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Clinical Orthopaedic Rehabilitation: A Team Approach E-Book

Clinical Orthopaedic Rehabilitation: A Team Approach E-Book

Charles E Giangarra | Robert C. Manske

(2017)

Additional Information

Book Details

Abstract

Evidence suggests a direct correlation between the quality of postoperative orthopaedic rehabilitation and the effectiveness of the surgery. Clinical Orthopaedic Rehabilitation, 4th Edition, helps today’s orthopaedic teams apply the most effective, evidence-based protocols for maximizing return to function following common sports injuries and post-surgical conditions. Charles Giangarra, MD and Robert Manske, PT continue the commitment to excellence established by Dr. S. Brent Brotzman in previous editions, bringing a fresh perspective to the team approach to rehabilitation.

  • Every section is written by a combination of surgeons, physical therapists, and occupational therapists, making this respected text a truly practical "how-to" guide for the appropriate initial exam, differential diagnosis, treatment, and rehabilitation.
  • Treatment and rehabilitation protocols are presented in a step-by-step, algorithmic format with each new phase begun after criteria are met (criteria-based progression, reflecting current best practice).
  • Revised content brings you up to date with new evidence-based literature on examination techniques, classification systems, differential diagnosis, treatment options, and criteria-based rehabilitation protocols.
  • Extensive updates throughout include new chapters on: medial patellofemoral ligament, shoulder impingement, pec major ruptures, thoracic outlet syndrome, general humeral fractures, foot and ankle fractures, medial patellofemoral ligament reconstruction, the arthritic hip, athletic pubalgia, and labral repair and reconstruction.

Table of Contents

Section Title Page Action Price
Front Cover Cover
IFC ES1
CLINICAL ORTHOPAEDICREHABILITATION: A Team Approach i
CLINICAL ORTHOPAEDIC REHABILITATION: A Team Approach iii
Copyright iv
CONTRIBUTORS v
FOREWORD BY GEORGE J. DAVIES xi
FOREWORD BY EDWARD G. MCFARLAND xii
PREFACE xiii
ACKNOWLEDGMENTS xiv
CONTENTS xv
VIDEO CONTENTS xix
1 - Hand and Wrist Injuries 1
1 - Flexor Tendon Injuries 2
IMPORTANT POINTS FOR REHABILITATION AFTER FLEXOR TENDON LACERATION AND REPAIR 2
REHABILITATION RATIONALE AND BASIC PRINCIPLES OF TREATMENT AFTER FLEXOR TENDON REPAIR 2
Timing 2
Anatomy 3
Tendon Healing 4
Treatment of Flexor Tendon Lacerations 4
Teno Fix Repair 5
Bloodless Surgery 5
Rehabilitation After Flexor Tendon Repair 5
REFERENCES 8
FURTHER READING 8
2 - Flexor Digitorum Profundus Avulsion (“Jersey Finger”) 9
BACKGROUND 9
TREATMENT 9
TENDON-TO-BONE REPAIR CONSIDERATIONS 9
SURGEON’S PREFERENCE 10
REFERENCES 11
FURTHER READING 11
3 - Extensor Tendon Injuries 12
ANATOMY 12
EXTENSOR TENDON INJURIES IN ZONES 1 AND 2 12
EXTENSOR TENDON INJURIES IN ZONE 3 12
EXTENSOR TENDON INJURIES IN ZONES 4, 5, AND 6 14
Zone 5 Extensor Tendon Subluxations 14
EXTENSOR TENDON INJURIES IN ZONES 7 AND 8 14
Extensor Tenolysis 14
Indications 14
MALLET FINGER (EXTENSOR INJURY—ZONE 1) 15
