Pt management of deformity new.pptx

It contain all types of deformity physiotherapy management

1. Pt management of deformity By Akshat Gautam Bpt 3 rd year Orthopedic physiotherapy

2. What is deformity Malformation of any component of body is called deformity The malformation may be due to bony deformation or Alternation in typography of soft tissue Types of deformity There are two types of deformity Congenital Acquired

3. Congenital deformity These are the deformity that are present by birth Some of these deformity present at birth while some develop during growth Deformity may be sever & lifetime Cause of congenital Deformity Genetic abnormality [ eg : diaphysial aclasis , Mongolism ] Environmental factor [ eg : Phocomelia ] Combined factor [ eg : Congenital dislocation of hip,clubfoot ]

4. Acquired deformity The acquired deformity is that which Was not present at birth and has developed after birth They could be bony disease,joint disease,muscle disease,ligament disease, They develop due to postural issue,nerve lesion,occupation related,pathological

5. Deformity covered Thoracic outlet syndrome Torticollis Congenital talipes equinovarus Pes cavus Pes planus Coxa Vera

6. Thoracic Outlet syndrome It is the varied pattern of sing and Symptoms Caused by the compression of upper Extremity neurovascular bundle at interval within thoracic outlet space.

7. Physiotherapy management Goal of treatment : Calm the nervous system Increase strength & functional stability In the core muscle of spine,shoulder & trunk improve cardiovascular condition Exercise Programme Breathing exercises in supine Seated ball exercise Foam roll exercise & thoracic mobilization

8. Cont , 4. Scapular strengthening 5. Neural mobilization Postural training & core stabilization Aerobic conditioning

9. Breathing exercises Main aim of Breathing exercises is to calm down the nervous system. There are 4 types of Breathing exercise Diaphragmatic Breathing exercises: Patient is in supine lying with hands rest on abdomen and knee are flexed or the position may be modified by genral relaxation technique (placing rolled towel below neck,shoulder,low back knee) To achive relaxation.Main aim of diaphragmatic Breathing is to Limit activation of sclanea muscle used in upper chest breathing. Patient is asked to do Inhalation through nose while tilting pelvis anteriorly Exhalation through mouth by blowing action while tilting pelvis posteriorly

10. https://youtube.com/shorts/1Fg0SO3pPfk?si=fe9ybYwXZziwBLTu

11. Cont , You can also support the upper extremity By using cotton tshirt or belt to achive more relaxation By putting brachial plexus in relaxed pose as well as upper extremity

12. Cont , Main advantage is that when patient tilt pelvis anteriorly; lumbar spine will extend & head will slightly flexed and shoulder or upper body will move toward feets Or when the patient tilt the pelvis posteriorly alignment of body segment become normal Result : >There is little or no movement seen in cervical spine,head & shoulder > If patient experience low back pain while doing this then the amount of pelvic tilt can be reduced

13. Cont , (B) Diaphragmatic breathing with paired lower extremity movement: position of patient is similar to that of first exercise. It is performed in two stage First stage : patient lying supine with knee extended & hip externally rotated and slightly abducted. Breathing pattern is same as first exercise Second stage : patient is lying supine and follow the same pattern of Breathing as demonstrate in first exercise. In addition there is external rotation of hip during inhalation & internal rotation during exhalation.

14. Cont , Result : > During extension there is a full body stretch occur. Some patient may experience in performing this extended pose then place a rolled towel under knee to slightly flex the knee.

15. (C) First rib mobilization with ball & stick: Patient is supine with ball is in posterior aspect of 1 st rib and the stick end touching the wall. As the patient inhale along with anterior tilting of pelvis.pushes the patient away from ball & vice versa. This exercises combine the effect of diaphragmatic Breathing with caudal mobilization of 1 st rib.

16. (D) Supine breathing with air bag : It is performed in 3 stages. Patient position is same and breathing pattern is also same. First stage : air bag is placed under hip Second stage : air bag is placed under lumbar spine Third stage : air bag is placed under thoracic spine

17. Seated ball exercise It is performed in 3 stages Seated ball exercise : patient is in sitting over exercise ball with back straight and head facing forward. Patient is instructed to initiate the diaphragmatic breathing while moving the ball in forward – backward direction, side to side direction, circulatory direction.

