Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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27.4 Frontiers in Orthopaedic Science
Table of Contents

UNDERSTANDING INJURY, HEALTH, AND ADAPTATIONS OF THE MUSCULOSKELETAL SYSTEM

Abstract:

CONTENT: This monograph focuses on a vital component of rehabilitation; understanding, managing, and respecting the healing response and repair process following injury. An abundant reference list supports his writing in an evidence-based manner. In the monograph, Dr O'Donnell first describes the stages and time frames of the body's response to inflammation. The process of tissue healing is then outlined. In particular, the role of macrophages, cytokines, and growth factors are described in detail. The impact of nonsteroidal anti-inflammatory medications is also discussed. Dr O'Donnell then individually discusses skeletal muscle, tendon, nerve, ligament, cartilage, and bone with regard to structure, injury repair mechanisms, and remodeling phases. Regeneration versus repair is differentiated. The ultimate goal was to summarize the literature, apply the findings to clinical practice, and allow reflection on how we facilitate return to function by respecting the healing process. The information presented provides fertile ground for clinicians to reflect on their practice patterns in trying to optimize healing. CASE ANALYSES: Two case studies conclude the monograph. The first case describes a 52-year-old male with lateral elbow pain and radiating symptoms into the wrist. The second case describes a 70-year-old female who fractured her left femur.

Keywords:​

therapeutic exercise, healing, rehabilitation

References:​

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THE ROLE OF POSTURE IN MUSCULOSKELETAL INJURY: EVALUATION AND TREATMENT GUIDELINES (POSTURAL ADAPTATIONS WITH SPORT, OCCUPATION, AND AGING)

Abstract:

CONTENT: This monograph will serve as a nice review of the basic principles of posture and its importance in the prevention and treatment of injuries. The author, Dr Loudon first defines posture and explains factors that influence posture. Proper standing alignment is cited in relation to frontal and sagittal plane vantage points. She then integrates regional alignment impairments with postural adaptations that can occur with sport, occupation, and aging. Sitting postural alignment is also addressed with recommendations for proper alignment. Treatment strategies are covered for a variety of postural deviations, and the role of body awareness programs in improving postural alignment is emphasized. CASE ANALYSES: Two case studies are reviewed using the format from APTA's Guide to Physical Therapist Practice. The first case discusses a 17-year-old female high school student who swims competitively and suffers from right shoulder pain. Postural deviations as contributors to her problem are highlighted. The second case is a 42-year-old male who participates in long distance bicycle tours but who also has to sit extensively at his job as an accountant and has a 5 year history of back pain. Each case exemplifies the role of postural imperatives as contributing factors.

Keywords:​

muscle balance, therapeutic exercise

References:​

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SYSTEMS AND PRINCIPLES OF THERAPEUTIC EXERCISE

Abstract:

CONTENT: In this monograph, Dr Flanagan defines key components of a paradigm and how it applies to the design of a therapeutic exercise program. The paradigm views both the patient and the exercise program as a “system” to identify and correct movement dysfunction. This concept may be somewhat new to readers, but it provides for a more integrated approach to prescribing exercise. In a subsequent section of the monograph, Dr Flanagan provides examples on how to apply the systems approach. The second part of the monograph examines principles of exercise and how they apply to designing a therapeutic exercise program. The goal of Dr Flanagan's monograph is not to cover specific therapeutic techniques but to show how a particular technique can fit into the overall scheme of a therapeutic exercise program. In addition, Dr Flanagan exposes what other acute program variables should be considered after a decision is made to use a particular exercise technique. The systems approach will stimulate further reasoning underlying the prescription of therapeutic exercise for your patients and allow you to reflect on your own philosophy of care. CASE ANALYSES: Two case studies are used to further illustrate how the concepts presented can be put into practice. Case one is a 15-year-old female volleyball player who was referred to physical therapy for anterior knee pain. Case two is a 42-year-old male with a disk herniation at L4–5 and subsequent single-level microdiskectomy. Dr Flanagan rationalizes his needs analysis and management of program variables in each case and shares his insight for his progression through each block of exercise.

