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There are a multitude of products to be used in physical therapy practices for lower-extremity injuries, and choosing tools that are not only useful, but also safe and cost-effective, can be a challenge. This article will highlight three common lower-extremity injuries—lateral ankle sprain, patello-femoral pain syndrome, and chronic hamstring strain—with suggestions for effective treatment tools.
LATERAL ANKLE SPRAIN
Lateral ankle sprains are very common injuries, but they can be especially challenging if [url=http://www.davidhabchy.com]barbour outlet[/url] they are recurring incidents as ligamentous laxity and muscular weakness often become chronic problems. One of the largest challenges in [url=http://www.1855sacramento.com/woolrich.php]woolrich bologna[/url] treating a lateral ankle sprain is instability, especially following a recurrent sprain. A major focus on the treatment should be to treat the acute deficits first, and then address any issues that may predispose the patient to reinjury.
Due to loss of proprioception and stretching of the ligaments and surrounding musculature, [url=http://www.sandvikfw.net/shopuk.php]hollister outlet sale[/url] balance is often a major deficit. Depending on the [url=http://www.getconversational.com]hollister france[/url] degree of the sprain and the severity of symptoms, the patient should gradually progress balance activities. One of the easiest ways to progress balance is by changing the surface. Balance is achieved by the use of three sensory systems: vision, proprioception, and vestibular. By changing the surface, it challenges the patient's proprioception and causes them to rely on the other systems. [url=http://www.achbanker.com/home.php]hollister[/url] Through training, they can gain ankle strength and also improve other components of balance.
Airex balance pads—available from Perform Better, [url=http://www.rathmell-arch.co.uk/hollister.html]hollister uk[/url] Cranston, RI, or OPTP, Minneapolis)—come in a variety of shapes and sizes. There is the standard balance pad, a larger XL pad, balance wedges, and a balance beam. Balance pads have a nonslip surface, which allows for dynamic movement, and they can be stacked on top of one another to increase instability, thereby further challenging the patient. The therapist can progress their patient through static or dynamic exercises, eventually progressing to squatting and lunging or tandem walking on the unstable surface.
Chango balance paws can be strapped to the bottom of a sneaker and used for standing, walking forward or backward, lateral movements, and then progressing to functional movements such as squatting and lunging. They are shaped like a half-sphere, provide multidirectional challenges, and can be fun for younger patients.
An advanced balance progression might try using the Core-Tex balance disc. The Core-Tex consists of a solid base and a dish that sits on top in a "floating design" upon three ball transfers, which causes the patient to frequently correct their posture in order to maintain upright position. It is designed to activate the core through constant balance shifting and can be used in standing, kneeling, sitting, etc. A safety handle can also be purchased for older or more unstable individuals. The Core-Tex is available from Exertools, Petaluma, Calif.
PATELLO-FEMORAL PAIN SYNDROME
Patello-femoral pain syndrome, or PFPS, is a common cause of anterior knee pain. It is somewhat of a catch-all term for retro-patellar knee pain resulting from changes in the mechanics of the patello-femoral joint. The pain is usually caused by improper tracking of the patella on the patello-femoral groove of the femur. The cause of this condition is usually multifactorial. Common contributors to PFPS are overuse, use of poor footwear/lack of supportive footwear, vastus medialis weakness, ilio-tibial band tightness, and weakness of the proximal hip musculature (such as abductors and external rotators). The clinician should first assess for probable causes and address muscle imbalances.
Squatting and stairs are often very painful for the patient, and poor mechanics during these movements can contribute to pain. An easy way to retrain squatting patterns is through use of the TRX suspension trainer from Fitness Anywhere, San Francisco. The TRX is made from heavy nylon straps that can be anchored on a doorway, wall, or pole. The sturdy material can hold up to 1,000 pounds. The straps allow the use of the upper body to support while performing a squat, therefore reducing load on the patello-femoral joint.
Through a body-weight-supported squat, the patient can slowly perform the movement while the therapist corrects form: knees over toes, increased forward trunk flexion, or a valgus movement at the knee joint (to name a few corrections). As the patient improves, the TRX can be used to progress past squatting activities for single-leg movements, core strengthening, etc.
