Muskuloskeletal final review based on the PPT
plantar fasciitis causes
chronic overuse
Your patient is performing pelvic tilt exercises for the first time and needs verbal and tactile cues (feedback) to perform the exercises correctly. This represents which stage of motor learning? Autonomous Associative Cognitive Contemplative
cognitive
tendinosis collagen
collagen disorientation, disorganization, and fiber separation by increased proteoglycan content, increased cellularity, neovascularization, with focal necrosis
ACL Injury (non-contact)
combined movements: Foot planted - Knee hyperextension, genu valgus and tibial rotation -Planting and pivoting in the opposite direction
rupture collagen
complete disruption of fibers
Dominance of hamstrings over glute max-->
decreased flexibility of the glute max --> decreased hip flexion ROM --> Excessive lumbar spine flexion, Excessive hamstring use --> overuse cramping, decreased flexibility --> injury
As tension in the muscle increases
discharge of the GTOs increases
Colles fracture:
fractured and dorsally displaced distal radius proximal to wrist FOOSH injury Distal Radius
ankylosis
fusion
chronic tendinitis collagen
greater evidence for microtears and increasing levels of collagen disorientation in tissue hypercellularity
hip flexion contracture has limited
hip extension
examples of contractures
hip flexion, knee flexion, plantar flexion
THA Post Operative rehab: regain strength and muscular endurance (4)
-Open-chain -Closed chain -Unilateral closed-chain -Resistance exercise
Achilles Tendinopathy (3)
-Pain at mid-portion of the tendon or calcaneal insertion -Usually a gradual onset -Stiffness in dorsiflexed positions
secondary impingement
-Results from inflammation with increased pressure -Subacromial space narrowed by alterations in shoulder function -May also be caused by instability
The head and or neck of the humerus is most commonly fractured because.... (5).... but one is more important
*of length of time immobilized and the extent of the acute inflammation both from the bone and soft tissue trauma* -Weakness is likely -Adhesive capsulitis is possible -Loss of normal ROM is one of the most significant consequence of fracture -Begin early range of motion when physician allows
plantar fasciitis risk factors (3)
- high BMI -inappropriate footwear -arches
inversion + plantar flexion sprain which ligaments do they damage (3)
-Anterior talofibular > calcaneofibular > posterior talofibular ligament
carpal tunnel syndrome
-Carpal tunnel formed by carpals and transverse carpal ligament -Median nerve becomes compressed in the carpal tunnel -Bilateral: Rule out cervical spine involvement
"high" ankle sprain which ligament
-Compromise of the tibiofibular ligaments
achilles tendinopathy impairments (3)
-Decreased dorsiflexion range -Decreased plantarflexion strength -Excessive foot pronation
plantar fasciitis impairments (3)
-Decreased muscle length of gastrocnemius and soleus -Hypomobility of plantar fascia -Excessive foot pronation
eversion sprains
-Deltoid ligament is very strong -Usually avulsion (tearing) of the medial malleolus
contracture contributing factors (3)
-Disease -Prolonged immobility in sitting such as wheelchair bound patients -Post-surgical after period of immobilization
Achilles tendinopathy prevention (2)
-Emphasize continuation of HEP and no reoccurrence of symptoms
mechanism of injury PCL
-Fairly rare injury (on its own) -Typically accompanies other damaged tissues
Glenoid Labral Tear - CAUSES (5)
-Falling on an outstretched arm -A direct blow to the shoulder -A sudden pull, such as when trying to lift a heavy object -A violent overhead reach, such as when trying to stop a fall or slide -Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion.
Spondylolisthesis treatment (6)
-Flexion exercise, avoid extension -Patient education -Modalities for pain -Positional stretches -Core Stabilization -Aerobic Conditioning
In a patient's medical record you see "knee flexion contracture." What does it mean? -The patient cannot actively contract the hamstrings to flex the knee. -The patient is unable to actively extend the knee through the full range of motion (ROM) despite full passive knee extension. -The quadriceps muscle group is tight and limits full, passive knee flexion. -Full, passive knee extension is not possible.
-Full, passive knee extension is not possible.
GH Instability and Dislocation (3)
-Injury to stabilizing structures of the shoulder increases shoulder instability -Anterior instability most common -Bankart lesion
subacromial bursitis
-Is an inflammation of the bursa below the acromion process -A bursa is a sac containing a small amount of fluid located between moving parts of a joint to reduce friction
The principle focuses on the following:
-It is progressive Intensity and volume of exercise is manipulated -Intensity is how much weight is applied to make the muscle work -Volume includes repetitions, sets, frequency of the exercise
spinal stenosis
-Narrowing of the spinal canal leading to potential compression of the spinal cord.
achilles tendinopathy risk factors (3)
-Obesity -Hypertension -Diabetes
Often results in subacromial decompression (also called acromioplasty)
-Post surgical immobilization for 1-2 weeks -Focus on rotator cuff function and scapulohumeral rhythm restoration
flat back (4)
-Posterior pelvic tilt -Hip extensors may be tight -Tight abdominals -Hip flexors may be weak
shoulder impingement
-Rotator cuff tendonitis often occurs first and contributes to shoulder impingement syndrome -Tendonitis, bursitis and pain producing abnormal scapulo-humeral movements - The subsequent abnormal movement patterns increase the impingement with increased inflammation that increases the pressure worsening the impingement.
Movement during the acute stage of healing following soft tissue injury: -Should begin on the fourth day and be tissue-specific. -Should be passive or assisted and should begin as soon as tolerated within the pain-free range. -Is contraindicated. -Should include the full ROM in order to prevent adhesions.
-Should be passive or assisted and should begin as soon as tolerated within the pain-free range.
