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Rehab Principles > Final Lecture Exam > Flashcards

Final Lecture Exam Flashcards

1
Q

Describe Grade I sprain

A

Stretching, small tears <50%

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2
Q

Describe Grade II sprain

A

Larger but incomplete tear >50% tear

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3
Q

Describe Grade III sprain

A

Complete tear, no end point, significant laxity

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4
Q

Describe Grade I sprain/strain laxity and end point

A

Mild laxity

Stable end point

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5
Q

Describe Grade II sprain/strain laxity and end point

A

Moderate laxity

Soft end point

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6
Q

Describe Grade III sprain/strain laxity and end point

A

Significant laxity

No end point

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7
Q

Describe Grade IV sprain/strain

A

Complete tear

Detachment of muscle or ligament from the bone

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8
Q

Ecchymosis

A

discoloration of the skin resulting from bleeding underneath, typically caused by bruising.

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9
Q

Difficulty bearing weight Grade I vs II vs III

A

I - no difficulty
II - usually have difficulty
III - almost always have difficulty

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10
Q

How many weeks to return to full activity after Grade I sprain?

A

2-4

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11
Q

How many weeks to return to full activity after Grade II sprain?

A

6-8 weeks

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12
Q

How many weeks to return to full activity after Grade III sprain?

A

12 weeks to 6 months

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13
Q

Phase I in the healing process is called

A

Inflammatory (acute)

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14
Q

Phase 1 lasts how long

A

48-72 hours

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15
Q

Key to controlling phase 1 is

A

Controlling inflammation

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16
Q

Acute signs of inflammation = S.H.A.R.P.

A 
Swelling
Healing
A loss of function
Redness
Pain
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17
Q

The second phase of injury is called

A

Repair (subacute)

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18
Q

How long is the repair/subacute phase?

A

72 to 6+ weeks

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19
Q

The third phase is called

A

Remodeling (chronic)

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20
Q

Remodeling (chronic) phase timeline

A

6 weeks - 2 years

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21
Q

What is the goal for phase 1: inflammatory (acute)?

A

Control inflammation

Reduce swelling and pain

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22
Q

What is the goal for phase 2.1: repair (subacute)?

A

Regain tensile (functional) strength

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23
Q

What assessments and/or treatments that we’ve done in class are appropriate for stage 2.2: repair (late subacute)?

A

Friction techniques / Instrument assisted soft tissue massage (IASTM)

Isometrics: METs (both RI and PIR with gentle stretching)

Can work directly at site with caution to not overly stress new tissues

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24
Q

What is the goal for phase 3: remodeling (chronic)?

A

Redirect healing fibers to increase strength and orient the tissue fibers along lines of greatest stress

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25
Q

What assessments and/or treatments that we’ve done in class are appropriate for stage 1: inflammatory (acute)?

A

Myofascial trigger point work for those that refer to injury site but NOT the acute site

Muscle Energy Techniques without stretching. RI is idea and PIR with pain-free contraction only

NO Key Movement Patterns

Evaluate breathing patterns

McGill’s Big 3: quadruped, dead bug, side bridge

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26
Q

What assessments and/or treatments that we’ve done in class are appropriate for stage 2: repair (subacute)?

A

Similar to acute stage, but now tissue adjacent to injury can be carefully addressed

Cross fiber, not longitudinal though

Be careful with distal treatment (e.g. working on the wrist if the elbow is injured)

Contrast hydrotherapy: alternating hot 2 mins and cold 1 min, repeat

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27
Q

What assessments and/or treatments that we’ve done in class are appropriate for stage 3: remodeling (chronic)?

A

Evaluate key movement patterns

Scar tissue reaches maximum stretch, often still only 70-80% of original tissue strength

ROM and strength

Stabilization tracks: quadruped, dead bug, bridge

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28
Q

What are the goals of soft tissue manipulation (8)?

