Mid-Term Study Guide Flashcards
Perfect posture - Anterior view
If the client was in perfect postural balance, the plumb line would fall: midway between medial malleoli; midway between knees; pubic symphysis; umbilicus; sternal notch; chin; nose; eyes.
Perfect posture - Lateral view
If the client was in perfect postural balance, the plumb line would fall: just anterior to the lateral malleolus; just anterior to head of fibula; greater trochanter; acromion process; external auditory meatus.
Perfect posture - Posterior view
If the client was in perfect postural balance, the plumb line would fall: midway between medial malleoli; midway between knees; gluteal cleft; in line with vertebrae; midway through external occipital protuberance.
Faulty Posture - Head
Chin up too high.
Head protruding forward.
Head tilted or rotated to one side.
Good Posture - Head
Head erect and well balanced.
Faulty Posture - Shoulders and Arms
Holding the arms stiffly.
Palms of hands face backward.
One shoulder higher than the other.
Both shoulders hiked up.
One or both shoulders drooping forward or sloping.
Shoulders rotated either clockwise or counter-clockwise.
Scapulae pulled back too hard.
Scapulae too far apart.
Winged scapula
Good Posture - Shoulders and Arms
Arms hang relaxed at the sides with palms of the hands facing toward the body.
Elbows are slightly bent, so forearms hang slightly forward.
Shoulders are level
Scapulae lie flat against the rib cage, neither too close together nor too wide apart.
Faulty Posture - Chest
Depressed, or “hollow-chest” position.
Lifted and held up too high, brought about by arching the back.
Ribs more prominent on one side than the other.
Lower ribs flaring out or protruding.
Good Posture - Chest
Chest is slightly up and forward (while the back remains in good alignment).
Chest half-way between exhaling and inhaling.
Faulty Posture - Abdomen
Entire abdomen protrudes.
Lower part of the abdomen protrudes while the upper part is pulled in.
Good Posture - Abdomen
In young children up to about age 10, the abdomen normally protrudes somewhat. In older children and adults, it should be flat.
Faulty Posture - Spine and Pelvis Lateral View
The low back arches forward too much (lordosis).
The normal forward curve of the low back has straightened out (flat back).
Increased backward curve in the upper back (kyphosis or round upper back).
Increased forward curve in the neck.
Lateral curve of the spine (scoliosis); toward one side (C-curve), toward both sides (S-curve).
Good Posture - Spine and Pelvis Lateral View
The front of the pelvis and the thighs are in a straight line.
The buttocks are not prominent in back but instead slope slightly downward.
The spine has four natural curves. In the neck and lower back, the curve is forward, and in the upper back and lowest part of the spine (sacral region), it is backward.
Faulty Posture - Spine and Pelvis Posterior View
One hip is higher than the other (lateral pelvic tilt).
The hips are rotated so that one is farther forward than the other (clockwise or counter-clockwise rotation).
Good Posture - Spine and Pelvis Posterior View
Body weight is even on both feet, and the hips are level.
Faulty Posture - Knees and Legs
Knees touch when feet are apart (genu valgum).
Knees are apart when feet touch (genu varum).
Knee curves slightly backward (hyperextended knee) (genu recurvatum).
Knee bends slightly forward, that is, it is not as straight as it should be (flexed knee).
Patellae face slightly toward each other (medially rotated femurs).
Patellae face slightly outward (laterally rotated femurs).
Good Posture - Knees and Legs
Legs are straight up and down.
Patellae face straight ahead when feet are in good position.
Looking at the knees from the side the knees are straight
Faulty Posture - Feet
Low longitudinal arch or flatfoot.
Low metatarsal arch usually indicated by calluses under the ball of the foot.
Weight borne on the inner side of the foot (pronation).”Ankle rolls in.”
Weight borne on the outer border the foot (supination). “Ankle rolls out.”
Toeing-out while walking or while standing in shoes with heels (“outflared” or “slue-footed”).
