Injuries and Proprioception Flashcards

Question

What is PCL MOI

Answer 1

- Sudden forcible external rotation of femur with foot fixed while knee adducted & flexed - Forcible displacement of tibia backwards on femur while knee flexed - Fall on flexed knee with force on upper end of tibia - Relatively uncommon in sports, knee hyperextension is most common or dashboard injury in MVA

Answer 2

- MUST accurately assess posterior instability - Acute treat as per ACL - Re-establish quads strength/function to overpower action of hamstrings - Quad strength goal = 60% body weight - Proprioception Remove inflammation, restore ROM/function, turn muscle back on and get them to learn to control their knee again.

Answer 3

* 80% of all meniscus tears = medial side * Foot fixed, weight-bearing, medial rotation of femur on tibia, valgus force to knee (includes MCL) * Poor blood supply except at MCL attachment (↑ chance of healing here) Symptoms: o Knee swelling (synovial irritation) o Occasional “giving way” o Pain on same side as injury, joint line o Recurrent swelling with use o Quads wasting o Positive McMurray’s test (65-75% tears) o Recurrent “clicking” with use o Unable to perform bilateral deep squat o Locking – 1 solid lock usually = surgery

Answer 4

Meniscal tear IR of the tibia + Varus stress = lateral meniscus ER of the tibia + Valgus stress = medial meniscus

Answer 5

Immediate - Do NOT force a locked knee into extension - PIER - NWB and refer to consult Surgical - Arthroscopy - Day surgery: patient walks out of hospital - 10-14 days post-op possible to RTP but potential complications - Treat for swelling and strengthen around the joint

Answer 6

Term used until knee viewed internally Includes several syndromes causing pain in anterior aspect of knee. Knee pain with no soft tissue injury related to it (muscles, ligaments and meniscus are fine) Causes: - Patellar malalignment - Congenital abnormalities in patella (too small, too large etc.) - Wide hips/Q-angle - Knee malalignment (bowlegged etc.) - Muscle imbalance (tight lateral structures, weak medially)

Answer 7

Depends on cause Stretch tightness Strengthen weakness Hip strengthen Foot alignment

Answer 8

“Sick cartilage of the patella” - True degeneration in articular cartilage of patella - Term can ONLY be applied post-surgically Treatment: FIND THE CAUSE, TREAT THE CAUSE ↑ patellar mobility Restore quads syncronicity Restore knee mechanics Strengthen quads Stretch lateral compartment Correct foot biomechanics Educate PIER

Answer 9

Jumper's knee Repetitive or eccentric knee extension activities (running, jumping) Between inferior pole of patella and tibial tubercle Tenderness, Stages of Pain 1. After activity 2. During and after activity 3. During and after activity (performance affected), pain constant and increased risk of rupture PIER after activity, rehab (massage, stretch), tape, brace - Due to repetitive impact and stress on that patella ligament - Shut them down, let inflammation go down and then gradually reintroduce them to activity while giving that tendon and quads a chance to strengthen - Maybe eccentrics and isometrics – debated how to best rehab this.

Answer 10

Apophysitis of tibial tubercle MOI: * Traumatic fracture or avulsion fracture of tib tub epiphysis * Excessive constant forceable pull of patellar tendon on tib tub before bony closure (most common) * Avascular disturbance of growth centre - Tibial tuberosity – growth plate underneath where the patellar ligament attaches. Repeated strain as well as the kids are growing so under constant tension. Squatting, jumping, running, kicking, falling on it. A lot like patellar tendinopathy – signs and symptoms and treatment are similar. - Give it time and rest them. Can get patellar straps that might help, some rehab and pain management will help but won’t heal until you slow down growing.

Answer 11

S/S: - Pain on direct pressure (kneeling) - Pain on active use (climbing stairs, running, jumping) - Pain extreme end range of extension - Enlarged tibial tubercle - 3x more common in males - Age 10-15 males, 8-13 females - Bilateral 25-30% of the time Treatment: Time Stretching Gradual strengthening Wraps, straps

Answer 12

- Infrapatellar is the most common b/c you fall on it. Significant point tenderness so might misdiagnose it.

