Exam II Flashcards
What type of exercises were used to treat spinal stenosis that biased flexion of the spine?
-Williams exercises
What was an issue with williams exercises?
-they lead to disc herniations
What exercises were used to treat radicular symptoms that emphasized extension of the spine?
-Mckenzie exercises
what was an issue with mckenzie exrcises?
-the did not treat the deep stabilizers of the spine
What was used to teach proper posture, body mechanics, posture and sleeping postures?
-Back schools
what was an issue with back schools?
-They were too general
What is neutral spine?
-A position of ROM of the spine that is defined by the patients signs and symptoms, pathology and restrictions
What is muscular fusion?
-utilizing co-contractions of the deep abdominals, and multifidus to hold the spine in nuetral
Where is all movement centered?
-The lumbopelvic hip complex
Why is spine stabilization surgery important?
-Important for posture and balance, increases force production, increase neuromuscular efficiency, and to treat and prevent LBP
What muscles are crucial in providing lumbar spine stabilization?
-Multifidi, internal obliques and transverse abdominis
What muscles dominate and attempt to stabilize the spine when there is dysfunction?
-Erector Spinae
Why is it an issue when the erector spinae attempt to stabilize the spine?
-the are not tonic muscle and not designed to be active all of the time, guarding bound to occur
Why aren’t global muscle efficient?
-They do not provide segmental stability
What happens if you do not train local muscles?
-They will be shut down because of the use of global muscles
What is the action of the lumbar multifidus?
- Back extension when they fire bilaterally
- contralateral rotation when they fire unilaterally
What are the first muscles to become weak?
-Multifidus
How else can the multifidi be affected by back dysfunction?
-They can have delayed activation, atrophy (have fatty infiltration) and hange from type I to type II fibers
To maintain posture how to the multifidi fire?
-Bilaterally
What is the deepest abdominal muscle?
-Transverse abdominis
What is the action of the transverse abdominis?
-compression, protection and support the abdomen
What is the first muscle to be activated when there is an unexpected loading of the spine?
-transverse abdominis
How are the transverse abdominis affected by low back pain?
-they are no longer recruited first, and global muscle will be recruited first
What muscle is just superficial to the transverse abdominis?
-internal obliques
What produces the greatest stabilizing effect of the spine?
-The internal obliques and transverse abdominis increasing intrabdominal pressure to stabilize the spinal
When a person is not injured, what is neutral spine?
-A position in which a vertical force exterted through the spine allow equal weight transference on all weight bearing surfaces
When a person is injured, what is neutral spine?
-the position in which the patient is most asymptomatic, can produce the most force and maintain posture and agility
What position should you use to train a person experiencing lower back pain?
-The position in which they do not experience pain
What can back pain decrease?
-Agility
What is a technique used to train co contraction of the deep stabilizers?
-Abdominal drawing
Training the deep stabilizers in a prone or quadraped position inhibits what muscle?
-Rectus abdominis
When using the abdominal drawing technique, what compensations should you look for?
-depression of the ribcage, and lateral flaring of the waist
When using a BP cuff to provide feedback, how much change in mmHg is okay?
-6-10
What type of load and duration dosage should you use to train the deep stabilizers?
-Low load, long duration
What type of contraction should you use to train the deep stabilizers?
-Isometric
What percent contraction do you need to train the deep stabilizers?
-1-25%
What else should you train to avoid LBP and injuries?
-Proprioception and agility
Why is agility and proprioception important in LBP rehab?
-They are needed to resspond to a stimuli and change direction before injury occurs
What is spine stabilization training effective for?
-Decreasing pain, decreasing disability, preventing injury, speeding up recovery and avoiding surgury
Who is the most qualified to treat LBP?
-Physical therapists
What is the difference between therapeutic exercise and therapeutic activities?
-Therapeutic activities are more functional
What is muscle setting?
-A low intensity isometric contraction performed against little to no resistance
What is muscle setting used for?
