Lec.2 - ROM, flexibility and manual muscle testing

Question 1

Injury assessment principles - Diagnostic sign

Answer 1

Objective & measurable

It is what you hear, feel, see or smell when you assess the patient

Question 2

Injury assessment principles - Symptom

Answer 2

Subjective, provided by the injured individual.

Their own perception of the problem

Question 3

Injury assessment principles - Acute injury

Answer 3

Sudden onset of symptoms

Question 4

Injury assessment principles - Chronic injury

Answer 4

Slow, insidious onset of symptoms

Question 5

Injury assessment principles - Microtrauma

Answer 5

Multiple small stimuli that culminate to a painful reaction

Question 6

Injury assessment principles - Macrotrauma

Answer 6

Large stimuli that leads to an instantaneous painful reaction

Question 7

Ex: acute or chronic
ankle sprain
stress fracture

Answer 7

ankle sprain = acute/macro

stress fracture = chronic/micro

Question 8

Evaluation process - why evaluate the uninjured side? (2)

Answer 8

1. Find a baseline

2. Find a goal to reach after the rehab

Question 9

HOPS acronym

Answer 9

History
Observation
Palpation
Stress tests/physical assessment

Question 10

History

Answer 10

Primary complaint, cause or MOI, S/S, past injuries, changes in training or equipment, etc.

Question 11

Observation

Answer 11

Posture, gait, deformities, bruising, swelling, etc.

Question 12

Palpation

Answer 12

Deformities, tenderness, heat, etc.

Question 13

Stress tests/physical assessment

Answer 13

AROM, PROM, RROM, flexibility, ligament testing, neurological exam, etc.

Question 14

Physical tests (3)

Answer 14

• Uninjured side to establish the baseline
• Multiple joints may be necessary
• The spine should also be assessed

Question 15

ROM (assesses?)

Answer 15

Assess the osteokinematic movements (ex: gross movement of knee flexors)

Question 16

Motion available at a single joint is affected by (2)

Answer 16

• Joint arthokinematics (bony structures)

- Soft tissue (muscles, ligaments, capsules)

Question 17

Flexibility (mobility)

Answer 17

Ability to move freely without restriction

Question 18

T or F: flexibility will affect ROM

Answer 18

TRUE

Question 19

To measure joint ROM in a joint in which 2 joint are involved :

Answer 19

The second joint should be placed in a shortened position

Question 20

To measure muscle length or flexibility of a 2 joint muscle :

Answer 20

The muscle should be placed in an elongated position across all joints

Question 21

AROM (infos)

Answer 21

Perform voluntary movement
Assess for muscle function
Total amplitude, willingness and fluidity of movement

Question 22

PROM (infos)

Answer 22

Performed by the professional without the participation of the patient
Assess for inert/noncontractile structures
Assess for end feel sensations and amplitude

Question 23

RROM

Answer 23

Muscle contraction against a resistance
Assess for muscle function at specific locations
Assess for strength and endurance of a muscle

Question 24

Open pack

Answer 24

With PROM

Allows for accessory movements to occur

Question 25

Accessory movements

Answer 25

Assess for the capsular/ligament limitations | Distraction, sliding, compression, roll and glide

Question 26

Close pack

Answer 26

When two structures fit precisely and accessory movement are not possible

Question 27

Types of stretching - Active

Answer 27

When a person supplies the force of the stretch

Question 28

Types of stretching - Passive

Answer 28

When an external force causes or increases a stretch

Question 29

Location of muscle spindles

Answer 29

Intrafusal muscle fibers

Question 30

Location of golgi tendon organs

Answer 30

Musculotendinous junction

Question 31

Golgi tendon organs

Answer 31

Sensitive to changes in muscle tension | Stimulation causes a muscle to reflexively relax

Question 32

Muscle spindles

Answer 32

Monitor changes in muscle length Creates stretch reflex when sensory neuron from muscle spindle innervates a motor neuron Muscle contraction with a rapid muscle lengthening

Question 33

Autogenic inhibition

Answer 33

• Relaxation that occurs in the same muscle experiencing muscle tension • Accomplished via active contraction of muscle immediately before passive stretch of that same muscle • Tension built up during active contraction stimulates GTO causing a reflexive relaxation of the muscle during the subsequent passive stretch

