View
4
Download
0
Category
Preview:
Citation preview
5/4/2018
1
Physical Therapy in
Spondyloarthritis
Angelo Papachristos BSc, BScPT ,CAFCI, MBA
Advanced Practice PhysiotherapistSt. Michael’s HospitalToronto, Canada
Boston, May 3, 2018
PT Management: What the Rheumatology Trainee Needs to
Know
Disclosures
• Nothing to disclose related to topic and discussion material
Objectives
• To better appreciate the common rehabilitation therapies and treatment modalities utilized in the treatment of spondyloarthritis in ambulatory care practice
• To appreciate the current rehabilitation landscape when referring clients for therapy
• Have basic understanding of treatment protocols and care plans implemented by PT
5/4/2018
2
• Strong recommendation:
– Physical therapy over no physical therapy
– Supervised exercise over passive interventions (massage, ultrasound, heat)
– Land based over aquatic therapy
“What does a rheum trainee
need to know”…about PT and SpAmanagement
1. Provide Education
2. Stretch/Strengthen/Postural
3. Cardiovascular conditioning programs
4. Mobilize / Manipulation
5. prescribe assistive devices / bracing / splinting / orthotics
6. Use of Therapeutic Modalities [electrotherapy and non-electrotherapeutics]
7. Ergonomic and functional abilities evaluation
Common Modalities
• TENS –Transcutaneous Electrical Nerve Stimulation
Interferential Current (IFC)
5/4/2018
3
Therapeutic Ultrasound Therapeutic Ultrasound
• Actually NOT a form of sound or electrical energy…..
• Mechanical Energy
• Piezoelectric crystal vibration at high frequency producing sound energy
• Typically humans hearing 16 Hz-20000Hz
• Ultrasound typically 1-3 Million cycles per second
• It is Pro-inflammatory
1 MHz vs. 3MHz
Half Value Depths
Blood Fat Nerve Muscle Skin Tendon Cartilage, Bone
Increased Protein content RESULTS in Increasing absorption
• To some degree operator dependent [settings, dose, duration, proper application]
• Reflection of almost all US at metal/air interface (>99.99%)
• Refraction if beam does not strike surface at 90°. ie the path of beam will be angled. If treatment head is at angle >15° beam will just travel via the dermal tissue /parallel to skin surface.
Pulsed vs. Thermal
• Thermal – essentially continuous wave,generates deep heating in tissue. Can raiseinternal temp to 40-45° and cause tissuehyperemia. Possible use in chronicinflammatory state
• Pulsed (Athermal): interrupted pulse,combination of cavitation and acousticstreaming. Most effective in proliferativestage, early remodeling stage
Low Level Laser Therapy [LLLT]
Superficial application of laser at wavelengths of 632-904 nm
The penetration of both He-Ne and infra-red lasers was observed for only a few millimeters.
The most important absorption was observed at the depth level of 0.4 and 0.5 mm.
5/4/2018
4
Acupuncture /Dry needling
12 Standard Meridians, 8 extraordinary channels 400 standard acupuncture body points
Graston Technique• “Changing the way soft tissue injuries are treated. Graston Technique® is
an evidence-based form of instrument-assisted soft tissue mobilizationthat enables clinicians to effectively address scar tissue and fascialrestrictions through comprehensive training, resulting in improved patientoutcomes”
Knee acupuncture /electroacupuncture
Yes…TAPE…because we can….
Shoulder Impingement /RC Cupping
5/4/2018
5
Acupuncture/ Moxa
Exercise Benefits
• Increased cardiovascular endurance• Reduced blood pressure and stress• Increased good cholesterol (HDL) • Maintains muscle mass• Maintaining bone density• Maintain or reduction in weight• Psychological –improves well being,
depression• Improves fatigue• Pain reduction / pain modification
ACSM RECOMMENDATIONS
Exercise Benefits –
Recommendations - Guidelines
• Osteoporosis Guidelines
▫ Exercise (30 min 5X /week , stretch 2X/ week), quit smoking, ↓ ETOH, ↓ Caffeine, ↑Vit. D.
• Diabetes Guidelines
• Osteoarthritis Guidelines
• Cardiac Guidelines
• Chronic Fatigue, Depression, Fibromyalgia
5/4/2018
6
% grade 9-12 students watching >3 hours TV /school night
5/4/2018
7
Get Started –Home Exercise
www.wegotyourbacktwh.ca
5/4/2018
8
iPhone App
5/4/2018
9
Neck Retraction
1 2
5/4/2018
10
12
3
140°
1.5-2 feet
5/4/2018
11
5/4/2018
12
Supine to Sit -Bed Rise from Chair
5/4/2018
13
Lumbosacral Rotation
Core –rotation with weighted ballSummary
• 150 minutes per week of physical activity is magic number!
• Passive modalities not indicated in SpA –exception rather than rule
• Link with physiotherapist /facility in community
that has interest in SpA
• Physiotherapy intervention for most part is to develop, monitor and alter physical fitness and wellness program for SpA over time.
• Program must be patient specific /setting specific
5/4/2018
14
Questions?
Core with weighted ball - BOSU
5/4/2018
15
Recommended