TherEx Exam 1
Chronic Pain Syndrome
- Pain that persists longer than 6 months. - The pain cannot be linked to a source of irritation or inflammation resulting in activity limitations and participation restrictions that affect many parameters of function.
How do you treat in the chronic stage
- Progressive strengthening and endurance exercises - Progressive stretching - Use concentric and eccentric resistance training - Develop functional independence
Describe the subacute stage
- Repair and heal - tissue remodeling (collagen and functional/mobile scar formation) - Pain felt at end range
Describe the chronic stage
- Tensile scar formation and remodeling (scar tissue) - No signs of inflammation
Hold-relax (HR) or contract-relax (CR) technique [pg.103]
- This stretching technique works on the principle of "autogenic inhibition"- a muscle will relax after contraction through firing of the Golgi tendon organ - the range-limiting muscle is first lengthened to point where patient is comfortable - pt is asked to contract for 5 secs then voluntary relax - examiner takes it to new range
Precautions for ROM
- Unstable fracture - Surgical procedures - Acute tears (only for PROM)
Describe the acute stage
- Vascular changes - ROM is painful and muscle guarding
What are the indications of AROM
- When patient is able to actively contract and move segment without assistance
What are the indications of AAROM
- When patient is unable to perform FULL ROM independently (2-/5 - 3-/5)
What are the limitations of PROM
- Will not prevent muscle atrophy nor increase muscle strength nor endurance - Is not as effective in increasing circulation as AROM
What is a myostatic contracture (+effect on sarcomeres)?
- adaptive *muscle shortening* with: - reduction in # of sarcomeres units in series - shortened length of individual sarcomeres ***marked loss of ROM
What factors do you have to remember about stretching
- alignment (posterior pelvic tilt) - stabilization
Contraindications for stretching
A bony block limits joint motion. Recent fracture Acute inflammation or infection Sharp acute pain when being stretched Hematoma/trauma Joint hypermobility If the short tissue provides stability for a patient with paralysis to perform certain functional skills (sometimes it's a good thing)
Which of these is included in the National Osteoporosis Foundation's exercise recommendations for individuals with osteoporosis? 8-10 major muscle group resistance exercises, 8 to 12 repetitions, 3 days per week 10 minutes of vigorous running every day of the week 20 minutes of fast walking on level surfaces 5 days per week wearing a weighted vest while sleeping
8-10 major muscle group resistance exercises, 8 to 12 repetitions, 3 days per week
What is the stress-strain curve?
A graphic representation that depicts the relationship between the amount of force (stress) applied to connective tissue [from an external force] and the amount of deformation (strain) it experiences.
FLEXIBILITY
Ability to move a joint through a full, non-restricted, pain free range of motion. Dependent on combination of joint range of motion and muscle flexibility - Dynamic flexibility (active ROM) - Passive flexibility (passive ROM)
Contracture
Adaptive shortening or skin, fascia, muscle, or a joint capsule
Neuromuscular Facilitation and inhibition techniques
Also known as PNF (proprioceptive neuromuscular facilitation) stretching. The use of facilitation or inhibition techniques to assist with muscle elongation.
What are the properties of soft tissues
Elasticity, plasticity, and viscoelasticity
What condition is characterized by: - trigger points in muscle - tight band of muscle - referred pain patterns - no fatigue
Myofascial syndrome "my-o-my" don't pull the trigger
List the types of contractures
Myostatic Fibrotic Irreversible Pseudomyostatic Periarticular (Arthrogenic) Arthrogenic (Inter-articular)
Can you perform stretching techniques across swollen joints?
NO contraindicated!!
Forced maximum resistance through ROM is good for a patient with OA
NO!!
What is the difference between Non-conservative and Conservative?
Non-conservative = surgical Conservative = rehab/PT/non-surgery
A chronic degenerative disorder primarily affecting the articular cartilage of synovial joints with eventual bony remodeling and overgrowth at the margins of the joints (spurs and lipping). With progression of synovial and capsular thickening and joint effusion.
OA
OA or RA?: - usually develops slowly over many years - affects those aged 40yrs+ - mainfests with: cartilage degeneration, altered joint architecture, osteophyte formation, crepitus, loss of ROM, pain with weight-bearing - affects asymmetrically - morning stiffness under 30 minutes - NO systemic signs or symptoms
OA
A disease of bone that leads to decreased mineral content and weakening of the bone
Osteoporosis
Joint mobilization/manipulation
Skilled manual therapy interventions applied to joint structures by the clinician to modulate pain and treat joint impairments that limit ROM.
What is the SAID principle?