Toeing-in while walking or standing (“pigeon-toed”)
Good Posture - Feet
In standing, the longitudinal arch has the shape of a half dome.
Barefoot or in shoes without heels the feet toe-out slightly.
In shoes with heels, feet are parallel.
Faulty Posture - Toes
Toes bend up at the first joint and down at middle and end joints so that the weight rests on the tips of the toes (hammer toes).
Big toe slants inward toward the midline of the foot (hallus valgus).
Good Posture - Toes
Toes should be straight, that is, neither curled downward nor bent upward.
They should extend forward in line with the foot and not be squeezed together or overlap.
Define walking
One foot is always in contact with the ground and within a cycle, there are two periods of single-leg support and two periods of double-leg support.
Define running
There is a period of time during which neither foot is in contact with the ground, a period called “double float.”
How is a normal gait cycle viewed?
From the perspective on one foot OR the other
Step length
the distance from the point of first contact of one foot to the point of first contact of the opposite foot
Stride length
the point of contact of one foot to the next point of contact of the same foot (two step lengths)
Stance phase
when the foot is in contact with the ground and bearing weight
Swing phase
when the foot is not fixed to the ground and is non-weight-bearing
Gait cycle
Stance phase plus swing phase
Gait observation - anterior
observe foot position, lateral pelvic tilt, trunk position
Gait observation - posterior
observe foot and heel positions and motions of knees, pelvis and trunk
Gait observation - lateral
note relative position and ease of motion of ankle, knee, hip, and low back
Initial Contact Abnormalities - If hip extensors are weak
trunk lurches forward with increased lordosis
Initial Contact Abnormalities - If hip adductors are weak
abnormal pelvis and leg rotation
Initial Contact Abnormalities - If knee extensors and flexors are weak
knee will buckle; reflex inhibition, L2-L4 nerve root lesion, internal knee derangement, or polio
Initial Contact Abnormalities - If foot dorsiflexors are weak
foot will drop or slap on heel strike: peroneal neuropathy or L4 nerve root lesion
Initial Contact Abnormalities - If there is pain on the heel
heel spur, bruise, bursitis
Midstance Abnormalities - If hip abductors are weak
Trendelenburg gait (pelvis on non-weight-bearing side drops)
Midstance Abnormalities - If foot plantar flexors are weak
short step on unaffected side; S1-S2 nerve root lesion
Midstance Abnormalities - If there is pain in foot or ankle
OA, pes planus, plantar fasciitis
Terminal stance abnormalities - If hip flexors are weak
compensation by moving the trunk posteriorly to passively swing the leg (glut max gait)
Terminal stance abnormalities - If knee extensors are weak
knee buckles
Pre-swing abnormalities - If hip adductors are weak
leg rotates
Pre-swing abnormalities - If hallux rigidus (great toe stiffness) is present
push off from lateral aspect of foot instead of great toe
Initial swing and mid-swing abnormalities - If foot dorsiflexors are weak
foot drop or steppage gait; L4 nerve root lesion
Terminal Swing abnormalities - If there is an S1-S2 nerve root lesion
the knee will snap out excessively at the end of the swing because the knee flexors that are normally active to slow knee extension are compromised
Antalgic (Painful) Gait
the result of injury
The stance phase on the affected leg is shorter than that on the nonaffected leg.
The swing phase of the uninvolved leg is decreased.
The painful region is often supported by one hand, if it is within reach, and the other arm, acting as a counterbalance, is outstretched.
If a painful hip is causing the problem, the client also shifts the body weight over the painful hip.
ataxic gait
If the client has poor sensation or lacks muscle coordination, there is a tendency toward poor balance and a broad base.
Cerebellar ataxia includes a lurch or stagger, and all movements are exaggerated.
The feet of an individual with sensory ataxia slap the ground, because they cannot be felt.
The client also watches the feet while walking. The resulting gait is irregular, jerky, and weaving.
contracture gait
Caused by prologued immobilization or pathology to the joint has not been properly cared for.
