Midterm Info Flashcards
Management of Whiplash- Associated Disorder Addressing Thoracic and Cervical Spine impairments: A case report (population, main purpose, highlights-2)*
Pop: A 34 year old female postal worker
Purpose: describe PT program addressing impairments of the thoracic and cervical spine in patient with whiplash injury from a MVA
Highlights:
- no studies that show a definitive method of treating whiplash successfully
- study suggests in some cases that addressing the thoracic spine first, then the cervical spine in whiplash cases with cervical pain might be a better strategy and result in better patient outcomes
Whiplash article: Treatment progression (1st, 2nd visits)*
1st: Noticed increase in symptoms/ restriction at the T2 & T4 level with T4 being the most irritable
- treated with soft tissue mobilization to T4, manual joint mobilizations, given 2 home exercises
2nd: 3 days after the first, progress in pain & ROM seen
- treated with soft tissue and joint mobilizations to the t2 area, thoracic manipulation, Reviewed exercises and added one to home program
Whiplash article: Treatment progression (3rd and 4th visit)*
3rd: 1 week later, continued to progress- returned to work
- soft tissue and joint mobilization and manipulation in upper thoracic spine/ lower cervical, contract-relax procedure to lower cervical spine (superior/ anterior & inferior/ posterior), reviewed and made corrections to HEP
4th: patient reports no pain, disability score of 0, able to return to work and recreational activities
Whiplash article: patient reported almost complete resolution after _ sessions, in a period of _ weeks. Suggests segmental mobility impairments of the _ _ and _ _ should be assessed in patients with functional limitations associated with neck pain.*
Almost complete resolution after 2 sessions, in a period or 2 weeks.
Suggest mobility impairments of the upper thoracic AND cervical spine should be assessed
RElationship b/w hip extension ROM and postural alignment: subjects? Purpose was to study the relationship b/w hip extension ROM and _ determinants of postural alignment. Name.*
25 healthy adult volunteers
Purpose: look at relationship between hip ROM and 3 determinants of postural aligment
Determinants: standing pelvic tilt, standing lumbar lordosis and abdominal muscle performance
Results of study on relationship b/w hip extension ROM and postural alignment: Results indicate there _ relationship b/w variables. And that the current correlation among clinical measures _ _ _. Clinicians _ design treatment plans for stretching shortened hip flexors or strengthening weakened abdominals based on?*
There isn’t a relationship between variables
Current hypothetical correlation among these parameters should be reassessed
Clinicians shouldn’t design tx plans for stretching hip flexors or strengthening Ab’s based on visual inspection of postural alignment
Effects of exercise on hip ROM, trunk muscle performance and Gait economy: subjects studied? Purposes were to examine effects of passive _ _ _ _ program on hip ROM. Examine the effects of _ _ _ on trunk flexor muscle performance. Examine effects of both on _ and _ _.*
Subjects: 25 healthy athletic male college students
Examined the effects of passive hip extension stretching exercises on hip ROM
examined effects of Trunk flexor exercise program on trunk flexor muscle performance
Examine effects of both on walking and running economy
Results from effects of exercise on hip ROM, trunk muscle performance and gait economy: Passive hip stretching program? Trunk flexor exercises? Walking/ running economy?*
Passive hip stretching improved hip ROM
Trunk flexor exercises improved muscle performance
Did not produce significant changes in walking & running economy
Effects of 2 stretching procedures on hip ROM and gait economy: purpose was to compare two commonly practiced stretching techniques to determine which _ _ _ for improving _ _ and to evaluate the effect of these techniques on? Subjects?*
Determine which is the most effective for improving hip ROM and to evaluate the effect of these techniques on gait economy
Subjects: 7 Asymptomatic males ages 18-22
2 stretching procedures used in hip ROM/ gait economy study? Results?*
Midrange stretching procedures (STM and PNF) and end-range static stretching
Both techniques are equally effective at improving hip ROM, however 10 minutes of end-range static stretching was found to be the tx of choice for improving hip ROM AND reducing metabolic cost/ gait economy
Passive v. Active stretching of hip flexor muscles in subjects with limited hip extension: purpose was to determine whether active or passive stretching? Subjects?*
Results in a difference between groups at improving hip extension ROM in patients with hip flexor tightness
Subjects: 33 patients with low back pain and LE injuries who showed a decrease in ROM
Results of passive v. Active stretching of hip flexors in patients with limited hip extension: 2 methods are? Whether both improve flexibility of _ _ or whether _ _ improves the function of the _ _ is _ _.*
Two methods are equally effective for increasing hip ROM
Whether both improve flexibility of other muscle groups or whether active stretching improves the function of the antagonist muscle is not known
Muscles and motor control in low back pain: low back pain is a _ _ and currently there _ _ _ of treatment that has _ and _ been able to _ or _ low back pain
Low back pain is a multi-factorial problems and currently there are is no regimen of treatment that has a singularly and successfully been able to prevent or manage low back pain
No dispute about fundamental role of _ and _ _ in the normal function of the vertebral column
Pelvic and trunk musculature
The effectiveness and rationales for many standard regimens of back exercises have been? May reflect? Also fail to acknowledge?
