Musculoskeletal Conditions: Basics, Assessment and Evaluation Objectives:
This course shall enable the candidate to establish first contact physiotherapy for the management of Musculoskeletal disorders and pain, expertise in the skills of manual medicine, advanced electro-diagnostic/ therapeutic skills, and ability to function as a consultant in the team of health professionals concerned with sports sciences, hand rehabilitation, women’s health as well as geriatric health and industrial set up. The sub headings are :

• Advances in manual medicine and pain management
• Rehabilitation of hand
• Sports sciences
• Industrial health and ergonomics
• Women’s health and geriatric health
• Applied bio-mechanics and bio-engineering

Section-I: Musculoskeletal Conditions – Basics

ANATOMY, PHYSIOLOGY AND BIOMECHANICS

• Embryological development of musculoskeletal system.
• Osteology; structure of bone, ossification of bones, skull bones, facial bones, bones of upper extremity,, lower extremity, pelvis, vertebral column, ribs.
• Myology; Structure of muscles , type of muscle, muscle fibers, origin , insertion,, nerve supply of muscles of upper extremity, lower extremity, Trunk.
• Structure of joints, types of joints, detailed structure and formation of all the joints, detailed structure and formation of al the joints, neurobiology of joint
• Neurology: peripheral nerves, dermatomes and myotomes,
• Physiology: Joint physiology (movements), muscle physiology
• Biomechanics of normal joints and Pathomechanics of fractures, deformed joints.

Section-II: Musculoskeletal Conditions- Assessment and Evaluation
Introduction, principles and concepts of Patient history, observation, Examination, Principles, scanning examination, examination of specific joints, functional assessment, specific tests, reflexes, cutaneous distribution, joint play movements, palpation and diagnostic imaging.

• Head and Face:
  Patient history, observation Examination, examination of the head, examination of the face, examination of the eye, examination of the nose, examination of the teeth, examination of the ear, special tests, reflexes and cutaneous distribution, joint play movements, palpation, diagnostic imaging.
• Cervical Spine:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, peripheral joint scanning examination, myotomes, functional assessment, special tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Temporomandibular Joint:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Shoulder:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Elbow:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Forearm, Wrist and Hand:
  Patient history, Observation – common hand and finger deformities, other physical findings Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Thoracic (dorsal) Spine:
  Patient history, observation Kyphosis, scoliosis, breathing chest deformities. Examination‐ active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Lumbar Spine:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Pelvis:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Hip:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Knee:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Lower leg, Ankle and Foot:
  Patient history, observation Examination, active movements, passive movements, resisted isometric movements, functional assessment, specific tests, reflexes and cutaneous distribution, joint play movements , palpation, diagnostic imaging.
• Assessment of Gait:
  
  • Normal patterns of gait, stance phase, swing phase , joint motion during normal gait Normal parameters of gait, base width, step length, stride length, lateral pelvic shift, vertical pelvic shift, pelvic rotation centre of gravity, normal cadence. Overview and patient history, Observation – foot wear Examination, locomotion score, compensatory mechanisms.
  • Abnormal gait, antalgic (painful) gait, arthrogenic gait (stiff hip or knee), ataxic gait, contracture gait, equines gait, gluteus maximus gait, gluteus medius ( Trendelenburg’s) , hemiplegic or hemiparetic gait, parkinsonian gait, plantar flexor gait, psoatic limp, quadriceps gait, scissors gait, short leg gait, steppage or drop foot gait.
• Assessment of Posture:
  Postural development, factors affecting posture, causes of posture Common spinal deformities, Lordosis, kyphosis, scoliosis Patient history, Observation – standing, forward flexion, sitting, supine lying prone lying Examination
• Assessment after acute injury of bone, ligament, and tendon
  
  • Mechanism of injury
  • History
  • Observation
  • Examination
  • Special tests
  • Palpation and diagnostic imaging
• Assessment of the Amputee:
  
  • Levels of amputation
  • Patient history, observation
  • Examination‐ measurements related to amputation active movements, passive movements, resisted isometric movements, functional assessment, sensation testing, psychological testing , palpation, diagnostic imaging.
• Pre operative and post operative assessment in orthopaedic surgeries
• Assessment and evaluation of pain Apart from the above; the student is expected to learn assessment and evaluation in the following clinical conditions (pre operative and post operative)

