Ther-Ex Final

What would be a typical patient response to stretching the wrist palm down hanging off the table?

"I feel a slight pulling in my wrist and forearm"

A maximum ______ (a) contraction produces less force compared to a maximum _____ (b) contraction under the same conditions.

(a) concentric (b) eccentric

For untrained individuals participating in resistance training exercise, what is the recommended starting point for time under tension?

1-2 seconds

Neurodynamic Testing/Exercises Contraindications

1. Acute or unstable neuro signs 2. Cauda equina symptoms; B/B, perineal sensation 3. Spinal cord injury 4. Neoplasm or infection

What was listed as a contraindication to neurodynamic exercises?

1. Acute or unstable neuro signs 2. Cauda equina symptoms; B/B, perineal sensation 3. Spinal cord injury 4. Neoplasm or infection

Neurodynamic Testing/Exercises Precautions

1. Be aware of other tissues/positions 2. Assess tissue irritability 3. Gradual progression 4. Cation with active disease or other pathology 5. Vascular compromise due to close proximity to nervous system

Contraindications to Stretching

1. Bony block limits motion 2. Recent fracture/incomplete healing 3. Acute inflammatory or infectious process 4. Sharp, acute pain (not normal response) 5. Hematoma or extensive tissue trauma 6. Joint hypermobility 7. Shortened soft tissues beneficial for the patient's situation in terms of providing stability to a joint

Precautions for stretching?

1. Don't force the stretch 2. Concerns for bone mineral density (ex. osteoporosis) 3. Lever arms - torque at a joint - a longer lever arm will create greater torque which will influence the force of the application in the tensile load through the target tissue 4. Prior immobilization - use cation because they lose their tensile strength after prolonged immobilization 5. Progression and muscle soreness - pain more than 24 hrs - adjust dosage; too much force or stretch being applied

What are guidelines for teaching self-assisted ROM?

1. Educate - on value of motion or exercise being prescribed 2. Teach correct alignment and stabilization 3. Observe performance and correct as necessary 4. Ensure safe and effective use of equipment 5. Provide specific guidelines/drawings for exercise + dosing - teach back technique to ensure understanding 6. Follow up visit - review exercises

Neurodynamic Tests

1. Every joints in the chain needs to be examined separately 2. Additional tests for nerve function 3. Test v. treatment positions 4. Test uninvolved side first 5. Active before passive - sense of level of irritability and willingness to move in those positions *Nerve palpation, sensation testing, reflex testing, dexterity testing, muscle testing

Signs and symptoms of impaired nerve mobility

1. History - pain is the most common symptom - monitor mobility. Pts may complain of stretch pain or paresthesias such as numbness and tingling when the tissues are in a neural stretch position 2. Neurodynamic tests - clinical tests used to detect tension or compression in the neural tissue *Both vascular and mechanical factors can contribute to nerve pathology

What are the main highlights of a resistance training program design?

1. Minimum 1 set, 8-12 reps for strengthening 2. Frequency: at least 2 days/week 3. Order: Larger, multi-joint exercises first 4. Progression: 2 for 2 Rule 5. Intensity: Borg CR-10 Scale

What are resistance training program design elements?

1. Needs analysis 2. Exercise selection 3. Training frequency 4. Exercise order 5. Training load and repetitions 6. Volume 7. Rest Period

For neurodynamic tests, what are the 4 requirements to be considered a positive test?

1. Reproduce pt's symptoms 2. Side-side differences 3. Support exam findings 4. Sensitizing maneuvers differentiate symptoms

For a (+) neurodynamic test

1. reproduce patient's symptoms (within that nerve distribution) 2. Side-side differences 3. Support exam findings 4. Sensitizing maneuvers differentiate symptoms (whether there is a nerve mobility issue)

The physiological overflow of isometrics is minimal, where it occurs no more than ______ degrees in either direction from the angle in which exercise is performed.

10

A patient expresses they would like to train for muscle endurance, but are unsure of which training parameters to use. Which of the following would be most appropriate to help the patient reach their goal? 5 reps (85% 1 RM) X 3 sets, 2 min of rest 8 reps (70% 1 RM) X 3 sets, 30 sec of rest 10 reps (65% 1 RM) X 3 sets, 20 sec of rest 2 reps (75% 1 RM) X 3 sets, 3 min of rest

10 reps (65% 1 RM) x 3 sets, 20 sec of rest

You are using the DeLorme technique for prescribing muscle strengthening. You determined your patient has a 10 RM of 200 lbs for a squat exercise. How much resistance should be applied for the 1st set (same session)?

