PTA 140 Ther Ex - Final Exam Study Guide
What is considered Faulty posture?
This is a deviation from correct posture that increases the stress on the joints and supporting structures.
The replacement of the femoral head and possibly the acetabulum with prosthesis.
Total Hip Replacement (THR) or Total Hip Arthroplasty (THA)
The replacement of the humeral head and possibly the glenoid fossa with a prothesis and is often necessary due to shoulder osteoarthritis
Total Shoulder Replacements/Arthroplasty (TSR)
What are treatment options for patients with pelvic floor dysfunctions?
- educating patients regarding the dimensions of their pelvic floor including the sling//hammock fibers, figure 8 mm orientation, and the funnel configuration -Visual aids -Verbal instructions- often not effective -Neuromuscular re-education -PNF internal techniques to the levator ani mm working on isolated contractions and reducing accessory muscle involvement (including gluteals, hip adductors, and abdominals). -Integration with ADL's -Biofeedback- use of internal instrumentation to provide feedback on the amount of mm contractions that is being accomplished.
The ____ _____ distribution of a muscle affects how resistant it is to fatigue.
Fiber Type
Name 3 types of equipment that can be utilized to assist with ROM activities. Explain what extremity you would use it for. Is the movement PROM,AAROM,AROM, or RROM?
Pulley, CPM, Wand
A diminished response of a muscle to a repeated stimulus, where muscle needs to be exercised to this point in order to improve and gain strength. Signs are looked for at the end of the repetitions that have been prescribed, not at the beginning.
Fatigue
A PTA provides a strengthening exercise for the lower extremity for a patient who is recovering from a knee injury. The pictured exercise would be most effective to strengthen the :
hip external rotators
List parameters a PTA may change/adjust exercises for to frequently to maintain fatigue as the muscle strength improves.
patient position type of resistance (e.g., isometric, theraband, hand/ankle weights), lever arm repetitions, sets contraction duration (for isometrics) frequency per day or week
What is AAROM (Active Assisted Range of Motion)?
Active motion assisted by an external force, either manual or mechanical, which requires the patient to partially activate the muscle and can be assisted by the pt, PTA or device
What is RROM (Resisted Range of Motion)?
Active motion that is resisted by an external force, either manual or mechanical.
These balance assessments observes a patient performing voluntary movements the requires postural set to counteract a predicted postural disturbance such as catching a ball, opening doors, lifting objects of different weights which includes these test: Functional Reach Test Multi directional Reach test Star Excursion Balance Test
Anticipartory Postural Control Tests (Feedforward)
What should be done Post Stretching?
Apply cold to the tissues that have been stretched to allow for cooling while the muscle is in a lengthened position, to assist in decreasing the risk of muscle soreness that is caused by micro trauma to the tissue during the stretch. Strengthen any new range acquired Maintain a balance in strength between the agonist and the antagonist muscles
List motions of the hip
Hip flexion Hp extension Hip abduction Hip adduction Hip medial rotation Hip lateral rotation
When there is an increase in muscle tension, and at the same time the GTO causes that muscle to relax this phenomenon is called
Autogenic Inhibition
A PTA is reviewing the Physical Therapy evaluation of a patient. The evaluation reports the patient had a positive Yergason test. Which of the following would this indicate? a. supraspinatus tear b. subacromial impingement c. infraspinatus tear d. subscapularis weakness
B. Subacromial Impingement
medial thigh
L2
medial knee
L3
What does the method of Stretching depend on?
Pt tolerance to the position when stretched Pathophysiology Balance Coordination
In addition to assessing the vertical and horizontal anatomical landmarks, a PTA should note what?
The spinal curvatures in the lateral view.
How do you decide the appropriate level of resistance?
MMT scale determines what type resistance should be used during therapeutic exercise as well as the the size of the muscle.
List functions of the somatosensory system
provides information about relative location of body parts proprioception kinesthesia sensory receptors located in soft tissue structures around the joint (muscles, capsules, ligaments, tendons)
What to expect when providing Stretches as a treatment?
PTA's can expect a slow, and gradual process that can take several weeks to see significant results.
What functional limitations would a patient have if they were lacking ROM or Strength in the primary movers of the knee?
Patellar Malalignment and Tracking problems Increased Q angle -> increased pressure on lateral facet against lateral femoral condyle w/ knee flexion
These assessment observes the patient's automatic postural response or reactive control to external perturbations pushes (small, or large, slow or rapid, anticipated or unanticipated) movements which include: Pull Test Push and Release Test (PRT) Postural Stress Test
Reactive Postural Control Tests (Feedback)
List the Manual Muscle Testing for the Shoulder Girdle
Scapular Elevation (Upper Trapezius ) Scapular Adduction (Middle Trapezius) Scapular Adduction & Depresson (Lower Trapezius) Scapular Abduction & Upward Rotation (Serratus Anterior)
List the Actions of the Shoulder Girdle
Scapular elevation Scapular depression Scapular protraction Scapular retraction Scapular upward rotation Scapular downward rotation
Brachialis
A flex elbow O distal half of anterior humerus I tuberosity & coronoid process of ulna N musculocutaneous, small branch from radial
Brachioradialis
A flex elbow assist with resisted pronation/supination O proximal 2/3 of lateral supracondylar ridge of humerus I radial styloid N radial
Explain 3 exercises that would be appropriate during the acute and/or early sub-acute phase to increase ROM for the shoulder joint
Codman's Gear shift Wand exercises wall and window washing ball rolling table top dusting pulleys
Which of the following statements is true about the relationship of the pelvis and the hip joint?
anterior pelvic tilt causes hip flexion posterior pelvic tilt causes hip extension
PNF D2 Flexion Lower Extremity Directions
Hip= Flexion, Abduction, Internal Rotation Knee= Straight (Flex/Ext) Ankle = Dorsiflexion, Eversion Toes= Extension
PNF D1 Flexion Lower Extremity Directions
Hip= Flexion, Adduction, External Rotation Knee= Straight (Flex/Ext) Ankle= Dorsiflexion, Inversion Toes= Extension
Tinetti Performance - Oriented Mobility Assessment (POMA) Scoring
Scoring Range = 0 (highest level of impairment) to 2 (individuals independence) Example: Total Balance Score = 16 Total Gait Score = 12 Total Test Score = 28 Interpretation: 25-28 = low fall risk 19-24 = medium fall risk < 19 = high fall risk
Which of the following would be and indication for a total ankle arthroplasty?
severe persistent pain with weight bearing after a significant time following arthrodesis of one ankle
According to the Canvas Notes, what are 3 different treatment options/interventions a PTA can utilize to address strength training?
Isometric exercises, Gravity eliminated,minimized, or against gravity. Resistance, Weights.
Oxford Regimen (Determination of a 10-RM)
10 Reps @ 100% of the 10-RM 10 Reps @ 75% of the 10-RM 10 Reps @ 50% of the 10-RM
Anconeus
A extend elbow O lateral epicondyle of humerus I olecranon proces and posterior proximal surface of ulna N radial
middle arm, index and middle finger, triceps reflex
C7
lateral shoulder, deltoid, biceps reflex
C5
medial arm, ring and little finger
C8
Tendinopathy
Chronic Tendon Pathology
What type of stretch that is performed prior to a dynamic activity significantly reduces an individuals power and increases their risk of injury?
Static Stretching
A kyphotic deformity also known as Hump Back, that is characterized by a localized, sharp, posterior angulation.
Gibbus Hump
What are clinical signs during Acute Stage?
Inflammation Pain before tissue resistance
List activities to help improve Sensory Organization
Reduce visual inputs Reduce somatosensory cues
The formation of discal fragments outside of the disc.
Sequestration
The complete loss of contact between the humeral head and the glenoid fossa.
Shoulder Dislocation
The inflammation of the supraspinatus tendon due to shoulder impingement.
Supraspinatus Tendonitis
What is Plasticity?
The ability of soft tissue to assume a new and greater length after stretching.
List the three sections of the Levator Ani of the pelvic floor
pubococcygeus puborectalis iliococcygeus.
Post Fracture (Period of Immobilization) Plan of Care
1. Educate the patient. 2.Decrease effects of inflammation during acute period. 3.Decrease effects of immobilization. 4.If patient is confined to bed, maintain strength and ROM in major muscle groups
Post Fracture (Post Immobilization ) Plan of Care
1. Educate the patient. 2.Provide protection until radiologically healed. 3.Initiate active exercises. 4.Increase joint and soft tissue mobility. 5.Increase strength and muscle endurance.6.Improve cardiorespiratory fitness.
Post Fracture (Period of Immobilization) Intervention
1. Teach functional adaptations. Teach safe ambulation, bed mobility. 2.Ice, elevation 3.Intermittent muscle setting. Active ROM to joints above and below immobilizedregion 4.Resistive exercises to major muscle groups notimmobilized, especially in preparation for futureambulation
According to the Kisner text, what common impairments might a patient demonstrate due to disc protrusion?
1. pain and muscle guarding 2. flexed posture and deviation away from the symptomatic side 3. neurological symptoms in dermatome and possibly myotome of affected nerve roots 4. Increased symptoms in with sitting, prolonged flexed postures, transition from sit to stand, coughing, straining 5. limited nerve mobility such as straight leg raise 6. peripheralization of symptoms with repeated forward bending.
Post Fracture (Post Immobilization) Intervention
1.I nform patient of limitations until fracture site is radiologicallyhealed. Teach home exercises that reinforce interventions. 2.Use partial weight bearing in lower extremity and nonstressfulactivities in the upper extremity. 3.Active ROM, gentle multiangle isometrics 4.Initiate joint play stretching techniques (using grades III and IV)with the force applied proximal to the healing fracture site. For muscle stretching, apply the force proximal to the healingfracture site until radiologically healed. 5.As the ROM increases and the bone heals, initiate resistive andrepetitive exercises. 6.Initiate safe aerobic exercises that do not stress the fracturesite until it is healed.
The most commonly used strategy for balance recovery, especially with small perturbations in which the patients movements include dorsiflexion, plantarflexion, eversion, and inversion used to regain balance.
Ankle Strategy
What do PRE program that produce training-induced strength gains use?
2 to 3 sets of a 6 to 12 repetitions.
What is PROM (Passive Range of Motion?
Available ROM that is slightly greater than AROM and is produced entirely by an external force which can be performed by PTA, or device.
The loss of blood supply to the femoral head, resulting in the necrosis (death) of the femoral head which is caused by a fracture, dislocation, lupus, sickle cell anemia, alcoholism, and prolonged steroid use.
Avascular Necrosis
List Precautions/Contraindications for Patient with a History for Posterior Shoulder Subluxation/Dislocation.
Avoid exercises that cause a posterior glide of the humerus such as shoulder flexion & internal rotation
List Precautions/Contraindications for Patient with a History for Anterior Shoulder Subluxation/Dislocation.
Avoid exercises that cause anterior glide of humerus such as shoulder extension & external rotation Strengthen Shoulder adductors & internal rotators to improve shoulder stability, and decrease risk of anterior subluxation/dislocation
List Components of Physical Function
Balance-proper body alignment against gravity Cardiopulmonary fitness-oxygen uptake, resting HR and BP Coordination and skill-quality of movement, hierarchy of tasks Mobility and Flexibility-goniometry Muscle performance-strength, power and endurance Neuromuscular control-sensory and motor systems Posture-static and dynamic balance Stability-maintaining proper alignment
The inflammation of the long head of the biceps tendon, which passes through the bicipital groove and attaches to the supraglenoid tubercle
Biceps Tendonitis
Thoracic outlet syndrom is most commonly caused by entrapment of the a. supraspinatus tendon b. scalenes c. biceps brachii d. sternocliedomastoid
B. Scalenes
Hermarthrosis
Bleeding into a joint, usually due to severe trauma
When weight bearing position is assumed and the body moves over a fixed distal segment, the term is
Closed Chain
The shortening of the muscle that is a form of dynamic muscle loading in which tension in a muscle develops and physical shortening of the muscle occurs as an external force (resistance) is overcome, as when lifting a weight.
Concentric contraction
Environmental disturbances to balance such as colliding with another person in a busy mall.
External perturbations
The movement of part of the nucleus pulposus into the epidural space
Extrusion
If it's in the Sagittal plane, then it's in the _________ axis
Frontal Axis
The body plane with an anterior and posterior view
Frontal Plane
Tendinosis
Degeneration of the tendon due to repetitive microtrauma
Patient with a recent shoulder injury now ready to progress to dynamic open chain scapular strengthening exercises. What exercise would be most appropriate a. alternating isometrics with manual resistance b. push ups c. isometric scapular retraction d. prone scapular retraction
D. Prone Scapular Retraction
These balance assessments observe standing or sitting on unstable surface or performing postural transitions and functional activities which include these test: Five Times Sit-To-Stand Test (5x STS)
Dynamic Balance Tests
List Actions of the Elbow & Forearm
Elbow flexion Elbow extension Supination Pronation
The ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time, which uses slow-twitch muscle fibers (Type I) to generate a small amount of force but can sustain the contraction for a long period of time, as well is improved with low resistance and high repetitions, and for many patients with impaired muscle performance, this has a more positive impact on improving function than strength training.
Endurance Training
List whats needed for a Tinetti Performance - Oriented Mobility Assessment (POMA)
Equipment needed: Hard armless chair Stopwatch or wristwatch 15 ft walkway Completion Time: 10-15 minutes
The study of how a person interacts with their environment when performing a repetitive task.
Ergonomics
This factors can affect lateral tracking of the patella
Excessive pronation genu valgus vmo weakness weakness of the hip external rotators tight IT band
Signs of Excessive Stress w/ Exercise or Activities
Exercise or activity soreness that does not decrease after 4 hours and is not resolved after 24 hours Exercise or activity pain that comes on earlier or is increased over the previous session Progressively increased feelings of stiffness and decreased ROM over several exercise sessions Swelling, redness, and warmth in the healing tissue Progressive weakness over several exercise sessions Decreased functional usage of the involved part
What muscles is usually affected by Lateral Epicondylitis ?
Extensor Capri radialis brevis
What are the anatomical alignment landmarks for a plumb line, vertical lateral view?
External acoustic meatus (ear hole) Acromion Greater trochanter Slightly posterior to the patella Slightly anterior to the lateral malleolus
rTSA ADL Precautions
For first 12 weeks: Observe ROM restrictions during functional activities —Do not reach behind the back or into hip pocket —When supine, support arm on pillowto avoid GH extension past neutral By 5-7 weeks light ADL permitted with elbow at waist level (writing, eating,washing face) Do not lean on involved arm (rising from or sitting down in chair Restrict lifting with operated arm for 12-16 weeks (no heavier than cup ofcoffee or glass of water) No driving (4 -6 wks) After 12-16 weeks Limit unilateral lifting to 6 lb Ultimate bilateral lifting limit: 10-15 lb Gradual return to light functionalactivities
List of Special Test for the Spine
Foraminal Compression Test Distraction Test Vertebral Artery Test Alar Ligament Stress Test Testing Mobility of the First Rib Babinski Test Straight Leg Raise Test Well Leg Straight Leg Raise Test 90-90 Straight Leg Raise Test Hoover Test Slump Test Ely's Test Pelvic Rock (Squish) Test Gaenslen's Sign Patrick (Faber) TestWaddell's Sign FABER - Flexion + ABduction + External Rotation
A common spinal postural dysfunction described as excessive anterior positioning of the head caused by the shortening of the sternocleidomastoid and scalenes and the overactivity of the semispinalis capitis, suboccipitals, and levator scapula.
Forward Head
A bone disorder where a structural break in the continuity of a bone, epiphyseal plate, or a cartilaginous joint surface occurs.
Fracture
This balance test is a quick screen of balance problems in older adults.
Functional Reach Test
List interventions that incorporate balance during functional activities.
Functional activities Dual or multitask activities (walking with secondary cognitive motor task)
List Intervention for Plantar Fasciitis and Shin Splints, in Subacute and Return to Function Phase
HEP Correct training errors/abnormal foot alignment Increase Flexibility ROM exercises (DF, PF, EV, InV) Alphabet writting Gentle repetitive warm up activities before intense exercise followed by stretching Proper foot support Stretch range limiting structures Improve muscle performance (Isometric -> Resistive dynamic exercises, open & closed chain) Muscular endurance/Eccentric loading drills Strengthen intrinsic muscles (toe control) Deep Massage or Joint Mobilizations
Also known as a herniated disc or ruptured disc, in which there are several types of disc herniations: protrusion, prolapse, extrusion, and sequestration.
Herniated Nucleus Pulposus (HNP)
List Joints for the Elbow & Forearm
Humeroulnar Humeroradial Proximal radioulnar Distal radioulnar
List Bones and Bony Landmarks for the Elbow & Forearm
Humerus Ulna Radius
The "most common bony injuries requiring surgical intervention in the United States" according to the textbook Rehabilitation for the Postsurgical Orthopedic Patient. which require an ORIF (open reduction internal fixation).
Hip Fracture
The degeneration of the articular cartilage in the hip joint
Hip Osteoarthritis or Degenerative Joint Disease (DJD)
This balance strategy uses hip flexion or extension predominately to regain balance, especially in response to larger perturbations or when ankle range of motion is limited.
Hip Strategy
PNF D1 Extension Lower Extremity Directions
Hip= Extension, Abduction, Internal Rotation Knee= Straight (Flex/Ext) Ankle = Plantar Flexion, Eversion Toes = Flexion
List Components of Tinetti Performance - Oriented Mobility Assessment (POMA) Gait Test
Initiation of Gait Step Length and Height Step Symmetry Step Continuity Path Trunk Walking Stance
What are causes of Nonstructural Scoliosis?
Leg-length discrepancy Muscle Guarding/Spasm Habitual/Asymmetrical Postures
List Ligaments for the Elbow & Forearm
Medial (ulnar) collateral Lateral (radial) collateral Annular Interosseus membrane
A tear in the medial and/or or lateral meniscus
Meniscus Tear or Repair
What are the risks of Scoliosis if not treated?
Mobility impairments in joints/muscles/fascia on concave side of curve Impaired muscle performance dues to stretch/weakness of musculature of convex side curves Decreased flexibility of hip adductors Weak/stretched hip abductors Decreased rib expansion Cardiopulmonary impairments - difficulty breathing
List Interventions for Dynamic Balance Testing
Moving support surfaces Move head, trunk, arms, legs Transitional and loco-motor activities
List interventions for Plantar Fasciitis and Shin Splints for Acute Phase
NSAIDS Activity Modification Rest Modalities (Ice Pack, Ice Massage) Splint Foot in PlantarFlexion or DorsiFlexion Cross Friction Massage Gentle Muscle Setting E-Stim AROM Taping/orthotic shoe inserts
What are the anatomical alignment landmarks for a plumb line, vertical anterior view?
Nasal Bones Xiphoid Umbilicus Midpoint between Knees Midpoint between Ankles
What are causes of Structural Scoliosis?
Neuromuscular diseases/disorders (CP, SCI) Osteopathic disorders Idiopathic disorders
A form of scoliosis that is reversible and can be changed with forward side bending, positional changes such as lying supine, realignment of pelvis by correcting leg-length discrepancy or with muscle contractions.
Nonstructural Scoliosis
In order for Rhythmic Stabilization to be Isometric the patient should ____ ____ during the exercise
Not Change
These assessments of sensory organization assess the safety of a patient during gait, locomotion, or balance.
Observations home assessments Activities-Specific Balance Confidence (ABC) Scale Falls Efficacy Scale
When a non weight bearing position is assumed and the distal segment (foot and hand) moves freely during exercise, the term is ____ ____
Open Chain
_____ _____ exercises you can target specifically one movement at a joint, where as _____ _____ exercises you can target synergistic movement patterns that mimic the firing patterns of functional tasks
Open- Chain; Closed Chain
A device that is an effective way to improve shoulder ROMs that utilize more muscle activity than therapist-assisted ROM and CPM and only be performed when muscle activity is desired.
Overhead Pulley
This injury is typically caused by falling directly onto the bone or joint of the knee which can either be nondisplaced which is treated with an immobilizer brace or displaced, which requires an open-reduction internal fixation (ORIF).
Patellar Fracture
The imaginary flat surfaces that pass through the body is called _________
Planes
This treatment the muscles primarily function to provide exact control of the finger and thumb positions. This requires a higher level of sensory input during tasks. Muscles function dynamically with these types of grips. The radial side of the hand and MCP joints are involved more in the precision and prehensile types of grasps.
Precision Grasp
A bulge in the disk posteriorly without the rupture of the annulus fibrosus.
Protrusion
List functions of the visual system
Provides information about head position, relative to movement Orients head to maintain level gaze Provides information about movement of surrounding objects
lateral margin of foot, little toes, Achilles tendon reflex
S1
These balance assessments are Clinical Test of Sensory Integration on Balance Test (CTSIB) which are also called the "Foam and Dome" Test, that measures the patient's ability to balance under six different sensory conditions.
Sensory organization Test
Size Variations of Rotator Cuff Tears
Small Tear = 1cm or less Medium Tear = 1 - 3cm Large Tear = 3 - 5cm Massive = More than 5cm or a full thickness tear of more than one tendon
When the ankle and hip strategies are insufficient, this strategy is used by patients by a step in any direction with a large single step or multiple smaller steps, especially in response to external perturbation applied by the therapist.
Stepping Strategy
List equipment used for Berg Balance Test
Stop Watch Ruler 2, 5, or 20 inches Chairs Step/Stool
What stage of healing is it most appropriate to begin active strengthening exercises?
