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Functional Restoration > Midterm > Flashcards

Midterm Flashcards

1
Q

What are the weak muscles in lower crossed syndrome?

A 
"Bag me Deep"
biceps femoris
lower abs
glute max
multifidus
deep erector spinae
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2
Q

What are the tight muscles in lower crossed syndrome?

A 
PEAR
Psoas
erectors (superficial)
adductors
rectus femoris
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3
Q

What is looked at in modified Bierring Sorenson Test?

A

it checks extension, flexion, and lateral flexion of the trunk.
Normal should be that Extension is greater than flexion and lateral flexion.

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4
Q

What can be done with a patient who has better trunk flexion in the modified Biering Sorenson Test?

A

trunk extension exercises focusing on the deep lumbar erector spinae

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5
Q

What do you expect to find in a patient with a positive pushup test?

A

forward head
protracted shoulders
increased internal shoulder rotation
scapular winging or “tipping”

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6
Q

Your patient demonstrates a positive prone active straight leg raiser test with form disclosure dysfunction. Which of the following myofascial stabilizing systems is most likely involved?

A

posterior oblique system

Lats and gluts

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7
Q

What is form closure of a ASLR?

A

lateral - medial compression of SI joint
core stabilization with emphasis on posterior oblique (lats/gluts) and temporary application of pelvic (trochanteric) belt

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8
Q

What are the goals of the assessment of spinal stability?

A

loss of stability
loss of motor control
loss of aberrant motor patterns

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9
Q

What is abdominal bracing?

A
  • contracting muscles of the trunk in a hoop like fashion without drawing the abdominal wall INWARD
  • Level of contraction should be about 10%
  • Continue to breathe while maintaining the brace
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10
Q

What is the positive and indicator of lumbar shear stability test?

A

Positive: Pain in resting position that diminishes in active position
Indicates: ability of the lumbar extensors to stabilize against shear instability

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11
Q

What are the corrective measures of a positive lumbar shear stability test?

A

spinal stabilization exercises

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12
Q

What are the characteristics of postural muscles?

A

short and tight
type 1 muscles
responsible for maintaining posture especially in gait
generally slow twitch muscles

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13
Q

What are the type 1 stabilizer muscles?

A 
postural; hyperactivity, tightness
triceps surae
hamstrings
adductors
rectus femoris
TFL
Iliopsosas
Erector spinae
QL
Pecs
Upper traps
SCM
Sub occipitals
Masticators
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14
Q

With exercise design, how do you maintain a positive slope?

A

Add new exercises one at a time after positive progression

Initiate reconditioning process with limited number of exercises 2-4

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15
Q

When developing rehabilitation programs for health, what is emphasized?

A

muscle endurance
motor control perfection
maintenance of spinal stability during exercise

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16
Q

What is force closure when doing a prone straight leg raise?

A

PRONE: patient extends arm on opposite to side engage lats while Dr. pushes down
**Decreased force closure w/ dysfunction of posterior oblique.

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17
Q

What are the indicators of the trunk flexion test?

A 
anterior pelvic tilt (anterior innominate)
gluteal amnesia
decreased abdominal tone
asymmetrical lateral grooves in ab wall
impaired respiration
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18
Q

What happens in the supine ASRL force closure?

A

activation of anterior oblique swing with patient crossing arms across chest and bringing elbow to opposite knee against tester resistance.

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19
Q

What is the corrective action with supine ASRL force closure?

A

core stabilization with emphasis on anterior oblique system

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20
Q

When doing the side lying hip abduction test, what muscles cause what actions?

A 
hip flexion (leg goes out) - TFL
Hip external rotation - piriformis
hip hiking before abduction - QL
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21
Q

What is the normal outcome of the side lying hip abduction test?

A

pure hip abduction to 45 degrees

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22
Q

How does the muscular system reflect the status of the sensorimotor system?

A

change in tone within the muscular system is often a refection of dysfunctional status of the sensorimotor system

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23
Q

In Janda’s Postural Syndromes, what do we expect of a patient with pes planus?

