12/15/2018 Do it Yourself: Disclosures Home Exercise for Lower Kristin Mathews, MS, ATC Hally Tappan, MA, ATC Extremity Problems Michael Mayes, MS, ATC ▪ We have nothing to disclose. 1 2 What is an Athletic Trainer (AT)? Athletic Training Domains Unique health care professional who collaborate with physicians ▪ to optimize activity of physically active Provide preventative services, emergency care, clinical ▪ assessment, therapeutic intervention and rehabilitation of injuries Prevention ▪ and medical conditions Evaluation ▪ Immediate Care ▪ AT improve functional outcomes and specialize in patient ▪ Treatment, Rehabilitation & Reconditioning ▪ education to prevent injury and re-injury Employed in a variety of settings ▪ 3 4
12/15/2018 AT Clinical Responsibilities at UCSF Presentation Goals ▪ Provide basic instruction of LE acute injury care ▪ Understand the importance of acute injury care ▪ Understand the goals of early phases of rehab 5 6 Goals of Acute Injury Care Injury Process ▪ Inflammatory Phase ▪ Minimize further damage • 1-4 days post injury ▪ Proliferation Phase ▪ Reduce hemorrhage and edema • 2-4 days post injury • Can last up to 6 weeks ▪ Relieve pain and spasm ▪ Remodeling Phase • Starts after at least 3 weeks ▪ Promote healing post injury • Requires 12 months to become maximal (Baoge 2012) (Baoge 2012) 7 8
12/15/2018 Inflammatory Phase Goals Proliferation Phase Goals ▪ P rotection ▪ Improve/maintain range of motion • Varies depending on injury/body part ▪ Limit loss/maintain muscle strength and coordination ▪ R est ▪ Continue to promote an ideal healing environment ▪ I ce ▪ C ompression ▪ E levation ▪ Minimum 2-3 days post injury! 9 10 Initial Rehab Exercises Thigh Injuries ▪ Goals of early intervention: ▪ Muscle strain • Decrease swelling • Quadriceps, hamstring, hip flexor • Decrease pain ▪ Muscle contusion • Restore range of motion ▪ Differential diagnoses • Restore strength • fracture, compartment syndrome, radiculopathy, etc. • Restore neuromuscular control 11 12
12/15/2018 PRICE Thigh Handout ▪ Protection • Typically thigh injuries do not require any type of DME ▪ Rest • Remove from activity. Consider assistive walking device ▪ Ice • 15-20 min every hour ▪ Compression ▪ Elastic wrap. Consider adding a compression stocking if patient develops lower leg edema. ▪ Elevation 13 14 Stretching Strengthening ▪ Early static stretching encourages elongation of maturing scar ▪ Early muscle activation reduces strength losses (Slider 2013) tissue (Kary 2010) ▪ Isometric → concentric → eccentric Flex Hamstring Stretching Quadriceps Stretching Hamstring Isometrics Quadriceps Isometrics 15 16
12/15/2018 Thigh Injuries Wrap-Up Ankle Injuries ▪ Can become a chronic issue due to poor treatment and/or rehab ▪ Ankle sprains are one of the most common musculoskeletal injuries ▪ Consider referral to physical therapy occurring in sports and sedentary persons. (Fong DT, 2008) ▪ Educate patient to return to activity slowly ▪ The rate of ankle sprains can occur from 15-20% of all sports injuries. (Aiken, 2008) ▪ 77% of all ankle sprains are lateral ankle sprains. ▪ Most occur during ankle inversion and plantar flexion. 17 18 Ankle Sprain Classifications Differential Diagnosis ▪ Syndesmosis sprain = high ankle sprain ▪ Grade 1 • Occurs in 1-24% of ankle sprains • Mild stretching of ligament complex w/o • If disrupted, may need surgical intervention joint instability, weight bearing, no hemorrhaging ▪ Fracture ▪ Grade 2 • Medial or lateral malleolus, base of 5th metatarsal, or navicular • Partial rupture of the ligament complex • Refer to Ottawa Ankle Rules with mild instability, hemorrhaging, tender to palpate, some loss of function ▪ Lis Franc fracture/dislocation ▪ Grade 3 • Disruption of the TMT ligaments at the TMT joint • Complete rupture of the ligament ▪ Osteochondral lesion of talus complex with joint instability, hemorrhaging, great loss of normal • Persistent pain and swelling function ▪ Achilles rupture 19 20
