Th Final Review

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Th Final Review

1. {Define massage therapy act}

- Massage Therapy Act (on): embodies rules that apply only to Massage Therapists (M.T's).

- defines the scope of practice of massage therapy within the province

2. {Regulated health professionals act}

○ governs behaviour of regulated health-care (H.C) professionals

applies to all H.C professionals

general; there is other, specific legislation for the different H.C professions

○ Minister of Health: administrates regulations

3. {Health care consent act}

○ provide rules with respect to consent to treatment apply consistently to all H.C practitioners

○ facilitates treatment for persons lacking capacity to make decisions about H.C

o enhances the autonomy of persons for whom treatment is proposed

○ promotes communication/ understanding between H.C practitioners & patients/ clients

○ ensures significant role for family members when a person lacks capacity to make a decision about treatment

4. Primary mandate of healthcare colleges (whom do they protect)

○ public

5. {Define informed consent (all points)}

The therapist gives the client information they need to make an informed decision about their care and is given the opportunity ask questions and clarify.

Assessment and/or treatment only begins after consent has been given to the R.M.T, and the consent may be withdrawn at any time.

○ Componentants:

■ Nature and of the assessment, including body areas involved

■ Purpose of the assessment

Benefits of a postural assessment

Possible side effects of assessment

Risks of the assessment

Likely consequences of not having the assessment

Alternative courses of action

Client is told they may alter or withdraw consent at any time

Client has an opportunity to ask questions

■ Consent is informed (client understands what is said)

■ Consent is Obtained

6. {Micro skills of attending}

○ R - Be relatively relaxed

○ O - Adopt an open posture

L - Lean towards speaker (if appropriate)

○ E - Maintain eye contact

○ S - Face client squarely

7. Examples of open and closed ended questions

Open-ended questions:

☑ 'What' factual information

'How' personal points of view, subjective information

☑ Could/Can you's stimulates detailed response

☑ 'Why'

may provoke defensive feelings (not recommended)

Closed-ended questions:

Tend to begin with:

• 'Did you...?'

• 'Do you...?'

• 'Have you...?'

Used to:

obtain very specific information (e.g. Yes, No, date, time, location)

• focus the client on a topic

8. {Treatment template.}

9. {Define observation.}

a.

- Observing the client's limbs, gait, posture, balance, ability to sit and stand, in order to provide insight into the client's signs and symptoms.

10. When does observation start? Is it part of assessment? Treatment?

- ☐ according to the treatment template above it is part of the assessment

Figure 8 summary: A flowchart depicting a clinical patient care process. The sequence begins with Client Intake (1), followed by Medical History (2), Informed Consent, and Assessment (3). Assessment leads to Observation and Physical Examination, both of which contribute to a Clinical Impression (4). From here, the path splits to either Refer or Treatment Aims (5), which are further categorized into Short-term and Long-term aims. These lead to a Treatment Plan (6), followed by another stage of Informed Consent and then Treatment (7). After treatment comes Re-assessment (8). Depending on the re-assessment, the outcome is either Refer or Home Care (9), with Home Care leading to Future Treatment (10) and Refer leading to either Future Treatment or No Future Treatment.

11. Physical exams. What makes them up? What assessments are performed first, last, etc?

Part of the assessment process, physical examination includes testing, both general and specific, performed to give an overview of a client's body structure and function to allow for and understanding of causes of and contributing factors to the client's signs and symptoms.

○ It also includes palpation of relevant structures.

12. Remember your plumb lines!! Ant, post, lat.

Image summary: A medical anatomical diagram displaying four views of a male human body—front, right profile, left profile, and back—used to analyze postural alignment. The figure is overlaid with a grid of vertical and horizontal reference lines that cross the head, shoulders, hips, knees, and ankles to evaluate symmetry and balance.

13. {Ethical decision making.}

1. Does the action keep the focus on safety and well-being of the client?

○ 2. Are you remaining in your scope of practice and level of training?

3. Are you being respectful of the power imbalance? Are you using this power imbalance to your own benefit?

4. Does the action create a dual relationship and make therapeutic boundaries less clear?

5. Does the action remain within the original contract with your client? Are you honoring the treatment plan and informed consent?

6. Could the action lead to future breakdowns of the client-therapist relationship?

○ If the answer is a no to any two of the above questions, then the situation the massage therapist is considering strongly indicates an inappropriate choice.

14. {Duel Relationships! (Don't Boink} Your R.M.T)

- When an R.M.T has some other type of relationship with a client in addition to the professional therapeutic relationship.

- Examples include personal friendships with clients, bartering with clients, treating family members or a romantic/sexual relationship with clients, which is always considered sexual abuse under the rhpa.

