Functional Restoration Midterm

Your patient's knees bow outward when in an overhead squat. What would you expect on janda's hip abduction? a. hip hike b. decrease hip abduction c. hip flexion d. hip external rotation

Hip external rotation

Your patient's knees bow outward with an overhead squat test. What would you expect to see on Janda's Hip Abduction Test?

Hip external rotation

During the overhead squat assessment, your patient demonstrates genus varus. What is a possible finding when performing Janda's Abduction test?

Hip external rotation at hip end range abduction

During static palpation analysis your patient demonstrates a mild toe out stance. what aberrant pattern would you be looking for when performing janda hip abduction? a. hip flexion midrange for abduction b. hip external rotation with abduction c. hip hike prior to abduction sense d. decrease in hip abduction

Hip external rotation with Abduction

Your patient has taken up walking now that she has significantly more free time. Unfortunately, she has developed left lateral knee pain that is worse sitting long periods of time and when going down stairs. There is +Ober's, +Noble's and in Modified Thomas you note a decrease in passive adduction. What aberrant movement pattern might you expect to see in Janda's Hip Abduction Test?

Hip flexion

When considering physical rehabilitation of an individual, the single most important portion of this is what?

History/physical exam

Your patient demonstrates 45 degrees of hip flexion during the active SLR test. You cue the patient to press his arms positively into the table and then attempt the active SLR. You note that this action creates an increase in an active SLR test. What does this indicate?

Hyper activation of core

Muscles predominantly static, tonic, postural have a tendency to become____. a. inhibited b. hypertonic c. weak d. hypotonic

Hypertonic

Your patient has ~45 degrees of right hip flexion during ASLR test. Placing the patient in left hook lying position. (Supine, left hip at 45 degrees, knee at 90 degrees with foot on the table), does not result in any change in the right ASLR. What could this indicate?

Hypertonic right hamstring

Muscles provide support and stiffness necessary at Intervertebral levels to sustain forces commonly encountered in life. What percent of maximal voluntary contracture (%MVC) of the abdominal and Paraspinals is required for spinal stability in neutral position? a. 5-10% b. 50-60% c. max contracture d. 30-40%

5-10%

Which of the following is a normal infrasternal angle? A. 110 degrees B. 45 degrees C. 90 degrees D. 75 degrees

90 degrees

During the neck flexion test, the patients head moves into slight extension. What does this indicate? A. Hypertonicity of SCM and suboccipitals B. Hypertonicity of Levator scapula C. Inhibition of SCM and suboccipitals D. Increased activation of longus capitis and longus coli

A

During the overhead squat analysis your patient demonstrates a genu varus stress. What muscle would you want to do a muscle length analysis on? A. Piriformis B. Gluteus Maximus C. IT bands D. Adductors

A

( Choose all that apply) Which would be an abnormal pattern during neck flexion test a. preferential recruitment of SCM over Longus cap and colli b. activation of the capitus/coli c. flexion of the occiput on atlas d. chin angle greater than 90

A&D

What is the functions of a ligament? (select all that apply) A. Joint stability B. Connect bone to bone C. Movement and position sense D. Generators of action potential

A, B, C

Which of the following is characteristic of pronation distortion syndrome? a. arthrokinetmatic dysfunction of the first MTP b. inhibition Glute medius c. decrease pronation control of the ankle d. inhibition of vastus lateralis

A, B, C

Which of the following would not constitute good breathing? a. Thoracic extension with inhalation b. Inhalation that is 2-4x longer than exhalation c. No pause between breaths d. Having the tongue rest on the roof of the mouth

A, B, C

The kinetic chain is made up of which of the following? (select all that apply) A. Muscle B. Fascia C. Viscera D. Neural system

A, B, D

What muscles trend towards inhibition in pronation distortion syndrome? (select all that apply) A. Tibilias posterior B. Adductors C. Gluteus medius D. IlioPsoas

A, C

Your 16 yoa female patient ran into the back of a stopped SUV, your patient believes she was going at least 40 mph when she hit the other vehicle.she reports that the accident happened two weeks ago, She was wearing her seatbelt, the airbag did deploy. she is currently having Cervico-thoracic discomfort, worse with long periods of sitting in her high school classes on Zoom. She also describes cervicogenic like headaches. What muscles would you want to evaluate for inhibition? a. longus Capitus/coli b. Transversus Abdominis and obliques c. Gluteus Maximus and Medius d. SCM, Sternallis, Sub-occipitalis

A.

