Exam 2 Prep Flashcards
What are William’s flexion exercises? What is the rationale behind them?
-Posterior pelvic tilt: strengthens the abdominals
-Single and double knee to chest: opens the posterior elements
-Hamstring stretch: keeps the posterior longitudinal ligament taught
What does lumbar spine extension do to the disc?
If the disc is protruding, lumbar spine extension “closes the barn door” on the disc
What must be ruled out before the McKenzie method is used?
-Rule out major underlying systemic disease
-Rule out major structural pathology of the spine
What are the three diagnostic categories of the McKenzie method?
-Postural
-Dysfunction (flexion or extension)
-Derangement
What is the criteria for diagnosing postural syndrome?
-Younger
-Insidious onset (not any specific injury)
-No acute episodes or trauma
-Delayed onset pain with extended static positions
-Localized ache
What are findings in the physical exam that could lead to diagnosis of postural syndrome?
-Abnormal sagittal plane posture (no lateral shift)
-Fully correctable
-No movement limitations
-Negative neuroscan
What is the dysfunction syndrome?
-Patient will say “something is stiff”
-Flexion (pain at end range flexion, posterior element tightness)
-Extension (pain at end range extension, anterior element tightness)
What are criteria for diagnosing dysfunction syndrome?
-Older
-Episodes of acute dysfunction
-Localized pain (w/ exception of an adherent nerve root)
What are objective findings that would lead to the diagnosis for dysfunction syndrome?
-Loss of normal posture and range of motion
-Negative neuroscan
-Unidirectional stiffness
-Movement into stiffness aggravates end range pain
-With repeated movement pain is relatively unchanged or mildly better
What are objective findings for flexion dysfunction?
-Increased lordosis
-Limited forward bending
-Loss of lumbar curve reversal
-Hamstring tightness
What are some ways to manage flexion dysfunction?
-Williams flexion exercises
-Childs pose
-Cat in cat-cow
What are some objective findings for extension dysfunction?
-Loss of lordosis
-Limited backward bending
What are some ways to manage extension dysfunction?
-Cobras
-Extension over ball
-Extension over bolster
What is derangement syndrome?
-A disc lesion
What are some criteria for diagnosing derangement syndrome?
-Age (middle aged people)
-Hx of progressive episodes
-Mechanism of injury (flexion, twisting, or loading)
-Localized and/or referred symptoms
What are different postures that can be associated with derangement syndrome? Why do people have these postures?
-Guarded flexion
-Lateral shift
-To get off of the disc
What are objective findings that can help diagnose posterior derangement syndrome?
-Positive neuroscan
-Repeated movements will quickly exacerbate symptoms either centrally or peripherally, or can improve or worsen limitations in range
What happens if you correct someone’s lateral shift and the symptoms stay localized? What if symptoms go down the leg?
-If symptoms stay localized then it is reducible and the disc is no longer protruding
-If the symptoms go down the leg then it is irreducible and you should not treat it
What happens if you put someone into flexion or extension and the symptoms stay localized? What if symptoms go down the leg?
-If symptoms stay localized then it is reducible
-If symptoms go down the leg then it is irreducible
What can you do if someone has irreducible posterior derangement?
-Mechanical traction
-Educate patient on how to self traction
What can you do if someone has a reducible posterior derangement?
-Give them McKenzie’s extension exercises
-Target progressive end range loading into extension
What does one spinal segment consist of?
-Adjacent two halves of vertebrae
-Disc
-Facets
-Associated ligaments
-Associated muscle, fascia, and integument innervated by the spinal nerve
What is the orientation of the cervical facet joints?
~45 degrees
What is the orientation of the thoracic facet joints?
Vertical
What is the orientation of the lumbar facet joints?
Horizontal
What are the normative values for cervical flexion?
45-50 degrees
What are the normative values for cervical extension?
85 degrees
What are the normative values for cervical rotation?