- Major concerns:

- The multiple relationships can become blurred or merged, making it difficult to maintain clear boundaries and distorting or compromising the therapeutic relationship.

15. Non verbal behaviours. What do they mean? What do body postures mean?

Non-verbal behaviours that May indicate anxiety, or discomfort [From Navarro, Therapeutic Communication]

Face/eyes:

- lip-biting

• knitting the brow

- head turned away, up or down

Hands/arms:

• hand-wringing

• fist-clenching

• hair-twirling

finger-tapping

• arms folded

• hands in pockets

Body:

• body turned away

• sitting at edge of chair

- hand covers eyes, mouth, ears, chest, throat

- gum-chewing

- smiling at inappropriate times

- obscene gestures

• shrugging/lifting the shoulders

- fidgeting with clothing, jewelry, etcetera

- rubbing part of the body

Legs:

• leg-or foot-shaking

- legs crossed at knees or ankles

Physiological:

• blushing/flushing

blanching ("white-as-a-ghost")

• falling asleep

Voice:

• rising or falling pitch

• rising or falling volume

• trembling

• winning eyes

- looking up or down

- eyes closed or staring

- eyes watering or filling

- raising the eyebrows

- picking at crumbs, lint or part of the body

• gestures indicating "stop", "go", etcetera, such as putting finger to lips, meaning "shh!"

• hyperventilating

- irregular breathing

- obscene language

- wavering voice

16. r.o.m Assessments, differences between A.F, P.R, A.R.

- A.F: evaluates contractile and non-contractile structures

- pain: may be due to a lesion in the muscles, or joints

- A.R: evaluates contractile structures

- pain: strongly suggests lesion to contractile structures - muscles

- P.R: evaluates non-contractile structures

- pain: strongly suggests a lesion of a non-contractile structure - ligaments

Pathological end-feels

Table summary: ROM Assessment end-feel classifications indicate underlying clinical conditions. A very soft or boggy end-feel suggests swelling, while a bouncy or springy block indicates a meniscus injury. Loose end-feels during movement point to a ligamentous injury. When the end range is not reached due to pain, it is classified as an empty end-feel, and an abrupt end-feel accompanied by muscle contraction and pain also signifies a muscle spasm.

18. Contraindications to A.R r.o.m exercises.

○ Never perform active resisted contraction in the following situations:

intlammation in a muscle or joint: resistance exercise can increase swelling and cause further damage if applied to inflamed tissues;

pain: do not continue if exercise is painful or pain lasts more than 24 hours.

19. What is Standard Order of r.o.m Assessments.

Image summary: A flowchart titled ROM Assessment: Order of Testing illustrating a diagnostic path starting from AF. From AF, the path splits into Pain or No pain, weakness. If Pain is present, it leads to PR; from PR, if Pain persists, it may be non-contractile tissue injury, whereas No pain leads to AR. If the initial state was No pain, weakness, it leads directly to AR. From AR, the results split into Pain and/or weakness, which equals a muscle problem, or No pain, which equals not a muscle problem.

20. Identify abnormal end feels! And what they mean!

Pathological end-feels

Table summary: Clinical meanings for various joint end-feel sensations. A very soft or boggy feel indicates swelling, while a bouncy or springy block suggests a meniscus injury. A loose feel during movement is associated with ligamentous injury. There are two types of empty end-feels where the range is not reached: one caused by the presence of pain and another characterized by abrupt contraction and pain caused by a muscle spasm.

21. Overpressure!!! What does it mean? What are we looking for? Why do we do overpressure?

- A sustained end-range stretch force, applied with overpressure, elongates a shortened muscle-tendon unit and peri-articular connective tissue by moving a restricted joint just past the available r.o.m

22. Grades of muscle strength and what do they mean? ex. 45% muscle strength

○ 0 = No contraction;

○ 1 = Trace: slight contraction but no motion;

○ 2 = Poor (25%): moves joint but not versus gravity;

○ 3 = Fair (50%): cannot resist minimal resistance;

○ 4 = Good (75%): over-comes moderate resistance;

○ 5 = Normal (100%): over-comes max. resistance.

23. Concentric vs eccentric vs isometric exercise. Define and differentiate.

○ Isotonic (Dynamic) Exercise is a dynamic muscle contraction that results in joint movement and associated movement of a body segment as the muscle shortens or lengthens under tension.

concentric contraction: muscle shortens as it contracts; biceps when lifting a barbell.

eccentric contraction: muscle lengthens as it contracts; biceps when lowering a barbell.

○ Isometric (Static) Exercise is a static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion.

