1, 2 Intro to T3 MSK and Lower Leg, Ankle, Foot

Question 1

What are the treatment priorities of MSK?

Answer 1

1. Decrease pain
2. Normalize ROM
3. Improve function (strength/endurance)

Question 2

What are causes of pain?

Answer 2

• Mechanical
• Inflammation
• Referral (TrP, Neurological)
• Visceral
• Psychosomatic

Question 3

How is Mechanical Pain assessed?

Answer 3

• postural assessment
• AF
• PR
• mm length testing
• palpation

Question 4

What are treatment options for mechanical pain?

Answer 4

• massage
• heat
• stretch

Question 5

How is Referral pain assessed?

Answer 5

TrP:

• referral patterns
• palpation
• mm length/strength tests

Neurological:

• dermatomes
• nerve tension tests
• tinnel’s
• TOS tests
• palpation

Question 6

What are some treatment options for referral pain?

Answer 6

TrP:

• petrissage
• heat
• stretch
• PIR
• acupuncture

Neurological:

• massage
• MF techs (nerve mobilization)
• acupuncture
• spine joint mobes if nerve root implicated

Question 7

How is visceral pain assessed and how is it treated?

Answer 7

Assessment:

• special tests
• palpation
• case history

Treatment:

• refer out or osteopathy

Question 8

What are causes of hypomobility?

Answer 8

• increased MRT (tone/TrP)
• decreased myofascial (muscular) extensibility
• adhesions/scarring
• periarticular adhesions/contracture
• swelling
• pain
• weakness/inhibition

Question 9

What’s the definition of muscle integrity?

Answer 9

The extent to which a muscle conforms to the expected anatomical and biological norms.

Question 10

What’s the definition of muscle tone?

Answer 10

The resting tension and responsiveness of muscle to passive elongation or stretch.

Question 11

What are normal degrees of ROM in the Talocrural and Talocalcaneal (subtalar) joints?

Answer 11

Talocrural:

• 0-20° dorsiflexion (at least 10° needed for normal gait)
• 0-50° plantarflexion

Talocalcaneal (subtalar): 5° inversion/eversion

Question 12

What bones is the Hindfoot composed of?

Answer 12

talus and calcaneus

Question 13

What bones is the Midfoot composed of?

Answer 13

navicular, cuboid, cuneiforms

Question 14

What bones is the Forefoot composed of?

Answer 14

metatarsals and phalanges

Question 15

What’s normal ROM for 1st MTP joint? How much range is needed for normal gait?

Answer 15

• normal: 70-90° of extension
• 65° needed for normal gait

Question 16

What are the “dynamic arch supporters” of the foot? What can happen if any of these are weak?

Answer 16

• Tibialis anterior, Tibialis posterior, Peroneus longus
• with weakness or inhibition of these mm, overpronation (of arches during gait) can occur

Question 17

In which direction does the lower extremity rotate during contact with ground during ambulation/heel strike?

Answer 17

rotates inward

Question 18

At what point during stance does the tibia start to rotate externally?

Answer 18

from mid-stance to terminal stance

Question 19

What’s the aka for Bunions?

Answer 19

Hallux valgus

Question 20

What’s Morton’s Neuroma and what’s its aka?

Answer 20

• Irritation of a branch of the plantar nerve between the 3rd and 4th toes leading to scar tissue formation around the nerve
• aka Intermetatarsalgia

Question 21

What’s Shin Splints? What normally causes this pain/dysfuntion?

Answer 21

• a non-specific term used to describe pain in the anteromedial or posteromedial tibia
• pain/dysfunction is usually one of the following:
  
  • periostitis
  • tibial stress fracture
  • exertional compartment syndrome

Question 22

What is Periostitis and where is it normally felt?

Answer 22

• inflammation of the periosteum
• commonly felt at the attachment of soleus, tibialis posterior, flexor digitorum mm

Question 23

What are predisposing factors of Periostitis?

Answer 23

poor biomechanics – excessive pronation is likely present

Question 24

What’s Exertional Compartment Syndrome?

Answer 24

(not the same as acute compartment syndrome) (generally ant. or [deep] post. comp syndrome)

• Results from an increase in the intracompartmental pressure in the compartment of the lower leg. Ant or deep post compartment are most commonly affected
• Repetitive (excessive) mm contraction leads to increased demand for blood to the tissues.
• Increased pressure leads to ischemia and pain.