Background 15
Classification of Mallet Finger 15
Treatment 15
REFERENCES 18
FURTHER READING 18
4 - Fractures and Dislocations of the Hand 19
METACARPAL AND PHALANGEAL FRACTURES 19
General Principles 19
METACARPAL FRACTURES 19
PHALANGEAL FRACTURES OF THE HAND 20
PROXIMAL INTERPHALANGEAL JOINT INJURIES 21
REFERENCES 22
FURTHER READING 22
5 - Fifth Metacarpal Neck Fracture (Boxer's Fracture) 24
BACKGROUND 24
CLINICAL HISTORY AND EXAMINATION 24
TREATMENT 24
Phalangeal Fractures of the Hand 26
Proximal Interphalangeal Joint Injuries 26
REFERENCES 28
FURTHER READING 28
6 - Injuries to the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint (Gamekeeper’s Thumb) 29
BACKGROUND 29
EVALUATION 29
Stable Thumb on Valgus Stressing (No Stener Lesion) 30
Unstable Thumb on Valgus Stressing (>30 Degrees) 30
REFERENCES 31
FURTHER READING 31
7 - Nerve Compression Syndromes 32
NERVE COMPRESSION PHYSIOLOGY 32
CARPAL TUNNEL SYNDROME 32
Background 32
Typical Clinical Presentation 33
Provocative Testing Maneuvers (Table 7.2) 34
Phalen Maneuver (Fig. 7.3, A) 34
Tinel Sign (Median Nerve Percussion) (Fig. 7.3, B) 35
Sensory Testing of the Median Nerve Distribution. Decreased sensation may be tested by the following 35
Additional Special Tests for Evaluation 35
Electrodiagnostic Evaluation 35
Treatment 36
Nonoperative Management 36
Surgical Treatment 36
Complications After Carpal Tunnel Release 38
Failed Carpal Tunnel Release 38
BOWLER’S THUMB (DIGITAL NEURITIS) 38
PRONATOR SYNDROME 38
RADIAL NERVE COMPRESSION 39
Radial Sensory Neuritis 39
Proximal Radial Nerve and Posterior Interosseous Nerve Compression 39
ULNAR NERVE COMPRESSION 40
Proximal Ulnar Nerve Compression 40
Guyon’s Canal 41
REFERENCES 41
FURTHER READING 41
8 - Scaphoid Fractures 42
BACKGROUND 42
CLINICAL HISTORY AND EXAMINATION 42
TREATMENT 43
REHABILITATION 43
REFERENCES 44
FURTHER READING 44
9 - Triangular Fibrocartilage Complex Injury 45
CLINICAL BACKGROUND 45
CLASSIFICATION 45
DIAGNOSIS 45
IMAGING STUDIES 47
TREATMENT 47
REFERENCES 50
FURTHER READING 50
10 - Metacarpal Phalangeal Joint Arthroplasty 51
REHABILITATION 52
REFERENCES 52
2 - Rehabilitation After Total Elbow Arthroplasty 53
11 - The Total Elbow 54
REFERENCES 56
FURTHER READING 56
12 - Rehabilitation After Fractures of the Forearm and Elbow 57
FRACTURES OF THE RADIUS AND ULNAR SHAFT 57
BOTH BONE FOREARM FRACTURE REHABILITATION (BOLAND 2011) 57
Phase I: (Weeks 0–2) 57
Phase II: (Weeks 2–6) 57
Phase III: (Weeks 6 and Beyond) 57
FRACTURES OF THE ELBOW 57
RADIAL NECK AND HEAD FRACTURES 58
SIMPLE OR COMPLEX ELBOW DISLOCATIONS 59
REFERENCES 62
FURTHER READING 62
13 - Pediatric Elbow Injuries in the Throwing Athlete: Emphasis on Prevention 63
INTRODUCTION 63
LITTLE LEAGUER’S ELBOW 63
MEDIAL TENSION INJURIES 63
LATERAL COMPRESSION INJURIES 63
POSTERIOR COMPRESSION INJURIES 63
PREVENTION 63
USA BASEBALL GUIDELINES 64
Pitch Counts 64
Pitch Types 64
Multiple Appearances 65
Showcases 65
Year-Round Baseball 65
REFERENCES 65
FURTHER READING 65
14 - Medial Collateral Ligament and Ulnar Nerve Injury at the Elbow 66
ANATOMY AND BIOMECHANICS 66
MECHANISM OF INJURY 66
EVALUATION 66
SURGICAL TREATMENT 66