Question 34

Reciprocal inhibition

Answer 34

``` • Relaxation that occurs in the muscle opposite the muscle experiencing tension • This occurs when one simultaneously contracts the muscle opposing the muscle that is being passively stretched • Tension in contracting muscle stimulates GTO and causes a reflexive relaxation of the stretched muscle ```

Question 35

Static stretching

Answer 35

Slow constant stretch that holds at end ROM for 15-30 sec | **Do not want to activate muscle spindles (stretch reflex- no contraction or the reflex is activated)

Question 36

Dynamic stretching (mobility drills)

Answer 36

Functionally based stretching Use sport and activity specific movements to prepare the body for warm up Promote dynamic flexibility

Question 37

Ballistic stretching

Answer 37

Involves active muscular effort and uses bouncing-type movement End position is not held Used pre-exercise Usually triggers stretch reflex

Question 38

Proprioceptive Neuromuscular Facilitation Stretch (PNF)

Answer 38

Designed to relax muscles with increased tone or activity Facilitates muscular inhibition Either isometric or concentric muscle contraction of the antagonist muscle + passive stretch of the antagonist muscle

Question 39

Hold-Relax

Answer 39

``` Passive stretch (10 sec) Isometric contraction (6 sec) Relax, then passive stretch performed in new ROM Repeat until no further gain in ROM (3-6x) ```

Question 40

Contract-Relax

Answer 40

Passive stretch (10 sec) Concentric contraction through full ROM Relax + passive stretch performed in new ROM Repeat until no further gain in ROM (3-6x)

Question 41

Slow Reversal Hold Relax

Answer 41

``` Passive stretch (10 sec) Isometric contraction (6 sec) Relax + athlete contracts agonist muscle to bring into new ROM Repeat until no further gain in ROM (3-6x) ```

Question 42

T or F: Slow reversal hold relax is the most effective due to autogenic and reciprocal inhibiton

Answer 42

True Hammies isometrically Antagonist to increase ROM

Question 43

Why is manual muscle testing important? (4)

Answer 43

- Need to know our anatomy - Determine the integrity of the muscular tissues - Determine the ability of athlete to RTP - Important to know for prescribing exercises

Question 44

Why do we get muscle weakness? (3)

Answer 44

1. Muscle imbalances (posture, repetitive movements) 2. Fatigue 3. Injury (ligamentous, muscular, nerve, joint)

Question 45

Weakness may be due to: (5)

Answer 45

``` Nerve involvement Disuse atrophy Stretch weakness Pain Fatigue ```

Question 46

Return of muscle strength may be due to: (6)

Answer 46

Recovery following the disease process Return of nerve impulse After trauma and repair Hypertrophy of unaffected muscle fibers Muscular development resulting from exercises to overcome disuse atrophy Return of strength after the tightness/stretch have been relieved

Question 47

Muscle weakness: If due to lack of use, then_____

Answer 47

exercise

Question 48

Muscle weakness: If due to overwork and fatigue, then ___

Answer 48

Rest

Question 49

Muscle weakness: If due to stretch and strain, then ____

Answer 49

Relief of stretch and stress before the stress of additional exercise

Question 50

Break test

Answer 50

- At the end of available ROM | - Patient is asked to hold position and do not allow the therapist to "break" the hold with manual resistance

Question 51

Active resistance

Answer 51

- Therapist gradually applies manual resistance until it reaches the maximal resistance the patient can tolerate - Requires skill and experience

Question 52

MRC scale - score of 0

Answer 52

No visible or palpable contraction

Question 53

MRC scale - score of 1

Answer 53

Visible or palpable contraction

Question 54

MRC scale - score of 2

Answer 54

Full ROM gravity eliminated

Question 55

MRC scale - score of 3

Answer 55

Full ROM against gravity

Question 56

MRC scale - score of 4

Answer 56

Full ROM against gravity, moderate resistance

Question 57

MRC scale - score of 5

Answer 57

Full ROM against gravity, maximum resistance

Question 58

Optimal position for muscle testing

Answer 58

End of the available ROM for 1 joint muscles | For 2 joint muscles testing is done at mid range of overall length

Question 59

Basic rules of applying MMT (8)

Answer 59

1. Place subject in a position that offers the best fixation of the body (supine, prone or sidelying) 2. Stabilize the part proximal to the tested part or adjacent to 3. Place the part to be tested in precise antigravity test position, whenever appropriate, to help elicit the desired muscle action and aid in grading 4. Use test movements in horizontal plane when testing muscle that are too weak to function against gravity 5. Apply pressure directly opposite the line of pull of the muscle 6. Apply pressure gradually, allowing the patient to “get set and hold” 7. Use a long lever whenever possible 8. Use a short lever if the muscles do not provide sufficient fixation for use of a long lever

Question 60

T or F : Muscles that are excessive in length are usually weak and allow adaptive shortening of opposing muscles

Answer 60

TRUE

Question 61

T or F: Muscles that are too short are usually strong and maintain opposing muscles in a shortened position

Answer 61

FALSE, maintain in a lengthened position