Subacute
axillary region, elbow
T1-2
List Types of Fractures
Transverse Oblique Spiral Comminuted Segmental Avulsed Impacted Torus Greenstick
The body plane with superior and inferior view
Transverse plane
In which body plane and axis do these occur? Internal / External Rotation Pronation / Supination Horizontal Abduction/ Adduction
Transverse plane & Vertical axis
List Muscles of the Shoulder Girdle
Trapezius Serratus Anterior Levator Scapula Rhomboids Pectoralis Minor
What are the Indications for Stretching?
When ROM is limited b/c soft tissues have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing functional limitations or disabilities. When restricted motion may lead to structural deformities otherwise preventable. When there is muscle weakness and shortening of opposing tissue. As part of a total fitness program designed to prevent musculoskeletal injuries. Prior to and after vigorous exercise to potentially minimize post exercise muscle soreness
A body systems adapt over time to the stresses placed on them
Wolf's Law
List Common Nerve Injures of the Wrist & Hand
Wrist Drop (Radial Nerve) Ape Hand (Median Nerve) Claw Hand (Ulnar Nerve)
According to the brochure What You Need to Know About Balance and Falls by the APTA, _________ people over the age of ______ (who live at home) will fall during the next year."
1 in 4, 65
What is Hypermobility?
A stretch that is well beyond the normal length of muscle and ROM of a joint and the surrounding soft tissue.
What is Stretching?
A technique used to increase muscle length and joint ROM by separating the origin from the insertion either by moving the origin/insertion from a stabilized origin/insertion.
Chronic Stage Clinical Signs
Absence of inflammation Pain after tissue resistance
dorsum of foot
L5
Infraspinatus
A: laterally rotate the shoulder, Adduct the shoulder, Stabilize the head of humerus in the glenoid cavity. O: Infraspinous fossa of the scapula I: Greater tubercle of the humerus N: Suprascapular C(4), 5, 6
posterior and outer surfaces LE
L5-S2
A device used to improve joint stability that is held in the center with one or two hands, moved back and forth in a small, rhythmical motion, as the patient tries to stabilize the motion by contracting the shoulder and core muscles.
Body Blade
A nerve that ensures motion and feeling in the upper limbs and injuries are often caused by trauma, traction and or compression of the nerves involved, with severe injuries, pain relief can be hard to achieve and chronic pain may result
Brachial Plexus
Contusion
Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and inflammatory response.
When a patient has an anterior shoulder dislocation, the position of dislocation should be avoided for several weeks. What combination movements would place the head of the humerus most anterior in the glenohumeral joint? a. Internal rotation and flexion b. Extension and internal rotation c. Abd to 90* with external rotation d. Adduction and internal rotation
C. Abd to 90 with External Rotation
List of Effects of Bedrest
Decubitus Muscle Atrophy Orthostatic Hypotension Edema Reduced Lung Volume Reduced Motivation Venous Thrombosis Atelectasis Disturbance of sleep/wake cycle Embolization Metabolic Alteration Decreased Strength of 1-1.5% daily
Chronic Stage Tissue Responses and Characteristics
Maturation of connective tissue Contracture of scar tissue Remodeling of scar Collagen aligns to stress
A patient who presents with reduced sensation in the posterior forearm and hand and has reduced ability to grasp an object between the thumb and forefinger may have damage to what nerve?
Median
Post Fracture (Post Immobilization) Impairments
Pain with movement, which progressively decreases Decreased ROM Decreased joint play Scar tissue adhesions Decreased strength and endurance
List Interventions for Anticipartory Balance Testing
Reaching Catching Kicking Lifting Obstacle course
Pain over the SI joint caused by the misalignment of the pelvis of an innominate half of a pelvis - the ilium, ischium, and pubis on one side is not in alignment, which can be caused by imbalances in muscle tightness and weakness.
Sacroiliac Joint (SIJ) Dysfunction
If it's in the Frontal plane,then it's in the ______axis
Sagittal Axis
The bod plane with a left to right view
Sagittal Plane
Risk Factors of Osteoarthritis (OA) or Degenerative Joint Disease (DJD)
aging obesity overuse Trauma.
The most effective method to stretch the gastroc-soleus complex?
during ankle dorsiflexion, flex the knee for the soleus and extend the knee for the gastrocnemius
It is very common for patients to compensate when performing Active ROM Exercises. What compensatory motions of the shoulder might a patient demonstrate when performing a wall climbing exercise? (Name 3)
going onto their tip toes, leaning laterally, scapular elevation with over use of the upper traps.
Remembering passive and active insufficiency and how it effects stretching, How would you position the fingers to get the most effective stretch to increase wrist extension.
placing the fingers in flexion would allow the wrist to extend more. If the fingers were extended, passive insufficiency would inhibit the wrist from extending further due to the wrist extenders already being on stretch with the fingers being extended.
Signs and Symptoms of Compartment Syndrome include
redness swelling pain possible hardness of the overlying skin
Treatment for OA or DJD may involve
rest heat weight management medications possible joint replacement.
List commonly used PNF techniques to rehabilitate shoulder conditions and injuries
rhythmic stabilization rhythmic initiation hold-relax contract relax alternating isometrics slow reversals
By not avoiding motions above the shoulder level with the arm in shoulder internal rotation can lead to what disorders from the impingment of he subacromial structures
shoulder impingment, subacromial bursitis, supraspinatus tendonitis rotator cuff tears.
rTSA ROM Exercises, Stretching, & Joint Mobilizations During Phase 1:
(when immobilizer can be removed): Grade I /II joint oscillations AROM: scapula and distal extremityjoints only Pendulum exercises PROM only of GH joint Observe ROM restrictions
DeLorme Regimen (Determination of a 10-RM)
10 Reps @ 50% of the 10-RM 10 Reps @75% of the 10-RM 10 Reps @ 100% of the 10-RM
How long does it take a normal fracture to heal in an adult? In an adult that has a normal healing fracture, At what stage of remodeling is immobilization no longer required?
10- 18 Weeks, and Remodeling Phase
Norrmal anteroposterior sway in adults is ___ degrees from the most posterior to the most anterior position
12
An average-height adult with a four inch base of support (distance between the feet), lateral sway is ____ degrees from side to side.
16
What is an Isometric muscle contraction? When would it be beneficial to instruct a patient with an isometric exercise program?
A static muscle contraction that produces a constant force without a change in length of the muscle or joint motion. A patient who is in an acute phase after an injury and is not permitted to do dynamic exercises. Isometric contractions also prevent muscle atrophy and can be used when initiating stabilization exercises.
Supinator
A supinate the forearm O lat. epicondyle of humerus, radial collateral ligament, annular ligament, supinator crest of ulna I anterior, lateral surface of proximal 1/3 of radial shaft N radial
List Indications for an Achilles Tendon Repair
Acute, complete rupture of the Achilles tendon Elite athlete or active individual who wishes to return to high-demand functional activities Chronic, previously undiagnosed or untreated complete rupture
Contracture
Adaptive shortening of skin, fascia muscle, or a joint capsule that prevents normal mobility or flexibility
The thickening of the glenohumeral joint capsule in response to inflammation in which patient present with significantly limited ROM.
Adhesive Capsulitis (Frozen Shoulder)
What PNF techniques would be appropriate to use when initiating strengthening exercises for the glenohumeral joint? Explain the order you would progress them
After isometric exercises have been initiated, a PTA may progress to alternating isometrics and/ or rhythmic stabilization having the patient alternate the direction they are isometrically contracting in one direction and then in another. Progressing to rhythic initiation for passive movement then progressing to active movement.. After the patient has achieved full ROM and as long as they are permitted to perform diagonal motions, PNF patterns can be incoorporated with manual resistance (slow reversals)
A PTA is treating a patient with medial epicondylitis and is initiating the strengthening phase ( later part of sub acute phase). Identify 1 strengthening exercises that would be appropriate for this patient. How would you progress this exercise towards functional movements? Explain detail of the exercises (dynamic vs static, isometric vs concentric/eccentric, open chain vs closed chain),
After the patient is able to tolerate isometrics into a position of wrist flexion, Wrist flexion and extension in open chain can be started with no weight on a table top with the forearm pronated. Light weight can be applied once the movement is too easy. later the patient can progress towards functional movements using a wrist roller exercise with no weight and then progress weight as necessary.
List of Basic Safety Considerations for Therapeutic Exercise
Awareness of Pt's Health Hx/Status Prescribed medications Clearance from a Dr Adequate amount of space/support of exercise Maintain good equipment Equipment fits, applied, used correctly Accurate movement w/ posture, performance - intensity, speed & duration Education of fatigue & risk of reinjury Be aware of precautions, contraindications, and safety precautions.
The imaginary or real line around which movement takes place is known as the ________ which is perpendicular to the plane of movement.
Axis
What are Contraindications of Stretching?
Bony block limits joint motion. After a recent fracture before bony union is complete. Evidence of an acute inflammatory or infectious process (heat and swelling) or when soft tissue healing could be disrupted in the tight tissues and surrounding region. Sharp, acute pain with joint movement or muscle elongation. Hematoma or indications of tissue trauma is observed. Hypermobility already exists. Contractures or shortened soft tissues are providing increased joint stability in lieu of normal structural stability or neuromuscular control. Contractures or shortened soft tissues are the basis for increased functional abilities, particularly in patients with paralysis or severe muscle weakness.
Symptoms recede up the leg or become localized to the back
Centralization
A headache that originates from the neck, that may be due to prolonged poor posture (such as that caused by sitting in front of a computer keyboard or driving daily for long periods), injuries of the upper spine (such as whiplash injuries), or other pathologies of the cervical spine (such as osteoarthritis).
Cervicogenic Headache
What are the three stages of Motor learning? A PTA has been treating a patient who recently had a CVA. The patient has been prescribed a HEP and has been doing the exercises 2 x a day. At this point the patient needs minimal verbal cues or feedback from the PTA on the correct technique.The patient demonstrates awareness of incorrect movement and may even self correct. What stage is this patient in?
Cognitive stage, Associative Stage, Autonomous Stage This patient would be in the associative stage. The movement has not become completely automatic but the patient is able to perform the task with little feedback from the PTA
Rationale for use of Concentric and Eccentric Exercise:
Concentric muscle contractions accelerate body segments Eccentric muscle contractions decelerate body segments (e.g., during sudden changes of direction or momentum.) Eccentric contractions also act as a source of shock absorption during high-impact activities.
This PNF stretch is based on autogenic inhibition which involves the muscle being stretched held in a static stretch to end ROM for 30 seconds, then patient concentrically contracts that muscle for 10 seconds, then muscle moved to a new end ROM.
Contract- Relax Stretch
List Management Guidelines for the Acute Phase of Rehabilitation/Intervention. (Up to 1 Week Post Injury)
Control the effects of inflammation RICE (Rest, Ice, Compression, Elevation) (48 hrs) Immobilize (Splint, cast, tape, rest) Educate the patient whats expected such as what is safe or unsafe and make sure to explain that this phase is not long lasting. Educating the patient on movement within safe parameters is important in order to promote circulation to the injured area. Passive Range of Motion - w/in limit of pain, specific to structure involved Gentle isometrics (muscle setting - etim) Massage Low-dosage mobilization/manipulation techniques (Grade I or II) joint oscillation w/ joint pain-free position AAROM, Free ROM, RROM &/or modified aerobic exercise to associated areas Adaptive/Assistive devices as needed for functional activities
Subacute Physicaly therapy goals and interventions for phase of Rehab
Controlled- Motion Phase: Intermediate Develop mobile scar: selective stretching, mobilization /manipulation of restrictions Promote healing: nondestructive active, resistive, open/closed chain stabilization, muscular/cardiopulmonary endurance exercises, carefully progressed in intensity & range
What is Hypomobility?
Decreased mobility or restricted motion.
What type of stretch that is performed prior to dynamic activity has a positive affect on an individuals performance and reduces their risk of injury?
Dynamic Stretching
Rapidly progressed, high intensity ______ ______ ______ are associated with significantly higher incidence and severity Delayed-Onset Muscle Soreness (DOMS)
Eccentric Muscle Contraction
The elongation of the muscle that involves dynamic loading of a muscle beyond its force-producing capacity, causing physical lengthening of the muscle as it attempts to control the load, as when lowering a weight.
Eccentric contraction
This common pathology is the stretching or tearing of the ligaments that surround the humeroulnar and humeroradial joints, which will lead to varus and/or valgus stress placed on the collateral ligaments. Signs and symptoms include pain, swelling, erythema, bruising and limited mobility. This condition is typically diagnosed with an assessment of the doctor by X-ray and MRI and graded according to severity (Grade 1, Grade 2 or Grade 3).
Elbow Sprain
List the ROM for Manual Muscle Testing of the Elbow & Forearm
Elbow flexion Elbow extension Supination Pronation
List Goniometry ROM for the Elbow & Forearm
Elbow flexion= 150 (Supine, Lateral Epicondyle, Acromion Radial Styloid) Elbow extension =0 (Supine, Lateral Epicondyle, Acromion Radial Styloid) Supination = 80 (Sitting, Ulnar Styloid, Humerus, Styloids) Pronation = 80 (Sitting, Ulnar Styloid, Humerus, Styloids)
In a resistance program refers to the number of exercise sessions per day or per week.
Frequency
What is the sequence that exercise order that is performed in an exercise program which has an impact on muscle fatigue and adaptive training?
Large muscle groups should be exercised before small muscle groups Multi-joint exercises should be performed before single-joint exercises Higher intensity exercises should be performed before lower intensity exercises.
List Intervention for a Lateral Ligament Repair - Acute Phase
Last 4-6 weeks AMB w/ AxCr, NWB Elevate Foot cont. No ROM Maintain strength of nonimmobilized muscle groups Prevent reflex inhibition of immobilized muscle groups
This is the inflammation of the structures near the lateral epicondyle which is also known as Tennis Elbow. It is often treated with a brace containing an ice pack which decreases the pull of the wrist extensor tendons on the lateral epicondyle while reducing the inflammation The treatment for this will begin with rest and activity modification.
Lateral Epicondylitis
The surgical repair of the anterior talofibular (ATF) ligament and possibly the calcaneofibular (CF) ligament and the anterior inferior tibiofibular (AITF) ligament when there is a ligament sprain.
Lateral Ligament Repair
List Components of a Grade I Ankle Sprain
Location = anterior talofibular ligament Edema = Slight and Local WB = Full or Partial Ligament = Damaged by overstretched Instability = None - Tenderness, no swelling, heals in 11.7 days
List Components of a Grade II Ankle Sprain
Location = anterior talofibular ligament and calcaneofibular ligament Edema = Moderate and local WB = Difficult w/ Crutches Ligament Damage = Partial Tear Instability = None or slight -Swelling, lateral tenderness, heals 2- 6 weeks
List Components of Grade III Ankle Sprain
Location = posterior talofibular ligament, anterior talofibular ligament and calcaneofibular ligament Edema = Significant and diffuse WB = Impossible w/o significant pain Ligament Damage = Complete Tear Instability = Definite - Heals Greater than 6 Weeks
What are the instructions for a proper techniques of a squat?
Maintain feet at shoulder width apart Keep eyes facing forward Send your butt back and down Do not let the knees roll inside of the foot Keep chest up Stay off of the balls of your feet Exert pressure on the outside of your feet when rising Do not roll shoulders/back Do not let knees protrude over the toes
What are the Uses of PROM for Treatment?
Maintain joint and soft tissue integrity Minimize formation of contractures Maintain Mechanical elasticity of muscle Assist circulation and vascular dynamics Decrease or inhibit pain Assist with healing process Enhance synovial movement for cartilage nutrition Maintain awareness of movement Demonstrate desired active movement Preparation for stretching
Explain the difference between closed kinetic chain and open kinetic chain Give an example of an activity or exercise that demonstrates each. Why would you choose one type of training over another?
Open kinetic chain is a movement of an extremity that involves the distal end of the extremity to move freely in space. Example- Standing knee flexion- the tibia is moving over the femur. Closed Kinetic chain is considered to be in a weight bearing position, The body moves over a fixed distal segment. Example- Standing squat- knee is flexing but foot in in weight bearing. The femur is moving over the tibia It is thought to be that closed kinetic chain exercise resemble more functional activites. If a patient was having difficulty sitting or standing or with stairs, Closed kinetic chain strengtheining may be more beneficial. If a patient was having difficulty with specific ROM or hamstring weakness open chain may be more beneficial.
Trapezius (Upper Fibers)
Origin: Base of the skull, Occipital protuberance, and posterior neck ligaments Insertion: Lateral 1/3 of the clavicle Action: Elevation, Upward Rotation, Extension of head, Rotation of head Innervation: Spinal Accessory Nerve and Branches of C3-C4
Subclavius
Origin: Coastal cartilage of 1st rib Insertion: Mid-portion of the clavicle Action: Depression and Abduction of the scapula. Protects and stabilizes SC joint. Innervation: C5-C6 nerve fibers
Rhomboids Minor
Origin: Nuchal ligaments and spinous processes of C7-T1 Insertion: Medial border of the scapula level with the spine Action: Adducts and DR of the scapula Innervation: Dorsal Scapular Nerve C4-C5
Trapezius (Middle Fibers)
Origin: Spinous Process of the C7-T3 Insertion: Acromion Process and Scapular Spine Action: Elevation, Adduction, and Upward Rotation of the Scapula Innervation: Spinal Accessory Nerve and Branches of C3-C4
Rhomboids Major
Origin: Spinous processes of T2-T5 Insertion: Medial Border of the Scapula from spine to Inferior Angle, inferior to minor Action: Adduction, Downward Rotation of the Scapula Innervation: Dorsal Scapular Nerve C4-C5 Deep to traps
Subacute Stage (Controlled Motion Phase) Structural & Functional Impairments
Pain when end of available ROM is reached Edema (decreasing but may still be present) Joint effusion (decreasing but may still be present if joint is involved) Soft Tissue, muscle and or joint contractures (developing in immobilized region) Muscle weakness from reduced usage or pain Decreased functional use of the part 7 associated areas
Osteoarthritis Structural/Functional Impairments, Activity Limitations, & Participation Restrictions
Pain with mechanical stress or excessive activity Pain at rest in the advanced stages Stiffness after inactivity Limitation of motion Muscle weakness Decreased proprioception and balance Functional limitations in ADLs and IADLs
What is passive insufficiency? Give an example of passive insufficiency.
Passive Insufficiency refers to the fact that two joint muscles cannot stretch maximally across both joints simultaneously. Example: Hamstrings may limit hip flexion when the knee is in full extension since they are maximally stretched in this position. This is due to passive insufficiency. If you were to flex your knees, you place the hamstrings on slack and you are able to move further into hip flexion.
A common knee disorder that presents as anterior knee pain, which may be caused by overuse, improper alignment such as excessive pronation or a Q angle greater than 20°, and a muscular imbalance in the quadriceps muscles
Patellofemoral Pain Syndrome (PFPS)
General Considerations and parameters for the Thoracic and Lumbar Spine - Subacute Phase
Patient education on pain management Spinal and postural awareness Increase mobility- self-stretching Stabilization exercises progress to initiating extremity exercises while maintaining stabilized spine Cardiopulmonary Endurance Stress management Educate on proper body mechanics and functional adaptations
What occurs during the Autonomous Stage of Motor Learning?
Patient has the ability to perform a motor task while coordinating other physical and cognitive activities. The task becomes automated.
Nerve injury that can be sustained from a number of causes, including accidents or trauma which can result in a minor injury or a fully severed nerve. Based on the type and amount of damage, nerve regeneration may or may not be possible. Treatment depends on the type of injury, symptoms and the amount of nerve injury sustained. Symptoms include pain in the affected area, burning sensations and numbness.
Peripheral Nerve Injury
When treating a patient after a back injury or surgery, it is important to watch for signs of peripherilization or centralization. Describe the difference between these two symptoms. Which of these symptoms would be a sign of improvement?
Peripheralization would be a sign that possible further damage has been done. If a patient demonstrates radiculopothy symptoms, activities that increase this should be stopped. Centralization is what a therapist would want to see happen when treating their patient. this means that radiculopothy is reducing and that symptoms are improving. The patient would have pain more in the actual sight of the injury rather than radiating pain and dermatomal symptoms.
Symptoms increase and are experienced not only at their site of pain in the low back but are now beginning to radiate down the leg
Peripherilization
In which body plane and axis do these occur? Flexion/Extension Dorsiflexion/Plantar Flexion Anterior/Posterior Pelvic Tilt
Sagittal Plane & Frontal Axis
A patient with normal balance exhibits a continuous shifting of the body's center of mass (COM) over its base of support (BOS).
Postural Sway
What are the treatments are included in the care of an Elbow Sprain?
RICE Pain management Slings
Tennis Elbow Test
Purpose: Tests for lateral epicondylitis. Position: The patient makes a fist and extends the wrist. Action: The clinician palpates the lateral epicondyle while applying a downward force to the dorsal surface of the hand. Positive Finding: Pain at the lateral epicondyle with contraction of the wrist extensors.
perineum
S2-4
What are Precautions and Contraindications for ROM?
ROM should not be done when motion is disruptive to the healing process. Carefully controlled motion within the limits of pain-free motion during early phases of healing has been shown to benefit healing and early recovery. Signs of too much or the wrong motion include increased pain and inflammation. ROM should not be done when patient response or the condition is life-threatening. PROM may be carefully initiated to major joints and AROM to ankles and feet to minimize venous stasis and thrombus formation. After myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty, AROM of upper extremities and limited walking are usually tolerated under careful monitoring of symptoms.
What occurs in the muscle spindle when the muscle is stretched?
Receptors transmit information about the velocity, duration, and length changes to the central nervous system (CNS).
