This case study examines the physiotherapy management of a 39-year-old patient presenting with axial spondyloarthritis (SpA). The patient experiences lower back pain, morning stiffness, and limited mobility. Through physical examination, lumbar flexion is limited by pain and stiffness. The advanced practitioner physiotherapist prescribes NSAIDs to reduce pain and inflammation, develops a home exercise program, and refers the patient to a rheumatologist for further evaluation and treatment. The goal of treatment is to manage the patient's pain and improve joint mobility through a combination of medication, exercise, manual therapy, and specialist care coordination.
Introduction Axial spondyloarthritis is a chronic inflammatory.pdfbkbk37
- The patient is a 39-year-old woman experiencing lower back pain, morning stiffness, and difficulty moving due to pain. She was referred by her GP to a physiotherapy clinic.
- Upon examination, the physiotherapist found limited back flexibility and leg movement due to pain. Imaging and blood tests ruled out disc issues or inflammation.
- The treatment plan included NSAIDs to reduce pain, exercises to improve flexibility and mobility, weight loss counseling, and referral to a rheumatologist for further evaluation. Regular follow-ups would monitor the patient's condition and adherence to the treatment plan.
The document discusses lower back pain, its causes, treatment, and prevention. It notes that lower back pain can be acute or chronic, and can result from issues like muscle strains, injuries, poor posture, degenerative changes, or herniated discs. Treatment may include NSAIDs, corticosteroids, epidural injections, cold/heat therapy, chiropractic manipulation, physical therapy, or stem cell therapy. Prevention involves maintaining good posture and taking breaks from prolonged sitting.
This document discusses chronic low back pain, including its natural course, diagnosis, interventional treatments, and costs. It notes that while low back pain is very common, affecting 80-90% of people at some point, its definition and classification are inconsistent. The natural course of low back pain is poorly understood. While previously thought to have a generally favorable prognosis, more recent research shows that a majority of patients still experience pain long after initial episodes. The document calls for a standardized classification system to improve research and guide treatment. It also reviews options for diagnostic testing, conservative and interventional treatments, and notes the need to base treatment selection on available evidence. Finally, it discusses issues around the organization and costs of medical specialist care for low
This randomized controlled trial investigated the effectiveness of pulsatile dry cupping therapy compared to no intervention for knee osteoarthritis. 40 patients were randomly assigned to receive either 8 cupping sessions over 4 weeks or no treatment. Outcome measures including pain, stiffness, physical function, and quality of life were assessed at 4 and 12 weeks. At 4 weeks, cupping resulted in significantly greater improvements in pain, physical function, and quality of life scores compared to the control group. Many benefits were still present at 12 weeks, though some scores were no longer significantly different. The study provides preliminary evidence that cupping may be an effective treatment for relieving symptoms of knee osteoarthritis.
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.
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
This document summarizes a presentation on integrating osteopathic manipulative treatment (OMT) and acupuncture for a case of low back pain. It provides background on the prevalence of complementary and alternative medicine (CAM) use in the US. It then describes OMT techniques like soft tissue work and muscle energy that were demonstrated for low back pain. It also reviews the evidence and safety of acupuncture and integrates it as a potential treatment option.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
Introduction Axial spondyloarthritis is a chronic inflammatory.pdfbkbk37
- The patient is a 39-year-old woman experiencing lower back pain, morning stiffness, and difficulty moving due to pain. She was referred by her GP to a physiotherapy clinic.
- Upon examination, the physiotherapist found limited back flexibility and leg movement due to pain. Imaging and blood tests ruled out disc issues or inflammation.
- The treatment plan included NSAIDs to reduce pain, exercises to improve flexibility and mobility, weight loss counseling, and referral to a rheumatologist for further evaluation. Regular follow-ups would monitor the patient's condition and adherence to the treatment plan.
The document discusses lower back pain, its causes, treatment, and prevention. It notes that lower back pain can be acute or chronic, and can result from issues like muscle strains, injuries, poor posture, degenerative changes, or herniated discs. Treatment may include NSAIDs, corticosteroids, epidural injections, cold/heat therapy, chiropractic manipulation, physical therapy, or stem cell therapy. Prevention involves maintaining good posture and taking breaks from prolonged sitting.