Ulnar Nerve Transposition 67
Rehabilitation Overview and Principles 67
Conservative Treatment of Medial Collateral Ligament Injuries 68
REFERENCES 70
FURTHER READING 70
15 - Treating Flexion Contracture (Loss of Extension) in Throwing Athletes 71
REFERENCES 73
FURTHER READING 73
16 - Post-Traumatic Elbow Stiffness 74
DEFINITION 74
CLASSIFICATION 74
HETEROTOPIC OSSIFICATION 74
EVALUATION OF THE STIFF ELBOW 74
History 74
Physical Examination 75
Radiographic Evaluation 75
NONSURGICAL TREATMENT 75
SURGICAL TREATMENT 75
POSTSURGICAL PROTOCOL 75
REFERENCES 76
FURTHER READING 76
17 - Treatment and Rehabilitation of Elbow Dislocations 77
REHABILITATION CONSIDERATIONS 77
ANATOMY AND BIOMECHANICS 77
MECHANISM OF INJURY 77
EVALUATION AND RADIOGRAPHS 77
CLASSIFICATION 77
TREATMENT 78
Operative Treatment 78
COMPLICATIONS 78
REHABILITATION CONSIDERATIONS 79
RESULTS 79
REFERENCES 80
FURTHER READING 80
18 - Lateral and Medial Humeral Epicondylitis 81
INTRODUCTION 81
EPIDEMIOLOGY AND ETIOLOGY 81
CLINICAL EXAMINATION OF THE ELBOW 81
ANATOMIC ADAPTATIONS IN THE ATHLETIC ELBOW 81
ELBOW EXAMINATION SPECIAL TESTS 82
TREATMENT 84
Tendinitis Versus Tendinosis 84
DEFINITIONS: TENDINITIS AND TENDINOSIS 84
ECCENTRIC TRAINING PROGRAMS 85
COMBINED EXERCISE PROGRAMS 85
ROTATOR CUFF AND SCAPULAR STABILIZATION 85
RETURN TO SPORT/INTERVAL RETURN PROGRAMS 87
REFERENCES 88
FURTHER READING 88
19 - Forearm Upper Extremity Nerve Entrapment Injuries 89
PRONATOR SYNDROME 89
RADIAL NERVE COMPRESSION 89
Radial Sensory Neuritis 89
Proximal Radial Nerve and Posterior Interosseous Nerve Compression 90
ULNAR NERVE COMPRESSION 91
Proximal Ulnar Nerve Compression/Cubital Tunnel 91
PERIPHERAL NERVE REHABILITATION 91
WHAT I TELL MY PATIENTS 92
FURTHER READING 92
3 - Shoulder Injuries 93
20 - General Principles of Shoulder Rehabilitation 94
BACKGROUND 94
SHOULDER REHABILITATION 98
REFERENCES 99
FURTHER READING 99
21 - Importance of the History in the Diagnosis of Shoulder Pathology 100
STRUCTURAL INJURY TO THE ROTATOR CUFF 100
GLENOHUMERAL INSTABILITY 101
DETACHMENT OF THE SUPERIOR GLENOID LABRUM 101
ADHESIVE CAPSULITIS (\"FROZEN SHOULDER\") 102
CALCIFIC TENDINITIS 102
BICEPS TENDINOSIS 102
ACROMIOCLAVICULAR DEGENERATIVE JOINT DISEASE 102
GLENOHUMERAL DEGENERATIVE JOINT DISEASE 102
CERVICAL SPINE PATHOLOGY 102
FRACTURES 102
GENERAL SHOULDER REHABILITATION GOALS 102
Range of Motion 102
Pain Relief 105
Muscle Strengthening 106
REFERENCES 108
22 - Rotator Cuff Tendinitis in the Overhead Athlete 110
ANATOMY AND BIOMECHANICS 110
THE THROWING CYCLE 110
PATHOGENESIS 111
HISTORY AND PHYSICAL EXAMINATION 112
IMAGING 112
Radiographs 112
Magnetic Resonance Imaging 113
MANAGEMENT 113
SUMMARY 116
REFERENCES 116
FURTHER READING 116
23 - Rotator Cuff Repair 117
TYPE OF REPAIR 117
TEAR PATTERN 118
SIZE OF THE TEAR 119
TISSUE QUALITY 119
LOCATION OF THE TEAR 120
ONSET OF ROTATOR CUFF TEAR AND TIMING OF THE REPAIR 120
PATIENT VARIABLES 120
ACUTE TEARS 120
IMAGING 120
EXAMINATION 121
TREATMENT 122
Acute Tears 122
Chronic Tears 122
REHABILITATION PROTOCOL 122
Immediate Postoperative Phase 122
Protection and Protected Active Motion Phase 128
Early Strengthening Phase 129
