Therapeutic Interventions Exam 1

What are contractures? what are some symptoms?

-static shortening of a muscle -tonic spasm, fibrosis, loss of muscle balance, hypomobile antagonists, paralysis, loss of motion at adjacent joints -named for action of the shorted muscle (i.e. tight elbow flexors--> can't fully extend elbow-->elbow flexion contracture)

What is the 3 rhythms associated with manual therapy?

-stationary hold -slow, smooth, rhythmic - staccato type rhythm

What is a staccato type rhythm?

-stiff joints, Grades 3 and 4 -speed into range quicker than return movement

What is torque?

-strength of a rotation produced by a force couple -can be considered a rotatory equivalent to a force -rotates an object around an axis of rotation -torque= force x direction or -torque= force x MA

Personal factors

-features of individual that aren't part of health condition or state i.e)level of motivation, coping skills, acceptance of chronic health condition; age, gender, race, lifestyle habits, character, affect, cultural and social background, education

What is elasticity?

property of a material demonstrate by its ability to return to its original length after the removal of a deforming force

Disablement

the impact(s) and functional consequence(s) of acute or chronic conditions, such as disease, injury and congenital or developmental abnormalities on specific body systems that compromise basic human performance and an individual's ability to meet necessary, customary, expected and desired societal functions and roles

What is an axis of rotation?

the pivot point for the angular potion, located within or very near the structure of the joint; axis is the point at where motion is zero

What is friction?

the resistance that one surface or object encounters when moving over another -need shear and contact force to create a friction force

Disability

the result of impairments in body functions and/or structures, activity limitations, and in participation restrictions

coordination

the correct timing and sequencing of muscle firing combined with the appropriate intensity of muscular contraction leading to the effective initiation, guiding and grading of movement; basis of smooth, accurate, efficient movement and occurs at a conscious or automatic level

What is the chronic phase of managing nerve injuries?

-compensatory function -preventative care -bracing, splinting: long term management

What are the classic phases of the warm-up?

-general aerobic warm up -stretching -specific warm-up -all used to increase HR, blood flow, muscle temp and respiration rate

What is muscle tension?

-the ability to develop tension and to exert a force on the bony lever is most important characteristic of muscle -active and passive tension components

What is the rate of force development?

-the development of maximal force in minimal time, typically used as an index of explosive strength -how long you sustain hold becomes imp if goal is to get peak force out of it

What is internal torque and its components?

-the product of the internal force (muscle) and internal moment lever arm -counterclockwise or flexion direction -internal torque moment arm: perpendicular distance btw axis of rotation and the internal force

What are the disadvantages patient response model?

-time and energy intensive -initially assumes relevance of all findings -within session or between session changes do not always equate to long term changes -requires concerted communication between PT and patient: have to explain to patient everything you are doing and why you are doing (time intensive) -possibility for epic failure

The energy system that is used is dependent on what?

-time! -1-4 sec: ATP-CP, ATP in muscles -4-10 ssec: ATP-CP system, ATP + CP -10-45 sec: anaerobic system, ATP+ CP+muscle glycogen -45-120 sec: anaerobic system, muscle glycogen -120-240 sec: anaerobic and aerobic systems, muscle glycogen+ lactic acid -240-340 secs: aerobic and anaerobic systems; muscle glycogen and fatty acids -340+ secs: aerobic and anaerobic systems, fatty avids and muscle glycogen

How can we maximize torque by manipulating the external force?

-torque can be increased by increasing the magnitude of the applied force -applying the force perpendicular to the lever -increasing the distance of the point of application of the force from the joint axis

Forces exerted on a body lead to...

-translation of a body segment -rotation of the joint

What is the expected response for manual therapy?

-treatment goals: want to treat pain prior to resistance for grades 1 and 2, treat resistance for grades 3 and 4 if pain not a limitation -response based on whether patient is fast or slow responder -keep track of changes with session, between session and across sessions

What are 5 ways we can describe motion?

-type: linear and angular -velocity: displacement per unit time in a given direction -speed/magnitude: displacement regardless of direction -direction -location *acceleration: change in velocity per unti time

Where is the axis of rotation typically and how would it remain stationary?

-typically located through convex member of the joint -only stationary if covnex member was perfect sphere articulating with a concave member-typically located through convex member of the joint -only stationary if convex member was perfect sphere articulating with a concave member

What is continuous passive motion?

-units are motorized devices that move one or more joints through a preset range of motion (passive) at a controlled speed -patient feels confined -prevents joint stiffness and increases synovial fluid lubrication -quicker return of ROM

What is active-assisted ROM, its benefits and indications?

-use other limb/arm to help involved side -begin as soon as safe and able -ideal for unilateral weakness or paralysis -indications: when patient is able to assist or actively contract muscles, weak muscles, part of aerobic program, joints surrounding immobilized areas -i.e. wand, finger ladder, ball rolling, pulleys

What is a slow, smooth, rhythmic rhythm?

-used for painful disorders, usually Grade 1 and 2 -imperceptible changes in movement direction -used to inhibit pain and see change in movement of the patient, less guarded maybe?

What is the force-velocity relationship?

-used in combo with length-tension to determine the effect length and velocity have on muscle tension -describes relationship btw velocity of muscle contraction and force produced -isotonic contractions: eccentric and concentric -velocity is a funciton of load being lifted: small load, max velocity, large load, slow to zero velocity

What is multiangle isometrics? how much overflow is there?

-used to improve strength throughout the ROM when joint motion is permissible but dynamic resistance is painful or inadvisable - Gains in muscle strength occur only at or closely adjacent to training angle, physiological overflow is minimal (within 10 degrees in both directions of the training angle) -For multiangle isometrics, resistance at 4-6 points/angles in ROM is recommended

What is the key to structuring a warm up?

-warmup influences potential improvements -needs to be specific to activity to be performed -tailor to individual's demands, needs, activity level -Warm up and transition into sport/intervention program should be seamless

What are the 6 decisions that must be made for manual therapy (throughout the process)?

-what is the desired effect? -what direction should i go? -where should i start? -what method should i apply? -what is the expected response? -what should be the means of progression?

What is irritability?

-what it takes to bring on symptoms, how long the symptoms last and when do the symptoms subside -irritability doesn't mean severity

When should we not used ROM?

-when its disruptive to the healing process: should be pain free, if it is painful, too much moving it or wrong motion -signs of doing the most: pain, bruising, apprehensiveness of patient -for an acute musculotendinous tear/lesion: stretching not indicated, might tear through what is left

What is regional interdependence?

-with respect to MSK problems, refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to or be associated with the patient's primary complaint -biopsychosocial, somatovisceral, MSK, neurophysiological-->all factor into a MSK response with gives a local and remote response

What are temporal considerations?

-within session changes: changes in ROM within the session -between session changes -across session changes: over 3-4 sessions what are the changes, how does the patient feel

What are the activate and mobilize part of RAMP?

-activate key muscle groups -mobilize key joints and ranges of motion used in the sport or activity

What is a pathologic fracture?

- A fracture that occurs in a weakened area of bone secondary to a disease involving the bone (tumor in bone or cancer in the body that reduces bone stock)

What is an agonist, antagonist and synergist?

- Agonist: muscle of muscle group that is directly related to the initiation and extension of a particular movement - Antagonist: muscle or muscle group that is considered to have the opposite action of a particular agonist -Synergists: pair of muscles cooperate during the execution of a particular movement; most meaningful movement of the body involve multiple muscles acting as synergists

Key Components of Disablement (a spectrum)

-acute or chronic pathology -impairments -functional limitations -disabilities, handicaps, or societal limitations

What is a manually resisted exercise?

- contraindications of resistance exercise: pain, inflammation, severe cardiopulmonary disease -form of active resistive exercise in which resistant force is applied by therapist to the dynamic or static muscular contraction - Patient contact: manual resistance (therapist) - Establish good working relationship with patient and good in figuring out what muscles are working -Mechanical resistance: equipment is applying resistance

What is hypermobility and how can it be dangerous?

- excessive ROM compared to normal limits -this may be normal and advantageous at times; most likely just an adaptive lengthening of their ligaments and muscles -does not mean instability -can suggest underlying medical condition, collagen dysfunctions

Functional Performance

- have good functional movements before moving onto performance -ability so sustain quality of movement and repeated work without fatigue -gross athleticism: strength, power, endurance, relates to ability to jump and run -good functional movement, usually excel in functional performance

What should we consider for localization of forces during manual therapy?

- specifics chosen to accommodate joint size, force requirement and movement (use thumb tips, pads, heel of hand) -grip should be no tighter than required, soft touch -embrace part to be moved or stabilized -feel around joint to monitor motion -monitor patient and treatment effect: modify grip or contact as needed, look at facial expressions and eyes

What is RAMP?

-Raise -Activate and Mobilize -Potentiate

What are the directions you can go for manual therapy?

-distraction, compression, glide

What are some ways the patient could be to blame for poor compliance?

-laziness, undisciplined, forgot, no time,

What is circuit training?

-pre-established resistance program that targets variety of major muscle groups -typically 8-10 diff exercises

Method to the Madness: Exercise session breakdown/flow of intervention

1. General warm-up: increase elasticity and blood flow 2. Dynamic Mobility exercise 3. Skill training 4. power 5. Strength 6. metabolic conditioning 7. Balance 8. Static mobility

How long does it take to see changes in sarcomere/muscle length? What about stretching connective tissue?

6-8 weeks can see diff after 1 day of mobilizations

What are CPT codes? What is 97110? 97112?97530?

97110: therapeutic exercise to develop strength and endurance, ROM and flexibility 97112: neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and/pr propioception for sitting and/or standing activiites (moveemnt patterns) 97530: dynamic activities to imprice functional performance, direct with the patient; ADL's -How we bill for interventions

What is an avulsion fracture?

A strong muscle contraction pulls a piece of bone off where the muscle attaches to that bone. Example is a groin injury with avulsion fracture

Do we rule in or out anything?

No! We rule up or down in importance

What is the #1 reason patients sue PT's?