Answer 13

MOI - Direct Blow (repeated, one time) - Friction - Poor Biomechanics S&S - Localized swelling, tenderness - Warm, red, spongy - Hx overuse, trauma - Crepitus with mvmt - ↓ ROM - Rebound pain with mvmts - Night pain

Answer 14

* PIER * Rest (use may irritate condition) * Protective padding (donut) * Stretch structures over top of bursa * Open space around bursa

Answer 15

Over-use irrititation of ITB over lateral epicondyle of femur in flexion and extension Bursitis or irritation of ITB itself

Answer 16

Lean individuals Varus knee (malalignment) Precipitated by contusion Continuous running Training errors Banked surfaces Running downhill Increased training

Answer 17

S&S - ↑ pain as activity time ↑ - Pt. tender over epicondyle (2-3cm above lateral joint line) - Crepitus with flex/extn - Stair climbing aggravates - Resisted knee flexion = no pain Treatment - PIER - Address mechanics - Good warm-up, stretches - Gradual RTP - Stop activity if pain returns

Answer 18

Improper footwear Down hill running Poor warm-up Poor Arch support Anterior Compartment Syndrome

Answer 19

Usually secondary to an inversion ankle sprain Need to be strengthened in inversion sprain rehab

Answer 20

- Caution necessary or could lead to rupture - Chronic irritation can = calcification - Poor warm-up and stretching, running uphill, poor footwear can cause this - Slow return to activity

Answer 21

- Definition: Trauma to muscle or MTJ from violent contraction or excessive forcible stretch - MOI: Violent contraction to overcome external force - Forced excessive stretch - Over use irritation, weakening of tendon predisposing to above mechanisms

Answer 22

Anterior compartment = tibialis anterior tendonosis Posterior compartment - tiabialis posterior tendonosis - Running on hard surfaces - Too much too soon - Poor arch support - Muscle imbalance - Poor mechanics of running - Garbage can term that lumps a whole series of conditions; generally refers to a muscle over-use condition of the lower leg, usually Tib Ant or Tib Post and the IM

Answer 23

Fix the surface, use running shoes not cleats, maybe it’s their biomechanics, can use some support. ROM exercise before you go onto field – warm up calves, gradually work into your running and with time hopefully it gets better. Lay off it. - Rest, change activity - Footwear change - Stretch, strengthen gradually Prevention is key

Answer 24

Injuring = ATFL, CFL, PTFL MOI - “Rolling” of the ankle; inversion - Often coupled with plantar flexion (landing from a jump) - Cutting, uneven ground

Answer 25

S&S - Instability (grade dependant) - Pain with Inv and PF - Swelling - Discolouration - Positive anterior drawer test Treatment - Keep ankle joint in neutral position to shorten ligaments - PIER - Open gibney - Crutches (higher grade) - X-ray - Strengthen peroneal group

Answer 26

Injured = gastroc, soleus, plantaris, ankle planter flexors MOI - ↓ flexibility - Foot-type: pes planus vs. pes cavus - New footwear - Changes in training schedules - ↑ mileage - ↑ hill training Overuse injury - too much volume too soon. Could be weakness, surface you’re on, shoes. Microtears that get worse. Can tape them if they must play and it’s not too bad. - Eccentrics and isometrics might be useful. Gradually reintroduce them, change footwear and surface.

Answer 27

Treatment - FIND THE CAUSE - Rest - Frictions/Ultrasound for adhesions - Heel lift for shoe - Taping - Gradual stretching, strengthening, eccentrics Prevention - Gradually increase activity - Proper time and progression of warm-up - ↑ Flexibility of G-S complex - Proper footwear - Recognition of early signs

Answer 28

high arched, rigid foot OR flat foot Prolonged pronation – excessive motion Footwear Training habits Partial/complete tear of ligament - Plantar fascia is connective tissue sheath that connects front/back of foot that creates the arch. Overuse injury with chronic inflammation so get those microtears. - Hard to lay off b/c you need to walk

Answer 29

S&S - Point tender, medial side of calcaneous - Localized pain (origin) - Stiff in AM or after inactivity - Swelling/inflammation - Unable to walk on toes - Pain ↑ with passive toe extension Treatment PIER (REST, ICE) X-ray Ultrasound Stretch Achilles Proper footwear Tape Orthotics, heel cup Balance Pelvis Roll/massage tendon

Answer 30

- Adduction/adbuction - Flexion/extension - Internal/external rotation - Horizontal abduction and adduction - Circumduction

