The Assessment of Muscle Strength by Physiotherapists

We depend on our muscles to allow us to do all the functional activities we want to perform, from walking to climbing stairs to typing and doing precise work. Our muscles can deliver huge amounts of power and endurance as well as highly coordinated and skilled manipulations. Loss of feeling may be more important in a limb but loss of sufficient muscle power compromises our independence particularly as we get older and find difficulty performing routine actions for ourselves. Muscle power can be reduced by a large number of causes including not using them when ill and forced to rest, pain from injury or operations, stroke or other neurological condition, disease and illness. The assessment and treatment of muscle weakness is a routine skill in physiotherapy.

The Oxford Scale is the rating system used by physiotherapists for the assessment and recording of muscle power when required. Knowledge of muscle anatomy is vital so that the joint can be positioned correctly and the tendon and muscle palpated so whether there is any muscle action can be judged. The muscle is rated on the Oxford Scale from one to five and written down as 2/5 or 4/5, at times with a plus or minus sign to show the muscle has more or less strength but not enough to go down or up the scale. The physiotherapist ensures the joint is in the optimal position to enable the muscle to function easily and for easy visualisation of the tendon and muscle.

Grade 0 is no action discernible in the muscle at all, with the physiotherapist palpating the muscle belly or tendon as the patient attempts to perform the activity several times. Grade 1 is a twitch as the muscle undergoes a small contraction but is not strong enough to perform any of its specified joint movement. Grade 2 indicates a muscle strong enough to perform its designated joint movement when the force of gravity is eliminated, making it much easier to perform. The joint must be accurately positioned for this to be tested correctly. Grade 3 is a muscle strong enough to perform the joint action to the full range against gravity but with no resistance applied. An example here would be lifting the arm above the head.

If the muscle can move the joint through the full movement both against gravity and against some resistance such as body weight then the Oxford Scale grading is 4/5. It is a professional judgment as to the resistance to be applied for the test, and the physiotherapist will have in mind the health, age, activity and weight of the patient. If a muscle is to be graded 5/5 it must be of normal power, but as this will vary greatly between individuals the physiotherapist must make an estimation of the expected full muscle power for that particular patient. Grade 5 for a frail sick person will be very different from grade 5 for a young, fit sports person.

If the patient can raise their arm up above the head to some extent but not very strongly nor to full range, the physiotherapist might grade that as 3/5 for the deltoid muscle but because it is not full it might be rated 3-/5. If the muscle will take good manual resistance but does not appear to be normal for that patient then the grading could be 4+/5. This grading scale allows the physiotherapist to test all the appropriate muscles and record them in the patient's notes, enabling progress to be charted against time as the strength improves. This can be very useful in tracking the progress of patients recoveries or recording their neurological status such as in spinal cord injury.

Muscle strengthening begins with encouraging muscle activity with gravity counterbalanced if the muscle is weak. Once a functional level of muscle activity is reached the patient can be encouraged to perform normal daily activities to power up their muscles. At a higher level resistance must be added as it is the intensity of work which develops muscle strength. This causes a breakdown of muscle fibres which regenerate with increased strength, a cycle which can be repeated with increased levels of applied intensity of resistance. Once simple resistance has been managed, the patient is taught to perform dynamic exercises using their bodyweight as this is the ultimate expression of muscle strength.

Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Glasgow.

Added: February 17, 2009
Source: http://ezinearticles.com/

Gait and Gait Analysis

Travelling short or medium distances for us is easily accomplished by walking, which is convenient and easy but needs our muscles and joints to be in good condition and to be pain free. Having enough muscle power and sufficient joint range of movement in the legs is necessary for efficient walking. As walking progresses one leg gives the body support while the other swings through to be placed forward and in its turn to take weight. The swing and stance phases are the easiest way of understanding where either leg is at a particular point.

The process of going through all the stages and getting back onto the same foot again is known as the gait cycle. Both feet are down on the ground for about 10% of the gait cycle, with a single down on the ground for about 40% percent overall. The remainder is made up of the swing part of the cycle as the legs are being brought through to be placed down on the ground again for the next step. As walking gets faster the duration of these phases of the gait cycle reduces and when we start running then there is no double support phase when both legs are on the ground at the same time.

The stance and swing phases consist of a precise and repeatable series of movements during normal locomotion, with five different stages of stance phase. These are initial contact, loading response, mid stance, terminal stance and preswing, although initial contact is often referred to as heel strike. Heel strike is a slight misnomer as some people do not heel strike or at least weight transfer to the heel later in the phase. Heel strike allows shock reduction and maintenance of stability and speed whilst accomplishing weight transfer to a new leg.