A
  • Mobilization of fluids/reduction of edema
  • Increase of local blood flow
  • Decrease muscle soreness/stiffness
    and ↑ ROM
  • Prevention or elimination of
    adhesions
  • Reduction of pain
  • Eliminate Myofascial Trigger Points
    (MFTP)
  • Facilitation of relaxation, reduction
    of spasm, hypertonicity and/or
    overactivity
  • Restore balance to motion segment
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29
Q

What are contraindications for soft tissue manipulation?

A
  • Acute inflammation, osteitis, periostitis
  • Acute circulator ydisturbance
  • Acute dermatological problem
  • Fever (systemic)
  • Local infection
  • Local malignancy
  • New burns
  • Potential embolus/thrombus, varicosities
  • Abdominal tumor, aneurysm
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30
Q

What are the 8 parts to low back rehab program?

A
  1. Neutral pelvis, abdominal bracing, hip hinging
  2. Directional preference
  3. Posture and breath training
  4. Return to activity
  5. Floor exercises to reprogram stability
  6. Weight-bearing exercises
  7. Balance large global muscles
  8. Proprioceptive/balance training
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31
Q

Why is hip hinging taught?

A

To avoid end-range loading during ADLs

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32
Q

Why is posture/breath training taught?

A

Address inefficient posture and breathing patterns

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33
Q

Why are floor exercises taught?

A

To work pts physiological corset

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34
Q

What are the 4 trunk postural muscles?

A
  1. Cervical and lumbar erectors
  2. Quadratics lumborum
  3. Scalenes muscles
  4. Sternocleidomastoid m
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35
Q

What are the 4 shoulder postural muscles?

A
  1. Pec major and minor
  2. Levator scapula
  3. Upper trapezius
  4. Bicep brachii
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36
Q

What are the 2 trunk phasic muscles?

A
  1. Mid thoracic erectors

2. Longus capitus and colli

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37
Q

What are the 4 shoulder girdle phasic muscles?

A
  1. Rhomboids
  2. Middle trapezius
  3. Lower trapezius
  4. Triceps brachii
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38
Q

What will the brain do when agonist muscle is firing?

A

Turn off tone to antagonist muscle

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39
Q

In upper crossed syndrome, what muscles are inhibited/weak?

A

Phasic muscles:
Cervical flexors
Rhomboids, lower traps

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40
Q

In upper crossed syndrome, which muscles are tight?

A

Postural:
Suboccipitals, upper trap, Levator scapula
Pectorals

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41
Q

What are common postural findings for upper crossed syndrome??

A
  • Anterior head carriage (chin jut)
  • Forward and rounded shoulders
  • Internally rotated humerus
  • Thoracic hyperkyphosis
  • Protruding abdomen
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42
Q

Which key movement patterns evaluate muscles involved in upper crossed syndrome?

A

Neck flexion
Trunk flexion
Shoulder abduction
Lowering from push-up with a plus

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43
Q

Which muscles are weak/inhibited in lower crossed syndrome?

A

Phasic:
Glut max
Abdominals

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44
Q

Which muscles are tight in lower crossed syndrome?

A

Postural:
Erector spinae
TFL, QL
Iliopsoas, Rectus femoris

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45
Q

What are common postural findings for lower crossed syndrome?

A

PELVIS: A/P tilt, torsion, hiking, lateral shift

GLUT MAX: flattened upper-outer quadrant, sagging fold

ADDUCTORS: distal “notch” ipsilateral hip dysfunction

HAMSTRINGS: overactivity in distal 1/3 = inhibited glut

CALF: soleus hypertrophy

LUMBAR ERECTORS: should be > TL erectors

46
Q

What key movement patterns evaluate lower crossed syndrome?

A

Hip extension
Hip abduction
Trunk flexion

47
Q

What are McGill’s “big 3” exercises?

A

Quadruped
Dead bug/curl-up
Side bridge

48
Q

What stabilization exercises train glut max?

A

Quadruped
Prone
Bridge

49
Q

What stabilization exercises train glut med?

A

Side-bridge
Side-lying
Single-leg bridge

50
Q

What stabilization exercises train scapula stabilizers?

A

Quadruped

Prone

51
Q

What stabilization exercises train abdominals?

