Orthopaedic PT Principles of Treatment

University of Scranton - Department of Physical Therapy
Edmund M. Kosmahl, PT, EdD
send e-mail to Dr. Kosmahl copyright 2000 Edmund M. Kosmahl

PT351 ORTHOPAEDIC PT PRINCIPLES OF TREATMENT

TREATMENT BY SIGNS AND SYMPTOMS

Better than treatment according to diagnosis - avoids problems that might arise because:

different patients with same diagnosis might display different signs and symptoms
same patient (with same diagnosis) might exhibit different signs and symptoms during the course of recovery

TREATMENT BY STAGE OF INFLAMMATORY RESPONSE

Paramount concern is to minimize length of time of inflammatory response
Avoid causing regression back through inflammatory stages
Avoid prolonging any stage of inflammation

TREATMENT TO RELIEVE PAIN

Immobilization and rest
Modalities
Manual therapy - Australian grades I & II, Norwegian grade I to fire mechanoreceptors

TREATMENT TO INCREASE MOBILITY

Exercise
Manual therapy
Connective Tissue Massage
Posture and biomechanical correction

TREATMENT TO REDUCE MOBILITY

Exercise
Postural and biomechanical correction
External support

TREATMENT TO RESTORE ANATOMICAL RELATIONSHIPS - e.g. disk displacement, subluxations

Exercise
Traction
Posture and biomechanical correction
Manual therapy

TREATMENT TO RESTORE FUNCTION

Exercise
Functional activities

TREATMENT TO PROMOTE HEALING

Immobilization and rest
Modalities
Exercise

TREATMENT TO CORRECT POOR POSTURE

Exercise
Manual therapy
Training

TREATMENT TO IMPROVE GENERAL FITNESS

Exercise

TREATMENT TO INSURE PATIENT COMPLIANCE

Education

REEVALUATION

Second Treatment - is hypothesis correct?
Informally, with each treatment
How did previous treatment affect symptoms?
Was stage of inflammatory response affected?
Formally, at prescribed intervals - document progress

CONNECTIVE TISSUE MASSAGE

Deep friction across target fibers
Hyperemia and breakdown of adhesions
"Tension" the tissue appropriately
20 minutes, 6 - 12 treatments

Tendon and Ligament

Adhesions between target structure and adjacent structures
Massage across fibers with tendon or ligament under tension

Muscle Tissue

Adhesions between adjacent fibers lead to pain and limited function
Massage across fibers with muscle relaxed
Isometric contraction (when sufficient healing) to "spread" muscle fibers and break adhesions

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