PT 851 part 2

what is excess body fat, centrally around the abdomen associated with

chronic conditions including hypertension, metabolic syndrome, Type 2 diabetes mellitus, stroke, cardiovascular disease, and dyslipidemia

5 types of tapotement

beating: use of closed to lightly hit Slapping: use of fingers to gently slap Hacking: use of edge of hand tapping: use of fingertips cupping: use of a cupped palm

navicular drop test

quantifies midfoot mobility and effect on other parts of kinetic chain in WB use ruler to measure height of navicular tuberosity from floor in subtalar neutral then, measures navicular bone from floor in normal relaxed standing difference is called navicular drop and indicates amount of foot pro during standing any measurement >10 mm is abnormal

which health fitness evaluation will determine someones health risk category

waist circumference

autonomic (SNS) effects for MFR

Fascial restriction can cause autonomic changes, so it is not surprising that when restriction is released, the autonomic system can be affected The patient's sympathetic system can be stimulated, and the patient demonstrates symptoms such as increased pulse rate, sweating, and BP changes Less intense responses include sensations of burning, tingling, stinging, or heat in the area being treated Although these sympathetic responses are unusual, you should be aware that they may occur and be prepared to respond appropriately

what physiological motions are the coronal/ant-post plane/axis of motion

abduction and adduction

neuromotor exercise involves which motor skills

balance, coordination, gait, agility, and proprioceptive training tai chi, qigong, and yoga

sports massage - rocking - SNS

Rhythmical technique (wave-like) Applied over sheets, no oil

which type of footwear increases the pressure on the ball of the foot, even while just standing

high heels

tendiopathy 6 phases of loading

1. reduce pain 2. improve strength 3. build functional strength 4. increase power 5. develop stretch-shortening cycle 6. sport specific

procedure of goniometry to the patient

-Introduce self and explain purpose -Explain and demonstrate goniometer -Explain and demonstrate anatomical landmarks -Explain and demonstrate testing position -Explain and demonstrate examiner's and patient's roles -Confirm subject's understanding

what pace will axonotmesis will regenerate at

1-3 mm/day

definition of a goniometer

A measuring instrument used to determine the amount of available ROM at a joint

function and benefits for the structure of the foot arches

An efficient system of stability for the body (static & dynamic) Provides flexibility to adapt to uneven terrain Protection of the underlying blood vessels and nerves

cartilage (tear) healing times

Articular cartilage: 9-24 months Meniscus/ labrum: 3-12 months

ischemic compression - pressure given

Before application, the patient should be informed that some discomfort may occur (≤5/10) Pressure is applied slowly and progressively over the trigger point as the tension in the trigger point and its taut band subsides Pressure is maintained until maximum tenderness or tension is reduced This often occurs within 10-30 sec, but may take up to 60 seconds This is followed by stretching of the tissue using ACSM parameters

what is CRF and what does it depend on

CRF is related to the ability to perform large muscle, dynamic, moderate-to-vigorous intensity exercise for prolonged periods Performance of exercise at this level of physical exertion depends on the integrated physiologic and functional state of the respiratory, cardiovascular, & musculoskeletal systems

physiology behind tissue healing for cartilage

Cartilage is avascular, meaning that it has no blood supply. The lack of blood circulation in cartilage means that it is a very slow-healing type of tissue. Nutrition to cartilage is maintained by fluid in the joints, which lubricates the tissue. The lubrication process occurs by a sort of flushing mechanism, when load is applied and then removed from the tissue repeatedly. Activities such as stationary cycling and walking that involve repeated smooth joint movement can promote this lubrication process without creating too much stress on injured cartilage tissue.

elastic range for stress strain curve

Collagen fibers elongate 2-5% of its total possible elongation ¤The tissue's full normal ROM is in the elastic range ¤If the force is released in this range, the tissue will return to its pre-stretch length

hip joint - what type of joint

Diarthrosis, spheroidal, ball-and-socket joint

static stretching

Involves slowly stretching a muscle/tendon group and holding the position for a period of time (10-30 seconds, 2-4 times/day, to total 60 seconds)

external healing factors for tissue healing

Movement (loading) Electro-Physical Agents

muscle length definition

Muscle length can affect the amount of ROM of a joint It is the maximal distance between the proximal and the distal attachments of a muscle to bone The greatest extensibility of a muscle-tendon unit

hip asymmetry

Not only will different people might need to squat differently, different legs might even need to squat differently

effleurage - long gliding strokes; how to perform it

Performed by continuously gliding the hand over the skin's surface, including on the return stroke - Slow, even and firm strokes, but not heavy Can be an introductory technique, a transition stroke, and/or a finishing stroke - Can help spread lotion When working on the extremities, the direction of the stroke moves from distal to proximal (toward the heart)

wringing method - petrissage

Performed by lifting and pushing tissue in opposite directions while gliding across tissue The technique is often preceded and followed by effleurage for relaxation

hold-relax-contract technique

Place a muscle in a stretch position and hold x 3-6 sec Then isometrically contract the stretched muscle (against resistance) and hold for 3-6 seconds Autogenic Inhibition: A prolonged stretch stimulates the GTOs (tension) to promote relaxation Then isotonically contract the muscle opposite to the stretched muscle to stretch deeper into the ROM holding for 3-6 seconds Reciprocal Inhibition: Contraction of an agonist muscle results in relaxation of the antagonist muscle Repeated 2-4 times

benefits of stretching after the warm-up

Recommended for adults exercising for overall physical fitness and for athletes performing activities in which flexibility is important

4 - speed - running velocity

Slow speeds increase the cumulative load at the knee for a given distance relative to faster running

stress strain curve

Stress is a force that changes the form or shape of a body Strain is the amount of deformation that occurs to a body when a stress is applied

pre-competition sports massage

Sympathetic Nervous System (SNS) - Tapotement - Vibration - Friction

creep - what is it the result of

The elongation of tissue when a low-level load, is applied over an extended time to cause plastic deformation Creep is time dependent, so a load that is applied for a longer time is more effective in causing a change in length than a load that is applied and released quickly* Creep occurs as a result of water and proteoglycan displacement and the re-alignment of collagen fibres

painful and limited in all directions of inert tissue lesion

The entire joint is affected (capsular pattern) Indicating arthritis or capsulitis

tendinitis definition

The global term used to identify a tendon with true inflammation (or signs and symptoms inflammation)

principle of periodization

The gradual cycling of specificity, intensity, and volume of training in order to achieve peak levels of fitness for a competition

force-velocity curve

The inverse relationship between force and velocity, meaning that an increase in force would cause a decrease in velocity and vice versa.

squat biomechanics - what tightness indicates and how to fix it

This tells us the visible 'tightness' was not a true 'shortening', but rather due to muscular tone This tension is often protective, or creating stability when adjacent joints are lacking stability i.e. hip tightness could be a result of lumbar instability Therefore, we can actually fix this 'tightness' through strengthening, not stretching! We can use isometric contractions to improve ROM for all joints... And is often advisable before performing joint mobilizations

plastic range for stress strain curve - what happens at a smaller level

Tissue loaded into this range undergoes permanent elongation in the direction of the stress (aka stretching) This is the result of failure of a few of the collagen fibers to withstand the stress, creating a disruption of some cross-links The ultimate tensile stress is the maximum stress that a material can withstand

principle of progressive overload

To gain strength or endurance, muscles must be loaded beyond the point to which they are normally loaded

6 - slope - uphill vs downhill running

Uphill running causes a progressive adoption of mid- to forefoot striking, increasing the contact time, decreasing the swing phase (aerial time), increasing the step rate, and increasing the internal mechanical work Downhill running causes a progressive adoption of rearfoot striking, increasing the ground reaction forces, while maintaining (or decreasing) the contact time, increasing the swing phase (aerial time), decreasing the step rate, and decreasing the internal mechanical work of the body

how to use the concave on convex rule for knee extension in prone and supine

When a concave surface moves on a convex surface, gliding occurs in the same direction as the roll (angular movement) E.g. manual therapy for knee extension in prone When a convex surface moves on a concave surface, gliding occurs in the opposite direction as the roll (angular movement) E.g. manual therapy for knee extension in supine

observations during resisted mov't

Whether the contraction causes pain and, if it does, the pain's intensity and quality - contractile injury Strength of contraction (MMT) - Weakness or fatigue Type of contraction causing problem* - E.g. concentric, isometric, eccentric

re-assess squat - standing; hip shift, joint or muscular issue

Which way did they shift? - A right shift is evidence of increased right hip adduction and increased left hip abduction (possible left FAI?) Joint issue or muscular issue? - Possible tight right adductors and internal rotators (TFL) or possible tight left abductors and external rotators

what is false regarding the passive and active insufficnecy

after completing a length test of a muscle, you will compare the ROM measured against the active ROM of the jt

factors which affects BMI

age, sex, ethnicity, and muscle mass

talocrural biomechanics

ankle into PF, talus moves anteriorly so posterior part of talus within mortise joint - can contribute to instability of ankle in PF and reason ankle sprains more comon most stable close packedis talus in DF when anterior is wedged into mortise joint

what accessory motion are used for ext

anterior glide

what accessory motion are used for ext rotation

anterior glide but if 90* flexed: superior glide

the accessory motion of CKC knee flexion

anterior glide of femur

when should ACL rehab start

before surgery

shortfall of BMI in terms of distinguishing

between excess fat, muscle, or bone mass

what has the research said about physiotherapy provided pre-operatively to an ACL tear

effective in increasing strength and balance which may limit the number the episodes of instability and decrease the incidence of re-injury in the ACL deficient knee

when should you exhale/inhale during strength training

exhale during concentric phase and inhalation during eccentric phase

these statements are correct related to resistance training

faster you perform less force a muscle can produce, when training do not want to reach muscle failure, multi-jt exercises should be performed prior to single jt in a single training bout, machines are safer than free weights

capsular pattern, what movements are larger ROM

flexion > abd'n > medial rot'n

what physiological motions are the sagittal/med-lat plane/axis of motion

flexion and extension

pes cavus (high arch)

foot has abnormally high medial long arch and heel varus deformity excessive amount of weight placed on ball and heel when walking/standing, local pain or ankle instability related to genetic make up or a neurological disorder

CSEP guidelines 2011 - children 5-11 years

for health benefits, children aged 5-11 years should accumulate at least 60 minutes of mod-vig intensity PA. this should include: - vig intensity activities at least 3 days per week - activities that strengthen muscle and bone at least 3 days per week more daily physical activity provides greater health benefits

closed packed position of the knee

full extension and lateral rotation

close-packed position of the hip

full extension, full medial rotation, slight abduction

squat assessment - standing

functional (active) assessment Assess your active standing squat in the sagittal plane and determine hip flexion ROM & end-feel Find the sagittal/coronal plane for your active standing squat that is the most comfortable, which might also allow the greatest amount of hip flexion ROM Partners: watch for mechanical "faults" à E.g. Knee Valgus collapse/ Hip internal rotation

re-assess squat - standing

functional active assessment Everyone: re-perform your squat in standing Find the sagittal/coronal plane for your active standing squat that is the most comfortable (for each hip), which might also allow the greatest amount of hip flexion ROM You may have to externally rotate one foot more than the other to feel more comfortable

what a fair - (3-) grade looks like

gradual release from the test position in gravity

what does it mean if a person is stuck in the healing phases of inflammation for greater than 4-12 weeks

have sub-acute or chronic inflammation

triple ext pattern during propulsion

hip ext, knee ext, ankle PF

triple flexion pattern during swing phase

hip flx, knee flx, ankle DF

why was the ACSM preparticipation screening algorithm made

identify participants at risk for cardiovascular complications during or following aerobic exercise increased risk for sudden cardiac death and acute myocardial infarction in adults with underlying cardiovascular disease who perform unaccustomed vigorous aerobic exercise NOT APPLICABLE TO RESISTANCE TRAINING

principle of reversibility

if you stop training, state of fitness will drop to a level that meets only demands of daily use.

