Green Module REMEX
Closed Chain Position
Distal end of extremity is fixed to be cognizant that insertion is fixed point/ origin will move towards insertion during muscle contraction, commonly referred to as reverse action of a muscle
Open Chain Exercise
Distal end of extremity is free to move
Open Chain Position
Distal end of extremity is free to move
Ankle Supination Degrees
45-60
Plantar Flexion Degrees
50
Peripheral Joint Mobilization: Sustained
7-10 seconds at each barrier for 1-2 minutes
Training Effect
70%-85% maximum heart rate (220-age)
Components of Physical Function: Stability
Stabilization of body segments to allow distal movements
Peripheral Joint Mobilization: Open-Packed Position For Ankle
10 degrees of plantar flexion
Hip Extension Degrees
10-15
Hip Flexion Degrees
110-120
Knee Flexion Degrees
135
Knee Extension Degrees
15
Ankle Pronation Degrees
15-30
Dorsiflexion Degrees
20
Knee Internal Rotation Degrees
20-30
Peripheral joint Mobilizations: Open-Packed Position For Knee
25 degrees of flexion
Hip Adduction Degrees
30
Hip Internal Rotation Degrees
30-40
Knee External Rotation Degrees
30-40
Hip Abduction Degrees
30-50
Hip External Rotation
40-60
Muscle Relationship: Synergist
"Helper", assists agonist by preventing an unwanted movement
Stretching/ Active Inhibition Technique (AIT): Types of Contractures; Pseudomyostatic
"Pseudo" means "fake", caused by brain/ spinal cord, central nervous system problem/ lesion, resemble myostatic contracture
Biomechanics
"The application of mechanics to the living human body"
Kinesiology
"The study of motion, combining theories and principles of anatomy, physiology, psychology, anthropology, and mechanics"
Peripheral Joint Mobilization: Application Open-Packed Position For Hip
45 degrees, 30 degrees of flexion, 30 degrees of abduction, slight external rotation
Third Class Levers
AFR, most common type of lever in human body, force is between axis/ resistance, tweezers, standing on toes, working hamstrings, quadriceps, biceps, glutes, give speed advantage, type of lever human body has for muscles/ joints
Resistance Exercise: Endurance
Ability to perform sustained low intensity exercise, low intensity, high repetitions, low weights
Resistance Exercise: Strength
Ability to produce tension/ force, high intensity, low repetition, high weights
AA
Active assisted, promote fluid movement/ slight muscle contraction, maintains muscles/ joints
AF
Active free, promote fluid movement/ slight muscle contraction, maintains muscles/ joints
AIT
Active inhibition technique, inhibits tight muscles, decreases muscle tone
AR
Active resisted, contract/ compress tissues, assessment end feel, treatment strengthening
Contraindications to Resistance Exercise
Acute pain, inflammation, joint effusion
Determinants of Resistance Exercise
Alignment, stabilization, intensity, volume, exercise order, frequency, rest interval, duration, mode of exercise, velocity, periodization
Second Law/ Law of Equilibrium (Mass/ Acceleration)
An object at rest/ an object in motion, will stay at rest/ in motion, unless some other force
Pelvis Can Move In Various Ways;
Anterior pelvic tilt, posterior pelvic tilt, lateral pelvic tilt, lateral pelvic tilt, anterior rotation of innominate, posterior rotation of innominate
Components of Physical Function: Balance
Body alignment against gravity
Osteokinematic/ Physiologic Movements
Bone swing, voluntary
Determinants of Force Production
CSA, fibre arrangement, fibre type, length tenstion relationship, recruitment of motor units, speed of contraction
Peripheral Joint Mobilizations: Limitations/ Contraindications
Cannot change disease process
Components of Physical Function: Endurance
Cardiovascular, how long can move for
Pronation of Tarsal (Foot) Joint Biomechanics
Combined movements of dorsiflexion, eversion, forefoot abduction
Supination of Tarsal (Foot) Joint Biomechanics
Combined movements of plantarflexion, inversion, forefoot adduction
Peripheral Joint Mobilization: Direction
Concave/ Convex rule, mobilize restricted movement
Slide
Concave/ Convex rule, points on bone surfaces do not move
Passive Insufficiency
Concept of muscles not being able to maximally lengthen over both joint simultaneously
Active Insufficiency
Concept of muscles not being able to maximally shorter over both joint simultaneously
Stretching/ Active Inhibition Technique (AIT): Types of Contractures; Myostatic
Contracture in muscle, adaptive, fixed with stretching
ROM Advantage
Convergent
Outcomes Oriented Model of Patient Management: Intervention