12/15/2018 Ottawa Ankle Rules Types of X-Rays WB Views NWB Views • In ortho clinics, WB XR are preferred because it shows: ‒ Alignment/Joint space narrowing ‒ Signs of instability ‒ Severity of displacement 21 22 PRICE PRICE - Protection ▪ Protection • Varies depending on severity of ankle injury ▪ Consider prescribing a brace or Air Cast walking boot ▪ Rest ▪ Grade I and II lateral ankle sprains • Remove from activity. Consider assistive walking device • Decreased pain/swelling (Kerkhoff et al. ▪ Ice 2001) • Reduced time off from work/sport • 15-20 min every hour compared to using elastic wrap ASO Brace (Beynnon et al. 2006) ▪ Compression ▪ Grade III lateral ankle sprains ▪ Elastic wrap. Consider adding a compression • Clinical consensus suggests that some form of immobilization is stocking if patient develops lower leg edema necessary (NATA 2013, Lamb et al. 2009) ▪ Elevation Cam Walker 23 24
12/15/2018 Ankle Handout Range of Motion Exercise Goal Frequency Photo Ankle Pump Restore and maintain 2 x 15reps ankle dorsiflexion and 3x/day plantarflexion ABC's Restore and maintain 2 sets A-Z ankle motion 3x/day Calf Stretch Restore and maintain 3 sets 2min ankle dorsiflexion 3x/day 25 26 Strengthening – Towel Toe Pulls Strengthening – Toe Pick-Ups ▪ Goal: Increase strength of toe/foot flexors ▪ Goal: Increase strength of toe/foot flexors ▪ Frequency: 1 sets 5 pulls, 3 times/day ▪ Frequency: 2-3 sets, 3 times/day 27 28
12/15/2018 Strengthening – Toe Taps Strengthening – Windshield Wipers ▪ Goal: Increase strength of tibialis anterior muscle ▪ Goal: Increase strength of peroneal and posterior tibialis muscles ▪ Frequency: 1 set to fatigue, 3 times/day ▪ Frequency: 1 set to fatigue, 3 times/day 29 30 Strengthening – Calf Raises Strengthening– Gait Training ▪ Goal: Increase strength of calf muscles ▪ Goal: Ensure proper walking gait ▪ Frequency: 2 set 10-12 reps, 3 times/day ▪ Frequency: Repeat until perfect throughout the day 31 32
12/15/2018 Ankle Injuries Wrap-Up Knee Injuries ▪ Can become a chronic issue due to poor treatment and/or rehab ▪ Most commonly injured joint in adolescent athletes (Gage et al 2012) ▪ Consider referral to physical therapy to work strengthening, neuromuscular control, and proprioception. (Nicholl et al 1991) 11% 33 34 PRICE - Protection PRICE – Protection (cont.) ▪ Consider prescribing a hinged knee brace or T-scope brace instead ▪ Knee Immobilizer (Gravlee, Van Durme 2007) of a knee immobilizer. • Quadriceps tendon rupture • More functional, allows for protected ROM, better ambulation. • Patella tendon rupture • T-scope brace commonly used after knee surgery. • Patella fracture or dislocation Hinged Knee Brace T-Scope Brace • Mild ligament injury • Ligament injury • Meniscus injury • Patella dislocation 35 36
12/15/2018 PRICE Specific Goals of Acute Knee Exercises ▪ Protection • Varies depending on severity of knee injury ▪ Rest ▪ Within 2 weeks post injury: • Remove from activity. Consider assistive walking device • Full knee ROM ▪ Ice • Good quad muscle activation • 15-20 min every hour • Restore normal gait pattern ▪ Compression ▪ Elastic wrap. Consider adding a compression stocking if patient develops lower leg edema. ▪ Discontinue use of crutches: ▪ Elevation • Normal gait pattern achieved • Ability to ascend/descend stairs w/o significant pain 37 38 Knee Handout Range of Motion Exercise Goal Frequency Photo Knee Extension Restore and maintain full 10-15min Bridges knee extension 3x/day Towel Slides Restore and maintain 3 x 10reps full knee flexion 3x/day 39 40
12/15/2018 Strengthening Refer to Ortho Specialist Exercise Goal Frequency Photo ▪ Initiate PRICE ▪ Order appropriate DME Quad Sets Increase strength 3 x 10reps of quadricep muscle 3x/day Flex ▪ Order MRI ▪ Begin acute rehab exercises ▪ Primary goals: Straight Leg Increase strength of 3 x 10reps Raises quadricep muscle 3x/day • Minimize swelling • Improve range of motion 41 42 Acute Injury Timeline Conclusion ▪ Example: ▪ Acute injury care is time sensitive ▪ Early intervention accelerates recovery Day 1 Patient is injured on the weekend Day 2-3 Patient makes appt to see PCP ▪ Follow the PRICE principle Day 4-5 Patient is seen by PCP and an MRI is ordered ▪ Provide patients with basic instruction of acute rehab exercises Day 6-10 Patient has MRI done and is referred to ortho specialist Day 11-20 Patient is seen by ortho specialist Up to 15 days before an intervention is prescribed. Consider recommending acute injury exercises. 43 44
12/15/2018 Thank you! 45
Recommend
More recommend
