Disclosures Home Exercise for Lower Kristin Mathews, MS, ATC Hally - - PowerPoint PPT Presentation

▶
disclosures
SMART_READER_LITE
LIVE PREVIEW

Disclosures Home Exercise for Lower Kristin Mathews, MS, ATC Hally - - PowerPoint PPT Presentation

Oct 17, 2023 221 likes •347 views

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

slide-1
SLIDE 1

12/15/2018

1

Do it Yourself: Home Exercise for Lower Extremity Problems

Kristin Mathews, MS, ATC Hally Tappan, MA, ATC Michael Mayes, MS, ATC

Disclosures

▪ We have nothing to disclose.

2

What is an Athletic Trainer (AT)?

▪ 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 and medical conditions ▪ AT improve functional outcomes and specialize in patient education to prevent injury and re-injury ▪ Employed in a variety of settings

3

Athletic Training Domains

▪ Prevention ▪ Evaluation ▪ Immediate Care ▪ Treatment, Rehabilitation & Reconditioning

4

slide-2
SLIDE 2

12/15/2018

AT Clinical Responsibilities at UCSF

5

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

6

Goals of Acute Injury Care

▪ Minimize further damage ▪ Reduce hemorrhage and edema ▪ Relieve pain and spasm ▪ Promote healing

7

(Baoge 2012)

Injury Process

▪ Inflammatory Phase

  • 1-4 days post injury

▪ Proliferation Phase

  • 2-4 days post injury
  • Can last up to 6 weeks

▪ Remodeling Phase

  • Starts after at least 3 weeks

post injury

  • Requires 12 months to

become maximal

8

(Baoge 2012)

slide-3
SLIDE 3

12/15/2018

Inflammatory Phase Goals

▪ Protection

  • Varies depending on injury/body part

▪ Rest ▪ Ice ▪ Compression ▪ Elevation ▪ Minimum 2-3 days post injury!

9

Proliferation Phase Goals

▪ Improve/maintain range of motion ▪ Limit loss/maintain muscle strength and coordination ▪ Continue to promote an ideal healing environment

10

Initial Rehab Exercises

▪ Goals of early intervention:

  • Decrease swelling
  • Decrease pain
  • Restore range of motion
  • Restore strength
  • Restore neuromuscular control

11

Thigh Injuries

▪ Muscle strain

  • Quadriceps, hamstring, hip flexor

▪ Muscle contusion ▪ Differential diagnoses

  • fracture, compartment syndrome,

radiculopathy, etc.

12

slide-4
SLIDE 4

12/15/2018

PRICE

▪ 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

Thigh Handout

14

Stretching

▪ Early static stretching encourages elongation of maturing scar tissue (Kary 2010)

15

Quadriceps Stretching Hamstring Stretching

Strengthening

▪ Early muscle activation reduces strength losses (Slider 2013) ▪ Isometric → concentric → eccentric

16

Hamstring Isometrics Flex Quadriceps Isometrics

slide-5
SLIDE 5

12/15/2018

Thigh Injuries Wrap-Up

▪ Can become a chronic issue due to poor treatment and/or rehab ▪ Consider referral to physical therapy ▪ Educate patient to return to activity slowly

17

Ankle Injuries

▪ Ankle sprains are one of the most common musculoskeletal injuries

  • ccurring in sports and sedentary
  • persons. (Fong DT, 2008)

▪ The rate of ankle sprains can

  • ccur 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.

18

Ankle Sprain Classifications

▪ Grade 1

  • Mild stretching of ligament complex w/o

joint instability, weight bearing, no hemorrhaging ▪ Grade 2

  • Partial rupture of the ligament complex

with mild instability, hemorrhaging, tender to palpate, some loss of function ▪ Grade 3

  • Complete rupture of the ligament

complex with joint instability, hemorrhaging, great loss of normal function

19

Differential Diagnosis

▪ Syndesmosis sprain = high ankle sprain

  • Occurs in 1-24% of ankle sprains
  • If disrupted, may need surgical intervention

▪ Fracture

  • Medial or lateral malleolus, base of 5th metatarsal, or navicular
  • Refer to Ottawa Ankle Rules

▪ Lis Franc fracture/dislocation

  • Disruption of the TMT ligaments at the TMT joint

▪ Osteochondral lesion of talus

  • Persistent pain and swelling

▪ Achilles rupture

20

slide-6
SLIDE 6

12/15/2018

21

Ottawa Ankle Rules Types of X-Rays

22

  • In ortho clinics, WB XR are preferred

because it shows: ‒ Alignment/Joint space narrowing ‒ Signs of instability ‒ Severity of displacement WB Views NWB Views

PRICE - Protection

▪ Consider prescribing a brace or walking boot ▪ Grade I and II lateral ankle sprains

  • Decreased pain/swelling (Kerkhoff et al.