A 
ipsilateral genu valgus
ipsilateral coxa varus
ipsilateral dropped iliac crest
ipsilateral lumbar scoliosis
CONTRALATERAL thoracic scoliosis
ipsilateral dropped shoulder
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24
Q

What complications would cause you to do a side lying hip abduction test?

A

lateral shift/rotated pelvis
asymmetrical height of iliac crest
adducted hips (coxa varus)
positive trendelenburg

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25
Q

A lateral shift of the pelvis and associated aberrant movement patterns found on the above named test (trendelenburg) is associated with what?

A

gluteus medius

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26
Q

Your patient has an anterior pelvic tilt with a noted positive Ely’s sign and a positive Thomas Test. What is an expected associated finding?

A

positive prone hip extension test
Ely’s sign - tight rectus femoris
Thomas Test - tight iliopsoas

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27
Q

What is the estimated percentage of muscle maximal volitional contraction (MVC) for spinal stability?

A

In neutral posture, 5-10% of abdominal and paraspinal muscles required for stability.

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28
Q

The increased muscle activation necessary to provide stability in spinal segments damaged by ligamentous laxity or disc disease?

A

results in greater compressive force

segments that have ligament laxity or disc disease require greater muscle activation, which results in greater compressive force.
Needs 15-20% instead of 5-10%

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29
Q

What are abnormal patterns of neck flexion test?

A

extension of occiput on atlas

chin poking towards ceiling meaning SCM

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30
Q

Which of the following contributes to the force closure stability of the SI joint?

A

anterior oblique myofascial sling

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31
Q

What muscle is primarily responsible for force closure?

A

glut max

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32
Q

What are consequences of compensations and adaptions occurring as a result of dysfunction in a component within the kinetic chain?

A

tissue overload
decreased performance
predictable patterns of injury

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33
Q

Since ligaments have sensory and mechanical properties, they have the ability to control:

A

muscle stiffness and coordination - sensory
joint stability - mechanical
moment and position sense - sensory

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34
Q

What test can prove that there may be kinetic chain deficits long after symptomatic recovery from injury?

A

Saharan Core stability test

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35
Q

With the patient in the modified thomas position we are able to assess the appropriate/inappropriate muscle length. When assessing the one joint adductor length, the patient:

A

should achieve passive hip abduction

Gracilis is 2 point abductor

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36
Q

During a cranio-cervial flexion test, what is the normal pressure the patient should be able to exert?

A

2mmHg for 6-10 seconds

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37
Q

A positive cranio-cervial flexion test would indicate?

A

decreased activation of deep segmental cervical stabilizing structure

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38
Q

A 42 year old female is training for her first 10k and has developed searing right lateral knee pain. Your findings include but are not limited to positive finding in the modified thomas test (decrease in passive adduction) and Ober’s Test. What aberrant movement pattern might you expect on Janda’s Abduction Test?

A

Hip flexion because of Tensor Fasica Lata - Ober’s Test

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39
Q

With a positie Ober’s Test what happens with the TFL?

A

TFL contracture which pulls laterally on upper and lower leg bowing the knee inward
Right Genu VALGUS

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40
Q

When testing muscle length of the levator scapula, which is a type _____ muscle fiber, the examiner passively flexes the neck laterally flexing away from the side being tested and rotation _____ tested side while depressing tested side shoulder.

A

II, away from

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41
Q

What are the type II muscle fibers?

A 
phasic muscles; weak/inhibited
tibialis anterior
glut max/med
rectus abdominus
lower/mid traps
scalenes
longus colli
deltoid
digastrics
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42
Q

Motor control in what muscles is shown to become dysfunctional with posterior neck or low back injury?

A

transverse abdominus
mulfifidus
longus capitis/colli

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43
Q

What aberrant movement pattern do you expect to see on hip extension test when a patient has a decreased limb posture during terminal stance gait?

A 
anterior pelvic tilt
lumbar lordosis
ilipsosas
lumbar erector spinae
hyperactive erectors
knee flexion = hamstrings
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44
Q

What are the lateral line muscles?

