lecture 2: ROM, Flexibility and Manual Muscle Testing Flashcards
what is a diagnostic sign
objective and measrable
see, feel, hear, assess
what is a symptom
subjective and provided by perception of injured athelte
what is an acute injurt
sudden onset of symptoms
what is an acute injurt
sudden onset of symptoms
what is a chornic injury
slow onset of symptoms
what is microtrauma
multiple small stim that culminate to a painful reaction
what is a macrotrauma
LARGE stimular that lead to instantaeaous painful reaction
give an example of an acute and macrotrauma
ankle sprain
give an example of a chronic and microtrauma
stress fracture
what are the 2 reasons its important to evaluate the uninjured side
1) serves as a baseline
2) serves as a goal to what we want to get back to
what is the acronym for evaluopton process
HOPS
(history, observation, palpation, special/stress tests/physical assessment
explain history of hops
primary compain, MOI, signs and symtpoms, past injuries, any changes
explain observation of hops
posture, gait, deformtiies, brising, swelling wtc
explain palplation of hops
looking for deformities, tenderness, heat
explain stress tests/ physical assessment
doing AROM, PRom, RROM, flexibility, lig testing, neurological exain
what side do you always start on and why
uninjured to establish a baseline
what is important to remmeber in terms of joints when doing physycial tests
some muscles cross more than one joint so you may noeed to evaluate multiple joints
in neuromulscular injuries/pathlogies, what can be the source of the pain and why
nerve
can cause neuralgia/reffered pain
where shiuld you assess if you suspect the pain is coming from a nerve
spine
what does osteokinetic mean
movement that is visible from the outisde
give examples of osteokinetic movement
abduction, rotation, flexion, extension, supination, etc
in ROM what type of movements are we assessing
osteokinetic movements
what are the 2 thigns that affect ROM
affected by
1) joint arthrokineamties (bony structures)
2) soft tissue (muscle. ligs, capsules(
what is arthrokinetic movement
movement resulting from the bone movement inside
what is another nsme for flexibility
mobility
what is the defintion of m=flexibility
ability to move freely wihtout restriction
true or false: flexiblity will not fffect ROM
false, it will
what are the 2 types of flexibility
passive and active
in order to measure JOINT ROM in a joint with 2 joint muscles involved, the first muscle must be BLANK and the second must be BLANK
first muscle be elongated
second joint should be in a shorted position
give an example of how the muscles should be when assessing knee joint ROM
While looking at knee flexion, since gastroc also affects the joint, the ankle must be in a shorted postion
in order to measure MUSCLE LENGTH of flex of a 2 joint muscle, how should the muscle be placed
the muscle should be placed in an elongated position across all joints
give an example of how joints shouodnbe for testing muscle length
if looking at the hamstring musxle length:
the hip muscle be in full flexion and the knee in full extension
what is active ROM
perform voluntary movemetn
what does active ROM assess
assess muscle function
total amplitude, willingness, fludiity of movement
what is passive ROM
performed by the professional without participation from the patient
what does passive ROM assess
assess non contractratile strcutires (joints, ligs)
assess for end fell sensations and amplituedes
what is resisted ROM
muscle contraction against a ressitance
what does RROM assess
assess for muscle function at specific ROM
assess strength and endurance
if someone has pain on PROM, what is it most likely do to
injury to non contractule strengthes
if someone has pain on RROM or AROM what is ut most likely due to
muscle function injury
what is required to stretch
rewquires a segment to go to a point of resistance in the ROM
when does active stretching occur
when a person stretching supplies the force of the stretch
when does passive stretcching occur
occurs when a extersnal force causes increases a stretch
what are the two proprioceptors for strecthing
golgi tendon organs and muscle spindles
where are msucle spindles located
intrafusal muscle fibers
what do muscle spindles monitor changes in
monitor changes in msucle length (and speed)
what happens when sensory neuron from a muscle spindke innervates a motor neuton in muscle spindles
create the stretch reflex
when there is a rapid msucle lengthening, what happens to the muscle and why
