Monday, 27 December 2010
Saturday, 11 December 2010
Saturday, 4 December 2010
Tough, inflexible and 'leather like'.
Lines the inside of the skull where it's attached to the bones.
Arachnoid mater - Middle layer (separated from the pia mater by the subarachnoid space)
Delicate spider-web like structure
Attached to the inside of the dura
Surrounds the inside of the brain and spinal cord
(aracnoidea encephali & spinalis)
Pia mater - Delicate innermost layer
Thin / mesh like
Closely envelops entire surface of brain
Runs down fissures of the cortex
Supplies brain tissue with blood vessels
Subarachnoid space - Between arachnoid mater and pia mater is the CSF which absorbs and disperses excessive mechanical forces that might otherwise cause serious injury. It's produced by the choroid plexuses in the lateral ventricles and drains into the dural venous sinus into the internal jugular vein.
Monday, 25 October 2010
It usually results in HEMIPLEGIA (paralysis to one side of the body) which is contralateral to the side of the brain in which the lesion occurs e.g. stroke on L = hemiplegia on the R
An interruption of blood flow to the brain leaves the patient with a focal loss of function of varying severity.
Motor deficit is the the most common but other neurological deficits can include:
84% of strokes are ISCHAEMIC in origin
- Cerebral thrombosis (mainly affects older population with Hx of high cholesterol)
When a thrombus (blood clot) develops in a cerebral artery (usually one affected by atherosclerosis)
- Emobolic (mainly affects those with heart disease/previous heart surgery)
When a clot forms elsewhere in the body and becomes lodged in a cerebral artery
16% of strokes are HAEMORRHAGIC in origin
Major Risk Factors:
- Raised cholesterol
- Cardiac disease
Minor Risk Factors:
- Obesity (too much Maccie Dees!)
- Physical inactivity (being a lard arse!)
- Contraceptive pill (use a condom!)
- Excessive alcohol consumption ('boozing'!)
Wednesday, 15 September 2010
Player comes in complaining of tightness in anterior proximal thigh.
Q. Which muscle is it?
Process: Think what's likely to be tight in footballers? Running. What muscles originate from that area?
A. Narrowed it down to rec fem and sartorius. You had to palpate deep but resisted isometric strength test for sartorius came out on top. Resisted hip flexion did not.
Saturday, 4 September 2010
"it's easier to cross off all the one's it's not than try to immediately pick which one it is"
Turned out to be adductor magnus after I'd originally guessed gracilis. When I thought about it, you could quickly cross off pectineus and brevis because they're only one joint muscles and much higher up than where the patient was complaining. Longus potentially but the magnus 2 heads:
ORIGIN: inferior ramus of pubis & ischial ramus
INSERTION: gluteal tuberosity, linea aspera, proximal supracondylar line of femur
Vertical head (hamstring head)
ORIGIN: ischial tuberosity
INSERTION: adductor tubercle
Remember that anatomically speaking the oblique head FLEXES & ADDUCTS the thigh @ hip
(much like pectineus) and the vertical head EXTENDS thigh at hip (like a hamstring!)
The important thing to remember though is that these muscles work differently in function, but that's for another day.
Friday, 27 August 2010
Involved bronchi DIE! ... By which I mean the bronchi are:
This results in:
- Airway obstruction
- Impaired clearance of secretions
Necrotizing (flesh eating) bacterial infection
Look for frequent GREEN/YELLOW SPUTUM
Smell for bad breath
Q. What is frozen shoulder?
A. Essentially a chronic fibrosing condition in which fibroblast cells become overactive and lay down abnormally thick layers of collagen causing marked thickening of the shoulder joint capsule. The capsular lining of the joint subsequently contracts and leads to shoulder joint stiffness and pain.
