PT 621 exam 1

deformation curve related to patient education

- guide patient toward activities that keep her out of microfailure - educate on how to avoid excessive load and deformation

components of subjective examination

- health screening/subjective exam - preliminary assessment statement - preliminary identification as appropriate for physical therapy

symptoms modulation clinical findings

- high disability - volatile symptom status - high-moderate pain - new or recurrent symptoms - AROM is limited/painful - increased sensitivity

intervention phase I: hemostasis

- highly irritable - difficulty finding positions of comfort - impaired ROM

importance of goals

- identify expected outcomes - assessing effectiveness of interventions

importance of patient goals

- identify expected outcomes of interventions - assess effectiveness of interventions

open kinetic chain exercises at the knee

- increased tibial translation - more rectus femoris muscle activity - less patellofemoral compressive forces - increased shear forces - less co-contraction

treatment for subacute lbp with mobility deficits

- mobilization/manipulation focused on improving mobility mid to end range

movement control clinical findings

- moderate disability - stable symptom status - moderate-low pain - AROM may be full with aberrant movements - impaired flexibility, activation, control

what ICF category does spondylolisthesis or lumbar instability likely fit?

- movement coordination impairment

apophyseal injuries

- muscle and tendon grwoth lag behind quickly growing bone creating tension at the apophysis leading to apophysitis or apophyseal avulsion ex. osgood schlatter disease or sever's disease

muscle strength changes with age

- muscle development in children correlates with acquisition of motor skills - increased muscle strength leads to coordination and increase muscle mass - gross and fine motor skills become refined during school ages

contraindications for stabilization classification

- negative prone instability treatment - absent aberrant movements - FABQPA <9 - no hypermobility with lumbar spring testing ??

neuropathic sensitization lbp with leg pain

- neuropathic pain with sensory sensitization such as allodynia, hyperalgesia, paroxysmal pain

thrust vs no thrust

- no difference between side lying and supine thrust techniques - mobilization does not equal manipulation

CPR for manipulation

- no symptoms distal to the knee - recent onset of symptoms <16 days - low FABQW score <19 - hypomobility of the lumbar spine - hip IR rotation >35 degrees (at least 1 hip)

signs and symptoms of lbp with radiating pain

- numbness and or tingle into LE within dermatomal pattern - weakness into LE within myotomal pattern - pain in low back or buttock region and or LE

distinguishing features of acute lbp with mobility deficits

- restricted ROM and segmental mobility - symptoms reproduced with provocation of involved segments

acute lbp with movement coordination impairments distinguishing feature

- restricted initial to mid range ROM and segmental mobility - flexion and ext

subacute lbp with movement coordination impairments distinguishing feature

- restricted mid range that worsens with end range - while performing self car/home management

intervention phase III: proliferation

- restrictions of capsule improved but remain - strength impairments - flexibility impairments

traction criteria

- signs and symptoms of nerve root compression - no movements centralize symptoms

benefits of TAR over arthrodesis

- similar revision rates - decreased in salvage procedures - ROM may be improved - smaller rate of degenerative joint changes in adjacent joints - high functional outcomes

what intervention could be used if 15sec single leg balance with eyes open and trendelenburg noted

- single leg balance 30-60 sec holds - 30 secs head turns - compliant surface

proprioception receptors are located in

- skin - joint capsule - ligaments - skeletal muscle - musculo- tendinous junctions ^ injury to any of these affect proprioception

EdUReP: reload

- specific exercises for condition - parameters: reps, sets, frequency - reloading may be painful but still helpful/not harmful

which treatment category do patients with lbp with movement coordination impairments likely fit?

- stabilizaiton

onset of LBP with mobility deficits

- strain - unguarded movement - awkward movement/position

functional optimization treatments

- strength and conditioning exercises - work or sport specific tasks - aerobic exercises - general fitness exercises = maximize performance

spondylolysis causes

- stress fracture from repetitive trauma (young athletes) - congenital due to failure of ossification of pars interarticularis

indications for specific exercise as treatment

- strong preference for sitting or walking - centralization with motion testing - peripheralization in direction opposite of centralization

rationale for manual therapy for movement control

- structural and psychosocial variables can degrade movement control - nerves, joint, and soft tissue can affect local mobility --> global stability

conditions in pediatrics

stress fracture growth asymmetry epiphyseal fracture/displacement osteoarthritic ligamentous sprains/avulsions osteochondritis dissecans apophysitis avulsion fractures osteochondrosis - avascular necrosis dif

type I avulsion injury

stretch?

occupation/roles of a child

student peer sibling explorer

structure of PT exam

subjective objective assessment plan

subjective impatient post operative PT

subjective: chart review patient interview discharge planning

subjective home health PT

subjective: intake review - precautions, what interventions has she been doing patient interview home/living arrangement assessment- getting dressed, showering

3 components of the assessment

summary statement diagnosis potential to benefit from physical therapy

triage by rehabilitation provider determining the appropriate rehabilitation approach

symptoms modulation movement control functional optimization

sets and reps for movement re-education

takes 100-150 reps to improve neural patterns - consider environment, feedback, practice schedule, dosage, and motivation

hindfoot complex

talocalcaneal, talonavicular, calcaneocuboid

midfoot

tarsal-tarsal, tarsal MT joints and first ray

why does nadine jones have pain on the medial and lateral sides with post tib dysfunction

tension on the medial side and compression on the right side cause pain

how do you know if you chose the correct treatment

test --> treat --> re-test

what serves as the reference for direction of tested motion?/ what determines the assessment/treatment plane

the convave surface of joint determines joint plane of motion - assessment/treatment motion should be parallel to concave surface

joint mobility assessments at the knee

tibiofemoral traction tibiofemoral PA glide tibiofemoral AP glide patellar superior glide patellar inferior glide

differential diagnosis age 4-10

transient synovitis legg-calve-perthes disease discoid lateral meniscus sever disease growing pains

PCL injury MOI

traumatic hyperflexion

plan SOAP

treatment and follow-up

true or false: significant decrease in recurrence of LBP if patients are taught MC exercises during the first onset of acute pain

true

classification of physeal fractures

types I Straight across II Above III Lower or beLow IV Two or Through V ERasure of growth plate or cRush

ACL sprain MOI

valgus knee force, hyperextension, rotation - deceleration, cutting, landings - 70% non-contact

ROM findings: AROM < PROM =

weakended musculature - due to disuse, lack of neuromuscular control, lack of neural input (neuropathy), pain

strengthen if

weakness (assess AROM << PROM)

