Exam 1 Review pt. 2

what happens during inflammation?

(1 to 10 days) prostaglandins, bradykinins, and histamine sensitize local nerve endings

what happens during hemostasis?

(1 to 3 days) fibrin plug stops leaking from damaged blood vessels

what happens during remodeling?

(21 days to 6-18 months) collagen transitions from type 3 to type 1

what happens during proliferation?

(4 days to 4 weeks) fibroblastic activity creates type 3 collagen

why is it important to first look at muscle isolation before integration when initiating a rehab plan?

- a muscle that doesn't activate, can't stabilize - athletes can hide isolated weakness by using other muscles to compensate during movements - isolation exercises of weak/inhibited muscles are a foundation for higher level tasks

what is the force velocity curve?

- as velocity increases, force decreases (concentric) - as velocity decreases, force increases (eccentric) - when velocity = 0 (isometric)

describe the impact of immobilization on soft tissue

- decreased ATP, ADP, and mitochondria - atrophy, decreased strength, and fatigue - decreased fiber size and oxidative capacity - immobilization causes the new collagen network to be organized in a disorganized way

describe facet joint movement with flexion, extension, sidebending, and rotation

- flexion: gaps (decreases loading) - extension: compresses (increases loading) - right sidebend: compress right side, gap left side - left sidebend: compress left side, gap right side - right rotation: gap right side, compress left side - left rotation: gap left side, compress right side

what is the duration of each soft tissue healing phase for muscles?

- inflammation: 1 to 21 days - proliferation: 7 to 21 days - remodeling: 6 weeks to 1 year

describe nerve sensitivity

- most people experience pain when a stimulus goes above their baseline and reaches their threshold. then overtime once that stimulus is removed their pain goes back down to their baseline - 1/4 people experience nerve sensitivity. A stimulus is strong enough for them to reach their threshold, but instead of their pain going down to their original baseline once the stimulus is removed, the pain goes down to a new baseline, one that is above the original baseline. - this means that weaker stimuli can now cause them pain --> before, a 3 mile run caused no pain, but now even just a 1 mile run can cause pain for them

what is the impact of muscle weakness and strength on the force-velocity curve?

- muscle weakness shifts curve to the left - muscle strength shifts curve to the right

describe tissue stress theory

- rehab exercises need to be challenging/intense enough to stress the body, but they can't be too intense that they will cause injury - training stress also needs to happen frequently enough for change to happen

describe the importance of progressive overload

- you don't get stronger by lifting weights, but instead you get stronger by recovering from lifting weights - the body will adapt to a stressor if it's given time to recover - in order to see progress, however, the stress needs to be great enough to cause an adaptation (the stressors only need to be a little bit more to cause an adaptation)

identify factors that contribute to musculoskeletal injuries

1) previous injury 2) asymmetry 3) muscle imbalances 4) poor motor control/mechanics

what are the 4 phases of strengthening in rehab?

1, endurance phase 2. hypertrophy phase 3. strength phase 4. power phase

what muscles are weak with lower cross syndrome?

1. abdominals 2. glute max/med/min 3. tibialis anterior/posterior 4. vastus medialis

5 phases of rehab

1. acute management 2. recovery and restoration 3. function and sport specific 4. return to sport 5. re-injury prevention

how do the phases of rehab relate to the phases of soft tissue healing and the performance pyramid?

1. acute management phase (inflammation phase, correct deviations & decrease pain) 2. restoration and recovery phase (early proliferation phase, late proliferation phase, flexibility & ROM, strength & endurance) 3. sport specific and function phase (later proliferation phase, early remodeling phase, strength & endurance, neuromotor & proprioception, function) 4. return to sport phase (late remodeling phase, performance)

rotational core progressions

1. bent knee fall-out to the side 2. quadruped arm lift 3. bird dog 4. bear position arm/leg lift 5. plank with arm lift

provide an exercise progression for lower body lateral

1. clam shells 2. side plank on knees 3. side plank on forearm 4. side lunge

steps of the performance pyramid

1. correct deviations & decrease pain 2. flexibility & ROM 3. strength & endurance 4. balance, coordination, agility 5. function 6. performance

what muscles make-up the inner core?

1. diaphragm 2. transverse abdominus 3. multifidus 4. pelvic floor

what are some strategies to decrease nerve sensitivity?

1. education 2. exercise 3. medicine 4. relaxation 5. sleep 6 nutrition

how do the 4 phases of strengthening in rehab relate to the phases of rehab?

