Active Care Exam 2 Flashcards
where does the most rotation occur in the cervical spine
upper cervical (C1-C2); 45 degrees
where does the most flexion/extension occur in the cervical spine
lower cervical
non-neural contributors to stability of the cervical spine
- osseoligamentous (20%)
- musculature (80%)
deep muscles control
segments (local/intrinsic)
superficial muscles control
movement (global/extrinsic)
local (intrinsic) cervical musculature that produces forward sagittal plane rotation during flexion movement
upper cervical - (rectus capitis anterior, rectus capitis lateralis)
local (intrinsic) cervical musculature that produces posterior sagittal plane rotation during extension movement
upper cervical - (rectus capitis posterior major/minor, obliques capitis sup/inf, semispinalis, splenius, and longissimus (capitis)
global (extrinsic) cervical spine musculature
- SCM
- anterior and middle scalene
- levator scapula
- upper trap
local (intrinsic) cervical spine musculature
- longus capitis and longus coli
- rectus capitis lateralis and rectus capitis anterior
- RCPMa, RCPMi, OCinf, OCsup
- semispinalis/splenius/longissimus capitis
- semispinalis/splenius/longissimus cervicis
upper cross syndrome
- weak deep neck flexors
- tight pectorals
- week lower trap and serratus anterior
- tight upper trap and levator scapula
cervical extension syndrome is classified by the facilitation and inhibition of which muscles
- facilitated pecs, SCM, suboccipitals, upper trap, levator scapula
- inhibited serratus anterior
muscle facilitations and inhibitions in cervical extension syndrome cause which postural deficits
facilitated pecs - rounded shoulders
what is characteristic of cervical flexion syndrome
facilitated pecs - rounded shoulders
facilitated SCM - anterior head carriage
facilitated suboccipitals - head extension
facilitated upper trapezius and levator scapula - elevation of shoulders
inhibited serratus anterior - winging scapula
painful flexion of the cervical spine is a characteristic of
cervical flexion syndrome
painful extension of the cervical spine is a characteristic of
cervical extension syndrome
breathing in which shoulders elevate and there is reliance on accessory muscles for inspiration
paradoxical breathing
during diaphragmatic breathing, which way do the ribs expand
mostly laterally; greater space as opposed to elevation of ribs
negative effects of hyperkyphosis in the thoracic spine
- scapular stability
- cervical motion
- respiration
hyperkyphosis results in scapular protraction
TRUE
what could scapular protraction lead to
- shoulder pain
- narrows joint space for movement
- strain on the ligaments in the shoulder
- decreased shoulder strength
what would indicated a failed wall angel test
if the T-L junction does not flatten
the wall slide focuses on mobility in the thoracic spine and stretching is felt in which muscles
latissimus and pectoralis
see lab handout for deep squat with overhead reach
…
what motions for the scapulae need improvement when there is decreased thoracic extension
retraction and depression; external humeral rotation is also implemented in the stretch
agonist-antagonist-synergy loss
cross syndrome
pattern of cross syndrome forms a cross when viewed anteriorly
FALSE; when viewed laterally
facilitated muscles in lower cross syndrome
- hip flexors
- rotators
- erector spinae
- TFL
- QL
- hamstrings
inhibited muscles in lower cross syndrome
- gluteal muscles
- abdominals
postural signs for lower cross syndrome
- lumbar hyperlordosis
- anterior pelvic tilt
- protruding abdomen
- foot flare
- pain over lateral knee or SI
lumbar hyperlordosis, anterior pelvic tilt, protruding abdomen, foot flare, pain over lateral knee or SI respectively
- shortened erector spinae
- weakness in gluteals, tight quads
- weak abdominals
- tightness in external hip rotators
- shortened TFL
assessment of lower cross syndrome
- hip extension patterns
- hip abduction patterns
- core strength testing
where is the hand placement of the doctor during hip extension motion pattern
- one hand on gluteals
- one hand on T-L paraspinals
which muscle groups does hip extension motion patterns affect
- ipsilateral hamstrings
- ipsilateral gluteals
- ipsilateral spinal extensors
- contralateral spinal extensors
treatment for altered hip extension
george costanza method… 1st stretch the tight muscles and then strengthen the weak muscles
describe the hip abduction motor pattern
- side lying with lower leg flexed
- slowly raise leg toward ceiling
- observe for normal motion
- hold position and observe for drift
altered hip abduction pattern
- decreased ROM
- hip flexion (forward drift)
- hip external rotation (foot flare)
- hip hiking (bending at waist)
what causes decreased ROM for altered hip abduction patterns
adductor tightness
what causes hip flexion (forward drift) for altered hip abduction patterns
TFL substitution
what causes hip external rotation (foot flare) for altered hip abduction patterns
piriformis substitution
what causes hip hiking (bending at waist) for altered hip abduction patterns
QL substitutions
two exercises to help strengthen gluteus medius
NAME?