PILL response

when applying mobilization with movement, to determine if appropriate we should see PILL response P = pain free I = instant result LL= long lasting - if not achieved vary glide parameters

ottawa ankle rules

x rays are required if there is pain in the malleolar region and any of the following - bone tenderness at any of the four areas - inability to weight bear four steps both immediately and in the ER

assessment SOAP

your interpretation of the data

X BW running

~4.5+ times BW

general STM principles

- superficial layers treated before deeper - force applied in direction of maximal restriction - choice of technique is dependent on: extent of restriction, amount of discomfort, degree of irritability

lumbar nerve root remote/referral to hip L1-L2 L3-L4 L5-S1

L1-L2: anteriorly L3-L4: laterally L5-S1: posteriorly

6 ICF classifications for LBP

LBP with mobility deficits LBP with radiating or referred pain LBP with movement coordination impairments LBP with related cognitive and affective tendencies LBP with related generalized apin

candidates for TAR should have

adequate vascualr flow to extremity adequate soft tissue envelope around the ankle to allow for wound healing and initiation of physical therapy and ankle ROM exercises post op

hemostasis timing

after injury up to 6-8 hrs; lasts up to 2 days

inflammation timing

after injury up to 7-10 hrs; peaks in 2-3 hrs

characteristics of lumbar stenosis

age of 65 relief of pain with sitting pain with standing and walking wide based gait

open packed position of ankle

all positions that are not a closed packed position

forefoot position

angle of forefoot vs angle of calcaneus - neutral varus or valgus

compensations for weak hip abductors

contralateral pelvic drop ipsilateral trunk lean

main? function of posterior tibialis

controls pronation and provides supination

lateral shift correction as treatment

correct shift before assessing sagittal plane motion

objective SOAP

data that you obtain through direct observation

subjective of SOAP

data you obtain through patient report (or family)

range of motion in newborns is _________ and range of motion in children is ________ in comparison with adults

decreased (newborn contractures), increased

STM if

decreased flexibility

spondyloysis

defect or weakening of pars interarticularis without any forward slippage - occurs in 5% of adult population, mainly at L5/S1

plastic region

deformation is permanent; failure point

medial ankle ligaments

deltoid ligament

maitlands 4 grades

developed the 4 point scale to describe the amount of movement and number of oscillations used during manual joint testing and treatment grade I: small amplitude at begining of movement grade II: large amplitude movement performed with free range but not moving into any resistance grade III: large amplitude movement performed up to the limits of the perceived range grade IV: small aplitude movement performed at the limit of the perceived range

pathoanatomical/ICF --> treatment based classification: disc stenosis radiating mobility deficits instability

disc = extension stenosis = flexion radiating = traction mobility deficits = manipulation instability = stabilization

lateral shift is associated with what pathoanatomical structures

discs

closed kinetic chain

distal segment is fixed and proximal segment moves - more co-contraction of various muscle groups

2 questions to screen for depression

during the past month, have you been bothered by feeling down, depressed or hopeless? during the past month, have you often been bothered by little interest or pleasure in doing things?

early, mid, and late treatment dosing of EdUReP model

early: even division of 4 components mid: mostly reloading late: mostly prevention

home health goals and planning

education length of need for home health safety begin process of rehab toward long term goals modification of exercise program

impatient PT goals and planning

education safety discharge goals begin process of rehab to individuals long term goals

what is considered an abnormal end feel

end feel that is different from the normal occurring end feel for the joint and when it occurs at a different point in the range than is normal

forefoot valgus

eversion of forefoot - lateral forefoot is higher = not normal

impairment goals

expected improvements in impairments - related to activity goals

nerve compression position with stenosis

extension > ipsilateral side bend > ipsilateral rotation

avulsion injuries

happen at bony attachment of ligament, tendon, joint capsule from its point of attachment to bone - more common in pediatrics due to maturing structures/skeleton - grades based on severity of separation from the bones (types I-IV)

stages of tissue healing

hemostasis inflammation proliferation remodeling

what is manipulation

high velocity low amplitude thrust aka grade V mobilization, spinal reposition maneuver, graded passive mobilization- local V

manipulation

high velocity thrust close to end range of motion - repeat twice and reassess in standing and walking

scoring of FPI

highly supinated: -5 to -12 supinated: -1 to -4 normal: 0 to +5 pronated: +6 to +9 highly pronated: +10

posterior THR precaution

hip flexion past 90 avoid IR avoid add across midline

mechanical stresses at the hip

hip handles tensile, torsional, and compressive loading

common MOI for ankle fracture

impact (fall) with forced DF

impairment improvement

impairment changes after treatment

interventions are driving by...

impairments with consideration to irritability

depression is associated with

increased pain intensity, disability, medication use, unemployment

tendinitis

inflammation of a tendon and myotendinous junction - microscopic tearing - resulting from tissue failure vs direct trauma - vascualr activation, inflammatory response

summary statement

introductory sentence(s) that briefly describe patient and summarize the background information

forefoot varus

inversion of forefoot when subtalar joint in neutral - medial forefoot is higher = normal

arthrokinematics

joint movement - motion occurring at the joint surfaces; roll, glide, spin

for the hypermobile joint, the stop will occur ________ and the end feel will feel _______

later; the same or less firm

tendinosis

painful degradation of collagen fibers - collagen fiber disorientation, focal necrosis - 1/3 population >35 y/o

elastic region

part of the curve before failure (microfailure) begins

type II avulsion injury

partial tear

3 levels of goals

participation goals activity goals impairment goals

interventions for hypomobility with medial glide & lateral tilt with hypomobility into medial tilit

patellar joint mobs - medial glide - medial tilt

ACL surgical options

patellar tendon graft (anterior knee pain) hamstring graft (strength deficits up to 10%) allograft procedure (high failure in youth)

supination is associated with ______ at the hip and knee

ER

EdUReP model for tendinopathy

Educate Unload Reload Prevent

pronation of the foot is associated with ______ at the hip and knee

IR

Grade I (Kaltenborn)

"loosening" movement is an extremely small traction froce that produces no appreciable increase in joint separation. GradeI traction nullifies the normal compressive forces acting on the joint

Grade III (Kaltenborn)

"stretching" movement is applied after the slack has been taken up and all tissues become taut

Grade II (Kaltenborn)