A 
peroneal muscles
anterior ligament of fibular head
ITB
TFL
Glut Max
Abdominal obliques
intercostals
splenius capitis
SCM
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45
Q

What are the spinal line muscles?

A 
Splenius capitis/cervicis
rhomboids
serrates anterior
external oblique
linea alba
internal oblique
TFL 
ITB
tibialis anterior
peroneous longus
biceps femoris
sacrotuberuous ligament
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46
Q

How do you test midsternal division of pec major?

A

the GH must be abducted to 90 degrees and externally rotated

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47
Q

How do you test the lower division of pec major?

A

the GH must be abducted to 150 degrees and externally rotated

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48
Q

What is anatomical overload?

A

tissue injury or overload complex (chronic)

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49
Q

What is clinical alteration?

A

acute injury

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50
Q

A patient with pronation distortion may need to do which exercise on a regular basis?

A

short foot/ foot crunches

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51
Q

What muscles are being tested in cranio-cervical test?

A

deep flexors:
recrus capitis anterior
rectus capitis lateralis
deep multifidus

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52
Q

What muscle is a huge knee stabilizer?

A

glut max

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53
Q

When doing the ankle dorsiflexion test, how far should the knee be able to clear the foot?

A

4-6 inches

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54
Q

What is an indicator of scar tissue around the anterior lateral portion of the ankle?

A

tightness of the gastrocs

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55
Q

What is one basic exercise to activate gluteus medius?

A

clamshells have patient open legs 4-6 inches laying on side

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56
Q

Name one low level neuro development exercise for glut medius, transverse abdominus, and closed shoulder kinetic chain.

A

Side plank from knees

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57
Q

One is one large muscle that is prone to tightness and what muscle test can be used?

A

psoas

modified thomas test

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58
Q

What is triceps surae differentiation?

A
  • Flex the patients knee while maintaining calcaneal distraction and dorsiflexion.
  • Increase in dorflexion following knee flexion indicates tight gastrocnemius
  • No increase in dorsiflexion following knee flexion indicates tight soleus
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59
Q

Weak muscles of upper cross syndrome:

A

deep flexor muscles
rhomboids
serratus anterior

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60
Q

Strong muscles of upper cross syndrome:

A

trapezius
levator scapula
tight pecs

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61
Q

Weak muscles of pronation/distortion syndrome:

A 
posterior tibialis
anterior tibialis
VMO
biceps femoris 
glut medius
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62
Q

Tight muscles of pronation/distortion syndrome:

A 
peroneals
adductors
medial hamstrings
TFL/ITB
Psoas
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63
Q

Neuromuscular dysfunctions with pronation/distortion syndrome:

A

decreased pronation control of foot and ankle
decreased frontal and transverse plane control at knee
increased compensation in the LPHC

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64
Q

What is an essential function of locomotion?

A

balance

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65
Q

___________ was the first to suggest straining for peripheral sensory deficit following ____________.

A

Freeman; ankle sprains

66
Q

What are the 3 Janda contributions to sensorimotor training?

A

-normalize peripheral proprioceptive structures - chiro adjustments/ joint soft tissue mobilization
-correct postural/muscular imbalance
-facilitate correct motor program
sensorimotor training

67
Q

What are the two stages of motor learning according to Janda?

A
  • voluntary control of movement

- automatic control of movement

68
Q

Voluntary control of movement requires:

A

(stage of motor learning Janda)
-cortical integration and patient concentration
-constant feedback from positive and negative experiences.
Feedback motor control
Inefficient for creating motor programs

69
Q

What makes up automatic control of movement?

A

(stage of motor learning Janda)

  • coordinated movement pattern programmed in subcortical region
  • requires less conscious processing, therefor quicker
  • feedforward motor control
  • Essential to protect joints for dynamic functional stability.
70
Q

What is essential to protect joints for dynamic functional stability?

A

automatic control of movement

71
Q

What are indications for sensorimotor training?