De Quervain's Syndrome treatment (3)
-Splint -May require surgery if unresolved -Corticosteroid injection before surgery a possible option
carpal tunnel syndrome treatment (7)
-Splint in neutral position & ergonomic analysis -Avoid repetitive gripping and wrist flexion and extension motions -Perform median nerve glides -Modalities -Corticosteroid injection -Surgery: Carpal Tunnel Release -Later begin strengthening those muscles weakened by median nerve compression
Ankylosing Spondylitis Treatment (5)
-Stretch/ROM: Emphasis is on extension of the spine and hips since tendency is for flexion and general mobility -Core stabilization -Modalities -Aerobic Conditioning -Patient Education
Glenoid Labrum Tears SLAP lesion
-Superior Labrum tear Anterior and Posterior in location -Biceps brachii may be involved as the long head origin is the superior glenoid near the superior labrum. -2° to throwing deceleration forces -Either arthroscopic debridement and repair or open repair
shoulder impingement test (2)
-Tenderness in the sub-acromial space -Painful arc between 60-120 degrees of motion + Hawkins Kennedy impingement and Neer's impingement tests -Pain with MMT of affected musculature
As a therapist, you can be relatively confident that motor learning has taken place when your patient demonstrates which of the following? -Increased speed demonstrated when carrying out the task -Decreased need for manual guidance during the treatment sessions -The ability to perform a slight variation of the task in a new context during the treatment session -Consecutive repetitions of a task without error during the treatment session
-The ability to perform a slight variation of the task in a new context during the treatment session
Critical time for protecting a new ACL (4)
-The graft undergoes necrosis-weak! -A "scaffold" is left -The body vascularizes the new ACL -Fibroblasts build a new ACL
During the repair process following tissue injury, the newly developing collagen fibrils are: -Laid down in alignment exactly replicating the fibers that were damaged. -Slow to be deposited. -Ready to withstand normal stresses by 3 weeks. -Thin and unorganized.
-Thin and unorganized.
What is most true about Ballistic stretching? -Utilizes quick bouncing movements during the stretching maneuver, resulting in an increased chance for tissue trauma and muscle soreness. -Can be very effective because the rapid force has greater chance of reaching the plastic range, leading to tissue remodeling. -Should be used with elderly patients or patients with long-standing contractures. -Is effective only if done concurrently with joint-mobilization techniques.
-Utilizes quick bouncing movements during the stretching maneuver, resulting in an increased chance for tissue trauma and muscle soreness.
plantar fasciitis rehabilitation: sub-acute phase (3)
-correct LE alignment issues -continues with orthotics -plantar facia stretching
acute tendinitis collagen
-degenerative changes with evidence of microtears, including fibroblastic and myofibroblastic proliferation and hemorrhage. Inflammatory cells in the paratenon. Focal collagen disorientation
plantar fasciitis rehabilitation: acute phase (3)
-night splinter to hold foot in dorsiflexion -orthotics in the shoes -cross friction massage to the site of the lesion
what does ACL stabilize ?
-stabilizes knee extension
Scapulohumeral rhythm serves at least two purposes:
1.It preserves the length-tension relationships of the glenohumeral muscles 2.It prevents impingement between the humerus and the acromion
short duration static stretching
30 sec stretch
Which of the following best describes scoliosis? An irreversible lateral curvature with fixed rotation of the vertebrae caused by lordotic posture A transverse plane deviation of the vertebrae usually involving the thoracic and lumbar regions A lateral curvature of the spine wherein rotation of the vertebral bodies is toward the convexity of the curve A collapse of intervertebral space resulting from weakness of the deep segmental muscle of the spine
A lateral curvature of the spine wherein rotation of the vertebral bodies is toward the convexity of the curve
Each of the following is true about patellar tendon versus hamstring tendon autografts for ACL reconstruction except: A patellar tendon graft involves bone-to-bone fixation, whereas a hamstring tendon graft involves tendon-to-bone fixation. A patellar tendon graft is most appropriate for the skeletally immature patient. A longer healing time and a more slowly progressed rehabilitation program are required with a hamstring tendon graft than with a patellar tendon graft. Anterior knee pain and difficulty kneeling are somewhat frequent complications with a p
A patellar tendon graft is most appropriate for the skeletally immature patient.
During the initial assessment of a patient who complains of a recent onset of "knee pain" when descending stairs and a sense of "giving way" both on the stairs and when walking. Which of the following injuries would lead you to believe the patient might have injured his ACL? A twisting injury when he slipped off the curb and his knee buckled inward A blow to the inside of his knee when his dog was jumping up to greet him A running injury resulting in pain along the inferior border of the patella and the tibial tubercle A forward fall onto his knee directly striking his patella
A twisting injury when he slipped off the curb and his knee buckled inward
what type of ROM should we use? 0/5
AAROM
what types of ROM should we use? 1/5
AAROM
what types of ROM should we use? 2/5
AAROM
effects help develop motor control and coordination for function
AAROM AROM
effects help prevent atrophy weak muscles and which one is the best ?
AAROM AROM (best)
what types of ROM should we use? 3/5
AROM
what types of ROM should we use? 4/5
AROM with resistance
what types of ROM should we use? >3/5
AROM with resistance
When applying manual resistance to the upper extremity using the D1 extension pattern (PNF), the muscle groups being facilitated (strengthened) are the shoulder extensors and the: Abductors, internal rotators, and wrist and finger extensors. Abductors, external rotators, and wrist and finger extensors. Adductors, external rotators, and wrist and finger flexors. Adductors, internal rotators, and wrist and finger flexors.
Abductors, internal rotators, and wrist and finger extensors.
Which of the following is true about managing a tear of the medial or lateral meniscus? After meniscus repair, initially avoid knee flexion beyond 60° to 70° during weight-bearing exercises for about 2 months because flexion beyond this range can displace the repaired meniscus in a posterior direction. A potential complication of a medial meniscus repair is intraoperative damage to or postoperative entrapment of the saphenous nerve. After meniscus repair, the knee is immobilized in approximately 45° of flexion. A tear of the peripheral portion (outer zone) of a meniscus does not lend itself well to surgical repair because this portion of the meniscus is avascular and does not heal well.
After meniscus repair, initially avoid knee flexion beyond 60° to 70° during weight-bearing exercises for about 2 months because flexion beyond this range can displace the repaired meniscus in a posterior direction.