A

Curl-up
Dead bug
Side-bridge

52
Q

What stabilization exercises train neck?

A

Quadruped

53
Q

Is dry needling allows under Oregon’s DC scope of practice?

A

Nope

54
Q

What aggravates trigger points (6)?

A
  • Strenuous use of the muscle (especially in a
    shortened position)
  • Quick stretching of the muscle
  • Direct pressure on the MFTP
  • Holding the muscle in a prolonged shortened position (often after being in bed or sitting for a while)
  • Sustained or repeated contractions
  • Exposure to cold draft (especially if the muscle is fatigued)
55
Q

Essential criteria to diagnose trigger point (3)?

A
  • Tender nodule within muscle or tendon
  • Predictable pattern of referred pain with palpation
  • Painful limited ROM
56
Q

What are trigger point perpetuating factors that are biomechanical (4)?

A
  • Postural dysfunction
  • Hyperventilation tendencies
  • Hypertonicity
  • Neural compression
57
Q

What are psychosocial reasons for perpetuating trigger points (2)?

A
  • Stress

- Hyperventilation

58
Q

What are biochemical reasons for trigger points perpetuating (4)?

A
  • Nutrition
  • Ischemia
  • Inflammation
  • Hyperventilation
59
Q

How do you find a trigger point (4)?

A
  1. Palpate across the fibers to locat taut band
  2. Search within band for nodule
  3. Apply NIMMO or travell
  4. Communicate with pt to work around 5-7 on the pain scale
60
Q

What are (4) steps for trigger points using NIMMO?

A
  1. Muscle relaxed
  2. Apply pressure for 3-7 seconds
  3. Repeat until improved or up to 5 minutes
61
Q

What are (4) steps for trigger points using Travell?

A
  1. Stretch muscle
  2. 20# pressure for 10-60 sec
  3. Repeat until improved or up to 5 minutes
62
Q

Other trigger point treatment?

A
  • Chaitow: like Travell, but 5 seconds on and 2 seconds off for 20-30 seconds
  • PIR
  • Percussion
  • Dry needling or TP injection
  • High-power pain threshold ultrasound
63
Q

Hypertonic muscles need vs tight muscle needs

A

Hypertonic: needs to relax
Tight: needs to stretch

Note: Tight muscle is like a leather belt

64
Q

What is the end range feel for hypertonic muscle?

A

Supple; but muscle cannot lengthen to expected length

65
Q

What is the end range feel for tight muscle?

A

harder, fibrotic, less resilient due to chronic shortening

66
Q

Explain the stretch reflex in hypertonic muscle:

A

More sensitive and engaged sooner

67
Q

What is a hypertonic muscle?

A

Physiologic condition in which excitability threshold is increased, resulting in increased resistance to lengthening

68
Q

What kind of problem is a tight muscle?

A

Facial or noncontractile problem

69
Q

What is central sensitization?

A

Long-lasting, increased excitability changes in spinal cord low
back wide dynamic range neurons caused by nociceptive
stimulation of low back tissues

70
Q

What is the body’s response of central sensitization (4)?

A
  • Increased ongoing impulse discharge
  • Increased responsiveness to previously effective peripheral stimuli (hyperalgesia)
  • The appearance of responses to previously ineffective somatosensory stimuli (allodynia)
  • The appearance of responses to stimulation outside of the zone
    that previously evoked responses (i.e., receptive field enlargement
    or expansion)
71
Q

How does muscle energy technique affect central sensitization?

A

Phasic and tonic inhibitory processes hyperpolarize already sensitized low back wide dynamic range neurons

72
Q

For MET how is force applied in acute vs chronic patient?

A

Acute: at a “resistance barrier”
Chronic: short of resistance barrier

73
Q

Resistance barrier refers to

A

Very first indication of palpation tension or resistance to free movement in a direction

74
Q

What are indications for Reciprocal Inhibition (RI) - antagonist

A
  • Restricted joints
  • Preparing joint for manipulation
  • Short and tight muscle
  • Muscle stretching when contraction of agonist is undesirable
75
Q

What are indications for Post Isometric Relaxation (PIR) - Agonish

A
  • restricted joints
  • preparing joint for manipulation
  • short and tight muscle
76
Q

What are the 4 steps of RI - Antagonist?

