Lesson Plan: Musculoskeletal Pathology 5 minutes: Breath of Arrival and Attendance 50 minutes: Musculoskeletal Pathology
Classroom Rules Punctuality- everybody's time is precious: Be ready to learn by 9:00, we'll have you out of here by 1:30 Tardiness: arriving late, late return after breaks, leaving early The following are not allowed: Bare feet Side talking Lying down Inappropriate clothing Food or drink except water Phones in classrooms, clinic or bathrooms You will receive one verbal warning, then you'll have to leave the room.
Musculoskeletal Pathology
Musculoskeletal Conditions List (Werner Page 61) Muscle Disorders Bone Disorders Muscular dystrophy Osteosarcoma Spasms Osgood-Schlatter Cramps Osteoporosis Strains Hyperkyphosis Hyperlordosis Scoliosis Rotoscoliosis
Musculoskeletal Conditions List (Werner Page 61) Joint Disorders Adhesive Capsulitis Osteoarthritis Baker cysts Patellofemoral syndrome Gout Spondylolisthesis Dislocations Spondylosis Subluxations Sprains Dysplasia Temporomandibular joint dysfunction Joint replacement surgery Lyme disease
Musculoskeletal Conditions List (Werner Page 61) Fascial Disorders Neuromuscular Disorders Compartment syndrome Carpal tunnel syndrome Dupuytren contracture Disc disease Ganglion cyst Herniation Hammertoe Degenerative disc disease Hernia Internal disc disruption Plantar fasciitis Myofascial pain syndrome Pes planus Thoracic outlet syndrome Pes cavus
Musculoskeletal Conditions List (Werner Page 61) Other Connective Tissue Disorders Bunions Bursitis Shin splints Tendinitis Tendinosis Tenosynovitis De Quervain tenosynovitis Whiplash
Spasms and Cramps
Spasms and Cramps Spasms Involuntary contraction of skeletal muscle. Low-grade and long- lasting. Cramps (AKA: charley horse) Involuntary contraction of skeletal muscle. Strong, painful, and short-lived.
Spasms and Cramps Etiology Nutrition deficiency Ischemia Vigorous exercise Splinting Underlying conditions
Spasms and Cramps Treatment Massage (circulation, attachment sites, and stretching) Heat Ice Ointments creating hot and cold sensations Medications Analgesics Muscle relaxants (if severe)
Spasms and Cramps Massage Avoid direct and aggressive bodywork to the muscle bellies Consider underlying conditions if cramping is frequent Painkillers and relaxants can mask pain and stretch limitations If splinting is due to injury, wait for acute stage to pass
Spasms and Cramps Pain-spasm-ischemia cycle Chronic contraction of a muscle begins a cycle of decreased oxygen supply, pain, and spasm.
Strains
Strains Strains Injuries to muscle fibers. Torn myofibers. Scar tissue production.
Strains Etiology Trauma (sudden and specific) Overuse (chronic and cumulative)
Strains Implications of scar tissue Impaired contractility Adhesions
Strains Signs and Symptoms Local pain Stiffness Pain on resisted movement or passive stretching No palpable heat or swelling unless severe.
Strains Treatment Accurate diagnosis PRICES (to control inflammation) Rehabilitation (realign scar tissue) Exercise, cross-fiber and linear friction, and passive stretching Prevent further injury Lymphatic drainage (limits edema) Avoid vigorous deep massage to a new or acute injury Medications NSAIDS (for pain and inflammation)
Sprains
Sprains Sprains Tears to ligaments. Etiology Not warming up results in a sudden snap Prolonged but extreme stretch after activity
Sprains Graded by severity 1 st degree (just a few fibers) 2 nd degree 3 rd degree (complete rupture)
Sprains Acute Stage Inflammation (including loss of function) Pain with passive stretches Duration of 24-48 hours Common sprains are anterior talofibular and sacroiliac ligaments Sub-acute Stage Inflammation (with regaining function)
Sprains Treatment RICE (limits edema and tissue damage) Moving the joint within range of pain tolerance ASAP Lymphatic massage during acute stage Linear and cross-fiber friction when sub-acute and post-acute May be a bone fracture if the “sprain” is not much better within a few days. Medications NSAIDs (for pain and inflammation)
Osteoporosis
Osteoporosis Osteoporosis Loss of bone mass and density. Osteopenia Pathological thinning of bones. Precursor to osteoporosis.
