Ther Ex Final Exam Review

AROM and AAROM goals

Activate proprioceptors in muscles. Stimulate bone and joint health. Develop coordination/motor skills. Prevent DVT

Physiologic Motion

Active (voluntary) movement by the patient (traditional motions, like flexion, extension, etc). angular motion of body segment.

AROM

Active range of motion. motion induced by active mm contraction

Glenohumeral Joint Capsular Pattern

ER, Abd, IR

Thoracic Vertebrae

costal facets, spinous process angled sharply, inferiorly

Hypomobility

decreased or restricted mobility or motion, caused by adaptive shortening of soft tissue

Precision/pinch grip

pad to pad, pad to tip, pad to side

D1 Flexion UE

shoulder: flexion, adduction, external rotation Elbow: flexion or extension Forearm: supination Wrist: flexion, radial deviation Fingers: flexion, adduction Hand placement (R UE): place index and middle fingers of your R hand in the palm of the patietns right hand and your L hand on the volar surface of the distal forearm or at the cubital fossa of the elbow.

Mobilization/Manipulation

Passive, skilled manual therapy techniques applied to joints and related soft tissues at varying speeds and amplitudes using physiological or accessory motions for therapeutic purposes.

Common thoracic/lumbar spine pathologies:

Postural Stress / Strain / Loss of Mobility Non-Specific Low Back Pain Spondylopathies Osteoporosis / Compression Fractures Sprains/Strains Degenerative Disc or Joint Disease (DDD, DJD) Spinal Stenosis Radiculopathies Segmental Instability Ankylosing Spondylitis

Acute Stage of Injury

Protection phase. Clinical Signs Inflammation Pain BEFORE tissue resistance (due to mm guarding) PT Goals Control inflammation and effects Prevent adverse effects of rest Management Educate on protective measures Control pain, edema, spasm (modalities) Maintain soft tissue integrity (gentle isometrics, PROM, etc)

Reactive assessments

Push and release test: the patient leans back pressing on the hands of the examiner; the examiner then suddenly removes their hands. Scores are based on the patient's correctional response when trying to regain balance. Scoring criteria are as follows: 0= recovers independently with 1 step of normal length and width 1= two to three small steps backward, but recovers independently 2= 4 or more steps backward, but recovers independently 3= steps but needs to be assisted to prevent a fall 4= falls without attempting a step or unable to stand without assistance Pull test: subject stands in a comfortable stance with eyes open (have feet shoulder width apart if they assume an unusually wide or narrow stance.) examiner stands behind the subject. The suject is instructed to do whatever it takes to not fall and are told that the examiner will catch them if the do fall. The examiner gives a sudden, brief backward pull to the shoulders with sufficient force to cause the subject to have to regain their balance. The subject should not know exactly when the pull is coming. Scoring is from 0 to 4 with 0= recovers independently may take 1 or 2 steps or an ankle reaction; 1= three steps or more backward but recovers independently; 2= retropulsion, needs to be assisted to prevent fall; 3= very unstable, tends to lose balance spontaneously; 4= unable to stand without assistance (UPDRS method) Interventions: Standing perturbations (all directions, small/large, fast/slow). Catching a ball (vary size/weight). Balance beam. SLS while looking or reaching in different directions.

Chronic Stage of Injury

Return to Function Phase Clinical Signs NO inflammation Pain AFTER tissue resistance PT Goals Improve tensile quality of scar Develop functional independence (functional, specific exercises) Management Educate (safe progression of activities) Restore mobility (more aggressive stretching/exercise) Improve neuromuscular control and endurance Progress resistance to functional levels Increase complexity of exercise (multi-plane, WB, etc) Increase repetitions, speed, etc Improve cardiovascular endurance Progress functional activities

Static Assessments

Romberg Sharpened Romberg Single leg balance stance test Stork stand test Interventions: Maintain a posture or position while: varying support surface, varying BOS, incorporating external loads.

