Posts tagged physical fitness
Physiotherapy Assessment of Muscle Strength
Muscle strength is very important for all of our functional activities, from heavy work such as climbing stairs or a hill to fine work such as sewing or typing on a keyboard. While losing feeling in a part of the body can be more disabling, losing muscle power always has consequences for our function and our independence, especially as we get much older when our power levels decline anyhow. We may lose muscle power for a wide variety of reasons: disuse; pain; injury; disease or neurological illness. Physiotherapists are skilled at the assessment of muscle power and in progressive strengthening techniques to restore power within the patient's capacity.
The Oxford Scale is the rating system used by physiotherapists for the assessment and recording of muscle power when required. Knowledge of muscle anatomy is vital so that the joint can be positioned correctly and the tendon and muscle palpated so whether there is any muscle action can be judged. The muscle is rated on the Oxford Scale from one to five and written down as 2/5 or 4/5, at times with a plus or minus sign to show the muscle has more or less strength but not enough to go down or up the scale. The physiotherapist ensures the joint is in the optimal position to enable the muscle to function easily and for easy visualisation of the tendon and muscle.
The physiotherapist will ensure the joint is positioned best for good visibility of the muscle, easy manual palpation of the tendon and muscle belly and the correct alignment for the expected strength of the muscle. Palpating the tendon and muscle, the physiotherapist will ask the patient to perform the muscle action desired, feeling for any contraction or movement. If there is none then the score is 0/5 and 1/5 if there is a just discernable contraction or a twitch, without apparent joint movement. If the joint can be moved through its whole motion but only without gravity resisting then the grade is 2/5, for which the joint needs careful positioning. 3/5 grade would be recorded when the joint can be moved through its range against gravity, an example being straightening the knee from bent in sitting.
To be rated as 4/5 on the Oxford Scale a muscle must be able to move its joint through full range against resistance and gravity. The physiotherapist will decide what degree of resistance is reasonable for this test, bearing in mind the characteristics of the patient such as age, sex, activity levels and medical status. The normal rating of 5/5 is given only when the muscle can move the joint painlessly to the extent that the tester feels is entirely adequate, given the personal status of the patient. Full power for a younger, strong man will be very different for a child or old person.
Grade three out of five for the shoulder muscles might be the ability to lift the arm above the head, but if this cannot be easily done or to full range then the muscle can be graded as three minus to indicate its inability to be fully grade three. If the physiotherapist can resist the muscle firmly but it still doesn't seem to be strong enough for a five, then the rating can be four plus. Physiotherapists go through all the muscles to be tested and rate them all on a muscle testing chart as a record of the muscle strength, which can be retested over time to chart recovery.
Physiotherapists begin muscle strengthening techniques in a position where gravity is eliminated, allowing a weak muscle to be repetitively exercised. As the patient's ability increases they can perform more functional activities of daily life which strengthens the muscles in a co-ordinated way which reflects normality. Next, resistance against muscle action is increased as muscle strength improves in response to the level of intensity of resistance and not just repetition. High intensity causes muscle fibre breakdown which repairs with increased size and power until the next intensity workout repeats the process. Progression is then moved to functional exercise with bodyweight resistance as dynamic movement is more useful.
Proper Treatment for Ankle Sprains
About ten percent of emergency department visits are the result of ankle injury. Most of these injuries are simple ankle sprains. These injuries are most commonly treated with RICE therapy. Patients are instructed to rest and ice the joint for 20 minutes sessions. Then, the injury is wrapped in compression bandages and elevated. The Jones compression uses alternate layers of elastic bandages and compression bandages. Finally, patients are instructed to elevate the ankle. To reduce pain, ibuprofen is usually provided. Patients who are ibuprofen-intolerant are given acetaminophen instead. This is the common procedure for ankle injuries.
RICE therapy is an effective for of treatment, to an extent. Unfortunately, it does little to prevent future ankle damage. The RICE technique provides initial damage control but more must be done to ensure future injury is avoided. Statistics show that 25% to 40% of all ankle sprains are recurring injuries. If original injuries go untreated, the patient has a good chance of damaging the ankle later in life. Minor forms of disability may also occur. One possible solution is OMT, or Osteopathic manipulative treatment.
The purpose of this treatment is to focus on the patient's unique needs. The specific treatment given to each patient varies from person to person. It is the osteopathic physician's job to examine the patient's injury and decide which soft tissue techniques would be best suited for the job. There are several soft tissue techniques osteopaths can use to manage ankle injuries. The average session lasts for 10-20 minutes. Studies show that OMT sessions do reduce ankle injury pain and many patients experience improved range of motion as well.