Your patient is having cervicogenic headaches, has a slight anterior head carriage, and during wall angel has a slight chin angle greater than 90 degrees. What follow up test do you want to perform? A. Neck flexion test with a pressure biofeedback unit B. Overhead squat assessment C. Shoulder abduction test D. Janda's hip extension

A.

Your patient presents with diffuse right shoulder pain, slightly protracted shoulders, and slight right shoulder elevation. What test would you like to perform? A. Wall angel B. Harvard step test C. Neck flexion test D. Dugas

A.

During the lumbar lock, your patient cannot move the required 40-45 degrees. When you passively move the patient, he can still NOT move the required 40-55 degrees. What is the corrective action?

Adjust thoracic spine

Regarding Boyle's Joint by Joint Theory, indicate those areas that should be stable. a. Ankle, Hip, Thoracic spine b. Lumbo-pelvis, Scapulo- Thoracic, C0/C1 c. Foot, Cervical spine, Gleno-humeral joint d. foot, knee, lumbo-pelvis

Knee, lumbo-pelvic, cervical spine

Your patient presents with localized low back pain and an obvious hyperlordosis. A static postural analysis reveals an anterior innominate and the lower leg is cylindrical in shape (versus a normal bottleneck shape). During Janda's Hip extension, it is clear the gluteals are not firing adequately. What additional test would you like to perform?

Lumbar lock

You note superior trunk elevation during a prone SLR test. What could you do to determine if your patient has a form closure problem?

Apply sustained lateral to medial pressure on greater trochanters during a prone SLR

What is the corrective action if your patient is having a force closure?

Corrective exercises

According to Herring and Kebler, micro trauma is defines as which of the following?

Failure of cellular mechanisms and tissue constitutes to maintain integrity of structures subjected to demands of physical activity overtime

Name a two joint adductor of the thigh. a. adductor longus b. pectinus c. adductor magnus d. gracillus

Gracillus

Your patient presents with posterior pelvic tilt. What muscles if tight could cause this presentation?

Right hamstrings

Muscles predominately static, tonic, postural have a tendency to become ________. (Pick all that apply)

Tight & Hypertonic

During a wall angel test, your patient has difficulty with GH external rotation. What anterior muscle may be hypertonic? a. Lat dorsi b. Pectoralis Major c. Subscapularis d. Infraspinatus and teres minor

Subscapularis

Your patient demonstrates approximately 60 degrees of right sided active hip flexión from the supine position. What does this indicate? a. Tight Right Hamstrings b. Not enough information provided. c. Deep Core weakness d. Tight left hip flexors

Not enough information provided

Long after someone has recovered from the symptoms of an injury, there may be kinetic chain deficits that go undetected by a standard physical exam. Which of the following could be found within a functional examination and detect more subtle movement deficiencies? a. Overhead Squat Assessment b. Othopedic Exam c. Fuduka Step Test d. Beep Test for functional Capacity

Overhead squat assessment

With your patient in modified Thomas position, his femur does NOT move easily into the midline. What muscle might be hypertonic?

TFL/IT band

(Choose all that apply) What soft tissues are part of the posterior oblique performance chain?

Vastus lateralis, latissimus dorsi, gluteus Maximus (NOT Adductors)

Your patient has an increase in paraspinal bulk and a lower gluteal fold. What is an expected associated finding?

positive janda hip extension

Your patient has a prone active SLR test that improves with sustained slight resisted GH extension. What is this finding and what is the corrective action?

Force closure issue & corrective exercises

Your patient seems to be having SI joint dysfunction (+Nachlas, +Hibb's). While performing a prone leg check, you note a slight flattening of the right gluteals. What follow up test would you like to perform?

