Extremities Course Introduction & Basic Principles

Question 1

During which of the 6 basic steps of the physiotherapeutic process do you begin to form a hypothesis?

Answer 1

Step 2: History-taking

Question 2

List the 6 fundamental steps of the whole physiotherapeutic process

Answer 2

1. Screening
2. History-taking (including forming a hypothesis)
3. Basic Assessment (Observation/Posture Analysis, Functional Assessment, Range of Motion, Manual Muscle Testing)
4. Special Testing (including Clinimetrics)
5. Treatment
6. Re-Assessment to evaluate the treatment

Question 3

What is the first of the 6 steps of the physiotherapeutic process?

Answer 3

Screening

Question 4

What is the second of the 6 steps of the physiotherapeutic process?

Answer 4

History-taking (including formation of a hypothesis)

Question 5

What is the third of the 6 steps of the physiotherapeutic process?

Answer 5

Basic Assessment (Observation/Posture Analysis, Functional Assessment, Range of Motion, Manual Muscle Testing)

Question 6

What is the fourth of the 6 steps of the physiotherapeutic process?

Answer 6

Special Testing (including Clinimetrics)

Question 7

What is the fifth of the 6 steps of the physiotherapeutic process?

Answer 7

Treatment

Question 8

What is the last of the 6 steps of the physiotherapeutic process?

Answer 8

Re-Assessment to evaluate the treatment

Question 9

What are 4 components that make up the Basic Assessment stage of the physiotherapeutic process?

Answer 9

1. Observation/Posture Analysis
2. Functional Assessment
3. Range of Motion
4. Manual Muscle Testing

Question 10

True or False: During the Screening stage of the physiotherapeutic process, it’s better to ask closed-ended, “yes”/”no” questions.

Answer 10

True

Question 11

What is the purpose of the Screening stage of the physiotherapeutic process?

Answer 11

to look for patterns that might show a severe pathology that falls outside of the physical therapy scope of practice and/or requires urgent referral to a physician (a.k.a “Red Flags”)

Question 12

What are the 7 steps of a good, thorough screening process?

Answer 12

1. Health-Seeking Question
2. General Red Flags
3. Specific Red Flags
4. Tract Anamnesis
5. Normal or Abnormal Course?
6. Is the Pain Mechanical / Movement-Dependent?
7. Your Conclusion

Question 13

What is meant by a “health-seeking question” in the physiotherapy screening process?

Answer 13

the patient is asked to briefly (in a few sentences) sum up why they are seeking your help

Question 14

What is the first of the 7 steps of a good, thorough screening process?

Answer 14

determining the patient’s health-seeking question

Question 15

What is the second of the 7 steps of a good, thorough screening process?

Answer 15

look for the presence of general red flags

Question 16

What is the third of the 7 steps of a good, thorough screening process?

Answer 16

look for the presence of specific red flags

Question 17

What is the fourth of the 7 steps of a good, thorough screening process?

Answer 17

determine if symptoms might be due to tract anamnesis

Question 18

What is the fifth of the 7 steps of a good, thorough screening process?

Answer 18

determine if this condition is following a normal or abnormal course

Question 19

What is the sixth of the 7 steps of a good, thorough screening process?

Answer 19

determine if the symptoms are mechanical / movement-related

Question 20

What is the last of the 7 steps of a good, thorough screening process?

Answer 20

your conclusion that the person is or is not appropriate for physiotherapy treatment and/or referral to a physician

Question 21

What are 11 questions to detect the presence of general red flags during the screening process?

Answer 21

1. Do you feel generally unwell at the moment?
2. Have you recently had an unexplained fever? (~2 weeks?)
3. Have you lost more than 10lbs in the past 2 weeks?
4. Have you ever had cancer?
5. Have you ever used corticosteroids for a prolonged period? (e.g. prednisone, cortisone)
6. Have you experienced physical trauma that led to your symptoms?
7. Do you have pain at night?
8. Do you experience widespread changes in sensation in your arms or legs?
9. Do you experience dizziness?
10. Do you experience problems with balance?
11. Do you experience problems with vision?

Question 22

Why, while screening for general red flags during a thorough screening process, should you ask the person if they feel generally unwell at the moment?

Answer 22

general malaise can indicate chronic inflammation, possibly due to infection or other systemic diseases

Question 23

Why, while screening for general red flags during a good screening process, should you ask the person about recent unexplained fever?

Answer 23

this can indicate chronic inflammation, possibly due to infection or other systemic diseases

Question 24

Why, while screening for general red flags during a thorough screening process, should you ask the person if they’ve lost more than 10 lbs in the past 2 weeks?

Answer 24

a tumor can consume a high amount of energy in order to sustain its growth, so people with cancer can lose weight quickly and unexpectedly

Question 25

Why, while screening for general red flags during a thorough screening process, should you ask the person if they’ve ever had cancer?

Answer 25

a history of cancer is the strongest predictor of future development of cancer

Question 26

Why, while screening for general red flags during a thorough screening process, should you ask the person if they’ve ever used corticosteroids for a prolonged period?

Answer 26

prolonged use of medications like Cortisone or Prednisone weakens soft tissue structures and bone, which can make them more prone to fracture or ligamentous injuries

Question 27

Why, while screening for general red flags during a thorough screening process, should you ask the person if the person experienced physical trauma?

Answer 27

mainly for screening for fracture risk

Question 28

Why, while screening for general red flags during a thorough screening process, should you ask the person if they have pain at night?

Answer 28

• pain at rest indicates non-musculoskeletal pathology
• this is only concerning if they aren’t talking about a specific position that is uncomfortable (ex. sidelying on a painful hip or shoulder)

Question 29

What 4 serious pathologies are you trying to detect during the General Red Flags stage of a good, thorough screening process?

Answer 29

1. Cancer
2. Infection
3. Fracture
4. Central Neurologic Problems

Question 30

Why, while screening for general red flags during a thorough screening process, should you ask the person if they experience widespread sensation changes in their arms or legs?

Answer 30

central nervous system pathology can cause bilateral sensory changes in the extremities

Question 31

Why, while screening for general red flags during a good, thorough screening process, should you ask the person if they experience dizziness?

Answer 31

central nervous system pathology can cause dizziness

Question 32

Why, while screening for general red flags during a thorough screening process, should you ask the person if they have problems with balance?

Answer 32

central nervous system pathology can cause balance issues

Question 33

Why, while screening for general red flags during a thorough screening process, should you ask the person if they have problems with vision?

Answer 33

central nervous system pathology can cause vision issues

Question 34

What are 5 things that may be general red flags for cancer?

Answer 34

1. cancer in the person’s past
2. pain at night
3. non-mechanical pain
4. general discomfort/unease
5. unexplained weight loss (more than 10 lbs in 2 weeks)

Question 35

What are 5 things that may be general red flags for infection?

Answer 35

1. night pain
2. non-mechanical pain
3. fever (greater than 100°)
4. night sweating
5. general discomfort/unease

Question 36

What are 4 things that may be general red flags for a fracture?

Answer 36

1. prolonged corticosteroid use (1 month or more, depending on the dose)
2. trauma
3. severe pain that does not reduce following the onset
4. night pain

Question 37

What are 4 things that may be general red flags for central nervous system pathology?

Answer 37

1. widespread sensation changes in the arms or legs
2. dizziness
3. problems with balance
4. problems with vision

Question 38

There are several “tracts” - or systems of body parts and organs - that can cause peripheral symptoms. List 5 of the major tracts to consider when performing a good, thorough screening process.

Answer 38

1. cardiovascular tract
2. respiratory tract
3. digestive tract
4. urogenital tract
5. locomotor tract

Question 39

When screening for Tract Anamnesis, what are 4 areas of the body that may be painful due to issues in the cardiovascular tract?

Answer 39

ischemic heart problems can cause pain in the:
1. left shoulder
2. left arm
3. anterior neck
4. cervicothoracic spine

Question 40

When screening for Tract Anamnesis, radiating medial arm pain can be caused by which underlying pathology? List 4 other signs/symptoms that may indicate this serious issue.

Answer 40

• A Pancoast Tumor (growth in the apex of the lung, above the 1st rib)
  1. unusual coughing
  2. changes in color, consistency, or blood in the phlegm/mucus
  3. existing lung disease
  4. shortness of breath / wheezing

Question 41

What serious underlying condition should be screened for / ruled out if someone presents with radiating medial arm pain?

Answer 41

respiratory tract anamnesis, specifically a Pancoast Tumor

Question 42

Unusual coughing, changes in the color/consistency of mucus, existing lung disease, and/or shortness of breath/wheezing are all red flags for which serious underlying pathology? How might this condition present similarly to a musculoskeletal issue?

Answer 42

• a Pancoast Tumor (growth in the apex of the lung, above the 1st rib)
• Pancoast tumors can present clinically as radiating medial arm pain

Question 43

When screening for Tract Anamnesis, what are 2 organs of the digestive tract can cause low back and/or groin pain?

Answer 43

1. the appendix
2. the small intestine

Question 44

When screening for Tract Anamnesis, what are 4 organs of the digestive tract can cause shoulder pain?

Answer 44

1. the liver
2. the gallbladder
3. the pancreas
4. the spleen

Question 45

When screening for Tract Anamnesis, which organ of the urogenital tract can cause low back or groin pain?

Answer 45

1. the kidney(s)

Question 46

When screening for Tract Anamnesis, what are two rheumatic diseases of the locomotor tract can cause multiple different symptoms that mimic musculoskeletal pain?

Answer 46

1. ankylosing spondylitis
2. rheumatoid arthritis

Question 47

When screening for tract anamnesis, pain in which 3 body parts might indicate screening for digestive tract pathology? List 5 things you should ask about during screening.

Answer 47

• low back pain
• groin pain
• shoulder pain

1. stomach aches
2. food intolerances
3. nausea
4. bowel movements
5. pain after eating

Question 48

List 4 organs/tissues that are innervated by the Phrenic Nerve (C3-C5) and can therefore cause referred shoulder pain

Answer 48

1. the liver
2. the diaphragm
3. the pericardium
4. the gallbladder

Question 49

List 4 organs/tissues that are innervated by the Phrenic Nerve (C3-C5) and can therefore cause referred neck pain

Answer 49

1. the liver
2. the diaphragm
3. the pericardium
4. the gallbladder

Question 50

Which nerve innervates the liver and can therefore cause referred shoulder pain? Which 3 nerve root levels contribute to this nerve?