A

post traumatic; postoperative
chronic neck, back pain
faulty posture especially w/ respiratory dysfunction
generally hyper mobility and/or instability
muscle imbalance
prevention of falls in seniors
maintenance of general fitness

72
Q

What are key postural areas according to Janda?

A 
-foot
   cutaneous and intrinsic muscle
   proprioceptive input
   small (short) foot
-pelvis especially SI joint
   proprioceptive input
   neutral lumbopelvic position
-cervical spine
   proprioceptive input
73
Q

The small (short) foot movement:

A

patient draws metatarsal heads towards calcaneous thus raising medial longitudinal arch and “shortening foot” without flexing toes.

74
Q

Progression in the small “short” foot:

A

tactile stimulation
passive remodeling NWB
active-assisted remodeling NWB
active-remodeling NWB - partial WB - WB

75
Q

What is level 1 of the sensorimotor training?

A

static phase

76
Q

What is the static phase of sensorimotor training?

A

maintain posture stability on progressively unstable surfaces.

77
Q

What are some exercises for the static phase of sensorimotor training ?

A

single leg balance eyes open
single leg balance eyes closed
single leg balanced eo and ec on labile surfaces
balance board, wobble board, air-ex cushion, dynadisc, foam roller

78
Q

What is a program design for static phase of sensorimotor training:

A

1-2 exercises
1-3 sets x 10-30 seconds or 10-20 repetitions
rest period 30 seconds
3-5 sessions/week

79
Q

What is the level 2 dynamic phase of sensorimotor training?

A

add arm and leg movements while maintaining postural stability on progressively unstable surfaces.

80
Q

What are exercises for the dynamic phase of sensorimotor training?

A

reaches on stable surface

reaches on unstable surface

81
Q

What is program design for dynamic phase of sensorimotor training?

A

1-2 exercises
2-3 sets x 10-12 repetitions
rest period 30 seconds
3-5 sessions a week

82
Q

What is the level 3 functional phase of sensorimotor training?

A

perform functional movements on progressively unstable surfaces.

83
Q

What are some exercises for level 3 functional sensorimotor training?

A

single leg squat
single leg deadlift
single leg resisted movements
balance sandal training

84
Q

What is a program design for functional sensorimotor training?

A

1-2 exercises
2-3 sets x 10-12 repetitions
rest period 30 seconds
3-5 sessions/week

85
Q

What is increased in clinical application of balance sandals?

A
  • significant increases in gluteal activation and decreases in time to 75% MVC in 7 days.
  • increased leg EMG activity particularly ankle everters and inverters in 11.6 - 14.9 weeks.
  • improved medial-lateral postural stability in stable and unstable ankles after 8 weeks of functional balance training.
86
Q

What is the initial stage in Janda balance sandal protocol?

A

stance training with support

sandals in horizontal position

87
Q

What is the second stage in Janda balance sandal protocol?

A
  • walking with support

- start with walking in place then progress to shoulder support only.

88
Q

What is the third stage in Janda balance sandal protocol?

A
  • short steps, a few meters forward and backward walking, sidestepping
  • 1-2 minutes several times a day up to 15 minutes total.
89
Q

What is the clinicians goal in active active care?

A

modify patient health behavior in direction of reactivation

90
Q

What are the six things to help understand active care management?

A
  • back pain traditionally viewed as acute, self limiting condition
  • now recognized as involving frequent reoccurrences and/or chronic course
  • many approaches for spine injury concerned only with diagnostic triage and pain management.
  • pain relief modalities will always be accepted treatment
  • patient education about about self-care through gradual reactivation rapidly gaining scientific traction.
  • becoming standard of care for prevention of disability associated with spinal disorders.
91
Q

What are the keys to active self-care?

A

reassurance and advice
cognitive behavioral approach
multidisciplinary biopsychosoicial approach

92
Q

What are examples of reassurance and advice in active self-care?

A
  • identify patient’s concerns and goals
  • reassurance regarding seriousness of condition
  • specific reactivation advice
93
Q

What are the key points in initial report of findings in reassurance and advice in active self-care?

