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ICP > ICP FInal (Exam 3 Cards) > Flashcards

ICP FInal (Exam 3 Cards) Flashcards

1
Q

Quantitative Measures

A

P = F * D/T or Power = Force * Distance/ Time

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2
Q

Mechanical model of Plyos

A

Elastic Energy is stored throughout the eccentric action, then released by concentric action

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3
Q

Series Elastic Component (SEC)

A

The workhorse, when stretched this stores elastic energy that increases the force produced. The tendons that are in series with the muscle.

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4
Q

Contractile Component (CC)

A

Actin/Myosin/Cross bridges, primary source of muscle force during concentric muscle action

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5
Q

What are the 4 components of the Parallel Elastic Component?

A

Perimysium, Epimysium, Endomysium, and Sarcolemma

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6
Q

What does the Parallel Elastic Component (PEC) do?

A

Exert a passive force with an unstimulated muscle stretch

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7
Q

If the concentric phase does not occur immediately or if the ECC phase is too long or the ROM is too great, what happens?

A

The stored Energy dissipates and lost to heat

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8
Q

The change in force-velocity characteristics of the muscle’s contractile components caused by stretch

A

Potentiation

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9
Q

Involuntary response to an external stimulus stretches the muscle

A

Stretch Reflex

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10
Q

Intrafusal muscle fibers that react to stretch, cause reflexive contraction, and response potentiates the activity of agonist muscles causing increase of force produced

A

Muscle Spindles

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11
Q

When extrafusal muscle spindals contract, what do they do?

A

Muscle spindles are unloaded, dorsal and ventral horn reflexes.

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12
Q

Reflextivity increases what?

A

Spindle Stimulation

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13
Q

According to Neurophysiological model, if the concentric action does not occur immediately or the ROM is too great

A

The stretch reflex is negated

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14
Q

A combination of the mechanical and neurophysiological model split into 3 phases: Eccentric -> Ammortization -> Concentric

A

Stretch Shortening Cycle (SSC)

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15
Q

The concentric phase is actually the weakest form of muscle contraction, EXCEPT during plyos due to what?

A

The stretch reflex

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16
Q

Stretch of the Agonist, Elastic E is stored in the SEC and muscle spindles are stimulated

A

Eccentric Phase of the Stretch Shortening Cycle (SSC)

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17
Q

Pause between Phase 1 and 2, Type 1a afferent neurons synapse with a motor neurons and those a motor neurons transmit signals to agonist muscle group

A

Ammortization phase of the Stretch Shortening Cycle (SSC)

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18
Q

Shortening of the Agonist, Elastic energy is released from the SEC, a motor neurons stimulates the agonist muscle group

A

Concentric phase of the Stretch Shortening Cycle (SSC)

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19
Q

FT 2b is recruited at what % intensity?

A

30-80%

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20
Q

2a and 2b are recruited at what % intensity?

A

80%

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21
Q

Clinical Guidelines for Plyo programming

A

Patient Education, Intensity/Volume, Age, Recovery, Abilities, Periodization Progression (Time-Based/Criterion-Based Healing Rehab)

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22
Q

DOMS for Plyos

A

Increased soreness 7-10 days after initiation, 80% max effort to stimulate the IIa and IIb FT fibers, ECC load 10-40% greater than concentric load, plyos cause microtrauma to the SEC and release hydroxypropoline (a major component of fibrillar collagen of all types)

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23
Q

Amount of stress placed on the tissue, controlled by the exercise/drill (factors include height, distance, and load)

A

Intensity of Plyos

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24
Q

Reps/Sets

A

Volume

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25
Q

As intensity increases, volume does what?

A

Decrease

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26
Q

What are an appropriate volumes for each experience level for Plyos

A

Beginner = 80-100
Intermediate = 100 - 120
Expert = 120-140

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27
Q

Factors affecting intensity

A

Point of contact (Single Leg or Double leg), Speed (higher speed = higher intensity), Height (Higher the center of gravity, the greater the force), Body weight (Greater the weight = greater stress on tissue)

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28
Q

Does Age determine plyometric programming?
Does ability affect plyometric programming?