Keywords:​

therapeutic exercise, healing, rehabilitation

References:​

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THERAPEUTIC STRATEGIES FOR DEVELOPING NEUROMUSCULAR CONTROL IN THE KINETIC CHAIN

Abstract:

CONTENT: In the monograph, Dr Nyland introduces the reader to the basic elements of the kinetic/kinematic chain and the importance of neuromuscular control in achieving dynamic joint stability. He then progresses to the finer details of neuromuscular control theory. There is a nice discussion on motor plans and programs, and factors that enhance control as well as lead to deficiencies. Throughout the monograph, Dr Nyland explains the importance of quickly identifying neuromuscular control factors that may prevent injury and restore function among athletically active individuals with shoulder, trunk, lumbo-pelvic, hip, knee, and ankle impairments. These principles are then carried over into the design and implementation of a proper therapeutic exercise program. In addition, Dr Nyland provides a brief overview of the complex interaction between cognitive focus, psychosocial and behavioral attributes, and biomechanical factors on neuromuscular control development. A separate section queries the reader to reflect on the following: how to assess and improve joint regions that are affected by poor neuromuscular control; how the extremities interact with the trunk to establish control; why a lack of neuromuscular control is detrimental; what interventions enhance motor learning, control, stability, and skill; and finally, how to avoid injury while training for neuromuscular control. CASE ANALYSES: Three interesting case studies assist the reader in applying the theories presented into clinical practice.

Keywords:​

exercise, rehabilitation

References:​

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SELECTION, PRESCRIPTION, AND PROGRESSION OF EXERCISES FOR THE LUMBAR SPINE: AN EVIDENCE-BASED SYSTEMATIC BIOMECHANICAL APPROACH

Abstract:

CONTENT: This monograph grounds the reader in the basic fundamentals of understanding lumbar spine biomechanics and application of this information to evaluation and treatment of low back pain. An evidence-based approach helps dispel the myths and misconceptions that inhibit the effective use of exercise in the treatment of low back pain. Dr Poppert first presents the current evidence as it pertains to the use of exercise to manage patients with low back pain. She sheds light on some of the limitations of past research methodologies in this area. Clinical practice guidelines are also discussed. Dr Poppert reviews current classification systems used to subgroup patients with lumbar spine disorders and how these classifications can be implemented to create the most appropriate exercise program. Static and dynamic models of lumbar spine stabilization exercise provide a firm didactic foundation on how to appreciate the biomechanical properties of the spine. The clinical reasoning process for prescribing exercise to maximize therapeutic effect and improvements in motor control is then highlighted. Dosing parameters are discussed and recommendations are made so clinicians and researchers can continue to effectively manage patients with low back pain. CASE ANALYSES: The monograph concludes with two case scenarios. The first is a 32-year-old male referred to physical therapy with a diagnosis of chronic low back pain. The second is a 52-year-old female with low back pain who also presents with multiple diagnoses.

Keywords:​

low back, lumbar stabilization, rehabilitation

References:​

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FUNCTIONAL THERAPEUTIC PROGRESSIONS AND RETURN TO FUNCTION FOLLOWING SURGERY

Abstract:

CONTENT: This collaborative work will help guide clinicians in taking a systematic approach to returning patients to full function following surgery. The authors first review the general phases of postsurgical rehabilitation. Each phase is discussed in the context of establishment of a functional exercise progression that incorporates range of motion, strength, power, and endurance. Specific rehabilitation progressions are then discussed for select injuries of the shoulder, elbow, wrist, hip, and knee. Each injury discussed is presented under the categories of immediate postoperative phase, intermediate postoperative phase, advanced strengthening, and return to activity phase. Even though the authors cannot cover every injury, the chosen injuries presented serve as fine representations on how to extrapolate a solid therapeutic progression to other conditions. CASE ANALYSES: Two case presentations at the end of the paper will help the reader apply the information in a clinical decision-making format. The first case documents a 22-year-old male baseball player who is being seen following right scaphoid nonunion repair. The second scenario highlights a 21-year-old female collegiate basketball player following anterior cruciate ligament reconstruction. Specific intervention plans are included for each case to provide the reader with a thorough understanding of treatment rationale and progression.

Keywords:​

exercise, outcome, rehabilitation

References:​

Click here.

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