This case report describes a Division I volleyball player who was diagnosed with idiopathic scoliosis at age 13 and later developed degenerative disc disease. MRI imaging at age 19 revealed disc extrusion and spinal stenosis. A core stabilization program and electrotherapy were implemented to manage pain, allowing her to continue playing volleyball without loss of participation. While the rehabilitation showed some success, adherence was inconsistent. Core stabilization programs have been shown to effectively treat low back pain, but compliance is important for achieving optimal outcomes.
This document provides definitions and explanations of key concepts in biomechanics and biomaterials. It begins by defining biomechanics as the science of forces on living bodies and biomaterials as any matter that interacts with biological systems. It then covers topics such as kinesiology, kinetics, stress, strain, material properties including elasticity and plasticity, metal characteristics like fatigue and corrosion, and common orthopedic implants including screws, plates, and locking plates. Key points are emphasized regarding the mechanical behaviors and characteristics of different materials as they relate to orthopedic applications and implant design.
The document provides an overview of the role of ultrasound in orthopedics. It begins with a description of normal sonographic appearances of structures like tendons, bones, cartilage and ligaments. It then discusses various sonographic artifacts and basic pathology concepts for evaluating musculoskeletal injuries and conditions like muscle/tendon injuries, bone injuries, infections, arthritis and soft tissue foreign bodies. Specific applications of ultrasound for assessing conditions in different body regions like shoulder, elbow, wrist, hip, knee, ankle and foot are covered. The document highlights advantages of ultrasound for diagnosis, interventions and treatments in orthopedics.
This document discusses total elbow arthroplasty. It provides an overview of the different types of elbow implants, including fully constrained, semi-constrained, and unconstrained designs. Semi-constrained implants are most commonly used. Patient selection criteria and contraindications are outlined. Post-operative care involves restricting motion and weight-bearing initially. Common complications include instability, polyethylene wear, osteolysis, loosening, and infection. Revision surgery may be needed in cases of painful or failed elbow replacements.
This document discusses bone grafting and grafting techniques. It defines what a graft is, describes different types of bone grafts including autografts, allografts, and bone graft substitutes. It covers the biological process of bone graft incorporation and lists various techniques for harvesting and placing bone grafts, such as onlay grafts, dual onlay grafts, and fibula grafts. Risks, advantages, and disadvantages of different graft options are also summarized.
This document provides an overview of metallurgy in orthopedics. It discusses the timeline of metallic implant development, from early use of bone pegs and brass wire to modern alloys like titanium and cobalt chromium. Key topics covered include the ideal properties of implant materials, commonly used metals like stainless steel, titanium and cobalt alloys, and problems that can occur like corrosion, stress shielding and fatigue failure. The document aims to define important metallurgical concepts and provide context on the role and evolution of metals in orthopedic surgery.
Cemented versus uncemented fixation in total hip replacementTunO pulciņš
The document discusses and compares cemented versus uncemented fixation techniques in total hip replacement (THR). Cemented fixation uses acrylic polymer to lock the bone and implant together, while uncemented implants have rough, porous coatings to allow bone ingrowth. Some advantages of cemented fixation are that it is more suitable for obese patients, has a better outcome for displastic hips, and is better for patients with osteoporosis. However, uncemented fixation has a lower revision rate within 10 years, a low risk of femoral loosening once stable fixation occurs, and does not commonly cause osteolysis. Both techniques have benefits depending on the individual patient's needs.
This document provides an overview of the history and types of spinal orthoses. It begins with a brief history of spinal orthotic use dating back to ancient times. It then describes various types of cervical, cervicothoracic, and thoracolumbosacral orthoses, including their indications, biomechanics, design features, and how they control spinal motion. Examples of custom-fit and prefabricated options are discussed. The document concludes with descriptions of specific orthosis designs like the halo, SOMI, and TLSO and how they immobilize different spinal regions.
This document discusses SLAP lesions of the shoulder. It defines SLAP lesions as injuries to the superior labrum. The etiology of SLAP lesions is controversial but may involve traction from the biceps tendon during throwing motions. People at risk include those with poor scapular control or tight posterior capsules. Physical exams do not conclusively diagnose SLAP lesions. Treatment involves a 3-phase rehabilitation program focusing on the kinetic chain, mobility, and strengthening. Core stability, scapular stabilization, and manual therapy techniques are emphasized. While surgery is an option, adaptive changes in throwers mean repairing anatomy may hinder performance. An integrated approach addressing the whole body is most effective for shoulder pain.
This document provides definitions and explanations of key concepts in biomechanics and biomaterials. It begins by defining biomechanics as the science of forces on living bodies and biomaterials as any matter that interacts with biological systems. It then covers topics such as kinesiology, kinetics, stress, strain, material properties including elasticity and plasticity, metal characteristics like fatigue and corrosion, and common orthopedic implants including screws, plates, and locking plates. Key points are emphasized regarding the mechanical behaviors and characteristics of different materials as they relate to orthopedic applications and implant design.
The document provides an overview of the role of ultrasound in orthopedics. It begins with a description of normal sonographic appearances of structures like tendons, bones, cartilage and ligaments. It then discusses various sonographic artifacts and basic pathology concepts for evaluating musculoskeletal injuries and conditions like muscle/tendon injuries, bone injuries, infections, arthritis and soft tissue foreign bodies. Specific applications of ultrasound for assessing conditions in different body regions like shoulder, elbow, wrist, hip, knee, ankle and foot are covered. The document highlights advantages of ultrasound for diagnosis, interventions and treatments in orthopedics.
This document discusses total elbow arthroplasty. It provides an overview of the different types of elbow implants, including fully constrained, semi-constrained, and unconstrained designs. Semi-constrained implants are most commonly used. Patient selection criteria and contraindications are outlined. Post-operative care involves restricting motion and weight-bearing initially. Common complications include instability, polyethylene wear, osteolysis, loosening, and infection. Revision surgery may be needed in cases of painful or failed elbow replacements.
This document discusses bone grafting and grafting techniques. It defines what a graft is, describes different types of bone grafts including autografts, allografts, and bone graft substitutes. It covers the biological process of bone graft incorporation and lists various techniques for harvesting and placing bone grafts, such as onlay grafts, dual onlay grafts, and fibula grafts. Risks, advantages, and disadvantages of different graft options are also summarized.
This document provides an overview of metallurgy in orthopedics. It discusses the timeline of metallic implant development, from early use of bone pegs and brass wire to modern alloys like titanium and cobalt chromium. Key topics covered include the ideal properties of implant materials, commonly used metals like stainless steel, titanium and cobalt alloys, and problems that can occur like corrosion, stress shielding and fatigue failure. The document aims to define important metallurgical concepts and provide context on the role and evolution of metals in orthopedic surgery.
