IPPA MST 2 Flashcards
Describe Non-weight bearing activity of the hip
Open chain
Head of femur moves on acetabulum
Convex on concave
Roll and glide in opposite direction
Describe weight bearing activity of the hip
Closed chain
Acetabulum moves on head of femur
Concave on convex
Roll and glide in same direction
What is medial collapse pattern caused by weak abductors?
Contralateral pelvic drop
Internal rotation of femur
Knee valgus
Internal rotation of tibia
Pronation (Eversion, abduction, dorsiflexion) of foot
Where do you use a cane?
Contralaterally, fix pelvic drop
What could anterior hip pain be?
C-sign (true FA pain)
Pubic Symphysis
Adductors
What could posterior hip pain be?
Sacroiliac joint
Ischiofemoral space
Piriformis/gluteal
What could lateral hip pain be?
Greater trochanter
Gluteal tendons
What is the difference between compensated and uncompensated trendelenberg?
Uncompensated- pelvic drop
Compensated- trunk to ipsilateral side to compensate for contralteral pelvic drop
What are the big signs in differentiating inter articular hip pain and lumbar structure?
HOPC- Valgus, internal rotation, young person sporting vs heavy lifting/sedentary
Aggs- kicking/cycling compared to bending over/walking
Special Q’s- clicking vs pain in cough and sneeze
What is FITTVPP for strength?
F- 2-3 x week
I- >60-70% 1RM or 7/8 out of 10 effort
T- 30-45 s
T- Resistance
V- 8-12 x 2-4
P- 2-4 min rest
P- Progress Load
What is FITTVPP for endurance?
F- 5-7 x week
I- <50% of 1RM
T- >30-45 S
T- Resistance
V- 15-20 x 1-2
P- <30s
P- Progress resistance/reps/sets
What is FITTVPP for stretching?
F- Daily
I- Slight discomfort
T- 10-30 s
T- Sustained stretch
V- 30s x 2-4
P- Most effective when warmed up
P- Progress range throughout hold
What is FITTVPP for aerobic exercise?
F- 3-5 days x week
I- Feeling the effects
T- 30-60 min
T- Rhythmic aerobic
V- Product of FIT
P- Increase time or intensity
What is FITTVPP for neuromuscular control?
F- >2-3 x week
I- Low intensity, about quality of activation
T- >20- 30 min
T- Motor skills and multifaceted (e.g. tai chi)
V-
P-
P- Increase duration and competing demands
What is the difference between alta and baja?
Alta is superior displacement of the patella
Baja is inferior displacement
What is varus and valgus?
Valgus knock kneed
Varus opposite
What degree of flexion/extension is the ACL vulnerable?
30 degrees flexion
How is arthrokinematics different in the knee?
Open chain concave tibia on convex femur, same direction
Closed chain convex femur on concave tibia, opposite direction
When does the locking mechanism occur?
Final 30 degrees extension
What 4 things could cause lateral glide of patella?
Overactive VL
Tight ITB
Shallow trochlear groove
Genu valgus/femoral anteversion increasing Q angle
What 2 things could cause medial glide of the patella?
Weak/delayed activation VMO
Stretched medial retinaculum
What 2 things could cause lateral tilt of the patella?
Tight ITB
Overactive VL
What 2 things could cause medial tilt of the patella?
Ruptured or stretched medial retinaculum
Loss of tone VMO
What is the Q angle and when does it increase?
Angle formed by a line between the ASIS and patella, and tibial tuberosity and patella
It increases with genu valgus, femoral anteversion and external tibial rotation
What is the difference between joint effusion and hemarthrosis?
Effusion- gradual onset, worse next morning, synovial irritation or inflammation
Hemarthrosis- rapid 1-2 hours, blood
What does it mean if walking downstairs is an aggs?
Patellofemoral pain syndrome as quads are in more control
What forces damage the MCL and LCL?
Valgus- MCL
Varus- LCL
When is the ACL injured?
Hyperextension
Decelerating, pivoting with some flexion
When is the PCL damaged?
Forced hyperflexion
What movements cause supination?
Inversion, adduction and plantarflexion
What movements cause pronation of the foot?
Eversion, abduction, dorsiflexion
Break down the subtalar joint?
Posterior joint: Convex calcaneal dome on concave inferior talus, calcaneus fixed in weight bearing
Anterior joint: concave calcaneal facets on convex inferior talar surface, calcaneus fixed in weight bearing
Which ligament is most commonly injured in inversion?
Anterior talofibular ligament (ATFL) (inversion/plantar flexion)
Calcaneofibular ligament less so (inversion/dorsiflexion)
What are some modifiable risk factors for lateral ankle sprain?
Reduced dorsiflexion ROM
Reduced proprioception
Body mass index
When is the posterior talofibular ligament injured?
Dorsiflexion/external rotation
When is the MCL of the foot injured?
Rarely injured but can in eversion/pronation
Which arch is higher and takes more weight bearing?
Medial
What does foot pronation help with?
Mobility: Shock absorption, changing direction
What does foot supination help with?