100 lbs

What is a typical PRE (progressive resistance exercise) program?

2-3 sets 6-12 reps 6-12 RM

For repetitions in reserve-based training, which rating would correspond with a description of perceived exertion of "3 repetitions remaining" ?

7

Which training load may be most appropriate for someone who is advanced/experienced when it comes to muscle-strengthening? 55% 1 RM 65% 1 RM 75% 1 RM 85% 1 RM

85% 1 RM

Strength Training

A systematic process that uses muscle force to raise, lower, or control heavy external loads for relatively low # of reps over a short period of time

Which of the following is generally a contraindication to stretching? Osteoarthritis Limited joint mobility Soft tissue extensibility concerns Acute inflammatory or infection process

Acute inflammatory or infection process

Does stretching enhance performance?

Acute static stretching either has no effect or decreases muscle performance in terms of strength, power, or endurance immediately following the stretching session Some dynamic warm up programs can lead to enhanced performance

Contracture

Adaptive shortening of the muscle tendon unit or other soft tissues that cross around the joint that contribute to significant resistance of passive or active stretching which limits ROM

Proprioceptive Neuromuscular Facilitation (PNF) Stretching

Aims to gain greater reflective muscle relaxation as a result of autogenic or reciprocal inhibition spinal processing of proprioceptive information 1. Hold-relax or contract-relax 2. Agonist contraction 3. Hold-relax with agonist contraction

Stretching

Any therapeutic intervention that increases the mobility of restricted soft tissues

Nerve is able to move without adverse stress due to:

Arrangement of the nervous system (spinal cord, nerve roots, and plexus - the movement is dissipated throughout the system and neural ischemia is avoided) Connective tissues (helps to absorb tensile forces) Perineurium (primary guard against excessive tension and allows for 18-22% strain before failure, due to its elastic properties and strength)

Elastic Range

Change in stress results in a proportional change in strain

What is a sensitizing maneuver for the median nerve and where should you feel the symptoms?

Contralateral cervical side flexion - changes the amount of stress placed through the nervous system; distal wrist

Hypomobility

Decreased mobility or restricted motion at a single joint or series of joints

Does stretching prevent injuries?

Depends on what type of stretching. Dynamic warm up is shown to be effective in reducing LE injuries. Static stretching does not prevent or reduce injury risk

Oxford Regimen

Determination of 10 RM 10 reps @ 100 of 10 RM 10 reps @ 75% of 10 RM 10 reps @ 50% of 10 RM

DeLorme Regimen

Determination of 10 RM 10 reps @ 50% of 10 RM 10 reps @ 75% of 10 RM 10 reps @ 100% of 10 RM

Stretch Intensity

Determined by the tensile load applied on the soft tissue

Limitations for AROM and AAROM exercises

Does not maintain or increase strength It does not develop skills or coordination except in that motor pattern that's used

Indications for PROM exercises

During acute, inflamed tissue after injury or surgery; When active ROM can be detrimental to the healing process When a pt is unable to actively move a segment such as when the pt experiences paralysis or is restricted to complete bed rest

On the stress-strain curve, what describes the endpoint of linear region?

Elastic limit

What neurodynamic test stresses the median nerve?

External rotation, abduction, elbow extension, wrist extension and forearm supination

Active range of motion is typically sufficient to maintain or increase strength? T or F

False

Stretching Stabilization

Fixation of a body segment that is an attachment muscle that's being stretched

Which structures are primarily being stretched with pt seated with wrist hanging off a table and therapist applying force through the palm back toward the arm?

Forearm flexors

What does FITTSBALL stand for?

Frequency Intensity Time Type Stage Beliefs Ability Limitations Life Satisfaction

Principles of neural mobilization treatment

Goal - neurodynamic exercise is to maximize the excursion of that nerve while minimizing the strain Intensity is dependent on irritability of the tissue, the pt's response, and the change in symptoms Technique/application of neurodynamic mobilization is performed relatively symptom free in a slow rhythmic and oscillatory motion so the therapist nudges the stretch and then backs off *not a static prolonged hold like in static stretching Link what you find from the neurodynamic testing to the neurodynamic treatment

Stress-Relaxation

If a subfailure load is applied to a viscoelastic tissue, and kept constant, there's a gradual decrease in the force required to maintain the amount of deformation. This is due to the viscoelastic nature of the connective tissue and redistribution of water content within the tissue

What are benefits to stretching exercises?

