To comply with professional boards/associations standards: I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship. Requirements for successful completion are attendance for the full session along with a completed session evaluation. Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity. Session 405: Active Care: Techniques & Tools to Clinically Progress Patient Outcomes John Hisamoto, PT, ATC & Shawn Burger, PT, DPT Leading the Way in Continuing Education and Professional Development. www.vyne.com
John Hisamoto PT, ATC Owner, Pro Active Physical Therapy Shawn Burger, PT, DPT Owner, PearFIT Physical Therapy Before we get started Phones Names on workbooks Bathrooms Waiver Pre test Latex Allergies? Anything else
Today s Schedule Evidence for Home Exercise Science Behind Elastic Resistance Evidence based Tools & Techniques Associations Between Treatment Processes, Patient Characteristics, and Outcomes in Outpatient Physical Therapy Practice Prospective, 2.5 years, 54 clinics, >22,000 musculoskeletal patients 1. HEP & visit compliance associated with better outcomes Poor home exercise program compliance had poor outcomes 2. Patient education is needed to improve compliance Need to sell patient that what they are doing will work 3. Modalities associated with worse outcomes Shoulder ultrasound particularly worse To improve cost effectiveness, improve outcomes first! Deutscher D et al. 2009. Arch Phys Med Rehabil. 90:1349-63. How do you improve compliance? 1. An Individualized exercise program is the key. 2. Identify patient s goals and barriers to exercise Barriers (more than motivators) predict adherence in home exercise programs (Forkan et al. 2006) 3. Both the therapist and patient are responsible for patient compliance (Sluijs et al. 1993) 4. Educate and Demonstrate
Delivering Home Programs Verbal explanation & demonstration (Chase et al. 1993) Handouts effective but not alone (Friedrich et al. 1996, Reo and Mercer 2004, Udermann et al. 2004) Correlation between performing exercises correctly and reducing pain (Friedrich et al. 1996) Therapeutic Exercise Progression Framework for Clinical Decision Making Anyone can follow a protocol How do you treat dysfunction?
Dysfunction Is it a Stability or Problem? Stability Emphasize strength, stability, motor control Emphasize joint and soft tissue mobility www.rehabeducation.com/sfma Assessment is Critical
Tools & Techniques Stability Movement Emphasize joint and soft tissue mobility Emphasize strength, stability, motor control Tools & Techniques
200 180 160 140 120 100 80 60 40 20 0 resistance-arm angle 0 11 22 33 45 57 69 83 98 115 135 156 180 joint angle 250 angle Force Elongation Characteristics of TheraBand CLX Tested 3 different lots of each color CLX 4 different lengths (number of loops) Validated published force values (within 0.2 pounds) No significant difference between number of loops used (ie, length of band) TheraBand Color ~125% stretch (pounds) Yellow 3.0 Red 3.7 Green 4.6 Blue 5.8 Black 7.3 Silver 10.2 Gold 14.2 Progression 25% in color 40% in color Same force at same elongation regardless of # of loops TheraBand CLX equivalence to weights (in pounds) 3 4 5 6 8 TheraBand CLX resistance provides a strength curve equivalent to ~125% elongation ISOTONIC ELASTIC Yellow = 3.42 lbs Red = 4.20 lbs Green = 4.93 lbs Blue = 6.23 lbs Black = 8.00 lbsbs 12 Silver = 11.99 lbs Gold 15.56 lbs ~125% 15.5 Regression equation predicts torque Force Angle FA = Angle created by force and lever arm Joint Angle resistance-arm angle Force Angle As joint angle increases, force angle decreases
Warning: RED Isn t Always RED Other retail products on the market Authentic TheraBand Red Equivalent to TheraBand Silver Equivalent to TheraBand Black Ensure your patients are using the appropriate resistance at home! Equivalent to TheraBand Blue TheraBand CLX Features Increase or decrease resistance by changing loops Easy connection to lower body Quick transition between exercises Create multiple resistance vectors Connect upper and lower chains Loop through Create spiral transverse plane CLX Wall Station Wall Station TheraBand CLX Wall unit Three Wall Anchors Accessory Rack Full color poster Clinic Focal Point Change setups quickly for maximum use Small footprint Transition from Clinic to HEP consistently and efficiently
Wall Unit Features Unique secure connect system Adjusts height quickly Can be mounted to be utilized with Silver and Gold CLX Prescription markers designed to help track and measure individual progress Tools & Techniques To assist joint motion when strength or pain limit ROM Assisted Range of Motion 1. Securely anchor CLX 2. Create vector of assistance 3. Assist motion with CLX Elbow Flexion AAROM
Apply constant low load resistance to joint capsule Low Load Prolonged Stretch 1. Securely anchor CLX 2. Create vector of resistance 3. Position at end ROM Anterior Capsule Stretch
1. Open Hands 2. Extend Fingers 3. Extend Thumbs 4. Extend Wrist 5. Supinate 6. Externally Rotate 7. Extend Elbows 8. Extend Arms 9. Retract Scapula Slowly return Facilitate phasic chain to reset posture by balancing postural muscles Postural Chain Reset Bruegger Upper Body Light muscle contraction followed by relaxation to reduce muscular trigger points Post Isometric Relaxation 1. Stabilize one end of CLX in line with target muscle 2. Shorten target muscle against light resistance 3. Hold for 3 seconds 4. Exhale as you relax into stretched position Upper Trapezius P.I.R.