Form vs. Force Closure

As noted in the audio portion of our week 1 PP the IlioPsoas is prone to hypertonicity. This in turn allows the gluteal muscles to become neurologically inhibited. With the gluteus max muscle inhibited which muscles are prone to becoming synergistically dominant? a. Gastroc, QL, thoraco lumbar fascia b. gluteus minimus and piriformis c. tibialis anterior and posterior d. transerus abdominis, multifidus, longus capitus/coli

Gastroc, QL, Thoracic lumbar fascia

What four motions are needed for the patient to have a successful Apleys superior? A. GH extension, GH external rotation, elbow flexion, thoracic flexion B. GH flexion, GH external rotation, elbow flexion, thoracic extension C. GH extension, GH internal rotation, elbow flexion, thoracic extension D. GH flexion, GH internal rotation, elbow flexion, thoracici extension

B

When performing half kneeling ankle dorsiflexion test, the knee of the forward foot should surpass the toe by how many inches? A. 0 inches B. 4 inches C. 2 inches D. 10 inches

B

Post cervical or lumbar injury, we see a loss of both feedback and feed forward motor.... Prone to inhibition in this scenario? (Select all that apply) A. Scalenes B. Transverse Abdominus C. Longus Capitis and longus coli D. Superficial erector spinae

B, C

Define micro trauma. A. Single event resulting in previously normal anatomical structures becoming suddenly and distinctly abnormal after injury B. Usually a process resulting from failure of homeostasis of cellular mechanisms and tissue constituents to maintain integrity of structures subjected to demand on physical activity over time C. Time. Place mechanism of injury (MOI) usually clear D. Two of the above

B.

During the lumbar shear test, your patient lies prone with his body on the table and feet on the floor. The clinician applies P-A pressure onto each spinous process noting segmental pain. The patient then slightly raises his legs off the floor and the examiner applies P-A pressure to any segment that was painful. What is a positive finding? a. Pain that occurs in the active position b. Pain with resting position that diminishes in the active position c. pain that occurs in the resting position and is maintained in the active position d. no adverse consequences in either position

B.

The thoraco lumbar fascia could become hypertonic is gait when what muscle is inhibited? a. gastroc and half kneeling ankle dorsiflexion b. glute max and janda hip extension test c. glute med and janda hip abduction test d. pec major and wall angel

B.

Your patient is a 48 year male attorney with a chief complaint of SI joint discomfort made worse with long periods of sitting. A static postural analysis reveals an increase lumbar lordosis, a unilateral anteriorly rotated ilium, During gait, he seems to have a decrease trailing limb posture at terminal stance. What two muscles could you hypothesize as being inhibited? a. superifical erector spinae and rectus femoris b. lower abdominals and gluteus maximus c. biceps femoris and psoas d. multifidus and adductors

B.

Your patient was in a motor vehicle accident ~3 weeks ago. Now he is experiencing cervicogenic headaches. A static postural analysis reveals a chin angle greater than 90 degrees. What muscles may be hypotonic allowing for this presentation? A. Suboccipitals B. Longus capitis and coli C. Pectoralis major D. SCM

B.

Ligaments have both mechanical and sensory properties. What are some proposed outcomes in a ligament has been damaged?

-Decreased in movement has a position sense -Decreased in joint stability

In an attempt to get a break from her children during the day, your patient has taken up walking 20 min 2-3 times per day. She now presents with 1st MTP pain that is worse with toe off. What are some items that you would be looking for on evaluation?

-Decreased pronation control of the foot and ankle -Tib Anterior and Glute Med inhibition -Tightness in ADDuctors and ID band

Which of the following is a characteristic of Lower Crossed Syndrome?

-Hypertonic ADDuctors -Weak abdominals

As noted in our week 1 lecture, the IlioPsoas is prone to tightness, the gluteals are prone to inhibition. With the gluteals inhibited, which muscles are prone to synergist dominance?