Specific Adaptations to Imposed Demands (SAID Principle) - Guides exercise prescription parameters - Stage of healing closely reflects the demands of the functional tasks - Exercise should be based on the level of healing that has occurred
Which of these is NOT a potential cause of the development of trigger points? acute overload of a muscle such as picking up an object of unexpected weight chronic, repetitive overload of a muscle due to job related demands daily sitting for up to 30 minutes in a properly fitted ergonomic desk chair poorly conditioned muscles that are unable to perform at demanded levels
daily sitting for up to 30 minutes in a properly fitted ergonomic desk chair
Muscle weakness
decrease in strength of muscle contraction
CREEP vs Stress-Relaxation: What is Creep?
due to viscoelastic property, soft tissue that is stretched for a sustained duration will elongate and not return to its original length after the load has been removed. The principle of creep is the basis for stretching. (Response to tissue over time with a constant force application. Slowly continues to elongate) *use ankle weight to hold stretch - Amount of elongation depends on = Stress (amount of force) & Length of time - Used in dynamic splints, serial casts, stretching with weights
Which type of stretch is preferred for a well-trained athlete when being performed as a warm-up for explosive activities? ballistic stretching dynamic stretching low load long duration stretching PNF stretching static stretching
dynamic stretching
Which of these is a pain-relieving surgical procedure that removes periarticular bone, intentionally creating a space that will be filled in with fibrotic scar tissue? excision arthroplasty excision arthroplasty with implant interposition arthroplasty joint replacement arthroplasty
excision arthroplasty
Which of these terms best describes the ability of the body to move through the range of motion? flexibility functional mobility relative flexibility stiffness
flexibility
Which of these is NOT an element to be included in the interventions for a patient with osteoarthritis? full range of motion exercise with maximum resistance joint-play mobilization techniques low-impact, full body aerobic exercises orthosis to correct faulty movement mechanics
full range of motion exercise with maximum resistance
mobility when it is for functional activities is called
functional ROM = ability of body to perform motor tasks
What is the yield point/elastic limit of the stress stain curve?
point at which the tissue does no return to its original shape and size
In which stage of non-conservative rehabilitation management would a PTA focus on gradually restoring functional activities and progressive strengthening? pre-operative patient education phase post-operative maximum protection phase post-operative moderate protection phase post-operative minimum protection phase
post-operative minimum protection phase
Generally speaking, which stage of non-conservative rehabilitation management begins approximately 4 to 6 weeks after surgery? pre-operative patient education phase post-operative maximum protection phase post-operative moderate protection phase post-operative minimum protection phase
post-operative moderate protection phase
While performing patellar mobilizations and gentle massage around the total knee arthroplasty scar, a PTA is also providing patient education regarding how to adjust home exercises in response to an increase in pain or swelling. This patient is likely in which stage of non-conservative rehab management? pre-operative patient education phase post-operative maximum protection phase post-operative moderate protection phase (subacute) post-operative minimum protection phase (the scar is adhered)
post-operative moderate protection phase (subacute)
contraction
process of actively tensing a muscle
Reflex muscle guarding
prolonged contraction of a muscle in response to a painful stimulus (ex. referred pain) (MEG WHEN I WORK ON HER cuz external force may cause pain)
Intrinsic muscle spasm
prolonged contraction of a muscle in response to the local circulatory and metabolic changes (SPASMS - stress) that occur when a muscle is in a continued state of contraction
Chronic Inflammation
- A state of prolonged inflammation may occur if injured tissue is continually stressed beyond its ability to repair itself. - There are symptoms of increased pain, swelling and muscle guarding that lasts more than several hours after activity. - There are also increased feelings of stiffness after rest, loss of ROM 24 hours after activity and progressively greater stiffness of the tissue as long as the irritation persists. - Causes: overuse/repetitive strain, trauma, re-injury, contractures or poor mobility/posture
What is autogenic inhibition? (page 95)
- Activates Golgi Tendon Organ which has inhibitory effect on the level of tension in the muscle tendon unit if the stretch force is applied. Causes inhibition of muscle (autogenic inhibition) during or immediately after contraction - the antagonist muscle relaxes and taken be taken to a new length
Name two Viscoelastic properties that are time-dependent
- CREEP - Stress-Relaxation
How do you treat in the acute stage
- Control effect of inflammation: PRICE method - Protect, Rest, Ice, Elevate - PROM, massage, nondestructive movement - Stretching and resistance are contraindicated!!!!