Cemented versus uncemented fixation in total hip replacementTunO pulciņš
The document discusses and compares cemented versus uncemented fixation techniques in total hip replacement (THR). Cemented fixation uses acrylic polymer to lock the bone and implant together, while uncemented implants have rough, porous coatings to allow bone ingrowth. Some advantages of cemented fixation are that it is more suitable for obese patients, has a better outcome for displastic hips, and is better for patients with osteoporosis. However, uncemented fixation has a lower revision rate within 10 years, a low risk of femoral loosening once stable fixation occurs, and does not commonly cause osteolysis. Both techniques have benefits depending on the individual patient's needs.
This document provides an overview of the history and types of spinal orthoses. It begins with a brief history of spinal orthotic use dating back to ancient times. It then describes various types of cervical, cervicothoracic, and thoracolumbosacral orthoses, including their indications, biomechanics, design features, and how they control spinal motion. Examples of custom-fit and prefabricated options are discussed. The document concludes with descriptions of specific orthosis designs like the halo, SOMI, and TLSO and how they immobilize different spinal regions.
This document discusses SLAP lesions of the shoulder. It defines SLAP lesions as injuries to the superior labrum. The etiology of SLAP lesions is controversial but may involve traction from the biceps tendon during throwing motions. People at risk include those with poor scapular control or tight posterior capsules. Physical exams do not conclusively diagnose SLAP lesions. Treatment involves a 3-phase rehabilitation program focusing on the kinetic chain, mobility, and strengthening. Core stability, scapular stabilization, and manual therapy techniques are emphasized. While surgery is an option, adaptive changes in throwers mean repairing anatomy may hinder performance. An integrated approach addressing the whole body is most effective for shoulder pain.
This document discusses common musculoskeletal problems seen in the community, including knee, shoulder, ankle and foot issues. It provides details on the causes, clinical features, diagnosis and treatment approaches for various conditions like patellofemoral pain syndrome, shoulder instability, adhesive capsulitis, rotator cuff tears, ankle sprains and plantar fasciitis. Special investigations like MRI and treatment methods such as injections, physiotherapy, manipulation and surgery are touched upon.
1. A 44-year-old shoe maker presented with inability to rotate his right forearm following a 2016 car accident that resulted in an open fracture of his right proximal ulna that was plated 10 days after the injury.
2. Examination and imaging showed a bony bridge between the radius and ulna, known as a radio-ulnar synostosis.
3. Risk factors for developing post-traumatic radio-ulnar synostosis include open fractures, surgery delayed more than 2 weeks, screws penetrating the interosseous membrane, and prolonged immobilization, all of which applied to this patient.
The document discusses how gene therapy can be used to better understand and treat musculoskeletal disorders and injuries by promoting tissue regeneration through localized delivery of growth factors and cytokines. It outlines how viral and non-viral vectors can be used to introduce therapeutic genes into tissues to accelerate healing and reduce recovery time for conditions like fractures, osteoarthritis, tendon injuries, and muscular dystrophy.
The ACL provides primary stability to the knee by limiting anterior tibial translation. It has an average tensile strength of 2160 N. An ACL tear is commonly seen in sports involving sudden stops and changes in direction. Clinical exams like the Lachman and anterior drawer tests can indicate an ACL tear. MRI is the gold standard for diagnosis. While conservative treatment is possible, surgery is often pursued to reconstruct the torn ligament using grafts like the patellar tendon. Post-operative rehabilitation and physiotherapy are important for a successful recovery.
This document discusses the history and development of bone cement. Some key points:
- Bone cement was first used in the 1870s to fix ivory knee prostheses. Modern cementing techniques using PMMA were developed in the 1950s-60s.
- Bone cement is composed of PMMA polymer powder mixed with MMA monomer liquid. Various types of bone cement have been developed with different viscosities.
- Bone cement is used to fix joint prostheses during arthroplasty and is contraindicated in active infection or allergy to components.
- The polymerization process after mixing cement has mixing, waiting, working, and hardening phases. Factors like temperature and mixing technique affect the process.
EVOLUTION AND GENERATION OF IMPLANTS_122609 (1)_114536 (002) (1).pptxParitoshdas17
This document discusses the evolution and generations of implants used in orthopedics. It begins by describing the earliest examples of fracture management found in Egypt from 3500 BC. It then covers the early use of wires, screws and plates in the 1700-1800s. The document discusses the developments of the AO group starting in the 1950s including compression plating and limited contact plating. It also covers developments in intramedullary nails including Kuntscher nails. In summary, the document provides a historical overview of the progression of implant technology from ancient Egypt to modern times.
BFR training uses occlusion to restrict blood flow during exercise, allowing for gains in strength and hypertrophy with lower training volumes and loads compared to traditional high load training. It works by increasing metabolic stress and fast twitch fiber recruitment within the occluded muscles. While not as effective for strength gains as high load training, it provides equivalent hypertrophy results. BFR can benefit bone health and muscle preservation after injuries. Safety concerns include DVT risk, but risks are low if proper guidelines are followed, such as using 40-80% of limb occlusion pressure and avoiding use in high risk populations.
Orthotics - FYBPO. These slides are regarding basic knowledge of orthotics, orthosis, and orthotist. It will help you understand the different types of orthoses used for the lower extremity.
Hamstring strains are common injuries that occur during activities involving sprinting or kicking. They frequently happen during the swing phase of sprinting when the hamstrings are lengthened. Risk factors include age, previous injury, low flexibility, weakness, fatigue, and improper warm-up. Prevention strategies include stretching, strengthening, sport-specific training, and combined programs addressing multiple risk factors.
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANIGirish Motwani
This document discusses Perthes disease and its management. It begins with an overview of the 4 stages of the disease based on the evolution: avascular necrosis, revascularization/fragmentation, ossification/healing, and remodeling. It then examines various classification systems used to assess the extent of involvement, including Catterall, Salter-Thompson, Herring, and Elizabethtown classifications. Containment methods like bracing and surgical options like femoral and pelvic osteotomies are covered. The talk emphasizes the importance of assessing the structural integrity of the femoral head, especially the lateral pillar, when determining treatment and prognosis.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
Chondrolysis is the progressive destruction of articular cartilage resulting in joint space narrowing and stiffness. It can be caused by infection, trauma, following slipped capital femoral epiphysis (SCFE), or idiopathically. In SCFE cases, chondrolysis risk is higher with osteotomy or casting versus percutaneous pinning. The accepted theory is that chondrolysis results from an autoimmune response in genetically susceptible individuals. Treatment involves supportive care, identifying potential causes like pin penetration, and surgery like traction or hip replacement for severe cases.
Dr. Paudel discussed bone graft substitutes, which are used to fill bone defects and promote healing. They discussed various types including allografts, ceramics, polymers, and composites. Allografts have disadvantages like immune reactions and disease transmission. Ceramics are osteoconductive but not structural. Composites combining materials like ceramics, cells, and growth factors may provide better fusion than any component alone. The ideal bone graft substitute would be osteoconductive, osteoinductive, and provide structural support like autografts, but without their disadvantages.