what is important for the unaffected leg during ACL post-rehab

important to maintain the highest level of strength and function possible in the unaffected leg as it will be used for comparison in the later stages of rehabilitation

benefits of PA for brain health for children 6-13 years

improved cognition (performance on academic achievement tests, executive function, processing speed, memory) reduced risk of depression, reduced depressed mood

how exercise benefits people with MS

improved physical function, including walking speed and endurance & improved cognition

why was the PAR-Q+ revised, what can it be used for

includes several additional follow-up questions to better guide preparticipation recommendation The PAR-Q was revised to reduce barriers for exercise and false positive screenings The PAR-Q+ may be used as a self-guided exercise preparticipation health screening tool OR as a supplemental tool for health professionals that may want additional screening resources beyond the algorithm

sarcoplasmic hypertrophy

increased glycogen storage in muscle

myofibrillar hypertrophy

increased myofibril size (myosin > actin)

CSEP guidelines 2011 for children 0-4 years old

infants (aged less than 1 years) should be physically active several times daily - particularly through interactive floor-based play toddlers (aged 1-2 years) and preschoolers (aged 3-4 years) should be accumulate at least 180 minutes of PA at any intensity spread throughout the day, including: - a variety of activities in different environments - activities that develop movement skills - progression toward at least 60 minutes of energetic play by 5 years of age more daily physical activity provides greater benefits

the accessory motion of patellofemoral flexion

inferior glide

what physiological motions are the transverse/vertical of motion

internal and external rotation

what type of reliability is higher

intratester reliability > intertester reliability

subtalar: inv & ev

lateral glide of posterior calcaneus medial glide of posterior calcaneus

maximal volume of oxygen uptake

maximum rate of oxygen consumption by your body through conversion into energy by oxidative phosphorylation and the Kreb's cycle implies an individual's true physiologic limit has been reached, with a plateau observed between the final two work rates of a progressive exercise test

what a poor + (2) looks like with gravity

mean the ability to move through a partial arc against gravity

amount of americans who met the 2018 physical activity guidelines

men below 30% (about 25%), women below 20 (about 17%)

what is key for managing tendinopathy

modification of load - tendons can withstand normal loading, not making it too freq or excessive manipulate the nature, speed, magnitude of the forces or load applied. can achieve goals of management without causing bad pathological changes

squat assessment - quadruped

motor control assessment Assess quadruped sagittal plane hip flexion and determine ROM & end-feel Find the sagittal/coronal plane for hip flexion that is the most comfortable, which might also allow the greatest amount of hip flexion ROM Ensure neutral spine!

what a good (4) grade looks like

muscle can hold the test position against mod. pressure

what a 2 (poor) grade looks like

muscle is capable of completing the ROM in the horizontal plane

muscular endurance

muscle's ability to continue to perform successive exertions or reps against a submaximal load Tests allowing >12 reps of a task prior to reaching muscular fatigue are considered endurance measures

muscular strength

muscle's ability to exert a maximal force on one occasion Traditionally, tests of 3 or less reps (e.g. 1-RM) to reach muscular fatigue have been considered strength measures However, performance of 4, 6, 8, or 10 reps of a given resistance can also be used to measure strength

muscular power

muscle's ability to exert force per unit of time (rate)

painful and limited or excessive mov't in some directions, but not others

non-capsular pattern - ex. ligament sprain

principle of individuality

not created with same capacity to adapt to exercise training

where are the deficits after an ACL injury

occur in strength, proprioception, coordination, and gait patterns In fact, strength and proprioceptive alterations occur in both the injured and uninjured limb

check out US physical activity guidelines graph

okay

squat assessment - supine

passive assessment Assess supine sagittal plane passive hip flexion and determine ROM & end-feel Find the sagittal/coronal plane for passive hip flexion that is the most comfortable, which might also allow the greatest amount of hip flexion ROM

if someone had weakness in a jt, what would not be a cause of apparent muscle weakness during MMT

passive insufficiency, NOT ACTIVE

some examples of research where sisometric muscle contractions has helped people

patellar tendinopathy women with fibromyalgia patients with LBP

subtalar neutral - position, assessed how

position where talus is easily palpable from medial and lateral aspect point of optimal alignment of subtalar jt assessed in WB and NWB

what accessory motion are used for int rotation

posterior glide but if 90* flexed: inferior glide

what accessory motion are used for flexion

posterior glide and inferiorly

talocrural: DF & PF

posterior glide anterior glide

the accessory motion of CKC knee extension

posterior glide of femur

the accessory motion of IR OKC of the knee

posterior glide of med tibia, anterior glide of lateral tibia

the accessory motion of OKC knee flexion

posterior glide of tibia

why stretching is important to include in all exercise training program & what the goal of flexibility program is

programs in order to improve range of motion and physical function The goal of a flexibility program is to develop ROM in the major muscle/tendon groups in accordance with individualized goals

foot biomechanics - pronation immediately after heel strike

provides flexibility for shock absorption

what is not a criteria for stopping a submaximal exercise test

rating of 17/20 on borg rating of perceived exertion (RPE)

what are the health benefits of enhancing muscular strength

significantly lower risk of mortality, fewer cardiovascular disease events, lower risk of developing physical function limitations, and lower risk of developing nonfatal diseases Improvements in body composition, blood glucose levels, insulin sensitivity, and blood pressure have also been found improve depression and anxiety, increase vigor, and reduce fatigue increases bone mass & bone strength & helps to reverse loss of bone mass in those with osteoporosis

tibiofemoral - anterior or posterior glide. patient position, clinician position, method & biomechanics

sitting with knee bent to 90*, alternative position: hook/crook lying. in front of patient with two handed hold on lower leg at tibial plateau. apply a P-A or an A-P force through tibia. concave tibia glides anteriorly on the convex femur during knee ext and posteriorly during flex

tibiofemoral joint distraction, patient position, clinican position, method, biomechanics

sitting with knee bent to 90*, in front of patient with two handed hold on lower leg at tibial plateau alt. grasp of tibia. apply a distraction force, joint distraction can increase jt mobility in all directions & can incorporate with MWM for flx and ext

failure point in stress-strain curve

when a tissue or object can no longer withstand a stress and breaks (tissue rupture) This can occur in a sudden movement, or it can occur over time with an accumulation of stress

before participating in regular exercise, look at ACSM preparticipation screening algorithm, what is something to look at

someone with heart condition who has been performing daily aerobic exercise for the past 6 months at mod intensity without incident, must get medical clearance in order to progress to vigorous intensity

2018 US physical activity guidelines

steep early slope: no lower threshold for benefit no obvious best amount about 70% of benefit reach by 8.25 MET - hours per week 150 - 300 minutes of moderate physical activity - no evidence of increased risk at high end MET: The ratio of the work metabolic rate to the resting metabolic rate. One MET is defined as 1 kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly.

the accessory motion of patellofemoral extension

superior glide

the accessory motion of patellofemoral flexion

superior glide

what accessory motion are used for add

superior glide

metatarsalphalangeal jt - type of jt, deg of freedom, end-feel, capsular pattern, close and loose packed position

synovial bicondylar jt 2 deg of freedom: - flx/ext - abd/add end feel: firm capsular pattern: great toe: ext>flx 2-5 toes: variable close: full ext loose: 10* of ext

subtalar joint - what type and movement, end-feel, capsular pattern, close-packed, loose-packed

synovial ellipsoid 1 deg of freedom add/abd - sup/pro end feel: inv: firm, ev: firm/hard capsular pattern: inv > ev close: supination (push-off) lose: pronation (shock absorption)

talocrural joint - what type and movement, end-feel, capsular pattern, close-packed, loose-packed

synovial hinge joint 1 deg of freedom DF/PF DF: firm PF: firm/hard DF > PF close: full DF (end phase of toe off) loose: 10* of PF, midway between inv and ev

interphalangeal jt - type of jt, deg of freedom, end-feel, capsular pattern, close and loose packed position

synovial hinge jt 1 deg of free: flx, ext end feel: flx: soft/firm ext: firm capsular pattern: flx>ext close: full ext loose: slight flx

all of these are criteria are grounds for stopping a submaximal exercise test

systolic BP drops >10, HR stops increasing despite intensity increasing, SOB, diastolic blood pressure rises >115mmHg

pronation - subtalar loose packed - triplanar rotational motion is the combo of the following

talocrural DF subtalar ABD subtalar EV

supination - subtalar loose packed - triplanar rotational motion is the combo of the following

talocrural PF subtalar ADD subtalar INV

necking in a stress-strain curve

tensile deformation due to large amounts of strain in a small region

what are some measurement of CRF examples that can be used

the 1.5 mile, cooper 12-min test, 6 min walk test, astrand-rhthyming cycle ergometer test, Queens college step test

the dysfunctional pattern during the squat is called

the butt wink

this statement is incorrect related to resistance training

the only difference between open kinetic and closed kinetic chain exercises is whether the distal segment moves freely or is fixed

chronic inflammation definition

the simultaneous progression of active inflammation, tissue destruction, and healing that persists beyond the usual expected length of time for tissue healing (>3-6 months)

during which trimester may pregnant women want to avoid supine position due to light-headedness

third trimester

closed kinetic chain - associated motions with supination

tibia laterally rotates knee ext hip ext hip laterally rotates

closed kinetic chain - associated motions with pronation

tibia medially rotates knee flexes hip flexes hip medially rotates Pronate - arch collapses and tibia will medially rotate. Lateral rotation locks it up. Valgus collapse (more stress on ACL and other structures). Can tell who will get ACL tear by making people jump off box and see how they land - if theyre valgus more likely to ACL

principle of specificity

training adaptations are highly specific to the type of activity and to the volume & intensity of the exercise performed

combined loading options, sets, reps; load, freq, details

various body weight initially, increased in phases based on patient status daily for 12 weeks for 6 months comprehensive programme including eccentric, concentric, balance, plyometric exs and return to sport

what should you do when performing MMT

vary amount of pressure depending on patient, ensure test movement is gravity resisted, apply pressure directly opposite to line of pull of muscle, stabilize the part proximal to limb being tested

classical swedish massage technique

vibration

the main goals of a "pre-habilitative" program prior to surgery include

- Attain full range of motion equal to the opposite knee - Minimize joint swelling - Ensure adequate neuromuscular control - Ensure adequate strength - Instill a positive state of mind - All of these factors facilitate optimal post-operative recovery

what are the three factors that help with grading of MMT

- Evidence of contraction - Gravity as a resistance - Amount of manual resistance

general recommendations for older adults in the ACSM guidelines

- Progressively difficult postures that gradually reduce the base of support (e.g. tandem stand à one-legged stand); - Dynamic movements that perturb the center of gravity (e.g. tandem walk, circle turns); - Stressing postural muscle groups (e.g. heel, toe stands); - Reducing sensory input (e.g. standing with eyes closed); and Tai chi

recording ROM & the 0-180 notation system

- The anatomical position is noted as '0' ¤Normally, a ROM begins at 0 degree and proceeds in an arc toward 180 degrees - A body position in which the extremity joints are halfway between medial (internal) and lateral (external) rotation is the neutral '0' position E.g. forearm pronation/supination

health benefits for children and adolescents for regular PA

- improved bone health (ages 3-17) - improved weight status (3-17) - improved CV and muscular fitness (6-17) - improved cardiometabolic health (6-17) - improved cognition (6-13) - reduced risk of depression (6-13)

relative contraindications to exercise for pregnancy

- recurrent pregnancy loss - gestational hypertension - a history of spontaneous preterm birth - mild/moderate CV or respiratory disease - symptomatic anemia - malnutrition - eating disorder - twin pregnancy after the 28th week - other significant medical conditions

contraindications for pregnant women to exercise

- ruptured membranes - premature labour - unexplained persistent vaginal bleeding - placenta previa after 28 weeks gestation - preeclampsia - incompetent cervix - intrauterine growth restriction - high order multiple pregnancy - uncontrolled type 1 diabetes - uncontrolled hypertension - uncontrolled thyroid disease - other serious CV, respiratory or systemic disorder

what the consistency of ground substance is like (comparison)