muscle contraction
to avoid injury
true or false: you waNT TO avoid activation of the msucle spindles in stretching
true
why wouldny you want the muscle spindles activated in stretching
cause it will contract the muscle
where are GTos locatied
nesar the musculortendinous junctions
what are GTO sensitive to
cahnges in muscle tension
what happens to a muscle when GTO are activatied,
causes the muscle to relax
relaxation that occurs in the SAME muscle experiences tension is called
autogenic inhibition
relaxation that occurs in the muscle opposite the muscle experiences tension is called
reciprocal inhibition
How is autogenic inhibitor accomplised
accomplished via active contraction of the miuscle immediated before passive strecth of that same muscle
what is happening at a physiological level f=during autogenic inhibition
tension built up during active contracion stimulates GTO cause a reflexive relation of the muscle during the subsequent passive stretching
what is happening at a physiological level during recripocal inhibition
tension in contracting muscle stimulates GTO and caauses reflexive relaxion of the stretched muscle
true or false: in static strecthing, you want to activat muscle spindles and why
false, you do not want to because the stretch reflex will happeen and cannot stretch properly if the muscle is being contracted
what is static strecthing
slow constant stretch that holds at the end of ROM for 15-30 sec
repeat multiple times
what is dynamic stretching
functionally based stretching
uses spirt ad activity specific movement to prepare the body for warm up
what does dynamic stretching promote
dynamic flexibility
what is dynamic flexibility
ability to actively move throug hROM needs for activity with proper muscle activation
what us ballistic strecthign
inolves active msucle effort andf uses a bouncing type movement
in ballistirc strethching, the end postiion is held?
false.
is ballistic used more pre or post exercuse
pre exercise
what is the issue with ballisitc stretching
if not controlled it can lead to injurt of the muscles/coonnetcive tissue since pushing the limits of ROM
what type of stretching usually triggesrs the strech reflex
ballistic
what does PNF stand for
prioprioceptive neuromusuclar facilitation strech
what was PNF orriginally created for
designed to relax muscles with icnreased tone or activity
to get rid of soreness
true ir falseL PNF facilitiates muscular activation
false
mscular inhibition
explain autogenic inhibition in PNF strecthign
either an isometic or concentric muscle contaaction of the antagonist muscle (the one being streched) is used prior to a passive strech of the antagonist
explain receprical inhibiton in PNF
use agonist muscle contraction
true or false: eccentric contraction is not used in PNF
truw
explain the hold relax strecth method
1) passive stretch (10s)
2) isometic cntatction (causes autogenic inhibition)
3) athetlete relate=ex and passive stretch is perfromed in new ROM for 30 s
repeat 3-6 or until no furhter gain in ROM
explain the contract relax
1) passive stretch (10s)
2) concentric contraction through full ROM
3) athltee relaxes and passive stretch is perfomed in new ROM for 30 sec
repeat
which is the most effective PNF strecth and why
HOLD RElax with with agonist contaction
slow reversal hold relax
because of autogenic and reciprocal inhibition
explain the slow reversal hold relax method
1) passive stretch(10s)
2) isometric contraction (6 sec)
3) Athlete relaxed and then contracts agonist muscle to bring through new rom
repeat
why is manual muscle testing imporatnt (3)
1) part of our assessment to determine the integrity of the muscular tissues
2) imporatnt for determining ability to RTP
3) important to know for prescribing exercises
what are the 3 reasons we get msucle wealkness
1) muscle imbalances (posture or repetiive movements)
2) fatigue
3) injury (lig injury, muscular injury, nerve injury,joint injury)
expkain how repetitive movements can cause msucle imbalances and waekness
in tennis for example
unilateral, other msucle gets negletcted
weakness may due to
nerve involvement disuse atrophy strecth weakness pain fatigue
what are some examples of return of muscle strength (5)
1) recovery after disease/trauma/repair
2) return of nerve impulse
3) hypertrophy of unaffected muscle fibers
4) muscualr development resulting from exrceises
5) return of strength after tightness has been relived
why would relieving tightness in a muscle return muscle strength