Advanced Strengthening Phase 129
MASSIVE ROTATOR CUFF REPAIRS 129
CONCLUSION 129
REFERENCES 129
24 - Shoulder Instability Treatment and Rehabilitation 130
INTRODUCTION 130
ANATOMIC CONSIDERATIONS 130
TERMINOLOGY 130
DIAGNOSTIC EVALUATION: HISTORY, PHYSICAL EXAMINATION, AND IMAGING 131
History 131
Physical Examination 132
Imaging Studies 132
TREATMENT OPTIONS 132
Nonoperative Treatment and Rehabilitation 133
Special Considerations 133
POSTOPERATIVE TREATMENT AND REHABILITATION 134
Anterior Instability 134
Posterior Instability 135
Multidirectional Instability 135
REFERENCES 156
FURTHER READING 156
25 - Adhesive Capsulitis (Frozen Shoulder) 158
INTRODUCTION 158
TYPICAL PRESENTATION 158
TREATMENT 159
REFERENCES 163
FURTHER READING 163
26 - Rehabilitation for Biceps Tendon Disorders and SLAP Lesions 164
REHABILITATION RATIONALE 164
Normal Anatomy 164
HISTORY AND PHYSICAL EXAMINATION 164
Proximal Biceps and Superior Labrum 164
Distal Biceps 165
Radiographic Evaluation 166
4 - Foot and Ankle Injuries 245
38 - Foot and Ankle Fractures 246
INTRODUCTION TO FOOT AND ANKLE TRAUMA 246
ANKLE FRACTURES 246
Background 246
Stable Versus Unstable 246
Rehabilitation 246
PILON FRACTURES 247
Treatment 247
Rehabilitation 248
TALUS FRACTURES 248
Background 248
Fracture Types 248
5 - Knee Injuries 307
47 - Anterior Cruciate Ligament Injuries 308
BACKGROUND 308
TREATMENT OF ACL INJURIES 309
Nonoperative Treatment (ACL-Deficient Knee) 309
Operative ACL Reconstruction 310
ACL REHABILITATION RATIONALE 311
Open and Closed Kinetic Chain Exercise 313
Pain and Effusion 314
48 - Perturbation Training for Postoperative ACL Reconstruction and Patients Who Were Nonoperatively Treated and ACL Deficient 322
COPERS 322
NONCOPERS 322
REFERENCES 325
FURTHER READING 325
49 - Gender Issues in ACL Injury 326
ACL INJURY IN THE FEMALE ATHLETE 326
Overview 326
Intrinsic Risk Factors 326
Extrinsic Risk Factors 326
Anterior Cruciate Ligament Reconstruction With Meniscal Repair 331
REFERENCES 333
FURTHER READING 333
50 - Functional Testing, Functional Training, and Criteria for Return to Play After ACL Reconstruction 334
RISKS WITH EARLY RETURN TO SPORT 334
CURRENT GUIDELINES TO RETURN TO SPORTS 334
TARGETING END-STAGE REHABILITATION 335
REFERENCES 339
FURTHER READING 339
51 - Functional Performance Measures and Sports-Specific Rehabilitation for Lower Extremity Injuries: A Guide for a Safe Return to Sports 341
FUNCTIONAL TRAINING 341
FUNCTIONAL PROGRESSIONS 341
FUNCTIONAL PERFORMANCE MEASURES/TESTS 341
FUNCTIONAL PERFORMANCE TESTING CATEGORIES: LOWER EXTREMITIES 342
Functional Strength Tests 342
Dynamic Joint Stability 342
ADVANCED LOWER EXTREMITY SPORTS ASSESSMENT 346
LIMB SYMMETRY INDEX 352
REFERENCES 352
FURTHER READING 352
52 - TREATMENT AND REHABILITATION OF ARTHROFIBROSIS OF THE KNEE 353
INTRODUCTION 353
PREVENTION 353
CLASSIFICATION 354
TREATMENT 354
Preoperative Rehabilitation 354
Surgical Intervention 356
Postoperative Rehabilitation 356
RESULTS 357
CONCLUSIONS 358
REFERENCES 358
FURTHER READING 358
53 - Posterior Cruciate Ligament Injuries 359
REHABILITATION RATIONALE 359
Normal Posterior Cruciate Ligament 359
Mechanism of Injury 359