Coordinate, communicate, document, patient/ client instructions, procedural interventions
Stretching/ Active Inhibition Technique (AIT): Tissue Response to Immobility; Connective Tissue
Crimp pattern straightened very rapidly, as force increases collagen strongly resists lengthening, slow, low intensity stress results in "creep" gradual elongation due to disruption of bonds between collagen fibres
Stretching/ Active Inhibition Technique (AIT): Tissue Response to Immobility; Muscle
Decrease number of myofibrils therefore atrophy/ weakness, if immobilized in a shortened position results in sarcomere absorption, affects length tension relationship causing weakness
Muscle Spindle
Detects length/ velocity, AIT/ agonist contract,muscle approximation to fix, prevents muscle from tearing
Close Chain Exercise
Distal end of extremity is fixed
Posterior Pelvic Tilt
Due to hot hip extensors (hamstrings/ gluteus maximus), bilateral shortness of abdominals
Anterior Pelvic Tilt
Due to short hip flexors (rectus femoris, iliospoas, sartorius, TFL), bilateral shortness of lumbar extensors (quadratus lumborum/ erector spinae)
Posterior Rotation of Innominate
Due to tight ipsilateral hip extensors
Anterior Rotation of Innominate
Due to tight ipsilateral hip flexors
Talocrual (Ankle) Joint Biomechanics
During dorsiflexion, wide anterior part of talus moves into mortise, this causes fibula to rotate laterally/ move superiorly, opposite occurs during plantarflexion
Components of Physical Function
Endurance, muscular work, balance, stability, neuromuscular control, flexibility, ROM, AF, AA, AR, PR, PF, AIT, PJM, balance, cones, muscles, ligaments, tendons, cardiopulmonary system, appendages, joints, flexibility, mobility, proprioception, neurological system, stability
Components of Physical Function: Muscular Work
Endurance, strength, power
Potential Benefits of Resistance Exercise
Enhance muscle performance, increase strength of connective tissue, greater bone mineral density/ less bone demineralization, decreased stress on joints during physical activity, possible improvement in balance, enhanced physical performance during daily living, occupation, recreational activities, positive changes in body composition, enhance feeling of physical well-being, possible improvement in perception of disability/ quality of life
General Rule of Application For Resistance Exercise
Evaluate clients ROM/ strength, explain/ demonstrate procedure, warm up muscles, place client in appropriate position, instruct client to breath, apply resistance to distal end of moving segment, apply appropriate resistance/ give client appropriate instructions, perform appropriate number of repetitions/ sets, incorporate recovery time, cool down
Outcomes Oriented Model of Patient Management: Re-Examination
Evaluate progress/ outcomes, modify prognosis, plan of care, modify intervention
Outcomes Oriented Model of Patient Management
Examination, evaluation, diagnosis, prognosis/ plan of care, intervention, re-examination, referrals/ consultations
AA/ PR ROM Protocol
Explain/ Demonstrate exercise to client, place client in comfortable position that allows appropriate access, support joints, support areas of poor structural integrity, move segment smoothly/ rhythmically through pain-free range, when performing AA ROM ensure client is totally relaxed, when performing AA ROM show client movement/ assist them to perform movement, perform movements in anatomical planes, combine movements, functional patterns, perform 10- 20 repetitions, observe for signs of increased pain/ inflammation
Protocol for Stretching
Explain/ Demonstrate to client, warm up, appropriate position, support limb, grade I distraction, 30 seconds 3 times, slow sustained application, cold application after stretch in lengthened position, use new range (AF/ AR/ ROM using new ROM), CMTO Technique Standard 13
First Class Levers
FAR, skull on spin in human body, axis is between force/ resistance, teeter totter, muscles at back of neck, gives ROM advantage (generally)
Second Class Levers
FRA, leg on ankle joint in human body, resistance is between axis/ force, wheelbarrow, push ups, when treating this classification, gives force advantage
Stretching/ Active Inhibition Technique (AIT): Mechanical Principles of Stretching Connective Tissue: 1) Intensity Impacts Deformation
Failure can occur from one high intensity load/ from many repetitive low intensity loads
Three Classes of Levers
First, second, third
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Stabilization