Answer 50

Right phrenic nerve (C3-C5)

Question 51

Which nerve innervates the liver and can therefore cause referred neck pain? Which 3 nerve root levels contribute to this nerve?

Answer 51

Right phrenic nerve (C3-C5)

Question 52

Which nerve innervates the diaphragm and can therefore cause referred shoulder pain? Which 3 nerve root levels contribute to this nerve?

Answer 52

Phrenic nerves (C3-C5)

Question 53

Which nerve innervates the diaphragm and can therefore cause referred neck pain? Which 3 nerve root levels contribute to this nerve?

Answer 53

Phrenic nerves (C3-C5)

Question 54

Which nerve innervates the pericardium and can therefore cause referred shoulder pain? Which 3 nerve root levels contribute to this nerve?

Answer 54

Phrenic nerves (C3-C5)

Question 55

Which nerve innervates the pericardium and can therefore cause referred neck pain? Which 3 nerve root levels contribute to this nerve?

Answer 55

Phrenic nerve (C3-C5)

Question 56

Which nerve innervates the gallbladder and can therefore cause referred neck pain? Which 3 nerve root levels contribute to this nerve?

Answer 56

Right phrenic nerve (C3-C5)

Question 57

Which nerve innervates the gallbladder and can therefore cause referred neck pain? Which 3 nerve root levels contribute to this nerve?

Answer 57

Right phrenic nerve (C3-C5)

Question 58

The gallbladder shares afferent innervation (Phrenic nerve) with which 2 body parts?

Answer 58

1. the right shoulder
2. the right neck

Question 59

The liver shares afferent innervation (Phrenic nerve) with which 2 body parts?

Answer 59

1. the right shoulder
2. the right neck

Question 60

The diaphragm shares afferent innervation (Phrenic nerve) with which 2 body parts?

Answer 60

1. the shoulders
2. the neck

Question 61

The pericardium shares afferent innervation (Phrenic nerve) with which 2 body parts?

Answer 61

1. the left shoulder/arm
2. the neck

Question 62

Which 2 organs/tissues are innervated by the Greater Splanchnic Nerve (T6-T9) and can therefore cause referred scapular pain?

Answer 62

1. the stomach
2. the pancreas

Question 63

Which 2 organs/tissues are innervated by the Greater Splanchnic Nerve (T6-T9) and can therefore cause referred mid-back pain?

Answer 63

1. the stomach
2. the pancreas

Question 64

Which nerve innervates the stomach and can therefore cause referred mid-back pain? Which 4 nerve root levels contribute to this nerve?

Answer 64

Greater Splanchnic Nerve (T6-T9)

Question 65

Which nerve innervates the stomach and can therefore cause referred scapular pain? Which 4 nerve root levels contribute to this nerve?

Answer 65

Greater Splanchnic Nerve (T6-T9)

Question 66

Which nerve innervates the pancreas and can therefore cause referred mid-back pain? Which 4 nerve root levels contribute to this nerve?

Answer 66

Greater Splanchnic Nerve (T6-T9)

Question 67

Which nerve innervates the pancreas and can therefore cause referred scapular pain? Which 4 nerve root levels contribute to this nerve?

Answer 67

Greater splanchnic nerve (T6-T9)

Question 68

The stomach shares afferent innervation (Greater splanchnic nerve) with which 2 body parts?

Answer 68

1. the mid-back
2. the scapular region

Question 69

The pancreas shares afferent innervation (Greater splanchnic nerve) with which 2 body parts?

Answer 69

1. the mid-back
2. the left scapula

Question 70

Which 2 organs/tissues are innervated by the Lesser Splanchnic Nerve (T10-T11) and can therefore cause referred mid-back pain?

Answer 70

1. the small intestine
2. the appendix

Question 71

Which nerve innervates the small intestine and can therefore cause referred mid-back pain? Which 2 nerve root levels contribute to this nerve?

Answer 71

Lesser Splanchnic Nerve (T10-T11)

Question 72

Which nerve innervates the appendix and can therefore cause referred mid-back pain? Which 2 nerve root levels contribute to this nerve?

Answer 72

the Lesser splanchnic nerve (T10-T11)

Question 73

The small intestine shares afferent innervation (Lesser splanchnic nerve) with which part of the body?

Answer 73

the mid-back

Question 74

The appendix shares afferent innervation (Lesser splanchnic nerve) with which part of the body?

Answer 74

the right mid-back

Question 75

Which organ is innervated by the Lesser and Lumbar splanchnic nerves (T10-L3) and can therefore cause referred pelvis pain?

Answer 75

the Colon

Question 76

Which organ is innervated by the Lesser and Lumbar splanchnic nerves (T10-L3) and can therefore cause referred low back pain?

Answer 76

the Colon

Question 77

Which 2 nerves innervate the colon and can therefore cause referred pelvis pain? Which 5 nerve root levels contribute to these nerve?

Answer 77

Lesser splanchnic & Lumbar splanchnic nerves (T10-T11 & L1-L3)

Question 78

Which 2 nerves innervate the colon and can therefore cause referred low back pain? Which 6 nerve root levels contribute to these nerves?

Answer 78

Lesser splanchnic & Lumbar splanchnic nerves (T10-L3)

Question 79

The colon shares afferent innervation (Lesser & Lumbar splanchnic nerves) with which 2 parts of the body?

Answer 79

1. the pelvis
2. the low back

Question 80

Which 2 organs/tissues are innervated by the Pelvic splanchnic nerves (S2-S4) and can therefore cause referred pelvis pain

Answer 80

1. the sigmoid colon
2. pelvic viscera

Question 81

Which 2 organs/tissues are innervated by the Pelvic splanchnic nerves (S2-S4) and can therefore cause referred low back pain

Answer 81

1. the sigmoid colon
2. pelvic viscera

Question 82

Which 2 organs/tissues are innervated by the Pelvic splanchnic nerves (S2-S4) and can therefore cause referred sacrum pain

Answer 82

1. the sigmoid colon
2. pelvic viscera

Question 83

Which nerves innervate the sigmoid colon and can therefore cause referred pelvis pain? Which 3 nerve root levels contribute to these nerves?

Answer 83

the Pelvic splanchnic nerves (S2-S4)

Question 84

Which nerves innervate the sigmoid colon and can therefore cause referred low back pain? Which 3 nerve root levels contribute to these nerves?

Answer 84

the Pelvic splanchnic nerves (S2-S4)

Question 85

Which nerves innervate the sigmoid colon and can therefore cause referred sacrum pain? Which 3 nerve root levels contribute to these nerves?

Answer 85

the Pelvic splanchnic nerves (S2-S4)

Question 86

Which nerves innervate the pelvic viscera and can therefore cause referred pelvis pain? Which 3 nerve root levels contribute to these nerves?

Answer 86

the Pelvic splanchnic nerves (S2-S4)

Question 87

Which nerves innervate the pelvic viscera and can therefore cause referred sacrum pain? Which 3 nerve root levels contribute to these nerves?

Answer 87

the Pelvic splanchnic nerves (S2-S4)

Question 88

The sigmoid colon shares afferent innervation (Pelvic splanchnic nerves) with which 3 parts of the body?

Answer 88

1. the pelvis
2. the low back
3. the sacrum

Question 89

The pelvic viscera share afferent innervation (Pelvic splanchnic nerves) with which 3 parts of the body?

Answer 89

1. the pelvis
2. the low back
3. sacrum

Question 90

Which organ is innervated by the Pudendal nerve (S2-S4) and can therefore cause referred low back pain?

Answer 90

the rectum

Question 91

Which organ is innervated by the Pudendal nerve (S2-S4) and can therefore cause referred sacrum pain?

Answer 91

the rectum

Question 92

Which organ is innervated by the Pudendal nerve (S2-S4) and can therefore cause referred gluteal pain?

Answer 92

the rectum

Question 93

Which nerve innervates the Rectum and can therefore cause referred low back pain? Which 3 nerve root levels contribute to this nerve?

Answer 93

the Pudendal nerve (S2-S4)

Question 94

Which nerve innervates the Rectum and can therefore cause referred sacrum pain? Which 3 nerve root levels contribute to this nerve?

Answer 94

the Pudendal nerve (S2-S4)

Question 95

Which nerve innervates the Rectum and can therefore cause referred gluteal pain? Which 3 nerve root levels contribute to this nerve?

Answer 95

the Pudendal nerve (S2-S4)

Question 96

The rectum shares afferent innervation (Pudendal nerve) with which 3 parts of the body?

Answer 96

(usually left-sided)
1. the low back
2. the sacrum
3. the gluteal areas

Question 97

Which 2 organs/tissues are innervated by the Lesser, Lumbar, and Pelvic Splanchnic nerves (T10-S4) and can therefore cause referred low back pain?

Answer 97

1. the ureters
2. the testes

Question 98

Which 2 organs/tissues are innervated by the Lesser, Lumbar, and Pelvic Splanchnic nerves (T10-S4) and can therefore cause referred upper thigh pain?

Answer 98

1. the ureters
2. the testes

Question 99

Which organ/tissue is innervated by the Lesser, Lumbar, and Pelvic Splanchnic nerves (T10-S4) and can therefore cause referred genital pain?

Answer 99

the ureters

Question 100

Which organ/tissue is innervated by the Lesser, Lumbar, and Pelvic Splanchnic nerves (T10-S4) and can therefore cause referred sacrum pain?

Answer 100

the testes

Question 101

Which 3 nerves innervate the ureters and can therefore cause referred low back pain? Which 12 nerve root levels contribute to this nerve?

Answer 101

the Lesser splanchnic, Lumbar splanchnic, and Pelvic splanchnic nerves (T10-S4)

Question 102

Which 3 nerves innervate the ureters and can therefore cause referred upper thigh pain? Which 12 nerve root levels contribute to this nerve?