24. {Accessory joint movement. Define.}

- o a.k.a joint play

- refers to the small, intrinsic motions that occur between joint surfaces, and the “give” inherent in the joint capsule - passive and involuntary

- occurs automatically with normal joint movement

- necessary for full, normal, pain-free joint function

- absence results in joint dysfunction

- Clarifying the term "joint play": used at times erroneously (incorrectly) to describe passive manipulation of client joints.

25. If I want to stretch illiopsoas without stretching rectus femoris, what movements do I use?

○ I think...not sure!

Keep the thigh and knee fixed, extend the trunk

O Iliopsoas flexes trunk towards the thigh

Rectus femoris flexes the thigh towards the trunk

26. Glides! Talo Crural joint glides and what they are used for (check cats supplemental workbook).

talocrural (ankle mortise)

- convex talus and concave mortise (tibia & fibula)

- resting position is 10 degrees plantarflexion

Image summary: An anatomical 3D render of a human ankle and foot bones. An orange highlight marks the joint space between the tibia and the talus, with a black arrow pointing specifically to the anterior distal end of this joint space.

posterior glide

• dorsiflexion anterior glide

• plantarflexion

27. If I wanted to stretch joint capsule, what joint move would I use.

○ Grades 3 and 4:

performed beyond the limit of available range

used to stretch tight joint capsules and reduce adhesions.

28. {Closed pack position.}

joint surfaces are congruent (fit together) and are tightly compressed

ligaments and joint capsule joint are tight

○ joint is most stable

☐ most likely to be restricted in a capsular pattern

○ avoid when assessing joint play, or mobilizing joints

29. Capsular pattern of restriction for G.H joint.

- lateral rotation (most restricted) arrow abduction arrow medial rotation

30. C/S lateral flexion standard value

5 degrees

O superscript o

○ C.3-C.7: 35 degrees

20 to 45 degrees for overall c/s lateral flexion

31. Know Protocol for Hold and Relax, Agonist Contract, P.N.F

○ Contract-Relax:

- The therapist leads the client through a series of short sub-maximal isometric contractions of a shortened muscle. Between contractions the client relaxes and the therapist passively lengthens the muscle into a stretch with the intention of gaining range

• shortened muscle: in a comfortably lengthened position

• resist: client's submaximal isometric contraction of up to 10 seconds

- ask client to relax - allow a few seconds for this

- slowly move the muscle to its new (lengthened) range

• hold at least 30 seconds – muscle in the lengthened position

- repeat process until there is no more increase in length (minimum of 3x)

○ Agonist contraction

- The therapist passively lengthens the shortened muscle to a comfortable position, they then have the client perform a concentric contraction of the opposite (antagonist to the shortened muscle) muscle or muscle group. The therapist provides a mild resistance to the contraction, but the movement is allowed to occur. The range-limiting (short) muscle will relax and lengthen as the result of reciprocal inhibition as joint movement occurs.

• shortened muscle: in a comfortably lengthened position

- mild resistance: to client's concentric contraction of the opposite muscle

32. When is stretching contraindicated (stage of healing)?

☐ Contraindications To Stretching

Bony-block end-feel.

Before bone union is complete after a fracture.

Acute inflammation, infection or tissue trauma.

■ Whenever there is sharp, acute pain with joint movement.

When hypermobility already exists.

Acute stage of healing

33. Be able to list inflammatory conditions.

○ Edema

○ All the conditions with -itis

Student-itis

Arthritis

☑ Tendonitis

■ Bursitis

34. What techniques are effective for treating hypertonicity?

Petrissage

○ M stripping

○ G.T.O/m approx/O&I

○ TrP

35. {Signs and symptoms of spasm.}

Muscle Spasm—An involuntary, convulsive contraction of an entire muscle or segment within a muscle. Usually affects skeletal or visceral (smooth) muscle.

○ Intrinsic muscle spasm s/s:

twitch

excessive muscle tone

pain within the muscle due to ischemia and build-up of metabolites

possible referred pain (e.g. arm pain during a heart attack)

36. {Effective technique for spasm.}

○ G.T.O/M approx/O&I

Agonist-contract

37. {Inflammation of joint: what are most effective protocols for early subacute.}

Contrast hydro

○ M.L.D

○ P.J.M

Stretch

38. {When can we use cold hydro?}

Acute stage

Reduce inflammation

■ Swelling

Heat

■ Pain

Bursitis

to stimulate weak, stretched structures

39. Tissue manifestations for someone who has... A decreased r.o.m and potential C.T shortening.

○ contractures (C.T shrinking)

40. Edema! Please read up on edema! What is it, causes, types, s/s.

Edema: accumulation of fluid in the interstitial spaces

○ Cause:

increased capillary permeability due to inflammation - for example, tissue trauma, burns (local)

venous obstruction - for example, pressure from casts, varicose veins (local)

decrease in blood plasma proteins - for example, liver or kidney disease (systemic)

physiological/hormonal - for example, pregnancy

Acute: usually due to inflammation – trauma

☑ allergic responses

■ local infection

○ Chronic:

☑ lymphatic blockage: scarring, surgery, infection

taut, shortened muscles crossing a joint

occupational: standing

systemic: viral, bacterial, parasitic infection

systemic conditions: for example, heart, kidney, liver disease, high blood pressure

■ nerve lesions

Pitting versus non-pitting edema les.