Fixation of on site of attachment of muscle as stretch force is applied to other bony attachment
Low Grade PJM
Fluid movement, stimulates joint kinaesthetic receptors, used to control pain, nourish articular cartilage
Third Law/ Law of Action & Reaction
For every action, there is an equal/ opposite reaction
Components of Physical Function: Power
Force produced in small unit of time, force/ strength per unit time
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Mode of Stretch
Form/ Manner in which stretch force is applied (static, ballistic, cyclic), degree of participation (passive, assisted, active, source of stretch force (manual, mechanic, self)
Transverse Tarsal (Foot) Joint Biomechanics
Formed by calcaneonavicular joints/ talocalcaneonavicular joints
Muscle Relationship: Fixator
Stabilizes an attachment (usually proximal one) so that muscle can do its job
Exercise Heart Rate
HRrest + 60%-70% [HRmax-HRrest]
Outcomes Oriented Model of Patient Management: Examination
History, systems reviews, tests/ measures
Peripheral joint Mobilizations: Contraidications
Hypermobility, joint effusion (swelling), inflammation (high grade)
Outcomes Oriented Model of Patient Management: Diagnosis
Identifications of dysfunction that will direct intervention, disabilities, signs/ symptoms, impairments, functional limitations
AR ROM Protocol (Stretching)
Identify functional limitations by evaluating client's ROM, explain/ demonstrate procedure to client, have client positioned so that they are comfortable/ stable, warm up tissue, apply appropriate amount of resistance, communicate with client, ensure client continues to breath, monitor for inability to complete ROM, signs of pain/ inflammation, tremors, substitute movements, 6 second contractions, 2-3 sets, 8-12 repetitions
Positive Changes in Body Composition
Increase lean muscle mass, decrease body fat
Perpheral Joint Mobilization: Effects
Increased fluid movement, proprioceptive feedback, decrease pain, increases tissue extensibility
Factors of Resistance Exercise Example
Intensity (exercise load), body position (non-weight bearing/ weight bearing), repetitions/ sets, type of muscle contraction, ROM, plane of movement, speed of movement, neuromuscular control, functional movement patterns
Outcomes Oriented Model of Patient Management: Evaluation
Interpret findings to determine diagnosis, prognosis, plan of care
Tibofemoral (Knee) Joint Biomechanics
Is a modified hinge/ bicondylar joint, allows flexion, extension, rotation, femoral condyles are different shapes, medial condyle is long anteriorly to posteriorly/ therefore tibia "travels" further along medial condyle than on lateral condyle, this results in lateral rotation occurring with extension/ medial rotation with flexion (Modified Helfet's Test)
Types of Contraction
Isometric (static), isotonic (dynamic), isokinetic
Stretching/ Active Inhibition Technique (AIT): Contractile Part
Made of many myofibril/ is under neurological control
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Intensity of Stretching
Magnitude of stretch force applied
Peripheral Joint Mobilizations: Precautions
Malignancy, fractures, joint replacement, systemic connective tissue disease (rheumatoid arthritis/ sclerderma), elderly
Tarsal (Foot)/ Talocrual (Ankle) Joints Biomechanics
Many joints in foot/ ankle to allow configuration of foot to ground, allows for distribution of force to ground
Coccylfemoral (Hip) Joint Biomechanics
Many of these positions are as a result of muscular tension (muscles only pull), pelvis also rotates as a unit to contralateral side when you tale a step, step side for pelvis is internal rotation, During forward bending of your trunk, pelvis, hip (SI joint) must nutate/ rotate posteriorly to maintain balance, as it does so tension increases in myofascial tissue (lumbar erectors, thoracolumbar fascia, glutes, (predominately gluteus maximus), hamstrings), after approximately 45 degrees of trunk flexion facet surface approximate/ together with ligaments, become weight bearing, during posterior pelvic tilt, pelvis, hip (SI joint) counter nutates/ rotates anteriorly to maintain balance, iliofemoral ligament becomes taut/ limits movement
Principles of Resistance Exercise
Strength, power, endurance, overload principle. SAID principle, reversibility principle
Torque
Measure of rotation forced around a fixed axis, amount of torque that can be produced as a given joint is related to length of lever, the longer the lever the more torque that can be produced; Note: Both muscle/ resistance creates torque in lever system