Contraindications for ROM
- DVT - disrupt healing process - unstable cardiac conditions
Describe Arthritis
- Definition: Inflammation of a joint - Many types of arthritis both inflammatory and non-inflammatory - Most common treated by physical therapy: RA & OA - Clinical signs and sxs: Pain from joint swelling (effusion), Impaired mobility (capsular pattern), Impaired muscle performance, impaired balance, functional limitations
Describe Arthrosis
- Definition: Limitation of a joint without inflammation - May be present following immobilization - Limited joint play and ROM due to CT and muscular contractures
What are the indications of PROM
- During acute stage of injury!!! Perfect for after surgical repair to prevent effects of immobilization - When patient isn't suppose to move a segment (postop) - When a patient cannot move a segment (paralysis)
Phases of healing of fractures
- Inflammatory: Tiny blood vessels are torn at the site resulting in internal bleeding followed by normal clotting - Reparative Phase Early stages of healing take place in the hematoma. Osteogenic cells proliferate from the periosteum and endosteum and form a thick callus At this stage the callus does not contain bone and is radiolucent on xray As the callus matures the osteogenic cells proliferate into osteoblasts and chondroblasts. The chondroblasts form cartilage near the fracture site and the osteoblasts form primary woven bone - Remodeling Phase Stage of clinical union - fracture site is firm enough so that it no longer moves. It is clinically united. The callus hardens as the cartilage ossifies. On x-ray you can still see the fracture line but there is evidence of bone in the callus. Usually at this stage immobilization is no longer required. Movement is allowed with caution Stage of radiographical union - bone is considered healed when the callus has been replaced my lamellar bone.
What are limitations of AAROM and AROM
- does not maintain nor increase strength!!!! - will not develop skill or coordination
Tissue injury grades
- grade 1 - mild pain within first 24 hrs and mild swelling - grade 2 - moderate pain that requires stopping activity and some injury to ligaments and fibers torn = increased joint mobility - grade 3 - near or complete avulsion with severe pain
What is periarticular (Arthrogenic) contracture
- loss of mobility in the connective tissues that cross or attach to a joint or joint capsule (restriction of the arthrokinematics) "peri" "articular" = around joint = joint capsule and ligaments **Progression from interarticular contracture (inter to peri)
What are the benefits of AAROM and AROM
- maintain elasticity and contractility - increase proprioceptive feedback - places stress on it increasing bone and joint integrity (Wolff's Law) - greater effect of circulation and thrombus prevention
What are the benefits of PROM
- maintain joint and soft tissue mobility - maintain elasticity - reduce the risk of contracture - assist in circulation - enhance synovial fluid for cartilage nutrition!!!! - decrease or inhibit pain - maintain patient's kinesthesia other uses = preparing patient for stretching
What is the role of the Golgi tendon organ (GTO)
- monitor changes in the TENSION - When stimulated, sends impulses to inhibit muscle contraction (counteract the muscle spindle fire action)
Interventions of patients with OA
- orthoses to correct faulty alignment or biomechanics - joint MOBS - low aerobic activity
Fibromyalgia and Myofascial pain syndrome similarities
- pain in muscles - decreased ROM - postural stresses
What are the risk factors for developing primary osteoporosis
- postmenopausal - caucasian or asian - low body weight - low diet in calcium and vitamin D - little or no physical activity - smoking
CPM machine benefits
- prevents adhesions and contractors - healing of tendons and ligaments - enhancing the healing of incisions (functional scar tissue formation) - increasing synovial fluid lubrication of the joint and thus increasing the rate of intra-articular cartilage healing and regeneration****** (not synovial regeneration) - preventing the degrading effects of immobilization
What are the recommendations for exercise for a patient with osteoporosis
- resistance training of 8-10 reps 2-3x/week - 30mins of fast walking (moderate activity) or 20 mins of running (vigorous activity) for 5-7x/week
What is interarticular (Arthrogenic) contracture
- results from inter-articular pathologies such as arthritis or joint injury - Joint effusion (swollen joint), articular cartilage damage, osteophytes
STUDY****What is reciprocal inhibition/stretch reflex?
- stretch reflex actives the muscle being lengthened to contract (antagonist) to resist lengthening creating decreased activity on the muscle on the opposite side (agonist)
What are risk factors of OA
- women - age - obesity - mechanical stress - genetic factors - injury
Characteristics of OA
-Capsular laxity leading to hypermobility or instability -Affected joints may become enlarged (Heberden's nodes at DISTAL IP joints) -Cartilage splits and thins out, causing Crepitus - INCREASE in density of bone along the joint line
When considering an effective protocol of ankle pumping exercises to minimize the risk of a postoperative deep vein thrombosis, which of these accurately reflects the number of minute(s) of active ankle pumping performed with the number of minutes of increased venous blood flow that has been shown to occur after exercise? 1 minute of ankle pumping exercises produces 15 minutes of increased venous blood flow 1 minute of ankle pumping exercises produces 30 minutes of increased venous blood flow 2 minute of ankle pumping exercises produces 20 minutes of increased venous blood flow 5 minute of ankle pumping exercises produces 60 minutes of increased venous blood flow
1 minute of ankle pumping exercises produces 30 minutes of increased venous blood flow
What are the types of PNF stretches
1. Hold-relax (HR) or contract-relax (CR) 2. Agonist contraction (AC) 3. Hold-relax with agonist contraction (HR-AC)
MEMORIZE*****Which sensory organs correspond to autogenic and reciprocal inhibition? and in which order do they follow?