"tightening" movement first takes up slack in the tissue surrounding the joint and then tightens the tissues

effeurage STM

"tough lightly" - used to warm up tissue, lymphatic drainage, relaxation - apply distal to proximal (follows lymphatic drainage)

direct method to assess joint mobility

(glide testing) - passive translatoric gliding movements are applied in all possible directions to determine joint-gliding restrictions - preferred method as it gives the most information about the degree and nature of restriction - relies on end feel

close packed position

(only 1 closed packed position for a joint) - maximal tautness of major ligaments - maximal surface congruity - minimal joint volume - maximal stability of the joint - movement toward close packed position involve an element of compression

resting position

(only 1 resting position) - slackening of major ligaments - minimal surface congruity - minimal joint surface contact - maximal joint volume - minimal stability of the joint - movements toward open packed position involve an element of distraction

lbp with related cognitive or affective tendencies categorized by one or more of the following:

- 2 positive responses to primary care evaluation of mental disorders for depressive symptoms - high scores on FABQ questionaire and behavior consistent with excessive anxiety or fear - high scores on pain catastrophizing scale and cognitive processes consistent with helplessness, rumination or pessimism about lbp

signs and symptoms of lumbar instability

- 20-40 yr olds - needs to change position often (increased time in position = pain) - may have directional preference toward flexion, but end ranges hurt - inconsistent hypomobility - not correlated with radiographs

open packed position

- Any position but "close-packed" - Joint surfaces do not fit congruently - Also referred to as loose-packed position

possible consequences of excessive pronation

- CCJ, midfoot will alter mechanics of extrinsic and intrinsic muscle function - lose windlass effect - abnormal pronation allows 1st ray to remain in DF, 1st MTP will not move into DF - instability in late stance

pre treatment assessment before manipulation at ankle

- DF end feel knee extended and flexed - weight bearing DF measurement ( contribution of multiple joints) - pain: VAS and location - functional reach measurement: 1) DF measure in standing, floor, and fibula (in degrees); 2) anterior reach in length

what are the hallmarks of clinical presentation of hip OA

- groin/thigh pain - morning stiffness - difficulty with transitional movements - antalgic gait - painful WB - avoid motion

contraindications for specific exercise as treatment

- LBP only - no distal symptoms - status quo will all movement s (flexion or extension doesnt help)

conservative management for post traumatic OA

- Medication - Patient education - Shoe modification - Bracing - Stretching - Mobilization - Strengthening - Symptom management

rehabilitation management clinical findings

- Medium to high psychosocial risk status - Low psychosocial risk status with predominantly leg pain - Minor or controlled medical comorbidities

what intervention could be used for a postive thomas test

- STM to rectus femoris ITB/TFL - stretching: manual and self stretch

early PT intervention for LBP is related with decreased risk of what

- advanced imaging - additional MD visits - surgery - injections - opiod medications decreases total cost of care

correction of lateral shift should:

- affect intensity of symptoms - cause centralization or lessening of peripheral symptoms

denervation lbp with leg pain

- arising from significant axonal compromise with marked sensory and/or motor deficits

maitlands joint mobilization

- both rotational and translational movement - oscillatory manner (one or two to three applications per second) - "feels for" abnormal resistance to motion and carefully monitors any symptoms reported by the patient

management and prognosis of discoid meniscus

- can be asymptomatic - surgical intervention for torn/unstable menisci

serious adverse events to manipulation

- cervical: death, spinal cord compression, vertebral artery dissection - T/s: compression fracture, rib fracture, rotator cuff tear, pneumothorax - l/s: fracture, HNP, cauda equina

what happens if we dont get a cavitation?

- check for procedure error /clean up technique - modify patient position - try three times; move it and move on

hip strengthening exercises

- clams - standing resisted hip abduction - RDL - fire hydrant - prone hip extension - lateral sidestep walk

EdUReP: prevent

- conditioning, changing mechaniscs - increasing ROM, strength, balance - education

fear-avoidance based therapy strategies

- de-emphazised anatomical correlations - encouraged patients to take an active role - educated that LBP is a condition, not a disease - performed a graded exercise program

closed kinetic chain exercises at the knee

- decreased tibial translation - more vastus medialis and lateralis muscle activity - greater patellofemoral compressive forces - more co-contraction - compression of meniscus and articular cartilage

what is osteoarthritis

- degenerative joint diseases - injury/deteriation to articular cartilage - demasked collagen fibers --> fissures --> subchondral sclerosis --> exposed bone

elements of diagnostic statement

- differential diagnosis - nature and location of pathology; health condition - classification - determination of etiology; anaylsis of causal factors - relation to activity limitations and participation - anlysis of functional consequences of condition and how it interfering with participation

components of intervention

- directed toward body structure and function impairment - directed toward activity limitations - directed toward participation restrictions

directional preference

- direction of spinal movement or posture that produces centralization - direction that decreases pain intensity without pain changing location or increased in previously limited motion

treatments for symptoms modulation

- directional preference exercises - manipulation/mobilization - traction - active rest = modulate symptoms

what can cause nerve root inflammation

- disc disorder with nerve irritation - stenosis with nerve irritation - nerve irritation from local tissue inflammation

how should we reload the post tib?

- eccentrically - closed chain inversion - low arch = use shoes - exercise should be guided by symptoms and technique

possible interventions for ankle sprain

- edema management (manual & modalities) - improve ROM (joint accessory motion, STM, motor re-education) - improve strength - pain control - improve balance/proprioception - improve movement patterns

EdUReP: education

- educate patient on their conditions, timing of injury, reason for exercise/rest, long term effect, time duration

implementation of care types

- education - manual therapy - therapeutic exercise - assistive devices - home program

Kaltenborn Joint Mobilization

- emphasis on straight line movement within a joint; "translatoric" - emphasis on end feel testing - sustained holds - glides are often repeated several times using different speeds of movement during testing

gillet march test

- evaluate mobility of SIJ via hip flexion - PSIS should move inferiorly before the sacrum moves - "+" = PSIS does not end inferior to sacral sulcus

forward bend test

- evaluate mobility of SIJ via lumbar flexion - "+" = if sacrum and PSIS move at the same time vs independently - sacrum --> innominate

sacral rotation test

- evaluate mobility of SIJ via lumbar side bend - should see ipsilateral sacral sulcus deepen as patient side bends - "+" = sulcus fails to deepend

abnormal foot pronations defined

- excessive pronation in an expected phase of gait or pronation occurring in the wrong phase of gait

common sources of LBP

- facet joints - nerve roots - outer layer of annulus fobrosis - vertebral periosteum - ligaments - muscles

how can you control excessive foot pronation

- footwear - taping of arch - foot orthoses (over the counter or custom)

differential diagnosis at foot/ankle

- fracture - subtalar sprain - peroneal tendon injury (tendon vs retinaculum) - achilles rupture/tendinopathy - osteochondral lesion (shows up later) - fifth MT fracture (avulsion vs jones fracture) - midfoot sprain (cuboid positional fault) - fracture anterior (calcaneal process) - plantar fasciitis - posterior tibial tendon dysfunction - ankle sprain (ligaments) - arthritis of joints