D1 Extension uE

Shoulder: extension, abduction, internal rotation Elbow: flexion or extension Forearm: pronation Wrist: extension, ulnar deviation Fingers: extension, abduction Hand Placement (R UE): grasp the dorsal surface of the patients hand and fingers with your R hand using lumbrical grip. Place your L (R) hand on the extensor surface of the arm just proximal to the elbow.

D2 Flexion UE

Shoulder: flexion, abduction, external rotation Elbow: flexion or extension Forearm: supination Wrist: extension, radial deviation Fingers: extension, abduction Hand placement (R UE): grasp the dorsum of the patients hand with your L hand using lumbrical grip. Grasp the dorsal surface of the patients forearm close to the elbow with your R hand

SAID

Specific adaptation to an imposed demand

spine pathology IVD extension exercises

Stabilization Exercises Gentle Mobilizations Avoid Flexion-BiasedExercises!!

spine pathology compression fractures/osteoporosis

Strengthen Mid-Thoracic Region Scapular Retraction Lower Trap Rows Stretch anterior musculature Shoulder IR & Horiz. Adductors Stabilization Exercises To improve control during lifting/motion NO FLEXION-BIASED EXERCISES!! Also avoid high-impact exercise

Shoulder Bursae

Subdeltoid Subacromial Subscapular: continuous with synovial capsule Subcoracoid

Force Couples- anterior/posterior rotator cuff

Subscap: inf/med Infraspinatus: inf/med Teres Minor: inf/med

Rotator Cuff Muscles

Subscapularis, infraspinatus, supraspinatus, teres minor

Shoulder capsular ligaments

Superior GH Lig: stabilizes inferiorly Middle GH ligament: stabilizes anteriorly Inferior GH ligament: ant/post Bands, Axillary pouch, stabilizes ant/post with shoulder at 90/90

Acromioclavicular Joint

Synovial Planar Joint Articular Disk Stabilized by coracoclavicular ligaments: conoid ligament, trapezoid ligament

Functional Excursion

The distance a muscle is capable of shortening after being fully elongated Strength: the extent that the contractile elements of muscle produce force.

Functional assessments

Tinetti Timed up and go Berg balance scale 4 square step test Dynamic gait index Interventions: assesses individuals ability to modify balance while walking in the presence of external demands Multi-task activities, recreational activities, reaching practice Safety during locomotion:

AROM AND AAROM Indications

To mobilize joints proximal/distal to immobilized joint For aerobic conditioning To relieve stress from sustained postures To help weak mm work through full range (AAROM)

Stretching Indications

Treat/reduce activity limitations due to decreased tissue extensibility: adhesions, contractures, scar tissue formation To reduce/prevent structural deformities To reduce/prevent musculoskeletal injuries or soreness (warm up/cool down).

Passive Insufficiency

Two-joint muscle on opposite side (antagonist) is in an extremely LENGTHENED position (stretched across two joints simultaneously so much that full range of motion cannot be achieved.

Force Couples- serratus anterior

UT: sup/med LT: inf/med SA: sup/lat

Balance Exercise Progression

Uninvolved-involved seated-standing double leg- single leg eyes open- eyes closed stable surface- unstable surface static- dynamic No perturbations- Perturbations small/slow- large/fast upper body still- reaching/lifting wide BOS- Narrow BOS

Active Stretching

Uses agonists and synergists as stretch force

Common Cervical Spine pathologies:

Whiplash Cervical Myelopathy Tension Headache Cervicogenic Headache TMJ Dysfunction Nonspecific Neck Pain Radiculopathies

Zygapophyseal Joint

Zygo= union, apophysis= outgrowth. Composed of: inferior articular facet of superior vertebra, superior articular facet of inferior vertebra, joint capsule and reinforcing ligaments.

Dynamic Stretching

a controlled movement through the active ROM for each joint.

Roll

a series of points on one articulating surface come into contact with a series of points on another surface. roll occurs in the same direction as angular movement. Usually occurs in combination with sliding or spinning.

