Practice for this week's OP
Jun. 2nd, 2011 09:53 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
alexmegamiEach of these has to be done in SIX MINUTES.
Assessments
Hi Simon, my name is Alex and I'll be your student therapist today. I've just come from washing my hands. Based on your concerns for today, there are three tests I would like to do. The first is a Straight-Leg Raise Test, because I'd like to rule out the weakness in your gluteals as being due to a nerve lesion from your fall. Then I would like to do the Sign of the Buttock Test, which will rule out whether the pain in your right ischial tuberosity (the bone you sit on) is due to bursitis, a tumor, or abscess or whether it is muscular. Then I would like to do an Adductors Length Test to determine whether the muscles on the inside of your thigh have shortened in response to your injury.
We are trying to recreate your symptoms. I can't modify the tests, but if they are too painful we can stop. Do you have any questions? Do I have your consent to start the tests?
SLR: Test the RIGHT leg first. There should be no nerve lesions on either side. It is negative bilaterally. A positive sign would be a sharp shooting pain along the spine into the lower legs or arms as tension was put on the dura of the spine, indicating a nerve lesion. One is not present.
Sign of the Buttock: Test the RIGHT leg first. As the hip will flex further when the leg is not straight, bilaterally this is a negative test. A positive sign would be if the hip did not move further in flexion when the knee was bent compared to when the knee was straight, it might indicate ischial bursitis, an abscess in the ischial tuberosity region, or a hip pathology.
Adductor Length Test: Test the LEFT leg first. Pain on length indicates that the muscle is shortened and most likely has a lesion from injury. A negative test would be no pain on lengthening.
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Treatments
Treat client in semi-supine due to elevated blood pressure. Work on left "compensatory" area.
When examiner enters, perform the following:
"I'm going to begin with some compressions to warm up the area. Since the major area affected is your inner thigh, may I have special consent to work on this area? Thank you. Let me know if you need me to stop or modify the treatment or any techniques I am using.
Next I'm going to apply some lotion. Because of your blood pressure, I'm going to modify my application of effleurage. [Start proximal, two short strokes proximal, one stroke distal, down the leg.]
Next I'll perform some specific petrissage to warm up the tissue. How is this depth? Would you like me to go lighter or deeper?
Next I'm going to do some gentle passive range of motion of the hip. This will help keep the joint healthy and nourished as you overcome your injury. This should be pain free, so let me know if I go too far. Can you hold the sheet here? [Perform techique 1x in all directions]
Next I'd like to do a technique called trigger point release. I'm going to cross-fiber palpate your adductor magnus muscle, and I feel a taut band in it. And here is a tender nodule. When I compress this, do you feel the pain in your thigh and knee? Yes? OK, on a scale of 1-10 I don't want your pain to go above a seven, or within your comfort level. Is this pressure a seven? Yes? OK, keep breathing normally. Trigger points are like little knots of muscle fibers that can create dull achy pain that refers elsewhere. Are you OK? It's at a 3 now? Okay, 2, 1, 0, and let's circulate the area to help promote healing. And now I'm going to do a gentle stretch for the area.
Lastly, I'm going to do a technique called agonist-contract. This helps stretch the muscle by using its opposite muscle to help lengthen it. Let me know if it is ever painful because it should not be. Can you hold the sheet here? I'm going to take you to the first barrier, now I want you to try and push further into the stretch while I resist you. [wait 10 seconds] Okay, now we're going to the second barrier, and push into me [10 seconds] and now we're going to go a little further and just hold for 30 seconds [15 seconds].
Okay great, now let's work on the tissue a bit more. How are you feeling? [Re-perform effleurage, compressions.]
------
Remedial Exercises
Okay, before you begin any exercise regimen I'd like you to speak to your doctor about safe exercise given your elevated blood pressure. Before any of the exercises you should do a quick warm up to get the blood flowing and your heart rate up.
Exercise one: Active range of motion of both hips. This should always be pain free and will help maintain the joint as you overcome your injuries. Only go to the end of your pain-free range. Move it ten times into each range, bending it up, to the sides, rotating it, and then turn over and move your leg behind you. Breathe normally throughout. Do each of these actions 10 times. Do this exercise for both hips, once a day, five days a week. As you start getting stronger and less pained, increase the range you go to. Are you OK? No pain doing this? If you feel pain, discontinue the exercise until you see me next.
Exercise two: Strengthen your left gluteus medius and minimus. We'll start without any weights besides the weight of your leg. Lie on your right side with your left leg straight. Slowly raise it in the air, breathing out. Then as you breathe in, bring it down slowly. Do this for 10 repetitions and 3 sets, 3 times a week, leaving a day in between. As you start getting stronger, you can add an ankle weight or tie therabands around your legs to provide resistance. You always want to only be able to finish 10 repetitions before you tire out. Where do you feel it? Do you feel any pain? If you do, discontinue the exercise until you see me next.
Exercise 3: Stretch the right adductors. On your hand and knees, gently stretch your right knee out as far as it can go. If you feel comfortable doing so, you can extend your knee. Hold this for 10 seconds, then come out - back in, 10 seconds, then out - back in, 10 seconds, then out. Do this once a day, five days a week. Once you feel more comfortable, you can hold it for 60 seconds straight. Where do you feel the stretch? Is it painful? If you feel pain, discontinue the exercise until you see me next.