intervention phase IV: remodeling

- functional limitations resolving - strength impairments improving but remain - underlying pathology considerations

mobilization with movement glide parameters

- glide mobilization in one direction - repeat 10-15 times - repeat this two to three times

how to avoid adverse events with manipulation

- good and complete medical history - detailed subjective interview - alertness with red flag signs - careful screen of ligament instability, VBI - choose right patient

gluteal muscle function and contribution to injury/apin

- greater posture sway - ITB syndrome - posterior tibial tendon dysfunction - total knee arthoplasty - total hip arthroplasty - patellofemoral pain syndrome

contraindications for STM

- infection - acute inflammatory process - acute circulatory condition - inflammatory skin condition - obstructive edema - acute rheumatologic conditions - hypersensitivity of skin - suture/hemorrhage sites - fractures - hypermobility - deep vein thrombosis - constant, severe pain - extensive radiation of pain - advanced diabetes - rheumatoid arthritis (when exacerbated) - presence of neurological signs (watch for increase) osteoporosis (cautious of pressure)

onset of radiating pain

- insidious with gradual buildup - injury or trauma usually associated with flexion& rotation, axial load/compression

What do we base exercise selection on?

- irritability - Pt goals - stage of healing - research!

intervention phase II: inflammation

- irritability - capsular restrictions in specific areas of capsule - muscle length - muscle length impairments

3 classifications (diagnosis)at the knee

- knee pain with mobility deficits - knee pain with muscle performance deficits - knee stability + movement coordination impairments

contraindications to ankle manipulation

- lack of diagnosis - patient positioning cannot be achieved because of pain and or resistance - lack of patient consent or understanding of the technique - age related contraindications (children without skeletal maturity and older persons with fragile neuromusculoskeletal system) - bone pathology including osteoporosis, long term corticosteroid use, osteomalacia, history of bone metastases - infection, dysplasia, trauma (fracture, dislocation), degenerative changes - RA - signs of peripheral nerve pathology - pulse-less foot - peripheral edema - open wound - pregnancy depending on stage

possible treatment for LBP with related LE pain

- lateral shift correction - repeated extension - mobilization into extension specific exercise extension!

signs and symptoms of movement coordination impairments

- lbp and associated lower extremity pain - restricted lumbar ROM and segmental mobility - movement coordination impairments of lumbopelvic region - diminished trunk or pelvic region strength and endurance - lumbar segmental hypermobility may be present - mobility deficits of thorax and lumbopelvic/hip region

acetabular contact during walking

- least during swing - greatest during single limb = most compressive forces

a dysfunctional joint often demonstrates (3):

- less quantity of movement - change in quality of movement (increased resistance to a movement within the available range) - more abrupt completion of movement with a firmer end feel

components of prognosis

- level of optimal improvement possible - time to achieve - guides plan of care, provides specific interventions and treatment that will be used - frequency and number of visits - patient educaiton/responsibility

what could be injured in a sprain

- ligaments (ex. ATFL, CFL, PTFL) - joint capsule - tendons (ex. peroneals) - bones (avulsion fracture) - cartilage (intra articular)

manual exam for LBP with mobility deficits

- limited segmental mobility - soft tissue palpation revealing restriction/guarding - limited excursion LE muscle length tests - symptoms reproduction with provocation of lower thoracic, lumbar or SI segments

common adverse events to manipulation

- local discomfort in area of treatment - pain in other areas - fatigue or HA - nausea, dizziness

characteristics of patient with LBP with mobility deficts

- local non radiating pain - referral into buttock or thigh - symptoms reproduction with end range motion and provacation of l/s, thorax, pelvis, or hip, SIJ - presence of lumbar, thoracic, pelvic, or hip segmental motion deficits

functional optimization clinical findings

- low disability - controlled symptom status - low to absent pain - aggravated by movement system fatigue - impaired endurance, power, strength

generalized guidelines for LBP (3)

- low stress aerobic exercises and gneral muscle reconditioning after two weeks - advice to remain as active as possible within limits of their pain - reminder that most persons with LBP return to full work capacity

esstential difference between the kaltenborn and maitland approach

- maitland was strongly influenced by neurophysiologic mechanisms for modulating pain = oscillatory - kaltenborn was influenced by joint based mechanical approaches = stretch

prognosis for those with LBP

- majority recover within 6 weeks; beyond 6 weeks improvements slows - even at one year, some patients have low to moderate levels of pain and disability

4 classifications for treatment based approach to LBP

- manipulation - stabilization - specific exercise: extension, flexion, lateral shift - traction

placebo effect of manipulation

- manipulation has better effect than sham but not statistically significant - better doctor-patient encounter improves outcomes

standing extension in individuals in the specific exercise: extension classification

- may be limited and aggravating due to compressive forces while standings - use extension in prone to concentrate bending movements in low back

symptoms patterns with radiating pain

- mechanical or inflammatory - stage of healing important to consider

cognitive ability considerations when working with kids

- meet the child at their age appropriate level - adapt instructions and interventions

regional precautions to manipulation

- mobility issues of the three joints of the ankle 1. inferior tibiofibular joint 2. superior tibiofibular joint 3. talocrural joint - stability of joints post fracture (dont do it) or post ligamentous injury(be cautious)

what to "move on to" if manipulation doesnt work

- mobilization - STM - exercise: strengthen, stretch, body mechanics/postural correction

treatment for acute lbp with mobility deficits

- mobilization/manipulation focused on improving mobility and reducing pain

knee osteoarthritis signs and symptoms

- older individual - joint hypomobility and limited ROM - pain with motion and compression - morning stiffness and after being in a static position - muscle weakness - crepitus, grinding, deep, achy pain

specifc exercise: flexion criteria

- older than 50 y/o - directional preference for flexion - imaging evidence of lumbar spinal stenosis

fundamental characteristics of well written functional goals

- outcomes, not processes - concrete - measure-able and testable - predictive but not aspirational - determined in collaboration with patient and family