This document discusses chronic low back pain, including its natural course, diagnosis, interventional treatments, and costs. It notes that while low back pain is very common, affecting 80-90% of people at some point, its definition and classification are inconsistent. The natural course of low back pain is poorly understood. While previously thought to have a generally favorable prognosis, more recent research shows that a majority of patients still experience pain long after initial episodes. The document calls for a standardized classification system to improve research and guide treatment. It also reviews options for diagnostic testing, conservative and interventional treatments, and notes the need to base treatment selection on available evidence. Finally, it discusses issues around the organization and costs of medical specialist care for low
This randomized controlled trial investigated the effectiveness of pulsatile dry cupping therapy compared to no intervention for knee osteoarthritis. 40 patients were randomly assigned to receive either 8 cupping sessions over 4 weeks or no treatment. Outcome measures including pain, stiffness, physical function, and quality of life were assessed at 4 and 12 weeks. At 4 weeks, cupping resulted in significantly greater improvements in pain, physical function, and quality of life scores compared to the control group. Many benefits were still present at 12 weeks, though some scores were no longer significantly different. The study provides preliminary evidence that cupping may be an effective treatment for relieving symptoms of knee osteoarthritis.
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.
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
This document summarizes a presentation on integrating osteopathic manipulative treatment (OMT) and acupuncture for a case of low back pain. It provides background on the prevalence of complementary and alternative medicine (CAM) use in the US. It then describes OMT techniques like soft tissue work and muscle energy that were demonstrated for low back pain. It also reviews the evidence and safety of acupuncture and integrates it as a potential treatment option.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
This document discusses various integrative medicine approaches for rheumatology patients, including diet, exercise, and lifestyle factors. It recommends adopting a Mediterranean diet rich in plants, fish, and olive oil while limiting red meat and sugar. Regular physical activity and weight management are also emphasized to reduce inflammation and cardiovascular risk. Additional lifestyle approaches discussed include stress management techniques like mindfulness meditation, adequate sleep, quitting smoking, and supplements like turmeric and fish oil which may provide benefits when used alongside medical treatments.
This study aims to investigate whether a 12-week neuromuscular exercise program combined with pain neuroscience education provides greater pain relief and improved physical function than pain neuroscience education alone for patients experiencing chronic pain after knee replacement surgery. 120 patients with chronic pain after knee replacement surgery will be randomly assigned to receive either the 12-week neuromuscular exercise program combined with pain neuroscience education or pain neuroscience education alone. Outcomes will be assessed at baseline and 3, 6, and 12 months post-intervention and will include measures of pain, physical function, fear avoidance beliefs, and pain catastrophizing. The findings may help establish effective treatment strategies for chronic pain after knee replacement surgery.
A 42-year-old male presents with lower back pain radiating to his left leg that began after lifting a heavy table one month ago. Examination reveals limited range of motion, pain on palpation of L5, and slightly reduced strength in his left leg. The primary diagnosis is lumbosacral radiculopathy, with differential diagnoses including disc herniation, vertebral osteomyelitis, paraspinal muscle strain, piriformis syndrome, and lumbar stenosis. Further assessment is needed to determine the specific cause and appropriate treatment.
The document summarizes a study that compared the effectiveness of different combinations of manual therapy and exercise for treating mechanical neck pain. All patients received neck exercises and cervical spine mobilization. Additionally, some patients received thoracic spine manipulation. Those who received all three treatments experienced greater reductions in neck pain and improvements in daily functioning after one week compared to those who only received exercises and cervical mobilization. The combination of neck exercises, cervical mobilization, and thoracic manipulation led to quicker relief of neck pain symptoms.
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
- Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the sacroiliac joints and spine that can lead to complete bony fusion. It has a strong association with the HLA-B27 gene.
- Clinical features include morning stiffness and low back pain that improves with movement. The disease progresses to involve the entire spine and cause rigidity. Peripheral joints may also be affected.
- Diagnosis is based on clinical features and confirmed with imaging showing sacroiliac joint changes or elevated inflammatory markers. There is no cure, but treatment focuses on exercises, medications, and lifestyle modifications to relieve symptoms and prevent deformities.
