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