Hip flexion contracture - increased lumbar lordosis, extension of the trunk combined with knee flexion to get the foot on the ground.
knee flexion contracture - excessive ankle dorsiflexion from late swing phase to early stance phase on the uninvolved leg and early heel rise on the involved side in terminal stance.
Plantar flexion contracture at the ankle - knee hyperextension (midstance of affected leg) and forward bending of the trunk with hip flexion (midstance to terminal stance of affected leg). Heel rise on the affected leg also occurs earlier.
Gluteus Maximus Gait
client thrusts the thorax posteriorly at initial contact (heel strike) to maintain hip extension of the stance leg - characteristic backward lurch of the trunk
Gluteus Medius (Trendelenburg) Gait
If the hip abductor muscles (gluteus medius and minimus)
The thorax is thrust laterally to keep the center of gravity over the stance
the contralateral side droops because the ipsilateral hip abductors do not stabilize or prevent the droop
If there is bilateral weakness of the gluteus medius muscles, the gait shows accentuated side-to-side movement, resulting in a wobbling gait or “chorus girl swing.”
Hemiplegic or Hemiparetic Gait
swings the paraplegic leg outward and ahead in a circle (circumduction) or pushes it ahead. the affected upper limb is carried across the trunk for balance. This is sometimes referred to as a neurogenic or flaccid gait.
Steppage or Drop Foot Gait
weak or paralyzed dorsiflexor muscles, resulting in a drop foot. To compensate and avoid dragging the toes against the ground, the client lifts the knee higher than normal. At initial contact, the foot slaps on the ground.
What is the “job” of the cruciate ligaments?
Check motion at the knee
- The cruciate ligaments are named according to their position on what bone?
tibia
- What are three common causes of anterior cruciate injury?
a blow to the lateral knee, forced extension with internal rotation of the tibia, a blow to the posterior tibia
- What are two common causes of posterior cruciate injury?
a blow to the anterior tibia, excessive hyperextension, or in a motor vehicle accident where the tibia is forced posteriorly during the accident
- Describe the signs and symptoms a grade 1 acute cruciate injury.
grade 1 – pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, will be able to continue the activity
- Describe the signs and symptoms a grade 2 acute cruciate injury.
grade 2 – pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, will be able to continue the activity
- Describe the signs and symptoms a grade 3 acute cruciate injury.
grade 3 - pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, a popping feeling in knee at the time of injury, unable to continue activity, hemarthrosis develops, skin over the joint is taut and hard to the touch, pain is sharp, with effusion the pain is dull and achy
- Which movement is limited with a chronic grade 2 or 3 anterior cruciate sprain?
Unable to run forward
- Which movement is limited with a chronic grade 2 or 3 posterior cruciate sprain?
Unable to squat, walk downstairs easily, or run backwards
- In the acute stage of knee injury, active range of motion is limited in extension and flexion due to what?
effusion
- In the acute stage of a knee injury, resisted strength testing should be painless and strong. If pain is present, what does this result indicate?
Accompanying muscular injury
- If swelling of an acute knee injury prevents full knee flexion and effusion tests are positive, what action must the massage therapist take?
The client is referred for immediate medical testing
- In later stages of a knee injury, why might the results of resisted strength testing of quadriceps be reduced?
Disuse atrophy
- What are the functions of menisci?
Provide shock absorption and to add increased gliding potential between the femur and the tibia
- What is a cause of meniscal injury?
a twisting injury while the foot is weight bearing and anchored to the ground
- List signs and symptoms of meniscal trauma.
pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed; Acute, more severe trauma – client may feel a tearing sensation in the knee. Local pain effusion at the joint and tenderness along the joint line. A small tear may not show immediate symptoms. Chronic – clicking sound in knee, knee locks in certain positions, quad disuse atrophy, buckling of knee, acute symptoms may occur with activity
- Explain neuropraxia.