This document provides guidelines for the management of acute low back pain. It recommends starting with acetaminophen or NSAIDs for two to four weeks. Physical therapy modalities like heat, cold packs, and massage can provide relief for the first two to four weeks. Bed rest is not generally recommended except for two to three days for acute radiculopathy; otherwise, activity modification is preferred. Exercise programs focusing on weight loss, trunk strengthening, and stretching can help alleviate back pain. Patient education on back protection and lifestyle changes is important. Surgery is only recommended for select groups with complications like cauda equina lesions or worsening/resistant neurologic symptoms.
Stemcell Research Paper on avascular necrosis-AVN-by Dr.Pradeep MahajanDr Pradeep Mahajan
This case report describes the treatment of a 35-year-old male patient with avascular necrosis of the left femoral head using a cell-based therapy. The patient had a 10-year history of left hip pain and was diagnosed with stage II avascular necrosis. He underwent a treatment involving harvesting bone marrow concentrate, stromal vascular fraction from adipose tissue, and platelet-rich plasma, which were injected into the affected area. Follow-up over one year showed improved hip range of motion and pain, and radiological evidence of reduced necrosis and improved joint space. The report concludes the cell-based treatment halted progression of avascular necrosis in this patient.
hip osteoarthritis is most disabling condition and surgery is a consequence of the same. but if this condition can assess on time so it can be manageable with conservative treatment and decrease the prevalence of AVN. further life of an individual become better.
The document discusses pain and its global burden. Some key points:
- Chronic pain affects 30-50% of the world's population.
- In the USA, chronic pain affects more people annually than diabetes, heart disease, and cancer combined.
- Pain comes in different forms including neuropathic pain (caused by nervous system dysfunction), nociceptive pain (from tissue injury), and mixed pain (with both neuropathic and nociceptive components).
- Scales like the numeric rating scale and visual analogue scale are used to measure pain levels.
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.
(2011)the role of intra articular hyaluronan (sinovial)종혁 임
This document reviews the role of intra-articular hyaluronan (SinovialÒ) in the treatment of osteoarthritis. It finds that viscosupplementation with hyaluronan injections relieves pain and improves function in osteoarthritis of the knee and other joints. Hyaluronan injections are well tolerated and have comparable efficacy to NSAIDs with fewer side effects. Hyaluronan supplementation is a valuable treatment approach for osteoarthritis patients if other therapies are contraindicated or have failed.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
AProf Jon Ford’s presentation from today at the World LBP Congress in Antwerp presenting new data on the STOPS approach, introducing STOPS Plus for more complex chronic pain and comparing clinical importance with STarT Back and Cognitive Functional Therapy
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
roles are largely complete when they hand an investigation.docxwrite4
This document outlines the responsibilities of investigators at different phases of a criminal investigation from initial response to a crime scene through trial preparation. It provides guidance to complete an assignment detailing the steps, procedures, best practices, legal obligations and potential pitfalls at each phase, including: processing the initial crime scene; gathering information and interviewing witnesses during the investigation; identifying, locating, apprehending and interrogating suspects; assembling the final report and presenting the case to prosecutors; and preparing evidence and testimony for prosecution and trial. The assignment criteria include describing responsibilities at each phase, examining relevant procedures, analyzing strategies, and citing references.
The military plays an important role in responding to domestic disasters by providing personnel, equipment, and logistical support. During 9/11 and Hurricane Katrina, fighter jets patrolled cities and the National Guard and Coast Guard conducted large-scale rescue operations. While the military is effective at disaster response, there are also debates around federalizing the National Guard, authorizing deadly force, and declaring martial law during relief efforts.
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This document discusses various integrative medicine approaches for rheumatology patients, including diet, exercise, and lifestyle factors. It recommends adopting a Mediterranean diet rich in plants, fish, and olive oil while limiting red meat and sugar. Regular physical activity and weight management are also emphasized to reduce inflammation and cardiovascular risk. Additional lifestyle approaches discussed include stress management techniques like mindfulness meditation, adequate sleep, quitting smoking, and supplements like turmeric and fish oil which may provide benefits when used alongside medical treatments.
This study aims to investigate whether a 12-week neuromuscular exercise program combined with pain neuroscience education provides greater pain relief and improved physical function than pain neuroscience education alone for patients experiencing chronic pain after knee replacement surgery. 120 patients with chronic pain after knee replacement surgery will be randomly assigned to receive either the 12-week neuromuscular exercise program combined with pain neuroscience education or pain neuroscience education alone. Outcomes will be assessed at baseline and 3, 6, and 12 months post-intervention and will include measures of pain, physical function, fear avoidance beliefs, and pain catastrophizing. The findings may help establish effective treatment strategies for chronic pain after knee replacement surgery.