Radial nerve Injury and tendon tranfersBADAL BALOCH
This document discusses radial nerve injury and tendon transfers. It begins by describing the radial nerve's innervations and mechanisms of injury. Common causes of radial nerve injury include fractures of the humeral shaft and gunshot wounds. Examination of radial nerve palsy involves assessing muscles like the triceps and extensors. Tendon transfers are indicated for radial nerve injuries that do not recover on their own. The Brand transfer is currently the standard protocol, involving the pronator teres, flexor carpi radialis, and palmaris longus muscles. Postoperative care focuses on immobilizing the arm for 6 weeks.
This document discusses age and sex considerations in exercise. For older adults, physical activity can help prevent disease progression and extend independent living. Aerobic capacity and cardiac function naturally decline with age, but training can help offset these changes. Adolescents can gain strength through resistance training primarily through neurological adaptations rather than muscle growth. Females generally have lower muscle mass, stroke volume and VO2max than males due to smaller body size, but training can significantly improve endurance and strength. Special concerns for both sexes include amenorrhea and reduced hormone levels from excessive exercise.
acl arthroscopic reconstruction single bundle vs double bundledrabhichaudhary88
The document discusses anterior cruciate ligament (ACL) repair, including a comparison of single bundle versus double bundle ACL reconstruction techniques. It provides details on ACL anatomy, biomechanics, injury mechanisms, treatment options, and surgical procedures. It also reviews findings from journal articles regarding clinical outcomes of single versus double bundle reconstruction.
Turf toe is an injury to the big toe caused by sudden forced extension of the toe upwards beyond its normal range of motion. This can occur during sports on hard artificial surfaces when an athlete's foot is forcibly stopped by their shoe gripping the ground. It damages the ligaments and joint capsule of the big toe, causing pain, swelling, and reduced motion. Treatment focuses on RICE and may include immobilization, physical therapy, or surgery for severe cases. Prevention involves wearing shoes with better support and limiting time on hard artificial surfaces.
This document discusses osteoarthritis of the knee. It begins by describing the pathologic features of OA including loss of hyaline cartilage and thickening of subchondral bone. It then discusses the mechanisms by which healthy joints are protected and how they fail in OA. Specifically, it outlines the roles of synovial fluid, ligaments, muscles, sensory nerves, and cartilage. Two major components of cartilage, type 2 collagen and aggrecan, are described along with how their degradation by enzymes like MMPs and aggrecanases contributes to OA. Risk factors for OA including age, gender, genetics, previous joint damage, malalignment, obesity, and repetitive activities are covered. Sources of pain in O
1) Heterotopic ossification is the formation of bone in soft tissues where bone is not normally present, usually occurring after injury or surgery.
2) It has three stages - early inflammatory phase with swelling, intermediate consolidation phase with calcification visible on x-rays, and late maturation phase where the bone hardens.
3) Risk factors include trauma, surgery, burns, and genetic conditions. It most commonly occurs around the elbow and hip.
4) Excision surgery aims to remove the ectopic bone, with different approaches depending on the location. Prophylaxis with indomethacin or radiation can decrease rates of recurrence after hip surgery.
Duolingo es una plataforma gratuita para aprender idiomas como inglés, portugués y alemán. Ofrece herramientas que ayudan a mejorar el aprendizaje del idioma, permitiendo estudiar varios idiomas a la vez y elegir el tiempo de estudio diario. Una ventaja clave es que es cómodo, fácil de usar y está disponible como sitio web y aplicaciones móviles.
This document discusses common musculoskeletal problems seen in the community, including knee, shoulder, ankle and foot issues. It provides details on the causes, clinical features, diagnosis and treatment approaches for various conditions like patellofemoral pain syndrome, shoulder instability, adhesive capsulitis, rotator cuff tears, ankle sprains and plantar fasciitis. Special investigations like MRI and treatment methods such as injections, physiotherapy, manipulation and surgery are touched upon.
1. A 44-year-old shoe maker presented with inability to rotate his right forearm following a 2016 car accident that resulted in an open fracture of his right proximal ulna that was plated 10 days after the injury.
2. Examination and imaging showed a bony bridge between the radius and ulna, known as a radio-ulnar synostosis.
3. Risk factors for developing post-traumatic radio-ulnar synostosis include open fractures, surgery delayed more than 2 weeks, screws penetrating the interosseous membrane, and prolonged immobilization, all of which applied to this patient.
The document discusses how gene therapy can be used to better understand and treat musculoskeletal disorders and injuries by promoting tissue regeneration through localized delivery of growth factors and cytokines. It outlines how viral and non-viral vectors can be used to introduce therapeutic genes into tissues to accelerate healing and reduce recovery time for conditions like fractures, osteoarthritis, tendon injuries, and muscular dystrophy.
The ACL provides primary stability to the knee by limiting anterior tibial translation. It has an average tensile strength of 2160 N. An ACL tear is commonly seen in sports involving sudden stops and changes in direction. Clinical exams like the Lachman and anterior drawer tests can indicate an ACL tear. MRI is the gold standard for diagnosis. While conservative treatment is possible, surgery is often pursued to reconstruct the torn ligament using grafts like the patellar tendon. Post-operative rehabilitation and physiotherapy are important for a successful recovery.
This document discusses the history and development of bone cement. Some key points:
- Bone cement was first used in the 1870s to fix ivory knee prostheses. Modern cementing techniques using PMMA were developed in the 1950s-60s.
- Bone cement is composed of PMMA polymer powder mixed with MMA monomer liquid. Various types of bone cement have been developed with different viscosities.
- Bone cement is used to fix joint prostheses during arthroplasty and is contraindicated in active infection or allergy to components.
- The polymerization process after mixing cement has mixing, waiting, working, and hardening phases. Factors like temperature and mixing technique affect the process.
EVOLUTION AND GENERATION OF IMPLANTS_122609 (1)_114536 (002) (1).pptxParitoshdas17
This document discusses the evolution and generations of implants used in orthopedics. It begins by describing the earliest examples of fracture management found in Egypt from 3500 BC. It then covers the early use of wires, screws and plates in the 1700-1800s. The document discusses the developments of the AO group starting in the 1950s including compression plating and limited contact plating. It also covers developments in intramedullary nails including Kuntscher nails. In summary, the document provides a historical overview of the progression of implant technology from ancient Egypt to modern times.
BFR training uses occlusion to restrict blood flow during exercise, allowing for gains in strength and hypertrophy with lower training volumes and loads compared to traditional high load training. It works by increasing metabolic stress and fast twitch fiber recruitment within the occluded muscles. While not as effective for strength gains as high load training, it provides equivalent hypertrophy results. BFR can benefit bone health and muscle preservation after injuries. Safety concerns include DVT risk, but risks are low if proper guidelines are followed, such as using 40-80% of limb occlusion pressure and avoiding use in high risk populations.
Orthotics - FYBPO. These slides are regarding basic knowledge of orthotics, orthosis, and orthotist. It will help you understand the different types of orthoses used for the lower extremity.
Hamstring strains are common injuries that occur during activities involving sprinting or kicking. They frequently happen during the swing phase of sprinting when the hamstrings are lengthened. Risk factors include age, previous injury, low flexibility, weakness, fatigue, and improper warm-up. Prevention strategies include stretching, strengthening, sport-specific training, and combined programs addressing multiple risk factors.
