Intro To Func Rest

Question 1

Two approaches for locomotor system pain and dysfunction

Answer 1

Structural

Functional

Question 2

Rooted in anatomy, biomechanics
Visualized with imagery or surgery
Diagnosed by clinical tests

Answer 2

Structural approach

Question 3

Structural approach repaired through

Answer 3

Immobilization, surgery, rehabilitation

Question 4

Basis for most medically-oriented education and practice

Answer 4

Structural approach

Question 5

Lesions cannot be observed directly with structural tools

Must be visualized virtually by understanding interactions of structures and systems

Answer 5

Functional approach

Question 6

Everything must work together - the sensory motor system - muscles
Recognizes the funciton of all processes and systems within the body, rather than focusing on a single site of pathology

Answer 6

Functional approach

Question 7

Janda’s theory

Answer 7

Joints, muscles, nervous system functionally integrated
Sensory and motor systems function together as sensorimotor system
Muscular system often reflects status of sensorimotor system

Question 8

Kinetic chain is made up of

Answer 8

The soft tissue system (muscle, ligament, tendon, and FASCIA), neural system and articular system

Question 9

Overuse injuries may be traced to improper technique that puts too much stress

Answer 9

Somewhwere on the kinetic chain

Question 10

Relationship between kinetic chain structure and function

Answer 10

Each component system within the kinetic chain works interdependently to allow structural and functional efficiency
If any systme does not work efficiently compensation adn adaptations occur in the other systems

Question 11

Compensations and adaptations lead to

Answer 11

Tissue overload, decreased performance, predictable patterns of injury

Question 12

3 subsystems in stabilizing the spine

Answer 12

Passive musculoskeletal subsystem
Active musculoskeletal subsystem
Neural and feedback subsystem
Need all to have good spinal stability

Question 13

Passive musculoskeletal subsystem

Answer 13

Spinal column

Question 14

Active musculoskeletal subsystem

Answer 14

Spinal muscles

Question 15

Neural and feedcback subsystem

Answer 15

Neuromuscular control unit

Question 16

**Basic biomechanical functions of the spinal system

Answer 16

To allow movements between body parts
To carry loads
To protect the spinal cord and nerve roots

Question 17

Normal function of the spinal stabilizing system

Answer 17

Provide sufficient spinal stability to match instantaneously varying demands due to
Postural changes, static loads, dynamic loads

Question 18

Degradation of spinal stabilizing system results from dysfunction in any of 3 subsystems

Answer 18

Injury
Degeneration
Disease

Question 19

Any abnormal loading conditions including overload and immobilization can produce

Answer 19

Tissue trauma and/or adaptive changes that may result in disc degeneration

Question 20

Adverse mechanical conditions can be due to

Answer 20

External forces or may result from impaired neuromuscular control of the paraspinal and abdominal muscles

Question 21

If and when pain is on board your body

Answer 21

Is unable to respond in a timely fashion due to loading you won’t have appropriate muscle timing/sequencing

Question 22

Movement of arm in patients with neck pain indicates

Answer 22

Significant deficit in teh automatic feedforward control of the cervical spine

Question 23

People with recurrent LBP respond differently to trunk loading despite

Answer 23

Remission from symptoms

Question 24

Neuromuscular function in athletes following recovery from a recent acute low back injury

Answer 24

Objective measures of neuromuscular function indicated altered muscle response pattern to sudden trunk loading in athlets following recovery

Question 25

Asymptomatic athletes with a recent history of LBP were slower during performance of teh timed 20 m shuttle run than atheletes wihtout Athletes with resolved LBP were

Answer 25

Slower than a matched group of normal atheltes without LBP

Question 26

Athletes with history of lower extremity injury

Answer 26

Significantly slower response time

Question 27

Kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits which may be missed on a

Answer 27

Standard physical assessment

Question 28

Believed that muscles are at functional crossroad between CNS and PNS

Answer 28

Janda theory

Question 29

Motor system acts as window into

Answer 29

CNS function

Question 30

Reflexes influence

Answer 30

Muscle balance and function

Question 31

Chronic musculoskeletal pain and dysfunction is functional pathology mediated by

Answer 31

CNS

Question 32

Janda’s muscle imbalanace paradigm

Answer 32

Impaired relationship between muscles prone to tightness vs inhibition/weakness

Question 33

Muscles predominantly static, tonic, postural have tendency to become

Answer 33

Tight

Question 34

Muscles predominantly dynamic, phasic have tendency toward

Answer 34

Weakness, inhibition

Question 35

If patient has upper and lower crossed syndrome

Answer 35

Layer syndrome

Question 36

7 muscles prone to hypertonicity (tightness) when the iliopsoas is tight and the gluteals have become inhibited

Answer 36

``` Quadratus lumborum Thoracolumbar fascia Piriformis Hamstrings Iliotibial band/tensor fascia lata Adductors Gastroc/soleus ```

Question 37

Mobility and stability joint by joint

Answer 37

``` Foot should be stable Ankel mobile Knee stable Hip mobile Lumbar stable Thoracic mobile Cervical stable C0-C2 mobile Hand stable Wrist mobile Elbow stable Shoulder mobile Clavicle stable ```

Question 38

Pronation distortion syndrome weak muscles

Answer 38

``` Posterior tibialis Anterior tibialis Vastus medialis oblique Biceps femoris Gluteus medius ```

Question 39

Pronation distortion syndrome tight muscles

Answer 39

``` Peroneals Adductors Medial hamstrings TFL/ITB Psoas ```

Question 40

Pronation distortion syndrome arhtrokinematic dysfunctions

Answer 40

1st MTP Subtalar joint Tibiotalar joint SI joint/ISjoint/PS joint

Question 41

Pronation distortion syndrome neuromuscular dysfunction

Answer 41

Decreased pronation control of the foot and ankle Decreased frontal and transverse plane control at the knee Increased compensation in the lumbopelvic hip complex

Question 42

The force transmission between muscle and its surroundings, passing via the outer limits of muscle-tendon complexes (epimysium)

Answer 42

Epimuscular myofascial force transmission

Question 43

The effects of myofascial force transmission have a major impact of our understanding of

Answer 43

In vivo muscle function

Question 44

Integrative approach for myofascial force transmission

Answer 44

To combine knowledge of functional properties of isolated elements of the locomotor system with the knowledge of effects of nearby structures belonging to a higher level of organization and their interactions

Question 45

Myer’s myofascial meridians: the lateral line

Answer 45

``` Myofascial tracks Peroneal muscles Anterior ligament of fibular head Iliotibial tract TFL Gluteus maximus Abdominal obliques Intercostals Splenius capitis/SCM ```

Question 46

Myer’s myofascial meridians: the spiral line

Answer 46

``` Splenius capitis, cervicis Rhomboids Serratus anterior External oblique Abdominal aponeurosis, linea alba Internal oblique TFL, iliotibial tract Tibialis anterior Peroneus longus Biceps femoris Sacrotuberous ligament TLF, erector spinae ```

Question 47

Back chain

Answer 47

``` Tuberosity of tibia Subpatellar tendon/patella Vastus lateralis Shaft of femur Gluteus maximus Sacrum Sacral fascia, lumbodorsal fascia, lat dorsi Shaft of humerus ```

Question 48

Front chain

Answer 48

``` Linea aspera of femur Adductor longus Pubic tubercle and symphysis Lateral sheath rectus abdominus 5th rib and 6th rib cartilage Lower edge pec maj Shaft of humerus ```

Question 49

Model for chiro

Answer 49

Macroinjury, microinjury, hypomobility, hypermobility, chronic stress - inflammation - connective tissue fibrosis - abnormal mechanical and nociceptive afferent input to CNS - altered motor patterns - abnormal tissue stress - more abnormal mechanical and nociceptive input to CNS and fibrosis - chiro specific adjusting, soft tissue mobilization and anti-inflammatory protocols - remodeling of connective tissue fibrosis - improvement of tissue mechanical function and improvemnt of mechanical and nociceptive neurological afferentation to CNS

Question 50

Assessment for kinetic chain dysfunction

Answer 50

Myofascial balance assessment Sensorimotor system assessment Spinal stabilization assessment

Question 51

Functional approach to treatment

Answer 51

Restore/improve proprioceptive input Restore myofascial balance Facilitation of afferent system and sensorimotor training

Question 52

Rehabilitation efforts that attempt to maximize the extent of cortical neuroplastic changes stand to provide the greatest potential for

Answer 52

Rehabilitation success

Question 53

Assessment of muscle length and movement patterns

Answer 53

Postural muscles | Phasic muscles

Question 54

Postural muscles

Answer 54

Responsible for maintaining posture esp during gait Type I slow twitch Tend to become short and tight - not necessarily weak Stabilizers

Question 55

Phasic muscles

Answer 55

Antagonistic to postural muslces Type II Tend to become weak/inhibited Mobilizers

Question 56

Upper crossed syndrome weak muscles

Answer 56

``` Rhomboids Medial/lower trapezius Serratus anterior Teres minor/infraspinatus Posterior deltoid Longus colli/capitis ```

Question 57

Upper crossed syndrome tight muscles

Answer 57

``` Pec major/minor Levator scapulae Upper trapezius Latissimus dorsi Subscapularis SCM Rectus capitus/scalenes ```