18. (B) Seated ball with pelvic tilt : Patient sit over the exercises ball and Tilt the pelvis anteriorly when inhale and vice versa https://youtu.be/Y2TLxsGVcU4?si=W8V7B6tabIZneVyV

19. (C) Supine ball exercise: First patient sit over ball with back straight (thinker pose). By sliding back over ball. During exhalation patient extend his neck and arms backward and while inhaling regain previous pose in diaphragmatic pattern. https :// youtu.be /Y2TLxsGVcU4?si=W8V7B6tabIZneVyV

20. Foam roll exercises & thoracic mobilization Patient lying supine over foam roller with hips flexed so that feets touches the ground and place upper extremity folded so that scapula remain protracted and ribcage or spine is fully exposed. Patient can use a towel roll to support head if uncomfortable. Then instruct the patient to slowly inhale via nose and then exhale in diaphragmatic pattern while doing this they can roll the roller to move laterally

21. Cont , Transverse foam roll exercises: patient lying over roller at mid scapular level and hands placed below the neck to support head. Thoracic spine may be extended or flat and hips or knee flexed so that feets touches the ground. Patient my touch or not touch there buttocks to ground. Patient is instructed to roll upward or downward while doing diaphragmatic breathing. Rolling should be done between inferior angle of scapula to upper thoracic spine. https://youtu.be/NS73eSohTbc?si=AU2fy-esFN5APsrT

22. Three inch roller at sacrum and lumbothoracic spine : Place a 3inch diameter roller at sacrum and instruct the patient to laterally rotate the knee After this patient is asked to place roller at L5-S1 level and asked to roll till lower thoracic spine to sacrum. Caution should be considered if patient has low back condition or spine disease. You can place a wedge below hip to flaten lower spine

23. Strengthening exercises Strengthening exercises for home are not advised ultil patient condition stabilized. Specific exercises should be selected based on patient tolerance Scapular & rotator cuff strengthening should be done Bicep and tricep crul may be added Slowly patient progress to lift weight in over head exercise Push ups or pull ups added later in program as per patient need Core strengthening or low extremity strengthening may be done as per patient need.

24. Stretching & neural mobilization Nerve Stretching & nerve flossing technique are directed It is not recommended that to continue nerve Stretching exercises along with strengthening exercises https://youtu.be/oYOASLgip28?si=bb6CsMVuJ_nSmpu_

25. Postural training Ask patient to sit with back straight to improve breathing pattern Slouched sitting is avoided because it may compress the nerves & abdomen It is found that thinker position is beneficial

26. Cardiovascular training It is recommended to walk 3 to 4 times a day 20 min at 3mph Help to reduce pain & enhance arm swinging It include myofacial release,Trigger point therapy,Cross fiber friction,Stripping , gentle passive stretching Manual therapy

27. Tapping Kinesio taping for scapular stabilization is used to reduce symptoms of TOS

28. Congenital Torticollis[Neck region] It is the condition in which sternocleidomastoid muscle gets contracture.so that neck move to the opposite side by the pulling action of tightened scm . Tumor Palpable at birth or during first two Week of life. More common on right side. Usually contracture develop at site of clavicle Attachment It attain maximum size in 1-2 month.

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30. Physiotherapy management Passive stretching- Physiotherapists often teach parents how to perform passive stretching exercises to gently stretch the tight neck muscles. These stretches should be done multiple times a day. Stretch include lateral rotation & flexion. Active Range of Motion Exercises: As the baby gets older, active range of motion exercises can be introduced to encourage the infant to move their head in both directions. Tummy Time: Placing the baby on their stomach when awake and supervised helps in developing neck strength and control. Positioning: Proper positioning of the baby during feeding, sleeping, and playtime is crucial. Using a headrest or pillow to support the non-affected side can help.

31. Continue Parent Education: Educating parents about the condition, the importance of consistent home exercises, and monitoring the baby’s progress is a key aspect of physiotherapy. Orthotic Devices: In some severe cases, orthotic devices like collars or helmets may be recommended to help maintain proper head position. Transcutaneous Electrical Nerve Stimulation (TENS): TENS units deliver low-level electrical currents to the skin’s surface, which may help with pain relief in cases where congenital torticollis causes discomfort. It could be used in combination with other physical therapy techniques. Electrical Muscle Stimulation (EMS): EMS can be used to facilitate muscle contractions and might have a role in strengthening and re-educating the neck muscles in congenital torticollis, especially in older children.