Answer 102

the Lesser splanchnic, Lumbar splanchnic, and Pelvic splanchnic nerves (T10-S4)

Question 103

Which 3 nerves innervate the ureters and can therefore cause referred genital pain? Which 12 nerve root levels contribute to this nerve?

Answer 103

the Lesser splanchnic, Lumbar splanchnic, and Pelvic splanchnic nerves (T10-S4)

Question 104

Which 3 nerves innervate the testes and can therefore cause referred low back pain? Which 12 nerve root levels contribute to this nerve?

Answer 104

the Lesser splanchnic, Lumbar splanchnic, and Pelvic splanchnic nerves (T10-S4)

Question 105

Which 3 nerves innervate the testes and can therefore cause referred sacrum pain? Which 12 nerve root levels contribute to this nerve?

Answer 105

the Lesser splanchnic, Lumbar splanchnic, and Pelvic splanchnic nerves (T10-S4)

Question 106

The ureters share afferent innervation (Lesser, Lumbar, and Pelvic Splanchnic nerves) with which 3 areas of the body?

Answer 106

1. the low back
2. the upper thigh
3. the genitalia

Question 107

The testes share afferent innervation (Lesser, Lumbar, and Pelvic Splanchnic nerves) with which 2 areas of the body?

Answer 107

1. the low back
2. the sacrum

Question 108

During the 5th stage of a good, thorough screening process, ask yourself: “Is this person’s pain following a normal course?”. As a general rule of thumb, nearly musculoskeletal all injuries heal within how many weeks?

Answer 108

12 weeks (or around 3 months)

Question 109

During the 5th stage of a good, thorough screening process, ask yourself: “Is this person’s pain following a normal course?”. Within 12 weeks (or around 3 months) of most injuries, what 2 changes in the person’s recovery would you expect to see?

Answer 109

during that time frame, we should expect to see

1. pain decrease
2. activity levels increase

Question 110

For most injuries, decreased pain and increased activity levels should occur within the first 12 weeks (or about 3 months). If not, what should next be explored?

Answer 110

What are the negative prognostic factors that have delayed / prevented recovery?

Question 111

During the 5th stage of a good, thorough screening process, what might be considered a red flag?

Answer 111

If pain and activity levels don’t improve within 3 months (for most injuries) & there are also no significant negative prognostic factors present
(rare cases)

Question 112

During the 6th stage of a good, thorough screening process, what is meant by calling pain “movement-dependent”

Answer 112

the person’s complaint can be aggravated or eased by movement and/or repositioning

Question 113

During the 6th stage of a good, thorough screening process, “non-mechanical” pain is common in which 2 pathologies?

Answer 113

1. infection
2. cancer

Question 114

Infection and cancer commonly cause “non-mechanical” pain that is constant. Musculoskeletal pain can also be constant. When differentiating between the two during a good, thorough screening process, what might be a way to tell the difference?

Answer 114

Even if that person’s musculoskeletal pain is constant, there should be certain movements that clearly aggravate or at least reduce their pain.

Question 115

Define “non-mechanical” pain

Answer 115

pain with an absence of a movement-dependent component

Question 116

During the 7th and final stage of a good, thorough screening process, it can be helpful to perform what mental exercise before proceeding?

Answer 116

Summarize your findings from the first 6 stages

Question 117

During the 7th and final stage of a good, thorough screening process, what is the fundamental question that you are trying to answer?

Answer 117

“Is this person appropriate for me to treat?”

Question 118

If you conclude your good, thorough screening process and the person is appropriate for you to treat, what next step should you take?

Answer 118

start History-taking

Question 119

If you conclude your good, thorough screening process that there are multiple different red flags, what next step should you take?

Answer 119

perform orthopaedic or neurologic screening tests to investigate specific red flags further

Question 120

During the second of the 6 steps of the physiotherapeutic process, the patient’s history is taken. What are 3 general goals of this step?

Answer 120

1. form a hypothesis about the person’s pathology
2. identify what the person’s impairments are
3. identify what negative prognostic factors that physiotherapy can influence

Question 121

What tool does Physiotutors recommend to help guide your history-taking process?

Answer 121

the Rehabilitation Problem-Solving (RPS) Form

Question 122

During the patient history-taking stage of the physiotherapeutic process, what are the first 2 general questions that you want to ask?

Answer 122

1. What happened to cause their issue?
2. What do they want to regain from physiotherapy treatment?

Question 123

During the patient history-taking stage of the physiotherapeutic process, what is the primary reason that you should have the patient elaborate on the mechanism of injury?

Answer 123

you want to be able to picture which structures might be affected

Question 124

During the patient history-taking stage of the physiotherapeutic process, it’s important to ask about signs of inflammation. List 5 things to ask about specific to the affected body part.

Answer 124

1. redness
2. swelling
3. warmth
4. pain
5. impairment in function

Question 125

During the patient history-taking stage of the physiotherapeutic process, you might ask the person to choose and rate at least 3 specific activities that are difficult or problematic due to their complaint. How do you know whether or not the activity should be considered an activity vs a participation impairment?

Answer 125

if an impaired activity has a social component, it is considered a participation impairment

Question 126

During the patient history-taking stage of the physiotherapeutic process, what are 2 important reasons to ask about a patient’s current medications?

Answer 126

Medications can give you an idea of
- comorbidities that might affect your treatment process
- the person’s coping skills/strategies for dealing with their condition

Question 127

During the patient history-taking stage of the physiotherapeutic process, you’re looking for both personal and environmental factors that might affect the treatment process. Explain the difference between the two & give a few examples of each.

Answer 127

• personal factors: inside of us; can’t be taken away (marital status, coping strategy, stress)
• environmental factors: outside of us; may have a good or bad influence on rehab (single-point cane, 3rd floor apartment with elevator)

Question 128

During the patient history-taking stage of the physiotherapeutic process, you should always ask about body functions, activities, participation, current medications, and personal/environmental factors around their complaint. List 3 other general things outside of their specific complaint that you should probably have information on.

Answer 128

1. any earlier pathologies
2. any earlier injuries
3. any co-morbidities

Question 129

During the patient history-taking stage of the physiotherapeutic process, there are several pain-specific questions that you should ask to help you form your diagnosis. List 8 particular aspects of someone’s pain that can give you valuable information and guide your hypothesis formation.

Answer 129

1. quality of pain (stabbing, throbbing, dull, fatigue, tensioning, burning, aching)
2. location (clearly limited / focal, diffuse, radiating)
3. timing of pain (24-hour behavior, on-and-off phases, how sx have behaved since onset)
4. onset of pain (increased training, workload, or cognitive/emotional stress; lifestyle changes)
5. intensity (severity at worst, best, and average)
6. behavior / “relation” (aggs/eases)
7. duration (brief, long, subchronical)
8. medications that may or may not help (NSAIDs, antieplieptics, antidepressants)

Question 130

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. Give 7 examples of pain “qualities” that may help you form your hypothesis. Which pain types are most often associated with these qualities?

Answer 130

1. stabbing (mechanical nociceptive)
2. pulsing/throbbing (inflammatory nociceptive)
3. dull (inflammatory nociceptive)
4. fatigue (ischemic nociceptive)
5. tensioning (ischemic nociceptive)
6. burning (peripheral neurogenic)
7. aching/”toothache” (peripheral neurogenic)

Question 131

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. List 3 different ways that patients may describe the location of their symptoms and give examples of some types of pain associated with them.

Answer 131

1. focal / clearly limited (mechanical nociceptive and peripheral neurogenic pain)
2. diffuse (central nervous system pain, output - sympathetic nervous system pain)
3. radiating (peripheral neurogenic pain)

Question 132

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions, including the initial onset of their pain. What are 4 common changes in a person’s life that may be associated with the initial onset of pain?

Answer 132

1. increased training
2. increased workload
3. increased cognitive/emotional stress
4. lifestyle changes

Question 133

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. Which 3 aspects of pain intensity/severity should you know to help form your hypothesis?

Answer 133

pain at worst, best, and on average

Question 134

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions.
What is meant by the “behavior” of pain?

Answer 134

what improves the pain & which movements or activities aggravate it?

Question 135

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. What are 3 different durations of pain that someone might describe, and which pain types are most closely associated with each?

Answer 135

1. brief (mechanical nociceptive, inflammatory nociceptive pain)
2. subchronical / repeats over a relatively short period (peripheral neurogenic pain)
3. long (ischemic nociceptive, central nervous system, output - sympathetic nervous system pain)

Question 136

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. Which medications have or have not reduced pain can help guide your hypothesis. List 3 types of pain medication and give examples of types of pain that are improved by each.

Answer 136

1. anti-inflammatories (maybe somewhat for mechanical & ischemic nociceptive pain, but most effective for inflammatory nociceptive pain)
2. antiepileptics (peripheral neurogenic & central nervous system pain)
3. antidepressants (central nervous system pain)

Question 137

During the patient history-taking stage of the physiotherapeutic process, you should ask pain-specific questions. List 3 aspects of the timing of pain that can guide your hypothesis.

Answer 137

1. 24-hour behavior
2. on-and-off phases
3. how sx have behaved since onset

Question 138

During the patient history-taking stage of the physiotherapeutic process, the person may describe a subchronical duration of their pain. Describe what is meant by “subchronical”.

Answer 138

pain that is episodic or that repeats over a relatively short period of time (6 weeks to 3 months)

Question 139

During the patient history-taking stage of the physiotherapeutic process, it’s very important to try to categorize someone’s pain, but very difficult. List the 6 different pain mechanisms described by Physiotutors.