Upward Rotation With Flexion Glenoid Positioning deficiency
Anterior scapular tilt + reduced upward rotation --> impingement
Your patient has a painful right wrist from typing a very large report. You find that she has full active and passive ROM and normal strength. Of the following mobilization techniques, which is most appropriate for managing this patient's signs and symptoms? Joint mobilization using these grades of sustained or oscillation techniques is not appropriate for this patient at this time. Anterior-posterior grade II oscillations Grade IV glides Sustained grade III glides
Anterior-posterior grade II oscillations
Pendulum (Codman's) exercises are used most effectively: To stretch the shoulder musculature and increase range of motion (ROM) when a patient does not have antigravity control of shoulder movement. As a PROM oscillation technique to inhibit pain and maintain mobility. As a strengthening exercise. As a grade III mobilization technique to increase ROM when mobility of the scapula is normal but there is chronic stiffness of the glenohumeral joint.
As a PROM oscillation technique to inhibit pain and maintain mobility.
Overuse syndromes occur: As a result of prolonged immobilization. Only if there is impaired circulation to soft tissue. As the result of repetitive, submaximal stress of a muscle or tendon. As the result of a severe blow to a muscle.
As the result of repetitive, submaximal stress of a muscle or tendon.
precautions for stretching (5)
Avoid vigorous stretching of muscles and connective tissue that have been immobilized for a long period of time. Connective tissue will lose their tensile strength after prolonged immobilization If the patient experiences pain after 24 hours after stretches, too much force was used and the patient has an inflammatory phase occurring. Avoid overstretching weak muscles Patients that have had multiple cortisone injections may have weakened tissue
To effectively stretch the scalene muscles on the left, the patient: Rotates head to the right, looks down, and places left hand behind the head. Tucks in chin and nods the head through 15° of motion. Places the left hand behind the head, rotates head to the left, and looks down. Axially extends the neck, side bends to the right, and rotates to the left.
Axially extends the neck, side bends to the right, and rotates to the left.
To prevent falls and maximize safety while lifting heavy objects from the floor, an elderly patient is instructed to: Bend at the knees as far as possible, keeping the back straight and placing the load between the legs. Keep the knees straight, bend at the hips, keep the back straight, and pick up the load quickly. Bend at the knees partially while keeping the back straight and pick up the load slowly. Bend the knees partially and rotate and laterally bend the back to lift the load to one side of the hips.
Bend at the knees as far as possible, keeping the back straight and placing the load between the legs.
Which of the following surgical procedures is performed for recurrent anterior instability or dislocation of the glenohumeral joint and involves reattachment and repair of the capsulolabral complex to the anterior rim of the glenoid? Hill-Sachs repair Anterior capsular shift SLAP lesion repair Bankart repair
Bankart repair
During closed-chain strengthening of the quadriceps, knee ROM in which the greatest amount of patellofemoral compression occurs is: At all portions of the ROM (i.e., compressive forces are equal throughout the ROM). Between 30° of knee flexion to full extension. Between 60° of knee flexion to full knee flexion. Between 60° of knee flexion to 30° of knee flexion.
Between 60° of knee flexion to full knee flexion.
Your patient is in the return-to-function phase of rehabilitation after recovering from a sprained ankle. She wants to be able to resume her hobby of extensive gardening and yard work. Which of the following combinations of progressions for balance describes less to more difficult activities? Single leg to tandem stance, open environment to closed environment, unresisted to resisted movements Narrow-base to wide-base stance, bilateral to unilateral activities, small- to large-range motions Stationary to moving surface, wide-base to narrow-base stance, high-magnitude to low-magnitude perturbations Bilateral to unilateral stance, firm surface to soft surface, slow- to high-speed repetitions
Bilateral to unilateral stance, firm surface to soft surface, slow- to high-speed repetitions
mechanism of injury contact MCL
Blow to the lateral side of the knee High valgus force
Achilles Tendinopathy causes (1)
Chronic overuse>acute strain
Which of the following stages of soft tissue healing is characterized by remodeling and maturation of collagen in the scar? Early subacute stage Chronic stage Late subacute stage Acute stage
Chronic stage
The primary value of a patient performing quadriceps setting exercises when the knee is immobilized in a long leg cast for an extended period of time is to: Stretch the anterior portion of the knee capsule. Maintain mobility of the patella. Prevent a knee extension contracture. Strengthen the quadriceps muscle.
Maintain mobility of the patella.
spinal stenosis effect
Can cause nerve root impingement, which can produce classic sciatica without disc rupture
carpal tunnel syndrome causes
Causes loss of sensation over median nerve distribution in the hand
Compression Fracture (axial overload): and there is damage to the
Common in osteoporosis. Usually results in vertebral body fracture before there is any damage to the annulus fibrosus.
patellofemoral pain syndrome and possible risk factors (7)
Mal-alignment of the patella in the intratrochlear groove Possible risk factors include: Increased Q-angle External tibial torsion Genu valgus Foot hyper-pronation Tight lateral retinaculum Weak VMO Weak hip external rotators and abductors
muscle spindles are located
in parallel with muscle fibers
plantar fasciitis pain with weight bearing greatest when ?
in the morning since it is in plantar flexed all night and you dorsiflex in the morning and develops pain
knee with hip/knee flexion -->
increased Q-angle
chronic tendinitis pathology (2)
increased tendon degeneration. increased tendon vascularity
Dominance of TFL over glute med --> and resulting
increased tension in the IT band, valgus
tight hip flexors-->
increases lumbar lordosis
Which of the following is a goal of passive range of motion (PROM) exercises? Increase joint range of motion (ROM) and muscle length Enhance movement of synovial fluid for articular cartilage nutrition Improve muscle performance Prevent muscle atrophy
Enhance movement of synovial fluid for articular cartilage nutrition
Which of the following functional activities should a patient avoid for the longest period of time after rTSA? Fastening a bra behind the back Hugging with both arms Reaching into abduction in the plane of the scapula at a drive-through window Reaching overhead
Fastening a bra behind the back
LCL known as
Fibular Collateral Ligament Extra-articular outside the joint capsule
To achieve maximum elongation of the long head of the biceps brachii during passive stretching: Extend the elbow with the forearm in supination and then extend the shoulder. Flex the shoulder overhead after extending the elbow with the forearm in pronation. Flex the shoulder overhead after extending the elbow with the forearm in supination. Extend the elbow with the forearm in pronation and then extend the shoulder.
