MSK Basic Interventions Flashcards
Practice!
According to convex/concave rule, to inc R forearm SUP @ prox RU jt PT should perform what glide?
Roll POST and Glide ANT
- Sup is ANTERIOR
- PPP-> Posterior glide for Proximal RU jt for PRO
Remember ALL JTS ALTERNATE!!!!!
Stretch _ Strengthen
BEFORE!!!!
OKC vs CKC
Which better for strengthening?
And what else to remember?
CKC!!!
KNOW YOUR PLANE– what plane of mvmt is the question asking you about?–likely answer is mm that controls that plane of mvmt Ex. glute med and abduction if hip drop
Rule of 6–>
aka: 3 Phases of Rehab
- First 6wks
- Up to 12wks
- Up to 6mos
**Major sx’s like rotator cuff **
Practice:
39yo comes into OPPT c/o neck probs. Which of following ex combos is MOST approp for pt who has FHP?
Remember Jandas Crossed Syndrome!!!
- Strengthen DCFMs and Stretch SCM and Upper CS EXTs
- Upper Crossed: Inhibited (Weak)–> DCFMs + Lower trpz/Serratus ant.; Facilitated (Tight)–> Upper trpz/Levator + Pec minor/SCM
TibioFemoral Jt and Screw-Home Mechanism
- Lat femoral condyle is flatter, does not ext as far distally, projects further post vs medial condyle
- Bc of this–> Tibia rotates LATERALLY (ER) ON FEMUR @ full EXT==Screw-Home
- This is in OPEN CHAIN–> last 20-30deg EXT
- Remember “Paper on Tibia trick”–It ERs!
NOTE: in CKC–Femur MEDIALLY rotates on TIBIA
Practice:
In order to UNLOCK knee from TKE in a CKC, what must occur?
LATERAL (ER) rotation of FEMUR on TIBIA
More on Screw-Home
- TOLL: Tibia in Open chain rotates LAT for LOCK
- CKC–> Femur moving on Tib
- Screw-Home in CKC–> Femur MED rotates on tib, so to UNLOCK must LAT (ER) rotate!
More on Screw-Home
OKC:
- Tibia Lat Rot== Locks
- Tib Med Rot== Unlocks
CKC:
- Femur Med Rot== Locks
- Femur Lat Rot== Unlocks
Iso vs Ecc vs Conc
Isometric: SAME length, no JRF
Ecc: Load > force (torque)
Conc: Load < force (torque)
Which type of contraction do biceps (elbow flexor/shoulder flexor/supinator) undergo as shoulder moves 180-90deg of flex?
ECCENTRIC—> biceps move from more flexion to LESS, Triceps working conc.
Another example: Stand–> Sit== Rec fem (quads) ecc. work to SLOW US
Shoulder Rotators
Mnemonic to remember UPWARD ROTATION—->
SALUTE
- Serratus Ant
- Upper/Lower Trpz
Note: Force Couplebw Upper/Lower Trpz–> MUST AGREE W/ EA OTHER
Easy way to mimic Upward and DOWNward scapular rotation
USE HANDS!!!!
Upward we go into ABDUCTION
Downward we go into ADDuction
use hand and thumbs as scapulas!
UPward rotators of scapula
“SALUTE”
- Serratus Ant
- Upper trpz (force couple)
- Lower trpz (force couple)
DOWNward rotators of scapula
- Rhomboids
- Pec Minor
- Levator Scap
Upward/Downward Rotators of scapula
*Trick to remember
Remember which mm’s counter ea. other AND that Serratus ant HELPS w/ upward rot & Pec minor HELPS w/ downward rot
- Upper trpz (UPward) matches w/ Levator (Downward)
- Lower trpz (Upward) matches w/ Rhomboids (Downward)
Practice!
Excess upward rot of L. scap noted w/ shoulder ABD. Which mm MOST LIKELY contributing?
Weakness of Rhomboid major/minor
bc they are NOT pulling scapula back DOWN!!!!
Rhomboids must BALANCE OUT upward rot w/ downward rot
What should you ABSOLUTELY REMEMBER about Active/Passive Insufficiency?
MAINLY due to Two/Multi-jt muscles!!!!
Active Insuff.
Crossbridge too CLOSE
Passive INsuff
Too lengthened
Active Insuff.
Definition + Ex.
- Inability of two-jt muscle to shorten simultaneously @ both jts
- Ex. Bicep curl (elbow flex) THEN try to get into 180deg shoulder flex—> CANNOT bc biceps are FULLY contracted ==> Active Insuff
Passive Insuff
Definition + Ex.
- Inability of two-jt mm to lengthen simultaneously @ both jts
- Ex. Ext knee fully & Flex trunk forward–> major stretch in HS’s and cannot lift leg up high bc HS can NO LONGER stretch over hip & knee anymore===> Passive Insuff
Active and Passive Insuff. Rules:
Steps 1, 2, 3, 4
- Step 1: Name mm
- Step 2: Is it a 2jt mm?