32. Continue Heat Therapy: Although not strictly electrotherapy, the application of moist heat through hydrocollator packs or warm compresses may help relax tight neck muscles and improve the effectiveness of stretching exercises.
Ultrasound Therapy: Ultrasound therapy can promote tissue relaxation and potentially aid in reducing muscle tension. It may be used in conjunction with manual therapy techniques. Kinesio taping : To apply kinesio tape to the SCM: on the affected side, place tape from insertion to origin of SCM with 5-10% tension; on the unaffected side place tape from origin to insertion with 10-15% tension

33. Continue https://youtu.be/LxGenW5EHxU?si=Px_7cLKDckTkLN5a ( for stretch) https://youtu.be/uLTv1_j1eMQ?si=QJn9oZQm06LFZVZa ( for orthotic) https://youtu.be/zsGtgofNJuw?si=Gnma_POmeyJbURPD ( for kinesio taping) Home care advice : place toys/decorations to encourage infant to turn to other side
position the crib or changing table, so the infant must turn to the other side to see / interact with caregivers

34. Coxa vara Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It cause adduction and external rotation of hip Idiopathic
congenital: mild or severe coxa vara , with associated congenital anomalies: see associations
developmental: progressive, usually appearing between the ages of two and six years, with characteristic radiographic features
rachitic: usually associated with active rickets
adolescent: secondary to the slipped capital femoral epiphysis
traumatic: usually following fracture of the femoral neck (rare in children)

35. Continue Inflammatory: secondary to tuberculosis or other infection
secondary to other underlying bone diseases such as: osteogenesis imperfecta cretinism
dyschondroplasia
Paget’s disease
osteoporosis Symptoms: It restrict Abduction,internal rotation Pain in the leg and/or hip
A one-sided limp or “waddling walk”
Stiffness when trying to move the leg out
A slight difference in leg length

36. Physiotherapy management Post operative pain,oedema & swelling: Cryotherapy, kinesiotaping , soft tissue mobilization Range of Motion Exercises: Physiotherapists will work on improving the range of motion in the affected hip joint through gentle and controlled exercises. These exercises help maintain flexibility and prevent joint stiffness. Emphasizes will be given to increase internal rotation & abduction. Hot packs, soft tissue massage and NMES should be done
Strengthening Exercises: Strengthening the muscles around the hip joint, especially the abductors, adductors, and gluteal muscles , can help provide stability and support for the hip. Strengthening exercises may involve resistance bands or bodyweight exercises.

37. Cont , Balance training: Static & dynamic balance training should be given
Stretching: Gentle stretching exercises can help alleviate muscle tightness and improve hip mobility. These may include stretches for the hip flexors, hamstrings, and quadriceps. Assistive Devices: In some cases, crutches or other assistive devices may be recommended to reduce the load on the affected hip joint and improve mobility Gait Training: Physiotherapists may focus on correcting walking and standing posture to alleviate stress on the hip joint and promote more efficient movement patterns. Re-education in walking to eliminate pelvis drop and waddling gait

38. Congenital talipes equinovarus Congenital talipes equinovarus , also known as clubfoot, is a congenital condition in which a baby is born with one or both feet turned inward and downward. Types of CTEV

39. Physiotherapy management Ponseti Method or kite method: The Ponseti method is the most widely used technique for treating clubfoot. It involves a series of manipulations, followed by casting of the foot in an improved position. This process is repeated over several weeks to gradually correct the deformity.
Stretching Exercises: Physiotherapists teach parents or caregivers how to perform gentle stretching exercises on the baby’s foot to maintain flexibility and prevent recurrence.
Casting: After each manipulation, a cast is applied to maintain the corrected position and gradually shift the foot to a more normal alignment. Bracing: Once the foot is corrected, a brace (commonly the Denis-Browne bar) is used to maintain the correction. This is usually worn for a few years, especially at night.

40. Pes cavus Pes cavus is a deformity characterized by an excessively high longitudinal arch that results from an equinus position of the forefoot in relation to the hind foot In this condition finger can be slipped under the navicular bone and it penetrates a distance of greater than 2 cm from the vertical edge of the foot.