Pronation

abduction, eversion, dorsiflexion

AAROM

active assisted range of motion. external assistance provided to help with weak active muscle contraction

Supination

adduction, inversion, plantarflexion

BOS

base of support: the perimeter of contact area between the body and its support

Wrist Anatomy

bones: radius, carpals. Ligaments: ulnar and radial collateral, dorsal and volar radiocarpal, ulnocarpal, intercarpal, radiocarpal joint arthrokinematics: concave radius, convex proximal carpals

Endurance

broad term that refers to the ability to perform repetitive or sustained activities over a prolonged period of time.

Power Grips

cylindrical, spherical, hook, lateral

Knee Anatomy

distal femur, proximal tibia, patella, fibula, menisci Patella: quadriceps tendon attaches the quadriceps to the patella. Patellar tendon attaches patella to the anterior tibia. Retinacular fibers support and stabilize the patella. Ligaments: ACL: anterior cruciate ligament, PCL: posterior cruciate ligament, MCL: medial collateral ligament, LCL: lateral collateral ligament Knee Muscles: quadriceps, hamstrings, gastrocnemius, TFL, sartorius, gracilis

Eccentric exercise

higher load capacity, greater gains in mass/strength, adaptations: mode/velocity specific, more efficient (less fatigue), post exercise soreness is more often/severe, effect on body segment decelerates, muscle force<load

D1 Extension LE

hip: extension, abduction, internal rotation Knee: flexion or extension Ankle: plantarflexion, eversion Toes: flexion Hand Placement (R LE): place your R hand on the plantar and lateral surface of the foot at the base of the toes. Place your L hand (palm up) at the posterior aspect of the knee at the popliteal fossa.

D2 Extension LE

hip: extension, adduction, external rotation Knee: flexion or extension Ankle: plantarflexion, inversion Toes: flexion Hand placement (R LE): place your R hand on the planter and medial surface of the foot at the base of the toes and your L hand at the posteromedial aspect of the thigh, just proximal to the knee.

D2 Flexion LE

hip: flexion, abduction, internal rotation Knee: flexion or extension Ankle: dorsiflexion, eversion Toes: extension Hand placement (R LE): place your R hand along the dorsolateral surface of the foot and your L hand on the anterolateral aspect of the thigh just proximal to the knee. The fingers of your L hand should point distally.

D1 Flexion LE

hip: flexion, adduction, external rotation Knee: flexion or extension Ankle: dorsiflexion, inversion Toes: extension Hand placement (R LE): place your R hand on the dorsal and medial surface of the foot and toes and your L hand on the anteromedial aspect of the thigh just proximal to the knee

Overload

improved muscle performance requires that "the muscle must be challenged to perform at a level greater than that to which it is accustomed"

PNF Stretching

integrates active muscle contractions into stretching to inhibit or facilitate muscle activation. Goal is to relax muscle to be stretched via autogenic or reciprocal inhibition (may be more complex than this). Relaxes only contractile structures, not connective tissue in and around muscles. Hold Relax Contract Relax Agonist Contract Hold Relax with Agonist Contract

Mobilization Grade III/IV

large (III) or small (IV) amplitude rhythmic oscillating movement up to the limit of the available motion and stressed into tissue resistance. used to gain motion. stretches the capsule.

Mobilization Grade II

large amplitude rhythmic oscillations are performed within the range, not reaching the limit (2-3 per second) manage pain and spasm, move synovial fluid

Center of Pressure

location of the vertical projection of the ground reaction force

Traction

longitudinal pull along long axis

Segmental Stabilization

longus colli, rectus capitis anterior/lateralis. TrA: via tightening of thoracolumbar fascia. Multifidus. Quadratus lumborum (deep fibers). Intertransversarii and rotators

Concentric exercise

lower load capacity, smaller gains in mass/strength, less specific adaptations, less efficient (more fatigue), post exercise soreness is less often or severe, effect on body segment: accelerates, muscle force>load.

Spin

occurs when one bone rotates around a stationary longitudinal mechanical axis. the same point on the moving surface creates a circular arc as the bone spine. Does not occur in isolation during normal joint motion.

