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