Answer 31

MOI: Direct blow Direct or Indirect (FOOSH) Grade I Point tenderness/pain over SC Tear of SC and CC lig’ts Grade II Bruising, swelling, pain, unable to x-flex, pain with scapular protraction and retraction Rupture of SC, tear of CC lig’ts Grade III Obvious deformity (anterior) May involve fracture Rupture of SC and CC lig’ts * Clavicle typically driven superior, medial and anterior

Answer 32

1st and 2nd degree: PIER 3rd degree: surgical repair

Answer 33

Separated shoulder! MOI: Direct or Indirect Blow 1st DEGREE Incomplete tear AC lig. (CC intact) No deformity 2nd DEGREE Tear of AC lig., partial tear of CC lig. Small step deformity 3rd DEGREE Complete tear AC, CC ligaments Large step deformity

Answer 34

PIER Tape AC (1st and 2nd degree) Sling and swath (2nd and 3rd degree) Surgical repair - rare - And then it’s standard shoulder rehab. Will take months before you can sleep on that side and push ups and bench press will take forever to do. Overhead press is okay.

Answer 35

MOI - Overuse - Trauma - Excessive ROM under load Treatment - RICE - Exercise - Corticosteroids - Platelet injections - Surgery * Common sports = hockey, football, rugby, riding, skiing, wrestling * Multidirectional = injury is the result of damage taking place in more than one plane * Sprains are graded according to Grade I – III

Answer 36

Head of humerus often slips anteriorly or posteriorly Athlete indicates feeling of instability “Felt like it was going to pop out” ANTERIOR Most common Abduction 90º with ER POSTERIOR Fall on outstretched hand INFERIOR Load from the top * Anterior is most common with high tendency to recur * Posterior most commonly missed for major joint injury; no gross deformity however coracoid may be prominent * Inferior – athlete supports arm and apprehensive about relaxing deltoid and raising arm - Often damaging labral tissue, capsule is torn, ligaments on first slide are ruptured.

Answer 37

* Most frequently dislocated major joint in the body * ACUTE- Treated with immobilization and immediate referral for x-rays and proper relocation * CHRONIC * Often result of poorly managed acute dislocation * Tend to be anterior, intracapsular dislocations * Tend to relocate spontaneously or with help of athlete * If does not reduce itself, treat as acute - Assess distal circulation & sensation - DO NOT REDUCE!!! - Sling and swath and ship immediately - Immobilization against body for 3-6 weeks - Pain-free ROM exercises after 3 weeks - Early re-alignment is KEY - X-rays to confirm no fracture pre and post reduction - RTP after full ROM and strength regained (2-3 months)

Answer 38

- Visible deformity: flat deltoid, prominent acromion - Arm held in abduction, ER or hanging loosely beside body - Humeral head palpable - Pain with all ROM

Answer 39

- Repetitive overuse, overhead movements - Excessive elbow flexion & supination - Inflammation and degenerative changes in the tendon or MTJ - Racquet sports, pitchers, football quarterbacks, swimmers, javelin throwers at risk - ↑ friction with biciptal groove - Long head of biceps travels under deltoid and it slides over the head of humerus. If doing a lot of curling action or forward flexion can get this. - Gets inflamed so hurts mostly during forward flexion. Sometimes can attempt to massage it out. - Have bicipital groove that gets irritated.

Answer 40

S/S: - Pt. tender ant. aspect shoulder, esp. with elbow flexed - Pain with: abduction, palm up Resisted elbow flexion GH forward flexion Palp of bicipital groove Treatment - Rest - Find cause, treat cause - Proper warm-up and stretching - Correct mechanical deficiencies to ↑ ROM and strength - U/S, Transverse frictions - Rest, what’s aggravating it? Usually, some sort of repetitive action and remove it With any tendonitis warm the area well, gradual reintroduction of activity, chronic stretching, isometrics, massage. Generally, leave it alone – can’t do that with lower body.

Answer 41

Painful arc (60°-120°) Pain with resisted abduction (esp. 0-10°) Pain with ER Stretch pain with IR Point tender over insertion History of overuse or overhand activity Treatment Rest Remove irritant Passive ROM Massage Isometric strength Scapular stabilization Eccentric loading - Point of the range of abduction where the subacromial space is the smallest, therefore structures running through the space have the greatest amount of tension placed upon them. - Usually pain on abduction. Probably the most common. Will tell them to put arms up to side and to push up or down on your hands. Their injured arm will just sink. Supraspinatus stops the internal rotation (eccentrically loaded). Stopping the serving action repeatedly. - Stop activity. If symptoms just start stop immediately – in a couple weeks they’ll be okay. - Then it’s standard shoulder rehab (bottom 3). Usually find that pink range is the no go range (pain). Need to work around it.