3 aspect of inflammation

- pain - decreased ROM - muscle weakness; decreased motor output

reasons for impaired movement

- pain - neuromuscular - ROM - habit - structural deformity

indications to ankle manipulation

- pain felt at anterior ankle - restriction of talocrurual dorsiflexion in standing

distinguishing features of subacute lbp with mobility deficits

- pain occurs mid to end range - symptoms reproduced with provocation of involved segments

radicular symptoms

- pain radiating along the dermatome of a nerve due to inflammation or other irritation of the nerve root

spondylolisthesis signs and symptoms

- pain with extension - may cause nerve compression - may have palpable step off

indications for joint mobilization

- painful restriction of accessory joint motion with loss of rotational motions - inadequate ROM with capsular end feel of the joint

treatment strategies based on irritability level moderate irritability

- patient education - activity modification - short duration (5-15secs); passive, AAROM to AROM - low to high grade mobilization - basic functional activities

treatment strategies based on irritability level low irritability

- patient education - high grade mobilization - low to high resistance end range strengthening - end range & overpressure, increased duration and cyclic loading - high demand functional activities

treatment strategies based on irritability level high irritability

- patient education - low grade mobilization - activity modification - shorter duration ROM/stretch (1-5secs); pain free, passive AAROM

interventions for lbp with radiating pain

- patient education regarding positions that reduce strain or compression - manual or mechanical traction - manual therapy to tissues adjacent to involved nerves or nerve roots that exhibit mobility deficits - neural mobility exercises in pain free ranges

every session note should include

- patient self report - changes in patient status as they relate to plan of care - interventions, including frequency, intensity and duration - progress toward goals

HVLA and transverse abdominis and multifidus contraction

- patients with lbp who met CPR for lumbar manipulation showed increased TrA and multifidus muscle thickness immediately post-manipulation - increased thickness = increased recruitment

strumming STM

- perform perpendicular to muscle belly - improve muscle length

referred symptoms

- phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury origin

CPR for stabilization treatment classification

- positive prone instability test - aberrant movements present (- younger than age 40 & SLR >90)

rehabilitation continuum

- pre operative care - inpatient post operative day one - skilled nursing facility/ acute rehab - home health - outpatient facility

sub groups of patients most likely to benefit from traction characterized by

- presence of leg symptoms - signs of nerve root compression - peripheralization with extension movements - crossed straight leg raise

roles of PT with LBP

- prevent recurrence - prevent acute eposodes from developing into chronic conditions

diagnosis defintion

- process and label - investigation or analysis of the cause or nature of a condition, situation or problem - statement or conclusion from such an analysis typically recognizable label

plan of care should include

- proposed frequency and duration of visits - planned date for re-evaluation and or anticipated date of discharge - coordination and communication interventions - patient related instruction interventions - treatment (procedural) interventions - documentation of informed consent

positional fault concept

- proposed injuries or sprains might result in a minor "positional fault" to a joint causing restriction in physiological movement - normal joints facilitate free but controlled movement while simultaneously minimizing the compressive forces generated by that movement - normal proprioceptive feedback maintains balance in a joint - alterations would change joint position or tracking during movement and would provoke symptoms of pain, stiffness or weakness in the patient

sacroiliac joint assessment

- provocation tests (laslett cluster) - palpation of bony/ligament landmarks for posture and pain - movement tests to identify side of dysfunction

what intervention could be used if poor eccentric control was noted bilaterally during desecnt

- quad muscle performance - PF muscle performance - glute muscle performance - movement coordination training

post operative management of discoid meniscus

- range of motion is key! -- extension - edema management - pain management - normalization of gait - prevention of secondary impairments due to asymmetries, compensatory strategies - functional activities, sport specific, access to school/home - strengthening and stretching

components of initial evaluation documentation (5)

- reason for referral - activities - impairments - assessment - goals - plan of care

contraindications for manipulation

- symptoms below the knee - increasing episodic frequency - peripheralization with motion testing - no pain with mobility testing - lack of consent - lack of appropriate diagnosis - children and geriatrics - bone pathology: fracture, infection, tumor, osteoporosis - ligament instability, pregnancy - RA, down syndrome - VBI, abdominal aortic aneurysms - bleeding datheses

specific exercise: extension criteria

- symptoms distal to buttock - symptoms centralize with lumbar extension - symptoms peripheralize with lumbar flexion - directional preference for extension

what can you do for a high severity/high irritability patient who cannot do lots of exercise

- taping or bacing - modalities: ice, heat, NMES, TENS, ultrasound

what intervention could be used for observed pronation lasting through terminal stance left to right

- taping or orthotics to support arch and cedrease pronation

components of objective examination

- task/movement analysis - hypothesis of key impairments - tests and measures - final assessment statement and goals

characterisitics of patients with unclear classificaiton

- tend to be less affected by their back pain;lower levels of disability, fewer fear avoidance beleifs - longer duration of back pain

treatment for stabilization classification

- training transverse abdominis and/or lumbar multifidi = motor control training is superior to general exercise in patients with recurrent or chronic BLP

what predicts better outcomes after an ankle fracture?

- unimalleolar fracture had better outcomes than bimalleolar and trimalleolar (distal post tib) - increased DF ROM after cast removal had better outcomes - age was not a predictor

specific exercise: lateral shift criteria

- visible frontal plane deviation of the shoulder relative to the pelvis - directional preference for lateral translation movements of the pelvis

considerations for HEP for children

- who is responsible? - fit the family's schedule into exercises: ex heel raises while brushing teeth

LBp with related (referred) LE pain symptoms pattern

- worse with sustained flexed postures - centralized and diminished with repeated movements = extension - can see lateral shift, reduced lordosis, limited extension mobility

chronic lbp with movement coordination impairments distinguishing feature

- worsens with sustained end range movements or positions - while performing community/work-related recreational or occupational activities

progress note

- written periodically and should summarize what is in the session notes emphasis on: - progress toward goals - evidence that skilled intervention has been required to achieve goals - revision of plan of care as necessary - justification for continued therapy

stabilization criteria

- younger than 40 - greater general flexibility (postpartum, average SLR ROM >90) - instability catch or aberrant movements during lumbar flexion and extension ROM - positive findings for prone instability test - postpartum: + psoterior pelvic pain with ASLP, pain provacation with palpation of long dorsal sacroiliac ligament/ pubic symphysis

windlass effect

-as you go into extension at MTP, it pulls on aponeurosis (plantar fascia) which pushes tarsal bones up -high arches = pes cavus

effects of immobilization

-cartilage degeneration (thinning or softening) -decreased mechanical and structural properties of ligaments; disorganized cellular and fibrillary alignment, weakening of insertion sites -decreased bone mineral density -weakness/atrophy of muscles; decreased strength and increased fatigue - increase scar tissue - adhesion between synovial folds in joint

self care management clinical findings

-low psychosocial risk status -predominantly axial low back pain -minor or controlled medical comorbidities

medical management clinical findings

-red flags -medical comorbidities precluding rehab -leg pain with progressive neurologic deficits

movement control treatments

-sensorimotor exercises -stabilization exercises -flexibility exercises = improve quality of movement

STM techniques

-sustained pressure -effleurage -strumming -petrissage

considerations when foot pronation is excessive

1. hypomobility of foot and ankle segment (ankle, STJ) 2. hypermobility of foot and ankle segment (TNJ, CCJ) 3. weakness of perimalleolar muscles 4. combination of all of the above

proliferation timing

1 day after injury up to 6 weeks - peaks in 2-3 weeks

3 answers to "is physical therapy appropriate?"

