1. Acute/traumatic2. Repetitive use/overuse injuries

Identifiable mechanism or event Almost always associated visible signs or subjective symptoms

Traumatic fall onto shoulder or outstretched arm

Unstable shoulder results, prone to reoccur

Can be an acute tear or degenerative tear

Joint effusion, pain when twisting/turning

May have joint line pain on palpation

The anterior talofibular ligament is the most often sprained ligament in the body

Requires early control of swelling and gradual return of ROM, strength and proprioception

X-rays to determine if there is a fracture present

Thompson Test – by squeezing the calf the ankle should plantar flex

Patient usually does not feel pain, feels like they were kicked in the heel

Repetitive Use Injuries

Repetition +Position + Force + Time + No rest

= Repetitive Use Injuries

The “itis” group Bursitis, tendinitis, epicondylistis… These pathologies come around gradually

Caused by fast forceful movements and awkward positions

Supraspinatus Test

General aching on daily activities If patient is unable to hold arm at 90 degrees ABD = ? tear

Neer’s Test

Non contractile tissue lying between the rotator cuff tendons and the acromion

Shoulder susceptible to tendinitis/bursitis injuries due to lack of stability

Usually caused by biomechanical breakdown

Can be overuse or acute Mechanical vs. Neurological

Mechanical Pain primarily in

the back May have pain in

the buttock/upper hamstring

Poor movement pattern

Neurological Pain down the leg Decreased reflexes Decreased

sensation Level specific

weakness

LIMITATIONS in◦ADLs: grooming, dressing, self care..

and/or◦ IADLs: meal preparation, grocery shopping,

household chores...and /or

◦Productivity: Nurse, warehouse worker, bus driver, accountant...

and/or◦Leisure: baseball, piano, jogging, biking,

dance...

Getting you better faster!

Spitze et al. 1995 Probability of returning to work decreases as the period of work absence increase ◦4 weeks post-injury, 50% resume work◦12 weeks post-injury, 75% resume work◦>12 weeks = high risk of permanently disable

Buijs et al. 200910-25% of patients with lower back painremain absent from work, which accounts for a societal and economic burden

General Physician (Coach) Physiotherapist (Offensive Coach) Occupational Therapist (Defensive Coach) Athletic Therapist/Kinesiologist (Throwing

coach) Specialists: Orthopaedist, Neurologist,

Psychologist (Special Tactics Coach) Patient (Player)

First point of contact following the injury

Diagnosis Help guide the patient to the next step…

Address medication and testing needs of patient

Decrease symptoms◦Decrease pain◦Decrease swelling◦Decrease muscular tension

Increase pain free ROM, strength and endurance ◦Realigns body structure◦Mobilizes body structure

Restore function- Holistic Approach (Person, Environment & Occupation) Regain functional capacities

Activity Analysis Strength and endurance program

Graded purposeful activities

Task simulation

Education Postural Hygiene principles: standing, sitting, sleeping Proper movement mechanics: lifting, bending, stooping, kneeling... Energy conservation techniques Joint Protection techniques Office Ergonomics Minimize influence of psychosocial barrier

Train proper muscular movement patterns

Reinforce proper alignment of body structure

Increase muscular strength and endurance

Home exercises to prevent further injury

Getting you better faster!

PT + OT

PT + OT

PT + OT + AT

PT + OT + AT

PT + OT + AT

Inter-Disciplinary Care Program

Lambeek et al. (2010) Duration until sustainable return to

work was 88 days for the integrated group compared with

208 days of the usual care group.

Lambeek et al. 2009◦evaluate the effectiveness of innovative low

back pain (LBP) interventions◦combining a patient-directed and a workplace-

directed intervention◦37 out of the 40 patients who were eligible to

participate in the integrated care program. The patients, their supervisors and the health care professionals were satisfied with the program.

Thank you