Final Theory Exam Flashcards
Understand what happens to a muscle when its stretched and when its strengthened. Think Origin and Insertion
Muscle becomes lengthened (stretched) O pulled from I
Muscles become shortened (contracted) O to I
Understand difference in approach for inflammatory conditions due to trauma in Protection, Controlled Motion, Return to Function Phases *NOT FINISHED
1) Protection Phase
- Don’t disturb tissue healing grade 1 distraction to help reduce pain
- Help circulate synovial fluid in the capsule it also helps improve tissue health and cartilage/Connective Tissue
- Decrease SNS firing by full body relaxation
2) Controlled Motion
3) Return to Function
Review muscle O and I’s listed in LPs
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Understand the movement of the Patella during Flexion and Extension of the knee
Extension: Patella slides superiority
Flexion: Patella slides inferiority
5 degree of flexion: Inferior patella begins to articulate with femur
90 degree of flexion: Patella inferior to patellar groove, quadriceps tendon is in contact
2 Articulation of Patella (Knee)
1) 2 Condyles of distal femur
2) 2 tibial plateaus on proximal tibia
Which complex muscles of the shoulder should be strengthened to provide stability for Ant GH Instability?
Strengthen Infraspinatus
Which complex muscles of the shoulder should be strengthened to provide stability for Post GH Instability?
Pectoralis Major
What are some conditions where muscle setting is appropriate or indicated?
- Prevent mm atrophy while you are in a cast
- Fractures: When client can’t move a joint
- During Protection Phase
Which muscles are active during each stage of Stance Phase Gait
1) Initial Contact (heel strike)
- Ankle dorsiflexors, hip extensors, knee flexors
(Tib Ant, Glute Max, Hamstrings)
2) Load Response (weight accepted/flat foot)
- Knee extensors, hip abductors, ankle plantar flexors
(Vasti, Glute med, Gastroc, Soleus)
3) Midstance (single-leg support)
- Ankle plantar flexors (isometric)
(Gastroc, Soleus)
4) Terminal Stance (Heel off)
- Ankle plantar flexor (concentric)
(Gastroc, Soleus)
5) Pre Swing (Toe off)
- Hip flexor
(Iliopsoas, Rec Fem)
Which muscles are active during each stage of Swing Phase Gait
1) Initial Swing
- Ankle dorsiflexor, hip flexor
(Tib ant, iliopsoas, rec fem)
2) Mid Swing
- Ankle dorsiflexor
(Tib Ant)
3) Terminal Swing (Deceleration)
- Knee flexor, Hip Extensor, Ankle Dorsiflexor, Knee Extensor
(Hamstring, Glute Max, Tib Ant, Vasti)
What type of joint is TMJ?
Synovial Condylar - Modified ovoid/Hinge Joint
What ligaments are found in TMJ?
1) Lateral Collateral
2) Capsular
Both coordinate movement between disc and condyle
A self-productive and a result of injury to the pelvis, hip, knee, ankle and foot. The stance phase on the affected leg is shorter than that on non-affected leg. Due to client trying to remove weight on affected side quickly
Antalgic (Painful) Gait
Gait pattern characterized by staggering and unsteadiness. Lack of coordination and tendency of poor balance. There is usually a wise base of support and movement are exaggerate
Ataxic Gait
Gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to dorsiflexor weakness. The foot will slap at initial contact with the ground secondary to decreased control
Stoppage (Drop Foot) Gait
Gait pattern with stiff movement, toes seeming to catch and drag, legs are held together, hip and knees slightly flexed. Commonly seen in spastic paraplegia
Spastic Gait
Gait pattern that denotes glute med weakness; excessive lateral trunk flexion and weight shifting over the stance leg
Trendelenburg Gait
Gait pattern in which the legs cross midline upon advancement
Scissor Gait
Staggering gait pattern seen in cerebella disease
Cerebellar
Number of steps per time unit. Normally 90-120 steps per minute
Cadence
How does age, sex and pathology affect cadence?