EVALUATION 359
Classification 359
Radiographic Evaluation 359
BIOMECHANICS OF THE POSTERIOR CRUCIATE LIGAMENT–DEFICIENT KNEE 360
BIOMECHANICS OF EXERCISE 361
NATURAL HISTORY 361
REHABILITATION CONSIDERATIONS 362
Motion 362
Weight bearing 362
External Support 362
Muscle Training 362
PATELLOFEMORAL JOINT 362
Treatment 362
Nonoperative Treatment 362
Operative Treatment 363
REFERENCES 366
FURTHER READING 366
54 - Medial Collateral Ligament Injuries 367
CLINICAL BACKGROUND 367
MECHANISM OF INJURY 367
DIAGNOSIS AND PHYSICAL EXAMINATION 368
RADIOGRAPHIC EXAMINATION 368
REHABILITATION AFTER MCL INJURY 369
REFERENCES 371
FURTHER READING 371
55 - Meniscal Injuries 372
CLINICAL BACKGROUND 372
MENISCAL MOVEMENT 372
REHABILITATION CONSIDERATIONS 372
Weight Bearing and Motion 372
Axial Limb Alignment 372
Rehabilitation After Partial Meniscectomy 373
Rehabilitation After Meniscal Repair 373
REFERENCES 375
FURTHER READING 375
56 - Patellofemoral Disorders 376
CLINICAL BACKGROUND 376
CLINICAL PEARLS FOR PATELLOFEMORAL PAIN 376
Other Important Patellofemoral Pearls 378
CLASSIFICATION 379
EVALUATION OF THE PATELLOFEMORAL JOINT 379
Signs and Symptoms 379
Physical Examination 380
CLINICAL TESTS FOR PATELLOFEMORAL DISORDERS 381
Q-angle 381
Soft Tissue Stabilizers of the Patella 381
Standing Alignment of the Extensor Mechanism 381
Local Palpation 382
Range of Motion (Hip, Knee, and Ankle) 382
Flexibility of the Lower Extremity 382
J-Sign 383
Patellar Glide Test 383
Lateral Glide Test 383
Medial Glide Test 384
Patellar Tilt 384
Bassett Sign 384
Lateral Pull Test/Sign 384
Radiographic Evaluation 384
IMPORTANT POINTS IN REHABILITATION OF PATELLOFEMORAL DISORDERS 385
Patellar Instability 385
REFERENCES 388
57 - Medial Patellofemoral Ligament Reconstruction 389
ANATOMY 389
PATHOGENESIS 389
TREATMENT 389
REFERENCES 392
FURTHER READING 392
58 - Hip Strength and Kinematics in Patellofemoral Syndrome 393
ADDITIONAL PATELLOFEMORAL PAIN SYNDROME REHABILITATION CONSIDERATIONS 393
PATELLAR EXCESS PRESSURE SYNDROMES (GPPS VERSUS ELPS) 394
REFERENCES 396
FURTHER READING 396
59 - Overuse Syndromes of the Knee 397
HISTORY OF PATELLAR TENDINITIS (JUMPER’S KNEE) 397
ILIOTIBIAL BAND FRICTION SYNDROME 398
HISTORY AND EXAMINATION 399
PREDISPOSING FACTORS 399
TREATMENT OF ILIOTIBIAL BAND FRICTION SYNDROME 399
REFERENCES 399
FURTHER READING 399
60 - Patellar Tendon Ruptures 400
BACKGROUND 400
ANATOMY AND BIOMECHANICS 400
ETIOLOGY 400
CLINICAL EVALUATION 400
Physical Examination 400
Radiographic Evaluation 400
Classification 401
Treatment 401
REHABILITATION FOLLOWING SURGICAL TREATMENT OF PATELLAR TENDON RUPTURE 402
General Principles 402
Termination of Rehabilitation 402
REFERENCES 404
FURTHER READING 404
61 - Articular Cartilage Procedures of the Knee 405
CLINICAL BACKGROUND 405
TYPES OF MOTION 405
MUSCLE STRENGTHENING 405
WEIGHT BEARING PROGRESSION 405
IMPORTANT REHABILITATION CONSIDERATIONS 407
REHABILITATION PROTOCOL 407
TROUBLESHOOTING TECHNIQUES AFTER ARTICULAR CARTILAGE PROCEDURES 407
Pain and Effusion With Exercise or Activity Progression 407
Quadriceps Inhibition or Persistent Knee Extensor Lag 407
REFERENCES 410