Physiotherapeutic Intervention in Clinical Musculoskeletal Conditions

Section-I: CLINICAL MUSCULOSKELATAL CONDITIONS

• General Musculoskeletal disorders:
  • Degenerative disorders of joints
  • Infections of bones and joints
  • Arthropathies
  • Tumors of the bone
  • Congenital deformities
  • Spinal deformities
  • Developmental disorders of bone
  • Metabolic and endocrine disorders
  • Conditions related to upper extremity, lower extremity and spine
  • Soft tissue: overuse injuries
  • Musculoskeletal problems in neuromuscular disorders
• Traumatic Orthopedics:
  • Classification of fractures
  • Dislocation of various joints
  • Fractures and dislocation of upper extremity
  • Fractures and dislocation of lower extremity
  • Fractures and dislocation of spine and pelvis
  • Fractures of skull, face bones and ribs
  • Soft tissue: acute traumatic injuries
• Orthopedic surgeries:
  • Amputation
  • Joint replacement surgeries
  • Osteotomy and Arthrodesis
  • Surgery for correction of bone deformities and contractures
  • Surgical procedures for fracture, dislocation
  • Tendon transfer principles and procedures
  • Bone grafting
  • Nerve suturing and grafting
  • Implants in Orthopedics

Recommended Books:

• Treatment of Fractures in Practice – Page. C, Henry Frowle.
• Outline of Fractures – Adams. J, Churchill Livingstone.
• Joint and Soft Tissue Injuries – Pfizer.
• Outline of Orthopedics – Adams, Hamblen, Churchill Livingstone.
• Apley’s system of Orthopedics and Fracture – Solomon. A, ARN.
• Physical signs in Orthopedics – Walsh, Henry. J, Jaypee.
• Management of common musculoskeletal disorders – Hertliny. K, Lippincott.
• Clinical Orthopedic Diagnosis – Pandey. S, Pandey. A, Jaypee.
• Clinical Assessment and Examination in Orthopedics – Rex.
• Orthopedic Physical Assessment – Magee, Jaypee.
• Clinical Orthopedic Examination – Mcrae. R, Churchill Livingstone.
• Campbell’s Operative Orthopedics – Speed. J.S, Mosby.
• Orthopedic Rehabilitation Assessment – David. I. P, Springer.
• Illustrated Orthopedic Physical Assessment – Evans. R, Mosby.

Section-II: PHYSIOTHERAPY INTERVENTIONS IN MUSCULOSKELATAL

CONDITIONS

• Physiotherapy management procedures in general musculoskeletal disorders:
  • Degenerative disorders of joints
  • Infections of bones and joints
  • Arthropathies
  • Tumors of the bone
  • Congenital deformities
  • Spinal deformities
  • Developmental disorders of bone
  • Soft tissue: overuse injuries
  • Neuromuscular disorders
  • Conditions related to upper extremity, lower extremity and spine
  • Metabolic and endocrine disorders
  • soft tissue acute traumatic injuries
• Physiotherapy management procedures in Traumatic Orthopedics:
  • Fractures and dislocation of upper extremity
  • Fractures and dislocation of lower extremity
  • Fractures and dislocation of spine
  • Fractures of sternum and ribs
• Physiotherapy management procedures in orthopedic surgeries:
  • Amputation
  • Joint replacement surgeries
  • Osteotomy and arthrodesis
  • Surgery for correction of bone deformities and contractures
  • Surgical procedures for fracture, dislocation
  • Tendon transfers
  • Bone grafting
  • Nerve suturing and grafting
• Orthosis, Prostheses and mobility aids in musculoskeletal problems:
  • Principles of Orthosis and prostheses
  • Biomechanical compatibility, materials and designs of mobility aids
  • Different types of Orthosis and Prostheses used in musculoskeletal problems
  • Functional training with Orthosis and Prostheses
• Physiotherapeutic approaches in musculoskeletal conditions:
  • Manual therapy approaches for specific joints of upper extremity, lower extremity and spine
  • Therapeutic exercises commonly used in musculoskeletal conditions including correction exercises and home exercises
  • Pilates and core stability exercises
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Hydrotherapy in common musculoskeletal conditions
  • Swiss ball exercises
  • Taping, Wrapping and Bracing techniques.
• Ergonomic principles and its application
• Recent advances in Orthopedic Physiotherapy.
• Community based rehabilitation in musculoskeletal conditions
• Evidence based physiotherapy management for different musculoskeletal conditions