Peripheral Joint Mobilization: Shape of Moving Bone
Movement of shaft of bone ='s swing/ osteokinematic movement, movement of articular surface of bone ='s slide, joint play, arthrokinematic movement, movement of concave moving bone is opposite for swing/ slide in terms of direction of movement, movement of convex moving bone is same for swing/ slide in terms of direction of movement
Accessory Movements
Movements withing joint/ surrounding tissue needed for "normal" ROM, synergists, antagonists, secondary joints that do that specific movement, made up of component motions, types of accessory movements within joints, slide, roll, spin, compression, distraction
Swing
Moves in some direction of roll
Stretching/ Active Inhibition Technique (AIT): Tissue Properties
Muscle contains contractile/ non-contractile elements,
Stretching/ AIT Inhibition Technique (AIT): Mechanical Principles of Stretching; 3)
Must use newly gained range to ensure proper remodeling in order to keep new length
Stretching/ Active Inhibition Techniques (AIT): Non-Contractile Part
Neurological control is largely via GTO/ muscle spindle, made up of connective tissue which is formed by collagen, cells, ground substances (log jam analogy)
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Frequency of Stretch
Number of stretching sessions per day/ per week
Lateral Pelvic Tilt
Once side of pelvis is pulled down due to tight gluteus medius, contralateral quadratus lumborum, contralateral adductors, tight/ contractured, Trendelenburg's Test
Roll
One bone side surface moves on different bone side surfaces so points are different
Muscle Relationship: Antagonist
Opposite muscle to prime mover
Peripheral Joint Mobilization: Duration
Oscillations; 1-2 minutes at restricted barrier
Stretching/ Active Inhibition Technique (AIT): Techniques that Allow for Elongation
PJM, AIT, O&I, muscle approximation, stretching, fascial
Peripheral Joint Mobilizations: Indications
Pain, spasm, joint restrictions, decreased joint health from immobilization
Speed Advantage
Parallel
Muscle Fibres Arranged in Different Patterns:
Parallel, pennate, convergent,
Stretching/ Active Inhibition Technique (AIT): Contracture
Passive adaptive shortening of connective tissue, fascia, ligaments, tendons, joint capsule
PF
Passive forced, stretch/ compress tissues, assessment end feel, treatment stretch
PR
Passive relaxed, promotes fluid movement/ stimulate joint kinaesthetic receptors
Force Advantage
Pennate
PJM
Peripheral joint mobilization
Peripheral Joint Mobilization: Force
Pertains to grade in which therapist needs to provide glide to specific joint
Peripheral Joint Mobilization: Speed
Pertains to oscillations being faster/ slower
High Grade PJM
Stretch joint tissues, increases joint play, restores ROM
PF ROM Protocol (Stretching)
Position client in comfortably/ appropriate position, explain/ demonstrate procedure, warm up area to be stretched, support affected joint, stabilize proximal segment, apply a gentle distraction force to avoid joint compression, apply slow sustained pressure in direction of stretch to a point just beyond tissue resistance (with multi-joint muscles move smaller, distal joints prior to larger, proximal ones), hold stretch for minimum of 30 seconds, 3 repetitions, release, rest, repeat, suggest that client use cold hydrotherapy to help "set" stretch/ use movements that use "new" ROM to functionally integrate it
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Alignment
Positioning a limb/ body such that stretch force is directed to appropriate muscle group
Use of Isometric Contraction
Prevent muscle atrophy during injury, re-establish neuromuscular control, postural stability, when dynamic strengthening contraindicated develop static strength
Muscle Relationship: Agonist
Prime mover, muscle doing action
Outcomes Oriented Model of Patient Management: Referrals/ Consultations
Problem outside scope of practice, need for complimentary service
Outcomes Oriented Model of Patient Management: Prognosis/ Plan of Care
Projection of optimal level/ time frame of improvements, description of patient/ client management anticipated goals, expected outcomes, frequency/ duration of interventions, discharge plan
Peripheral Joint Mobilization: Stabilization
Proximal to joint therapist wants to mobilize, mobilize joint distally
Muscle Fibre Arrangement Affords Muscle Different Advantages
ROM advantage, speed advantage, force advantage
ROM
Range of motion
Resistance Exercise: Power
Rate at which muscle produces force
Strength VS. Endurance