PT's neglect to supervise patients and they get hurt

Neuromuscular Impairments managed with therapeutic exercise

Pain, impaired balance/ postural stability/control, incoordination, delayed motor development, abnormal tone -instruct patients to be aware of their bodies, relearning movements and exercises

Cardiovascular Impairments managed with therapeutic exercise

Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) Pain with sustained physical activity (intermittent claudication)

What is bending?

combination of 3 of more loads applied to a structure, causing it to bend about an axis external to itself

What is a combined load?

combination of two or more loading modes applied to a structure at the same time

Impairment

consequence of pathological conditions and encompass signs and symptoms that reflect abnormalities; reflection of person's health status - manifest differently from one patient to another

What force is constant and what systems does it affect?

Gravity -affects musculoskeletal, neuromuscular and circulatory systems

What is a concurrent force system?

contains forces where lines of action meet at a particular point (i.e. patella and quad tendon meet in the center: will produce a compressive or tensile force to the knees)

Types of Impairments

Musculoskeletal Neuromuscular Cardiovascular/pulmonary Integumentary

What is the #1 most common complaint about PT?

PT not around or present -therapeutic alliance between patient and PT is important

Why are patients and clients referred for PT services typically?

Physical impairments associated with disorders of the movement system caused by injury, disease or health-related conditions that restrict their abilities -also for people that want to improve overall fitness and QOL to reduce risk of injury/disease

What are primary and secondary impairments?

Primary impairments are the direct result of a health condition (i.e pain, limited ROM due to impingement) and secondary impairments that are preexisting that lead to the primary impairment (poor posture that led to altered use of upper extremity and impingement)

What is test-treat-retest-instruct?

So you start with a test, and go through all the asterisks, gather the information and make a decision as to how you want to treat it. Once you finish treatment, retest using the same interventions used during the first test and gather information. If there is improvement, instruct patients on similar movements to do at home. if doesn't work, start the whole process over.

What are stable joints? what are mobile joints?

Stable: foot, knee, low back, scapula, elbow Mobile: ankle, hip, t-spine, neck, shoulder, wrist -do flexibility training for more mobile joints, not stable ones

My way of remembering which way the slide and roll is in.

These movements are in place to prevent the bone from falling off, so just think of what needs to happen in order to achieve that. If I'm raising my arm in abduction, the roll is up, but I don't want my arm to slide up and off the joint, so the slide has to be down. In the opposite direction, I'm lowering my arm but I don't want it to fall off inferiorly so the slide has to be up to keep it in the socket.

What is the convex-concave relationship/why does it exist?

improves joint congruency, increases surface area for dissipating contact forces, helps guide movement between bones

Why is knowing the underlying pathology associated with health conditions important background information, but not helpful in PT's assessment and treatment of patient's impairment?

You can have an accurate medical diagnosis and thorough knowledge of the condition, but two patients with the same diagnosis and same symptoms/measurements, may have different severities of impairment, activity and participation limitation and thus, different degrees of disability.

What is kinetics?

a branch of the study of mechanics that describes the effect of forces on the body

What is curvilinear motion?

a combination of linear and rotational movement around the ICoR (instanstaneous center of rotation)

What is slide?

a single point on one articular surface contract multiple points on another articular surface

What is a spin?

a single point on one articular surface rotates about a single point on another articular surface

What movements are in the frontal plane?

abduction and adduction lateral flexion ulnar and radial deviation eversion and inversion *anteroposterior axis (Z)

Cardiopulmonary endurance

ability to perform moderate intensity, repetitive, total body movements over an extended period of time; aka cardiopulmonary fitness

What is the difference between active and passive motion?

active is movement caused by stimulated muscle and passive is movement caused by an external source (gravity, a push)

Health conditions

acute or chronic diseases, disorders or injuries that have an impact on a person's level of activity -characterized by set of abnormal findings--> indicative or alterations/interruptions of structures of function

Translation occurs....an axis. Rotation occurs.....an axis.

around along

Therex+ manual therapy=

best patient care

Muscle performance

capacity of muscle to produce tension and do physical work; encompasses strength, power, and muscular endurance

What are cardinal movements vs combined motions?

cardinal- planar movements combined- ?

Functioning

characterized by the integrity of body functions and structures and the ability to participate in life's activities

Activity limitation

difficulties in executing actions, task, activities

Functionally relevant impairments

directly contribute to current or future limitations and restrictions in a patient's daily life

Farming

don't give therapeutic exercises solely to PTA's and techs

what is compression?

equal and opposite loads applied toward the surface of a structure (IV discs)

What is redundancy in the CNS? What is the nervous tissue's relation to neighboring bony segments?

folding and twisting of axons -redundancy within the tissues of the CNS allows neural structures to elongate prior to being exposed to significant tensile forces -nerve not elastic, crimping nature -normal movement of the body requires that tissues of the CNS be able to move past adjacent structures in which they are housed (i.e. notch in scapula)

What is a linear force system?

forces act in a straight line; if two forces are to be in equilibrium in this type of system, forces must be equal in magnitude and opposite in direction

What are the 4 aspects of manual therapy-method of application?

grade, amplitude, rhythm, duration

Client

individual without diagnosed movement dysfunction who engages in PT services to promote health and wellness and to prevent dysfunction

Fundamental component of PT services

individually designed therapeutic exercise program

What are the phases of tissue healing?

hemostasis inflammatory phase proliferative phase remodeling

How do we determine what axis is being used and its corresponding plane/movements?

if given a plane, the axis is perpendicular to that plane and vice versa; movements are determined however by the plane

Patient

individual with impairments and function deficits diagnosed by a PT and is receiving PT

What movements are in the horizontal plane?

internal (medial) and external (lateral) rotation axial rotation (rotation of the spine) *vertical/longitudinal axis (Y)

muscles vs movement

isolate muscle or focus on movement? -time and place for both -start with isolating muscle groups and progress to reinforcing movement and movement patterns to make it functional

What knowledge is needed for the delivery of effective heath care services?

knowledge of the complex relationships among health status, functioning and disability -provides theoretical framework upon which practice can be organized and research can be based

What is translation?

linear motion in which all parts of a rigid plane move parallel to and in the same direction as every other part of the body; can occur in a straight line or curvilinear; unit is meters or feet

Match level of ability: what are floor and ceiling effects?

match activity based on patient ability -avoid floor effect by starting where the patient is (don't make too hard right off the back) -avoid ceiling effects by being able to challenge patient; get them to where they need to be, they shouldn't be able to do everything with ease

What is rotation?

motion in which an assumed rigid body moves in a circular path around some pivot point; all points in the body simultaneously rotate in the same angular direction across the same number of degrees; angular displacement, unit is radians

What is osteokinematics and what are the planes?

motion of bones relative to the three cardinal planes of the body (sagittal, frontal, horizontal)

What is the roll movement? What is the analogy for it?

multiple points along one rotating articular surface contact multiple points on another surface -tire rotating across a stretch of pavement

What is a grade 3 soft tissue injury?

near complete to complete tear, severe pain, anatomical defect; frank instability

What is the Seddon classification of nerve injuries?

neuropraxia axonotmesis neurotmesis

Therapeutic exercise

one of the key elements at the center of programs desigened to improve/restore an individual function or to prevent dysfunction -systematic, planned performance of physical movements, postures, or activities intended to provide a patient/client with means to... (see card 2.)

What is torsion?

opposing loads applied to the surface of a structure resulting in twisting about an internal axis

Impairments of body function

pain, reduced sensation, decreased ROM, deficits in muscle performance, imparied balance or coordination, abnormal refleces, reduced ventiliation

The ability to work at home, workplace, community, during activities independently contignent upon...

physical, psychological and social function

What is R1 (Resistance)?

point in passive ROM at which the therapist sense resistance from a stretch on the non-contractile structures of a joint; first bit of resistance that you can surpass

what are the primary variables of kinematics?

position, velocity, acceleration

participation restrictions

problems in involvement in life situations, including self care, responsibilities in home, workplace or community; recreations, leisure and social activities

Impairments in body function versus impairments in body structure

problems with body systems (physiological and psychological) vs problems with anatomical features (significant deviation or loss) affects all body systems

Systems of the body that control each of the elements of physical function...

react, adapt and develop in response to forces and physical stresses placed upon tissues of the body systems

Impairments of body structures

readily apparent -joint swelling/scarring, presence of open wound, lyphedema, amputation of limb -palpation: adhesions, joint crepitus -imaging: MRI or X-ray-->torn ligament or muscle

What is R2?

resistance felt at the end of available passive ROM; full resistance

Composite Impairments

result of multiple underlying causes and arise form comb of primary and secondary impairments

What is the valsalva maneuver?

should not happen during resistance training; expiratory effect against closed glottis, deep inhale, close glottis, contract ab muscles; increases intra-abdominal pressure, forces blood from heart, causing an abrupt, temp increase in arterial BP

What are accessory movements?

small movements that help improve stability around the joint

What are the types of stretching?

static, dynamic, ballistic, PNF

Mobility

the ability of structures of segment of the body to move or be moved in order to allow the occurrence of ROM for functional activities -passive mobility is dependent on soft tissue extensibility (contractile and noncontractile) -active mobility requires neuromuscular activation

Balance

the ability to align body segments against gravity to maintain or move the body (center of mass) within the available base of support without falling; ability of body movement in equilibrium with gravity via intersection of the sensory and motor systems

Flexibility

the ability to move freely, w/o restriction; aka mobility

What is ROM?

the amount of motion available to a joint (magnitude of displacement) within the anatomical limits of the joint structure

What is work?

the capacity of a muscle to do work -force x distance -3 main components: strength, power and endurance

What is a force couple?

two forces that are equal in magnitude, opposite in direct and parallel in relationship to one another in space

What is a muscular force couple?

two or more muscles simultaneously produce forces in different linear directions although the torques act in the same rotatory direction

postural control, postural stability, and equilibrium

used interchangeably with static or dynamic balance

Why should we match Interventions to Impairments?

what does this patient need? -patient might tell you what they need but it is up to you to use the exam to tailor the program to what they need -i.e. patellofemoral pain: have dynamic valgus and weak glute medius; work on lumbopelvic region to strengthen it -take EMG studies with grain of salt and think of function of muscle

What are autogenic and reciprocal inhibition (GTOs)?