- Women usually 6-9 steps per min higher than men
- With age, cadence decreases
- With pathology of deformity, cadence pattern may be altered
CI’s to stretching and AITs
1) Bony block limits joint motion
2) Recent fracture and bony union is incomplete
3) Acute inflammation
4) Sharp acute pain with joint movement or muscles elongation
5) Hematoma
6) Joint hypermobility
7) Shorted soft tissue provide necessary joint stability in lieu of normal structural ability or neruromuscular control
8) Shorted soft tissue enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible
Know Oscillation Joint Mobilization Grades
Grade 1: Small-amplitude performed at beginning of range (quick vibration)
Grade 2: Large-amplitude performed within range (Slow 2/3 sec for 1/2 mins)
Grade 3: Large-amplitude performed within range and to resistance (Slow 2/3 sec for 1/2 mins)
Grade 4: Small-amplitude performed at available limit to resistance (quick vibration)
When would you use Oscillation Mobilization’s?
Grade 1 and 2 are for pain and muscle guarding (No stretch motions to improve nutrition to cartilage).
Grade 3 and 4 are used as stretching maneuvers
Describe the grades of Sustained Mobilization’s
Grade 1 (Loosen): Small distraction (7-10 seconds) Grade 2 (Tighten): Enough distraction to tighten tissue (take up the slack) Grade 3 (Stretch): Large distraction to place stretch around joint (6 sec hold, release to grade 1/2 then repeat 3/4 sec)
Indications to use Sustained Distraction
Grade 1: Relieve pain
Grade 2: Determine how sensitive joint is (Assessment)
Grade 3: Stretch the joint - increase joint play
Palpating of Masseter
Gloved finger between cheek and molars with client’s teeth gently clenched
Palpate Medial Pterygoid
Gloved finger place on last molar, slide around medial surface of molar and inferiority past the gum towards the floor of the mouth.
Keep finger pad against inner surface of mandible the finger is then slid posteriorly to medial pterygoid
(Resist Elevation - Closing)
Palpate Lateral Pterygoid
Finger placed between cheek and molar with fingernail against last upper molar, finger slid superiority posteriorly between maxilla and coronoid process into the hollow at the roof of the cheek
(Resist depression - Opening)
Palpate Mylohoid
Finger placed between lower teeth and tongue. Beginning at incisors the finger pad slid down inner surface of mandible to the floor of the mouth, continuing posteriorly to the last molar where mylohyoid ends
(Resist depression - opening)
Review Ligament Injuries **NOT FINISHED*
1) ACL
2) MCL
3) Medial Meniscus
Close vs Open Chain of Tibial Joint
Open Chain is Concave on Convex
Flexion Roll
- Posterior and medial rotation slide: Posterior
Extension Roll
- Anterior and lateral rotation slide: Anterior
Closed chain is convex on concave
Close vs Open Chain Femoral Motion
Closed Chain (Flexion) Roll - Posterior and lateral rotation slide: Anterior
Closed Chain (Extension) Roll - Anterior and medial rotation slide: Posterior
Open vs. Closed Chain Ankle Joint
Close Chain: Ankle Dorsiflexion
Open Chain: Ankle Plantarflexion
Close vs Open Chain Subtalar (Talocalcaneal) Joint
Open Chain: Convex posterior portion of calcaneus slides opposite to motion ad concave middle and anterior positions slide in same direction (Door knob/tap)
Cant find close chan
What is Open chain for Talonavicular Joint?
Pronation
- The navicular slide dorsal and laterally
Supination
- Navicular slide plantarly and medially
What is closed pack position of TMJ?
Teeth tightly clenched
Unilateral Distraction TMJ
- Use hand opposite the side on which you are working
- Place thumb in patients mouth on back molars
- Fingers are outside wrapped around the jaw
- Force is in downward (caudal) direction
Unilateral Distraction with Glide TMJ
- After distracting jaw, pull it in anterior direction with tipping motion
- Other hand can be placed over TMJ to palpate amount of movement
Bilateral Distraction of TMJ
Supine (Stand at head of table)
Sitting (Stand in front of patient)
- Use both thumbs placing them on molars on each side of mandible
- Fingers are wrapped around jaw
- Force from thumbs is equal in caudal direction
Self Mobilization of TMJ
- Place cotton dental rolls b/t back of teeth and have client bite down
- This distracts condyles from fossae in joints
Review common types of injuries from LP 15 & 16 COME BACK TO THIS
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What physiological movements make up Supination of Foot?
