comprehensive review.docx

[COMPREHENSIVE REVIEW] **EFFECTS OF MASSAGE (Rattray page 7-16)** The effects of massage are physiological and psychological in nature Its reflexive effects through the neurological systems -- central, peripheral and autonomic systems Cause muscle flexibility and relaxation and decreases stress...

[COMPREHENSIVE REVIEW] **EFFECTS OF MASSAGE (Rattray page 7-16)** The effects of massage are physiological and psychological in nature Its reflexive effects through the neurological systems -- central, peripheral and autonomic systems Cause muscle flexibility and relaxation and decreases stress levels Positive touch Decrease stress, anxiety and depression Effective in reducing pain and managing it Effect on local blood flow and increase circulation Increase lymphatic flow, decrease edema Can reduce blood pressure, decrease hypertonicity What massage therapy cannot do is increase muscle tone, increase muscle strength or bulk. It also cannot directly decrease the amount of cellulite or adipose tissue. Cannot prevent muscular atrophy in the denervated tissue. MASSAGE TECHNIQUES Components of the massage are: 1. Direction of movement: For relaxation or reduction of edema, the direction is centripetal (towards the heart) or in the direction of blood flow For treatment of fibrotic tissue, the techniques are applied in a cross-fibre direction in the direction of the restriction 2. Pressure: For relaxation, the pressure is usually light to moderate Deeper pressure is used to reach deeper structures and for the treatment of adhesions 3. Rhythm of movement: An even rhythm of movement should be used 4. Rate of movement: For relaxation -- movement is slower and can be matched to client's respirations Stimulation -- techs are applied more quickly 5. Duration of a technique: How long one applies a technique depends on the size of the area massaged, the pathological condition and the client's tolerance. EG: petrissage to an area of acute lumber pain may only be tolerated for a short time before the tissue becomes irritated whereas to reduce edema, a tech mayu be applied for 20 mins or more 6. Part of the therapist's hand or arm is used: Various parts of the hand or arm may be used to apply a technique. An elbow or thumb can achieve a more focused effect than the dull surface of the palm, which apples more general pressure. So depends on size and condition, tolerance and age of a client -- do not spend an hour on babies! Hand Contact -- why is it important? Maintaining hand contact during a massage is crucial for several reasons, enhancing both effectiveness and comfort: Trust and Connection: Continuous contact builds trust and reassures the client, creating a sense of safety. Client Comfort: Sudden breaks in contact can be jarring. Continuous touch helps the client stay relaxed. Therapist's Awareness: Keeping hands on the client allows the therapist to monitor muscle tension and adjust techniques in real-time. Smooth Transitions: Hand contact ensures smooth transitions between different techniques, enhancing the overall experience. Energy Flow: Continuous contact maintains a consistent energy flow, beneficial for healing and relaxation. Sensory Feedback: Continuous touch provides feedback to both the client and therapist, enhancing the effectiveness of the massage. Professionalism: It shows the therapist\'s focus, attentiveness, and commitment to providing a seamless experience. Overall, maintaining hand contact during a massage enhances its therapeutic effect, ensures client comfort, and reflects the therapist\'s competence and care. The difference between a relaxing effect and a stimulating effect is: Relaxing Effect -- slow, rhythmical and repetitive manner, decreases SNS firing, predictable rate, superficial techs using light pressure tend to be relaxing but so as deep pressure if applied with a broad touch (ie: full palmer surface of the hand or the ulnar border of the forearm can cause a soothing effect) Stimulating Effect -- briskness, erratic and less predictable patterns will generally increase the SNS firing. Deeper pressure may also have this effect. When smaller areas is used to apply the techs such as thumbs or fingertips or olecranon, the