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANIGirish Motwani
This document discusses Perthes disease and its management. It begins with an overview of the 4 stages of the disease based on the evolution: avascular necrosis, revascularization/fragmentation, ossification/healing, and remodeling. It then examines various classification systems used to assess the extent of involvement, including Catterall, Salter-Thompson, Herring, and Elizabethtown classifications. Containment methods like bracing and surgical options like femoral and pelvic osteotomies are covered. The talk emphasizes the importance of assessing the structural integrity of the femoral head, especially the lateral pillar, when determining treatment and prognosis.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
Chondrolysis is the progressive destruction of articular cartilage resulting in joint space narrowing and stiffness. It can be caused by infection, trauma, following slipped capital femoral epiphysis (SCFE), or idiopathically. In SCFE cases, chondrolysis risk is higher with osteotomy or casting versus percutaneous pinning. The accepted theory is that chondrolysis results from an autoimmune response in genetically susceptible individuals. Treatment involves supportive care, identifying potential causes like pin penetration, and surgery like traction or hip replacement for severe cases.
Dr. Paudel discussed bone graft substitutes, which are used to fill bone defects and promote healing. They discussed various types including allografts, ceramics, polymers, and composites. Allografts have disadvantages like immune reactions and disease transmission. Ceramics are osteoconductive but not structural. Composites combining materials like ceramics, cells, and growth factors may provide better fusion than any component alone. The ideal bone graft substitute would be osteoconductive, osteoinductive, and provide structural support like autografts, but without their disadvantages.
Radial nerve Injury and tendon tranfersBADAL BALOCH
This document discusses radial nerve injury and tendon transfers. It begins by describing the radial nerve's innervations and mechanisms of injury. Common causes of radial nerve injury include fractures of the humeral shaft and gunshot wounds. Examination of radial nerve palsy involves assessing muscles like the triceps and extensors. Tendon transfers are indicated for radial nerve injuries that do not recover on their own. The Brand transfer is currently the standard protocol, involving the pronator teres, flexor carpi radialis, and palmaris longus muscles. Postoperative care focuses on immobilizing the arm for 6 weeks.
This document discusses age and sex considerations in exercise. For older adults, physical activity can help prevent disease progression and extend independent living. Aerobic capacity and cardiac function naturally decline with age, but training can help offset these changes. Adolescents can gain strength through resistance training primarily through neurological adaptations rather than muscle growth. Females generally have lower muscle mass, stroke volume and VO2max than males due to smaller body size, but training can significantly improve endurance and strength. Special concerns for both sexes include amenorrhea and reduced hormone levels from excessive exercise.
acl arthroscopic reconstruction single bundle vs double bundledrabhichaudhary88
The document discusses anterior cruciate ligament (ACL) repair, including a comparison of single bundle versus double bundle ACL reconstruction techniques. It provides details on ACL anatomy, biomechanics, injury mechanisms, treatment options, and surgical procedures. It also reviews findings from journal articles regarding clinical outcomes of single versus double bundle reconstruction.
Turf toe is an injury to the big toe caused by sudden forced extension of the toe upwards beyond its normal range of motion. This can occur during sports on hard artificial surfaces when an athlete's foot is forcibly stopped by their shoe gripping the ground. It damages the ligaments and joint capsule of the big toe, causing pain, swelling, and reduced motion. Treatment focuses on RICE and may include immobilization, physical therapy, or surgery for severe cases. Prevention involves wearing shoes with better support and limiting time on hard artificial surfaces.
This document discusses osteoarthritis of the knee. It begins by describing the pathologic features of OA including loss of hyaline cartilage and thickening of subchondral bone. It then discusses the mechanisms by which healthy joints are protected and how they fail in OA. Specifically, it outlines the roles of synovial fluid, ligaments, muscles, sensory nerves, and cartilage. Two major components of cartilage, type 2 collagen and aggrecan, are described along with how their degradation by enzymes like MMPs and aggrecanases contributes to OA. Risk factors for OA including age, gender, genetics, previous joint damage, malalignment, obesity, and repetitive activities are covered. Sources of pain in O
1) Heterotopic ossification is the formation of bone in soft tissues where bone is not normally present, usually occurring after injury or surgery.
2) It has three stages - early inflammatory phase with swelling, intermediate consolidation phase with calcification visible on x-rays, and late maturation phase where the bone hardens.
3) Risk factors include trauma, surgery, burns, and genetic conditions. It most commonly occurs around the elbow and hip.
4) Excision surgery aims to remove the ectopic bone, with different approaches depending on the location. Prophylaxis with indomethacin or radiation can decrease rates of recurrence after hip surgery.
Duolingo es una plataforma gratuita para aprender idiomas como inglés, portugués y alemán. Ofrece herramientas que ayudan a mejorar el aprendizaje del idioma, permitiendo estudiar varios idiomas a la vez y elegir el tiempo de estudio diario. Una ventaja clave es que es cómodo, fácil de usar y está disponible como sitio web y aplicaciones móviles.
This document discusses object-oriented analysis and design (OOAD) and the Unified Modeling Language (UML). It introduces object-oriented concepts like classes, data members, methods, and diagrams. It also covers the main components of OOAD like functional requirements, static structure, and dynamic behavior that are modeled using UML diagrams.
La Web 2.0 representa la evolución de las aplicaciones tradicionales hacia aplicaciones web enfocadas al usuario final. Incluye blogs, wikis, podcasts, YouTube y otras herramientas para expresarse, publicar y compartir información, así como redes sociales y aplicaciones en línea para la colaboración y el aprendizaje. Facilita un aprendizaje más autónomo y participativo a través de fuentes de información y canales de comunicación compartidos.
El documento invita a los ciudadanos a apoyar la postulación de 5 candidatos independientes a diputados constituyentes para la nueva Constitución de la Ciudad de México en enero de 2017. Los partidos políticos ya han reservado 40 de los 100 escaños y ponen requisitos difíciles para los independientes. Los candidatos independientes promoverán una agenda basada en ampliar derechos, democracia participativa, diversidad e igualdad, anticorrupción y derecho a la ciudad.
This document summarizes the Symantec Complete Website Security solution. It provides comprehensive security features such as vulnerability assessments, malware scanning, Extended Validation SSL/TLS certificates, DDoS protection, and a web application firewall. It also offers tools to simplify SSL/TLS certificate management and discovery. Finally, it enhances website performance through a content delivery network, elliptic curve cryptography encryption, and use of the trusted Norton Secured Seal.
I'm seeking a permanent job or long term contract. It will be nice when Employment Agencies are honest when they write "Contract to Perm"., From my experience this is an outright lie in most cases and I'm not the only person who believes this. At any rate, please be upfront and truthful regarding your agenda (i.e. money, helping others, sleeping with boss, other) when presenting contract or permanent positions.We job-seekers aren't getting paid to look for jobs. I'd rather be walking my dog.Thank yiou
El documento trata sobre el derecho penal. Explica que el derecho penal regula la potestad punitiva del Estado al establecer delitos y penas. Se compone del derecho sustantivo, que incluye el código penal, y el derecho procesal penal, que establece cómo aplicar las leyes penales. Además, analiza las definiciones de derecho penal, sus fuentes, relación con otras ramas del derecho y evolución histórica.