Another way to train multiple muscles such as the quadriceps, hip abductors, and external rotators is through resistance tubing and bands. They can be used free-form or anchored to the wall to allow for increased control. The Lifeline Wall Gym 2000 is a cable system with [url=http://www.mylnefieldanalysis.co.uk/barbour.html]barbour factory shop[/url] multiheight attachments as well as a horizontal bar for overhead movements. It allows for attachments at any level and is wall mounted to save space. Examples of exercises on the Wall Gym 2000 include: steamboats (standing on the affected leg and briskly kicking the unaffected leg in different directions, promoting balance and stability), squatting with band crossed above the knees and directing the patient to maintain alignment without going [url=http://www.1855sacramento.com/peuterey.php]giubbotti peuterey[/url] into valgus position, and lunging with a resistance band around the trunk to provide increased resistance.
Once the patient progresses in terms of core stability and dynamic control, you may want to move away from a wall- or door-mounted piece of equipment to allow for increased difficulty. A great way to progress squatting and lunging patterns is through the use of the ValSlide, created by fitness trainer Valerie Waters. The ValSlide consists of plastic discs padded with foam that are able to slide on carpet, tile, and linoleum. They can be used for both upper- and lower-extremity exercises and allow for varying degrees of movement, especially lateral movements and lunging.
If muscular endurance is an issue for the patient, they may benefit from the use of a recumbent bike or the NuStep. The NuStep is a recumbent cross trainer that involves both the lower and upper extremities. It allows the patient to adjust the resistance and can gradually allow them to increase difficulty as strength and endurance improve. It can be particularly beneficial for unloading a painful patello-femoral joint.
CHRONIC HAMSTRING STRAIN
Hamstring strains can vary across the board in terms of severity of [url=http://www.achbanker.com/home.php]hollister france[/url] the injury to the muscle, and they can occur in a variety of ways: forceful kicking, running, strength training, etc. As the hamstring heals, it will often form adhesions, which will prevent the muscle fibers from laying down in their normal orientation. Breaking up adhesions can be done with manual treatment such as massage or myofascial release, but there are plenty of tools that the patient can use to promote proper healing in the muscle.
Prior to choosing a rehabilitation strategy involving soft-tissue mobilization, the clinician should apply palpation skills to determine whether it is appropriate for the injury. Appropriate healing time should also be considered. Once the clinician feels it is appropriate to perform soft-tissue mobilization, the patient can assist in this treatment technique.
A portable tool to address adhesions is the Stick-self roller massager. The Stick comes in a variety of sizes and consists of a solid core that has rotating plastic spindles around it. The spindles allow for varying degrees of pressure, and the patient holds both ends of the spindles, which enables them to adjust the intensity of the massage as [url=http://www.mansmanifesto.com]doudoune moncler[/url] needed.
Foam rollers are portable tools to promote blood flow and break down adhesions. For some patients, using them may be easier than using the Stick [url=http://www.rtnagel.com/louboutin.php]louboutin pas cher[/url] because they are able to sit or lie directly on the foam roller and massage. Foam rollers [url=http://www.rathmell-arch.co.uk/hollister.html]hollister outlet[/url] come in a variety of lengths and densities, allowing for different depths of massage. The PB Elite soft molded foam roller, from Perform Better, is soft and somewhat dense. The PB Elite molded foam roller is denser than the soft roller and can be used when increased intensity of massage is required. Increased intensity or depth of the massage may be required depending on the chronicity of the injury or if the patient prefers more pressure in order to feel relief.
The Rumble Roller is another option. While it may look intimidating, this roller has small but flexible bumps covering its surface. The bumps allow for focal pain reduction in small areas and, like regular foam rollers, the Rumble Roller also comes in various densities and sizes.
If sore spots are difficult to isolate with the rollers, a posture ball can be used. A posture ball is made of EVA foam material and can be placed under any part of the extremity to address focal points of tightness and pain. The posture ball is durable enough to retain its shape even after prolonged use.
These treatment options are just part of a strategy to be included in a comprehensive treatment plan for ankle sprains, patello-femoral pain syndrome, and chronic hamstring strains. The clinician must evaluate the patient for other deficits and apply proper principles of healing in order to effectively rehabilitate the injury.
However, these treatments are suggested to address common deficits, such as instability, muscle imbalance, and scar tissue formation, associated with common outpatient physical therapy injuries.
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