-increase motor recruitment, correct muscle firing, to decrease muscle spasm, promote relaxation and circulation during the acute stage of healing, delay atrophy, and facilitate muscle firing
What is stabilization exercises?
-submaximal, sustained level of coconctration
What do stabilization exercises help with?
-improves postural stability and dynamic stability of a joint
what is used as resistance during stabilization exercises?
-body weight or manual resistance
What is a system of isometric exercise in which resistance is applied manually or mechanically at multiple joint positions within available ROM?
-Multiple-angle isometrics
When are mutliple angle isometrics helpful?
-When a patient has painful arc to strengthen throught the range
What must you do with resistance throughout ROM with multiangle isometrics?
-Change based on where you are in the range
Repetitive 6 to 10 second hold can help decrease what?
-Muscle cramping
What is the physiological overflow?
-Strengthening in one point in the range will only strengthen within 10 degrees of that angle
How many points should you use multiangle isometric throughout rom?
-4 to 6
Multiangle isometrics improve what type of strength?
-static (has little impact on dynamic strength)
What is a precaution for isometrics?
-Valsalva Maneuver
What are the contraindications of isometrics?
-Cardiac Disease, Vascular disorders,
What type of exercise would you use to strengthen someones hamstrings who lack deceleration during the termnial swing phase of gate?
-Eccentrics
What is the order of force production and mechanical efficiency for the 3 types of contraction from least to greatest?
-Eccentric, isometric, concentric
In what type of contraction is force production proportional to the number of units recruited?
-Concentric
Which contraction requires more motor unit recruitment, concentric or eccentric?
-Concentric
Why dont eccentric contraction require as much motor unit recruitment as concentric?
-Noncontractile component supply some resistance
Which contraction uses more energy, concentric or eccentric?
-Concentric
Which contraction creates the most DOMs?
-Eccentric
When should you use eccentrics?
-For improving strength, dont use post surgically
What is some downfall to eccentric training?
-It is more more mode specific, velocity specific, and transfer is limited
What principle should be used for eccentric training programs?
-Exercise should mimic function
What is effective in preventing DOMS?
-Submaxive exercise
What is the repeated bout effect?
-Once soreness is gone and the same exercise is repeated, the same soreness will not result (adaptations have occured)
How can you prevent DOMS with eccentric training?
-Gradually increase loads
What strength grade must a patient have in order to use isometrics?
-3-/5
What types of issues can eccentrics help treat?
-Muscle weakness, disuse, hypermobility and hypomobility
Eccentric training is effective in training what at lower loads than concentric?
-type II fibers
When should you not use eccentrics?
-When acute inflammation is present
What does concentric training improve that eccentrics does not?
-local circulation and capillary density
What type of eccentric exercises are recommended in the acute stage?
-NONE
What type of eccentric exercises are recommended in the sub-acute stage?
-Sub maximal at low speeds
What type of eccentric exercises are recommended in the settled/chronic stage?
-Max load/faster speeds
When should you use isokinetic eccentric exercises?
-the final stages of rehab
What should you dose eccentrics at for treating tendonopathy?
-3 sets for 15 reps, 2x per day, 7 days per week
What should you progress to to improve functionality?
-multiplanar motions
What type of exercises apply dynamic resistance against a constant external resistance? (4)
-Free weights, fixed cable systems, weight machines, functional movements
What types of exercise apply variable resistance?
-Therabands, adjustable cable systems, weight machines,hydraulic, isokinetic
When useing free weights, where should midrange be?
-When the arm is perpindicular to the LOG (parrallel to the floor)
What strength grade must a patient have to perform resistance exercise using weight length tension?
-greater than 3/5
When using a theraband, where does the band stop being matched to the length tension curve of the muscle?
-When it is perpindicular to the level arm
What two things does plyometrics combine?
-Speed and strength
What is the purpose of plyometrics?
-to heighten the exictability of the nervous system for improved reactive ability of the neuromuscular system