○ Autogenic (autogenic inhibition reflex): sudden relaxation of a muscle upon development of higher tension (self-induced, inhibitory, negative feedback lengthening reaction-protects muscle against a tear) ○ Reciprocal: process of muscles on one side of a joint laxing to accommodate contraction on other side of the joint; opposing sets of muscles work in sync for smooth movement Contract quads, hamstrings have to reciprocally inhibited

For musculotendinous injuries....

○ More myofilament reaction ○ Peripheral muscle fiber contraction with the first 2 hours ○ Edema and anoxia will result in in cell damage and death in first 24 hours ○ Protein breakdown- produces damaged cells that leads to further edema Phagocytosis eventually rids the area of cell debris and edema

What is the Lactic Acid System

-AKA: anaerobic glycolysis, lactacic system -Fuel source: glycogen (in muscle) glucose (in blood) -Intensity of Activity: High>85% max HR -Duration of system: 5-60 secs -Peak Power: 5-15 secs -ATP amt produced: small 2-3 ATP each glucose molecule -Speed ATP produced: longer chemical rxn than ATP system -By-products: lactic acid, H+ ions, ADP, pyruvic acid -creates energy at 16 cal/min; after 30 min accumulating lactic acid, decreased power and muscle fatigue

Exercise Safety/Risk-to-Benefit Ratio

-fundamental consideration in every aspect of the program -every intervention must be slow, progressive, logical exercise that leads to an end goal

What happens during eccentric, isometric, and concentric contraction in the force-velocity relationship?

- Concentric: as shortening speed decreases, the tension in muscle increases - Isometric: speed of shortening is zero and tension is greater than in the concentric contraction -Eccentric contraction: as speed of lengthening increases, tension in muscle increases and then plateaus

What are single joint and multi-joint muscles?

- Cross only on joint, recruited to produce force primarily concentric and isometric contractions Recruitment happens when simple movement produced at one joint, or multiple joints -multi-joint: Recruited to control the fine regulation of torque during dynamic movements involving more eccentric than concentric contractions; complex motions around multiple axes

What is firing frequency and how does it affect motor unit recruitment?

- Firing frequency: vary to affect force modulation; small distal muscles rely on increased frequency of firing while larger proximal muscles rely on recruitment of additional motor unit -More rapid recruitment of motor units may occur during fatiguing actions (constant force or position is maintained)

What is hold relax with agonist contraction?

- Following isometric hold, patient will flex hip and move into more ROM, final stretch should be grater -Reciprocal inhibition: activation of hip flexors -Autogenic inhibition: activation of the hamstrings -phase 1 & 2 similar to HR and CR -Phasse 3: concentric action of agonist in addition to passive stretch to add more force

What is happening to the moment arm and torque potential of the knee when moving from flexion into extension?

- From knee flexion into knee extension, the moment arm is getting bigger -The torque potential: increases, have to overcome the gravitational force, need more force from quads to overcome the changing torque

What is PNF stretching? What are the two explanations as to what is going on?

- Integrates active muscle contraction to inhibit or facilitate muscle activation ○ Increases likelihood that muscle to be lengthened remains as relaxed as possible while it's stretched - Reciprocal inhibition: reflexic relation occurs during stretching maneuvers as a result of this autogenic reciprocal inhibition-->leads to decrease tension in muscle fibers and therefore decreased resistance to elongation by contractile elements of muscle while its stretched -Sensorimotor processing: gains in ROM during or after PNF stretching due to combo of viscoelastic adaptation of musculotendinous unit as well as changes in patient's tolerance to stretching maneuver

How does isometrics reduced perceived pain?

- Isometrics and ability to increase pain pressure threshold: how much force is needed to produce pain - Reveals that patients have increased pain pressure threshold contralaterally and long-term -Not just for symptomatic, asymptomatic patients saw improvements

What are the components of a lever system?

- Lever: can be used to change direction of applied force, speed of force, and strength of an applied force -Effort arm: side of the fulcrum to where you apply the effort; moment arm for effort force -Fulcrum -Resistance arm: point that bears the load -effort force: producing resultant torque -resistance force: creating an opposing torque

What is the peripheral mechanism of manual therapy?

- MSK injuries--> inflammatory response in PNS--> healers and pain processing -Inflammatory mediator interact in response to injury--> manual therapy reduce/influence inflammatory response/markers after mobilizations

What is mechanical advantage and how do we use levers to gain it?

- Mechanical advantage: ratio of the effort arm to the resistance arm - We cannot change the effort arm: Effort arm is the muscular force as its applied to the bone (can't change orientation of muscle fibers, tendon placement) -Can change the resistance arm

Which exercises produce greater force? Which can control greater loads? Have more gains in muscle strength?

- More force production with eccentrics - Greater loads can be controlled in eccentric than concentric - Training induced gains in muscle strength and mass are greater with max effort eccentric training than max effort concentric -Eccentric contraction more efficient metabolically and generate less fatigue

Which of the fibers can regenerate: CNS or PNS?

- Most CNS fibers do not regenerate because: clean-up is slow, oligodendrocytes inhibit regeneration and the environment is not optimal for regeneration -PNS fibers can regenerate: clean-up is faster by macrophages, schwann cells help in regeneration, time is of the essence

What is the size principle of motor unit recruitment? What are factors that influence motor unit recruitment?

- Motor units with small cell bodies and fewer fibers are recruited first, larger ones are recruited if necessary - Favors energy conservation -Factors that influence motor unit recruitment: size, energy needed to complete a task, nature of task (variable within individual muscle of synergistic groups), firing frequency and fatigue

What are proprioceptive inputs?

- Muscle spindles: sensory receptors within belly of muscle; detects changes in lengths of muscles, info conveyed to CNS via sensory neurons (brain can process this to determine position of body part) - Golgi tendon organ: proprioceptive sensory receptor, changes in muscle tension; lies in origins and insertion of skeletal muscle fibers

What is overtraining?

- Seen more in sports population - Deleterious cognitively, emotionally and physically to athlete - Decline in physical performance in health individuals in high-intensity, high-volume strength and endurance training programs -staleness, burnout, loss of interest in program -They fatigue more quickly, require more time to recover from strenuous exercise because of physical and psychological factors

What are the 4 types of asterisks?

- Subjective: patient self-report (pain scale rating) - Objective: what the PT observes, change in ROM - Functional: ability/inability to do a task -Comparable sign: finding out what type of issue it is (is it really a hip problem or lower back)

What is synovitis, hemarthritis, ganglion, busitis and contusion?

- Synovitis: inflammation of synovial fluid - Hemarthosis: blood in the joint (body phagocytizes the blood-not good at selectively attacking blood, can attack the cartilage of the joint also) - Ganglion: swelling/pocket on top of tendon, not a sign of an underlying disease, no symptoms - Bursitis: inflammation of bursa -Contusion: soft tissue bruise

What is tenosynovitis, tendonitis and tendonois?

- Tenosynovitis: inflammation of fluid filled sheath that surrounds the tendon; tendon is ok, synovium around tendon that gets inflamed (transient synovitis in boys) - Tendonitis: inflammation of tendon -Tendonosis: tendinopathy; degenerative

What is the subluxation theory and what are the problems with it? what is the good news?

-"out of alignment" -creates dependence on practitioner -poor inter and intra-rater reliability -"owned" by one profession -fosters fear avoidance behavior -utilizes strict pathoanatomic model: if out of alignment have to realign in order to live whole and healed -no evidence found for subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention

What are some buzz words we should avoid telling patient?

-"out of alignment" -you have an instability -you are a mystery -no end in sight: quantify with patients how long you want them to do exercises and what your plan is for them during therapy

What are the interventions for the inflammatory phase?

-0-14 days -some debate about PROM vs complete immobilization -pretty standard to completely immobilize for 2 wks -RICE - Large infiltration of inflammatory cells, followed by platelets and fibroblasts to begin proliferate over next 2-3 weeks - Strength, patient education (anticipated recovery time, how to protect the wound), soft tissue integrity and mobility, associated areas, pain management - Leave the incision alone: make sure it's clean and dry

What are the interventions for the proliferative/repair phase?

-14-28 days -begin PROM: therapist assist -Grade I and II joint mobilizations -don't overstress tissue - Difficult to get pure passive ROM< minimizing muscle activation but will get some muscle contraction - Collagen deposition and growth factor increases, peak around 10 days post op, plateaus from anywhere between 28 and 50 days post-repair: Newly formed collagen network still tenuous, general stress will positively affect fiber orientation, but excessive forces will negatively impact ability to heal - Patient education: what to do at home, monitor it - Pain management: want his to move it, pain induced by activity; pain dropped significantly unless we do too much - Strength: can strengthen some in a certain range (closed chain position) need some loading to heal well; bearing weight - Soft tissue integrity and mobility: scar mobilizations -Don't use bike to get ROM back

What is the remodeling phase?

-3 weeks to 12 months -remodeling/maturation phase - Gradually cross linking and shortening of collagen fibers will promote formation of a short, tight scar: remodeling of collagen will increase functional capacity of muscle tendon and other tissues; Final aggregation or orientation and arrangement of collagen fibers tends to occur during this phase - Regeneration of the injured muscle does not fully restore muscle tissue to prior levels, as fibrous scar tissue heals slowly

What is the rate of fracture healing for children, adolescents and adults?

-4-6 wks -6-8 wks -12-18 wks

What is hemostasis?

-6-8 hours -stop bleeding -vasoconstriction -platelet aggregation -leukocyte migration: prevent infection -seconds to days

What is the aerobic system?

-AKA: oxygen system, aerobic glycolysis -Fuel source: Rest (FFA's and CHO) submax activities (CHO, fats when CHO is gone, protein in extreme conditions_ -Intensity of Activity: rest, sub max activity (under 80% max HR) -Duration of system: >75 secs -Peak Power: 60-90 secs -ATP amt produced: lots, CHO (38 ATP/glucose molecule), fats (441 ATP/triglyceride molecule) -Speed ATP produced: medium (complex chemical rxn) fats slower to resynthesize ATP than fats -By-products: CO2, H2O, heat -10 cal/min

What is the ATP-PC system?

