Manual Therapy

10-21-09

Thoracic spine was our topic today in manual therapy as well as what treatments can be performed. First test we learned was a mobilisation of the thoracic spine. So we first have the patient lie prone on the table where we go onto find the most prominent vertebra C-7 to give us a reference point so we can go up or down on the spine stopping where the patient has discomfort. Have bed level with superior aspect of patella while standing sideways over patient. Placing thumbs back to back over spinous process then apply PA (posterior---->anterior) movement using body weight over vertical arms and then grade accordingly. Next technique was a manipulation called the "Butterfly" (i.e. lying extension rotation). Have patient in prone position with feet resting over a pillow. Bed level with patella and locate C-7 spinous process and count accordingly to level at which patient feels discomfort. Than find transverse process of levels to be manipulated. From here you want to locate the scaphoid of your upper hand on lower segment and pisiform of lower hand on upper segment. Apply downward pressure and rotate hands together like a butterfly to take up soft tissue slack. Ask patient to take a deep breath in and out. On way out of patients follow the release of air with hands and at end of breath apply short amplitude thrust to receive a "crack" in patients back. Finally, the last technique was called "over hand technique." Essentially, this does the same thing as the butterfly but in a more complex way. Not going to type instructions out for this one because it's better to be in person. But you can look it up on youtube or come see me! Cheers!

Clinic

10-20-09

In clinic today, we began our day with a follow up assessment on the women in her mid thirties who complained of lower back pain. When we asked how the exercises we gave her last time were going, she told us that she could only get through one set with the prayer stretch. We then went on to re-assess her with lumbar mobilisations on T-12, L-1 & L-2 with Maitland's grades I & II on painful R side and grades III & IV on L side. These tests were done centrally and bilaterally. We noticed muscle spasms with in T-12, L-1 & L-2 R side. Her pain has gone down since last week when we last saw her. From there, we gave her some soft tissue massage and ending with giving her a revised Home Exercise Plan(HEP). On the HEP we took 2 out of the 3 sets in the prayer stretch seeing as how she could barely get through one last time but did add that if she felt capable of doing another set she should attempt. The next patient was also a follow up being a man in his early 70's complaining of lower back and R thigh pain. Since seeing him last week he has gone to get a MRI done but won't know his results till later next week. Doctors believe it could be spinalstenosis( spinal canal narrows & compresses the spinal cord along with the nerves) which would correlate with his pain into his thigh in regards with the nerve impingement. So we went on with a very light soft tissue massage over lumbar region. That is what we ended with and will wait till next week when we hopefully hear results from MRI. The following case dealt with a new patient, woman, in her later forties complaining of unstable R knee joint. Took her through some knee assessments and only found her to be quite laxity around the knee joint along with patellar misalignment to the medial aspect of knee. She has been a avid mountain hiker and cyclist but the only medical history she has had was from twelve years ago on a bike fall where she ended up braking her clavicle. Unfortunately, she has been living with this unstable knee for the last two years to the best of her knowledge and we can think it may be a degenerative disease. We did give her some strengthening exercises like the one legged squat but told her to only go down to 30 degrees. The last patient of the day was a N/P, woman, 18 year old footballer. Starting get pain around two months ago in L foot particularity the bottom of her heel as well as along the medial aspect of her foot. Pain is insidious so the patient is unaware of onset with lack of symptoms; just came about. The only medical history she has was she broke her L foot last year and was given orthodics for both feet but the orthodics turned out to be painful for her so she ended up not wearing them. Her tests that came up positive were resisted & passive inversion. We decided to refer her to the podiatrist as we though it was a mechanical problem on her gait analysis not a muscloskeletal problem.

Manual Therapy

10-19-09

Cervical and Lumbar Spine Manipulations

We continued our manual therapy class with spine assessments, along with different manipulations pertaining to the cervical spine as well as the lumbar spine. Cervical spine movements include: side to side, traction and gliding into extension. These cervical spine manipulations are usually performed in the supine position. Next, a interphangeal contact is positioned over the articulating pillar of the affected joint which is than placed at its end ROM where joint is locked out of play. It is than followed by a high velocity, low amplitude impulse. Moving onto the second half of class where we went on to learn lumbar spine manipulations. These like the cervical spine have some clinical effects following the appointment; for example, temporary relief of musculoskeletal pain, shorten time to recover, temporary increase passive ROM & physiological effects to the CNS. The sacroiliac joint manipulation is performed having the patient lie on their side with hip and knee fully flexed for the leg with the legion. Add counter pressure to patients shoulder & the fulcrum being the ischial tuberosity. The joint will than be stressed to its end ROM & lock out any joint. At this point, the practitioner will apply a very high velocity, low amplitude(like the cervical spine manipulations) impluse at end of ROM.

Functional Rehab 2

10-16-09

Sportsmetrics

Friday's Functional Rehab class is dedicated to applying what we learn the day before in lecture and using it in a practical way. We have been learning about sportsmetrics and how it helps athletes warm up in a very educated diverse way. When I say educated, I mean using not only stretching or running as a warm up but incorporating dynamics, plyometrics, stretches, strengthening and flexibility warm ups all in one. Technique is extremely important in sportsmetrics as we are essentially retraining our neuromuscular system hoping to decrease the likelihood of injury as well as improving sports performance. Quality over quantity is key. Not only does sportsmetrics help us in that aspect but gives the body a great 20 min cardio workout when we do all these exercises. I honestly was dripping sweat by the end of the 20 min. and I like to think of myself as a pretty fit guy. The reason why sportsmetrics does a great job at reducing risk of injury to an athlete is because the different manoeuvres perform relate directly to manoeuvres performed by the athlete on the field(i.e. cutting/turning/twisting/jumping/landing). So to talk about today, we did the twenty minute sportsmetric program in the gym and each had a partner so we could be evaluated on technique. The thing with retraining neuromuscular control is that you can relearn in a matter of days so each week we anticipate improvement.