A
  • identify spine related worries and fears
  • provide assurance that there is no serious disease
  • explain that injuries and degeneration can be pain precipitators but likey pain perpetuators are controllable factors.
  • provide specific activity modification and reactivation advice.
  • pain relief options
  • recovery expectations
94
Q

What is the cognitive behavioral approach in active self-care?

A

more structured approach involving cognitive behavioral classes/sessions

  • address patients worries and fears
  • teach methods to reduce fear and apprehension
95
Q

When is cognitive behavioral approach in active self-care more appropriate?

A

subacute patients at heightened risk for chronic pain
“yellow flag” patients
chronic pain patients

96
Q

What is multidisciplinary biopsychosocial approach in active self-care?

A

comprehensive, multidisciplinary approach that combined CB model with strategies that address return to work obstacles.

  • employer issues
  • compensation issues
97
Q

Multidisciplinary biophychosocial approach in active self-care may be appropriate for?

A

chronic patients if step 1 and step 2 are not successful

98
Q

What is the patient centered approach in active self-care?

A
  • patient is not a diagnosis or label

- report of findings shifts model from biomedical/HCP-centered fix to biosocial/patient-centered cope and adapt model.

99
Q

How to enhance patient motivation to resume activity in active self-care?

A
  • collaboratively establish functional goals
  • reassurance that the spine is not damaged
  • education that gradual reactivation will enhance recovery whereas rest will inhibit recovery.
  • consistant verbal and written messages
  • make exercises simple enough to be performed at home without significant equipment needs.
  • establish realistic expectations regarding possibility/probability of “flare-ups”
100
Q

What are tips for enhancing patient compliance in active self-care?

A
  • education that hurts does not necessarily equal harm.
  • education that fitness is the key to prevention.
  • make exercises simple enough to be performed at home without equipment needs.
  • link exercises to specific functional goals.
  • encourage patients to work at an exercise level that is somewhat hard for them.
  • realistic expectations regarding possibility of “flare-ups”
101
Q

What are neurodynamic sites of injury?

A 
soft tissue, osseous, fibro-osseous tunnels
sites of nervous system branching
sites to relative fixation to interface
areas with high possibility of friction 
tension points
102
Q

What are the neurodynamic tensioners?

A
  • neurodynamic test that increase tension in neural structures.
  • relies on natural viscoelasticity of nervous system and does not exceed elastic limit.
  • does not produce plastic reformation or damage.
103
Q

What are the steps of the median nerve tension?

A

dorsiflexion of the wrist
extension of the elbow
abduction of the shoulder

104
Q

What are the steps of ulnar nerve tension?

A

dorsiflexion of the wrist
position of maximal stress of ulnar nerve: elbow flexion
abduction of the shoulder
tilt head to contralateral side

105
Q

What are the steps of radial nerve tension?

A 
pronation of the radio-ulnar joint
volar flexion of the wrist
extension of the elbow
abduction of the shoulder
tilting of head to contralateral side
position of maximal stress of radial nerve (at thumb)
106
Q

What are neurodynamic sliders?

A
  • nerve flossing
  • neurodynamic maneuver whose purpose is to produce a sliding movement of neural structures relative to their adjacent tissues.
  • can be thought of as tensioners with one end on slack
107
Q

Median nerve neurodynamic test:

A
  1. patient’s thumb and finger tips supported, plus some of the weight on examiner’s thigh.
  2. shoulder abduction to symptom onset, or tissue tightness, or approx. 100 degrees.
  3. Wrist extension, make sure shoulder is stable
  4. Wrist supination, make sure shoulder is stable
  5. shoulder lateral rotation, to system onset or where the tissues are a little tighter.
  6. elbow extension to symptom onset
  7. neck lateral flexion away, making sure is is whole neck and not just cervical spine.
  8. Neck lateral flexion towards. This should ease evoked symptoms.
108
Q

Ulnar neve neurodynamic test:

A
  1. starting position, with hand under patient’s scapula depress shoulder girdle.
  2. shoulder abduction
  3. lateral rotation of shoulder
  4. elbow flexion
  5. wrist and finger extension
  6. forearm pronation
109
Q

