Orthopedic Injuries/Illnesses and Therapeutic Exercise.

Posture, the evaluation of

2011-02-02T21:30:00.001-10:00

Posture

Good posture is important because it helps your body function at top speed, movement, efficiency and endurance. It also contributes to an overall feeling of well-being.
Good posture is also good prevention. If you have poor posture, your bones are not properly
aligned, and your muscles, joints, and ligaments take more strain than nature intended. Faulty
posture may cause you fatigue, muscular strain, and, in later stages injury. Many individuals with
chronic pain can trace their problems to years of faulty postural habits. In addition, especially in the elderly, poor posture can affect the position and function of your vital organs, particularly those in the abdominal and thoracic region. Good posture also contributes to good appearance; the person with good posture projects poise, confidence, and dignity.

Goals of Physical Therapy:
A long-term goal in Physical Therapy is to teach the patient how to manage and/or alleviate their current problem and how to prevent future episodes of injury from reoccurring.
Specific goals may be to increase strength, stability, flexibility, decrease pain, muscle tightness and ridiculer signs. Other functional goals are made based on the patient's specific sign and symptoms and complaints, whether there is an inability to sleep, sit/stand for an extended period of time, do ADLs, exercise or work without decrease function pain or discomfort.

Motivation:
If we as a clinic, can be mindful of our own posture, co-workers and patients, we possibly give tactful reminders to each other when appropriate, it may make us more mindful of posture in our day to day lives.

Anatomical Posture:
We can think of posture in relationship to joints, vertebral disc, cartilage, and other soft tissues. And how these things relate to our patients diagnosis.
When standing properly your center of gravity should be directly under your Pelvis. When we are leaning to much in any direction it moves our center of gravity in the same direction putting undue stress on us. Segmentally this is also true if one segment of our bodies is not in the proper alignment it will also put undue stress on that segment and others.

Plume Bob.
Correct posture is best described by using a plume line as a reference point.

From the lateral view, certain bony landmarks can be compared with reference lines to access proper alignment.

Slightly anterior to the lateral malleolus
Slightly anterior to the midline of the knee joint
Approximately through the greater trochanter
Midline of the trunk (through the bodies of the lumbar vertebrae).
Through the shoulder joint (middle of shoulder)
Through the bodies of the cervical vertebrae
Through the lobe of the ear

Abnormalities or asymmetry you may see:
Forward Head,
Rounded Shoulders
Protracted Shoulders
Rib hump, Scapular winging
Kyphosis
Straight Back
Lordosis
Leg(s) bent, straight or hyper-extended to much

Problems with:
Increase lordosis or concavity can
Shorten, lengthen, weaken, over over strengthen soft tissue.
Decrease active and passive range of motion needed for normal wear and lubrication of joints,
    and ease of motion
Pinching Lumbar, Thoracic or Cervical disc bulge or herniation (most being posteriolateral), making it swell or impinge on nerve root.
Puts to much pressure on the facet joints

Problems with:
Increased rounded / convexity of spine posteriorly
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
Also Kyphosis of the upper thoracic area.
exacerbate bulge, causing it to bulge more
Increasing or causing radicular signs

Problems with:
Rounded shoulders with protraction
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
    Significant decrease in glenohumeral motion
Soft tissue impingement with pain and tenderness
Adding to kyphosis, increases cervical concavity and those associated problems.
Problems with rib articulations
Facet joints
Bulging or herniated disc
Disc and/or joint degeneration

Plum Bob From the anterior view, all structures front and back should be symmetrical about the plum line.
ASIS
Pelvic Rim
Shoulders
Knees

From the Anterior or posterior view:
Asymmetrical knees, pelvis hip, spine, shoulder or head, anteriorly or posteriorly
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
One shoulder to high, one arm to close to the body

Ideal situation:
A neutral spine without to much posterior, anterior pelvic tilt, excessive lordosis or flat back, Kyphosis, thoracic convexity or cervical concavity. With the ideal posture the joints and soft tissue will be in there more normal position with less stress. Promoting the normal curves of the spine will help all segments of the body. A ore neutral pelvis will help improve the Lumbar, thoracic and cervical regions. so when we focus on the other, seemingly non-related segments of a patients body it is also helpful.