A

No and No, any age and any ability level can do plyos. You have to cater them to your audience.

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29
Q

How does power, endurance, and timing affect recovery when doing plyos?

A

Power - For every 1 second of work, 5-10 seconds of rest.
Endurance - Decreased work to rest ratio, so for every 1 second of work means 10-15 seconds of rest.
Timing - Utilize physiological knowledge and timetables to understand timing

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30
Q

Contraindications for Plyos

A

Laxity, Inflammation, and Soft tissue limitations (Base strength or foundation)

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31
Q

How do plyos increase Neuromuscular coordination

A

Train the nervous system to make movements more automatic.

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32
Q

Identify desired participation and function (using a Pt-centered hx and patient reports), Determine assessment evidence (using PC and CC evidence), and Plan interventions that lead to those desired results

A

Goal development approach steps

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33
Q

Managing by-products of injury and healing, Protecting tissue from further damage and correct neural program errors, Restoring ROM/tissue length, Activating muscles and restoring motor control, strengthening muscles

A

Impairments of building an intervention plan

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34
Q

Neuromuscular control/balance/and coordination, functional activities (skills to building activities), and sport specific activity

A

Impairments of Function & Performance

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35
Q

Tissue/Structures Affected -> Determine severity of injury -> Determine stage of healing -> Determine irritability & stability of tissue/structure affected -> determine disablement -> develop goals both time and criterion based -> Effect of the intervention

A

Steps of an Intervention Plan & Progression

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36
Q

Injury to the 5th Metatarsal

A

Jones Fx

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37
Q

What are the 3 zones of a Jones Fx and what do they indicate?

A

Zone 1 - Tuberosity avulsion fx found most distally
Zone 2 - Classic “Jones Fx” area, at the metatarsal in the middle
Zone 3 - Proximal Diaphyseal stress fx

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38
Q

How do you treat a Jones Fx according to the zone it occured in?

A

Zone 1 - Treat conservatively (boot)
Zone 2 - Delyaed union and nonunion when treated conservatively
Zone 3 - Protracted healing and non-union

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39
Q

Conservative management for each Zone

A

Zone 1 - Weight Bearing as Tolerated in boot for 6-8 weight
Zone 2/3 - 6 weeks non-weight bearing and then 6 weeks with boot with gradual weight bearing

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40
Q

Surgical Management for each zone

A

Zone 1 - No
Zone 2/3 - Open reduction and internal fixation (ORIF) (better outcomes in Zone 2 and 3 in athletes)

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41
Q

Post-Op Treatment of a Jones Fx

A

Immobilized for 2 weeks after surgery, transition to boot & gradual progression to full weight bearing 2-6 weeks. At week 6, switch to regular shoes with full length carbon insert, RTP at weeks 10-12 with x-ray to confirm healing

42
Q

Immobilization of Jones Fx considerations

A

Bone loss as early as 2 weeks after immobilization, as immobilization time increases, increased brittleness. For muscles, Integrate NWB ROM and isometrics to diminish losses

43
Q

What is Return to Run Criteria for a Jones Fx

A

General Criteria - 2 weeks of pain free walking with normal mechanics, normal ROM restoration of LE, no swelling. In the interim use cross training (NWB) or unloaded (pool)

44
Q

Most common in runners, increased loads and inadequate rest increase risk

A

Stress Fractures

45
Q

Intrinsic Factors of a Stress Fx

A

Sex, Race, Age, Genetics, Alignment, Strength, Fatigue, Flexibility, Biomechanics, Recovery, Nutrition

46
Q

Extrinsic Factors of a Stress Fx

A

Footwear, Training surface, Training Load

47
Q

Low-Risk Stress Fx

A

Posteriomedial Tibial, 2nd/3rd Mets, Calcaneus, Distal Fibula, cuboid, cuneiforms

48
Q

High-Risk Stress Fx

A

Anterior Tibial Cortex, Medial Malleolus, Navicular, Talus, Base of 5th, Base of the 2nd, hallux sesamoids