sensation is concentrated and specific, the effect may be more stimulating for the client. STROKING CI : Stroking is not used over uncovered open or contagious lesions Principle of Massage: Page 63-65 General \-\-\-\-\--\> Specific \-\-\-\--\> General and Superficial \-\-\-\--\> Deep \-\-\-\-\-\-\--\> Superficial - Refer to a group of techs applied to an area of the body - This sequence has many effects -- it accustoms the client to the therapist, it allows the therapist to palpate through layers of tissue, prepared tissue by increasing circulation, reduces SNS firing - Tapotement to remove mucus - Help with pressure - SDS PDP -- refers to how techs are applied to the limbs in order to increase local circulation of blood and lymph - Help to decrease swelling PDP PCP -- peripheral -- centripetal -- peripheral - Treating acute and subacute local injuries - Toxin removal and tx areas of pain Draping pg 133 Draping the client is designed to make the client feel comfortable, secure and warm during tx Only the part of the client that is being worked on is uncovered MT should not go below the draping, the line that the draping forms is a boundary for the client's security Draping Boundary LINES Prone Undrape the back -- PSIS Undrape the leg -- GT and lateral iliac crest to work on glutes Side lying Undrape back to the lateral iliac crest Undrape leg to -- GT, lateral iliac crest to work on glutes Supine Undrape pecs for female to the rise of the breast Undrape Abdomen -- ASIS and xiphoid process Undrape legs -- GT Control is the space is front of you that you can control ROM pg 75 A black text on a white background Description automatically generated READ DEGREES AND END FEELS ACTIVE FREE -- performed when the client actively contracts the muscles crossing a joint, moving the joint through the unrestricted range  A close-up of a page Description automatically generated - Make sure to do unaffected first then affected - Bilateral is to compare - Ie : wrist pain -- do elbow joint first and then do wrist or if shoulder pain do elbow first. Tibialis Anterior -- what ROM do you do to lengthen? Peroneus longus -- what ROM lengthen? Dorsi and inversion Rectus femoris -- extension of the hip and flexion of the knee Which muscle does planta flexion? All posteriors including flexors QL -- which movements do lengthening? Lateral side (same) -- shortening Lateral side (opposite) -- lengthening GH -- Flexion decreases the angle and Extension increases the angle REMEDIAL EXCERCISES:  A close-up of a text Description automatically generated ISOMETRIC  Isometric -- to do initially after tissue is safe to tolerate contraction  Isotonic with movement -- More tension is eccentric/highest PG 119 **4 T's** A close-up of a document Description automatically generated  A close-up of a text Description automatically generated CONSENT PG. 99 to 103  CONSENT TO TREAT IS 30 pnt conset When is consent informed? Always before treatment Consent is always given before assessment, before treatment and reassessment JOINT MOBS -- PG 53 A black and white text on a white background Description automatically generated  A close-up of a manual Description automatically generated  Hypo -- perform joint play Hyper is contraindicated  FRICTION (pg 41) Who invented friction? James Cyriax to breakdown adhesions, contractures and scar tissue A close-up of a text Description automatically generated CI -- A white paper with black text Description automatically generated TAPING - Kinesiology tape is a thin, flexible tape that was developed to aid muscle movement and enhance athletic performance. It is often used to relieve pain, reduce swelling and inflammation and provide support to joints and muscles. The elasticity, or stretchiness, of kinesiology tape allows for movement. PNF  A close-up of a text Description automatically generated  A close-up of a document Description automatically generated  What is the main reason for Active Inhibition Techniques? DRAPING -- PG 183 When draping becomes undone accidentally redrape and say nothing Draping create boundary lines Never go under Areas expose where we have to work Make client safe and secure, comfort and security When treating upper chest -- special consent First thing