Final Exam Flashcards
Nerve Injury Healing
2-4 years
Normal Posture
-Through ear, GH joint, greater trochanter
-Anterior to knee and lat mal
Lordotic Posture
-lordotic with kyphosis
-increased lumbosacral angle
-forward head
-abducted scaps
-kyphotic thoracic
-hyperextended lumbar
-Hips flexed
-anterior pelvic tilt
-hyperextended knees
-Short/tight: low back, hip flexors, neck extensors
-Weak/lengthened: abs, erectors, upper back, hamstrings
Swayback Posture
-lordotic with kyphosis
-flat lumbar spine
-forward head
-winged scaps
-kyphotic thoracic
-flat lumbar
-Hips hyperextended
-posterior pelvic tilt
-hyperextended knees
-Weak/Lengthedt: upper back, hip flexors, neck flexors, ex obliques
-Short/tight: internal oblique, erectors, low back, hamstrings
Flatback Posture
-decreased lumbosacral angle
-forward head
-flat thoracic
-flat lumbar
-Hips extended
-posterior pelvic tilt
-extended knees
-Short/tight: abs, hamstrings
-Weak/lengthened: hip flexors
Ligament Injuries
-trauma, mechanical stress, gender differences
-3-6weeks
-85% type I collagen, turn into type III
-30-50% weaker
Laxity:
-3 weeks= mild tension
-6 weeks= resume normal activities
-12 weeks= almost max tensile strength
Time:
-Grade 1: 0-3 days
-Grade 2: 3w to 6months
-Grade 3: 5w to 1 yr
-Graft: 3m to 2 yrs
Tendon Injuries
-singular incident or cummulative
-patial tear or rupture @ junction
-surgical repair essential for full return if >50% diameter
Healing:
-limited blood supply, 7.5x lower than muscle
-type III collagen aligned randomly (proliferative)
-increase in type 1 lonngitudianlly (remodeling)
Timelines:
-Tendinopathy/itis: 3-7 weeks
-Tendinosis: 2-6 months
-Laceration: 5w to 6 months
Muscle Injuries
Time:
-Exercise Induced: 0-3days
-Grade 1: 0-14 days
-Grade 2: 4 days to 3 months
-Grade 3: 3 weeks to 6 months
Bone Healing Time
5 weeks to 3 months
Articular Cartilage Tear
2 months to 2 years
Fundamental 6-Pack
TrA/IO
Multifidus
Pelvic Floor
Glute Max
Lat
Diaphragm
Sacral Nutation and Pelvic Movements
-flexion in relation to innominates
-base moves ant and inf
-Apex moves pos and sup
Open Chain:
-Posterior innominate, PPT, decreased lordosis, hip flx, spinal extension, PF post
-ASIS up, PSIS down
Closed Chain:
-Posterior innominate, hip ext
Sacral Counternutation and Pelvic Movements
-extension in relation to innominate
-base moves post and sup
-Apex moves ant and inf
Open Chain:
-Anterior innominate, APT, increased lordosis, hip ext, spinal flexion, PF anteriorly
-ASIS down, PSIS up
Closed Chain:
-Anterior innominate, hip flexion
Lateral Pelvic Tilt
-hip drops, same side abd, opposite side add
-hip hikes, same side add, opposite side Abd
Pelvic Rotation
-anterior rotation produces IR of stance
-posterior rotation produced ER of stance
Tendinopathy Exercise Prescription
- Isometrics
- Isotonics
- Plyometrics (energy storage)
- Return to Sport
PAILS/RAILS
-stretch problem child restricting motion (1-2mins)
-activate problem child 10-100% (15s)
-activate target muscle 100% (10s)
Hip IR Importance
-hip IR when extending from flexed
-when flexed 60-100deg
Ex:
-frog breathing
-box squat isometric hold
-unwinding
-side-lying Stride
drives force into the ground
Femoroacetabular Impingement
-FAI
-damages labrum snd cartilage
Cam Impingement:
-related to femoral head and neck morphology
-common with SCFE or LCPerthes
-anteversion or coxa vara
Pincer Impingement:
-acetabular abnormalities
-retroversion, coxa profunda
-woman>
Pain locations:
-Flx, IR, clicking, dec ROM, pain, giving away
Total Hip Precautions
-WB?