Answer 139

1. Mechanical Nociceptive
2. Inflammatory Nociceptive
3. Ischemic Nociceptive
4. Peripheral Neurogenic
5. Central
6. Output - Sympathetic Nervous System

Question 140

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 of the most common characteristics associated with the quality of Mechanical Nociceptive pain

Answer 140

1. stabbing
2. focal / localized to one area

Question 141

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 of the most common characteristics associated with the quality of Inflammatory Nociceptive pain

Answer 141

1. pulsating/throbbing
2. dull

Question 142

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 of the most common characteristics associated with the quality of Ischemic Nociceptive pain

Answer 142

1. fatigue
2. tensioning
3. feeling of “breaking” or “pulling” apart

Question 143

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 of the most common qualities of Peripheral Neurogenic pain

Answer 143

1. burning
2. radiating
3. aching (“toothache”)

Question 144

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 5 common qualities of Central Nervous System pain

Answer 144

1. diffuse pain
2. changes location / behavior (“does what it wants”, “has a mind of its own”)
3. Multiple locations (“Everything hurts”)
4. extensive pain (spread over large area)
5. “mirror” pain (bilateral)

Question 145

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 of the most common qualities of Output - Sympathetic Nervous System pain

Answer 145

1. swelling (or the sensation of swelling)
2. sweating
3. hot/cold sensations

(trophic changes)

Question 146

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is associated with qualities such as stabbing, focal pain that is clearly limited to one area?

Answer 146

Mechanical Nociceptive pain

Question 147

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is associated with pulsating, throbbing, and/or dull qualities?

Answer 147

Inflammatory Nociceptive pain

Question 148

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is associated with the qualities of fatigue and tensioning?

Answer 148

Ischemic Nociceptive pain

Question 149

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is associated with the qualities of burning, radiating, or a “toothache” that is limited to a specific area?

Answer 149

Peripheral Neurogenic pain

Question 150

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type is associated with the qualities of diffuse/extensive pain that “has a mind of its own”? What other qualitative phenomenon may also occur with this type of pain?

Answer 150

• Central Nervous System pain (Nociplastic)
• Mirror pain (pain occurs in the same location contralaterally)

Question 151

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is associated with trophic changes like swelling, sweating, and hot/cold sensations?

Answer 151

Output - Sympathetic Nervous System pain

Question 152

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 behaviors most commonly associated with Mechanical Nociceptive pain

Answer 152

1. clear, on/off behavior
2. occurs with certain movements
3. rest improves pain

Question 153

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 behaviors most commonly associated with Inflammatory Nociceptive pain

Answer 153

1. pain at rest
2. pain at night
3. careful movement / avoidance behaviors

Question 154

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 behaviors most commonly associated with Ischemic Nociceptive pain

Answer 154

1. posture-dependent
2. worse with sustained positions
3. improved with movement

Question 155

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 behaviors most commonly associated with Central Nervous System pain

Answer 155

1. unpredictable
2. possibly dependent on stress/emotional state
3. changes day-to-day

Question 156

Physiotutors describes multiple different types of pain mechanisms and their attributes. List the pain behavior most commonly associated with Output - Sympathetic Nervous System pain

Answer 156

pain may be connected to stress / emotional state

Question 157

Physiotutors describes multiple different types of pain mechanisms and their attributes. List the 2 types of pain that generally have a relatively short duration

Answer 157

1. Mechanical Nociceptive pain
2. Inflammatory Nociceptive pain

Question 158

Physiotutors describes multiple different types of pain mechanisms and their attributes. List the 3 types of pain that generally have a longer duration

Answer 158

1. Ischemic Nociceptive pain
2. Central Nervous System pain
3. Output - Sympathetic Nervous System pain

Question 159

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain generally presents as “subchronical” pain that repeats over relatively short periods (6-12 weeks)

Answer 159

Peripheral Neurogenic

Question 160

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Mechanical Nociceptive pain?

Answer 160

usually a shorter duration of symptoms

Question 161

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Inflammatory Nociceptive pain?

Answer 161

usually a shorter duration of symptoms

Question 162

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Ischemic Nociceptive pain?

Answer 162

longer duration of symptoms

Question 163

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Peripheral Neurogenic pain?

Answer 163

episodic / “subchronical” (repeating over a relatively short period of time)

Question 164

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Central Nervous System pain?

Answer 164

longer duration of pain

Question 165

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the duration of Output - Sympathetic Nervous System pain?

Answer 165

longer duration of pain

Question 166

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Mechanical Nociceptive pain?

Answer 166

medication isn’t always very effective in reducing pain

Question 167

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Inflammatory Nociceptive pain?

Answer 167

NSAIDs tend to help

Question 168

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Ischemic Nociceptive pain?

Answer 168

medications don’t tend to help very much

Question 169

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Peripheral Neurogenic pain?

Answer 169

CNS-inhibiting medications such as anti-epileptics (Gabapentin) reduce pain

Question 170

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Central Nervous System pain?

Answer 170

CNS-inhibiting medications such as anti-epileptics (Gabapentin) as well as anti-depressants reduce pain

Question 171

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the relationship between medication and Output - Sympathetic Nervous System pain?

Answer 171

hardly any influence on pain (Calcitonin was taken off the market due to cancer risk)

Question 172

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what 2 types of pain have the best prognosis for rehabilitation?

Answer 172

1. Mechanical Nociceptive pain
2. Inflammatory Nociceptive pain

Question 173

Physiotutors describes multiple different types of pain mechanisms and their attributes. What type of pain has a generally good prognosis if the person is able to address their movement/postural habits?

Answer 173

Ischemic Nociceptive pain

Question 174

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what type of pain has a good, but months-long, prognosis for rehabilitation?

Answer 174

Peripheral Neurogenic pain

Question 175

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what 2 types of pain have the worst prognosis for rehabilitation?

Answer 175

1. Central Nervous System pain
2. Output - Sympathetic Nervous System pain

Question 176

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Mechanical Nociceptive pain?

Answer 176

generally good

Question 177

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Inflammatory Nociceptive pain?

Answer 177

generally good

Question 178

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Ischemic Nociceptive pain?

Answer 178

generally good, but requires habit changes

Question 179

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Peripheral Neurogenic pain?

Answer 179

generally good, though it may take months

Question 180

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Central Nervous System pain?

Answer 180

generally bad, especially if the “cause” is not identified

Question 181

Physiotutors describes multiple different types of pain mechanisms and their attributes. Generally, what is the prognosis for rehabilitating Output - Sympathetic Nervous System pain

Answer 181

generally bad, especially if the “cause” is not identified

Question 182

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated with manual therapy?

Answer 182

Mechanical Nociceptive pain

Question 183

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated with medication, immobilization, physiotherapy, and/or load removal?

Answer 183

Inflammatory Nociceptive pain

Question 184

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated by identifying causal factors / postural habits?

Answer 184

Ischemic Nociceptive pain

Question 185

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated with decompression and neurodynamic mobilization?

Answer 185

Peripheral Neurogenic pain

Question 186

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated with education, information, addressing cognitive-affective components, and multi-professional rehab?

Answer 186

Central Nervous System pain

Question 187

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain should be treated with relaxation/breathing exercises, thoracic mobilization, stress management, and lymphatic drainage?

Answer 187

Output - Sympathetic Nervous System pain

Question 188

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 of the best treatment approaches for Mechanical Nociceptive pain

Answer 188

1. mechanical treatment (increase ROM & strengthen)
2. manual therapy

Question 189

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 4 treatments for Inflammatory Nociceptive pain

Answer 189

1. medications
2. immobilization
3. physiotherapy/exercise
4. load reduction/removal

Question 190

Physiotutors describes multiple different types of pain mechanisms and their attributes. What is the primary treatment for Ischemic Nociceptive pain?

Answer 190

identifying causal factors / postural habits

Question 191

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 treatments for Peripheral Neurogenic pain

Answer 191

1. decompression
2. neurodynamic mobilization

Question 192

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 treatments for Central Nervous System pain.

Answer 192

1. patient education/information
2. identifying cognitive-affective components
3. multi-professional rehab

Question 193

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 4 treatments for Output - Sympathetic Nervous System pain

Answer 193

1. relaxation/breathing exercises
2. stress management
3. thoracic mobilization
4. lymphatic drainage

Question 194

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to a restriction in joint motion?

Answer 194

Mechanical Nociceptive pain

Question 195

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to trauma or tendonitis?

Answer 195

Inflammatory Nociceptive pain

Question 196

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to ergonomics or hypermobility?

Answer 196

Ischemic Nociceptive pain

Question 197

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to carpal tunnel syndrome, thoracic outlet syndrome, radiculopathy, or piriformis syndrome?

Answer 197

Peripheral Neurogenic pain

Question 198

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to chronic low back pain or whiplash disorder?

Answer 198

Central Nervous System pain

Question 199

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain would be most likely to occur due to chronic regional pain syndrome, T4 Syndrome, and possibly lateral epicondylalgia?

Answer 199

Output - Sympathetic Nervous System pain

Question 200

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 of the most common injuries/conditions associated with Inflammatory Nociceptive pain

Answer 200

1. trauma
2. tendonitis

Question 201

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 of the most common injuries/conditions associated with Ischemic Nociceptive pain

Answer 201

1. posture
2. hypermobility

Question 202

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 4 examples of common injuries/conditions associated with Peripheral Neurogenic pain

Answer 202

1. carpal tunnel syndrome
2. thoracic outlet syndrome
3. radiculopathies (cervical / lumbar)
4. piriformis syndrome

Question 203

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 3 examples of common injuries/conditions associated with Central Nervous System pain

Answer 203

1. chronic low back pain
2. whiplash-associated disorder
3. fibromyalgia
   (really, all chronic musculoskeletal complaints)

Question 204

Physiotutors describes multiple different types of pain mechanisms and their attributes. List 2 examples of common injuries/conditions associated with Output - Sympathetic Nervous System pain. What additional condition may also be associated with a similar mechanism?

Answer 204

1. chronic regional pain syndrome
2. T4 syndrome

• possibly lateral epicondylalgia

Question 205

Physiotutors describes multiple different types of pain mechanisms and their attributes. What type of pain is caused by hip osetoarthritis?

Answer 205

Mechanical Nociceptive pain

Question 206

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is caused by systemic diseases like Bechterew’s Disease (Ankylosing Spondylitis)?

Answer 206

Inflammatory Nociceptive pain

Question 207

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is caused by arteriosclerosis and/or peripheral artery disease (PAD)?

Answer 207

Ischemic Nociceptive pain

Question 208

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is caused by polyneuropathies and/or amputations?

Answer 208

Peripheral neurogenic pain

Question 209

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is caused by chronic functional problems of the inner organs?

Answer 209

Central Nervous System pain

Question 210

Physiotutors describes multiple different types of pain mechanisms and their attributes. Which type of pain is most closely associated with burnout / chronic fatigue syndrome?