Answer 42

Overuse: throwing, backstroke in swimmers Direct Trauma: FOOSH, arm driven backwards S/S - Pain with medial rotation (backstroke) - impingement - Painful arc - Pain with active and resisted lateral rotation - Point tender over insertion Treatment is the same as supraspinatus.

Answer 43

AKA Adhesive Capsulitis Clinical syndrome characterized by ↑ shoulder pain and restricted GH ROM MOI: - Single traumatic episode, multiple minor - Post-immobilization (fracture, sling) - Post-surgery (radical mastectomy) - Someone who probably has a history of shoulder injury. Usually older and males who do a lot of overhead work. - When you injure something it’s also often things around it. Joint capsule is inflamed, remodels and gets calcified. Can’t lift shoulder hurts too much.

Answer 44

S/S: - Pain, stiffness - Capsular pattern: ER, Abduction, IR - Limited scapular movement (moves as a unit) - Unable to sleep on shoulder - Referred pain down arm - Muscle atrophy Treatment - Mobilization of scapula to restore scapulothoracic rhythm - Pendulums - Broomstick ROM exercises - Therapist assisted stretching - Surgery should be a LAST resort! Sometimes presents as rotator cuff tendonitis but stiffer than that. History will help you.

Answer 45

- “goose egg” over olecranon process - SHARP - ↓ ROM - May be blood in bursa - Point tender - Calcification may be present (x-ray) Treatment - PIER (emphasizing pressure and ice) - Pressure pad 4-7 days - Aspiration possible - Pulsed U/S - Surgery (chronic) - RTP = donut & padding - Mild activity, passive range is okay. Need to let it go away. In extreme cases might drain it. - Might do donut pad and wrap it if you have to do an activity. - Wait for inflammation to go away then things return to normal.

Answer 46

- Insidious onset, progresses - Local pain at common extensor tendon - Seldom swelling - Weak wrist extensors - ↓ wrist flexibility (flexion) Calcium deposits in tendon (crepitus) - Pain at lateral epicondyle during gripping actions - Pain ↑ using hand/forearm ↓ muscle strength Treatment - PIER - Find cause, treat cause - Avoid causative activity - Breakdown scar tissue - Realign tissue at cellular level - ↑ ROM - ↑ muscle flexibility, strength and endurance - BALANCE the muscle groups - Taping/Bracing * Irritation or inflammation at the attachment of the tendons of the extensor and supinator muscles * A direct trauma or a strain that are not allowed to heal may become chronic as a result of consistent use of the injured extensor tendon * Causes tears at MTJ - Most commonly affected is the Extensor Carpi Radialis Brevis - Chronic stretching seems to work, repetitive low load mobility exercises (high load hurts it and is what caused it), getting that supination/pronation movement back. Massage might release it but can make it worse. Use straps for this. Has a ball on it and a pad and you put it on when doing activities that may aggravate it.

Answer 47

Golfer’s Elbow, Thrower’s Elbow Lesion of the common flexor tendon at the medial epicondyle S/S similar to tennis elbow (but on medial epicondyle!) Most commonly involved = Pronator Teres and Flexor Carpi Radialis Treatment – see lateral epicondylitis

Answer 48

Flexion Extension Supination Pronation Ulnar deviation Radial deviation Grips: Pinch Span Push Disc Hook

Answer 49

MOI = FOOSH - COMPLICATION: blood flow to scaphoid easily compromised, especially when fracture is through middle of bone - Scaphoid – can occur in a couple different areas. Common but easy to manage. Hard to tell if it is a fracture on field. Hard to tell if a sprain. Will have pain that point (super point tender).

Answer 50

- Moderate pain/point tenderness and swelling in anatomical snuff box - Pain with thumb extension and abduction - Pain with wrist extension & radial deviation - ↓ grip and thumb strength - Limited wrist movements Treatment X-ray (often initially neg) Immobilize (cast) X-ray again 3-4 weeks Treat as a fracture until proven otherwise!