-AKA: phosphagen system -Fuel source: phosphor creatine or creatine phosphate -Intensity of Activity: High>95% max HR -Duration of system: 1-5 secs -Peak Power: 2-4 secs -ATP amt produced: 0.7 ATP each PC molecule -Speed ATP produced: explosive: relied on simple chemical rxn -By-products: inorganic phosphates, ADP and AMP -responsible for immediate demands of muscle; stored ATP addresses energy demand

What is PNF contract-relax?

-Concentric activation of the muscle being stretched (not like hold-relax), active movement -similar to hold-relax

What is the convex on concave rule?

-Convex surface moving on a concave surface will cause roll & glide in the opposite direction -movement of bone is in opposite direction to slide -would manipulate joint in in same direction as slide

What is fatigue?

-Diminished response of muscle to a repeated stimulus -Cardiopulmonary fatigue die to decrease in glucose levels, glycogen stores in muscle, depletion of K+ -Factors that affect fatigue: health status, diet, lifestyle, underlying physiological disorders, environmental factors (temp, air quality, altitude)

What is a fixed external load?

-FEL -fixed end with external load -closely resembles closed chain

Functional Movement

-Foundation of the FMS -ability to move well without limitations and with balance -fundamental movement patterns: being well balanced, having static/dynamic stability, showing full ROM, good movement control and body awareness, good posture -measured with functional movement screen, perform 7 different movements and graded on a 3 step scale (3= optimal, 2=some deficits, 1= significant movement pattern deficits, 0=pain) -i.e. deep squat, lunge

What are the grades of mobilizations?

-Grade 1: small amplitude, out of resistance (beginning of range), pain modulation -Grade 2: large amplitude, out of resistance (beginning of range), addresses pain -Grade 3: large amplitude, into resistance at end of range, engaging the barrier, improve ROM -Grade 4: small amplitude into resistance at end of range, improve ROM -Grade 5: high velocity, low amplitude into resistance (thrust)

What is the difference between gravity facilitated, gravity reduced and anti-gravity?

-Gravity facilitated: gravity helps out - Gravity reduced/minimized: sideline shoulder flexion, gravity will have impact but not as much as if we were standing -Anti-gravity

What is neuromuscular control? What do we use it for in interventions?

-Interaction of the sensory and motor systems that enables synergists, agonists and antagonists, as well as stabilizers and neutralizers to anticipate or respond to proprioceptive and kinesthetic information and, subsequently, to work in correct sequence to create coordinated movement. -correct timing and sequencing of muscle firing combined with appropriate intensity (muscle contracting) leads to initiation and guiding to creating a movement; smooth accurate and efficient movement -instructing patient to be aware of their body when doing an exercise, re-learning movements

What is the lactate threshold?

-Lactate threshold: lactate inflection point; above 85% of max heart rate (75% of VO2 max) will accumulate abruptly -any performance at or below those two number, body will remove it w/o it building up

What is the strength to mass ratio?

-Larger athletes have smaller strength to mass ratio--> anytime you increase your body size, muscle volume and body weight increases proportionately more than actual cross section area of muscle

what is a moveable external load?

-MEL -moveable end with external load -combination of open and closed chain -i.e. military press: hands fixed to bar, bar will move

What is a moveable no load?

-MNL: movable end with no load -closely resembles open chain activity -end is moving without a significant load

What are the types of contractures?

-Myostatic: shortening of MTU, decreased # of sarcomeres in series, ppl who don't stretch -Pseudomyostatic: results in hypertonicity and/or rigidity (spastic diplegia); underlying neurologic condition -Arthrogenic & Periarticular: secondary to intra-aarticular pathology (OA), address underlying issue to improve flexibility -Fibrotic & Irreversible: underlying medical condition (Poland's syndrom)

What are the 3 energy systems for replenishing ATP in human skeletal muscle?

-Phosphagen ATP-CP -Glycolytic (Lactate) -Oxidative (Aerobic)

What are the functions of muscle?

-Support self against gravity, produce motion, mobility and stability, produce or control movement of bony lever around an axis, Resist extraneous movement of joint surfaces through the approximation of joints

Greatest tension produced with which type of contraction?

-Tension developed in an eccentric contraction is greater than what could be developed in either isometric or concentric (may not be true for all joint in all ROM though), may be due to mechanical factors, attachment of cross bridges, or alterations of neural pathways in the muscle

What is a joint reaction force?

-The resultant of all forces acting on a joint (muscle, gravity, load). It will be equal & opposite to the sum of all x and y vectors. -prevents fast acceleration of a limb in a direction

Functional Skill

-Top of the pyramid -sport specific skill; how well you perform in your specific sport skill; competition statistics and any specific testing related to that sport -i.e. lay up, kicking a field goal

upper and lower extremity typically move in open or closed chain?

-UE: often moves in open chain, can do closed chain -LE: mostly closed chain, still does open chain

Considerations for Home Exercise Prescriptions

-Understand your patient -frequency of treatment, commitment, outside engagement(s), etc. -give patient long-term battles (flexibility/strength) -dynamic processes requiring constant needs assessment; regularly pdated and assessed to make sure it is still challenging

What is the concave on convex rule?

-When a concave surface moves upon a convex surface, roll and slide movements should occur in the SAME direction -movement of bone is in same direction to slide

What are the zones of the stress-strain curve?

-Zone A (nonlinear region/toe region): slightly stretched ligament, small amount of tension because collagen fibers must be taut before significant tension measured (uncrimping of myofibrils to 0-1.5 or 2% of strain) -Zone B (elastic deformation): linear region in normal ligament, ratio of stress:strain in a ligament is a measure of its stiffness, elastic region of the plot, large stress but tissue can still return to its original length without deformity , collagen ligaments are gonna orient themselves in the direction of tensile, mechanical load, and begin to stretch (intermolecular slide of collagen),tendon will return to original length, reversible (1.5-3% of muscle strain) - Zone C (Yield/plastic region): exhibits plasticity (extreme and abnormally large stretch, tissue generates only marginal increases in tension as it continues to elongate), permanent deformity, intermolecular crosslinks between collagen fibers fail, stretch beyond physiological limit, microfailure continues to accumulates, stiffness reduces -Zone D: initial point of failure/ultimate (tendon strength beyond 8-10% of its original length) -Zone E: complete failure (6-30% of of muscle), macrotrauma

What is vicosity?

-ability of a material to resist flow and dampen shear forces -synovial fluid minimizes shear forces, lose this as we age, degenerative changes around the joint

Patient Safety: During the Exercise, things to consider

-accuracy of performance of exercises (proper posture, alignment of body, execution of correct movement patterns, performed with appropriate speed, intensity and duration) -inform patients of signs of fatigue, importance of rest for recovers during and after exercise; risk of injury due to fatigue -more important when patient is at home and not under PT supervision

What is the reversibility principle?

-adaptive changes in the body's systems, such as increases strength or endurance, are transient unless training-induced improvement are regularly used for functional activities or unless an individual participates in a maintenance - Detraining: lose the improvement from training, begins in 1-2 weeks after stopping training Maintenance programs are important-> home exercise program that is long-term that is doable and avoids reversibility principle and maintain gains at the clinic program of resistance exercises

Patient Safety: Environmental Factors to Consider

-adequate space, proper support surface, lighting (if have concussion, won't bother them), noise (music for motivation or someone who is sensitive to noise), temperature -well maintained exercise equipment, fits the patient, applied and used properly

When or why might we stretch?

-adhesions, contractures, scar tissue limiting ROM -weakness secondary to shortened muscle length -part of total fitness program -post exercise: get muscle back to resting length

Types of Exercise Interventions

-aerobic conditioning and reconditioning -muscle performance exercises: strength, power and endurance training -stretching techniques (muscle lengthening and joint mobilization/manipulation) -neuromusuclar control, inhibition and facilitation; posture awareness training -postural control, body mechanics, stabilization exercises -balance exercises and agility training -relaxation, breathing, ventilatory muscle training exercises -task-specific functional training

What are the supra-spinal mechanisms of manual therapy?

-anterior cingular cortext (ACC) -periaqueductal gray (PAG) -amygdala -psychologic factors: placebo effect, expectation, psychosocial factors

Therapeutic exercise interventions

-applying carefully graded physical stresses and forces that are imposed on impaired body systems, specific tissues, or individual structures in a controlled, progressive, safely executed manner to reduce physical impairment and improve function -individualized; therapist determines underlying cause of patient impairment, activity limitations or restrictions

What are neurodynamic tests?

-assess both mechanical tolerance as well as physiologically driven sensitivity -normal to experience stretch, discomfort and/or paresthesias -positive test: reproduction of familiar symptoms, >10 degree difference side to side, structural differentiation supports neurogenic source

What is the spinal cord mediated mechanism of manual therapy?

-autonomic response: skin temp, skin conductions, cortisol levels, heart rate -neuromuscular responses: motoneuron poop, afferent discharge, muscle activity -temporal summation: bombard CNS with input from muscle propioceptors, lessens pain (counter-irritant for modulation)

What is active ROM, its benefits, and its indications?

-begin as soon as safe and able -most functional -can go against gravity in order to improve strength -indications: when patient is able to assist or actively contract muscles, weak muscles, part of aerobic program, joints surrounding immobilized areas

What is the overflow or cross-training effects?

-carryover of training effects from one variation of exercise to another

What is displacement?

-changes in position over time

In regards to the starting position, what should we take into consideration for the therapist position and prep?

-comfortable position: easy to maintain, shouldn't be strain on fingers or shoulder, butt and abs engaged -optimal positioning to allow: complete control of movement, proper direction of force, good base of support, core engagement, full mechanical advantage -confidence

What are the mechanisms of nerve injury? Injury to which part of the neuron is regenerative/non-regenerative?

