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PHTH 527 > Flexibility and Core Stability > Flashcards

Flexibility and Core Stability Flashcards

1
Q

define instability

A

excessive range of movement which there is no protective muscular control

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2
Q

what scales do we use for hyper-mobility ? what is it scored out of?

A

beighton scale

out of 9

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3
Q

mechanical instability

A

disruption of the passive stabilizers and decreased structural integrity

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4
Q

functional instability

A

lack of neuromuscular control of the joint during activities

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5
Q

what makes up Panjabi’s spinal stability system

A 
passive subsystem (spinal column) 
active subsystem (spinal muscles) 
control subsystem (neural )
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6
Q

causes of hypermobility

A

can be traumatic or non -traumatic (genetic, adjacent hypomobility, habitual movements

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7
Q

explain the treatment process for hypermobility

A

1) mobilized hypomobile tissues or joints (manuel therapy, massage, IMS, stretching)
2) activate & strengthen to stabilize the hypermobile/unstable area
3) control excessive movement
4) facilitate co-contraction of muscles surrounding the joint
5) provide feedback & focus on quality

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8
Q

Other aspects of treatment of hypermobility

A

movement re-education & motor control
postural training
patient education
supportive devices

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9
Q

what are the purposes of bracing/taping?

A

restrictive of movement

proprioceptive - tells joint where it is in space

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10
Q

precautions to hyper mobility treatment

A

ensure patient has adequate control when exercises are performed
monitor fatigue of dynamic stabilizing muscles
educate patient to monitor control & precision of movement

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11
Q

define neutral zone

A

small range near neutral position of every joint where there is minimal resistance provided by the passive system
increase with injury

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12
Q

what are some inner unit muscles?

A

TA, multifidus, pelvic floor, diaphragm

segmental control

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13
Q

which unit controls during strengthening first

A

always inner unit

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14
Q

what does the outer unit consist of

A

anterior oblique sling
posterior oblique sling
lateral sling

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15
Q

what makes up the anterior oblique sling?

A

internal and external obliques, abdominal fascia & contralateral adductors

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16
Q

what makes up the posterior oblique sling?

A

latissimus dorsi, contralateral glut max & biceps femoris

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17
Q

what makes up the lateral sling?

A

glute med & min and contralateral adductors

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18
Q

where can you find TA to palpate

A

2.5 cm medial to ASIS

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19
Q

describe some characteristics of TA

A 
anticipatory 
not direction specific 
active continuously 
inhibited by pain / fear 
not affected by cognitive processes
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20
Q

what works with TA?

A

pelvic floor muscles

active in lifting

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21
Q

what are some recruitment strategies

A

position (supine,prone, sidelying)
palpation
verbal cues
visualisation and imagery

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22
Q

explain how to use the PFM

A 
patient supine knees bent 
relax butt and thighs 
palpate TA 
contract PFM 
note the ability to recruit & holding time
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23
Q

what is the rationale for using the SLR

A

test for failed load transfer through lumbopelvic region , positive test means failed load transfer

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24
Q

what should we look for in the ASLR

A 
note:
ability to ASLR 5 cm 
pelvic tilting or rotation
muscle fasciculation 
any symptoms 
get PT to contract TA any difference? 
compare side to side
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25
Q

describe exercise prescription for inner unit

A

prolonged static hold
low load
25% max voluntary contraction
10 sec holds 10 reps

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26
Q

how can we progress this exercise prescription?

A 
increase holding time & reps 
add simple leg movements 
add simple arm movements
combine arm and leg movements 
stable -unstable base
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27
Q

Most important Goal of exercise prescription

A

focus should be on local control of the inner unit should be achieved prior to global stabilization

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28
Q

define hypo-mobility

A

decreased ROM, mild muscle shortening - irreversible contractures

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29
Q

what are the factors that contribute to hypomobility

A

prolonged immobilization

  • extrinsic/intrinsic factors
  • postural faults
  • habitual faults
  • paralysis & tonal abnormalities
  • aging
30
Q

define contracture

A

adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch & limitation of ROM

31
Q

list out the types of contracture

A 
myostatic 
pseudomyostatic 
arthrogenic 
periarticular 
fibrotic
32
Q

explain what relative flexibility is

A

stiffness in one muscle group that causes another part of the body to compensate for that lack of movement

33
Q

what happens when you immobilize muscle?

