Cheat sheet Flashcards
What is OA?
Degeneration of articular cartilage -> narrowing of joint space -> osteophyte formation -> subchondral sclerosis (bone hardening)
What research is there around OA and post-traumatic OA?
Post-traumatic arthritis causes 12% of all OA cases in US.
Around 35% of patients who sustained substantial joint trauma developed OA.
Osteophyte volume significantly increased in a fairly linear manner at 4, 6 and 8 weeks post ACL rupture/trauma. (Hsia, 2016)
What is the best way to treat OA?
Strengthening exercises and loading- muscles around joint become stronger and accept more load- eases stress on joint
If you aren’t fully sure about OA as the diagnosis, how are you going to treat this patient?
In a study of 7008 patients across GP’s, the GP did not make a specific diagnosis for the presented health consultation in 36% cases. 25% of the cases related to MSK problems. (Rosendal, 2015)
Study showed that giving a patient a diagnosis can be detrimental as it focuses the patient’s attention on the injury and not on what they need to do to fix the problem. Eva and Regher 2016 referred to this as the ‘goal of thinking’ not the ‘aid to thinking’
Illic stated that “diagnosis always intensifies stress, defines incapacity, imposes inactivity and focuses apprehension on nonrecovery”- not always true however pt already quite anxious so incorrect diagnosis could cause deterioration.
What are the principles of sport and overload, and how did they affect your treatment exercises?
Specificity, Progressive, Overload, Reversibility, Tedium
Frequency, Intensity, Time, Type
What is activity modification?
1 to 5 pain/discomfort is seen as the area to exercises within, stop exercise if 6+ , combats fear avoidance behaviours
What is neuromuscular adaptivity?
6-8 weeks= Neural changes
8-10 weeks= Strength changes
10-12= hypertrophy
What is mechanotherapy?
loading of tissue -> stimulates cellular response -> tissue adaptation occurs -> tissue improves structure -> tissue able to maintain homeostasis= less pain
What is the sets and reps continuum?
A low repetition scheme with heavy loads (1-5, 80-100% 1RM (RPE)) optimises strength increases
A moderate repetition scheme with moderate loads (8-12, 60-80% 1RM(RPE)) optimises hypertrophic gains
A high repetition scheme with light loads (15+ reps, below 60% of 1RM(RPE)) optimises local muscular endurance improvements
Some studies have shown that training to, or close to, failure results in better hypertrophy and increased strength gains
What are SMART goals?
Specific, Measurable, Attainable, Realistic, Timed
Empirical research demonstrates that there is a strong correlation between setting and achieving goals and a reduction in distress and anxiety.
Why did you prescribe side lying bent abduction?
- Easier than straight leg abduction- shorter lever to lift up
- Glute muscles are main abductor, and pt had weak abduction, so exercise to target and strengthen them
- Produced best MVIC for glute med (Distefano, 2009)- wanting to target all three sections of glute muscles
- Weak glutes have been associated with several lower extremity dysfunctions and increased risk of injury such as: ACL tears, patellofemoral pain syndrome, iliotibial band syndrome, and knee collapse (Harrison, 2017)
Why did you prescribe glute bridges?
Aimed to strengthen glutes through a different plane (sagittal) and movement
Works to also limit internal rotation of hip by placing ball inbetween legs
Pt had a tendency to internally rotate the leg- don’t want to promote this with exercises so: “The TFL is a hip abductor, but it also internally rotates the hip. Both gluteal muscles were significantly more active than the TFL in glute bridging and the clam. The gluteal-to-TFL muscle activation index ranged from 18 to 115 and was highest for the clam (115) and third highest glute bridge (59). (Selkowitz, 2013)”
Why did you prescribe sit to stand?
Used to target quadriceps as pt had weak quads (hip flex, knee ext)
Began STS from bed height as pt reported pain at R knee when STS from 42cm height (toilet)- needed support to get up from this height (OT involvement)
A short-term conditioning program consisting of repeated sit-to-stand exercise is effective in increasing quadricep strength and reducing the muscular effort required for lowering and raising the body. (Fujita, 2019)
In elderly people, the inability to perform a functional STS independently can lead to institutionalisation and impaired functioning and mobility in ADL’s (Janssen, 2002)- aiming to progress to toilet seat height of 42cm
Why did you prescribe 90/90 stretch?
Tight hamstrings was limiting strength (hip ext+, knee flex)
Dynamic stretches shown to be safer than static stretches
Additionally, more research has found that dynamic stretching can improve your muscle power and overall performance. Therefore, if the goal is to increase joint ROM and to enhance muscle force and/or power, dynamic stretching seems to be a suitable alternative to static stretching. (Opplert, 2018)
Results show that using PNF in the 90/90 active stretch provided better knee range-of-motion improvements and hamstring flexibility than the 90/90 passive methods did. (Fasen, 2009)
Hysteresis: amount of lengthening a tissue will maintain after a cycle of stretching(deformation) and then relaxation
How did you go about treating the patients anxiety regarding activity and pain?
PAIN PERCEPTION
Peerdman et al in 2016 showed in their meta analysis that pain in patients could be reduced, and functioning improved, by modulation of expectancy with medium to large effects- if patient expects slight pain then pain tolerance will increase and as a result pain experience will decrease (Wiech, 2016). These papers stemmed from a study completed by Davey in 2009 which found a relationship between prior expectancies and surgical outcomes. Patients with high prior expectancies had significantly reduced pain than patients with low prior expectancies.