The swing phase occurs as the other leg supports the weight of the body, taking the body centre of support to be placed over the foot in what is referred to as mid stance which initiates the phase of single leg support. The supporting foot lifts at the heel as the cycle progresses into terminal stance, a phase which stops when heel strike is obtained on the other foot. The swing phase is about to start and preswing consists of the last part of the double support phase before the leg goes on into swing. There are three swing phases, initial, mid and terminal, which allow the leg to be brought forward for the next heel strike and for the leg to clear the intervening ground.

Energy conservation and shock absorption are important parts of efficient gait. The joint contact forces can be increased if there are joint restrictions or loss of muscle power, leading to structural pathologies in the abnormally loaded areas. Sixty percent of the bodyweight loads extremely quickly onto the leg in the early stance phase, taking only twenty milliseconds.

The leg joints absorb and control these forces as they act as shock absorbers and dampers. When the leg is placed initially on the ground the forward forces involved tend to make the knee bend so we resist this by making the knee straighter even though this increases the forces through the joints. Loading forces are minimised by eccentric muscle action by the hip adductors and quadriceps.

Walking always takes energy but these demands are relatively small for normal adults walking on the level at their natural speed. We each tend to have a naturally chosen walking speed which minimises the amount of energy we expend. All muscular or neurological conditions slow walking speed down but do not necessarily increase the amount of energy used per time due to the slower cycle. Even though the energy cost per unit time may not change the actual cost of getting along a particular distance can increase markedly, for instance more than 3 times the normal in stroke.

Using a wheelchair cuts energy requirements per distance by 50% and allows speed to be maintained. The choice of using a wheelchair may be made by a patient when the amount of energy to get across a certain distance exceeds a certain level, often when the load exceeds 300% of what would be normally required.

Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Brighton or elsewhere in the UK.

Added: February 16, 2009
Source: http://ezinearticles.com/

HGH Therapy - What is it and What Can it Do For Your Body?

HGH therapy is an effective mode of treatment for related abnormalities in HGH deficiencies. This type is now used in anti-aging treatments very popular not only with the elderly but also with young people. Medically, the HGH therapy deals with helping to cure adults and children with pituitary functions impairment. Deficiencies shall include short stature, with symptoms of fatigue, poor sleep, decreased muscle and strengths in bones, psychological problems, increase in lipids and visceral fats.

The therapy is now used to assist in anti aging treatment with therapies that aid in the body being rejuvenated. It is believed to have the components to reverse and enhance metabolisms of carbohydrates, fat, and proteins. It can help one achieve a trim body, high energy level, excellent immune system, sharp hearing and vision, nice and firm hair and skin. Low blood pressure and cholesterol level, reduced risk in heart attack, improved sexual performance, and overcome the effect of chronological age.

Though there are a lot of good effects, the side effects or difficulties of HGH therapy are experienced by some such as:
1. Body joint pain
2. Carpal tunnel syndrome
3. Feeling of headaches
4. Fluid retention

The benefits and good effect of the therapy on the other hand are as follows:
1. Increase in body vitality and energy
2. Reduce cellulite and fats which reduce risk of heart problems
3. Build muscles not fats to be good looking inside and outside
4. Gives the skin a glow and rejuvenation
5. Improvement in memory for children and adults
6. Elevates and normalizes the mood of one person
7. Enhance the sexual function and activities
8. Regulate the sleep and gives ample rest
9. Improves the immune system
10. Rejuvenate the brain functions
11. Protection and strengthen the body cells

Autor: Faviano Torres

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Added: February 15, 2009
Source: http://ezinearticles.com/

New Knee Brace For Patella Tendonitis and Osgood-Schlatter's Disease

Unlike any other knee brace, The Mueller's Hg80 Hinged Knee Brace is constructed of an exclusive HYDRACINN fabric, which produces a moisture wicking catalyst that prevents sweat and heat retention under the brace. The sleeve is made of an antimicrobial fabric that is uniquely breathable and extremely soft to the touch.

Compare this to standard neoprene style braces that retain heat and sweat, not to mention odor and bacteria accumulation.

The shape of the Mueller Hg80 utilizes a unique hourglass design to provide superior comfort to the thigh and leg, with uniform compression throughout the brace.