-IT Band/TFL, Piriformis -Gastroc, ADDuctors, QL

Your patient is a 26 year old electrical engineering student with a chief complaint of cervico-thoracic discomfort. During the wall angel test you note a chin angle greater than 90 degrees and early scapular elevation. During the overhead squat assessment, you note cervical pronation as well. What other findings might you be looking for as you continue your exam?

-Inhibition of mid/lower traps -Hypertonicity of upper traps -Hypertonicity of pec major

(Choose all that apply) Which of the following are characteristic of upper crossed syndrome? a. inhibition of posterior delts cross b. decrease stability at LPHC upper c. excessive scapular depression d. increased activation of the lats

-Inhibition of posterior deltoid -Increased activation of Latissimus dorsi

With regards to Janda's Postural Syndrome, we can view a patient with right Pes planus and suggest which of the following? (Choose all that apply)

-Internal rotation of right tibia and femur -Right calcaneal valgus

Your patient is a 17 year old soccer player that has developed localized low back pain. He has been sedentary for 3 months, sleeping in, playing video games and is getting back out on the field. There are no red flags, static posture analysis reveals the right anterior innominate. During the overhead squat assessment for the lateral view, you notice increase in lumbar extension and arms come forward. What two muscles would you like to evaluate for Hypertonicity.

-Latissimus dorsi -IlioPsoas

During Wall Angel, your patient has difficulty with GH external rotation. What two posterior muscles may be hypertonic?

-Subscapularis -Latissimus dorsi

What is the correct patient position when performing a muscle length assessment for the right upper trapezius? A. Pt. Supine. The clinician would bring the patient into full cervical flexion, left lateral flexion, and cervical rotation right B. Pt supine. The clinician would bring the patient into full cervical flexion, left lateral flexion, and cervical rotation left C. Pt supine. The clinician would bring the patient into full cervical flexion, right lateral flexion, and cervical rotation right D. Pt supine. The clinician would bring the patient into left lateral flexion and right cervical rotation

A

You are performing lumbar lock. With the patient in the correct position can NOT rotate 40 degrees. When you are assisting them, they still can NOT rotate 40 degrees. What does this indicate? A. Joint mobility disorder or tissue extensibility disorder B. Hyper mobility C. Stability motor control disorder D. Lumbar issues

A

Your patient presents with localized low back pain. With jandas hip extension you notice the superficial erector spinae fire early. Prone SLR improves with contralateral latissimus dorsi activation. What intervention might this patient need? A. Gluteus Maximus activation B. Sternal crunch exercise C. Greater trochanteric belt D. Gluteus medius inhibition

A

Which of the following is a characteristic of lower cross syndrome? a. short and tight adductor muscles b. short and tight gastrocs c. weak abdominal d. hypertonic glutes

A & C

(Choose all that apply) Ligaments have both mechanical and sensory properties. What are 2 proposed outcomes of a ligament has been damaged? A. Decrease control of muscles coordination and stiffness B Numbness in the tarsal tunnel region C increase movement and position sense D. Decrease in joint stability

A & D

(Choose all that apply) Your patient presents with symptoms of plantar fasiosis and you notice she also has a short broad Achilles. What additional tests would you perform? a. Half kneeling ankle dorsiflection b. Anvil test c. Morton's test d. Ankle dorsiflexion test

A & D

(choose all that apply). Your patient has a decrease in GH internal rotation. What would you like to further evaluate? a. teres minor b. diaphragm c. supraspinatus d. subscapularis

A & D

What are some neuromuscular dysfunction seen with pronation distortion syndrome? (select all that apply) A. Decrease pronation control at the foot and ankle B. Increased compensation at the Lumbopelvic hip complex C. 1st MTP D. SI/IS/PS joint

A and B

What are two examples of abnormal loading that could predispose our patients to adaptive changes that result in disc degeneration?(select all that apply) A. Immobilization B. Overload C. Body weight squats D. Deadlifts

A and B

You note aberrant movement in the superior portion of the trunk during a prone straight leg raise. What could you do to determine if your patient has a force closure problem? a. Isometric glenohumeral extension holds during a prone straight leg raise test. b. Assign corrective exercise, specifically a hip hinge/dead lift pattern c. Perform janda's hip extension test d. apply sustained lateral to medial pressure on the ilia during a prone straight leg raise.