A 42-year-old male presents with lower back pain radiating to his left leg that began after lifting a heavy table one month ago. Examination reveals limited range of motion, pain on palpation of L5, and slightly reduced strength in his left leg. The primary diagnosis is lumbosacral radiculopathy, with differential diagnoses including disc herniation, vertebral osteomyelitis, paraspinal muscle strain, piriformis syndrome, and lumbar stenosis. Further assessment is needed to determine the specific cause and appropriate treatment.
The document summarizes a study that compared the effectiveness of different combinations of manual therapy and exercise for treating mechanical neck pain. All patients received neck exercises and cervical spine mobilization. Additionally, some patients received thoracic spine manipulation. Those who received all three treatments experienced greater reductions in neck pain and improvements in daily functioning after one week compared to those who only received exercises and cervical mobilization. The combination of neck exercises, cervical mobilization, and thoracic manipulation led to quicker relief of neck pain symptoms.
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
- Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the sacroiliac joints and spine that can lead to complete bony fusion. It has a strong association with the HLA-B27 gene.
- Clinical features include morning stiffness and low back pain that improves with movement. The disease progresses to involve the entire spine and cause rigidity. Peripheral joints may also be affected.
- Diagnosis is based on clinical features and confirmed with imaging showing sacroiliac joint changes or elevated inflammatory markers. There is no cure, but treatment focuses on exercises, medications, and lifestyle modifications to relieve symptoms and prevent deformities.
This document provides guidelines for the management of acute low back pain. It recommends starting with acetaminophen or NSAIDs for two to four weeks. Physical therapy modalities like heat, cold packs, and massage can provide relief for the first two to four weeks. Bed rest is not generally recommended except for two to three days for acute radiculopathy; otherwise, activity modification is preferred. Exercise programs focusing on weight loss, trunk strengthening, and stretching can help alleviate back pain. Patient education on back protection and lifestyle changes is important. Surgery is only recommended for select groups with complications like cauda equina lesions or worsening/resistant neurologic symptoms.
Stemcell Research Paper on avascular necrosis-AVN-by Dr.Pradeep MahajanDr Pradeep Mahajan
This case report describes the treatment of a 35-year-old male patient with avascular necrosis of the left femoral head using a cell-based therapy. The patient had a 10-year history of left hip pain and was diagnosed with stage II avascular necrosis. He underwent a treatment involving harvesting bone marrow concentrate, stromal vascular fraction from adipose tissue, and platelet-rich plasma, which were injected into the affected area. Follow-up over one year showed improved hip range of motion and pain, and radiological evidence of reduced necrosis and improved joint space. The report concludes the cell-based treatment halted progression of avascular necrosis in this patient.
hip osteoarthritis is most disabling condition and surgery is a consequence of the same. but if this condition can assess on time so it can be manageable with conservative treatment and decrease the prevalence of AVN. further life of an individual become better.
The document discusses pain and its global burden. Some key points:
- Chronic pain affects 30-50% of the world's population.
- In the USA, chronic pain affects more people annually than diabetes, heart disease, and cancer combined.
- Pain comes in different forms including neuropathic pain (caused by nervous system dysfunction), nociceptive pain (from tissue injury), and mixed pain (with both neuropathic and nociceptive components).
- Scales like the numeric rating scale and visual analogue scale are used to measure pain levels.
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.