41. Cause of pes cavus : Congenital Acquired: neurological, orthopedic & neuromascular condition Muscle imbalance Muscle weakness Club foot Post traumatic bone malformation Contracture of calf Charcot-Marie-Tooth (CMT) disease, spinal dysraphism , polyneuritis, Intraspinal tumors , poliomyelitis, syringomyelia , Friedreich ataxia, cerebral palsy, and spinal cord tumors , can cause muscle imbalances that lead to elevated arches

42. Cont ,

43. Physiotherapy management Correction of the primary deformity which is equinus and pronation of the foot is done first. Secondary deformities like contracted plantar fascia, clawed toes and varus of the heels are corrected next.Early stages Require conservative line of treatment.Late stages Surgery is required and it consists of soft tissue release in children and bony surgeries in adults. Lateral heel cup orthotic & High arched shoes are prescribed to prevent rubbing of the foot. Bracing is given if foot drop also occur. If patient has sensory defect due to neurological condition Plastazote lining in brace is provided

44. Cont ,

45. For increasing flexibility & ROM: contrast bath to relief stiffness, Stretching of gastrocnemius , plantar fascia & tibialis posterior, Joint mobilizations, ROM exercise. For increasing muscle strength: Strengthening exercises of peroneal muscle & tibialis anterior is beneficial For reducing pain : Cryotherapy after therapy to restore damage & prevent inflammatory soreness and hot packs or electrical stimulation For skin integrity: patient edu & refer to skin specialist Balance & gait training : by using balance bord & assistive devices are given to prevent fall

46. Functional Training: as per patient need task are given. Night splinting & casting are done https://youtube.com/shorts/gw8wipktv1k?si=CwyzBIlecvrICw2M

47. Pes planus Disorder of foot characterized by loss of medial longitudinal arch of foot Also know as flat foot

48. Cont ,

49. Physiotherapy management Rest Cryotherapy Heat Therapy Soft tissue Manipulation Combo therapy : Ultrasound & pulsed electrical stimulation Increasing flexibility: PROM, Stretching of gastrocnemius & soleus & peroneal brevis muscle Increase arch : ball rolling under foot Plyometric exercise

50. Strengthening exercises:To prevent valgus and flattening of the anterior arch, muscles such as the anterior and posterior tibialis muscles, the flexor hallucis longus , the intrinsic, the interosseus plantaris , and the abductor hallucis are strengthened.

51. Links Strengthening of tibialis posterior- https://youtu.be/AMasoQG4Id0?si=k--bmTQaJ0y0lh6- Strengthening of tibialis anterior - https://youtu.be/CZhPw__uulw?si=yFQR0kww3rP69n6E Strengthening of peroneal muscles- https://youtube.com/shorts/gw8wipktv1k?si=NSwwUu1PokV_4jYq Strengthening of Flexor hallucis longus - https://youtube.com/shorts/zz8r9_F9jKI?si=P_Oy8unGRpKnro7-

52. Cont , Arch lift /short foot exercise https :// youtu.be /vcx_NNR7b1k?si=yEck0qqu0ZC74mN7 Towel crul exercises Stair arch raise https://youtube.com/shorts/Ur4PR_vXuxs?si=wulPltP9vTuHTKyN For proprioception- Toe & heel walking Single leg weight bearing Toe extension & Toe spreading

53. Kinesio taping - https://youtu.be/ZLtAUy6GhNs?si=ITI7CGiu5vT3u98T Extra arch support also used

54. Home care advice Encourage patient to walk on outer edge of foot Encourage to walk over sand Advice for hot water immersion exercise Within cast slight movement of moveable joint is encouraged Procedure to make cast - https://youtu.be/NI6Dt9Ud9G0?si=uEqaW3NSC_Xnr_NM Children who are not engage in physical activity should be encouraged to maintain enough strength of muscle to maintain arch Adolescents whose foot is not developed should be advised to not participate in overloaded activity

55. Cont , They could engage in high leg lifting, jumping activities (such as rope skipping, long jump, high jump, vertical take-off, etc.), and climbing activities (such as climbing ladders, using balance beams, rope climbing, pole climbing, etc.) to fully exercise the muscles and ligaments of the arch of the foot Tibialis posterior muscle was strengthened with resistance band, 3-4 sets and 10 repetitions per set, stretching of iliopsoas was in 30-second hold each time and three times in total. Towel curl exercise was performed 100 repetitions. Some research say hip & knee strengthening improve foot pressure

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