Neuropraxia are compression or entrapment injuries which cause a local conduction block in a peripheral nerve, but with no structural damage to the axon or to tissue distal to the lesion.
- What is the result of compression of peripheral nerves from external or internal forces?
It impairs oxygenation and local neural conduction.
- What other structures may be compressed along with the nerve in a compression syndrome?
Blood vessels within the nerve, as well as those travelling alongside the nerve (a neurovascular bundle), may be compressed along with the nerve.
- Name three common compression syndromes in the upper and lower extremities.
Carpal tunnel syndrome, piriformis syndrome (sciatica), thoracic outlet syndrome
- List the symptoms likely to occur with a nerve entrapment.
Numbness, tingling, pain, and weakness in the affected limb
- What contributes to impaired nerve transmission when an entrapment occurs?
An inflammatory response causes a subsequent increase in vascular permeability and local edema, contributing to impaired nerve transmission.
- What influences the length of recovery time when an entrapment occurs?
The longer the disruption of microcirculation, the longer the recovery period. This is due in part to the development of intraneural edema during a prolonged compression.
- What is the key to treatment of a nerve compression?
Relief of the compression on the nerve.
- Define flaccidity
motor loss
- Define paresis
weakness
- Define anesthesia
sensory loss
- Define paresthesia
sensory impairment
- Define dysesthesia
pain
- What is a peripheral nerve lesion?
An injury to a peripheral nerve which, depending on the severity, results in motor loss, weakness, sensory loss, sensory impairment, or pain, as well as autonomic dysfunction.
a. neuropraxia (1st degree)
the compression of a nerve causing a local conduction block, with no structural damage to the axon or to tissue distal to the lesion
b. axonotmesis (2nd degree)
the prolonged, severe compression of a nerve, causing a lesion at the site of the compression followed by degeneration of the axons distal to the injury
c. neurotmesis (3rd -5th degree)
severance of part or all of the nerve trunk, including the endoneurial tube, , resulting in the degeneration of the nerve
a. complete nerve lesion
all fibers within the nerve are affected
b. partial nerve lesion
only some fibers are affected
c. regenerating nerve lesion
repairing itself
d. permanent nerve lesion
the nerve is unable to grow
a. Neuritis
inflammation of the nerve, characterized by constant dull pain; causes: secondary to a pathology such as diabetes, trauma to the nerve, chronic exposure to a toxin; massage is contraindicated
b. Neuralgia
nerve pain characterized by recurrent attacks of sudden, excruciating pain along the distribution of the affected nerve; causes: local compression from a trauma, prolonged exposure to cold; massage is locally contraindicated in the acute stage, but can play a significant role in alleviating discomfort especially when caused by pressure from soft tissue or local swelling
c. Causalgia
a severe pain syndrome characterized by the sudden onset of an intense, persistent, usually burning pain; causes – gunshot wounds, iatrogenic nerve injuries, electrocutions, amputations, injuries from high velocity sharp objects; relaxation massage is indicated, as well as AF ROM and AA ROM
d. reflex sympathetic dystrophy
a pain syndrome sometimes called minor causalgia; causes: trauma, surgery; massage is indicated, MLD to control edema, AA and AF ROM performed, heat can be use but is contraindicated with tissue dystrophy or lack of vasomotor control
e. neuromas
a tumor composed of nerve cells; causes: a partial or complete severance of a peripheral nerve causes the proximal nerve stump to respond by sending nerve sprouts toward the distal endoneurial tube stump, forming a bundle; relaxation massage is indicated, if compression of the neuroma is painful, massage is locally contraindicated
- Which cranial nerve is affected in trigeminal neuralgia?
Trigeminal nerve aka cranial nerve V
- What are the primary causes of trigeminal neuralgia?
Local compression or demyelinating conditions
When is range of motion remex performed?
in the early stages of an injury, before the client has regained normal range of motion of the injured area or joint
Goal of ROM remex
maintain joint range of motion, maintain proprioception, maintain circulation and lymphatic flow, maintain succussive action and in some cases maintain muscle strength
how is ROM remex performed?
in a pain free manner in the early (or acute) stage of healing. In later stages of healing, the movements are performed within the client’s pain tolerance.