Question 58

Upper crossed syndrome arthrokinematic

Answer 58

``` C0-C1 Cervico-thoracic Thoracic/rib AC joint SC joint ```

Question 59

Upper crossed syndrome neuromuscular dysfunction

Answer 59

Excessive cervical protraction Scapular winging Early/excessive scapular elevation

Question 60

Lower crossed syndrome weak muscles

Answer 60

``` Lower abdominals Multifidus Deep erector spinae Gluteus maximus Biceps femoris ```

Question 61

Lower crossed syndrome tight muscles

Answer 61

Psoas Superficial erector spinae Rectus femoris Adductors

Question 62

Lower crossed syndrome arhtrokinematic dysfunctions

Answer 62

``` SI joint Iliosacral joint Iliofemoral joint Proximal tibio-fibular joint Subtalar joint ```

Question 63

Lower crossed syndrome neuromuscular dysfunctions

Answer 63

Altered hip extension Decreased frontal plane stabilization Increased lumbar extension

Question 64

Muscle length assessment of tightness-prone muscles

Answer 64

``` Triceps surae Hip flexors Hip adductors Hamstrings Piriformis Pec major Upper trapezius Levator scapula ```

Question 65

Triceps surae

Answer 65

Make hook with 5th MCP and hold calcaneus between hook and thenar eminence Distract calcaneus distally until reach barrier to fix inserion of triceps surae Apply pressure to sole of foot to passively dorsiflex ankle without inversion/eversion Normal is 90 degrees dorsiflexion

Question 66

Ankle dorsiflexion test - triceps surae differentiation

Answer 66

Flex pt knee while maintaining calcaneal distraction and dorsiflexion Increase in dorsiflexion following kene flexion indicates tight gastrocnemius No increase in dorsiflexion following knee flexion indicates tight soleus

Question 67

Muscle length assessment of tightness-prone muscles: hip flexors and adductors

Answer 67

Pt contacts table with ischial tuberosities and pulls knee on non-tested side to chest, hold and rolls back to lie supine on table Examiner stablizes the patinet non-tested leg and observe position of tested leg Normal = thigh on tested side should lie horizontal with leg vertical

Question 68

Pec major lower sternal

Answer 68

150

Question 69

Pec major mid sternal/clavicular

Answer 69

90

Question 70

Functional screening sequence

Answer 70

Assessment of quality of stereotypical movements Obsrevation with light palpation Look for alterations in muscle firing - selection, timing, intensity

Question 71

Functional screening sequence muscles

Answer 71

``` Hip extension Hip abudction Trunk curl-up Cervical felxion Shoulder abduction Wall angel Apley’s Stright leg raise Deep squat SFMA ```

Question 72

Hip extension screen indicators

Answer 72

Decreased gluteus maximus bulk Increased hamstring bulk Observation of spinal horizontal grooves or creases Anterior pelvic tilt Increased or asymmetrical paraspinal bulk Decreased trailing limb posture at terminal stance during gait

Question 73

Hip Abduction screen indicators

Answer 73

Lateral shift or rotation of pelvis Asymmetrical height of iliac crest Adducted hips or varus position Positive result on single-leg stance test Trendelenburg sign or increased lateral pelvic shift during loading response during gait

Question 74

The SFMA top tier movements

Answer 74

``` Cervical movement patterns UE movement patterns Multi-segmental flexion Multi-segmental extension Multi-segmental rotation Single leg stance Squatting pattern ```

Question 75

Cervical movement patterns

Answer 75

Flexion, extension - feet together teeth together

Question 76

UE movment patterns

Answer 76

Apley’s | Inf shouldn’t get winging

Question 77

Multi-segmental flexion

Answer 77

Patient should be able to touch her toes, should have uniform spinal curve and sacral base angle of 70 at least

Question 78

Multi-segmental extension

Answer 78

Feet together, ASIS should clear the toes, spine of scapula should clear heels, uniform spinal curve, GH joint should maintain at least 70-90 of humeral flexion

Question 79

Multi-segmental rotation

Answer 79

50 deg hips, | 50 deg torso

Question 80

Single leg stance

Answer 80

10 sec eyes open 10 sec eyes closed Leg raised should be to 90 degrees and no loss in height when doing this

Question 81

Top Tier movements are categorized by functional or dysfunctional and then non-painful or painful

Answer 81

FN, DN, FP, DP

Question 82

Dysfunctional non-painful movments

Answer 82

Are further broken down

Question 83

How do you break down a test

Answer 83

Fully loaded with full influence of gravity (dys due to mobility, stability, and/or motor control) Partially loaded with partial influence of gravity (dys could be due to mobility, stability, and/or motor control) Unloaded, PROM (dys most likely due to mobility)

Question 84

Mechanics of breathign

Answer 84

Abdomen expands outward during inspiration and inward during expiration Not anterior-posterior plane movement Cylindrical like filling a balloon Belly breathing often encourages movement in 1 plane

Question 85

What constitutes good breathing

Answer 85

Nasal breathing pattern - rest tongue in roof of your mouth Increase in intra-abdominal pressure especially on left side and without moving into spine extension Should be authentic Relaxed inhalation followed by LONG exhalation (2-4x as long as inhalation) with a pause between breaths Try to keep xiphoid and pubic bone in approximation during exhale Get out of your neck!!!!

Question 86

Ability of body to control the whole range of motion of a joint so that there is no major deformity, neurological deficit or incapacitating pain

Answer 86

Spinal stability

Question 87

Spinal stability

Answer 87

Neural control subsystem - neural Passive subsystem - spinal column Active subsystem - spinal muscles

Question 88

Osteo-ligamentous cervical spine shown to buckle with

Answer 88

10.5N of applied axial compression | 1/5 to 1/4 the weight of the average head

Question 89

Osteo-ligamentous lumbar spine shown to buckle with

Answer 89

90N of applied axial compression | Normal loads in standing 2-3x body weight

Question 90

Muscles provide

Answer 90

Support and stiffness necessary at intervertebral level to sustain forces commonly encountered in life

Question 91

Requirement of spinal stability in neutral posture estimated to be 5-10% MVC co-contraction of

Answer 91

Abdominal and paraspinal

Question 92

Endurance is more important than strength to maintain spinal stability

Answer 92

Strength reserve necessary for unpredictable activities

Question 93

Segments damaged by ligamentous laxity or disc disease require greater muscle activation

Answer 93

Results in greater compressive force

Question 94

Coordination of muscle activity to respond to both

Answer 94

Expected and unexpected forces

Question 95

Must activate correct muscles in the right amount at the right time in order to

Answer 95

Protect spine from injury

Question 96

Loss of both feedforward and feedback motor control seen in

Answer 96

Lumbar and cervical injury (pain) patients

Question 97

Motor control shown to become dysfunctional post neck and low back injury Changes also seen in muscle structure

Answer 97

Transverse abdominis Multifidus Longus capitis Longus colli

Question 98

Goal of assessing spinal stability is

Answer 98

To identify loss of stability, motor control and aberrent recruitment patterns

Question 99

Results for assess spinal stability

Answer 99

Provide data for reeducation of faulty motor patterns | Creating dynamic stability in the presence of mechanical compromise

Question 100

Spinal stabilization assessment

Answer 100

``` LPHC muscle imbalances Abdominal bracing Shear/prone instability Neuromuscular control (NMC) Endurance Force transfer from lower to upper extremities ```

Question 101

Abdominal bracing

Answer 101

Contracting the muscles of the trunk in a hoop-like fashion without drawing the abdominal wall inward The level of contraction should be low = 10% of maximum Continue to breathe!

Question 102

Lumbar shear stability positive

Answer 102

Pain with resting position that diminishes in active position

Question 103

Sahrmann core stability test - level 1

Answer 103

Begin in supine, crook-lying position while abdominal bracing Slowly raise 1 leg to 100degree of hip flexion with comfortable knee flexion Opposite leg brought up to same position

Question 104

Sahrmann level 2

Answer 104

From hip-felxed position, slowly lower 1 leg until heel contacts ground Slide out leg to fully extend the knee Return to starting flexed position

Question 105

Sahrmann level 3

Answer 105

From hip-flexed position slowly lower 1 leg until heel is 12 cm above ground Slide out leg to fully extend the knee Return to starting flexed position

Question 106

Sahrmann level 4

Answer 106

From hip-flexed position, slowly lower both legs until heel contacts ground Slide out legs to fully extend the knees Return to starting flexed position

Question 107

Sahrmann core stability test level 5

Answer 107

From hip-flexed position, slowly lower both legs until heels 12 cm above ground Slide out legs to fully extend the knees Return to starting flexed position In order to attain next level of stabilization must maintain pressure change +/-mm pressure

Question 108

In order to attain next level of stabilization must maintain pressure change

Answer 108

+/- 10mm pressure

Question 109

Sahrmann core stability test explanation

Answer 109

Pt braces, needle can move 10 mmHg either way but shouldn’t move at all. Pt is able to abdominal brace and not change pressure of biofeedback unit under lumbar spine. Then take pt through various positions, can pt hold their own legs without abherrent movement in the needle.

Question 110

Pressure biofeedback placed under the spine with the subject in sidelyihgn position and inflated until the lumbar curve was straight to determine target pressure

Answer 110

Hip abduction test

Question 111

Hip abduction test, pressure changes of 5 mmHg from the target pressure are allowed to accomodate

Answer 111

Changes induced by breathing

Question 112

Hip abduction test explanation

Answer 112

Bladder between iliac crest and ribs in love handle region. This time bladder is pumped up so pt is now in spine neutral then ask patient to abduct the leg. Should not see any chnges in the needle moving.

Question 113

Pressure biofeedback device folded in 3, fastened and placed behind the neck at the occiput. Inflated until pressure is stabilized on the baseline of 20 mmHg Pt attempts to nod the head to inc cushion pressure by 2mm and hold 6-10 sec Progressive inc attempted up to 30mm

Answer 113

Craniocervical flexion test

Question 114

Craniocervical flexion test positive

Answer 114

Inability to achieve deesired pressure change

Question 115

Craniocervical flexion test indicates

Answer 115

Decreased activation of deep segmental cervical stabilizing musculature

Question 116

Craniocervical flexion test corrective action

Answer 116

Reactivation of deep neck flexors via craniocervical flexion exercise training

Question 117

Assessment for deep neck flexor endurance

Answer 117

Pt supine, tuck chin, lift head 2 cm and hold | Test terminated when chin tuck no longer maintained

Question 118

Mean endurance capacity for deep neck flexors

Answer 118

