David Ip Orthopedic Rehabilitation, Assessment, and Enablement
David Ip Orthopedic Rehabilitation, Assessment, and Enablement With 133 Figures 12
Dr. David Ip MBBS (HKU), FRCS (Ed) Orth, FHKCOS, FHKAM, FIBA (UK), FABI (USA) Vice-President of the Recognition Board of World Congress of Arts, Sciences, and Communications Deputy Governor, American Biographical Institute Research Association, Musculoskeletal Rehabilitation Service, Pamela Youde Nethersole Eastern Hospital, Hong Kong ISBN 978-3-540-37693-4 Springer Berlin Heidelberg New York Library of Congress Control Number: 2006931062 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springer.com Springer-Verlag Berlin Heidelberg 2007 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Editor: Gabriele M. Schröder, Heidelberg, Germany Desk Editor: Irmela Bohn, Heidelberg, Germany Production: LE-T E X Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany Cover: Frido Steinen-Broo, estudio Calamar, Spain Typesetting: K+V Fotosatz GmbH, Beerfelden, Germany Cover illustration: Courtesy of Vicon Motion Systems Ltd. Printed on acid-free paper 24/3100 Di 543210
Foreword Medical practitioners involved in the treatment of diseases, disorders, and injuries of the musculoskeletal system will appreciate the very important role of rehabilitation. Following the publication of two books Orthopedic Principles A Resident s Guide and Orthopedic Traumatology A Resident s Guide, Dr. Ip has expended further time and effort to produce a third book, which contains a comprehensive account of orthopaedic rehabilitation. The material is easy to grasp with succinct points. There are 19 chapters, arranged in a logical sequence. The first chapter gives a holistic view of what the rehabilitation process should include and emphasises that the unique feature of a rehabilitation service is thinking about a patient and his problems, not simply doing something to the patient, and the focus should be on trying to help each patient achieve his own goals. Chapters 2 to 8 are about the rehabilitation tools for assessing, investigating and treating patients. Chapters 9 to 17 are about rehabilitation for specific types of musculoskeletal disorders, each of which has its own complex problems, requiring practitioners to gain further in-depth training and experience to give effective treatment. The format is similar to the previous two books, containing brief, yet comprehensive, core information on the subject, which can be enhanced by more detailed literature review if necessary. This unique feature renders the book very readable. All three books should be available to residents and staff in any orthopaedic department. Therapists and nurses treating patients with musculoskeletal diseases will also find this book useful. Professor John C. Y. Leong, OBE, FRCS, FHKAM (Orth. Surgery), JP President, Open University of Hong Kong; Formerly Professor & Head, Department of Orthopaedic Surgery, University of Hong Kong; Past President, Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)
Foreword Dr. David Ip, author of two extremely successful orthopaedic review texts, has produced yet a third and perhaps his very best, entitled Orthopedic Rehabilitation, Assessment, and Enablement. This is a remarkable work of scholarship covering topics that, to date, have rarely received sufficient exposure in the orthopaedic community. I can state with extreme certainty that it will become the standard review text for anyone involved in the rehabilitation aspects of the musculoskeletal system. Nineteen comprehensive chapters cover not only every aspect of rehabilitation of the musculoskeletal system, but extend further into such topics as alternative medicine, holistic therapies, acupuncture, neurophysiologic testing, overuse injuries, work assessment and outcome measures. Each chapter covers the basic science of the subject, clinical assessments, rehabilitation options and methods, and the outcomes of these. Take for example the chapter on gait analysis. Following the introduction, the subdivisions of information include the nature of gait analysis, key evaluations of the gait cycle, the contributions of ground-reactive force data, kinematic data collection, temporal parameters, dynamic EMG data and gait anomalies. The latter covers gait issues with amputees, prosthetic usage, cerebral palsy, to name but a few issues. The nineteenth and final chapter is an extremely stimulating one entitled New Evidence-Based Programme for Preventing and Rehabilitating Hip Fractures. For such a common injury, rarely has such an exhaustive study of all of the issues related to hip fracture rehabilitation been made, and is contained in this thesis written by Dr. Ip to the Hong Kong College of Orthopedic Surgeons. The thesis presents a scientific investigation of the problems regarding not only epidemiology, but also issues as to aetiologic factors in the causation of hip fractures, the science of data analysis, kinematics and joint function, and of equal importance, rehabilitation. There are a number of factors that have been recognised to be important not only in the rehabilitation of the hip, but also in the rehabilitation of the individual back to an independent lifestyle.