When there is an increase in muscle tension and the GTO causes the opposite muscle of that action to relax this phenomenon is called
Reciprocal Inhibition
General Intervention of Nonoperative Shoulder Pathologies (Acute Phase)
Reduce Pain/Swelling, Control Inflammation, Protect Injury site: (PRICEMEM - protection, rest, ice, compression, elevation, manual therapy, early motion, medication) Improve Postural awareness Begin Regaining pain-free PROM> AAROM in the entire kinetic chain: below 90 deg abd -Codman's pendulum -PROM - Flex, Abd, ER, IR elbow flex/ext -AAROM - ER, Abd, w. wand or cane -Overhead pulley Retard Muscle Atrophy & Minimize detrimental effects of immobilization & activity restriction -Submaximal Isometrics below 90 abd/flex - muscle setting -Elbow Flex/Ext PREs -Strengthening Transition: GH RTC, LS, SA, Mid Trap,Rhomboids > Deltoid, Lats, Pec Maj -Active exercise performed standing, sitting or lying -PNF ext-abd- ER or flex-add- IR (strengthening) -Prone Row, Abd, 45 flex
Principle, which stands for Specific Adaptation of Imposed Demands, states that tissues remodel in accordance to the stresses placed upon them which is based on Wolff's Law, which states that body systems adapt over time to the stresses placed upon them.
SAID Principle
The second phase of bone healing in which the early stages of healing take place. A callus starts to form osteoblasts and chondroblasts then begin to form cartilage near the fracture site and form primary woven bone.
Reparative Phase of Bone Healing
posteromedial thigh
S2
List Integumentary Common Physical Impairments Managed with Therapeutic Exercise
Skin hypomobility (immobile or adherent scarring)
A technique where a slow, resisted rhythmical concentric contractions alternating between the stronger agonist and the weaker antagonist muscle groups without relaxation occurring between reversals. Quick stretch can be applied in the lengthen end range to initiate movement as needed.
Slow Reversals
List Interventions for Static Balance Testing
Vary postures Vary support surface Incorporate external loads
List the Action of the Wrist & Hand
Wrist Flexion Wrist Extension Wrist Radial Deviation Wrist Ulnar Deviation Finger And Thumb Flexion Finger And Thumb Extension Finger And Thumb Adduction Finger And Thumb Abduction
List the ROM for Manual Muscles Testing of the Wrist & Hand
Wrist Flexion And Radial Deviation Wrist Flexion And Ulnar Deviation Wrist Extension And Radial Deviation Wrist Extension And Ulnar Deviation
Adhesion
Abnormal adherence of collagen fibers to surrounding structures during immobilization after trauma or as a complication of surgery which restricts normal elasticity and gliding of the structures.
Shoulder Scaption with Internal Rotation should be performed at what degree to prevent shoulder impingement?
90 Degrees
What are guidelines of repetitions (for the average, untrained adult) for strength training?
90% of 1-RM 4-5 repetitions 75% of 1-RM 10 repetitions 60% of 1-RM 15 repetitions
List Intervention for a Total Ankle Arthroplasty - Acute Phase
-Elevate operated limb -Re-establish independent ambulation and functional mobility -Minimize atrophy of the ankle and foot muscles of the operated limb -Prevent stiffness of the operated ankle and foot and loss of extensibility of surrounding soft tissue and regain ROM
List a Timed Up and Go Test (TUG) Scoring
<10 seconds = freely mobile community dwellingolder adults should be able to perform the TUG in 12 seconds or less >20 seconds = may need Assistive Device >30 seconds = dependence
What are the indications for ROM?
*Where there is acute, inflamed tissue, passive motion is beneficial (active motion would be detrimental to the healing process or Inflammation after injury or surgery usually lasts 2 to 6 days) *When a patient is not able to or not supposed to actively move a segment or segments of the body (comatose, paralyzed, or on complete bed rest), movement is provided by an external source.
Pronator quadratus
A pronate the forearm O medial, anterior surface of distal ulna I lateral, anterior surface of distal radius N median
The inflammation of the long head of the biceps tendon, which passes through the bicipital groove and attaches to the supraglenoid tubercle in which repetitive overhead motions or positions should avoided.
Biceps Tendonitis
List the Dermatomes for the Upper Extermity of the Shoulder Girdle
C5 - lateral shoulder area, deltoid, biceps reflex C6 - lateral arm, thumb, brachioradialis reflex C7 - middle of arm, index and middle finger, triceps reflex C8 - medial arm, ring and little finger
lateral arm, thumb, brachioradialis reflex
C6
An exercise that requires the patient to bend forward at the waist so the back is parallel to the floor, allowing the involved arm to hang down loosely, and perpendicular to the floor. Patient perform a pendulum swinging motion that is initiated by having the patient move their trunk slightly back and forth and can be progressed to all other motions of the shoulder with an increase in the arc of motion as tolerated by the patient. This exercise should not cause any pain.
Codman's (Pendulum) Exercises
List the Three Stages of Motor Learning
Cognitive Stage Associative Stage Autonomous Stage
A kyphotic deformity that results from postmenopausal osteoporosis.
Dowager's Hump
Why is ROM important?
Prevents tightness within a joint capsule, ligaments and tendons Maintains muscle length Maintains functional capability
perianal area
S3-5
What is a Contracture?
The shortening of the soft tissues surrounding a joint resulting in limited ROM, which can be significantly resistant to stretching.
This balance test is a quick measure of dynamic balance and mobility.
Timed Up and Go Test (TUG)
What are the 4 different types of joint ROM that are performed in single anatomical planes? Describe each and explain the PTA's role when providing each intervention.
*PROM*- Available ROM is slightly greater than AROM and is produced entirely by an external force. PROM is performed by the therapist, caregiver, another part of the patient's body, pulley, wand, gravity, or continuous passive motion (CPM) device *AAROM*-Active Assisted Range of Motion Active motion assisted by an external force, either manual or mechanical. AAROM requires the patient to partially activate the muscle. AAROM is performed by patient and therapist, caregiver, another part of the patient's body, pulley, or wand. *AROM*-Active Range of Motion is completed by active muscle contraction. AROM is performed solely by the patient without any assistance. The PTA may observe and provide verbal feedback or correction. *RROM*- Resisted Range of Motion that is active motion that is resisted by an external force, either manual or mechanical
List functions of the pelvic floor
- Provide support for the pelvic organs and content - Withstand increases in intra-abdominal pressure - Contribute to stabilization of the spine/pelvis - Maintain continence at the urethral and anal sphincters - Sexual response and reproductive function
List Intervention for a Total Ankle Arthroplasty - Subacute/Chronic Phase
-Achieve 100% of the ROM obtained intraoperatively -Restore strength, muscular endurance and balance in the lower extremities for functional activities -Improve aerobic capacity and cardiopulmonary endurance -Resume a safe level of work related and recreational activities
What is assess in patients with Diastasis Recti, before initiating a strengthing program?
-Any separation greater than 2 fingers wide is considered significant. - Most often occurs during pregnancy, labor, or after child birth in women, But it can also occur in men. - If severe enough, the abdominal contents (viscera) can herniate (protrude). This would be cause for surgical intervention.
RTC Repair Precautions for Strengthening Exercises
-Isometric resistance to scapulothoracic musculature, be sure to support the operated arm to avoid excessive tension in repaired GH musculature. - Use low exercise loads; resisted motions should not cause pain. - NWB (closed-chain) exercises or activities for 6 weeks. - Delay dynamic strengthening (progressive resistive exercise,or PRE) for a minimumof 8 weeks postoperatively for small,strong repair and for at least 3 months for larger tears. - If the supraspinatus or infraspinatus was repaired, proceed cautiously when resisting external rotation. - If the subscapularis was repaired, proceed cautiously with resisted internal rotation. - After an open repair, postpone isometric resistance exercises to the repaired deltoid and cuff musculature for at least 6 to 8 weeks unless advised otherwise
What are general knee precautions?
-Maintain weight bearing precautions if appropriate. -After a TKA, pt should be discharged from the hospital with 5° and 90° assuming no complications. -After an ACL repair, protect the graft, by avoiding resisted open chain quadriceps exercises between 45-30 degrees to full extension due to increased anterior tibial translation which stresses the ACL ligament during the early stages of rehabilitation. Avoid closed-chain strengthening of the quadriceps between 60 and 90 degrees of knee flexion -After an ACL repair, avoid deep lunges (greater than 120°) during the early stages of rehabilitation -Ensure that it is appropriate to remove a brace for exercises.
What are reasons William's Flexion excerises where developed for low back injuries
-Men under 50 and women under 40 years of age - Patient experiencing exaggerated lumbar lordosis, x-ray films showed decreased disc space between lumbar spine segments (L1-S1), -Symptoms were chronic but low grade. -To reduce pain and provide lower trunk stability by actively developing the "abdominal, gluteus maximus, and hamstring muscles as well as passively stretching the hip flexors and lower back (sacrospinalis) muscles.
What things done to assess and identify Sacroiliac Dysfunction or SI joint impairments?
-Obeservation: Look for symmetry in heights of iliac crests, PSIS and ASIS -General SI Joint Hypomobility: Pelvis will rise up on the restricted side in March Test -Anterior rotated innominate:PSIS will be higher and the ASIS will be lower on the involved side - Posterior rotated innominate: PSIS will be lower and ASIS will be higher on the involved side -Upslipped innominate: All bony landmarks will be higher on the side of the upslip
Types of RTC Repair Surgeries
-Traditional Open RTC Repair = vertical incision over anterior shldr, deltoid dettached or divided -Mini-Open (Arthroscopically Assisted) = arthroscopic SAD, & deltoid-splitting approach -Arthroscopic approach = few small incisions
What are precautions of patients with Pelvic Organ Prolapse.
-Trunk strengthening can increase an undetected prolapse or aggravate tissues that are susceptible to prolapse if the pelvic floor is not activated effectively during the exercises. -Once there is true prolapse, PT may not be able to help. It is important to be proactive and educate patients before this happens- especially females.
When treating a healthy but untrained adult, how would a PTA determine how much resistance to apply when having a patient perform an exercise using a leg press machine without using the one rep max? What exercise regimens could you use to develop a program?
A PTA may choose to use the DeLorme or Oxford technique and have a patient complete 10 reps using resistance that is challenging. When the patient can complete 10 reps, but no more then the PTA has found their "10 rep max" The PTA may choose to start at that weight (oxford regimen) and reduce it in increments of 25%, or the PTA may start at 50% of the 10 rep max ( DeLorme) and increase it by 25 % with each set of 10. The PTA also has an option of determinging a patient's 1 rep max and then training between 40 and 70 % of that 1 rep max.... Example: if the patient could lift 100 lbs but no more, they may be instructed to perform 3 sets of 12 at 40 lbs to start. A PTA may also choose to use The DAPRE approach: it uses a 6 rep max and starts with 10 reps for set 1, at 50% of the 6 rep max, Set 2 at 6 reps 75% of the 6 rep max. Set 3 100% of the 6 rep max and on the 4th set depending on how difficult the 3rd set was, a PTA may choose to decrease, keep the same or increase the weight by 5-15 lbs.
Pronator Teres
A pronate the forearm, assist to flex elbow O common flexor tendon from the medial epicondyle of the humerus, coronoid process of the ulna I middle of lateral surface of radius N median
List what posture training techniques are used in correcting patients
Verbal Reinforcement Tactile Reinforcement Visual Reinforcement
Biceps brachii
A: Flex the elbow, Supinate the forearm, Flex the shoulder. O: Short head: Coracoid process of the scapula. Long head: supraglenoid tubercle of scapula I: Tuberosity of the radius and aponeurosis of the biceps brachii N:musculocutaneous C5, 6
Coracobrachialis
A: Flex the shoulder, Adduct the shoulder. O: Coracoid process of the scapula I: Medial surface of mid-humeral shaft N: Musculocutaneous C6, 7
Teres minor
A: Laterally rotate the shoulder, Adduct the shoulder, Stabilize the head of humerus in glenoid cavity. O: Upper two-thirds of the lateral border of the scapula I: Greater tubercle of the humerus N: Axillary C5, 6
Subscapularis
A: Medially rotate the shoulder, Stabilize the head of humerus in glenoid cavity. O: Subscapular fossa of the scapula I: Lesser tubercle of the humerus N: Upper and lowwer subscapular C5, 6, 7
List Contraindications for a Total Ankle Arthroplasty
Active or Chronic Infection Severe Osteoporosis Avasuclar Necrosis of Talus Peripheral Neuropathy -> Paralysis Impaired lower extremity vascular supply Long term Corticosteroids Ankle Instability Varus or Valgus deformity of hindfoot >20 degrees <20 degree total arc of dorsi/plantarflexion Obesity High function Athletes
What is included in Gait Training Intervention?
Activity (Gait Training) Distance (50 ft, 100 ft, 150 ft, 200 ft) Assistance (Max A, Mod A, Min A, CGA, Supervision, I) Assistive Device (PUW, FWW, quad cane, straight cane, axillary crutches) Weight-Bearing Status (NWB, 50% PWB, WBAT, FWB), if appropriate Precautions (Hip Precautions, Fall Risk) Patient Response (Loss of Balance, Orthostatic Hypotension)
This form of compartment syndrome is usually treated with a fasciotomy, a surgical incision in the fascia along the length of the compartment which relieves pressure and promotes blood flow
Acute Compartment Syndrome
This is the first stage of rehabilitation which is considered the inflammatory reaction phase that last 4-6 days, with signs of swelling, redness, heat, pain at rest, loss of function and movement can be painful resulting in guarding against movement before end range is achieved.
Acute Phase (Stage) of Rehabilitation
Energy system associated with low-intensity, repetitive exercise of large muscle groups performed over an extended period of time and the mode of exercise primarily increases muscular and cardiopulmonary endurance.
Aerobic Exercise
What can be done to progress a patient surface during balance training?
Altering the surface that a patient is standing on can increase difficulty significantly. Stable floor to uneven surfaces.
A type of isometric contractions where a patient contracts isometrically, rhythmically on one side of the joint then the other, with no relaxation occurring between contractions. The goal is to increase endurance or strength to hold a position. This is often done in midline or in weight bearing positions
Alternating Isometrics
What is Valsalva Maneuver Phenomenon?
An expiratory effort against a closed glotti in which a deep inspiration is followed by closure of the glottis and contraction of the abdominal muscles that increase intrathoracic pressures causing an abrupt and temporary increase in arterial blood pressure.
What are the Signs and symptoms of muscle fatigue?
An uncomfortable sensation within the muscle, even pain and cramping. Tremulousness in the contracting muscle. Active movements are jerky, not smooth. Inability to complete the movement pattern through the full range of available motion during dynamic exercise against the same level of resistance. Use of substitute motions, that is, incorrect movement patterns, to complete the movement pattern. Inability to continue low-intensity physical activity. Decline in peak torque during isokinetic testing.
Energy system which involves high-intensity (near maximal) exercise carried out for a very few number of repetitions because muscles rapidly fatigue such as strengthening exercises fall in this category.
Anaerobic Exercise
Name the two techniques for ROM
Anatomical Planes of Movement Proprioceptive Neuromuscular Facilitation (PNF)
An injury that requires an ORIF (open reduction internal fixation), essentially plates and screws in the bone to maintain realignment
Ankle Fracture
List three strategies that are used to recover balance
Ankle strategy Hip strategy Stepping strategy
Subacute Stage Precautions
Approach phase/moving too quickly is harmful to the fragile new and healing tissue. Moving too slow/ not progressing the patient enough can also prove to be detrimental. Caution: Eccentric and PRE's may increase trauma to muscles-this is usually not used in the early subacute stage
Why should Valsalva Maneuver Phenomenon be avoided for certain patients during resistance exercise?
At risk patients which should be closely monitored and exercise limited for pt's w/ a history of coronary artery disease, myocardial infarction, cerebrovascular disorders, or hypertension.
General Intervention of Nonoperative Shoulder Pathologies (Chronic/Functional Phase)
Attain Full Pain Free ROM - progressed as tol - ER/IR stretches Restore Normal Joint Arthrokinematics -Joint Mobilizations techniques - Caudal, Anterior, Posterior Glide Improve muscle strength & neuromuscular control to w/in normal limits & restore normal muscle force couples -RTC exer (empty can, full can) - SA, Deltoid, Lats, Pec Maj ( quadruped >prone push ups kneeling> WB thru medicine ball) -Elbow prop -Dynamic WB -Triceps lift -Plyometric drills -Functional/sport specifc drills for athlete
What are precautions of Osteoporosis?
Avoid flexion activities and exercise because stress into spinal flexion increases the risk of a vertebral compression fracture. Avoid combining flexion and rotation of the trunk to reduce stress on the vertebrae and intervertebral discs. Avoid increasing intensity and resistance too quickly.
If it's in the Transverse plane then it's in the______ axis
Vertical Axis
List Motions of the Ankle and Foot (Talocrural Joint)
Dorsiflexion - tibialis anterior Plantarflexion - gastrocnemius, soleus
Alignment Dysfunctions - Pronation
Dorsiflexion, Eversion, Abduction Hip - Coxa Vara (out) Knee - Genu Valgus (in) Foot - Calcaneal Valgus (in) excessively large Q angle
List that help improve safety during gait, locomotion, or balance
Balance within stability limits; environmental modifications; assistive devices, external support
This type of stretching uses rapid, forceful movements at a high-speed and high-intensity, which may not be recommended due to increased chance of muscle soreness and injury.
Ballistic Stretching
Ganglion
Ballooning of the wall of a joint capsule or tendon sheath, arising after trauma or from disease like rheumatoid arthritis
List Precautions for Achilles Tendon Repair
Be cautious of resistance / stretching Postpone WB unilaterally until FWB w/o pain Initially NWB stretches Limit DF to 10 degrees beyond netural until 8-12 wks WB stretches in sitting -> BIL standing only w/o pain Postpone Unilateral standing stretches/resistance until 12-16 weeks Strengthening exercise start NWB-> PWB-> FWB
List Muscles for the Elbow & Forearm
Brachialis Brachioradialis Biceps brachii Supinator Triceps brachii Anconeus Pronator teres Pronator quadratus
A PTA is treating a patient who has is recovering from a SLAP repair involving re-attachment of the biceps tendon. The PTA is to educate the patient on positions to avoide. Which of the following positions would create the most tension in the bicep? (there are 2 answers) a. Shoulder flexion with elbow flexion b. Shoulder extension with elbow extension c. Shoulder horizontal abduction with external rotation d. Shoulder horizontal abduction with elbow flexion
C. Shoulder Horizontal Abduction with External Rotation
List Treatment Options for ROM
CPM RROM AROM AAROM PROM PNF Stretching
The entrapment of the median nerve in the carpal arch on the anterior wrist which contains the median nerve, flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus.
Carpal Tunnel Syndrome
List incorrect posture repetitive motion injuries
Carpal tunnel syndrome. Bursitis Muscles strains Tendonitis, Lateral epicondylitis).
What are basic strategies for computer workstation set up to reduce injury?
Chairs should have lumbar support to maintain slight lumbar lordosis. Chair height should allow hips and knees to be flexed to 90 degrees and feet resting comfortably on the floor. Armrests should be utilized if prolonged sitting is required . This will decrease stress placed on the shoulders and cervical spine The monitor and keyboard should be placed directly in front of the employee to avoid unnecessary spinal rotation. Desk height should be adequate to avoid leaning over Frequently change positions or educate a patient to get up and walk every hour.
List Precautions and Contraindications for the Shoulder Complex
Check for parameters set by the Doctor for specific precautions Any increase pain or irritability in joint after ther ex, dosage was too strong, or technique shouldn't be used Exercise and activities should be modified for ability level Be carefully when using Codman's exercise, pt may experience orthostatic hypotension when standing upright after trunk flexion, pt should be guarded and sit if dizzy Watch for compensations and substitutions
List Fracture Healing Time Frames for each age group
Children = 4 to 6 Weeks Adolescents = 6 to 8 Weeks Adults = 10 to 18 Weeks
A softening or wearing away of the articular cartilage, like when the patella articular cartilage softens on the posterior aspect of the patella.
Chondromalacia
This is the third stage of rehabilitation which is considered the maturation and remodeling phase that may last 6 months to one year, with no signs of inflammation, contractures or adhesions may have formed by this stage, and function, muscle weakness, muscle endurance and neuromuscular control is limited.
Chronic Phase (Stage) of Rehabilitation
A painful condition that develops when edema occurs in an enclosed space, a compartment bound by fascia, in which the four compartments in the lower leg: anterior, lateral, superficial posterior, and deep posterior where there is no room to expand, pressure in the compartment prohibits blood flow and causes tissue death
Compartment Syndrome
When patients are challenged beyond their ability they often recruit unwanted muscle groups in order to complete the task, this is considered _______ _______
Compensation and Substitution
Concentric vs. Eccentric: What are the comparisons?
Concentric contractions are commonly used in the rehabilitation process due to the frequent occurrence in ADL's Greater loads can be controlled with eccentric rather than concentric exercise Training-induced gains in muscle strength and mass are greater with maximum-effort eccentric training than maximum-effort concentric training Adaptations associated with eccentric training are more mode and velocity specific than adaptations as the result of concentric training Eccentric muscle contractions are more efficient metabolically and generate less fatigue than concentric contractions Following unaccustomed, high-intensity eccentric exercise, there is greater incidence and severity of delayed-onset muscle soreness than after concentric exercise.
A PNF technique performed in the agonist pattern used to gain range when muscle tightness or guarding is limiting the motion required for functional activities. The limb is moved (active or passive) toward the point of limitation and held for 30 sec. An isotonic contraction is performed for up to 10 seconds into the antagonist pattern. The patient then relaxes (2-3 sec). Passive movementis moved into the new range of the agonist pattern for a stretch of 30 seconds. This is repeated until no further gain can be achieved.