``` Males = 18.2 sec Females = 14.5 sec ```

Question 119

Modified biering sorenson test

Answer 119

Turnk extensor endurance time Trunk flexor endurance time Trunk lateral flexor endurance time

Question 120

Normal modified biering-sorenson test

Answer 120

Trunk extensor endurance greater than flexor and/or lateral flexor endurance

Question 121

Modified biering-sorenson Test extensor endurance time

Answer 121

Pt prone with lower body fixed to table at ankles, knees, and hips upper body on floor or stool Exertion Beginning of exertion, upper limbs held across chest with hands resting on the opposite shoulders Upper body lifted off teh floor until upper torso horizontal Pt instructed to maintain horizontal position as long as possible Endurance time recorded in seconds from point at which pt assumes horizontal position until upper body comes in contact with support surface

Question 122

Modified Biering-Sorenson Test Flexor Endurance Time

Answer 122

Pt sits on table with upper body against a support with an angle of 60degrees and knees and hips flexed to 90. Pt arms folded across the chest with the hands placed on the opposite shoulder and teos were placed under toe straps. Pt instucted to maintain the body posiiton while supporting wedge pulled back 10cm Test terminated when the upper body fell below 60d angle

Question 123

Modified Biering-Sorenson Test Lateral Flexor Endurance Time

Answer 123

Pt sidelying on a table with legs extended Top foot placed in front of lower foot support Pt instructed to lift hips off table to maintin a straight line over their full body length supported on one elbow and both feet. Uninvolved arm held across the chest with hand placed on the opposite shoulder Test ended when the hips returned to the table.

Question 124

Modified Biering-Sorenson Test | Extensor

Answer 124

``` Norm time male = 146 sec Norm time female = 189 sec Norm ratio male = 1.0 sec Norm ratio female = 1.0 sec NWNL ratio = N/A ```

Question 125

Modified Biering-Sorenson Test flexor

Answer 125

``` Norm time male = 144 sec Norm time female = 149 sec Norm ratio male = .99 sec Norm ratio female = .79 sec NWNL = >1.0 ```

Question 126

Modified Biering-Sorenson Test Side Bridge, Right

Answer 126

``` Norm time male = 94 sec Norm time female = 72 sec Norm ratio male = .64 sec Norm ratio female = .38 sec NWNL ratio = >0.75 or side-to-side difference >0.05 ```

Question 127

Modified Biering-Sorenson Test Side Bridge, Left

Answer 127

``` Norm time male = 97 sec Norm time female = 77 sec Norm ratio male = .66 sec Norm ratio female = .40 sec NWNL = >0.75 or side-to-side difference >0.05 ```

Question 128

Corrective action for NWNL ratio =

Answer 128

Spinal stabilization exercise training to improve balance in endurance times

Question 129

Form closure

Answer 129

Cut out of white boxes can easily hold black on like a shelf

Question 130

Force closure

Answer 130

Pick up niece or nephew by ears - hands cupping either side and lift them off the ground

Question 131

We are a combination of form and force closure

Answer 131

SI joints cut at an angle and sacrum sits in that. Muscles force that together

Question 132

Myofascial slings contributing to SI joint force closure: posterior oblique system

Answer 132

Glute with opposite latissimus

Question 133

Myofascial slings contributing to sI joint force closure: anterior oblique system

Answer 133

Anterior oblique with piriformis

Question 134

Supine active leg raise (ASLR)

Answer 134

Assesses force transfer from lower extremities to upper extremities through pelvic girdle Pt supine, flex hip and elevate leg off table noting degree possible right versus left; ease of performance (subjective and objective); compensatory pelvic or trunk rotations

Question 135

Corrective for ASLR form ligamentous

Answer 135

Greater trochanteric belt

Question 136

Form closure augmentation in ASLR

Answer 136

Passive compression of SI joints with medially-directed force applied to lateral innominate as patient attempts ASLR

Question 137

ASLR form vs force dysfunction improvement in any assessment criteria indicates

Answer 137

Positive test

Question 138

Corrective action form vs force closure dysfunction in ASLR

Answer 138

Temporary applicaiton of pelvic (trochanteric) belt | Core stabilization training with emphasis on anterior oblique system

Question 139

Force closure augmentation ASLR

Answer 139

Activation of anterior oblique sling with patient reaching UE toward opposite knee against tester resistance as patient attempt ASLR

Question 140

Corrective action ASLR force closure

Answer 140

Core stabilization training with emphasis on anterior oblique system

Question 141

Prone active straight leg raise (ASLR)

Answer 141

Assesses force transfer from lower extremities to upper extremities thorugh pelvic girdle

Question 142

Prone active straight leg raise (aSLR) | Pt prone, extend hip and elevate leg off table noting

Answer 142

Degree possible right vs left Ease of performance (subjective and objective) Compensatory pelvic or trunk rotations

Question 143

Form vs force closure: posterior sling

Answer 143

Raise leg as high as can while keeping stright, then other leg Check form closure first, greater trochanters squeeze then have raise legs same as before Improved height = less abherrant problems = form closure problem = greater trochanteric belt and corrective exercises - lats and glutes Check force closure put one arm by side, extends and hold 45 away from body, push down on arm while she holds, raise leg if does better = force closure = lats and glutes exercises Focusing on posterior oblique ssytem

Question 144

Form vs force closure: anterior oblique sling

Answer 144

Pt lies supine - looking at ant oblique chain Raise leg, then other one with foot flexed Form = passive Force = active Check form - use your muscles to push SI together as hard as can have pt raise both legs - if SLR improves when pushing SI joint together = form closure problem = greater trochanteric belt Check force - pt hand on opposite shoulder, 1/2 sit up, then raise leg - if improves = hyperactivating obliques = need to focus on corrective exercises specifically the obliques

Question 145

Lumbar shear stability test

Answer 145

ASIS laid on table, hanging on to table, feet still on ground Start at L1, pincer grip press in PA - any pain? Go down level by level asking if pain If says yes - then have pt raise legs - press in again - if now says no = turns on extensors = positive test = corrective exercises for extensor group

Question 146

Apley’s (FMS)

Answer 146

Looking for quality of movement Measure hand from distal wrist crease to tip of chiro finger 1.5 hand length total = ok Feet together, arms out, thumbs in palms, measure Look to see if have scapular winging or loss of height from jutting head forward, no spinal deviation Asymmetry from L to R is predictor of future injury - depending on what she has going on as a pt might tease that out - need abduction, external rotation and elbow flexion superior - GH extension, internal rotation, and elbow flexion for inferior If pt does not have good thoracic extension, won’t be able to get into this apley’s position To gain thoracic extension - chiro adjustment

Question 147

Wall angel test

Answer 147

Feet 4-6 inches from the wall, spine leaning against the wall, get rid of lumbar space - shoulders should be able to be against wall without moving. EOP should be against wall too. Don’t let patient extend neck to get against wall - tight SCM, suboccipital in addition with problem with anterior head carriage Pt stuck in ant flexion pulls head off the wall as well - they’re gonna tilt back again. Pt abducts shoulders to 90 degrees - double check to make sure stays against wall - really tight = terrible thoracic extension Ask pt to ext rotate both hands - if can’t get to full ext rotation = tightness in the subscap

Question 148

Janda’s trunk flexion test

Answer 148

Not common test done often Pt hands on thighs, does crunch, shoulder blades up off the table. Doc stands near feet with hands underneath heels If heels comes off table that’s not good - should be able to move trunk without heels moving - positive test

Question 149

Cervical flexion test

Answer 149

C0-C1 neck flexion - hold for 10 sec - watch to see if have any abherrant movment patterns Let go slowly and have pt maintain that position, if they break position and starts to chin jut toward ceiling that’s tightness in suboccipital or SCM - pt shaking = fail. Pt head shifts to one side or another or rotate = maybe levator scap issues Should be able to hold for whole 10 seconds

Question 150

Muscle length assessment upper trap and levator scap

Answer 150

Pt supine, bring her into FULL cervical flexion - we’re assessing the left upper trap, lateral flex away and rotate her toward the upper trap you’re assessing - hand goes on AC articulation and give some muscle play For levator scap on left - bring pt to FULL cervical flexion, go lateral flex away from levator and cervical rotate away from levator checking - go to AC articulation and give SI pressure to see if have spring If doesn’t have spring have tightness in levator scap and/or upper trap

