Lecture Practice Flashcards
what are the 4 types of cryotherapy
ice massage, ice pack, cold immersion, and whirlpool
what is the temperature for cold immersion
4-10 degrees celsius
what is the temperature for whirlpool (cold)
10-15 degrees celsius
what can be done alongside cryotherapy
compression, elevation, and exercise
what are the time frames for CBAN
C = 1-3, B = 2-7, A = 2-7, N = 5-12+, numbness lasts for 3-5 minutes
what are the indications for cryotherapy
pain, spasm, inflammation/swelling
what are the precautions for cryotherapy
diminished sensation, poor local circulation, over superficial nerves, slow healing wounds, medically unstable
what are the contraindications for cryotherapy
raynauds phenomenon, cryoglobinemia, hemoglobinuria, cold urticarial (hives) , proximal cold
what are the types of thermotherapy
hot tub, heat pack, whirlpool, paraffin wax, heat lamp
how long is thermotherapy done
20-30 minutes
how do you prepare a heat pack
from hydrocollator (7-76 degrees C), 6 layers (terrycloth) + 1 towel
when is thermotherapy used
following inflammatory stage, for pain and spasm
what are the temperature guides
neutral = 92-96, warm = 96-98, hot = 98-104, very hot = 104-110
what are the indications for thermotherapy
decrease pain, decrease muscle spasms, heat superficial joint capsules
what are the precautions for thermotherapy
medically unstable, coronary heart disease
what are the contraindications for thermotherapy
open wound, diminished sensation, poor local circulation
what is ultrasound
heating or mechanical (crystal vibrations)
what is the dosage for ultrasound
0.1-3 W/cm^2
what is the frequency for ultrasound
deep = 1 and superficial = 3 MHz
what is the difference between thermal and non-thermal ultrasound
thermal = continous, non-thermal = pulsed with a 0.2-0.8 ms duty cycle
what is the purpose of non-thermal ultrasound
increase in metabolic activity of fibroblasts
what are the indications for ultrasound
heat deep tissue, increase blood flow deep, decrease inflammatory process and speed repair
what are the contraindications of ultrasound
pregnant, over pacemaker/eyes/genitals, over growth plates, acute inflammation, cancer history in area, infection
what are the 2 types of electrical currents
IFC and NMES
what is IFC for
pain modulation, neuromuscular facilitation, and increase circulation
what are the parameters for IFC
high = 80-150pps for sensory/sub-motor, low = 2-10pps for strong muscle contraction
how long should IFC be done for
15-20 minutes
whta can IFC be combined with
ice and heat
what is NMES for
reducing atrophy/weakness, retrain neuromuscular function following injury/surgery
skip card
what level is NMES performed at
whatever they can tolerate, strong muscle contraction
how long is NMES performed for
15 max contractions to 10-15 minutes of submaximal contractions
how is NMES performed
work with machine (1:5 ratio, with 2-3 second ramp up), co-contract agonists or reciprocal antagonist/agonist
what are the indications for electrical currents
pain control, decrease/prevent atrophy, restore neuromuscular control
what are the contraindications for electrical current
pregnancy, over carotid artery, cardiac pacemakers
what are the two ways to write goniometer scores
single-motion or SFTR
why is ROM used
circulation and vascular dynamics, synovial movement for cartilage nutrition, elasticity, maintain joint and CT mobility, help maintain awareness of movement
what is the general benefit of remobilization
prevent abnormal cross-links, increase fluid content in ECM of CT
what is the benefit of remobilization on muscle
increase hematoma absorption, strength and myofiber regeneration/arrangement
what is the benefit of remobilization on articular cartilage
controlled weight bearing and loading -> repairs damaged cartilage
what is the benefit of remobilization on periarticular CT
prevents abnormal crosslinks and maintains content of matrix
what is periarticular CT
ligaments, fascia, cap, tendons
what are the 4 mechanical CT properties present in collagen
elasticity, viscosity, viscoelasticity, and plasticity
what is viscoelasticity
resist force and return to normal if stretched too far
what is plasticity
allows permanent change
what is the main principle of stretching
move tissue into plastic range for long term effects
what is fatigue failure
structural failure causes tissue failure
what is structural fatigue
failures from cumulative stress (stress fractures, tendinopathy, etc.)