(2011)the role of intra articular hyaluronan (sinovial)종혁 임
This document reviews the role of intra-articular hyaluronan (SinovialÒ) in the treatment of osteoarthritis. It finds that viscosupplementation with hyaluronan injections relieves pain and improves function in osteoarthritis of the knee and other joints. Hyaluronan injections are well tolerated and have comparable efficacy to NSAIDs with fewer side effects. Hyaluronan supplementation is a valuable treatment approach for osteoarthritis patients if other therapies are contraindicated or have failed.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
AProf Jon Ford’s presentation from today at the World LBP Congress in Antwerp presenting new data on the STOPS approach, introducing STOPS Plus for more complex chronic pain and comparing clinical importance with STarT Back and Cognitive Functional Therapy
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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1. HLST246 Musculoskeletal Physiotherapy
Answers:
Introduction
Axial spondyloarthritis (SpA) is a chronic inflammatory disease. It affects the axial skeleton
predominantly. This type of SpA includes both radiographic and non-radiographic SpA is
called AxSpA or ankylosing spondylitis. These are considered as the two stages of one
pathology (Adshead et al., 2020).The patient is presented with the pelvis and low back pain
that is chronic with morning stiffness, (Barnett et al., 2020), like in this case study. However,
other aetiologies of pain give the symptoms of intense back pains. This makes the diagnosis
of SpA to be challenging to clinicians during the disease's early stages. Seronegative
Spondyloarthropathy is a rheumatic disease that involves the sacroiliac joint. In this study,
the case illustrates the effective and safe care management and successful examination of
axial spondyloarthritis patient in practitioner physiotherapy advanced clinic that applies
NICE guidelines (Barnett et al., 2020). SpA affects mostly persons in the third decade.Due to
endometriosis, it is rampant in women than in men.
It also demonstrates the relationship between advanced practitioners and GPs in
physiotherapy of muscoskeleton in NHS (Adshead et al., 2020). Based on the patient's
personal history, the description demonstrate the appropriate threshold ofSpA(Manarad et
al., 2021),which was worsened through inactivity of the body by having stiffness for about
30 minutes to one hour early in the morning. NSAIDs and body exercise improved the onset
of SpA on the patient. This improvement is according to the criteria for back pain
inflammation by Spondyloarthritis international society's assessment. Axial SpA is
suggested to begin in the third decade. In this case, the patient is 39 years (McCrum et al.,
2019). It is characterized by irritable bowel syndrome, Reiter's syndrome, Gluten allergies,
and Psoriasis disorder (Derakhshan et al., 2020),as illustrated in this case study. This occurs
within three months with the absence of the signs of dactylitis, arthritis, and enthesitis.
This can be confirmed through MRI scans and blood tests,(McCrum, 2020), which provide
an effective plan for treatment and better outcomes to the patient. SpA pathology cause
significant disabilities to patients in the third-decade ages like in this case study; therefore,
early management and diagnosis are essential (Manara et al., 2021).If the diagnosis of SpA
is delayed, the outcomes worsen, such as changes in bone pathology, spinal mobility, and
2. function due to delayed treatment initiation to block factors of tumour necrosis which
worsen to cause disability and impaired movements NICE guidelines give the required
interventions to bring about care and safety of the patient based on the best outcomes of the
clinical practices(Derakhshan et al., 2020). The growth of prevalence of arthritis in several
countries demonstrates limited, timely access to rheumatic clinical care.
There is an increased need for orthopaedic and rheumatic care, which has led to emerging
models of care that entail extended practitioner roles such as nurses, physiotherapists, and
occupational therapists(Adshead et al., 2020). The comprehensive role Practitioners are
skilled professionals who provide rheumatic or musculoskeletal care as first contact givers.
They also make a diagnosis, prescribe medications and infiltrations, and triage candidates of
surgery (Derakhshan et al., 2020). For this reason, the Advanced clinician practitioner in
arthritis care has established training programs to train occupational therapists and
physiotherapists to be of assistance in rheumatic care. The services given by these
specialists are based on evidence-based nursing practice to ensure patient safety by
providing suitable interventions for better outcomes that are person-centred (Barnett et al.,
2020). In this case, the patient takes her dog on a walk to exercise the bones of which she
feels pain when not exercising.
