Student: Stanley

Respond to the 4 post below. (100-200 words)

Respond to the 4 post below. (100-200 words) APA Format- NO TITLE PAGE DUE FRIDAY April 24, 2020 (On time please) 1. ADAM JENT Now that we have a definitive diagnosis for our patient’s shoulder pain, we can begin to focus on his rehabilitation in order to help him return to his training as quickly as possible. In an article by Harvard Health (2019), the authors tell us that rotator cuff tendinitis is the most common source of shoulder pain and will usually take between 2 and 4 weeks for recovery, so long as the case is not more advanced and severe. Since our patient just recently started his training, I assume his case will be easier to work with, so I will operate under the assumption his rehabilitation will fall within this typical time frame. As we begin to plan for our patient’s rehabilitation exercises, it is important to consider the variables that should be addressed in order to help the patient return to his sport. Reinold and Curtis (2013) teach that we should focus on range of motion, strength, stabilization, and neuromuscular control to effectively eliminate the pain our patient is experiencing. Reinold and Curtis continue to explain that our approach to treating our patient’s shoulder pain should take place across 4 phases: the acute phase, intermediate phase, advanced strengthening phase, and return to activity phase. For our treatment, the corresponding phases and their exercises can be seen outlined below, per the suggestions of Reinold and Curtis. Phase 1: Acute Phase Our goal in the phase is to reduce the inflammation in the patient’s shoulder while simultaneously attempting to improve the strength and dynamic stability of his shoulder. During this time, our patient should avoid repetitive activities that exacerbate his pain. Additionally, it will be helpful for our patient to take anti-inflammatory medication and periodically ice the shoulder in order to assist with the reduction of inflammation in the shoulder. Exercises we will use during this phase will utilize light weight and generally be of lower intensity. Exercises we will use in this phase include: • Side lying external rotation using exercise bands • Prone rows • Internal rotation using exercise bands • Cross body arm stretch • Finger walks up a wall In order for our patient to progress to the next phase of treatment, they will need to demonstrate an improvement in their shoulder strength while having minimum to no pain or inflammation in the shoulder. Phase 2: Intermediate Phase As our patient enters phase 2 of rehab, Reinold and Curtis tell us that our goals should now expand our focus to continue strengthening the shoulder while restoring muscular balance between external and internal rotation while also maintaining flexibility and mobility of the joint. In this phase, we will include the previous exercises with increased weight/resistance while adding a few new exercises as well. The new exercises will include: • Exercise ball push-ups for increased stabilization • Stabilization using a ball against the wall • Two-handed plyometrics In order to progress to the next phase of rehab, our patient will now need to demonstrate the ability to go through a full range of motion in the absence of pain. Phase 3: Advanced Strengthening Phase For this phase of rehabilitation, our primary goal is to further improve the strength of our patient’s shoulder. In order to accomplish this, it is best to continue with the previously mentioned exercises while increasing the weight or resistance as needed. Additionally, we can now include one-handed plyometric exercises into the patient’s program. Reinold and Curtis suggest that these exercises can include the following: • 90/90 throws • Wall dribbling • Wall stabilization while the arm is in 90° abduction and external rotation If the patient is able to demonstrate full range of motion and shoulder strength at this time, it is safe to move them into the final phase of rehab. Phase 4: Return to Sport At this time, we will begin to ease our patient back into swimming. Instead of giving him the full green light for training, it would be more prudent to limit his time in the pool to prevent a recurrence of the shoulder pain. By easing him back into a training routine that allows a progression to the distances needed for his triathlon, his chances of avoiding this issue in the future is enhanced. Besides these basic rehabilitation exercises, I think the medical provider overseeing our patient’s care is likely to suggest our patient uses NSAIDs, as previously mentioned, along with intermittent icing of the shoulder as well. Additionally, I believe the provider will instruct our patient to avoid overhead activities that are repetitive or result in pain in the shoulder. For our patient, this means he will have to take time away from training for the swimming portion of his triathlon until he can advance through the stages of rehabilitation outlined above. Additionally, I feel that myofascial release techniques can be used to enhance the experience our patient has in his treatment. Bron, et al. (2011) claim that 55% of shoulder patients studied report even greater improvement in their pain levels after this type of treatment. 