Extend the elbow with the forearm in pronation and then extend the shoulder.
To fully lengthen the muscle-tendon unit typically involved in medial epicondylitis, have the patient perform a self-stretch by using the opposite hand to: Extend the wrist. Assist with making a strong gripping motion. Flex the wrist. Flex the elbow.
Extend the wrist.
Achilles tendinopathy remodeling phase (1)
Focus on Eccentric loading continued -Heel Raises: Up on 2, down on 1 off edge of a step for larger ROM Wean from unloading devices
mechanism of injury non contact MCL
Foot planted - cutting and pivoting in the opposite direction
Upward Rotation With Flexion Glenoid Positioning function
Glenoid (scapula) moves to give rotator cuff a mechanical advantage + maintain relative Glenohumeral alignment
achilles tendinopathy proliferative phase (5)
Correct gait deviations Focus on Eccentric loading -Approximately 12 weeks total -Heel Raises: Up on 2, down on 1 -GRADUAL reloading -Slow speeds
Mr. J underwent a repair of a torn biceps brachii 2 days ago. During PROM exercises, which combination of motions should you avoid at end range to protect (not disrupt) the healing tissue? Elbow extension, shoulder flexion, forearm pronation Elbow extension, shoulder extension, forearm pronation Elbow extension, shoulder extension, forearm supination Elbow extension, shoulder flexion, forearm supination
Elbow extension, shoulder extension, forearm pronation
Which of the following is true of resistance training for the patient with known osteoporosis? Only isometric exercises should be prescribed in order to eliminate torque on the bones. Evidence has shown that resistance exercise is an essential element in the rehabilitation, conditioning, and aerobic programs of patients both at risk for and with known osteoporosis. Safe resistance training imposes only submaximal loads-no more than the patient encounters during activities of daily living. Resistance training is contraindicated for patients with known osteoporosis due to the risk of pathological stress fracture.
Evidence has shown that resistance exercise is an essential element in the rehabilitation, conditioning, and aerobic programs of patients both at risk for and with known osteoporosis.
Hip flexor structural or functional impairment will result in a change in the normal gait cycle. The therapist should suspect hip flexor dysfunction when observing gait and noting a: Forward flexion of the trunk during weight bearing. Lengthened stride. Posterior lurch of the trunk at foot contact. Lateral shift of the trunk over the stance leg when the opposite leg swings.
Forward flexion of the trunk during weight bearing.
achilles rupture s/p repair: maximum protection phase (4)
Generally the first 4-6 weeks post surgery Prevent inhibition of immobilized muscle groups Isometric muscle setting inside cast/brace NO ACTIVE PLANTARFLEXION until specified by physician Weight bearing and ROM per physician
A properly applied and progressed therapeutic exercise program should: -Begin with passive exercise, progressing to active assistive exercise, active exercise, and then resistive exercise by the third week after injury. Follow a pre-established protocol in order to be consistent for all patients with the same diagnosis. Grade the exercise to the stage of recovery to stress the tissues safely. Push the patient beyond his or her current stage of recovery in order to progress the healing process.
Grade the exercise to the stage of recovery to stress the tissues safely.
Compression Fracture (axial overload): treatment (3)
Immobilization Avoid flexion exercise Patient Education
You are seeing a patient to initiate exercises 5 days after reconstruction of the ACL with a patellar tendon autograft. During the first phase of the postoperative exercise program, your primary concern is: Imposing controlled loads on the knee while protecting the graft from excessive stresses. Preventing knee extension contracture. Preventing atrophy and reflex inhibition of the quadriceps. Facilitating joint swelling.
Imposing controlled loads on the knee while protecting the graft from excessive stresses.
lordosis of the spine - 5
Increased weight bearing on facets, decreased IVF space Tight iliopsoas and lumbar paraspinals Weak abdominals
elasticity
Increasing tissue elasticity reduces restriction and allows muscles to relax. Allowing muscles to relax decreases tension and increases the range of movement. Decreasing tension and increasing the range of movement can decrease pain. Decreasing restriction and decreasing pain improves relaxation
Osteoarthritis of the hip is typically characterized by a progressive decrease in range of motion (ROM) of the following movement combinations: External rotation and adduction. External rotation and extension. Internal rotation and extension. Equal loss of internal and external rotation.
Internal rotation and extension.
A patient has nerve root symptoms and has been diagnosed as having degenerative joint disease of the spine. The approach for treating the cause of the symptoms should be: Heat and massage. Relaxation exercises, including head rolls and conscious tension-release techniques. Intermittent setting exercises with the extensor muscles in the shortened position. Interventions that temporarily increase the size of the intervertebral foramina.
Interventions that temporarily increase the size of the intervertebral foramina.
The objective of treatment during the moderate protection/controlled motion phase of rehabilitation should be to: Introduce and progress stretching to increase mobility and alignment of newly forming scar tissue. Maintain passive range of motion (PROM). Control the pain and inflammation. Encourage the patient to permanently stop doing the activity that caused the injury.
Introduce and progress stretching to increase mobility and alignment of newly forming scar tissue.
acute stage (2)
Isometric contractions Pain free
Why is The "minimally invasive knee arthroplasty" chosen over other surgical approaches? It is less disruptive to the soft tissue, with increased rate of postoperative recovery and less postoperative pain. It is an arthroscopic procedure, so the rehabilitation is shorter. The incidence of intraoperative complications is lower. It is easier to perform and therefore is the choice of the less-experienced surgeon.
It is less disruptive to the soft tissue, with increased rate of postoperative recovery and less postoperative pain.
Which of the following is true of a flat low-back posture? It is typically associated with tight hip flexor muscles. It should be the goal of all back rehabilitation programs. It reduces the shock-absorbing function of the spinal curves. It is the best posture for a healthy spine.