Answer 51

- Median Nerve compression as it runs through carpal tunnel - Fluid retention - Overuse - Secondary to trauma - Progressive paralysis and atrophy of the thenar muscles - Tinel’s sign positive at wrist Find cause, eliminate cause Immobilization or support of wrist via splints Surgery to release retinaculum

Answer 52

Most common mass or lump in the hand non-cancerous, fluid-filled cysts arise from the ligaments, joint linings, or tendon sheaths when they are irritated or inflamed Most often seen on dorsum of hand Cause is unknown They may disappear or change size quickly Epithelial connective tissue that fills with fluid ganglion cysts do not require treatment if the cyst is painful, interferes with function or the patient does not like the appearance referral is made to an orthopaedic surgeon can remove the fluid, inject steroids, or remove it surgically

Answer 53

The body's ability to transmit joint position sense, interpret the information, and respond consciously or unconsciously to stimulation through appropriate execution of posture and movement. - Interpret info coming from joints and then consciously or unconsciously manipulate the body

Answer 54

Joint movement sense - Knowing where joint is in space without seeing them.

Answer 55

1. Sense of movement 2. Sense of position 3. Sense of effort 4. Sense of force

Answer 56

Visual, vestibular, mechanoreceptors lead to proprioception which goes into motor control.

Answer 57

Desired state --> Comparator which goes to either actuator sensor - Feedback controlled – certain task you want to achieve. You tell your brain this is the action I want to do to pick this up. Need to balance, extend arm, grip and pick it up. Area in brain understands desired state have the plan which is sent to the actuator and the sensors tell us if the task was done. - Comparator is the plan. - If you don’t do it you try again.

Answer 58

Input --> Intention --> Controller --> comparator and then actuator or sensor - In athletics you see this more. Don’t have time to be saying I am reaching out, I am grabbing, I am lifting. Happens too fast. - Have an input to an intention (task I need to achieve) goes to control center which says you need to execute program – comparator turns on that path and then actuator and sensor feedback into input - Sensor sends info back to comparator and then you can redo the plan.

Answer 59

Cerebrum - Planning, initiation - Slow Brain stem, cerebellum and basal ganglia - Comparator Spinal Reflex - Protection, splinting, fast - Motor control centers in cerebrum send a neuron down into the brain stem, and then it crosses over from right side to left side and synapses at spinal cord level which then that motor neuron goes on to muscle fibers it innervates. - Comparators – blueprint storage areas. mainly cerebellum is this. Cerebellum says this is the plan to execute (what I want to achieve). Premotor areas are managers – you go and execute the task. - Then the sensation comes up and back through the cerebellum and evaluates if you did the task – reinforce and store that or reevaluate and modify.

Answer 60

* Cognitive/conscious o Unconscious incompetence o Conscious incompetence * Associative o Conscious competence * Automatic/autonomous o Unconscious competence - Associative – more feedback control - Automatic – feed forward - Need to go through feedback control before feedforward control.

Answer 61

Ruffini Pacinian GTO-like Free nerve endings

Answer 62

Spindle GTO

Answer 63

1. Afferent impulses from stretch receptor to spinal cord 2. Efferent impulses to alpha motor neurons cause contraction of the stretched muscle that resists/reverses the stretch 3. Efferent impulses to antagonist muscles are damped (reciprocal inhibition) - Muscle spindle reflex – myotatic stretch reflex. In the muscle body have these small muscle fibers wrapped in sensory neuron called a muscle spindle (intrafusal muscle fibers). When muscle contracts these are on and when stretched those nerves fire (depolarize) sending a message to spinal cord. - Blue neuron turns on which stimulates red neuron to contract. Neg inhibitory interneuron so inhibits opposite action? Stretch reflex is a fast way to respond to a perturbation in muscle length. - Use patellar hammer. This stretches the muscle and you get a kick response.

Answer 64

Pressure receptors embedded in the tendon. When under pressure it squishes those endings which turns them on. blue neurons turns on and goes into spinal cord which goes to inhibitory neuron which turns off the quads. Safety mechanism if over exerting it shuts the muscle down which is a problem if trying to exert a lot of force. Muscle says you’re about to tear so need to stop. - Pain receptors are similar.

Answer 65

* Located in joint capsule (flexion side) * Detect loading of the capsule * Fast conducting * Slow adaptation rate * Most active at full extension and rotation - Back of joint capsule and turn on when legs are extended. Are under pressure so leg is straight. Tells you where joint is in space. Keep telling you your leg is straight. Don’t turn off very quickly.