Increased flexibility and ROM - increased muscle tendon unit extensibility in order to improve flexibility and ROM Biomechanical and neural changes in the contractile and non-contractile elements of the muscle tendon unit and surrounding fascia.

Elastic

It returns to its pre stretch resting length directly after a short duration stretch force is removed

Which would be a logical regression (less challenging) for a closed kinetic chain exercise? Eyes open to closed Large to smaller excursion of limb movement Stable to unstable surface Bilateral to unilateral bas of support

Large to smaller excursion of limb movement

Exercise Prescription for Strength Training

Novice - Intermediate 60-70% 1 RM Advanced - Experienced >80% 1 RM Increased load will more effectively increase strength 8-12 Reps; 1-3 sets (3 sets are most effective) Rest in between sets: 2-3 min; 2-10 sec rest b/w sets may allow increased loads Velocity (slow-mod): untrained individuals start at 1-2 sec; increased tension time may increase strength gains

Creep

Occurs through gradually increasing external load and then is sustained. Then the tissue will continue to slowly elongate during the maintained stretch. The amount of tissue deformation depends on the amount of force and the rate at which its applied; low load, long duration stretching improve mobility

Which method of resistance training exercise progression is described by decreasing the amount of resistance over three sets?

Oxford

Neurodynamic Test: Screening (active test)

PT describes a specific position and demonstrates the position for the pt. to attain. Allows PT to assess pt's willingness to move into those positions and whether or not it brings on any symptoms

Neurodynamic Test: Passive Test

PT intentionally positions the joints in a sequential manner to gradually place stress through the nervous system. Allows for differentiation in trying to determine whether or not the nervous system is involved with the issue

Which structures are primarily being stretched when the pt is seated on the plinth with leg stretched out and therapist applies an A-P force through the distal femur and proximal tibia?

Posterior joint capsule, knee flexors

Which is NOT characteristic of isometric exercise? Quantifies strength performance Minimizes muscle atrophy Develops postural or joint stability Develops ROM-specific strength

Quantifies strength performance

Which structures are primarily being stretch when lying supine with a cane with the right elbow on a pillow and left arm slightly off the table; using the cane for ROM pushing it into the right hand

R shoulder internal rotators

Stretch Mode

ROM in that it can be manually applied or can be a self-stretching program

Precautions/Contraindications to ROM exercises

ROM should not be done when motion is disruptive to the healing process 1. early benefits and recovery 2. watch for increased pain and inflammation 3. life threatening conditions 4. PROM to major joints and AROM to ankles and feet to minimize venous stasis and thrombus formation 5. ROM considerations for medically complex patients

Cyclic loading and connective tissue fatigue

Result of repetitive loading within a short time duration which increases heat production any may causes failure at levels lower than what's needed from a single load ex. stress fractures and overuse syndromes

Which structures are primarily being stretched when pt is supine and therapist is stretching arm laterally toward the head?

Shoulder adductors

Neural sliders vs tensioners

Sliders: less aggressive as the aim is to essentially slide the nerve back and forth within its container Increases tension proximally while decreasing tension distally Tensioners: greater intensity and the greatest amount of stress

Stretch Speed

Slowly applied stretch - reduces muscle activation and reduces risk of injury to tissues and post stretch muscle soreness

Plastic Range

Strain goes beyond the elastic limit and causes permanent tissue deformation

You want to perform PROM to improve R hip flexion. The patient recently fell resulting in painful abrasions on their L side. Which would be the most optimal position to perform this exercise, keeping in mind the aim of minimal muscle activation?

Supine

You provide the door stretch exercise to progress shoulder ROM. The pt arrives at the next visit with increased pain and a 10 degree reduction in shoulder ER AROM. Which would be a logical exercise to attempt today? Supine shoulder AAROM for ER Prone shoulder overhead ER with dumbbells Standing shoulder overhead ER with cable resistance Standing shoulder overhead ER with band resistance

Supine shoulder AAROM for ER

Plasticity

Tendency of a soft tissue to take a new and greater length after a stretch force is removed

As the patient goes from standing to rising onto the ball of their foot, which of the following is accurate? The gastroc-soleus is contracting eccentrically The gasroc-soleus is contracting isometrically The anterior tibialis is contracting concentrically The gastroc-soleus is contracting concentrically

The gastroc-soleus is contracting concentrically

Neural Tension

The intensity of a stretch and its influence on blood flow may depend on several factors such as the body region, rate of stretch and population being studied; we want to avoid excessive stretching or stresses to the nerve Sites of vulnerability are subjective to increased pressure or tension