since its too tight the actin and myosin is too close together with too much overlap therefore theres not a good amount of stretch
muscle weakness should be treated in accordance with…
cause of weakness
(ex: if lack of use=exercise
if fatigue=rest
if strain=treat
what are the 2 types of manual testing
1) break test
2) acttive resistance
explain the break test
at the end of available ROM
patient is asked to hold that position and do not allow therapist to break the hold with manual resistance
explain active resistance
therapist graudally applied manual resistance until it reaches maximal resistance they can tolerate
(requires skill and experience)
when applying resistance, what are the aviable points of the scale
0-5
what does a 0 mean on the scale and what is that usually from
no visible or palpable contaction
usually from nerve damage
what is a 1 on the scale
visible or palpable contaction
what is a 2 on th scLe
full ROM gravity eliminated
whaet is a 3 on the scale
full ROM aganst graivity (but cannot with resistance (
what is a 4 on the scale
full ROM against gravity against a mod. resistance
what is a 5 on the scale
ful lROM against gravity with max resitance for 6 s
what is the optimal postiiton fir msucle testing for 1 and 2 joint muscles
1 joint muscle: end of availble ROM
2 joint msucle: done at midrange of overall length
what are the 8 basic rules for appliying MMT
Place subject in a position that offers the best fixation of the body (supine, prone or sidelying)
Stabilize the part proximal to the tested part or adjacent to
Place the part to be tested in precise antigravity test position, whenever appropriate, to help elicit the desired muscle action and aid in grading
Use test movements in horizontal plane when testing muscle that are too weak to function against gravity
Apply pressure directly opposite the line of pull of the muscle
Apply pressure gradually, allowing the patient to “get set and hold”
Use a long lever whenever possible
Use a short lever if the muscles do not provide sufficient fixation for use of a long lever
muscles that are excessive in length are usually BLANK and allow BLANK of opposing muscles
are usually weak and allow adaptaive shortning of opposing muscles
(ex; back muscle is weak and lenghted which causes pecs to shorten and contract
msucles that are too short are usually BLANKS and maintain opposing muscles in BLANK positive
too strong and legnthed
pain in passive ROM indicates a possible lesion to what type of structure
ligs, joints, non contaractile
Pain in active and resisted ROM indicates a possible lesion to what type of structure?
muscles
Pain with the closed pack position may indicate what type of injury?
bone or ligament
If your patient has a nerve paralysis; what tests do you expect to be normal and what tests do you expect to be abnormal: AROM, PROM, RROM?
AROM: abnomral
PROM: norma
RROM: abnomral
how do you assess for capsular/ligament limiations
use accesary movements
what are some examples of accessory movements
disatrction, sliding, compression, roll and glide
assessing for capsular, ligament limitations is usually done how
woth PROM in open back
what is open pack
ligaments and structures are less tight, not as much contact, allows for accessory movements to occur
what is closed pack
two strcutures fit preciesley and accesory movements are not possible
where does a joint have more ROM and can do more accessory movements, closed or open pack
open pack
pain in the close pack position is related to what injuries
bone or ligmenats injuries
a decrased accesorry movement will have a direct impant on what
AROM AND PROM
what type of stretching is asscoaited to moving through a rom in controlled manner
dynamic
what type of stretching is associated with bouncing
ballistic
what type of stretching is associated with slow constant stretch
static
what type of stretching involved isometric or concentric contraction
pnf strectching
the hold relax pnf stress uses autogenic or reciprocal
autogenic
the contractt relax uses autogenic or reciprocal inhibittion
autogenic
the slow reversal hold relax strtch uses autogenic or reciprocal
both
what is a 2 joint muscle
a muscle that crosses over 2 joints
where should you test a 2 joint muscle and give example
midrange
ex: since bicep crosses glenoheum and elbow joint =, do not test it at ends of rom but rather mid range for optimal muscle testing position
using a long level means AT hands are closer or further from joint
furhter
is it better to use long or short levers
long levers (easier)