Question 151

Muscle length assessment hamstring: passive and active

Answer 151

Passive first - start with opposite knee flexed in hookline position - 45 hip flexion, 90 knee flexion - try to raise other leg should be 70-90 degrees passive hip flexion Ask pt feet together, toes to nose, raise leg as high as can go, now bend other knee which will put that iliopsoas in slack and have them actively raise again. If now can do it - need to maybe look at putting some length on the opposite iliopsoas Pt bend elbows to 90 degrees and drive them into the table, feet together toes to nose, raise leg If get length gain = hyperactive core

Question 152

Muscle length assessment piriformis

Answer 152

Pt supine bring them into little knee flexion and int rotation and look for a little springy feel Alternative way - prone - bring legs into 90 degrees and let legs fall outward - feel tighter than the other one? Should be able to see which is not rotating as well - this means you’re able to see active ROM easier

Question 153

Muscle length assessment pec major: clavicular vs sternal division

Answer 153

Elbo flexed at 90, abduct GH to 90 and ext rotate - your hand tractioning sternum pointing toward shoulder - should drop below or be parallel to the floor - clavicular division Sternal = abduct to 150 deg - should drop below table again with humerus or parallel to floor Pec major is like a chinese fan - fanning out - by doing this both clavicular and sternal you’re getting all the fibers

Question 154

Muscle length assessment adductors: 1 vs 2 joint

Answer 154

Doc in between pt’s legs Should be able to abduct leg into 45 deg If get stuck before that, differentiate between 1 or 2 joint adductors Now bend knee and abduct more - problem tightness is in 2 joint adductor If meet resistance and then bend knee but no more abduciton = 1 joint adductors are tight

Question 155

Modified thomas: iliotibial band and adductors

Answer 155

Ischial tube is barely on edge of table, bring one knee to chest then lay back - brace foot of bent knee on oblique of you, if thigh is already in abduction = IT band might already be tight. Try to pull into adduciton, if not good springiness = tightness in IT band/TFL Adductors - push into abduction - if already in adduction could already have adductors tight. If don’t have length won’t move nicely in abduction.

Question 156

Modified thomas: iliopsoas and rectus femoris

Answer 156

Ischial tubes barely on table - one knee to chest then lie straight back, brace as in above Looking for thigh to be parallel or closer to floor - if high then tight iliopsoas If doesn’t have springiness = tight iliopsoas Rectus femoris - tibia should be 90 deg relative to femur - if doesn’t meet that then come in and see If have springiness = tight rectus femoris (attaches AIIS to tibial tuberosity)

Question 157

Half kneeling ankle dorsiflexion

Answer 157

Proposal position - looking for knee to come over toe by 4 inches or 10 cm - normally shoes off - keep heel on ground

Question 158

Janda’s hip abduction

Answer 158

Side lying - straighten them out, bend bottom knee so they’re more stable, bottom arm cups head for stability - raise top leg towards ceiling - looking for at least 45 deg of hip abduction - if when raising leg she hip hikes first it’s dominance of quad lumborum. If as raises leg abducts and sneaks into hip flexion that’s tight TFL. If raises up and starts to ext rotate = tight piriformis. Looking for firing pattern of glutes, quad lumborum, TFL, pure hip motion into abduction

Question 159

Janda’s hip extention

Answer 159

Pt prone Keep one leg stright and raise to ceiling while doc has one hadn on glutes and one on mid lumbar region - looking for glutes or hamstrings to go first and erectors to go 3rd or 4th - if not then that’s a problem If we get knee flexion - adding in hamstring - don’t want that Goes into lumbar lordosis before raising that’s a problem

Question 160

Progressive model for rehabilitation of physically active individuals

Answer 160

Physical exam Control swelling, control pain, restore integrity of injured tissue Restore ROM, restore control of volitional contractions Restore strength and endurance, restore reflex reactions Restore control of complex functional movements Return to functional activities

Question 161

4 principles of functional rehabilitation

Answer 161

Discovery of type of injury present Determination of method of presentation of injury Complete and accurate diagnosis of injury Plan of treatment of injury: short term goals, long term goals, progression and return-to-play criteria

Question 162

Framework for funcitonal rehabilitation

Answer 162

Type of injury Method of presentation How to rehabilitate Knowledge of injury type and presentation method determine what needs to be rehabilitated

Question 163

Macrotrauma

Answer 163

Due to spcific event Time, place mechanism of injury (MOI) usually clear Single event resulting in previously normal anatomical structures becoming suddenly and distinctly abnormal after injury

Question 164

Microtrauma

Answer 164

Chronic, repetitive injuries Usually a process resulting from failure of homeostasis of cellular mechanisms and tissue constituents to maintain integrity of structures subjected to demand of physical activity over time Fairly long process Clinically evident adaptive changes in flexibility, balance, strength, biomechanics, performance occur with continued sports participation

Question 165

Acute

Answer 165

Injury episode easily recalled | Activity halted or curtailed

Question 166

Chronic

Answer 166

Usually microtrauma with gradual symptom onset Pain may be widespread Activity still ongoing although at reduced performance level

Question 167

Acute exacerbation of chronic injury

Answer 167

Previous injury apparently successfully treated; symptom resolution does not equal normal function Acute exacerbation occurs with return to acitivity History of previous injury and rehab plan give clues to remaining underlying deficits: inflexibiilities, strength deficits/imbalances, biomechanical faults

Question 168

Subclinical adaptations to athletic activity

Answer 168

Maladaptations to training Asymptomatic strength, flexibility, biomechanical changes that predispose to future injury Need to screen for kinetic chain dysfucntion prior to implementing strength and conditioning program

Question 169

Clinical alteration

Answer 169

Clinical symptom complex

Question 170

Anatomic alteration

Answer 170

Tissue injury complex | Tissue overload complex

Question 171

Physiologica na dmechanicl alteration

Answer 171

Functional biomechanical deficit complex | Subclinical adaptation complex

Question 172

Framework for functional rehab clnical alteraltion

Answer 172

Frequently occurs in presence of subclinical alterations May be present with acute injury or may be produced as a result of acute injury Clinical symptom complex

Question 173

Clinical symptom complex

Answer 173

Pain, swelling, decreased ROM

Question 174

Tissue injury complex

Answer 174

Actual tissue that has been damaged

Question 175

Tissue overload complex

Answer 175

Tissues that have been stress/overloaded | Contribute to or exacerbate injury

Question 176

Functional biomechanical deficit complex

Answer 176

Alterations in activity performance mechanics: caused by abnormalities in strength, strength/muscle balance, flexibility

Question 177

Subclinical maladaptation complex

Answer 177

Substitute motions Altered recruitment patterns Synergistic dominance

Question 178

Dec pain and restor normal joint motion Restore balance in muscle system - length, strength, endurance Improve proprioceptive input - local facilitation, peripheral stimulation Re-educate movement patterns and posture on an automatic basis

Answer 178

Good quality good control of motion and posture

Question 179

Philosophy of exercise design

Answer 179

Training for health versus performance Integration of prevention and rehabilitation strategies Continuous improvement in function/pain reduction ADL journal Ensuring the progressive positive slope Patient lifestyle changes

Question 180

Training for health vs performance

Answer 180

Emphasizes muscle endurance, motor control perfection, maintenance of spine stability during ADLs

Question 181

Integration of prevention and rehabilitation strategies

Answer 181

Must reduce source that exacerbates tissue overload | Exercise enhances prevention and rehabilitation outcomes

Question 182

Continuous improvement in function/pain reduction

Answer 182

Return of function and reduction of pain can be slow process | Patients have good and bad days during reconditioning process

Question 183

ADL journal

Answer 183

Documenting back pain/stiffness essential in identifying link with mechanical stresses

Question 184

Ensuring the progressive positive slope

Answer 184

Initiate reconditioning process with limited number of exercise Add new exercises one at a time after positive slope established Add/remove exercises based on positive slope changes

Question 185

Patient lifestyle changes

Answer 185

Must change patterns that result in tissue loading in excess of threshold

Question 186

Guidelines for core stabilization training

Answer 186

Develop sound basis for exercise prescription

Question 187

Basic issues core stabiliztion training

Answer 187

Flexibility Strength Endurance

Question 188

Flexibility

Answer 188

Generally spine flexibility should not be emphasized until spine has stabilized and undergone endurance and strength conditioning Lumbar problem = hypermobile lumbar. Hypomobile thoracics or hips

Question 189

Strength

Answer 189

Appears to have little relationship with spine health | Perturbed ration of flexor-to-extensor strength ration may have effect on low back health

Question 190

Endurance

Answer 190

Diminished trunk extensor endurance linked to low back injury

Question 191

Aerobic exercise

Answer 191

Appears to enhance effects of spine-specific exercise

Question 192

Order of exercises within a session

Answer 192

Prior activity can modulate biomechnicas of spine in subsequent activity Motion exercises performed first to reduce spinal tissue viscosity

Question 193

Breathing

Answer 193

Must learn to maintain spinal muscle stiffness during torque demands adn breathing patterns

