Biomechanical Exam Flashcards
Functional Motion for Extremities: —— ask patient what?
Ask the patient to perform essential ADLs
-i.e. reaching, walking, partial squat, heel raise, single limb stance, etc. per scan
If essential ADLs are WNL and more investigation is needed, ask the patient to perform ________ ADLs
-example:
higher level; lifting, throwing, jumping, or running per scan
-Positions patient to apply a gliding motion gently and passively along with joint surface
-Observe quantity and quality of motion, partially the end feel and including facial responses.
-Determines P! and point of limitation relationship
Accessory Motion Testing
What is normal Accessory Motion Testing?
appropriate gliding with firm end feel; no P!, click clunk or spasm
If Accessory Motion Testing has limited gliding and firm end feel; consistent limitation with ROM then that indicates:
Hypomobility- reduced accessory motion; intra-articular restriction
If Accessory Motion Testing has click, clunk, spasm; later, softer and/or empty end feel; may be more than expected gliding with limited ROM then that indicates:
Hypermobility- excessive accessory motion-extra-articular restriction
If Provocative Test is abnormal then that indicates:
involved tissue based on symptoms per test
What is a normal Stability Test when stress is applied?
No symptoms, laxity, m. guarding with normal end feel
If Stability Test has immediate symptoms click, clunk, spasm; later soft and/or empty end feel when stress is applied then that indicates?
Acute condition
If no immediate symptoms when performing the stability test you should:
hold for 10 sec, like with stress tests
If no immediate symptoms when performing the stability test you should:
hold for 10 sec, like with stress tests
If Stability Test is abnormal when you hold for 10 sec. you should repeat it with:
M. activation, CPP, corrected posture, and/or external support.
If Stability Test (w/10sec hold) is repeated and pt. has improved symptoms, motion activation, and or function then that indicates:
normal - need for stabilization
If Stability Test (w/10sec hold) is repeated and pt. has NO improved symptoms, motion activation, and or function then that indicates:
abnormal- worse case of instability
M.length test had limited motion then which indicates:
abnormal- shortened muscle
Following biomechanical exams initially positions the pt. in the mid-range position and away from any painful position.
-Instructs the patient “don’t let me move you”
-Apply smooth, exponentially increasing, and appropriate resistance on the distal segment of the joint being tested for 3 sec.
MMT
If MMT is only painful in the lengthed range then that indicated:
grade I contractile strain
When retest of MMT was performed; pt. had improved P!/function then that indicates:
Inhibited m./regional interdependence
When restest of MMT was performed; pt. had fatiguing weakness then that indicates:
decreased nerve conduction
When restest of MMT was performed; pt. had consistent weakness that indicates:
deconditioned/persistent contractile rupture
When restest of MMT was performed; pt. had worse P!/function then that indicates:
severe/acute condition
Which of the following Biomechanical Exams asses for activation endurance through palpation, observation, and use of either test for specific muscles typically a local muscle
Muscle Activation & Endurance
What is a normal Muscle Activation and Endurance Test?
Good activation and control with 20 reps and 20 sec holds for local muscles.
If Muscles Activation and Endurance Test has poor activation and control with < 20 reps or > 20 sec holds; global m. compensation then that indicates:
inhibited
When should we test the O-C2 Accessory Motion Upper Cervical Region?
When Rot. < 60
Two options for the O-C1 joint:
- Limited rot. with an anterior nod;flexion (ipsilateral restriction)
- Limited rot. with a posterior nod;extension (contralateral restriction)
-Gently, with 2nd and/or 3rd digit and appropriate depth assess temperature, skin tugor, swelling circulation, and or tenderness.
Palpation:
RT limited < 60
RT worse with flexion
indicates abnormality on which side?
ipsilateral side
Ex: RT R & flexion –> right side problem
Palpation: elevated/lowered temperature:
acuity or fever/impaired circulation
RT limited < 60
RT worse with extension
indicates abnormality on which side?
contralateral side
Ex: RT R & extension –> left side problem
Palpation: immobile/sensitive skin
dehydration/nociplastic pain
Palpation: Redding
Acuity
Palpation: Watery/pitting swelling
Acuity/Chronicity
Palpation: Absent or diminished/bounding pulse
0 or 1+/3+; impaired circulation
RT worse with flexion:
stabilize _______ & scoop ___ _______
stabilize occiput
scoop C1 anterior/superior
RT worse with extension:
stabilize _____ & scoop ____ _______
stabilize C1
scoop occiput superior/anterior
Mild, moderate, severe, or jump sign tenderness with or without flinching/grimacing
Less to more serve sensitivity/condition
describe the hold-relax PNF for right side rotation restriction worse in flexion
stabilize ipsilateral occiput, scoop C1 anterior/superior
instruct pt to resist against you (moves head towards you) hold 10 sec, relax
rotate in right direction slightly, instruct patient to resist against you
repeat 5x
-positions patient to isometrically act (hold/relax) or concentrically act (contract relax) with < 60% or light muscle action in opposite direction of the restriction
-hold 10 sec, relax, move further into restricted direction, and repeat up to 5x
-
PNF
-Grade V
-Avoid neck rotation
-Gentle thrust example at 1st tissue stop
-Thrust at 2nd tissue stop
reienforce all gains with immediate neuromuscular re-education
Mobilization/Manipulation
describe hold-relax PNF for right side restriction worse in extension
stabilize contralateral C1, scoop occiput superior/anterior
instruct pt to resist against you (moves head toward you) hold 10 sec, relax
rotate in left direction slightly, instruct patient to resist against you
repeat 5x
rotation limited < 60
flexion AND extension doesn’t make it worse
which joint is indicated?