Another unique feature of the brace is the use of silicone inner grip strips on the inside of the brace, which helps prevent brace slippage and preserve high-performance support. For those athletes that have had to stop to readjust their brace during activity can attest to this common complaint.

The best feature of this brace has to be the patented triaxial hinges. This hinge provides maximum protection with near-normal knee motion. The hinge is low profile and incorporated into the fabric of the brace to prevent metal exposure.

For patients with patella instability, the Mueller Hg80 Hinged Knee offers a tibial containment system, featuring a custom secondary shell with stabilizing patella buttress and a rear support strap. The upper strapping system locks the brace in position.

The brace even comes with its own protective nylon mesh laundry bag, which is custom-sized for every Hg80 knee brace, to shield your clothes and other equipment in your gym bag or your washing machine from the hook and loop straps. The open weave design with locking cinch string allows for a thorough yet gentle cleaning. Now that is a first!

The Mueller Hg80 hinged knee brace is indicated for patella tendonitis, patella tracking and Osgood-Schlatter's Disease. It also helps protect the MCL (Medial Collateral Ligament), LCL (Lateral Collateral Ligament) and meniscus.

I have never seen such detail and features in a brace in this price range, and should be considered for anyone who has sensitivity or allergies to neoprene or latex materials. In terms of compression and comfort, this is the top of the line. When you are looking for mild to moderate knee support, the Mueller Hg80 should be at the top of your list.

It is always recommended to consult with your treating doctor to determine the correct brace for your orthopedic condition.

Autor: Dr. Kenneth Shapiro

Dr. Kenneth Shapiro is one of the medical advisors for The Brace Shop, an online orthopedic brace store.

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They supply hospitals, sports teams, schools, doctors, therapists, nursing homes & military bases around the world. Shop Where The Pros Go!

Added: February 8, 2009
Source: http://ezinearticles.com/

Analysis and Remedy Equals an Active Lifestyle After Surgery

It's not enough to get the best diagnosis, have the latest in surgical techniques and most recent advances in prosthesis if you can't recover quickly and get moving better than you did prior to the process. You want to know when you go to the Watseka Illinois hospital that you will be able to come out better than when you went in. Having joints replaced is one of the miracles of modern medicine. Whether you use your own parts in a creative way or you get artificial replacements you are expecting to be able to be active again.

The first thing to expect from your team of medical professionals is to get a good diagnosis. The preoperative portion is key to successful recovery. At the Braidwood hospital in Illinois you will expect the best with your medical professionals like you would at any hospital. After the preoperative sessions you expect the best in surgical procedures and the latest in technology possible. Once you have the surgery, the real test is about to begin and that is getting you back to an active lifestyle.

Whether you are at the Dwight Illinois hospital or another hospital in the Chicago area, you want to get back on your feet quickly. The treatment processes for orthopedic patients is being streamlined at various hospitals so the patient has to spend less time in the hospital and can get into a post-operative program efficiently. This will provide the best possible outcome for the patient recovering from an injury or surgery.

Autor: Alice Lane

The Riverside Medical Center and Healthcare organization is outstanding in their advancements in rehabilitation. Whether you are provided the services at the Watseka Illinois hospital, Braidwood hospital or the Dwight Illinois hospital, you will find the best in care and the latest in techniques to get you back to your active lifestyle.

Added: February 7, 2009
Source: http://ezinearticles.com/

Knee and Hip Replacements - Tips on Exercise Frequency and Duration After Surgery

During your rehabilitation process from either a hip or knee replacement, you will have been presented with a host of exercises to complete to assure your success. The exercises should be presented in an orderly fashion taking into consideration the date of surgery, your overall medical condition and age.

In the hospital immediately after surgery, most of the exercises you will have been given will be what is known as isometric in nature. The frequency and duration that you will be advised to complete these type of exercises will depend on either your surgeons protocol or, the acting physical therapist assigned to you.

After leaving the hospital, you will then be assigned to either a skilled nursing facility or out patient clinic or,receive home health to continue your physical rehabilitation. It is generally within one of these three settings that your exercise program will intensify and the ease in which exercise can be carried to far is at its most prevalent.

Exercise frequency and duration is a key component that needs to be discussed with each patient not only before but after surgery. There is so much information out today on how and when to exercise along with the amount that it leaves most people confused. Along with that most information is conflicting. There is also the old school thinking of " no pain no gain" which from my previous writings I have mentioned that it is not necessarily the case and progress can be made without excessive pain. In fact, it has been determined in most patients that by promoting excessive pain after surgery actually will slow down the healing process and also promotes noncompliance with the exercise protocol.