what is hysteresis
the repetitive stretching heats tissues to decrease viscosity. and increase length and failure point
what influences stretching/ROM
amount (type) of collagen/elastin in structure, amount of force applied, amount of time the force is applied, timing (stage of healing), tissue temperature, relationship (healing, degree, ability to change)
what is duration for stretching
10-30 seconds, 2-6 times per week, 2-6 sets
what is CREEP for
chronic fibrotic contractures, long static, can add heat, following immobilization, do AROM after
what is the timing for active stretching
15-30 seconds, 3-5 reps
what is the point of passive stretching
past R1 and R2
what is collagen for
stiffness and strength
what is elastin for
elastic/stretch abilities (extensibility)
what is ground substance for
reducing friction between elastin and collagen
what is CT turnover
natural shortening with reorganization -> stretch to decrease
what is the effect of immobilization in general
increase fibrosis (edema and immobilization, decrease ground substance and increase worms, hard/dense fibre meshwork, new cross-links, weak, wound contracture
what is the effect of immobilization on muscle
structural changes, histological changes, and clinical changes
what are the structural changes from immobilization on muscle
decrease size, myofibrils, oxidative capacity, capillary density, proprioception , and increase fat
what are the histological changes of immobilization in muscle
decrease in ATP, ACP, CP,and mitochondria, and an increase in lactic acid
what are the clinical changes of immobilization in muscle
weak/atrophy, decrease reflex, and decrease endurance and recovery
what are the effects of immobilization on articular cartilage
less matrix orgaization, necrosis, irreversible damage, increase i fibrofatty tissue which becomes scar tisue
what is the effects of immobilization on periarticular CT
CT thickens and fibrotic, decrease mobility (sticky), and decrease GAG and water in ground substance
what is hookes law
stress strain curve, deformation caused when stress is applied
what is a static muscle contraction
isometric = tension produced in muscle without a change in the muscles length
what are the advantages of static muscle contractions
strength without stress, can start early, muscle too weak for other exercises
what are the disadvantages of static muscle contractions
only gains around 20-30 degrees around isometric angle, valsalva maneuver
what is the prescription for static muscle contractions
2-6-2, 66-100% MVC, rep dependent
what are the benefits of OKC strengthening
more stabilizers, more shear force, start earlier, increased velocity, decreased force, easier to isolate joints
what is the benefit of CKC strengthening
weight bearing, all components are healed, decreased shear, increased force/resistance
what are the general strengthening principles
- endurance -> hypertrophy -> strength -> power (increase with intensity, decrease velocity), timeline = endurance -> power -> strength, start ASAP (phase 2), have a purpose and individualize everything
what happens with recovery after fatigue
initial = decrease lactic acid and other wastes, later = metabolites restored, final = > 40 mins
what is sets/reps prescription for hypertrophy
65-85%, 6-12 reps, 3-6 sets, 30-90 second
what is the sets/res prescription for power
80-90%, 1-3 reps, 1-3 sets, 2-5 minutes
what is the strength timeframe
initial 6-10 weeks = neural
6+ = hypertrophy
12-16 = strength
16+ = power (needs coordination)
what is the SNAP progression principle
S = specific exercise (mimic sport/occupation and timing)
N = no pain
A = attainable goals
P = progressive overload
what are the 3 progressive overload methods
delorme, oxford, and DAPRE
what are the 2 bottom lines for strengthening
- strengthening requires progressive overload
- regularly evaluate strength to determine if increase is warranted
what is proprioception
the body’s ability to correctly transmit and interpret position information and respond to a stimulus
what is proprioception dependent on
flexibility and strength
what is balance
ability to maintain equilibrium by controlling C of M
what is balance influenced by
strength and CNS input
what are the 3 components systems of balance
oculomotor, vestibular, somatosensory
what are the balance evaluation tests
romberg, single-leg stand, BESS, berg, foam and dome
what are the progressions of balance
static -> dynamic
simple -> complex
what is coordination
appropriate intensity and timing
what are the neuro requirements of coordination
activity and position perception, repetition and adjustments, inhibition
what are the progressions for coordination
simple -> complex
slow -> fast
static -> dynamic
low load -> high load
coordination -> agility
what is agility
ability to control body during rapid, complex, and skillful activities
what are the 5 components of agility
