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Practitioners

To learn more about guidelines for the care of patients with musculoskeletal disorders, and resources for practitioners, see below.

Clinical Practice Guidelines contain evidence-based recommendations based on best available evidence at the time of publication. Healthcare professionals are encouraged to review recent high quality studies to further guide clinical decisions where appropriate and consult the licensing or regulatory body in their jurisdiction for any additional requirements or practice standards that may apply.  

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Managing adult lower extremities disorders

Lower extremities disorders

Key recommendations

Key recommendations for lower extremity disorders from the FSCO report (2015) (please see full report for details)

  • Provide care in partnership with the patient. Involve the patient in care planning and decision-making.
  • Reassure patients about the benign and self-limited nature of their pain.
  • Educate patients about the benefits of being actively engaged and participating in their care plan by remaining active and continuing movement.
  • Emphasize active rather than passive treatments.
  • Deliver time-limited care.
  • Do not provide ineffective or experimental treatments.

Key recommendations for persistent patellofemoral pain

  • Consider supervised clinic-based combined exercise (25 minutes of progressive loaded exercise for the quadriceps, adductor and gluteal muscles, 9 visits over 6 weeks; 25 minutes of home exercise daily for 3 months).

Key recommendations for recent onset ankle sprain

  • Consider initiating a home exercise program within one week post-collision based on patient tolerance.
  • Do not offer a supervised progressive exercise program.
  • Consider mobilization of the distal and proximal tibiofibular joints, talocrural, and subtalar joints. The program should include 5 repetitions (30 seconds; grades I-IV mobilization at the therapist’s discretion), twice per week for 4 weeks.
  • For grades I/II ankle sprains, consider home-based cryotherapy.
    The program should include standard application of 20 minutes of continuous ice treatment performed every two hours; or, ice applied for 10 minutes, the ankle is rested at room temperature for 7 minutes, ice is reapplied for 10 minutes and performed every two hours; over the first 72 hours.
  • For grades II/III ankle sprains, consider semi-rigid brace during the daytime (4 weeks), semi-rigid boot during the daytime (4 weeks) or below-knee immobilization walking cast (10 days).
  • Do not offer low-level laser therapy.

Key recommendations for chronic ankle sprain

  • Consider mobilization of the distal and proximal tibiofibular joints, talocrural, and subtalar joints. The program should include 5 repetitions (30 seconds; grades I-IV mobilization at the therapist’s discretion), twice per week for 4 weeks.

Key recommendations for persistent Achilles tendinopathy

  • Offer shock-wave therapy. The program should include 2000 pulses/session (8 pulses/second, energy flux density=0.1mJ/mm2, targeted circumferentially at area of maximum tenderness) provided 1 session per week for 3 weeks.
  • Do not offer night splint.
  • Do not offer semi-rigid brace.

Key recommendations for recent onset plantar fasciitis and heel pain

  • Consider a home program of plantar fascia stretching (10 repetitions, 3 times daily, for 8 weeks).
  • Do not offer trigger point therapy to the gastrocnemii.
  • Do not offer radial shock-wave therapy.

Key recommendations for persistent onset plantar fasciitis and heel pain

  • Do not offer home-based static stretching of calf muscles alone.
  • Do not offer trigger point therapy to the gastrocnemii.
  • Offer prefabricated foot orthoses for short-term improvement in function for 8-10 weeks.
  • Do not offer low-Dye taping.
  • Consider a multimodal program of care that includes mobilization
    * and manipulation* (of the hip, knee, and ankle as indicated), as well as clinical massage** and home exercise***. Provide a maximum of 6 visits over 4 weeks.
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