Principles of Musculoskeletal Treatment and Management: A Handbook for Therapists (Physiotherapy Essentials)

Fully updated and revised for a second edition, this textbook offers a comprehensive, evidence-based guide to the treatment and management of the neuromusculoskeletal system, providing vital support for both students and experienced therapists. As with the previous edition the text deals with function and dysfunction of joints, muscles and nerves offering treatment options in all cases. Underpinning theory and research is used extensively to explain the clinical use of each treatment option. This new edition has benefited from the author – Nicola Petty – becoming editor and enabling leading clinicians and academics to contribute to the text which now offers a broader range of perspectives. Provides critical knowledge and theory that underpins clinical practice and decision-making Guides the reader through the various options available for patient management drawing a solid evidence base Emphasizes the importance of hands on skill, as well as communication and clinical reasoning skills Templated structure throughout creates an accessible tool for use in teaching and practice Revised drawings in 2-colour provide the reader with enhanced visual learning tools Front Cover Half title page Dedication Principles of Musculoskeletal Treatment and Management - Volume 2 Copyright Page Table Of Contents Foreword References Preface Contributors 1 Introduction Reference 1 Principles of Tissue Management 2 Function and Dysfunction of Joints Chapter Contents Joint Function Classification of Joints Anatomy, Biomechanics and Physiology of Joint Tissues Ligaments Fibrous Joint Capsules and Synovial Membranes Articular Cartilage Compressive Loading of Articular Cartilage. Synovial Fluid Synovial Joint Lubrication. Boundary Lubrication. Fluid Lubrication. Fat Pads Menisci and Meniscoids Bursae Labra Intervertebral Disc Nerve Supply of Joints Ruffini End-Organs Pacinian Corpuscles Golgi Endings Free Nerve Endings Effect of Joint Afferent Activity on Muscle Effect of Joint Afferent Activity on Pain Classification of Synovial Joints Joint Movement Joint Glide During Physiological Movements Biomechanics of Normal Joint Movement End-Feel. Functional Movement Proprioception Joint Dysfunction Joint Pathology and Muscle/ Nerve Dysfunction Joint Immobilization and Muscle/ Nerve Dysfunction Joint Instability and Muscle/ Nerve Dysfunction Joint Nociception and Muscle Dysfunction Classification of Joint Dysfunction Hypomobility Immobilization Hypermobility Joint Instability Altered Quality of Joint Movement Production of Symptoms Nociception and Pain Pain Referral Areas References 3 Principles of Joint Treatment Chapter Contents Joint Mobilizations Types of Joint Mobilizations Accessory Movements Physiological Movements Passive Physiological Movement Combined With Accessory Movements Active Physiological Movement With Accessory Movement Manipulation Application of Joint Mobilizations Dose Patient Position Direction of Movement Magnitude of the Force/Grades of Movement Amplitude of Oscillation Speed and Rhythm of Movement Time Symptom Response Choice of Treatment Dose Modification, Progression and Regression Assessment of Outcome Effect of Mobilizations Mechanical Effects Neurophysiological Effects Local Analgesic Mechanisms Spinal Cord-Mediated Mechanisms Supraspinal Mechanisms Effect of Manual Therapy on Motor Activity Placebo Effect Evidence Base for Joint Mobilizations Exercise for Joint Dysfunction Degenerative Joint Disease Key Points and Summary References 4 Function and Dysfunction of Muscle and Tendon Chapter Contents Skeletal Muscle Function Anatomy, Biomechanics and Physiology of Muscle Contractile Tissue of Muscle Non-Contractile Tissue of Muscle Musculotendinous (or Myotendinous) Junction Osteotendinous Junctions Tendons Blood Supply of Tendon. Biomechanics of the Muscle–Tendon Unit Types of Muscle Fibre Nerve Supply of Muscles Muscle Spindles Summary of the Muscle Spindle. Golgi Tendon Organs Summary of the Golgi Tendon Organ. Free Nerve Endings Mechanoreceptors Chemical Receptors Thermal Receptors Nociceptors Efferent Nerve Fibres Muscle and Proprioception Muscle Strength Muscle Power Muscle Endurance Classification of Muscle Function Muscle Architecture Monoarticular and Polyarticular Prime Mover, Antagonist, Fixator and Synergist Prime Mover and Antagonist Co-Contraction of Agonist and Antagonist Fixators Synergists Skeletal Muscle Dysfunction Reduced Muscle Strength Immobilization Time of Immobilization. Position of the Muscle. Predominant Type of Muscle Fibre Within the Muscle Effect of Immobilization on the Musculotendinous Junction and the Tendon Measurement of Muscle Strength Reduced Muscle Power Reduced Muscle Endurance Altered Motor Control Muscle