It reduces the shock-absorbing function of the spinal curves.
chin tuck
Keep eyes level and pull chin straight back.
Fundamental techniques that every patient with spinal impairments should learn before progressing to basic and advanced training exercises include: Safe use of weights and elastic resistance while maintaining the spine in a neutral posture. Strengthening exercises for the cervical and trunk stabilizers, including the abdominals, longus colli, quadratus lumborum, and cervical and lumbar multifidus muscles. Safe stretching techniques prior to any stabilization, strengthening, or power training. Kinesthetic awareness of safe spinal positions and movement, activation of deep segmental muscles, and global muscle control of spinal posture when moving the extremities or moving from one position to another.
Kinesthetic awareness of safe spinal positions and movement, activation of deep segmental muscles, and global muscle control of spinal posture when moving the extremities or moving from one position to another.
LCL attachment sites
Lateral epicondyle of the femur -> lateral surface of the head of the fibula
What is the best method for determining the progression of exercise during the Mod protection stage of healing? Increase endurance exercises by 3 repetitions each treatment session Let patient response guide the progression of exercise Increase range of motion 10° each treatment session Increase strength training by 1 lb each treatment session
Let patient response guide the progression of exercise
Which of the following types of active exercises are the most appropriate to use first during the Max Protection phase of healing after a muscle injury? Active ROM exercises Low-intensity muscle setting Submaximal isokinetic concentric exercise at slow velocities Multiple-angle isometrics against manual resistance
Low-intensity muscle setting
Passive ROM and grade I or II joint-mobilization techniques are appropriate during the acute stage (Max Protection) of soft tissue healing. What do these interventions have in common when used during this stage? -Include movements into tissue resistance -Used to increase ROM -Maintain fluid dynamics and nutrition in a joint -Affect muscle, ligament, and capsular tissue around the site of injury equally
Maintain fluid dynamics and nutrition in a joint
Exercise programs developed specifically to increase strength will require a progression that focuses on: Increasing the speed of performance. Increasing the number of repetitions. Increasing the resistance. Increasing the duration of the exercise.
increasing the resistance
A patient has mild joint swelling and pain during active ROM, but resisted tests of the muscles that cross the swollen joints do not cause pain. Your goal is to maintain or possibly increase strength through the available ROM. The most appropriate choice of exercise is: Eccentric/concentric, closed-chain exercise throughout the ROM. High-velocity isokinetic exercise. Multiple-angle isometric exercise against resistance. Muscle setting exercises at the end of the ROM.
Multiple-angle isometric exercise against resistance.
plasticity
Muscles, bones, and other connective tissues also exhibit plasticity. Through targeted exercises, stretching, and resistance training, physical therapists can help patients improve muscle strength, flexibility, and endurance. This adaptation of musculoskeletal tissues is essential for recovering from injuries, surgeries, or chronic conditions.
signs of ankle sprains (3)
Often an audible snap or pop followed by pain and swelling of the ankle
Spondylolisthesis:
One vertebra slips forward on the vertebra below. It is the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. Normally, L5 on S1 or L4 on L5
You are treating a 78-year-old woman with an intertrochanteric fracture of the proximal femur who underwent an ORIF (screw-plate fixation) 3 days ago. She is being seen for postoperative exercise and gait/functional training (initially with minimal weight bearing on the operated side). It is unclear if the patient will be discharged home with her spouse or to a SNF. Prior to discharge from the hospital, which of the following is the lowest priority intervention? Closed-chain, resisted exercises for the upper extremities and sound lower extremity, emphasizing extension in functional patterns Gait training with a walker and transfer/bed mobility training Open-chain, resistance exercises for the operated lower extremity Active-assistive range of motion (A-AROM), progressing to active range of motion (AROM) of the operated hip
Open-chain, resistance exercises for the operated lower extremity
Which of the following mobilization techniques can be used to "stretch" a joint? Oscillation grade II Oscillation grade III Sustained grade I Sustained grade II
Oscillation grade III
In a nutshell, the overload principle states that if a muscle is to improve its performance, IT MUST BE CHALLENGED TO
PERFORM AT A HIGHER LEVEL
effects Promote synovial fluid movement and nourishment of cartilage
PROM AAROM AROM
effects help prevent development of adhesions in healing soft tissue and contractures and promote proper healing
PROM AAROM AROM
effects maintaining muscle length
PROM AAROM AROM
effects of decrease pain
PROM AAROM AROM
effects of maintaining joint range of motion
PROM AAROM AROM
effects of promoting sensory awareness
PROM AAROM AROM
effects facilitate circulation and which one is the best
PROM AAROM AROM (best)
Which of the following signs and symptoms in the hip region and/or lower extremity is most consistent with the finding associated with trochanteric bursitis? Groin pain at rest that increases with weight bearing coupled with a positive Trendelenburg sign and pain with hip abduction Groin and anterior thigh pain that becomes evident or is aggravated during activities that require repetitive hip flexion Pain that becomes evident during extended periods of sitting, with most pain experienced in the buttock region over the ischial tuberosities Pain along the lateral hip joint to the insertion of the iliotibial band; pain typically worsens with prolonged asymmetrical standing with more weight shifted to the involved side
Pain along the lateral hip joint to the insertion of the iliotibial band; pain typically worsens with prolonged asymmetrical standing with more weight shifted to the involved side
plantar fasciitis symptoms (2)
Pain at plantar heel Tender to palpation
Which of the following is a true statement about ROM exercises? Whenever possible, active-assistive ROM should be performed in positions that eliminate the effect of gravity on the weak muscle that is actively contracting. Passive ROM is synonymous with stretching. Passive ROM can be carried out manually or mechanically. If a joint is hypermobile, PROM exercises are contraindicated.
Passive ROM can be carried out manually or mechanically.
A quadriceps lag may be described as: Patient cannot actively extend the knee to full extension even though there is full passive knee extension. Patient has full passive knee flexion but limited passive knee extension. Patient has full active knee extension but exhibits increased time to peak torque when knee extensors are evaluated on an isokinetic dynamometer. Another term for knee extension contracture.
Patient cannot actively extend the knee to full extension even though there is full passive knee extension.