There are many soft tissue treatments. The physician studies the bones, from toe to ankle, and decides where most attention should be focused. Osteopaths have many options for ankle treatment. Sometimes muscle energy and strain-counter strain techniques prove useful. In other situations, lymphatic drainage is the main focus of the treatment. Drainage is an important part of the pain reduction process. The majority of ankle injury pain is the result of the fluid that builds up in the joint areas around the bones. This fluid can severely decrease mobility and slow down the recovery process.
Ankle sprains require immediate treatment. Physicians aim to return the ankle to proper working order. The goal is to get the patient up and walking normally as soon as possible. They also try to increase the overall range of motion and reduce pain levels as much as possible. Studies prove that even one Osteopathic manipulative treatment session can greatly improve the recovery process for acute ankle injuries.
Ankle injuries are not to be thought of lightly. Even a slight sprain should receive medical attention. If injuries go untreated, proper healing may never occur, leading to permanent disability. Fortunately, treatment is readily available. RICE (rest, ice, compression, and elevation) therapy and a quick session with an osteopath physician can reduce pain and shorten recovery time. Osteopath therapy also reduces the risk of future ankle injury.
The Treatment of Sciatica by Physiotherapists
Sciatica results from a structure impinging on a lumbar nerve root, causing compression and/or inflammation enough to cause neurological changes in the skin, reflexes and muscles served by the affected nerve. Not a common syndrome, it is estimated that 3-5% of the population suffer this kind of problem at some time. It affects men and women equally with men most susceptible in their forties and women in their fifties. Up to a quarter have symptoms which last more than six weeks and referral to physiotherapists for acute management is routine.
Disc prolapse can result in the internal nuclear material being extruded past the outer disc wall, physically compressing the nerve root which runs nearby. The nuclear material is also chemically irritating to the nerve structure and these irritants make the nerve and nearby structures swell, partly blocking the local circulation and the nerve's message transmission. Disc prolapse is typically the cause of proper sciatica but the size of the prolapse is not closely related to the amount of pain the person suffers.
The great forces which we impose on the low back mean the lumbar intervertebral discs suffer structural changes and prolapses. Many activities involve a significant level of leverage, such as flexing over, performing movements in an upright position and lifting with the arms away from the body. This greatly magnifies the forces on the discs and due to their fluid mechanics they suffer 3-5 times the loads on the skeleton. This can cause the disc walls to degenerate, giving weak areas and predisposing to prolapse at some time.
The onset of lumbosacral radiculopathy is often sudden with low back pain and any back pain may disappear at the start of the leg pain. Worsening factors are sneezing, coughing and sitting with lying down or standing up common easing factors. Sciatic pain typically occurs in the buttock, back or side of the leg and calf and into the foot. If the disc prolapse is higher up (prolapses at disc levels L1 to L3 are 5% of the total) the pain may be in the front of the thigh no further than the knee. A patient may have an isolated area of pain and still have a prolapse.
A thorough history performed by the physio will uncover any red flags, an indication of a possibly serious underlying medical condition responsible for the pain. Loss of weight or appetite, severe pain at night, a history of cancer, unwellness or fever, bowel or bladder control difficulties, young or older patients, all these things ring warning bells and the physio will refer the patient on to a medical specialist for evaluation. The location, nature and response to activities and postures of the pain will be noted by the physiotherapist.
The physiotherapist begins with postural observation of the patient which can show an inability to stand up or a thoracic shift to one side. Spinal movements are performed and the pattern of movement limitation noted, with a full neurological examination of the lower limbs. The physio is looking for deficits in muscle power, reflexes or feeling which are related to the specific nerve root involved. The straight leg raise may be performed to check the stretch reaction of the spinal nerve.
The McKenzie technique works on pain centralisation, the tendency for pain to move towards the back from the legs, suggesting a disc problem, and many physios use this technique. Pain in the front of the thigh and over the knee can be referred from the hip joint, so the physiotherapist will assess the lower limb joints to check the diagnosis. A thorough examination informs the physiotherapist of the likely diagnosis and how they might treat the syndrome, or that the patient needs to be referred to a medical practitioner for a consultation and investigation.
Treatments for sciatica due to disc prolapse are many and physiotherapists can choose to use mobilisations and manipulations, lumbar stabilising exercises, the McKenzie treatment path, soft tissue mobilisations such as massage and myofascial release, using analgesics, education about the condition, advice on resting and the best position to relieve extreme sciatica pain. Sciatica naturally settles in time in the vast majority of cases and physios would encourage patients to establish an exercise regime over the long term.