Q. What are the features of frozen shoulder?
- Slow onset of pain felt near insertion of deltoid
- Trouble sleeping on affected side
- Restriction in both active and passive elevation & external rotation
Q. What's the difference between primary and secondary frozen shoulder?
See also Bowen technique
Wednesday, 4 August 2010
pH - 7.35 - 7.45
pCO2 - 4.7 - 6.0 kPa (35-45 mmHg)
pO2 - 11 - 14 kPa (80-100 mmHg)
HCO3 (bicarbs) - 22 - 26 mmol/l
BE (metabolites) - +2 - -2
Thursday, 20 May 2010
"Hello it's Thursday the 19th, it's the day after the viva exam and was there any point in worrying? Not at all."
Were my first words that I said on a recording of myself made about a week before my PAM 2 viva exam. I go on to speak about how I was comfortable and settled in very quickly, had an answering for every question, was able to elaborate on every question and that it went better than I thought it would and I had expected it to go well. Also that movement analysis was easy and was just a case of looking and working it out.
I had realised and taken action on the insight about BELIEF and visualisation. The more vivid, the more real, the more tangible you can make it the more likely it will become your reality.
I was constantly thinking and visualising myself doing well, not just well but great! Thoughts enterred my head during this with comments such as "come on, that's not realistic", "you can't really think that, it doesn't happen". But I just suspended those thoughts and accepted that it's just conditioned thinking and not a part of me. Like Tony Robbins advised, I dared to be powerful beyond measure. Or to put it more accurately, beyond expectation. My own expectation to be precise.
If you want to do something that nobody's ever done, that you've never done and/or that you think you can't do. DON'T EVER PUT A LIMIT ON YOUR DREAMS! That is your power! No one can tell you not to dream big, no one can stop you and for every person that says "it's just not realistic" (including yourself) shut them the fuck up! Like Will Smith said, "it's not realistic that somebody could walk into a room flick a switch and light would appear, that's not realistic". Thomas Edison didn't think so. "It's not realistic that someone can mould metal into an object and design it so that it can fly across oceans, that's unrealistic". Fortunately the Wright brothers and others didn't agree with that. Every great moment, every achievement that's wowed and surprised the world and made history has occured as a result of somebody saying "NO!" to thinking realistically and "YES!" to daring to dream, visualise and act upon creating something never done before, something incredible in their eyes.
Reality matched my voice recording to the letter by the way. To the absolute letter and I now have even more belief that the level we vibrate at, that energy you feel when you think of an idea or something you want to do that gets you so excited is sending out a signal to the universe that then conspires to assist you in making that a reality. If this sounds stupid to you, I don't care because it's worked for me on many occasions now and it seems like the more in tune I get with it, the better the results.
My advice to you is this. If you want to do something, be something, reach your goals and dreams start living them in your mind. Really living and experiencing them! If you get a thought that tells you to pull the reigns back because you're getting a bit to ambitious dream even bigger! Great moment are created when beyond achieve things beyond their own expectations of themselves. So work your imagination and stretch it as far as it will go and with action you'll go far :)
Thursday, 6 May 2010
Saturday, 1 May 2010
Friday, 30 April 2010
D1 - Deficient sensation (will be unaware if unstable cavitation is occuring resulting in burns)
D2 - DVT in treatment area (could become dislodged and cause pulmonary embelism)
O1 - Over spinal cord after recent spinal surgery (unstable cavitation in CSF)
O2 - Over pelvis or abdomen during menstruation or pregnancy
C1 - Compromised circulation (vessels can't deal with excess demand)
C2 - Cancer (irradiated tumours grow larger and heavier)
P1 - Physio untrained
P2 - Peripheral vascular disease (tissues can't cope with excess metabolic demand)
P3 - Previous deep x-ray therapy (radiotherapy)
M - Metal or plastic implants (cause more standing waves)
I - Infection in treatment area
N - No consent
S - S.E.G Skull, eyes, gonads
U - Unknown diagnosis
- Stabilise scapula by depressing shoulder
- Abduct shoulder 1st
- Extend wrist and fingers
- Laterally rotate
- Extend elbow
Apply each one fully and check if the patient's alright before progressing to the next movement.