Which of the following exercises, designed to self-stretch the hamstrings, is the safest and utilizes the most effective stabilization? Patient sits on the floor in a hurdler's position, keeps the back straight, and reaches toward the foot of the straight leg. Patient stands on one leg, places the other leg on a table, bends forward, and reaches toward the foot of the elevated leg. Patient sits on the floor in a long-sitting position with the knees straight and does a bilateral toe touch. Patient stands, bends forward, keeping both knees straight, and attempts to touch the nose to the thighs.
Patient sits on the floor in a hurdler's position, keeps the back straight, and reaches toward the foot of the straight leg.
As you develop progressions of exercise programs for varied patients, which of the following describes the appropriate use of plyometric drills? Patients with unstable joints should perform plyometric drills early in the course of therapy to challenge firing of antagonistic muscle groups. Patients in advanced phases of rehabilitation should be trained to return to high-demand functional activities and sports Every patient on a strengthening program should progress to plyometric drills during the return-to-function phase of rehabilitation. Pediatric programs should include plyometric drills because they are fun to perform and will engage the patient in functional activities.
Patients in advanced phases of rehabilitation should be trained to return to high-demand functional activities and sports
Muscles that typically are shortened in patients with increased thoracic kyphosis; forward head; and protracted, forward tilted scapula are the: Pectoralis major, teres major and minor, and serratus anterior. Teres major and minor, subscapularis, infraspinatus, and triceps. Pectoralis major and minor, latissimus dorsi, infraspinatus, and teres minor. Pectoralis minor, subscapularis, and levator scapulae.
Pectoralis minor, subscapularis, and levator scapulae.
test for carpal tunnel syndrome
Phalen's test
Post THA when do they begin PT
Physical Therapy begins day of surgery or the next day Evaluation then twice daily treatment Typically hospitalized for 3-4 days NEWER- fast track-> discharged post-op day 2
A patient who underwent a right cemented total hip arthroplasty through a posterolateral conventional incision 3 to 4 weeks ago is permitted to do each of the following except: Ambulation with crutches or a walker, bearing weight on the operated lower extremity as tolerated. Active abduction of the operated hip while standing on the sound lower extremity. Pivot to the right while bearing weight on the operated lower extremity. Flexion of the operated hip to 80° or 90°.
Pivot to the right while bearing weight on the operated lower extremity.
Of the following choices, which is the most appropriate application of the hold-relax method of muscle inhibition and elongation of the gastrocnemius muscle? Extend the patient's knee, stabilize the lower leg, and: -Place the patient's ankle in as much dorsiflexion as possible; have the patient isometrically contract the dorsiflexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle. Place the patient's ankle in a fully plantar flexed position. Have the patient concentrically contract the dorsiflexors against your manual resistance through as much ROM as possible. Place the patient's ankle in a comfortably dorsiflexed position; have the patient eccentrically contract the plantar flexors against your resistance through the available ROM. Then have the patient dorsiflex the ankle as far as possible. Place the patient's ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantar flexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle.
Place the patient's ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantar flexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle.
herniated disc treatment (3)
Positioning more in extension, Core Stabilization, traction
The Effect of Positioning the Low Back on the C-Spine
Positioning of the low back affects the cervical spine. In a slumped position, the neck assumes a forward head position that is difficult to correct even with a chin tuck. Maintain correct sitting position with proper lumbar support and maintenance of lumbar lordosis.
A long-axis distraction of the humerus provides which direction of gliding? Posterior Anterior Superior Inferior
inferior
Progressing resistance and stretching exercises vigorously during the early subacute (Mod Protection)stage of soft tissue healing: Decreases recovery time. Helps scar tissue resolve more quickly. Increases the strength of the healing tissues. Prolongs the inflammation and promotes adhesion formation.
Prolongs the inflammation and promotes adhesion formation.
plantar fasciitis and what does it cause
inflammation of the plantar fascia can cause heel pain
spondylitis
inflammation of the spine
A patient with DJD of the knees currently reports left knee pain and periodic "giving way" of her right knee for the past week. The patient has significant morning stiffness of the knee and after sitting for an extended period of time. Pain is still notable during walking and with movement toward the end of the range of motion (ROM) (more so in flexion than extension). Knee ROM is limited (active and passive knee flexion 100°; passive knee extension lacks 10°; active knee extension lacks 20°). The strength of knee musculature is 4/5. She exhibits an antalgic gait pattern. Which of the following interventions is most appropriate for this patient at this time? Ice, rest, active-assistive ROM through the pain-free range, quads and hamstring setting exercises, ambulation with crutches until pain and swelling subside Low-intensity stretching to increase knee flexion, static and dynamic strengthening with unilateral closed-chain exercises, stationary cycling Quadriceps setting exercises, active ROM within pain-free ranges, resisted multiple-angle isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation Activit
Quadriceps setting exercises, active ROM within pain-free ranges, resisted multiple-angle isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation
patellofemoral pain syndrome kinematic approach (3)
Resolve femoral internal rotation and adduction -Gluteus medius and gluteus maximus strengthening -Emphasis/awareness of LE alignment especially with knee flexion in weight bearing positions
primary impingement
Result of structures present that narrow the subacromial space (i.e., acromial spur)
Scapula on Thoracic Wall Serratus Anterior function
Serratus anterior holds scapula on thorax
tendinosis pathology
intratendinous degeneration commonly due to microtrauma, vascular compromise, and cellular/tissue aging
smith's fracture
involves the radius, but the distal radius fragment displaces volarly.