1. endurance phase -- acute management phase 2. hypertrophy phase -- restoration and recovery phase 3. strength phase -- sport specific and function phase 4. power phase -- return to sport phase

what muscles are shortened with anterior pelvic tilt?

1. erector spinae 2. iliopsoas 3. rectus femoris

what muscles are lengthened with anterior pelvic tilit?

1. hamstrings 2. abdominals

what are the 4 stages of soft tissue healing?

1. hemostasis 2. inflammation 3. proliferation 4. remodeling

what muscles are lengthened with posterior pelvic tilt?

1. hip flexors 2. spinal erectors

what muscles are tight with lower cross syndrome?

1. hip flexors 2. spinal erectors 3. TFL 4. latissimus dorsi 5. gastroc/soleus 6. hamstrings 7. adductors 8. piriformis

what are the rehabilitation benefits of strengthening exercises?

1. improves circulation to injured tissue 2. decreases nerve sensitivity 3. improves joint stability

structurally, how do strength exercises improve force production?

1. increased cross sectional area

how does BFR produce muscle hypertrophy?

1. increased hormone production 2. cellular swelling 3. metabolic stress from build up of blood lactate and H+ ions

describe 3 ways stretching changes muscles length

1. increased stretch tolerance (improves pain tolerance so there's less pain with stretching) 2. viscoelastic properties (elastic and plastic changes) 3. sarcomeregenesis (adding sarcomeres in series)

how do the phases of soft tissue healing match-up with the phases of rehab?

1. inflammation phase -- acute management phase 2. early proliferation phase -- recovery and restoration phase 3. late proliferation phase -- sport specific and function phase 4. remodeling phase -- return to sport phase

what muscles make-up the outer core?

1. internal oblique 2. external oblique 3. rectus abdominus 4. spinal erectors 5. quadratus lumborum

provide an exercise progression for lower body push

1. knee extension 2. leg press 3. DL squat 4. SL squat

what postures/positions put less strain on the intervertebral disc?

1. laying down (supine or prone) 2. side lying

what are the 4 primary lower body movement patterns?

1. lower body push 2. lower body hip extensions 3. lower body lateral 4. triple extensions

what exercises are most beneficial to treat extension based LBP?

1. lumbar flexion exercises (child's pose, piriformis stretch, hamstring stretch) 2. hip flexor stretching (done in posterior pelvic tilt) 3. train hip extensors without lumbar extensions (prone hip extension on ball, hip thrusts) 4. train into posterior pelvic tilt (hooklying march, dead bugs, plank)

muscle hypertrophy can occur through what 3 things?

1. mechanical tension 2. muscle damage 3. metabolic stress

neurologically, how do strength exercises improve force production?

1. motor unit recruitment 2. motor unit synchronization

what are 3 benefits of improving mobility?

1. move with larger ROM 2. move with better alignment 3. move with less perceived effort

what are the 2 ways strength exercises improve force production?

1. neurologically 2. structurally

what activities/exercises should you NOT do with an acute lumbar disc herniation?

1. no abdominal strengthening in the early rehab phases (increases intra-abdominal pressure) 2. no lumbar flexion exercises in the early rehab phases (puts more stress on the nerve root) 3. no hamstring stretching in the early rehab phases (can over-stretch sciatic nerve)

what causes muscle weakness?

1. pain 2. atrophy/disuse 3. nerve root compression 4. fatigue 5. instability

common signs of extension based LBP

1. pain on lumbar extension 2. pain with deadlift, squat, military press, bench 3. midline low back pain or highly localized on one side 4. pain with running, jumping, twisting 5. usually hypermobile into lumbar lordosis 6. poor anterior core strength 7. tight hip flexors

signs/symptoms of a lumbar disc herniation

1. pain on lumbar flexion 2. pain with prolonged sitting 3. pain along a dermatomal pattern 4. aching, shooting, severe pain 5. tingling/numbness 6. "tight" hamstrings, piriformis or calf muscle 7. myotomal weakness 8. symptoms may decrease with extension 9. pain with cough/bearing down 10. (+) SLR

anterior core progressions

1. pelvic neutral holds 2. hooklying march 3. hooklying march with longer lever arm 4. sequential march 5. dead bug

posterior core progressions

1. prone hip extension 2. prone hip extension on ball 3. bird dog 4. DL hip extension on ball 5. glute bridge

provide an exercise progression for lower body hip extensions

1. prone hip extensions 2. glute bridge 3. donkey kicks 4. RDL 5. SL RDL

what muscles are shortened with posterior pelvic tilt?

1. rectus abdominus 2. glute mac 3. hamstrings

what are the 2 types of benefits for strengthening exercises?