Radial nerve neurodynamic test:

A
  1. the patient lies with their shoulder just over the side of the bed. The therapist uses their thigh to carefully depress the shoulder girdle.
  2. elbow extension
  3. notice how the therapist has brought his left arm “around” to grasp the patient’s wrist in order to medially rotate the whole arm.
  4. whole arm medial (internal) rotation
  5. wrist and thumb flexion can be added, leave fingers out because extensors will get to tight.
  6. adding a few degrees of shoulder abduction will sensitive the test and elevation of shoulder girdle will provide structural differentiation.
110
Q

Slump Test:

A
  1. Patient sits erect
  2. Patient slumps lumbar and thoracic spine while examiner holds head in neutral.
  3. Patient flexes head and neck
  4. Examiner carefully applies overpressure to cervical spine as patient extends knee
  5. Patient dorsiflexes foot
  6. Patient extends head and neck.
111
Q

Femoral nerve neurodynamic test:

A

-Prone knee bend
-Slump knee bend:
for the left SKB-
-patient’s left leg should be around 90 degrees
-get patient to hold right knee in some hip flexion then extend the hip.
-Use neck flexion/extension for structural differentiation.
-For heavy legs try with test leg downside
-Hip lateral and medial rotation can be added to test groin nerves such as illioinguinal and iliohypogastric

112
Q

What nerves can be tested with the femoral nerve neurodynamic test when you add hip lateral and medial rotation to the leg?

A

ilioinguinal and iliohypogastric nerves.

113
Q

How to perform obturator nerve neurodynamic test?

A

Use the same way you would test the femoral nerve with the addition of:

  • abduct the hip
  • this can be an assessment and treatment technique for neurogenic components to groin and medial knee pain.
  • neck used for nerve differentiation
114
Q

Peroneal nerve neurodynamic test:

A

Patient supine

  1. foot held in plantar flexion/inversion
  2. as the hip is flexed the dr. arm maintains knee extension
  3. In a flexible patient the dr. puts the leg on the dr. shoulder and walks in.
115
Q

Tibial nerve neurodynamic test:

A

Patient supine
1. foot is held in dorsiflexion/eversion/and pronation
2. Straight leg raise performed with the dr arm on the shaft of the tibia.
3. opposite leg can be flexed
Leg can be put on Dr. shoulder if flexible

116
Q

Sural nerve neurodynamic test:

A

patient supine

  1. the ankle is dorsiflexed and inverted and held firmly
  2. Dr. forearm is on the tibia maintaining knee extension during SLR.
117
Q

What are the muscles of the core?

A

lumbar spine muscles
abdominals
hip muscles
cervical spine muscles

118
Q

What are the muscles of the transversospinalis group?

A 
Rotators
Interspinalis
Semispinalis
Intertransversarii
Mutifidus
119
Q

_______ has a poor mechanical advantage relative to movement production.

A

Transversospinalis group

120
Q

Transversospinals group is made up of mostly _________ fibers.

A

primarily type I muscle fibers with high degree of muscle spindles 2-6x is normal.

121
Q

Transversospinalis group is designed for ________ and _________.

A

stabilization

proprioception

122
Q

What is the transversospinalis primarily responsible for?

A

providing proprioreceptive information to the CNS

123
Q

What are some of the functions of the transversospinalis group?

A
  • segmental deceleration of flexion and rotation of spine during functional movements.
  • inter-intra segmental stabilization
  • dynamic stabilization
124
Q

What may be the most important muscle of the transversospinalis and what does it do?

A

multifidus

provides intersegmental stabilization in all positions

125
Q

What are the erector spinae and what do they do?

A

thoracic longissimus and iliocostalis
-Long extension movement arm with minimal compression
-most efficient lumbar extensors
lumbar longisiumus and iliocostalis
-create posterior shear with lumbar flexion

126
Q

What does quadrates lumborum do?

A

stabilizer in wide variety of tasks involving flexion, extension, and lateral bending.

127
Q

What is the function of the abdominal musculaturei?