Question 194

Time of day for exercise

Answer 194

No forward bending exercise in first 1-2 hours after rising with low back pain

Question 195

Our discs rehydrate

Answer 195

Overnight

Question 196

Stage 1 of patient progression

Answer 196

Awareness of psine position and muscle contraction

Question 197

Awareness of spine position and muscle contraction

Answer 197

Distinguishing hip flexion from lumbar flexion Maintaining mild abdominal contraction Learning abdominal bracing

Question 198

Stage 2 patient progression

Answer 198

Stabilization exercises to groove stabilizing motor patterns and build endurance

Question 199

Stabilization exercises to groove stabilizing motor patterns and build endurance

Answer 199

Key is to determine optimum starting level For chronic patients may want to undershoot Once positive improvement slope estabilished can increase rehab challenge

Question 200

Stage 3 of patient progression

Answer 200

Ensuring stabilizing motion patterns and muscle activation during ADLs

Question 201

Ensuring stabilizng motion patterns and muscle activation during ADLs

Answer 201

Clinician must identify range of ADLs for which patient must prepare Rehearse spine-sparing strategies and appropriate motor patterns related to ADLs

Question 202

Methodology of sensorimotor training

Answer 202

Establish key postural stability points

Question 203

Key postural stability points

Answer 203

Foot SI joint Cervical spine

Question 204

Stages of progression

Answer 204

Static Dynamic Functional

Question 205

Static phase senosrimotor training

Answer 205

Emphasis on stable core Maintenance of postural stability on progressively unstable surfaces Progression methods - weight shift, eyes closed, adding head moevment

Question 206

Dynamic phase sensorimotor training

Answer 206

Addition of arm and leg movements Use of progressively unstable surfaces External resistance applications - manual, elastic, isotonic

Question 207

Functional phase sensorimotor training

Answer 207

Performance of functional movements - squats, lunges | Integrate use of unstable surfaces and external resistance - resisted lunges on labile surfaces

Question 208

Active self-care and functional reactivation

Answer 208

``` Spine-sparing strategies: Hip hinge Safe squatting ADL modification Slump posture self-care Micro-breaks ```

Question 209

Active self care hip hinge

Answer 209

Pole/broomstick behind back, hold above head and behind near butt and hip hinge with back stragith against pole

Question 210

Sit to stand using hpi hinge

Answer 210

Practice from chair

Question 211

Wall squat

Answer 211

Hands against wall above head, squat while keeping hands on wall

Question 212

Ball squat

Answer 212

Ball behind back, sit down like in wall sit

Question 213

ADL modification brushing teeth

Answer 213

Use stool and put one foot up

Question 214

Slump posture self-care

Answer 214

Bruegger relief position - sit on very edge, hands against chair Wall lean - sit on very edge of setat arms against wall Wall slides - stands against wall feet about 6 inches forward hands in ext rotation 90 degrees, slide down wall

Question 215

Postures of development

Answer 215

``` Supine Prone Quadraped Sitting Kneeling Vertical stance ```

Question 216

4-6 months old before can

Answer 216

Sit and diaphragm starts to act as spinal stabilizer

Question 217

Super important how we originally develop some of our stability and moviblity movements from

Answer 217

When we were a child | We crawl, then push up, then pull up

Question 218

Patterns of developemnt

Answer 218

``` First thing when baby is born = takes a breath Breathign and gripping is our first pattern of development Reaching Head movement Rolling and crawling Hinging and rocking Squatting Pulling up/pushing down Gait ```

Question 219

Flexibility

Answer 219

Ability of soft tissue structures to elongate through available joint ROM

Question 220

Often single structure is cause of movement restriction | Not uncommon to have concurrent limitations from more than 1 structure

Answer 220

Flexibility

Question 221

Limitation from structural involvement can be caused by trauma, surgery or lack of stretching or lack of general appreciation of what we’re supposed to be able to do

Answer 221

Flexibility

Question 222

Pain associated with disruption to tissue or joint swelling may inhibit ability to

Answer 222

Actively and passively generate joint movement

Question 223

types of muscle hypertonicity****

Answer 223

``` Limbic system dysfunction Interneuron dysfunction MTrPs Reflex spasm Muscle tightness ```

Question 224

Limbic system dysfunction

Answer 224

Caused by psychological stress Inc muscle tone in cervico-thoracic-shoulder complex, low back, pelvic floor muscles Headache, LBP, dysmenorrhea, dyspaneuria, urinary frequency

Question 225

Caused by aberrant afferent info sent by spinal or peripheral joint dysfunction (subluxation) - like when you get adjusted, walk in tight and then feel less tight

Answer 225

Interneuron dysfunction

Question 226

Hypertonicity in segmentally-related muscles that can spread beyond involved segments

Answer 226

Interneuron dysfunction

Question 227

Interneuron dysfunction prone to

Answer 227

Form MTrPs Muscle imbalance including reciprocal inhibition, synergistic dominance Faulty movement patterns established and perpetuated

Question 228

MTrPs

Answer 228

Myofascial trigger points

Question 229

Hyperirritable spot usually within taut band of skeletal muscle or in the muscle’s fascia, that is painful upon compression and can give rise to characteristic referred pain, tenderness and autonomic phenomena

Answer 229

Myofascial trigger points

Question 230

MTrPs formed as a result of dysfunction

Answer 230

``` Sustained shortened position Sustained lengthened position Acute overload (muscle strain) ```

Question 231

Zone of intense pain in a hardened muscle band that refers (triggers) pain distantly when stimulated

Answer 231

Myofascial trigger points

Question 232

Central TrPs

Answer 232

Develop in muscle belly at endplate zone (motor point) | Primary

Question 233

Attachment TrPs

Answer 233

Enthesopathy that develops at each end of involved fibers | Secondary due to sustained tension

Question 234

Active TrPs

Answer 234

Causes clinical pain complaint | Always tender

Question 235

Latent TrPs

Answer 235

More common than active TrPs Pain free unless palpated Alter muscle activation patterns

Question 236

Sensory abnormality characterized by primarily by pain

Answer 236

Can be local to site of taut band and distant (referred) to another part of body Autonomic dysfucntions - abnormal sweating, lacrimation, salivation, pilomotor activity Clinical attributes of TrPs

Question 237

Clinical attributes of TrPs | Proprioceptive dysfunctions

Answer 237

Imbalance, dizziness, baragnosis | Motor dysfunction characterized by constant, discrete hardness within muscle

Question 238

Motor dysfunction characterized by constant, discrete hardness within muscel

Answer 238

Taut band or nodule within belly of muscle Constant feature of active TrP Can be present in absence of pain Primary abnormality that develops in response to stressors that activate TrP

Question 239

Development of TrPs | Acute overload

Answer 239

Unaccustomed eccentric exercise or eccentric overload (muscle strain) Eccentric exercise in unconditioned muscle Maximal or submaximal concentric exercise leading to muscle fiber damage adn hypercontraction within muscle fiber Like going to the gym at the start of january

Question 240

Chronic overload devleopment of TrPs

Answer 240

Sustained or repetitive postures and/or movements - us sitting all day long or doing the same movment all day long like a hairstylist

Question 241

We should not stretch myofascial trigger points,

Answer 241

It won’t fix them, might just make them

Question 242

Scalene MTrPs

Answer 242

Medial border of scapula over shoulder lateral arm doewn lateral forearm into first and second digit on dorsum of hand, 2 points above nipple on same side

Question 243

Trapezius MTrPs

Answer 243

TrP1 = behind ear down neck, angle of mandible, behind eye TrP2/3 = top of shoulder, back of occiput on either side of time TrP 4/5/6 = top of GH joint, medial border of scapula, T3-6 on side of spine

Question 244

This patient with sinus infections with ear pain

Answer 244

SCM or suboccipital MTrPs

Question 245

SCM trigger points

Answer 245

Behind ear, top of head, in EAM, path from in front of EAM up over eyebrow, below end of SCM, forehead above eye from one side to teh other

Question 246

Suboccipital MTrPs

Answer 246

Behind ear up to behind eye

Question 247

Quadratus Lumborum MTrPs

Answer 247

Top of iliac crest and near greater trochanter, sacrum and ischial tube, front lower ab next to iliac crest

Question 248

Iliopsoas MTrPs

Answer 248

Next to lumbar spine, anterior thigh

Question 249

Gluteus minimus MTrPs

Answer 249

Anterior portion: butt lateral side of thigh through pes anserine through to back of calf Posterior portion: butt into iliac crest, back of thigh, popliteal fossa, back of calf

Question 250

Reflex spasm

Answer 250

Muscle spasm in response to nociception

Question 251

Reflex spasm frequently acts as

Answer 251

Splinting mechanism

Question 252

Once underlying pain process resolves

Answer 252

Hypertonicity often remains

Question 253

If left uncorrected reflex spasm leads to

Answer 253

MTrP formation and faulty movement patterns

Question 254

Myopathological and neuropathological state where muscle becomes hyperactive and shortened

Answer 254

Muscle tightness

Question 255

Most commonly from overuse esepcially in postural function | Results in reciprocal inhibition, synergistic dominance

Answer 255

Muscle tightness

Question 256

Over time muscle tightness leads to formation of

Answer 256

Joint dysfunction (Subluxation), MTrP formation, aberrant movement pattern

Question 257

Techniques to restore flexibility

Answer 257