Be aware of your posture and ELITE
Inform the patient of what you're looking for, for them to not adjust their position as it will effect the results of the test and may produce a false positive and to inform you if they feel any pain or parasthesia
Make sure patient is positioned properly on plinth so arm doesn't fall into horizontal extension or not enough room for abduction
- ANT can be used to both diagnositcally test (assess) and treat neural problem
Sunday, 25 April 2010
Wednesday, 21 April 2010
It can result from:
- thrombus formation
Causes either acute or chronic ischemia to arms or legs
Monday, 19 April 2010
Thursday, 15 April 2010
Hyperesthesia = a condition that involves an abnormal increase in sensitive stimuli of the senses (hear,touch,taste etc). Increased touch sensitivity is known as 'tactile hyperesthesia' and increased sound sensitivity is known as 'auditory hyperesthesia'.
Wednesday, 14 April 2010
Aetiologies for glenohumeral impingement can be divided into primary (direct cause) or secondary (indirect cause)
- Subacromial bursal thickening
- Increased subacromial loading
- Trauma (direct macrotrauma/repetetive microtrauma)
- Excessive overhead activity (too much waving to someone)
- Acromioclavicular arthrosis (osteophytes)
- GH laxity/instability (note: laxity may be normal for some people)
- Muscle imbalance
- Scapula dyskinesia (difficulty or distortion in performing voluntary movements)
- Glenoid labrum lesions (joint will be less stable if the socket depth is decreased)
Arthroscopic procedures can be used to evaluate or to treat many orthopaedic conditions such as: floating cartilage, torn surface cartilage, ACL reconstruction, trimming damaged cartilage.
Wednesday, 7 April 2010
'I' is for
'M' is for
Sunday, 4 April 2010
Saturday, 3 April 2010
- to increase muscle endurance and circulation whilst avoiding overexertion
Stage 2 - increasing resistance, add in isometrics in inner ranges
- designed to increase strength and sensitivity to stretch
Stage 3 - Continue to increase resistance (usually 80% 1RM) and add isometrics through a full but not maximal range
Thursday, 1 April 2010
Monday, 15 March 2010
2 main types: SUB ACROMIAL (supraspinatus tendon or subacromial bursa)
CORACO HUMERAL (long head of biceps or subscapularis tendon)
Tests to determine impingement: 'Empty Can' test, Kinetic medial rotation test (KMRT) to differentiate between impingement and instability.
Impingement can result from a number of factors but it's important to remember to not just concentrate on the area of pain the patient presents but to look at the big picture (i.e. kinetic chain) as the pain may be resulting from dysfunction or imbalance elsewhere. It could be a postural habit, a muscle imbalance, trauma or a combination of other pathologies that have led to the impingement syndrome.
REMEBER! at the initial assessment cast your net wide!
Saturday, 23 January 2010
- Greenstick fractures usually occur in immature bone (i.e. children)
- Pathological fractures are normally a result of cancer and/or osteoporosis etc
- When looking for problems with non-contractile elements, you'll get pain on passive, isotonic, active etc just NOT with isometric! Why? Because isometric is straining the soft tissues structures (i.e. muscle) and not stressing the joint!
- Remember during gait there is a lot of eccentric muscle activity occuring so don't get stuck in the concentric mind frame!