2001)

  • Reduced time off from work/sport

compared to using elastic wrap

(Beynnon et al. 2006)

▪ Grade III lateral ankle sprains

  • Clinical consensus suggests that

some form of immobilization is necessary (NATA 2013, Lamb et al. 2009)

23

Air Cast ASO Brace Cam Walker

PRICE

▪ Protection

  • Varies depending on severity of ankle injury

▪ 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

24

slide-7
SLIDE 7

12/15/2018

Ankle Handout

25

Range of Motion

Exercise Goal Frequency Photo

Ankle Pump Restore and maintain ankle dorsiflexion and plantarflexion 2 x 15reps 3x/day ABC's Restore and maintain ankle motion 2 sets A-Z 3x/day Calf Stretch Restore and maintain ankle dorsiflexion 3 sets 2min 3x/day

26

Strengthening – Towel Toe Pulls

▪ Goal: Increase strength of toe/foot flexors ▪ Frequency: 1 sets 5 pulls, 3 times/day

27

Strengthening – Toe Pick-Ups

▪ Goal: Increase strength of toe/foot flexors ▪ Frequency: 2-3 sets, 3 times/day

28

slide-8
SLIDE 8

12/15/2018

Strengthening – Toe Taps

▪ Goal: Increase strength of tibialis anterior muscle ▪ Frequency: 1 set to fatigue, 3 times/day

29

Strengthening – Windshield Wipers

▪ Goal: Increase strength of peroneal and posterior tibialis muscles ▪ Frequency: 1 set to fatigue, 3 times/day

30

Strengthening – Calf Raises

▪ Goal: Increase strength of calf muscles ▪ Frequency: 2 set 10-12 reps, 3 times/day

31

Strengthening– Gait Training

▪ Goal: Ensure proper walking gait ▪ Frequency: Repeat until perfect throughout the day

32

slide-9
SLIDE 9

12/15/2018

▪ Can become a chronic issue due to poor treatment and/or rehab ▪ Consider referral to physical therapy to work strengthening, neuromuscular control, and proprioception.

33

Ankle Injuries Wrap-Up Knee Injuries

▪ Most commonly injured joint in adolescent athletes (Gage et al 2012)

34

(Nicholl et al 1991) 11%

PRICE - Protection

▪ Consider prescribing a hinged knee brace or T-scope brace instead

  • f a knee immobilizer.
  • More functional, allows for protected ROM, better ambulation.
  • T-scope brace commonly used after knee surgery.

35

T-Scope Brace

  • Ligament injury
  • Meniscus injury
  • Patella dislocation

Hinged Knee Brace

  • Mild ligament injury

PRICE – Protection (cont.)

▪ Knee Immobilizer (Gravlee, Van Durme 2007)

  • Quadriceps tendon rupture
  • Patella tendon rupture
  • Patella fracture or dislocation

36

slide-10
SLIDE 10

12/15/2018

PRICE

▪ Protection

  • Varies depending on severity of knee injury

▪ 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

37

Specific Goals of Acute Knee Exercises

▪ Within 2 weeks post injury:

  • Full knee ROM
  • Good quad muscle activation
  • Restore normal gait pattern

▪ Discontinue use of crutches:

  • Normal gait pattern achieved
  • Ability to ascend/descend stairs w/o significant pain

38

Knee Handout

39

Range of Motion

Exercise Goal Frequency Photo

Knee Extension Bridges Restore and maintain full knee extension 10-15min 3x/day Towel Slides Restore and maintain full knee flexion 3 x 10reps 3x/day

40

slide-11
SLIDE 11

12/15/2018

Strengthening

Exercise Goal Frequency Photo

Quad Sets Increase strength

  • f quadricep muscle

3 x 10reps 3x/day Straight Leg Raises Increase strength of quadricep muscle 3 x 10reps 3x/day

41

Flex

Refer to Ortho Specialist

▪ Initiate PRICE ▪ Order appropriate DME ▪ Order MRI ▪ Begin acute rehab exercises ▪ Primary goals:

  • Minimize swelling
  • Improve range of motion

42

Acute Injury Timeline

▪ Example:

43

Day 1 Patient is injured on the weekend Day 2-3 Patient makes appt to see PCP Day 4-5 Patient is seen by PCP and an MRI is ordered 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.

Conclusion

▪ Acute injury care is time sensitive ▪ Early intervention accelerates recovery ▪ Follow the PRICE principle ▪ Provide patients with basic instruction of acute rehab exercises

44

slide-12
SLIDE 12

12/15/2018

45

Thank you!