1. Muscle spindle = reciprocal - contract 2. Golgi Tendon Organ = autogenic - relax
What are the types of stretches
1. Static 2. Cyclic (intermittent) 3. Dynamic 4. Ballistic 5. PNF/active or facilitative stretching
What are the types of stresses used in stretching technique
1. Tension - the resistance to a force applied in a manner that will lengthen the tissue. A stretching force results in tension stress. 2. Compression - resistance to a force applied in a manner that approximates the tissue. Weight bearing through a joint with produce a compression stress. 3. Shear - resistance to two or more forces that are applied in opposing directions.
What are the two types of osteoporosis?
1. primary = predisposed 2. secondary = result of other medical condition
STUDY page 90 ****In what order do the following 5 events occur on the stress-strain curve: TOE REGION ELASTIC RANGE YIELD POINT/ELASTIC LIMIT PLASTIC RANGE FAILURE POINT
1. toe region 2. elastic/linear range 3. Elastic limit/yield point 4. Plastic range 5. Failure point
Preferred length of time + frequency for stretching
30secs-5minute hold 2-5x/week
What is the antagonist and agonist as it pertains to PNF stretching
Antagonist = range-limiting muscle (preventing stretch) Agonist = opposite muscle to the range-limiting muscle
What is self-stretching
Any stretching exercise that is carried out independently by the patient after instruction and supervision by a therapist
Severe stress, stretch, or tear of soft tissues such as ligaments is the definition of: A. dislocation B. sprain C. strain D. subluxation
B. sprain
precautions for stretching
Be aware of normal age & gender differences in ROM - don't force beyond normal limits (unless needed for sport specific) Exercise caution with clients who have or are at risk for OSTEOPOROSIS Protect newly united fractures Proceed cautiously with tissue that has been immobilized for long time Progress dosage gradually to minimize soreness & trauma to tissue Avoid OVERSTRETCHING of weak muscles
A person has been performing therapeutic stretching for 3 weeks. Upon re-evaluation, the PT determines that the patient has not gained any ROM. Therapeutic stretching without an increase in ROM demonstrates which property of muscle? A. Thixotrophy B. Elasticity C. Plasticity D. Extensibility
C. Plasticity
A PTA is instructing a patient on utilizing equipment to assist with range of motion exercises. Which of the following is NOT a typical piece of equipment used with active assisted range of motion? CPM machine finger ladder overhead pulleys straight cane
CPM machine
Healing time for fractures
Children: 4-6 weeks Adolescents: 6-8 weeks Adults: 10-18 weeks
Myofascial pain syndrome
Chronic regional pain syndrome associated with myofascial trigger points that refer pain in an identified pattern
When applying the hold-relax technique to a person lacking knee flexion, what SHOULD you instruct the patient to do? Contract their quads, then contract their hamstrings Contract their quads, then relax their quads Contract their hamstrings, then contract their quads Contract their hamstrings, then relax their hamstrings
Contract their quads, then relax their quads
A rapid stretching of a muscle is MOST likely to stimulate activation of which of the following neuromuscular structures? A. Golgi tendon organ B. Relaxation reflex C. Moro ballistic reflex D. Muscle spindle
D. Muscle spindle
Which of these is NOT a goal or indication for the use of passive range of motion (PROM)? (Pg.62) A. PROM can be used as a teaching tool for stretching activities B. PROM can be used when a contraction would disrupt healing C. PROM can be used when active range of motion is too painful D. PROM can prevent strength loss during immobilization
D. PROM can prevent strength loss during immobilization
Soft tissue mobilization
Designed to improve the extensibility of any soft tissue that limits mobility.
What condition is characterized by: - tender points - poor sleep - no referred pain (generalized widespread pain) - fatigue
Fibromyalgia "F" = fender bender = Tender "gia" = pain (not specific = general so no referred pain)
Is it Fibromyalgia or Myofascial that has fatigue associated with it?
Fibromyalgia = more of a pathology vs Myofascial = is a condition
Which of these is NOT associated with a diagnosis of osteoarthritis? capsular laxity with hypermobility and instability cartilage splitting and thinning with joint crepitation Heberden's nodes in the proximal interphalangeal joints increased density of bone along the joint line
Heberden's nodes in the proximal interphalangeal joints (its wrong because it is in the DISTAL IP joints!!)