Inhibition Timing of Onset Increased Muscle Activation Altered Activation of Agonist and Antagonist Altered Muscle Length Production of Symptoms Referral of Pain From Muscle Tendon Injury and Repair Tendon Repair Muscle Injury and Repair Muscle Repair References 5 Principles of Muscle and Tendon Treatment Chapter Contents Principles of Increasing Muscle Strength, Power and Endurance Overload Specificity Individuality Motivation Learning Diminishing Returns Reversibility Increasing Muscle Strength Underlying Effect of Strengthening a Muscle Motor Learning Muscle Hypertrophy Increasing Muscle Power Increasing Muscle Endurance Underlying Effects of Increasing Muscle Endurance Aerobic Endurance Clinical Implications of Strength, Power and Endurance Training Altering Motor Control To Increase Muscle Activation Increase Speed of Onset To Reduce Muscle Activation Altering Muscle Length Increasing Muscle Length Passive Muscle Stretching by the Clinician Direction of Movement. Magnitude of Force. Speed of Movement. Duration. Temperature. Symptom Response. Passive Muscle Stretching by the Patient Summary of Increasing Muscle Length Increasing Length via the Contractile Unit of Muscle Hold–Relax. Contract–Relax. Agonist–Contract. Reducing Symptoms Descending Inhibition of Pain dPAG vPAG Addressing the Biopsychosocial Aspects of Symptoms Muscle Injury and Repair Delayed-Onset Muscle Soreness Tendon Injury and Repair Choice of Muscle Treatment Modification, Progression and Regression of Treatment Modification of Treatment Progression and Regression of Treatment Summary References 6 Function and Dysfunction of Nerve Chapter Contents Nerve Function Anatomy and Physiology of the Spinal Cord Tracts of the Spinal Cord Anatomy and Physiology of Peripheral Nerves Sensory and Motor Fibres Cutaneous Sensory Receptors Axonal Transport Immune Cells Connective Tissue Covering of Peripheral Nerves Blood Supply of Peripheral Nerves Nerve Supply of Peripheral Nerves Biomechanics of Peripheral Nerves Movement of the Nervous System Movement of the Brain Movement of the Spinal Cord Movement of the Nerve Roots Movement of Peripheral Nerves Summary of Nerve Function Nerve Dysfunction Neuropathic Pain Mechanisms of Local Dysfunction Detrimental Mechanical Effects Compression. Strain. Inflammatory and Immunological Change Mechanisms of Central Dysfunction Changes to the Dorsal Root Ganglion and Dorsal Horn Subcortical and Cortical Changes Summary of Local and Central Mechanisms Clinical Examples of Nerve Pathology Canal, Lateral Recess and Foraminal Stenosis Cauda Equina Syndrome Cord Compression Nerve Regeneration and Repair Reduced Nerve Movement Carpal Tunnel Syndrome – a Clinical Example Production of Symptoms Summary of Nerve Dysfunction References 7 Principles of Nerve Treatment Chapter Contents Overview of Types of Nerve Treatment Neurophysiological Effects of Nerve Treatment Oedema Immune Cell Changes Descending Inhibitory Pain Pathways Blood Flow and Axonal Transport Systems Biomechanical Effects of Nerve Treatment Nerve Interface Treatments Treatment Dose: Considerations in Relation to Nerve Treatment (Table 7.2) Time and Repetitions Grades of Movement Symptom Response Active Movement by the Patient Addressing the Biopsychosocial Aspects of Symptoms Modification, Progression and Regression of Treatment Effectiveness of Nerve Treatment Philosophical Considerations Clinical Example Assessment Treatment Session 1 Treatment Session 2 Treatment Session 3 References 2 Principles of Patient Management 8 Understanding and Managing Persistent Pain Chapter Contents Introduction Understanding Persistent Pain Acute, Subacute and Persistent Pain Physiological Aspects of Persistent Pain Sensory Transmission in the Dorsal Horn Central Sensitization Descending Inhibition and Facilitation Behavioural Aspects of Persistent Pain Actions Avoided Actions Taken Social Aspects of Persistent Pain Psychological Aspects of Persistent Pain Assessing Persistent Pain – General Approach Managing Persistent Pain Overview Pain Education Active Pain Rehabilitation Relaxation and Mindfulness Conclusion References 9 Principles of Communication and Its Application to Clinical Reasoning Chapter Contents The Power of Communication Preparations Initial Contact Preparing Yourself Preparing the Environment History Taking Meeting and Greeting Additional Clinicians The Importance of First Impressions Building Rapport What Communication Happens During a Musculoskeletal Consultation? Opening Questions Questioning Styles Sensitive Questioning Handing Over Control Active Listening Silence Is Golden Empathy The Content of Musculoskeletal Consultations Interruptions The ‘Threatened State’ and Communication Challenging Conversations The Physical Examination The Power of Touch and Its Role in Communication Articulating