to do is drape chest when turning on supine Extra consent medial thigh PREGNANCY: PG 177  A close-up of a document Description automatically generated  A close-up of a text Description automatically generated  A close-up of a paper Description automatically generated Symptoms continued: Supine hypotension SOB Backache -- hyperlordosis and hyperkyphosis Abdominal pain  Varicose veins Hemorrhoids Pigmentation Stretch Marks Nosebleeds and Emotional A close-up of a document Description automatically generated  Costal margin pain Frequent urination and incontinence Fatigue, Insomnia and restlessness Emotional FOURTH TRIMESTER SYMPTOMS\ Physical changes -- need to regain body balance to pre-preg, ligaments are long, joints unstable, backpain post delivery Post-Surgical recovery -- epis or c-section Breast enlargement -- sore, cracking Emotional and possible post-partum depression Second semester is know as quiet months but eclampsia, increased in BP, diabetes can occur at this time Review Ketoacidosis and Compression syndromes in trimester 3 CONTRAINDICATIONSA close-up of a document Description automatically generated  A questionnaire with black text Description automatically generated  EDEMA PG 217 A close-up of a text Description automatically generated Causes of Edema are: 1. Increased permeability of the capillaries -- inflammation, tissue trauma, immune response, burn 2. Obstruction of the lymphatic flow -- infection, parasites, lymphatic disease, sx removal of nodes, Radiation tx 3. Increased capillary pressure -- heart failure, thrombophlebitis, pregnancy, allergig response, hives, eczema, sodium retention, prolonged standing 4. Decrease is plasma protein -- kidney disease, starvation, burns  Superficial and deep lymphatic drainage system. The shaded area drains into the right lymphatic duct, while the rest of the body drains into the thoracic duct. A close-up of a text Description automatically generated  What caused the edema? A fall, CHF. Kidney Issues? Systemic -- both limbs Unilateral or local -- could be injury A close up of a text Description automatically generated CONTRAINIDCATIONS:  A close-up of a paper Description automatically generated MLD is the best type of massage for edema LORDFICARAHM Get to know client's condition Their daily routine Organize the precautions Understand the client  PG 109 SOAP A close-up of a text Description automatically generated  A close-up of a document Description automatically generated READ QUIZ ONE NOTES ON CMTO AND WHO GOVERNS Standard of Practice: A \"standard of practice\" is a set of guidelines that defines how professionals in a specific field should perform their jobs. It includes: 1. **Quality Assurance**: Ensures work meets certain quality levels. 2. **Ethical Conduct**: Provides rules for ethical behavior. 3. **Accountability**: Sets benchmarks to evaluate performance. 4. **Public Trust**: Maintains public confidence in the profession. 5. **Legal Compliance**: Helps professionals follow laws and regulations. These standards vary by profession, like healthcare, law, engineering, and finance, each having specific rules to follow. They ensure consistency, reliability, and professionalism in the services provided. - Minimum level of performance required to perform a task Subacute -- 2. ISOMETRIC -- only when client can contract but 1. ROM is initial 3\. ISOTONIC -- after about 2 weeks when client can move and contract4 Sports Massage: Pre-event -- Stimulation techs like tapotement, fast and superficial Post-event -- Relaxation, Deep and Slow BONY LANDMARKS -- EOP, GT, PSIS Palpation -- heat is temp from 4 T's DAY 3 -- Scalenes as a group -- Laterally flex on same side and rotate head to opposite side Tibialis anterior is lateral to shin bone and it does two actions -- dorsi and eversion Iliospsoas -- Lesser trochanter, por -- umbilicus or zypoid, hip flexion O AIN of ilacus and Psoas Tibialis Anterior -- what is the action? AGONIST, ANTAGONIST and SYNERGIST AGONIST -- a group od muscles that carry out the same action ANTAGONIST -- A Muscle that has the opposite action of the agonist SYNERGIST -- A muscle that supports the agonist ILIOSPOAS AGONIST -- Ilispaos SYNERGIST -- Rectus Femoris, TFL ANTAGONIST -- Gluteus