Contract Relax
What are strengthening options for patients with pelvic floor dysfunction
Contract and relax- This involves imagery like stopping the flow of urine but it is very important not to encourage a patient to acutally do this when urinating as this may cause backflow of urine. Quick contractions Elevator exercises Pelvic floor relaxation Avoid Valsalva maneuver
PNF Patterns: Give an example of a 2 functional activites including 1 lower extremity and 1 upper extremity (ADL's) that could potentally improve by performing PNF ROM. Explain if the pattern is D1 or D2.
D1 UE- combing/brushing hair D 1 LE=- Crossing the legs to put on your shoes.
What is DOMS? In relation to Concentric and Eccentric muscle contractions, which of these is thought to be responsible for DOMS? How can DOMS be prevented?
DOMS- Delayed onset muscle soreness- is the result of high intensity eccentric muscle contractions. If the intensity and the volume of eccentric exercise is progressed gradually and not rapidly, DOMS doesn't occur.
List General Interventions for Ankle and Foot - Acute Phase
Decrease pain, inflammation, and swelling Protect the healing area from reinjury Begin to re-establish pain free ROM (towel stretches, ankle circles/pumps, BAPS/Wobble Board AROM/AAROM Increase Weight Bearing tolerance ( Maintain fitness levels as appropriate Prevent Muscle atrophy and increase neuromuscular control (Isometric -> Concentric -> Eccentric)
List Cardiovascular/Pulmonary Common Physical Impairments Managed with Therapeutic Exercise
Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) Pain with sustained physical activity (intermittent claudication)
Subacute Stage Clinical Signs
Decreasing inflammation Pain synchronous with tissue resistance
Exercise induced muscle tenderness or stiffness that occurs 24 to 48 hours after vigorous exercise.
Delayed-Onset Muscle Soreness (DOMS)
_____ technique builds a warm-up period into the protocol, whereas the ______ technique diminishes the resistance as the muscle fatigues.
Delorme and Oxford Regimens
An area of skin in which sensory nerves derive from a single spinal nerve root, each of these relay sensations (including pain) from the brain to the particular region of the skin that it supplies.
Dermatomes
List of Proprioceptive Neuromuscular Facilitation (PNF) Stretches
Diagonal Patterns Hold-Relax Stretch Contract-Relax Stretch Hold-Relax w/ Agonist Contraction
The separation of the rectus abdominis muscles in the middle of the linea alba.
Diastasis Recti-
What are the Uses of AAROM/AROM as assessment?
Differentiate cause of pain Basis for Manual Muscle Testing (MMT)
An ergonomic grip with four spring-loaded buttons that allow patients to flex and strengthen each finger separately. Available in five levels of resistance: yellow at 1.5 lbs, red at 3 lbs, green at 5 lbs, blue at 7 lbs, and black at 9 lbs.
DigiFlex
List Precautions of OA
Do not increase ROM unless pt has sufficient strength to control motion already available, may cause impaired stability Techniques that force the knee into flexion by using the tibia as a lever or by using strong quadriceps contractions (during a hold-relax maneuver) may exacerbate joint symptoms.
Rheumatoid Arthritis Contraindications
Do not perform stretching techniques across swollen joints, can lead to hyper-mobility or subluxation Vigorous stretching or manipulative techniques Do not apply heavy resistance exercise that cause joint stress
A machine that measures bone density of the hip and spine, where fractures are most likely to occur.
Dual-energy X-ray absorptiometry (DEXA) scan
Exercise is the total number of weeks or months during which a resistance program is carried out, this is typically determined by the PT.
Duration
rTSA Resistance Exercises
During Phase 1: Only light, NWB isometrics of ST and deltoid muscles with shoulder in scapular plane During Phase 2: Emphasis on improving function of deltoid and ST muscles Submaximal isometrics (NWB only) of GH and ST muscles Delay resisted rotation for several weeks (to protect repaired subscapularis and teres minor, if preserved) Progress to low-resistance, dynamic strengthening of elbow and wrist; STand GH joints if mechanics during AROM allow —NWB positions only (through week 12) During Phase 3 Begin closed-chain stabilization exercises Progress UE PRE in functional patterns
This is a type of stretching that is a slow and controlled movement that is usually most beneficial prior to sports activities or dynamic and powerful movement.
Dynamic Stretching
What are the anatomical alignment landmarks for a plumb line, horizontal posterior view?
Ear lobes Acromion processes Inferior angles of scapula Iliac crests Posterior superior iliac spines Greater trochanters Gluteal folds Popliteal crease Ankle malleoli
Acute Stage Plan of Care
Educate the patient Control Pain, edema, Spasm Maintain soft tissue and joint integrity & mobility Reduce joint Swelling if symptoms are present Maintain integrity and function of associated areas - ROM,
Subacute Stage Plan of care
Educate the patient Promote healing of injured tissues Restore soft tissue muscle &/or joint mobility Develop neuromuscular control, muscle endurance, & strength in involved & related muscles Maintain integrity & function of associated areas
Chronic Stage Plan of Care
Educate the patient. Increase soft tissue, muscle and/or joint mobility Improve neuromuscular control,strength, muscle endurance Improve cardiopulmonary endurance Progress functional activities.
List interventions of Joint Disorders: Rheumatoid Arthritis & Osteoarthritis
Educating the patient on resting, joint protection, and modification of activities Pain relief with use of modalities and gentle massage Immobilize in splint or use of supportive/assistive devices Range of motion techniques such as PROM, AAROM, and gentle joint mobilization to avoid joint stiffness Gentle isometrics Positioning properly to prevent joint deformity Do not push the patient to continue therapeutic techniques when they are fatigued or in pain. May require frequent, short treatment sessions rather than one long treatment session. Low intensity resistance exercises/muscle repetition Nonimpact or low impact aerobic exercise Balance Training
What is the difference between elasticity, plasticity and how are they relevant to stretching?
Elasticity is the ability of soft tissue to return to its pre-stretch resting length directly after a short duration stretch force has been removed. Plasticity is is the tendency of soft tissue to assume a new and greater length after the stretch force has been removed. This is important with stretching because it is necessary to be able to sustain a stretch in order for the muscle fibers can assume a new length, therefore improving muscle flexibility.
What are the anatomical alignment landmarks for a plumb line, horizontal anterior view?
Eyes Acromion Processes Iliac Crest Anterior Superior Iliac Spines Greater Trochanters of Femur Patellas Ankle Malleoli
List Motions of the Knee and muscles responsible
Flexion - biceps femoris, semitendinosus, semimembranosus Extension - rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
What are movements of the Cervical Spine and the primary muscles?
Flexion - longus capitis & colli, anterior scalene, sternocleidomastoid Extension - erector spinae, suboccipitals, semispinalis capitis, splenius capitus & cervices, upper trapezius Lateral Flexion (Sidebending) to Same Side - splenius capitus & cervices, longus capitis & colli, sternocleidomastoid, scalenes Rotation to Same Side - splenius capitus & cervices, longus capitis & colli Rotation to Opposite Side - sternocleidomastoid, scalenes
What are movements of the Thoracic and Lumbar Spine and the primary muscles?
Flexion - rectus abdominis, external oblique, internal oblique Extension - erector spinae group, transversospinalis group, quadratus lumborum Lateral Flexion (Sidebending) to Same Side - quadratus lumborum, external oblique, internal oblique, erector spinae group Rotation to Same Side - internal oblique Rotation to Opposite Side - external oblique, multifidi, rotatores
List the Goniometry ROM of the Wrist & Hand
Flexion= (80, Sitting , Triquetrum, Olecranon, 5th Metacarpal) Extension=(70, Sitting,Triquetrum, Olecranon,5th Metacarpal) Radial Dev. = (20, Sitting, Capitate ,Midline of Forearm, Lateral Epicondyle, 3rd Metacarpal) Ulnar Dev.= (30, Sitting,Capitate, Midline of Forearm, Lateral Epicondyle, 3rd Metacarpal)
List Shoulder Goniometery ROM
Flexion=(180,Supine, Greater Tubercle,Midaxillary,Lateral Epicondyle) Extension = (60, Prone, Greater Tubercle, Midaxillary,Lateral Epicondyle) Abduction = (180, Supine, Acromion, Midline, Humerus) IR = (70, Supine, Olecranon, ^ to floor, Ulnar Styloid) ER = (90, Supine, Olecranon, ^ to floor, Ulnar Styloid)
In which body plane and axis do these occur? Abduction/Adduction Lateral Flexion/Lateral Tilt Inversion/Eversion
Frontal Pland & Sagittal Axis
TSA Criteria for Progression out of Phase 2 (Moderation Protection/Controlled Motion)
Full, PROM of the shoulder, at least 130° to 140° of pain-free, PROM or AAROM shoulder flex & 120° of abd. In scapation, at least 60° pain-free, passive ER & 70° ER Active (unassisted), antigravity elevation of the arm to at least 100° to 120° in scapation while maintaining joint stability and using appropriate shoulder mechanics, particularly no scapula elevation prior to elevating the arm 4/5 strength of RTC & deltoid muscles. rTSA pts should have documented improvements in function and increasing strength of the deltoid and periscapular muscles prior to progressing to the next phase.
The grade of a sprain that has mild pain within the first 24 hours of the injury accompanied by mild swelling, and tenderness
Grade 1 (First Degree)
The grade of a sprain that has moderate pain which requires stopping an activity where palpation of the tissue increases pain tremendously.
Grade 2 (Second Degree)
Th grade of a sprain that has near complete or complete tear of the tissue (tendon ligament) with severe pain.
Grade 3 (Third Degree)
TSA ROM Exercises, Stretching, & Joint Mobilizations During Phase 1:
Grade I /II joint oscillations AROM: scapula and distal extremity joints only Pendulum exercises, Shldr Rolls/Posture Education,Gripping Pulley (second week0 PROM→A-AROM GH joint —Perform in supine(0-3 weeks) —Progress to A-AROM in sitting and standing AROM of GH joint by 4-6 weeks No active IR for at least 6 weeks (protect subscapularis repair)
The inflammation of the bursa over the greater trochanter, which is commonly associated with a tight iliotibial band.
Greater Trochanteric Bursitis
List Equipment Used in the Treatment of the Wrist & Hand
Hand Putty DigiFlex Hand Griper Flexbar Eggsercizer PowerWeb Beads
A PTA is treating a patient for shoulder pain. The patient comes in for their scheduled appointment and complains that they have increased pain and they don't want to do the home exercises anymore. What is the most appropriate option?
Have the patient demonstrate how they are doing the exercises
The Correct positions for a computer work station
Head - Directly over Shoulder Neck - Elongated & Relaxed Shoulder - Kept Down, Chest Open & Wide Back - Upright or Slightly Forward from Hips Elbows - Relaxed at Right Angle Wrist - No Flexing Up or Down Hips/Knees - Flexed at 90 degrees Feet - Flat or on a Foot Rest`
What are corrective exercises that a patient can perform to correct Diastasis Recti?
Head lift- patient must approximate the rectus muscle with their hands. Head lift with pelvic tilt Exercises performed until the rectus abdominus has no more than 2 fingers width of separation.
PNF D2 Extension Lower Extremity Directions
Hip= Extension, Adduction, External Rotation Knee= Straight (Flex/Ext) Ankle = Plantar Flexion, Inversion Toes = Flexion
What are the signs and symptoms of a possible fracture?
History of a fall, direct blow, twisting injury, accident Localized pain aggravated by movement Muscle guarding with passive movement Decreased function of the body part Swelling, deformity, abnormal movement Sharp, localized tenderness at the site
This isometric PNF technique is performed in the agonist pattern at the point of limited range of motion held for 30 seconds. The isometric contraction for 10-15 seconds into the antagonist pattern.The patient then relaxes (2-3 sec.). The passive movement is moved into the new range of the agonist pattern for a stretch of 30 seconds. Its repeated until no further gain can be achieved.It is effective when ROM is reduced because of muscle tightness on one side of the joint, or when pain is part of the limitation.
Hold- Relax
This PNF stretch is based on autogenic inhibition which involves the muscle being stretched to end ROM for 30 seconds, patient will then isometrically contract for 10 seconds, then stretched again.
Hold- Relax Stretch (HR)
This PNF stretch is similar to an HR stretch, but utilizes the agonist contraction of the muscle being stretched which includes performing a static stretch to the range limited muscles, then having the patient perform a resisted isometric contraction, the patient would then relax and immediately perform a concentric contraction to the antagonist muscle.
Hold- Relax with Agonist Contraction Stretch
Injury typically occuring at the proximal humerus when a patient falls on an outstretched arm and may require an ORIF (open reduction internal fixation), essentially plates and screws in the bone
Humerus Fracture
Explain why a patient who is diagnosed with carpal tunnel may need physical therapy treatment for other surrounding areas such as the elbow, shoulder, and cervical spine.
If the median nerve is entrapped, it may be compressed at the wrist however because it stems from the brachial plexus cervical nerves C5-T1, it is important to address the upper exremity and cervical spine to ensure the patient is not experiencing nerve entrapment at a level higher than the wrist. Also dysfunction of the wrist may lead to compensetory motions of the elbow and upper arm, and effect posture. All of these modifications may lead to further dysfunction of multiple joints if left untreated.
Pain felt over the lateral knee due to a tight IT Band
Iliotibial Band Syndrome
List Interventions for Achilles Tendon Repair - Subacute Phase
Increase ROM of the operated ankle with joint mobilization and stretching techniques Improve strength and muscular endurance of the operated lower extremity Improve balance reactions Reestablish a symmetrical gait pattern Improve cardiopulmonary endurance
List of Effects of Deconditioning
Increased heart rate response to any effort Decreased physical work capacity Decreased adaptation to position change Decreased circulating blood volume Decreased lung volume and vital capacity Decreased contractile strength of muscle Decreased metabolic rate
Bursitis
Inflammation of a bursa
Synovitis
Inflammation of a synovial membrane due to excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease
Tendinitis
Inflammation of a tendon; there may be resulting scarring or calcium deposits
Tenosynovitis
Inflammation of the synovial membrane covering a tendon
Tenovaginitis
Inflammation with thickening of a tendon sheath
Acute Stage (Protection Phase) Structural and Functional Impairments
Inflammation, pain, edema, muscle spasm Impaired movement Joint effusion Decreased use of associated areas
The first phase of bone healing in which the dense bone of the shaft of a long bone is fractured and the tiny blood vessels are torn at the site causing internal bleeding followed by normal clotting.
Inflammatory Phase of Bone Healing
Post Fracture (Period of Immobilization) Impairments, Activity Limitations, & Participation Restrictions
Initially, inflammation and swelling Progressive muscle atrophy, contracture formation, cartilage degeneration, and decreased circulation in the immobilized area Potential overall body weakening if confined to bed Limited activity and restricted participation in ADLs, IADLs, and work imposed by the fracture site and method of immobilization used
What are the Uses of PROM as assessment?
Integrity of articular surfaces, joint stability Extensibility of joint capsule, associated with ligaments and muscles Limitation of motion
Exercise in a resistance training program is the amount of resistance (weight) imposed on the contracting muscle during each repetition of an exercise.
Intensity
List Motions of the Ankle and Foot (Subtalar Joint)
Inversion - tibialis posterior Eversion - peroneus longus & brevis
List Treatment Options for Strengthening
Isometric Gravity Eliminated Gravity Minimized Against Gravity Resistance Thera-Band (Yellow, Red, Green, Blue, Gray) Weights
A static muscle contraction that produces a constant force without an appreciable change in the length of the muscle and without visible joint motion
Isometric contraction
A static muscle contraction that produces a constant force without an appreciable change in the length of the muscle and without visible joint motion.
Isometric contraction
What is Functional Excursion as it pertains to Muscle Length?
It is the distance a muscle is capable of shortening after it has been elongated to its maximum.
Impingement is very common in patients with shoulder injuries. Explain positional strategies a PTA would use to avoid pain and exacerbation of impingement when providing or instructing a patient with ROM exercises
Keeping the UE in a "thumbs up position" avoiding combination movements such as internal rotation and horizontal adduction. Ranging the UE in the plane of the scapula (scaption) rather than abduction.
A device that is used after injury or surgery that a patient may need to wear for stabilization or range of motion limitation to prevent further injury or to protect a recent tendon or ligament graft.
Knee Bracing
A common spinal postural dysfunction in a patient has excessive posterior curvature of the thoracic spine
Kyphosis
anterior and interior surfaces LE
L1-4
List Dermatomes of the Lower Extermity
L1-L4 - anterior and inner surface of lower extremities L2 - medial thigh L3 - medial knee L4 - medial ankle and medial side of great toe, patellar reflex L4-S1 - foot L5 - dorsum of foot L5-S2 - posterior and outer surfaces of lower extremities S1 - lateral margin of foot, little toe, Achilles tendon reflex S2-S4 - perineum S2 - posteromedial thigh S3 -S5 - perianal area
medial ankle, medial side great toe, patellar reflex
L4
foot
L4-S1
The area of space in which a person can maintain balance without changing position, in which a patient's postural sway must not exceed this space.
Limits of stability.
A common spinal postural dysfunction were patient has an excessive lumbar curvature.
Lordosis
A surgical intervention to remove parts of the nucleus pulposus pressing on the spinal nerves
Lumbar Microdiscectomy
The surgical union of two or more vertebrae with rods and screws which prevents motion at these intervertebral joints.
Lumbar Spine Fusion
Explain Manual versus Mechanical stretching. Give examples of each.
Manual stretching is when a PTA applies an external force to move the involved body segment slightly beyond the point of tissue resistance and available ROM- Example PTA manually stretching a patient's hamstrings with a hold relax technique. Mechanical Stretching is when a device applies a low intensity stretch force over a prolonged period of time to create permanent lengthening of soft tissues. Example- Cuff weight, weight pulley system, orthotic splints for knee flexion contractures.
This helps to improve low back pain by centrilizing the pain from one side to the just one location eventually reducing the pain through an extended position of the back.
McKenzie Extension Execises
This nerve is a branch of the medial and lateral cords of the brachial plexus, which rovides sensation to the thumb, 2nd, 3rd and half of the 4th finger, innervates muscles in the forearm and hand that allow pincher grasp. Signs and symptoms of injury may include pain in the wrist or hand, and may be felt in the upper arm which is called referred pain. Sensation changes such as burning, decreased sensation, numbness and tingling may also occur in the distribution pathway for this nerve. Muscle weakness which leads to difficulty in maintaining grasp may occur. It can become entrapped between the heads of the pronator muscle and mimic carpal tunnel syndrome.
Median Nerve
Rationale and Indications for use of Isometric Exercise:
Minimizes muscle atrophy when joint movement is not possible (casts, splints, skeletal traction) To facilitate muscle activity in order to begin to re-establish neuromuscular control but protect healing tissues when joint movement is not advisable after soft tissue injury or surgery To develop postural or joint stability To improve muscle strength when use of dynamic resistance exercise could compromise joint integrity or cause joint pain To develop static muscle strength at particular points in the ROM consistent with specific task-related needs
What is included in Thermal Modalities Intervention?
Modality (Hot Pack, Paraffin, Cold Pack, Ice Massage) Side (Right, Left, Bilateral) Location (Low Back, Shoulder, Knee) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting) Duration (10 min, 15 min) Skin Condition (Skin Sensation & Integrity Intact), if appropriate
What is included in Ultrasound Interventions?
Modality (Ultrasound, Underwater Ultrasound) Side (Right, Left, Bilateral) Location (Low Back, Shoulder, Knee) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting) Frequency (1 MHz, 2 MHz, 3 MHz) Intensity (1.2 W/cm2, 1.5 W/cm2) Pulsed, Continuous (10% Pulsed, 20% Pulsed, 50% Pulsed, Continuous) Duration (5 min, 8 min)
What is AROM (Active Range of Motion)?
Motion completed by active muscle contraction and is performed solely by the patient without any assistance.
A form of scoliosis that has a irreversible lateral curvature with a fixed rotation of the bodies of the vertebrae toward the convexity of the curve
Structural Scoliosis
Chronic Stage Precautions
No signs of inflammation Some discomfort will occur as activity level progressed, but not last longer than a couple of hours. Signs progressing too quickly or with too great dosage are swelling, pain >4hrs, requires medication for relief or decrease strength or fatiguing more easily.
Fracture Precaution
No stretch or resistive forces distal to fracture site, until bone radiololgically healed No excessive joint compression or shear for several weeks Use protected weight bearing until site is healed.
Describe steps for teaching safe body mechanics to patients for lifting objects.
Observe patient's technique Instruct the patient to finding a neutral spine Squatting is the preferred method Have patient carry an object close to their COG Pt practice shifting the load that they are carrying from side to side or when turning. When turning, have the patient practice w/ hip rotation and minimal trunk rotation When picking up light objects, instruct the patient on the "golfer's lift"
Factors that influence progression of Rehab of RTC after Repair
Onset of injury (Chronic/Acute ) Size and location of the tear(large tears slow) Associated pathologies such as GH instability or fracture Preoperative strength and mobility of the shoulder (preexisting weakness/atrophy, limited ROM) Patient's general health (poor ) History of steroid injections or previous, failed cuff surgery (bone/tissue quality ) Pre-injury level of activity or postoperative goals Age of patient Type of surgical approach (arthroscopic> mini-open> traditional) Type of repair (tendon - bone > tendon -tendon) Mobility (no excessive tension on the repaired tendon when arm at side) and integrity of the repair Patient's compliance with the program Philosophy, skill, and training of the surgeon
The progressive deterioration of the cartilage in the knee joint, which often causes excess bone mass called bone spurs to form
Osteoarthritis (OA) or Degenerative Joint Disease (DJD)
General Considerations and parameters for the Thoracic and Lumbar Spine - Acute Phase
Patient Education on maintaining within precautions Decrease acute symptoms of pain, inflammation and muscle spasms with use of modalities as prescribed Patient Education and awareness of postural alignment and safe postures Initiation and control of stabilizing muscles Train on safety in performance of ADL's Diaphragmatic breathing See Dutton and Kisner and Colby for exercises
A PTA is treating a patient with a diagnosis of "knee sprain". The PTA notes in the patient's chart that they have a positive anterior drawer test. What does this indicate? What motions or exercises would be contraindicated?