1. Yes 2. treat and refer 3. no, refer out

STM uses (7)

1. address tissue restrictions 2. reduce spasm 3. improve lympathic flow/decrease edema 4. reduce pain 5. improve ROM/flexibility 6. increase temperature due to change in peripheral blood flow --> bring nutrients to area 7. improve balance when combined with mobilization

guidelines for mobilization with movement (mulligan)

1. identify aggravating movement 2. select appropriate glide 3. weight bearing or no weight bearing depending on severity, irritability and nature of patient problem 4. glide is sustained throughout the movement until joint returns to starting position; pressure sustained, being aware of minor alterations in treatment plane 5. mobilizations always performed into resistance and without pain 6. immediate relief and improvement in ROM is expected (PILL)

CPG parallels TBC except 3 things:

1. incorporates ICF terminology of body function impairments 2. addresses psychosocial domains by adding cognitive and affective domains, generalized pain 3. assesses level of acuity in terms of duration of symptoms and relationship to movement and pain

stabilization criteria for postpartum

1. posterior pelvic pain provocation test 2. ASLR 3. provocation of long dorsal ligament 4. modified trendelenburg

CPR: individuals who responded better (after manipulation) had three of the following four findings:

1. symptoms are worse when standing 2. symptoms are worse in the evening 3. navicular drop greater than or equal to 5.0mm 4. distal tibiofibular joint hypomobility

6 components of FPI

1. talar head palpation 2. supra and infralateral malleolar curve 3. calcaneal frontal plane position 4. bluge in region of TNJ 5. height and congruence of medial longitudinal arch 6. abduction/adduction of forefoot on the rearfoot

imaging signs of tendonosis

1. tendon enlargement 2. destruction within tendon; white noise 3. fluid at surface of tendon

joint mob treatment procedure for decreasing pain

1. test to determine grade reproducing pain 2. apply sustained/oscillary hold at a grade lesser than that reproducing pain (grade 1 or 2 sustained hold or oscillation) 3. hold for 7-10 secs or oscillate at 2-3 Hz for 40 secs, repeat 3-5 times 4. reassess to determine the grade reproducing pain

maintenance of balance involves integration from 3 systems

1. vestibular 2. visual 3. somatosensory

xBW walking

1.3-5.8

on average, most epiphyseal plates/growth plates close in long bones at ages:

12-15 in girls 15-17 in boys

subacute injury

14 days - 3 months

remodling timing

2-3 days after injury up to 1 year - peaks around 3 months

x BW during standing on 1 leg

2.4-2.6

laslett cluster

3 or more = 94% sensitivity - distraction - thigh thrust - compression - sacral thrust - (gaenslen's)

kaltenborn's three grades

3 point scale to describe amount of movement and percieved resistance during manual joint testing and treatment grade I: "loosening" movement is an extremely small traction froce that produces no appreciable increase in joint separation grade II: tightening grade III: stretchnig

x BW stair climbing

3 x

reps and intensity for power training

3-5 (fast) reps with 85-95% intensity

reps and intensity for strength training

3-5 reps with 85-95% intensity

treatment based classifications and overlap precentages

50% of patients fit into one category 25% fit into more than 1 25% dit not fit into any categroy

outcomes with manipulation for those positive on CPR

50% reduction in ODI treatments and maintained benefit for 6 months

what are range is likely affected?

50-80% >65% y/o have OA virtually 100% >75 years old have some degree of OA

reps and intensity for hypertrophy training

6-12 reps with 67-80% intensity

how long does a typical fracture take to heal?

6-8 weeks

acute injury

<14 days

reps and intensity for endurance training

>12 reps with <66% intensity

chronic injury

>3 months

ABCDE format for patient goals

A- actor; whos in charge of the goal B- behavior; what behavior is happening C- condition; does something specific need to occur D- degree; how much change E- expected time; how long will it take

ABCDE goal format

Actor - identify who Behavior - select expected behavior Conditions - context, circumstances Degrees - quantitative specifications Expected time - time period to achieve goal

neurophysiological responses to manipulation (7)

Change in Nociceptor Afferent System - changes pressure pain threshold; need increased pressure to cause pain Change in Autonomic Nervous System - manipulation increases skin temp, conductance, respiration rate, HR and BP Change in Hoffmann's Reflex - suppression of motor neuron excitability; decrease muscle firing Change in EMG activity - decreased resting emg signal intensity and emg activity in muscle spasm Change in Muscle Performance - increased TA thickness; no change in asymptomatic individuals - modulation of EMG at paraspinals during flexion and extension movement Change of Neuropeptides in Blood Vessels - reduced inflammatory cytokines - increased neurotensin, oxytocin, cortiol (pain modulation and hypoalgesia) Change in Cortical Excitability - changes in corticospinal excitability - changes in functional connectivity: increased activity in area that modulates pain after manipulation to lumbar spine - potentially alter pain hormones

forefoot

MT, MTP joints

objective outpatient PT

Observation/posture Movement analysis Functional analysis AROM/PROM Flexibility Joint accessory motion MMT Palpation Special tests

objective exam includes

Observe posture Movement analysis Functional movement analysis AROM/PROM Flexibility Joint accessory motion MMT Palpation Special tests

peripheralization

Occurs when symptoms increase in distribution - carries a poor prognostic value

physical exam for lbp with radiating pain

Posture Observation - look for increased lumbar and thoracic spinal curves - position of comfort - presence of lateral shift Lumbar Spine ROM - active - response to repeated motion - overpressure as needed Neurological Exam - manual muscle test - sensation - DTR - nerve tension: SLP, slump

key impairments to look for

ROM strength alignment sensory other systems (GP, GI, integumentary) pain edema balance impaired gait

what special tests to preform for osteoarthritis

ROM with overpressure, distraction (should provide relief), walk on heels (increases compression)

patellofemoral pain syndrome MOI

overuse - mal alignment of patella and femur = decreased contact area with increased mechanical stress