The document discusses key considerations for manufacturers in implementing changes required by the 2016 Medicaid Program Covered Outpatient Drug Final Rule. It identifies areas that may require changes to master data, pricing methodologies, reports, and system configurations. Specific provisions that could significantly impact systems include distinguishing mail order pharmacies, identifying pediatric drugs, implementing a monthly 70/30 test to determine the average manufacturer price methodology, and calculating quarterly average manufacturer price using reported monthly values.
Asana es una herramienta de gestión de proyectos y tareas que permite a los equipos compartir, planificar y organizar tareas asignadas a cada miembro para seguir el progreso, de forma sencilla y a través de la web o dispositivos móviles. Cuenta con funciones como listas de tareas y proyectos, notificaciones, integración con Dropbox y comentarios para mejorar la colaboración entre equipos de forma remota.
El gabinete aloja los componentes principales de la computadora. Viene en diferentes tamaños y formas, como escritorio o torre. En la parte frontal se encuentran el interruptor de encendido y unidades de disco, y en la parte posterior puertos de conexión. El motherboard contiene conectores para tarjetas de expansión como video y red, y lleva componentes como la CPU, memoria y controladores. La CPU es el cerebro formado por millones de transistores e incluye unidades de control y aritmético-lógica. La memoria RAM es de ac
El documento describe una serie de ejercicios para practicar el uso de Windows, incluyendo la creación de accesos directos, carpetas y gadgets; la organización y configuración de la barra de tareas, escritorio, pantalla y resolución; y el cambio de atributos y temas.
Este documento presenta 20 ejercicios sobre la interpretación y construcción de gráficas. Los ejercicios cubren temas como leer valores e identificar características de gráficas dadas, construir gráficas basadas en descripciones de situaciones, y asociar gráficas con expresiones analíticas. El documento proporciona una serie de problemas y preguntas sobre gráficas para practicar y demostrar la comprensión de conceptos gráficos fundamentales.
Osteoarthritis is a degenerative disease caused by wear and tear on cartilage in joints. Obesity increases the risk by putting more stress on joints, while exercise, a healthy diet, and maintaining a normal weight can help prevent and minimize symptoms. Foods like salmon, green vegetables, bananas, ginger and pineapple are especially beneficial due to their anti-inflammatory and nutrient-rich properties. Maintaining an 80% alkalizing diet with more whole foods and less acidic foods like meat and dairy can also help reduce inflammation and support joint health.
Prestashop se puede instalar descargando el archivo .zip de la página oficial, extrayéndolo en la carpeta htdocs de XAMPP y siguiendo los pasos del asistente de instalación para configurar la base de datos, idioma y detalles de la tienda. Una vez completada la instalación, se recomienda eliminar la carpeta "install".
This curriculum vitae summarizes the professional experience of Corneliu Dincă, including:
1. Over 30 years of experience in Romania working on projects related to regional development, small and medium enterprises, marketing, employment measures, and more.
2. Specific experience managing projects funded by the EU, World Bank, and other organizations focused on rural development, employment, social services, and more.
3. Extensive training and education in areas like regional development, project management, entrepreneurship, marketing and foreign trade.
This case report describes an uncommon case of a 25-year old male football lineman who presented with low back pain. MRI revealed a herniated disc at L5-S1. Surgery was expected to be a microdiscectomy but had to be changed to a discectomy with laminotomy due to extensive damage. During surgery, the surgeon had to repair the dura and bundled nerves around the herniated disc. Though an uncommon presentation, the patient made a full recovery after surgery and returned to normal activities.
This case report describes the conservative treatment of a 40-year-old female patient presenting with a left ipsilateral sciatic scoliosis using McKenzie method physical therapy techniques over 17 sessions in 3 months. The patient's lateral shift deformity and lower extremity pain resolved, muscle weakness improved, and disability levels decreased substantially. Corrective side glide mobilizations and self-techniques were effective at reducing the disc protrusion and decompressing the nerve root, resolving the patient's symptoms and abnormal posture.
The document describes two case studies of twin sisters who were both diagnosed with Ankylosing Spondylitis (AS). Athlete 1 was the first to experience symptoms and be diagnosed after numerous physician visits. Her symptoms worsened over time and impacted her ability to play sports. Athlete 2 later began experiencing similar symptoms and was also diagnosed with AS by one of Athlete 1's physicians. Both underwent various treatments and imaging to confirm AS, and adjusted their athletic activities in response to their conditions.
This document discusses the evaluation and management of non-union of neck of femur fractures. It begins by defining non-union and describing the blood supply of the femoral head. It then discusses the causes of non-union in neck of femur fractures, including factors related to the initial fracture and treatment. The document outlines the history, physical exam findings, and investigations for evaluating a suspected non-union. It describes various treatment options for head-preserving or head-sacrificing management, including open reduction and fixation, bone grafting procedures, osteotomies, and arthroplasty. A classification system is presented for predicting the appropriate treatment based on factors like fracture pattern, gap size, and femoral head viability.
juliet Nnaji Review of Case study 2Top of FormEpisodicFoc.docxLaticiaGrissomzz
juliet Nnaji
Review of Case study 2
Top of Form
Episodic/Focused SOAP Note
Patient Information:
JO, 46-year-old female, African American
S.
CC: Pain in both ankles, but more concerned about her right ankle.
HPI: The patient is a 46-year-old African American female who presents to the clinic with complaint of bilateral ankle pain, but more concerned about her right ankle. Patient reports that she heard a pop come from her right ankle while playing soccer 3 days ago over the weekend, and ever since her right ankle has become increasingly uncomfortable. She is able to bear weight but it is uncomfortable when standing or walking. Patient described the pain as a dull uncomfortable pain and she rates the pain as 7/10 to the right ankle and 3/10 to the left ankle. She believes that the right ankle is bruised and swollen. She reports that she takes Ibuprofen and Tylenol alternately for pain and swelling and it makes it tolerable. Pain is aggravated whenever she puts weight on it to stand or walk but feels better when she is seated with her right foot raised.
Current Medications:
Ibuprofen 600mg every 8 hours as needed for the pain
Tylenol 1000mg every 4 hours as needed for pain
One-A-Day Women’s Multivitamins one tablet daily
Ferrous Sulfate 325mg once daily
Allergies: Denies any drug, food, latex or seasonal allergies
PMHx: Osteoarthritis (diagnosed 7 years ago), Type 11 DM and HTN (diagnosed 3 years ago). Right total knee replacement (3 years ago). Received influenza vaccine this season, Current on Covid and other vaccines. Last Tdap 11/25/2020. No recent hospitalizations
A.