AA - test both anterior and posterior glide
AA joint, testing contralateral side
stabilize _________ with SB
move ____ __(direction)___
point elbow _____
stabilize occiput/C1 w/ SB
move C1 anterior/inferior
point elbow down
AA joint, testing ipsilateral side
stabilize _________ w/ SB
move ______ ___(direction)____
stabilize occiput/C1 w/ SB
move C2 up
SB limited < 45
worse w flexion
indicates abnormality on which side?
contralateral side
Ex: R SB, flexion –> left side problem
SB limited < 45
worse w extension
indicates abnormality on which side?
ipsilateral side
Ex: R SB, ext –> right side problem
Mobilization/Manipulation: worsened symptoms, motion, muscle activity, and/or function
•Abnormal- mechanical joint motion creates neurophysiological influence
-increase nociceptive input
-decrease large, myelinated mechanoreceptor stimulation
-increase motor neuron excitability
-increases m. spindle activity
-Increases alpha motor neuron activity
-Do NOT release opioids, and anti-inflammatory and tissue healing substances
-No Psychosocial factors
-Increases temporal summation
SB worse w flexion
move Z joint _______
superior
SB worse w extension
move Z joint ________
inferior
Mobilization/Manipulation: improved symptoms, motion, muscle activity, and/or function
•Normal- mechanical joint motion creates neurophysiological influence
-Reduce nociceptive input
-Increase large, myelinated mechanoreceptor stimulation
-Decrease motor neuron excitability
-Eases m. spindle activity
-Limits alpha motor neuron activity
-Release opioids, and anti-inflammatory and tissue healing substances
-Psychosocial factors
-Diminish temporal summation
describe the hold-relax PNF for right side SB restriction worse in flexion
move Z joint superior on left side
instruct pt to resist against you (move head to left) hold 10 seconds, relax
move patient in right SB slightly, instruct patient to resist against you
repeat 5x
describe the hold-relax PNF for right SB restriction worse in extension
move Z joint inferior on right side
instruct pt to resist against you (move head to left) hold 10 seconds, relax
move patient in right SB slightly, instruct patient to resist against you
repeat 5x
SB limited < 45
flexion and extension both worse
indicates what joint?
U joint
Selects appropriate Rx of sets/reps/l/oafs based on finding(s) and purposes(s) for 3-5 exercises.
MET
MET: uncontrolled motion, undesirable symptoms, inappropriate fatigue, increasing dysfunction, etc.
inapporiate Rx and education
MET: controlled mobility with rare instances of mild P! increases within Rx parameters
appropriate Rx and education
anterior glide with R SB restriction:
Z joint guides ______ on ______ side
fingers ____ TP moving _______ on ______ side
Z joint guides inferior on contralateral side
fingers under TP moving anterior on ipsilateral side
posterior glide with R SB restriction:
Z joint guides ______ on ______ side
fingers ____ TP moving _______ on ______ side
Z joint guides superior on ipsilateral side
fingers on top TP moving posterior on contralateral side
First thing to do to test for upper thoracic abnormality
RT –> if ends with SB, indicates abnormality
R RT abnormality –> R rib _______
R right elevates (should depress)
abnormal R RT with extension:
during extension movement occurs
Z joint problem on _______ side
_______ restriction
Z joint problem on ipsilateral side
unilateral restriction
abnormal R RT with flexion:
during flexion movement occurs
Z joint problem on _______ side
_______ restriction
Z joint problem on contralateral side
unilateral restriction
Assess segmental assessment of SP w/ abnormal R SB with extension:
seat patient, hands behind neck, elbows together
stand on opposite side, weave arms between elbows. push pressure on right side more than left between SPs
lean patient into SB slightly, move down every thoracic level of spine
abnormal finding: restricted motion at a level
assess segmental assessment of SP w/ abnormal R SB with flexion
seat patient, hands behind neck, elbows together
stand on same side as restriction, weave arms between elbows. push pressure on left side more than right between SPs
lean patient into SB slightly, move down every thoracic level of spine
abnormal finding: restricted motion at a level
If a T4 restriction, manipulation at T4 is needed
First, check:
- slump test
- chest recoil
- spinal compression test
if slump test, chest recoil, and spinal compression test are OK –> perform:
manipulation test
how do you perform manipulation test for T4 restriction?
place rolled towel at T5 level
patient hugs themself
from behind, grab at elbows, patient leans backwards, relaxes head on chest
pull up on them for 10 sec, relax
perform rapid thrust
what indicates a bilateral restriction?
RT with SB on both sides
movement in flexion and/or extension on both sides
- when performing segmental assessment on SP, put pt in flexion/extension
3-5 MET progressions for OA joint
3-5 MET progressions for AA joint
3-5 MET progressions for Z joint
3-5 MET progressions for U joint
3-5 MET progressions for upper thoracic region
