Week 1- Lecture 2 Principles of Treatment prescription for Musculoskeletal pain disorders

Body diagram • Area of symptoms • other related areas • Areas of paresthesia Consistancy of pain Nature of pain. How would you describe it? Depth of pain Severity of pain Does it radiate out Pain relationships HPC PMH- related to pain Social history Aggravating and easing factors 24 hour behaviour X-rays/ investigations Medications General health (GH) unexplained weight loss Pyschosocial factors - what you you think is causing the pain

 Observation  Functional Testing  Screening of other joints  ROM  Physiological  AROM +/- OP  PROM  PAMs/passive accessory movements(if indicated  Palpation  Orthopaedic/special tests(FADIR /FABER)  Test of the muscular system - Resisted tests - Muscle length - Muscle performance/MMT  Motor control (loading & mvmt control)  Neuro Exam  NTPT’s

Treatment: Specific intervention performed by the clinician, passive in nature(hands on) • Passive joint mobilisation • EPA modalities • HR, rythmic initations • Taping Managment(Mx): Specific or general action or activity performed by patient under the direction on prescription of the clinician • Excercise presciption • Posture reeducation • Provision of external support eg brace

If non mechanical & serious/systemic pathology have been excluded (NO RED FLAGS) If the disorder is likely to be favourably influenced by physiotherapy

Acute tissue injury - Focus more of the signs and symptoms which relate to the acute inflammatory process egMx of pain and swelling Non-Acute injury or Absence of significant tissue injury -Focus on the cause eg underlying impairments of MSK function eg biopsychosocial factors

Support and reassurance Information on prognosis Provide an explanation Develop and discuss a treatment plan Promote usual activity incl work ADL’s hobbies (w modification) -increase activity levels based on time vs pain especially with non acute disorders Promote self efficacy and self Mx

• Passive accessory(or physiological)movement techniques • Active /AA mobility excercises w passive over pressure • Techniques aimed at reducing tone,co-contraction or loss of length • Address associated or secondary strength/endurance • Address psychosocial, behavioural or lifestyle issues.

–Loss of joint ROM due to joint hypomobility Patient can’t independently restore ROM due to pain or loss of tissue compliance • Physiological Mvmnt limited by resistance(R2) not Pain • Associated PAM is limited by resistance(R2) not pain

Usually more COMFORTABLE than physiological mobilization PAMS treatment should not be painful unless some was demonstrated in Ax.

GRADE 1 Small amplitude applied at beginning of avaliable range GRADE 2 Large amplitude ossilation applied at beginning of ROM to middle ROM GRADE 3 Large amplitude ossillation applied at the movement barrier GRADE 4 Small amplitude ossilation applied at the movement barrier

Reasess AROM after each set Reasess mvmt most likely to improve first Always ask resting pain proir to reasessing AROM Looking for changes in range, quality, area pain,functional test

Trigger point release(TP) -TP pressure with muscle on slight stretch if tolerated Myofascial release(MFR) -Longitudinal massage strokes Massaging tequniques HR tequniques HEP: Passive stretches,heat, foam roller

Aim: normalise suboptimal postures,loading strategies,movement control & or muscle imbalances • improve proprioceptive/kinasthetic awareness • Integrate newly established MC into aggravating movement/activitites/functional tasks • Restore mms balance