Transfer of Training

overflow or cross-training effect. The more similar we can make a training activity the more it will benefit the patient in the actual activity they will be needing to perform.

PROM

passive range of motion. motion induced by external force

Glide

passively induced slide. the same point on one surface comes into contact with a series of points on another surface.

Hip anatomy

pelvis-divided into 3 areas. Ilium- upper two fifths. Ischium- posterior and lower two fifths. Pubis-anterior and lower one fifth Femur: head, neck greater trochanter, lesser trochanter Hip muscles- flexion Primary: iliopsoas, rectus femoris, sartorius, tensor fasciae latae. Secondary: pectineus, adductors, gracilis Hip muscles- extension Primary: gluteus maximus, hamstrings. Secondary: Adductor magnus, Piriformis, Gluteus Medius Hip muscles- Abduction Primary: gluteus medius, gluteus minimus, tensor fasciae latae. Secondary: sartorius, piriformis Hip muscles- adduction Primary: adductor magnus, adductor longus, adductor brevis, pectineus, gracilis. Secondary: quadratus Femoris, obturator externus, gluteus maximus Hip muscles- internal rotation Secondary: gluteus medius, gluteus minimus, tensor fasciae latae, adductors, pectineus Hip muscles- external rotation Primary: gluteus maximus, piriformis, quadratus femoris, obturator internus/externus, inferior/superior gemelli. Secondary: gluteus medius/minimus, sartorius

Muscle Strength

refers to the extent that the contractile elements of muscle produce force.

Muscle Power

related to the strength and speed of movement and is defined as the work (force x distance) produced by a muscle per unit of time (force x distance/time)

Distraction

separation or pulling apart (line of pull is perpendicular to the joint surfaces)

D2 Extension UE

shoulder: extension, adduction, internal rotation Elbow: flexion or extension Forearm: pronation Wrist: flexion, ulnar deviation Fingers: flexion, adduction Hand placement (R UE): place the index and middle fingers of your R hand in the palm of the patients hand and your L hand on the volar surface of the forearm or distal humerus.

Ankle Anatomy

skeletal: talus, calcaneus, tarsals (navicular cuboid, cuneiforms), metatarsals, phalanges. Foot/Ankle Joints: inferior tibiofibular joint, talocrural joint, subtalar joint, transverse tarsal joint (talonavicular joint and calcaneocuboid joint), intertarsal, TMT, MTP, IP joints. Ankle Muscles: Plantar flexion: gastrocnemius, soleus, tibialis posterior, flexor digitorum longus, fibularis long/brev. Dorsiflexion: tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius Ankle Ligaments: Medial: deltoid ligament (anterior/posterior tibiotalar, tibiocalcaneal, tibionavicular) Lateral: anterior talofibular, posterior talofibular, calcaneofibular

Convex/Concave

slide is opposite the direction of angular motion. Concave: Slide is same as the direction of angular motion

Mobilization Grade I

small amplitude rhythmic oscillating movement at the beginning of range of movement (rapid, like a vibration) manage pain and spasm, move synovial fluid

Manual Stretching

stretch force provided by therapist. Therapist controls parameters. Can be static, cyclic, passive, or assisted, PNF

Mobility

the ability of body structures or segments to move so that range of motion for functional activities is allowed.

Flexibility

the ability to move a single joint or series of joints through pain-free, unrestricted movement.

Contracture

the adaptive shortening of the muscle-tendon unit and other soft tissue that surround or cross a joint = decreased ROM. Named for action of shortened tissue. Not synonymous with contraction. Can occur within the joint (arthrogenic) or in surrounding tissues (periarticular). Normal muscle/connective tissue may become fibrotic.

Limits of stability

the sway boundaries that can be maintained without changing the BOS. 12 degrees A->P and 16 degrees laterally

Lumbar Vertebrae

thickest discs, largest vertebral bodies

Cervical Vertebrae

transverse foramen, C1-C2 Unique

Glenohumeral Joint

triaxial joint. Mobility vs. stability. Articulations: glenoid fossa, humeral head (3-4x bigger than glenoid) Loose packed position: 55 deg abd, 30 deg horizontal add Close packed position: end range abd/ER Capsular pattern: ER, Abd, IR

Active Insufficiency

two-joint muscles (agonist) is in an extremely SHORTENED position (contracts across two joints simultaneously) so much that full range of motion cannot be achieved.