When recovering from your replacement surgery the ideal exercise frequency that I find with my patients is twice a day. Once in the morning another exercise session in the afternoon. The timing of these two sessions can be critical as well. Proper spacing of the sessions needs to be taken into account to avoid excessive fatigue and pain. Anything more then three exercise sessions a day is counter productive and will only break the body down physically.

Its is recommended that the exercise sessions be spaced approximately 4-6 hours apart. If the exercise session was intense enough this time frame will allow your body to recover and be refreshed for the next session.

By properly spacing out the exercise frequency along with the duration or time spent exercising you will have much better control over your levels of pain along with edema in the affected limb.

There are many components involved in having a successful hip or knee replacement. One of the major issues though you will want to understand will be your exercise frequency and duration. If you can master that and listen to what your body is telling you will have a successful outcome.

Remember no more then three sessions a day but preferably two. Total exercise time during your sessions should be no more then 20-30 minutes, with no more then 5-8 exercises total each session.

Autor: Richard A Haynes Richard A Haynes
Level: Basic PLUS
I live in Punta Gorda Florida and have worked in the field of Physical Therapy since 1995. I have been a fitness consultant since 2000 ... ...

Richard Haynes PTA/CPT

Punta Gorda, Florida.

http://www.richardhaynes.com

Added: February 5, 2009
Source: http://ezinearticles.com/

Proprioception and Sensibility

Our sensory system conveys the information we need to our brains so we can make the right decisions in daily life. Huge amounts of information flow in to our brain at all times and we must decide the importance or otherwise of this. Hearing, touch and sight are clearly used by use to manage our responses to the challenges of normal life but there are other sensory modalities which are just as important in our mobility. The feelings coming in from all our bodily structures such as our muscles, ligaments, discs and joints are very important for normal movement function. Joint position sense is more specifically related to our joints and is also called proprioception.

Have you ever woken up in the night to find you have a numb and dead arm? I woke up on my back to find an arm laid across my chest so I lifted it off to the side. Very soon it came back. I moved it again, this time with a bit more speed. It came back. Gradually waking up I felt up the arm until I got to my shoulder. It was my own arm! Since I had laid on my arm, cutting off the blood supply to the nerve or compressing it, all sensory input to my brain from the arm had been cut off. My arm did not exist as far as by brain was concerned and when I gripped and moved my arm I had no sense that it was mine. As far as I was concerned the lack of feeling coming in meant that the arm had to be someone else's.

Compression of the nerves in the arm or cutting off their circulation in the same manner can completely interrupt the incoming messages to the brain, making the brain think that the area of the body does not exist at all and therefore has no movement function. The brain is unable to picture the limb and its position so is cannot plan any useful movement for the limb either. Working as a physiotherapist for over twenty years has left me with a clear view of the importance of sensory input in our management of normal movement.

Sensory input, the constant incoming signals to the brain from the various parts of the body, informs us what is going on and where we are in space. This is much more important than we realise. Losing muscle power is difficult but people adapt and manage well but losing sensory information from a body part makes it extremely difficult or impossible to use the part. Losing sensibility is more troublesome than losing muscle power, although both are important.

The loss of movement is the most obvious disability we see when we observe a stroke patient, but what we don't see is the loss of accurate sensory input, an impairment which may be more disabling overall. The joint position sense (JPS), also called proprioception, is the ability which allows our system to understand at any point where our joints are, what stresses are acting on them, how fast they are moving and how much muscle effort is being expended.

Monitoring of the positions, stresses and effort being exerted through all our joints is streaming in to our brains all the time from the joint position sense and other sense organs in our muscles and tendons. We need all this incoming information to make sense of where our limbs are so that we are in a position to do the next actions we desire. Accurate JPS information is essential if we are to be able to plan our next movement.

The loss of the ability to feel any part of our body accurately can have profound consequences, reducing our functional independence in many normal daily activities. Typical conditions include stroke, paraplegia and direct nerve damage but more surprising injuries can reduce JPS input. A sprained ankle or ruptured anterior cruciate ligament reduces the accuracy of joint position sense and requires rehabilitation. Physiotherapists are skilled in the rehabilitation of proprioceptive ability in multiple conditions.

Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Brighton or elsewhere in the UK.

Added: February 4, 2009
Source: http://ezinearticles.com/