Plantarflexion
Inversion
Adduction
What physiological movements make up Pronation of Foot?
Dorsiflexion
Eversion
Abduction
Common causes of overuse syndromes? (In relation to the leg)
1) Faulty alignment
2) Mm imbalances
3) Fatigued mm
4) Change in exercise routine
5) Training errors
6) Improper footwear
7) Predisposing issues
What is the Q Angle?
Formed by 2 intersecting lines
- ASIS to mid patella & mid patella to tibial tuberosity
- Greater in women (10-15 degrees)
Lateral shift of mandible resulting from movement of condyles along the lateral inclines of the mandibular fossa during lateral jaw movement
Bennett Shift
Time frames to change phases for surgical repair of GH dislocation?
1) Max Protection Phase
- Control pain and inflammation
- Prevent/correct posture
- Maintain mobility
- Restore shoulder mobility while protecting tissues
- Prevent reflex inhibition and atrophy of GH mm
2) Moderate Protection
- Regain nearly full, pain-free, active ROM
- Continue to increase strength and endurance of shoulder
3) Minimum Protection (Return to Function)
- Usually begins at 12 weeks post-op (late as 16 weeks)
- Stretching should continue until ROM consistent with functional needs have been attained
- Exercise to improve strength and endurance
- Level of intensity determined by demand of returning functional activity
When does Return to Function Phase begin?
- Usually begins at 12 weeks post-op (late as 16 weeks)
What is resting position of TMJ?
Mouth slightly open, lips together, teeth not in contact
What muscle is common source of knee pain but often overlooked as a cause of knee pain?
Sartorius or all Pes Anserine muscles
Bonus Question
What is the O and I, Action of Sartorius?
O: ASIS
I: Prox medial shaft of tibia at Pes anserine tendon
FD: Inferomedial
Action: Flex hip, flex knee, abduct and external rotate hip
What are the aims of treatment of client still in protective phase (no surgery)?
Decrease pain, mm setting as long as joint doesn’t move
In maximum protection (with surgery) phase what is the aim?
Minimize atrophy of mm
In controlled motion phase would you start to incorporate more aggressive technique
Yes!
Frictions to help prevent scar tissue
When is muscle setting best used in which phase?
Protective (Fractures are best)
Would you perform conditioning exercises in protective phase of healing?
No!!
Hamstring activate during terminal swing phase, what type of contraction?
Eccentric Contraction
- controls contraction by deceleration
Is TMJ joint Biconcave?
- What is the purpose?
Yes
- Prevents disc from being displaced
Look at Heel Spurs, Hip pain - Bone Spurs
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What muscle sometimes may be weak during midstance?
Glute Med (Controls lateral shift of hip) - Contralateral hip would drop Trendelenburg gait, causes people to be unbalance
Drop foot is associated with steppage gait. What could you do to help correct it?
Strengthen Tib Ant and Dorsiflexor
Know Actions of Muscles of TMJ
Will add actions later
Posterior glide of the radial head at prox radioulnar joint would increase what?
Pronation
Subtalar Joint
What glide would increase inversion
Lateral Gilde
Subtalar Joint
What glide would increase eversion
Medial Glide
To increase flexion of the hip what glide would you apply?
Posterior
When he hip is flexed what way does it roll?
Anterior
Are roll and swings the same?
Yes
How would you injure ACL?
Lateral blow
- Cause femur to translate anterior on the tibia, also injured MCL and medial meniscus
What cause Anterior Shin Splint
- *Most Common**
- Overuse of Ant Tib mm, hypomobile Gastroc and weak Tib Ant mm
- Foot pronation
- Pain increase with active Dorsiflexion and when mm is stretched in plantarflexion
What causes Posterior Shin Splints?