Manual Resistance

type of active resistive exercise in which external resistance is provided by a therapist or other health professional.

Relaxation techniques for spine pathology

(Stress often contributes to pain) Systematic AROM Conscious Relaxation Training

Mobilization Grade V

(high velocity low amp. thrust or HVLAT) small amplitude, high velocity, starts at point of resistance

Global Stabilization

(like guy wires) erector spinae, rectus abdominis

Local Endurance

(muscle endurance): the ability of a muscle to contract repeatedly against an external load, generate and sustain tensions, resist fatigue over an extended period of time.

Cardiopulmonary Endurance

(total body endurance): associated with repetitive, dynamic motor activities, such as walking, cycling, swimming, or upper extremity ergometry, which involve use of the large muscles of the body.

Open Packed Position- Glenohumeral Joint

55 deg Abd, 30 deg horizontal Add

Dynamic assessments

5x sit to stand test Functional reach Star excursion balance test Interventions: Move the support surface, move other body segments, move an external load, jumping, hopping, stepping, lunging

Ballistic Stretching

A rapid, forceful intermittent stretch that is a high velocity and high intensity stretch. Characterized by fast joint movement that quickly elongates the targeted soft tissues.

PROM Indications

Acute, inflamed tissue, precludes use of AROM Patient not able/allowed to actively more a segment

Joint Mobilization Application

All joint mobilizations follow the convex-concave rule •Patient should be relaxed & comfortable •Explain purpose & expectations (how will it feel?) •Evaluate motion BEFORE, & pt response AFTER treatment •Stop the treatment if it is too painful for the patient •Use proper body mechanics •Use gravity to assist the technique if possible •Begin & end treatments with Grade I or II oscillations

Motor Strategies:

Ankle strategy (sagittal plane): elicited by small range, slow velocity perturbation. Muscles contract distal to proximal. Weight-shift strategy (frontal plane): elicited by lateral perturbations. Activates primarily hip muscles. Also can activate ankle muscles Suspension strategy (sagittal plane): used to lower the COM to allow greater control. Important when both mobility and stability are required. Hip strategy (sagittal plane): elicited by greater (larger range, faster) perturbations. Muscles contract proximal to distal Stepping strategy (all planes): elicited through: unexpected perturbations in static standing, perturbation that puts COM outside BOS. Includes stepping and/or reaching to widen/move BOS or regain new BOS

Precautions and contraindications for ROM

Avoid, if detrimental to the healing process Example: multiple or unstable fx's, external fixation devices, new tendon/cartilage repair Avoid, if patient response or condition is life-threatening Stop if it causes pain/inflammation

Elbow Anatomy

Bones: humerus, ulna, radius Ligaments: annular, medical collateral, lateral collateral. Joints: humeroradial, humeroulnar, proximal radioulnar, distal radioulnar Motions: flexion/extension, sup/pronation Elbow and forearm muscle function: ElbowFlexion•Brachialis•Biceps Brachii•Brachioradialis. Elbow Extension•Triceps Brachii•Anconeus. Supination•Supinator•Biceps Brachii•Brachioradialis. Pronation•Pronator Teres•Pronator Quadratus

Hand anatomy

Bones: metacarpals, phalanges Ligaments: transverse CMC, longitudinal CMC, Collateral MCP and IP, Volar MCP and IP Arthrokinematics: IP: distal partner is concave, MCP: concave phalanx, CMC 2-5: concave MC, CMC thumb: MC is concave in flex/ext, and convex in abd/add Muscles of Hand: palmar interossei (adduction of fingers) dorsal interossei(abduction of the fingers) lumbricals (MCP flexion IP extension)

Stretching Contraindications

Bony block Unhealed fracture Acute inflammation or infection Sharp pain with movement Hematoma Hypermobility Hypomobility is desired. Improves function and provides needed stability