SOAP notes format

S: subjective O: objective A: assessment P: plan

open kinetic chain

When the distal end of an extremity is not fixed to any surface, allowing any one joint in the extremity to move or function separately without necessitating movement of other joints in the extremity. - better muscle isoloation

discoid meniscus

congenital deformity - 1.5-15% of pedicatrics presents at 7-8 y/o - lateral meniscus is irregularly shapes, impeding on intra articular space

can weakness influence balance

Yes - hip fatigue results in greater postural changes than from ankle fatigue during single limb stance

salter-harris fracture

a fracture of the epiphyseal plate in children

Wong-Baker FACES scale

a pain assessment tool that asks patients (often children) to select one of several faces indicating expressions that convey a range from no pain through the worst pain

why would the medial forefoot come off the ground with supination

a rigid foot

stress/strain curve

graphical representation of a material's mechanical properties

3 steps of learning for global stability

activation acquisition assimulation

interventions for SIJ dysfunction

active corrections: hip flexors/ext, piriformis, multifidus passive corrections manipulation

injury time based

acute subacute chronic

acute and chronic presentation of ACL sprain

acute: swelling, laxity, pain chronic: unstable joint, loss of function

lateral ankle ligaments

anterior talofibular, calcaneofibular, posterior talofibular

resting position of ankle

approximately 10 degrees PF and midway between maximal inversion and eversion

envelope of function

area under the tissue stress curve - training increases envelope

degenerative joint disease

arthritis of the foot and ankle caused by post traumatic (70%), osteoarthritis, inflammatory (RA = 10-50% or bone cyst)

operative care for OA

arthrodesis (fusion) TAR post operative PT

TAR complications

aseptic loosening malalignment deep infection

overall, interventions must include

assessment sign prescribed intervention parameters ability to describe potential compensations reassessment sign (immediately and long term)

interventions must include (5)

assessment sign prescribed intervention linked to impairment gathered from activity limitations parameters ability to describe to another the potential compensations reassessment sign - same as assessment

interventions for ROM restriction

assistive device strengthening soft tissue mob joint mob

activity limitations with MCL injury

avoid activities causing valgus knee stress: examples - breast stroke - dependent pivot transfers - W sitting

activity limitations with PCL injury

avoid posterior tibial translation: examples - kneeling knee ext ROM - lie prone instead of supine avoid HS activation such as lunges, HS curls, bridges

are these positons the same when the joint is pathological

axis could change --> resting position could change

sites in children that are more suseptible to trauma

bone growth plate epiphysis (articular cartilage) apophysis ischemia

what tissues are more vulnerable to injury in children compared with adults

bone more than ligament and tendon

osteokinematics

bone movement - whole bone moving around a joint axis; measured as angle in degrees

musculoskeletal lbp with leg pain

pain referred from non neural structures such as disc or the facet joints

3 examples of mobility assessments at the foot

calcaneal cuboid, talonavicular, dorsiflexion in STJN flexed and extended

foot posture during pronation

calcaneus = eversion talus = PF/horiz add tibia = IR navicular = pronation (PF?) cuboid = abduct 1st metatarsal = DF (maybe supination)

EdUReP: unloading

can use this time to strengthen surrounding musculature reduce stress by - changing activity, footwear - use of assistive device - bracing/taping - foot orthoses

5 primary end feels

capsular bony soft boggy empty

hip intra articular sources of pain/symptoms/movement dysfunciton

capsule labrum osseous structures

joint mob is

capsule impairment; hypo-mobility

orthostatics

change in vitals with change in position - decrease of systolic BP by 20 mmHG or diastolic BP by 10 mg Hg within 3 minutes of changing position (supine to sitting or sitting to standing)

firm end feel

characteristic of muscular or capsular/ligamentous end feel; firm end feel is variable among individuals depending on factors such as age, size, and extent of degenerative changes

soft end feel

characteristic of soft tissue approximation or soft tissue stretching

patellar tendinopathy

common overuse injury to patellar tendon, resulting in tiny tears. can cause necrotic degenerative change or inflammation in the tendon and pain. (injury common in jumping sports - also called "Jumper's knee")

what shall I do when I forget the angles of these assessment or treatment positions

compare to other side/other positions

type IV avulsion injury

complete tear

type III avulsion injury

completion of tear

indirect method to assess joint mobility

concave-convex rule - based on relationship between normal bone rotations and the gliding component of the corresponding joint movement - it is useful for joints with very limited movement - useful whens severe pain limits movement - useful for early career clinicians

genu varum/valgum 16 yr old female vs male

female slight genu valgum, male slight genu varum

red flags

fever chills night sweats weight loss or gain malaise/fatigue unexplained nausea/vomiting paresthesia shortness of breath dizziness

biomechanical effects of manipulation

fibroud adhesions develop (around facet) --> thrust manipulation separates facet joint --> gapping facet joint breaks up adhesions --> facet joint can move normally - realigns the spine - gapping of facet - reduction of crepitus

kaltenborn described 3 common end feels

firm or capsular hard or bony soft

nerve compression position with disc herniation/ limited nerve mobility

flexion > contralateral side bend > contalateral rotation

intervention for stenosis

flexion! - flexion exercises - manual therapy - body weight support TM

solution to problems with soap notes

focus on goals - functional outcomes documentation - benchmark tasks

how do you measure foot posture

foot posture index (FPI)

neutral forefoot

forefoot perpendicular to calcaneus

what is cavitation

formation of vapor and gas bubbles within fluid through local reduction in pressure, when the collapse of vapor cavities gives rise to noise

two pioneers of joint play testing

freddy kaltenborn and geoffrey maitland

pediatric specific interventions

gaming aquatic functional directed play adpatations in ther ex to make it a game

systemic/visceral sources at the hip

genitourinary - pain during urination, menstrual cycle inguinal hernias - coughing, laughing, sneezing local infection - fever, recent surgery/ illness

what intervention could be used for observed femoral IR in terminal stance and contralateral pelvic drop during stance bilaterally

gluteus medius and maximus muscle performance (ER and ABD) movement coordination training to improve mechanics

from a completed examination we develop what

goals plan of care implementation of treatment

leg alignment 1y, 7m

legs straight

Grade II Sprain/Strain

ligament fibers partially torn - moderate swelling, tenderness and ROM deficits - full weight bearing, may need assistive device - 4-8 weeks till return to normal activities

grade I sprain/strain

ligament fibers stretched - mild swelling tenderness and ROM deficits - full weight bearing - 1-2 weeks till return to normal activities

Grade III sprain/strain

ligament fibers torn with instability - severe swelling, tenderness, and ROM deficits - limited to no ability to ambulate without assistive device - 12-16 weeks till return to normal activities

why would you perform iliopsoas STM?