2.0 Pathophysiology Of The Chronic Inflammatory Rheumatic Diseases And Symptom
Behaviour
History :The referral from the GP to the APP indicated that the patient is 39 years
old characterized by disabilities indicated by morning stiffness, strained movements, low
back pain(Adshead et al., 2020).In this case study, the patient experiences lower back pain
associated with his greater weight and a full-time job in an office (McCrum et al., 2019). The
patient has the responsibility of taking care of her children singly and elderly parents. The
patient has to be done counseling to put up with emotional stress. During the physical
examinations and assessment, the APP has to offer psychological support to the patient
through advice and how to cope with the family responsibilities at the same time ensuring
safety and recovery (McCrum, 2020). The APP has to propose the kind of activities the
patient has to engage in and those to avoid to ensure the back pain is managed to prevent
further injuries. The patient in physical assessment exhibits a gluteal area that is injured
due to a fall on the buttock of the right side, leading to burning sensation and pain localized
in the spinal end and swollen toes. The APP should issue the patient with both verbal and
non-verbal cues on how to handle the pain by use of non-steroid medications and exercise
of the injured leg to induce movements (Adshead et al., 2020). The patient must be advised
to increase bones movement to exercise the joints to reduce the morning stiffness and the
inabilities to twist the lower limbs with pain that makes her awake every night. This may
help the patient's flexibility to increase the twisting of the limb, thus preventing the
disabilities that may arise later. It shows that during the day, the patient is engaged in
activities that decrease the pain; however, at night, it is a period of inactivity which
increases the pain of the body bones. Also, medications have to be prescribed by the APP to
3. contain the lower back symptoms (Barnett et al., 2020). Based on evidence-based practice,
the prescription must be documented clearly to instruct the patient on how and when to
take the medications. NSAIDs also improve the morning stiffness pain by relieving thusthe
pain thus preventing the possibility of occurrence of disabilities and deformation on the
patient(Adshead et al., 2020). The patient has to communicate without hurting her
emotions about her body weight, which brings about painful knees during
exercise(Adshead et al., 2020). Slimming exercises and supplements have to be induced to
reduce the weight to walk her dog peacefully without getting painful knees that stop the
entire practice.
SpA pathology is related to low back pain which affects almost 1%of the population of the
US.It is characterized by patterns of inflammatory back pain, IBP , which entails insidious
chapter before 45 years with morning stiffness which can be improved through exercise
rather than rest(Adshead et al., 2020).It has a good response to NSAIDs. Other features to be
checked in IBP patients include enthesitis, peripheral arthritis, dactylitis, human leukocyte
antigen positivity for B27,IBD and family history.It is of critical importance to recognise and
diagnose SpA early enough(Adshead et al., 2020).
The patient has to discuss through shared decision making about the medication she is
comfortable with that reduces the pain without side effects and contraindications. The
private physiotherapy and sessions of manipulations have to be encouraged for the patient
as they positively impact the patient's pain management. The return of the pain indicates
this if physiotherapy is stopped(McCrum et al., 2019).
The patient exhibits lumber flexions due to stiffness pain which has to be managed by
NSAIDs. Failure to intervene may lead to disabilities that may inhibit the movements of the
patient. Also, the physiotherapy and manipulation exercises must be continuous to avoid
the return of sciatica pain(Adshead et al., 2020).
NSAIDs are Nonsteroid anti-inflammatory drugs that reduce pain in patients. In this case, it
is demonstrated that NSAIDs relieved morning stiffness in the patient dramatically. They
include ibuprofen, aspirin, and other non opioid analgesics (Derakhshan et al., 2020). For
severe pain, NSAIDs are proposed according to the NICE guidelines than opioids like
morphine. NSAIDs include class such as naproxen and ibuprofen, which is widely used to
relieve pain. Anti-inflammatory drugs reduce inflammation by affecting sensitivity and
nerve stimulation to reduce heat, irritation, pain, and swelling(Navarro-Compán., 2021).
They also reduce fever and high temperature in patients. This can be effective in patients
with midnight pain. The drug's action produces less prostaglandin on the inflammatory site,
thus reducing pain in the damaged tissue by blocking COX enzymes responsible for blood
clotting (McCrum et al., 2019). The drugs should therefore have anticlotting
features. Some NSAIDs such as aspirin need not be taken daily because of the health risks
that outweigh the benefits of preventing artery diseases that lead to stroke and heart attack.
NSAIDs relieve symptoms of flu and cold but do not kill the virus of the illness.