Ankylosing Spondylitis (Marie Strumpell's Disease) and causes
is a long-term disease that causes inflammation of the joints between the spinal bones and the joints between the spine and the pelvis. It eventually causes the affected spinal bones to fuse together.
bankart lesion
is an injury of the anterior inferior glenoid labrum due to repeated (anterior) shoulder dislocation
Kyphosis and resulting in... ?
is associated with a tilting forward of the scapula, resulting in pinching of the rotator cuff under the coracoacromial arch and resulting in decreased range of motion.
symptoms of the subacromial bursitis
shoulder pain, weakness, tender, limitation of movement, crack or pop Like rotator cuff tendonitis, bursitis may be caused by overuse of the shoulder both in motion and positioning impingement
Which of the following terms associated with aspects of physical function is used to describe the ability of the neuromuscular system to statically or dynamically hold proximal or distal body segments in appropriate positions using synergistic muscle action? Muscle strength Coordination Stability Muscle power
stability
The Romberg Test measures: Reactive balance control. Dynamic balance control. Anticipatory balance control. Static balance control.
static balance control
What types of ROM should we use ? 5/5
Strengthening with functional carryover
muscle spindle sensitive to
stretch
Herniated disc
The spinal disc degenerates or grows thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate and produce symptoms of nerve impingement.
Lateral Epicondylitis (Tennis Elbow) and the cause
Tears and scarring and inflammation of the common extensor tendon of the lateral humeral epicondyle -Overuse caused by repeated wrist extension against resistance results in lateral pain
Your patient has rheumatoid arthritis and currently is exhibiting mild symptoms in the wrist. This patient will benefit from grade I or II mobilization techniques at this time because these techniques: Reduce preexisting deformity. Increase the ROM by stretching restrictions. Temporarily relieve pain, thereby allowing freer motion of the wrist. Reverse synovitis and the progression of the disease process, if only temporarily.
Temporarily relieve pain, thereby allowing freer motion of the wrist.
THA Post - Operative Rehab: how many weeks of moderate protection; and full healing how long does it take ?
Some degree of moderate protection necessary for 12 weeks post-op Full healing of bone and soft tissue continues for up to one year
De Quervain's Syndrome
Tendinopathy of the extensor pollicis brevis and abductor pollicis longus (same sheath in first compartment)
Your patient is lying supine and you are strengthening the iliopsoas on the (R) using manual resistance. The main reason you would want to place the patient's (L) hip and knee in flexion (foot planted on the table) is to: Place the pelvis in a slight anterior tilt so the trunk is more stable and the iliopsoas can generate greater tension. Improve the mechanical efficiency of the iliopsoas on the (R). Stretch the erector spinae muscles in the lumbar region of the back. Stabilize the pelvis in a neutral to posteriorly rotated position to lessen the possibility of an anterior pelvic tilt occurring, placing stress on the low back.
Stabilize the pelvis in a neutral to posteriorly rotated position to lessen the possibility of an anterior pelvic tilt occurring, placing stress on the low back.
The semicircular canals of the vestibular system would contribute the most to balance control during which of the following activities? Standing and quickly turning the head to look at a person Standing on a bus that suddenly accelerates forward Standing on an elevator that suddenly accelerates downward Sitting in a chair reading a newspaper
Standing and quickly turning the head to look at a person
Which of the following statements about stretching is true? To stretch the posterior tibialis, you dorsiflex and evert the foot and ankle. To maximally lengthen the wrist extensors, you fully flex the wrist and flex the elbow. To stretch the long head of the triceps brachii, you fully flex the elbow and then extend the shoulder past neutral. To effectively stretch the tensor fascia latae, you first flex the hip to 30° and then adduct the hip.
To stretch the posterior tibialis, you dorsiflex and evert the foot and ankle.
The spinal muscles that are activated first with rapid arm movements are the: Transversus abdominis and multifidus. Erector spinae and rectus abdominis. Internal and external obliques. Multifidus and internal obliques.
Transversus abdominis and multifidus.
A patient exhibits a forward head posture and excessive thoracic kyphosis. Considering the muscles that typically are weak with this faulty posture, which of the following muscles of the shoulder girdle are most important to strengthen? Upper and lower trapezius and serratus anterior Upper and lower trapezius and pectoralis minor Serratus anterior and levator scapulae Pectoralis minor and levator scapulae
Upper and lower trapezius and serratus anterior
Upward Rotators
Upper trapezius Lower trapezius Serratus anterior
To maintain gains in ROM achieved as the result of a stretching program, it is recommended to: Perform daily resistance training of the stretched muscle. Perform daily resistance training of the muscle group opposite the stretched muscle. Apply heat on a daily basis to the lengthened muscle groups. Use the stretch-induced gains in ROM during functional activities as soon as able on a regular basis.
Use the stretch-induced gains in ROM during functional activities as soon as able on a regular basis.
patellofemoral pain syndrome traditional approach (4)
VMO strengthening -Open Chain knee extension with hip lateral rotation -Use of electrical stimulation and biofeedback Lateral structure mobility and flexibility
To improve a patient's dynamic postural control using visual and vestibular inputs, the most appropriate activity for the patient to perform is: Standing on a foam surface with feet apart and eyes open. Marching in place on a firm surface with eyes open. Walking with a narrowed base of support on foam with eyes open. Walking with a narrowed base of support on a firm surface with eyes closed.
Walking with a narrowed base of support on foam with eyes open.
When a patient is involved in a stretching program, it is recommended that you: Ice the muscle to be stretched before stretching. Avoid active exercises for warm-up prior to stretching because it may increase excitability of the muscle tissue and prevent relaxation during stretching. Warm up the tissues to be stretched by engaging in light-intensity active exercise or using therapeutic heat prior to stretching. Stretch no more than once a week.
Warm up the tissues to be stretched by engaging in light-intensity active exercise or using therapeutic heat prior to stretching.
I want to stretch the hamstring
We can activate the GTO in hamstrings to "relax" or turn off the hamstrings
increased kyphosis
Weak and lengthened rhomboids and thoracic erector spinae Shoulders IR
Which of the following correctly identifies biomechanical abnormalities that contribute to patellofemoral pain or patellar instability? Excessive external tibial torsion, genu valgum, weak vastus lateralis muscle, overstretched lateral retinaculum, excessive pronation of the feet, weakness of the hip abductors and external rotators Weakness of the VMO, tight lateral retinaculum, genu valgum, excessive external tibial torsion, excessive pronation of the feet, weakness of the hip abductors and external rotators Genu varum, overstretched lateral retinaculum, weakness of the vastus medialis obliques (VMO) muscle, excessive supination of the feet, weakness of the hip adductors and internal rotators Excessive internal tibial rotation, genu varum, weakness vastus lateralis muscle, tight lateral retinaculum, excessive supination of the feet, weakness of the hip adductors and internal rotators
Weakness of the VMO, tight lateral retinaculum, genu valgum, excessive external tibial torsion, excessive pronation of the feet, weakness of the hip abductors and external rotators
Each of the following is a contraindication to stretching shortened tissues except: Sharp, acute pain during ROM. Recent fracture A bony block. When ROM is limited because scar tissue has reduced soft tissue extensibility.