``` Ballistic (dynamic) stretching Static stretching Proprioceptive neuromuscular facilitation (PNF) Self-myofascial release (SMFR) Neurodynamic stretching ```

Question 258

Ballistic (dynamic) stretching

Answer 258

Bouncing movement in which repetitive contractions of agonist work to stretch antagonist muscle

Question 259

Static stretching

Answer 259

Stretch to point of discomfort and hold at that point for period of time

Question 260

Proprioceptive neuromuscular facilitation (PNF)

Answer 260

Involves alternating contractions and stretches

Question 261

Self-myofascial release (SMFR)

Answer 261

Gentle force application to adhesion or knot within the fascial ssytem in the body

Question 262

Neurodynamic stretching

Answer 262

Gentle technique to release adhesions within nervous system fascia

Question 263

Muscle relaxation techniques (MRT) basis in

Answer 263

Proprioceptive neuromuscular facilitation (PNF)

Question 264

Used to relax overactive muscles and associated fascia | Involve manual resistance of patient’s isometric or isotonic muscular effort

Answer 264

Muscle relaxation techniques

Question 265

Utilize post-contraction inhibition and reciprocal inhibition (RI) Sometimes referred to as postisometric relaxation (PIR) and neuromuscular stretching

Answer 265

Muscle relaxation techniques

Question 266

Neurophysiology of MRT | 2 aspects to MRT

Answer 266

Ability to relax overactive muscle | Ability to inc extensibility of shortened muscle or fascia when connective tissue changes are present

Question 267

Ability to relax overactive muscle

Answer 267

Increased neuromuscular tension Spasm Myofascial trigger points

Question 268

Post contraction inhibition

Answer 268

After a muscle contracts it is a brief latent/inhibitory states - 25-30 seconds with agonist or antagonist contraction vs 10 seconds with static stretching

Question 269

Reciprocal inhibition

Answer 269

Sherington’s law of reciprocal inhibition | When a muscle contracts its antagonist is automatically relaxed

Question 270

Essential to relax neuromuscular component of a muscle prior to attempting forceful stretching

Answer 270

Inhibits stretch reflex | Prevents sarcomere damage adn reduces patient pain in the presence of MTrPs

Question 271

Muscle length changes can be caused by

Answer 271

Neuromuscular factors Connective tissue factors Both

Question 272

If a muscle lengthens spontaneously after application of MRT then probably a

Answer 272

Primary neuromuscular cause | If not porobably primary connective tissue

Question 273

Clinical application of PIR

Answer 273

Bridge between passive adn active care

Question 274

Complementatry to chiro adjustment

Answer 274

Main application is in directly treating muscular component to enhance efficacy of adjustment May be used to relax tension in muscles before adjustment May be used to stretch chronically shortened muscle or fascia after adjustment

Question 275

require patient participation and are less likely to result in dependency can be used in place of deep massage in areas with hypersensitivity to pressure Easily tolerated in all phases of healing

Answer 275

MRT

Question 276

Engaging the barrier

Answer 276

Muscle elongated to extent that full resting length attained Wind-up muscle taking out slack in all planes Barrier is point at which further lengthening would cause initiation of stretch reflex Must engage barrier but not go past

Question 277

Use of isometric contraction

Answer 277

Least amount of force necessary is used Gentler contraction tried first in order to isolate TrP Duration usually 4-10 seconds, can be as long as 30-60 seconds

Question 278

Use of breathing and eye movements

Answer 278

Most muscles facilitated with inhalation and inhibited with exhalation Some muscle facilitated with eye movement in certain direction and inhibited with opposite eye movment

Question 279

Feeling the release

Answer 279

After isometric contraction released wait for tension to release Not a stretch Guide muscle until new barrier is reached and repeat process

Question 280

Hamstring PIR

Answer 280

Pt supine, straight leg raise up | Push above knee toward feet and at ankle toward head

Question 281

Iliopsoas PIR

Answer 281

Pt on edge of table, knee up to chest, lean back push knee down into chest and down into floor OR Side lying - one knee bent, other pulled back

Question 282

Quadratus lumborum PIR

Answer 282

Pt side lying, have them hip hike, then relax you lean on above iliac crest

Question 283

Erector spinae PIR

Answer 283

Pt side/back lying, top leg off table behind them, bottom leg bent, pull shoulder forward and push iliac crest back

Question 284

Upper trapezius PIR

Answer 284

Pt supine, lat flex head to one side, push shoulder toward feet on other side

Question 285

Levator scapula PIR

Answer 285

Head lat flex push it forward while pushing shoulder down

Question 286

Scalene PIR

Answer 286

Anterior scalene middle scalene: head off table, laterally flex over

Question 287

Pec Minor PIR

Answer 287

Arm off table push down on GH joint

Question 288

Self-myofascial release (SMFR) focuses on

Answer 288

The fascial system in the body

Question 289

Gentle force application to the adhesion or knot Elastic collagenous fibers are manipulated from a bundled position (that causes the adhesion) into an alignment that is straighter with the direction of the muscle and/or fascia

Answer 289

SMFR

Question 290

SMFR

Answer 290

Self-myofascial release

Question 291

Also assist in releasing the knot by stimulating the golgi tnedon organ and thus create autogenic inhibition

Answer 291

SMFR

Question 292

Find the tender spot (this indicates an adhestion) and sustain pressure on that spot for a minimum of 20-30 seconds to activate the autogenic response

Answer 292

SMFR

Question 293

Possibly stimulates fascial Ruffini end-organs creating gel-to-sol effect

Answer 293

SMFR

Question 294

Helps restore the body back to an optimal level of function and performance by resetting teh soft tissue proprioceptive mechanisms

Answer 294

SMFR

Question 295

Use prior to static stretchign for postural distortion patterns and/or activity as well as a useful cool-down

Answer 295

SMFR

Question 296

Mechanism of myofascial release

Answer 296

Practitioner’s manipulation stimulates intrafascial mechanoreceptors CNS repsonse includes change in tonus of related striated muscle fibers and autonomic nervous system effects: altered global muscle tonus, change in local vasodilation and tissue viscosity, lowered tonus of intrafascial smooth muscle cells

Question 297

Resotring myofascial balance

Answer 297

Foam roller self-myofascial release

Question 298

PIR

Answer 298

25% effort | 4-10 seconds

Question 299

Adductor PIR

Answer 299

Looking for inferior ilium or IT band - inc bulk at upper 1/3 of medial thigh, genu valgus stress in midstance, femoral acetabular discomfort - lower crossed syndrome,

Question 300

High ilium side is

Answer 300

Tight quadratus lumborum

Question 301

High ilium Diffuse pain Janda’s abduction test will hip hike then abduct Treatment is PIR quad lumborum

Answer 301

Quad lumborum

Question 302

Femoral acetabular joint falls anterior to malleoli, butt is flat

Answer 302

Hamstrings PIR option

Question 303

Pt gets headache crawling up the side of the neck

Answer 303

Upper trapezius PIR

Question 304

Do some of this before cervical adjustment, could make adjustment go easier

Answer 304

Levator scapula PIR

Question 305

Posterior scalene

Answer 305

Lateral flexion and rotation away

Question 306

Anterior scalene

Answer 306

Lat flex away, rotation towards. Shoulder elevate and reflex

Question 307

Middle scalene

Answer 307

Hook left occiput area, shoulder shrug

Question 308

Suboccipital PIR

Answer 308

Take head and make occiput go away from atlas like on a stick when cooking a pig. He looks backwards with his head and eyeballs. Pt has sensation of a double chin

Question 309

Thoracic clean-up move. Person in VP area has bump

Answer 309

Cross their hands, put them on EOP, bring elbows together. Inferior hand goes on elbow, superior hand on his crossed fingers. Pt looks backwards with ehad and eyes

Question 310

Pec Minor PIR

Answer 310

Shoulder protraction. Grab shoulder joint and move it like on an axel. If coracoid process is coming closer to the ribs, want to take shoulder like roll it back. Grab inferior angle of scapula, other hand is on GH area. Pt will rotate into your top hand, then when he relaxes you’ll push back up and around.