Patient's may be referred to PT for knee sprains and without MRI diagnostic can have an actual tear of the ACL. If the patient has an ACL tear, they may have a positive anterior drawer test. Exercise contraindications may include no open chain strengthening. Try to reinforce closed chain exercises. An example would be mini squats to 45 degrees knee flexion.
List examples of Williams' Flexion Exercises:
Pelvic Tilt Single Knee to Chest Double Knee to Chest Partial Sit Up Hamstring Stretch Hip Flexor Stretch Squat
List the causes of Positional Deformity
Poor postural habit. Psychological factors, especially self-esteem. Normal developmental and degenerative processes. Pain leading to muscle guarding and avoidance postures. Muscle imbalance, spasm, or contracture. Respiratory conditions. General weakness. Excess weight. Loss of proprioception.
List of Spinal Curves of the Neck & Trunk
Primary - thoracic & sacral Secondary - cervical & lumbar
Progression of an exercise by modifying parameters, system of dynamic resistance training in which constant external load is applied to the contracting muscle by some mechanical means and incrementally increased, in which Repetition Maximum (RM) is used as the basis for determining and progressing the resistance.
Progressive Resistance Exercise (PRE)
A rupture of the annulus fibrosus.
Prolapse
What are factors that cause Hypomobility?
Prolonged immobilization of a body segment Sedentary lifestyle Postural malalignment and muscle imbalances Impaired muscle performance (weakness) associated w/ an array of msculoskeletal or neuromuscular disorders Tissue trauma resulting in inflammation and pain Congenital or acquired deformities Any factor causing decreased extensibility of soft tissue
What muscles is most affected by Medial Epicondylitis?
Pronator teres and Flexor carpi radialis
List examples of Typical McKenzie Back Extension Exercises.
Prone lying Prone lying on elbows Prone Press Up Progressive extension with pillows Standing extension
Acute Stage Precaution
Proper dosage of rest & movement must be used during the inflammatory stage Signs of too much movement are increased pain or inflammation
The awareness of the position of a stationary body part (static position); kinesthesia is the awareness of the position of a moving body part (dynamic position).
Proprioception
What are physical therapy goals and interventions for Acute Phase of Rehab?
Protection Phase: early Control effect of inflammation: selective rest, ice, compression elevation Prevent deleterious effects of rest: nondestructive movement: PROM, massage, & muscles setting w/ caution
What is a function of the vestibular system?
Provides information about orientation of the head in space and on acceleration
Tinel Sign
Purpose: Tests for a neuroma within a nerve. The Tinel Sign may be used at multiple locations throughout the body where the nerve is superficial. Position: The patient relaxes the arm. Action: The clinician taps the groove between the olecranon and the medial epicondyle. Positive Finding: Tingling sensation down the forearm along the ulnar distribution in the hand.
List Treatment Options for Pain
R.I.C.E. Ice Pack Ice Massage Contrast Hot Pack Paraffin Bath Ultrasound Phonophoresis Massage
TSA Criteria for Progression out of Phase 1 (Protection Phase)
ROM: 90° of passive elevation, at least 45° ER, 70° of IR in scapation w/ minimal pain Almost full,passive shoulder motion with little to no pain No pain during resisted, isometric IR of subscapluaris Ability to perform most waist-level activities of daily living(ADLs) without pain. For rTSA, criteria include tolerance of assisted ROM and demon of the ability to isometrically activate deltoid and periscapular musculature while the joint is positioned in the scapular plane.
List the Ligaments of the Wrist & Hand
Radial Collateral Ulnar Collateral Palmar Radiocarpal Dorsal Radiocarpal Intercarpals Flexor Retinaculum (Transverse Carpal and Palmar Carpal) Capsular Carpometacarpal Collateral
A nerve that runs down the posterior side of the arm. Injury may be caused by physical trauma or infections. Signs and symptoms of injury to the deep branch include loss of motor functions in the thumb, wrist, finger extensors, supinator. In the superficial branch, symptoms would include loss of sensory function of the posterior forearm and hand.
Radial Nerve
List the Joints of the Wrist & Hand
Radiocarpal Midcarpal Carpal Metacarpal (CMC) Metacarpal Phalangeal (MCP) Proximal Interphalangeal (PIP) Distal Interphalangeal (DIP)
What is ROM?
Range of Motion (ROM) is a therapeutic technique used to maintain joint ROM and muscle length by moving each joint and muscle through its available arc of motion and can be performed to prevent tightness in capsules, ligaments, and tendons.
The third phase of bone healing in this is the stage of clinical union. The fracture site is firm enough that it no longer moves. The callus that consisted of the cartilage and the woven bone now surround the fracture site and hardens. Immobilization is no longer required in this stage.
Remodeling Phase of Bone Healing
Subacute Tissue response and characteristics
Removal of noxious stimuli Growth of capillary beds into area collagen formation granulation tissue Very fragile, easily injured tissue
The greatest amount of weight a muscle can move through the full range of motion a specific number of times in a load-resisting exercise routine.
Repetition Maximum (RM)
What is resistance?
Resistance is any form of active exercise in which a muscle contraction is resisted by an outside force which may be gravity, manual or mechanical force.
Rheumatoid Arthritis Precautions
Respect fatigue & increased pain Do not overstress osteoporotic bone or lax ligaments Dosage of stretching & joint mobilization techniques used to counter any contractures or adhesions must be carefully graded
Critical element of a resistance training program and is necessary to allow time for the body to recuperate from the acute effects of exercise associated with muscle fatigue.
Rest Intervals
List General Interventions for Ankle and Foot - Functional/Chronic Phase
Restore normal joint arthrokinematics Attain full range of pain free motion Improve neuromuscular control of the lower extermity in a full-weight bearing posture on both level and uneven surfaces Improve or regain lower extermity strength and endurance through integration of local kinetic chain exercises Return to previous level of function or recreation
Chronic Stage Physical Therapy goals/interventions
Return to Function Phase:advanced Increase tensile quality of scar:progressive strengthening and endurance exercises Develop functional independence: functional exercises, and specificity drills
How do you Prepare for Stretching?
Review the POC for the goals and outcomes Select a stretching technique that will be most effective and efficient for the patient Warm up tissues by applying heat or by the patient performing low-intensity exercise Make sure that the patient is in a comfortable and stable position to allow for motion in the proper plane of movement (Remember: The direction of the stretch is exactly opposite of the direction of the muscles actions) The patient should be dressed comfortably to allow for the stretch to happen without interference of restrictive clothing The patient must also be as relaxed as possible
Arthritis that affects the joints of the wrist and hand which results in decreased functional abilities and pain, impaired mobility and joint .
Rheumatoid Arthritis
What is the most common joint disorders of arthritis that is inflammatory or non-inflammatory treated by PTs ?
Rheumatoid Arthritis & Osteoarthritis
A physical therapist assistant observes a patient ambulating in the clinic. The physical therapist assistant notes that the patient's pelvis drops on the left during the left swing phase. this deviation is usually caused by a weakness of the:
Right gluteus medius
A common pathology of the Shoulder Girdle were there is a separation of the medial border of the scapula from the posterior thoracic cage which may be caused by paralysis or weakness in the serratus anterior, rhomboids, and middle trapezius.
Scapula Winging
PNF D2 Extension Upper Extremity Directions
Scapula= Depression, Abduction, Downward Rotation Shoulder= Extension, Adduction, Internal Rotation Elbow= Straight (Flex/Ext) Forearm = Pronation Wrist = Flexion, Ulnar Deviation Fingers= Flexion, Adduction Thumb= Opposition
PNF D1 Flexion Upper Extremity Directions
Scapula= Elevation, Abduction, Upward Rotation Shoulder= Flexion, Adduction, ER Elbow= Straight (Flex/Ext) Forearm= Supination Wrist= Flexion, Radial Deviation Fingers= Flexion, Adduction Thumb= Flexion
PNF D1 Extension Upper Extremity Directions
Scapula=Depression, Adduction, Downward Rotation Shoulder= Extension, Abduction, IR Elbow= Straight (Flex/Ext) Forearm= Pronation Wrist=Extension, Ulnar deviation Fingers= Extension, Abduction Thumb= Extension
An impingement of the sciatic nerve, which causes pain to radiate from the buttock to the posterior lower leg (tibial nerve), lateral lower leg (superficial peroneal nerve), or anterior lower leg (deep peroneal nerve). If the pain is in a dermatomal pattern, there is likely impingement of one of the spinal roots (L4-S3) that make up the sciatic nerve
Sciatica
A common spinal postural dysfunction were a patient has a lateral curvature of the spine, usually at the thoracic and lumbar region, which is detected by asymmetrical trunk flexion.
Scoliosis
An overuse injury resulting in pain to the posterior medial and anterior lateral aspect of the tibia, that is associated with overuse of the tibialis anterior or posterior muscle, tight gastrocnemius and soleus, and excessive foot pronation.
Shin Splints
List Treatment Options for Anterior Pelvic Tilt Posture
Short TFL and IT Band General limitations of Hip ER Weak, stretched posterior portion of gluteus medius and piriformis Excessive IR during the first half of the stance phase of gait-This increases stress to medial structures of the knee Compensation of the lower extremity
List Treatment Options for Slouched Posture
Shortened rectus femoris and hamstrings General limitations of hip rotators Weak, stretched iliopsoas Weak and shortened posterior portion of gluteus medius Weak, poorly developed gluteus maximus Compensation of the lower extremity
List Treatment Options for Flat Back Posture
Shortened rectus femoris, IT Band, and gluteus maximus Variations of the above two postures
The entrapment of the supraspinatus tendon under the acromial arch
Shoulder Impingement
Factors to Identify a Type of Fracture
Site (Diaphyseal, metaphyseal, epiphyseal, intra-articular) Extent (Complete, Incomplete) Configuration (Transverse, Oblique, or Spiral, Comminuted) Relationship of the Fragment (Undisplaced, discplaced) Relationship to the Environment (Closed, Open) Complication (Local/Systemic, Injury or Treatment)
List Components of Tinetti Performance - Oriented Mobility Assessment (POMA) Balance Test
Sitting Balance Arises Attempts to Arise Immediate Standing Balance Standing Balance Nudged Eyes Closed Turning 360 Degrees Sitting Down
Chronic Stage (Return to Function Phase) Structural & Functional Impairments
Soft tissue and/or joint contractures and adhesions that limit normal ROM or joint play Decreased muscle performance—weakness, poor endurance, poor neuromuscular control Decreased functional usage of the involved part Inability to function normally in an expected activity
This concept states that adaptive effects of training such as improved strength and endurance are highly task-specific, in which exercises in a training program should mimic the anticipated function and can also vary in a degree of cross-over whereby adaptation will enhance traits needed to perform another activity.
Specificity of Training
What are the anatomical alignment landmarks for a plumb line, vertical posterior view?
Spinous processes Gluteal cleft Midpoint between the knees Midpoint between the ankles.
Injury of severe stress, stretch or tear to soft tissue, that is a typical term associated with ligaments, joint capsule, tendon, mucsle and is has three grades/degrees of severity.
Sprain
Stages of Idiopathic Frozen Shoulder (Adhesive Capsulitis)
Stage 1: Gradual onset of pain that increases w/ movement & is present at night. Loss of ER motion w/ intact RTC strength. duration < 3 months. Stage 2 ("Freezing" Stage). Persistent/intense pain even at rest. Motion is limited in all directions & cannot be fully restored with IA inj. Between 3 and 9 months. Stage 3("Frozen" Stage): .Pain only with movement, significant adhesions, and limited GH motions, w/ substitute motions in the scapula. Atrophy of the deltoid, RTC, biceps, and triceps brachii muscles between 9 and 15 months. Stage 4("Thawing" Stage). Minimal pain/ no synovitis but significant capsular restrictions from adhesions. Motion may gradually improve during this stage. Lasts from 15 to 24 months or longer. Some patients never regain normal ROM.
These balance assessments observes the patient's ability to maintain different postures which include these test: Romberg Test sharpened (tandem) Romberg Test Single-Leg Stance Test Stork Stand Test.
Static Balance Tests
This type of stretching is when the muscles and connective tissues are held in a stationary position at their greatest possible length for 15-30 seconds.
Static Stretching
To prevent falls, patients must maintain their balance during ______ and ________ activities
Static, Dynamic
List Ligaments of the Shoulder Girdle
Sternoclavicular Costoclavicular Interclavicular Acromioclavicular Coracoclavicular (Trapezoid & Conoid) Coracoacromial
List Joints of the Shoulder Girdle
Sternoclavicular - Sternum & Clavicle Articulation Acromioclavicular - Acromion Process of the Scapula & Clavicle Articulation Scapulothoracic - Scapula & Thoracic Vertebrae Articulation
The inflammation of the bursa between the acromion and the supraspinatus tendon due to shoulder impingement
Subacromial Bursitis
This is the second stage of rehabilitation which is considered the proliferation, repair, & healing phase that last 10-17 days or 14-21 days post onset of injury, signs of inflammation decrease, pain experienced when newly developed tissue is stressed, and muscle weakness and functional limitations are present.
Subacute Phase (Stage) of Rehabilitation
List the three funnel shaped layers of the pelvic floor
Superficial Urogenital diaphragm Pelvic diaphragm (includes coccygeus and the levator ani)
The surgical repair of the glenoid labrum, with SLAP lesions being common in pts with impingement with proximal attachment of long head of biceps tendon, recurrent anterior instability of GH jt, in which arthroscopic repair involves debridement of torn superior labrum, abrasion of boney surface of superior glenoid & reattachment of labrum /biceps tendon.
Superior Labral Anterior Posterior (SLAP) Repair
List of Dermatomes for the Spine
T1-T2 - axillary region, elbow T4 - nipple area T6 - xiphoid process T10 - umbilicus T12 - inguinal or groin area, pubis L1-L4 - anterior and inner surfaces of lower extremities L2 - medial thigh L3 - medial knee L4-S1 - foot L5 - dorsum of foot L5-S2 - posterior and outer surfaces of lower extremities S1 - lateral margin of foot, little toes, Achilles tendon reflex S2-S4 - perineum S2 - posteromedial thigh S3-S5 - perianal area
umbilicus
T10
inguinal or groin area, pubis
T12
nipple area
T4
xiphoid process
T6
What is the most common type of ankle sprain? What ligament is most commonly sprained? Explain what interventions would be appropriate for each phase of recovery for each grade
The most common type of ankle sprain is a lateral sprain. The ligaments that can be stretched or torn are the Anterior talofibular ligament and the calcaneofibular ligament. Sometimes the posterior Talofibular ligament will be involved. There are 3 types of sprains Grade I- minimal to no swelling and patients can continue athletic acivity at 11.7 days Grade II- Swelling and lateral tenderness. These require 2-6 weeks before returning to athletic function Grade III-Full thickness tear. May need surgery. Requires more than 6 weeks to return to fucntion and can take up to 4 years for complete relief of symptoms. Phase I- PRICEMEM, ROM, Stabilizing brace and non weight bearing, temporary immobilization Phase II- Partial weight bearing, low level balance training (seated baps board) Phase III- full weight bearing , progress balance training Phase IV- return to jogging and progress to running, shuttle runs and cutting drills. Phase II
How is a Berg Balance Scale Performed?
The patient is asked to maintain a given position for a specific time and points are deducted for these reasons - the time or distance requirements are not met - the subject's performance warrants supervision - the subject touches an external support or receives assistance from the examiner - should understand that they must maintain their balance while attempting the tasks.
What is a normal response for a patient when performing a Romberg Test?
The patient should be able to maintain balance in this position with both the eyes open and closed for at least 30 seconds
What distal upper extremity nerve passes through the cubital tunnel posteromedial to the olecranon process? What symptoms might a patient present with if this nerve is entrapped?
The ulnar nerve passes through the cubital tunnel posteromedial to the elecranon process. Patients who suffer soft tissue trauma or fractures may present with burning sensations in the medial forearm, little finger, ring finger, and decreased strength of the finger flexor muscles, lumbricals, thumb abductor and flexor carpi ulnaris.
Rehab Protocol for Adhesive Capuslitis (Frozen Phase)
Ther Ex: AROM RTC strengthening (3x/wk, 8-12 reps/3 sets) Closed-Chain isometric strengthening w/ elbow flexed 90 arm at side ( ER/Abd/Flex) Progress to Open-chain strengthening (IR/ER/Abd/Flex) Strengthening scapular stabilizers Self Stretching ( ER/IR, Capsular stretch) Closed-chain strengthening exer: - Scap Rec (rhomboids, mid traps) - Scap Pro (Serratus Anterior) - Scap Dep (Lats, Traps, SA) - Shldr Shrug (Trap, LS) Deltoid Strengtening Mobilization w/ movement (MWM) HEP - ROM 2x/day
Rehab Protocol for Adhesive Capsulitis (Freezing Phase)
Ther Ex: Immobilize Muscle Setting Pendulum (codman's ) Controlled Pain Free PROM, Stretching at ROM limits Focus on Fwd Flex, ER/IR w/ arm at side/elbow 90deg AAROM/AROM ex HEP - ROM 3x/day, sustained stretch 15-30 secs a end ROM Ther Mod: Ice Nonpulsed Ultrasound E-Stim
Describe the Golgi Tendon Organ.
This a mechanoreceptor located between the muscle and tendon, which acts as a protective mechanism that detects the increase in tension within a muscle in order to relax the muscle to prevent injury.
Plumb Line
This line is either real or hypothetical, which is also called a line of gravity, that provides a reference for assessing whether a patient has correct or faulty posture.
What does the Subjective section of a SOAP note include?
This section includes statements made by the patient written in quotations that are their opinion and generally cannot be verified by the therapist.
Shoulder Scaption with External Rotation can be performed at what ROM.
Throughout the FULL ROM
What movement of the thumb is required for the precision grasp Tip Prehension? What primary muscle is responsible for this movement. What common nerve pathology might effect a patient's ability to perform this grasp?
Thumb opposition is required for the tip prehension grip. The opponens Pollicis is the primary muscle that opposes the thumb. Because it is innervated by the median nerve, if a patient suffers carpal tunnel syndrome their tip prehension may be effected.
If treating patients to decrease pain PTA's should
To treat pain use modalities based on their stage of healing, location of pain, and pain scale rating.
List Motions of the Foot /Toes
Toe Flexion at MTP Joint - lumbricals, flexor hallucis brevis Toe Flexion at PIP & DIP Joints - flexor digitorum longus & brevis, flexor hallucis longus Toe Extension at MTP Joint - extensor digitorum longus & brevis Toe Exension at IP Joints - extensor hallucis longus Toe Abduction - dorsal interossei Toe Adduction - palmar interossei
A common spinal postural dysfunction also known as wryneck, which is caused by the shortening of one of the anterior neck muscles, most often the sternocleidomastoid
Torticollis
This surgical option is carefully selected for patients who have disabling pain associated with advanced, symptomatic arthritis of the talocrural joint whose only surgical alternative is ankle arthrodesis.
Total Ankle Arthroplasty
The replacement of the distal femur, proximal tibia, and posterior patella with prosthesis
Total Knee Replacement (TKR) or Total Knee Arthroplasty (TKA)
A muscle fiber that generates a low level of muscle tension but can sustain the contraction for a long period of time, these fibers are geared towards aerobic metabolism and are very slow to fatigue.
Type I (tonic, slow-twitch)
A muscle fiber that generate a great amount of tension in a short period of time, in which fibers are geared towards anaerobic metabolic activity and tend to fatigue quickly.
Type II (phasic, fast-twitch)
List the Bones and Bony Landmarks of the Wrist & Hand
Ulna Radius Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Metacarpals Proximal Phalanges Middle Phalanges Distal Phalanges
This pelvic floor dysfunction can be caused by neuromuscular and musculoskeletal impairments. Patients can have this after childbirth due to compression of the levator ani and pudendal nerves. or Increase caffeine intake may contribute to this.
Urinary and Bowel Incontinence
What are the precaution of repetition maximum?
Use of a 1-RM as a baseline measurement of dynamic strength is inappropriate for some patient populations because it requires one maximum effort. It is not safe for patients, for example, with joint impairments patients who are recovering from or who are at risk for soft tissue injury, patients with known or at risk for osteoporosis or cardiovascular pathology.
A PTA is treating a patient for knee strengthening. The PTA instructs the patient with partial squats (mini squats). The following exercises would be appropriate progressions
Using hand weights while performing squats Flexing the trunk farther forward in order to keep the knees over the feet. Placing elastic tubing under both feet and grasping with hands while straightening up
Osteoarthritis Characteristics
Usually after age of 40 Usually develops slowly over many years in response to mechanicalstress Cartilage degradation, altered jointnarchitecture, osteophyte formation Affects a few joints (usually asymmetrical); typically: —DIP, PIP, 1st CMC of hands —Cervical and lumbar spine —Hips, knees, 1st MTP of feet Morning stiffness (usually <30 min),increased joint pain with weight-bearing and strenuous activity;crepitus and loss of ROM No Systemic signs or symptoms
What are tissue responses and characteristics during the Acute Stage (Inflammatory Reaction)?
