Lab Final

Question 1

Key Movement Patterns to know

Answer 1

Hip Extension
Hip Abduction
Trunk Flexion
Shoulder Abduction
Neck Flexion

Question 2

KMP Guidelines

Answer 2

Expose the area to be examined
Inform of pain or discomfort during the movement
Give minimal cues to see the most natural movement
Observe from two directions to best identify results

Be able to give a possible muscle imbalance for the movement

Question 3

KMP Hip Extension Procedure

Answer 3

Lie patient prone not the table with the low back exposed
Instruct patient to lift leg towards the ceiling (no more than 20-25 degrees)
Observe from side and head of the table

Question 4

Hip extension common faults

Answer 4

Early hyperlordosis = Glut max inhibition, possible functional instability
Lateral or rotational deviation of pelvis or lumbar spine = glut max inhibition
Decreased extension = Inhibited glut max or tight hip flexors
Knee flexion = Tight/overactive hamstrings
Upper back/cervical contraction = Overactive upperback/cervical compensating for inhibited glut max

Question 5

KMP Hip Abduction Procedure

Answer 5

Have patient lie side posture with bottom leg bent and lower back exposed
Instruct patient to lift leg towards the ceiling
Observe from behind the patient and at the head of the table

Question 6

Hip Abduction common faults

Answer 6

Cephalad shift of the pelvis = Inhibited/weak glut med.; overactive or tight QL
Hip Flexion = Inhibited glut med; overactive/tight TFL, psoas
Hip extension = Inhibited or weak glut med; overactive/tight adductors
Pelvic rotation = Overactive/tight TFL

Question 7

Trunk Flexion/curl-up Procedure

Answer 7

Patient is supine with neck in neutral, knees bent, and hands crossed over chest
Instruct patient to curl-up until shoulder blades come up off of the table
Observe from the heels (palpate?)
Observe from the side and palpate

Question 8

Trunk Flexion/Curl-Up Common Faults

Answer 8

Back is straight, Pelvis tilts anteriorly = inhibited/weak bdominal muscles; overactive/tight psoas
Decreased heel pressure = Inhibited/weak abdominal muscles; overactive/tight psoas
chin protrusion = Inhibited/weak abdominal muscles; overactive/tight SCM
Shaking = Inhibited/weak abdominal muscles; overactive/tight adductors

Question 9

Shoulder Abduction Procedure

Answer 9

Patient is sitting or standing With back exposed and elbows bent to the side
With elbows bent instruct patient to abduct to 100 degrees
Observe from behind the patient

Question 10

Shoulder Abduction Common Faults

Answer 10

Elevation of shoulder/scapula during first 60 degrees of abduction = inhibited/weak middle and lower trapezius and levator scapula
Winging of inferior angle = inhibited/weak serratus anterior; overactive/tight pec major and minor
Contralateral flexion of the trunk = inhibited/weak shoulder abductors; overactive/tight QL

Question 11

Head Neck Flexion procedure

Answer 11

Patient is supine with head in a neutral position and neck exposed
Instruct patient to bring their chin to their chest
Observe from the side and the head of the table

Question 12

Head/Neck Flexion Common Faults

Answer 12

Chin protrusion = Inhibited/weak neck flexors; overactive/tight SCM, scalene, or suboccipital
Chin Deviation = inhibited/weak deep neck flexors; overactive/tight unilateral SCM, scalene, or suboccipital
Shaking = general weakness of deep neck flexors

Question 13

Tracks to know

Answer 13

Bridge
Dead bug
Quadruped
Side lying
Side bride

Question 14

What to cue patient on for tracks

Answer 14

Neutral pelvis
Abdominal bracing
Breathing

Question 15

General guidelines for Tracks

Answer 15

Keep hands on patients back and belly to monitor the pelvis and bracing
Take patient step by step through the track
When they lose form the step is too hard for them
The step prior is then their homework
Give specific sets, reps, and frequency

Tell them to stop if they shake, lose form or aggravate pain

Question 16

Muscle to know for trigger point technique

Answer 16

Temporalis
Upper Trapezius
Pectoralis Major
Infraspinatus
Gastrocnemius
Piriformis
Wrist extensors

Question 17

Criteria for diagnosis of a Trigger Point

Answer 17

Presence of a tender nodule within a tight band
recreates a familiar sensation or pain
Muscle is shortened and tight and is painful to the touch

Question 18

Other findings with trigger point

Answer 18

Pain or sensation may refer in a typical way
Patient may jump
Local twitch response is seen/felt within a disturbed muscle
Muscle may be weak or inhibited

Question 19

General guidelines for Trigger Points

Answer 19

Treat superficial, then deep 
Treat proximal to distal 
Treat medial prior to lateral 
No more than 5 active points a session 
Direct pressure is contraindicated acute injury

Question 20

Trigger point palpation guidelines

Answer 20

Cross fiber palpation or “flick” to identify taut band
Pincer or finger pad along the band towards the center to identify the trigger point
Check near attachment to identify satellite trigger points
Pressure can be increased as tissue begins to release and symptoms decrease

Question 21

NIMMO

Answer 21

Muscle is relaxed
Apply pressure for 3-7 seconds, then release
Repeat until improved or 5 minutes has passed

Question 22

Travell

Answer 22

Muscle is in a stretched position
Apply pressure for 10-60 seconds with up to 20% pressure
Repeat until improved or 5 minutes has passed
Follow with a moist hot pack
The patient performs an active stretch after treatment

Question 23

Pin and Stretch: Muscles to know

Answer 23

Upper trap
Levator scapulae
Pec major
Serratus anterior 
Temporalis
Masseter
Biceps Brachii
Gastrocnemius
Piriformis
Psoas Major
Iliacus

Question 24

Pin and stretch general guidelines

Answer 24

Start with the muscle in a shortened position
Using the thumb or digit pin down the muscle near the origin
Take a tissue pull AWAY from the joint that will be moved
Lengthen muscle while maintaining pressure and tissue pull through the thumb and digit
Can also strip along muscle belly length while lengthening muscle

Question 25

Muscle Energy Technique: Muscles to know

Answer 25

Upper trapezius
Levator Scapulae
Scalenes (Anterior, Middle, Posterior)
Subscapularis
Pectoralis major
Iliopsoas
Hamstrings

Question 26

Muscle Energy Technique: General Guidelines

Answer 26

Find the first barrier of resistance (lengthen muscle) before start of contraction

20% isometric contraction for 6-10 seconds
(Post Isometric Contraction - agonist contracts; Reciprocal Inhibition - antagonist contracts; CRAC - both a PIR and RI need to be performed)

After complete relaxation (up to 5 seconds of rest), move muscle to the new barrier and hold for 30 seconds (do not allow muscle to shorten between rounds)

Repeat 3-5 times