[...]... and gradually increase their maximal heart rate For a 40-yearold a pulse rate of 11 7 to 13 5 and for a 60-year-old a pulse rate of 10 4 to 12 0 would be a safe range to recommend Very little extra cardiovascular benefit is obtained by increasing the rate beyond 75% for the average patient in the primary care setting Include resistance training and stretching in the plan Emphasize that increasing strength... programs are based on the model of acute care rather than chronic care In the acute care model, patient participation in decision making is minimal to nonexistent The medical problems in the acute care model will resolve in a short period of time and require minimal follow-up and minimal patient involvement in the treatment Simply stated, the clinician tells the patient what to do and they do it Examples.. .1 Key Principles of Outpatient Musculoskeletal Medicine 5 minimal support medially and the cleats were worn out on the medial side This information helped with both diagnosis and treatment of his condition The physical examination helps confirm the history and make the diagnosis Knowledge of the anatomy helps the clinician perform the examination For example, in Chapter 15 in the case of the 36-year-old... will depend on the phase of tissue injury The first 48 to 72 h is the acute or the first phase Control of pain and edema decreases the associated inflammatory process in this phase RICE is the mainstay of treatment at this point Ice reduces the release of inflammatory chemicals at the injury site Application of ice for 15 min decreases pain and inflammation Elevation of the extremity above the heart and... because the distal limb is not moving Closed kinetic chain exercises are started before OKC exercises Use of a leg extension machine or placing a weight on the ankle and extending the knee against resistance is an example of an OKC exercise The distal 1 Key Principles of Outpatient Musculoskeletal Medicine 7 end of the limb is moving in OKC exercises so the stress is greater on the knee Wait until the. .. and electrotherapy may be helpful in decreasing pain and edema, promoting healing, and increasing flexibility Heating modalities facilitate stretching and strengthening by increasing blood flow to muscle and inducing muscle relaxation Heat is not used during the acute phase because of increased edema and inflammation Ultrasound, a deep heating agent, is used to promote heating of the joint and to drive... the end of Chapter 12 9 Principle 9 Medications for relief of pain and inflammation are helpful but can also have negative effects, especially in the elderly Tylenol (acetaminophen) and NSAIDs are the most commonly used medication for pain relief in MS injury 1 Key Principles of Outpatient Musculoskeletal Medicine 11 Tylenol is an analgesic with minimal anti-inflammatory action that is effective in. .. elasticity, thinning of cartilage, decreased tendon length, and tendon weakness Decreased gait stability secondary to impaired proprioception and balance Some of the changes are age-related and others are secondary to lack of use There is also overlap between changes related to aging and those related to 13 14 E.J Shahady TABLE 2 .1 Benefits of exercise 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Reduces the incidence... muscle shortening The shortening results in a decrease in the range of motion and a disruption of the shock-absorbing capability Bed rest or other forms of inactivity are devastating to muscles and joints One of the most devastating pieces of advice we sometimes give to patients is “take it easy.” Some patients interpret this as a command to do nothing, rather than the intended decrease in activity for... the 36-year-old man with foot pain, examination revealed pain upon palpation of the left heel over the medical tubercle of the calcaneus The plantar fascia attaches at this site The pain was aggravated by dorsiflexion of the great toe and standing on the tips of his toes Both of these maneuvers stretch the plantar fascia Dorsiflexion of the left foot was decreased, indicating tightness in the posterior . w1 h1" alt="" Primary Care of Musculoskeletal Problems in the Outpatient Setting Edward J. Shahady, MD Tallahassee, FL, USA Editor Primary Care of Musculoskeletal Problems in the Outpatient Setting With. perform the examination. For example, in Chapter 15 in the case of the 36-year-old man with foot pain, examination revealed pain upon palpation of the left heel over the medical tubercle of the calcaneus is the mainstay of treatment at this point. Ice reduces the release of inflamma- tory chemicals at the injury site. Application of ice for 15 min decreases pain and inflammation. Elevation of the