Standard regimens have been difficult to substantiate
May reflect problems encountered in testing the validity and efficacy of one treatment for back pain
Also fails to acknowledge interdependence of the CNS and musculoskeletal systems in normal and abnormal function
Muscles can be a source of both _ and _ _. A _ _ as a defense reaction against _ and _, itself may be _ or be a source of _ _.
Muscles can be the source of local and referred pain
Muscle spasm as a defense reaction against pain and pathology may be itself Asymptomatic or be a source of muscle pain
The _ or _ of muscles may vary in degree between subjects but rarely in? In general, muscles that are _ to _ are approximately _ _ than those prone to _.
The tightness or weakness may vary amongst subjects but it rarely varies in distribution (follows patterns of weakness/ tightness)
In general muscles that are prone to tightness are approx. 1/3 stronger than those prone to inhibition
Adequate _ _, _ _ and _ _ of the _ _ has probably been underestimated in pathologies of lower back pain. More highly mechanized and sedentary lifestyles lead to a _ _ _ which in itself may decrease _ _ essential for good motor patterns
Adequate sensory input, proprioceptive control, and proper function of sensorimotor integration has probably been underestimated
More highly . . .lead to a reduction in the variety of movement, which in itself may decrease the proprioceptive stimulation essential for good motor patterns
2 common syndromes associated with muscle imbalance
Pelvic Crossed syndrome
Layer syndrome
Clinical experience has shown that attention should first be directed towards? Once their _ influence has been _, activity of _ or _ muscles should be? Finally attention must be directed toward gaining _ and then _ _ of good coordinated muscle activity and movement.
First directed towards gaining normal muscle length in muscles that are overactive or tight
Once their inhibitory influence has been remove need, activity of inhibited/ weak muscles should be actively facilitated
Finally, directed toward gaining voluntary and automatic control of good coordinated muscle activity and movment
Common postural pattern
Kyphosis- Lordosis posture, flat back posture, sway back posture
In general people tolerate _ forces more than _ forces.
Tolerate compressive forces more than shearing forces
In PT_ _ _ are the biggest driver of what treatment is appropriate for the patient
Physical impairment findings
The key to impairment based findings is to determine?
Physical impairment(s) that are most closely associated with the patients reported limitations and disability
Restricted mobility, pain at end of range, and shortened muscle length are?
Indications for mobilization
Joint instability at the level of treatment, joint hypermobility, osteoporosis, inflammatory joint disease, metastatic bone disease and pregnancy are all?
Contraindications for mobilization
What are the 10 fundamentals of soft tissue techniques: 3 m’s
Maintain alignment of COM over BOS
Maintain mid-range position of joints
Maintain alignment of segments
What are the 10 fundamentals of soft tissue techniques: U’s
utilize appropriate velocity
Utilize appropriate depth
Utilize adequate base of support
What are the 10 fundamentals of soft tissue: 2 D’s, and NP
Determine ROM limitation
Determine tissue Hypomobility
Position patient
Neutral weight shift
If muscle is in a shortened position for a prolonged period of time you will see? If muscle has been lengthened/ stretched?
Shortened: decreased number of sarcomeres
Lengthened: increased number of sarcomeres
In a lengthened position there is a _ overlap between actin and myosin. In a shortened position there is? Difficulty of each?
Lengthened: decreased overlap so it more difficult to contract
Shortened: increased overlap so it is difficult to lengthen
Shortened muscles are tested by? Lengthened? Treatment
Shortened
ROM/ Muscle length tests: stretch
Lengthened
ROM/ MMT: strengthen
Myofascial shortening is more pronounced in?
One joint muscles
Common postural pattern
Kyphosis- Lordosis posture, flat back posture, sway back posture