FURTHER READING 410
62 - The Arthritic Knee 411
CLASSIFICATION 411
DIAGNOSIS 411
RADIOGRAPHIC EVALUATION 411
TREATMENT OPTIONS 412
Physical Therapy 412
Unloading Braces 413
Insoles 413
Weight Loss 413
Oral Therapy 413
Topical Agents 413
Intra-Articular Corticosteroid Injection 413
Viscosupplementation 413
Operative Treatment 414
GENERAL CONSIDERATIONS 414
Osteotomy of the Knee 414
Total Knee Arthroplasty Rationale 415
GOALS OF REHABILITATION AFTER TOTAL KNEE ARTHROPLASTY 415
Perioperative Rehabilitation Considerations 415
Continuous Passive Motion 416
Deep Vein Thrombosis Prophylaxis 416
Management of Rehabilitation Problems After Total Knee Arthroplasty 416
Recalcitrant Flexion Contracture (Difficulty Obtain 416
Delayed Knee Flexion 416
REFERENCES 416
FURTHER READING 416
63 - Total Knee Replacement Protocol 417
REFERENCES 420
FURTHER READING 420
6 - Hip Injuries 421
64 - Hip Injuries 422
TREATMENT OF INTRA-ARTICULAR HIP PATHOLOGY 422
HIP ARTHROSCOPY 422
POSTOPERATIVE REHABILITATION FOLLOWING HIP ARTHROSCOPY 423
Protective Phase 423
Strengthening Phase 423
Return to Functional Baseline Phase 424
OPEN PROCEDURES OF THE HIP 425
TOTAL HIP ARTHROPLASTY 425
PREOPERATIVE PATIENT EDUCATION 425
POSTOPERATIVE PHYSICAL THERAPY 426
SKILLED NURSING AND HOME HEALTH INTERVENTIONS 426
OUTPATIENT ORTHOPEDIC PHYSICAL THERAPY 426
RETURN TO SPORT 427
TREATMENT OF EXTRA-ARTICULAR HIP PATHOLOGY 429
COXA SALTANS 430
Internal Coxa Saltans 430
External Coxa Saltans 430
GLUTEAL TEARS 431
REFERENCES 431
FURTHER READING 431
65 - The Arthritic Hip 432
CLINICAL BACKGROUND 432
GENERAL FEATURES OF OSTEOARTHRITIS 432
PRIMARY SYMPTOMS AND SIGNS OF OSTEOARTHRITIS 432
Symptoms 432
Signs 432
CLASSIFICATION OF HIP ARTHRITIS 432
DIAGNOSIS OF HIP ARTHRITIS 432
TREATMENT OF HIP ARTHRITIS 433
Nonoperative Treatment 433
Medical Treatment 433
Operative Options for Hip Arthritis 434
REFERENCES 435
FURTHER READING 435
66 - Total Hip Replacement Rehabilitation: Progression and Restrictions 436
PREOPERATIVE MANAGEMENT 436
SURGICAL APPROACH 436
MULTIMODAL PAIN MANAGEMENT 437
HIP PRECAUTIONS 437
POSTOPERATIVE TOTAL HIP ARTHROPLASTY REHABILITATION PROGRAMS 437
WEIGHT BEARING 437
LEVELS OF REHABILITATIVE CARE 438
POSTOPERATIVE PROTOCOL AFTER PRIMARY TOTAL HIP REPLACEMENT 439
Management of Common Problems after Total Hip Replacement 439
Gait Faults 439
Outpatient Total Hip Arthroplasty Physical Therapy Protocol 439
RETURN TO SPORT AFTER TOTAL HIP REPLACEMENT 440
SPORT-SPECIFIC EXERCISES FOR THE GOLFER WITH A TOTAL HIP REPLACEMENT 440
REFERENCES 442
FURTHER READING 442
67 - GROIN PAIN 443
BACKGROUND 443
HISTORY 443
Acute (Traumatic) Injuries 443
Chronic Injuries or Those With No Clearcut Traumatic, Musculoskeletal Mechanism 443
EXAMINATION 443
TREATMENT 446
REFERENCES 446
FURTHER READING 446
68 - Hamstring Muscle Injuries in Athletes 447
CONSIDERATIONS OF APPLIED ANATOMY AND BIOMECHANICS 447
CLASSIFICATION OF HAMSTRING INJURY 447
ETIOLOGIC CONCERNS 447
PHYSICAL EXAMINATION 448
DIAGNOSTIC IMAGING 449
HAMSTRING INJURIES OTHER THAN STRAINS 449
Avulsions 449
Rehabilitation of Hamstring Injuries 449
Rehabilitation of Acute Hamstring Injuries 450
Protection 450