Answer 66

* Located in joint capsule, cartilaginous surface * Pressure receptors * Fast conducting * Greatest density at end ranges * High adaptation rate - Also in joint capsule and on cartilaginous services. Detect pressure. Tell you you are moving but quickly can tell you you aren’t moving anymore.

Answer 67

1. Replicating joint angle 2. Replicating movement 3. Detecting movement 4. Balance and sway 5. Latency of reflex activation - Need to find things that evaluate movement, joint angle and force. Maybe pressure? - Can they sense the movement? If you move them, can they tell you where they are and when to stop at a given angle target. - Do you know how to control your body in a ground-based activity – balance and sway - Does the muscle activate when you stim it?

Answer 68

Balance Coordination Agility

Answer 69

Balance – can you stand up? Pass/fail. weight shift – pass/fail, 1 leg balance, and balancing while moving in diff directions. All pass/fail. Balance needs to relate to activities you’re going to do. * The body's ability to maintain equilibrium by controlling the body's center of gravity over its base of support * Static or dynamic * Utilizes visual, vestibular and peripheral mechanoreceptors * Injury impairs * Aging impairs – weakness, sensory deficit, mobility deficit * Balance training may not have carryover in sport

Answer 70

Coordination – do you have the ability to grip something and move something. Can you follow a series of instructional tasks that are complex and achieve them * The complex process by which a smooth pattern of activity is produced through a combination of muscles acting together with appropriate accuracy, intensity and timing. * Motor learning: whole-part-whole * Avoid fatigue - Process involving smooth patterns of activity that are purposeful where you have a target and a goal. - Do they perceive what needs to be done and know where body is in space to do it? Are they getting feedback? Do it a bunch and limit inhibition of performance.

Answer 71

Can you do this stuff with high rates of speed and unpredicted environmental change. * the ability to control the direction of a body or segment during rapid movement * requires flexibility, strength, power, speed, balance, and coordination * Is best trained in a sport-specific fashion - Coordinated complex motor tasks done under higher rates of speed and some cases unpredictable conditions

Answer 72

Coordination training involves: 1. Activity perception 2. Feedback 3. Repetition 4. Inhibition

Answer 73

* Non-weight bearing * Weight bearing * Single limb activities * Functional activities * Object manipulation * Return to activity

Answer 74

- Traditional ROM - OKC strengthening exercises - Varied loads, contraction types, ROMs - Repositioning exercises

Answer 75

- Weight shifting - CKC - Perturbations - Unstable surfaces - Eyes open or closed - Manipulating objects

Answer 76

- Stable - Unstable - Perturbations - Movement of other limbs - Manipulating objects

Answer 77

- Specific tasks - Walking, jogging, running - Forward, backwards - Stairs, ramps - Hopping, jumping, cutting - Agility

Answer 78

1. Proprioception/Kinesthetic Awareness 2. Dynamic Joint Stability 3. Reactive Neuromuscular Control 4. Functional motor patterns

Answer 79

* Repositioning tasks (passive, active) * Weight bearing in functional positions * Walk on stable surface * Two feet on unstable surface * Eyes open or closed * Simple to Complex

Answer 80

* Running * Lateral slides * Mini-trampoline * Active repositioning * Sway techniques * Planned perturbations

Answer 81

* Running with direction change * Cutting drills * Carioca * Plyometrics * Unplanned perturbations

Answer 82

Functional Motor Patterns * Vulnerable positions * High speed * Sport-specific movements * Four corner running while dribbling * Carioca while defending

Answer 83

The capacity of the stabilizing system to maintain the intervertebral neutral zones within physiological limits

Answer 84

- Control (CNS) - Passive (ligaments, facets) - Active (muscle contraction)

Answer 85

* Allows lumbar spine to support limited load (approx 10 kg) * Far less than body weight! It just runs like a connective tissue sheath up anterior or posterior side of the vertebrae. Connective tissue is strong but it’s thin and has a low load tolerance. This system helps but isn’t strong enough to prevent it from snapping under force

Answer 86

* Provides support for body mass * Also provides resistance to external loads and propulsion for dynamic activities Have little muscles that go segmental spine to spine and then longer guide muscles – erector spinae, rectus abdominus, large wires that help anchor the outside then deep down we have the small segmental ones keeping things balanced vertebrae to vertebrae.