- End range? Function of mm?
- Active or Passive Insuff?
NOTE: 1 jt mm’s will NOT display Active or Passive Insuff!!!!
Mnemonic/Way to remember Active vs Passive Insuff
- Active Insuff==SAME–> Active insuff will be SAME function of mm. Ex. HS= knee flex/hip ext
- Passive Insuff==OPPOSITE–> Passive insuff will be OPP motion of mm function. Ex. HS will then be knee ext/hip flex
Practice!
Active Insuff of R. Iliopsoas (hip flex, LF same side)
Hip flexion + R. LF of trunk
Practice!
Pt c/o reduced mobility in R hip. PT notices pt has INCd hip flexion w/ knee flexion as compared to knee ext. What is most likely cause of **reduced hip flexion w/ knee extension? **
The motion they are asking about is OPPOSITE TO HS FUNCTION.
PASSIVE INSUFF== OPP motion of mm
A: Passive insuff of HS’s bc hip flexion and knee ext is OPP to HS function
Practice!
Pt c/o reduced mobility in R hip. PT notices pt has INCd hip flexion w/ knee flexion as compared to knee ext. What is most likely cause of **reduced hip flexion w/ knee extension? **
The motion they are asking about is OPPOSITE TO HS FUNCTION.
PASSIVE INSUFF== OPP motion of mm
A: Passive insuff of HS’s bc hip flexion and knee ext is OPP to HS function
Kinematic Chain ex.
Starting pt= Overpronation of foot
- Over PROnation of foot–> Leg IRs–> Knee moves INward (valgum)–> Coxa varus–> Pelvis tilits forward (APT)
Be familiar with how things move UP THE CHAIN
Practice!
Pt presents w/ foot pain during running. PT notes excess foot PROnation and would like to provide orthotic to relieve pain. Which would beneift pt most?
Medial post under first MetHead
This will LIFT medial aspect of foot OFF ground
Anteversion: What will you see w/ this?
Transverse plane
IN-toeing
- Normal= 15deg
- >15deg== Anteversion (IN-toe to fix)–to “put back in socket”—–note pic says 35degs Anteversion for In-toe
- <15deg==Retroversion (OUT-toe to fix)
Hip Malalignments:
Table
THINK ABOUT WHAT HAPPENS UP THE CHAIN!
see pics (but most of this you already KNOW!)
Excessive anteversion
Related posture?
In-toeing–> subtalar PRO–> lat patellar sublux–> med tibial torsion–> med femoral torsion
Excessive RETROversion
Related posture?
OUT-toeing–> subtalar SUP–> Lat tibial torsion–> Lat femoral torsion
Coxa VARA
Related posture?
Subtalar PRO–> Medial rotation of leg–> knee valgus–> Anterior pelvic tilt
SHORT I/L leg—- bc PRO makes leg SHORTER
Coxa VALGA
Related posture ?
SUP subtalar–> Lateral rotation of leg–> knee varus–> POST pelvic tilt
**LONG ipsilat leg **— bc SUP makes leg LONGER
Practice!
PT is treating peds pt w/ autism. Pt stans w/ IN-TOEing. Postural strategies?
Anteversion!
- Medial rotation of leg, knee valgum, coxa vara, APT
- A: Internal tibial torsion, Incd femoral ANTEversion
ALL assocd w/ In-Toeing
- PRO foot
- Med tibial torsion
- Metatarsus varus
- Talipes varus or equinovarus
- Tibial or genu varum
- Medial femoral torsion
- Excess femoral ANTEversion
- Tight hip IRs
Rule of 6
for Sx’s
- First 6 weeks
- Up to 12 weeks
- Up to 6 mos
major Sx like RTC
Rule of 6 and Training for ADL activities
Tips:
- 1st priority ALWAYS SAFETY
- 2nd priority should be placed on obeying the above (Rule of 6) while choosing MOST relevant exercise to desired task
Practice!
Pt underwent sx repair of full thick RTC tear 6d ago. PT wants to perform passiveand assisted mvmt. Which pos MOST approp
THINK–6d ago???? == MAX PROTECTION
Pt in SUPINE w/ arm ABDd 45deg w/ slight flex
bc gravity eliminated!!!! Least amt of force on Jt or repair!!!
Rule of 6!!!!!
Rule of 6 applied:
Post-op Achilles Tendon Repair or Reconstruction w/ Graft
See pics
NOTE: @ 6-8wks, and Beyond 12 wks
Practice!
Pt underwent R. Achilles tendon repair 6 wks ago (Rule of 6) and now able to FWB. PT giving advice on shoe mods. Which is best?
- Things to keep in mind: NO DF, want to keep heel in slight PF to keep Achilles shortened and protect repair
- A: Shoes w/ 1-1.5cm heel lift (as per table)
