Exercise Prescription

Question 1

Define MET

Answer 1

Metabolic equivalent of Task; rate of energy expenditure at rest

Question 2

Describe a Light Activity MET. What are some examples?

Answer 2

Non-sedentary waking behavior requiring less than 3 METS Slow walking, cooking, and light household chores

Question 3

Describe moderate activity in regards to METS. What activities does this include?

Answer 3

Requires 3-6 METs walking briskly, doubles tennis, raking

Question 4

Describe vigorous activity in regards to METS. What activities does this include?

Answer 4

6+ METs including running, carrying heavy objects upstairs, shoveling snow, strenuous fitness class

Question 5

What are the recommendations for children 3-5 in regards to physical activity?

Answer 5

Physically active throughout the day

Question 6

What are the recommendations for children 6-17 in regards to physical activity?

Answer 6

60 minutes or more of moderate vigorous activity

Question 7

What are the recommendations for adults in regards to physical activity?

Answer 7

150-300 minutes of moderate activity or 75-150 minutes of vigorous activity -sit less and move more -muscle strengthening

Question 8

What are the physical recommendations for pregnancy and postpartum?

Answer 8

• 150 minutes per week of moderate aerobic activity - If doing vigorous activity before pregnancy, continue this

Question 9

What is Sheringtons Law of Reciprocal Innervation

Answer 9

“When a muscle contracts, its direct antagonist relaxes in an equal extent allowing smooth movement.” – Sir Charles Scott Sherrington

Question 10

Describe the hypertonic muscles in regards to stress- which muscles get tight and what does this result in? (upper back)

Answer 10

Upper trapezius – elevates scapula • Sternocleidomastoid – together pulls head forward • Levator scapulae – elevates scapula • Pectoralis muscles – internal rotation shoulder (major), scapula protraction (minor) • Cervical erector spinae – cervical extension • Scalenes – Elevation of ribs

Question 11

Describe the hypnotic muscles in regards to stress? What does this cause? (upper back)

Answer 11

• Mid and lower trapezius – (mid) scapula retraction, (lower) depress scapula • Latissimus dorsi – extension, adduction, and internal rotation of humerus • Deep cervical flexors • Rhomboids – elevation and retraction of scapula results in hunching over

Question 12

What are hypertonic muscles that are involved with stress in the lower extremity?

Answer 12

• Iliopsoas – hip flexion • Quadratus lumborum – sidebending of trunk, depress rib 12 • Thoracolumbar erector spinae – spine extension • Hamstrings – hip extension, knee flexion • Rectus femoris – hip flexion, knee extension • Piriformis – abduction of flexed hip, external rotation of extended hip • Thigh Adductors • GastrocSoleus complex – Plantarflexion

Question 13

What are hypotonic muscles that are involved with stress in the lower extremity?

Answer 13

• Gluteus minimus – abduction of femur, internal rotation • Gluteus medius – abduction of femur, internal rotation • Gluteus maximus – hip extension • Vastus medialis, intermedius, and lateralis – knee extension • Rectus abdominis – flexion of spine • Tibialis anterior - dorsiflexion

Question 14

***Describe the Levator scapula stress

Answer 14

For left side: 1. Grasp back of chair with left hand and lean toward right knee. 2. Look down at right chest, “in your pocket.” 3. Use right hand to reach behind head and apply minimal pressure at occiput toward right knee. Recommend using 4th and 5th fingers. 4. Inhale deeply and stretch further with exhalation.

Question 15

***If a patient presented with pain in the base of the neck, how would you treat the patient?

Answer 15

Levator Scapula stretch

Question 16

***If a patient presented with a 1st or second rib somatic dysfunction, how would you treat the patient?

Answer 16

Scalene Stretch

Question 17

***Describe the scalene stretch

Answer 17

For left side:

1. Use right hand to reach over head and grab just above the left ear.
2. Sidebend head away from affected side using force from hand on head.
3. Inhale deeply and stretch further on exhalation.

For added stretch, place hand of affected side under buttocks palm up.

