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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
As intensity increases, volume does what?
Decrease
26
What are an appropriate volumes for each experience level for Plyos
Beginner = 80-100 Intermediate = 100 - 120 Expert = 120-140
27
Factors affecting intensity
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)
28
Does Age determine plyometric programming? Does ability affect plyometric programming?
No and No, any age and any ability level can do plyos. You have to cater them to your audience.
29
How does power, endurance, and timing affect recovery when doing plyos?
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
30
Contraindications for Plyos
Laxity, Inflammation, and Soft tissue limitations (Base strength or foundation)
31
How do plyos increase Neuromuscular coordination
Train the nervous system to make movements more automatic.
32
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
Goal development approach steps
33
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
Impairments of building an intervention plan
34
Neuromuscular control/balance/and coordination, functional activities (skills to building activities), and sport specific activity
Impairments of Function & Performance
35
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
Steps of an Intervention Plan & Progression
36
Injury to the 5th Metatarsal
Jones Fx
37
What are the 3 zones of a Jones Fx and what do they indicate?
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
38
How do you treat a Jones Fx according to the zone it occured in?
Zone 1 - Treat conservatively (boot) Zone 2 - Delyaed union and nonunion when treated conservatively Zone 3 - Protracted healing and non-union
39
Conservative management for each Zone
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
40
Surgical Management for each zone
Zone 1 - No Zone 2/3 - Open reduction and internal fixation (ORIF) (better outcomes in Zone 2 and 3 in athletes)
41
Post-Op Treatment of a Jones Fx
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
Immobilization of Jones Fx considerations
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
What is Return to Run Criteria for a Jones Fx
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
Most common in runners, increased loads and inadequate rest increase risk
Stress Fractures
45
Intrinsic Factors of a Stress Fx
Sex, Race, Age, Genetics, Alignment, Strength, Fatigue, Flexibility, Biomechanics, Recovery, Nutrition
46
Extrinsic Factors of a Stress Fx
Footwear, Training surface, Training Load
47
Low-Risk Stress Fx
Posteriomedial Tibial, 2nd/3rd Mets, Calcaneus, Distal Fibula, cuboid, cuneiforms
48
High-Risk Stress Fx
Anterior Tibial Cortex, Medial Malleolus, Navicular, Talus, Base of 5th, Base of the 2nd, hallux sesamoids
49
Common MOI for Lisfranc Fx
Axial Load and PF
50
Diagnosis of a Lisfranc Fx and Treatment
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
Motion in most joints are ___ as axes are not in straight planes
Triplanar
52
Injury caused by eccentric overload an occur at the middle section, 2-6 cm proximal to insertion site is hypovascular zone
Achilles Tendon Rupture
53
Achilles tendon rupture occur at MT junction what percentage of the time? Mid-portion? Insertion?
MT Junction - 9% Mid-Portion - 72% Insertion - 19%
54
What population is most affected by achilles tendon ruptures
Men (12:1)
55
Non-Operative management following early recognition is
Successful but 3x more likely to re-rupture and decreased PF strength
56
Operative Management of an Achilles Injury
May result in complications (wound infection and sural nerve injury). Different types of surgical procedures - open, percutaneous, minimally invasive open
57
Achilles Rupture Rehabilitation
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
Chronic Lower Leg Conditions
PFPS, MTSS, Plantar Fasciitis, Tendonitis
59
Grades of Evidence for Plantar Fasciitis Treatment
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
MTSS
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
Anterior Compartment
Tib Ant, Extensor Digi Long, Extensor Hallucis Long, Peroneus Tertius, Deep Fib Nerve and Ant tib vessels
62
Lateral Compartment
Fib Long, Fib Brevis, Superficial Fib Nerve and Fib Artery
63
Deep Posterior Compartment
Tib Post, Flexor Digi Long, Flexor Hallucis Long, Popliteus, Tibial Nerve, Post Tib artery and Post Tib Vessels
64
Superficial Posterior Compartment
Gastroc, Soleus, Plantaris, Tib Nerve
65
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
Fasciotomy
66
Experiences tissue degeneration
Tendinopathy
67
Treatment strategies for Tendinopathy
Eccentrics and/or slow concentrics, Leukocyte rich plasma therapy, prolotherapy, and shockwave therapy
68
What is the Silbernagel Protocol used for?
Tendinopathy
69
Establish Cause of Dysfunction
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
General Rule of Thumb
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
High Ankle Sprain LAS
High Prevalence, 40% develop Chronic Ankle Instability after initial sprain
72
Subtalar joint estimated to be affected in _% of people with CAI
75-80%
73
Prognosis in Pt with CAI
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
Arthrokinematic LAS Problems
Decerased posterior talar glide Anterior positional fault of distal fibula Eversion ROM restriction
75
General LAS problems
Edema/effusion & pain Altered mechanoreceptor inputs - altered postural control and proprioception
76
Tissue LAS problems
Spasm and Fascial restictions
77
What is a posterior talar glide used for?
Decreased motion of the talus on the tibia
78
What is a Subtalar Rock Glide used for
Increases general ROM
79
What is a medial glide used for
Increases Eversion
80
What is a lateral glide used for
Increases Inversion
81
What is a Posterior-Anterior (PA) On Talus glide used for
Increasing plantar flexion
82
Characteristics of Fibular Motion
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
Fibular Mobs
Distal Mob: Mobilize the lateral malleolus directly posterior Proximal Mob: Mobilize the fibular head anteriorly
84
MET for Proximal Fibula
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
Myofascial Trigger Points
Tib Ant, Peroneals, Soleus, Tib Post
86
What are tender points?
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
What are the 2 things that mediate tender points
Nociceptors and Mechanoreceptive
88
Trigger points as a result of trauma result in
Hypertonicity, inflammation, ischemia, and chemical mediators
89
How long do you apply pressure to a trigger point?
90 seconds
90
How long do you wait in between treatment of trigger points
1 week
91
Arthrokinematic Cuboid Pain Problems
Cuboid depressed into plantar foot, pain with mobility test
92
Biomechanical Cuboid Pain Problems
Pain with push-off phase, Pain with heel raise or single leg hop
93
Tissue Cuboid Pain Problems
Spasm, Fascial Restrictions, potential muscle inhibition due to positional faults (tib ant, soleus, hamstrings)
94
Cuboid Syndrome Diagnosis
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
Cuboid MET
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
Plantar Fasciitis Arthrokinematic problems
Decreased posterior talar glide, altered subtalar motion, altered knee or hip motion
97
Plantar fasciitis biomechanical problems
Pronation or excessively rigid foot
98
Plantar fasciitis tissue problems
Length of gastroc-solus complex Fascial restrictions
99
Soft Tissue work for Plantar Fasciitis
EPAX and MTEX
100
Once good arthrokinematics are estabilished, what next?
Have pt work on basic ankle ROM and flexibility. Next is gait training, strengthening, RTR protocols

ICP (3 decks)

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