Stability
What does cavus/planus mean?
Cavus = supination
Planus = pronation
What does calcaneovarus and calcaneovalgus mean?
Calcaneovarus = Inversion
Calcaneovalgus = Eversion
What are some foot fracture signs?
Cannot weight bear immediately and bruising
How many degrees of thoracic extension is need for full shoulder abduction?
15 degrees
What 3 things does scapulothoracic rhythm allow?
- Additional range
- Preserve length-tension relationship
- Prevent bony impingement
What muscles contribute to upward rotation of the scapula?
Upper traps, lower traps, serratus anterior
What muscles contribute to downward rotation of the scapula?
Rhomboids, levator scapulae
What muscles contribute to protraction of the scapula?
Pec minor and major
What muscles contribute to retraction of the scapula?
Rhomboids, middle traps
What muscles contribute to elevation of the scapula?
Upper traps
What muscles contribute to depression of the scapula?
Lower traps
What muscles contribute to winging of the scapula?
Weak serratus anterior or tight pec minor
What is varus and valgus of the elbow referred as?
Cubitus valgus and varus. Different extremes of the carry angle
Describe the accessory movements of the elbow in flexion?
Trochlear notch of ulna rolls and slides anteriorly on trochlea
Radial head rolls and slides anteriorly on capitulum
Detail the representation of pain?
Identity beliefs (What is pain?)
Causal beliefs (What caused pain?)
Consequence beliefs (Consequences to pain)
Control beliefs (How can I control pain?)
Timeline beliefs (How long will pain last?)
Define pain
Unpleasant sensory and emotional experience that may or may not involve tissue damage
What is nociception?
Response to noxious stimuli
What does mechanical pain feel like?
Sharp, prickling
What does thermal pain feel like?
Burning or freezing
What is neuropathic pain?
Result of lesion or dysfunction of the nervous system itself
What is nociplastic pain?
Pain from altered nociception resulting in hypersensitivity in apparently normal tissue
What is an outcome measure for pain?
Self-reported questionnaires
What is the general idea of the Health Beliefs Model?
Perception determines behaviour not real benefits or risks. Using people’s perception helps identify problems in education and motivation.
What factors lead to perceived threat and outcome measures respectively?
Susceptibility to problem and severity of consequences of problem -> perceived threat
Perceived benefit of action and barriers to action -> outcome measures
What does perceived threat and outcome measures lead to?
Self-efficacy
What is the general idea of the Transtheoretical model?
It helps identify what stage someone is in in the change process
What are the 5 stages of the Transtheoretical model?
Precontemplation
Contemplation
Preparation
Action
Maintenance
What is the general idea of the social cognitive theory?
People need to see other people do action to believe in self
What are the three aspects of the Social Cognitive theory
Behavioural factors- skills, self efficacy
Cognitive factors- knowledge, expectations, attitudes
Environmental factors- social norms, access to community
What is the general idea of the Social Ecological model?
Self-efficacy is determinate of personal and external factors
What is the three aspects of the Social Ecological model?
Broad social, community and behavioral factors
What is the general idea of the COM-B Model?
Behaviour is a product of three conditions, capability (physiologically and psychologically), opportunity (accessibility, money, time) and motivation (reflective e.g. intend to stop smoking and automatic e.g. anticipated pleasure of eating chocolate)
What is the general concept of the Chronic Care Model?
Essential elements that provide high quality care. Usually only works when ‘plane is about to crash’. Education not changing behaviour. Collaboration, to get an idea of everyone’s problems/solutions. Integrated care.
What are the three elements of primary healthcare skills?
Health literacy, health behaviour change, chronic disease self-management
What’s the difference between a health behaviour and outcome?
Behaviour, action taken to preserve good health
Outcome, result of condition that affects quality or length of life. Outcomes don’t tell you what to do to achieve them.
Eating chocolate vs losing weight
What are some essential characteristics of self-management support?
Respect choices and circumstances
Not an intervention, its a philosophy
What are the four sources of self-efficacy?
Mastery experiences- performing task successfully or failing
Social modelling- seeing other people succeed
Social persuasion- help someone believe they have the skills to succeed
Psychological responses- moods, emotional states affect actions
What is the Stanford Chronic Disease Self-Management Program?
Six weeks, group based course with structured content
What are some pros and cons to the Stanford Chronic Disease Self-Management Program?
Pros
- Group reduces isolation, facilitates self-efficacy (social modelling)
- Facilitates empowerment
Cons
- Limited in addressing individual barriers
- Structure limits flexibility
What is the Flinders Program?
One-on-one self management and care planning using standardized tools/forms
What are the pros and cons of the Flinders Program?
Pros
- Individualized
- Trains clinicians in self-management and chronic illness
Cons
- Time intensive
- Does not provide tools for ongoing self-management
What is Health Coaching?
Trains practioners, draws on motivational interviewing and cognitive behavioural approaches to increase adherence
What are the pros and cons of Health Coaching?