: Table summary: Pitting edema is typically associated with chronic conditions and presents as boggy, mushy, and cool skin with pallor or cyanosis, generalized swelling, trophic skin changes, and may be painless. In contrast, non-pitting edema is typical of acute local trauma or infection, characterized by firm skin that may be warm with bruising or redness, localized swelling, no trophic skin changes, and marked tenderness or pain on movement.

- Passive stretch

- O Proprioceptive Neuromuscular Facilitation (P.N.F)

- Special muscle length & strength tests (isolating individual muscles)

42. Adhesions! What are they? What causes them?

○ Adhesions—Uniting of two tissue surfaces that are normally separate.

gluey' fibrous scar tissue

coalesce with (join) adjacent structures which they are not normally attached to

form during the sub-acute stage of healing

mature in the chronic stage of healing

restricts range of motion

result of the resolution of inflammatory process

acute trauma, chronic overuse syndromes

more likely to occur when injured tissue is immobilized; severe injuries require immobilization.

43. What technique is most effective when realigning collagen fibres in scar tissue.

- Friction + stretch + ice

44. What is kickback pain? TrP. How can it be avoided?

○ 1. Clients may experience “kick-back” pain after a myofascial trigger point treatment.

2. The therapist can minimize the risk of kick-back pain by observing the following

protocols and precautions post M.T.P treatment (source: Travell and Simons, volume 1):

apply consistent, gradual pressure

• hold the pressure until the tissue softens, then go deeper

complete the treatment (pressure re-activates latent M.T.P's)

flush the muscle with circulatory techniques

• stretch the muscle

apply deep moist heat to the muscle

• encourage A.F r.o.m of the muscle

• address synergists and fixators of the muscle

• identify and eliminate perpetuating factors to prevent reoccurrence

45. {Generally where muscles of mastication.}

- Temporalis

- Masseter

- Medial Pterygoid

- Lateral Pterygoid

46. {Protocol for TrP therapy.}

○ Ischemic compression + stretch + heat

Technique application:

a. place the muscle to be treated in a relaxed, mid-range position;

b. apply enough pressure to stimulate the M.T.P, but remain within client pain tolerance (7/10 on pain scale maximum recommended level);

c. as the pain decreases and M.T.P softens, gradually increase pressure;

d. continue for up to one minute to avoid prolonged tissue ischemia;

e. perform circulatory massage to the area treated; rule of thumb = flush the area for as long and as deep, as the M.T.P treatment;

f. stretch the affected muscle; passive stretching or A.I.T's;

g. apply heat to the area; if unavailable, flush for a longer period;

○ h. encourage A.F r.o.m of muscles treated to re-educate proprioception.

Or, muscle stripping

47. {Protocol for atrophy} .

keep in neutral or shortened position

massage gently, with light techniques

apply brisk, stimulating techniques

apply cool hydrotherapy to stimulate

○ initially, use gentle P.R or A.F motions

gradually work up to gentle stretches

○ use A.R exercises to strengthen muscles and gently stress bones, tendons, fascia

relax hypertonic muscles - deep, slow techniques

○ Precautions:

avoid using pressure, drag, deep longitudinal techniques, or stretching on atrophied muscles

pillow/position the affected part in its neutral position to avoid tractioning healing tissue

care should always be taken when treating elderly, bedridden or chronically ill clients

do not attempt to restore r.o.m via stretching until muscle strength has returned to 80% of normal

48. {Techniques over flaccid mm tissue.}

○ avoid techniques that involve grasping, torquing, stretching or compressing flaccid muscles

49. >freebi registered trademark which neurological disorder presents with spasticity?

○ Multiple Sclerosis (M.S).