flexibility, power, strength, speed, and coordination
what is the most important part about agility prescription
making it sport specific
what are the effects of body misalignment
slow changes over time, and shortening of some structures with lengthening of others
what goes with medial tibial torsion
varum
what are the major problems with back pain (percentages)
- affects 70-85% of population
- 90% improve, but 50% recurrence
- 85% cannot get a diagnosis
- small # of definitive diagnoses
what is the clinical management of compression fractures
bed rest, pain management, bracing, extension, education on proper lifting, fix posture and stabilization
what is the MOI of spondylolysis
hyperextension sports with rotation (injury to contra side) -> scotty dog fracture
what is the clinical management of spondylolysis
stretch hams and glutes, keep in flexion and strengthen abs
what is the MOI/history of spondylolisthesis
15-16 yrs (family predisposition), slipped disk, “bilateral spony”
what is the clinical management of spondylilosthesis
keep in flexion, posure, rest, brace, surgeon if > 6 months
what questions do you ask before you attempt to treat low back pain
- serious systemic disease
- neurological compromise
- social/psychosocial distress
what are the systemic disease/ cancer red flags
- over 50
- history of cancer
- night pain
- bladder incontinence/ bowel
- nerve pain/damage (change in sensation/paralysis, reflexes and myotomes)
- weight loss
what is the evidence of neurological compromise
bladder/bowel incontinence, saddle region/leg numbness, tingling, pain, or weakness, and pain radiates distally
what is the history of acute nerve compression
disk prolapse, 20-55 at L5/S1 or L4/L5
what are the triggers for social/psychological distress
previous failed treatments, substance abuse, disability compensation
what are the deep c-spine muscles
flexion = rec cap, long coli, and long capi
extension = sub occ, multifidis, interspinlis
what are the global c-spine muscles
flexion = SCM, scalene, suprahyoid
extension = erect spin, semispin, longissimus
what are the neck c-spine recruitment tests
- craniocervicular fleixon test (nod)
- with cuff
- wall slide
- endurance test
what needs to be considered about c-spine recruitment vs strength
big neutral zone and low reps and sets to high reps and sets
what are the global and local muscles of the core
global = rectus, bliques, lats, glutes, sup paraspinals, GL
local = transverse, multifidis
what is the neutral zone
glass vs bowl, tight ligaments = more stable and vice verse -> dyanmic stabilizers have to do less
what are core dysfunctions
alongside back pain, multifidis or TA
what is the core cannister
diaphragm (top) pelvic floor (bottom) and multifidis and TA (sides)
what are the 5 components of CORE exercise design
- type of contraction
- body position
- level. ofresistance
- repetition
- progression
what are the reps and mehods of core stability
increase time then increase reps, static to dynamic, low loads to functional movements
how do you turn off global core muscles
4 point stance, then turn on local with 30-40% MVC
what is aquatic exercise
how water affects the body’s ability to move and exercise
what is specific gravity
the density of an object relative to water
what is the specific gravity of a person
0.95, 0.93 = fat and 1.10 = muscle
what is buoyancy
upward force equal to water it displaces (opposite to gravity)
what is the significance of buoyancy
relative weightlessness and movement resistance
what is viscosity
friction between liquid molecules -> resistance to flow
what is drag
resistance of water to body -> frictional, wave (speed) and form (size)
why is the water having higher pressure than the atmosphere a good thing
reduces swelling because with increased pressure = increased compression
what is ideal water temp for aquatic exercise
warm/body temp, water conducts heat 25x faster than air, and heat transfer is increased with movement
what are the equipment types for aquatic therapy
water dumbbells, vest/belt, floatation cuffs, boots and bells (surface area)
what are the indications for aquatic exercise
spasm, non-weight bearing, pain, inflammation/edema, weakness, decreased endurance, loss of motion, CVS maintenance
what are the precautions of aquatic exercise
ear infection, fear of water, medications, special conditions like CVD, seizures, diabetes, etc.
what are the contraindications of aquatic exercise
fever/illness, open wound, medical conditions such as kidney disease, urinary/bowel incontinence, tracheostomy/NG tube, radiation treatment in past 3 months (decreased immune system)
what are the mechanics of assistive devices
to increase stability, reduce weight bearing
how do you fit for canadian crutches (lofstrand)
hand grip at greater troch and cuff just below elbow, 20-30 degree elbow bend
how do you use a cane
contra side, 25% weight bearing, 2nd class lever