Answer 210

Output - Sympathetic Nervous System pain

Question 211

During the second of the 6 steps of the physiotherapeutic process, the patient’s history is taken and hypotheses are formed. What are the 2 types of hypotheses that should be considered?

Answer 211

1. a hypothesis of the person’s pathology
2. a hypothesis of the person’s impairments that are negatively impacting their recovery

Question 212

During the second of the 6 steps of the physiotherapeutic process, the patient’s history is taken and hypotheses are formed. Why is it important to distinguish between hypotheses about pathology vs those about impairments?

Answer 212

While it’s important to try to establish a hypothesis about the pathology (e.g. diagnosis), it’s important to realize that it’s very often not treatable.

This is why we as physios pay more attention to the impairments (on ICF level) that focus on things like pain, ROM, mobility, strength, endurance, and coordination that ARE treatable by physiotherapy.

Question 213

What does ICD stand for and how does this relate to hypothesis formation during the second of the 6 steps of the physiotherapeutic process?

Answer 213

International Classification of Disease

ICD is a system for coding disease, illness, and injury. It pertains to a specific diagnosis or a musculoskeletal pathology or condition. (often not directly treatable by a physiotherapist)

Question 214

What does ICF stand for and how does this relate to hypothesis formation during the second of the 6 steps of the physiotherapeutic process?

Answer 214

International Classification of Functioning, Disability, and Health

Forming hypotheses about impairments (rather than pathology) allows us to focus on things like pain, ROM, mobility, strength, endurance, and coordination, which negatively impact the ability to recover. (and are directly treatable with physiotherapy)

Question 215

During the second of the 6 steps of the physiotherapeutic process, the patient’s history is taken and hypotheses about impairments are formed (ICF). In addition to factors such as pain, ROM, mobility, strength, endurance, and coordination, what are 2 other factors that are also described and classified by the ICF?

Answer 215

1. environmental factors
2. personal factors

Question 216

During the physiotherapeutic process, what is the goal of the physical assessment as it relates to your hypothesis formation?

Answer 216

the goal of the physical assessment is to confirm (or reject) your hypothesis(es)

if your hypothesis is rejected, move to your next likely hypothesis

Question 217

Form and describe 4 hypotheses about the following case example:
A person has limited active knee extension due to an ACL tear. They experience severe limitations in ADLs and participation and suffers from a fear of movement as a result. Give examples of tools that might be associated with each one.

Answer 217

1. ACL tear (ICD)
   - test: Lachman test
2. limited active knee extension ROM (ICF)
   - tool: goniometer
3. severe limitations in ADLs and participation (ICF)
   - tool: Knee Injury and Osteoarthritis and Outcome Score (KOOS)
4. fear of movement (ICF)
   - tool: Tampa Scale of Kinesiophobia

Question 218

Roughly, how long can Lateral Epicondylalgia (Tennis Elbow) last?

Answer 218

anywhere from 6 - 18 months (about 90% of people achieve resolution of symptoms)

Question 219

Roughly, how long can Plantar Heel Pain last?

Answer 219

13-24 months on average

Question 220

Roughly, how long can Patellofemoral Pain last?

Answer 220

2-8 years (half of people never experience complete resolution of symptoms; no longer considered self-limiting)

Question 221

Roughly, how long can Frozen Shoulder last?

Answer 221

1-3.5 years, with an average of 2.5 years (mild to moderate pain and/or disability may still persist)

Question 222

Roughly, how long can Cervical Radiculopathy last?

Answer 222

substantial improvement in 4-6 months, with 83% of people completely recovering within 2-3 years

Question 223

Roughly, how long can Acute Low Back Pain last?

Answer 223

substantial improvement in pain and disability within 6 weeks, though improvement starts to slow (most people still have minimal, but still present, pain by 1 year)

Question 224

Roughly, how long can Ankle Sprains last?

Answer 224

rapid improvement in pain by 2 weeks, but many continue to have pain, recurrent sprains, and/or instability in the following 1-4 years

Question 225

Roughly, how long can Acute Neck Pain / Whiplash-Associated Disorder last?

Answer 225

about half of people will experience decreased pain and disability by 6 weeks, but anywhere from 50%-80% of people will still have some level of symptoms 1 year later

Question 226

Roughly, how long can Achilles Tendinopathy last?

Answer 226

3-12 months (most patients recover, but 23%-37% of people will still have symptoms at 10 years)

most of the improvement comes within the first year, which means that we shouldn’t take a wait-and-see approach

Question 227

Roughly, how long can Patellar Tendinopathy last?

Answer 227

6+ months (progress is slow and can often take longer)

Question 228

Roughly, how long can Rotator Cuff Related Shoulder Pain last?

Answer 228

half of people will recover within 6 months, but progress often plateaus within the first year (30% of people experience some level of symptoms by 1 year)

Question 229

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and wide-spread pain, specifically?

Answer 229

there is a strong association between wide-spread pain and poorer recovery

Question 230

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and high disability, specifically?

Answer 230

there is a strong association between high disability and poorer recovery

Question 231

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and somatization, specifically?

Answer 231

there is a strong association between somatization and poorer recovery

Question 232

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and high pain intensity/severity, specifically?

Answer 232

there is a moderately strong association between high pain intensity/severity and poorer recovery

Question 233

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and long pain duration, specifically?

Answer 233

there is a moderately strong association between long pain duration and poorer recovery

Question 234

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and depression, specifically?

Answer 234

there is a moderately strong association between depression and poorer recovery

Question 235

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and anxiety, specifically?

Answer 235

there is a moderately strong association between anxiety and poorer recovery

Question 236

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and previous pain episodes, specifically?

Answer 236

there is a weak association between previous pain episodes and poorer recovery

Question 237

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and poor coping strategies, specifically?

Answer 237

there is a weak association between poor coping strategies and poorer recovery

Question 238

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and movement restriction, specifically?

Answer 238

there is a weak association between movement restriction and poorer recovery

Question 239

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and level of education, specifically?

Answer 239

there is strong evidence showing no significant association between level of education and recovery

Question 240

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and use of pain medication, specifically?

Answer 240

there is moderately strong evidence showing no significant association between use of pain medication and recovery

Question 241

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and older age, specifically?

Answer 241

there is weak evidence showing no significant association between older age and recovery

Question 242

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and gender, specifically?

Answer 242

there is weak evidence showing no significant association between gender and recovery

Question 243

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and social support, specifically?

Answer 243

evidence is inconclusive about the association between someone’s social support and recovery

Question 244

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. What is the relationship (and degree of association) between recovery and heavy lifting, specifically?

Answer 244

evidence is inconclusive about the association between heavy lifting and recovery

Question 245

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List 3 prognostic factors that have strong evidence associating them with whether someone will recover from a musculoskeletal condition.

Answer 245

1. the presence of wide-spread pain
2. high levels of disability
3. somatization

Question 246

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List 4 prognostic factors that have moderately strong evidence associating them with whether someone will recover from a musculoskeletal condition.

Answer 246

1. high pain intensity/severity
2. a long duration of pain (3+ months)
3. depression
4. anxiety

Question 247

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List 3 prognostic factors that have weak evidence associating them with whether someone will recover from a musculoskeletal condition.

Answer 247

1. poor coping strategies
2. previous episodes of pain
3. movement restriction

Question 248

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List a prognostic factor that has strong evidence showing no significant association with whether someone will recover from a musculoskeletal condition.

Answer 248

level of education

Question 249

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List a prognostic factor that has moderate evidence showing no significant association with whether someone will recover from a musculoskeletal condition.

Answer 249

use of pain medication

Question 250

Understanding generic prognostic factors is important when setting someone’s expectations and creating a plan of care. List 2 prognostic factors that have weak evidence showing no significant association with whether someone will recover from a musculoskeletal condition.

Answer 250

1. older age
2. female gender

Question 251

During the third step of the physiotherapeutic process, you begin your basic physical assessment with your hypothesis(es) in mind. What is always the first part of your physical assessment? What is the goal of this part?

Answer 251

• Observation/posture analysis in standing
• the goal is to examine the person’s posture and compare bony landmarks (look for structural abnormalities that you might link to your patient’s complain)

Question 252

During the third step of the physiotherapeutic process, you begin your basic physical assessment with your hypothesis(es) in mind. How should you prepare the patient in order to perform the typical observation/posture analysis in standing?

Answer 252

• in order to see specific landmarks, Physiotutors recommends asking the person to remove their shirt & shoes
• ask them to stand upright, looking straight ahead; relax the shoulders and leg the arms hang by the sides

Question 253

During the third step of the physiotherapeutic process, you should first perform your observation/posture analysis in standing. From what 3 positions should you perform you observations?

Answer 253

1. Frontal plane anterior
2. Sagittal plane
3. Front plane posterior

Question 254

During the third step of the physiotherapeutic process, you should first perform your observation/posture analysis in standing. List 11 things you should look for when observing someone in the anterior frontal plane.

Answer 254

1. is head rotated or leaning? (imagine a line from the tip of the nose to the chin to the manubrium of the sternum)
2. compare the heights of the AC joints
3. compare the angles of the clavicles
4. compare the heights of the nipples
5. compare the heights of the iliac crests
6. compare the heights of the ASISs
7. compare the spaces between the trunk and each arm
8. compare arm length by observing the levels of the fingertips
9. compare the apices of the patellae (inferior point)
10. are the knees valgus or varus? (caved or bow-legged)
11. compare the heights of the medial malleoli

Question 255

During the third step of the physiotherapeutic process, you should first perform your observation/posture analysis in standing. List 7 things you should look for when observing someone in the sagittal plane.

Answer 255

1. use the lateral plumb line to see if the head is positioned excessively anteriorly or posteriorly (line runs from earlobe through the humeral head)
2. are the shoulders protracted or retracted?
3. any abnormalities of the cervical lordosis?
4. any abnormalities of the thoracic kyphosis?
5. any abnormalities of the lumbar lordosis?
6. is there about a 15° angle between the PSIS and ASIS? (PSIS is higher)
7. are the knees hyper-extended?