limited hip ext, pain with palpation

deformation curve

load vs deformation

tissue stress curve

load vs frequency; tolerance of tissue - increase load, decrease frequency - decreased load, increased frequency

categories of sources of pain and movement dysfunction

local neuro/musculoskeletal (intra or extra articular) remote/referred neuro/musculoskeletal systemic sources

sacroiliac joint disfunction

localized pain and tenderness at the PSIS, ligaments - may radiate to buttock or groin region - more pronounced with single leg standing or landing on one leg

joint mobilization treatment options

low velocity joint mobilization - sustained holds - oscillatory motions high velocity, low amplitude mobilizations mobilization with movement

sustained pressure STM

maintain constant pressure while providing clockwise or counter clockwise force - parallel or perpendicular to restriction - can be used to break up scar tissue

manual treatments for joint limitations

manipulation/mobilization

joint mobilization/manipulation definition

manual therapy technique comprised of a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement

closed packed position of ankle

maximal dorsiflexion

triage by the first contact health care provider

medical management rehabilitation management self care management

leg alignment 6m

minimal genu varum

leg alignment in newborn

moderate genu varum

plan of care

overall goals stated in measurable terms that indicate predicted level of improvement in functioning - general statement of interventions to be used - proposed duration and frequency of service required - anticipated discharge plan

problem with soap notes

overly mechanical often lack focus

functional improvement

movement change after treatment

hip extra articular sources of pain/symptoms/movement dysfunciton

muscles, tendons bursae local peripheral nerves

joint mob treatment aiming at increasing motion

need to know hypomobility is limiting motion, not pain - grade 3 sustained hold or grade 3-4 oscillations - pattern of restriction of a joint (capsular pattern) - history or pain --> pain and restriction --> restriction - capsular end feel

peripheral nerve sensitization lbp with leg pain

nerve trunk inflammation with marked mechanosensitivity - neural mobilization as treatment

manual treatment for positive sensitized neural tension tests (nerve)

neural mobilization

objective impatient post operative PT

objective: vitals post surgical precautions assessment of bed mobility assessment of transfers assessment of gait (assistive devices) UE and LE neurological screen

objective home health PT

objective: vitals demonstrates knowledge of surgical precautions environment precautions and concerns assess bed mobility assessment of transfers assessment of gait, steps/stairs LE, UE neuro screen

acquisition - findings and treatment

observe impaired ability to dissociate or coordinate thoracolumbar and lumbopelvic/hip movements - training to acquire skill of dissociating/coordinating

assimilation - findings and treatment

observe impaired control of multiplanar movements under dynamic loading - assimilate loaded multiplanar movements into ADLs

activation - findings and treatment

observe poor ability to activate individual muscles - training to activate hypoactive muscles

relationship between osteokinematics and arthrokinematics

occur simultaneously directly proportional normal arthrokinematic motion must occur for full range osteokinematic motion to occur - osteokinematic impairment is not always caused by arthrokinematics but impairments with arthrokinematics will cause osteokinematic impairment

hard end feel

occurs when bone or cartilage meet

centralization

occurs when symptoms move from periphery back toward center of spine and overall diminsh in distribution

MCL injury MOI

often accompanied with ACL

differential diagnosis birth to age 5

osteomyelitis spectic arthritis transient synovitis occult fractures kohler syndrome

what are some ways to know you are progressing to next phase of intervention in regards to tissue healing?

patient response - change in response of specific activity - use of self reported outcome measures reassessment! - BSF reassessment - activity level reassessment - patient goals are being achieved

assessment and reassessment with HVLA

patient symptoms and location during tests and measures - ankle DF in STJN with knee extended and flexed to 90 - AP glide of talus with end feel - CKC DF measure

leg alignment 2y, 6m`

physiologic genu valgum

late stage rehab for ACL sprain (knee stability + movement coordination impairments)

plyometrics advanced balance and proprioception agility

activity goals

predicated functional performance skills needed to achieve participation goals

balance definition

process by which the body's COM is controlled with respect to the base of support whether the base of support is stationary or moving - ability to maintain position, voluntarily move, react to preturbation - visual system assists in balance by providing input about head and body in space

participation goals

purpose of physical therapy interventions - specific roles Pt wishes or needs to participate

what special tests do we use to assess PF pain syndrome

quad contraction with inferior or posterior compression

meniscal saucerization with stabilization

repair tears and take out excess middle of meniscus

assistive device used if

restriction is due to pain = offload

subjective outpatient PT

review understanding of precautions review of rehabilitation current concerns symptoms behavior long term goals addressed

apophysis

secondary ossification center and site of tendinous attachment to bone - biomechanically the weakest point of musclulotendonous bone unit during school age-tennage years

end feel definition

sensation perceived by your hands at the limit of available motion

petrissage STM

several subcategories of techniques involving compression of soft tissue structures - includes kneading, rolling, picking up technique - goals: improve areas of muscle fibrosis, mobilize waste products

ROM findings: PROM >/= AROM but < optimal =

shortended musculature - use STM and stretching

glute medius exercise with the most glute med activations

side plank

differential diagnosis age 11-15

slipped capital femoral epiphysis osgood schlatter disease osteochondritis dissecans tarsal coalition freiberg disease accessory navicular

manual treatments for impaired soft tissue compliance

soft tissue mobilization passive stretches

for hypomobile joint, the spot will occur ____ and the end feel will feel _____

sooner; the same or more firm

what is proprioception

specialized variation of the sensory modality of touch - important role is coordinating muscle activity - involves integration of sensory input concerning static joint position. joint movement, velocity of movement, and force of muscle contraction - can be conscious or unconscious

aggravating factors with PF pain syndrome

squatting, kneeling, stretch to the knee extensors, and prolonged sitting

early stage rehab for ACL sprain (knee stability + movement coordination impairments)

stability and movement coordination training - balance proprioceptive training - movement re education (train technique)

diagnosis documentation

state differential diagnosis or health condition and rational - describe patients activity limitations, impairments and participations restrictions

types of stretching

static, dynamic, ballistic, PNF

health conditions that dont fit extension specific exercise

stenosis spondylolisthesis SIJ dysfunction

stimulus and pattern for joint/articular surfaces

stimulus: AROM, PROM, weight bearing/compression, end-feel testing pattern: pain may be deep or poorly localized with compression, gentle motion sometimes reduces pain

stimulus and pattern for muscle pain

stimulus: AROM, muscle contraction pattern: usually localized to damaged area

stimulus and pattern for tendon pain

stimulus: AROM, overstretch, contraction at end range pattern: localized to tendon, myotendinous junction or boney insertion

stimulus and pattern for ligament pain

stimulus: PROM, end range active movements pattern: pain at attachment points, unstable