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Chapter 13 Therapeutic Exercise Program Flashcards

1
Q

What are the steps to developing a therapeutic exercise program?

A

Assess the present level of function and dysfunction
Organize and interpret the assessment
Establish goals
Develop and supervise the treatment plan
reassess the progress of the plan and adjust as needed

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2
Q

What is the goal of control of inflammation?

A

Control inflammation by limiting hemorrhage, edema, effusion, muscle spasm and pain

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3
Q

How does trauma lead to pain and muscle spasms?

A

Trauma ==> hemorrhage and edema at the site of injury ==> pooling of tissue fluids and blood products that increase pain and muscle spasm

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4
Q

How does an increased pressure lead to hypoxia?

A

increased pressure ==> decreases blood flow to injury site ==> hypoxia

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5
Q

What happens to the pain threshold when pain continues?

A

pain threshold is lowered

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6
Q

How does cryotherapy affect the control of inflammation?

A

decrease circulation, cellular metabolism, need for oxygen, conduction velocity of nerve impulses to break the pain-spasm cycle

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7
Q

How can elevation and AROM play a role in control of inflammation?

A

reduce pooling and pressure

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8
Q

How does electrical therapy play a role in the control of inflammation?

A

decrease pain and muscle spasm

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9
Q

What is the PRICE (RICE) principle?

A

Ice application – crushed ice for 30 minutes directly to skin, repeat every 2 hours when awake, extend to more than 72 hours postinjury
Compression – apply a wrap from distal to proximal to avoid forcing extracellular fluid into distal digits, maintain compression continuously on the injury for the first 24 hours
Elevation – elevate the body part 6-10 inches above the level of the heart
Restrict activity and protect the area – unable to walk = crutches, protective device to limit unnecessary movement, UE = sling

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10
Q

What are the effects of immobilization?

A

Muscle tension, muscle and ligament atrophy, decreased circulation, loss of motion – prolong the repair and regeneration of damaged tissue
Partial to full weight bearing for LE – to maintain strength
Muscle – immobilization = loss of strength within 24 hours
Decrease muscle fiber size, total muscle weight, size and number of mitochondria, nerves less efficient
Articular cartilage – greatest impact of immobilization, loading and unloading of synovial joints is necessary to ensure the proper metabolic exchange
Softens and decreases in thickness, > 30 days = osteoarthritis
Ligaments – immobilization = weaker and more compliant, decrease tensile strength = decrease joint stability
Bone – bone loss, greater immobilization = bone resorption occurs 🡪 brittle

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11
Q

What are the effects of remobilization?

A

Early mobilization = speed healing process
Bone and soft tissue respond to the physical demands that are placed on them 🡪 formation of collagen to remodel or realign along the lines of stress
Early 🡪 maintain joint lubrication to nourish articular cartilage, menisci and ligaments
Muscle – regeneration begins within 3-5 days, muscle contractile activity rapidly increases protein synthesis, NMES
Articular cartilage – changes reversible if immobilization is less than 30 days
Ligaments – bone-ligament junction recovers more slowly than the midpoint of the ligament
Bone – period of recovery can be a lot greater than the period of immobilization

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12
Q

When should you start working on restoration of motion, proprioception and flexibility?

A

4 days to several weeks after injury

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13
Q

What are arthrokinematics?

A

involuntary joint motion occurring with physiological motion, spinning, rolling, gliding

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14
Q

What is the definition of hypomobility?

A

limited passive ROM

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15
Q

What are the benefits to restoring PROM?

A

Prevents degenerative joint changes and promotes healing

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16
Q

What are joint mobilizations?

A

oscillating forces applied in the open-packed position to free up stiff joints

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17
Q

What are the benefits to joint mobilizations?

A

Breaking up adhesions and relieving capsular restrictions
Distracting impacted tissues
Increasing lubrication for normal articular cartilage
Reducing pain and muscle tension
Restoring full ROM and facilitating healing

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18
Q

What is the Maitland Scale?

A

Grade I – small-amplitude of movement at the beginning of available ROM
Decrease pain and spasm
Grade II – large-amplitude of movement within the available ROM
Decrease pain and spasm
Grade III – large-amplitude of movement up to the pathological limit in the ROM
Grade IV – small-amplitude at the very end of the ROM
Increase ROM
Grade V – small-amplitude, quick thrust delivered at the end of ROM

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19
Q

What is the convex rule?

A

convex bone moves in opposite direction as movement (roll and glide opposite)

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20
Q

What is the concave rule?

A

concave bone moves in same direction as movement (roll and glide the same)

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21
Q

What is the definition of flexibility?

A

Total ROM at a joint that occurs pain-free in each of the planes of motion
Combo of normal joint mechanics, mobility of soft tissues and muscle extensibility

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22
Q

What are muscle spindles?

A

INTRAFUSAL
lie parallel to muscle fibers, they stretch with the muscle ==> stimulated= muscle contracts reflexively to inhibit the stretch (respond to a change in length)

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23
Q

What are golgi tendon organs?

A

connected in a series of fibers located in tendons and ligaments, they respond to tension ==> stretch continues for an extended period of time (longer than 6-8sec), (when excessive contraction they inhibit the muscle causing relaxation)
Reflex inhibition in antagonist muscles, protects the musculotendinous unit from excessive tensile forces that could damage muscle fibers

24
Q

What is proprioceptive neuromuscular facilitation (PNF)?