Maximus, Hamstrings Satorious -- Sit like the Prez Knee Flesion Hip Flexion Medial rotation of knee Adduction Which muscles insert at the pes anserine - Gracilis, Sartorius and Semitendinosus GH as a group -- deltoid and supraspinatus Which muscle does knee extension\>? Quadriceps group REGIONS  Don't need to study organs!! Frontal and Ventral/Dorsal  STRAIN Pg 285 SYMPTOMS FOR ACUTE  A close-up of a medical report Description automatically generated  DO NOT USE HEAT!!!! Acute TX -- RICE -- reduce pain Chronic TX -- Treat Adhesions, rehabilitate tissue damage CONTRAINDICATIONS: SPRAINS PG 305  COMMON SPRAINS ARE: Deltiod -- Eversion and Anterior Talofibular Ligament - Inversion  What are the common tests for this?  ROM and Passively overstretch for positive sign Stretch will be more than normal accompanies with pain, looking for hypermobility SPECIAL ORTHOPEDIC TESTS PG 1106 Q ANGLE Intersection -- Superior iliac spine and Patella Patella to tibial tuberosity What lines to what lines? Lateral view -- knee -\> hyperextension KNOW ALL KNEE SOT's SI JOINT: Gapping -- Anterior Squish -- Posterior Gillets Yomans Gaeslens Figure 4 GH -- Know All! Appley scratch AC Shear Know Vertebral Artery Test PG. 1062 Painkillers -- do not do friction  Make sure client is seated for the GH tests Pg 1075 Painful Arc must be done all the way and Drop arm test to 90 degrees! Painful Arc 60-120 is supraspinatus and bursa The difference between the two is bursa Speeds, Yeargasons and Lipmanns -- bicipital tendinitis Appley Scratch -- combined movements of GH, GH pathology PG 1076 AC Shear -- AC joint Trendelenburg -- For Gluteus Medius weakness Speeds -- Bicipital Tendonitis Lachmans -- ACL Yergasons -- ligament and transverse Humeral Mcconnells, Mcmurray Appley Scratch Elys --Rrectus Femoris shortening Valgus -- Lateral (K and E) Varus -- Medial (K and E) Adsons has 5 steps! ULTT 1 -- 110 degrees (median nerve)\ ULTT 2 - 10 degrees (median, musculocutaneous, axillary) ULTT 3 -- 110 degrees (Radial Nerve) ULTT 4 -- 90 degrees (Ulnar Nerve) SLAP -- Superior labrum anterior posterior (meniscus like GH) Anterior and posterior Tear (DO CLUNK TEST) If microtear happens it is because of other condition. Affects all ROM Need sx to fix  TENDONITIS VS. BURSITIS  Massage helps with tendinitis -- Pain increases with activity Massage does not help with bursitis -- Pain is constant Painful arc is for bursitis Which tests are for tendinitis? Pace Abduction -- Pain in trigger points and weakness determines grades Ulnar -- Froments KNOW MYOTOMES AND DERMATOMES HIPFLEXION L1/L2 DERMATOMES DTR INFLAMMATION -- PG 217 RATTRAY and INTRO TO MASSAGE -- DAY 1  A close up of text Description automatically generated  A white background with black text Description automatically generated  A close-up of a white and purple page Description automatically generated  A Man has a fracture and so does a kid. The Kid will heal faster because of his age, severity of the injury, nutritional support and other conditions he may have such as renal or liver disease. SMOKING Affects the healing process!!!! GAIT ASSESSMENT PG 1057  STANCE -- HEEL STRIKE, FLAT FOOT, PUSH OFF and ACCELERATION TRPS MEDIAL PTERYGOID: LATERAL PTERYGOID: Pain into ear and zygomatic arch MASSETER: eyebrow, ear, maxilla, ant mandible and into the temple and to the lower molars TEMPORALIS: temporal region, eyebrow, upper teeth and into the TMJ, can cause headaches and maxillary toothache TRIGGER POINTS -- how do you know if you are in the right spot? How do you know if you are in the right spot? Referral of pain and on muscle belly How many trigger points per tx? One-three but not all of them. There is soreness after 2 Techniques of TRP -- Ischemic compression and Sustained ROM Affected? Yes Is there inflammation and TRP? No it is not related. Is there pain with ROM? YES Protocol for TRP -- INFORM, ASK REFERRAL, PRESS, BREATH, PAIN SCALE 7, when pain decreases -- FLUSH, HEAT, STRETCH TREATMENT GOALS FOR TRP ARE: PG 243 SCAR TISSUE   A close-up of a text Description automatically generated CI is also if Client refuses PG 913 HIGH BLOOD PRESSURE  CONTRAINDICATIONS  Divide back into square! ROM -Not full ROM in elderly OMNIOUS SIGNS -- CARDIOLOGY