What is the purpose of stretching?
Stretching lengthens soft tissue and as a result increases range of motion in an area of restriction.
What are the three different stretching techniques?
active inhibition techniques, passive stretching, passive joint mobilizations
What tissue does active inhibition technique affect?
Mostly affects contractile tissue
What tissue does passive stretching affect?
both contractile and non-contractile tissue are lengthened
What tissue does passive joint mobilization affect?
This technique stretches the soft tissue crossing the joint and the joint capsule itself, to increase the available range of the joint.
What is the affect of hold-relax
has the effect of lengthening soft tissue when pain and restricted ROM are present
How do you do hold-relax?
maximal contraction; isometric
* therapist: moves target muscles to pain-free barrier
* client: isometric, maximal contraction of target muscle for 5-10 sec
* client: full relaxation at the barrier (therapist holds it at the barrier)
* therapist: passively moves muscle to new pain-free barrier
* repeat until desired length achieved
How do you do contract-relax?
- maximal contraction; minimal isotonic, concentric movement
- therapist: moves target muscles to pain-free barrier
- client: maximal contraction of target muscle with minimal concentric movement (intent to move)
- hold 5-10 sec
- client: full relaxation at the barrier (therapist holds it at the barrier)
- therapist: passively moves target muscles to new barrier
- repeat until desired length achieved
What is the affect of contract-relax?
the effect of lengthening soft tissue when no pain is present
What is the affect of PIR (post-isometric relaxation)?
the effect of lengthening soft tissue, decreasing muscle tone, decreasing symptoms of trigger points, and specifically aligning direction of force of individual muscle fibres
How do you do PIR?
- minimal contraction; isometric; eye movement; breathing
- therapist: moves target muscle to pain-free barrier
- client: isometric, minimal contraction of target muscle while inhaling 5-10 sec
- client: full relaxation at the barrier while exhaling with eye movement (therapist holds it at the
barrier) - therapist: passively moves muscles to new barrier
- repeat until desired length achieved
What is the affect of agonist contraction?
the muscle opposite to the muscle in spasm contracts
Method one: has the effect of reducing muscle spasm.
Method two: has the effect of lengthening restricted soft tissue when pain or spasm are present
How do you do agonist contraction?
Method one: * maximal contraction; client contracts; therapist gives instructions only
* client: maximal, isotonic contraction of tibialis anterior (and other ankle dorsiflexors); 5-10 sec
Method two: * submaximal contraction; isotonic or isometric, concentric
* therapist: moves target muscle (hamstrings) to pain-free barrier
* client: isotonic or isometric, minimal concentric contraction of rectus femoris (and other hip flexors) 5-10 sec
* method 2 can be isotonic or isometric during the resisted contraction.
How is a passive stretch performed?
- tissue prepared before the passive stretch with: active free movement, active inhibition technique, heat, or other massage technique to warm up the tissue
- client: relaxes target muscle
- therapist: controls direction, duration, force and speed
- therapist: apply slowly and hold for 15-30 sec, repeat several times
- therapist: stretch applied beyond resting length or into restricted range to increase available range
- effects: lengthens contractile and noncontractile soft tissue
What is isometric contraction?
This is a muscular contraction in which there is no visible joint movement.
Purpose of resistance exercises?
increase a muscle’s strength, endurance, and overall physical function
What is the affect of isometric contraction?
The effects of isometric exercises are to maintain muscle strength when a joint is unstable or immobilized and in the early stages of healing when the tissue is fragile
What is isotonic contraction?
This is a muscular contraction in which there is visible joint movement. There are two types of isotonic contractions. These are
* concentric movements that occur as a muscle shortens against resistance
* eccentric movements that occur as a muscle lengthens against resistance
What joints are joint play performed on?
performed on synovial joints
What are joint play technniques?