Acute physiologic response to exercise:

Cardiovascular Increased HR (increased freq. of SA node depolarization) Increased myocardial contractility Increased cardiac output Increased systolic blood pressure Decreased total peripheral resistan Respiratory Increased alveolar ventilation TV and RR increase (minute ventilation)

Chronic physiologic adaptations to exercise:

Cardiovascular: Decreased resting HR and BP Increased blood volume and hemoglobin Decreased VO2 at submax (only if efficiency of motion improves) Increased VO2 max Muscle: Increased myoglobin and capillary density Increased number and size of mitochondria Increased concentration of enzymes that help speed ATP formation via oxidative metabolism (Changes above all help increase O2 use by muscle) Respiratory: In a person with healthy lungs, respiratory ability should not limit aerobic exercise. We can all move plenty of air. Lack of blood flow to both the lungs and the muscles is usually the limiting factor, Larger lung capacity (no not really, TLC is based on height/rib cage diameter which don't change) Greater diffusion capacity (more alveolar surface area) (the # of alveoli doesn't change, we breathe more deeply so we use more of the alveoli we always had and most importantly we can send more blood to lungs to pick up more O2 and drop off more CO2) Increased maximal ventilation capacity- respiratory muscles (diaphragm, intercostals) can contract more efficiently and rapidly to move larger volumes of air per minute

Subacute Stage of Injury

Controlled-Motion Phase Clinical Signs Decreasing inflammation Pain AT tissue resistance PT Goals Mobilize Scar Promote Healing (controlled exercises) Management Educate (HEP, expectations, etc) Promote healing (wean from splints, progress HEP) Restore mobility (progress PROM->AROM) Improve neuromuscular control Multi-angle isometrics Stabilization exercises Progress to resistance as tolerated Integrate function (start to try light functional activities)

PROM Goals

Decrease complications from immobilization such as cartilage degeneration, adhesions, contracture and impaired circulation. Decrease or inhibit pain. Assist with the healing process after an injury or surgery. Increase kinesthetic awareness.

spine pathology instability

Deep Segmental Stabilization: Bridging Progressions "Bird Dog" "Dead Bug" Global Stabilization: Superman Crunches Side Bridge Reps

Force Couples- deltoid- rotator cuff

Deltoid pull superolaterally and RC pulls inferomedially Net result: upward rotation with joint compression

spine pathology muscle performance

Dynamic Stabilization Exercises Deep Segmental Global Muscle Endurance Exercises Strength/Power Exercises

Stress-Strain Curve

Elasticity: (contractile and non-contractile) returns to pre-stretch length after short duration stretch. Plasticity: (contractile and non-contractile) ability to assume new and greater length after the stretch force has been removed.

Static Stretching

Elongate just past point of tissue resistance. Sustained stretch force in lengthened position. Utilizes autogenic inhibition. Duration depends on goal (5 sec to 5+ min) may be done manually or self-stretch, passive or active.

Muscle Anatomy- noncontractile elements

Endomysium, perimysium, and epimysium, tendon, ligament, skin Has the ability to resist deforming forces Contracture= adhesions in and around the collagen fibers that resist and restrict movement Tissue composition Collagen: strength and stiffness of tissue, resist tension Elastin: provide extensibility (but fails easily) Reticulin: provide tissue with bulk Ground substance: organic gel containing" Water: reduces friction, maintains space between fibers Proteoglycans: hydrate matrix, resist compressive forces Glycoproteins: linkage between matrix components

Shoulder Labrum

Fibrocartilage ring Deepens the fossa Provides negative intra-articular vacuum effect Has attachments to the capsule Biceps long head is anchored at superior labrum

spine pathology spondylopathy

Flexion-based approach; NO EXTENSION!!! Stretch hip flexors Strengthen abs and hip abductors Educate on flexed position (posterior pelvic tilt) Stabilization Exercises Gentle Mobilizations