- Tight Gastroc and foot pronation and inflamed Tib Post
- Pain experienced when foot is passively dorsiflexed with eversion and active supination
What is purpose of Progressive Relaxation Exercises?
Decrease SNS firing
Increase body awareness
Proprioceptive
What 2 bones form the Mortis?
Distal portion: Medial and Lateral Malleoli
What is Step Length?
Contact points between the opposite foot
What is Base Length?
While standing, foot to foot
What is Stride Length?
Distance between the same foot
When you are in the Protective Phase of healing should you be completely immobilized to heal?
No
Would movement help to maintain cartilage and connective tissue if it is pain free?
Yes
When flexing the knee, what degree of flexion would be the most compression?
75 degrees
What phase of healing post-surgical rotator cuff repairs would you restore and maintain full px free ROM?
Moderate (Controlled Motion) Protection Phase
When would you use Pendulum (no weight) exercise?
Protection Phase for Shoulder Impingement
If you have Anterior instability of GH what mm would you want to maintain strength?
- Rotator Cuff and Scapular mm
- Infraspinatus
Would you do Grade 3 or 4 glides for anterior instability of GH?
No
What stage of healing would you want to do cross fiber friction and develop strong mobile scars? (LP15, Pg3)
Moderate (Controlled Motion) Phase
If you have a cast on what technique is appropriate for treatment?
Muscle setting
What 3 things are appropriate in Protection Phase?
1) Main management
2) Multiangle mm setting
3) Passive assisted/ Active ROM
What muscle is most common in shin splints?
Tib Anterior
What joint mobilization is appropriate during a flare up of a client with RA?
Grade 1 Oscillation
When the tibia is in a closed chain position, the femur undergoes slight internal rotation during terminal extension. This is known as which mechanism?
Screwhome Mechanism
Your client has multi angled instability of the GH in the Return to Function Phase. What exercise is appropriate?
Ball on the wall
What can cause Patellar Malalignment and tracking problems?
1) Increase Q angle
2) Muscle fascia hypertonicity and tight quads
3) Hip mm weakness (cause pes planus)
The Q angle if formed by?
ASIS to Mid patella -> Mid patella to Tib tuberosity
What type of bursitis is aggravated by excessive hip flexion?
Psoas Bursitis
Muscle imbalances can cause repetitive trauma. Which mm would be dominant if Glute Med/Min is weak?
- TFL, Rec Fem (Hip Flexors, Abductors and Int Rot)
- Can cause low back, knee problems (faulty mechanics on weight bearing)
Muscle imbalances can cause repetitive trauma. Which mm would be weak with Dominant Piriformis?
- Glute max/med is weak
- Can cause low back, knee problems (faulty mechanics on weight bearing)
What are the bones found in the Hindfoot?
Calcaneus and Talus
What are the bones found in the Midfoot?
Navicular, Cuboid, 3 Cuneiforms (Medial, Intermediate, Lateral)
What are the bones found in the Forefoot?
5 Metatarsal and 14 phalanges
In the Talocrual Joint you are most likely to sprain your ankle in plantarflexion, why?
Most unstable in plantarflexion
What is the joint rule of Talocrual (synovial hinge)?
Convex on Concave
To increase dorsiflexion of the Talocrual joint what glide would you perform?
Posterior
On the distal femur, why is the medial condyle larger?
Contributes to locking mechanism for screw home mechanism
What is the resting position of the TMJ?
Mouth slightly open, lips together and teeth not in contact
What are the 4 muscles of Mastication?
1) Masseter
2) Lateral Pterygoid
3) Medial Pterygoid
4) Temporalis
List the 4 Suprahyoid mm?
1) Digastric
2) Geniohyoid
3) Mylohyoid
4) Stylohyoid
List the 4 Infrahyoid mm?
1) Thyrohyoid
2) Sternohyoid
3) Omohyoid
4) Sternothyroid
What is the lateral shift of the mandible resulting from the movements of the condyles along the lateral inclines of the mandibular fossae during lateral jaw movement?