the Assessment Findings Perceptions of Diagnosis Clinical Reasoning and Its Influence on Communication Exploring Your Own Beliefs and Bias Clinician Emotion, Communication and Reasoning Shared Decision Making Changing Behaviour Motivational Interviewing Gaining Consent Communicating the Treatment Negotiating an Exit Suggestions to Enhance Your Communication Skills Further Acknowledgements References 10 Principles of Exercise Rehabilitation Chapter Outline Introduction Reloading in Rehabilitation: a Physiological Construct Mechanotherapy and Tissue Homeostasis Fundamentals of Mobility and Motor Control Training Mobility and Stability Paradox Considerations When Rehabilitating to Regain Mobility Motor Control and Pain The Role of Proprioception in Motor Control Clinical Testing for Proprioceptive Deficits Testing for Postural Stability Balance Error Scoring System. Star Excursion Balance Test. Testing for Joint Position Sense Considerations When Rehabilitating to Regain Proprioceptive Acuity Progressively Challenging Static Balance Movement Dissociation Training Movement Control in Motor Skill Learning Extrinsic versus Intrinsic Training Feedback Cues Guidance for Providing Feedback Adding Complexity to Movement Skill Training Considerations When Rehabilitating to Regain Motor Control Skill Fundamentals of Strength Training and Adaptation Exercise Prescription by Intention, Adaptation and Physical Outcome Defining Work Capacity and Strength Work Capacity Muscular Strength Rate of Force Development Exercise Progression Within Reloading Rehabilitation Performance Needs Analysis Progressing Load and Function (Entry Criteria for Progression) Tissue Function and Exercise Specificity Tissue Loading Task-Specific Training Monitoring the Effect of Rehabilitation Exercise Load Pain Stiffness Swelling Regaining Chronic Capacity Return to Performance: Decision Making and Measuring Effectiveness Summary References Index A B C D E F G H I J K L M N O P Q R S T U V W Z Now in its third edition, this core textbook continues to provide a comprehensive, evidenceenhanced guide to the principles of treatment and management of the musculoskeletal system. Nicola Petty is joined by Kieran Barnard in editing this new edition which also sees an expanded number of specialist clinicians and academics contributing individual chapters. Principles of Musculoskeletal Treatment and Management provides both students and experienced practitioners with an invaluable guide to the principles applied in contemporary musculoskeletal therapy.Provides theory and research knowledge to underpin treatment and management strategies for patients with musculoskeletal conditions Provides a rationale to support clinical decisionmaking Offers an uptodate evidenceenhanced approach to patient treatment and management Emphasizes the importance of communication and clinical reasoning, as well as handson and rehabilitation skills Brandnew chapter on the principles of communication and its application to clinical reasoning Brandnew chapter on the principles of exercise rehabilitation Highlights the health benefits of some treatment approaches References updated throughout Printed book plus PageburstT access - you will receive a printed book and access to the complete book content electronically. PageburstT enhances learning by not only bringing world class content to your fingertips but also letting you add to it, annotate it, and categorize it all in a way that suits you. PageburstT frees you to spend more time learning and less time searching. Fully updated and revised for a second edition, this textbook offers a comprehensive, evidence-based guide to the treatment and management of the neuromusculoskeletal system, providing vital support for both students and experienced therapists. As with the previous edition the text deals with function and dysfunction of joints, muscles and nerves offering treatment options in all cases. Underpinning theory and research is used extensively to explain the clinical use of each treatment option. This new edition has benefited from the author - Nicola Petty - becoming editor and enabling leading clinicians and academics to contribute to the text which now offers a broader range of perspectives Printed book plus PageburstTM access - you will receive a printed book and access to the complete book content electronically. PageburstTM enhances learning by not only bringing world class content to your fingertips but also letting you add to it, annotate it, and categorize it all in a way that suits you. PageburstTM frees you to spend more time learning and less time searching. Fully updated and revised for a second edition, this textbook offers a comprehensive, evidence-based guide to the treatment and management of the neuromusculoskeletal system, providing vital support fo