*A more neutral cervical spine with a slight concavity or retracted posture.
*shoulders in the proper alignment with the persons head/ear and thorax.
*Normal thoracic convexity
*Neutral Pelvis, with neither to much anterior, posterior or lateral tilt.
*Normal Lumbar lordosis / concavity
*Normal symmetry of the knees Superior or posterior plane
*Normal ankle pronation, supination and arch (Pes Planus/flat foot).

Abnormalities or asymmetry you may see:

*Locked knees versus knees relaxed versus increased lordosis, forward shoulder and head
*Shoulders in a forward rounded and retracted posture versus bilateral scapula in an
   adducted and    protracted posture
*Forward Head verses a normal retracted head position
*Excessive anterior pelvic tilt (Flat Back) versus normal pelvic tilt
*Excessive posterior pelvic tilt (Lordosis) versus normal neutral pelvic tilt
*Feet pointed straight, to much inversion, eversion, pronation or supination versus
   normal foot with slight eversion.
*Pelvis high on one side versus symmetrical pelvis

Side Notes:
*Vertebral Artery Syndrome.
When a patient has a impingement of there vertebral artery their blood flow can be included if their neck is extended and rotated. If    this happens, and they pass out, you need to put there neck in the proper anatomical position to restore blood flow.

*Taking into consideration that normal posture may be different for different people. And that changing posture of a person without etiology may not, always be advisable.

Help with your Injury or Illness

2010-09-10T11:06:00.002-10:00

In order to treat your specific injury or illness you need to see a physician for evaluation and a diagnosis, and then if needed, a consult for an evaluation & treatment from another health care professional, such as a Physical Therapist, Occupational Therapist, Speech Pathologist or other health care professional.

We can give you general information about what interventions and procedures are common place when a person has a certain injury or illness, but we can not give you specific instructions about what you should do with your specific problems. Any interventions that we discuss are not meant specifically for any particular individual and are meant for educational purposes only. The information that you squire from this site may be used to trigger additional thought and research on what type of interventions you are receiving or may be needed. The information may also help you understand about possible precautions and insight about treatment regiments.

It is our intention to help you understand more fully about several topics dealing with orthopedic injuries, illnesses s, and address some of your general concerns.

We will be pleased to answer your questions to the best of our ability.
Please feel free to voice your comments and concerns

Decrease or Eliminate Recurring Back Injury

2010-04-22T09:26:00.041-10:00

"With the right type of exercises your back problem has a greater chance of recovering more completely and staying healthy, but without them, reoccurring back injuries is probable and it is likely that your back problems will get worse in time."

It has been estimated that around 80% of people in Western countries will experienced low back pain in their lives. When you injure your back the first time it normally gets better within a short period of time. But, typically, within 1 year 60-80% of the population will have back pain again. It is also typical for back injuries to get progressively worse each time they happen. Research has reported that with significant low back injuries certain stabilizing muscles of the back shutdown to some extent. These muscles do not typically recover fully without specific stabilization exercises, even if you are pain free. These muscles include the lumbar multifidus and the transversus abdominus. The deepest layer of muscles of the the back are the lumbar multifidi. They attach from the vertebral arches to the spinous processes. Each multifidi connects 1-3 vertebrae, controlling movement between the vertebrae. The deepest of the abdominal muscles are the transversus abdominus which is also a stabilizer of the spine. The transversus abdominus is the most important of the abdominal muscle and is usually the weakest in those who have chronic back problems and pain. Together the two muscles form a deep internal corset that helps stabilize the spine during movement. Stabilizing the back will help protect your back and improve daily activities. Stabilization exercises will increase a persons physical condition, decrease symptoms, increase flexibility and movement along with improving posture, strength and coordination. The right stabilization exercises will significantly increase your chances of recovering from a back injury completely without reoccurring problems.

For more information about stabilization exercises, please send me a note.

Therapeutic Exercises

2010-04-20T17:37:00.009-10:00

Basic Principles of Therapeutic Exercises

Be appropriate for your injury or illness

Allow good posture and body mechanics when performed

Should increase or maintain proper muscle strength, range of motion, flexibility, stability, balance, and integrity of soft tissue, joints and spine as directed by a medical professional

Should be either passive, active assistive, active, active resistive or a combination of them depending on your injury or illness and the therapeutic results wanted

Be appropriate for a persons: age, sex, ability, injury or illness

Be specific in the amount of resistance, repetitions, frequency and progressions

Should promote a decrease in signs and symptoms from injury or illness

May be combined with modalities such as cold, heat, electric stimulation, and manual joint and soft tissue manipulation