A. Isometric GH extension holds during a prone SLR

What is one the basic biomechanical functions of the spine? A. Discourage opportunities to carry loads B. To protect the peripheral nerves C. To encourage and support movements between body parts D. To encourage dendrite formation and accumulation

C

Your patient is having SI joint dysfunction, static postural analysis revelas flattening of the gluteal muscles in the upper quadrant of the buttocks or the buttocks have a loosely hanging appearance. what two test would you perform? a. modified thomas b. lumbar shear c. janda hip extension d. prone form vs force closure

C & D

Your patient has a positive trendelenburg, What test would you do follow up with? a. form vs force closure b. modified thomas c. janda hip abduction d. janda hip extension

C.

With regards to the importance of breathing, what should the infrasternal angle be? a. 30 b. 45 c. 90 d. 135

C. 90 degrees

Your patient is a 38 year old female who refurbishes old furniture. Recently, she has developed chronic rib subluxations. What muscles might you want to assess for hypotonicity? a. Rhomboids & middle traps b. Gluteus maximus c. scalenes d. pec major

C. Scalenes

What percent of maximal voluntary contraction is required for spinal stability? A. 25-30 B. 100 C. 50-60 D. 5-10

D

With regards to rehabbing a patient, what may be the single most important part? A. Restoring ROM B. Restoring control of complex movements C. Restoring strength and endurance D. Physical exam

D

With regards to spinal stability, which is most important? A. Ligamentous laxity B. Fascia C. Strength D. Endurance

D

Your patient has begun participating in a walk group, now walking 3 miles, twice a week. She is experiencing diffuse pain in the SI joint region. An overhead squat assessment reveals slight genu valgus. During Jandas hip abduction, you note abduction of only 35 degrees. What muscle do you suspect could be hypertonic and what additional test would you like to perform? A. Gastrocnemius and half kneeling ankle dorsiflexion test B. Gluteus Maximus and Jandas hip extension C. IT band/TFL and modified Thomas test D. Adductors and modified Thomas test

D

Your patient presents with localized diffuse nagging low back pain. During your initial exam, you note an infrasternal angle greater than 90 degrees. This indicates dysfunction of what muscle? A. Scalenes B. Deep erector spinae C. Pelvic floor D. Diaphragm

D

During a static postural analysis, your patient appears to have pelvic unleveling or pelvic obliquity. What muscle, if tight, could create a high iliac crest? A. Latissimus Dorsi B. Hamstrings C. IlioPsoas D. Quadratus lumborum

D.

Your patient appears to have a tight IlioPsoas and weak gluteus Maximus. Due to this scenario, what other muscles may be hypertonic? A. Hamstrings and peroneals B. Gluteus medius and minimus C. Pectoralis major, upper trapezius, and Levator scapula D. Piriformis, Thoracolumbar fascia, gastrocnemius

D.

Your patient has approximately 50 degrees of right hip flexion during the active straight leg raise test. Placing the patient in a hook lying position now allows for the patient to achieve 70 degrees. what follow up test would you like to perform? a. janda hip abduction b. multi segmental flexion c. right passive straight leg raise d. left modified thomas

D.

Your patient is a 36 year female who is trying to get "great arms" prior to summer and is going to Burn Bootcamp 4-5 days/week. She is now having dull, nagging right sided shoulder pain. +Empty can, +impingement, -speed's, -Yergason's. Watching her GH ROM, you note she has early scapular elevation during abduction. What muscles might you eventually want to assess for inhibition? a. supraspinatus, rectus capitus b. posterior deltiod, serratus anterior c. subscapularis, teres major carysupelentapo d. middle/lower trapezius, Rhomboid

D.