Bennett Shift
What type of joint is the TMJ?
- Synovial Condylar Modified Ovoid and Hinge joint
- Disc (biconcave) divides joint into 2 cavities and provides congruent contours and lubrication of the joint
What 2 motions are needed for full opening and closing of the mouth?
Gliding and Rotation
What rule of subtalar joint applies?
Convex on Concave
To increase eversion of the subtalar what glide would you perform?
Medial Glide
To increase inversion of subtalar joint what glide would you perform?
Lateral Glide
What is the convex/concave rule for the Proximal Radioulnar?
Convex on Concave
What is the convex/concave rule for Distal Radioulnar?
Concave on Convex
Does the roll go in the same direction as the moving bone?
Yes (Opposite of the glide)
What joint mob is safe for a painful joint?
Grade 1 Oscillation
When you injure your ACL what is the most common mechanism?
Lateral blow to the knee (Valgus force)
What other structures can be injured in ACL injury?
MCL and Medial Meniscus can also be injured with ACL
How would you increase dorsiflexion in Talocrual Joint?
Posterior
How would you increase plantarflexion in Talocrual Joint?
Anterior
When you are stretching do you stretch into pain?
No
When you are distracting TMJ what is the direction?
Inferior
Purpose of eccentric exercise?
Strengthen not just your muscles, but also your body’s connective tissue. Helping both rehab any aches and pains as well as prevent injuries ranging from tendinitis to ACL strains
What type of joint is a Talocrural joint?
Synovial Hinge Joint
What actions are happening with supination of the foot?
1) Plantarflexion
2) Adduction
3) Inversion
What is normal base width?
2 - 4 inches (distance b/t 2 feet)
What is the distance between successive contact points on opposite feet?
Step Length
What is the linear distance in the plane of progression between successive points foot to foot contact of the same foot?
Stride Length
Do males or females have bigger step length?
Males
Do males or females have higher cadence?
Females
What is the number of steps per time unit (given period of time)?
Cadence
What is pelvic list?
Side to side movement of pelvis during walking
Why is it necessary (Lateral Pelvic shift)
Centre body over the stance leg for balance
What are the benefits of Proprioceptive exercises?
1) Improve joint position, stability, mobility, balance
2) Decrease risk injury and mm compensation
3) Mm may become overactive if proprioception is decreased as they will compensate to stabilize the joint
What is convex/concave rule for Subtalar?
Convex on Concave
What glide would increase Eversion in the Subtalar joint?
Medial
What glide would increase Inversion in the Subtalar joint?
Lateral
What is the difference between Roll and Glide?
Roll: Same as moving bone (doesn’t use convex/concave rule)
Glide: Use convex/concave rule
What is the purpose of Eccentric Contraction?
Lengthening the muscle but is done to control the movement
What type of joint is Talocrual?
Synovial Hinge
In an open chain of Talonavicular joint, Pronation- Navicular slides?
Dorsally and Laterally
In an open chain of Talonavicular joint, Supination- Navicular slides?
Plantarly and Medially
Anterior dislocation of GH, what position is Anterior?
Abduction and External Rotation
Anterior dislocation of GH, what position is Posterior?
Adduction and Internal Rotation
5 Periods of the Stance Phase?
1) Initial Contact
2) Load Response
3) Midstance
4) Terminal Stance
5) Pre Swing
3 Periods of the Swing Phase?
1) Initial Swing
2) Mid Swing
3) Terminal Swing
What muscles are weak with Steppage Gait?
Tibialis Anterior
What type of Gait has a staggering Gait pattern?
Cerebellar Gait
What type of gait has a pattern which the legs cross midline upon advancement?
Scissor Gait
What rule applies (convex/concave) for the Tibiofemoral (open chain)?
Concave on Convex
What rule applies (convex/concave) for the Talocrural?
Convex on Concave
What rule applies (convex/concave) for the Subtalar?
Convex on Concave
What rule applies (convex/concave) for the Distal Tibiofibular?
Convex on Concave
To improve knee flexion of the patellofemoral joint, what glide would you perform?
