Chiro - PT Boards Flashcards
Heating modalities: Deepest to shallow
- Ultrasound
- Short wave diathermy
- microwave diathermy
- IR
- Ultraviolet
Ice Modalities: Best to worst
Used in acute cases
- Ice
- Positive pole of Low Volt Galvanic
- Pulsed Ultrasound
- PRICE
Subacute phase (eliminate edema) modalities
- Contrast therapy
- Pulsed ultrasound
- Interferential
Subacute Exercise
- Stretching/passive/ROM
- Isometric exercise
Chronic Rehab
Warm up/ use heat modality
Target HR Equation
220-Age = Est. Max HR (EMHR)
EMHR - Resting Heart Rate (RHR) = Heart Rate Reserve (HRR)
HRR x 0.6 - 0.9 (epends on lifestyle) = Workout HR
Workout HR + RHR = Target HR
Williams Exercises
- Sit ups and Crunches
- Pelvic Rocks/Tilt
- Knee to Chest
Aerobic Exercise is in what range of Max HR?
60-90%
Aerobic Exercise must be for at least how long?
15-20 minutes
Aerobic Exercises
UBC = Upper Body Cycle –> used for people with what problems?
Lumbar Problems
Williams Approach says that all activities should b geared towards ____ lumbar lordosis
Reducing/decreasing Lumbar Lordosis (Flexion)
McKenzie Approach is a spinal assessment and therapy based on the behavior of pain and mechanical response to ____ loading
Dynamic and static loading
Postural Pain Syndrome =
End range stress of normal structures
Dysfunction pain syndrome =
end range stress leading to contracted of adherent structures
Derangement Pain Syndromes=
anatomical disruption or displacement of structure “herniated disc”
Plyometric Exercises -
- Box Drills
- Depth Jumps
- Jumps
- Hops
- Bounds
Acute Care mngmt
-First 4 weeks
- Ice
- pole LVG
- Pulsed US
- Price
Plyometrics based on concept of power
Equation for power?
Force x Speed = Power
Chronic phase starts after ___ weeks
12
Chronic phase therapy - >12weeks
Therapies:
-Strengthening
-Heat/warm-up
-Stretch the decreased ROM places
Mensuration and Wexler Scale for quantitative measurements
Lower Crossed Syndrome:
MM involved and state they are in
Erector Spinae - Tight/Fascilitated
Iliopsoas - Tight/Fascilitated
Glut. Max - Weak/Inhibited
Abs - Weak/ inhibited
Toe in or out for VMO during leg extensions?
Toe Out
Upper Crossed Syndrome:
MM involved and their state
Deep neck Flexors/Longus Coli - Weak
Lower Trap/ Serratus Anterior - Weak
Pectoralis - Tight
Upper Trap/Levator Scap - Tight
Usual Tight Mm:
Iliopsoas Rectus Femoris TFL Adductor Group Errector Spinae Gastroc / Soleus
Action of TFL
- Abducts
- Flexes and Medially Rotates the hip joint
Lower Cross Syndrome results in positioning of: Pelvis into \_\_\_ Lumbar \_\_\_ Hip \_\_\_ Knees \_\_\_
Pelvis anterior rotation
Increased lumbar lordosis
Hip Flexion
Knees hyperextended
Adductor group mm.
Lower, magnus, longus/brevis
Errector Spinae Action
Ext. Vertebrae in thoracic region
Draws Ribs down
Usual Weak/inhibited mm.
Rectus Abd.
Obliques
Glut. Max and Med.
Hamstrings
Trendelenburg Test - Tests ABductor strength
Usual Upper Body Tight Mm.
Pec Major and minor Levator Scap. Teres Major Upper Trap Ant Delt. Subscap Lats SCM, Scalenes, and rectus capitus
Usual upper Body Weak Mm.
Rhomboids Lower Trap, Serratus ant. Post Delt. *Teres Minor, infrspinatous, Post. Delt Longus Coli
Clayton’s exercises
crawling exercises to mobilize the spine and exercise mm in scoliosis
Thoracolumbosacral Supports
-Milwaukee brace: for what? how long/day? When is it indicated?
Milwaukee brace
- scoliosis. worn 23 hours/day
- employ for scoliosis that are between 20-40 degrees
Extremity braces:
Types and their uses:
- Figure eight (Louisiana Strap): inversion ankle sprain
- Lennox-Hill (derotational Brace): Knee
- Cockup Splint: Wrist -Carpal Tunnel syndrome - Puts wrist into extension and opens tunnel
Frenkel’s: Sx and treatment
Ataxic motion and to develop coordination (wobble board).