HYPOMOBILITY vs HYPERMOBILITY
Hypo- a decrease in the normal movement of a joint or body part. Joints are too tight and have decreased range of motion. Hyper - an increase
Another term for acute stage
INFLAMMATORY stage
INTRA vs INTER
INTRA = within (one person; two measures) INTER = between (two people; one measure)
Selective stretching
Improve function by applying stretching techniques selectively to some muscles and joints, but allowing limitation of motion to develop in other muscles or joints
What is Viscoelasticity?
Initial resistance to stretch but allows for tissue elongation as the stretch is held for longer durations. The tissue will return to its previous length after the stretch is no longer applied. ViSCOelasticity - SCO = reSistance/Strain Calms Over time
Muscle energy techniques
Involves voluntary muscle contractions by the patient in a controlled direction and intensity AGAINST a counterforce applied by the practitioner.
Indications for stretching
Limited ROM due to adhesions, scar tissue and contractures. Restricted motion that may lead to deformities. Limited ROM due to shortened opposing structures. Can be used as a warm up prior to exercise.
To achieve the desired physiological lengthening effects of therapeutic stretching, the stretch SHOULD be applied with which approach? Short duration, high magnitude Long duration, low magnitude Short duration, low magnitude Long duration, high magnitude
Long duration, low magnitude
Mechanical/manual vs passive vs assisted stretching
Mechanical/manual = they do it Passive = external force; they are relaxed Assisted = they help some but have help
A PTA is providing stretching intervention for a ballet dancer who is trying to increase hip adduction range of motion. The goal is to achieve an aggressive increase in that range by taking advantage of neuromuscular interaction. While the increase is only temporary the dancer can take advantage of that temporary gain, incorporating the newly gained range into their daily dance and practice routine. Which is the stretch of choice for this situation? ballistic stretching dynamic stretching low load long duration stretching PNF stretching static stretching
PNF stretching
What is another term for subacute stage
PROLIFERATION stage
An individual may develop a cumulative trauma or overuse injury from any of these EXCEPT: bony malalignment with weak structural support Progressive Resistance Exercise program muscle strength and length imbalances sustained awkward postures or movements
Progressive Resistance Exercise program
An autoimmune, chronic inflammatory systemic disease affecting synovial lining of joints and other connective tissue
RA
OA or RA?: - develops suddenly within weeks to months - begins between age 15 to 50 - manifests with: inflammatory synovitis and irreversible structural damage to cartilage and bone, morning stiffness, joints may be: red, warm, swollen - affects bilaterally - systemic signs and symptoms: fatigue, weight loss, fever, rheumatoid nodules, and respiratory, hematological, or cardiac symptoms
RA
What is another term for chronic stage
REMODELING stage
AROM is
ROM by voluntary muscle contraction
What is a Synovectomy
Removal of the synovial lining of the joint in the presence of chronic joint inflammation. - Typically performed in persons with rheumatoid arthritis.
What is the failure point of the stress strain curve?
point at which mechanical disruption occurs - tissue is damaged
ballisitc stretching
Stretching the muscle by bouncing rapidly - can be damaging!!! quickly elongates the targeted soft tissues. = greater residual muscle soreness high velocity; high intensity May lead to hyper-mobility
What stage do you focus on mobilizing scars?
Subacute
What stage of healing is most prone to reinjury
Subacute
What is an Osteotomy
Surgical cutting and realignment of a bone. (alignment issue: high tibial osteotomy)
What is an Arthrodesis
Surgical fusion of joint surfaces used in cases of severe joint pain; associated with late stage arthritis and instability.
Neural tissue Mobilization
Techniques used to improve or restore nerve tissue mobility that may be restricted by adhesions or scar tissue. Increased tension is placed on nerve tissue by these adhesions leading to pain and/or neurological symptoms
Muscle activity that causes or controls motion comes from
The CNS
MOBILITY
The ability of body structures or segments to move so that range of motion for functional activities is allowed.
STRETCHING
Therapeutic maneuver designed to increase soft tissue extensibility with the intent of improving flexibility and ROM by lengthening structures that have adaptively shortened. Goal is to restore the ROM and restore flexibility of tight structures aiding in impairment of movement.
Validity vs. reliability of tests
Validity: accuracy - degree to which a test measures what it claims to measure (tested for soundness) Reliability: precision - degree to which a test produces similar results under consistent conditions (able to be repeated)
What is a fibrotic contracture
When there is a change in the fibrous connective tissue causing adherence of tissue. **Progression from myostatic (muscle to tissues)
Can capsular tightness be helped by stretching?