Sunday, 17 January 2010
- Physiological passive movements (mobilisations)
- Accessory movements (mobilisations) - Glides,Rolls,Distractions,Compressions,Rotations (cannot be performed actively)
- Passive stretching (mobilisations)
- Adverse Neural Tensioning (ANT)
- INTRA-ARTICULAR: subchondral bone; articular cartilage, synovial fluid, synovial membrane, menisci and fat pads
- PERI-ARTICULAR: joint capsule, supporting ligaments, tendons, muscles, fascia, skin, blood & lymphatic vessels, nerves
Normal Restrictions to Joint ROM:
- Joint capsule
- Muscles & their tendonous attachements (active/passive insufficiency)
- Bone/cartilage approximation i.e. shape and joint surface (loose packed,closed packed)
Abnormal Restrictions to Joint ROM:
- Increased synovial fluid volume/pressure
- Muscle imbalance
- Abnormal physiological changes in connective tissue due to immobilisation
- Decrease in water in tissue matrix = abnormal points of collagen cross-linking - 'adhesions'
- Atrophy of ligaments
- Tendons degrade
- Muscle contractures
- Nerve tensioning
- Synovial tissue atrophy
- Pain/guarding mechanism (muscle spasm)
Beneficial Physiological Effects:
- Maintains ROM/Increases ROM
- Cartiliage healing/nutrition (hydrokinetic transport)
- Smearing of synovial fluid reducing friction
- Appropriate alignment
- Increases lymphatic drainage/helps reduce oedema
- Assessment of passive ROM
- Diagnostic testing
- Maintaining joint ROM in a paralysed or unconscious patient
- Reducing joint pain
- Reducing muscle spasm / guarding
- Restoration of range (correction of 'mal-tracking and/or passive stretching)
- Facilitates healing process
- CANNOT CHANGE DISEASE PROCESS
- WILL NOT prevent muscle atrophy
- WILL NOT increase strength or endurance
- Excessive pain
- Joints adjacent to unstable fractures
- DVT in area
- Active inflammatory (R.A)
Range of Motion
- Direction of movement will depend on the desired efffect
- Amplitude of the passive movement can be graded to indicate where in the available range the technique is being performed
- Helpful in matching the induced range of P.M. to the desired mobilising effect depending on the irritiability of the lesioned structure
Maitland Grading Scale
- 1 - SMALL amplitude movement performed at the beginning of range (within resistance free zone)
- 2 - LARGE amplitude movement performed within a resistance free part of the range
- 3 - LARGE amplitude movement performed into resistance or up to the limit of resistance
- 4 - SMALL amplitude movement performed into resistance or up to the limit of resistance
- 5 - High velocity, short amplitude thrust often near or at the limit of abnormal movement, at speed outside of patient's control
Friday, 15 January 2010
- Weight bearing appropriate?
- Reactive (external stimuli or not and are these varied in weight,size,shape if objects, speed, is the trainer or therapist the stimuli?)
- Goal driven?
- Functional? (e.g. sports specific)
- Base of support (wide, narrow, stable, unstable)
- Visual Stimuli or no visual stimuli (eyes closed or open?)
- Pace (slow or quick? Does it hit the slowly adapting and rapidly adapting proprioceptors?)
IS THE EXERCISE...
- Weight bearing appropriate? (NWB/PWB/FWB)
- With or against gravity? (e.g. gravity counter balanced or additional resistance - Oxford Scale)
- OVERLOAD (is the target muscle or muscle group being stressed enough to elicit an adaption?)
- SPECIFICITY (SAID - Specific Adaptions to Imposed Demands)
- Single plane or multi-plane? (is the muscle being loaded in all 3 planes?)
- Open or closed chain?
- Ranges? (through full ROM? Inner/Mid/Outer - appropriate to rehab level?)
- Isometric/eccentric/concentric (appropriate to stage of injury?)
- Fibre recruitment (is it recruiting the fibres required for their function e.g. Type I, Type IIa/IIb slow and fast twitch)
- Intensity (high/med/low?)
- Reps & Sets? (endurance,hypertrophy,strength) avoid atrophy
- Isolated or intergrated? (compound/mutli-joint exercise or isolated muscle?)