Differential Diagnoses
1)Primary Diagnosis is Ankle Sprain:
An ankle sprain is an injury to one or more ligaments in the ankle with symptoms such as pain, swelling, soreness, bruising, limited range of motion and joint stiffness (Dains, Baumann, & Scheibel, 2019). It is an inversion-type twisting of the foot, followed by pain and swelling (Young, 2019). This type of injury is often associated with physical activities or sports. Sports injuries occur when running, cutting, landing from a jump, or from direct contact which can produce an audible tear or pop causing pain and swelling that are immediate, but ecchymosis may lag a day or two behind (American Orthopedic Foot & Ankle Society, 2021). JO has most of these symptoms and is able to bear weight which rules out a more complex structural injury or fracture.
2) Bursitis: Bursitis can be described as the acute or chronic inflammation of a bursa that results in localized pain, tenderness, and swelling over the bursa (Maffulli, et al, 2018). Other symptoms that are associated with this condition is low-grade temperature, the warmth of overlying skin, and a palpable bump over heel (Maffulli et al., 2018).
3) Plantar fasciitis: This affects women twice as often as men. It is caused by chronic weight-bearing stress when laxity of the foot structures allows the talus to slide forward and.
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
Acupuncture for the Treatment of Foot Drop- A case ReportJudith Miller
This document discusses a case study of a 75-year old male who presented with left foot drop. He received six acupuncture treatments over six weeks, which included scalp acupuncture and body acupuncture points. After treatment, his low back and leg pain resolved, dorsiflexion range of motion in his ankle increased by 47 degrees, and muscle strength in dorsiflexion of his ankle and big toe improved. The case study suggests acupuncture may provide an alternative treatment approach for foot drop, but more rigorous research is still needed.
This document discusses lumbar radiculopathy (sciatica) which is nerve root irritation or compression in the lower spine causing pain radiating from the back into the leg. Common causes include herniated discs, spondylolisthesis, degenerative changes, and spinal stenosis. Lumbar radiculopathy is often treated initially with physical therapy, medications, and injections before considering surgery.
S.I.C.K. Scapula with Clavicle Fractures Case Study Presentation (2013)ctoney
Each semester as an Athletic Training student we are required to take a clinical course. We are assigned to a clinical site and at the end of each semester we must present on an injury we encountered while working with athletes. Taking further interest into the injury we had to do research. I chose a clavicle fracture because working at a small high school I didn't see many injuries. Once evaluating my patient I realized he had S.I.C.K. Scapula (Scapular Malposition on rib cage, Inferior Medial Scapular Winging, Coracoid Tenderness, Scapular Dyskinesis). After realizing this I continued my research on this condition. I found it to be interesting because I hadn't learned about it in my classes at that point.
This document discusses low back pain, including its causes, risk factors, and treatments. It notes that 80% of people will experience low back pain in their lifetime. Common causes include mechanical issues like spinal degeneration or disc herniations that put pressure on nerves. Chiropractic care can help by improving spinal balance and mobility to reduce pain and prevent further issues. Maintaining good posture and exercising are also recommended for prevention and treatment.
Concussions are a growing concern, especially in young athletes. Common symptoms include headaches, dizziness, and memory issues. While rest is usually recommended, longer periods of inactivity do not necessarily lead to faster recovery. Physical therapy can help address lingering symptoms through manual therapy, soft tissue work, vestibular rehabilitation, education, and light aerobic exercise. Further research is still needed to better understand and treat concussions.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
A 70-year-old female presented with bilateral knee pain diagnosed as osteoarthritis. She received four weeks of physical therapy involving exercises to increase strength and flexibility in the knees and hips. The therapy resulted in decreased pain, improved range of motion and strength. While progress was made, the patient required additional therapy to further improve functional strength.
The document summarizes lumbar herniated discs, including the anatomy and biomechanics of the lumbar spine, causes of herniated discs like prolonged sitting and lifting, symptoms like low back and leg pain, diagnostic tests like MRI, and treatment options like medications, physical therapy, and surgery. Conservative treatments include medications, physical therapy with modalities like traction and exercises, while surgery may be considered for severe or progressive cases. Prevention involves good posture, exercise, weight management, and avoiding heavy lifting.
Degenerative lumbar spondylolisthesis is a condition where one vertebra slips over the one below due to degenerative changes in the spine. It commonly occurs at the L4-L5 level and is associated with low back and leg pain. Non-surgical treatment options include bracing, flexion exercises to strengthen the spine, stabilization exercises, and epidural steroid injections, with the goal of reducing pain and improving function. Surgical intervention is considered if non-surgical options fail to provide relief from persistent or progressive pain and neurological symptoms.
This document describes a case study of an inpatient physical therapy program for a 13-year old male patient with an incomplete spinal cord injury at L2. The physical therapy program utilized a variety of activities to promote neuroplasticity and neuromuscular reeducation. Over the course of 10 days, the patient received physical therapy once daily, focusing on improving bed mobility, transfers, ambulation, balance, therapeutic exercises, and caregiver training. By discharge, the patient was able to transfer and ambulate short distances with minimal assistance.
Recovering from Achilles Tendon Repair in an Outpatient Rehab FacilityKristen White, PT, DPT
This case study describes a patient's 14-week progression through physical therapy following an Achilles tendon repair. Treatment included manual therapy, therapeutic exercises, modalities, and a home exercise program. The patient showed improvements in pain, range of motion, strength, and function. While deficits remained compared to the uninjured side, the patient was able to return to activities like golf and continue therapy to further improve walking on uneven surfaces and inclines. Instrument assisted soft tissue mobilization was used throughout to help break up scar tissue and adhesions from the injury and repair.
Recovering from Achilles Tendon Repair in an Outpatient Rehab Facility
CaseStudy
1. Scoliosis with Degenerative Disc Disease in a Collegiate Women’s
Volleyball Player: A Case Report on Decreasing Pain Without Loss of
Play Time
Allison M. Corcino
California State University, Fresno
ABSTRACT
Background: A 19-year-old NCAA Division I
women’s volleyball player diagnosed with
idiopathic scoliosis during elementary school
screening in fifth grade, that ultimately caused pain
while participating in competitive volleyball for 13
years. As she transitioned into NCAA Division I
Intercollegiate Volleyball, she complained of sharp,
aching pain in the upper thoracic and lower lumbar
spine. The supervising athletic trainer treated the
pain and consulted the team physician.
Differential Diagnosis: Muscular imbalance,
Spondylosis
Treatment: The patients existing condition of
idiopathic scoliosis prompted the team physician to
refer for an anteroposterior Magnetic Resonance
Image (MRI). The MRI revealed extensive disc
disease and extrusion, central spinal stenosis,
annular tears and osteophytes in multiple levels of
the lumbar spine. A core stabilization program was
implemented with the help of a chiropractor, while
the athletic trainer utilized neuromuscular electrical
stimulation, heat therapy and cryotherapy to
manage symptoms associated with degenerative
disc disease.
