Physiological Effects of Aerobic Exercise During Pregnancy
Many women who have been doing aerobic exercises choose to continue exercising during pregnancy to maintain their cardiopulmonary fitness. Maternal and fetal responses have been well studied; therefore this information is used to guide both the therapist and the patient in determining necessary modifications to an existing exercise program.
Maternal […]

Walsh has identified three causative factors for TOS that could be interrelated or exist separately: compressive neuropathy, faulty posture, and entrapment.
• Compressive neuropathy. Compression of the neurovascular structures can occur if there is a decrease in the size of the area through which the brachial plexus and subclavian vessels pass. Compression can result from muscle […]

Thoracic Outlet Syndrome
The thoracic outlet is the region along the pathway of the brachial plexus from just distal to the nerve roots exiting the intervertebral foramen to the lower border of the axilla.. The outlet is bordered medially by the scalenus anterior, medius, and posterior and the first rib; posteriorly by the upper trapezius and […]

Prevention
These maneuvers may be used to prevent restrictive adhesions from developing if done early during treatment after an acute injury or surgery.
Precautions and Contraindications to Neural Tension Testing and Treatment
There is incomplete scientific understanding of the pathology and mechanisms occurring when mobilizing the nervous system. Use caution with the stretch force; neurological symptoms of tingling […]

Sciatic Nerve: Straight-Leg Raising with Ankle Dorsiflexion
Patient Position and Procedure. The patient is supine. Lift the lower extremity in the straight-leg raise (SLR) position and add ankle dorsiflexion. Several variations may be done; ankle dorsiflexion, ankle plantar flexion with inversion, hip adduction, hip medial rotation, and passive neck flexion. The maneuver may also be performed […]

Median Nerve
Patient Position and Procedure. Begin with the patient supine; sequentially apply shoulder girdle depression, then slightly abduct the shoulder, extend the elbow, laterally rotate the arm, and supinate the forearm. Wrist, finger, and thumb extensions are then added; finally, the shoulder is taken into greater abduction. The full stretch position includes contralateral cervical side […]

Butler proposed that symptoms are the result of tension being placed on some component of the nervous system. If compression is preventing normal mobility, tension signs occur when the nerve is stressed either proximal or distal to the site of compression. Restriction of movement can be from inflammation and scarring between the nerve and the […]

History
Vascular and mechanical factors can lead to nerve pathology. Pain is the most common symptom. Sensory responses, reported as stretch pain or paresthesia, occur when tissues are in the neural stretch position. Clinical reasoning is used to understand the possible mechanism of injury, such as pathological insult to the nervous tissue or surrounding tissues or […]

While the nerve is regenerating, or if nerve recovery is incomplete
• Inspect skin regularly; provide prompt treatment of wounds or blisters
• Compensate for dryness with massage creams or oils
In the upper extremity
• Avoid handling hot, cold, sharp, or abrasive objects
• Avoid sustained grasps; change use of tools frequently
• Redistribute hand pressure by building up the […]

In general, recovery from nerve injury can be viewed as occurring in three phases.
• Acute phase: This is early after injury or after surgery, when the emphasis is on healing and prevention of complications.
• Recovery phase: This is when reinnervation occurs. Emphasis is on retraining and re-education.
• Chronic phase: This occurs when the potential for […]

Nerve tissue that has become irritated from tension, compression, or hypoxia may not have permanent damage and shows signs of recovery when the irritating factors are eliminated. When the nerve has been injured, recovery is dependent on several factors including the extent of injury to the axon and its surrounding connective tissue sheath, the nature […]

In a number of orthopedic procedures to repair damaged structures, tissue grafts are implanted during the repair process. For example, soft tissue grafts are routinely used to reconstruct ligaments of the knee or ankle. Grafts are also used in articular cartilage repair procedures and many bony procedures.
Types of Graft
Tissue grafts can be placed into several […]

Arthroscopy is used as a diagnostic tool and as a means of treating a variety of intra-articular disorders. Arthroscopic procedures are typically performed on an outpatient basis and often under local anesthesia.
Arthroscopy involves several very small incisions (portals) in the skin, muscle, and joint capsule for insertion of an endoscope to visualize the interior of […]

Postoperative rehabilitation is often a lengthy process. Given the limited number of justifiable therapy sessions available for postoperative management, it is highly unlikely for a therapist to have direct, ongoing contact with a patient through all phases of a rehabilitation program. Consequently, the key to successful postoperative outcomes is effective self-management that includes therapist-directed perioperative […]

Postoperative pain because of disruption of soft tissue
Postoperative swelling
Potential circulatory and pulmonary complications
Joint stiffness or limitation of motion because of injury to soft tissue and necessary postoperative immobilization
Muscle atrophy because of immobilization
Loss of strength for functional activities
Limitation of weight bearing
Potential loss of strength and mobility in unoperated joints
Time-Based and Criterion-Based Progression
Time frames for each phase […]