-Hardware
-Education/functional training/infection/DVT
-Mobilization
-Restore ROM
Post:
-no flx, IR, ADD
Ant:
-no ext, ER, ABD
Lateral:
-hip abd
Knee Surgery Goals
-ROM (ext) 0-110
-strength
-pain/swelling
Meniscus
-enhance stability and increase contact
-shock absorption (50-70% in flx, 85-90% in ext)
-lubrication
Movement:
-posterior with flx, anterior with ext
-helps nutrition and vascularization
Anterior Cruciate Ligament
Motions:
-prevents ant tibial translation (post femur)
-Prevents tibial IR
Orientation:
-medial aspect of lateral femoral condyle
-anterior medial tibia
Anteromedial Bundle:
-taut in flexion
Posteriorlateral Bundle:
-taut in ext
Posterior Cruciate Ligament
Motions:
-prevents ant femoral translation (post femur)
-Prevents tibial IR
-Prevents varus/valgus forces
Orientation:
-posterior lateral tibia
-lateral aspect of medial femoral condyle
Anterolateral bundle:
-taut in flexion
Posteriomedial Bundle:
-taut in ext
Posterolateral Corner Injury
-popliteus tendon, popliteofibular ligament, LCL, ITB, biceps femoral
MOI:
-direct varus hit to tibial on an extended knee
-posterior force on flexed knee with tibial ER
-chronically after trauma to ACL or PCL
S/s:
-varus thrust gait
-posterolateral instability
-knee giving way
-common fib irritation
Tx:
-hinged brace
-avoid active flx for 4 months
ACL Interventions (Strong/moderate/weak)
Strong:
-Therex
-Estim
-Neuro re-ed
Moderate:
-immobilization
-cryo
-rehab
Weak:
-CPM
-knee bracing
-early weight bearing
ACL Injury Prevention CPG
Strong:
-review lit
-use programs before sports
-multiple components
-high compliance
Moderate:
-handball players 15-17
-don’t have to include balance
-programs led by coaches and med prof
Osgood Schlattter Syndrome vs. SLJS
OS:
-tib tub
-pain at tib tub with activity
-may have swelling
SLJS:
-at inferior pole of patella
-pain with activity
-swelling/calcificattion at inf pole
High Ankle Sprain
-at Tibiofibular syndesmosis
-interosseous membrane
-anterior talofibular lig
-during ER and DF
S/s:
-less swelling, NWB, bruising, cant fully PF
Lateral Ankle Sprain
-inv and PF
Mild: 5-14d, atfl
Mod: 2-3w, atfl, cfl
Severe: 3-12w, cfl, ptfl
Medial Ankle Sprain
-Eversion
-rare
S/s:
-medial side brusing and swelling
-NWB
Dorsiflexion at Talocrural J
Open Chain: talus rolls anteriorly and glides posteriorly
Closed Chain: mortise rolls and glides anteriorly
-Closed packed position full DF
Plantarflexion at Talocrural J
Open Chain: talus rolls posteriorly and glides anteriorly
Closed Chain: mortise rolls and glides posteriorly
-Loose packed position 5-10deg
Subtalar Motion
Open Chain:
-Supination: calcaneal INV, ADD/PF
-Pronation: calcaneal EV, ABD/DF
Closed Chain:****
-Supination: calcaneal INV, talar ABD/DF, tib/fib LR (closed packed)
-Pronation: calcaneal EV, talar ADD/PF
Resting: btwn pronation and supination
Closed Packed: supination
Capsular Pattern: Sup/in» pron/ev
Shoe Considerations
High Arches: mobility shoe
Low Arches: stability shoe
Order of Exercise Progression
Mobility>Control>Load
Hinge Movement Progressions/Regression
Supine (bridge to thrust)> Standing (assisted to Good Morning)>Single Leg (b stance to SL RDL)
Mobility
-find out what is decreasing it
-muscle, tone, stiffness
Tx:
-Self-mobility (breathing, foam roll, massage stick, stretch)
-Manual Therapy
Control
-stability and Nm control
-Train for strength AND function in OC/CC
Load
-progressions and regressions
Squat Progressions/Regression
Leg Press > Assisted Squat > Sit to Stand > Counterbalance Squat > Squat
Step Up Progressions/Regression
Assistted step up > BW > Weighted > Crossover (curtsy)