YES
Define ROM
a basic technique used for the examination of movement and for adding movement to a therapy program (ROM is the fullest motion possible)
Which of these is a correct statement regarding stretching? a carefully selected program of low-load, long duration stretching may correct capsular tightness pre-activity stretching will increase all aspects of event performance, particularly in high level athletes posture and stabilization do not matter as long as the patient "feels the stretch" with every repetition proper stretching is vital to all stages of healing, including the acute inflammatory phase of rehabilitation
a carefully selected program of low-load, long duration stretching may correct capsular tightness the answer is not "pre-activity stretching will increase all aspects of event performance, particularly in high level athletes" because it has been shown to improve strength and power...things such as speed, etc. have not been tested.
Fibromyalgia
a chronic condition characterized by widespread pain - Must have 11 of 18 tender points at specific sites
What is a trigger point
a hyper irritable area in a tight band of muscle
What is Plasticity?
a property of soft tissue that allows for tissue elongation even after a stretch (remain new length) is no longer applied.
What is the role of the muscle spindle
a sensory receptor located within a muscle **Sensitive to quick and sustained (tonic) stretch **It detects and conveys information about muscle length changes and the velocity of those changes - RAPID Quick stretch facilitates muscle contraction - deep tendon reflex. **reciprocal inhibition - Distributed throughout the belly of the muscle - Important to control posture and involuntary movements
When a muscle is shortened to a point too short to produce much tension that is called
active insufficiency
While a patient is standing upright, the left hamstring muscles are fired to bring the knee into full flexion, but the hamstrings are then unable to also bring the hip into full extension at the same time. This is an example of: active insufficiency passive insufficiency
active insufficiency
Adhesion
adherence of collagen fibers to surrounding structures causing restricted ROM
Following a period of prolonged immobility while in a cast, an individual developed limitations of the joint. This is known as: arthralgia arthritis arthrosis ankylosis
arthrosis
What type of stretch involves quick, repetitive movements that oscillate in and out of the available range of motion? ballistic stretching dynamic stretching low load long duration stretching PNF stretching static stretching
ballistic stretching
How do you treat in the subacute stage?
begin light stretching, mobilization/manipulation *Progressive exercises - isometric to isotonic (resistance) exercises to increase repetition Careful not to reinjure!!!! Promote healing
CPM guidelines
can be used up to 6-8hrs a day!!! 1. the device may be applied after surgery while patient is still under anesthesia 2. arc of motion: low = 20-30; then increase by 10-15 each day 3. rate of motion is usually 1 cycle/45sec or 2 min 4. Length of time anywhere from a continuous 24 hrs or 1 hr 3x a day (the longer the time = shorter hospital stay) 5. PT is initiated when patient is off CPM 6. Minimum duration on CPM is 1 week 7. Are adjustable and easily portable and versatile (some function off a battery)
When a PTA develops a stretching program that fits the patient's lifestyle and that the patient is likely to follow, it is reasonable to expect improvement in all of the following areas EXCEPT: cardiorespiratory performance functional performance muscle flexibility muscle performance
cardiorespiratory performance
A patient is receiving ergonomic counselling and wearing a brace to protect the affected joint. While out of the brace, cross-fiber friction massage and soft tissue mobilization is applied to break down adhesions. Exercises are focused on correcting faulty mechanics, postural stabilization and improving timing, coordination, and endurance. This patient is in which stage of healing? acute or maximum protection stage subacute or controlled motion stage chronic or return to function stage chronic inflammation stage
chronic inflammation stage
Hold-relax with agonist contraction (HR-AC)
combines: patient resists pressure of examiner (HR or CR) but then patient voluntary takes to new range throughout agonist contraction
PROM is
comes from external force with no voluntary muscle contraction to go through unrestricted and available ROM **not the same as stretching!
Following an injury, a patient experiences adaptive shortening of the skin, fascia and muscle which restricts normal mobility or flexibility of the area. This is best known as: adhesions contracture dysfunction muscle guarding
contracture (is not synomous with adaptive shortening since adaptive shortening can be functional as in neurological cases)
In which of the following cases would stretching NOT be indicated? a patient after a stroke with shoulder flexion that is limited to 135 degrees an individual with a severe hip flexor contracture due to prolonged immobilization gastrocnemius-soleus stiffness in a swimmer who specializes in 100-meter butterfly greater than normal finger flexion tightness in a patient with a C6 spinal cord injury
greater than normal finger flexion tightness in a patient with a C6 spinal cord injury
Myofascial compartment syndromes
increased interstitial pressure in a closed, non expanding, myofascial compartment that compromises the function of the blood vessels, nerves, and muscles.