combination of upper and lower cross syndrome
stratification syndrome; aka layer syndrome
layer syndrome
stratification syndrome
which muscles are weak during stratification syndrome
- lower scapular stabilizers
- lumbosacral erector spinae
- gluteals
which muscles are tight during stratification syndrome
- cervical erector spinae
- upper traps
- levator scapulae
- thoracolumbar/erector spinae
- hamstrings
when load exceeds strength of tissue causing failure
tissue tolerance
tissue tolerance depends on which factors
- time
- load
- repetitions
- characteristics of the lifter
if load is applied but the failure tolerance is not reached, with rest will the margin of safety be higher or lower than it was before
higher; with applied load and rest the margin of safety increases with time
is performing heavy work by itself a risk factor for low back disorders
no
blue collar workers that alternate between position and task have reduced risk for low back disorders
TRUE
how much height do discs lose throughout the day
19mm
half of the height lost from the discs during the day occurs within the first 30 minutes
TRUE
muscles compensate by restricting motion when waking up in the morning due to the increased amount of fluid in the discs
FALSE
disc bending stress is higher than ligament stress in the morning compared to the evening
TRUE; disc bending stress is 300% higher and ligament stress is 80% higher
to avoid injury and prolonged stress on the lumbar spine, you should have the lumbar spine in line and lift quickly
FALSE; lift slow and smooth
hip hinge can help with what action
standing from a sitting position or lifting
describe how the hip hinge is performed
- keep abdomen tense
- keep the knees behind the toes
- grip the floor (spread the floor)
- don’t flex lumbar spine (maintain lordosis)
a region of laxity around the neutral resting position of a spinal segment
neutral zone
neutral zone
a region of laxity around the neutral resting position of a spinal segment
a significant decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones within physiologic limits which results in pain and disibility
clinical instability
what happens to the neutral zone after high-speed trauma
neutral zone increases
the most stable position for stress on the spine
within the neutral zone
what influences the neutral zone
- passive system (vertebrae, IVD, Z-joints, ligs)
- neural system (CNS and PNS)
- active system (muscles, tendons)
provide stability through increasing spinal segmental stiffness
local system
anatomically more superficial muscles
global system
play a role in anticipation of motion
local system
larger torque producing muscles
global system
anatomically deep muscles
local system
control spinal orientation and balance or external loads
global system
local system includes which muscles
- transversus abdominis
- pelvic floor
- diaphragm
- multifidus
a force pulling in one direction is equally opposed by a force pulling in the opposite direction
tensegrity; stability
balance of tension and compression forces
geodesic dome
deepest of the abdominal muscles
transversus abdominus
where does the transverse abdominus originate
thoracolumbar fascia between iliac crest and 12th rib
where does the transverse abdominus insert
- inguinal ligament
- iliac crest
- lower six ribs
- anteriorly to the abdominal aponeurosis
contraction of the transversus abdominus achieves what
- increases intra-abdominal pressure
- causes core stiffening
- stiffens lumbar spine
- provides compression to SI joints (closes/stabilizes SIJs)
muscle recruited before any limb movement occurs
transversus abdominus
is the multifidus muscle a part of the local or global system
it has local action
the multifidus muscle contains many type I fibers
TRUE
functions of multifidus muscle
- postural maintenance
- stiffens the spine
- controls motion in the neutral zone
- controls lumbar lordosis
muscles that make up pelvic floor. which make up the levator ani
- coccygeus
- iliococcygeus
- pubococcygeus
(iliococcygeus and pubococcygeus = levator ani)
since kegel exercises strengthen the muscle that stops urine flow it is only logical to stop urine flow as an exercise
FALSE; empty bladder first
vleeming active straight leg raiser test graded on a scale from 0-5 based on pain findings
FALSE; it is concerned about the ability to perform the test.
grading for the vleeming active straight leg raiser test
0 - no difficulty 1 - slight difficulty 2 - moderate difficulty 3 - marked difficulty 4 - significant difficulty 5 - unable to perform
there are more than 20 primary and accessory muscles associated with respiration, and almost all of them have a postural function
TRUE
where does the diaphragm attach (4)
- lower 6 ribs
- xiphoid process
- L1-L4
- central tendon
forms top of abdominal core
diaphragm
paradoxical respiration includes which findings
- chest breathing predominates
- clavicles or shoulders elevate
- abdomen moves in on inspiration
limb loading or extremity movement activates trunk musculature via
feed-forward mechanism
end-range stress of normal structures
postural syndrome
end-range stress of shortened structures
dysfunction syndrome
anatomical disruption or displacement within the motion segment
derangement syndrome