49
Q

Common MOI for Lisfranc Fx

A

Axial Load and PF

50
Q

Diagnosis of a Lisfranc Fx and Treatment

A

Need Weight-Bearing X-Ray to diagnose

If stable, treated non-operatively. Boot NWB to PWB as tolerated. Transition to normal shoes at 4-6 weeks

If unstable, ORIF with RTP in around 5 months

51
Q

Motion in most joints are ___ as axes are not in straight planes

A

Triplanar

52
Q

Injury caused by eccentric overload an occur at the middle section, 2-6 cm proximal to insertion site is hypovascular zone

A

Achilles Tendon Rupture

53
Q

Achilles tendon rupture occur at MT junction what percentage of the time? Mid-portion? Insertion?

A

MT Junction - 9%
Mid-Portion - 72%
Insertion - 19%

54
Q

What population is most affected by achilles tendon ruptures

A

Men (12:1)

55
Q

Non-Operative management following early recognition is

A

Successful but 3x more likely to re-rupture and decreased PF strength

56
Q

Operative Management of an Achilles Injury

A

May result in complications (wound infection and sural nerve injury). Different types of surgical procedures - open, percutaneous, minimally invasive open

57
Q

Achilles Rupture Rehabilitation

A

Better outcomes with an early functional protocol compared to NWB cast for 6 weeks. Use Posterior splint for 14 days in anywhere from 10-30 degrees PF. Check wound daily, Revascularization and healing takes up to 12 weeks (NWB to PWB may begin prior to week 6, FWB at 2-3 months, full activity at 5-6 months

58
Q

Chronic Lower Leg Conditions

A

PFPS, MTSS, Plantar Fasciitis, Tendonitis

59
Q

Grades of Evidence for Plantar Fasciitis Treatment

A

A - Manual therapies (Joint and soft tissue mobes), stretching, anti-pronation tape and orthotics, night splints

D - Electrophysical agents

F - Therapeutic Exercise and Neuromuscular control

60
Q

MTSS

A

Follow Protocol that works on soft tissue and joint mobs, increase soft tissue length, focus on general strengthening, use foot orthotics, use a RTR and soreness rules as guide, and retrain running with shorter stride length

61
Q

Anterior Compartment

A

Tib Ant, Extensor Digi Long, Extensor Hallucis Long, Peroneus Tertius, Deep Fib Nerve and Ant tib vessels

62
Q

Lateral Compartment

A

Fib Long, Fib Brevis, Superficial Fib Nerve and Fib Artery

63
Q

Deep Posterior Compartment

A

Tib Post, Flexor Digi Long, Flexor Hallucis Long, Popliteus, Tibial Nerve, Post Tib artery and Post Tib Vessels

64
Q

Superficial Posterior Compartment

A

Gastroc, Soleus, Plantaris, Tib Nerve

65
Q

In runners, pain decreased and resulted in a RTP in 84% of patients. Of this group, 56% went back to competitive running. Recurrence of sx occurred in 19% of patients. Consistent disagreement about post-op outcomes

A

Fasciotomy

66
Q

Experiences tissue degeneration

A

Tendinopathy

67
Q

Treatment strategies for Tendinopathy

A

Eccentrics and/or slow concentrics, Leukocyte rich plasma therapy, prolotherapy, and shockwave therapy

68
Q

What is the Silbernagel Protocol used for?

A

Tendinopathy

69
Q

Establish Cause of Dysfunction

A

Distinguish between osteokinematic and arthrokinematic restriction

Do this by:
Assess ROM, Assess PROM and end feels, Assess accessory joint motion at talocrural and subtalar joints, Assess tissue length and fascial movement

70
Q

General Rule of Thumb

A

Restore normal arthrokinematics, then deal with tissue dysfunction (use mobs, MET, Myofascial release)

Lengthen a shortened muscle before strengthening (MET, positional release, myofascial release)

Restore Neural input to tissue (Neural Glides)