Every individually designed postoperative rehabilitation program must be based on initial and ongoing examinations of a patient. In addition to the components of a preoperative examination noted previously in this section, an assessment of integumentary integrity is important after surgery. The incision should be inspected before and after each exercise session to identify any evidence […]

Patient education can be initiated preoperatively, either during an individual instruction session with a patient or in a group setting with patients planning to undergo similar surgeries. Some large, acute-care facilities, for example, have reported descriptions of programs for patients scheduled for joint replacement surgery that focus on preoperative group instruction by team members from […]

• Examination and evaluation of a patient’s preoperative impairments and functional status to establish a baseline for documenting postoperative improvement
• Opportunity to identify and prioritize a patient’s needs and understand a patient’s goals and functional expectations after surgery
• A basis for establishing rapport for enhanced continuity of care after surgery
• A mechanism for patient education […]

Although surgical intervention can correct or reduce adverse effects and impairments (e.g., pain, deformity, instability) associated with musculoskeletal pathology, a carefully planned and progressed rehabilitation program is essential for a patient to achieve optimal functional outcomes after surgery. In an ideal situation, rehabilitation begins with patient education before surgery and continues after surgery with direct […]

An array of injuries, diseases, and disorders of the musculoskeletal system that affect muscles, tendons, ligaments, cartilage, fascia, joint capsules, or bones can cause impairment of the upper or lower extremities or the spine, resulting in functional limitation and disability to such an extent that surgical intervention is required. Ideally, surgery is preceded by a […]

The guidelines identify therapeutic interventions for common impairments during the early postoperative period and those that could develop at a later time.
Special Considerations
Patient education. The length of stay for patients after surgery for breast cancer is short. Therefore, direct intervention by a therapist starts on the first postoperative day with an emphasis on patient education […]

The following impairments and complications may occur in association with treatment of breast cancer. Many of these problems are interrelated and must be considered jointly when a comprehensive postoperative rehabilitation program is developed for the patient.
Postoperative Pain
Incisional pain. A transverse incision across the chest wall is made to remove the breast tissue and underlying fascia […]

Breast cancer-related dysfunction of the lymphatic system and subsequent lymphedema of the upper extremity is a somewhat common and potentially serious complication of the treatment for breast cancer. It is estimated that 15% to 20% or as many as one in four patients with invasive breast cancer develop upper extremity lymphedema during or sometime after […]

If a patient is at risk of developing lymphedema secondary to infection, inflammation, obstruction, surgical removal of lymphatic structures, or chronic venous insufficiency, prevention of lymphedema should be the priority of patient management. In some situations, such as after removal of lymph nodes or vessels, preventive measures may be needed for a lifetime. Even when […]

A patient’s history, a systems review, and specific tests and measures provide information to determine impairments and functional limitations that can arise from lymphatic disorders and the presence of lymphedema. Key components in the examination process that are particularly relevant when lymphatic dysfunction is suspected or lymphedema is present are summarized in this section.Other tests […]

Lymphedema
Location. When lymphedema develops, it is most often apparent in the distal extremities, particularly over the dorsum of the foot or hand. The term dependent edema describes the accumulation of fluids in the peripheral aspects of the limbs, particularly when the distal segments are lower than the heart. In contrast, lymphedema also can manifest more […]

One of the primary functions of the lymphatic system, which consists of lymph vessels and nodes, is to collect and clear excess tissue fluid from interstitial spaces and return it to the venous system Edema is a natural consequence of trauma to and healing of soft tissues. If the lymphatic system is compromised and does […]

Patient education is fundamental in the management of chronic venous insufficiency and varicose veins. A patient must be advised on how to prevent dependent edema, skin ulceration, and infections. The therapist may be involved in (1) measuring and fitting a patient for a pressure-gradient support garment; (2) teaching the patient how to put on the […]

Impairments
Dull ache or pain usually in the calf
Tenderness, warmth, and swelling with palpation
Prevention of Deep Vein Thrombosis and Thrombophlebitis
Every effort should be made to prevent the occurrence of a DVT and subsequent thrombophlebitis, particularly in patients at risk. The following interventions are implemented to reduce the risk of a DVT.
· Prophylactic use of anticoagulant therapy […]

As with arterial disorders, a complete history and systems review help determine the presence of a venous disorder. These tests complement a comprehensive integumentary and neuromuscular examination that includes skin integrity, mobility, color, texture, temperature, vital signs including peripheral pulses, sensation, pain, functional mobility, ROM, strength, and cardiopulmonary endurance.
Tests and Measures of Venous Sufficiency
· Girth […]