-compression -laceration: cut through nerve -Stretch: traction injury -Radiation -Electricity: burns -cell body damaged=no regeneration -axon or terminal damaged: regeneration possible at rate of 1mm/day

What are the 3 types of forces nerves have to withstand?

-compression, tension, excursion

What are the types of muscle action?

-concentric: bones move closer as muscle shortens -isometric: whole muscle activated, bones don't move -eccentric: bones move away as muscle lengthens -muscle action=joint action

ICF- International Classification of Functioning, Disability and Health

-conceptual framework and system for classifying disability -bio-psycho-social model; integrates abilities and disabilities and provides coherent perspective of various aspects of human functioning and disability as they relate to the continuum of health -common language used by all health professions for documentation/communication

What are the functions of the nervous system?

-conduct and regulate impulses via continuous electrochemical antegrade and retrograde flow -associate physical, psychological and environmental inputs -adapts dynamically to maintain and change its own function -facilitates coordinated conscious and unconscious reactions of multiple body systems

why is a person taller in morning than at night?

-constant compression on spinal cord squeezes fluid out of IV discs, fluid is reabsorbed at night as person sleeps -example of creep phenomena

What are some contraindications for manual therapy?

-contagious infection -severe cardiovascular disease -DVT -phlebitis -inflammatory arthritis -malignancy -bone disease -fracture -congenitally deformed bone -vertebral artery insufficiency -high severity or irritability -recent operative procedure etc.

What are the mechanical properties of the nervous system?

-continuity of nervous tissue tract -supporting connective tissues: ligaments, soft tissue, vascular supply -PNS: interneural and intraneural plexus formation, quantity of fascicles bound within nerve -CNS: folding and twisting of axons, nervous tissue movement in relation to neighboring bony segments

What are the axis of rotation in osteokinematics?

-coronal (x-axis)-side to side -vertical (y-axis)- up and down -anteroposterior axis (z-axis)-front to back -bones rotate about a joint in a plane that is perpendicular to an axis of rotation -each axis couples with a plane that has specific movements

What are the 3 time dependent properties?

-creep -hysteresis -stress-relaxation

What is rhabdomyolysis?

-damaged skeletal striated muscle breaks down rapidly -breakdown of products of damaged muscle cells released into bloodstream (protein myoglobin)-harmful to kidneys -severe muscle pain, vomiting, confusion -Pushing patients so hard, breakdown skeletal muscle, release of myoglobin into blood stream; Dark urine; Always bilateral

What is the proliferative phase?

-days to 6 weeks -rebuild structure and regnerate -fibroblast proliferation: synthesize scar tissue, makes 3 types of collagen which appears in 4 days -extracellular matrix reorganization: random and mature in fiber organization -angiogenesis: capillary budding occurs to bring nutrition and it enhances collage cross-linking -granulation tissue formation -epitheliazation -as more collagen is laid down, less fibroblasts present -wound contracture ends this phase: shortening of whole injured area

What are the late adulthood characteristics in regards to changes in strength?

-decline of strength now 15-20% per decade after 6th and 7th decade; 30 % thereafter -by 8th decade, 50% muscle mass compared to at peak, deterioration in functional abilities -Muscle fiber size, type I and II fiber numbers, and number of alpha motoneurons decrease (preferential atrophy of type II fibers) -decreased speed of contractions and peak power -loss flexibility -with a resistance training program, a significant improvement in muscle strength, power, and endurance is possible

What is stress-relaxation?

-decrease in the stress within a structure in the presence of constant strain -initially feels like a lot of load, but after some time, the load on the tissue will decrease/feel like its decreased even though the load itself has not changed -stress acting on tendon will eventually reduce under a constant deformation

What is the problem with static stretching before a warm-up? when should we static stretch?

-decreases force production, running speed, reaction/movement time, strength and endurance -low level of aerobic warm-up -static stretch after working out/event, helps decrease soreness

What is axontmesis?

-demyelination and axon loss, endoneurium is still intact (means neuron can regrow, body is still there also), terminal will die (wallerian degeneration), seen in crash injuries and displaced bone, great prognosis (i.e, police officers heavy belts that compress nerve for long time) -results of prolonged compression or stretch causing infarction and necrosis

What are the questions to ask when determining reps and sets?

-depends on the patient! -how much weight am i moving? -what is my goal -what fiber type am i taxing? -is this early or late in the session? -how are the patient's mechanics?

What are arthokinematics?

-describes the motion that occurs between the articular surfaces of joints -functions to maintain joint integrity, prevent subluxation, dislocation, and encourages smooth articulations

What is passive tension?

-developed in the parallel elastic component of the muscle -created by lengthening the muscle beyond slack length of the tissues

What is the duration portion of the method of application? What do we use for stiffer joints/more painful joints?

-dictated by patient symptom response (becomes better, worse no change) -treat pain with shorter duration interventions, can flare patient up if do too much -treat stiffness with longer duration if no pain

What changes the healing potential of tissue? List the healing potential of tissues from greatest to least.

-differs based on what type of tissue it is -muscle->tendon->extraarticular ligament (heal on their own)->intraarticular ligament (poor healing, need surgical intervention)->articular cartilage (not vascularized, don't heal) *blood supply is important

What is the open kinetic chain?

-distal end of extremity not fixed, allowing joint to function independently without necessarily causing motion at another joint -typically in nonweightbearing positions -Muscle activation occur predominately at prime mover and is isolated to muscles of moving joint -advantages: identifies strength deficits and improves muscle performance on individual muscle group, great control for single moving joint, less potential for substitution - Resistance applied to moving distal segment External stabilization usually required

What is the closed kinetic chain?

-distal limb is restrained against an immobile object -interdependent joint movements -typically in WB position -internal stabilization -body segment may move distally or proximally -advantages: greater for co-activation and stabilization, greater stimulation of mechanoreceptors, kinesthesia, better at improving balance and postural control

Multidimensional aspects of physical function/fitness

-encompass diverse, interrelated areas of movement performance -muscle performance, cardiopulmonary/endurance, mobility/flexibility, neuromuscular control/coordination, stability, balance/postural equilibrium

What are the goals of manual therapy in regards to activity limitations and participation restrictions?

-enhance health, wellness, and fitness -enhance or maintain physical performance -increase the ability to move -improve physical function

What are the benefits of resistance training?

-enhance muscle performance: muscle works more efficiently, produce more power -improve strength of connective tissue -decreased stress on joints: encourages muscles to get stronger and accept weight of body instead of the articular cartilage) -improved balance -positive changes to body composition -improve bone mineral density -enhanced insulin action -increased resting metabolic rate -improve perception of quality of life

What is tension?

-equal and opposite loads applied away from the surface of a structure -pulling things apart -when testing ACL grafts, are testing the tensile properties of those items (ultimate strength to failure)

What is the compression force on a nerve?

-exposure to compression is normal if magnitude of forces and duration of exposure are not excessive -alterations in fluid and blood flow within neural tissue can occur -nerves fairly resilient to compression

What are some ways that life could be to blame for poor compliance?

-family, stress, failure of equipment, lose equipment

What is a type 2x/b fiber and its characteristics?

-fast glycolytic -large diameter -white color -sparse capillaries -low myoglobin -fast sped of contraction -fast rate of fatigue

What is a type 2a fiber and its characteristics?

-fast oxidative glycolytic -intermediate diameter -red color -dense capillary system -intermediate myoglobin content -fast speed of contraction -intermediate rate of fatigue

Most of the articular surfaces of joints range from........ what is the relationship between them?

-flat to curved shape (most are curved) -convex-concave relationship

What movements are in the sagittal plane?

-flexion and extension -dorsiflexion and plantarflexion -forward and backward bending *coronal axis (X)

What are the interventions for the remodeling phase(6-8 wks post op)?

-focus on proper neuromuscular control -begin progressive AROM program -submax isometrics -don't push through abnormal movement patterns (i.e. shoulder shrug after surgery)

What is a load, and what can affect the body's ability to withstand it?

-force acting on the body -healthy tissues typically able to partially resist changes in their structure/shape; all need to somewhat be able to withstand load -age, trauma, altered weight bearing status affect resilience of connective tissue

What is distraction? what is it ussed for?

-force applied away from treatment plane, pulling two joints surfaces away -pain modulation, improve general joint ROM

What is the muscle force vector?

-force applied by a muscle to a bony segment is the resultant of mnay individual force vectors through muscle fibers pulling on a common tendon -each fiber is a vector with common point of application and form a concurrent force system that represents the total muscle force vector -action line/direction of pull is always towards the center of the muscle

What is glide? What is it used for?

-force applied in treatment plane -pain modulation, improve specific joint ROM

What is compression? What is it used for?

-force applied toward treatment plane -pain modulation, promote stability

What is ballistic stretching>

-force beyond normal ROM -bouncing and jerking -use muscles as springs -not beneficial can be harmful -decrease in performance and increase in possibility of muscle injury

How do forces benefit the body? What happens if you have too much or too little stress?

-forces during routine physical activity can help the body maintain a functional level of strength, cardiopulmonary fitness and mobility -too much: acute injuries (sprains/fractures) or chronic conditions (stress fractures) -too little: degeneration, degradation, deformity; decreased efficiency of circulatory and pulmonary systems

What is the patient-response model?

-foundation of good clinical reasoning, how we find out if manual interventions even work -considers pain reproduction and reduction occurring with positioning or movement -patient response during and after intervention guides treatment -does not necessarily rely on strict biomechanical model -surrounds patient self-report -test-treat-retest-instruct

What are some fracture identifiers?

-fracture site: diaphysial, metaphyseal, epiphyseal, intra-articular -orientation: transverse, longitudinal, oblique, spiral -position of fragment: nondisplaced, medial displaced, distracted -communited vs noncommunited (pieces or not) -open vs closed

Therapists must identify these things for effective management of patient's dysfunction

-functionally relevant impairments -impairments that can predispose patient to secondary health conditions/impairments -underlying causes

Most routine movements of upper extremity involve...Lower extremities can perform...

-involve distal on proximal segment kinematics (proximal segment stabilized by muscles or gravity) -one example of proximal on distal is a pull-up -lower extremities perform both distal-on-proximal and proximal-on-distal

What are the interventions for the remodeling phase (4 weeks post op)?