A

Uses both active and passive stretching to promote the response of the neuromuscular system through stimulation of the proprioceptors

25
what are the different ways to achieve active inhibition?
Contract-relax Hold-relax Slow reversal hold-relax
26
What is reciprocal inhibition?
uses active agonist contractions to relax a tight antagonist muscle
27
When is isometric RROM useful?
Motion is contraindicated by pathology or bracing Motion is limited because of muscle weakness at a particular angle called a sticking point A painful arc is present Prescribed postsurgical
28
What is proprioception?
A specialized variation of the sensory modality of touch that encompasses the sensation of joint movement and position
29
What are the different sensory receptors?
skin, muscles, tendons, ligaments, joints provide input into the CNS relative to tissue deformation
30
What are the joint mechanoreceptors?
found in joint capsule, ligaments, menisci, labra, and fat pads Ruffini corpuscles – sensitive to intra-articular pressure and stretching of the joint capsule Golgi receptors – intra-ligamentous and become active when the ligaments are stressed at the end ranges of joint movement Pacinian corpuscles – sensitive to high frequency vibrations and pressure Free nerve endings – sensitive to mechanical stress and the deformation and loading of soft tissues that comprise the joint
31
What are muscle mechanoreceptors?
Muscle spindles – innervated by both afferent and efferent fibers, detect muscle length and rate of change in muscle length Golgi tendon organs – respond to both contraction and stretching of musculotendinous junction
32
True or False. Injury can interrupt neuromuscular feedback mechanisms?
True
33
What is open kinetic chain?
distal segment of the extremity is free to move without causing motion at another joint, non-weightbearing Isolate a specific muscle group for intense strength and endurance Limited functional application, single plane motion
34
What is closed kinetic chain?
distal segment of the extremity in an erect, weight-bearing position
35
What are closed kinetic chain exercise useful for?
Stimulate and re-educate the proprioceptors Increase joint stability and congruity Provide greater joint compressive forces Exercise multiple joints through weight bearing and muscular contractions Better control velocity and torque Reduce shear forces Increase muscle coactivation Allow better use of the specific adaptations to imposed demands principle Permit functional movement patterns Facilitate postural and dynamic stabilization mechanics
36
What is muscular strength?
The ability of a muscle or a group of muscles to produce force in one maximal effort
37
What is concentric contractions?
shortening of muscle fibers, decreases the angle of the associated joint, work to accelerate a limb
38
What are eccentric contractions?
muscle resists its own lengthening so that the joint angle increases during the contraction, work to decelerate a limb, generates greater force
39
What are isotonic contractions?
a maximal muscle contraction generates a force to move a constant load throughout the ROM at a variable speed
40
What is isokinetic training?
allows an individual to provide muscular overload and angular movement to rotate a lever arm at a controlled velocity or fixed speed
41
What is muscular endurance?
ability of muscle tissue to exert repetitive tension over an extended period of time
42
What is the rate of muscle fatigue related to?
to the endurance level of the muscle
43
What are the physiological changes leading to developed (greater) muscle endurance?
density in the capillary beds increases, providing greater blood supply, thus greater oxygen supply
44
How would you increase muscle endurance?
gained by lifting low weights at a faster velocity with more reps
45
What is muscular power?
the ability of a muscle to produce force in a given time
46
When should you start power training after an injury?
When injured limb has regained at least 80% of the muscle strength in the unaffected limb
47
What does power training involve?
involves weight training at higher contractile velocities or using plyometric exercises
48
What is plyometric training?
inherent stretch-recoil characteristics of skeletal muscle through an initial, rapid eccentric (loading) pre-stretching of the muscle, thereby activating the stretch reflex to produce tension before initiating an explosive concentric contraction of the muscle
49
How can strength/endurance/power be increased?
Strength/endurance/power can only be increased by using the overload principle – states that physiological improvements occur only when an individual physically demands more than normally is required of the muscles
50
How is overload achieved?
achieved by manipulating the intensity, duration, frequency, specificity, speed and progression in the exercise program
51
What is coordination?
body's ability to execute smooth, fluid, accurate and controlled movements
52
what are the two categories of coordination?
gross motor movements involving large muscle groups and fine motor movements using small groups
53
What is sport-specific skill conditioning?
Therapeutic exercise should progress to the load and speed that are expected for the individual’s sport or physical activity Work the affected extremity through functional diagonal and sport-specific patterns
54
What is cardiovascular endurance?
Aerobic capacity The body’s ability to sustain submaximal exercise over an extended period and depends on the efficiency of the pulmonary and cardiovascular systems
55
What happens when you stop aerobic training?
detraining occurs within 1-2 weeks
56
How do you calculate the max HR?
HRmax=220-age
57
What are the recommended cardiovascular guidelines?
Moderate-intensity PA for minimum of 30 minutes/session 5+ days/week or vigorous PA minimum of 20 minutes/session 3+ days/week Bone health – 30-60 minutes of weight-bearing CV exercises 3-5x/week, resistance exercises 2-3x/week

NCE (16 decks)

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