-Sometimes it can be clear and watery -Other times it can be hard and crusty - -(The only difference is the amount of water content)

what contractile lesion would be strong and painful

1st or 2nd degree strain or tendinitis

examples of recording ROM

0-140 degrees 20-140 degrees (hypomobile) 20-0-140 (hypermobile) Placing the '0' between the starting and end values indicates that the '0' occurs within these two ranges (i.e. that the ROM passes through the neutral position)

if you move through complete ROM in horizontal plane, what grade is it

2

how often should neuromotor training is effective in reducing and preventing falls

2-3 days/week

7 S of treadmill running anaylsis

1) Strike - Strike pattern 2) Sound - Sound at contact 3) Step Rate - aka cadence 4) Speed - Running velocity 5) Swing - Arm & leg swing 6) Slope - Angle of incline or decline 7) Shoes - Effect of footwear

8 phrases to recite to injured runners 1 & 2

1. ALL FOOT STRIKE PATTERNS WORK UNTIL THEY DON'T - All foot strikes are viable options when it comes to running, yet possess unique characteristics. One strike pattern is not necessarily superior to others in most cases. 2. NOTHING GOOD IS HAPPENING THE LONGER YOUR FOOT IS IN CONTACT WITH THE GROUND - The longer your foot is in contact with the ground, the more range of motion and control you need. - Unfortunately, most recreational runners are lacking in both of these. So get those feet turning over a bit faster.

rehab (treatment) design timeline

1. Tissue Healing & Pain/Swelling Reduction 2. Mobility & General Fitness 3. Stability & Load Progression 4. Sport/Work Specific Tasks Each of these rehabilitation goals must be restored to at least pre-injury levels to safely resume normal activities (including sports)

what are the long-standing optimal health values for percentage of body fat

10-22% body fat for males 20-32% body fat for females

custom made foot orthoses for treatment of foot pain

11 RCTs or CCTs involving 1332 participants were included: 5 trials evaluated foot pain with plantar fasciitis (n=691) 3 trials evaluated foot pain with RA (n=231) 1 trial evaluated foot pain with pes cavus (n=154) 1 trial evaluated foot pain with hallux valgus (n=209) 1 trial evaluated foot pain with JIA (n=47) Currently, the evidence says custom‐made foot orthoses were effective for painful pes cavus, rearfoot pain in rheumatoid arthritis, foot pain in JIA, and painful hallux valgus; It is unclear if custom‐made foot orthoses were effective formetatarsophalangeal joint pain in RA, or plantar fasciitis

what the foot is composed of

14 phalanges 5 metatarsals 5 tarsals Calcaneus and talus

epithelial tissue injury healing timeline

2-8 weeks Typically by day 21 there is wound closure, however wound strength is only ~20% By ~6 weeks, it has about 80% of its long-term strength

when you hold test position against gravity with no added pressure, what is the grade

3

sets, reps, load, freq and details for eccentric loading for tendinopathy

3, 15 body weight initially, increased as pain allows twice daily for 12 weeks "heel drops", with straight or slightly flexed knee

8 phrases to recite to injured runners - 3, 4, 5

3. FIVE WILL GIVE YOU 20 - Heiderscheit and colleagues demonstrated that a 5% increase in step rate, relative to one's preferred cadence, led to a 20% reduction in energy absorption at the knee 4. YOU MUST BE ABLE TO WALK BEFORE YOU RUN - If you are not able to tolerate walking, then chances are you are asking for trouble to attempt running. - If you are rebounding from an injury, make sure that you are first able to tolerate walking, unless you want to prolong your recovery. 5. IF YOU CAN SKIP, YOU CAN RUN - The demands of skipping are very similar to running. Skipping is also a plyometric activity that demands rhythm, timing, and reciprocity.

loose-packed position of the hip

30° of flexion, 30° of abduction, slight lateral rotation

what percentage of kids between 2-19 are overweight

31.8% of US children

heavy slow resistance, sets, reps; load, freq, details

4, 15-6 progressed at specific time points over 12 weeks pain allowing 3 times per week for 12 weeks bilateral squat, leg press and hack squat with gradual progression in load, includes eccentric and concentric for 6 seconds per rep

percentage of US high school studnets who met the aerobic PA and muscle strenghening guidlines from 2011- 2015

42% of children 6-11 yr and 8% of adolescents aged 12-19 yr meet the recommended guidelines according to the ACSM

what percentage of adults over 20 are obese

42.4% of adults

bone (fracture) time for healing

6-12 + weeks

8 phrases to recite to injured runners - 6, 7, 8

6. IF THERE'S ONE THING YOU SHOULD DO, IT'S STRENGTH TRAIN - At this point, the research has clearly demonstrated the benefits of strength training when it comes to safeguarding against overuse injuries. Strength training serves to build a runner's capacity while eliciting neuromuscular adaptations and improved economy. 7. "RECOVERY RUNS," ARE ONLY FOR ELITE RUNNERS - How can a plyometric activity be used as a means to foster recovery? For most recreational runners, a recovery run is what I call a walk. 8. WHEN IN DOUBT TAKE A REST DAY - Anytime a world class runner or endurance athlete is interviewed at the end of their career, and asked "What would you do differently if you could go back in time?" the response is invariably, "I would've rested more."

what percentage of adults over 20 are overweight

71.6% of adults

what percentage of adults over 20 are severely obese

9.2% of adults

amount considered to indicate a positive navicular drop test

>10 mm

examination of myofascial trigger points - compression test and local twitch response

A compression test over the muscle can detect taut bands, nodules, and local and referred pain A local twitch response confirms the presence of a trigger point Apply a snapping palpation (perpendicular strum) over the taut band A positive response is the taut band twitches

myofascial trigger points definition

A focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception Trigger point referral patterns do not follow neurological referral patterns, which is an important distinction

gravity being used for MMT

A form of resistance that is basic to MMT, however it is only used in ~60% of extremity muscles It is not required in tests for the following groups: -Finger/toe muscles or supination/pronation -Facial muscles or pelvic floor muscles

foam rollers

A form of self-MFR used to promote flexibility

soft tissue mobilization definition

A manual therapy technique used to relax tense muscles, reduce scar tissue, and stretch or lengthen your fascia

tendinosis definition

A non-inflammatory condition that involves microscopic tears of the tendon caused by repeated trauma/strain

resisted isometric movements - what is being tested and what is relaxed

A strong, static, voluntary muscle contraction Used to determine the amount of strength of tissue Used to determine whether contractile tissue is at fault, although the nerve supplying the muscle is also tested Ligamentous structures should be relaxed Some compression and shear may occur to the joint, but generally minimal stress is applied to the inert tissue Performed in the resting position (mid-range) and held x 5 seconds

tendinopathy definition

A tendon that demonstrates signs and symptoms of pain, swelling, and reduced function related to overuse

MFR - active release techniques

ART is a patented, soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerve

pain-free and limited mov't of inert tissue lesion

Abnormal end-feel, typically Hard (Bone-to-Bone) Indicates a symptomless osteoarthritis

MMT contraindications

Active inflammatory process (e.g. RA flare) or active infection in the area Pain that may be exacerbated by testing* or when MMT may cause further damage Patients who recently underwent abdominal or hernia surgery Inability to follow instructions

active vs passive static stretching

Active static stretching involves holding the stretched position using the strength of the agonist muscle Passive static stretching involves assuming a position while holding a limb or other part of the body with or without the assistance of a partner or device

why the medial long arch is important

Acts as a support base that provides the necessary stability for upright posture with minimal muscle effort Provides flexibility to adapt to uneven terrain

pain/injury timeline - phases and duration

Acute (Weeks 0-4) Sub-Acute (Weeks 4-12) Chronic (Weeks 12+) this is the symptom duration

connective tissue injuries (tendon itis/osis/rupture) and timeline for healing

Acute: 2-4 weeks* Sub-acute: 4-12 weeks* Chronic: 12+ weeks (-osis)* Surgical repair (e.g. biceps): 4-12+ months tendons have a more limited blood supply than muscles, makes them slower healing structures in comparison to muscle

2018 physical activity guidelines for adults with chronic health conditions and adults with disabilities

Adults with chronic conditions or disabilities, who are able, should do at least 150 minutes of moderate- to vigorous -intensity aerobic physical activity per week. Preferably, aerobic activity should be spread throughout the week. Adults with chronic conditions or disabilities, who are able, should also do muscle-strengthening activities that involve all major muscle groups on 2 or more days a week. When adults with chronic conditions or disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity.

systemic healing factors for tissue healing

Age Disease (health) Medications Nutrition/ Hydration Sleep

intrinsic factors that influence the onset and propagation of tendinopathy

Age Sex Pathomechanics (structural abnormalities and muscle imbalances) Genetic or acquired systemic diseases (e.g. Marfan syndrome or Diabetes Type II)

why cool downs are important

Allows general recovery of HR and BP and removal of metabolic waste products from the muscles used during the more intense exercise conditioning phase

why warm ups are important

Allows the body to adjust to the changing physiologic, biomechanical, and bioenergetic demands placed on it during the conditioning or sports phase of the exercise session Warming up also improves ROM and may reduce the risk of injury

MFR - stripping technique - SNS

Applied to deeper fascia, by applying a slow, consistent, and deep pressure along the length of the taut band and is often uncomfortable The pressure increases progressively with each successive pass along the muscle, continuing at the rate of 1 cm per second As the effects of the technique become apparent, the taut band relaxes, and the area ceases to be tender and no longer refers pain

a brief history of massage

Archaeological evidence of massage can be found in the Egyptian Tomb of Akmanthor (aka "The Tomb of the Physician") - It dates back to 2330 BC and depicts two men having massage done on their feet and hands Sanskrit records (1500-500 BC) indicate that massage has had a long history of being practiced in India - Massage is referenced in the earliest Ayurvedic texts as holding an important medical function that can encourage the body's innate healing energy 722 BC - A compilation of medical texts forming the foundation of Traditional Chinese Medicine reference massage in 30 chapters - Shiatsu: Use of hands to deliver treatment - Ashiatsu: Use of feet to deliver treatment 460 BC - Hippocrates, the Greek father of modern medicine, widely advocated the use of massage, and wrote: - "The physician must be experienced in many things, but assuredly in rubbing" 44 BC - Julius Caesar, Roman Emperor, received daily massage to relieve his neuralgia and thought to prevent his epileptic attacks Classic Massage, aka "Swedish Massage" - Per Henrik Ling (1776 AD), a Swedish Physical Therapist, is often erroneously credited for having invented "Swedish Massage" - 1878 AD - Johan Georg Mezger, a Dutch practitioner, applied French terms to name the 5 basic massage techniques

5 - swing - arm & leg swing

Arm swing does not play a role on propulsion through horizontal velocity, however it provides lateral balance and assists in counterbalancing for the legs Looking for symmetry in the swing of both legs as well as both arms Asymmetry in the arms may be attempting to offset something regarding the lower extremity that needs further assessing

how PNF stretching facilitates autogenic inhibition

As tension applied to a tendon increases, the GTO is stimulated, which causes simultaneous inhibition of the muscle being tensed, assisting in muscle relaxation and elongation

physiology behind axonotmesis healing

Axonotmesis is a more severe nerve injury with disruption of the neuronal axon, but with maintenance of the epineurium. This type of nerve damage may cause paralysis of the motor, sensory, and autonomic. Mainly seen in crush injury. Axonotmesis involves the interruption of the axon and its covering of myelin but preservation of the connective tissueframework of the nerve (the encapsulating tissue, the epineurium and perineurium, are preserved). Because axonal continuity is lost, Wallerian degeneration occurs.

