Week 1 Lecture 2

Question 1

Discuss the concepts of physiotherapy “treatment” as distinct from physiotherapy “management”

Answer 1

Treatment (Rx): specific intervention performed by the clinician, passive in nature (“hands on”)

          	- PAM
          	- soft tissue treatment (STT)
          	- EPA modalities
          	- HR, rhythmic initiations
          	- taping

Management: specific or general action or activity performed by patient under direction on prescription by clinician

          	- Education and advice
            - Support and reassurance
          	- Exercise prescription
          	- Advice or exercise aimed at prevention or                  recurrence
          	- Provision of home exercise (HEP)
          	- Posture re-education
          	- Provision of external support (brace)
          	- Addressing any contributing psychosocial, lifestyle and whole person factors

Question 2

Discuss the indications for physiotherapy treatment for peripheral musculoskeletal disorders

Answer 2

Non-mechanical and possibly serious or systemic pathology has been EXCLUDED (ie NO red flags)
If disorder is likely to be favorably influenced by physiotherapy
If informed consent given
If planned Rx mets patient’s expectations

Question 3

Discuss the relative importance of treating the cause of the symptoms versus addressing the contributing factors, and how this may change over time

Answer 3

Symptoms commonly but not always pain
Depends on degree of tissue injury and stage

• Acute tissue injury – emphasis on Rx of signs and symptoms, which relate to acute inflammatory process. Management of pain swelling etc.
• Non-acute injury or absence of significant tissue injury or damage – emphasis on addressing the cause and less on Rx of the injury site directly ie treat the cause and the symptoms will resolve

Question 4

• Describe the key treatment objectives for movement impairment disorders

Answer 4

GOAL: restore normal mobility
Address associated/secondary issues of m/s strength, endurance if required
Techniques aimed at relaxing/inhibiting excessive m/s guarding/tone/co-contraction or restoring length if contributing

Question 5

• Discuss the rationale and indications for passive mobilisation treatment technique

Answer 5

PAMS indications:
- Loss of joint ROM due to joint/articular hypomobility (ie capsule-ligamentous tissue, not (predominantly) contractile tissue
- This loss of mobility is related to the patient’s functional complaint(s) and symptoms
- Patient can’t actively or independently restore ROM due to pain or loss of tissue compliance
- Physiological ROM is limited by resistance (R2), not pain (P2)
PAMS rationale:
-usually more comfortable for patient than physiological mobilisation Rx techniques
-Passive movement stimulus for recovery of normal active movement and normal function

Question 6

Discuss reassessment principles following passive joint mobilization

Answer 6

• Reassess AROM after each set
• Always ask resting pain PRIOR to assessing AROM
• AROM – look for changes in range, quality, pain onset

-reassess relevant FUNCTIONAL test after 3 sets

Question 7

• Discuss the rationale behind the prescription of active / active-assisted exercises following passive joint mobilization

Answer 7

• Essential to provide active or active assisted ROM to maintain gains in range
• Active preferred in most cases so muscles work in new range

Question 8

• Describe the key treatment objectives for motor control disorders

Answer 8

GOAL: normalize sub-optimal postures, loading strategies, movement control &/or muscle imbalances

Question 9

• List commonly used self-report disability questionnaires (Appendix 5 will assist)

Answer 9

Quick DASH
VISA-A questionnaire (Achilles tendinopathy)
Lower extremity functional scale
Patient –specific functional scale