Overload principle

The intensity of resistance exercises, how much external resistance is imposed on a muscle, and progressive overload is required in order to see specific adaptations; Manipulate factors such as intensity or volume of an exercise program

Median Nerve Upper Lumb Neuro Test Position 1 (passive test)

The nerve is slowly and carefully elongated across each joint in succession until there is a symptom provocation or slight tissue restriction is appreciated - note final testing position It is sensitized by moving one of the joints out of the elongated position Goal is to determine if nervous system component is contributing to the pt. chief complaint

Stretch Duration/Frequency

The period of time a stretch force is applied and how often

DAPRE Technique

The suggested working weight is based on the maximum number of repetitions using the working weight and set #3 to determine the working weight for the next exercise session: 1 set; 10 reps; 50% 6 RM 2 sets; 6 reps; 75% 6 RM 3 sets; max possible; 100% 6 RM 4 sets; max possible; 100% adjusted working weight

Which statement is accurate regarding neurodynamic testing? The uninvolved limb is tested first Neurodynamic tests are the only tests used to assess nerve function Passive test is applied prior to the active test The test and treatment positions are typically quite different

The uninvolved limb is tested first

Viscoelasticity

Time dependent property of soft tissue that initially resists deformation, such as change in length, of the tissue when a stretch force is first applied

Stress-Strain Curve Failure

Tissue ruptures and loses its integrity here at the end of the stress stain curve

Eccentric contractions consume less oxygen and energy stores versus concentric exercise: T or F

True

Limitations to PROM exercises

True PROM can be difficult to obtain if pt is guarding PROM does not prevent muscle atrophy or work to increase strength or endurance as compared to active or voluntary muscle contraction

Active-assistive ROM (AAROM)

Type of AROM where assistance is provided mechanically through an external force because the muscles need a little bit of help to complete the motion

Rate Dependence

When a load is applied rapidly, the slope of the stress strain curve will be much steeper vs. if its were applied slowly. The tissue will become stiffer when the load is applied at a higher rate

Stress-Stain Curve

When a tensile load is applied to a certain structure, it produces elongation. The stress-strain curve shows the strength properties stiffness and amount of energy the material can store before failure of that structure. Strength is the force per unit area of load. Strain is the amount of deformation or lengthening that occurs when an external load such as a stretch force is applied to a structure

When is self-assisted ROM typically indicated?

When aiming to protect the healing tissues after surgery or traumatic injury

2 for 2 rule

When someone can perform 2 extra repetitions on their last set for two consecutive sessions

Muscle endurance

ability of the muscles t contract repeatedly against an external load generating sustained tension and resist fatigue over an extended duration

Which is proposed to be a better choice for promoting improved balance? closed kinetic chain exercise open kinetic chain exercise

closed kinetic chain exercise

Muscle strength

degree that the contractile properties of the muscle can produce force

Tissue creep occurs through

gradually increasing load to encourage slow elongation of tissues

What is a common guidelines when all reps and sets can be easily completed?

increase by 5-10%

SAID principle

notion that in order to improve a specific muscle performance component, the resistance program needs to match elements of that construct. So specificity of training or exercise suggests that the adaptive effects of training are highly specific to the training method employed

Periodization

organization and planning of a training intervention so the program is sectioned off into specific time periods. Periodization begins w/ determining the training target or goal and then the program plan is broken down into macrocycles, mesocycles, and microcycles

Stretching Alignment

positioning of a limb or body segment so that the stretch force is directed to that appropriate muscle group

Goals for AROM and AAROM exercises

provides other physiological benefits from muscle contraction when it comes to motor learning from volitional muscle action Works to maintain physiological elasticity and contractility of muscles Provides sensory feedback and stimuli for bone and joint tissue integrity Works to increase circulation and thrombus formation Helps to develop coordination and motor skills for functional activities

Indications for AROM and AAROM exercises

pt is actually able to contract the muscles and move segment with or without assistance

If applying a stretch on the right wrist passively to the elbow (therapist applied stretch), where would the point of contact be located to ensure effective manual stabilization?

right humerus

What would be an appropriate exercise if strength impairments are detected during a prone hamstring MMT?

seated knee flexor strengthening against theraband resistance

Macrocycle

several months to a year

Mesocycle

several weeks to months (2-6 weeks is most typical)

Goals for PROM exercises

to assist with circulation and synovial movement of joints for cartilage nutrition to help reduce pain and assist with healing process

Microcycle

training days and sessions

Muscle power

work produced per muscle unit of time