Assessments
Hi Simon, my name is Alex and I'll be your student therapist today. I've just come from washing my hands. Based on your concerns for today, there are three tests I would like to do. The first is a Straight-Leg Raise Test, because I'd like to rule out the weakness in your gluteals as being due to a nerve lesion from your fall. Then I would like to do the Sign of the Buttock Test, which will rule out whether the pain in your right ischial tuberosity (the bone you sit on) is due to bursitis, a tumor, or abscess or whether it is muscular. Then I would like to do an Adductors Length Test to determine whether the muscles on the inside of your thigh have shortened in response to your injury.
We are trying to recreate your symptoms. I can't modify the tests, but if they are too painful we can stop. Do you have any questions? Do I have your consent to start the tests?
SLR: Test the RIGHT leg first. There should be no nerve lesions on either side. It is negative bilaterally. A positive sign would be a sharp shooting pain along the spine into the lower legs or arms as tension was put on the dura of the spine, indicating a nerve lesion. One is not present.
Sign of the Buttock: Test the RIGHT leg first. As the hip will flex further when the leg is not straight, bilaterally this is a negative test. A positive sign would be if the hip did not move further in flexion when the knee was bent compared to when the knee was straight, it might indicate ischial bursitis, an abscess in the ischial tuberosity region, or a hip pathology.
Adductor Length Test: Test the LEFT leg first. Pain on length indicates that the muscle is shortened and most likely has a lesion from injury. A negative test would be no pain on lengthening.
-----
Treatments
Treat client in semi-supine due to elevated blood pressure. Work on left "compensatory" area.
When examiner enters, perform the following:
"I'm going to begin with some compressions to warm up the area. Since the major area affected is your inner thigh, may I have special consent to work on this area? Thank you. Let me know if you need me to stop or modify the treatment or any techniques I am using.
Next I'm going to apply some lotion. Because of your blood pressure, I'm going to modify my application of effleurage. [Start proximal, two short strokes proximal, one stroke distal, down the leg.]
Next I'll perform some specific petrissage to warm up the tissue. How is this depth? Would you like me to go lighter or deeper?
Next I'm going to do some gentle passive range of motion of the hip. This will help keep the joint healthy and nourished as you overcome your injury. This should be pain free, so let me know if I go too far. Can you hold the sheet here? [Perform techique 1x in all directions]
Next I'd like to do a technique called trigger point release. I'm going to cross-fiber palpate your adductor magnus muscle, and I feel a taut band in it. And here is a tender nodule. When I compress this, do you feel the pain in your thigh and knee? Yes? OK, on a scale of 1-10 I don't want your pain to go above a seven, or within your comfort level. Is this pressure a seven? Yes? OK, keep breathing normally. Trigger points are like little knots of muscle fibers that can create dull achy pain that refers elsewhere. Are you OK? It's at a 3 now? Okay, 2, 1, 0, and let's circulate the area to help promote healing. And now I'm going to do a gentle stretch for the area.
Lastly, I'm going to do a technique called agonist-contract. This helps stretch the muscle by using its opposite muscle to help lengthen it. Let me know if it is ever painful because it should not be. Can you hold the sheet here? I'm going to take you to the first barrier, now I want you to try and push further into the stretch while I resist you. [wait 10 seconds] Okay, now we're going to the second barrier, and push into me [10 seconds] and now we're going to go a little further and just hold for 30 seconds [15 seconds].
Okay great, now let's work on the tissue a bit more. How are you feeling? [Re-perform effleurage, compressions.]
------
Remedial Exercises
Okay, before you begin any exercise regimen I'd like you to speak to your doctor about safe exercise given your elevated blood pressure. Before any of the exercises you should do a quick warm up to get the blood flowing and your heart rate up.
Exercise one: Active range of motion of both hips. This should always be pain free and will help maintain the joint as you overcome your injuries. Only go to the end of your pain-free range. Move it ten times into each range, bending it up, to the sides, rotating it, and then turn over and move your leg behind you. Breathe normally throughout. Do each of these actions 10 times. Do this exercise for both hips, once a day, five days a week. As you start getting stronger and less pained, increase the range you go to. Are you OK? No pain doing this? If you feel pain, discontinue the exercise until you see me next.
Exercise two: Strengthen your left gluteus medius and minimus. We'll start without any weights besides the weight of your leg. Lie on your right side with your left leg straight. Slowly raise it in the air, breathing out. Then as you breathe in, bring it down slowly. Do this for 10 repetitions and 3 sets, 3 times a week, leaving a day in between. As you start getting stronger, you can add an ankle weight or tie therabands around your legs to provide resistance. You always want to only be able to finish 10 repetitions before you tire out. Where do you feel it? Do you feel any pain? If you do, discontinue the exercise until you see me next.
Exercise 3: Stretch the right adductors. On your hand and knees, gently stretch your right knee out as far as it can go. If you feel comfortable doing so, you can extend your knee. Hold this for 10 seconds, then come out - back in, 10 seconds, then out - back in, 10 seconds, then out. Do this once a day, five days a week. Once you feel more comfortable, you can hold it for 60 seconds straight. Where do you feel the stretch? Is it painful? If you feel pain, discontinue the exercise until you see me next.
