MUSC PHYSIO - JB

- Severe traumatic Injury
- Suspicion of serious injury
- unusual clinical presentation
- unknown diagnosis following examination
- injuries that are unresponsive to treatment

NOTE: big factor for introduction of X-ray is it likely to change the treatment option

- Patient Identification
- relevant clinical history
- identify possible pathology
- consider the timing of the examination i.e. you might get the X-ray just before they come back to see you as this is going to show any changes

- Structural show
- position
- collimation
- Exposure criteria
- Image markers e.g. correct date, patient date, side

- show an objective way that treatment is useful to society
- enable evaluation and demonstration of effectiveness of treatment
- collate data

- morbidity
- limitations to functional activity e.g. clothesline etc.
- pain
- mental health e.g. stress
- vitality --> wellbeing

- Disease progress
- Treatment success
- health outcomes
- quality of life

Physical Impairment (there are some standardisation issues with this, between practioners within the same patient)
- ROM, MMT, Special Tests.

Pain
- Verbal
- VAS e.g. scale from 1-10 or face pain scale
- questionaires

Functional
- free of limitation i.e. testing more the effects of the condition on the life rather than the actual condition itself
- Patient Specific function pain scale e.g. Qs
- Roland Morris Disability questionaire
- Neck

Yellow Flags
- Orebo ÖMPQ Short form-12 (ÖMPQ SF-12): 12 items, maximum score = 120
* Low risk: <57 points
* Medium risk: 57-72 points
* High risk: >72 points

Quality of Life
- Sickness Impact Profile
- SF 36 (Physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health)

- statiscal signficance vs clinical relevance
- quality of the data
- causality
- ordinal scales i.e. no basis between number
- Bias

- used for reducing pain + restoring function + increase mobility
- used in conjunction with education + good communication + restoring function
- looking to change mobility

- soft tissue manipulation
- massage
- manual traction
- joint manipulation / joint mobilisation
- PAM + PPM (kinda fits in more than one place though)

1. Stimulates large diameter joint afferents
- inhibits nociceptive activity
2. reduces pain by stretching / muscle contraction reducing efferent activity via stretch of joint capsule

Nociceptive = acute localised pain
Neuropathic = somatosensory e.g. direct injury to the nerve
Nociplastic = change in nociceptive processing with CNS i.e. more excitibility

- increase production of mediators
- restoration of normal joint and connective tissue
- Mobilisation reduces pain as dorsolateral PAG non-opiod pain
- Analgesic systems

- Joint opening techniques on nerve root
- neural mobilisation --> disperse neural fluid

- Reduce pain severity
- Improve physical functioning
- Improve overall physical and mental health

Regular Physical activity
- increases release of endogenous opiods into the brainstem, inhibits facilitory neurons = less pain

Sedentary Conditions:
- Less opiod in brainstem therefore less overall inhibition, more facilitation after nociceptive input.

- Aerobic exercise induces large EIH,
- Dynamic resistance exercise induces small EIH
- Isometric exercise does not cause EIH.

1. Initial Stage = Regain range, normal / neutral position of the joint
- Light resistance in neutral, isometrics and working in force coupling around the joint in increasing
- ROM, ensuring quality of movement and quality of contraction (Closed kinetic chain activities for proprioception)

2. Intermediate Stage = treating joint, movement etc.
- Strength and endurance training can commence
- Specific functional training (low load, high volume)
- Proprioception work through increasing range – low load high volume

3. Advanced Stage = strengthening of muscles using progressive overload
- progress through functional activity
- local rehab to general fitness

4. Return to functional activity = symptom free
- confidence, sport etc.
- management strategies and warning signs