Question 311

Self-myofascial release (SMFR) focuses on

Answer 311

The fascial system in the body

Question 312

Gentle force application to the adhesion or knot Elastic collagenous fibers are manipulated from a bundled position (that causes adhesion) into alignment that is straighter with the direction of the muscle and/or fascia

Answer 312

SMFR - self-myofascial release

Question 313

Assist in releasing the knot by stimulating the golgi tendon organ and thus create autogenic inhibition Possibly stimulates fascial ruffini end-organs creating gel-to-sol effect

Answer 313

SMFR

Question 314

SMFR how to

Answer 314

Find tender spot (indicates adhesion) and sustain pressure on that spot for a minimum of 20-30 seconds to activate the autogenic response

Question 315

Helps restore the body back to an optimal level of function and performance by resetting the soft tissue proprioceptive mechanisms

Answer 315

SMFR

Question 316

Use prior to static stretchign for postural distortion patterns and/or activity as well as a useful cool-down

Answer 316

SMFR

Question 317

Practitioner’s manipulation stimulates intrafascial mechanoreceptors

Answer 317

Mechanism of myofascial release

Question 318

CNS response includes change in striated muscle fibers and autonomic nervous system effects - mechanism of myofascial release

Answer 318

Altered global muscle tonus Change in local vasodilation and tissue viscosity Lowered tonus of intrafascial smooth muscle cells

Question 319

Functional anatomy of core musculature

Answer 319

Lumbar spine muscles Abdominals Hip muscles Cervical spine muscles

Question 320

Transversospinalis group parts

Answer 320

``` Rotatores Interspinales Semispinalis Intertransversarii Multifidus ```

Question 321

Poor mechanical advantage relative to movement production Primarily type 1 muscle fibers with high degree of muscle spindles (2-6x normal) Designed for stabilization and proprioception

Answer 321

Multifidus

Question 322

Primarily responsible for providing proprioceptive information to CNS Inter/intra-segmental stabilization

Answer 322

Transversospinalis group

Question 323

Segmental deceleration of flexion and rotation of spine during functional movements Must be trained to allow dynamic stabilization

Answer 323

Transversospinalis group

Question 324

___ may be most important part of transversospinalis group Provides intersegmental stabilization in all positions

Answer 324

Multifidus

Question 325

Erector spinae

Answer 325

Thoracic longissimus and iliocostalis Long extension moment arm with minimal compression

Question 326

Most efficient lumbar extensors

Answer 326

Erector spinae

Question 327

Lumbar longissimus and iliocostalis

Answer 327

Create posterior shear with lumbar flexion

Question 328

Quadratus lumborum

Answer 328

Stabilizer in wide variety of tasks involving flexion, extension and lateral bending

Question 329

Latissimus Dorsi

Answer 329

Largest moment arm of all back muscles therefore great effect on LPHC Any UE rehab has to pay attention to it and its impact on LPHC

Question 330

Bridge between upper and lower extremities

Answer 330

Latissimus dorsi

Question 331

Operate as a functional unit to help maintain optimal spinal kinematics

Answer 331

Abdominal musculature

Question 332

Provide sagittal, frontal and transverse plane stabilization by controlling forces reaching LPHC

Answer 332

Abdominal musculature

Question 333

Abdominal musculature

Answer 333

Rectus abdominis External oblique Internal oblique

Question 334

Attaches to posterior layer of thoracolumbar fascia

Answer 334

Internal oblique

Question 335

Contraction of TrA and internal oblique create traction and tension forces on

Answer 335

TL fascia

Question 336

Enhances regional inter-segmental stability in LPHC

Answer 336

Abdominal musculature

Question 337

Provide dynamic stabilization against rotational and translational stress Provide optimal neuromuscular control to entire LPHC

Answer 337

Transverse abdominis (TrA)

Question 338

Contraction precedes activation of other abdominal muscles regardless of direction of reactive foreces

Answer 338

Transverse abdominis

Question 339

Important for dynamic stabilization during all trunk movements

Answer 339

Transverse abdominis

Question 340

Active during all trunk movements

Answer 340

Transverse abdominis and multifidus

Question 341

Contributes to stability of lumbar spine during inspiration and expiration Involved in the control of postural stability during sudden voluntray movement of the limbs

Answer 341

Diaphragm

Question 342

Normally in horizontal position in adults Cephalad posiition is inhibitory of normal function

Answer 342

Diaphragm

Question 343

Posterior intersegmental cervical spine muscles

Answer 343

Multifidi and suboccipitalis

Question 344

Deep cervical flexors

Answer 344

Longus capitis and colli Primary segmental stabilizer Feedforward contraction with arm movment

Question 345

Lower cervical/upper thoracic extensors

Answer 345

Semispinalis cervicis and longissimus cervicis

Question 346

Scapular mobilizers and stabilizers

Answer 346

Upper, middle, lower trapezius Levator scapula Pectoralis minor Serratus anterior

Question 347

Injury mechanics in the lumbar spine

Answer 347

Too many repetitions of force and motion and/or prolonged postures/loads

Question 348

Cumulative loading

Answer 348

Compression, shear, or extensor moment Injury mechanics in the lumbar spine

Question 349

Axial torque with flexion or extension loading Cumulative exposure to unchanging work

Answer 349

Injury mechanics in the lumbar spine

Question 350

Any abnormal loading conditions (including overload and immobilization) can produce

Answer 350

Tissue trauma and/or adaptive changes that may result in disc degeneration

Question 351

Adverse mechanical conditions can be due to

Answer 351

External forces, or may result from impaired neuromuscular control of the paraspinal and abdominal muscles

Question 352

Most important modifiable mediating factor for primary OA

Answer 352

Muscle dysfunction

Question 353

Gute med exercise

Answer 353

Clam shells Side plank from knees - downside is getting glute med, you’re getting closed kinetic chain closed shoulder, neurodevelopmental

Question 354

Reducing tissue damage

Answer 354

Reduce peak and cumulative spinal compressive loads Reduce repeated spine motion to full flexion Reduce repeated full-range flexion to full-range extension Reduce peak and cumulative shear forces Reduce slips and falls Reduce length of time in prolonged sitting especially exposure to seated vibration

Question 355

Name one way to teduce repeated spine full motion to flexion

Answer 355

Hip hinge

Question 356

Abdominal bracing

Answer 356

Tightening in a hoop like fashion - uses multiple muscles and we want that!

Question 357

Ab hollowing is using one muscle

Answer 357

Transverse abdominus - suck belly button into spine as much as you can

Question 358

Stiffening or tightening muscles of the midsection as if someone was about to strike you in the trunk

Answer 358

Abdominal bracing

Question 359

Abdominal bracing

Answer 359

The level of contraction should be low about 10% maximum

Question 360

Train core stabilizaing musculature without focus on any 1 muscle Minimize shear and compression McGills Big 3

Answer 360

Shown to train core stabilizing musculature with relatively low compressive loads

Question 361

McGill’s big 3

Answer 361

Curl-up Side bridge Birddog

Question 362

High level of rectus abdominis activation with posterior pelvic tilt High level of compression

Answer 362

Hanging knee-up

Question 363

High compressive load (6000N) Extension load of posterior elements Potential damage to interspinous ligaments

Answer 363

Superman

Question 364

High compressive load (4000N) Extension load of posterior elements Lumbar extensors not designed for powerful extenstion movements

Answer 364

Roman Chair Back Extension

Question 365

Phases

Answer 365

Corrective Functional Performance

Question 366

Corrective phases

Answer 366

Stability training

Question 367

Functional phases

Answer 367

Functionally integrated training

Question 368

Performance phases

Answer 368

Strength and power training

Question 369

Corrective exercise training goals focus on

Answer 369

Postural control, muscle balance, pain reduction/centralization

Question 370

Train coordination and endurance with

Answer 370

Safe, low-load exercises

Question 371

Progress to complex activites and functional exercises once patient learns to

Answer 371

Move and position spine in fundamental ways

Question 372

Program corrective design

Answer 372

At least 1 session a day!! Longer than 8 seconds could cause muscle trigger points in muscles

Question 373

Cat camel

Answer 373

Warmup

Question 374

Leg loading with

Answer 374

Biofeedback device

Question 375

Dead bug progression

Answer 375

Back, knees at 30d One leg lifted Both legs lifted Both lifted, one at 90, one straight, one arm above head, one toward ceiling

Question 376

Quadraped birddog

Answer 376

All fours One hand out One leg out One hand and opposite leg out

Question 377

Sidelyign bridge beginner

Answer 377

Knees down, one or two hands

Question 378

Sidelying bridge advanced

Answer 378

On feet only...then one leg lifted

Question 379

Rotational bridge

Answer 379

Side plank, plank, other side plank, plank...etc

Question 380

Abdominal curl up

Answer 380

One knee up, hands behind back | Lift head and shoulders

Question 381

Supine bridge progression

Answer 381

Supine bridge | Then one leg in air, one on mat

Question 382

Clamshell

Answer 382

On side, top knee up and down

Question 383

Cranio-cervical flexion

Answer 383

Feet on table, kenes up, flex head

Question 384

Stability ball hamstring training hip extension

Answer 384

Feet on exercise ball, lying on back, do supine glute bridge

Question 385

Stability ball double leg curl

Answer 385

Feet on exercise ball, spine bridge, bring knees in while rolling ball

Question 386

Stability ball hamstring training single leg curl

Answer 386

One leg on ball, supine bridge, one knee in air, bring other knee in

Question 387

Stability ball bridge ball braidge

Answer 387

Supine bridge with feet on ball

Question 388

Stability ball abdominal curl up

Answer 388

Back over ball, crunch

Question 389

Core stability trained in exercises mimicking patients

Answer 389

ADLs SRAs DE

Question 390

Training with movements that are within patients fucntional range while being as functional as possible. Progression continue until

Answer 390

Pt’s functional range includes ADLs, SRAs and DEs expected to be encountered

Question 391

Functional exercise training program design Acute variables

Answer 391

2-3 exercises 2-3 sets x 10-12 reps Rest period approx 45 sec 2-4 sessions/week

Question 392

Performance exercise training goals

Answer 392

High-level activites with narrow safety/stability margin Atheletic activity performance enhancement and innjury prevention

Question 393

Built on a foundation of conscious-kinesthetic awareness of appropriate motor control

Answer 393

Performace exercise training goals

Question 394

Sites of injury****

Answer 394

Soft tissue, osseous, fibro-osseous tunnels Sites of nervous system branching Sites of relative fixation to interface Areas with high possibility of friction forces from unyielding interface structures Tension points

Question 395

Neurodynamic tensioners

Answer 395

Neurodynamic test that increases tension in neural structures

Question 396

Relies on natural viscoelasticity of nervous system and does not exceed elastic limit Does not produce plastic deformation or damage

Answer 396

Neurodynamic tensioners

Question 397

Median nerve tensioner

Answer 397

Arm out to side palm up, extend wrist as far as possible, laterally flex head away

Question 398

Ulnar nerve tensioner

Answer 398

Like going to hit yourself in side of head with wrist extended and head laterally flexed away

Question 399

Radial nerve tensioner

Answer 399

Arm out, palm towards back fully flexed, laterally flex head away

Question 400

Neurodynamic sliders/flosser

Answer 400

Neurodynamic maneuver whose purpose is to produce a sliding movement of neural structures relative to their adjacent tissues

Question 401

Sliders can be thought of as

Answer 401

Tensioners with one end put on slack

Question 402

Nerve flossing

Answer 402

Neurodynamic sliders

Question 403

Lower extremity neurodynamic tensioners

Answer 403

Hands behind back, leg out front, flex head in

Question 404

Sequence of subject postures in slump test

Answer 404

Pt sits erect Pt slumps lumbar and thoracic spine while ex holds head in neutral Pt flexes head and neck Ex carefully applies overpressure to cervical spine as pt extends knee Pt dorsiflexes foot Pt extends head and neck If symptoms are reproduced at any stage, further sequential movements are not attempted

Question 405

Femoral nerve neurodynamic test

Answer 405

Prone knee bend | Slump knee bend

Question 406

Obturator nerve neurodynamic test

Answer 406

Slump SLY/KF/HE HAb obturator test

Question 407

Peroneal nerve neurodynamic test

Answer 407

PR/IN/SLR | PF/IN/SLR via shoulder

Question 408

Tibial nerve neurodynamic test

Answer 408

DF/EV/SLR and reversal

Question 409

Sural nerve neurodynamic test

Answer 409

DF/IN/SLR

Question 410

Balance is an essential function of

Answer 410

Locomotion

Question 411

Freeman first to suggest training for peripheral sensory deficit following

Answer 411

Ankle sprains

Question 412

Freeman about ankle sprains established importance of addressing

Answer 412

Proprioceptive deficit throughout locomotor system

Question 413

Janda’s contributions to sensorimotor training

Answer 413

Believed that msucle imbalances led to movement impairments and altered motor programming

Question 414

Treatment approach janda

Answer 414

Normalize peripheral proprioceptive structures Correct postural/muscle imbalance Faciliatate correct motor program

Question 415

Stages of motor learning according to janda

Answer 415

Voluntary control of movement | Automatic control of movement

Question 416

Voluntary control of movement requires

Answer 416

Cortical integration and patient concentration | Constant feedback from positive and negative experiences

Question 417

Voluntary control of movement

Answer 417

Feedback motor control | Inefficient for creating motor programs

Question 418

Automatic control of movement

Answer 418

Coordinated movement pattern programmed in subcortical region Requires less conscious processing, therefore quicker Feedforward motor control

Question 419

Essential to protect joints for dynamic functional stability

Answer 419

Automatic control of movement

Question 420

Indications for sensorimotor training****

Answer 420