50. Effective technique for chronic edema D/T scar tissue from reoccurring ankle sprain.

○ M.L.D

Strengthening muscles of ankle

51. Contusions!! I want to know what colour of contusion indicates about stage of healing.

○ Acute: red, black, blue

○ Sub-acute: ecchymosis [discoloration] changing from red slash black slash blue to green slash yellow slash brown

○ Chronic: ecchymosis fades to green/yellow/brown

52. Assessments and treatment for acute contusions, acute mm strain.

○ Contusion:

Assessing severity - bilateral comparison:

- Strain:

A.F r.o.m:

• mild: little loss of r.o.m (less than one third lost)

moderate: significant loss ( one third minus two thirds ) lost

severe: highly limited ( greater than 2/3 of r.o.m lost)

P.R r.o.m:

- mild: little or no pain/restriction on stretch of affected muscle/tissue

- moderate/severe: restriction with significant pain on stretch of tissue

A.R Testing:

- mild: isotonic contractions may be performed leads to some pain

- moderate: isometric only; isotonic: not possible due to pain/weakness severe: not possible due to extreme pain and muscle weakness

Acute stage of healing: treatment

Lymphatic drainage techniques: proximal to contusion leads to stimulate drainage of if which leads to decrease edema.

Techniques to enhance lymphatic flow:

- coarse vibrations: over proximal lymph nodes

• manual pumping (compressions): proximal lymph nodes

• running vibrations: directed proximally

- manual lymph drainage techniques: very slow, very light & broad hand contact—use cornstarch or very slippery oil as lubricant

- elevation of the limb

• diaphragmatic breathing: 'massages' the thoracic duct and increases lymphatic return

- pain-free, A.F r.o.m: active muscle contractions move lymph along lymphatic vessels

Techniques to promote proximal venous return: repetitive effleurage, stroking, petrissage.

Purpose of applying P.R r.o.m in the pain-free range:

- minimize, or prevent adhesion formation

- maintain available r.o.m

Table summary: Treatment goals and techniques for the Acute stage of healing. The primary aims include limiting inflammation, which is addressed using MLD; improving circulation through the application of heat and petrissage proximal to the site; decreasing pain via on-site cold hydrotherapy and MLD; and maintaining ROM using MLD along with pain-free AF and PR ROM.

53. Questions about deriving condition from assessment finding.

○??

54. Tendonitis, define, assess, treatment goals.

- Tendinitis: 'inflammation of a tendon'; not very common, although the term is used regularly instead of tendinosis or tendinopathy.

Testing

- applied to differentially assess tendinosis from other, similar, inflammatory conditions

- subjecting an inflamed tendon to a tensile force assesses for a possible tendinosis

- pain that increases as the force of muscle contraction increases indicates a (+) result

Testing a muscle for tendinosis: A.R testing and stretching of the affected muscle. A.R testing might show muscle weakness; be careful using A.R testing - subject muscle to isometric/isotonic contractions throughout the entire range.

○ Muscle strains may also cause pain when the affected muscle is stretched, or contracted.

○ Treatment

Acute stage of healing:

• decrease inflammation at the lesion site (if present)

• prevent adhesion formation

- reduce hypertonicity, spasm M.T.P's in proximal and affected muscles

• eliminate hypertonicity, spasm M.T.P's including the distal muscles

- maintain joint health and r.o.m

Chronic stage of healing:

• eliminate edema (if present) at the lesion site & increase circulation to the tendon

• eliminate adhesions

• normalize joint biomechanics

55. What do you avoid during active flair up of chronic Tendonitis.

anti-inflammatory medication

○ frictions are contraindicated

underlying pathologies prolonging healing time: precaution - do not further compromise the health of tissue

56. What is bursitis? Acute vs chronic presentation. Assessment and treatment

Inflammation of a bursa. Usually secondary to another condition.

Acute stage of healing: pain develops over a 48 to 72 hour period, as the bursa sac swells with edematous fluid; may interrupt sleep.

Chronic bursitis: may develop over a long period of time if the irritation is minor but prolonged—it can last for years if the primary cause is not eliminated.

☑ dull ache over bursa

pain on compression (not as severe acute)

pain at end range of passive movements and/or painful arc may be present (compressing bursa)

bursa wall feels thickened (fibrosis)

■ sac feels 'boggy' and appears swollen (edema)

Primary aim of treatment: eliminating adhesions and scar tissue; formed due to production of excessive collagen fibres

Assessment Findings:

Hypertonicity: muscles crossing the bursa and antagonists.

Rom Testing:

A.F r.o.m:

- acute: severely limited by pain

- chronic: range may be limited by pain in a single position/range; bursa compressed by nearby structures

P.R r.o.m:

- acute: not done

• chronic: painful on compression of bursa at end range; end-feel is 'boggy' = chronic edema

A.R Testing - Differential Assessment:

tendinitis: muscle-contracted, increased pain; increased contraction force equals increased pain

• bursitis: pain is constant during muscle contraction, increased force equals same pain

Contraindication: avoid compressing the bursa, due to the severe pain it causes.