OSTEOARTHRITIS A black text on a white background Description automatically generated CAUSES: OBESITY and IMMOBILIZATION COMMON AREAS: Hand, Spin, Hip and Knee  MULTIPLE SCLEROSIS MAIN SYMPTOMS ARE: - FATIGUE - Spasticity - Inefficient movement patterns - Altered posture - Compensatory changes. - Paresthesia - Cold extremities or sweating abnormalities - Mood Swings - Euphoria CONTRAINDICATIONS: A white text on a white background Description automatically generated FROZEN SHOULDER: AKA -- ADHESIVE CAPSULITIS  *SYMPTOM PICTURE:* A close up of a text Description automatically generated  *CAPSULAR PATTERN IN ORDER FOR RESTRICTION:* - *lateral rotation* - *Abduction* - *internal rotation* A black and white text on a white background Description automatically generated *[causes: ]{.smallcaps}*  *CONTRACTURE:* A black line with a black line Description automatically generated with medium confidence *friction can be used, cold can be used, heat can be used as it is now chronic* *friction + skin rolling + Stripping* *stretching as a technique and remedial exercise* *compartment syndrome:*  A diagram of a human body Description automatically generated  A close-up of a medical information Description automatically generated  *PATELLOFEMORAL SYNDROME* Black text on a white background Description automatically generated TFL is tight, vastus lateralis is tight TFL pulls IT band  CONTRAINDICATIONS: A white background with black text Description automatically generated CAUSES: Abnormal biomechanics A small, high-riding patella Tight posterior and anterior structures Weakness of muscles -- vastus medialis Knee injury Arthroscopic Procedures Repeated knee stress **The Unhappy Triad (Blown Knee)** - - - - - - **What is an unhappy triad?** The unhappy triad is the name of a severe injury involving three crucial parts of your knee joint. Other names for it include: - terrible triad - O'Donoghue's triad - blown knee Your knee joint runs from the bottom of your [[femur]](https://www.healthline.com/human-body-maps/femur), which is your thigh bone, to the top of your [[tibia]](https://www.healthline.com/human-body-maps/tibia-bone), your shin bone. Ligaments connect these two bones and provide stability for your knee joint. Ligaments are strong, but they aren't very elastic. If they stretch out, they tend to stay that way. And when stretched too far, they can tear. The unhappy triad involves damage to your: - **Anterior cruciate ligament (ACL).** The [[ACL]](https://www.healthline.com/health/anterior-cruciate-ligament-acl-injury/health/anterior-cruciate-ligament-acl-injury) crosses your inner knee joint diagonally. It helps to prevent your tibia from moving too far forward and stabilize your leg when you twist at the waist. - **Medial collateral ligament (MCL).** The [[MCL]](https://www.healthline.com/health/medial-collateral-ligament-mcl-injury-of-the-knee) prevents your knee from bending too far in the direction of your other knee. - **Medial meniscus. **This is a [[wedge of cartilage]](https://www.healthline.com/human-body-maps/medial-meniscus) on the tibia in your inner knee. It acts like a shock absorber when you walk or run while also stabilizing your knee. Read on to learn more about the unhappy triad, including how it's treated and how long it takes to recover from surgery. **What are the unhappy triad's symptoms?** The symptoms of the unhappy triad come on suddenly immediately after your knee is injured. They can include: - severe pain on the inside of your knee - significant swelling that begins within minutes of the injury - difficulty moving or putting weight on your knee - feeling like your knee will give out - knee stiffness - sensation that your knee is locking or catching on something - bruising that appears a few days after the injury **What causes the unhappy triad?** The unhappy triad usually results from a hard blow to your lower leg while your foot is planted on the ground. This pushes your knee inward, which it isn't used to doing. It also causes your femur and tibia to twist in opposite directions. This causes your medial meniscus and ligaments to stretch too far, making them prone to tearing. This might happen when a football player has their cleats planted in the ground while being hit with great force on their outer knee. It can also happen to a skier if their ski doesn't release from the bindings during a fall. The ankle can't turn in a ski boot, so the knee ends up twisting, which can stretch or rupture ligaments. **How is the unhappy triad treated?