Neuromuscular

Question 1

What is a motor unit?

Answer 1

A single motor neuron and the multiple muscle fibers it innervates

Question 2

What are myofibrils?

Answer 2

Multiple bundles of small fibers that make up muscle cells

Question 3

What are myofilaments?

Answer 3

Smaller fibers inside the myofibril that are made up of the proteins actin and myosin

Question 4

What are sarcomeres?

Answer 4

Short segments of actin and myosin

Question 5

Characteristics of Skeletal muscle contraction

Answer 5

A minimum amount stimulus is needed to initiate a muscle contraction
All fibers contract one a stimulus is applied (all or none)
Muscle contractions stop once the stimulus is removed
There is a change in the number of motor units stimulated based on the need (graded response based on activity)

Question 6

What is Reciprocal Inhibition?

Answer 6

Smooth movement requires a coordinated contraction in the agonist an a slight relaxation in the antagonist (but not complete inhibition)

Question 7

What is the Stretch Reflex?

Answer 7

When a rapid lengthening of a muscle occurs, a concentric contraction is signaled ( to protect muscle from tearing) by the muscle spindles

Question 8

What are the two types of muscle spindles?

Answer 8

Alpha afferents: sensitive to lengthening of the muscle

Gamma afferents: sensitive to the rate of lengthening

Question 9

What is gamma gain?

Answer 9

Increased sensitivity of the muscle spindle to a sudden lengthening after a muscle has been static for an extended period

Question 10

What is the Inverse Stretch Reflex?

Answer 10

The Golgi tendon organ (a proprioceptive sensory receptor that is at the origins or insertions of muscle fibers) monitors the force of contraction to protect muscles from tearing
GTOs are sensitive to tension in the muscle and respond to increased tension by inhibiting contraction

Question 11

What are postural adaptation?

Answer 11

Muscles held in shorter or longer than normal positions for extended periods of time that cause reduced muscle performance

Question 12

What are the characteristics of Upper Crossed Syndrome?

Answer 12

Forward head, depressed chest, rounded shoulders, and increased kyphosis
Causes: headaches, thoracic outlet syndrome, scapular dyskinesis, and shoulder impingement

Question 13

What are the characteristics of Lower Crossed Syndrome?

Answer 13

Excessive lordosis and protruding belly

Causes: Sciatica, SI dysfunction, chronic low back pain

Question 14

What is muscle hypertrophy?

Answer 14

Increase in size and strength of the muscle fibers in response to exercise
Takes several weeks to build muscle

Question 15

What is muscle atrophy?

Answer 15

Decrease in size and strength of the muscle fibers from lack of use or denervation (use it or lose it)
Occurs quickly and could impede circulation to the area

Question 16

What are muscle cramps?

Answer 16

Acute involuntary muscle contractions caused by muscle fatigue or metabolic imbalances (involuntary)

Question 17

What are muscle spasms?

Answer 17

Involuntary muscle contractions sustained for hours, days, weeks, or months that restrict the blood vessels and compress the free nerve endings
They can lead to faulty biomechanics and movement patterns
they can reduce blood flow if left untreated and cause ischemia

Question 18

What are trigger points?

Answer 18

Hyperirritable nodules (or Knots) within a muscle that give rise to pain with compression
It feels like a tight rope-like band and radiates pain when pressed
**only treat a trigger point when it is the cause of the symptoms

Question 19

What are some causes of Trigger Points?

Answer 19

Increased mechanical strain
Impaired circulation (ischemia)
Trauma/local inflammatory response
Disuse
Mental/emotional distress

Question 20

What are tender points?

Answer 20

Hypersensitive small zones of tense and tender myofascial tissue caused by a small neurologically generated local muscle spasms (due to false stretch reflex signal)
Treated by muscle relaxation, not stretching
**Doesn’t radiate

Question 21

What is neuromuscular Release (NMR)?

Answer 21

Includes any technique that is directed at reducing muscle tension and spasm that restricts ROM and/or makes that movement painful

Question 22

What are the three categories of NMR?

Answer 22

Trigger Point
Positional Release
Proprioceptive techniques

Question 23

What is Direct Treatment?

Answer 23

Treatment that confronts the pain and tension with some type of opposing force or reverse soft tissue manipulation
Proprioceptive techniques and Trigger Point Release Techniques

Question 24

What is indirect treatment?

Answer 24

Treatment that moves away from the restriction and into a position of comfort
Positional Release techniques

Question 25

When can/should neuromuscular techniques be used?

Answer 25

any limited and/or painful movement

Question 26

What are the contraindications of neuromuscular techniques?

Answer 26

``` Don't perform during the acute phase when "splinting" is occurring Acute swelling/inflammation Open wounds or sutures Local infection Acute rheumatoid arthritis Malignancy ```

Question 27

What is the purpose of Proprioceptive techniques?

Answer 27

Effective and fairly easy to administer to patients Reduces muscle tension by stimulating specific neuromuscular reflexes (GTO) that control tone using active muscle contraction

Question 28

What are the goals of Proprioceptive techniques?

Answer 28

to inhibit muscle spasm that restricts ROM and causes pain | Enhance the effectiveness of trigger point and positional release techniques

Question 29

What are the types of Proprioceptive techniques?

Answer 29

Contract Relax Reciprocal Inhibition Contract Relax Active Contraction (CRAC)

Question 30

Contract-Relax

Answer 30

Tight muscle is passively lengthened within pain free ROM until PT notes slight tissue tension then back off slightly less then 25% contraction of the target muscle is provided against PT resistance Hold for 5-10 s then have patient relax Move to new ROM then repeat up to 6 times then reassess

Question 31

Reciprocal Inhibition

Answer 31

Tight muscle is passively lengthened w/in pain free ROM until PT notes tissue tension less than 25% contraction of the antagonist to the target muscle against PT resistance Hold 5-10 seconds then relax PT moves to new range and stops at next tissue barrier

Question 32

Contract-Relax Active Contract (CRAC)

Answer 32

Same as Contract-Relax but instead of PT moving pt into new range after contraction, the pt actively move to new range and holds for 10 s before contraction

Question 33

What is an active trigger point?

Answer 33

A trigger point that reproduces the symptoms and may have a local twitch response when compressed

Question 34

What are some of the different types of trigger points?

Answer 34

Associated: TrP in one muscle that occurs concurrently with a TrP in another Attachment: TrP located at the musculotendinous junction of muscle Central: TrP located near center of muscle Key: TrP responsible for activating one or more satellite TrPs Satellite: Central TrP that develops in response to a key TrP Latent: Painful only when paplated

Question 35

How do you find trigger points?

Answer 35

sweeping cross-fiber movement of muscle believed to have a trigger point; once a taut band is located, a pincer grip is used along the band to locate the nodule

Question 36

What is the maximum pain a trigger point release should cause?

Answer 36

5-6/10

Question 37

What is the approximate time it may cause a trigger point to release?

Answer 37

30-120 seconds

Question 38

What should you NOT do to relieve a tenderpoint?

Answer 38

Use compression or stretching

Question 39

How much should the immediate reduction in tenderness be after treating a tenderpoint?

Answer 39

about 70%

Question 40

How long should you hold a tenderpoint release?

Answer 40

90 seconds