Uniqueness: Although diagnosed at a young age
with spinal curvature measuring 45º, the patient was
not treated with surgical intervention or typical
bracing techniques. Patient has participated in
competitive volleyball for 13 years and continues to
participate in Division I intercollegiate women’s
volleyball with interventions used daily for
treatment of pain.
Conclusions: Increased success with secondary
treatment denotes that both patient and clinician
adherence to rehabilitation is important in the
treatment of pain associated with idiopathic
scoliosis. The Schroth method is a rehabilitation
protocol that can be utilized for scoliosis patients
who have not been treated surgically or with
bracing techniques, but is impractical for treatment
in the athletic training setting due to the amount of
treatment time necessary for success.
diopathic scoliosis is identified as scoliosis with
no underlying disease causing the deviation of
the spinal axis (Trobisch et al, 2010). A criterion
for diagnosing scoliosis is a spinal curvature
exceeding ten degrees, viewed on an anteroposterior
radiograph imaging machine (Trobisch, 2010). This
particular case is unique in that the patient is a 19-
year-old female competing in intercollegiate
Division I Volleyball with scoliosis convex to the
right, diagnosed as a child at a 45º
curvature. Extensive disc disease with central disc
extrusion is present in her spine at the L3-4 central
and left paracentral disc extrusion at the L4-L5
level. Left paracentral disc extrusion is also present
at the L5-S1 level. Research has shown that middle-
aged patients with idiopathic scoliosis have an
increased frequency of disc degeneration and back
pain
(Trobisch, 2010). Although the patient is not
middle aged, she suffered from spinal stenosis as
well as disc extrusion as complications from her
diagnosed idiopathic scoliosis. This case report will
discuss the rehabilitation methods used to decrease
pain while the patient continued to participate in
intercollegiate athletics.
CASE REPORT
During
an
examination
in
the
fifth
grade,
a
NCAA
Division
1
women’s
volleyball
player
showed
signs
of
scoliosis
during
a
routine
elementary
school
screening
for
early
detection.
Upon
the
visit
to
Children’s
Hospital,
radiographs
showed
Idiopathic
Scoliosis
present
in
the
spine.
The
physician
stated
that
her
case
was
a
very
unique
form
of
scoliosis
and
that
she
had
curvatures
in
both
her
upper
thoracic
and
cervical
spine.
The
physician
mentioned
that
it
I
2. was
unusual
that
the
sacro-‐iliac
joints
were
unaffected.
During
her
freshman
year
of
high
school
competition,
noticeable
spinal
changes
and
left
shoulder
elevation
caused
a
sharp
shooting
pain
that
affected
her
upper
thoracic
and
lumbar
spine.
As
she
matured,
she
noticed
when
competition
and
time
on
the
court
increased,
pain
also
increased.
At
this
time,
the
student-‐athlete
also
noted
that
repeated
shoulder
and
vertebral
flexion
and
extension
caused
sharp,
shooting
pain
in
her
lumbar
and
upper
thoracic
spine.
She
competed
in
high
school
volleyball
as
a
starter,
but
had
no
treatment
or
rehabilitation
during
these
years.
During her sophomore year in college, the
student-athlete complained of sharp, aching pain in
her upper thoracic and lower lumbar spine that
increased during practice when she performed
excessive hitting. She also noted an increase in pain
when she felt “overworked”, having multiple
practices daily paired with multiple games in a
week. Upon evaluation, the Certified Athletic
Trainer (ATC) found that trunk rotation placed
stress on the intrinsic muscles of her spine, causing
muscle cramping and sharp pains. The athlete and
ATC met with the team physician during a weekly
physician clinic held at the University, and the
physician referred the patient to receive a Magnetic
Resonance Image (MRI) of the lumbar spine.
Findings of the MRI results showed
extensive disc disease, central spinal stenosis,
central disc extrusion, and annular tears located in
the lumbar spine. Extensive disc disease and
extrusion measured 6mm the L3 and L4 levels. Also
at this level, moderate central spinal stenosis was
present along with minimal inferior extension of
discal material measuring 4mm. Increased signal is
shown at the L3-4 level that suggests an annular
tear. A 6mm central and left paracentral disc
extrusion was noted at L4 and L5, along with an
increased signal that represents an annular tear and
spinal stenosis at this level. At the L5-S1 level there
was a median disc extrusion that measured 4mm,
and increased signal suggesting an annular tear. The
origin of the left S1 nerve root at the L5-S1 level
appears posteriorly displaced to the right.
Osteophytes deposited at L3-4, L4-5, and L5-S1
suggest degeneration of cartilage in the vertebral
joints. Right and left sacro-iliac joints appeared
maintained.
REHABILITATION
The supervising Athletic Trainer consulted
the team chiropractor to assist in the design of a
rehabilitation program. A modified Watkins-
Randall core stabilization program was created to
lengthen the spine and decrease muscle spasm
symptoms (see Table 1). The athlete remained in
competition at full participation, and was only
limited when necessary. Records indicate that this
rehabilitation program began in August 2014, but at
the time, adherence to rehabilitation was
documented only once per week. It is unknown if
the athlete was scheduled daily, and was not
compliant with the schedule, or if the supervising
athletic trainer did not schedule her consistently. In
February 2015, Crossover Symmetry (see Image 1)
was added into the rehabilitation protocol, and was
done on average 3x per week. However, it is
unknown if the athlete came into treatment greater
than three times per week for treatment of
symptoms associated with diagnosed idiopathic
scoliosis. Before participation in practice or weekly
weight training, interferential electrical stimulation
was utilized on the lumbar region to treat sharp
aching pain in combination with a moist heat pack.
Hi-Volt electrical stimulation was also used in
combination with a moist heat pack on the right
upper thoracic portion of the spine to treat muscle
spasms and aching pain before practice. On days
where the athlete felt overworked and sore,
electrical stimulation was used in combination with
cryotherapy to reduce pain and symptoms
associated with her diagnosis.
Image 1. Crossover Symmetry Rehabilitation
3. Table 1. Daily Stabilization Protocol - Modified Watkins-Randall
Exercise Level 1 Level 2 Level 3 Level 4 Level 5
Superman 2 min
Alternate arms
2 min
Alternate
Opposite
Arms/Legs
3 min
Arms/Legs up
2# legs
4 min
Arms/Legs up
3# legs
5 min
Arms/Legs up
4# legs
Partial Sit-ups
Forward &
Diagonal
3 x 10 each 3 x 20 each 3 x 30 each
2.5#
3 x 30 each
5#
3 x 50 each
5#
Dying Bug
3 x R, 1 x L
2 min
Slow Pace
One foot on the
ground
2 min
Moderate pace
2 min
Straight Leg
Slow pace
2 min
Straight Leg
Moderate
pace
3 min
Straight Leg
Moderate Pace
Bridge 3 min
Both feet on
floor
Hold 10 sec
3 min
Alternate legs
Hold 10 sec
4 min
Alternate legs
Hold 10 sec
5 min
Alternate legs
7 min
Alternate legs
Hold 10 sec
Child’s Pose
Traction
15x 20x 25x 30x 35x
Quadraped 2 min
Slow reps
Knees flexed
2 min
Slow reps
Flexed knee to
extension
2 min
Slow reps
Leg extended
3 min
Slow reps
Leg extended
4 min
Leg extended
Moderate
transition
Wall Squat 1 min hold 1.5 min hold 2 min hold 3 min hold 5 min hold
Lunges 1 min
Slow reps
Partial dips
Slow transition
2 min
15 sec hold
Partial dips
Moderate
transition
3 min
15 sec hold
90° dips
Quick
transition
3 min
15 sec hold
90° dips
Quick
transition
3# arms
5 min
15 sec hold
90° dips
Quick
transition
5# arms
Prone Plank 30 sec 1 min 2 min 3 min 5 min
Sitting Thoracic
Rotation
10x each way 20x each way 25x each way
5#
30x each way
7#
30x each way
10#
Bridge W/ Reach
3 x R, 1 x L
2 min
Arm by side
3 min
Arm by side
3 min
Arm at 90°
ABD
4 min
Arm at 90°
ABD
5 min
Arm at 180°
ABD
4. DISCUSSION
There
are
many
limitations
to
this
case
report.
