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