70-90 degrees
What are the normative values for cervical side bending?
40 degrees
How do you palpate L5 spinous process?
-Find the top of the iliac crests and go medially, you will find the spinous process of L4
-Bring your finger down until you find the spinous process of L5
What are physical agent modalities?
-Thermal
-Acoustic
-Electromagnetic
-Electrical
-Mechanical energy
-Transmission of low, medium, or high frequency energies into tissues to stimulate them in ways that are not possible by the patient
What types of physical therapy modalities are there?
-Superficial heat and cold
-Intermittent pneumatic compression
-Traction
-Hydrotherapy
-Deep heating agents
-Electrotherapies
-Cold light laser
What type of electrotherapy is used to stimulate muscle contraction?
Neuromuscular electrical stimulation (NMES)
What type of electrotherapy is used to modulate pain?
Transcutaneous electrical nerve stimulation (TENS)
What else can electrotherapy be used for?
To promote edema reduction and wound healing
What mechanical modalities are there?
-Hydrotherapy
-Intermittent pneumatic compression
-Mechanical traction
What are indications for intermittent pneumatic compression?
-Traumatic edema
-Stump reduction following amputation
-Wound healing
-Prevention of DVT
-Venous stasis ulcers
-Lymphedema
What are contraindications for intermittent pneumatic compression?
-Acute pulmonary edema
-Congestive heart failure
-Uncontrolled hypertension
-Acute or recent DVT’s
-Infection
What is a typical protocol for intermittent pneumatic compression?
-Continuous with very low intermittent pressure
-Pressure must be below diastolic
-15-30 minutes
-Stop if swelling in other areas is seen, pt has SOB, or numbness
How are modalities commonly applied?
In combination with each other (i.e. ice and TENS)
What are different ways to heat/cool the body?
-Conduction
-Convection
-Conversion
-Radiation
-Evaporation
What is conduction?
Direct contact between two objects must occur and they must have different temperatures
What is convection?
There is a medium present and heat is transferred from the circulating medium to the tissue
What is conversion?
Converts a non-thermal form of energy (mechanical, electrical, chemical) into heat
What is radiation?
Direct transfer of energy from a material with a greater temperature but there is no medium or direct contact (infrared lamp)
What is evaporation?
-Material that absorbs energy and changes it from liquid to a gas vapor
-Fluoromethane spray
-Historically known as Travell’s Spray and Stretch
What are indications for therapeutic heat?
-General and muscle relaxation
-Pain control
-Increased ROM/decreased joint stiffness
-Promote healing (increased circulation, increased oxygen, increased metabolic rate)
What are the effects of vigorous heat?
-Vasodilation
-Increased oxygen hemoglobin dissociation
-Neuromuscular effects (increased nerve conduction velocity)
What are contraindications for therapeutic heat?
-Acute injury or inflammation
-Recent or potential hemorrhage
-Thrombophlebitis
-Impaired sensation
-Impaired cognition
-Malignancy
-IR radiation of the eyes
What are precautions for therapeutic heat?
-Pregnancy
-Impaired circulation
-Poor thermal regulation
-Edema
-Cardiac insufficiency
-Metal in the area
-Paraffin over an open wound
-Where topical counterirritants have recently been used
What are adverse effects of superficial heat?
-Burns
-Fainting
-Bleeding
-Skin and eye damage from infrared
What are methods of application for superficial heat?
-Moist heat
-Electric heating pads
-Whirlpool
-Paraffin
-Infrared
How many layers should be between the skin and the heat pack?
6-12 layers
What temperature should the heat packs be for mild heat? What about for vigorous heating?
-Mild heat: < 40C (104F)
-Vigorous heating: 40-45C (105-113F)
How long is muscle strength decreased for after using heat?
-30 minutes after
-Increased for the next two hours compared to pre-treatment
What are the effects of heat combined with stretch?
-Increased tissue extensibility
-Expect about 3-6% length gain with some loss following 24 hours
What are different applications of cold?
