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CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

  1. Understand and describe the principles of a comprehensive rehabilitation program during the various phases of healing.

  2. Discuss the various components of the intervention and their respective importance.

  3. List the clinical tools that can be used to decrease pain and inflammation and promote healing.

  4. Discuss the intrinsic and extrinsic stimuli that can be used to promote and progress healing.

  5. Describe the benefits of each of the electrotherapeutic modalities.

  6. Describe the benefits of each of the physical agents and mechanical modalities.

  7. Understand the rationale for the therapeutic techniques used in each of the three stages of healing.

  8. Understand the importance of patient education.

OVERVIEW

OVERVIEW

Clinicians make recommendations on how best to manage patients, and these recommendations are often characterized by different clinical and philosophical approaches that range from biomechanical to psychological.1 The goal of an intervention (Box 8-1) is to address the impairments noted in the initial examination. Intervention, using evidence-based practice (EBP), can be organized into the following three categories2:

  1. Remediation. Consists of enhancing skills and resources or reversing impairments through symptom-modification with the assumption that the potential for change exists in the system and the person. The historical approach for this was to identify the structure associated with the patient’s pain and symptoms by using a series of orthopaedic tests. However, this approach has been challenged recently by multiple investigations that suggest that, in isolation or in combination, clinical tests are often incapable of identifying the structure associated with the symptoms with sufficient confidence.1 Similar findings have been highlighted between the results of imaging studies and their correlation with patient symptoms in the absence of trauma and ominous pathology. To address this uncertainty, clinicians and researchers have suggested that clinical practice could be guided by the identification and modification of potential kinematic, kinetic, or motor control impairments in musculoskeletal function, that is, a kinesiopathological approach.1,3

  2. Compensation or adaptation. Refers to the alteration of the environment or the task and is the approach taken when it is determined that remediation is not possible.

  3. Prevention. Refers to the management of anticipated problems.

The purpose of the physical therapy intervention is to prevent any anticipated problems whenever possible, and to safely return a patient to his or her preinjury state, with as little risk of reinjury as possible and with the minimum amount of patient inconvenience. For muscles and tendons, this is generally accomplished through measured rest, physical therapy procedures and techniques including, manual therapy, high-voltage electrical stimulation, central (cardiovascular) aerobics, resistance exercises, and general conditioning, while avoiding compromise to the healing structures. For the inert structures, such as ligaments and menisci, more emphasis is placed on controlling the level of tension and force placed on them. Beyond the healing phase, the progression may include advancing to high-functional demands or ...

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