Lumbar/SI Supports: Types and indications
Sacroiliac Girdle (Trochanteric belt) -Goes around Hip circumference and is for SI hypermobility.
Fitting Crutches 2-10-30 rule
- 2” from axilla
- Tip of crutch 10” from malleolus
- Crutches should be at 30 degrees
Contraindications to all PT modalities:
HIM
- Hemorrhage (systemic)
- Infection w/suppuration (not inflammation) - Exception = UV superficially
- *Malignancy (most important) unless 100% benign.
Contraindications to ALL Electric Modalities :
- Pacemaker
- Low Back and abdomen during pregnancy
- Decrease sensation (LVG only)
- Brain = Transcerebral (Co-planar = ok)
- Eyes
- Heart = Transthoracic
- Carotid Sinus
DC Current PT Electric Modality
LVG
HV
AC Current PT Electric Modality
- Sine Wave
- Faradic
- IF
Systematic Approach for PT Modalities:
WAT DP PICS
- Wavelength and Frequency
- Action
- Types
- Dosage
- Penetration
- Physiological Affects
- Indications
- Contraindications
- Special Tests
Contraindications to ALL Heating Modalities:
DALED
- Decrease in heat sensation
- Active TB
- Low Back and abdomen during pregnancy
- Encapsulated Swellings (Herpes simplex and non draining sinusitis, uviitis, osteomyelitis)
- Diabetes Mellitus - Late stages
*What PT modality is in the medium frequency range?
Interferential
What is the deepest e- Modality
Interferential
Massage’s action (mechanical) has the greatest affect on what system?
Vascular
Levator Scapula actions:
Origin Fixed:
Insertion Fixed:
Origin: Elevated scapula and assists in rotation so the glenoid cavity faces caudally
Insertion: Unilateral acts to laterally bend the cervical neck. Bilateral assists in extension of cervical spine
Anterior Deltoid actions:
Abduction of shoulder.
Ant. fibers flex and in supine position medially rotate shoulder joint.
Lattisimus Dorsi actions:
Origin Fixed:
Insertion Fixed:
Bilateral:
- Origin: Int. rotation, adducts, and extends shoulder. depresses shoulder girdle and assists in lateral flexion of trunk
- Insertion: Assists in tilting pelvis anterior and laterally
- Bilateral: hyperextending the spine, anteriorly tilting pelvis or flexing the spine, depending on axis.
May acts as accessory respiratory mm.
Cybex machine
Used for isokinetic movements
-good for rehabbing painful arc syndrome
Buerger-Allen Exercises
- For patients with Buerger’s, Raynauds, Elderly, bedridden, or early stage DM.
- Administrated to patients with vascular disease. Done 6-7 reps and several times a day.
1. support legs in an elevated 60-90 degrees for 30-180 seconds or until blanching of extremities. Then actively dorsiflex and plantarflex the ankle throughout the rest of the procedure.
2. Allow feet to hang over the bed for 2-3 minutes or as long as it takes to produce hyperemia then add 1 min. The total time should not exceed 5 min.
3. Place legs in horizontal position for 3-5 minutes.
Extension type exercises for low back conditions and CAN be done during the acute phase:
McKenzie Exercises
Codman’s Exercises AKA Pendular Exercises:
Goal:
Uses:
To strengthen the shoulder girdle while eliminating the use of the supraspinatus mm. - Finger wall walking for abduction of the shoulder
Uses: Frozen shoulder, and rotator cuff rehabilitation.
-works everything but internal and external rotation
DeLorme’s Exercises:
Systematic approach to mm strength by increasing the resistance on the mm. Ex. Weight lifting.
Sets of 3 x 10 reps
Trigger points =
myofascitis
*Kegel exercises are for who?
Pregnant females and ppl with urinary incontinence.
Jacobson’s exercises
Stress exercise to relax mm.
- Galvanic Skin Response (GSR)
- Mental Imagery
OA of the hip - which hand do you place the cane?
Opposite of OA
High (Heat) Frequency modalities- 100,000 Hz or higher
- UV
- IR
- SWD
- MWD
- US
**Medium Frequency modalities - 2K-10K Hz
-IF –> Deepest E-modality
Low Frequency modalities - 1 - 2K Hz
Used to tetanize or exercise a mm.