physiology behind bone healing

Bones heal best when loads are applied to them. Weight bearing activities through injured bones stimulates an increase in bone growth at injury sites and a subsequent increase in bone strength. This concept is why immobilizer boots are often used in ankle and foot fractures rather than plaster casts. Allowing patients to walk while protecting their healing bone allows the bony repair process to occur faster and more thoroughly than keeping weight entirely off of a fracture site. After a fracture, even if a patient is allowed to bear weight, the injured bone should be immobilized so that the healing process can occur. Allowing too much movement at a fracture site too early in the healing process can lead to delays in fracture repair.

borg's rating of perceived exertion

Borg's RPE is a way of measuring physical activity level or intensity As you exercise you can rate your PE by the word anchors *A high correlation existsbetween a person's PE ratingmultiplied by 10, and theiractual HR during physicalactivity

3 - step rate - cadence

Cadence tends to fall between 140-180 steps per minute for both distance runners and sprinters Research shows that a 5% increase in step rate, can lead to a 20% reduction in shock absorption at the knee and lower the stress on the Achilles However, increasing cadence >10% occurs at a greater metabolic cost

MMT precautions

Cardiovascular problems (Valsalva) Situations where fatigue or overwork might be detrimental to the patient's condition (e.g. MS) Osteoporosis (amount of resistance) Substitute or trick movements

what does fascia contain (in terms of cells)

Contains collagen, elastin, cellular components, and ground substance Ground substance (extrafibrillar matrix) consists of water and proteoglycans and lubricates fibers allowing smooth gliding - Injury to fascia causes a change in the biochemical structure of the ground substance, and it changes it from the water-like substance which enhances movement, to a gel-like substance that restricts movement

skin rolling method - petrissage

Continuous contact using: Palm, thumb, fingers, knuckles Grasp the tissue and lift away from the underlying structures using your fingers and thumbs of both hands The thumbs apply constant pressure, while your fingers walk up the area mobilizing tissue into the thumb pressure The technique is often preceded and followed by effleurage for relaxation

petrissage - kneading and lifting - how to perform it

Continuous contact using: Palm, thumb, fingers, knuckles Kneading - Performed using compressive rhythmic circles - Slow, small, specific, and circular The technique is often preceded and followed by effleurage for relaxation Continuous contact using: Palm, thumb, fingers, knuckles - Lifting/Picking Up - Performed by intermittently grasping soft tissue with both hands and lifting away from underlying structures to create separation The technique is often preceded and followed by effleurage for relaxation

how much can cortical bone and ligaments elongate before failure

Cortical bone can undergo ~2% strain before failure; ~ Ligaments can elongate by ~20-25% of original length before failure

tendinopathy rehab - phase 1; reducing tensile and compressive loads on the tendon

Decrease the training load and stretch shortening cycles - E.g. runners can reduce tensile load by decreasing how their distance, speed, or frequency of their runs Decrease the time spent with compression on the tendon - E.g. the proximal hamstring tendon is compressed against the ischial tuberosity when the hip is flexed, such as during sitting When running uphill, the hamstring will both undergo physical compression due to the increased hip flexion range required, and it will undergo increased tensile load due to the resistance of the incline Identify and modify those internal and external factors that may be influencing the patient's tendinopathy

friction - firm, deep, circular movments - how to perform it, its intent and the neurophysiological response

Deep-pressure movement of superficial soft tissue against underlying structures using either the thumb or finger pads - The underlying structure may be ligaments, bone, tendon, muscle, or fascia The intent is to loosen small areas of scar tissue and adhesions of these underlying structures to improve the movement and gliding of these structures - Friction also helps to stimulate circulation of the local area Neurophysiological response likely the true reason for improved movement after hands-on therapy, causing a decrease in muscular tension/tone

ACSM preparticipation - what is the algorithm based on

Diagnosis of cardiovascular, metabolic, or renal disease; The presence of signs or symptoms of cardiovascular, metabolic, or renal disease; The individual's current level of physical activity (PA); and The desired intensity of the aerobic exercise program

what is the first step in the ACSM preparticipation screening algorithm

Does your client experience/have: - chest discomfort with exertion - unreasonable breathlessness - dizziness, fainting, blackouts - ankle swelling - unpleasant awareness of a forceful, rapid or irregular HR - burning or cramping sensations in lower legs when walking short distance - known heart murmur IF ANY MARKED, STOP AND SEEK MEDICAL CLEARANCE

tendinopathy rehab - phase 1; no streching

Don't stretch! Stretching often bends tissue over bone in order to produce a stretch, therefore causing tendon compression If muscle length is an issue you need to address, it is probably wiser to wait until after the reactive stage - Alternatively, you could use a foam roller or trigger ball on the muscle belly to help improve flexibility without causing tendon compression Massage may be a better option than stretching to manage muscle length and flexibility in compressive tendinopathy

why its important to achieve mobility early in the therapeutic healing process

During healing, there is a window of opportunity to influence and change scar tissue mobility Once that time frame has passed, the likelihood of successfully achieving full ROM is diminished considerably -- As scar tissue matures, it tightens and contracts, which can be detrimental due to possible ROM restrictions If efforts are not made early in the remodeling phase, when the newly formed scar tissue is most easily influenced, attempts to improve ROM will be very difficult Engaging in general fitness improves blood flow and decreases muscle loss

what the pes cavus looks like in walking

During the gait cycle, the foot remains locked in hindfoot inversion and forefoot varus throughout the stance phase, causing less stress dissipation. This can result in metatarsalgia, stress fracture of the fifth metatarsal, plantar fasciitis, medial longitudinal arch pain, and instability.

ischemic compression - frequency, what it is similar to

Each trigger point should only be treated once per treatment session, however there may be multiple trigger points within a single muscle May be performed 2-4x/day, daily, or at least 2-3 days/wk *Reported to be the best and most effective method at decreasing trigger point pain levels Similar to "Acupressure", which is pressure on TCM acupuncture points

tendinopathy rehab - phase 3; eccentric training

Eccentric Training It's generally accepted that eccentric training is a useful part of managing degenerative tendinopathy

what is great about eccentric contractions

Eccentric contractions can generate 20-50% more force within the muscle (due to the elastic properties and less energy required) shown to be more effective in promoting increases in muscle mass & girth

5 styles of stroke for classic massage

Effleurage - long gliding strokes Petrissage - kneading and lifting Tapotement - rhythmic percussive tapping Vibration - rapidly shaking specific muscles Friction - firm, deep, circular movements

types of excessive or repetitive load applications which creates tendinopathy

Excessive increases in the progressive overload Excessive durations/distances Excessive increases in speed

extrinsic factors that influence the onset and propagation of tendinopathy

Excessive or repetitive load application Inappropriate equipment or footwear Training errors Occupations (factory)

what is wrong with exercising only 1-2 d/week (weekend warriors)

Exercise of only 1-2 d/wk (aka "Weekend Warrior") is not recommended for adults because the risk of MSK injury and adverse CV events, in spite of possible ex. benefits

classic massage application - informing, contact

Explain the procedure to the patient and instruct the patient to inform you if he or she feels pain with the massage Keep your hand in good contact with the patient and your fingers together, not spread apart Maintain a comfortable position during the treatment and use proper body mechanics

MMT procedure

Explanation and instruction -> informed consent Place the subject in a comfortable position that offers the best fixation of the body as a whole (lying or sitting) Ensure the test movement is in the gravity-resisted position Stabilize the part proximal (or adjacent) to the tested part to ensure no substitutions Have the patient perform the active screen test against gravity (e.g. shoulder flexion) - Helps determine if any contraindications or precautions are present - Palpate muscle to ensure muscle twitch and no trick movements If able to move through full ROM and hold the test position against gravity (at least a grade 3), manual resistance is then applied in the mid-range test position Use a long lever for manual resistance whenever possible, without unnecessarily crossing additional joints "Hold this position, don't let me move you" Apply pressure directly opposite the line of pull of the muscle or muscle segment being tested Apply pressure gradually, but not too slowly, starting with slight pressure and progressing to strong pressure Hold for 5 seconds If subject is unable to achieve full ROM and hold the test position -> Grade accordingly Place the subject in a comfortable position that offers the best fixation for body part to be tested in the gravity-eliminated position (horizontal plane) Stabilize the part proximal (or adjacent) to the tested part to ensure no substitutions Have the patient perform the active test Palpate muscle to ensure muscle twitch Determine amount of ROM Determine if able to resist any pressure

3 degrees of freedom

Flexion-Extension Abduction-Adduction Lateral Rotation-Medial Rotation

AROM of the hip - ranges

Flexion: 110-120° Extension: 10-15° Abduction: 30-50° Adduction: 30° Lateral Rotation: 40-60° Medial Rotation: 30-40°

end feel for the different ROM of the hips

Flexion: Firm/STA Extension: Firm Abduction: Firm/Hard Adduction: Firm/STA Lateral Rotation: Firm Medial Rotation: Firm

how people with chronic health conditions benefit from exercise

For people with various chronic medical conditions, reduced risk of all-cause and disease-specific mortality, improved physical function, and improved quality of life. Reduced risk of cancer at a greater number of sites. Brain health benefits, including possible improved cognitive function, reduced anxiety and depression risk, and improved sleep and quality of life.

femoral anteversion

Forward torsion of the femoral neck (NORMAL) Increased anteversion leads to squinting patellae & toeing-in These individuals exhibit excessive medial hip rotation, and decreased lateral rotation

how to modify exercise prescription in strengthening to encourage exercise adherence

Frequency - Allow for flexibility in the different combinations of frequency and/or time/duration to perform the Ex. Rx - Allowing individuals to self-select frequency and time, which may influence compliance Intensity - Research suggests that individuals new to exercise are more likely to adhere to lower intensity programs Type - An activity that the individual enjoys and has the means for (e.g. walking)

FITT principles for children and adolescents

Frequency (how often) - Aerobic Exercise ---Daily Muscle-strengthening Exercise - At least 3 times per week Bone-Strengthening Exercise - At least 3 times per week Most young individuals are healthy and able to start moderate intensity exercise training without medical screening (and then progress to more vigorous activities over time) Children and adolescents may safely participate in strength training activities provided they receive proper instruction and supervision. Generally, adult guidelines for resistance training may be applied. Aerobic Exercise - Moderate-to-vigorous intensity Muscle-strengthening Exercise - Moderate intensity (hypertrophy) Bone-strengthening Exercise - Moderate intensity (hypertrophy) Evidence suggests that prepubescent children who participate in resistance training can achieve relative strength gains, similar to those seen in adolescents However, because prepubescent children have immature skeletons, younger children should not participate in excessive amounts of vigorous intensity exercise. Children also have a lower anaerobic capacity as compared to adults, therefore limiting their ability to perform sustained vigorous intensity exercise. Aerobic Exercise - At least 60 minutes of moderate-to-vigorous intensity Muscle-strengthening Exercise - 2-3 minutes between sets; tempo = 2:1:2:1 Bone-strengthening Exercise - 2-3 minutes between sets; tempo = 2:1:2:1 Children and adolescents who are overweight or physically inactive may not be able to achieve the 60 min/day of moderate-to-vigorous intensity physical activity. These individuals should start out with moderate intensity physical activity as tolerated and gradually increase the frequency and time to achieve the 60 min/day goal. In addition to these physical activity guidelines, the National Heart, Lung, and Blood Institute and the American Academy of Pediatrics also recommend children limit total entertainment screen time to <2 hrs/day Excess screen time has been linked to increased adiposity; decreased fitness; and elevated blood pressure, blood lipids, and glycohemoglobin levels in youth aged 5-17 years old Perhaps most importantly, the PA and sedentary behaviour patterns in children track into adulthood, so it's vital that youth initiate and maintain a physically active lifestyle from any early age.

phase 6 - sport specific - further progress

Further progress your power training by reducing the repetitions, but increasing the speed of the muscle contraction to build power Further develop the tendon's response to the SSC by progressing to single-legged plyometrics Add training drills specific to the sport Return to competition when the patient is tolerant to full training program

different grades of muscle strains and healing timelines for each

Grade 1: 2-8 weeks Grade 2: 2-4 months Grade 3: 9-12 months Surgical repair (e.g. biceps): 4-12+ months

ligament sprain grades of injuries and timelines for healing

Grade 1: 2-8 weeks Grade 2: 2-6 months Grade 3: 6-12 months Surgical repair (e.g. ACL): 12+ months

step 3 of ACSM preparticipation screening algorithm

Has your client had or do they currently have: - a heart attack - heart surgery, cardiac catheterization, or coronary angioplasty - pacemaker/implantable cardiac defibrillator/rhythm disturbance - heart valve disease - heart failure - heart transplantation - congenital heart disease - diabetes - renal disease

step 2 of ACSM preparticipation screening algorithm

Has your client performed planned, structured physical activity for at least 30 minutes at moderate intensity on at least 3 days per week for at least the last 3 months?