A
  • operate as functional unit to help maintain optimal spinal kinematics.
  • provide sagittal, frontal, and transverse plane stabilization by controlling forces reaching LPHC.
  • enhances regional intersegmental stability
128
Q

What is the bridge between upper and lower extremities?

A

lats

129
Q

What makes of abdominal musculature?

A

rectus abdominus
external oblique
internal oblique

130
Q

Where does the abdominal musculature attach?

A

posterior layer of thoracolumbar fascia

131
Q

Contraction of _________ and _________ create traction and tension forces on TL fascia.

A

transverse abdominus and internal oblique

132
Q

What is the function of transverse abdominus?

A
  • provide dynamic stabilization against rotational and translational stress
  • provide optimal neuromuscular control to entire LPHC
  • contraction precedes activation of other abdominal muscles regardless of direction of reactive forces.
  • important for dynamic stabilization during all trunk movements.
  • active during all trunk movements like multifidus
133
Q

What are the functions of the diaphragm?

A
  • contributes to stability of lumbar spine during inspiration and expiration.
  • involved in the control of postural stability during sudden voluntary movement of the limbs.
  • cephalad inspiration position is inhibitory of normal function.
134
Q

What are the posterior intersegmental muscles of cervical spine?

A

mutifidus

subocciptals

135
Q

What are the deep cervical flexors and what are their function?

A

longus captis
longus colli
-primary segmental stabilizer
-feedforward contraction with arm movements.

136
Q

What are the lower cervical/upper thoracic extensors?

A

semispinalis cervicis

longissimus cervicis

137
Q

What are the scapular mobilizers and stabilizers?

A

upper, middle, and lower traps
levator scapula
pectoralis minor
serratus anterior

138
Q

What are some of the injury mechanics in the lumbar spine?

A
  • Too many repetitions of force and motion and/or prolonged postures/loads
  • Cumulative loading (compression, shear or extensor moment)
  • Axial torque with flexion or extension loading
  • Cumulative exposure to unchanging work
139
Q

Any abnormal loading conditions (including overload and immobilization can produce________________ and/or adaptable changes that may result in ____________.

A

tissue trauma
disc degeneration . Adverse
mechanical conditions can be due to external forces, or
may result from impaired neuromuscular control of the
paraspinal and abdominal muscles [emphasis added].

140
Q

Adverse mechanical conditions can be due to external forces or may result from impaired neuromuscular control of the _______ and _______ muscles.

A

paraspinal

abdominal

141
Q

In 1999, ______ reviewed the basic science evidence and proposed that properly contracting muscles are the main _________ __________ for the joint, and that muscle dysfunction is the most important modifiable mediating factor for _______ ________.

A

Hurley
force absorber
primary OA

142
Q

Ways to reduce tissue damage:

A
  • Reduce peak and cumulative spinal compressive loads
  • Reduce repeated spine motion to full flexion
  • Reduce repeated full-range flexion to full-range extension
  • Reduce peak and cumulative shear forces
  • Reduce slips and falls
  • Reduce length of time in prolonged sitting especially exposure to seated vibration
143
Q

What is abdominal bracing?

A

_Abdominal bracing is the act of “stiffening” or “tightening” the muscles of the midsection, as if someone was about to strike you in the trunk
-Begin by contracting the muscles of the trunk in a hoop-like fashion without drawing the abdominal wall inward
The level of contraction should be low, about 10 % of maximum
-Continue to breathe while maintaining the abdominal brace

144
Q

What are the best core exercises:

A
  • Train core stabilizing musculature without focus on any 1 muscle
  • Minimize shear and compression
  • McGill’s hanging knee, superman, chair back extension
  • Shown to train core stabilizing musculature with relatively low compressive loads (Kavcic et al 2004)
  • Curl-up
  • Side Bridge
  • Birddog
145
Q

What is the “hanging” knee up exercise?

A
  • High level of rectus abdominis activation with posterior pelvic tilt
  • High level of compression 3,300 N
146
Q

What is the superman exercise?