Precautions/modifications to testing and treatment to avoid compression of a bursa: Avoid...

• palpating the bursa directly

- active or passive movement of tissues crossing the bursa (A.F/P.R r.o.m, stretching, A.I.T's)

- contraction of muscles over the bursa (A.R)

- positioning/moving the client where the bursa may be compressed

• be careful not to jostle the bursa excessively (shaking, r.o.m to unaffected joints)

- use techniques that move skin toward the bursa (picking-up/open C's) rather than away

- apply hydrotherapy around, not over, the bursa (acute - cold towel roll in doughnut shape)

57. Hydro during various stages of healing

Acute: cold

○ Sub-acute: contrast

○ Chronic: hot

58. Home care for someone with Hypertonicity

○ Apply heat?? Lol

stretch

59. {Treatments for acute bursitis}

○ ice

Decrease inflammation

○ Increase circulation

○ Increase venous drainage

Decrease sympathetic N.S responses

60. {Define strain vs sprain.}

- Strain: Excessive, sudden stretching of a muscle, resulting in tearing of muscle fibres.

- Sprain: Injury to a joint in which the bony partners are momentarily separated in such a way that some, or all, the ligaments supporting it are stretched or torn

61. If I sprain deltoid ligament, what mm do I want to strengthen?

- Muscles that do inversion

- tibialis anterior, tibialis posterior

62. What does vascular damage dt sprain look like?

- swelling and the blue, bruise-like discolouration due to the rupture of capillaries.

- During the sprain, the small blood vessels and fibres in the flesh burst, causing blood to enter the surrounding tissue.

63. Dislocation: assessment, treatment protocol for acute.

- Acute & early sub-acute stages of healing:

- do not put pressure/weight on joints with massage/hydrotherapy applications

- remedial exercises: C/I (acute stage)

- do not remove protective muscle splinting

- do not place the joint in the position it was originally dislocated in

64. T/F: how do you assess and test fracture?

testing the involved muscles/joints - C.I; can disturb the healing process

never do anything which may disturb the healing process (a fracture is a severe injury)

○ immobilization, for example, splints, should never be removed without a doctor's approval

○ increasing circulation to distal tissues - Cl; can further congest the fracture site

○ joints within the cast should never be tractioned

○ hydrotherapy C.I: if blood vessels or autonomic (vasomotor) functions are impaired; vessels cannot dilate/constrict normally

65. When a cast is removed what manifestations do you expect to see?

Casting results in tissue changes

• skin is fragile and trophic

• muscle are weak and atrophied (disuse)

- immobilized joints have very limited r.o.m

- adhesions/scars have formed

• compensatory changes are present

- joint biomechanics are altered

• residual edema may be present

- area may have healing wounds; surgical repair of a complete fracture

• bone may have metal pins/implants

66. Know protocol for post cast fracture. What stretches?

Hydrotherapy applications—avoid....

- extreme temperature—skin is hypersensitive

- hydrotherapy altogether if metal pins/implants present

Aims of treatment:

• increased drainage from limb if residual edema present

• reduce adhesions/make scars more mobile

• reduce compensatory changes, for example, hypertonicity

- increase muscle tone and strength

• improve skin health - exfoliate / tone

• improved circulation to the area

- improve r.o.m and restore joint biomechanics

67. {Osteoarthritis} : definition, causes, describe early stage of degeneration.

Osteoarthritis: progressive cartilage deterioration in synovial joints and vertebrae, due to 'wear & tear'

○ Primary conditions:

caused directly by an injurious agent; for example, trauma, bacteria.

idiopathic: a generalized syndrome affecting 4 or more joints; usually weight bearing.

○ Secondary conditions:

follows in the 'foot-steps' of a pre-existing conditions: for example, altered biomechanics due to severe strain

■ altered biomechanics and abnormal joint compression may bring bony surfaces into contact, injuring articular cartilage

prolonged contact, may lead to cartilage softening and degradation

○ Secondary causes include:

- inflammatory disorders: may alter biomechanics (fibrosis, antalgic gait/posture)

- trauma: for example, fractures, dislocations, sprains

- structural bony disorders: for example, hip dysplasia

- postural conditions: for example, lordosis, scoliosis

- metabolic disorders: for example, Ca crystal deposits

- hereditary disorders of collagen formation: needed for strong, healthy cartilage

Early stage:

- pain: dull, achy; may be difficult to localize

- joint pain: aggravated-activity; relieved-rest

- morning stiffness: usually relieved after 30 minutes; gets easier the more you move

- r.o.m: slight decrease (capsular pattern)

• hypertonicity, muscle spasm & trigger points: muscles surrounding affected joints

- no swelling or visible change in the joint

68. What technique is not indicated for late stage osteoarthritis?

○??