Vascular changes Exudation of cells and chemicals Clot formation Phagocytosis, neutralization of irritants Early fibroblastic activity
This system provides information about the position of the head in space and about acceleration (change in speed).
Vestibular System
What can be done to progress a patient's visual ability during balance training?
Visual sensory cues can be challenged during balance training as well by dimming lights, use of glasses and closing eyes should be challenged
This system provides information about the position of the head relative to the environment to maintain a level gaze and provides information about surrounding objects and the speed of movement.
Visual system
Balance is maintained with input from which three systems
Visual system Vestibular system Somatosensory system
An exercise that is done actively or with the use of a finger ladder can assist the patient in improving shoulder ROM, by performing with the shoulder in flexion or abduction. The patient begins to increase the ROM into flexion or abduction by slowly stepping closer to the wall as the arm is elevated.
Wall Climbing
Patients with disc protrusion or disc herniation often find that extension positions and exercises are most tolerable. Before initiating a McKenzie program, what contraindications would a PTA need to check?
When no position or movement decreases or centralizes the pain When saddle anesthesia and or bladder weakness is present When a patient is in such extreme pain that they hold their body immobile with any attempt to correct.
Injuries to the cervical spine that may occur in a motor vehicle accident, which can may be subjected to sudden hyperextension followed by hyperflexion resulting in pain and muscles spasms.
Whiplash Injury
What occurs with increased Q angle?
Wide pelvis Femoral anteversion Coxa Vara Genu Valgum Laterally displaced tibial tuberosity
What are the Limitations of AAROM/AROM?
Will not maintain or increase strength in overly strong muscles Only develops skill and coordination in the patterns used (specificity of training)
A PTA is treating a patient who susatained a grade II rotator cuff strain 5 days ago. Which of the following interventions would be LEAST appropriate? a. thermal ultrasound b. ice massage c. PROM d. gentle muscle setting
a. Thermal Ultrasound
A PTA is instructed to begin stretching exercises for a patient who sustained a hamstring strain. Wich of the following time frames would be most appropriate to begin stretching activities assuming that the patient no longer displays signs and symptoms of inflammation? a. 3-5 days b. 10-17 days c. 6 months-1 year d. stretching can be performed any time
b. 10- 17 days
After a fracture, immobilization may be removed during which phase of healing? a. reparative b. Inflammatory c. comminuted d. remodeling
d. Remodeling
List the different types of Power Grasps
fist cylindrical ball hook pliers grasps
List the different types of Precision Grasps
pulp-to-pulp pinch lateral prehension tip prehension three-fingered pinch five-fingered pinch
List Interventions for Achilles Tendon Repair - Return to Function Phase
s/p 12-16 wks Stretch til Full ROM achieved Emphasize eccentric loading of Gastroc/Soleus w/ unilateral stance or heel raises 16 wks start plyometric exercises Pt education to reduce reinjury
List of Precautions and Contraindications of the Neck & Trunk
- Always follow protocols set forth by the Doctor. - Maintain weight bearing precautions if appropriate. - Patient may require education for log roll to get into and out of bed. - Typically spinal surgeries follow general precautions of no Bending, no Lifting and no Twisting (commonly referred to as BLT). - The patient should maintain proper body mechanics. The difficulty level of the exercise should be adjusted if the patient is unable to maintain the proper lordotic curve during the activity. - Be watchful for signs of peripherilization and centralization with patients that have a disc herniation. These symptoms should be documented.
RTC Repair Precautions for Stretching Exercises
- Avoid vigorous stretching, the use of contract-relax procedures, or grade III joint mobilizations for at least 6 weeks and often for 12 weeks post operatively to give time for the repaired tendon(s) to heal and become strong. - If the supraspinatus or infraspinatus was repaired, initially avoid end-range stretching into internal rotation. - If the subscapularis was repaired, initially avoid end-range stretching into external rotation. - If the deltoid was detached and repaired, initially avoid end-range shoulder extension, adduction, and horizontal adduction.
RTC Repair Exercise Progression for Phase III (Minimum Protection/Return to Function)
- Begins 12-16 wks post op for strong repairs (small/medium), & 16 wks for tenuous repair (large/massive tear) which last for 6 months or more - Similar to Nonoperative Shldr Management and SAD but progression is gradual & precautions are extended -Full ROM no restored yet so include Passive stretching of GH muscles, joint mobilization -Activities that increase ROM (swing gold club/tennis racket -Advanced task-specific strengthening -Pt unable to return to high-demand activities for 6 months to 1 yr post op depending on comfort, strength, flexibility
RTC Repair Exercise Progression for Phase II (Moderate Protection )
- Begins 4-6 wks post op & last 6 wks for small/medium tears, but may begin as late as 12 wks post op for large/massive tears - Strengthening exercise begin around 8 weeks post op- -Restore nearly complete or full pain free PROM of shldr (S-AAROM w/ end range holds w/ wand or pulley single plan/diagonal, add shldr IR/ext/ horiz add, mobilization of incision site) - Incerease strength and endurance & re-establish dynamic stability of the shldr musculature ( AROM thru pain free range, Isometric/dynamic strengthening to scapulothoracic stabilizers w/ alternating isometrics in NWB > rhythmic stabilization w/ light UE WB activities, Submaximal multi-angle isometrics of RTC w/ increasing resistance, Dynamic strengthening/endurance training of GH muscles w/ light tubing or 1-2lbs below shldr level, UE ergometry, light functional activities Criteria for progression: -full pain free PROM - Progressive improvement of shldr strength/endurance - Stable GH jt.
What are Shoulder Impingement Treatment (Phase I (Protetion Phase) )
- Control Inflammation/Promote Healing (modalities, low-intensity cross fiber massage, sling for rest) - Pt Education (modify/avoid activities that flare symptoms) -Maintain integrity/mobility of soft tissue (pain free PROM>AAROM >S-AROM; protected stabilization, muscle setting, stabilize RTC, Biceps, Scap muscles) -Control pain/maintain joint integrity (Pendulum, grade II joint distraction & oscillation motions) -Develop Support in related regions (postural awareness, supportive techniques)
What are Shoulder Impingement Treatment (Phase III (Return to Function Phase))
- Increase Muscular Endurance: repetitive loading of defined patterns 3-5 minutes - Develop quick motor responses to imposed stresses: Stabilization exercises applied w/ increased speed Plyometric training in both open/closed chain patterns for power -Progress Functional training : Specificty of training (timing/sequence of events) eccentric training progressed to maximum load functional activities mimiced from controlled > challenging conditions Patient assess performance for corrections.
RTC Repair Exercise Progression for Phase I (Maximum Protection)
- Last 3-4 Weeks for Small>Medium Tears to 6-8 weeks for Large >Massive Tears - Control pain/inflammation (periodic icing, arm support, shldr relaxation, grade I oscillations GH jt) - Prevent loss of mobility of adjacent regions (AAROM of elbow, AROM C-spine, wrist, hand) - Prevent shoulder stiffness/restore shoulder mobility (Pendulum exer(day 1), PROM (supine), S-AAROM (hand/wand by 1-2 wks for small/medium tears, >2wks for large tears), AAROM flex) -Prevent/correct postural deviations (spinal alignment/shldr retract) - Develop control of scapulothoracic stabilizers (AROM, Submaximal isometrics, Side-lying pro/retract for SA) - Prevent inhibition & atrophy of GH musculature (Low intensity, muscle setting , minimal resistance (1-3 wks post op) Criteria for progression: - well healed incision - minimal pain w/ AAROM shldr - progressive improvement in ROM
RTC Repair Precautions for Early Shoulder Motion
- Only passive, nonassisted ROM for 6- 8 weeks after massive repair/ traditional approach to prevent deltoid avulsion - Start PROM in supine - Initiate Passive/assisted shldr rotation suping w/ shldr slightly flexed & approx 45 abd. - Perform passive or assisted shoulder ROM within safe and pain-free ranges based on the surgeon's intraoperative observation of the mobility and strength of the repair and the patient's comfort level during exercise. - Initially perform passive and assisted shoulder ROM in the supine position to maintain stability of the scapula on the thorax. - Minimize anterior and superior translations of the humeral head and the potential for impingement. Position the humerus slightly anterior to the frontal plane of the body and in slight abd -While at rest in the supine position, support the distal humerus on a folded towel. - When initiating assisted shoulder extension, perform the exercise in prone (arm over the edge of the bed) from 90° to just short of neutral. Later progress to exercises behind the back. - When performing assisted or active exercises in the upright position (sitting or standing), be certain that the patient maintains an erect trunk posture to minimize the possibility of impingement. - To ensure adequate humeral depression and avoid superior translation of the head of the humerus when beginning active elevation of the arm, restore strength in the rotator cuff, especially the supraspinatus and infraspinatus muscles,before dynamically strengthening the shoulder flexors and abductors. - Do not allow actives houlder flexion or abduction until the patient can lift the arm without hiking the shoulder.
Treatment Options for Carpal Tunnel Syndrome
- Protect Nerve ( splints, areas w/ decreased sensitivity) - Modify activity/educate pt - Mobilize restricted joints, connective tissue & muscle/tendon (carpals, tendon glide exercises, median nerve mobilization ) - Improve muscle performance (gentle multi-angle muscle setting, progress resistance/endurance, fine finger dexterity) -Progress functional independence
What are Shoulder Impingement Treatment (Phase II (Controlled Motion Phase))
- Pt education of avoidance of irritating positions -Develop strong, mobile tissues: (manual therapy techniques > Isometric contractions ) - Modify joint tracking and mobility: Mobilization w. movement (posterolateral glide w/ active elevation, Self treatment) - Develop balance in length & strength of shoulder girdle muscles: (Stretch shortened muscles (pec maj/min, lats, TM, Subscap, LS), Strengthen/train scapular stabilizers (SA, Low Traps, Mid Traps, Rhomboids) , Strengthen/train RTC muscles (especially ER) - Develop Muscular stabilization & endurance: Alternating isometric resistance to scapular muscles, Scapular/GH patterns, Closed-chain stabilization, muscular endurance progressed by increase time exercise performed. - Progress Shoulder Function: Dynamically load UE w/ submaximal resistance w/ increase time 1-3 minutes
RTC Repair Precautions for Activities of Daily Living
- Wait until about 6 weeks after a mini-open or arthroscopic repair and 12 weeks after a traditional open repair before using the operated arm for light functional activities. - After repair of a large or massive cuff tear, avoid use of operated arm for functional activities that involve heavy resistance (pushing, pulling, lifting, carrying heavy loads) for 6 to 12 months post operatively.
Supraspinatus
A: Abduct the shoulder, Stabilize the head of humerus. O: Supraspinous fossa of the scapula. I: Greater tubercle of the humerus N: Suprascapula C4, 5, 6
Deltoid
A: Abducts the shoulder, Flex the shoulder, Medially rotate the shoulder, Horizontly adducts the shoulder, extends the shoulder, laterally rotates the shoulder, horizontly abducts the shoulder. O: Lateral one-third of the clavicle, acromion and the spine of the scapula. I: Deltoid tuberosity N: Axillary C5, 6
Triceps brachiix
A: All heads: extends the elbow. Long head: extend the shoulder, adducts the shoulder O: Long head: Infraglenoid tubercle of the scapula. Lateral head: Posterior surface of proximal half of the humerous. Medial head: Posterior surface of distal half of the humerous I: Olecranon process of the ulna N: Radial C6, 7, 8, T1
Brachialis
A: Flex the elbow O: Distal half of the anterior surface of humerous I: Tuberosity and coronoid process of ulna N: Musculocutaneous, small branch from radial C5, 6
A rupture of this ankle tendon, that is most commonly occur spontaneously in healthy, young, active individuals who are 30-50 years old and have no history of calf or heel pain
Achilles Tendon Rupture
Shoulder complex surgeries to reshape the underside of the acromial arch to prevent shoulder impingement
Acromioplasty and Subacromial Decompression (SAD)
Shoulder complex surgeries to reshape the underside of the acromial arch to prevent shoulder impingement due to narrowing of joint space and formation of osteophytes which can contribute to rotator cuff tears
Acromioplasty and Subacromial Decompression (SAD)
What is active insufficiency? give an example of active insufficiency.
Active Insufficiency occurs when a multi-joint muscle reaches a shortened (contracted) length where it can no longer apply an effective force. Example: Make a fist (finger flexors), you can make a strong fist when your wrist is in a neutral or slightly extended position. But when you flex your wrist with a clenched fist you loose some of the grip. This is because the finger flexors are unable to shorten any more due to active insufficiency and begin to extend and lose grip strength.
What phase of rehab is it most appropriate to begin Progressive resistance exercises?
After the subacute stage leading into the Chronic stage and progress indefinitely after that
What are the normal values of a Functional Reach Test?
Age 20-40: Men - 16.7 in Women - 14.6 in Age 41 -69: Men - 14.9 in Women - 13.8 Age 70-87: Men - 13.2 in Women - 10.5
A device that is used to prevent or maintain certain range of motion of the ankle joint creating a stretch to help reduce pain.
Ankle Splinting
Ankle Bracing depends on specific __________ that may require to ________which treatment may involve specific equipment, balance activities, and plyometrics
Ankle pathology, immobilization
List of directions the Pelvis Tilts
Anterior Posterior
An athletic injury of the knee that occurs as the result of a quick deceleration, hyperextension, or rotational injury
Anterior Cruciate Ligament (ACL) Sprain or Tear
Lordosis is caused by what?
Anterior pelvic tilt Overweight adults Pregnancy. Weak Abdominal muscles
What is the difference between autogenic and reciprocal inhibition? What PNF stretching techniques use these phenomenons as an advantage to improving muscle extensibility?
Autogenic inhibition is the phenomenon that the GTO in a Muscle will contribute to reflexive muscle relaxation after a contraction, allowing the muscle to be elongated. Hold and contract relax are techniques that take advantage of Autogenic inhibition too improve muscle flexibility. Reciprocal inhibition is the phenomenon that if one muscle contracts, the opposite muscle will relax. Hold relax Agonist contraction technique uses this phenomenon to apply stretching. This technique is used more when contract relax or hold relax is too painful for a person.
Precautions for patients with a THR are..
Avoid hip flexion greater than 90°, hip adduction past mid-line, and hip internal rotation.
Precautions of a Total Ankle Arthroplasty
Avoid plyometric training Avoid high impact activities Avoid Quick Stop and Go motions ROM not permitted until 4 weeks Bilateral RA or OA NWB -> WBAT for 2 -6 weeks
When applying manual resistance when strengthening the Extensor carpi radialis longus, what area of the hand should you apply the resistance? a. palmar (volar) surface of the second and third metacarpals b. Dorsal surface of second and third metacarpals c. Palmar (volar) surface of forth and fifth metacarpals d. Dorsal surface of second and third metatarsals
B. Dorsal Surface of Second & Third Metacarpals. You would want to put resistance around the area of where the muscle inserts for the most effective muscle contraction.
A patient who has golfers elbow places the most stress on which of the elbow ligaments? a. Lateral collateral b. Medial collateral c. Annular ligament d. Coracoacromial arch ligament
B. Medial Collateral
A PTA is treating a patient who presents with long thoracic nerve palsy. Which of the following exercises would be the MOST appropriate when beginning a scapular stabilization program? a. Closed chain rhythmic stabilization b. Open chain rhythmic stabilization c. Closed chain rhythmic initiation d. Open chain rhythmic initiation
B. Open Chain Rhythmic Stabilization For scapular winging, closed chain exercises may be too challenging. Begin scapular strengthening in open chain positions intitially.
A PTA is treating a patient who presents with thoracic structural kyphosis and complains of glenohumeral joint pain. The plan of care has strengthening of the rhomboids on the plan of care. Which of the following exercises would target this muscles the MOST? a. supine forward punches with scapular abduction b. prone arm lifts with elbows extended with scapular adduction c. Codman's pendulum d. prone arm lifts with arm overhead with scapular elevation
B. Prone Arm Lifts with Elbows Extended with Scapular Adduction
You are treating a patient with a recent shoulder injury. The PT wants you to begin exercises with closed chain static scapular stabilization. What exercise would be most appropriate? a. wall push ups b. scapular isometrics with manual resistance in protected wt bearing c. rhythmic stabilization in supine with a wand d. pulleys
B. Scapular Isometrics with Manual Resistance in Protected Weight Bearing.
The ability to maintain the center of mass (COM) over the base of support (BOS), which is extremely important to patient's functional mobility.
Balance
List Lateral Ligament Repair Precautions
Begin stretching in non weight bearing positions Postpone unilateral heel raises in standing to strengthen PFs later Risk of reinjury by overstressing repaired ligaments high w/ LOB or execessive inversion w/ PF Modify Activities (low impact sports) Minimize or avoid high impact sports Participate in pre-season injury prevention programs (propriceptive/plyometic training) Wear prescribed orthotic devices Tape ankle/insert lateral shift in shoe
What are the Uses of AAROM/AROM for Treatment?
Benefits of PROM Maintain physiological elasticity and contractility of muscle Provide sensory feedback Provide stimulus for bone integrity Increased circulation and prevent thrombus formation Develop coordination and motor skills Allows for control of strengthening efforts Can improve cardiovascular and respiratory responses
General Considerations and parameters for the Neck & Trunk - Subacute- Chronic Phase
Cervical and Cervicothoracic stabilization exercises Co-contraction of cervical musculature Co-Contraction of agonist and antagonist will support stabilization Note: Isokinetic exercises of the neck are not functional and therefore not recommended as a strengthening tool Perform repetitive motions of the upper extremity. Be sure to palpate the affected segment to check for unwanted motion. Only movements of the upper extremity that maintain the segment neutral should be performed. Progress to adding weights, using a foam roll, sitting/standing against a wall to provide feedback as to where the head is in space. Take caution with overhead weighted activities as this places higher demands on the stabilization system Treatment of neck injuries should include postural assessments and scapular retraction activities. Retraction may need to begin in supine in order to avoid too much neck pain. A progression of these exercises may move from supine-->prone-->sitting-->standing-->standing with resistance. Strengthening considerations should include the entire kinetic chain. This can include activities such as lat pull-downs, PRE's for the middle trapezius and rhomboids, and upper extremity PNF patterns
What are the contraindications to stretching? What are the precautions to stretching according to your Kisner text?
Contras: When ROM is disruptive to healing process ROM should not be done when a patient response or the condition is life threatening Precautions: after a MI, CABG, or percutaneous transluminal coronary angioplasty, AROM is limited in the UE's When patient's pain increases.
General Considerations and Parameters for the Neck & Trunk - Acute Phase
Control pain, inflammation, and muscle spasms - PRICEMEM- (Protection, rest, ice, compression, elevation, manual therapy, early motion and medications prescribed by physician) - Patient may require education on how to position pillows at home to maintain correct alignment of the neck (neutral position) Patient may require use of soft cervical collars.The collar serves a number of functions: - The patient should be weaned off the collar as they progress in their recovery. This is based on significant improvements in range of motion and as pain levels decrease. Provide support in maintaining the cervical spine erect - Reminds the patient that the neck is injured and prevents the patient from engaging in unexpected or excessive movement - Allows the patient to rest the chin during activities so it offsets the weight of the head - Allows the patient to perform cervical rotations while the weight of the head is offset
List Intervention of OA w/o surgery - Acute Phase
Control pain/protect joint - pt education and functional adaptions Maintain soft tissue/ joint mobility - PROM->AAROM->AROM
The ability to perform smooth, accurate, and controlled motions, which allows patients to maintain balance gracefully, that can be assessed using numerous special tests, including a finger-to-nose test or a hand flip test.
Coordination
What are Precautions to be aware of when Stretching?
Do not stretch past normal ROM Protect fracture sites Consider effects of osteoporosis, age, immobilization, and steroids or other meds If soreness lasts longer than 24 hours, intensity was too great Avoid stretching edematous tissue, more susceptible to injury Avoid overstretching weak muscles.
What are the use of a repetition maximum?
Documents a baseline measurement of dynamic strength to which improvements can be compared Identifies initial exercise load to be used for a specified number of repetitions
TSA Resistance Exercises
During Phase 1: Only light, NWB isometrics of ST and deltoid muscles with shoulder in scapular plane Iso Abd, ER/IR, muscle setting During Phase 2: Emphasis on improving function of rotator cuff and ST muscles Submaximal isometrics of GH muscles combined with light weight bearing through UE Delay resisted rotation for several weeks (to protect repaired rotator cuff) Progress to low-resistance dynamic strengthening of elbow and wrist (dumbells); ST and GH joints if mechanics during AROM allow Theraband exer IR/ER During Phase 3 Progress PRE in functional patterns Progress closed-chain stabilization exercises Dumbbell - Abd, Scapation, Flex Lightweight exer for ER/IR
TSA ROM Exercises, Stretching, & Joint Mobilizations During Phase 2 & 3:
During Phase 2: Continue AROM AAROM - Flex, ER/IR Gradually increase GH rotation Gentle stretching after 6-8 weeks, if needed Cont Pulley & Pendulum During Phase 3: Progress end-range self-stretching
rTSA ROM Exercises, Stretching, & Joint Mobilizations During Phase 2 & 3:
During Phase 2: Increase PROM while observingmotion restrictions A-AROM→AROM of GH joint —Begin in supine; progress to sitting, standing —Gradually increase internal rotation past neutral During Phase 3: Gentle stretching, if needed within motion restrictions
Exercise against constant external resistance is a form of resistance training in which a limb moves through a ROM against a constant external load, which include concentric and eccentric muscle contractions.