** Treatment depends on how severe the injury is. If the tears in your ligaments and meniscus are mild, you might be able to avoid surgery by: - resting your knee so it can heal without getting worse - applying [[ice packs]](https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold) to reduce inflammation and swelling - wearing [[compression bandages]](https://www.healthline.com/health/compression-wrapping) to reduce swelling - elevating your knee while keeping it supported whenever possible - doing physical therapy to increase strength and mobility A Cochrane Review found that active adults with ACL injuries didn't have any reduced knee function two and five years after injury. This was the same for those who underwent nonsurgical treatment and those who opted for surgery. However, [[51 percent]](https://www.cochrane.org/CD011166/MUSKINJ_surgical-versus-conservative-interventions-treating-anterior-cruciate-ligament-injuries) of those treated without surgery ended up having the surgery within 5 years due to knee instability. This is something to keep in mind when considering your treatment options. Another potential problem is that by delaying surgery, the potential for developing arthritis exists because of the instability that could affect the knee as the patient gets older. **What types of surgery are used for the unhappy triad?** If you do need surgery, there are several options based on what needs to be repaired and how severe the injury is. Most surgeries are done using a minimally invasive approach called [[arthroscopy]](https://www.healthline.com/health/knee-arthroscopy). This allows a surgeon to insert miniature surgical tools through a through a small incision in your knee. The unhappy triad includes three injuries, but only two tend to require surgery: - The ACL can be [[reconstructed]](https://www.healthline.com/health/acl-reconstruction) using a tendon graft from a muscle in your leg. - The meniscus can be repaired by removing the damaged tissue with a procedure called a meniscectomy. A surgeon may instead decide to repair or transplant the meniscus. The MCL usually doesn't need to be repaired because it heals on its own. **Physical therapy** Physical therapy is an important part of your recovery regardless of whether you have surgery. Your doctor will likely recommend doing six to nine months of physical therapy and rehabilitation to help regain strength and range of motion in your knee. - SPORTS INJURY -- SURGERY - \_\_\_\_\_\_\_\_\_\_\_ to lateral knee [RHEUMATOID ARTHRITIS:]  A diagram of a skeleton Description automatically generated  A close-up of a document Description automatically generated [DIFFERENCE BETWEEN GOUT AND RA] RA can be bilateral Gout can be unilateral Gout and rheumatoid arthritis (RA) are both forms of arthritis, but they have distinct causes, symptoms, and treatment approaches. Here are the key differences between the two: **Causes** **Gout:** - **Cause:** Gout is caused by the accumulation of uric acid crystals in the joints. Uric acid is a waste product that forms when the body breaks down purines, substances found in certain foods and drinks. - **Risk Factors:** High-purine diet (e.g., red meat, shellfish, alcohol), obesity, certain medications, and conditions that affect kidney function can increase the risk of developing gout. **Rheumatoid Arthritis (RA):** - **Cause:** RA is an autoimmune disorder where the body\'s immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. - **Risk Factors:** Genetics, smoking, and possibly hormonal changes are associated with a higher risk of developing RA. It is more common in women than in men. **Symptoms** **Gout:** - **Onset:** Sudden and severe attacks of pain, swelling, redness, and tenderness in the joints, often the big toe. - **Symptoms:** Intense joint pain, lingering discomfort, inflammation, and redness. - **Pattern:** Often affects one joint at a time (especially the big toe) but can