Rehabilitation of Common Musculoskeletal Disorders

1. Rehabilitation of Common Musculoskeletal Disorders 新光醫院 復健科 謝霖芬 醫師

3. Classification of Common Musculoskeletal Disorders • Soft tissue lesion • Muscle: strain, myofacial pain sydrome • Tendon: tendinitis, tear • Ligament: sprain, rupture • Bursa: bursitis • Cartilage: degeneration, herniation, injury • Bone and joint lesion • Arthritis • Fracture and/or dislocation

4. Muscle strain • Damage to the musle fibers • Due to overstretch or too much contraction • Classification: 1st, 2nd, and 3rd degree

5. Myofacial pain syndrome • Local and referred pain patterns • Muscle stiffness and shortening • Taut bands in muscle • Presence of trigger points • Local twitch response or jump sign • Autonomic dysfunction

7. Tendinitis or tendosynovitis • Local pain & tenderness • Resisted isometric contraction induces pain • Tendon stretch induces pain • May have local swelling or crepitus • May have tendon shortening or adherence (triggering)

9. Bursitis • Pain on motion and at rest • Local tenderness and/or swelling • Regional loss of active movement

10. Arthritis: joint inflammation • Local findings • redness, swelling, heat, tenderness • Impairment of joint function • ROM restriction • Impairment of force transmission

12. Major Problems of Musculoskeletal Disorders • Pain • Contracture • Muscle weakness, atrophy • Instability • Functional impairment

13. Definition of Pain (IASP) • “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” • Acute pain vs chronic pain • Individual variations • Psychological factors

15. Visual analogue scale (VAS) 10cm line Likert scale Quantitation of Pain

16. Pain Generator • Bone • Joint • Muscle • Tendon • Ligament • Nerve • Vessel

17. Contracture • Arthrogenic: arthritis, capsular fibrosis • Myogenic: trauma, inflammation, degeneration • Other soft tissue: tendinitis, ligamentous tear • Mixed • Most common cause: lack of joint mobilization throught full alowable range

19. Muscle weakness or atrophy • Disuse • Pain inhibition • Muscle or tendon lesions • Neuropathy • Side effect of drugs

20. Instability • Bone and cartilage damage • Muscle atrophy • Relative lengthening of tendon, ligament

21. Evaluation of Musculoskeletal Disorders • History taking • Physical examination • Special examinations

22. History Taking • Location • Disease duration • Cause • Course • Severity • Factors relieving or worsening the symptom • Other sensory complaints

23. Physical Examination • Inspection: redness, swelling, atrophy, ecchymosis, discoloration, deformity, physical defect • Palpation: tenderness, local heat or coldness, swelling, atrophy, mass, local defect • Neurological examination: sensory, motor, DTRs • Check ROM, joint stability, soft tissue flexibility • Special tests:

31. Special Examinations • Conventional radiography • Ultrasound • Computed tomography • Magnetic resonance imaging • Bone scan • Arthrography • Arthroscopy • EMG & NCS • Motion analysis (gait laboratory)

38. Goals of Rehabilitation • Symptom relief • Mobility and strength • Sense of self-worth • Maximal functional ability • Maximal independence

39. Therapeutic Exercise • Mobility exercise • Strengthening exercise • Aerobic exercise • Recreational exercise

40. Mobility Exercise • Range of motion • active • active-assistive • passive • Stretching • ballistic • PNF (proprioceptive neuromuscular facilitation) • static • Joint mobilization

41. Strengthening Exercise • Isometric - same length • Isotonic - same load • Isokinetic -same speed

45. Aerobic Exercise • Mode: swimming, bicycle, walking • Frequency: 3-5 times/week • Duration: 20-60 min • Intensity: • 55-90% maximal HR • 40-85% HR reserve • 40-85% VO2 reserve • 12-16 RPE (rate of perceived exertion) .

48. Purposes of Orthoses (splints) • Unweigh joints • Stabilize joints • Decrease joint motion • Improve joint function