Question 256

During the third step of the physiotherapeutic process, you should first perform your observation/posture analysis in standing. List 12 things you should look for when observing someone in the posterior frontal plane.

Answer 256

1. see if the head is rotated or leaning to one side
2. look for scoliotic curvature of the spine (named after the convex side) - this may be an opportunity to check for McKenzie’s “lateral shift”
3. compare the heights of the acromions
4. compare the heights of the spines of the scapulae
5. compare the heights of the inferior angles of the scapulae
6. look to see if either medial border of the scapulae are raised from the spine/ribcage
7. compare the heights of the iliac crests
8. compare the heights of the PSISs
9. compare the gluteal folds (optional)
10. are the knees valgus or varus? (caved or bow-legged)
11. compare the heights of the medial malleoli
12. look to see the number of toes that are visible from behind (more than 2 toes or any asymmetries should be noted)

Question 257

What is the Postural-Structural-Biomechanical (PSB) model of orthopaedic medicine? What are its limitations currently?

Answer 257

• things like deviations of posture from “normal”, body asymmetries, and pathomechanics are either predisposing and/or maintaining factors for musculoskeletal conditions
• a lot of these PSB factors haven’t been able to show an association with pain, nor shown to cause musculoskeletal pain in the first place

Question 258

In 2009, Van Nieuwenhuyse et al investigated the relationship between physical exam findings and the development of low back pain over the following year in young healthcare or distribution workers (avg age 26). What did they find?

Answer 258

although obese people were more than twice as likely to develop low back pain, if someone had no low back pain during the physical exam, then the exam was “not useful to predict workers at risk for the development of low back disorders one year later”

Question 259

In 2008, Christensen et al performed a systematic review of 54 studies investigating the relationship between sagittal spine curvatures (lordosis/kyphosis) and health (including spinal pain). What did the authors find?

Answer 259

• study quality was low, generally
• there was a moderate association between sagittal spinal curvatures and things like TMD, pelvic organ prolapse, daily function, and death (but “these associations are unlikely to be causal”)
• “evidence from epidemiological studies does not support an association between sagittal spinal curves and health, including spinal pain”

Question 260

In 2005, Knutson et al performed a review of leg length discrepancy and it’s clinical significance. What did they conclude?

Answer 260

• on x-ray, 90% of people have a measurable leg length discrepancy
• the average leg length difference was about 5mm (1/4 thumb’s width)
• leg length difference doesn’t appear to be clinically relevant until about 2 cm (1 thumb’s width, or 3/4 inch)
• “anatomic leg length inequality is near universal, but the average magnitude is small and not likely to be clinically significant”

Question 261

According to Knutson et al (2005), when is leg length discrepancy is likely to be more clinically relevant? What is one way of estimating this in the clinic?

Answer 261

• when there is at least 2 cm (3/4 inch) difference between the two legs
• this is about 1 thumb’s width

Question 262

What is the Weber Barstow Maneuver? How is it performed?

Answer 262

• a technique for estimating leg length discrepancy
• have the patient lie in supine
• apply gentle traction to both legs
• palpate the inferior medial malleoli with your thumbs
• guide the patient’s legs into hooklying
• have the patient perform one repetition of a bridge, then relax
• straighten the legs and bring them together so that your thumbs are almost touching
• compare the heights of the malleoli using your thumbs
  (the average person can have anywhere up to 1/2 a thumb’s difference - if there’s no overlap between thumbs, it may be more significant)

Question 263

During the third step of the physiotherapeutic process, you perform your basic physical assessment with your hypothesis(es) in mind. What should follow your observation/postural assessment?

Answer 263

a functional assessment

Question 264

During the third step of the physiotherapeutic process, you perform your basic physical assessment with your hypothesis(es) in mind. What is the general goal of performing a functional assessment, specifically?

Answer 264

to get a quick idea of which movements the person is having trouble with

Question 265

During the third step of the physiotherapeutic process, a functional assessment is performed. How do you choose which movements to assess?

Answer 265

• the movements should already be familiar from history-taking
• it’s important to choose activities that are part of that person’s familiar routine / ADLs

Question 266

During the third step of the physiotherapeutic process, a functional assessment is performed. Give 3 common examples of functional movements and the biomechanics that you’d investigate with each.

Answer 266

1. walking (gait analysis)
2. picking something up from the floor (forward bending, squatting)
3. reaching overhead (shoulder flexion)

Question 267

During the third step of the physiotherapeutic process, a functional assessment is performed. List 4 things that you should be looking for when the patient demonstrates the movement that they’re having trouble with.

Answer 267

1. the quality of the movement
2. pain and in what range of the movement
3. how far they can go (AROM)
4. how strong the movement is (and/or how stable are they)

Question 268

During the third step of the physiotherapeutic process, a functional assessment is performed. The word “functional” is thrown around a lot. What are the definitions of the terms “functional” and “function”?

Answer 268

• functional: affecting bodily functions, but not structure; designed or developed chiefly from the point of view of use
• function: the natural or proper action of a bodily part in a living thing; the particular purpose for which a person or thing exists; any group of related actions contributing to a larger action

Question 269

During the third step of the physiotherapeutic process, a functional assessment is performed. Physiotutors gives an example of watching someone stand from sitting. As the person stands up, what information can you get from watching their hips, knees, and ankles, respectively?

Answer 269

1. hip joint: AROM (110° flexion to 0° extension), strength (glute max / hip extensor strength of at least 3/5)
2. knee joint: AROM (100° flexion to 0° extension), strength (quads/knee extensors at least 3/5)
3. ankle joint: AROM (~10° dorsiflexion to 0° plantarflexion), strength (gastroc-soleus/plantarflexors at least 3/5)

Question 270

What clinical tool do Physiotutors recommend to use when performing a gait analysis

Answer 270

The Nijmegen (“nay-may-hun”) Gait Analysis form

Question 271

According to the Nijmegen gait analysis form, what 6 areas of observation should you note while assessing someone’s walking gait?

Answer 271

1. general movement
2. the trunk
3. the pelvis
4. both hips
5. both knees
6. both ankles

Question 272

According to the Nijmegen gait analysis form, what are the 11 items to be observed while assessing someone’s gait?

Answer 272

1. shortened stance phase on either leg
2. trunk position relative to hips
3. trunk lateral flexion
4. trunk stiffness / arm swing
5. pelvis rotation
6. hip extension
7. knee extension
8. knee flexion - absent?(“stiff knee”)
9. knee flexion - reduced?
10. knee extension absent in stance
11. ankle plantarflexion in late stance

Question 273

According to the Nijmegen gait analysis form, what is the first and most general item that should be assessed when observing someone’s walking?

Answer 273

is a shortened stance present on either leg?

Question 274

According to the Nijmegen gait analysis form, what 3 things about the trunk should be assessed when observing someone’s walking?

Answer 274

1. what is the trunk position relative to the hip? (should be above or just slightly anterior to the pelvis)
2. is the trunk laterally flexed? (should only be slight flexion toward the stance leg)
3. is arm swing reduced? (a way of assessing trunk rotation)

Question 275

According to the Nijmegen gait analysis form, what about the pelvis should be assessed when observing someone’s walking?

Answer 275

is there any noticeable rotation of the pelvis? (normally, it only rotates 5° forward & backward, so you shouldn’t be able to see it)

Question 276

According to the Nijmegen gait analysis form, what about the hip should be assessed when observing someone’s walking?

Answer 276

is hip extension reduced? (should be extended 10° by contralateral heel strike)

Question 277

According to the Nijmegen gait analysis form, what 4 things about the knee should be assessed when observing someone’s walking?

Answer 277

1. is knee extension in late swing reduced? (should be 0° by initial contact)
2. is the knee flexion movement absent? (should flex to 25° when first weight-bearing)
3. is the amount of knee flexion reduced? (less than 25°)
4. is knee extension in stance reduced? (should be 0° in mid-stance)

Question 278

According to the Nijmegen gait analysis form, what about the ankle should be assessed when observing someone’s walking?

Answer 278

is plantarflexion during late stance reduced? (should be 20° by contralateral initial contact)

Question 279

What is the difference between step length and stride length?

Answer 279

• step: initial contact of one foot to initial contact of the other foot
• stride: initial contact of one foot to the initial contact of the same foot
  (1 stride = 2 steps)

Question 280

Define step length

Answer 280

the distance between the initial contact of one foot to the initial contact of the contralateral foot

Question 281

Define stride length

Answer 281

the distance between the initial contact of one foot and the next initial contact of the same foot
(1 stride = 2 steps)

Question 282

What are the two phases of the gait cycle? What percentage does each phase make up?

Answer 282

• Stance phase (60%)
• Swing phase (40%)

Question 283

During the stance phase of the gait cycle, the foot is always in contact with the ground. List 3 tasks that the stance leg has to complete during this phase.

Answer 283

1. accept the weight of the body
2. move from absorbing impact to propelling the body forward
3. shift the weight of the body onto the contralateral leg to begin weight acceptance on the other side

Question 284

During the normal gait cycle, what is the “loading response”?

Answer 284

the period of stance that starts with initial contact with the ground and ends when the opposite foot lifts off of the ground to begin it’s swing phase

Question 285

During a gait analysis, what are the 4 parts of the stance phase that you should observe?

Answer 285

1. loading response
2. mid-stance
3. terminal stance
4. pre-swing

Question 286

During a gait analysis, what are the 3 parts of the stance phase that you should observe?

Answer 286

1. initial swing
2. mid-swing
3. terminal swing

Question 287

During a gait analysis, what makes up the terminal stance portion of the stance phase?

Answer 287

the heel leaves the floor while the opposite foot makes initial contact

Question 288

During normal gait, what is the main task of the leg during the swing phase?

Answer 288

to bring our leg forward to accept body weight on it again

Question 288

During normal gait, what part of the gait cycle occurs when the opposite leg is in its loading response?

Answer 288

pre-swing (toe off marks the end of the loading response on the other side)

Question 289

During normal gait, how is the initial swing defined?

Answer 289

from toe off to the point when the feet are next to each other

Question 290

During normal gait, how is the mid-swing defined?

Answer 290

the short period between the feet being next to each other to the point where the tibia is vertical

Question 291

During normal gait, how is terminal swing defined?