4. Other medical history of the patient according to the diagnosis included overweight, chronic
lower back pain, fall on her right buttock, localised end of spine pain, swelling Right big toe,
Neuropathic medication for sciatica pain that improved the pain of paraesthesia, painfull
knees when walking her dog and she had had manipulation sessions and physiotherapy that
improved her sciatica pain that returned immediately she stopped the physiotherapy. The
subjective findings included the pain induced by physical exercises that is eased with
NSAIDS , physiotherapy and gentle movements when going for shopping. Based on the
prevalence of the low back pain, the incidence of arthritis is ruled from further findings.In
the past, she had irritable bowel syndrome, Reiter's syndrom, Gluten allergies and Psoriasis
disorder accompanied with chronic back pain . The APPs diagnosis with X-ray showed clear
with no IVD and the blood test indicated negative inflammatory markers with low level of
Vit D
NSAIDs are contains dictated to alcohol intake as the interaction of alcohol with the drug
causes gut irritation and internal bleeding of the stomach. It is essential to use only one kind
of NSAID as mixing may lead to adverse effects. It contradicts the allergies, asthmatic,
breastfeeding, and pregnant and heart problem patients(Derakhshan et al., 2020). NSAIDs'
most common side effects include headaches, dizziness, gut complaints and indigestion,
drowsiness and fluid retention, kidney, liver, circulation, and heart are rare effects. They
also increase blood pressure that may cause stroke and heart attack, unlike aspirin (Barnett
et al., 2020). Patients with heart problems should be prescribed aspirin to prevent heart
attack and stroke during pain management to ensure the safety of the patients. Also, it leads
to gastrointestinal bleeding due to the reduction of prostaglandin, which helps to produce
mucus on the intestinal lining. Reduction in number exposes the stomach to acid, thus the
development of peptic ulcers. The drugs should not be taken for long term or high
doses(Manara et al., 2021).
3.0 Discussions
Objective Examination/ Physical Examination And Findings.
In objective and physical examination of the patient, lumbar flextion is limited by pain due
to stiffness, right and left rotation limited by end of spine pain and burning, pain on groin,
40 straight rise of the leg due to groin and gluteal pain. The patient was able to stand on
heels and tiptoes but could not squart bilaterally due to gluteal burning. There is no groin
tenderness this implied degeneration of lumbar arthritis due to nerve irritation and bulge of
traumatic disk. This calls for deferential diagnosis for sacroiliac joint Spondyloarthropathy,
hip arthritis and gluteal tendinopathy.
The alignment of the bones is the critical factor for arthritis, disability and pain in patients.
There has to be the employment of evidence based practice in assessment, such as extensive
set-up and equipment in the clinical settings (Manara et al., 2021). A range of joint
movement techniques has to be used to assess the flexions. This can be considered through
5. the determination of the patient's weight. The APP has to advise the patient to engage in
motion exercises such as walking the dog every day to improve the joint flexions. This
would help to bring about clear communication to the patient on the kind of activities to
engage in depending on the strength of the muscles. This can also be measured using
dynamometers to quantify the plantar flexion and dorsiflexion power of the muscles. Joint
proprioception has to be studied to increase risks of falls, injury, and joint functioning. Gait
analysis for joint motion dynamic assessment is done(Derakhshan et al., 2020). This
establishes the displacement and angles of the joints and muscles that bring about lower
back pain. Although costly, they provide reliable movement measures for the joints.
The patient has to engage in balance tests such as one leg tasks to evaluate the deficits in
balance. The centre of pressure is identified during the assessment. The foot structure also
determines the hip and knee movement ranges, demonstrated in the case-patient. The
diagnosis exhibited a VAS 7/10 at night and morning and during day time, 3/10. Scored a
mild risk on STARTbavk stool and 31% Ostwestry Disability index. Due to tight time, Roland
Morris Questionnaire was used in this case study. This exhibited no red flags record
according to IFOMPT, malignancy infection and spinal fracture based on the low back pain
prevalence (McCrum et al., 2019).
This determines both static and dynamic tasks of the patients (Derakhshan et al., 2020).
Once the symptoms have been assessed, decisions are made on treatment interventions for
musculoskeletal conditions to relieve pain by administering NSAIDs, alignment restoration
to improve the patient's quality of life through load distribution, mechanics, and
motions(Manara et al., 2021). The rehabilitation strategies for rheumatoid arthritis patients
include early detection, wellness approaches for self-management and physical activities,
and foot interventions such as orthoses. The patient's past medical history included
Irritable bowel syndrome, chronic back pain, gluten allergies, psoriasis disorder, Reiter's
syndrome which was linked to the examination whose diagnosis results gave no IVD
disorder according to X-ray and negative inflammatory markers and low vitamin D from the
blood tests (Barnett et al., 2020)
Care Management Plan
For MSK management, pain treatment improves mechanics such as motions, load
distribution, and alignment by reducing symptoms. This case study will consider pain
management for the lower back pain, gluteal burning sensations and movements. This
returns the patient to desired activities participation. These interventions target the
impairments identified during the assessment of the patient. The person-centred
rehabilitation practices include stretching, therapeutic exercises, orthoses, modification of
footwear, and manual therapies (McCrum et al., 2019). The stretching activities may be
recommended to about 30 minutes of moderate aerobic exercise to strengthen the muscles
and flex the joints. This is done by stretching to the point of discomfort or stiffness. Manual
therapy involves massage of the trigger point, manipulation, and mobilization of the joints.