Pros
- Flexible
- Range of different techniques
Cons
- Boundary issues with non-counselling clinicians
- More evidence to support
What is the RULE of Motivational Interviewing?
R: Resist the righting reflex
U: Understand and explore motivation
L: Listen with empathy
E: Empower, encouraging hope and optimism
What is Motivational Interviewing?
A collaborative conversation for strengthening someone’s own motivation
What are the pros and cons of Motivational Interviewing?
Pros
- Flexible
- Suits those at in different stages of readiness
Cons
- No formal structure, can be difficult for clinicians to learn
What is OARS of Motivational Interviewing?
Open ended questions
Affirmations- notice something positive
Reflections- offering guess as statement not question
Summaries
What is developing two minds?
Looking at positives and negatives to change, ambivalence shows client is working
What is roll with resistance?
Seek to clarify and understand, reinforce person’s role as problem-solver. Be flexible
What is change talk?
Statements by patient demonstrating a consideration or motivation for change e.g. ‘I’d probably feel a lot better if I started exercising’
What is sustain talk?
Statements by patient demonstrating wish to keep status quo e.g. ‘I can never find the time to exercise’
What muscles contribute to anterior tilt?
Pec minor, rhomboids, levator scap
What muscles contribute to posterior tilt?
Serratus anterior, upper/lower trap
What are the arthrokinematics of the GHJ?
Roll and glide opposite direction, humeral head convex, glenoid labrum concave
What is active insuffiency?
Multi-joint muscle too short, unideal length-tension, cannot grip properly. E.g. if wrist is flexed, full flexion of fingers cannot occur because finger flexors are shortened
What is passive insufficiency?
Multi-joint muscle, maximal slack of muscle taken up. E.g. finger and wrist flexion
Explain the four grips and what actions are required?
Spherical grip- start bigger than the object, wrist extension, finger abduction and extension. Then digit flexion to hold
Hook grip- suitcase type grip. MCP neutral, flexed IP
Lateral prehension- adduction, paper between hands
Cylindrical grip- hand mid pronated, fingers flexed. e.g. hammer
What is the FITTVPP of mobilizing/stretch exercise?
F- Daily
I- Slight discomfort
T- 10-30s
T- Sustained stretch
V- 10-30s x2-4
P- Most effective when warmed up
P- Progress range throughout hold
Describe the relationship between the zygapophyseal joints
and the intervertebral joints.
Intervertebral joints and zygapophyseal joints both guide movement and limit it. IVJ nucleus pulposus separates the vertebrae allowing flexion and extension and becomes tight during rotation to limit. ZJ are orientated to limit rotation.
What is the zygapophyseal facet orientation in the lumbar spine and which movements does it favour?
Sagittal, flexion/extension
What is the function of the IV joint in the lumbar spine?
NP separates vertebrae, AF keeps it together. Allows mobility and stability, weight bears, shock absorber
Which structures would be affected if a person has an
increased lumbar lordosis?
Tight, quadratus lumborum, hip flexors, erector spinae
Lengthened, rectus abdominis, gluteal muscles, hamstrings
Discuss the role of transverse abdominus for trunk stability.
Creates pressure in the abdominal cavity and attaches to thoracocolumbar fascia
Discuss the role of the trunk global muscles.
Large muscles to enable flexion and extension and then limit flexion/extension eccentrically
What do you need to be mindful of when a person
presents with low back pain and has been diagnosed with a
lumbar spondylolisthesis?
VB can move further on IV because there is no forward restraint resulting in greater shear force on disc. Worse in extension
Discuss the role of quadratus lumborum in lumbar
movements?
Bilateral = extension
Unilateral = lateral flexion
Discuss the role of multifidus for trunk stability
Line of pull perpendicular to spinous processes
Explain how a limitation of hip movement affects movement
at the lumbar spine.
Compensatory movement, bending the spine more
Or hip flexors allow lumbar flexion and the same for extension
What is the difference between somatic and radicular lumbar spine pain?
Somatic- musculoskeletal structure
Radicular- disorders of spinal nerves or roots
Describe somatic lumbar pain
Nociceptive, deep, dull and achy, hard to localize
Describe radicular lumbar pain
Lancinating or shooting pain, can be compression or inflammatory
What is the difference between discogenic and facetogenic pain?
D: acute inability to straighten, moving between positions, neurological signs, flexion
F: Extremes of movement, local unilateral, compression pattern
What is the difference between stiffness and instability?
S: movement restricted, muscle tightness,
I: Irritable, jolting, unpredictable aggs
What are the three things that cause tendinopathy?
Excessive tensile loading (overtraining
Excessive compressive loading
Stress-shielding (stop loading)
State the regions of the thoracic cage
Vertebro-manubrial: T1-2, ribs 1-2, manubrium
Vertebrosternal: T3-7, ribs 3-7, sternum
Vertebrochrondral: T8-10, ribs 8-10
Thoracolumbar: T11-12, ribs 11-12
What are the accessory muscles of inspiration?
Sternocleidomastoid, pecs, subclavius.
Pull ribcage, attached to clavicle