NSAIDS 450
ICE 450
Intramuscular Corticosteroid Injection 450
Therapeutic Exercise 450
Soft Tissue Mobilization Techniques 452
FUNCTIONAL PROGRESSION AND RETURN-TO-PLAY GUIDELINES 453
PREVENTION 454
Risk Factors 454
Stretching 454
Hamstring Stretching Regimen 456
Single-Leg Hamstring Stretch. For the single-leg hamstring stretch, the athlete should lie supine with both legs flat on the tab... 456
Straddle Groin and Hamstring Stretch. For the saddle groin and hamstring stretch, the athlete sits on the floor with both legs s... 456
Side-Straddle Groin and Hamstring Stretch. For the side straddle, the athlete sits on the floor with the injured leg straight, k... 456
Pelvic-Tilt Hamstring Stretch. For the pelvic-tilt, the athlete sits on the edge of the chair with the injured leg resting strai... 457
Hamstring Muscle Strengthening. Hamstring muscle strength has been considered predictive of recurrent hamstring injury. Recurren... 458
Hamstring Strengthening Regimen for Injury Prevention 458
Isometric Hamstring Curls. For isometric hamstring curls, the athlete sits on the floor with the uninjured leg straight. The inv... 458
Prone Hamstring Curls. For prone hamstring curls, an ankle weight is placed on the involved leg. The athlete lies prone, with a ... 458
Standing Hamstring Curls. For standing hamstring curls, an ankle weight is placed on the involved leg. The athlete stands with t... 458
Hamstring Curl Machine. The exercise can be performed on a prone or a standing hamstring machine. The weight will be at the ankl... 458
Seated Walking. While sitting on a rolling stool with wheels, the athlete begins walking forward while sitting on the stool (Fig... 458
Check online videos: Prone Eccentric Hamstrings Manual Resistance (Video 68.1) and Supine Hamstring Curl (Video 68.2) 460
REFERENCES 461
FURTHER READING 461
69 - Athletic Pubalgia 462
INTRODUCTION 462
EPIDEMIOLOGY/SPECIAL POPULATION (ATHLETIC) 462
CLINICAL PRESENTATION 462
RISK FACTORS 462
DIFFERENTIAL DIAGNOSIS 462
ANATOMY 462
PHYSICAL EXAMINATION 463
DIAGNOSIS 464
MANAGEMENT 464
OUR APPROACH 464
CONCLUSION 465
REFERENCES 465
70 - Femoro-acetabular Impingement: Labral Repair and Reconstruction 466
INTRODUCTION 466
RELEVANT ANATOMY 466
CONSERVATIVE MANAGEMENT AND PREOPERATIVE REHABILITATION 466
SURGICAL TREATMENT 467
POSTOPERATIVE REHABILITATION GUIDELINES 467
IMMEDIATE POSTOPERATIVE REHABILITATION 468
OUTPATIENT REHABILITATION 468
Phase 1: Initial Exercises (Initiated Postoperative Week 1) 468
Phase 2: Intermediate Exercises (Initiated Postoperative Week 4) 471
Phase 3: Advanced Exercises (Initiated Postoperative Week 7) 473
Phase 4: Sport-Specific Training (Initiated Postoperative Week 9) 475
REFERENCES 477
FURTHER READING 477
7 - Spinal Disorders 478
71 - Whiplash Injury: Treatment and Rehabilitation 479
THE WHIPLASH EPIDEMIC 479
DIAGNOSIS 479
TREATMENT: REVIEW OF THE LITERATURE 479
TREATMENT OF ACUTE WHIPLASH (0 TO 3 WEEKS) 480
TREATMENT OF SUBACUTE WHIPLASH (3 WEEKS TO 3 MONTHS) 482
Exercise 482
AROM Exercises 482
Postural Exercises 482
Spinal Stabilization Exercises (Sterling et al. 2003b) 482
Proprioception/Balance Exercises 483