- LVG
- HV
- SW
- Faradic
- TENS
- IF
Ultra Low Frequency Modalities - below 1 Hz
-Micro-current:
Primary Action:Incr. ATP and AA
Secondary Action: Decrease Pn
Micro-current:
Primary and secondary actions:
Primary Action:Incr. ATP and AA
Secondary Action: Decrease Pn
Electrokinetic action:
Contracting a mm electrically
Massage:
Physiological Effects:
-Increases: Blood and lymph flow, HR, BP, Breaks adhesions (Transverse Friction Massage-TFM), Removes Lactic Acid -Decreases: Edema Congestion Nerve activity (sedation effect)
Massage:
Indications:
Strains/Sprains, Bruises, Bursitis, Tendonitis
Massage:
Contraindications:
*Key = Vascular problems
Phlebitis, Thrombosis, Varicosities, Ulcerations, Local acute conditions
Types of Massage:
-Effleurage - stroking
-Petrissage - deep kneading for mm tissue
-Tapotment - percussion:
1 Flat hand slapping
2. fist pounding
3. finger tips tapping for young kids
4. ulnar side hacking
5. cupping for cystic fibrosis
-Friction - deep rubbing (Powder)(TFM)
-Vibration - shaking (extremities only), genie rub, G5, and thumper
-Deep Pressure - Nimmo acupressure
Transverse Friction Massage - TFM:
Actions:
Indications:
- Breaks adhesions in mm., ligaments, and joint capsules
- Decreases chemical cross linking
Indications: Sprain/strain, tendonitis, bursitis
***-not recommended fro calcific tendonitis or bursitis (will inflame the tissue even more)
Traction:
Action:
Types:
Physiological Effects:
Action: mechanical
Types: Constant and intermittent (pumping, gliding, *disc problems)
Phys. Effects: Decrease intradiscal pressure, increase IVF space, break adhesions (intermittent), straightens curves (continuous), breaks mm spasms (intermittent), gliding of facet joints
Traction:
Indications:
- Disc syndromes
- Foraminal encroachment
- hyperlordosis
- chronic mm spasms
- fibrotic adhesions
Traction:
Contraindications
- Bone weakening conditions (osteoporosis, rickets, osteomalacia)
- Pregnancy Not at any time - relaxin
- Rheumatoid arthritis (transverse ligament laxity, Down’s syndrome) unless flx and ext. views are taken
- Acute mm spasms
- Fx (even healed compression fx)
- Hypertensive disorders
Traction:
Dosage for cervical:
Position:
- Cervical: begin at 5% of BW and increase a max of 2lb/treatment to a max of 50lbs never exceeding patient tolerance
- Position: C2-C7 Flx. 25-28 degrees. C0-C1 neutral or 0 degrees
it takes 10lbs to overcome weight of the skull. So min = 10lbs
***Traction:
Dosage for lumbar:
Position:
-Dosage: Begin = 25% of BW. Increase a max of 5lbs/treatment to a max of 150 or 50% of BW whichever comes first. Never exceed patient tolerance.
-Position: Supine with legs flexed and knees flexed AKA: 90/90 Traction or Goucher’s position (Relaxes mm, flattens lumbar curve)
**Cryotherapy:
Action:
Hypothermal - removes heat and reduces tissue temp.
Uses: Life-threatening fever.
avoid BP Problems
Cryotherapy:
Physiological Effect: Local and Systematic
Local:
- Vasoconstriction (followed by vasodilation Hunting-Lewis Reaction)
- Decrease capillary pressure
- Edema reduction
- decreased nerve metabolism
- anesthetic to the nervous system
Systemic:
- incr. BP
- Decr. Blood flow
***Cryotherapy:
Contraindications:
- Circulatory compromise (Raynauds, Beurgers)
- Patient hypersensitive to cold (elderly)
- Frostbite
- Chillblains - after Fb (use + pole galvanize)
- HBP
Cryotherapy:
Types:
- ice packs (1 towel layer for 20 min.)
- Blue Ice (1 towel layer for 20 min)
- Ice immersion - 10-15 minutes**
- Vapocoolant sprays flouromethane (ethyl chloride) flexible keep 14-18” away from patient
- Cryokinetics -ice massage for 5 min. and ROM or movements