2. Marcus C Depending of what state and what techniques are available the following tools may be utilized in a chiropractic office, spinal manipulation, joint mobilization, dry needling, class 4 laser therapy, manual myofascial release, extracorporeal shockwave therapy, and therapeutic exercise. If I was treating this patient I would use spinal manipulation, dry needling, and therapeutic exercise. Tendon injuries have three phases of healing which are the inflammatory (1-7days), repairing (1-5 weeks), and the remodeling phase (post 6 weeks) (Camargo, 2014). With this in mind I would set up a treatment plan for 6 weeks. I would use spinal manipulation every visit if the thoracic spine had mobility deficits due to its relationship with shoulder injuries (Muth, Barbe, Lauer, & McClure, 2012). For the initial phase 3 dry needling treatments of the rotator cuff muscles and tendons as well as the trapezius and levator scapulae. Dry needling has been shown to increase range of motion, decrease nocicepetion, and promote a positive inflammatory environment for remodeling (Dixit, Bishop,Erickson, & Romeo, 2019). Lastly for the initial phase the patient would be instructed to self mobilize the shoulder into a direction that reduces symptoms. The patient may end range load either shoulder flexion, extension, horizontal abduction, or extension with internal rotation for 10 repetitions every 2 hours everyday for a week (Kidd, 2013). These therapies should improve range of motion and decrease pain to allow for the progression into the active intermediate phase. From the second to the sixth week therapeutic exercises will be utilized to strengthen the rotator cuff muscles as well as the scapular stabilizers. Eccentric exercises of external rotation and scapular plane abduction will be performed consisting of 3 sets of 8 repetitions 6-8 seconds per repetition twice a day(Dejaco, Habets, Van Loon, Van Grinsven, & Van Cingel, (2016). Scapular stabilizing exercises of 3 sets of 10 will start in a static position and advance to more dynamic positions. These exercises include push up plus, wall angels, and banded wall walks. Starting the third week the patient will be allowed to start swimming again at a decreased volume and progress each week (Matzkin, Suslavich, & Wes, (2016). 3. Todd S 1. Rehab Program • Inactive phase o Goal: to decrease the amount of inflammation surrounding the injured area and to decrease the patient’s perception of pain (Houglam, 2016)  Therapeutic modality intervention  Low level laser therapy – anti-inflammatory, analgesic, and wound repair effects (Awotidebe, Inglis-Jassiem, & Young, 2015)  Passive range of motion exercises  Shoulder: Flexion, extension, adduction, abduction, internal/external rotation  Elbow: flexion, extension  Cervical: flexion, extension, rotation, lateral flexion  Thoracic: flexion, extension, rotation, lateral flexion • Active phase o Goal: improving flexibility, ranges of motion, and overall mobility of the joint (Houglam, 2016)  Active range of motion exercises – addressing the same areas as passive ROM  Progress to resisted ROM when the patient demonstrates proper active ROM  Neuromuscular exercises: rhythmic stabilization, mirroring exercises with eyes closed and eyes open (Partin, Stone, Ryan, Leuken, & Timm, 1994) • Resistive phase o Goal: regaining strength and endurance (Houglam, 2016)  Continue ROM, progress on to strengthening exercises  The following band exercises would be included (Meister & Seroyer):  Standing row  External rotation with arm abducted to 90 degrees  Internal rotation  External rotation  The patient could then use dumbbells to work on bicep curls, trapezius kickback, lateral raise  Continue neuromuscular exercises • Return to activity phase o Goal: promote restoration of proper sport-related biomechanics and decrease their risk of developing another injury (Houglam, 2016)  At this point in the program, the focus is on the patient’s swim technique. During the freestyle there are essentially four phases – hand entry, early pull through, late pull through, and recovery (Spigelman, Sciascia, & Uhl, 2014). Having the patient start using only a kick board and progressively working back into his routine is where I would start. As we have the patient progress to a freestyle swim, we would want to monitor his hands, elbows, shoulders, and body rolls (Spigelman, Sciascia, & Uhl, 2014). If any deficiencies were noted, the patient is probably compensating somehow so I would work to correct the improper mechanics. I found an article with a lot of exercises that I didn’t want to list here, so if anyone is interested it’s in the references. 