shoulders

■ Rhythmic and gentle specific petrissage to the patient’s hands, feet, and face

■ specific compression for the neck, shoulder, and low back muscles

■ Gentle passive stretches of the muscle groups being massaged