Repetitions/ Sets (concept of repetition maximum (RM)), educational guess of persons amounts ability of repetitions they can do, D.A.P.R.E. method, intensity, duration, type of exercise
Enhanced Muscle Performance
Restoration, improvement/ maintenance of muscle strength, power, endurance
Stretching/ Active Inhibition Technique (AIT): Types of Contractures; Fibrotic
Restriction caused by inflammation/ scar tissue formation, irreversible, frictions to fix
Stretching/ Active Inhibition Technique (AIT): Types of Contractures; Arthrogenic
Restriction in joint capsule/ ligament, adaptive, joint restrictions, PJM to fix
Arthrokinematic Movement
Roll, spin, slide in joint movements, involuntary
Use of Isotonic Eccentric Contraction
Same as concentric, may lead to delayed onset muscle soreness (DOMS), less motor unit recruitment means often used in early rehabilitation
Use of Isotonic Concentric Contraction
Same as isometric but indicated to use when movement is not contraindicated
Isometric (Static)
Same length, muscle setting (engage muscle/ use for strains/ sprains), multi-angle (contract muscle through many angles), medium amount of force generated
Isokinetic
Same speed
Isotonic (Dynamic)
Same tone, concentric (move toward body/ closed chained/ least amount of force generated), eccentric (move away from body/ open chained/ most amount of force generated)
GTO
Senses tension in muscle, AIT/ hold relax, O&I, C-bowing, S-bowing to fix
Components of Physical Function: Neuromuscular Control
Sensory/ Motor systems coordinated
Resistance Exercise: SAID Principle
Specific Adaptation To Imposed Demands
Other Factors to Keep in Mind
Specificity, individualization, maintenance vs. improvement, plateau
Stretching/ Active Inhibition Technique (AIT): Determinants of Stretching; Speed of Stretch
Speed of initial application of stretch force
Progression of Resistance Exercise Example
Submaximal -> Maximal/ Near maximal; Variable: Depending on pathology/ impairments/ weight-bearing restrictions, pain, swelling, instability, goals of rehabilitation program; low volume -> high volume; Concentric/ Eccentric: Variable progression; short arch -> full arch, stable position of range -> unstable portion of range, uniplanar -> multiplanar, slow -> fast velocities, proximal -> distal control, simple -> complex, single joint -> multi joint, proximal control -> distal control
Tarsal (Foot) Joint Biomechanics
Subtalor, talocalcaneonavicular, calcaneonavicular joints, allow for pronation/ supination, in general, distal bone forming a tarsal joint, concave from superior to inferior, convex from superior to inferior
Remedial Exercise
Systemic and planned performance of bodily movements, postures and physical activities intended to remediate and prevent impairments,and enhance and restore physical function, organized/ planned movements, fix/ prevent problems/ make person better
Increased Strength of Connective Tissue
Tendons, ligaments, intramuscular connective tissue
First Law/ Law of Inertia
The more mass an object has the more it wants to keep moving in a given direction acts upon it
Passive Insufficiency: Two Joint Muscle Crosses At Least Two Joints
These muscles cannot maximally lengthen over both joint structures simultaneously
Active Insufficient: Two Joint Muscle Crosses At Least Two Joints
These muscles cannot maximally shorten over both joints simultaneously
Newton's Law
Three laws that relate to objects/ how they interact with their environment, first law/ law of inertia, second law/ law of equilibrium (mass/ acceleration), third law/ law of action & reaction
Stretching/ Active Inhibition Technique (AIT): Mechanical Principles of Stretching Connective Tissue: 2)
Tissues healing capabilities can handle repetitive loads if given time
Stress Strain Curve
Toe region, elastic range, elastic range, plastic range
Determining Endurance Intensity
Training effect/ exercise heart rate
Peripheral Joint Mobilizations: Low Grade (Grade I/ II)
Used to control pain, create synovial fluid movement to decrease swelling, nourish articular cartilage
Peripheral joint Mobilization: High Grades (Grade III/ IV)
Used to increase joint play, used to restore ROM, stretched joint capsule
Resistance Exercise Precautions
Valsava maneuver (holding breath), fatigue, exercise recovery, over-training, substitute motions, osteoporosis, DOMS, cardiovascular, geriatrics
Stretching/ Active Inhibition Technique (AIT): Hypermobility
decreased movement due to prolonged immobilization, pain, inflammation, bony block, soft tissue restriction