-gentle stretching -Grades III-IV mobilizations -begin AAROM -application of low level forces aid in orienting fibers within the collagen matrix and enhance tensile strength of the repair - Type 3 collagen slowly replaced by type 1 collagen, not fully mature until scar fully formed, even after a year out - Remodeling/repair tissue doesn't meet maximum tensile strength for 4 months post-repair - Patient education: exercises, more advanced - Pain management: shouldn't be pain, if have pain worked them too hard - Associated areas: won't isolate regionally like I would in subacute phase- Soft tissue: if still adhered down, introduce cross friction massage -Strength: load limb eccentrically (produces most force on the body)

What is dynamic stretching?

-gradually increase in output -controlled movement -within limits of ROM -no bouncy movement -used to increase reach, speed, or both -safe

What are some methods of Delivering HEP?

-handwritten sheet of paper -computer generated -online program (email, printed, video component) -selfies -video feedback with verbal cues is the best

Spotlight on osteoporosis?

-high intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit on influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass - Reduce and prevents osteoporosis - Cheaper and better for body -Encourage women in younger years to resistance change to combat osteoporosis

Contextual factors

-highlights of external/internal influences (environment/personal attributes) and societal expectations facilitate or hinder functioning -entire background of an individual's life and living situation composed of environmental and personal factors

What is the inflammatory phase?

-hours to days -early neutrophils: contain and kill the invader; flood the wound, phagocytic cells, cleanse wound of debris (necrotic cells and pathogens); highest number within the wound between 24 and 48 hrs post inury, by 72 hours, PMN numbers are lower just in time for macrophages to enter -late macrophages -phagocytosis and removal of foreign body/bacteria -wound debridement: pain and swelling, redness, increase in temp

What are ground reaction forces?

-how much force patient lands with, force pushing up into the body, has to be absorbed somewhere

What is the difference between absolute and relative strength?

-how much weight you can push/pull/lift: males>females -how much you can push/pull in regard to cross section area of muscle: males=females

Functional Movement Screen Optimal Performance Pyramid

-how we move and hot it relates to functional activities -helps determine how well you move and present good goals in activities tailored to you

What are asterisk signs? What are the 4 types of asterisk signs?

-identify signs and symptoms deemed to be comparable to the patient's complaints and relevant to patient's outcomes -subjective, objective, functional, comparable sign

What is the mechanical stimulus mechanism of manual therapy?

-if it be stiff, move it -much more complicated than that

What is the overload principle?

-if muscle is to improve, a load that exceeds the metabolic capacity of the muscle must be provided -muscle must be challenged to perform at a level greater than that to which it is accustomed

What is the acute phase of managing nerve injuries?

-immobilization -movement -splinting or bracing -patient education

What are the goals of manual therapy in regards to body function and structure?

-improves tissue extensibility -increase ROM -induce relaxation -modulate pain -reduce soft tissue swelling or restriction

To what point do we want to stretch to see length changes?

-in the plastic region -want to go past yield point to see changes (5-6% of strain) -microtrauma is good

What is passive insufficiency?

-inability of a multi-joint muscle to lengthen to a degree that allows full range of motion of all the joints it crosses simultaneously -i.e. tenodesis: fingers flex when wrist extended

What are the physiological responses of a warm up?

-increased muscle and core temp -enhanced neural function -improvement in force development and reaction time -improved muscle strength and power -lowered viscous resistance in muscles and joints -preps patient mentally and physically, can connect with patient -***getting neuromuscular system ready to function in higher capacity

What is the difference between induced and reactionary torque?

-induced torque/induced moment: external torque upon a segment by gravity and/or GRF; labeled according to direction of joint motion they facilitate -reactionary torque/reactionary moment: internal torque upon a segment generated by muscle forces in response to induced torque; labeled according to direction of joint motion they facilitate

What is the ICoR?

-instantaneous center of rotation -point fixed to a body undergoing planar movement that ha zero velocity at a particular instant of time

What are internal active forces and internal passive forces?

-internal active: muscle under volitional control, largest of the internal forces -internal passive: tension in stretched tissues, ligaments, joint capsules

What are internal and external forces?

-internal: produced from structures within the body (active or passive); internal active and internal passive components -external: produced by forces outside of the body (gravity, physical contact, etc.), free weights

What is the interneural and intraneural plexus formation in the PNS?

-interneural: serves to distribute force within combination of nerves; one part can be folded and another on slack -intraneural: serves to distribute force within specific nerves, fascicles form plexus structure with the nerve

What are the advantages of the patient response model?

-intuitive and easy to learn -minimizes therapist bias -respects diagnosis, but guides treatment based on impairments -not overly reliant upon diagnostic or biomedical models -facilitates specificity of treatment -encourages patient buy-in

What is the length-tension relationship?

-isometric tension development in a muscle and length of sarcomere in the muscle fibers -optimal sarcomere length exists where fibers capable of developing max isometric tension; having a length above or below the optimal leads to decreased isometric tension

What are some factors that affect flexibility?

-joint structure -age and sex: lose 10% of flexibility with each decade, female and young peeps more flexible -muscle and connective tissue/muscle bulk -stretch tolerance: stretching too much or being apprehensive of a stretch -neural control: think we are stretching muscle but its more neurologic stretching -resistance training: inverse relationship btw strength and flexibility -activity level: sedentary ppl are tighter

What is an open-packed position and characteristics of this position?

-joints are least congruent at mid-range, minimal congruency -ligaments and capsule slack -joint surfaces-unlocked -intra-articular volume is maximized -static efficiency: poor because rely on muscles for stability -dynamic stability: room for error bc of slack ligaments, safe

What are some things to think about when stretching patients?

-keep them calm: CNS down means a better stretch -what are you stretching: soft tissue or nervous system -stabilize the proximal joint segment: stretches feel different standing up versus stabilizing the joint -Therapist assisted vs self stretch: spending time with patient, feel different to patient -set realistic expectations: stretching as home exercise (6-8 wks to see improvement) -follow up with active movement: do a stretch and then follow up with an active movement to reinforce the movement pattern (neuromuscular control, i.e. waling quad stretch) -understand genotype -don't compartmentalize systems -know your patient's demands (baseball player vs someone who needs tenodesis grip)

What is hysteresis?

-lag of an effect when forces acting upon a material are changed -energy is often lost as heat -when a viscoelastic tissue is loaded and unloaded, the unloading curve is different than loading curve, diff between two curves or the middle space represents energy lost during loading

What are factors that can affect torque potential?

-length of moment arm of muscle force: changes with joint position -length of musle: changes as joint moves -velocity of shortening or lengthening during dynamic movements

Things to consider with strength training in females?

-less absolute strength than males but equal relative strength -longer neuronal adaption period required for more complex multipoint movements -psychological characteristics the same as in males -programs only differ in weight, shouldn't be different otherwise

Patient Safety: Intrinsic Factors that we should consider before starting a program

-level of supervision -patient's health history, current heath status must be explored (developed case of bronchitis and altering exercises to developing illnesses) -medications: may affect balance/coordination or cardiopulmonary response to exercise -novice to exercise: may be at risk for adverse effects from exercise associated with known or un-diagnosed health condition -medical clearance from physician may be needed

What is hypomobility?

-limited ROM compared to normal limits -stiff joint: rarely hurt -may be completely normal: older people have stiffer joints -hypermobile joints become irritated for compensating or hypomobile joint

What is tenodesis and how is related to passive insufficiency?

-loss of wrist and finger flexor and extensor function reduces an individual's ability to actively grasp objects -passive insufficiency leading to tenodesis can allow this active grasp: flexing wrist will cause fingers to straighten and release, extending wrist will cause fingers to curl and grasp -DO NOT STRETCH the finger extensors and flexors to allow individuals relying on tenodesis to retain the ability

If you have a patient who has a high number or or severe nature of risk factors, what is the level of benefit and action to be taken?

-low predicted benefit -avoid treatment

If patient has low number or low nature of risk factors, what is the level of benefit and action to be taken?

-low/moderate/high predicted benefit of manual therapy -treat with care/continual monitoring for change/new symptoms

Set-Up your patient for success

-make sure they are achievable, frequent enough but not too much, simple (simplest that they can do based on their ability), appropriately challenging, "feeling it" (what they should feel during their home exercises) -explain well enough so they know what to expect at home, how the exercises should feel -keep the patient from being depressed because they don't have an accurate picture of what the exercises should be like or if they feel that they are not progressing -explain to them how long they should be doing exercises

What is manual therapy/all the terms falling under that umbrella term?

-manual lymphatic drainage -manual traction -connective tissue massage -mobilization/manipulation -neural mobilization -passive range of motion -just touching the person does not count as manual therapy, intention is needed to be considered manual therapy

What is the potentiate part of RAMP?

-means to improve performance -increase intensity to a point where subsequent activities can be performed at max level -select activities that can contribute to a supra-maximal effect via utilization of a post-activation potentiation effect - Athlete: improve effectiveness in subsequent training that will take place -Begin to shift movements performed to work on key aspects of upcoming training session to be completed - Sports specific movements with increased intensity - Pushing patient hard, full-speed movement and activity - Types of movement should reflect training about to take place

If the patient has a moderate number or moderate nature of risk factors, what is the level of benefit and action to be taken?

-moderate predicted benefit -avoid or delay treatment/monitor and reassess

What is hypertension?

-monitor for breath holding -ask patient to breathe rhythmically, count or talk -exhale when lifting and inhale when lowering -high-risk patients should avoid high-intensity resistance exercise - Minimize hypertensive effect (lifting will raise BP naturally) -High BP patients should minimize their BP before starting resistance program

What does the stress/strain relationship of viscoelastic material look like?

-more deformable at low strain rates and less deformable at high strain rates -low strain rate tendons: absorb more mechanical energy, less effective and carry more mechanical loads -high strain rate tendons: become stiffer, more effective in transforming load to muscle

With certain populations who feel that they are so tight and just need to stretch, what is really going on?