ROM and flexibility exercises for weeks 0-2 rehab treatment

Heel slides (+/- slider board) Supine with legs up wall - heels slides with gravity assisted Bike pendulums: high seat ½ circles forward/backward Progress to full circles and lower seat Sitting passive leg extension with roll under heel OR prone leg hangs off end of bed/plinth Seated hamstring stretch (back straight) Seated calf stretch with towel - Knee bent (soleus) - Knee straight (gastrocs) Ankle pumping +/- with leg elevation

anthropometric methods for body composition

Height, Weight, and Body Mass Index Circumferences (waist, waist-to-hip ratio) Skinfold measurements

other methods for body composition analysis

Hydrodensitometry (underwater volume) Dual-energy X-ray Absorptiometry (DEXA) Total Body Electrical Conductivity (TOBEC) Bioelectrical Impedance Analysis (BIA)

instrument-assisted soft tissue mobilization - what its used for and the proposed mechanism

IASTM is applied using instruments that are usually made of stainless steel with beveled edges and contours that can conform to different body anatomical locations and allows for deeper penetration It is used for the detection and treatment of soft tissue disorders The proposed mechanism of IASTM is it can break down scar tissue and fascial restrictions creating localized microtrauma and inflammatory response, facilitating a cascade of soft tissue remodeling

Myofascial trigger points - proposed mechanism of trigger point creation

If an injured muscle fiber's sarcoplasmic reticulum is damaged, its calcium is released, thus stimulating the sarcomere, and producing a sustained contraction

2nd stage of tendinopathy - tendon dysrepair (tendinitis)

If the tendon continues to be excessively loaded and not given sufficient time for repair, then the tendinopathy progresses to this stage Dysrepair is similar to the reactive stage, but the tendon structure begins to exhibit collagen separation and disorganization of the tendon matrix due to breakdown (inflammatory response) Increased vascularity and neuronal ingrowth will begin to occur within the tendon However, tendon changes are still reversible at this stage

3rd stage of tendinopathy - degenerative tendinopathy (tendinosis)

If the tendon is exposed to chronic overloading, then the tendinopathy progresses to this stage There are multiple tendon structure changes making it less efficient at dealing with load Collagen becomes further disorganised and advanced matrix breakdown takes place Further increases in vascularity and neuronal ingrowth The tendon can appear thickened and nodular and there is risk of tendon rupture with advanced degeneration Improvement in symptoms may be made at this stage, however the degenerative changes are irreversible

proprioception and coordination for stability and load progression

Impairments in these categories increase the risk of re-injury - These can be improved by slowing down and focusing on proper movement technique - When the technique is performed well, they are ready for load progression

what happens during remodelling phase (day 9 forward) and rehab techniques

Improving function with less pain, and less swelling Type III collagen being replaced by type I collagen à scar tissue becoming more permanent (greater tensile strength) Modalities only if indicated ¤Move from full motion exercises to resistive exercises Incorporate proprioceptive/balance and coordination exercises Aggressiveness (load & speed) of exercises is increased as tissue strength improves Functional and activity-specific drills are incorporated at the end of rehabilitation

toe region of stress strain curve

In connective tissue, the collagen fibers have a wavy arrangement at rest, known as crimp, which becomes taut when loaded

alfredson protocol - achilles rehab

In the mid 1990's Dr. Alfredson had chronic Achilles tendon pain himself and asked his chief to book him in for surgery His chief refused because he thought it wasn't serious enough and the clinic couldn't afford to have him off on sick leave Frustrated, Dr. Alfredson decided to aggressively load his Achilles to the point of needing immediate surgical repair... However, the eccentric loading strategy didn't worsen his symptoms, but in fact completely resolved them - It is proposed that the 'eccentric' component helps rearranges the healing tendon collagen helping maturation

collagen degeneration vs synthesis - time periods

In the short term there will be a net loss of collagen production for around 24-36 hours post exercise - so allow adequate rest days between strength sessions. repeated training with rest periods that are too short can result in a net degradation of the matrix and can lead to overuse injury

squat assessment - mechanical "faults"

Increased lumbar extension Increased lumbar flexion (aka the "Butt wink") Knee Valgus collapse/ Hip internal rotation

tendinopathy rehab - phase 4; introduce speed training

Increasing speed with strength training will create improvements in power and prepare for activities involving the stretch shortening cycle (SSC)

how can progressive overload principle be performed

Increasing the amount of resistance lifted during training (the most common progression) Increasing the number of sets per muscle group or the number of training days per muscle group per week Increasing the number of repetitions can also be a form of progression, however this may alter their benefits of resistance training

what a fair (3) grade looks like

Indicates that a muscle can hold the limb in the test position against the resistance of gravity, but cannot hold the position if even slight pressure is added

which phases (and duration of each) are part of the inflammation timeline

Inflammation Phase (Days 1-6) Proliferation Phase (Days 3-20) Maturation Phase (Day 9-Month 24)

paratendinitis definition

Inflammation and thickening of the paratendon sheath of tendons that do not have synovial sheaths

tenosynovitis definition

Inflammation of the synovial sheath that surrounds a tendon (typically where large friction forces are produced: e.g. Achilles and Biceps Tendon)

dynamic stretching

Involves a gradual transition from one body position to another, and a progressive increase in reach and range of motion as the movement is repeated several times

proposed mechanism of trigger point creation - ischemia, ATP and neurological pathology

Ischemia occurs with this sustained contraction, so the muscle cells, deficient of oxygen, are unable to produce enough ATP to relax the contraction Without any ATP, the sarcomere's filaments cannot release and remain fixed in contraction Another theory suggests that there is a neurological pathology causing trigger points and their associated sensory, motor, and autonomic changes

tendinopathy rehab - phase 1; introduce isometric exercise

It can reduce pain and maintain muscle strength - isometric exercise at 25-50% MVC appears to be the optimal range to exert a generalized pain inhibitory response - loads should be performed for 45 seconds, 5 repetitions, and 2-3 times per day in order to reduce pain and maintain some muscle capacity and tendon load In highly irritable tendons, a bilateral exercise, shorter holding time, and/or fewer repetitions per day may be indicated This contraction should be done in a position where there is no tendon compression, usually in mid-range

2018 physical guidelines for american - children and adolescents

It is important to provide young people opportunities and encouragement to participate in physical activities that are enjoyable, offer variety, and appropriate for their age. Children and adolescents ages 6-17 years should do 60+ minutes of moderate-to-vigorous physical activity daily: - Aerobic: Most of the 60+ min per day should be moderate-to-vigorous aerobic physical activity at least 3 days a week. - Muscle-strengthening: As part of their 60+ min of daily physical activity, children and adolescents should include muscle-strengthening on at least 3 days a week. - Bone-strengthening: As part of their 60+ min, children and adolescents should include bone-strengthening physical activity at least 3 days a week.

friction part massage - warning patient, pressure and area

It is important to warn the patient that some discomfort may be felt, but that it will not be lasting A firm and consistent pressure and rhythm are applied in a perpendicular (or parallel) direction to the tissue's fiber arrangement A small area at a time is massaged until the discomfort of the massage subsides, or tissue mobility is increased Little or no massage medium (lubricant) is used

criterion-related validity

Justifies the validity of the measuring instrument by comparing measurements made with the instrument to a well-established gold standard of measurement The best gold standard is radiography

manual therapy definition

Loosely applied to any kind of passive movement of joints or soft tissues

sports massage - shaking/jostling - SNS

Large gross vibrations - Can be up-down or side-to-side Can be stimulating or sedative depending upon rate of application Good for reducing muscle guarding and hypertonicity

what is the order for strength training for muscle size & # of jts

Large muscle mass & multi-joint exercises should be trained first (greater release of anabolic hormones), followed by small muscle mass & single joint exercises (benefit from hormone exposure) Smaller muscles should not be fatigued prior to performing large compound movements

screw home mechanism definition

Lateral rotation of the tibia during full extension, causing increased joint congruency/stability

what happens during proliferation phase (days 3-20) and rehab tehcniques

Less muscle spasm, but may continue to have swelling, pain, loss of function Type III collagen forming, increasing the tensile strength Continue with modalities and exercises for non-involved segments Begin ROM to influence collagen arrangement: mild PROM, AAROM, and some AROM Mild isometrics may be possible

physiology behind ligament healing

Ligaments generally have a more limited blood supply than either muscle or tendon - lengthening their healing time.

fascia definition

Loose connective tissue that provides support and protection to the joint, and acts as an interconnection between tendons, aponeuroses, ligaments, capsules, nerves, and the intrinsic components of muscle

CRF is considered a health-related component of physical fitness bc:

Low levels of CRF has been associated with markedly increased risk of premature death from all causes; Increases in CRF are associated with a reduction in death from all causes, and specfically from CVD

contraindications of MFR

Malignancy Hypermobile joints Recent fractures Osteoporosis Hemorrhages or blood clots Current use of anticoagulant medications Open wounds or local infections Any lesions that may spread with direct contact Acute inflammation Connective-tissue disorders Fibromyalgia when flared up Rheumatoid arthritis when flared up

iceberg theory

Mechanical stress increases in some form (freq., intensity, load, or type), exceeding the tendon's ability to withstand those loads causing microtrauma and possible failure

three arches of the foot

Medial longitudinal arch Lateral longitudinal arch Transverse arch

what a trace (1) grade looks lik

Minor tension may be felt in a muscle when palpated or the tendon becomes slightly prominent; however, no movement of the limb is visible

causes of muscle weakness

Muscle strain Tendon pathology Avulsion Pain/reflex inhibition Peripheral nerve injury Nerve root lesion (myotome) Upper motor neuron lesion - Weakness can still be present even if the muscle has hypertonicity or spasticity Psychological overlay Active Insufficiency - The inability of a two-joint (or multi-joint) muscle to generate effective force when in a fully shortened position (Length-Tension Relationship)

myofascia definition, type of properties it makes up in muscle, how fascia helps muscle

Myofascia refers to the intimate relationship between the deep fascia and the muscle it surrounds These make up the contractile, and non-contractile properties of muscle à partly responsible for the increased strength during eccentric contractions Fascia helps provide structure and form to the muscle, lubrication between muscle fibers and muscles, and nutrition for the muscles

myofascial release - what it treats

Myofascial Release refers to the treatment of the deep fascia that surrounds the muscle However, myofascial techniques actually commonly treat the fascia associated with the skin, and other structures in the superficial layer that have limited mobility, not just the fascia surrounding muscles

myofascial trigger points - what they invove, when pain is amplified and how it is relieved