Answer 87

* Continuously monitors * Adjusts muscle forces instantaneously based on feedback from muscle spindles, GTOs and ligaments to maintain posture and produce/resist external forces * Must balance stability and desired ROM - Receives feedback about postural position constantly.

Answer 88

Segmental Stability – “local” stabilizing system Trunk Stability – “global” stabilizing system Whole Body Stability – “peripheral” stabilizing system

Answer 89

Small, deep muscles Control intersegmental motion Slow-twitch Involved in endurance activities Selectively weaken Activated at low resistance levels E.g. multifidus, rotatores, interspinals, intertransverse (Tr.A) Typically isometric contractions Between each vertebrae

Answer 90

Large, superficial muscles Transfer forces between thoracic cage and pelvis Utilized in power activities Preferential recruitment Activated at higher resistance levels Act to increase intra-abdominal pressure E.g. rectus abdominus, external obliques, erector spinae, QL, psoas major - Flex, extend, rotate

Answer 91

* Hollowing = drawing in of abdomen toward the spine (scooping motion up and in) without movement of spine or pelvis * Emphasizes deep local muscles * More favorable in contracting TrA, multifidus etc. over global abs * Some concern about leading to injury if performed during exercise due to decreased activation of other abdominals required for dynamic movement * Better suited for static exercise? - Putting finger on belly button and pulling it away. - Assumed muscles are off and if you turn them back on you fix the problem. Transverses abdominis was thought to be weak in those with back pain so need to train it

Answer 92

* Bracing= coactivation of all abdominals or lateral flaring of abdominal wall * Considered more suitable for athletes and dynamic movements - Need to look at whole unit so you do bracing not just the one muscle. Hit yourself. This stabilizes everything.

Answer 93

* Change in local and global control can be the cause or result of injury * Creates a disruption in kinetic chain * Important to address with almost any injury to create stable base - Want to maintain local and global stabilizers to maintain neutral spine. - Need to train entire kinetic chain as a unit so when you get in positions you maintain neutral spine in the least loads possible while still maintaining the action. Lumbopelvic stability and injury

Answer 94

Endurance has the greatest protective benefit against injury - Not flexibility or strength alone Prevention programs should include trunk endurance training.

Answer 95

Back extension:1/2 sit up ratio - A strength endurance ratio of back extension hold compared to a quarter sit up hold for time – that ratio predicted back injury. Whoever had the worse asymmetry between flexion and extension endurance were more likely to be injured.

Answer 96

5 levels Begins in supine crook lying Requires pressure cuff (BP cuff works) placed under lumbar curve Inflate to 40 mmHg Have patient activate TrA/multifidus using abdominal hollowing There should be no change or slight ↓ in pressure To advance to next level, must maintain pressure in cuff within 10mmHg

Answer 97

1 - bring one leg down at a time 2- lower 1 leg and slide heel out to extend the knee 3 - lower 1 leg to 12cm above ground and slide heel out to extend the knee 4 - Lower both legs to the ground and slide heel out to extend the knee 5 - lower both legs to 12cm above ground and slide heel out to extend the knee

Answer 98

* Stage 1: Re-education of stabilizing muscles * Stage 2: Exercise progressions for static stabilization - anti movements * Stage 3: Exercise progressions for dynamic stabilization * Stage 4: Sport/ADL specific stabilization * * May need to start at different points with different people/injuries

Answer 99

Stage 1: 1-2 exercises, 10 + sets, 5-10 seconds Stage 2: 2-3 exercises, 1-3 sets, 20-60 seconds Stage 3 & 4: 2-3 exercises, 2-3 sets, 5-25 reps - Should be able to fatigue in 10 minutes. - In stage 1 it’s usually sets of isometric holds. Contract relax 5 seconds on and then 5 off. Might take 5-7 minutes - 2 – maybe anti flexion, anti extension or anti lateral flexion. Still holding but usually around 30 seconds. Building up to 1 minute. - Stage 3 – 15-20 reps is common. - 5-10 minutes is all you need and want to add it twice a week into workouts. Is a tonic muscle (on all the time), endurance (ST dominated), long duration holds with short recoveries, supersets, complexes.

Answer 100

* Does stability ball training improve athleticism? * No clear answer * May enhance performance in untrained populations * No evidence for improved performance in trained populations * Undue emphasis may hamper strength/power training - This is useful for core in phase 2 and 3 but not that useful in return to play. Activation goes up in other supplementary muscle groups but total strength goes down when you add instability.