-more of an instability issue, get stability from muscles instead of bones, tense to guard against certain movements -tightness comes on bc of a secondary issue: instability or hypermobility

What is a grade 2 soft tissue injury?

-more substantial tearing, not completely torn through; when palpate, will elicit pain; laxity in ligament

What is the recovery phase of managing nerve injuries?

-motor retraining: sliding and gliding nerve -desensitization: may be hypersensitive at first since nerve hasn't functioned properly in a while -discrimination sensory re-education: localize where patient feels palpation (homunculus) -patient education

What is an isokinetic machine?

-movement at a constant speed -range of training 0-500 degrees/sec -accommodates for a painful arc: if patient has transient pain at some portion of arc of motion, patient pushes less vigorously against resistance arm to move w/o pain; resistance eliminated as soon as patient stops pushing -velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device--> isokinetic dynamometer -accommodation to muscle fatigue -what are the limitations: facility dependent, expensive, limited carryover, isolates single muscle group, open-chain

What is a uniaxial joint? A biaxial joint? All synovial joints have some ... motion because of muscle acting on it or do to the laxity of the joint.

-moves in one plane, 1 degree of freedom -moves in 2 planes, 2 axes, 2 degrees of freedom -translation (mostly passive)

What is rotatory motion?

-moves on a fixed axis *rare that we have one type of motion and without some sort of outside stimuli

What are the pre-adolescent characteristics in regards to changes in strength?

-muscle fiber size and mass increase linearly from infancy to puberty -muscle strength (absolute and relative) and mass slightly greater in boys than girls -training-induced strength gains occur equally in sexes without evidence of hypertrophy until puberty -predictable, slow, stable -muscle 25% of body weight at birth

What are the young and middle adulthood characteristics in regards to changes in strength?

-muscle mass peaks in females btw 16-20, males 18-25 -decrease in muscle mass starts at age 25 -after 3rd decade, strength 8-10% per decade through 5th or 6th decade (less so in physically active ppl) -strength and endurance improvement possible with only modest increase in physical activity

What factors impact recovery from nerve injuries?

-nature of injury -timing and surgical technique: graft or not -age and motivation of patient -level of injury -regenerative potential of nerve -healing potential: lifestyle factors

What is acute muscle soreness?

-need microtears in muscle, swelling, increased soreness--> not necessarily adverse -should be mild -common -lack of adequate blood flow and oxygen -temporary buildup of metabolites (lactic acid and potassium) -characterizes as burning, aching, and tighness

Is youth resistance training safe?

-needs to be properly designed and supervised resistance training program -girls have greater training-related sport-specifc performance gains compared with bodys -resistance training with free weights most effective for increasing muscle strength ( less propioceptive/kinesthetic demand with machines)

What are the terminology challenges with manual therapy? What are some manual therapy descriptors?

-needs to be standardized -rate of force application -location in range of available movement -direction of force -target of force -relative structural movement: what structure is intended to remain stable, what is being moved (i.e. tibia on talus) -patient position

How does the number of fascicles housed in a peripheral nerve affect compression pressure?

-nerve compression with greater pressure required to affect nerve fibers in a nerve with a smaller number of fascicles

What is the breakdown of the nerve (structurally)?

-nerve surrounded with epineurium--> fascicles inside nerve each surrounded by perineurium--> in each fascicle are neurons surrounded by endoneurium -motor neuron: dendrites receive signals, body, terminal bulbs release neurotransmitters and responses -unmyelinated and mylinated fibers -spinal nerves are the PNS

what are tension forces on the nerve?

-neural tissue is not elastic -increased tensile loading leads to decreased cross-sectional area and increased intraneural pressure

What is radiculopathy?

-neurological state in which conduction is blocked along a spinal nerve or its roots -defined by objective neuro signs: dermatomal changes, myotomal changes, relfex changes -not defined by pain, but can occur with radicular pain

Disablement Process

-not unidirectional, not necessarily unpreventable or irreversible -in most instances the progression of the process can be altered and function improved -understanding and application of this process shifts focus from impact of dysfunction--> to the patient's function as well as the underlying causes of the dysfunction

What are degrees of freedom? How many are there? Why do people sometimes say 6?

-number of independent direction of movement allowed at a joint -3, but we also have 3 additional degrees of linear or accessory motion freedom; the first 3 have to do with angular freedom

What is active insufficiency? How can it be used clinically?

-occurs when a multi-joint muscle reaches a length (shortened) where it can no longer apply an effective force (-i.e. can't make fist with wrist flexed) -related to length-tension relationship -can be used to increase isolated demands of a muscle group during testing and training i.e. glute and hamstrings can act as hip extensors when knee is maintained at extended position; when knee is flexed, hamstrings placed in active insufficiency (in regard to their action at hip); test glute for hip extension only

What are chronic issues and how do we treat them?

-old injuries, have healed already; no inflammatory response anymore (only happens up to 6 wks after injury); can't call them tendinitis bc no inflammation--> start degenerative breakdown -Want to jump start healing process again by encouraging inflammation through eccentric exercises or poking holes in tendon

What is shear?

-opposing loads applied parallel to the surface of a structure -articular cartilage: superficial zone has chonrocytes layered sideways to handle shear forces; transitional zones have condrocytes organized more superiorly to inferiorly and can handle more compression forces -sliding patients will inflict significant shear forces

What are some things that we see with controlled weight-bearing immobilization?

-optimal fracture healing appears to need some cyclical loading--> stimulates bone formation -improved ROM -decreases pain: locally and regionally -reduced long term rehab

What is radicular pain?

-pain evoked by ectopic discharges from dorsal horn or ganglion -HNP most common -Inflammation critical -can occur in absence of radiculopathy

What is PNF hold-relax?

-pain free range -isometric, sub maximal contraction -GTO -After assuming initial passive stretch, muscle being stretched is isometrically contracted from 6-15 seconds, after which muscle is briefly relaxed for 2-3 seconds--> then passive stretch even further past initial stretch, held for 6-15 seconds

Musculoskeletal Impairments managed with therapeutic exercise

-pain, muscle weakness, decreased muscular endurance, limited ROM (due to restriction of joint capsule, periarticular connective tissue) decreased muscle length, joint hypermobility, faulty posture, muscle length/strength imbalances

What are the signs and symptoms of a spinal nerve lesion?

-partial weakness -absent muscle atrophy -reduced or absent muscle stretch reflexes -sensory loss not confined, blurred, indistinct borders -paresthesias present in terminal distribution or dermatome -absent muscle fasciculation -pain radiates distally from spine

What are the goals of the different types of ROM?

-passive: maintain mobility (not increase), inhibit pain, increase kinesthetic awareness; will not increase strength, endurance, prevent atrophy or improve circulation to the extent of volitional muscle contraction -AAROM and AROM: increase circulation, sensory feedback, functional activities; will not increase strength or maintain it in strong muscles, or develop skill or coordination except in the specific movement pattern used

In regards to the starting position, what should we take into consideration for the patient position and prep?

-patient needs to be relaxed -put them in a position to allow for optimal movement (max exposure to treatment area, required joint ROM, desired treatment effect) -functional or weight-bearing position as needed -inform patient regarding procedure and what to expect -start at NWB but then go to functional WB to maximize patient outcomes

What are the neurophysiologic effects of manual therapy?

-peripheral -spinal -supraspina

What is the moment arm (MA)?

-perpendicular distance between force & axis of rotation -produces a torque or moment of force -a force acting without a moment arm can push and pull an object generally in a linear fashion

Environmental factors

-physical, social and attitudinal environment; can facilitate or hinder functioning (contribute to disability); facilitators or barriers i.e)availability of assistive devices, modification in work or home for accessibility

What are laterals?

-player tosses ball behind or sideways, not making forward progress at the time for the purpose of gaining yardage -do more laterals with Therex, so you take an intentional step backwards or sideways for the purpose of keeping patient engaged and making forward momentum -2nd most common complaint is that do the same exercises all the time -be creative with your exercises (i.e. weight baring on unstable surfaces, plank position with push-up or wobble board or dumbbell rows)

What is cavitation and is it necessary?

-pop! -belief shared by patients and operators that if there is no joint noise associated with the manipulation, then nothing happened is false--> ultimate criterion for determining if something worked is how the patient felt afterwards -sometimes a good stretch is all that is needed!

What is the close-packed position and characteristics of this position?

-position where joints best fit -articulate best, usually at the end of ROM, -minimal accessory movements: ligaments and capsule are taut/tense -joint surfaces are locked, max joint congruency with minimal space (knee extension) -very efficient in static positions (rely on bones and ligaments for stability, not muscles) -dangerous in dynamic positions (no slack to accommodate sudden perturbations)

What are some things to consider with geriatrics resistance training?

-possibly need it even more than youth -strong-dose response -progressive strength training in the elderly, even in high intensities, is effective to reduce sarcopenia and retain motor function -adding sensorimotor components to strength training to improve postural control, is imperative in a multimodal training program -goal is to increase muscle mass and also promote neuronal adaption (intermuscular and intramuscular coordination) -minimize natural loss of strength -more they do, the more gains they see

What is the "raise" part of RAMP?

-practice techniques at lower intensity, raise body temp and recruit proper musculature - Use more sports specific movement patterns (identify the key patterns in the upcoming event--> adequately prepare patient) ○ Improve movement quality developed and train with no additional time required from patient - I.e.: back peddles, quarterback drops for a football player - Benefits ○ allow patient extra time to practice the technique at a lower intensity, can do it more frequently -Raise body temp and utilize necessary musculature

Why do we use isometric exercises?

-prevent/minimize atrophy when joint movement is contraindicated -protect joint -develop postural or joint stability -develop static strength - Used in early stages of rehab/acute phases - Static exercise in which muscle contracts and produces a force without change in length of muscle or visible joint motion - Activate muscle and begin to reestablish neuromuscular control but protect healing tissues - Intensity of contraction: amt of tension generated depends on joint position and length of muscle at time of contraction -Duration of muscle activation: hold for 6-10 secs, repetitive contractions

What is passive ROM, its benefits and its indications?