Myofasical trigger points involve a taut band of muscle tissue and its surrounding fascia, and can be palpated as a nodule Myofascial trigger point pain becomes amplified by muscle activity, which can come in the form of passive stretching, direct pressure, prolonged stationary positions, repeated or sustained muscle activity, and cold temperatures They are often relieved with short periods of rest, heat, sustained slow stretches, low level activity, and specific treatment techniques

do foot orthoses treat plantar fascisitis

NO! 135 participants with plantar fasciitis were recruited and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic) After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses However, there were no significant effects on primary outcomes at the 12-month review The findings suggest that foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects

do orthotic insoles prevent limb overuse syndrome

NO! 228 military males were randomly assigned to use or not to use orthotic insoles. The insoles were molded to the shape of the foot to provide support during physical activity. The main outcome measure in the present study was the number of physician-diagnosed lower limb overuse injuries 46.6% subjects in the insole group were diagnosed with a lower limb overuse injury compared with 38.1% in the control group during the 6-month study period The findings suggest that routine use of orthotic insoles does not prevent physical-stress-related lower limb injuries in healthy young male adults

do foot orthotics help lower limb soft tissue stressors (shin splints)

NO! 25 RCTs involving 30,252 participants were included The interventions tested in the included trials fell into four main preventive strategies: exercises, modification of training schedules, use of orthoses, and footwear & socks All 25 included trials were judged as 'unclear' or 'high' risk of bias for at least one of the four domains listed above Custom‐made biomechanical insoles may be more effective than no insoles for reducing shin splints (medial tibial stress syndrome) in military recruits (one trial, n=146) No evidence in military recruits that wearing running shoes based on foot shape, significantly reduced rate of running injuries (2 trials, n=5795)

NWB and WB assesment of subtalar neutral

NWB: patient in prone and therapist puts it in neutral by controlling foot at 4/5 MT and rocking b/w pro and sup to determine optimal alignment WB: patient elevates and lowers medial long arch while keeping toes and heel on floor to determine optimal alignment

nerve tissue injury timeline

Neurapraxia (myelin damage) - Hrs to mths Axonotmesis (crush injury) - 1-3 mm/day Neurotmesis (laceration injury) Varied - can sometimes be no full recovery

physiology behind neurapraxia

Neurapraxia is the least severe form of nerve injury, with complete recovery. In this case, the axon remains intact, but there is myelin damage causing an interruption in conduction of the impulse down the nerve fiber. Most commonly, this involves compression of the nerve or disruption to the blood supply (ischemia). There is a temporary loss of function which is reversible within hours to months of the injury (the average is 6-8 weeks). Wallerian degeneration does not occur, so recovery does not involve actual regeneration.

physiology behind neurotmesis healing

Neurotmesis is the most severe lesion with no potential of full recovery. It occurs on severe contusion, stretch, or laceration. The axon and encapsulating connective tissue lose their continuity. The last (extreme) degree of neurotmesis is transsection, but most neurotmetic injuries do not produce gross loss of continuity of the nerve but rather internal disruption of the architecture of the nerve sufficient to involve perineurium and endoneurium as well as axons and their covering. Denervation changes recorded by EMG are the same as those seen with axonotmetic injury. There is a complete loss of motor, sensory and autonomic function.

what a 0 grade MMT looks like

No evidence of any muscle contraction palpable or visible

what is the popliteus function in OKC and CKC for unlocking the screwhome mechanism in flexion

OKC - During the first 20-30° of knee flexion, the tibia medially rotates and unlocks the knee CKC - During the first 20-30° of knee flexion, the femur laterally rotates and unlocks the knee

locking in extension in screw home mechanism in both OKC and CKC

OKC - During the last 20-30° of knee extension, the tibia laterally rotates and locks the knee CKC - During the last 20-30° of knee extension, the femur medially rotates and locks the knee

who are special populations

Older Adults Pregnant and Postpartum Chronic Health Conditions - Multiple Sclerosis Adults with Disabilities Children and Adolescents - Exercise Prescription

the principle of hard/easy

One or two days of hard training, should be followed by one day of easy training, allowing the body and mind to fully recover before the next hard day of training

why you should stop submaximal exercise tests

Onset of angina or angina-like symptoms Shortness of breath, wheezing, leg cramps, or claudication Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin Failure of HR to increase with increased exercise intensity Noticeable change in heart rhythm (palpate or auscultate) Drop in systolic BP of >10 mm Hg Excessive rise in BP: systolic >250 or diastolic >115 mm Hg Subject requests to stop Physical or verbal manifestations of severe fatigue (RPE) If a client reaches 70% of the HRR or 85% of the HRmax Failure of the testing equipment

what PNF stretching consists of

PNF techniques take several forms, but typically involve an isometric contraction of the selected muscle/tendon group followed by a static stretching of the same group For PNF stretches, it is recommended that individuals of all ages hold a light-to-moderate contraction (20-75% of max voluntary contraction) for 3-6 seconds, followed by an assisted stretch for 10-30 seconds PNF stretching using "submaximal contractions [20-60%] are just as beneficial at improving hamstring flexibility as maximal contractions [100% of MVC], and may reduce the risk of injury associated with PNF stretching."

how pain can assist with tissue healing

Pain tends to improve faster than tissue remodeling Pain can be altered through touch (manual therapy), electro-physical agents (modalities), and education The tissue is at risk of re-injury until complete tissue remodeling has occurred When looking at tissue healing timelines it is important to educate the patient that this does not represent the duration of pain, just the duration of remodeling

post-competition sports massage

Parasympathetic Nervous System (PNS) - Effleurage - Petrissage

goals in weeks 0-2 of rehab treatment design/timeline

Patient education re: weight-bearing status; changes to rehab guidelines with any concurrent pathologies (i.e. PF pain, MCL injury, meniscal repair vs debridement, etc.) Decrease pain and swelling Maintain cardiovascular fitness Increase range of motion & restore full extension* Maintain flexibility of hamstrings, calves Quadriceps activation Proprioceptive/balance re-education *Remember - It is important to restore and maintain range of motion early, especially full extension. This is not detrimental to the graft or its stability, andmay prevent PF pain and compensatory gait pathologies

what needs to be recorded in the patient's chart for goniometry

Patient's name, age, and gender Examiner's name (same examiner increases reliability) Date and time of measurement (ROM changes over the day) Make and type of goniometer used (reliability) Side of the body, joint, and motion being measured ROM, including the number of degrees at the beginning and end of the motion Type of motion being measured (AROM, PROM) Any subjective information reported during testing; e.g. pain Any objective information obtained during testing E.g. protective muscle spasm, crepitus, end-feels Description of any deviations from the testing positions

classic massage application

Patient's skin and your hands should be clean Hands should be warm, nails trimmed, rings, watches, wrist jewelry should be removed A lubricant is used to reduce friction for effleurage - Less with petrissage to allow to grasp the tissue - No lubricant is needed for: Tapotement, vibrations, and friction, Rocking, shaking/jostling Before beginning, position the patient comfortably with the body segment to be massaged properly exposed If the massage is to reduce edema, elevate the part to let gravity enhance lymphatic flow

tapotement - rhythmic percussive tapping

Performed to stimulate the sympathetic nervous system

using vibration for classic massage - how its perfomed, type of movements & its indications

Performed with quick rhythmical shaking (tremor-like) by moving the palm, side of the hand, or fingertips causing vibrations - This is created by simultaneously contracting the flexors and extensors of the elbows or IRs and ERs of the shoulder May be fine or gross movement May be static or dynamic (running up the body/limb) Indicated for pulmonary conditions (& cupping)

why is completing a pre-exercise evaluation important (patient history)

Performing the pre-exercise evaluation with a careful review of prior medical history, helps identify potential contraindications and increases the safety of the health-related physical fitness assessment

contract-relax PNF technique

Place a muscle in a stretch position and hold x 3-6 sec Then isotonically contract the stretched muscle (against resistance) for 3-6 seconds Then relax and stretch into deeper ROM holding for 10-30 seconds Repeated 2-4 times

hold-relax technique for PNF stretching

Place a muscle in a stretch position and hold x 3-6 sec ¤Then isometrically contract the stretched muscle (against resistance) and hold for 3-6 seconds Then relax and stretch into deeper ROM holding for 10-30 seconds Repeated 2-4 times

two common impression methods for foot orthotics

Plaster Casts - Applied to the plantar foot in subtalar neutral while supine or prone - NWB - Very accurate Foam Boxes - Impression made into box while in subtalar neutral - WB - Moderately accurate

accuracy in MMT grading depends on

Precision of patient positioning (lying down or sitting) - The stability of the patient - The fixation of the part proximal to the limb being tested Examiner's application of pressure - Pressure should be provided as distal as possible without crossing additional joints - The amount of pressure varies with the age and size of the patient, the part being tested, and the leverage Examiner's instructions - Clear, precise, and consistent If one extremity is unaffected, the examiner may use this strength as an index for the patient's normal strength when testing the affected extremity

what is not a contraindication for pregnant women to exercise and how to fix this issue

Pregnant women who experience light-headedness, nausea, or feel unwell when they exercise flat on their back should modify their exercise to avoid the supine position

introduced guidance for preschool children - 2018 physical activity for preschool children

Preschool-aged children (ages 3 through 5 years) should be physically active throughout the day to enhance growth and development. Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types improved bone health and weight status for children ages 3-5 y.o.

benefits of exercise during pregnancy

Prevention of excessive gestational weight gain Prevention of gestational diabetes mellitus Decreased risk of preeclampsia (HBP complications) Decreased incidence/symptoms of low back pain Decreased risk of urinary incontinence Prevention/improvement of depressive symptoms Prevention of postpartum weight retention

tenidnopathy rehab - phase 6; sport specific training

Prior to returning to sport, you should be pain-free at rest - Pain may settle in 5-10 days, but the tendon will still be sensitive to high loads and training needs to be progressed gradually to prevent relapse Slowly, progressively increase the load of exercise - For running, this would involve progressing their walk-run program, either with distance, speed, or frequency Resist the temptation to push your training intensity - Remember: Tendons are known to have a latent response to loading. Therefore, when managing load be guided by how the tendon responds not just immediately after training, but also 24-36 hours later.

muscle length testing

Purpose is to ascertain whether the hypomobility or hypermobility at a joint is caused by the length of the muscle crossing the joint Not measured directly Determined by the maximal PROM of the joint(s) crossed by a muscle

strength and endurance exercises for weeks 0-2 for rehab treatment

Quadriceps isometrics in standing/sitting/lying +/- muscle stimulation (NMES) Mini squat (30°) à Hip/Gluteals: Gluteal squeezes supine Side lying abduction/add'n Prone hip extension Calves: Standing calf raises with/without support

when is ROM improved in flexibility training what flexibility helps with when are flexibility exercises most effective

ROM is improved immediately* after performing flexibility exercise and shows chronic improvement after about 3-4 weeks of regular stretching of at least 2-3x/week may result in a reduction in musculotendinous injuries, low back pain, or delayed onset of muscle soreness It is most effective to perform flexibility exercise when the muscle temperature is increased through warm-up exercises

which type of exercise do you introduce during the proliferative stage (days 3-20)

ROM/isometric exercise

1 - strike - strike pattern, rearfoot, midfoot, forefoot strike

Rearfoot strike (RFS) - ground contact is initiated with the lateral aspect of the heel Midfoot strike (MFS)- contact is initiated across the metatarsal heads with the heel subsequently contacting the ground Forefoot strike (FFS) - contact also occurs on the metatarsal heads though the heel never touches the ground Nearly 90% of recreational runners and almost 75% of elite level runners initiate contact with the ground via their rearfoot RFS entails a greater demand on the knee, whereas a FFS will bias the load to the structures of the ankle and foot

what happens during inflammation phase (days 1-6) and rehab techniques

Redness, increased heat, swelling, pain, loss of function Fragile fibrin plug provides stability Modalities to relieve pain, reduce muscle spasm, and swelling No exercise that might disrupt the fibrin clot (bridging/filling the defect/injury)* May exercise non-involved body segments and cardiovascular training

effects of effleurage and petrissage

Repetitive pressure stimulation without irritation to the skin causes transmission from peripheral receptors to the spinal cord and brain, which results in relaxation of muscles (parasympathetic nervous system) Mechanical effects promote mobilization of fluid by improving blood and lymphatic flow, decreasing edema Mechanical effects stretch and break down adhesions to ultimately assist in improving tissue mobility The overall end result is a reduction of pain

