Degenerative Joint Disease: Introduction (10:07)
Shane Malecha introduces himself and asks participants what they hope to gain from the conference. This seminar will describe medications as well as modalities to help with pain management.
Osteoarthritis: Introduction (13:00)
Those afflicted will experience constant pain if they are experiencing an active inflammatory state. The disease process begins after the age of 25 and normally manifests in the lower extremities; patients may grow osteophytes to try to stabilize the joint and limit motion. RA is a systemic autoimmune disease and affects other body systems and not just a particular joint.
Stages of OA (16:26)
Osteoarthritis begins after the age of 25 on average. Cartilage acts as a cushion and creates synovial fluid. Malecha describes the pathophysiology of DJD.
Joint Pain (16:02)
Patients tend to move less, causing muscle atrophy. After three weeks of performing muscle-strengthening activities, patients report less pain. Risk factors for OA include age, weight, overuse injuries, athletics, genetics, and weak muscles.
OA Management: Introduction (16:53)
Treatments for osteoarthritis include modalities, weight reduction, splinting devices, pharmacology, and nutrition. Ultrasound and diathermy must be given three times a week to achieve a cumulative effect. Induce an inflammatory response to reduce chronic pain.
OA Management: Proliferation and Remodeling Stages (10:36)
Malecha discusses Wolff's Law and Davis' law regarding bone and soft tissue remodeling. During the inflammatory stage, patients experience heat, swelling, redness, and loss of function in the joint. Justify continuation of physical therapy in clients with several co-morbidities by using smaller measurements.
OA Management: Modalities (16:52)
When reading literature, examine who funded the research because it may be a conflict of interest. Electronic stimulation, ultrasound, and diathermy do not cure a patient of pain but can help the joint's range of motion during stretching. Malecha discusses gate control, opiate-mediated control, and muscle weakness theory parameters for different machines.
OA Management: Ultrasound (24:19)
Malecha discusses the parameters, benefits, and drawbacks for using this modality. Most clinics have electronic stimulation and ultrasound, but Diathermy and light therapy tend to be site specific. Ask the physician or a nurse when a transdermal patch or lotion has been prescribed because contraindications change; follow your state's and manufacturer's guidelines.
OA Management: Supportive Devices (04:51)
Supportive devices with a rigid structure can change alignment and cause pain. Malecha suggests starting simple.
OA: Weight and Exercise (13:04)
The addition of a pound of adipose tissue causes three pounds of increased force in the knee and six in the hip. Exercise is only one component of losing weight; nutrition plays a large role. Foods that reduce inflammation include fish, flaxseed, and vitamin c; omega six rich foods increase swelling.
OA: Yoga Poses (16:08)
Malecha discusses various yoga poses and how to adapt them for people with joint issues. Incorporate physio balls to make surfaces unstable in younger populations. Notice any peripheralization or radicular symptoms.
OA: Pharmacology (17:36)
Malecha discusses the function and efficacy of acetaminophen, cyclooxygenase two inhibitors, selective COX inhibitors, topical nonsteroids, Tramadol, and narcotics. Do not recommend other medications. Research demonstrates that alternating Tylenol and Ibuprofen can have the same effect as an opioid.
OA: Supplements (11:09)
Malecha discusses the function and efficacy of glucosamine, chondroitin, Turmeric, fish oil, Indian frankincense, bee venom, and avocado. Do not recommend supplements; tell the patient to consult with their physician. The precision of the injection site alters the potency of cortisone.
OA: Surgery (08:36)
Malecha discusses arthroscopic debridement, arthroplasty, osteotomy, and fusion. Recent advances in ankle replacements gave it a higher success rate. Other treatments include platelet-rich plasma and mesenchymal stem cells.
Rheumatoid Arthritis (16:14)
This disorder only affects one percent of the population and causes joint, renal, and liver issues. Pharmaceutical companies focus on larger patient pools. Malecha discusses the disease progression, manifestations, and treatment options.
Gout usually occurs in males between 30 and 40 and is a chemical imbalance. Causes include renal insufficiency, diuretics, and cancer. Malecha discusses the disease progression, manifestations, and treatment options.
Afternoon Session Begins (11:29)
This afternoon the seminar will provide a power-point, a demonstration of joint mobilizations, and participants will divide into groups and practice on each other. Geriatric patients benefit more than young athletes.
Mobilizations: Introduction (14:17)
Osteokinematics means movement of the whole bone while arthrokinematics means movement of a particular joint. Malecha describes, defines, and demonstrates saddle and ovoid joints in the human body. Precautions include inflammatory arthritis, malignancy, tuberculosis, ligament ruptures, bone fractures, osteoporosis, and total joint replacements.
Mobilizations: Stages (07:35)
Malecha describes grade 1-5 mobilizations to increase the range of motion. Pain dictates what type of mobilization to perform.
Demonstration: Knee (20:01)
Keep the patient in a loose pack position because it produces the most amount of joint space. Malecha shows how to mobilize the knee in grades 1-5, concentrating on cephalic and caudal movements. In some states, occupational therapists are not allowed to duplicate services.
Practical: Knee (17:09)
Malecha suggests asking a clinic if they perform joint mobilizations for a specific population. Use a belt for the hip, but it is not necessary for the knee. Participants divide into groups and practice the movements.
Power Point: Knee (05:26)
Malecha reiterates knowing the anatomy and how to mobilize the knee. Use grade one manipulations on knees that are inflamed.
Demonstration: Ankle (14:56)
There are 29 bones and 31 joints in the ankle. Malecha demonstrates how to mobilize the mortise and the subtalar joint. Movements include anterior glides, posterior glides, traction, and lunging motions.
Practical: Ankle (09:48)
Make sure the physician clears any physical therapy performed on a fracture. Participants divide into groups and practice anterior glides, posterior glides, subtalar traction, and lunging motions. Malecha visits each team of therapists to make corrections and reviews the mobilizations.
Demonstration: Glenohumeral Joint (14:24)
Each patient's glenohumeral joint can be different. Malecha demonstrates how to perform a surface anatomy check, examining the infraspinatus, scapula, clavicle, and acromioclavicular joint. Mobilizations include posterior glide, traction, and inferior glides.
Practical: Glenohumeral Joint (14:39)
Participants divide into groups and practice the posterior glide, traction, and inferior glides. Malecha visits each team of therapists to make corrections and reviews the mobilizations.
Demonstration: Acromioclavicular Joint (10:23)
If patients cannot obtain the last ten degrees of range of motion, examine the thoracic region or the AC joint. Use your entire thumb surface. Malecha demonstrates how to perform a posterior and anterior glide; the prone position is preferred but harder for geriatric patients.
Practical: Acromioclavicular Joint (06:14)
Participants divide into groups and practice the posterior glide in supine and sitting position. Malecha visits each team of therapists to make corrections and reviews the mobilization.
Demonstration: Hand and Wrist (10:18)
The carpal bones, distal interphalangeal joint, and proximal interphalangeal joint are treated similarly in physical therapy. Malecha demonstrates how to perform a volar, dorsal, radial, and ulnar glide, changing only the position of the hand.
Practical: Hand and Wrist (07:36)
Participants divide into groups and practice a volar, dorsal, radial, and ulnar glide. Malecha visits each team of therapists to make corrections and thanks the members of the seminar.
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