spread to other joints. **Rheumatoid Arthritis (RA):** - **Onset:** Symptoms can develop gradually or suddenly and often affect joints symmetrically (both sides of the body). - **Symptoms:** Joint pain, swelling, stiffness (especially in the morning or after periods of inactivity), fatigue, fever, and loss of appetite. - **Pattern:** Typically affects multiple joints, including hands, wrists, and knees, symmetrically. **Diagnosis** **Gout:** - **Tests:** Blood tests to measure uric acid levels, joint fluid test to detect uric acid crystals, and imaging tests (X-rays, ultrasound, or CT scans). **Rheumatoid Arthritis (RA):** - **Tests:** Blood tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to detect inflammation. Imaging tests (X-rays, MRI, or ultrasound) to assess joint damage. **Treatment** **Gout:** - **Acute Attack Management:** Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids. - **Long-term Management:** Medications to lower uric acid levels, lifestyle changes (diet, weight management, and reducing alcohol consumption). **Rheumatoid Arthritis (RA):** - **Medications:** Disease-modifying antirheumatic drugs (DMARDs), biologics, NSAIDs, and corticosteroids. - **Other Treatments:** Physical therapy, lifestyle changes (exercise, healthy diet), and sometimes surgery to repair or replace damaged joints. **Prognosis** **Gout:** - With proper management, gout can often be controlled effectively, and the risk of further attacks and joint damage can be minimized. **Rheumatoid Arthritis (RA):** - RA is a chronic condition that can cause significant joint damage and disability over time. Early and aggressive treatment can help manage symptoms and slow disease progression. Understanding these differences is crucial for proper diagnosis and treatment. If you suspect you have either condition, it is important to consult a healthcare provider for an accurate diagnosis and appropriate management plan. Gout -- avoid seafood, red meat and bear Gravity and lower temp SPASM PG 193  A close-up of a list of medical information Description automatically generated GOALS:  A white background with black text Description automatically generated Once the spasm has been reduced, increase the ROM Top of Form Bottom of Form [UPPER MYOTOMES] C1 - none C2 -- Neck Flexion (LOOK at Your Shoe) C3 -- lateral flexion (CUT a Tree) C4 - Shoulder shrug C5 -- shoulder abduction C6 -- wrist extension elbow flexion C7 -- wrist flexion and thumb extension T1 -- finger abduction and adduction [LOWER MYOTOMES] L1 -- NONE L2 -- hip flexion (lift your shoe) L3 -- knee extension (extend your knee) L4 -- dorsiflexion -- stop the door L5 -- Big toe extension -- (toes divide) S1 -- plantar flexion (lifts a ton) S2 -- Knee flexion (shoe to you) [UPPER DERMATOMES] C2 -- posterior head to ear C3 -- bottom of neck C4 -- medial of clavicle to ac joint C5 -- 1/3 and 1/3 (latera; - humerus to radial) C6 -- anterior shoulder to base of thumb and index finger C7 -- won't go to heaven (palm to 3 middle fingers) C8 -- ulnar styloid to tip of 4^th^ and digit T1 -- 2/3rds/2/3rds (medial of arm humerus and forearm) [LOWER MYOTOMES] L2 -- GT to 4/5^th^ of lateral thigh L3 -- Middle of medial leg from groin to medial tibial condyle L4 - ¼ down medial knee pass medial malleus to under big toe L5 -- ¼ down lateral leg to tip of big toe in a diagonal line S1 -- lateral malleolus to side of pinky [CERVICAL SPINE] Flexion - 80-90 Extension -- 70 Lateral flexion -- 20-45 Lateral flexion -- 20-45 Internal rotation -- 70-90 External rotation -- 70-90 [G/H] Flexion -- 160-180 Extension -- 70 Abduction -- 170-180 Adduction -- 50-75 Internal rotation 60-100 External rotation -- 80-90 [ELBOW] Flexion -- 140-150 Extension -- 0-10 Supination -- 90 Pronation 90 [Wrist] Flexion -- 80-90 Extension -- 70-90 Radial deviation -15-20 Ulnar deviation -- 30-45 [HIP] Flexion -- 110-120 Extension -- 10-15 Abduction -- 30-50 Adduction -- 30 Internal rotation -- 30-40 External rotation -- 40-60 [KNEE] Flexion -- 135 Extension -- 0-15 Internal Rotation -- 10 External Rotation -- 10 [ANKLE] Dorsiflexion -- 20 Plantar flexion -50 Eversion 15-30 Inversion 45-60 [LUMBAR ] Flexion - 40-60 Extension 20-35 Lateral flexion 15-20 Internal rotation 3-18