-Ice pack
-Ice massage
-Ice bath
-Fluoromethane spray
What are indications for therapeutic cold?
-Acute and sub-acute musculoskeletal trauma and inflammation
-Hemodynamic effects (vasoconstriction)
-Pain control (anesthetic effect, lowers nerve conduction velocity)
When can tissue damage occur with tissue cooling?
-At 15C (59F) tissue damage can occur
-At -4 and -10C (14-39F) tissue death can occur
How long should cold applications be applied for?
No longer than 10-15 minutes
How can you make a cold pack at home?
-1 part rubbing alcohol
-3 parts water
-Place in freezer
How long should ice massage be applied for?
8-10 minutes (but that may be too long, usually only 5 minutes)
What are the stages of sensation with cold therapy?
-Stage I: cold, 1-3 minutes
-Stage II: burning, 3-5 minutes
-Stage III: aching, 5-7 minutes
-Stage IV: numbness, 7+ minutes
What are the neuromuscular effects of cold therapy?
-Temporary decrease in spasticity which may be due to decreased nerve sensitivity
-After 45 minutes of ice application there is decreased hyper-reflexia and is sometimes used on pts with spasticity due to UMN lesion
What are indications for cold therapy?
-Inflammation control
-Edema control
-Pain control
-Modification of spasticity
-Facilitation of strength
What are contraindications of cold therapy?
-Cold hypersensitivity
-Cold intolerance
-Raynaud’s disease (bc hands and feet vasocontrict & get really cold)
-Over a regenerating nerve
-Over an area with circulatory compromise or peripheral vascular disease
How long should patients avoid activities that typically aggravate their symptoms for after icing?
1-2 hours after because the analgesia may mask pain
How quickly do nerves regenerate?
An inch a month
What are precautions with cold therapy?
-Superficial main branch of a nerve
-Open wound
-Hypertension
-Poor sensation or cognition
-Very young or very old patients
What are adverse effects of cold therapy?
-Tissue death
-Frostbite
-Nerve damage
-Unwanted vasodilation
What are forms of hydrotherapy?
-Whirlpool
-Jacuzzi’s and pools
What are indications for hydrotherapy?
-Alternative exercise medium
-Wound care
-Advantages of immersion properties
-Pain reducing environment
What is aquatic physical therapy?
A therapeutic procedure which attempts to improve function through the application of therapeutic aquatic exercises
What are general benefits of aquatic physical therapy?
-Improve circulation, strength and endurance, balance, and coordination
-Increased range of motion
-Decrease tissue swelling
-Normalize muscle tone
-Protect joints during exercise
-Reduce stress
What are indications for aquatic therapy?
-Orthopedic conditions
-Weight-bearing restrictions
-Joint replacement
-Obesity
-Pre/post-natal dysfunction
-Neurologic conditions (Parkinson’s, MS, CP)
-Spinal cord injury
-Rheumatologic conditions
What are unique properties of water that are an important part of aquatic PT?
-Buoyancy
-Hydrostatic pressure
-Drag
-Temperature
What is bouyancy?
-Archimedes’ Principle
-Upward force that works opposite of gravity
-Gives relative weightlessness and unloads joints, making movement easier
What is the percentage of weight bearing when immersed to the waist? What about to the mid-chest and neck?
-54% at waist
-35% at mid-chest
-8% at neck
What is hydrostatic pressure?
-Pascal’s Law
-Pressure exerted on immersed objects
-Pressure will increase with depth
How does hydrostatic pressure help in aquatic PT?
-Increased pressure decreases effusion
-Assists in venous return
-Induces bradycardia and centralizes peripheral blood flow
What is drag?
-Cumulative effects of turbulence and fluid viscosity acting on an object in motion
-As movement speed increases, so does resistance
-Moving water past the patient required more work to maintain same position
-Equipment increases amount of drag
How can temperature of the water help in aquatic therapy?