A
  1. Antagonist contracts isometrically 6-10 secs
  2. Complete relaxation 5 secs
  3. Passive stretch: take tissue passively to new barrier and beyond
  4. Hold new stretch 30-60 secs

Repeat 3-5 times

Note: this is exactly the same as PIR with the exception of step 1: agonist/antagonist isometric contraction

77
Q

Where do RI and PIR both start?

A

Short of first restriction barrier

78
Q

What are the (4) steps for PIR - agonist

A
  1. Agonist contracts isometrically 6-10 secs
  2. Complete relaxation 5 secs
  3. Tissue taken passively to new barrier and beyond
  4. Hold new stretch 30-60 secs

Repeat 3-5 times

Note: this is exactly the same as RI with the exception of step 1: agonist/antagonist isometric contraction

79
Q

In both PIR and RI, what do you do differently post-contraction between acute and chronic patient?

A

Acute — gentle lengthening to new barrier on exhalation (because the function is to relax)

Chronic — rest 5 seconds. Gentle lengthening to new barrier and slightly beyond on exhalation. Engage patient assistance. Hold 30-60 sec (because function is to stretch)

80
Q

A post-facilitation stretch is for which muscle (antagonist or agonist)?

A

Agonist

81
Q

When is post-facilitation stretch indicated?

A

Stretching chronic restricted, fibrotic, contracted soft tissue

82
Q

What are the 5 steps for post-facilitation stretch - agonist?

A
  1. Contraction initiation from midrange
  2. Pt contracts at/near 100% — hold 6-10 secs
  3. Pt relaxes muscle as quickly as possible
  4. Dr aggressively stretches muscle — hold 15 secs
  5. Relax in midrange up to 30 secs
83
Q

What are the 6 steps of Contract-Relax Antagonist Contract (CRAC)?

A
  1. Pt actively stretches tissue to barrier
  2. Dr supports this position
  3. Pt isometrically contracts agonist against Dr support — 10-20 secs
  4. Pt uses antagonist to find new barrier
  5. Dr supports new position

Repeat #3-#5 … 3-5 times

  1. Pt isometrically contracts agonist against Dr support — 10-20 secs, relax
84
Q

What is isolytic lengthening?

A

When a muscle contracts while external forces cause it to lengthen

86
Q

If postural stability is required during aerobic challenge AND physiologic demand for O2 is high, what will the nervous system prioritize?

A

Respiration over spinal stability

87
Q

When breathing becomes labored, what happens to the abs?

A

Abs are inhibited to maintain respiration

88
Q

What are 2 common 1˚ respiratory faults?

A
  1. Apical breathing or upper chest breathing

2. Paradoxical breathing when abdomen moves “in” during inhalation and “out” during exhalation

89
Q

What are 7 commong 2˚ respiratory faults?

A
  1. Breathing is shallow with little motion in abdomen or rib cage
  2. Asymmetrical motion in abdomen or rib cage
  3. Sequence from abdomen to chest is altered
  4. Rhythm is abrupt or “over-effort is seen”
  5. Inhalation and expiration are rapid or uneven in duration
  6. Excess tension seen in face, lips, jaw, tongue
  7. Frequent sighing or yawning
90
Q

What are the 3 parts of breathing assessment?

A

1 - movement should initiate in abdomen
2 - lower ribcage widens in horizontal plan
3 - upper ribs fan open

91
Q

Breathing assessment can be performed in these 5 positions:

A 
Seated
Standing
Supine
Prone
In functional activities
92
Q

List the 3 steps of external TMJ muscle palpation technique

A
  1. Palpate all 3 bellies of temporalis
  2. Palpate masseter S-I
  3. Palpate inferior aspect medial pterygoid