2- sound - soft or hard

Runners are able to decrease the GRFs when running more quietly Decreasing GRFs can possibly decrease injury rate A simple cue to change landing force is to: "Quiet their feet down"

MFR - soft tissue release technique

STR is a dynamic, highly effective technique that has an immediate and powerful effect on muscle and connective tissue; it is a combination of MFR, stretching & massage The technique involves applying precise pressure during a specific stretch performed in multiple planes of movement - Pin & Stretch, Tack & Tension, Lock & Glide, Lock & Load Results are often obtained very quickly

who will the ACSM preparticipation screening algorithm identify

Should receive medical clearance before initiating an exercise program or increasing the frequency, intensity, and/or volume of their current program; Have clinically significant disease(s), but may benefit from participating in a supervised exercise program; and Have medical conditions that may require exclusion from exercise until those conditions are better controlled

proprioception exercises for weeks 0-2 for rehab treatment

Single leg stance 30-60 seconds Wobble boards with support (table, bars, poles): side-to-side, forward/backward Gait [1&2] Weight shifting: side-to-side and forward/backward Progress from 2 crutches to 1 (maintaining normal patterning) Modalities [1] Ice IFC/TENS

three types of custom orthotics

Soft (accomodative) pes cavus - Used to provide stress absorption Rigid (functional) - pes planus - Used to improve alignment & stability Semi-rigid (accommodative & functional) - Used for pes planus in active populations for the benefits of soft and rigid orthotics

different myofascial release techniques

Soft Tissue Release (STR) Active Release Technique (ART) Trigger Point Release Instrument-Assisted Soft Tissue Mobilization - IASTM Gua Sha Foam Rolling Cupping Percussion Therapy Massagers

7 - shoes - effect of footwear, soft, thicker midsoles and minimalist shoes

Softer midsoles can reduce impact forces & loading rates; Thicker midsoles can provide better cushioning effects and attenuate shock during impacts, but may also decrease plantar sensations of a foot; Minimalist shoes can: - Improve running economy - Increase the cross-sectional area and stiffness of Achilles tendon - But minimalist shoes increase the MTP & ankle joint loading

systemic review of role of footwear constructions in running biomehcanics - implications for running-related injury and performance

Some running shoe constructions positively affect athletic performance and injury-related variables: 1) increasing the stiffness of running shoes at the optimal range can benefit performance-related variables; 2) softer midsoles can reduce impact forces & loading rates; 3) thicker midsoles can provide better cushioning effects and attenuate shock during impacts; 4) minimalist shoes can improve running economy and increase the cross-sectional area and stiffness of Achilles tendon, but it would increase the MTP & ankle joint loading. Research on shoelace, heel flare, heel-toe drop, and heel cup still requires further investigation

tendinopathy rehab - phase 2 & 3; isotonic training

Strength, power or endurance work will all have a role and help in preventing relapse issues in future Heavy loads (70-85% of 1RM) are needed to promote positive changes for load capacity in muscles & tendons - Avoid exercising in positions where there is likely to be tendon compression (stay in the mid-range position) Increasing time under tension during heavy slow loading may increase strain on the tendon and result in greater positive adaptation Progress strength work into more functional tasks

benefits of stretching during the cool-down

Stretching following the conditioning exercise is recommended for athletes where physical strength, power, and endurance are important for performance Performing static stretching >45 sec. immediately prior to these activities may result in short-term ( <30 min) decreases in the above attributes Overall, stretching following the conditioning exercise is recommended as reasonable practice

fascia is divided into 3 layers

Superficial layer - attached to the undersurface of the skin - Within this layer lies capillaries, lymph vessels, nerves, & fat - An area where edema accumulates following injury Deep Fascia - attached to muscles, joints, bone, etc. - Much stiffer, and less able to accommodate edema à problematic w/ conditions like compartment syndrome Subserous Fascia - surrounds internal organs - Contains fluid channels to assists in lubricating organs

gua sha

TCM treatment in which the skin is scraped to produce light bruising

types of inappropriate equipment or footwear that leads to tendinopathy

Tennis racket grip is too large Athlete ties shoes too tightly Playing basketball on a concrete surface Typing on angled keyboard

tendinopathy rehab - phase 5; introduce plyometric training

The SSC occurs when the tendon has to behave a like a spring, stretching (storing energy) then shortening quickly (releasing energy). - This usually occurs during high speed, plyometric activities, including jumping or reactive drills Can begin a graded return to running Cross-training involving minimal tensile or compressive forces may be appropriate (walking, swimming, cycling)

definition of mobility

The ability of a joint to move easily through a ROM

definition of flexibility

The ability of a muscle to lengthen easily without breaking

plasticity definition

The ability of a substance to undergo a permanent change in size or shape after a deforming force is applied Connective tissue has plastic properties, as it can remain elongated after being stressed (viscoelastic)

stiffness definition

The ability of an object to resist deformation when a stress is applied to it

extensibility vs fleibility

The ability to be stretched or increase in length VS The ability of a muscle to lengthen easily without breaking

speed and agility training for sport/work specific tasks

The ability to control the direction of a body/segment during rapid movement - Requires: Mobility, proprioception, coordination, strength, and speed - Accurate execution of functional and sport specific skills requires full attainment of all previous parameters

elasticity defiition

The ability to return to normal length after an elongation force/load/stress has been applied Connective tissue has elastic properties, as it can return to normal length after being stressed (viscoelastic)

sports massage definition

The application of specific and treatment oriented massage techniques to an athlete with the purpose of enhancing the athlete's preparation for, or recovery from the physical demands of training or competition

passive insufficiency

The inability of a two-joint (or multi-joint) muscle to lengthen & allow full ROM at all joints the muscle crosses, simultaneously the antagonist muscle cannot stretch any farther if you have passive, you automatically have active insufficiency of the agonist muscle

active insufficiency

The inability of a two-joint (or multi-joint) muscle to shorten & allow full ROM at all joints the muscle crosses, simultaneously the agonist muscle cannot shorten any farther to bring you closer

hysteresis

The increased duration that a tissue takes to return to its pre-stretch state after releasing the stress The resulting increase in length is known as the 'set' As the tissue was stretched, energy in the form of heat was released As the local tissue is heated and changes length with repetitive stretches, greater strain is tolerated in subsequent reps Therefore, applying heat to a muscle/tissue before stretching permits a greater stretch/'set'

measuring two jt or multi jt muscles

The length of a two-joint and multi-joint muscle is usually not sufficient to allow full PROM to occur simultaneously at all joints crossed by these muscles E.g. Triceps stretched into elbow flexion combined with shoulder flexion (DEMO) When measuring the ROM of a joint crossed by a multi-joint muscle, it must be ensured that the muscle is relaxed across all other joints it crosses to not show a limitation in joint ROM due to muscle tightness

windlass mechanism

The manner by which the plantar fascia shortens as a result of extension of the great toe and provides support to the foot during a closed-kinetic chain

definition of goniometry

The measurement of joint angles created by the movement of the shafts of human bones (osteokinematic movement) An important part of a comprehensive examination of joints and surrounding muscle tissue Used to measure the amount of active and passivejoint motion

craig's test

The pt lies prone with the knee flexed to 90° The examiner palpates the posterior aspect of the greater trochanter of the femur The hip is then passively rotated medially and laterally until the greater trochanter is parallel with the examining table or reaches its most lateral position The degree of anteversion can be estimated/measured, based on the angle of the lower leg with the vertical This test has been found to correlate well with x-rays within 4°

reciprocal inhibition - abductors vs adductors

The reduction in muscular tension of the antagonist muscle group (e.g. hip adductors) when the agonist muscle group (e.g. hip abductors) is contracting to prevent muscles from working against each other Accomplished by the actions of an inhibitory interneuron in the spinal cord

hooke's law

The strain is proportional to the stress producing it (so long as the strain is not too great) Once the elastic limit is exceeded, permanent deformation occurs)

iceberg theory - stress response & what occurs

The stress response of neoangiogenesis (formation of new blood vessels) and nerve proliferation occur giving rise to an increased pain response

autogenic inhibition - external rotators

The sudden reduction in muscular tension after a period of a contraction under high tension Attributed to inhibitory input arising from Golgi tendon organs (GTOs) within the same muscle

massage therapy definition

The systematic and scientific manipulation of soft tissue, either manually or with mechanical aids, for remedial or restorative purposes

ACSM guidelines for older adults

There are no specific recommendations regarding specific frequency, intensity, or type of exercise that incorporate neuromotor (balance) training into an exercise program However, neuromotor exercise training, which combines balance, agility, and proprioceptive training, is effective in reducing and preventing falls if performed 2-3 days/week

guidelines for MFR

Treatment can be applied through the finger pads, thumb, knuckles, heel of hand, forearm, or elbow Techniques should be applied with the least amount of force that is appropriate for achieving the established goals Start with only 5-10 passes of treatment at the beginning until the patient's tolerance increases - treatment can be daily Can progress up to 5-10 minutes of treatment

two different heel-drop exercises - how often you should perform them

Two different heel-drop exercises: Single-leg straight-leg and bent-leg heel drops Raise yourself up onto your tiptoes with help from your other leg (or your arms on the railing), then gradually lower your heel below the forefoot, then repeat Do three sets of 15 reps (of each exercise), twice a day (yes, that's 180 reps per day) for 12 weeks When you feel no discomfort/soreness during the exercise or the next-day, add weight in a backpack

local healing factors for tissue healing

Type, Size, Location Infection/ Inflammation

1st stage of tendinopathy - reactive

Typically in response to a rapid increase in loading E.g. runners either increasing their mileage per week, or reducing the number of rest days, or a change in training type (such as introducing hill or speed work) The tendon swells due to movement of water into the tendon matrix and not due to inflammatory products It can also occur from direct trauma to a tendon Pain will often be severe during reactive tendinopathy The tendon is structurally intact and there is minimal change in collagen integrity Therefore, this is a reversible process

how to improve reliability for goniometry

Use consistent, well-defined positions Use consistent, well-defined, and carefully palpated anatomical landmarks to align the goniometer Note: skin moves, so landmark at the end of the ROM Use the same device to take successive measurements When aligning the arms and reading the scale of the goniometer, the examiner must be at eye level with the goniometer to avoid the parallax effect use appropriate size goniometer record mean of several measurements rather than a single measurement

percussion therapy massagers

Used to decrease muscle soreness and tightness, by increasing blood flow to an area

palpation assessment for myofascial release

Used to determine the soft tissue extensibility, movement, end-feel, and response to treatment When examining and treating, you should move from superficial structures to deeper structures Normal tissue has no tenderness when palpated

cupping therapy

Uses special cups on the skin to create a vacuum suction causing increased in blood flow to affected area.

ballistic stretching

Uses the momentum of the moving body segment to produce the stretch Although often considered "contraindicated," properly performed ballistic stretching may be considered for individuals engaging in activities that involve ballistic movements such as gymnastics, and can be equally effective as static stretching for increasing joint ROM

how PNF facilitates use of stretch reflex

When a muscle lengthens, the muscle spindle is stimulated, which causes the muscle fibers to contract to resist the stretch A 2° set of neurons causes the opposing muscle to relax (reciprocal inhibition)

if dehydration occurs, adhesions can result in the fascia

When fascia either restricts normal motion or does not provide skin, subcutaneous, muscle, and other tissue with support, lubrication, or other functions, fascial dysfunctions can prolong symptoms following an injury and extend disability

