Orthopaedic

PhysioU App update alert! Fall risk assessment added to Clinical Pattern Recognition Apps!

 
 

As clinical specialist who will care for clients over the life span, it is critical to be aware of fall risk in patients with conditions that may impair their balance! This includes asking two critical questions and performing some quick tests that can help with screening for fall risk:

2 key questions:

  • Have you fallen in the last 12 months?

  • Do you have difficulty with balance or walking?

Conduct a balance and mobility screen:

  • STEADI

  • 30 second chair stand test

  • 4-stage balance test

  • Timed up and go test

Fall risk assessment has been added into the differential diagnosis tab for these common conditions!

  • Knee osteoarthritis

  • Knee meniscus tears

  • Hip osteoarthritis

  • Ankle sprains

  • Posterior tibial tendonitis

  • Plantar fasciitis

  • Ankle osteoarthritis

  • Hallux valgus

  • Hallux rigidus

  • Morton's neuroma

  • Tarsal tunnel syndrome

Special Thanks to Dr. Gregory Hartley for his input on adding this important geriatric consideration to the Clinical Pattern Recognition Apps!

This comes from the 2015 article in the Physical Therapy Journal.

Clinical Pattern Recognition: Hip dysplasia or Hip pain with mobility deficits

An interesting group of patients we have been seeing are many women with hip dysplasia.

 
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As shown in one of our earlier gait videos this past week, you note a vaulting to clear the long limb, she has a 2cm leg length discrepancy and a set of impairments that helps to define this clinical pattern. (PS. The model in the pictures where the face is showing, is not the patient, just a volunteer from the clinic.)

 
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Significant loss of ipsilateral hip ER range of motion

Typically increased hip IR

Decreased left hip accessory mobility

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Significant weakness of the hip abductors

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Significant weakness of the hip extensors

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As suggested by the clinical practice guidelines, our primary management involved manual therapy and exercises that helped to restore hip joint mobility as shown below…

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Long axis distraction joint manipulations

Mobilizations with movement to improve hip external rotation

This was followed by exercises to improve the muscle power deficits of the hip abductors and extensors.

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Clam shells to work on gluteus medius activation

Increasing the load with theraband for hip abduction external rotation

An orthotic to minimize the leg length discrepancy was used to improve the gait pattern.

This pattern is unique since we do not see much of this in our country where hip dysplasia is screened for and addressed early in life. Typically, we see hip pain with mobility deficits in the 50 and over age group as the hip joint osteoarthritis progresses. This mobility deficit (hip dysplasia), we find in young people and the loss of hip external rotation is very different than the hip osteoarthritis group, which generally lacks hip internal rotation. Ultimately, the key impairment is a loss of mobility and secondarily a loss of muscle strength.

Physical therapy can be successful for these patients as long as we recognize the clinical pattern and address it with relevant interventions!

Great news for the Physical Therapy community!

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While we are busy building the latest evidence-based learning tools to enhance Physical Therapy education, the PhysioU team is delighted to extend a two-week unlimited access free trial to our web app

As part of the PhysioU web app, which you can access on any device with a browser (saves on your memory usage since there are so many videos), you will have access to: 

Furthermore, if you decided to purchase this web app, we are throwing in below apps, that are in development right now and will be released this summer, as an EXTRA SWEET BONUS for our web app users. This is a limited-time offer. Sign up now before we change our mind! 

Check out these behind-the-scenes videos and see the experts in action.

NeuroRX: PNF

Assistive Devices, Transfers, Gait Training

Cardiopulmonary Rehabilitation

Also, we'd love to hear what you think of our apps on Facebook or drop us a line here

Leveraging the power of the Clinical Practice Guidelines!

Well, it has been a busy weekend! Marshall and I have been working on updating all the techniques in the apps to show a grade of evidence as shown by the clinical practice guidelines. The guidelines are so powerful because they summarize the current best evidence and make recommendations. This allows clinicians to quickly get a sense of the value of the examination or technique based on multiple studies!

See the images below of how Evidence in graded in the guidelines.

You will see in all of your apps over the next week…. These grades being built into the relevant tests, interventions, outcome measures and patient education!

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