Mechanical Resistance

Form of active-resistive exercise in which external resistance is applied through the use of equipment or mechanical apparatus. Mechanical resistance is useful when the amount of external resistance necessary is greater than what the therapist can pally manually

FIVVDRM

Frequency: number of exercise sessions per day or per week. Decreases with increased intensity/volume Intensity: "exercise load" (amount of resistance). "1 Rep Max" used in weight-lifting. May also include velocity of motion. Higher risks involved at higher intensity Volume: total number of reps and sets in single session. Will depend on goal (strength, power, endurance) Velocity: Speed at which exercise is performed. Affects how much force can be produced. Concentric: high speed = low force. Eccentric: high speed = high force (initially). Limited transfer of training to other velocities. Duration: total length of exercise program. Need 6-12 weeks for muscle hypertrophy Rest: frequency and duration of rest breaks. More needed for higher intensity. Consider how much between sets AND sessions. Mode: Includes: form of exercise, type of contraction, manner/position in which the exercise is performed

Aerobic

Fuel Source: glycogen, fats and proteins. Oxygen required. Low max power potential. Large max capacity. Predominates after 2 minutes

Phosphagen (ATP-PC) energy system

Fuel source: PC/ATP stored in muscle. no oxygen required. high max power potential. small max capacity. predominates 1st 30 seconds.

Anticipatory assesments

Functional reach Star excursion balance test Interventions: Reaching activities, kicking or throwing a ball, obstacle course, lifting (vary weights, heights, shaped, etc.)

Anaerobic energy system

Glycogen or glucose is energy source. No oxygen required. intermediate max power potential. intermediate max capacity. predominates 1st 30-90 seconds

ICF Model

ICF Model shows how our ability to function is an interaction Between our health condition and extrinsic as well as intrinsic factors Know what falls in each category.

Advantages of Closed chain exercises

Increase joint compressive forces Decreased shear forces Decreased acceleration forces Stimulation of proprioceptors Co-activation and co-contraction

Advantages of Open Chain Exercises

Increased acceleration forces Increased distraction and rotational forces Can isolate to single joint motion Work other joints in a NWB Work joints adjacent to inflamed/swollen joints

Accessory Motion

Joint motions necessary for normal ROM, but cannot be actively performed by the patient (joint play). roll, slide/glide/translation, spin, compression, distraction.

LLLD

Low load long duration stretching (can be 10+ minutes)

Balance

Maintaining COG within BOS

Spine Pathology mobility and flexibility

Manipulation/Mobilization Muscle Energy Stretching

Spine pathology aerobic conditioning

Moderate to high intensity conditioning shown to reduce LBP Need to tailor the activity to the individual & pathology Biking: Road biking is a flexion-oriented activity not recommended for IVD pathology—may try stationary recumbent bike Walk/Run: Extension-oriented (not recommended for stenosis) Elliptical: Emphasizes extension Lower Extremity Strengthening—especially gluteals and quads

Muscle Anatomy- contractile elements

Muscle ->fiber->myofibril->sarcomeres->myofilaments (actin/myosin) Stretch force transmitted to sarcomeres by non-contractile tissues Responds to prolonged stretch by adding sarcomeres in series Responds to prolonged shortening by reducing sarcomeres Effects are transient if new ROM not used functionally Physiological properties of contractile tissue Muscle spindle: sensory organ of muscle, responsive to quick and sustained stretch Function: sense and control changes in the length of a muscle and the velocity of length changes Golgi Tendon Organ (autogenic inhibition): sensory organ located near musculotendinous junctions Function: protect muscle from excessive tension by inhibiting the muscle being stretched

spine pathology kinesthetic awareness

Neutral Spine Pelvic Tilt Cervical Retraction (Chin Tuck) Control of spine position (static & dynamic) Awareness of "pain-free zone"

Intervertebral Disc

Nucleus pulposus: gelatinous center, function: allows motion and provides shock absorption Anulus fibrosus: tough outer fibrous ring that surrounds the nucleus pulposus. Function: restrains nucleus and limits motion (complex ligament). Weakest in posterolateral corners