Passive joint mobilizations
What is joint play used for?
Assess and treat a dysfunctional joint
How does joint play work?
It focuses on the dysfunctional area of the joint capsule and uses a passive intermittent stretch to mobilize and restore movement to the area
What are graded oscillations?
rhythmic movements performed at various points in the soft tissue range
What are grade 1 and 2 oscillations used for?
used for pain management and spasm in muscles that cross the joint
What are grade 3 and 4 oscillations used for?
Used as a stretching maneuver to increase mobility of joint
What is grade 5 oscillations used for?
outside of scope of practice
How are oscillations performed?
Smoothly as a rate of 2-3 per second, up to 2 minutes
What are grade 1 oscillations?
- Rhythmic, small amplitude oscillations
- Used at beginning of soft tissue range, before tissue limitation
- Used to reduce pain and spasm
- Used in acute injury, if appropriate
What are grade 2 oscillations?
- Rhythmic, large amplitude oscillations
- Used at beginning of soft tissue range, before tissue limitation
- Used in acute injury, if appropriate
What are grade 3 oscillations?
- Rhythmic, large amplitude oscillations
- Used up to the limit of available motion and are then stressed into the tissue resistance
- Used with chronic injury, if appropriate
What are grade 4 oscillations?
- Rhythmic, small amplitude oscillations
- Used up to the limit of available motion and then stressed into tissue resistance
What is a sustained translatory glide?
Used primarily for regaining joint play movement and functional ROM, although it can be used to reduce pain and assess the function of a joint.
What are grade 1 sustained translatory glides?
- For pain
- Intermittent distraction at right angles applied for 10 seconds, released, repeat several times
- No stress on the joint capsule
- Non-corrective
- “loosening”; extremely small traction force, nullifying the normal compressive forces on the joint
What are grade 2 sustained translatory glides?
- Used to assess joint function
- Distraction is applied to “take up the slack” and then glide to tighten the joint capsule
- Non-corrective
- “tightening”; first takes up slack surrounding the joint, then tightens the tissues
What are grade 3 sustained translatory glides?
- Used to increase joint play
- Distraction is applied to “take up the slack” and then glide to tighten the joint capsule
- Apply for 6 seconds and partially release; repeat at 3-4 second intervals
- Corrective, use with caution
- “stretching”; applied after all slack has been taken up
Joint play contraindications
Hypermobility
Effusion
Inflammation or joint sepsis
Osteophytes
Prolonged corticosteroid use
Recent fracture
Neoplasm
Acute inflammatory disease
Acute pain response to joint play
Surgical pins, screws
Surgical reduction of ligaments
OA with osteophytes
Osteoporosis
translatory glides to increase overall ROM in gh joint
use axial glide/long axis and lateral distraction
translatory glides to increase flexion in gh joint
use posterior or inferior glide
translatory glides to increase extension in gh joint
use anterior glide
translatory glides to increase abduction in gh joint
use inferior glide
translatory glides to increase internal rotation in gh joint
use posterior glide
translatory glides to increase external rotation in gh joint
use anterior glide
translatory glides to increase overall ROM in HU joint
use distraction
translatory glides to increase overall ROM in RC joint
use axial distraction
translatory glides to increase flexion in RC joint
use dorsal glide of proximal carpals or lunate/scaphoid
translatory glides to increase extension in RC joint
use palmar glide of proximal carpals or scaphoid
translatory glides to increase ulnar deviation in RC joint
use radial glide
translatory glides to increase radial deviation in RC joint
use ulnar glide
translatory glides to increase overall ROM in coxal jt
use axial or lateral deviation
translatory glides to increase flexion in coxal jt
use inferior and posterior glide
translatory glides to increase extension in coxal jt
use anterior glide
translatory glides to increase internal rotation in coxal jt
use posterior glide
translatory glides to increase external rotation in coxal jt
use anterior glide
translatory glides to increase overall ROM in TF jt
use axial distraction
translatory glides to increase extension in TF jt
use anterior glide of tibia
translatory glides to increase flexion in TF jt
use posterior glide of tibia
translatory glides to increase overall ROM in TC jt
use axial distraction
translatory glides to increase plantar flexion in TC jt
use posterior glide of tibia on talus
translatory glides to increase dorsiflexion of TC jt
use posterior glide of talus on tibia
what spinal oscillations are there?
anterior spinous challenge, lateral spinous challenge, spinal oscillations
What is a peripheral nerve lesion?
