rehab & treatment cases

Question 1

22 y/o overweight offensive lineman,
c/o diffuse LBP x 2 wk. pain is nonradiating and increases with strenuous lifting

DX: lumbosacral muscle spasm

RX: treatment goals and modalities?

Answer 1

IFC 5-10 sec on/off for 15-30 mins

Massage

Question 2

20 y/o female volleyball player c/o (L) buttocks and LBP, x 6

Piriformis syndrome - sciatica nerve

Answer 2

IFC 5-10 sec on/off
TENS 5-10 sec on/off

15-30 minutes

Massage

Question 3

44 y/o male painter c/o pain in R shoulder and limited shoulder ROM due to pain

Chronic supraspinatus tendinosis

Answer 3

IFC & TENS 5-10 sec on/off for 15-30 minutes

Question 4

22 y/o male soccer goalie, x 3 mo status post bone graft for avascular necrosis of L scaphoid

Hypomobile radial carpal joint in all motion due to prolonged cast immobilization

Answer 4

Ultrasound 3 MHz 5-8 minutes

Question 5

1st degree inversion ankle sprains swelling 24 h post injury

Answer 5

RICES

Cryokinetics to decrease swelling and increase ROM

IFC 5-10 sec on/off for 15-30 mins

Question 6

Carpal tunnel syndrome: c/o tingling and numbness in R hand with loss of ROM and grip strength

Answer 6

Median nerve

Ice packs
Ice water immersion

Question 7

Marathon runner c/o chronic pain in area of L Achilles’ tendon

Answer 7

Achilles tendinosis

3 MHz ultrasound 5-8 mins

Question 8

C/o pain in cervical region with muscle spasms what appropriate steps

Answer 8

Rule out fx first

TENS and IFC 5-10 sec on/off for 15-30 mins

Question 9

Male soccer player c/o pain on L mid-portion of quadriceps with swelling 30 minutes post injury

Answer 9

RICES
Cryostretch
Cryokinetics
IFC

Question 10

Female collegiate miler c/o pain chronic pain in area of R patellar tendon

Answer 10

Patellar tendinosis

3 MHz ultrasound 5-8 mins

Question 11

18 y/o female tennis player c/o chronic pain in area of R elbow

Answer 11

Lateral epicondylosis

3 MHz ultrasound 5-8 mins

Question 12

Rugby player c/o pain on R AC joint with swelling 2 h post injury. No visible or palpable step off deformity

Answer 12

1 degree AC sprain of R shoulder

RICES
TENS and IFC 5-10 sec for 15-30 mins

Question 13

20 y/o female soccer player c/o pain on L mid-portion of hamstring with swelling 30 minutes post injury

Answer 13

Moderation contusion

RICES
IFC

Question 14

RICES

Answer 14

Acute injuries

Swelling 
Pain
Muscle spasm 
Neural inhibition 
Secondary injury

Question 15

Cryostretch and Cryokinetics for which acute injuries

Answer 15

Cryostretch: 1 degree acute muscle strains, low grade muscle spasms, and contusions

Cryokinetics: acute joint sprains (ankle, finger, shoulder)

Question 16

Cold water immersion

Answer 16

Single or small groups

Question 17

Ultrasound: continuous and pulsed for what type of dose

Answer 17

Continuous: thermal dose
Extensibility of collagen (protein) fibers in tendon and joint capsules
Decreased joint stiffness
Reduce muscle spasm
Increased metabolism and blood flow

Tendons, ligaments, muscles, menisci

Pulsed: nonthermal dose
Tissue regeneration
Wound healing

Question 18

3 MHz ultrasound

Answer 18

Chronic degenerative conditions

Plantar fasciitis
Achilles tendinitis
Epicondylitis
Medial tibia stress syndrome

Continuous delivers thermal effects

Question 19

1 MHz ultrasound

Answer 19

Soleus
Piriformis
Hip adductor muscles
Bone healing

Pulsed delivers nonthermal effects

Question 20

During evaluation of athlete who is 2 weeks post ACL surgery

i. AROM 11-92 degrees
ii. Limited VMO activation
iii. Mild effusion
iv. Pain 2/10

Which of the following treatments/exercises are MOST appropriate at this time?

a. Weighted Prone Hangs ;
b. PNF stretches of the hip flexor group ;
c. PNF stretches of the hamstring group ;
d. Patellar mobilizations ;
e. High Volt monophasic setup continuous duty cycle

Answer 20

weighted prone hangs
PNF stretches of hamstring group
high volt monophasic setup continuous duty cycle