Distal or Inferior
If this mm is tight, it can be a contributing factor to trochanteric bursitis?
TFL
What mm usually Atrophy after Meniscus surgery?
Quads
What injury causes clicking and locking of the knee?
Meniscus
With an injury to the ACL what other structures are commonly injured with it, due to valgus force to the knee?
MCL and Medial Meniscus
What phase of healing would you do toe curls and ABV exercises for Ankle Sprain?
Controlled Motion
What part of the Calcaneus do the plantar fascia insert?
Medial Tubercle
How do you stretch the plantar fascia?
1) Dorsiflexion
2) Toe Extension
3) Eversion
What phase of rehabilitation is Gait training appropriate for ACL post-op?
Controlled Motion
What 2 muscles can you stretch or foam roll to release IT band?
1) TFL
2) Glute Max
If Glute Max is weak what is a muscle that can be over used to compensate?
Biceps Femoris (Hamstrings)
In the Return to Function phase what type of strengthening is beneficial for healing tendons (tendonitis)?
Eccentric
ACL & PCL are named where they attach to on the Tibia
!
How would you know which way the Tibia is rotated?
The way the Tibial Tuberosity is angled
What is the most peak compression of the knee?
75’
When is the Patella the most inferior?
90’
Which other joint functions with the Knee when weight bearing?
Ankle (Talocrual)
What muscle unlocks the Knee?
Popliteus
Which way is the Femur rotated when the Knee is locked?
Medially
Which what is the Femur rotated when the Knee is unlocked?
Laterally
Where does the Patella glide?
Intracondylar Groove
Where is the Base of the Patella? The Apex?
Base: on top
Apex: on bottom
What is the purpose of the cartilage of the Patella?
Reduce friction
What does Apley’s compression/distraction test for?
Compression: Meniscus
Distraction: MCL ligaments
Can Pendulum Swings be used as a joint mob?
Yes a Grade 1 & 2 with no weight
What test, test for Patella Tracking?
Clarks Sign
What glide would increase Knee Flexion?
Inferior/Distal
What type of joint is a Mortise?
Talocrual
Explain the Roll, Swing and Glide rule
Roll is the same direction as the Swing
Glide follows the same rule as Convex/Concave
Talonavicular slide direction Pronation/Supination
Pronation: Navi slides Dorsally/Laterally
Supination: Navi slides Planterally/Medial
What is the rule for Open Chain Tibofemoral?
Concave on Convex
Rule for Intermetatarsal/Metatarsophalangeal/Interphalangeal?
Concave on Convex
What direction to increase mobility to Proximal Tibofibular
Anterior Glide
What rule of Distal Tibofibular
Convex on Concave
Is Extension or Flexion most important in the Foot?
Extension is the foot
Flexion in the hand
What is a good exercise to improve sleep?
Nightly progressive exercises
Would you use Posture/Balance exercises on open or closed chain?
Closed chain (open isn’t stable enough)
What would be an Extrinsic factor of Rotator cuff injury?
Bursitis
What would be important to strengthen in shoulder injury?
Scapular shoulder muscles
Best exercise for multiangle instability
Ball on the wall
Lateral Epicondylitis effects which muscles of the forearm?
Extensors
Medial Epicondylitis effects which muscles of the forearm?
Flexors
Muscle imbalances can cause repetitive trauma. Which mm would be weak with Dominant Hamstrings?
Glute Max
What is the most commonly sprained ligament in the body?
Anterior Talofibular
Which muscle is Eccentric Contracted in Terminal Swing (Deceleration)
Hamstring
Which muscles are weak with Steppage Gait?
Ankle Dorsiflexors
What are 4 Things that can cause pain in the Heel in Initial Contact Phase
1) Heel Spur
2) Bone Bruise
3) Heel fat-pad bruise
4) Bursitis
What is common cause for pain to occur in Toe Off gait
1) Hallux Rigidus
2) Turf Toe
3) Any pathology involving great toe
Why is it open pack position of the ankle
Talus is wider anteriorly