Which of these is a sign that the treatment intervention is appropriate or that the stresses from exercise or activities are being appropriately applied? increased pain compared to the previous session increased stiffness/decrease ROM over several sessions increased redness and warmth in the healing tissue increased soreness up to 12 hours after treatment
increased soreness up to 12 hours after treatment
What is magnitude?
intensity
What is inhibition?
it is a state of decreased neuronal activity and altered synaptic potential which diminishes the capacity of a muscle to contract
What is Pseudomyostatic contracture
limited ROM due to hypertonicity associated with the CNS!!! (ex: spasticity, rigidity) - Muscle can be restored to normal length if relaxed - Treatment - neurological inhibition techniques
A PTA is planning a home stretching program for a patient who has an extremely low pain tolerance. To increase patient compliance, this program will primarily rely on which type of stretching that is known to have a lower possibility of residual soreness? ballistic stretching dynamic stretching low load long duration stretching PNF stretching static stretching
low load long duration stretching
AAROM is
manual or mechanical assistance provided to patient for them to get ROM
Joint dysfunction
mechanical loss of normal joint play in synovial joints; commonly causes loss of function and pain
Which of these joint protection and energy conservation techniques is important for individuals with rheumatoid arthritis? change positions at least every 2 hours throughout the day monitor activities and stop when fatigue begins to develop omit activities that provoke pain that lasts more than 20 minutes plan for less frequent exercise session, usually in the mornings
monitor activities and stop when fatigue begins to develop
Which of these is a chronic regional pain condition that is characterized by hyperirritable points within specific muscles? fibromyalgia syndrome myofascial pain syndrome rheumatoid arthritis trigger points syndrome
myofascial pain syndrome
Extra-articular pathological changes associated with rheumatoid arthritis can include all EXCEPT: muscular weakness ossific ankylosis rheumatoid nodules tenosynovitis
ossific ankylosis
A patient presents with cartilage degradation, osteophyte formation, joint pain and crepitus (particularly in weight bearing activities), that has become progressively more debilitating over the past 10 years. Which of these best describes this condition? osteoarthritis progressive arthrosis psoriatic arthritis rheumatoid arthritis
osteoarthritis
Which of these is associated with myofascial pain syndrome? fatigue and waking unrefreshed lack of referred pain patterns palpable tight bands of muscle site specific tender points
palpable tight bands of muscle
When a muscle is lengthened to a point too long and limits motion that is called
passive insufficiency
A PTA explains the benefits of passive range of motion to a patient with a diagnosis of cerebral vascular accident (CVA) with left hemiplegia. Which of the following is NOT correct regarding passive range of motion? passive range of motion aids in nutrition of articular cartilage passive range of motion can minimize the potential for contracture development passive range of motion will assist with circulation, enhancing venous return passive range of motion will prevent muscle atrophy from occurring
passive range of motion will prevent muscle atrophy from occurring
Which of these contractures is the result of hypertonicity associated with central nervous system lesions or pain related muscle guarding? arthrogenic contracture fibrotic contracture myostatic contracture pseudomyostatic contracture
pseudomyostatic contracture
Which of these is NOT an indication for surgical management rather than conservative management? abnormal joint alignment that impacts function incapacitating pain when the patient is at rest prior surgical management of the same joint range restricting edema that lasts 3-5 days
range restricting edema that lasts 3-5 days
Agonist contraction (AC)
reciprocal inhibition - the muscle opposite the muscle being stretched contracts against resistance to inhibit the muscle being stretched - patient actively contracts opposite muscle and brings to end ROM and holds for a few seconds, then repeats.
signs of infection
redness and swelling feeling hot to touch fatigue drainage (other than clear) foul odor fever malaise chills night sweats
signs of inflammation
redness, heat, swelling, pain, loss of function
What is PNF stretching
reflexive muscle relaxation that occurs during the stretch as the result of autogenic and reciprocal inhibition (pg 103)
What is the toe region of the stress strain curve?
represents "settling" of the structure being tested (basically point 0) (initial stress that results in the wavy collagen fibers becoming - initial response to stretch - straight and aligning with one another.)
Low load; long duration (Static) stretching...
safest form and least amount of residual muscle soreness + minimizes voluntary and involuntary muscle guarding
A patient is instructed to stretch all muscles of the lower leg, using available equipment as necessary, and performing all stretches for 10 repetitions without assistance. Which type of stretching does this describe? overstretching PNF stretching selective stretching self stretching
self stretching
Which of the following is NOT an expected outcome associated with poor flexibility? faulty movement patterns in adjacent joints localized discomfort in the inflexible tissue severe limitations in daily functional activities stretch weakness of agonistic muscle groups
severe limitations in daily functional activities (pg 82- hypomobility may lead to activity limations but not severely)
Cyclic
short-duration stretch force repeatedly but gradually applied
With a patient positioned in supine, the PTA supports the patient's right arm loosely and comfortably at the wrist and hand. Which motion must be allowed to occur to achieve full shoulder abduction? elbow flexion shoulder extension shoulder external rotation shoulder horizontal adduction
shoulder external rotation
What do you start and then what do you finish stretching with?