Eccentric contraction to facilitate collagen realignment Eccentric Stretch 1. Secure CLX 2. Shorten muscle to be stretched WITHOUT resistance 3. Load muscle in shortened position by stretching CLX 4. Slowly lengthen muscle against CLX 5. Hold stretch at end Achilles Eccentric Stretch
Pre stretch contraction improves passive motion after stretch Contract Relax 1. Secure CLX 2. Grasp other end of CLX to stretch muscle 3. Contract target muscle against resistance Hamstring Contract Relax Additional Tools & Techniques
Standard versus feedback augmented shoulder pulley exercises Shoulder patients were randomly given either TheraBand or white shoulder pulley for home exercise TheraBand shoulder pulley group had significantly more shoulder range of motion after therapy Marks help with instruction and feedback for patient. A comparison of assisted and unassisted PNF techniques and static stretching TheraBand Stretch Strap provides flexibility gains similar to partnerassisted PNF stretching competitive athletes should use these techniques to improve flexibility in a separate stretching routine, and not immediately before training and competition Maddigan et al. 2012. J Strength Condition Res. 26(5):1238 44. Foam Rolling for DOMS and Recovery of Dynamic Performance Measures 20 minutes of foam rolling massage on quadriceps immediately after inducing DOMS. Repeated 24 & 48 hours post. Significantly reduced pain and increased performance compared to control condition
Conclusion: Short term increases in ROM without affecting muscle performance Dosage: Foam Roller: 30 60 sec (2 to 5 times) Roller Massager: 5 120 sec (2 to 5 times) May benefit pre exercise warm up & cool down Cheatham SW et al. 2015. IJSPT. 10(6):827 838 Theoretical mechanisms of myofascial rolling Change viscoelastic and thixotrophic properties of soft tissue Increased blood flow and tissue temperature Changes muscle spindle length or stretch perception Mechanical mobilization of fascia and scar tissue Higher density tools may have stronger effects than softer density TheraBand Foam Rollers and Roller Wraps Depth of tissue releasing is controlled through: Body Weight & positioning Stroke length & fluidity Progressive wrap densities and heights (colors) Gentle tissue work (3 point support, yellow) Aggressive tissue work (1 point support, blue)
TheraBand Roller Massager Standard Portable Unique ridged design and latex free material Retractable handles Depth of tissue releasing is controlled through: Pressure applied Body part positioning Stroke length and fluidity Neutral Calf Elongated Calf Shortened Calf TrP Release Elongated muscle position + longer strokes for superficial tissue layers Shorter muscle position + shorter strokes for deeper knots and tightness Deep dig with handles for trigger point / tension point ( knots ) release TheraBand Foot Roller Ridged design Increases pressure points to deliver enhance mobilization Hollow core helps shape to foot Can be chilled or frozen
IASTM and STM Techniques Mechanical: Recreation or Stimulation of the Inflammatory cascade Fascial: Superficial (skin), Middle and Deep (muscle + ligament) Neurological: Afferent Stimulation Pain control, gait control theory Facilitation, motor control pathway Fluid Dynamics: Improve edema, fluid mobility, tissue health Improved biomechanical function in treated tendons Increased cross sectional area in treated tendons. IASTM Techniques *This study was performed in animal models Untreated Achilles Tendon Bon Vital & Prossage Prossage Salve & Balm (Menthol) For IASTM and Scar massage Prossage Cream & Oil (Menthol) Bon Vital Muscle Therapy Massage Cream For Soft Tissue Mobilization
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