Functional Rehab 2

10-15-09

Proprioception Training & Neuromuscular Control

Today's lecture was mainly about how important proprioception training is when incorporating it into an injury prevention exercise circuit. Let's define proprioception as the conscious and unconscious appreciation of joint position. When we look at traditional treatment methods there is a definite emphasis on pain restoration of ROM(range of motion) and strength/endurance; which makes perfect sense. BUT there isn't much account for proprioception and balance as well as tying everything together for the particular sport. In turn, it leads to incomplete restoration of function and increased risk of injury. To get back to proprioception, one can expand the term in regards to neuromuscular control: afferent stimulus (towards CNS) ---->reactive efferent output. When we injure proprioception, we will do it in one of two ways: Direct or Indirect. Direct involves trauma caused by a ruptured nerve fiber as indirect may involve someone with acute swelling around a ligament which leads to loss of reception due to pressure. Moving onto ankles, most common phrase correlated to ankle injuries would probably be "Can't help it, I have weak ankles." But my professor would beg to differ with that and correct that to "No you have stupid ankles." Because even strong ankles can be injured on uneven ground, if the neuromuscular system is not trained to react appropriately. On a final note, 20-50% of ankles injuries are reoccurring so what does that tell us? Did they properly rehab there ankle; ligamental, muscular, tendous and proprioceptive attributes, back to normal if not above normal? More than likely the answer will be no. Just a thought.

Sports Injury and Rehabilitation Clinic

10-13-09

Today was my second week working in the Sports Injury and Rehabilitation Clinic. I need to be there at 8:30 and don't get done till about 5:30. Long day, no doubt. This clinic is mainly for podiatry practice but on Monday and Tuesday's they share four rooms with us "rehabbers."
So there is nine of us sport rehab student's on Tuesday so we split up in pairs(one group of three) and see a patient off the street for an hour appointment. Keep in mind these patients are paying 12 pounds for their visit but do understand that this is also a learning experience for the students.
I got paired with Stacey this week and began our day with a women in her mid-thirties complaining of lower back pain. [NOTE: For every patient we begin with a medical history followed by a physical assessment. When we are done with that part Mike or Steve (Mike licensed practitioner at the clinic and Steve being a licensed practitioner as well as a Prof. at the Uni.) come in to give a diagnosis to what they believe is the problem and set up various exercises/stretches pertaining to the specific injury.]
After the women, we saw a male in his late twenties with medial collateral ligament damage due to martial arts. And the last patient we saw with actual injury was a women in her early twenties with what looks to be a subluxation in the hip joint; cause unknown but did inform us that she had an emergency caesarean section 14 months ago...The other four patients we had came in for a full body massage with minor complaints of stiffness. Honestly, four massages that are hour sessions takes a huge toll on the shoulders and back as I quickly found out.

Manual Therapy

To start the third week in Manual Therapy we begin learning different spine tests and what to look for while performing these tests. When checking the joints we will use passive tests(does it bring on pain). Then when checking roots signs we will use resistricted tests, looking for weakness in myotomes. The stroking test involves the therapist to literally stroke the dermatomes up and down on both sides; checking for any different sensations on either side of the patient. Reflex test will test the myotomes more specifically the nerve pathways; lower and upper motorneurons. Babinskies Reflex is the use of a sharp ended pointer that the therapist guides up the heel of the foot along the lateral aspect looking for flexion of the toes. Capsule pattern is inflammation from some pathological disease in Rheumatoid Arthritis (RA). RA=chronic systemic inflammatory disorder that may affect many tissues and organs but really attacks joints producing an inflammatory synovitis. Trauma Arthritis(TA)=caused by blunt force in an inappropriate motion of a joint. Osteoarthritis(OA)=a group of diseases and mechanical abnormalities involving degradation of joints including articular cartilage and the subchondral bone next to it. Finally, we talked about spondylolishesis which is an anterior displacement of vertebra column in relation to vertebra below(i.e. slippage).

Day 1 of classes

I start off my Junior year at Salford with my practical manual therapy class which is led by Julian Hatcher. Julian is a great guy who has helped me throughout this whole process of coming to England to study. He begins the class with a few jokes as he is a very humorous guy. A brief introduction of manual therapy is given as a obvious starting point for this class. Manual therapy is thought to be used as far back as 2000 B.C. with the ancient Greeks & Egyptians. Their theories per se had no scientific background but more down the lines of do these practices make the body feel better(reduce pain). Their theories can be related to our present day stance of manipulation and traction. It wasn't until the early 1800's that Europe would come across any such techniques in manual therapy. Julian then goes on in lecture given us some credible contemporary authors; each having their own opinion and technique of manual therapy. This is very beneficial as rehabing the musculoskeletal system is not specific in one technique but will incorporate several. In all, this class will give me the knowledge that a majority of American therapist don't incorporate into their practices.