Dynamic Exercise: Constant External Resistance (DCER) (also known as isotonic)
An injury caused from a fall on an outstretched hand and is most common at the radial head. Casting causes the joint to become extremely stiff and immobile. Immediately following immobilization AROM and PROM should be performed. The goal would be to reach 15-105 degrees of motion by the end of week 2.
Elbow Fracure
List the Muscles of the Wrist & Hand
Flexor Carpi Ulnaris Flexor Carpi Radialis Palmaris Longus Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris Flexor Digitorum Superficialis Flexor Digitorum Profundus Extensor Digitorum
List the Components of the Wrist & Hand that make up the Carpal Tunnel
Flexor Digitorum Superficialis Flexor Digitorum Profundus Flexor Pollicis Longus Median Nerve
It is recommeneded to strength these muscles for PFPS because to the muscular imbalance they may cause.
Vastus Medialis Oblique (VMO) Tensor Fascia Latae (TFL) Gluteus Maximus Hip Abductors Hip External Rotators
General Considerations and parameters for the Thoracic and Lumbar Spine - Functional/Chronic Phase
Focus on spinal control during activities and exercises Improve muscle performance Educate on safe progression to higher level activities Habitual Training (Body mechanics during functional activities)
TSA ADL Precautions
For first 4 to 6 weeks Observe ROM restrictions: —Do not reach behind the back or into hippocket —When supine, support arm on pillow to avoid GH extension past neutral —Light ADL permitted with elbow at waistlevel(writing, eating, washing face) Do not lean on involved arm (rising from orsitting down in chair) Lifting limit: 1 lb (cup of coffee or glass of water) From 6-12 weeks Limit unilateral lifting to 3 lb After 12 weeks Ultimate bilateral lifting limit: 10-15 lb Gradual return to light functional activities
Integration of rest into exercise is dependent upon the ________ ____ _________of exercise where the higher the intensity the longer the rest interval or moderate intensity, a rest period of 2-3 minutes is recommende or Low intensity exercises, a shorter rest period is recommended
Intensity and Volume
Patient's who are referred to PT for knee pain/weakness are often instructed in hip strengthening exercises. If a patient has genu valgus alignment of the knee while descending stairs, what 2 hip muscle group needs to be strengthened? Name one exercise for each of them that a PTA could instruct a patient with.
If a patient has a genu valgus alignment it is possible that their hip external rotators and abductors are weak. This patient could benefit from hip abduction with isolating specifically the gluteus medius ( ext/internal rotation and then into abduction) and the external rotators by doing clam shell exercises.
How does Biceps tendinitis contribute to risk of RTC tears?
If tendon ruptures or dislocate it may escalate impingement of tissues in the suprahumeral space, can become restrictive and compounds & perpetuates problems leading to RTC tears
A dynamic muscle contraction that produces a constant force throughout the range of motion. There are two types of isotonic contractions: concentric and eccentric
Isotonic contraction
Why is scapular stabilization important when developing a strengthening program for a patient who has had a shoulder injury?
In order for the Glenohumeral joint to have functional ROM and strength, the scapla must be able to accomodate motion. As the glenohumeral joint abducts, the scapula will elevate 1 degree for every 2 degrees the humerus is raised. If the scapula is unstable, It may not allow efficient movement and therefore the glenohumeral joint may be unstable and proper muscle initiation will be hindered. If the scapula is sitting in a position that is to low or downwardly rotated, the acromion will not allow sufficient movement of the head of the humerus inside the glenoid fossa. This may lead to impingement and tears. It will also prevent full ROM of the glenohumeral joint.
What should be noted when assessing a patient spinal curvature?
In standing, the patient should have moderate spinal curves for correct posture were it should not be absent or excessive and with trunk flexion, there should be a gentle curve to the whole spine. Faulty posture contains areas of increased bending
Why is it important to be aware of both Active and Passive Insufficiency over multi-joints?
It can affect the ability of muscles to move at their fullest potential of ROM dependent on the position that they are in.
List Management Guidelines for the Subacute Phase of Rehabilitation/ Intervention (up to 3 Weeks postinjury).
Initiate and progress nondestructive exercises and activities, performing exercises and activities within the tolerance of the healing tissue to avoid re-injury or inflammation. Use assistive device, splints, tape or wrap and progressively decrease device as strength increases Patient Education on what to expect during this stage. Encouraging patients to return to only the activities that do not exacerbate their symptoms is ideal. Initiate multiple-angle isometrics w/ pt tol w/ mild resistance Progress isotonic exercises w/ increase repetition, emphasizing control of pattern and proper mechanics Initiate Active exercises within pain-free ranges progressing to endurance and strengthening exercises with care Initiation of stretching once the tissues have been warmed and relaxed can begin in this stage Scar tissue massage- increase mobility of scare specific to structure involved Strengthen newly acquired range of motion Progress PROM>AAROM>AROM w/in limits of pain
Causes of Painful Shoulder Syndromes that can lead to Shoulder Impingement
Intrinsic Impingement: - RTC disease (Stage I.Edema, hemorrhage; Stage II.Tendonitis/bursitis and fibrosis; Stage III.Bone spurs and tendon rupture Extrinsic Impingement (Mechanical Compression of Tissues) - Primary extrinsic: Anatomical factors (AC Jt degeneration, humeral head hypertrophic changes ), Biomechanical factors (clavicle/scapular alter movement, increased humeral head translation) , Acromion Shape (Type I (flat), Type II (Curved) , Type III (hooked) -Secondary extrinsic: Multidirectional instability, unidirectional instability w/ or w/o impingement - Internal extrinsic impingement Tenonitis/ Bursitis - Supraspinatus tendonitis -Infraspinatus tendonitis - Bicipital tendonitis - Superior glenoid labrum - Subdeltoid (subacromial) bursitis -Other musculotendinous strains (specific to type of injury ortrauma) - Anterior—from overuse with racket sports (pectoralis minor,subscapularis, coracobrachialis, short head of biceps strain) -Inferior—from motor vehicle trauma (long head of triceps,serratus anterior strain Insidious (atraumatic) Onset
Posture
It is the position of the body in space in which it is correct when muscular and skeletal balance is maintained to protect the supporting structures of the body against injury or progressive deformity.
What is included in a Manual Muscle Test Intervention Documentation?
Joint (Scapula, Shoulder, Elbow, Wrist, Hip, Knee, Ankle) Action (Elev, Re/Protraction, Flex/Ext, Abd/Add IR/ER, Sup/Pro) Grade (0/5, 1/5, 2-/5, 2/5, 2+/5, 3-/5, 3/5, 3+/5, 4/5, 5/5
What position should the wrist be in when applying isometrics for the first time to a patient with lateral epicondylits, What is the reason for this?
Lateral epicondylitis is very painful. It effects the wrist extensors. You can begin gentle isometric contractions with the wrist in extension and progress with each set by moving the wrist closer to a flexed position. The flexed position would cause full stretching of the wrist extensors and may be painful if you do not move slowly through the movement. Sets of gentle isometric holds will relax the wrist extensors in order to achieve a stretch into wrist flexion if tolerated.
List Interventions for Achilles Tendon Repair - Acute Phase
Maintain ROM of nonimmobilized joints Prevent reflex inhibitions of immobilized muscle groups Prevent joint stiffness and soft tissue adhesions in the operated ankle and foot Begin to restore balance reactions in standing Maintain cardiopulmonary fitness
This is inflammation of the structures near the medial epicondyle, which is also known as Golfer's Elbow. Symptoms include pain that may radiate down the forearm. Pain radiation may be caused by ulnar nerve compression. Initial treatment will involve rest and activity modification.
Medial Epicondylitis
A decrease in the amount of bone mineral density (BMD) which may progress to osteoporosis, where the BMD is determined by using a dual-energy X-ray absorptiometry (DEXA) scan, that has a BMD that is between 1 and 2.5 standard deviations below normal.
Osteopenia
A bone disorder that causes bones to become weak and brittle, so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture.
Osteoporosis
A decrease in the amount of bone mineral density (BMD) that predisposes the patient to a fracture in which the BMD exceed 2.5 standard deviations below normal.
Osteoporosis
Pectoralis Minor
Origin: Anterior Surface of ribs 3-5 Insertion: Coracoid Process of the Scapula Action: Protraction, Downward Rotation, and Depression of the Scapula Innervation: Medial Pectoral Nerve (C8-T1)
Trapezius (Lower Fibers)
Origin: Spinous processes of T4-T12 Insertion: Triangular space at the base of the scapular spine Action: Adduction, Depression, and Upward Rotation of the Scapula Innervation: Spinal Accessory Nerve and Branches of C3-C4
Serratus Anterior
Origin: Surface of the Upper 9 Ribs at the side of the chest Insertion: Medial Border of the Scapula Action: Abduction, Upward Rotation of the Scapula Innervation: Long Thoracic Nerve (C5-C7)
Levator Scapulae
Origin: Transverse processes of C1-C4 Insertion: Medial border of the scapula, from superior angle to spine Action: Scapular elevation Innervation: Dorsal scapular nerve C3-C5
A disorder that most commonly affects joints in your hands, neck, lower back, knees and hips and can gradually worsen with time. Treatments can slow the progression of the disease, relieve pain and improve joint function.
Osteoarthritis
Principle states that muscles performance improves only if the muscle is challenged to perform at a level greater than that to which it is accustomed such as muscles gain strength when challenged to fatigue by consistently increasing the exercise load once adaptation to a given load has taken place.
Overload Principle
List Neuromuscular Common Physical Impairments Managed with Therapeutic Exercise
Pain Impaired balance, postural stability, or control Incoordination, faulty timing Delayed motor development Abnormal tone(hypotonia, hypertonia, dystonia) Ineffective/insufficient functional movement strategies
List Musculoskeletal Common Physical Impairments Managed with Therapeutic Exercise
Pain Muscle weakness Decreased muscular endurance Limited ROM due to restriction of joint capsule and periarticular connective tissue Decreased muscle length Joint hypermobility Faulty posture Muscle length/strength imbalances
Contraindications to Resistance Exercise
Pain during active free (unresisted) movement Pain during isometric contraction resistance exercises Pain that cannot be eliminated by reducing the resistance In the presence of inflammatory neuromuscular disease Dynamic resistance is a contraindication for acute inflammation of a joint Severe cardiac or respiratory diseases or disorders w/ acute symptoms
Chronic Inflammation/Cumulative Trauma Syndromes Structural & Functional Impairments
Pain in the involved tissue of varying degrees: ■Only after doing repetitive activities ■When doing repetitive activities as well as after ■When attempting to do activities; completion of demands prevented ■Continued and unremitting Soft tissue, muscle, and/or joint contractures or adhesions that limit normal ROM or joint play Connective tissue weakness in painful region Muscle weakness and poor muscular endurance in postural or stabilizing muscles as well as primary muscle at fault Imbalance in length and strength between antagonistic muscles; biomechanical dysfunction Decreased functional use of the region Faulty position or movement pattern perpetuating the problem
What occurs during the Associative Stage of Motor Learning?
Patient demonstrates further development and refinement of the strategies. Movement patterns become more efficient, but the patient must still attend to the task
List Management Guidelines for Chronic Phase of Rehabilitation/Intervention (> 3 weeks post injury)
Patient education on progressing safely with proper body mechanics and avoiding re-injury caused by fatigue during exercise. Stretching techniques specific to tight tissue Cross Fiber Massage Recommend modifications for daily activities Progress strengthening exercises submax-max resistance resisted concentric & eccentric, weight - non weight bearing single plan - multiplanar motions simple - complex motions stimulating functional activities Low - High reps at slow speeds progressing complexity & time and speed & time Aerobic exercies Trunk stabilization and balance exercises Return to high demand activities such as drills that mimic functional activity Increase speed of movement once the patient is capable and progress to challenging the action further
What are the directions for a Functional Reach Test?
Patient instructed to stand next to, but not touching a wall and position the arm that is closer to the wall at 90° of shoulder flexion with a closed fist The examiner records the starting position at the 3rd metacarpal head Instruct the patient to "reach as far as you can forward without taking a step." The examiner then records the location of the 3rd metacarpal The score is determined by assessing the difference between the start and the end position as the reach distance, usually measure in inches
What are the directions for a Romberg Test?
Patient stand with feet as close together as possible Examiner stands behind and to the side of the patient Ask the patient to maintain balance while standing with the feet positioned as close together as possible The test is repeated with the eyes closed
What occurs during the Cognitive Stage of Motor Learning?
Patients must apply their full attention to the task to develop gross motor problem-solving strategies, what and how to perform activities correctly
What is done to progress a patient's tasking ability during balance training?
Patients should master singular tasks before incorporating additional tasks. Additional tasks can include cognitive or physical tasks.
This condition is any descent of the pelvic viscera out of their normal alignment due to muscular, fascial and/or ligamentous deficits and increase abdominal pressure, which can occur in women who have had vaginal delivery of 1 child are 4 x more likely, women who have delivered 2 children are 8 x more, women who have never been pregnant but has excessive straining with chronic constipation, smoking, chronic cough, obesity and hysterectomy.
Pelvic Organ Prolapse
What is included in Therapeutic Exercise - Hold-Relax Stretch Intervention?
Side (Right, Left, Bilateral) Name (Hamstring Stretch) Technique Hold-Relax (HR) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting, Standing) Repetitions (1x, 2x, 3x) Frequency (qd, 3x/wk)
What are the physical therapy treatment options for Lateral & Medial Epicondylitis?
Phase 1: - Increase flexibility ( stretches into wrist ext>flex; elbow ext>flex; forearm sup>pro) - Decrease inflammation/pain (cryotherapy, phonophoresis, iontophoresis w/ dexamethasone) - Promote tissue healing (avoid painful movements, friction massage) Phase 2: - Improve flexibility (cont flexibility exer) -Increase muscular strength/endurance (concentric>eccentric strengthening, initiate shldr strengthening) - Increase functional activities to return to function (use counterforce brace, cont use of cryotherapy after exer/function, initiate gradual return to stressful activities, gradually reinitiate previous painful movement Phase 3: - Improve muscular strength/endurance (cont strengthening exer, emphasize shldr/elbow strength -Gradually return to higher level of activity (ie. sports activity), ( gradually diminish use of counterforce brace, cryotherapy as needed)
The impingement of the sciatic nerve by a tight piriformis muscle, which the sciatic nerve passes deep to the muscle.
Piriformis Syndrome
Explain the difference between piriformis syndrome and Sciatica. What are the symptoms of each of these dysfunctions (including dermatomes) ? What tests would a PT use to evaluate a patient for these dysfunctions? Name one exercise for each dysfunction that would help reduce symptoms.
Piriformis syndrome occurs when the piriformis muscle is compressing the sciatic nerve at the sciatic foramen due to tighness or inflammation of the muscle. Sciatica occurs at the level of the spinal cord where the sciatic nerve root begins ( L 4-S3) This compression can occur due to HNP, or spinal stenosis. Patients with sciatica would have dermatomal symptoms including pain radiating down the posterior/lateral thigh and possibly the anterior and posterior lower leg as well. Either pattern can occur with piriformis syndrome or sciatica. Treatment can include neural stretching, piriformis stretching, Strengthening of the core muscles to reduce excessive lordosis and pt education on posture/habitual mechanics.
The inflammation of the plantar fascia where a bony growth known as a heel spur may form where the plantar fascia inserts on the calcaneus, which is associated with excessive foot pronation, hypomobile gastrocnemius-solues msucle.
Plantar Fasciitis
With a conventional approach to a surgical repair of an achilles tendon tear, what motion is the ankle placed in during the immobilization/limited motion phase of recovery?
Plantarflexion
Alignment Dysfunction - Supination
Plantarflexion, Inversion, Adduction Hip - Coxa Valga (in) Knee - Genu Varus (out) Foot - Calcaneal Varus (out) excessively smaller Q Angle
An exercise that use explosive movements to develop muscle power, which may include trampoline activities, jumping over obstacles, figure-eight drills, lateral shuffle drills, burps, or carioca.
Plyometric exercises
What exercises can help correct Lordosis?
Posterior Pelvic Tilt /Neutral Spine
Regarding Total Hip Arthroplasty, what surgical aproach is most commonly associated with hip dislcoation? What is the reason that this approach increases a patient's risk for dislcoation? What strategies would a patient utilize to prevent dislocation?
Posterior or Posterolateral approach is the most common THA. The Physician has to make an incision into the posterior capsule of the joint and dislocate it. This puts a patient at increased risk for instability. The patient should not internally rotate the hip, adduct the hip past midline, or flex the hip beyond 90 degrees.
Things that may improve incorrect sitting posture.
Postural awareness Strengthening Stretching Eyeglasses (if necessary) Ergonomically designed seating which includes adequate lumbar support.
What does ergonomic assessment evaluate?
Potential risks of a musculoskeletal injury and provides suggestions for modifying the environment to improve safety, efficiency, and productivity.
The combination of strength and speed of a movement, were the main focus of power training is to maximize strength in the smallest amount of time.
Power
A type of treatment that involves clamping an object with counter pressure from the adducted thumb, and is primarily an isometric muscle contractions.
Power Grasps
What are some precautions and contraindications for balance training.
Risk of Falling Progress from simple task to complex task Remove unnecessary obstacles Use a gait belt, hand contact or parallel bars Patients with cognitive impairments may have poor safety awareness.
What are the Patient Education Techhniques on Breathing during Exercise
Pt should not hold breath during exercise Pt should breath rhythmical, count, or talk during exercise Pt should exhale when lifting, and inhale when lowering a load High-Risk pt should avoid high intensity resistance exercise
Finkelstein Test
Purpose: Tests for De Quervain's. De Quervain's is tenosynovitis found at the radial border of the anatomical snuffbox. Tenosynovitis means inflammation of the synovial tunnel surrounding the tendons. Many tendons throughout the body are surrounded by synovial tunnels to decrease friction. In the case of De Quervain's, there is inflammation of the synovial tunnel containing the abductor pollicis longus and extensor pollicis brevis tendons. Position: Sitting or standing with a fist around the thumb. Action: The clinician ulnar deviates the patient's wrist. Positive Finding: Pain over the abductor pollicis longus and extensor pollicis brevis tendons indicating tenosynovitis. Pain is caused by the restricted movement of the tendons in a tunnel narrowed by inflammation.
Empty Can (Supraspinatus Test)
Purpose: Tests for a tear in the supraspinatus tendon and/or muscle. Weakness of the supraspinatus muscle may be the result of suprascapular nerve involvement. Position: Standing with 90o of shoulder abduction, 30o of horizontal adduction, and internal rotation so that the patient's thumbs point toward the floor. Action: The clinician applies resistance to abduction. Positive Finding: Weakness and/or pain.
Sulcus Sign
Purpose: Tests for an inferior or multidirectional shoulder instability. Position: Sitting with the forearms and hands resting in the lap. Action: The clinician grasps the patient's forearm below the elbow and pulls the arm distally. Positive Finding: Excessive inferior humeral head translation with a visible and/or palpable "step-off"or "sulcus" deformity immediately inferior to the acromion.
Apprehension Test for Shoulder Dislocation
Purpose: Tests for anterior shoulder instability. Position: Supine with 90o of shoulder abduction and 90o of elbow flexion. Action: The clinician slowly externally rotates the shoulder. Positive Finding: The patient senses that the shoulder may possibly dislocate and has facial expressions of apprehension.
Yergason Test
Purpose: Tests for bicipital tendinitis. Position: Sitting with 90o of elbow flexion with the forearm pronated. The clinician places one hand along the subject's forearm and another hand on the proximal portion of the humerus near the bicipital groove. Action: The clinician resists the patient's attempt to actively supinate the forearm and externally rotate the humerus. Positive Finding: Pain in the bicipital groove.
Phalen's Test
Purpose: Tests for carpal tunnel syndrome. Position: Sitting with the dorsal aspect of both hands in full contact so that both wrists are maximally flexed. Action: Maximal wrist flexion is held for 1 minute. Positive Finding: Numbness & tingling in the median nerve distribution (i.e., thumb, index finger, middle finger and lateral half of the ring finger).
Clunk Test
Purpose: Tests for glenoid labrum tear. Position: Supine. The clinician places one hand on the posterior aspect of the humeral head. The clinician places the other hand proximal to the patient's elbow joint along the distal humerus. Action: The clinician fully abducts the arm over the patient's head. The clinician then pushes anteriorly with the hand over the humeral head while the other hand rotates the humerus into lateral rotation. Positive Finding: Grinding or clunking sensation.
Golfer's Elbow Test
Purpose: Tests for medial epicondylitis. Position: The patient relaxes the arm. Action: The clinician supinates the forearm and then extends the elbow and wrist. Positive Finding: Pain at the medial epicondyle with stretch of the wrist flexors.
Drop Arm Test
Purpose: Tests for rotator cuff tears. Position: Standing with 90o of shoulder abduction. Action: The patient is instructed to slowly lower the arm to the side. Positive Finding: The arm drops uncontrollably to the side and/or has significant pain during the test.
Hawkins-Kennedy Impingement Test
Purpose: Tests for shoulder impingement, particularly of the supraspinatus tendon. Position: Sitting with 90o of shoulder flexion and 90o of elbow flexion. Action: The clinician forcibly internally rotates the patient's shoulder. Positive Finding: Pain.
O'Brien Test (Active Compression, SLAPrehension Test)
Purpose: Tests for shoulder impingement, particularly of the supraspinatus tendon. Position: Sitting with 90o of shoulder flexion, 30o to 45o of horizontal adduction, and maximal internal rotation. Action: The patient horizontally adducts and flexes the shoulder against the clinician's manual resistance. The test is then repeated with the subject's arm in an externally rotated position. Positive Finding: Apprehension, pain and/or popping that is present in the internally rotated position but absent in the externally rotated position is indicative of a SLAP (superior labral anterior-posterior) lesion.
