musculoskeletal pain

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musculoskeletal pain

  1. 1. on AWH SPECIAL COLLEGE KALLAI 14th bpt Presented by, Akhil Rahman Akhila K.S Aswathi senan Aswathi K
  2. 2. INTRODUCTION  Musculoskeletal pain is believed to arise from the muscles,ligaments,bones or joints  Pain may be due to local causes such as tumours,fractures,infections and systemic and neurological causes  It can be localized or widespread  Lower back pain is the most common type of muscular pain,other common type include tendinitis,myalgia and stress fractures
  3. 3. CAUSES  Any injury to the bone,joints,muscles,tendon.ligaments,nerve  It can be caused by jerking movements, car accidents,falls,#,sprain,dislocation,direct blow to the muscles,overuse,poor posture,immobilization
  4. 4. Area of pain 35 30 25 20 15 10 5 0 lower back shoulder neck thoracic knee hip buttocks
  5. 5. Type of pain  Neuropathic  Mixed  Somatic referred  somatic
  6. 6. symptoms  Localized or widespread pain that can worsen with      movement Aching or stiffness of entire body Fatigue Sleep disturbances Twitching muscle Sensation of burning in muscle
  7. 7. Types of MSK pain  Bone pain  Muscle pain  Tendon and ligament pain  Fibromyalgia  Joint pain  Tunnel syndrome
  8. 8. Treatment it is treated by treating its causes It includes  NSAID and joint injections(medical Rx)  Pain reducing electrotherapy modalities  Manual therapy  Using a splint to immobilize the affected joint and allow healing  Using heat or cold  Reducing work load and increasing rest  Reducing stress through relaxation and biofeedback  Strengthening and conditioning exs  Therapeutic massage and stretching exs
  9. 9. Manual therapy Different type of manual therapy using for the msk pain. This includes OMPT(orthopeadic manual physical therapy)  OMPT utilizes the application of hands-on manipulation to restore pain-free living and proper function. Based on techniques originated in Europe, and recognized by the American Medical Association, OMPT is proven to more effectively stimulate the neuro-musculoskeletal system, and promote greater joint motion and soft tissue function than conventional approaches to physical therapy.  benefits • Relieves the symptoms by focusing on the cause of the problem • Increases range of motion and joint mobility • Reduces muscle tension and inflammation • Provides pain relief and eases recovery • Promotes proper circulation and the healing of soft tissues • Restores proper joint and muscle function for optimal outcomes
  10. 10.  Swedish massage(Dr.johan George)  Shiatsu massage  Deep friction massage by James cyriax  Soft tissue mobilization such as A. Stretching B. Myofacial release C. Trigger point technique D. Deep tissue technique E. Active release technique  PNF technique by Margaret Knott & Dorothy Voss  Post isometric relaxation(European manual technique )
  11. 11. NEED FOR THE STUDY  Pain and disability associated with musculoskeletal     conditions represent and significant health burden in India An episode of msk pain is of short duration, but it may reoccur The successful management of acute pain reduces the risk of chronic pain Simple interventions like physiotherapy providing early recovery from acute stage and can prevent reoccurrence This study mainly focuses on how manual therapy effective in musculoskeletal pain
  12. 12. HYPOTHESIS TRUE HYPOTHESIS  Available evidence suggest manual therapy as effective in treatment of msk  From the techniques we could find out what are the physiological effect gained from that  For example mobilization with small amplitude oscillatory and distraction are used to stimulate mechanoreceptors that inhibit transmission of nociceptive stimulus, thus pain is relieved
  13. 13. Evidences Technique Out come 1. Joint based manipulation Improved range of motion mobilization Decreases muscle spasm Improved range of motion 2 Soft tissue based Swedish massage Improved circulation deep tissue massage Decrease muscle spasm trigger point release Relaxation Re-align soft tissues, break adhesion Increase range of motion 3 nerve based neural dynamics Decreases pain Increase range of motion
  14. 14. Review of Literature  Manual therapy techniques were practiced as a treatment plan in past centuries  Hippocrates described combination of traction and manipulation  The other evidence of manual therapy technique in the olden days was by Sir Ambroise Pare who advice the use of manipulation in the treatment spinal curvature  Mechanical diagnosis and therapy(MDT)proposed by famous Newzealand physiatrist Robin meckanzie.These treatment were used to treat spinal discogenic dysfunction.
  15. 15.  Brain Mulligan the suggested as an etiology for joint dysfunction thought to respond to a unique manual therapy intervention called movement with mobilization(mwm)  A journal of orthopedics manual therapy published on 2010 also suggested the effect of manual therapy in the treatment of MSK
  16. 16. METHODOLOGY STUDY DESIGN :experimental study STUDY SETTINGS: patients with MSK pain medically screened and referred for PT by a physician in a multispecialty university teaching hospital Selection criteria: participants of any age, gender, with MSK were included PROCEDURE: patients with low back pain,shoulder,knee and hip were selected. They were treated for exs and manual therapy,TENS,acupunture,NSAID and topical treatment and examined its effects EQUIPMENT: VAS(visual acquity scale )
  17. 17. RESULT patients with MSK pain were selected& they were divided into 6 groups with 5 patient in each. Each groups were given different types of treatment like manual therapy ,topical treatment,acupunture,jont injection,NSAID,TENS & examined for 2 months ,all the treatment were effective but each group of people responded to the treatment in different way  3o
  18. 18.     Those who were given joint injection which are usually a combination of a local anesthetic or numbing agent,which provides immediate relieve and corticosteriod,such as cortisone shots, reduces inflammation and pain for temporary, but not the causes People who treated for acupuncture was effective, but the effects are not well understood People who were treated for TENS ,pain were reduced but was of short duration Manual therpay:-people who were treated for manual therapy was more effective than other treat ment.Many techniques were used according to their cause of MSK pain. Manual therapy finally resolved the underlying cause and reduced pain after 2 wks of treatment., and the reoccurrence was less compared to all other treatment
  19. 19. Topical applicants:- were effective for 2-4 hours NSAID:-work in the body by altering the brains pain receptor &blocking pain stimulus technique Effect of treatment(duration) Manual therapy 6wks NSAID 1 ½ wk Joint injections 3days Topical applicants 2-4 hours TENS 2days acupuncture 1 wk
  20. 20. Y-Values 45 40 35 30 25 20 15 10 5 0 Y-Values (in days) manual therapy NSAID joint injection (Treatment) topical applicants TENS
  21. 21. DISCUSSION  The findings highlight the effect of manual therapy in patient with MSK pain. Traditional literature emphasized more on manual therapy techniques& its mechanisms  Understanding the pain mechanism would help therapists to identify uniqueness in patients symptoms & would facilitate better individualized treatment planning and implementation  Manual therapy are the most effective treatment of pain and palliative care
  22. 22.  Bialosky explained the mechanism based role of manual therapy in the treatment of MSK pain and this may thus be applicable for other PT treatment as well  Manual therapy was become a continuous and inextricable part of PT CONCLUSION  Summarizing the physical cycle of pain, unless the movement restrictions in the spine& extremities are examined, identified, discovered & treated ,pain will always be present, as long as there is movement restriction there will always be compensation and there will always be pain when this is the case ,pain pills, injection shots, and acupuncture will just be masking the pain and results will be just for temporary. However when the mobility of the joints, muscles and soft tissues are regained and maintained by manual therapy

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