-Water retains heat 1000X more than air
-Body is less able to dissipate heat in water
-Water can penetrate to deeper tissues with increases time
What are the temperature guidelines for aquatic therapy?
-79-82F for cardiovascular training and aerobic exercise
-84-90F for flexibility, gait training, and relaxation
-91F for therapeutic exercise for patients with acute painful MSK injuries
How much does hydrostatic pressure on the chest wall increase the work of breathing?
By 65%
What are contraindications for aquatic therapy?
-Cardiac failure
-Respiratory dysfunction
-Severe peripheral vascular disease
-Danger of bleeding or hemorrhage
-Severe kidney disease
-Open wounds, colostomy, and skin infections
-Water and airborne diseases
-Bowel and bladder incontinence
-Uncontrolled seizures
What are precautions for aquatic therapy?
-Fear of water
-Neurologic/cognitive disorders
-Seizures
-Cardiac dysfunction
-Small open wounds
-Skin conditions or irritations to pool chemicals
What types of exercise can be done in the pool?
-Stretching (increased relaxation)
-Strengthening (drag, speed)
-Aerobic conditioning
-Balance (no fear of falling from being in water)
What populations is aquatic therapy good for?
-Pregnant people (reduces weight bearing)
-Those with sensory issues (elicits greater somatosensory input)
-People with arthritis (unloads joints)
What are current techniques in aquatic therapy?
-Aquatic PNF
-BackHab (back rehab and gait training)
-Fluid Moves- Feldenkrais
-Watsu
What is BackHab?
-Back rehabilitation
-Gait re-training
-Focus on coordination of all body parts
What is Fluid Moves/Feldenkrais?
-Uses gentle movement and directed attention
-Aims to increase ease and range of motion, flexibility, coordination, and enhance functional integration
What is Watsu?
-Client held or cradles in warm water while provider stabilizes or moves one body segment, resulting in a stretch of another segment due to drag
-Used for pain reduction, increased ROM, increased circulation, psychological problems, relaxation, and stress reduction
-Also used in orthopedic problems, pregnancy, physical disbility, etc.
What type of equipment is used in aquatic therapy?
-Collars, rings, belts, vests
-Dumbbells
-Gloves, fins, paddles, boots
-Kickboards and mats
What are different types of tape?
-Leukotape
-Athletic tape
-Kinesio/rock tape
What is athletic tape used for?
-Used by PTs/ATCs
-Purpose is to provide support
-Flexible, cloth tape
-Easily torn
-Not elastic
-Stiffer than kinesio/rock tape
What is athletic tape commonly used for?
-Ankle sprains/instability
-Wrist
What is leukotape?
-Rigid, cloth tape
-Requires scissors to cut
-Purpose is to provide support and positioning
-Used in McConnell taping
What is McConnell taping?
-Developed by Jenny McConnell
-Tape applications designed to unload soft tissue
-Research on patellofemoral, shoulder, and lumbar pathology
What is kinesio tape?
-Developed in 1970s in Japan
-Elastic, flexible tape
-Designed to assist in healing traumatized tissues
-Used for increased lymph drainage, muscle inhibition or facilitation
-Must be applied in a specific direction
How does taping help reduce bruising and swelling?
-Opens lymph channels and promotes reabsorption to reduce bruising and swelling
What is rock tape?
-Knock off of kinesio tape
-Sturdier than kinesio tape
-Doesn’t matter what direction tape is applied
What is the purpose of kinesio/rock tape?
-Pain mitigation
-Neurosensory input
-Decompression
-Skin to brain connection
What are precautions of taping?
-History of tape irritation
-No experience with tape
-Blood thinners
-Hormone cycle
-Lighter/ginger skin types
What are contraindications of taping?
-Open wounds
-Active infection
-Active cancer site
-Kidney/congestive heart failure
-Overstretch of tape ends
-History of skin reactions