An injury to a peripheral nerve which can result in motor loss (flaccidity), weakness (paresis), sensory loss (aesthesia), sensory impairment (paresthesia) or pain (dysesthesia), as well as autonomic dysfunction.
What is neuropraxia?
First degree nerve injury, the compression of a nerve causing a local conduction black, with no structural damage to the axon or to tissue distal to the lesion.
What is axonotmesis?
second degree nerve injury, the prolonged, severe compression of a nerve which causes a lesion at the site of the compression followed by degeneration of the axons distal to the injury.
What is neurotmesis?
Third degree nerve injury; an injury to the nerve as a result of severance of part or all of the nerve trunk, including the endoneurial tube. Results in degeneration of the nerve.
definition of grade one strain
minor stretch and tear to musculoskeletal unit
definition of grade three strain
complete rupture of musculoskeletal unit
definition of grade two strain
tearing of musculoskeletal unit
what is the onset of a strain
sudden trauma
mechanism of injury for a strain
sudden overstretch or extreme contraction of muscle against heavy resistance
sounds/sensations present during grades of strain
one - no sound
two - possible snapping sensation or sound
three - snapping sensation or sound
loss of function for each grade of strain
one - continue with mild discomfort
two - difficulty continuing activity
three - cannot continue activity
grade one acute strain symptoms
mild px local to injury; minimal or no redness, edema, heat, bruising; px during AF ROM; slight limitation and mm spasm with empty end feel due to px during PR ROM; normal or weak/painful AR ROM; no muscle spasm, gap in muscle
grade three acute strain symptoms
severe px local to injury; major redness; firm/major edema; major heat; red/black/blue bruising; significant limitation in range and significant pain during AF ROM; PR ROM and AR ROM and contraindicated; muscle spasm and gap in muscle present with bunching of muscle
grade two acute strain symptoms
moderate px local to injury; moderate redness; firm/moderate edema; moderate heat; red/black/blue bruising; moderate limitation in range and moderate pain during AF ROM; PR ROM and AR ROM and contraindicated; muscle spasm and gap in muscle present
grade on subacute strain symptoms
no px, redness, edema, heat or bruising, normal to slight limitation in ROM during AF and PR; normal or mild weakness and px during AR ROM; no mm spasm
grade two subacute strain symptoms
moderate px moves to mild; redness reduced, decreased firmness and redness from edema, reduced heat, bruising moved from blue/black to green/yellow/brown; mild limitation and px during AF ROM; limitation and tissue stretch with empty end feel due to px during PR ROM; mild weakness and pain during AR ROM; spasm moves to HT and adhesions; gap in mm
grade three subacute strain symptoms
severe pain reduced to moderate; redness reduced; decreased firmness and redness from edema, reduced heat, bruising moved from blue/black to green/yellow/brown; moderate limitation and px during AF ROM; limitation and tissue stretch with empty end feel due to px during PR ROM; moderate weakness and pain during AR ROM; spasm moves to HT and adhesions; gap in mm and bunching
grade one chronic strain symptoms
no remaining symptoms, can continue activity
grade two chronic strain symptoms
px when stretched, chronic edema, no heat or cooler than normal, mild limitation for ROM on affected joint during AF ROM, limitation and tissue stretch with empty end feel due to pain during PR ROM, atrophy and weakness during AR ROM, HT, trigger points, adhesions, can continue activity, gap in mm