Osteoporosis Etiology Endocrine imbalances Poor metabolism of calcium Nutritional deficiency Non-controllable risk factors Smaller stature, white and Asian females with a family history
Osteoporosis Signs and symptoms No signs in early stages. Test regularly if high-risk Fractures Hyperkyphosis Chronic or acute back pain
Osteoporosis Treatment Light pressure massage to increase movement and decrease pain Pharmaceutical intervention Weight-bearing exercise Dietary adjustments Pressure light enough to prevent fractures Positioning and bolstering for comfort
Postural Deviations
Postural Deviations Hyperkyphosis (AKA: humpback) Overdeveloped thoracic curve due to muscular imbalance or osteoporosis of ankylosing spondylitis.
Postural Deviations Hyperlordosis (AKA: swayback) Overdeveloped lumbar curve.
Postural Deviations Scoliosis Lateral curvature of the spinal column in a C or S shape. Rotoscoliosis Lateral curvature and twist of the spinal column.
Postural Deviations Etiology Functional (soft tissue tension) Structural (bony distortion) Congenital Cerebral palsy Polio Muscular dystrophy Osteogenesis imperfecta Spina bifida
Postural Deviations Signs and symptoms Muscle tension Nerve impingement Chronic ache Loss of range of motion Impaired rib movement Cardiac and respiratory problems
Postural Deviations Treatment Osteopathy, chiropractic, physical therapy, and exercise therapy Massage If hyperkyphosis is due to osteoporosis, use light pressure If lung or cardiac function is impaired, consult a doctor
Joint Disruptions
Joint Disruptions Joint disruptions Articulating bones of a joint are not in correct relationship.
Joint Disruptions Dislocation Articulating bones are no longer touching, usually due to trauma.
Joint Disruptions Subluxation Bones are out of best alignment, but the joint capsule is intact. Joint is functional, but lacks full range of motion.
Joint Disruptions Dysplasia A congenital anomaly involving the formation of an abnormal acetabulum or femoral head.
Joint Disruptions Signs and symptoms Acute, traumatic cause: Pain, swelling, damage, bleeding, fractures, damaged tissues, nerves, ligaments, muscles, and tendons. Chronic, progressive cause: Low-level pain Referred pain due to nerve root pressure
Joint Disruptions Medications NSAIDs (for acute pain and inflammation) Massage Massage locally contraindicated if acute. If sub-acute or chronic, respect the limitations of range of motion. Massage adjoining tissues to manage pain, and improve tissue function.
Osteoarthritis
Osteoarthritis Osteoarthritis (AKA: degenerative joint disorder) Joint inflammation due to wear and tear of articular cartilage. Most common form of arthritis.
Osteoarthritis Etiology Aging Weight-bearing stress Repetitive movements Inflammation and damage at synovial joints (especially weight- bearing)
Osteoarthritis Triggers and factors Old age and overweight History of trauma or surgery Repetitive pounding stress Hormonal imbalances and nutritional deficiencies
Osteoarthritis Signs and symptoms Deep pain and stiffness Thickening of phalangeal epiphyses
Osteoarthritis Treatment Counterirritant ointment Exercise Medications NSAIDs (for pain) Steroidal anti-inflammatories Massage Acute inflammation contraindicates massage that promotes local circulation Do not focus specifically on the affected joints
Tendinopathies
Tendinopathies Tendinopathy Umbrella term that covers injury and damage to tendons and tenosynovial sheaths.
Tendinopathies Tendinitis (AKA: acute tendinopathy ) Acute injury of tendons. Inflammation, edema, and pain sheaths. Less common.
Tendinopathies Tendinosis Long term degeneration of tendons involving no inflammation, collagen degeneration, and loss of weight-bearing capacity.
Tendinopathies Tenosynovitis Irritation developing where tendons slide through their synovial sheaths. Characterized by crepitus (gritty sensation during movement).
Tendinopathies DeQuervain tenosynovitis Tenosynovitis specifically of the abductor and extensor pollicis tendons.
Tendinopathies Intrinsic factors Direct or shearing forces through tendon Overuse without recovery time Poor flexibility Underlying disease History of corticosteroid injections
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