69. Please define fascial p the thoracic spine. Often accompanied by anterior head carriage, 'winged' scapulae and protracted shoulders.

- Hyperlordosis: refers to a condition of excessive anterior curvature of the cervical or lumbar spines. - Lordosis may be accompanied by hyperkyphosis.

○ Scoliosis: a lateral curvature in one, or more, of the regions of the spine, usually, there is some rotation of the vertebrae, as well.

- Pes planus: condition where the medial longitudinal arch of the foot flattens.

- Plantar fasciitis: an overuse or repetitive condition resulting in inflammation of the plantar fascia. Usually a secondary condition resulting from altered biomechanics in the pelvis, hip, knee, ankle, foot.

A. Structural — bony changes:

- deformities: bony structures of the spine, pelvis and/or lower limbs

- correction: surgery

• treatment: relief of symptoms

B. Functional—positional:

- poor habits (most common): lead to muscle imbalance/contractures

- pain: may cause antalgic posture to obtain relief

- muscular dysfunction: spasm, weakness, H.T

- other: obesity, loss of proprioception, respiratory conditions

70. {What is hyperkyphosis? Causes?}

- Hyperkyphosis: excessive posterior curvature of the thoracic spine.

71. How to address anterior shoulder roll? When prepping for treatment.

○ Place something under the shoulders to help retract them

☑ Towel, bolster.

72. Treatment protocol for hyperkyphosis.

lengthen: shortened muscles/fascia

■ Pec major

■ S.C.M

strengthen: weak muscles

■ Rhomboids

■ Splenius capitis

■ traps

correction: client education—remedial exercise and postural awareness.

73. Presentation of hyperlordosis. Psis vs asis.

- Anterior pelvic tilt:

- pelvis rotates forward - A.S.I.S's are anterior to the pubic symphysis (coronal plane), or

- the angle of an imaginary line joining A.S.I.S-P.S.I.S is greater than approximately 10 degrees

74. Know what nerve innervates deltoid.

○ Axillary C.5, C.6

75. What does Ely's, obers, Thomas, 90/90 straight leg raise, test for?

○ Ely's test (rectus femoris)

Ober's test (T.F.L/I.T.B)

Thomas' Test (hip flexor contracture)

○ 90 to 90 Straight Leg Raise Test (hamstrings)

76. Scoliosis assessment. Structural versus functional. Convex versus concave.

- Stand behind the client and watch their spine as they bend forward (flexion), or side-bend toward the convex side – noting the change in the curve.

- postural scoliosis: curve changes, or corrects

- structural scoliosis: curve gets worse

77. Effective technique for structural scoliosis post surgical correction. (Steel rods)

○ Approach to treatment

stretch and soothe the spasming, contracted muscles on the concave side

strengthen and stimulate the weakened, lengthened muscles on the convex side

mobilize the joints of the vertebrae and ribs to increase their mobility and restore normal biomechanics

■ discern the underlying cause of the problem and correct it (most important in the long run)

☐ Contraindications to treatment

refer client to physician (if not done) for a full assessment before treating

do not use heat over metal implants; absorb heat pain

do not mobilize vertebrae that are: fused or immobilized by rods; hypermobile

do not stretch contracted fascia if it is providing stability

78. True or false: what is pes planus, treatment goals, causes,

- Pes planus: condition where the medial longitudinal arch of the foot flattens.

Mechanism of Injury

• displacement of the talar head medially and down from the navicular bone

• stretches the spring ligament & tibialis anterior and posterior muscles

translates as a loss of the medial longitudinal arch of the foot

Causes

- Habitual bad posture - walking or standing:

○ stress on the tibialis anterior & posterior: foot remains everted for long periods

○ both weaken the muscles

• Increased body weight:

○ ↑ weight = ↑ load on the arches of the foot; for example, pregnancy, obesity, carrying weights • Defective biomechanics:

- changes in the lower limb that ↑ foot pronation

- o congenital deformities: affect biomechanics of hip, knee, ankle; tend to the arch

• Paralysis or injury: muscles of inversion/arch.

- Trauma: traumatic injury/strains to legs or feet

- Degenerative bony changes

• p

Generic short term aims

• reduce pain by decreasing hypertonicity

• reduce pain by eliminating trigger points

• reduce inflammation

• stretch shortened muscles

- maintain r.o.m of affected joints

Contraindications to be considered:

Avoid...

