Contra/Precautions Exam 2 Flashcards
1
Q
What are the precautions for the Neck an Trunk?
A
- Increased intradiscal pressure (ie when pelvic tilts, trunk raising ex with valsalva maneuver)
- RA-potential of subluxations and dislocations
- Stretching hypomobile joints if technique stresses hypermobile area
- Hyperextension with bony changes and osteophytic spurs
- Vertebral artery test is required before extension past neutral, especially in elderly secondary to osteoarthritis
- When working with a patient involved in a serious MVA, make sure an open mouth x-ray has been done to confirm transverse ligament is in place
2
Q
What are the contraindications for neck and trunk?
A
- When changing position does not alter acute pain
- Movement that peripheralizes the symptoms during acute and subacute period.
- Spinal extension is contraindicated when:
- No position change or movement decreases or centralizes the pain
- With saddle anesthesia and/or bladder weakness
- When patient guards or hold body immobile because of extreme pain
- Backward bending with rotation with acute joint symptoms - Spinal flexion is contraindicated when:
- When extension relieves symptoms
- When flexion movements increase pain or peripheralize symptoms
3
Q
What are precautions for the shoulder girdle?
A
- When using Codman’s exercises, some pts may get dizzy when standing upright after being flexed; guard them carefully and if they get dizzy have them sit.
- Watch carefully for substitutions and faulty mechanics.
- Self-stretching to increase extension if pt. is prone to anterior subluxation or dislocation of humerus.
4
Q
What are the contraindications for the shoulder girdle?
A
- Exercises, ROM that cause anterior glide of humerus following anterior shoulder dislocation
- Avoid excessive and painful forward flexion of the humerus with internal rotation or horizontal adduction across the chest with posterior dislocation of the shoulder.
5
Q
What are the precautions for Cardiovascular endurance?
A
- CAD, MI, CHF, cardiac conditions
- Hypertension
- Permanent pacemaker
- Marfan’s syndrome
- Severe lung diseases
- Electrolyte abnormalities
- Uncontrolled metabolic diseases (diabetes, etc)
- Diabetes (Strenuous ex. may cause hypoglycemia; be sure diabetes controlled)
- Any serious systemic disorder (hepatitis, Mono, etc.)
- Marked obesity
- Anemia
6
Q
What are the contraindications for cardiovascular endurance?
A
- Coronary disease
- Severe coronary artery disease
- Uncontrolled ventricular or atrial arrhythmias
- Uncontrolled hypertension
- Acute myocarditis - Recent PE or DVT
- Pregnancy
- Injury or diseases affecting musculoskeletal systems
7
Q
What is the precaution for balance?
A
- Patient’s safety
8
Q
What is the contraindication for balance?
A
- Patients who are inherently unsafe in balance-challenged positions (ie cognitive impairment limiting understanding purpose, mechanics, instructions of the activity)
9
Q
What are the precautions for elbow, wrist, and hand?
A
- If elbow flexion and extension are limited as well as rotation of the radius, there may be a FX or subluxation of the radial head
- Be alert to signs of a wrist or hand FX because small fractures may not show for up to 2 weeks on an x-ray
- Initiate joint-play techniques for normal gliding of the joint surfaces before stretching wrist or hand muscles.
10
Q
What are the contras for elbow, wrist, and hand?
A
- With elbow arthroplasty, avoid antigravity elbow extension or stretch to the triceps in the acute phase.
- Stretching of the brachialis is contraindicated if it is the limiting motion in elbow extension with pronation with the biceps elongated across the shoulder because stretching may precipitate myositis ossificans.
- Heavy lifting or excessive weight bearing on the hand postoperatively with total wrist arthroplasty
- Stretch or resistance to the extensors post op. MCP implant arthroplasty
- Hyperextension of the CMC jt in CMC jt replacement of the thumb
- Pressure on the dorsum of the hand with repair of ruptured extensor tendons
- Do not let PIP and MCP jts hyperextend when stretching tendons over the wrist.
11
Q
What are the precautions for hip exercise?
A
- weight bearing status
- Rectus femoris stretch must be monitored carefully if pt has instability or pain (at hip).
- Hip adductor and IR stretch: teach pt to stabilize pelvis and lumbar spine by actively contracting abdominal ms and maintain PPT.
12
Q
What are the contraindications for hip exercise?
A
- THP (total hip precautions)
- Posterior lateral approach: no hip flexion greater than 60-90 degrees, no hip adduction past neutral, no internal rotation past neutral.
- Anterior approach: no hip extension past neutral (hyperextension), no hip abduction past neutral, no hip external rotation past neutral. - Pain radiating down pt’s leg with hip flexor stretch
13
Q
What are the precautions for knee exercises?
A
- Strong muscle contractions may exacerbate joint symptoms (adapt dosage to pt’s tolerance).
- Passive stretching using the tibia as a lever can exacerbate joint symptoms; use these only when joint play is available and the technique does not increase pain
- Knee joint surgery (TKA, ACL repair, arthroscopic surgery, etc.) has specific guidelines for ROM, exercise in specific ROM, etc.
- Perform a PPT when stretching rectus femoris
14
Q
What are the contraindications for knee exercises?
A
- Do not increase joint ROM unless the patient has strength to control the ROM/motion already available.
- Adding resistance during SAQs is not appropriate after an ACL injury or with an unstable knee.
- Adding resistance during open chain HS curls is not appropriate in the early stages of a PCL injury or reconstruction
15
Q
What are the precautions for ankle exercises?
A
- During chronic phase of treatment of sprains and minor ligamentous tears for sports activities, ankle should be splinted, taped, or wrapped and proper footwear worn.
- Follow weight bearing restrictions
- When pt. has weight bearing precautions, pt should have shoes with arch supports during weight-bearing exercises to stretch the plantarflexors