Answer 291

the short period between the point where the tibia is vertical and the initial contact of the foot on the ground

Question 292

During the gait cycle, what is the first of the 4 stages of stance phase?

Answer 292

initial contact / loading response

Question 293

During the gait cycle, what is the second of the 4 stages of stance phase?

Answer 293

mid-stance

Question 294

During the gait cycle, what is the third of the 4 stages of stance phase?

Answer 294

terminal stance

Question 295

During the gait cycle, what is the last and 4th stage of stance phase?

Answer 295

pre-swing / toe-off

Question 296

During the gait cycle, what is the first of the 3 stages of swing phase?

Answer 296

initial swing

Question 297

During the gait cycle, what is the second of the 3 stages of swing phase?

Answer 297

mid-swing / “tibia vertical”

Question 298

During the gait cycle, what is the last and 3rd stage of swing phase?

Answer 298

terminal swing

Question 299

What is normal shoulder flexion AROM? What is considered “functional” AROM?

Answer 299

180°, ~120°

Question 300

What is normal shoulder extension AROM? What is considered “functional” AROM?

Answer 300

45°-60°, 45°

Question 301

What is normal shoulder external rotation AROM? What is considered “functional” AROM?

Answer 301

90°, 70°

Question 302

What is normal shoulder abduction AROM? What is considered “functional” AROM?

Answer 302

150°-180°, 130°

Question 303

What is normal shoulder internal rotation AROM? What is considered “functional” AROM?

Answer 303

70°-90°, 30°-50°

Question 304

What is normal shoulder horizontal adduction AROM? What is considered “functional” AROM?

Answer 304

130°, 115°

Question 305

What is normal elbow flexion AROM? What is considered “functional” AROM?

Answer 305

145°, 130°

Question 306

What is normal elbow extension AROM? What is considered “functional” AROM?

Answer 306

0°, 30°

Question 307

What is normal wrist flexion AROM? What is considered “functional” AROM?

Answer 307

70°, 5°

Question 308

What is normal wrist extension AROM? What is considered “functional” AROM?

Answer 308

70°-80°, 30°

Question 309

What is normal finger (MCP) flexion AROM? What is considered “functional” AROM?

Answer 309

90°-100°, 60°

Question 310

What is normal finger (MCP) extension AROM? What is considered “functional” AROM?

Answer 310

30°-45°, 10°-30°

Question 311

What is normal trunk flexion AROM? What is considered “functional” AROM?

Answer 311

70°-90°, 40°-60°

Question 312

What is normal trunk extension AROM? What is considered “functional” AROM? (Bonus points for thoracic/lumbar ROM, specifically)

Answer 312

25°-35° (~10° thoracic, ~25° lumbar), 20°-30°

Question 313

What is normal trunk rotation AROM? What is considered “functional” AROM? (Bonus points for thoracic/lumbar ROM, specifically)

Answer 313

40°-70° (~45° thoracic, ~10° lumbar), 30°-40°

Question 314

What is normal trunk lateral flexion AROM? What is considered “functional” AROM?

Answer 314

30°-60°, 20°-30°

Question 315

What is normal hip flexion AROM? What is considered “functional” AROM?

Answer 315

110°-120°, 115°-120°

Question 316

What is normal hip extension AROM? What is considered “functional” AROM?

Answer 316

10°-15°, 10°

Question 317

What is normal hip abduction AROM? What is considered “functional” AROM?

Answer 317

30°-50°, 40°-50°

Question 318

What is normal hip adduction AROM? What is considered “functional” AROM?

Answer 318

30°, 15°-30°

Question 319

What is normal hip external rotation AROM? What is considered “functional” AROM?

Answer 319

40°-60°, 40°-60°

Question 320

What is normal hip internal rotation AROM? What is considered “functional” AROM?

Answer 320

30°-40°, 30°-40°

Question 321

What is normal knee flexion AROM? What is considered “functional” AROM?

Answer 321

130°, 90°-120°

Question 322

What is normal knee extension AROM? What is considered “functional” AROM?

Answer 322

-0° (up to 10°-15° hyperextension is common), 0°

Question 323

What is normal ankle dorsiflexion AROM? What is considered “functional” AROM?

Answer 323

20°, 10° (for walking) - 35° (for squatting)

Question 324

What is normal ankle plantarflexion AROM? What is considered “functional” AROM?

Answer 324

50°, 20°

Question 325

During the third step of the physiotherapeutic process, you should assess passive and active range of motion to confirm/rule out your hypothesis. What are 3 reasons that a joint’s PROM is normal, but AROM is limited?

Answer 325

1. pain
2. muscle weakness
3. active insufficiency

Question 326

What is “active insufficiency” and how does this concept relate to your ROM assessment during examination of a joint?

Answer 326

• when a multi-joint muscle actively shortens across all joints simultaneously, reducing its ability to generate optimal tension/force
• active insufficiency should be suspected if PROM is full, but the person is unable to move through the full range actively

Question 327

During the third step of the physiotherapeutic process, you should assess passive and active range of motion to confirm/rule out your hypothesis. What are 6 reasons that both a joint’s PROM and AROM are equally limited?

Answer 327

1. capsule is limiting motion (arthrogenic)
2. bone-to-bone (arthrogenic)
3. muscle spasm (myogenic)
4. contracture (myogenic)
5. shortened muscle (myogenic)
6. passive insufficiency

Question 328

What is “passive insufficiency” and how does this concept relate to your ROM assessment during examination of a joint?

Answer 328

• when a multi-joint muscle is stretched across all joints simultaneously, limiting how far the joint can move
• during the examination, passive insufficiency should be suspected with the AROM and PROM are equally limited

Question 329

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What are the 3 normal types of end-feel? Give an example of each.

Answer 329

1. bone-to-bone (elbow extension)
2. soft tissue approximation (knee flexion)
3. tissue stretch (ankle dorsiflexion, shoulder external rotation)

Question 330

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What are the 9 abnormal types of end-feel? Give reasons/examples for each.

Answer 330

1. early muscle spasm (protective response following injury)
2. late muscle spasm (more often due to shortened soft tissue stretching)
3. tissue stretch (tight muscle)
4. spasticity (upper motor neuron lesion)
5. hard capsular (ex. frozen shoulder)
6. soft capsular (ex. synovitis, soft tissue swelling)
7. bone-to-bone (ex. osteophyte formation)
8. empty (pain, ex. acute subacromial bursitis)
9. springy block (ex. mensicus tear)

Question 331

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “capsular” end-feel? How should this feel? Give an example.

Answer 331

• indicates that the joint capsule is limiting the range of motion
• feels like stretching a leather belt
• ex. knee extension

Question 332

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “ligamentous” end-feel? How should this feel? Give an example.

Answer 332

• indicates that ligament tightness is limiting the ROM
• feels like stretching a leather belt
• ex. wrist radial deviation

Question 333

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “bony” end-feel? How should this feel? Give an example.

Answer 333

• indicates that bone touching bone is limiting the ROM
• feels like pushing two wooden surfaces together
• ex. elbow extension

Question 334

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “muscle stretch” end-feel? How should this feel? Give an example.

Answer 334

• indicates that muscle tightness is limiting the ROM
• feels like stretching a bicycle tire inner-tube
• ex. hip flexion with a straight knee

Question 335

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “soft tissue approximation” end-feel? How should this feel? Give an example.

Answer 335

• indicates that subcutaneous tissue (muscle bulk, fat) are pushing against each other and limit the ROM
• feels like squeezing two balloons together
• ex. knee flexion

Question 336

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “springy” end-feel? How should this feel? Give an example.

Answer 336

• indicates that a loose body is limiting the ROM
• feels “bouncy”, like you are compressing a spring
• ex. torn meniscus limiting knee extension

Question 337

During the third step of the physiotherapeutic process, you should assess passive range of motion to confirm/rule out your hypothesis. What is meant by a “empty” end-feel? How should this feel to the examiner?

Answer 337

• indicates that you didn’t reach the end-feel (usually the person is not willing to allow motion due to pain or apprehension)
• feels like the joint has more range, but the person is purposefully stopping you

Question 338

In 1943, the Medical Research Council created which orthopaedic system as a practical tool for clinicians during World War II to diagnose and manage peripheral nerve injuries sustained in combat?

Answer 338

the MRC Muscle Strength Grading system

Question 339

What are the 6 grades of the MRC muscle strength grading system?

Answer 339

0: no muscle activation
1: trace/flicker of muscle without joint movement
2: movement only with gravity eliminated
3: movement through gravity only
4: movement through moderate resistance
5: movement through strong resistance

Question 340

Which MRC muscle strength grade is described as: no muscle activation

Answer 340

Grade 0

Question 341

Which MRC muscle strength grade is described as: muscle activation without movement of the joint

Answer 341

Grade 1

Question 342

Which MRC muscle strength grade is described as: movement only if gravity is eliminated

Answer 342

Grade 2

Question 343

Which MRC muscle strength grade is described as: movement against gravity only

Answer 343

Grade 3

Question 344

Which MRC muscle strength grade is described as: movement through full range against moderate resistance

Answer 344

Grade 4

Question 345

Which MRC muscle strength grade is described as: movement through full range against strong resistance

Answer 345

Grade 5

Question 346

Define the Medical Research Council’s muscle strength grade 0.

Answer 346

no muscle activation/movement

Question 347

Define the Medical Research Council’s muscle strength grade 1.

Answer 347

the person can activate the muscle, but can’t move the joint at all (“muscle activation with trace/flicker of movement”)

Question 348

Define the Medical Research Council’s muscle strength grade 2.

Answer 348

the person can only move through the full range of motion if gravity is eliminated

Question 349

Define the Medical Research Council’s muscle strength grade 3.

Answer 349

the person can move the joint through the full range of motion against gravity, but not against any resistance

Question 350

Define the Medical Research Council’s muscle strength grade 4.

Answer 350

(a.k.a. “weakness with resistance”, the person can move the joint through the full range of motion with moderate resistance

Question 351

Define the Medical Research Council’s muscle strength grade 5.

Answer 351

(a.k.a. “full strength”), the person can move through the full range of motion against strong resistance

Question 352

What does the literature currently say about our ability to distinguish between muscle strength grades?