- mobilizing hypermobile joints

• stretching tibialis anterior/posterior

- using heat over acutely inflamed areas

Pes planus - long term aims of treatment:

• restore the arches of the foot

• restore ankle and foot r.o.m

strengthen weak muscles supporting the arch

• increase client awareness

79. {Babinsky sign in adults.}

This can mean that you may have an underlying nervous system or brain condition that's causing your reflexes to react abnormally.

80. Integrity of spinal nerve segments. What assessments can we use?

- Deep tendon reflex

Table summary: A five-point clinical scale for grading reflex intensity, ranging from zero to four. A score of zero indicates absent reflexes or areflexia, one represents diminished reflexes or hyporeflexia, and two denotes an average or normal reflex response. Higher scores indicate hyperreflexia, with three representing exaggerated reflexes and four indicating clonus or very brisk reflexes associated with spasticity.

- Myotome

- Dermatome

81. Assessing Achilles tendon, what nerve root level is assessed?

82

○ Biceps: C.5 through C.6

○ Brachioradialis: C.5-C.6

○ Triceps: C 7 through C 8

83. Review Dermatomes. What D.T.R should I test?

C.6 dermatome = skin over lateral antebrachium & dorsal thumb musculocutaneous sensory distribution = skin over anterolateral forearm

C.6 myotome = elbow flexors and wrist extensors musculocutaneous motor distribution = biceps brachii, brachialis, coracobrachialis

।Image summary: An anatomical diagram showing the sensory and motor dermatomes and myotomes of the human upper body. The left side illustrates sensory regions, with labels such as C2, C5, T1 through T12, and L1 through L2. The right side illustrates motor regions, mapping spinal nerve roots to specific areas of the back and arm, including C2 through C8 and T1 through T12, as well as S1 through S4. A label specifically highlights the C6 region of the arm, associated with elbow flexion and wrist extension.

84. Peripheral nerve lesions. Read up on this!!

- Pg. 333, 334

85. {Causes of constipation.}

a) stress: increases S.N.S activity leads to decrease in intestinal motility;

b) low dietary fibre: feces lack bulk leads to decreased stimulation of intestinal wall leads to decreased motility leads to constipation (e.g., vegetables, beans)

c) ☑ water intake: intestinal contents are dense, hard to difficult to eliminate (increased water intake)

d) incomplete mastication: food particles difficult to digest leads to greater amounts undigested leads to difficult to eliminate

e) lack of exercise: decreased muscle tone leads to decreased stimulation;

f) pregnancy: hormonal changes; later pressure on the intestines

g) weak abdominal muscles: decreased intra-abdominal pressure leads to difficult defecation

h) side-effects of medications;

○ 1) pathologies: for example, tumours, intestinal obstruction = physical blockages.

86. {Dermatome vs mayotomes.}

- Myotome: a group of muscles (common action) supplied by nerves whose fibres arise from a single nerve root (spinal cord level).

- Dermatome: an area of skin innervated by a single nerve root (spinal cord level).

87. Contraindications for massage and hydro therapy.

- For hot hydro penis and bolts and plates

88. {Positioning for constipation.}

- supine?

89. {Rebound test. What is it?}

○ Push on McBurney's point, if ouchie ouch?

■ Acute appendicitis

90. Hypertension C.I. And Treatment Protocol.

Major aims of treatment:

• S.N.S activity. (affects blood vessels)

• blood flow in peripheral blood vessel

Massage techniques/hydrotherapy:

- petrissage to the extremities

• massage limbs segmentally

- as peripheral vessels dilate and receive more blood, peripheral resistance decreases, lowering B.P

- mild heat applications to the extremities - for example, warm hand/foot baths (paraffin wax too hot)

B.P may rise using techniques that draw blood to the trunk, or increase venous return.

C.I— protocols/techniques that support venous return...

- no pillows under the legs/no elevation of limbs

- no repetitive effleurage; long drainage strokes

- no large motion r.o.m - limb elevation

- no heat sources on the trunk

Avoid (to diminish S.N.S firing):

• stimulating techniques: for example, tapotement, vigorous shaking, brisk massage of any sort

painful techniques: for example, M.T.P's, frictions

essential oils in lotions/oils

Positions: Fowler's, supine, right side-lying or seated

91. {Treatment protocol for diabetes, and what should you do before treatment.}

All: must carefully monitor what/how often, they eat to avoid complications.

Diabetes affects many systems, including C.V, renal, N.S - requiring treatment modification.

Massage may enhance local circulation. A client with diabetes who has not eaten for several hours and receives a massage that enhances circulation leading to an increase in glucose uptake by cells and 'plunging' sugar levels, may feel 'woozy'.