Thursday, 7 January 2010
- 2 degrees freedom of movement (flexion/extension & ext/interal rotation)
- Conjunt rotation (external rotation) occurs during the last 30 degrees of extension to
achieve closed packed position (automatic/accessory movement)
- Adjunct rotation (physiological/voluntary) movement in flexion
ANKLE - Uniaxial hinge type synovial joint
- Between tibia/fibula and trochlea of talus
- Reinforced by fibrous capsule, medial deltoid ligament (4 parts), lateral ligament
- 1 degree freedom of movement (dorsi/plantar flexion)
HIP - Multi axial ball & socket synovial joint
- Between acetabulum and head of femur
- Acetabular labrum deepens the acetabular cavity creating more stability
- Fibrous joint capsule reinforced by 3 ligaments
- 3 degrees freedom of movement (flexion/extension, ab/adduction, med/lateral rotation)
MTP - Multiaxial condyloid synovial joint
- Surrounded & strengthened by articular capsules and collateral ligaments
- 2 degrees freedom of movement (flexion & extension & ab/adduction)
Tuesday, 5 January 2010
2) Local initial vasoconstriction (to limit fluid loss - but results in more cell death due to increased lack of oxygenated blood available at injury site)
3) Release of chemical mediators (histamine/serotonin etc) from dying cells causing VASODILATION or surrounding undamaged vessels, increasing their permeability, which can be seens as REDNESS (erythema) and felt as HEAT (calor) - permeability allows leukocytes to emigrate into site of injury guided by chemotaxis.
4) Damaged nerve endings give rise to pain (dolor), chemical irritation from mediators and increasing pressure from excess fluid and inflammatory exudate in the area (more responsible for pain in the later stages)
5) 'Walling Off' - Local vasodilation is not enought to prevent fluid loss so we get platelets activated by cell death (necrosis) become very sticky and release chemicals to activate the enzyme thrombin which converts fibrinogen (element of blood plasma) into FIBRIN which creates a sticky matrix to trap cellular debris and platelets to form a blood clot (temporary solution to fluid loss)
6) Leukocytes (neutrophils 6-24 hrs / monocytes & lymphocytes 24-48hrs) or white blood cells clear debris that wasn't caught by the sticky matrix and fight off an infection present.
7) Histamine causes local vasodilation within hours to introduce new plasma* rich blood for next stage of repair (each phase is laying the ground work for the next)
*Plasma = liquid portion of blood (90% water)
- Sarcomere - The portion of a myofibril between two Z-discs
- Sarcoplasmic reticulum (SR) - Loose network of flattened tubules that surrounds the myofibrils in the muscle cell
- Transverse 'T' tubules - Invaginations of the sarcolemma that allow muscle action potentials (electrical chemical impulses) to pass into the centre of the cells causing depoloraization and release of calcium ions from the SR (run over and around the sarcoplasmic reticulum)
- Terminal Cisternae (lateral sacs) - Expanded regions of the SR, found on both sides of T tubules
- Calcium ions - concentrated in the SR when muscle fibre is at rest (flood out when muscle contracts)
- Triad - A T tubule and two terminal cisternae
- Sarcolemma - the plasma membrane in muscle fibre
- Muscle fibres are multinucleotide - Being exceptionally wide and long, muscle fibres (0r cells) need many nuclei to regulate the metabolic demands of contractile proteins (e.g. actin and myosin)
- Sarcoplasm - The protein filled cytoplasm of muscle fibres
Sunday, 3 January 2010
- Ongoing phagocytosis
- Production of collagen fibres (initially produced in random fashion)
- Absorption of inflammatory exudate
- Severity of initial trauma: A severe second degree ligament sprain of the lateral ligament complex of the ankle will have a more prolonged proliferation and remodelling period than a first degree ligament sprain affecting the same structure.
- Early Management: When the necessary foundations have been set in place (e.g. protection, rest of tissues etc) for proliferation and repair can potentially reduce onset of chronic inflammation.
- Tissue Vascularity: e.g. skeletal muscle = highly vascular = more potential for repair than a a ligament = avascular
- Age: Younger people are quicker to heal than older
- Nutrition: e.g. protein deficiency, adequate nutrition that is also related to bloodflow is required for healing to take place
- Medication: Use of NSAIDS and steroidal drugs slow down proliferation and remodelling processes.
- Temperature: Colder it is = slower rate of healing
- Appropriate loading of healing tissue during rehab
- To reduce pain
- To limit and reduce inflammatory exudates
- To reduce metabolic demands of tissue
- To protect the newly forming tissue from disruption
- To promote new tissue growth and fibre alignment
- To maintain general levels of cardiovascular and musculoskeletal fitness / activity
'REDUCE, REDUCE, PROTECT, PROMOTE, LIMIT, MAINTAIN'