Note: palpate all mm while relaxed and while teeth clench

93
Q

List the 3 steps of internal TMJ muscle palpation technique for Masseter

A
  1. Begin at outer edge of lower teeth — 1 finger inside cheek and several on the outside
  2. Palpate proximal to inferior edge of coronoid process
  3. Have Pt clench to capture bulk of mm
94
Q

List the 2 internal palpation steps to move from Masseter to Temporalis Tendon

A
  1. release masseter (from previous step)

2. travel up coronoid process to insertion of temporalis tendon

95
Q

How would you internally palpate Lateral Pterygoid (pretend you just finished palpating the temporalis tendon)

A

Probe superiorly, posteriorly, medially in the pocket between teeth and cheek — Pt can shift mandible side to side

96
Q

How would you palpate the medial pterygoid (after the lateral)

A

Finger on the inside edge of lower teeth: palpate as it travels down the angle of the mandible

97
Q

The body’s initial reaction to musculoskeletal injury is often

A

Over reaction

Inflammatory responses of tissues to injury are nonspecific to their etiology and the process is generally conceded to be excessive for those of traumatic or mechanical musculoskeletal origin

98
Q

The body’s overreaction to musculoskeletal injury can lead to

A

Excessive collagen formation and fibrosis

99
Q

What are 5 indications to use transverse friction soft tissue manipulation (STM)?

A
  1. Recent/old trauma to muscle, tendon, ligament
  2. Injury/degeneration changes at myotendinous junction
  3. Acute/chronic tendon itis, tenosynovitis, tenovaginitis
  4. Ligamentous sprains, recent and chronic
  5. Chronic bursitis (NOT ACUTE)
100
Q

What are 6 contraindications to Transverse friction STM?

A
  1. Bacterial infections
  2. Traumatic arthritis
  3. RA and tendinitis
  4. Acute bursitis (chronic is OK)
  5. Over superficial nerves
  6. Those common to all soft tissue treatment: acute inflammation, hematoma, calcification, decreased vascularity, local sepsis, local skin disease
101
Q

Gua Sha

A

Coin rubbing

102
Q

4 Indications to use longitudinal soft tissue manipulation

A
  1. Any abnormality of the body may warrant gua sha
  2. Pain anywhere may warrant gua sha, acute or chronic
  3. When finger pressure on skin causes blanching that is slow to fade,
    sha (stasis) may be suspected.
  4. May treat or prevent acute conditions (e.g., common cold, flu,
    asthma, bronchitis) or chronic problems involving pain or congestion of the qi and blood.
103
Q

4 contraindications to use longitudinal soft tissue manipulation

A
  1. Acute traumatic bruising or abrasion
  2. Sunburn, rash, pimple, mole or break in skin
  3. Pregnant abdomen, deficient patients
  4. Bleeding disorders
104
Q

Isolytic lengthening is thought to (3):

A

Promote orientation of collagen fibers along lines of stress and direction of movement

Limit infiltration of cross bridges between collagen fibers

Prevent excessive collagen formation preventing any muscle stiffness

105
Q

Postural muscles are what kind of muscle fibers?

A

Type 1

Tendency to shorted and tighten when chronically stressed and/or injured

106
Q

Phasic muscles are what type of muscle fibers?

A

Type 2

Burn out quickly and tend to lengthen and weaken

107
Q

If SCM is short and tight and rhomboids are long and weak, what would you do?

A

RI technique for rhomboids to get shoulder girdle back into position

108
Q

Tight psoas?

A

RI on psoas will activate it and lengthen postural muscles

109
Q

Open kinetic chain vs closed kinetic chain

A

Open: distal segment is not fixed

110
Q

Active vs latent trigger point?

A

Active: produces symptoms
Latent: does not trigger pain until someone pokes at it

111
Q

“Key” vs “Satellite” Trigger point

A

Key: when treated, decreases activity in satellites
Satellite: when treated, usually does not decrease key activity or pain — its more a compensation trigger point

112
Q

What is the diagnostic criteria for trigger points (3)?

A
  • reproduction of pain
  • jump sign
  • local twitch response with snapping palpation

Note: #1 and #2 is not sufficient for diagnosis

Rehab Principles (6 decks)

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