-prevents joint stiffness, contractures -increases synovial lfuid lubrication -quicker return of ROM -pain relief -performed by therapist or patient -indications: use if have acute, inflamed tissue, active movement is contraindcated or impossible -i.e. table slides

What is external torque and its components?

-produce of external force and the external moment arm -external moment arm: perpendicular distance between axis of rotation and the external force -rotates arm clockwise or extension direction -we as physicians can exert an external torque on our patients to assess, facilitate and challenge a particular muscle activity

What is creep?

-progressive strain of a material when exposed to a constant load over time -deform tissue via low stress over a long time to gain back a specific movement or ROM -long load, long duration stretch, beneficial for super stable joints (knees and elbows)

Therapist Safety: What are things to consider as a PT?

-proper body mechanics and joint protection to minimize own risk of injury -smaller women usually best manipulators because use proper mechanics to get leverage -tall man syndrome: back injuries from bending over so much -bulky guys: rely on their muscles and not mechanics, injuries occur; use butts and abs to stabilize you

What is viscoelasticity and its 3 main properties?

-property of material expressed by changing stress-strain relationship over time -exhibited by all body tissues that combine viscosity and elasticity properties -creep, hysteresis, stress-relaxation

What are the pros and cons to immobilization?

-pros: help with acute pahse of healing, prevents firther damage, minimizes acute pain (Thomas was for this) -cons: delayed soft tissue, contractures and adhesions, loss of articular cartilage, muscle atrophy, shortening and thickening of capsular tissue (Championniere was for this, early AROM to accelerate restoration of function)

What are forces?

-push or pull that can produce, arrest or modify movement -provide ultimate impetus for movement and stabilization of the body -force=mass x acceleration -types of forces/loads: tension, compression, bending, shear, torsion, combined loading

What are vectors? What are the parts of it?

-quantity that is specified by its magnitude and direction, need to know sense and point of application also -Magnitude->length of arrow -Direction-> spatial orientation of the arrow -Sense->orientation of the arrowhead -Point of application: where the base of the arrow contacts the part of the body (where muscle inserts to the bone)

What are plyometrics?

-quick powerful movement using a prestretch/countermovement, that involves the stretch-shortening cycle -increase power of movement using the elastic components of muscle tendon in the stretch reflex -plio=more, metric=to measure -increase power of movement

What are the puberty characteristics in regards to changes in strength?

-rapid acceleration in muscle fiber size and mass (30% a year) -rapid increase in muscle strength -gender discrepancies begin (males mass peaks before strength, females strength peaks before mass) -significant neuromuscular changes -relative strength gains as the result of resistance training are comparable btw sexes, greater muscle hypertrophy in boys

What are the determinants of muscle force production?

-recruitment of motor units -muscle fiber type -muscle length -speed of contraction -muscle action-torque potential -muscle architecture

What are some reasons to perform manual therapy?

-reduce pain -improve ROM -Establish patient trust -reduce tone -facilitate muscle activation: help muscles fire -inhibit muscle activation

What are successful outcomes of treatment?

-reduction or resolution of functional deficits and restoration or improvement of daily functioning -not just eliminating or reducing/correcting physical impairments of body function

What is active tension?

-refers to tension developed by the contractile elements of the muscle -initiated by cross bridge formation and movement of thick and thin filaments -amount of active tension generated depends on neural factors (frequency, #, size of motor units firing) and mechanical properties of the muscle fibers (length-tension and force-velocity relationship)

How can fiber type affect force production?

-reflective of physiological characteristics of muscle fibers (affect speed of contraction, magnitude of force generation, fatiguability of the muscle fiber) -fiber types found in varying proportions in the body throughout the population and throughout muscles

Therapeutic exercise helps patients to have the means to (card 2)

-remediate or prevent impairments of body functions or structures -improve, restore, or enhance activities and participation -prevent or reduce health-related risk factors -optimize overall health, fitness, or sense of well-being

What is a stress fracture?

-repeated microtrauma to bone over time; hypertrophy of bone; don't pick up with x-ray acutely; see them as they are starting to heal; due to overuse -A series of microscopic fissures in bone

What are the training adaptations that come with resistance and aerobic training?

-resistance: increase in size of muscle fiber, movement speed, strength and anaerobic capacity; no change in number of muscle fibers or aerobic capacity -aerobic: only an increase in aerobic capacity, everything else is unchanged (smaller fiber=more efficient)

What is neurotmesis?

-results of laceration, avulsion, rupture -most severe, demyelination, axon loss and one of the following (damage of endoneurium-fair growth but not as well as if it were intact; damage of perineurium-poor growth, epineurium damage- no growth), distal ends undergo degeneration , lifelong problems and dysfunction, permanent long term sequalae

What is neuropraxia?

-results of mild ischemia from compression or traction -segmental demyelination, reversible conduction block; compression in the axon, axon intact but myelin sheath is compressed (i.e. wrist drop, foot becomes numb when sit on it too long, hit your funny bone)

What is overwork?

-secondary to underlying neuromuscular disorder (GBS, polio, nerve root avulsion) -prevention is key -limited endurance at first, push them, but they get so tired that they can't function for a few days; progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disease -Identify disorders that put them at risk-->prevention (low and gradual approach to Therex progression), monitor closely, reevaluated frequently, not exercise to exhaustion and given longer and more frequent rest intervals

What is DOMS?

-serious pain, different from acute muscle soreness -not caused by lactic acid, but mechanism not well understood -happens 24-72 hrs after workout, intractable pain -maybe caused by microscopic tears in connective tissue elements that sensitive nociceptors and thereby heighten the sensation of pain -Greater incidence and severity in DOMS following unaccustomed high intensity eccentric than concentric exercise

What are the signs and symptoms of a peripheral nerve lesion?

-severe weakness -muscle atrophy -normal muscle stretch reflexes -sensory loss confined to sharply demarcated borders -paresthesias present in distribution of nerve -present muscle fasciculation -pain radiates proximally or distally from lesion

What is the proper dose of stretch>?

-short term benefits from 3 min-24 hours -dedicated program needed: 2-3x/week for a min of 5 weeks -30 sec per stretch idea, diminished returns less than and over that -sensation of gentle stretch, not pain -small load, longer duration stretch more effective

what are some precautions to manual therapy?

-significant joint laxity/instability -pain exacerbated by lying down -5 D's (drop attacks, dysarthria, diplopia, dysphagia, dizziness) -history of cancer or cardiovascular disease -medication that alters pain perception or circulatory response -acute injury/wound -nerve root signs etc.

Rolling surfaces usually have an accompanying what?

-slide in the opposite direction to prevent superior migration, changes the axis of rotation and the leverage of the muscles that cross that joint

What is the excursion force on the nerve?

-sliding -neural tissue has the ability to slide relative to adjacent interfacing extraneural tissues -sliding nature of neural tissue, can utilize neurodynamics to treat injuries of the nerve: powerful and potentially provocative

What is a type 1 fiber and its characteristics?

-slow oxidative -small diameter -red -dense capillary system -high myoglobin content -slow speed of contraction -slow rate of fatigue

What are the risks of resistance training?

-soreness: is okay!, normal side effects for new lifters -increased BP: risk to those who are hypertensive or who have bad form -joint or soft tissue injury if done incorrectly

What is the SAID principle?

-specific adaptation to imposed demands -When body placed under physical stress, makes adaptations to help it take the stress better the next time around -Specificity of training: adaptive efforts are highly specific to the training method employed, exercises incorporated should mimic the anticipated functions -a framework of specificity is necessary foundation on which exercise programs should be built -exercises incorporated in a program should mimic the anticipated function

What is variable resistance?

-specifically designed resistance equipment imposing various levels of resistance: load them more effectively at multiple points in ROM -irregular shaped CAMs -weight cable system or lever arm -hydraulic or pneumatic

What is the historical perspective of manual therapy?

-started out as bone setting, joint manipulations, no formal training (16th-18th centuries) -osteopathic medicine (AT still 1828-1917, standardization of practice) -Chiropractic: DD Palmer (1845-1913)

What is static/passive and active stretching?

-static passive: relaxed stretching, self-stretch/with partner/with apparatus, typically 3 sets of 20-30 sec stretches -static active: no assistance, held by strength of agonist muscles, reciprocal inhibition

How many reps should we prescribe to build strength/power? High intensity endurance much greater than strength and power (60 m dash)? low intensity greater than high intensity endurance(1600 m run)? low intensity endurance (marathon)?

-strength/power: 0-6 reps, longer breaks -6-12 reps -12-20 reps -20-30 reps

What are the interventions for the remodeling phase(8-12 post op)? (12 weeks +)?

-strengthening of muscles: tendon to bone healing is ready to accept isotonic load -isotonic and light closed kinetic chain therapeutic exercises after 12 weeks... -remodeling phase almost done -interventions more advances with heavier weight, unilateral exercises

What are stress and strain, and the curve that they represent?

-stress: force generated as a tissue resists deformation -strain: ratio of tissue's deformed length to its original length -stress/stain or load deformation curve

What is the stationary hold?

-stretching a stiff joint, painful at limit, back off a little from the limit and hold -hold stretch until pain subsides and then move to a new barrier

What is a Grade 1 softtissue injury?

-structural integrity, still intact/sound; damage to ligament still (ligament still feels stable); low grade inflammatory response

What are stabilization exercises?

-submaximal, but sustained -don't push as hard as you can, get good contraction and hold it 6-10 seconds

What is strength?

-the ability of contractile tissue to produce tension and a resultant force based on the demands placed on a muscle -the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort

Stability

-the ability of the neuromusuclar system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement -joint stability: maintenance of proper alignment of bony partners of a joint by means or passive/dynamic components

What are some considerations for home exercise?

be clear, tell patients what to expect with exercises (pain or stretching) -sometimes life happens: family, stress, failure of equipment/lose equipment, -perhaps the are lazy and undisciplined, forgetful, don't have time -simplicity is best! video feedback with verbal cues

What is a compression fracture?

bone is crushed; common in porous bones osteoporotic condition, crumbing of vertebrae

What is kinematics?

branch of mechanics that describes the motion of a body, without regard to the forces or torques that may produce the motion