2. Other treatment options • Chiropractic care o Each visit the patient could be assessed for areas of joint restriction in the cervical and thoracic regions, as well as the upper extremities. 4. GINA Rotator cuff tendinitis is a common injury in overhead athletes which makes sense as a final diagnosis for the case of our swimmer. The repetitive overhead motion causes trauma and the shoulder tissues need to adapt. Overhead athletes often present that the laxity in the anterior capsule of the glenohumeral joint increases while the posterior capsule gets tighter (Giangarra et al. 2018). Since our athlete presents only inflammation, we should address these before it gets aggravate and a worse injury happens. Our goal is to strengthen the rotator cuff and scapulothoracic musculature, recover the laxity of the posterior capsule, and improve postural habits. According to Tovin et al. (2006), this athlete should take some precaution during the rehabilitation program before returning to the water, “Activity modification in swimming may consist of the following tasks: • Temporarily reduce training distance and frequency. • Alter training patterns so that different strokes are used more frequently throughout the practice. This alteration will reduce the repetitive pattern at the glenohumeral and allow the muscles to function differently. • Avoid the use of hand paddles, kickboards, and surgical tubing. • Use swim fins to enhance the propulsion from the legs and reduce the stress on the shoulder” The following is the rehabilitation program prescribe to the athlete: Phase I • Goals o Decrease inflammation o Decrease pain o Increase posterior capsule laxity - active ROM o Increase rotator cuff scapulothoracic musculature strength o Avoid overhead activities o Educate about better postural habits • Treatment o Active ROM  Pendulum stretch  Inferior capsule stretch  Glenohumeral joint manual mobilization  Active assisted forward elevation  Active assisted external rotation  Cross-body adduction  Finger wall  Pulley o Strengthing exercises  Isometric shoulder flexion  Isometric shoulder extension  Isometric abduction  Isometric external rotation  Isometric internal rotation Phase II • Goals o Progress strength exercises o Improve ROM o Improve neuromuscular function • Treatment o Flexibility (The following stretches are in addition to the current ones)  Sleeper stretch  Wall stretch (get as closer to the wall as you can)  Pectoral major and minor stretch o Strength exercises  Internal rotation  External rotation  Horizontal abduction external rotation  Shoulder flexion (Protaction)  Shoulder extension (Retraction)  Prone row on stability ball  Prone T, Y, W, L on a stability ball  Scaptions  Bruggers  Bicep curls  Tricep extension *Perform these exercises with elastic bands or light weights. Do 1-2 sets of 10 repetitions. Phase III • Goals o Continue the current ROM exercises o Continue and progress the strengthing exercises o Start functional training • Treatment o Strength exercises  Prone on stability ball horizontal abduction to external rotation  Prone forward elevation with external rotation  Standing scaption with external rotation  Push up plus  Scapular pull-ups  Pull apart  Scapular squeeze  Elastic band rows  Lat pulldown  Shoulder taps  Shoulder flexion with mini-band  Military presses  Z presses  Clap to push-ups (Incline surface first then progress to the floor)  Ball on wall circles  Ball on wall alphabet  Wall out on stability ball  Arms step over *Perform 2-3 sets of 10-12 repetitions. *In this phase, we can start to incorporate some lower body and lumbopelvic stability and strength training. Phase IV • Return to swimming • Continue the ROM exercises • Continue the shoulder exercises • Prioritize and focus on lower body and lumbopelvic stability and strength on sports specific Criteria to return to swim • The athlete shouldn’t present any pain • Full ROM • Proper stability and strength

Budget: $20.00

Due on: April 24, 2020 00:00

Posted: 6 months ago.

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