Question 18

***If a patient presented with a shoulder extension SD, how would you treat them?

Answer 18

Prayer stretch for the latissimus dorsi

Question 19

***If a patient presented with a shoulder internal rotation somatic dysfunction, how would you treat?

Answer 19

Subscapularis (IR) gravity Stretch

Question 20

***Describe the subscapularis (IR) gravity stretch

Answer 20

For left side:

1. Lying supine, abduct left arm 90 degrees and externally rotate to restriction.
2. Inhale deeply and exhale fully for 3-5 cycles.

Question 21

***If you had a patient present with a shoulder internal rotation SD, other than the subscapularis gravity stretch, what is another treatment that you could perform?

Answer 21

Pec major and minor stretch

OR the scapular retratining stretch

Question 22

***Describe the Pectoralis major and minor stretch

Answer 22

1. Stand in doorway and place hands on door frame. 2. Lean forward at chest.
2. Hold stretch for 10-60 seconds.
3. Vary height of hands to stretch different parts of the muscle.

Question 23

***What is a stretch that targets the rhomboids? What is it used for?

Answer 23

Scapular retraining stretch; used for a shoulder internal rotation SD

Question 24

***Describe the Scapular retraining stretch

Answer 24

1. Lying supine, push elbows posteriorly

and squeeze scapulae together. Chin tuck may enhance exercise.

Question 25

***If a patient presents with a hip flexions SD, how would you treat the patient?

Answer 25

Iliopsoas and rectus femoris stretch

Question 26

*** Describe the iliopsoas and rectus femoris stretch

Answer 26

For left side:
1. Stand in front of a chair.

2. Place dorsal aspect of left foot on chair, keeping both knees slightly bent.
3. Push hips forward until stretch is felt

Question 27

*** If a patient presetned with a hip adduction SD, how would you treat them?

Answer 27

Lower Extremity ADductor stretch

Question 28

***Describe a lower extremity ADductor stretch

Answer 28

1. With back straight, sit as close to a wall as possible, soles of feet together.
2. Place hands on floor behind hips and press hands into the floor.
3. Arch back to initiate stretch.

Question 29

***If a patient presents with a weak Gluteus medius, what exercise would you encourage them to do? You could see the weakness with a Trendelenberg gait

Answer 29

Clamshell Exercise

Question 30

***Describe the clamshell exercise

Answer 30

For left side:

1. From a lateral recumbent position, flex hips to 45 degrees and flex knees 90 degrees.
2. Keeping feet together, raise left knee ~6 inches (~15 cm) while exhaling.
3. Return to starting position during inhalation. 4. Repeat 10-15 times per session.

Question 31

If a patient presents with pain and tenderness to the bttocks and the posterior leg, which stretch would you have them do?

Answer 31

The piriformis stretch

Question 32

Describe the piriformis stretch?

Answer 32

For left side:

1. Lay supine with left hip flexed and adducted and knee flexed. Place left foot lateral to right knee.
2. Place right hand on lateral aspect of left knee.
3. With exhalation, apply gentle pressure to pull knee further to right side of body.

Question 33

***If you have a patient present with lumbar side beding SD and low back pain, what stretch would you have them do?

Answer 33

Quadratus lumborum stretch

Question 34

Describe the quadratus lumborum stretch

Answer 34

For left side:

1. Stand with feet roughly shoulder width apart.
2. Reach right arm down to knee while looking toward the ceiling.
3. Inhale deeply.
4. On exhalation, look down and stretch hand further down leg.

Question 35

What are the stretching guidelines?

Answer 35

stretch after exercise

Hold the stretch for 10-30 seconds

tension should be comofrtable not painful

breath freely

do not lock joints

repeat 2-3 times

Question 36

***Describe balance training

Answer 36

1. Balance on left leg with hands on hips. May hold onto a stationary object if needed.
2. Slowly reach out with right leg as far as possible without touching the floor.
3. Repeat with varying directions for right leg.

Question 37

What are the 5 models of osteopathic care

Answer 37

biomechanical

respiratory

neurologic

metabolic

behavioral