Your patient is a 35 year old IT consultant who has recently began having localized low back pain when squatting. There are no red flags. static postural analysis reveals a right anterior innominate. When viewing in the overhead squat assessment from the lateral view, you note lumbar hyperlordosis and the arms are falling forward. What two additional tests would you like to perform to rule in/out specific muscles hypertonicity? a. Prone piriformis muscle length assessment and wall angel b. ankle dorsiflexion test and glenohumeral flexion ROM c. modified thomas test and upper trapezius muscle length assessment d. modified thomas test and pec major muscle length assessment

D. Modified Thomas test and pec major muscle length assessment

What constitutes good breathing?

Exhalation that is 2-4X longer than inhalation -Having the tongue rest on the roof of the mouth -Pause between breaths

Which of the following is a normal pattern of muscle activation in the Neck Flexion test?

Flexion of occiput on atlas

You notice that she has a short board Achilles. Name one test you would want to perform.

Half kneeling ankle dorsiflexion

During single leg stance test, you note a positive Trendelenberg. What follow up test would you like to perform?

Janda's Hip ABduction

Your patient has ~45 degrees of right hip flexion during the active straight leg raise test. Placing the patient in the left hook lying position (supine, left hip at 45 degrees, knee at 90 degrees with the foot on the table), now allows the patient to achieve 70 degrees of right hip flexion. What follow up test would you like to perform?

Left modified Thomas- assessing IlioPsoas

Your patient is a 28 year old female that has been working from home unable to go to her gym. She has recently been finding various workouts on YouTube to "tone her arms". She has subsequently began to develop cervico-thoracic discomfort. On static postural analysis you note a slight higher right shoulder. You note cervical rotation right that occurs with bilateral shoulder adduction. Name one muscle length assessment you would like to perform.

Levator scapula

Your pt is a 48 year old male attorney with a chief complaint of SI joint discomfort made worse with long periods of siting. A static postural analysis reveals an increase lumbar lordosis, an unilateral anteriorly rotated ilium. During gait, he seems to have a decrease trailing limb posture at thermal stance. What two muscles could you hypothesize as being inhibited?

Lower abdominals and gluteus Maximus

Your patient is a 17 y/o male gamer. He is complaining of cervico-thoracic pain after sitting for a long hours in his bean bag chair. During a wall angel test he has an inability keeping his upper/middle t-spine on the wall. During an both superior and inferior Apley's, he has difficulty demonstrating the requisite ROM. What is one additional test you may want to perform?

Lumbar lock

Your patient is a 33 year old male architect with chronic localized left shoulder pain. Positive impingement sign, pain with Apley's superior. During Apley's inferior, he cannot bring his left hand to touch his right scapula. During Wall Angel, he has difficulty keeping his upper thoracic spine on the wall. Name one additional test you would like to perform.

Lumbar lock

What is the correct position for doing a muscle length assessment of the left pectoralis major muscle (clavicular division)?

Pt. Supine, pt is at the end of the table so the humerus clears the table, elbow flexion at 90 degrees, GH ABduction to 90 degrees, externally rotate.

Your patient has a narrow infrasternal angle what muscles may be hypertonic? a. scalenes b. iliopsoas c. rectus abdominis d. obliques

Rectus Abdominus

Your patient has recurrent 1st rib subluxations, chronic cervico-thoracic pain & decreased cervical rotation. What muscles might you want to assess for tightness?

Scalenes

Your patient is a 14 yoa female avid reader. She is complaining of crevice-thoracic pain after sitting for long hour curled up on the couch. During a Wall Angel Test she has an inability keeping her upper/middle t-spine on the wall. During an both superior and inferior Apley's, she has difficulty demonstrating the requisite range of motion. What is one additional test you may want to perform? a. Shoulder abduction test b. Shoulder depression test c. Lumbar lock d. Lumbar shear

Shoudler abduction test

During Lumbar lock your patient is unable to rotate 45 degrees on their own. With your patient still in the lumbar lock position, you are able to easily rotate your patient the requisite 45 degrees. What does this indicate? a. subluxation b. joint mobility dysfunction c. stability motor control dysfunction d. tissue extensibility dysfunction

Stability motor control dysfunction

Regarding Boyle's Joint by Joint Theory, name those areas that SHOULD BE STABLE.

knee, Lumbopelvic, cervical spine