VIII Foreword The work in this thesis must become part of the general curriculum of all individuals involved in the management of the elderly patient far beyond those that deal primarily with the musculoskeletal system. This should be part of general medical training and knowledge, and in the long run the information presented in this thesis should go far to help our fellow citizens avoid the disastrous effects of a fractured hip and enhance the quality of life for citizens around the world. While the information throughout the text is presented in bullet points, the subjects are covered in extraordinary detail. I feel for certain that this text will serve a wide community of healthcare professionals and will be part of required reading for any and all disciplines involved in musculoskeletal rehabilitation, neuromuscular disorders, burn rehabilitation, and evaluation of pain and pain management. Jesse B. Jupiter, M.D. Director, Orthopaedic Hand Service Massachusetts General Hospital Hansjörg Wyss/AO Professor, Harvard Medical School
Preface It was to the author s delight that the medical and scientific communities have so warmly received his previous two books, also published by Springer, on the subjects of orthopaedic trauma and orthopaedic principles. The current text summarises the many conceptual and technological advances in the field of orthopaedic rehabilitation that the trainee surgeons will be eager to know. It breaks away from the traditional cookbook -like approach detailing standard protocols from one or two centres, but rather places stress on a basic understanding of the subject matter, not only in an evidence-based manner, but also by looking at each particular subject from various viewpoints. The book ends with the description of a thesis originally submitted by the author to the Rehabilitation Sub-Specialty Board of the Hong Kong College of Orthopedic Surgeons detailing a brand new look and new strategies for the rehabilitation of fragility hip fractures. The design of such an evidence-based programme is far from easy, for it requires knowledge of neurophysiology, biomechanics, theoretical physics, physiotherapy, besides orthopaedics and gait analysis. Overall, the current book represents a distillation of the experiences of the author throughout more than 20 years in medical practice; including his overseas training in rehabilitation in the Scandinavian countries, USA, UK and Canada. The author is now the Hon Director General Asia of the International Biographical Association in Cambridge UK. Besides being a fellow of several orthopaedic societies including the Royal College of Surgeons (orthopaedic sub-specialty) and the Hong Kong College of Orthopedic Surgeons; he is also a member of the AAOS, the Association of Academic Physiatrists in the USA, and an active member of the IASP (International Association for the Study of Pain), the WIP (World Institute of Pain), the ESMAC (European Society of Movement Analysis), and the GCMAS (Gait and Clinical Movement Analysis Society). The author s biography can be found in Marquis Who s Who in Science and
X Preface Engineering and Marquis Who s Who in Medicine and Healthcare, among others. Finally, the author wishes to extend his heartfelt gratitude to Professor John Leong and Professor Jesse Jupiter for kindly writing the forewords to this book. Thanks are also due to the many different companies that have kindly provided pictures for illustration purposes, such as Vicon Motion Systems Ltd, Stryker, Bioness, Sigmedics, Ossur, among many others. David Ip Hong Kong, November 2006
Contents 1 The Rehabilitation Process, ICIDH vs ICF 1 2 Physical Forces Used in Musculoskeletal Rehabilitation 19 3 Basic Science on Injury and Repair of Skeletal Muscle, Ligaments and Tendons 53 4 Common Physical Therapy Techniques and Alternative Medicine 73 5 Principles of Assessment: A Holistic and Case-Based Approach 111 6 Assistive Technology 137 7 Neurophysiological Testing and Intraoperative Monitoring 171 8 Gait Analysis 189 9 Principles of Sports Rehabilitation 219 10 Amputee Rehabilitation 237 11 Cerebral Palsy Rehabilitation 287 12 Rehabilitation of Spinal Cord Injuries 321 13 Burn Rehabilitation 387 14 Rehabilitation After Total Joint Replacement 407 15 Orthopaedic Pain Management 433
XII Contents 16 Back Pain 481 17 Overuse Injuries and Work-Related Injury Assessments 513 18 Outcome Measures and Clinical Governance 533 19 New Evidence-Based Programme for Preventing and Rehabilitating Hip Fractures (Thesis Submitted to the Rehabilitation Board of HKCOS) 545 Subject Index 619