Recommended Books:

• Musculoskeletal intervention Techniques for Therapeutic Exercise – Voight. M, McGraw Hill.
• Rehabilitation for the Post surgical Orthopedics – Maxey. L, Mosby.
• Clinical Orthopedic Physical Therapy – Richardson. J, W. B. Saunders.
• Orthopedic Rehabilitation Science – Loudon, Kalte, Butterworth.
• Therapy for Amputees – Engstorm. B, Churchill Livingstone.
• Musculoskeletal Physiotherapy: Clinical Science and Evidence Based Practice – Refschugae. K, Butterworth Heinnemann.
• Orthopedic Examination, Evaluation and Intervention – Dutton. M, McGraw Hill.
• Inpatient Physiotherapy management of Orthopedic Surgery – Chipchase, Butterworth Heinemann.
• Physiotherapy in Orthopedics: A Problem solving Approach – Atkinson, Elsevier.
• Handbook of Orthopedic Rehabilitation – Brotzman. B, Mosby.
• Orthopedic Physiotherapy – Tidswell. M, Mosby.
• Treatment and Rehabilitation of Fractures – Hoppenfeld, Lippincott Williams.
• Orthopedic Physical Assessment by David J. Magee (Dec 10, 2007)
• Orthopedic Manual Therapy: An Evidence-Based Approach by Chad Cook (Aug 18, 2006)
• Pocketbook of Taping Techniques by Rose Macdonald BA FCSP (Aug 27, 2009)
• Principles of Neuromusculoskeletal Treatment and Management: A Guide for Therapists by Nicola J. Petty (Oct 2, 2004)
• Differential Diagnosis for the Orthopedic Physical Therapist by James Meadows (Jan 1, 1999)
• Orthopaedic Examination, Evaluation, and Intervention, 2nd Edition (Book & DVD) by Mark Dutton (Feb 19, 2008)
• A System of Orthopaedic Medicine by Ludwig Ombregt (Dec 23, 2002).
• Hand and Upper Extremity Splinting: Principles and Methods by Elaine Ewing Fess, Karan Gettle, Cynthia Philips and Robin Janson (Aug 4, 2004)
• Principles of Assessment and Outcome Measurement for Occupational Therapists and Physiotherapists: Theory, Skills and Application by Alison J. Laver Fawcett (May 8, 2007)
• Pocket Guide to Musculoskeletal Assessment by Richard Baxter (Jul 3, 2003)
• Critical Pathways in Therapeutic Intervention: Extremities and Spine by David C. Saidoff BS PT and Andrew L. McDonough EdD PT (Jan 15, 2002)
• Rehabilitation of the Spine: A Practitioner’s Manual by Craig Liebenson (Mar 3, 2006)
• Clinical Orthopaedic Rehabilitation by S. Brent Brotzman MD and Kevin E. Wilk PT DPT (Jan 24, 2003)
• Macnab’s Backache by David A. Wong and Ensor Transfeldt (Oct 30, 2006)
• Orthopaedic Physical Therapy by Robert A. Donatelli PhD PT OCS and Michael J. Wooden MS PT OCS (Jul 27, 2009)
• The Swiss Ball: Theory, Basic Exercises and Clinical Applications by Beate Carrière, V. Janda and R. Tanzberger (Nov 28, 2000)
• Orthopaedic Medicine: a practical approach by Monica Kesson MSc Grad Dip Phys MCSP Cert Ed Cert FE and Elaine Atkins DProf MA MCSP Cert FE (Oct 8, 2005)
• Neck Pain: Medical Diagnosis and Comprehensive Management by David G. Borenstein MD, Sam W. Wiesel MD and Scott D. Boden MD (Aug 15, 1996)