Cardiovascular Exercises 483
Manual Therapy (Spitzer et al. 1995) 483
Neural Tissue Mobilization 483
Education 483
TREATING CHRONIC WHIPLASH (3 MONTHS AND MORE) 484
REFERENCES 485
FURTHER READING 485
72 - Therapeutic Exercise for the Cervical Spine 487
EXERCISES TO IMPROVE MUSCULAR COORDINATION, ENDURANCE, OR STRENGTH 487
EXERCISES TO IMPROVE MUSCULAR COORDINATION 487
EXERCISES TO IMPROVE MUSCULAR ENDURANCE OR STRENGTH 489
EXERCISES TO IMPROVE REPOSITIONING ACUITY, OCULOMOTOR CONTROL, OR POSTURAL STABILITY 491
EXERCISES TO IMPROVE MOBILITY 492
REFERENCES 494
FURTHER READING 494
73 - TREATMENT-BASED CLASSIFICATION OF LOW BACK PAIN 496
BACKGROUND 496
HISTORY 496
REFERENCES 497
FURTHER READING 497
74 - Core Stabilization Training 498
ANATOMY 498
MECHANISMS OF INJURY TO THE CORE 501
REHABILITATION: ASSESSMENT AND INTERVENTION 502
Examination 502
Exercises/Training Techniques 504
WHERE TO BEGIN: FORMAL MOTOR SKILL TRAINING 504
INCORPORATION INTO LIGHT FUNCTIONAL TASKS 505
GENERAL FUNCTIONAL EXERCISES 507
Transversus Abdominis With Ue Perturbations 508
Ipsilateral IO/EO—Side Flexion 508
Contralateral IO/EO—Rotation 508
Diaphragm and Pelvic Floor 508
DYNAMIC, PROGRESSIVE FUNCTIONAL CHALLENGES 508
Lunge Onto Unstable Surface Using Exercise Ball 508
Squat With Overhead Sustained Lift 508
Four-Way Tubing Pulls on Unstable Surface 509
Overhead Medicine Ball Toss Kneeling on Bosu Ball 509
Single-Limb Stance on Bosu Ball With Repeated Rowing 509
Half-Kneeling Medicine Ball Side Toss 509
Diagonal Tubing Pulls on Unstable Surfaces 510
Core Ball Punch on Unstable Surface 510
Single-Limb Dead Lift 510
CONCLUSION 511
REFERENCES 513
FURTHER READING 513
75 - McKenzie Approach to Low Back Pain 514
TYPES OF PAIN 514
ACTIVATION OF PAIN 514
STAGES OF TISSUE HEALING 515
INTERVERTEBRAL DISC 515
MCKENZIE CLASSIFICATION OF SYNDROMES 517
Derangement Syndrome 517
Dysfunction Syndrome 517
Postural Syndrome 518
Summary of Syndromes 518
MCKENZIE EVALUATION 518
INTERVENTION 520
SUMMARY 522
REFERENCES 522
76 - Rehabilitation Following Lumbar Disc Surgery 523
LUMBAR DISC SURGERY 523
CURRENT BEST EVIDENCE: POSTDISCECTOMY REHABILITATION 523
THE POSTDISCECTOMY “PROTOCOL” 524
EDUCATION 525
EXERCISE 525
WALKING PROGRAM 528
MANUAL THERAPY 528
Neural Tissue Mobilization 528
Additional Treatments 529
Timing, Dosage, and Frequency 529
REFERENCES 529
FURTHER READING 529
77 - CHRONIC BACK PAIN AND PAIN SCIENCE 532
INTRODUCTION 532
CURRENT MODELS FOR MANAGING CHRONIC SPINAL PAIN 532
IMPORTANT ISSUES IN UNDERSTANDING PAIN 534
The Sensitive Nervous System 534
THE BRAIN’S PROCESSING OF PAIN 536
THE OUTPUT SYSTEMS 536
CHRONIC PAIN: BEST EVIDENCE MANAGEMENT 537
CONCLUSION 539
REFERENCES 539
FURTHER READING 539
78 - Spinal Manipulation 541
DEFINING SPINAL MANIPULATION 541
EVIDENCE FOR SPINAL MANIPULATIVE THERAPY 541
CLINICAL PREDICTION RULES 542
THE AUDIBLE POP 543
SPINAL POSITIONING AND LOCKING 543
8 - Special Topics 576
82 - Running Injuries: Etiology and Recovery-Based Treatment 577
INDEX 605
A 605
B 606
C 607
D 607
E 608
F 608
G 609
H 609
I 610
J 610
K 610
L 610
M 611
N 612
O 612
P 612
Q 614
R 614
S 615
T 616
U 617
V 617
W 618
Y 618
Z 618
IBC ES2