``` Post-traumatic, postoperative Chronic neck, back pain Faulty posture especially with respiratory dysfunction General hypermobility and/or instability Muscle imbalance Prevention of falls in senirs Maintenance of general fitness ```

Question 421

Key postural areas according to janda

Answer 421

Foot Pelvis espeically SI joint Cervical spine

Question 422

Foot

Answer 422

Cutaneous and intrinsic muscle proprioceptive input | Small (short) foot

Question 423

Pelvis esp SI joint

Answer 423

Proprioceptive input | Neutral lumbopelvic position

Question 424

Cervical spine

Answer 424

Proprioceptive input

Question 425

The small (short) foot

Answer 425

Attempt by patient to draw metatarsal heads toward calcaneus thus raising medial longitudinal arch and shortening foot wihout flexing toes

Question 426

Progression small short foot

Answer 426

Tactile stimulation Passive remodeling NWB Active-assisted remodeling NWB Active remodeling NWB - partial WB - WB

Question 427

Level 1 sensorimotor training - static phase

Answer 427

Maintain postural stability on progressively unstable surfaces

Question 428

Exercises level 1 sensorimotor training staitc phase

Answer 428

Single leg balance eyes open Single leg balance eyes closed Single leg balance EO/EC on labile surfaces like balance board, wobble board, airex cushion, dynadisc, foam roller

Question 429

Static phase level 1 program design

Answer 429

1-2 exercises 1-3 sets x 10-30 seconds or 10-20 repetitions Rest period 30 sec 3-5 sessions/week

Question 430

Level 2 sensorimotor training dynamic phase

Answer 430

Add arm and leg movements while maintaining postural stability on progressively unstable surfaces

Question 431

Level 2 exercises

Answer 431

Reaches on stable surface | Reaches on unstable surfaces

Question 432

Level 2 sensorimotor program design

Answer 432

1-2 exercises 2-3 sets x 10-12 repetitions Rest period 30 sec 3-5 sessions/week

Question 433

Level 3 sensorimotor training - fucntional phase

Answer 433

Perform functional movements on progressively unstable surfaces

Question 434

Level 3 sensorimotor exercises

Answer 434

Single leg squat Single leg deadlift Single leg resisted movements Balance sandal training

Question 435

Level 3 sensorimotor program design

Answer 435

1-2 exercises 2-3 sets x 10-12 repetitions Rest period 30 sec 3-5 sessions/week

Question 436

Janda’s balance sandals

Answer 436

Sandals with balls on the bottom

Question 437

Clinical application of balance sandals

Answer 437

Significant increases in gluteal activation and decreases in time to 75% MVC in 7 days Increased leg EMG activity particularly ankel evertors and invertors in 11.6 + or - 14.9 weeks Improved medial-lateral postural stability in stable and unstable ankles after 8 weeks of functional balance training

Question 438

Janda balance sandal protocl

Answer 438

Initial stage Second stage Third stage

Question 439

Jandas balance sandal initial stage

Answer 439

Stance training with support | Sandals in horizontal position

Question 440

Second stage jandas balance sandals

Answer 440

Walking with support | Start with walking in place then progress to shoulder support only

Question 441

Third stage jandas balance sandal

Answer 441

Short steps, a few meters forward and backward walking, sidestepping 1-2 minutes several times per day up to 15 minutes total

Question 442

Patients in pain often worry that will cause more harm than good if

Answer 442

Active

Question 443

Advice to let pain be your guide reinforces

Answer 443

Attitudes and beliefs that support pain-avoidance behavior

Question 444

Clinicians goal in active care is to modify

Answer 444

Patient helath behavior in direction fo reactivation

Question 445

Back pain traditionally viewed as

Answer 445

Acute, self-limiting condiiton

Question 446

Now recognized as involving frequent reoccurrences and/or chronic course

Answer 446

Back pain

Question 447

Many approaches for spine injury concerned only with

Answer 447

Diagnostic triage and pain managment

Question 448

Pain-relief modalitis will always be accepted treatment Patient education about self-care through gradual reactivation rapidly gaining scientific traction Becoming

Answer 448

Standard of care for prevention of diability associated with spinal disorders

Question 449

Keys to active self-care

Answer 449

Reassurance and advice Cognitive behavioral approach Multidisciplinary biopsychosocial approach

Question 450

Reassurance and advice

Answer 450

Identify pt concerns and goals Reassurance regarding seriousness of condition Specific reactivation advice

Question 451

Key points in initial report of findings reassurance and advice

Answer 451

Identify spine-related worries and fears Provide assurance that there is no serious disease Explain that injuries and degeneration can be pain precipitators but likely pain perpetuators are controllable factors Provide specific activity modification and reactivation advice

Question 452

Cognitive behavioral approach

Answer 452

More structured approach involving cognitive behavioral classes/sessions

Question 453

Cognitive behavioral approach

Answer 453

Address pt worries and fears Teach methods to reduce fear and apprehension May be appropriate for subacute patienst at heightened risk for chornic pain or chronic pain patients

Question 454

Comprehensive, multidisciplinary approach that combines CB model with strategies that address return-to-work obstacles

Answer 454

Employer issues Compensation issues May be appropriate for chronic patients if steps 1 and 2 arenot successful

Question 455

Patient education alone often not sufficient to

Answer 455

Engage patients in active self-care model

Question 456

Must take patient-centered approach

Answer 456

Patient is not a diagnosis or label | Report of findings shifts model from biomedical/HCP-centered fix to biosocial/patient-centered cope and adapt model

Question 457

Enhancing patient motivation to resume activity

Answer 457

Collaboratively establish functional goals Reassurance that the spine is not damaged Education that gradual reactivation will enhance recovery whereas rest with interfere with recovery Consistent verbal and written messages Make exercises simple enough to be performed at home without significant equipment needs Establish realistic expectations regarding possiblity/probability of flare-ups

Question 458

Tips for enhancing patient compliance

Answer 458

Education that hurt does not necessarily equal harm Education that fitness is the key to prevention Make exercises simple enough to be performed at home without significant equipment needs Link exercises to specific fucntional deficits/goals Encourage patients to work at an exercise level that is somewhat hard for them Establish realistic expectations regarding possibility/probability of flare-ups