Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

Search
Foundation for Physical Therapy Find a Physical Therapist OrthoPT on Facebook OrthoPT on Twitter OrthoPT on Instagram
Login

29.2 Neurology in Orthopaedics
Table of Contents

Neurophysiology Underlying Muscle Function, Injury, and Recovery and Treatment

Abstract:

CONTENT: In this monograph, the neural organization underlying the voluntary control of movement is first presented. Also presented is the basic science of motor control and adaptive and maladaptive motor learning. This will be followed by a discussion of maladaptive reorganizations that can occur in the central nervous system following musculoskeletal pain and the role of these reorganizations on the development of chronic pain. Thereafter, the impact of the central nervous system reorganization on the processing of nociceptive inputs and the control of movement will be discussed. Ways to clinically objectify these central reorganizations with established valid tests will be then presented, followed by examples of how rehabilitation programs for individuals with musculoskeletal pain can be adapted to consider the central changes discussed throughout this monograph. Finally, new emerging therapies for individuals with musculoskeletal pain and central reorganization, such as noninvasive brain and peripheral neuromuscular stimulations, will be presented. CASE ANALYSES: Three case studies are presented. The first two cases describe two women both 36 years old referred for the same neck and right arm pain, perceived after a similar sudden movement of the neck and shoulder. One incident occurred two months ago while the other happened two years ago. These two case studies are used to highlight different adaptations of the central nervous system following similar injuries. The third case involves a 46-year-old manual laborer with recurrent low back pain associated with impaired trunk control accompanied by fear-avoidance behaviors.

Keywords:​

musculoskeletal disorders, motor control, motor learning, plasticity

References:

Click here.

Joint Mobility and Stability Strategies for the Shoulder

Abstract:

Conservative treatment of the shoulder is often the treatment of choice in many shoulder pathologies. With the lifetime prevalence of shoulder pain as high as 66%, it is important to accurately assess the shoulder complex and design effective treatments to return individuals to full function. Understanding the role of the neuromuscular system in pathology and recovery is essential to accurate assessment and effective treatment. Assessing the shoulder complex includes evaluation of the quality of movement. The presence of scapular dyskinesis in conjunction with other abnormal objective findings will guide the focus of intervention. Interventions should focus on proper scapular and glenohumeral muscle recruitment along with causal inhibiting factors such as pain, muscle imbalances, and regional dysfunction. Controlled scapuloglenohumeral motion through the entire arc of motion and functional exercise are also critical interventions. This monograph will describe the role of the neuromuscular system in shoulder injury and recovery using evidence-based strategies with clinical application.

Keywords:​

shoulder pain, neuromuscular control, conservative treatment

References:

Click here.

Motor Learning Approaches to Joint Mobility and Stability Strategies for the Knee

Abstract:

Traumatic injury and degenerative conditions of the knee joint may occur from suboptimal movement that overloads some tissues. Regardless of the cause of injury, knee joint problems often result in altered movement strategies that limit an individual’s ability to participate in normal life situations. Changing movement with motor learning approaches can be successful to reduce pain, restore mobility, and ultimately, return an individual to their pre-morbid activities. The purpose of this independent study course monograph is to provide a primer on motor learning and illustrate its use in orthopedic conditions of the knee joint via case studies. The case studies emphasize practical application and methods to vary training to improve motor learning and retention.

Keywords:​

motor learning, joint instability, progressive training

References:

Click here.

Core Stabilization

Abstract:

This monograph covers the past, the present, and the emerging evidence for the concept of core stabilization. The initial section of the monograph provides the required anatomical background for developing a better understanding of the concept of core stabilization. The monograph also details traditional biomechanical concepts and the critical role of the central nervous system in core stabilization. The assessment section covers common tests used to identify spinal instability. The management section presents evidence on core stabilization exercises that are used routinely in the clinic. Three stimulating and challenging case studies are presented that apply the concepts of core stabilization. Each case study highlights the importance of thorough clinical reasoning and developing an appropriate treatment plan to address patient symptoms. The first case study describes the assessment and management of a 36-year-old mother with a history of low back pain for more than a year. The second case is a 39-year-old army veteran who had suffered from low back pain for 5 years prior to coming to physical therapy. Finally, the third case is an 18-year-old cross country runner, whose complaint of bilateral knee and back pain had limited her ability to run for more than a mile.

Keywords:​

lumbar spine, biomechanics, instability, low back pain

References:

Click here.

Joint Mobility and Stability Strategies for the Ankle

Abstract:

This monograph details the anatomy and neurophysiology of the multi-segmented ankle-foot complex, injury pathomechanics, and the clinical sequela that ensue following lateral ankle sprain and chronic ankle instability. Impairments in the human movement system, which include deficits in joint mobility and stability, sensorimotor function, postural control, walking, running, and jump-landing are discussed. Changes in pain and measures of health-related quality of life to include physical health, mental health, and function following lateral ankle sprain and chronic ankle instability are also detailed. Suggested clinical evaluation techniques in the assessment and treatment of impairment, activity limitation, and participation restriction following ankle sprain are provided. Three case studies are presented that details the mechanism and sequela regarding lateral ankle sprain and chronic ankle sprain. In the first case, we discuss the physical function of a young man who experienced a first-time ankle sprain during sport. In the second case, we discuss a young man who experienced a first-time ankle sprain 14 months prior who recovered without any residual perceived or episodic instability in the ankle. In the final case, we present a young woman who sprained her ankle for the first time 3 years prior and with regularly recurring perceived and episodic giving-way of the ankle. In the three cases, we detail pain, health-related quality of life, and impairments of the human movement system to include joint mobility and stability, neuromotor function, and dynamic balance in the ankle-foot complex.

Keywords:​

ankle injuries, musculoskeletal system, rehabilitation, physical examination, therapeutics

References:

Click here.

Understanding Lower Extremity Tunnel Syndromes

Abstract:

This monograph discusses common nerve entrapments of the lower extremity. Pain from neurological sources may complicate and challenge the orthopedic specialist in developing an accurate diagnosis and specific treatment program. The pathogenesis of such pain may be caused by neurological structures, specifically, nerve root and peripheral nerve entrapments. The purpose of this review is to outline the anatomy, etiology, and treatment of specific nerve entrapments of the lower extremity. This monograph will detail common and uncommon nerve entrapments of the hip, groin, buttock, thigh, leg, ankle, and foot. Three intriguing case studies are presented. Each case highlights strong clinical reasoning and proper care. The first case involves a 54-year-old female with diffuse buttock pain that radiates to the posterior-lateral leg. The second case describes a 17-year-old male who is rehabilitating from an anterior cruciate ligament reconstruction and meniscal repair. He is experiencing unusual pain and sensations along the medial aspect of the leg and into the foot. The third case describes/details the evaluation and treatment of a 45-year-old female teacher and recreational runner with chronic paresthesia and pain into the medial aspect of the foot.

Keywords:​

nerve entrapment, radicular pain, dysfunction

References:

Click here.

Academy of Orthopaedic Physical Therapy
2920 East Ave. South Suite 200, La Crosse, WI 54601 | 1-800-444-3982 | FAX 608-788-3965 | Member Login | Officer Login
Website Development by Webteam, Inc.