2018 physical activity guidelines for women during pregnancy and postpartum

Women should do at least 150 minutes of moderate-intensity aerobic activity a week during pregnancy and the postpartum period. Preferably, aerobic activity should be spread throughout the week. Moderate-intensity physical activity is safe for generally healthy women during pregnancy Women who habitually engaged in vigorous-intensity aerobic activity or who were physically active before pregnancy can continue these activities during pregnancy and the postpartum period. Physical activity increases cardiorespiratory fitness without increasing the risk of negative pregnancy outcomes, such as low birth weight, preterm delivery, or pregnancy loss.

how exercising pregnant women should monitor their exercise

Women who are pregnant should be under the care of a health care provider who can monitor the progress of the pregnancy. Women who are pregnant can consult their health care provider about whether or how to adjust their physical activity during pregnancy or postpartum. - PARmed-X for Pregnancy (physical activity readiness)

what a good - (4-) grade looks liike

ability to hold test position against slight to mod

what a good + (4+) grade looks like

ability to hold the test position against moderate to strong pressure

what a fair + (3+) grade looks like

ability to hold the test position w/ slight pressure

what a poor- (2-) grade looks like

ability to move through a partial arc or motion in the horizontal plane

what a poor + (2+) grade looks like

ability to move through the complete ROM in the horizontal plane with some resistance applied

transition into toe-off, foot transitions from a mobile adapter to a rigid lever for propulsion via supination

acts as a lever during push-off

the accessory motion of the ER OKC of the knee

anterior glide of the medial tibia, posterior glide of the lateral tibia

the accessory motion of OKC knee extension

anterior glide of tibia

when performing MMT, what is something you should not do

apply pressure as distal as possible to create a mechanical advantage

how exercise benefits: cancer survivors breast cancer survivors colorectal cancer survivors prostate cancer survivors osteoarthirits hypertension

cancer: improved health-related quality of life, improved fitness breast cancer: lower risk of dying from breast cancer, lower risk of all-cause mortality colorectal: lower risk of dying from colorectal cancer, lower risk of all-cause mortality prostate: lower risk of dying from prostate cancer osteoarthiritis: decrease pain, improved physical funciton, improved health related QoL, no effect on disease progression hypertension: lower risk of CV disease mortality, reduced CV disease progression, lower risk of increase BP over time For people with various chronic medical conditions, reduced risk of all-cause and disease-specific mortality, improved physical function, and improved quality of life. Reduced risk of cancer at a greater number of sites.

overtraining definition

consistent training at levels that exceed the tissue's ability to recover, resulting in decreased performance

what happens if your patient said yes to regular exercise participation but had marked any of the staements in step 3

continue to exercise at light to moderate intensity without medical clearance. vigorous exercise would need medical clearance Light: 30-39% HRR or VO2R, RPE 9-11 Moderate: 40-59% HRR or VO2R, RPE 12-14 Vigorous: 60-89% HRR or VO2R, RPE 15-17

pes planus (low arch/flat foot)

foot has loss of medial long arch and heel valgus deformity whole foot makes contact with the ground deformity usually asymptomatic, but may be associated with pain at foot, ankle, knee, hip or even low back congenital or acquired and flexible or rigid flexible flat foor has a normal arch when non-weight bearing when arch is intact on heel elevation and non-bearing but disappears on full standing on foot, flexible flat foot

CSEP guidelines 2011 - for 12-17 years

for health benefits, youth aged 12-17 years should accumulate at least 60 min to mod-to-vig intensity PA daily. this should include: - vigorous intensity activities at least 3 days per week - activities that strengthen muscle and bone at least 3 days per week more daily physical activity provides greater health benefits

what accessory motion are used for abd

inferior glide

primary tensile supporting structures

longitudinal arches are the ligamentous structures and the plantar fascia The tibialis ant. & post. support the medial longitudinal arch The per. longus & short muscles of foot support all 3 arches

purpose of foot orthotics

make the abnormal foot function in a manner closer to that of a "normal" foot, thereby reducing these abnormal stresses They are used to correct or support symptomatic rearfoot and/or forefoot malalignment to reduce joint stresses and improve the patient's mechanical efficiency

what occurs during tendinopathy - response to overuse

pain swelling reduced function hypertrophying and remodelling (like muscle and bone) - tendon's sheaths become thickened - nodules/adhesions can be palpated on superficial tendons increased density/number of nervous system nociceptors increase vascularity (form of neurovascularity) so neural input in form of pain amplifies along with the vascular supply normal levels of prostaglandins (mediate inflammation) so no point in using NSAIDS

look over common tendinopathy location and position of compression

okay

2018 Physical Activity Guidelines for Americans - guidelines for older adults

older adults should include balance training as well as aerobic and strengthening activities - Older adults should determine their level of effort for physical activity relative to their level of fitness - Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely - When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week, they should be as physically active as their abilities and conditions allow

determined that a patient's thumb needs strengthening. which principle is the reason their thumb flexor muscles will get stronger if he trains them

principle of specificity

what is body composition expressed as

relative percentage of body mass that is fat vs. fat-free tissue

what contractile lesion would be weak and pain-free

rupture of a muscle or tendon, nerve root or peripheral nerve involvement or UMN lesion

what contractile lesion would be weak and painful

severe lesion around jt, such as a fracture. weakness caused by reflex inhibition to pain

CSEP guidelines 2011 for 18-64 year olds

to achieve health benefits, adults aged 18-64 years should accumulate at least 150 minutes of moderate-to-vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more it is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days a week * more physical activity provides greater health benefits

CSEP guidelines 2011 for adults 65 +

to achieve health benefits, and improve functional abilities, adults should accumulate at least 150 minutse of mod-vigorous exercise in bouts of 10 minutes or more it is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week those with poor mobility should perform physical activities to enhance balance and prevent falls more physical activity provides greater health benefits

CSEP guidelines for adults with MS

to achieve important fitness benefits, adults aged 18-64 years with MD who have mild to mod disability need at least: 30 minutes of moderate intensity aerobic activity, 2 times per week AND strength training exercises for major muscle groups, 2 times per week meeting these guidelines may also reduce fatigue, improve mobility and enhance elements of health-related QoL

components of exercise program

warm up: At least 5-10 min of cardiorespiratory and muscular endurance activities at light-to-moderate intensity conditioning/training: ¤At least 20-60 min of aerobic, resistance, neuromotor, and/or sports activities (exercise bouts of 10 min are acceptable) cool-down: At least 5-10 min of cardiorespiratory and muscular endurance activities at light-to-moderate intensity stretching: At least 10 min of stretching exercises performed after the warm-up or cool-down phases

what is true regarding passive and active insufficiency

when performing a length test of a muscle & measuring with a goniometer the second jt you move is the jt you will measure & if you discover the presence of active insufficiency, you will automatically have passive insufficiency present as well

goals of weeks 2-6 for rehab treatment

¤Achieve near or full ROM in knee flexion & extension [2] ¤Continue flexibility exercises of other joints [2] ¤Continue strengthening exercises with control: hip, hamstrings, quadriceps, calves [3] ¤Strengthen non-injured leg (documented strength losses in unaffected limb) [3] ¤Progress proprioception [3] ¤Normal WB gait without crutches [1&2] ¤Maintain cardiovascular fitness [2]

goals for weeks 20-24

¤Adequate cardiovascular fitness, strength, power, agility, neuromuscular control, symmetry and stability [4] ¤Return to sport skills on own at practice with minimal risk of re-injury [4]

ROM and flexibility exercises for weeks 2-6 for rehab treatment

¤Continue as needed with all previous ROM exercises ¤May need to progress stretches: ¤Assisted knee flexion à (belt or opposite leg) ¤Standing calf stretches ¤Knee bent (soleus) ¤Knee straight (gastrocs) Patellar and/or tibial-femoraljoint mobilizations if needed to achieve terminal ROM(this doesn't strain the ACL graft

goals for weeks 9-12 for rehab treatment

¤Continue flexibility exercises [2] ¤Quadriceps strength progression [3] ¤Address documented hamstring strength deficits [3] ¤Continue lower chain concentric/eccentric strengthening of quadriceps & hamstrings, both inner range (60-95°) & full range [3] ¤Proprioceptive progression [3] ¤Sport specific cardiovascular fitness [4]

proprioception and CV fitness in weeks 6-9 for rehab treatment

¤Continue on wobble boards & BOSU and add upper body mov'ts to challenge balance ¤Progress BOSU ¤Marching ¤1 leg balance +/- support ¤Squats (60-90°) ¤Cardiovascular Fitness [2] ¤Biking: increasing time/ resistance ¤Swimming: Flutter kick only ¤Treadmill: walking, increase speed

goals for weeks 12-16 for rehab treatment

¤Continue with flexibility exercises for the lower chain [2] ¤Continue strengthening of the lower chain [3] ¤Sport specific quadriceps & hamstrings strengthening [4] ¤Sport specific proprioception training [4] ¤Sport specific cardiovascular fitness [4]

goals of weeks 6-9 for rehab treatment

¤Full and pain free knee range of motion [1&2] ¤Functional quadriceps strength [3] ¤Initiate isotonic quadriceps strengthening from 0-90°: [3] ¤**only if: ROM is full, no swelling, adequate muscle control, and no meniscal or patellofemoral pathology ¤Continue strengthening lower extremity muscle groups, specifically through full range hamstrings/quadriceps (without pain at the donor graft site) [3] ¤Advance proprioception exercises [3] ¤Increase cardiovascular fitness [2]

what is important to note with isometric contractions

¤Isometric contractions only have a transfer of strength within 10 degrees of the joint angle trained -> therefore, recommended to train at 4-6 points throughout the ROM

agility exercises for weeks 12-16 for rehab treatmetn

¤Ladder drills - fwd/backward, side-to-side (focus on footwork/speed/timing) ¤Side step-overs (hurdle) - progress to side hop-overs ¤Carioca patterning ¤Initiate 2 legged hop tests (hop for distance, hop for height, triple hop) prior to single leg hop tests in next stage - ensure patterning and landing is proficient prior to 1 leg progression

strength and endurance for weeks 2-6 for rehab treatment

¤Mini squats progress to 45°-60° ¤Supine bridging ¤Hip strengthening with pulleys or ankle weights - all directions ¤Standing calf raises 2-1 foot ¤Proprioception [3] ¤Continue with full ROM on wobble boards with decreased support ¤BOSU 2 leg balance weight shift forward/backward, side-to-side, eyes open/closed progress to mini squats (0-30°) à

goals for weeks 16-20 for rehab treatment

¤Sport specific quadriceps, hamstrings and lower chain strengthening progressing to plyometrics [4] ¤Proprioceptive training [3] ¤Sport specific cardiovascular fitness [4]

strength and endurance exercises for weeks 9-12

¤Static Lunge à dynamic lunge à lunge walking ¤Eccentric step down with control on 6 à 8" step ¤Continue hip strengthening with increased weights/resistance ¤Prone eccentric hamstrings with pulleys/tubing ¤Proprioception ¤Perturbation drills with tubing on boards or BOSU ¤Single leg stance on BOSU with unaffected leg performing kicking drills

strength and endurance exercise for weeks 6-9

¤Terminal extension with tubing ¤Step-ups 6-8" forward & lateral ¤Eccentric step down on fwd & lateral 2 à 4 à 6" step w/ control ¤Full squats to 90° ¤Supine with legs on swiss ball: bridging plus knee flexion (heels to buttocks) ¤Standing hamstrings curls - when able to attain 90° ROM against gravity add 1-2 lbs

what does neuromotor exercise help with

¤improvements in balance, agility, and muscle strength among older adults, and even reduces the risk of falls and the fear of falling The optimal effectiveness of the various types of neuromotor exercise, doses (i.e. FITT), & training regimens are not known