start = heat (warmup) end = ice (cool down)
A PTA is providing intervention for a patient with a diagnosis of right elbow flexion contracture. As the soft tissues are stretched, the biceps brachii is elongated past the point of tissue resistance and then held in the lengthened position for a sustained amount of time. This is called... ballistic stretching cyclic stretching dynamic stretching static stretching
static stretching
What is the plastic region of the stress strain curve?
strain beyond the elastic limit that causes permanent tissue deformation (collagen fibers and tissues fail and thus new ROM) **In order for lengthening to occur, must go into the beginning of the plastic range
Overstretching
stretch beyond moral length of muscle
Which of these activities is contraindicated in the acute stage (maximum protection phase) of rehabilitation? grade I joint oscillations joint immobilization range of motion stretching activities
stretching activities
A patient presents 2 weeks after the initial injury, with joint effusion that is decreasing but muscle weakness due to pain. Treatment activities have been moved from multi-angle isometrics to progressive isotonic exercises with increased repetitions. They are spending less time in protective bracing and decreasing the use of assistive devices. This patient is in which stage of healing? acute or maximum protection stage subacute or controlled motion stage chronic or return to function stage chronic inflammation or cumulative trauma syndrome
subacute or controlled motion stage
During which stage of healing is physical therapy intervention aimed at developing a mobile scar through selective stretching and mobilization of restrictions? acute inflammatory stage subacute proliferation stage chronic remodeling stage chronic maturation stage
subacute proliferation stage
Which of these would be LEAST EFFECTIVE for eliminating a trigger point? contract-relax active stretch contract-relax passive stretch intramuscular dry needling therapy systematic resting of overloaded muscles
systematic resting of overloaded muscles
Which of these is NOT an immediate post-surgical complication? deep vein thrombosis or pulmonary embolism tapment from scar tissue formation pulmonary dysfunction, including atelectasis rupture of soft tissue repair or reconstruction
tapment from scar tissue formation
dynamic stretching
technique in which muscles are stretched by moving joints slowly and fluidly through their range of motion in a controlled manner; also called functional stretching - recommended for athletes for strength
Which of these is a surgical procedures that is designed to realign or stabilize a tendon in order to enhance function? (Pg. 370) tenodesis tenolysis tenoplasty tenorrhaphy
tenodesis
Which of the following correctly matches the muscle stretch receptors / sensors with their normal physiologic function? the Golgi Tendon Organ monitors tension and adjust the force of the agonist muscle during a stretch the Golgi Tendon Organ prevents damage during stretching by facilitating surrounding muscles the muscle spindle receives and conveys information regarding the rate and strength of fiber contraction the muscle spindle responds to gradual changes in velocity and muscle length changes
the Golgi Tendon Organ monitors tension and adjust the force of the agonist muscle during a stretch
What is Elasticity?
the ability of soft tissue to return to its previous length after a stretch is no longer applied.
What is functional excursion
the distance that a muscle is capable of shortening after it has been elongated to its maximum
Which of these is TRUE regarding proper alignment when stretching the hamstring muscles? the ankle should be positioned in full dorsiflexion the hip should be positioned in full extension the knee should be positioned in full extension the pelvis should be positioned in a full posterior tilt
the knee should be positioned in full extension
CREEP vs Stress-Relaxation: What is Stress-Relaxation?
the longer a stretching force is maintained, the more the tension within the tissue decreases, therefore less force is required to maintain the same tissue length.
What is the elastic/linear region of the stress strain curve?
the structure is strained beyond linear region and the tissue returns to the original length after the deforming load is removed
During a home health visit one week after surgery, a PTA inspects the surgical incision. Which of these would warrant contacting the supervising physical therapist for re-evaluation due to the potential development of a post-surgical infection? a small amount of serious drainage mild warmth around the incision site moderate edema throughout the joint tissue necrosis around the sutures
tissue necrosis around the sutures
Static
tissue resistance held in the lengthened position for a sustained period of time - low load, long duration
Which of the following is NOT an immediate goal of active range of motion exercise (pg. 62) to increase proprioceptive and kinesthetic sensory feedback to maintain contractility throughout the available range of motion to promote muscle coordination (for function and return to activity) to stimulate bone and tissue integrity
to promote muscle coordination (for function and return to activity)
Which of the following is NOT a suitable situation for the use of active assisted range of motion exercises? with a patient after a stroke, for a muscle group with 2/5 strength while moving against gravity with a patient after removal of an orthosis, to increase range of motion in a muscle with a contracture with a patient in the return to function phase, when focusing on correct performance of a motion with a patient who has a post-operative condition that does not permit a full, strong muscle contraction
with a patient after removal of an orthosis, to increase range of motion in a muscle with a contracture (we need to stretch)