1. rehabilitation benefits 2. performance benefits

what are the performance benefits of strengthening exercises?

1. shifts force-velocity curve to the right 2. increases running speed and vertical jump 3. increases endurance performance (less effort per stride)

lateral core progressions

1. side plank on knees 2. side plank on forearms 3. cable overhead reach 4. kneeling offloaded military press 5. standing SL offloaded hold

provide an exercise progression for triple extensions

1. squat with calf raise 2. kettlebell swing 3. walking lunge 4. burpee 5. SL vertical jump

what postures/positions put more strain on the intervertebral disc?

1. standing flexion 2. sitting flexion 3. squatting to pick something up 4. leaning over to carry something

what are the 5 bi-motor abilities?

1. strength 2. endurance 3. flexibility 4. coordination 5. speed

what is the anticipated recovery fro a graft (we.g., ACL) ligament strain?

12+ months

what is set and repetition prescription for enhancing endurance?

2-4 exercises per movement/region 2-4 sets 15-25 reps 30-60 sec rest

what is a set and repetition prescription for enhancing strength?

2-4 exercises per movement/region 3-5 sets 3-8 reps 3-5 min rest

what is a set and repetition prescription for enhancing hypertrophy?

2-4 exercises per movement/region 3-5 sets 6-15 reps 1-2 min rest

what is the anticipated recovery for a grade 2 muscle strain?

2-4 months

what is the anticipated recovery fro a grade 2 ligament strain?

2-6 months

what is the anticipated recovery for a grade 1 muscle strain?

2-8 weeks

what is the anticipated recovery fro a grade 1 ligament strain?

2-8 weeks

what is the anticipated recovery fro a grade 3 ligament strain?

6-12 months

what is the anticipated recovery for a grade 3 muscle strain?

9-12 months

describe creep and give an example

= elongation of tissue when a low load is a applied for a long time Ex) throw legs up a wall and hold there for 10 minutes

describe stress-strain and give an example

= plastic range (deformation happens) and elastic range (no deformation level changes) Ex) stretching hamstrings and holding it there for a little

describe hysteresis and give an example

= repetitive stretching (stretch on, stretch off, stretch on, stretch off) Ex) stretching muscle back and forth with oscillations

explain how hysteresis desensitizes the nervous system

The oscillations tell the nervous system that it's okay to move there and that you won't get injured if you move there

explain the envelope of function

There is a certain amount of frequency and load that someone's body can tolerate before risking injury. If someone gets injured, their envelope of function decreases so a lower frequency and lower load is needed to aggravate their body. If someone goes above their envelope of function, they are at more risk for injury. The goal of rehab is to try and increase someone's envelope of function.

what exercises should you avoid when treating extension based LBP?

avoid all extension based exercises (squat, RDL, deadlift, military press, bridge, bench)

S1 dermatome

calf/hamstring

in the long-term rehab process, why is it important to train movements, not muscles?

compound movements train stabilizers/muscles in their functional roles

what causes pain with a lumbar disc herniation?

compression of the nerve root and inflammation in the local area (both cause increased nerve sensitivity)

L4 myotome

dorsiflexion

what types of exercises will stimulate muscle damage for muscle hypertrophy?

eccentric focus (slow negatives)

what lumbar motion is most painful with facet syndrome and spondylolysis?

extension

what direction does the lumbar spine have the greatest mobility?

extension and flexion

what direction do facet joints move with anterior pelvic tilt?

extension, facet joints compressed

what direction do facet joints move with posterior pelvic tilt?

flexion, facet joints are gapped

L2 dermatome

groin

what types of exercises will stimulate mechanical tension for muscle hypertrophy?

high load (8 RM or less)

what types of exercises will stimulate metabolic stress for muscle hypertrophy?

high reps (15 RM or greater)

L5 myotome

hip abduction, 1st MTP extension

L2 myotome

hip flexion

what mechanical stretch is good for the inflammation stage?

hysteresis because you use oscillations

why would you use BFR?

it increases exercise stress at light loads

why should strengthening progress from general exercises to specific

it's important to develop general exercises before specific because general exercises carry over to and are the foundation of specific exercises

L3 myotome

knee extension

S1 myotome

knee flexion, plantarflexion

L4 dermatome

knee/medial shin

what physiological way of strengthening to produce muscle hypertrophy is best for the proliferation phase?

metabolic stress (high reps -- 15 RM or greater)

define pain

pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage

L3 dermatome

quad

L5 dermatome

top of foot/lateral calf