A
  • High compressive load (6000N)
  • Extension load of posterior elements
  • Potential damage to interspinous ligaments (McGill 1998)
147
Q

What is Roman chair back extension?

A
  • High compressive load (4000 N)
  • Extension load of posterior elements
  • Lumbar extensors not designed for powerful extension movements
148
Q

What are corrective exercise training goals?

A
  • Focus on postural control, muscle balance, pain reduction/centralization
  • Train coordination and endurance with safe, low-load exercises
  • Progress to complex activities and functional exercises once patient learns to move and position spine in fundamental ways
149
Q

What is a good corrective training exercise program?

A
  • Acute Variables
  • 1-3 sets X 6-15 reps, up to 8 second holds (McGill et al 2000)
  • Start with 1 set 6 reps
  • Progress to 1 set 15 reps
  • Further progress with reverse pyramid
  • 2nd set 12 reps
  • 3rd set 8 reps
  • At least 1 session per day
  • 5-7 sessions/week
  • Duration 6 weeks-3 months
150
Q

What are good corrective exercises:

A 
cat-camel warmup
leg-loading with biofeedback device
dead bug progression
quadruped/birddog
side-lying bridge (beginner)
side-lying bridge (advanced)
rotation bridge
abdominal curl up
supine bridge
supine bridge progression
clamshell
cranio-cervical flexion (w/wo biofeedback device)
core exercise on labile surfaces
stability ball hamstring stretching/hip extension
stability ball hamstring double leg curl
stability ball hamstring single leg curl
stability ball bridge
stability ball abdominal curl up
151
Q

What are functional exercise training goals?

A

-Core stability trained in exercises mimicking patients
ADLs
SRAs
DE
-Training with movements that are within patient’s functional range while being as functional as possible
-Progressions continue until patient’s functional range includes ADLs, SRAs, and DEs expected to be encountered

152
Q

Functional exercise training program:

A
  • Acute Variables
  • 2-3 Exercises
  • 2-3 sets X 10-12 reps
  • Rest period ~ 45 sec
  • 2-4 sessions/week
153
Q

What are some performance exercises?

A 
reach and pull
chops
lifts
pulldown
cable power-chops
cable power lifts
medicine ball power training
154
Q

What are performance exercise training goals?

A
  • High-level activities with narrow safety/stability margin
  • Athletic activity performance enhancement and injury prevention
  • Built on a foundation of conscious-kinesthetic awareness of appropriate motor control
155
Q

Performance exercise training program:

A
  • Acute Variables
  • 2-3 Exercises
  • 2-3 sets X 8-10 reps
  • Rest period ~ 60 sec
  • 2-3 sessions/week
156
Q

Janda’s Lower Crossed Syndrome

A

Tight: erector spinae and iliopsoas
Weak: abdominal and glute max

157
Q

Janda’s Upper Cross Syndrome

A

Tight: trapezius and levator scap and pectoralis
Weak: deep neck flexor, rhomboids, serratus anterior

158
Q

LCS + UCS = Layer Syndrome

A

Hypertonic: trapezius, levator scap, thoracolumbar erector spinae, hamstrings
Hypotonic: lower stabilizers of scapula, lumboerector spinae, glute max

159
Q

What are the symptoms with a over-pronated foot?

A 
Ipsilateral genu valgus
Contralateral coxa varus 
Ipsilateral low crest
Ipsilateral low shoulder
Ipsilateral lumbar scoliosis 
Contralateral thoracic scoliosis
160
Q

Lateral line muscles of myers myofascial meridian:

A 
Peroneous muscles
Anterior ligament of fibular head
TFL
IT Band
Glut Max
Abdominal obliques
Intercostals
Splenus capitis
SCM
161
Q

Spiral Line muscles of Myers myofascial meridian:

A 
Splenius capitis
Splenius cervicis 
Rhomboids
SA
External oblique
Abdominal apaneurosis
Internal oblique
TFL, IT Band
Anterior tibialis
Peroneous longus 
Biceps femoris 
ST Ligament 
Erector spinae

Functional Restoration (1 decks)

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