Although
the
ATC
utilized
multiple
available
resources,
it
seems
that
the
athletes
non
compliance
affected
the
possible
positive
outcomes
of
the
rehabilitation
process.
It
is
important
to
note
that
core
rehabilitation
can
positively
affect
the
symptoms
associated
with
low
back
pain.
In
a
systematic
review
reviewing
the
clinical
effectiveness
of
core
stabilization
exercises
in
the
reduction
of
chronic,
acute
and
subacute
low
back
pain
LBP,
it
was
found
that
segmental
stabilizing
programs
are
more
effective
in
the
treatment
of
LBP
in
reducing
long-‐term
recurrence
of
low
back
pain
than
comparison
to
treatment
by
general
practitioner
alone
(Standaert,
C.,
Herring,
S.,
2007).
In
terms
of
rehabilitation
programs,
it
is
safe
to
assume
that
athlete
compliance
will
increase
positive
effects
if
utilizing
evidence
based
literature
to
treat
injuries.
Half
of
interventions
seem
to
fail,
although
successful
adherence
interventions
exist
(Dulmen
et
al,
2007).
Poor
health
outcomes,
low
quality
of
life,
and
increased
health
care
costs
are
repercussions
of
non-‐adherence
to
medical
treatment
resulting
in
the
inability
to
gain
maximum
benefits
of
medical
treatment
(Dulmen,
2007).
A variety of conservative treatments are
utilized in the conservative treatment of idiopathic
scoliosis. Interventions such as physical exercises,
neuromuscular electrical stimulation, manipulation
techniques, physical therapy, bracing, and insoles
are common in the treatment of adolescents with
developing scoliosis. These treatments are aimed at
reversing or diminishing the curvature of the spine
while the patients are still maturing, with literature
to support the impact of physical exercise on
decreasing spinal curvature associated with
scoliosis. Intensive inpatient physiotherapy protocol
was introduced in rehabilitations of 107 patients
between the ages of 10.9-48.8 with average curves
of 43º (Fusco et. al., 2011). Treatment included the
rehabilitation of 4-6 weeks at 6-8 hours per day of
elongation of the spine, realignment of trunk
segments, positioning of the arms, the use of
specific breathing patterns with proprioceptive
control exercises (Fusco, 2011). An improvement
was found in 44% of patients with a worsening in
only 3% (Fusco, 2011). This intensive inpatient
physiotherapy protocol was mirrored off of the
Schroth method originally proposed by Katharina
Schroth in 1921 (Weiss, 2011). Schroth developed
her program inspired by a balloon, correcting it by
inflating the concavities of her body in front of a
mirror and recognized that “postural control can
only be achieved by changing postural perception”
(Weiss, 2011). Implementation of this method in the
athletic training setting is impractical due to the
amount of rehabilitation time needed for success of
the Schroth method.
There is a lack of clinical trials and research
information on the Watkins-Randall lumbar trunk
stabilization protocol; no peer-reviewed original
research has been done or could be found.. Due to
this, it was difficult to verify if this is a quality
treatment option utilized for core stabilization.
CONCLUSION
After
the
initial
treatment
of
core
stabilization
program
and
treatment
by
use
of
NMES
as
well
as
heat
and
cryotherapy,
the
patient
went
home
for
summer
and
returned
the
following
year
with
the
same
signs
and
symptoms.
The
position
of
athletic
trainer
has
recently
changed,
and
the
implementation
of
rehabilitation
by
Watkins-‐Randall
techniques
has
been
successful
in
the
decrease
of
symptoms
associated.
Part
of
the
success
is
that
the
athlete
is
required
to
complete
the
exercises
at
least
three
times
per
week,
and
has
been
required
to
come
in
for
treatments
every
day
before
and
after
games.
The
supervising
athletic
trainer
has
decided
to
implement
cross
symmetry
three
times
a
week
during
the
off-‐season
and
suspects
positive
results
as
she
has
used
this
rehabilitation
protocol
for
athletes
with
back
pain
in
the
past.
Due to the athletes success of decreased pain
and increased mobility, it is important to note that
the only factors that changed was the amount of
rehabilitation sessions, as well as patient education
as to why it is important to utilize compliant
rehabilitation in combination with treatment by
general practitioner.
Through researching the Schroth method, it
it is found that it is a rehabilitation technique that
should be considered when working with athletes
and patients alike that are diagnosed with Idiopathic
Scoliosis. As a future clinician, these rehabilitative
techniques will be researched and utilized to
increase evidence-based practice in the treatment of
spine related injuries in the future.
5. With the treatment of idiopathic scoliosis,
the athletic trainer will usually come in contact with
this patient when they are almost fully developed
and have gone through other conservative or
surgical treatment options. It is important to
research and utilize evidence based practice as well
as clinician and patient adherence to rehabilitation
for increased results.
REFERENCES
1. Dulmen, S., Sluijs, E., Dijk, L., Ridder, D.,
Heerdink, R., Bensing, J. (2007). Patient
adherence to medical treatment: a review of
reviews. BMC Health Services Research 2007,
7(55).
2. Fusco, C. , Zaina, F. , Atanasio, S. , Romano,
M. , Negrini, A. , et al. (2011). Physical
exercises in the treatment of adolescent
idiopathic scoliosis: An updated systematic
review. Physiotherapy Theory and Practice,
27(1), 80-114.
3. Standaert, C. , & Herring, S. (2007). Expert
opinion and controversies in musculoskeletal
and sports medicine: Core stabilization as a
treatment for low back pain. Archives of
Physical Medicine and Rehabilitation, 88(12),
1734-1736.
4. Trobisch, P. , Suess, O. , & Schwab, F. (2010).
Idiopathic Scoliosis. Deutsches Arzteblatt
International, 107(49), 875-U27.
5. Weiss, H. (2011). The Method of Katharina
Schroth - history, principles and current
development. Scoliosis, 6(1), 17.