Always follow up with exercise to stabilize

71
Q

High Ankle Sprain LAS

A

High Prevalence, 40% develop Chronic Ankle Instability after initial sprain

72
Q

Subtalar joint estimated to be affected in _% of people with CAI

A

75-80%

73
Q

Prognosis in Pt with CAI

A

Altered joint mechanisms, Altered sensory inputs (decreased hip adductor strength in pts with CAI),
increased muscle inhibition (hamstring, soleus, Tib Ant), Altered neuromuscular control, Altered proprioception/balance

74
Q

Arthrokinematic LAS Problems

A

Decerased posterior talar glide
Anterior positional fault of distal fibula
Eversion ROM restriction

75
Q

General LAS problems

A

Edema/effusion & pain
Altered mechanoreceptor inputs - altered postural control and proprioception

76
Q

Tissue LAS problems

A

Spasm and Fascial restictions

77
Q

What is a posterior talar glide used for?

A

Decreased motion of the talus on the tibia

78
Q

What is a Subtalar Rock Glide used for

A

Increases general ROM

79
Q

What is a medial glide used for

A

Increases Eversion

80
Q

What is a lateral glide used for

A

Increases Inversion

81
Q

What is a Posterior-Anterior (PA) On Talus glide used for

A

Increasing plantar flexion

82
Q

Characteristics of Fibular Motion

A

Proximal fibula moves anterior and lateral or posterior and medial (~30 degrees)

In Lateral Ankle Sprains, inferior fibula is usually “stuck anterior” (restricting eversion) and the fibular head is posterior causing increased tone of the lateral hamstring

83
Q

Fibular Mobs

A

Distal Mob: Mobilize the lateral malleolus directly posterior

Proximal Mob: Mobilize the fibular head anteriorly

84
Q

MET for Proximal Fibula

A

Internally rotate the lower leg and invert the foot, Palpate the proximal fibular head, ask pt to move foot into dorsiflexion and eversion against resistance, simultaneously pull the fibular head in the anterolateral direction

85
Q

Myofascial Trigger Points

A

Tib Ant, Peroneals, Soleus, Tib Post

86
Q

What are tender points?

A

Localized hyper-irritable points that feels like a small nodule located in subcutaneous, muscular or fascial tissue. These are thought to affect postural muscles which are placed in constant tension

87
Q

What are the 2 things that mediate tender points

A

Nociceptors and Mechanoreceptive

88
Q

Trigger points as a result of trauma result in

A

Hypertonicity, inflammation, ischemia, and chemical mediators

89
Q

How long do you apply pressure to a trigger point?

A

90 seconds

90
Q

How long do you wait in between treatment of trigger points

A

1 week

91
Q

Arthrokinematic Cuboid Pain Problems

A

Cuboid depressed into plantar foot, pain with mobility test

92
Q

Biomechanical Cuboid Pain Problems

A

Pain with push-off phase, Pain with heel raise or single leg hop

93
Q

Tissue Cuboid Pain Problems

A

Spasm, Fascial Restrictions, potential muscle inhibition due to positional faults (tib ant, soleus, hamstrings)

94
Q

Cuboid Syndrome Diagnosis

A

Plantar flexion and inversion, cuboid TTP, positive mid tarsal mobility test, antalgic gait, MMT weak and pain with inversion and eversion, functional testing pain

95
Q

Cuboid MET

A

Pt = Prone
Grab foot stabilizing the calcaneus, lift cuboid, plantar flex and medially rotate forefoot. Resist dorsiflexion of forefoot or HVT of acute plantar flexion

96
Q

Plantar Fasciitis Arthrokinematic problems

A

Decreased posterior talar glide, altered subtalar motion, altered knee or hip motion

97
Q

Plantar fasciitis biomechanical problems

A

Pronation or excessively rigid foot

98
Q

Plantar fasciitis tissue problems

A

Length of gastroc-solus complex
Fascial restrictions

99
Q

Soft Tissue work for Plantar Fasciitis

A

EPAX and MTEX

100
Q

Once good arthrokinematics are estabilished, what next?

A

Have pt work on basic ankle ROM and flexibility. Next is gait training, strengthening, RTR protocols

ICP (3 decks)

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