6. Manipulations improve muscle activations and range of movements(Adshead et al., 2020)
significantly.
The patient has to be advised to combine foot exercise interventions. These activities may
include gymnastics such as toe spreading, heel warm-up activities, and other skill games
with the toes to improve muscle strength. Tai chi also improves the strength and mobility of
joints and muscles in MSK patients. They increase muscle extensor strength and joint flexor.
This shows that exercise programs by the patient improve mobility(McCrum, 2020). For
the injured toe of the patient, orthoses and footwear modifications have to be used to treat
the knee pain.
In pain management, the patient is prescribed NSAIDs such as aspirin to relieve the night
lower back pain, and the toe should be fitted with fitting shoes in terms of length and width.
The patient must perform the daily flex exercise to ensure joint motions and mechanics
(Derakhshan et al., 2020). There should be a schedule of activities to engage in by the
patient to exercise the bones.The APP completed STIR with MRI scan with blood tests
showing positive anti CCP and HLA-B27.This helps to indicate the level of inflammatory SpA
disorders.Afterwards, the patient is referred to a rheumatologist for treatment and injection
consultations(Adshead et al., 2020. The injection localized the stiffness and burning pain
and resolved the swollen big toe. Injection also controlled the scatia pain but did not
disappear completely.
Discussion’s Summary And Management Plan
For evaluation of the advanced practice for MSK, the patient is referred to a rheumatologist
for further assessment based on the established assessment results. The patient has to visit
the clinic for checkups, and follow-up activities are done to monitor the condition. This
ensures that the patient conforms to the prescription, ensuring the patient's safety (Barnett
et al., 2020). This can also help establish the side effects of the prescribed drugs through
direct expression by the patient on personal experience. Negative interactions call for a
change of prescription or further advice on substances to avoid improving the drug's
performance in the patient's body (Adshead et al., 2020).
Clear communication between the caregiver and the patient brings improved quality of life
by promoting wellness. MRI scans show the nature of joints, the inflammation, and
alignment that bring about sound management of the pain based on the assessment
established. The patient has to be communicated with about a healthy diet that improves
bone strength and NSAIDs to relieve pain. Blood tests indicate the level and causes of
inflammation and the nutrient deficiencies that must be added to strengthen the bones
(Derakhshan et al., 2020). Follow-up activities help to monitor the patient's progress
through balance tests, pain levels, and monitoring the effects of the NSAIDs on the heart and
circulatory system of the patient (Adshead et al., 2020).
7. Conclusion
Currently, the studies are still describing and examining the roles of advanced practitioners
in MSK through solid evidence that diagnoses the inflammation SpA. This entails the MRI
scans by STIR and blood tests to determine the inflammatory cells for a safe and effective
disease management plan (Adshead et al., 2020). Based on this case study, the APP shows a
positive response to the management as the patient improves dramatically through
diagnosis, management, assessment and reassessment practices that are evidence based for
rheumatism (Navarro-Compán., 2021). The patient is issued with the correct information
through clear communication about the condition, diagnosis, assessment, outcomes
expected and management plan for person centred provision of quality and safe services
during decision making after assessment. The patient is referred to a rheumatologist to
access extensive care for the rheumatoid condition. This study shows agreement between
the APP and the rheumatologist assessment that affects advanced patient care to ensure the
best care outcomes(Adshead et al., 2020). The symptoms by the APP is forwarded to the
Rheumatologist to determine whether the patient has inflammatory arthritis. After
confirmation, the patient has prescribed the correct interventions based on clinical
decisions of the patient's condition to bring about a sound management plan for
interventions.
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