When ROM is limited because scar tissue has reduced soft tissue extensibility.
Which of the following is a contraindication to PROM exercises? Presence of chronically impaired circulation When a patient is in a coma When movement of a body segment is disruptive to the healing process Presence of muscle weakness or paralysis
When movement of a body segment is disruptive to the healing process
A patient who had a total hip replacement 3 days ago is being discharged from the hospital tomorrow. The home instructions should include each of the following except: Whenever possible, perform transfers toward the operated side. Perform assisted, progressing to active, ROM exercises of the hip and knee within protected ranges. Perform ankle-pumping exercises on a regular basis throughout the day with the legs elevated. Avoid moving the hip past midline when moving in bed; do not cross your legs.
Whenever possible, perform transfers toward the operated side.
scapula on thoracic wall serratus anterior deficiency
Winging --> reduced subacromial space
lateral epicondylitis treatment (6)
Wrist stabilization or tennis elbow support, ice, modalities including iontophoresis and cross-friction soft tissue, ROM progressing to stretching, strengthening (Therabar) as inflammation subsides
Which of the following is a contraindication to implementing resistance exercise? Acute pain or inflammation Joint instability Muscle soreness that occurs after a bout of exercise Risk of pathological fracture due to osteoporosis
acute pain or inflammation
The center of gravity in most adult humans is located slightly: Posterior to the S2 vertebra. Anterior to the S2 vertebra. Posterior to the L2 vertebra. Anterior to the L2 vertebra.
anterior to the S2 vertebra
ballistic dynamic stretching quick stretch
applied during sporting activities-not done to restore motion but in preparation for return to activity in advanced rehab phase.
During several physical therapy sessions, a patient you have been treating for low back pain learned how to perform pelvic tilt exercises in several positions (supine, sitting, quadruped, standing). With continued practice at home, your patient is now able to perform extremity movements while maintaining a stable pelvic position. This represents which stage of motor learning? Autonomous Cognitive Continuous Associative
autonomous
A patient with a history of recurrent dislocation of the patella underwent a surgical procedure for realignment of the extensor mechanism. Considering the position of immobilization postoperatively, you should expect to find each of the following impairments when it is permissible to begin exercises except: Weakness of the quadriceps and hamstrings. Lack of full or almost full passive knee extension. Quadriceps (extensor) lag. Lack of full knee flexion.
lack of full or almost full passive knee extension
Although interventions used to manage patellofemoral pain syndrome are based on an examination of each patient on an individual basis, each of the following interventions is commonly employed except: Lateral gliding of the patella. Strengthening the knee and hip extensors in weight-bearing and non-weight-bearing positions. Using an insert (orthotic device) in a patient's shoe to correct excessive foot pronation. Stretching the tensor fasciae latae (TFL) and iliotibial (IT) band.
lateral gliding of the patella
Which of the following terms is defined as "the sway boundaries in which an individual can maintain equilibrium without changing his/her base of support"? Limits of pressure Center of mass Center of gravity Limits of stability
limits of stability
Tight hip extensors-> loss of....
lordosis
contracture
more than just tightness
healthy tissue pathology
no inflammation
spindles facilitate activation
of the muscle
Weakness of muscles of thenar eminence: (3)
opponens pollicis, abductor brevis , a bit of flexor pollicis brevis
healthy tissue collagen
organized collagen, absent blood cells
Which of the following is an indication for joint mobilization? Joint effusion Joint hypermobility Pain Muscle contracture
pain
if the ankle dorsiflexors are weak, the ankle will be pulled into
plantar flexion
If the work begins to plateau, then the performance of the muscle will
plateau
Which of the following surgical approaches for conventional total hip arthroplasty is associated with the highest risk of postoperative hip dislocation if the hip flexes (passively or actively) beyond 80° to 90° during the early postoperative weeks? Lateral Anterolateral All approaches pose an equally high risk. Posterolateral
posterolateral
Plyometric drills are prescribed to improve which dimension of muscle performance? Balance Flexibility Power Endurance
power
plantar fasciitis rehabilitation: chronic phase (4)
prevention: no symptoms with function, supportive footwear, ROM before getting out of bed, recovery time post high intensity activities
Each of the following is an expected outcome of conservative management of osteoarthritis of the knees except: Regenerating worn articular cartilage. Preventing deformity. Relieving pain. Maintaining functional range of motion and strength.
regenerating worn articular cartilage
LCL function
restricts varus
long duration positioning with overpressure
several minutes
acute tendinitis pathology
symptomatic degeneration of the tendon with increased cellularity, vascular disruption, minimal inflammatory repair response. Inflammation of the outer layer of the tendon (paratenon) alone whether or not the paratenon is lined by synovium
Peripheralization
symptoms are experienced farther down the leg
centralization
symptoms recede up the leg or become localized to the back
rupture pathology
tendon failure
Golgi tendon organs are located in
tendons near the myotendinous junction and are in series, that is, attached end to end with muscle fibers.
GTO sensitive to
tension
Golgi tendon organs are activated when
the tendon attached to an active muscle is stretched.
overload
working the body or parts of the body beyond normal expected levels
sub-acute for wrist (2)
•Eccentric Strengthening -Therabar
ACL post op week 2-4 (9)
◦Open Chain Knee Extension: 90-40 degrees ◦Low-load PRE of hamstrings ◦Aerobic conditioning -Stationary cycle -Quadriceps control -Core stability -Avoidance of varus / valgus moment with exercises ◦Balance activities ◦Proprioception exercises