A

decreased muscle fibre cross-sectional area
decreased number of myofibrils in a muscle fibre
decreased motor unit recruitment
muscle atrophy & weakness

34
Q

what happens when the muscle is immobilization in a shortened position

A 
decreased number of sacormeres 
muscle shortening 
increased atrophy 
length-tension curve shifts LEFT 
have stretch weakness
35
Q

what happens when the muscle is immobilized in a lengthened position

A

increased number of sarcomeres
decreased atrophy
length tension curve shifts right
adaptive shortening

36
Q

stretch weakness

A

weakness in mid and inner range

37
Q

what happens to tendon post immobilization

A

decreased tensile strength

38
Q

what happens with ligaments post immobilization

A

decreased tensile strength
adhesions and stiffness
bony resorption at entheses

39
Q

what happens to articular cartilage post immobilization

A

decreased lubrication

softening and fragmentation

40
Q

what happens to bone post immobilization

A

decrease bone mass and bone mineral content

41
Q

possible events that happen to our flexibility when we age

A

connective tissue tensile strength decreases
decreased elasticity
increased adhesions

42
Q

what are the 3 categories we need to think about that could be limiting movement

A

myofascial
articular/periarticular
dural

43
Q

define creep

A

increased length of the tissue as it becomes warmer

44
Q

stress relaxation

A

slow application of force will allow the tissue to move farther into its range

45
Q

indications for stretching

A

limited ROM due to loss of soft tissue extensibility
restricted motion that may lead to structural deformities that are otherwise preventable
presence of muscle weakness & shortening in opposing tissues
part of pre-hab maintenance program
enhance performance

46
Q

what are some key considerations for stretching?

A

does lack of muscular flexibility contribute to their dysfunction?
is there less than normal ROM noted on muscle length/flexibility testing?
is there an appropriate (muscular) end feel?

47
Q

What are the contraindications for stretching

A 
bony end feel 
acute inflammation/active infection 
recent fracture/bony union incomplete 
hematoma 
specific surgeries 
shortened tissue enables functional skills that otherwise are not possible
48
Q

precautions for stretching

A

recent corticosteroid injection
joint effusion & edematous tissue
osteoporosis & long term steroid use
newly united fracture
frail elderly
avoid vigorous stretching of recently immobilized tissues

49
Q

when you are prescribing stretching exercises make sure you think about :

A 
alignment 
stabilization 
intensity (tightness or slight discomfort)
duration 
frequency 
speed of stretch (slowly applied, dynamic, ballistic) 
mode of stretch 
integrate function with stretching
50
Q

What should be the volume per session/week/days per week

A

better increased time per session (60 seconds vs 60-120 s vs >120 s
time -5-10 mins & >10 min
More times a week the better

51
Q

reasonable stretching guildeline for clinical populations

A 
slowly applied, low intensity 
total dose >120 sec 
- 30-60 sec
-2-4 reps 
at least once daily 
6 days per week better
52
Q

active strategies of stretching

A

PNF
dynamic
muscle energy
eccentric exercise

53
Q

passive strategies of stretching

A

static stretch/self stretch
partner stretching
manual methods
mechanical

54
Q

when would u use mechanical stretching

A

chronic contractures
low load, long duration
Continuous passive motion (serial casting)

55
Q

What are some adjunctive agents for stretching

A 
active warm-up 
heat 
massage/ soft tissue techniques 
biofeedback & relaxation training 
joint traction /mobs 
ice/cold
56
Q

describe a muscle imbalance

A

certain muscles can be facilitated/overactive & inhibited/under active

57
Q

what can these muscle imbalances create

A

change in recruitment patterns
strength
length

58
Q

when the muscle is in a normal range where is it strongest

A

mid range

59
Q

what happens when a muscle is habitually shortened/lengthened muscle

A

tests strongest in a position closest to inner range or if lengthened outer range

60
Q

what are some sources for muscle imbalance?

A

injury/trauma muscle inhibition due to pain/inflammation
disease
repetitive stress
postural habits

61
Q

explain the price the body has to pay for muscle imbalances

A

altered joint motion& movement patterns
dysfunctional movement
tissue breakdown
pain

62
Q

tonic muscle

A

always on

ex multifidus

63
Q

phasic muscle

A

turns on and off when needed

biceps

64
Q

local stabilizer muscle

A 
close to the joint 
single joint 
stability 
tonic 
non-direction specific 
anticipatory
65
Q

dysfunction of local stabilizers

A

atrophy
phasic
inhibition

66
Q

global stabilizer muscle

A 
single joint 
stability & angular motion 
tonic 
decelerative 
direction specific
67
Q

dysfunction of global stabilizer muscles

A

inhibition
atrophy
lengthen
phasic

68
Q

global mobilizer

A

multi-joint
phasic
accelerative
creates movement

69
Q

dysfunction of global mobilizer

A

hypertrophy
shorten
tonic

70
Q

what direction should we test muscle length

A

take the muscle in the opposite direction that it would contract
one end is fixed while insertion moves passively

71
Q

considerations for muscle length testing

A

dont do if patient has acute pain
dont put in contraindicated positions
watch for cheats to move in the least amount of resistance

72
Q

how do we correct muscle imbalances

A

1) inhibit the overactive muscles
2) lengthen short overactive muscles
3) activate weak under active muscles
4) integrate into function

PHTH 527 (3 decks)

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