Ligamentous Stability Test
Purpose: Tests for the stability of the medial and lateral collateral ligaments of the elbow. Position: Sitting with slight elbow flexion. Action: The clinician stabilizes the posterior elbow while applying a medially and laterally at the distal forearm. Positive Finding: Medial laxity suggests instability of the lateral collateral ligament. Lateral laxity suggests instability of the medial collateral ligament
Retinacular Test
Purpose: Tests for tightness of the retinacular ligaments. Position: The patient is sitting with the fingers relaxed. Action - Part 1: The clinician holds the PIP joint in neutral while flexing the DIP joint. If the joint does not flex, then the limitation may be either joint capsule or retinacular tightness. Action - Part 2: To differentiate, the clinician then holds the PIP in slight flexion while flexing the DIP joint. If the DIP flexes, then the retinacular ligaments are tight. If the DIP does not flex, then the joint capsule is tight. Positive Finding: The DIP joint does not flex with the PIP joint in neutral, but the DIP joint does flex with the PIP joint in slight flexion.
What is included in Therapeutic Exercise - Contract-Relax Stretch Intervention?
Side (Right, Left, Bilateral) Name (Hamstring Stretch) Technique Contract-Relax (CR) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting, Standing) Repetitions (1x, 2x, 3x) Frequency (qd, 3x/wk)
Principle of adaptive effects of training such as improved strength and endurance are transient unless maintained by functional activities or a regular exercise program and extended rest intervals reduce physical fitness.
Reversibility Principle
A PNF technique in which movement progresses from completely passive to active assisted to slightly resisted as the patient relaxes and is capable of actively moving. Use on patients who unable to initiate movement, or ROM is limited by hypertonia,or has difficulty learning motor skills. Movement should be repetitive, slow and rhythmic. Avoid quick stretch of any muscle group that should be relaxing.
Rhythmic Initiation
A progression of Alternating Isometrics that uses facilitation of co-contraction, which is applied in a weight bearing position, used to improve trunk, shoulder girdle, and pelvic stability in the technique starts with manual resistance applied simultaneously on opposite sides of the body to produce an isometric co-contraction. The therapist will then reverse the manual resistance.
Rhythmic Stabilization
A surgical intervention is necessary when the bone requires internal fixation devices such as a rod or plate with screws to keep the bone stable as it heals and are usually removed once the fracture is united.
Rigid Internal Fixation
This balance test is one of the oldest sensory tests for postural control.
Romberg Test
List Components of the Brachial Plexus
Roots (real) - C5, C6, C7, C8, T1 Trunks (therapists) - superior, middle, anterior Divisions (drink) - anterior, posterior, anterior, posterior, anterior, posterior Cords (cold) - lateral, medial, posterior Branches (beverages) - musculocutaneous, median, ulnar, axillary, radial
A tear in one of the rotator cuff muscles, most commonly the supraspinatus secondary to shoulder impingement., RTC repair is the surgical repair of the torn rotator cuff muscle
Rotator Cuff Tear
List things that patients should be educated about balance safety
Rugs Clutter Slippery conditions Uneven surfaces Unsecured cords and wires Appropriate footwear Avoid high heels, slippers, and open-toed sandals.
List Bone and Bony Landmarks of the Shoulder Girdle
Scapula Clavicle Sternum
PNF D2 Flexion Upper Extremity Directions
Scapula = Elevation, Adduction, Upward Rotation Shoulder= Flexion, Abduction, ER Elbow= Straight (Flex/Ext) Forearm= Supination Wrist= Extension, Radial Deviation Fingers= Extension, Abduction Thumb= Extension
The entrapment of the supraspinatus tendon under the acromial arch due to weaken musculature or instability
Shoulder Impingement
The excessive hypermobility of the humeral head in the glenoid fossa during active movement
Shoulder Instability
A partial dislocation of the humeral head with the glenoid fossa.
Shoulder Subluxation
What is included in a Goniometry Intervention Documentation?
Side (Right, Left) Joint (Shoulder, Elbow, Wrist, Hip, Knee, Ankle) Action (Flex/Ext, Abd/Add, ER/IR, Pro/Sup) ROM (AROM, PROM) Degree End-Feel (Optional, Ex. Firm End-Feel)
What is included in a Special Test Intervention Documentation?
Side (Right, Left), if appropriate Name (Yergason Test, Drop Arm Test, Apprehension Test) Result (Positive or Negative) Patient Response (Optional, Ex. Pain with Shoulder ER.)
What is included in Therapeutic Exercise - Static Stretch Intervention?
Side (Right, Left, Bilateral) Name (Hamstring Stretch) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting, Standing) Hold (15 sec, 30 sec) Repetitions (1x, 2x, 3x) Frequency (qd, 3x/wk)
What is included in a Therapeutic Exercise - Endurance Intervention?
Side (Right, Left, Bilateral) Name or Action (Hamstring Curl or Knee Flexion) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting, Standing) Resistance (Red Theraband, 2 lb Ankle Weight) Contraction Duration (5 sec, 10 sec, 15 sec, 20 sec) Repetitions (10x, 15x, 20x) Sets (1x, 2x, 3x) Frequency (bid, qd)
What is included in a Therapeutic Exercise - Strengthen Intervention?
Side (Right, Left, Bilateral) Name or Action (Hamstring Curl or Knee Flexion) Position (Supine, Prone, Right Side-lying, Left Side-lying, Sitting, Standing) Resistance (Red Theraband, 2 lb Ankle Weight) Repetitions (10x, 15x, 20x) Sets (1x, 2x, 3x) Frequency (qd, qod, 3x/wk)
When documenting therapeutic exercises for strength training, what are 7 components that are necessary in the objective section of a note?
Side, Name or action Position resistance amount Reps Sets Frequency
List components of a Berg Balance Test
Sitting to Standing (no help/assistance) Standing Unsupported (2min) Sitting w/ back unsupported but feet supported on floor or on a stool (2min) Standing to Sitting Transfers Standing Unsupported with Eyes Closed Standing Unsupported with Feet Together Reaching Forward w/ Outstretched Arm While Standing Pick Up Object from the Floor From Standing Position Turning to Look Behind Over Left and Right Shoulders While Standing Turn 360 Degrees Place Alternate Foot on Step or Stool While Standing Unsupported Standing Unsupported One Foot in Front Standing on One Leg
Immobilization of Shoulder based on RTC Tear Size
Small Tear (<1cm) = Sling 1-2 (3)weeks, removal for exercise day of surgery or 1 day post op; abduction orthosis (6 wks) Medium to Large Tear (1cm - 5cm) = Sling or abduction orthosis/pillow for 3-6 weeks; removal for exercise 1-2 days post op Massive Tear (>5cm) Sling or abduction orthosis/pillow for 4 (6)-8 weeks, removal exercise 1-3 days post op
This system provides information about sensation, proprioception, and kinesthesia. and sensation provides input about contact with supporting surfaces.
Somatosensory system
List Interventions for Reactive Postural Control Balance Testing
Standing sway Ankle strategy Hip strategy Stepping strategy Perturbations
List a Timed up and Go Test (TUG) direction and instructions.
Start: Back against the chair On go, stand and walk 3 m (10 ft), turn, return to chair May use AD (no physical assistance). In a re-test, use the same AD as pre-test Walk at your normal pace to the line on the floor, turn around and sit down with your back against the chair. Perform practice test
List Intervention for a Lateral Ligament Repair - Subacute/Return to Function Phase
Starts after 4-6 post op, last 12 weeks gradual weaning from immobilizer and restoring pain-free ankle mobility and neuromuscular control during weight bearing FWB by 6 weeks w/ immobilizer Restore pain free ROM of operated ankle (AAROM ->AROM DF/PF, no InV/EV until 8 wks) Increase isometric and dynamic strength of ankle and foot musculature and throughout both lower extremities Improve muscular endurance and cardiopulmonary fitness Improve neuromuscular control, balance reactions, dynamic stability and agility Reestablish pain free symmetrical weight bearing during gait and related activities Safety return to functional activities and prevent reinjury
Explain the difference between Ballistic, Static and dynamic stretching. What type of stretching is least often used in physical therapy? What type of stretching is mostly used before activity? What type of stretching should be used after activity?
Static stretching is when a muscle is stretched to the point of tolerance and then that stationary position is held for a length of time. ( 15-30 seconds). Dynamic stretching involves slow and controlled active movement. Ballistic involves high velocity active stretches. Dynamic stretching is more appropriate prior to activity, followed with static stretching after activity. Ballistic stretching is only appropriate for a well trained athlete prior to a specific activity such as a gymnast.
Injury that occurs from slight trauma or unaccustomed repeated trauma of a minor degree to soft tissue that is overstretching, overexertion, or overuse of tissue and is typically less severe than a sprain.
Strain
Explain the difference between a sprain and a strain. Which type (sprain or strain) might involve and actual tear of a muscle, tendon, or ligament?
Strains are usually referring to injuries involving the muscle or a musculotendinous junction. Strains are usually involving a ligament. A grade III strain, or sprain can involve tearing of a ligament, tendon, or muscle. Example: supraspinatus tear- Grade III strain, ACL tear= Grade III Sprain.
The greatest measurable force that can be exerted by a muscle to overcome resistance during a single, maximum effort., that uses fast-twitch muscle fibers (Type II) to generate a large amount of force in a short period of time but fatigue quickly and is improved with high resistance and low repetitions.
Strength
A systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time.
Strength Training
When the muscle spindle detects a rapid stretch, the muscle spindle causes the agonist to contract and the antagonist to relax, this phenomenon is called
Stretch Reflex
What exercises is used to correct Torticollis?
Stretch affected muscle "sternocleidomastoid" into cervical extension, RT/LT sidebending, and RT/LT rotation, depending on the side affected.
What exercise is used to correct Forward Head?
Stretch anterior muscles that are shortened sternocleidomastoid and scalenes. Strengthen the semispinalis capitis, suboccipitals, and levator scapula muscles that are overactive.
What are the strategies for treatment of Scoliosis?
Stretch muscles on the concave side and strengthen muscles on the convex side
Acute Stage Contraindications
Stretching & Resistance exercise should not performed at the site of the inflamed/swollen tissue Active movement at the site
What stage of inflammation is it appropriate to initiate Stretching exercises and why?
Stretching exercises should not be initiated until phase II (the subacute stage). If stretching is initiated when the patient is still experiencing acute inflammation, it could cause increased inflammation since the muscle fibers and soft tissue is attempting to repair, stretching would cause the tissues to think they are being "injured again" and the inflammatory process would begin again.
Rehab Protocol for Adhesive Capuslitis (Thawing Phase)
Stretching/Strengthening progressed as joint tolerates Self-Stretching Return to function Exer progressed to replicate ADL demands
The surgical repair of the glenoid labrum, with SLAP lesions being common in pts with instability or impingement.
Superior Labral Anterior Posterior (SLAP) Repair
This balance strategy is observed during balance tasks when a person quickly lowers his or her body Center of Mass (COM) by flexing the knees causing associated flexion of the ankles and hips .
Suspension Strategy
List Balance Equipment and System They Challenge
Swiss Ball Balance Pad Balance Discs Wobble Boards BAPS board BOSU Foam Rollers (Whole or Semicircle) Trampoline Rebounder - Visual Bongo Board Pro Fitter w/ balance aids Slide Board
Define Therapeutic Exercise
Systemic/Planned performance of bodily movements, postures, or physical activities to improve overall health revent health-related risk factors, and to improve or prevent functional limitations or impairments.
TSR / rTSA ROM Restrictions
TSR Limit from 0-4 weeks ( Phase I/Acute): Elevation of the arm: up to 120° Fwd Flex- 0-90, ER up to 30° (arm at side)/ Abd 0-20 IR to 30/Abd 0-30 Limit for 4-6 weeks (Phase II/Subacute): No GH extension past neutral After 6-12 weeks(Phase 3/Chronic) Combined adduction, internal rotation,extension permitted rTSA Limit for 12 weeks or more: No GH Ext or IR past neutral No combined GH Ext, Add, IR 0°-20° ER and up to 90°-120° arm elevation in scapular plane
TSR and rTSA Progression of Rehab
TSR ( non RTC repair) Phase 1: postop weeks 0-4 Phase 2: postop weeks 4-12 Phase 3: postop weeks 12+ rTSA Phase 1: postop weeks 0-6 Phase 2: postop weeks 6-12 or 16 Phase 3: postop weeks 12+ or 16+
TSR /rTSA Immobilization
TSR (no RTC repair) No immobilizer unless rotator cuff repaired Sling worn for comfort when shoulder unsupported and when in crowded, public areas or during sleep for about 4 weeks Sling removed for exercise soon after surgery as directed by surgeon. rTSA Abduction splint (shoulder in scapularplane), Worn 24 hours/day for first 3-4 or upto 6 weeks Removed for pendulum exercises 3-4 times/day and personal hygiene
A form of traditional Chinese mind-body relaxation exercises that combines slow movement, meditation, and breath regulation.
Tai Chi
According to the Kisner/Colby text, when deciding on an intervention such as therepeutic exercises, the type of intervention selected should be:
Task specific
What are the Principles of PNF (Proprioceptive Neuromuscular Facilitation)?
Teach the patient the full movement Use verbal cues to educate the patient on proper movement Allow for smooth transitions between movements
What are can be done as an intervention for patients with Urinary and Bowel Incontinence
Teaching of developing habitual counter bracing of pelvic floor muscles before activities which increase intra-abdominal pressure will help reduce incontinence.
Rheumatoid Arthritis Structural/Functional Impairments, Activity Limitations & Participation Restrictions
Tenderness and warmth over the involved joints with joint swelling Muscle guarding and pain on motion Joint stiffness and limited motion Muscle weakness and atrophy Potential deformity and ankylosis from the degenerative process and asymmetric muscle pull Fatigue, malaise, sleep disorders Restricted ADLs and IADLs
List Special Test for the Elbow & Forearm
Test for Ligamentous Stability Tennis Elbow Test Golfers Elbow Test Tinel Sign
What is the Q angle? What is considered "normal" Q angle? How does the measurement of the Q angle effect a patient's potential for having patellar tracking or patellofemoral pain issues? What muscles should a patient strengthen if they have a high Q angle?
The Q (quadriceps) angle is measured by drawing a a line from the ASIS to the center of the patella. Another line is drawn from the center of the patella to the tibial tubercle. The distance between the two measures the Q angle. If a Q angle is greater than 14 in men, or 17 in women ( dutton), a patient may have a higher potential for patellar tracking issues due to the line of pull of the quadriceps. It may have tendency to pull more laterally. A patient should strengthen the VMO and gluteus medius to improve medial tracking
What is Viscoelasticiy?
The ability of soft tissue to change in length whith stretching, but return to its pre-stretched state after the stretch force is removed
What is Elasticity?
The ability of soft tissue to return to its relaxed length after stretching.
How is an assessment performed for a patient with Diastasis Recti?
The patient will be positioned hook-lying. Have the patient slowly raise their head and shoulders off the mat, reaching hands toward the knees until the scapular spine leaves the mat. Place your fingers horizontally across the the mid-line of the abdomen at the umbilicus. If the separation exists, the fingers will sink in. Document how many fingers wide it is. This should be assessed above at and below the umbilicus.
Why is is important to address the pelvic floor (especially in women) when designing a core strengthening program?
The pelvic floor contributes to the stabilization of the spine and pelvis. When implementing a core training program,it is important to improve a patient's awareness of the pelvic floor musculature since core exercises may cause increased pressure on the pelvic floor if not done correctly. A patient who already has a weak pelvic floor could do more damage with core strengthening if not stabilizing the pelvic floor musculature.
What are the primary and secondary curves of the spine and what is the difference between them?
The primary curves are present at birth and are the thoracic and sacral curves, were as the secondary curves develop with weight-bearing and are the cervical and lumbar curves.
What is Positional Deformity in regards to Faulty Posture?
This deformity mainly involve an imbalance in soft tissue structures such as muscles, ligaments, and joint capsules.
What is a Structural Deformity in regards to Faulty Posture?
This deformity predominately involves bony abnormalities that are a result of congenital anomalies, developmental problems, trauma, or disease, such as a leg length discrepancy.
If a patient had a shoulder injury 3 days ago, What interventions including therex and modalities would be most appropriate at this phase of healing? What interventions would not be appropriate for this patient?
This patient may benefit from non thermal ultrasound, PROM and gentle isometrics may be initiated if the patient can tolerate them . The patient may benefit from soft tissue mobilization and ice massage or ice pack after PROM. Stretching at this time would not be appropriate. Also the patient should not apply heat until the they are out of the inflammatory phase- 3-4 weeks.
What does the Assessment section of a SOAP note include?
This section includes the PTA's professional opinion of the patient's performance during the treatment session.
What does the Objective section of a SOAP note include?
This section includes what the PTA does include Goniometry, MMT, Joint Mobilization, Special Tests, Modalities, Therapeutic Exercise, Transfers and Gait Training.
What does the Plan section of a SOAP note include?
This section may include a solution to the problem identified in the assessment, detailed statements that will remind the PTA what exercises to add or delete during the next treatment session, information about the number of appointments remaining in PT.
The compression of the brachial plexus nerves due to entrapment in the scalene (anterior & middle) neck muscles in which treatment may involve stretching the scalene muscles.
Thoracic Outlet Syndrome (TOS)
These are functional test that provide a brief measure of both static and dynamic balance in older adults as it pertains to their gait and balance to determine their functional abilities or limitations during tasks
Tinetti Performance-Oriented Mobility Assessment (POMA) Berg Balance Scale (BBS)
List test or assessments under sensory organization that assess a patients balance during functional activities.
Tinetti Performance-Oriented Mobility Assessment (POMA) Timed Up and Go Test (TUG), Berg Balance Scale (BBS) Four Square Step Test (4SST) Dynamic Gait Index (DGI) Functional Gait Assessment (FGA) Community Balance and Mobility Scale High Level Mobility Assessment (HiMat) Dizziness Handicap Inventory (DHI)
If treating patients to increase ROM, PTA's should
To treat stiffness, pts' are progressed from PROM → AAROM → AROM → PNF. If muscle length is limiting the ROM, then stretching is appropriate.
If treating patients to increase strength, PTA's should
To treat weakness, pts are progressed from Isometric → Gravity Eliminated → Gravity Minimized → Against Gravity → Resistance (resistive exercise bands, tubing, hand/ankle weights).
The replacement of the humeral head and possibly the glenoid fossa with a prothesis and is often necessary due to shoulder osteoarthritis
Total Shoulder Replacements (TSR)
A knot in the flexor tendon resulting in jerky finger flexion caused by repetitive gripping actions which is a painful condition caused by a narrowing of the sheath that surrounds the finger tendon. In severe cases, the affected finger locks in a bent position.
Trigger Finger
What are the Limitations of PROM?
True PROM is difficult with a conscious patient and innervated muscle It will not prevent atrophy, increase strength or endurance It does not assist circulation to the extent that active, voluntary muscle contraction does.
What is included in Transfer Intervention?
Type of Transfer (Sliding Board, Sitting Pivot, Standing Pivot, Hoyer Lift) Starting Position (Supine, Sit, Stand) Ending Position (Supine, Sit, Stand) Assistance (D x 2, D, Max A, Mod A, Min A, CGA, Supervision, I) Assistive Device (PUW, FWW, quad cane, straight cane, axillary crutches) Weight-Bearing Status (NWB, 50% PWB, WBAT, FWB) Precautions (Hip Precautions, Loss of Balance, Fall Risk)
A nerve that crosses superficially at the medial aspect of the elbow joint line leaving it vulnerable to impact forces., with its most common injury is entrapment in which it is compressed. It may result from bone damage, such as an elbow fracture or dislocation, swelling of soft tissue, or external pressure from certain activities or positions. Signs and symptoms are decreased sensory and motor functions in the hands and fingers, burning sensation in medial forearm, little finger and ring finger and decreased strength of finger flexor muscles, lumbricals interossei, thumb abductor and flexor carpi ulnaris.
Ulnar Nerve
This term refers to tearing the ACL, MCL, and medial meniscus, which most commonly occurs in contact sports when the knee is hit from the outside.
Unhappy Triad
What are some balance activities that can be performed for a patient's arm be progressed?
Vary the position and use of the upper extremities. Use of bilateral upper extremities (BUE) and progress to single upper extremity for support Use of a single finger for support. Arms spread out to a patients side or held up to shoulder height and eventually bringing the arms in and across their body.
Rheumatoid Arthritis Characteristics
Usually begins between age 15 and 50 May develop suddenly, within weeks or months Inflammatory synovitis and irreversiblestructural damage to cartilage and bone Usually affects many joints, usually bilateral; typically: —MCP and PIP of hands, wrists, elbows, shoulders —Cervical spine —MTP, talonavicular and ankle Redness, warmth, swelling, and prolongedmorning stiffness; increased joint pain withactivity General feeling of sickness and fatigue, weightloss and fever; may develop rheumatoid nodules, may have ocular, respiratory,hematological, and cardiac symptoms
The balance strategy is used to control mediolateral perturbations that is involved in shifting the body weight laterally from one leg to the other, in which the hips are the key controllers for this strategy by moving the COM in a lateral plane.
Weight Shift Strategy (Lateral Plane)
Osteoarthritis Precautions
When strengthening supporting muscles, increased pain in the joint during or following resistive exercises probably means that too great a weight is being used or stress is being placed at an inappropriate part of the ROM. Analyze the joint mechanics and at what point during the range the greatest compressive forces are occurring. Maximum resistance exercise should not be performed through that ROM.