Answer 352

• Reliability is probably limited, and it can be difficult to distinguish between grades.
• There was an attempt to establish a Grade 4+ to describe “near-normal” strength, but clinicians just had a harder time agreeing on that

Question 353

In 2017 Nagatomi et al performed a case control study of 53 people with rotator cuff tears. Muscle strength grading was performed and compared with dynamometry. What did they find about our ability to reliably determine muscle strength during manual testing of the shoulder?

Answer 353

• (at least in the shoulder…) we can reliably feel a 60% strength difference between the two shoulders manually
• any difference smaller than 60% and we can’t all seem to reliably agree on how good/bad it is compared to the other side

Question 354

What is the role of special orthopaedic testing during the physiotherapeutic process? What should special testing NOT be used for? Why?

Answer 354

• Special tests can help guide your physical exam and rule in / out a hypothesis about pathology or impairment
• Special tests should not be our main source of information about the person’s condition
• Most special orthopaedic tests just aren’t that reliable in detecting specific pathology or causes of pain, even if the underlying tissue mechanism makes intuitive sense to us

Question 355

During the 4th step of the physiotherapeutic process special orthopaedic tests are utilized, but how might previous steps of the process also be considered “special tests”?

Answer 355

Both the screening and patient history can be considered “special testing” in their own way. During these parts of the physiotherapeutic process, each question makes your hypothesis more or less likely. Orthopaedic special tests work the same way.

Question 356

True or False: Most orthopaedic special tests are designed to assess for a specific ICD pathology.

Answer 356

True

Question 357

Why are orthopaedic special tests helpful?

Answer 357

• In a lot of cases, people are going to present with very similar signs/symptoms that occur in multiple different pathologies, and it can be difficult to have a hypothesis among many conflicting possibilities
• Special tests can help you rule in/out some options for your hypothesis

Question 358

Most orthopaedic special tests are focused on diagnosis/pathology. Why is it important to remember the difference between pathology vs. impairment (ICD vs ICF) when performing your special testing?

Answer 358

• It’s the job of the physio to pau much more attention to the impairments
• Pathology is very often not directly treatable
• Focus on pain, mobility, range of motion, strength, endurance, coordination, and environmental/personal factors that can delay/prevent recovery

Question 359

Which are the two main statistical concepts that are most important to focus on when assessing the efficacy of a special orthopaedic test?

Answer 359

1. Reproducibility
2. Validity

Question 360

Define “clinimetrics”

Answer 360

the science of clinical measurements (“clini-“ = observation of the actual patient, outside of theory or the lab. + “-metric” = a system or standard of measurement)

Question 361

The goals of using clinimetrics (e.g. the goal of measuring someone’s clinical presentation) can usually be described as falling into which 3 different categories?

Answer 361

1. Diagnosing/Discriminating (discriminating between ‘sick’ vs health subjects)
2. Evaluating (did your treatment lead to a better outcome?)
3. Predicting (is there an increased chance of chronicity?)

Question 362

List 8 things that you want to ask yourself when considering orthopaedic special tests for use in the clinic?

Answer 362

1. What exactly is this trying to measure?
2. What is the goal of measuring it?
3. What instrument do you want to use?
4. How do you find the instrument (ex. on Pubmed)
5. Is this test feasible? (cost, time, easy for the pt to understand, physical/cognitive demands)
6. How good is the ‘methodological quality’ of the measurement instrument? (how well can it avoid errors/bias?)
7. How are you going to analyze the data the test gives you?
8. How to you interpret and report the outcomes?

Question 363

It’s very important that our findings from tests and measurements are reproducible - either by ourselves or between us and another therapist. What are the two fundamental questions that are addressed when assessing a tests reproducibility?

Answer 363

1. If you’re taking several measurements on one person: “Has my treatment produced a real change?”
2. If you and a colleague conduct the same measurement: “Does another clinician have the same result that I do?”

Question 364

Define reproducibility. What other two statistical measures are included under the umbrella of reproducibility?

Answer 364

• the degree to which a test or a measurement is free from measurement errors (in other words, the degrees to which repeated measures produce the same results)
• reliability and agreement are both aspects of reproducibility

Question 365

The terms ‘reproducibility’, ‘reliability’, and ‘agreement’ are frequently confused and used interchangeably when assessing clinical tests & measures. Define ‘reliability’ and give an example. (What is another term for reliability?)

Answer 365

• reliability is the ability of a test to produce similar results under the same conditions
• ex. measuring someone’s height or weight is very reliable, even with multiple people over multiple measurements
• (reliability = “precision”)

Question 366

What are the 2 forms of reliability that are commonly used? What are two statistics that are used to measure them?

Answer 366

• Intra-rater & Inter-rater reliability
• Kappa K (for “yes”/”no” tests) & Intra-Class Correlation Coefficient (for something on a continuum like blood pressure, weight, or ROM)

Question 367

What is a Kappa K?

Answer 367

• a statical measurement of either inter-rater or intra-rater reliability
  (it takes into account that you might get the same measurement again by shear dumb luck, so it shows you the results that are less likely to be by chance)

Question 368

On what scale is a Kappa K statistic measured?

Answer 368

on a scale from 0 (not reliable) to 1.0 (perfectly reliable

Question 369

The Kappa K statistic is used to measure reliability. What does a score of less than 0.2 denote?

Answer 369

the test or measurement method is, at best, only slightly reliable

Question 370

The Kappa K statistic is used to measure reliability. What does a score of 0.2-0.4 denote?

Answer 370

the test or measurement method has fair reliability

Question 371

The Kappa K statistic is used to measure reliability. What does a score of 0.4-0.6 denote?

Answer 371

the test or measurement method is moderately reliable

Question 372

The Kappa K statistic is used to measure reliability. What does a score of 0.6-0.8 denote?

Answer 372

the test or measurement method is substantially reliable

Question 373

The Kappa K statistic is used to measure reliability. What does a score of greater than 0.8 denote?

Answer 373

the test or measurement method has excellent reliability

Question 374

The Kappa K statistic is used to measure reliability. What does a score of 1.0 denote?

Answer 374

the test or measurement method is perfectly reliable

Question 375

What Kappa K score denotes that a test or measurement is only slightly reliable?

Answer 375

K = less than 0.2

Question 376

What Kappa K score denotes that a test or measurement has only fair reliability?

Answer 376

K = 0.2-0.4

Question 377

What Kappa K score denotes that a test or measurement is moderately reliable?

Answer 377

K = 0.4-0.6

Question 378

What Kappa K score denotes that a test or measurement is substantially reliable?

Answer 378

K = 0.6-0.8

Question 379

What Kappa K score denotes that a test or measurement has excellent reliability?

Answer 379

K = greater than 0.8

Question 380

In statistics, what does ICC stand for?

Answer 380

Intra-class Correlation Coefficient

Question 381

What is an Intra-class Correlation Coefficient?

Answer 381

• a statical measurement of either inter-rater or intra-rater reliability, specifically when the test or measurement doesn’t have a “yes/no” answer

(like a Kappa K, it takes into account that you might get the same measurement again by shear dumb luck, so it shows you the results that are less likely to be by chance)

Question 382

On what scale is an Intra-class Correlation Coefficient measured?

Answer 382

on a scale from 0 (not reliable) to 1.0 (perfectly reliable

Question 383

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of less than 0.2 denote?

Answer 383

the test or measurement method is, at best, only slightly reliable

Question 384

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of 0.2-0.4 denote?

Answer 384

the test or measurement method has only fair reliability

Question 385

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of 0.4-0.6 denote?

Answer 385

the test or measurement method is moderately reliable

Question 386

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of 0.6-0.8 denote?

Answer 386

the test or measurement method has substantial reliability

Question 387

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of greater than 0.8 denote?

Answer 387

the test or measurement method has excellent reliability

Question 388

The Intra-class Correlation Coefficient statistic is used to measure reliability. What does a score of 1.0 denote?

Answer 388

the test or measurement method is perfectly reliable

Question 389

What Intra-class Correlation Coefficient score denotes that a test or measurement is only slightly reliable?

Answer 389

ICC = less than 0.2

Question 390

What Intra-class Correlation Coefficient score denotes that a test or measurement has only fair reliability?

Answer 390

ICC = 0.2-0.4

Question 391

What Intra-class Correlation Coefficient score denotes that a test or measurement is moderately reliable?

Answer 391

ICC = 0.4-0.6

Question 392

What Intra-class Correlation Coefficient score denotes that a test or measurement is substantially reliable?

Answer 392

ICC = 0.6-0.8

Question 393

What Intra-class Correlation Coefficient score denotes that a test or measurement has excellent reliability?

Answer 393

ICC = greater than 0.8

Question 394

In general, what is considered an acceptable Kappa K or Inter-class Correlation Coefficient when measuring inter-rater reliability?

Answer 394

0.75 or greater

Question 395

In general, what is considered an acceptable Kappa K or Inter-class Correlation Coefficient when measuring intra-rater reliability?

Answer 395

0.9 or greater

Question 396

Intra- and Inter-rater reliability are both measured using either Kappa K or Inter-class Correlation Coefficient statistics, but the two have different values that are considered ‘acceptable’. What is the difference?

Answer 396

• an inter-rater reliability is considered acceptable if Kappa K or ICC = 0.75 or greater
• intra-rater reliability needs to meet a higher threshold, at Kappa K or ICC = 0.9 or greater to be considered acceptable

Question 397

We want to keep pretty high standards when we conduct and assess our research. So, in general, an intra-rater reliability (ICC or Kappa K) of greater than 0.9 and an inter-rater reliability of greater than 0.75 are considered ‘acceptable’. Put this is common language.

Answer 397

Your test or measurement is considered acceptable if its reliability is good enough that at more than 75% of the time, you’d agree with your colleague and more than 90% of the time, you’d agree with yourself.

Question 398

In the clinic, you may have several goals or reasons for why you’d select a particular test or measurement. List 3.

Answer 398

1. discrimination (who has a condition vs who is ‘healthy’)
2. evaluation (did a treatment have an effect)
3. prediction (can the test predict a certain outcome - ex. developing chronic pain)