quiz 2 Flashcards
how much motion occurs at hip (degrees)
35 degrees flexion at heel strike
10-15 degrees Flexion at pre swing
AB/Add 10 degrees
greatest force of wb occurs during what activity (hip)
running
order of best exercises for glut med
LOW: good mornings, cable walk outs
Mod: bilateral bridge, clam
High: quadruped with a lift, wall squats
Very high: lateral band walk, or SL hib abd
what are the generals of femoral ant glide syndrome
limited post glide
Insufficient posterior glide during flexion
Stiff hip extensors, posterior hip capsule
Excessive flexibility of anterior capsule
what is dominant with femoral ant glide
TFL
what pathologies go with femoral ant glide
FAI
labrum tear
hip flexor issues (strain/pain)
what exercise is good for femoral ant glide issue
PASSIVE knee flexion (supine)
what muscles do you need to strengthen for someone with femoral ant glide
gluts
list some general info about femoral lateral glide syndrome
Dancers
femoral head is lateral
has hypermobility
They stand adducted (bc their abductors and ER are weak)
anatomic dx’s related to femoral lateral glide syndrome
Trochanteric bursitis
Snapping hip syndrome
Piriformis strain
for femoral lateral glide, do you do mobs
no - they are hypermobile
what mm to strengthen for femoral lateral glide
abd
ER
gluts
what really simple task can you teach a pt with femoral lateral glide syndrome for tx
sleep with pillow btwn knees to abd (since they are often stuck adducted) (femoral head is lateral but leg is adducted)
hip OA is aka
femoral hypomobility syndrome
what is the cascade of pathos for hip
FAI = labral tear = OA
cane goes with what leg
opp of impaired
good txs for OA
MT and EX
water aerobics/therapy
distraction (inf and lateral)
strengthen gluts
what 2 things cause hams strain
eccentric control
sprint take off
location of acute vs chronic hams strain
acute - in belly (bruises)
chronic - at mm tendon junction (px deep at isc. tub)
recovery time strain
6-8 wks
chronic hams strain occur where
proximally
slump stretching exercises are really good for
proximal (chronic) hams strain
PFPS - list some general ideas
Excessive pull laterally = patella pulls laterally
IR of femur – causes patella to track laterally
Pronation of foot (at subtalar jt) creates IR of tibia which creates IR of femur
Art cart underneath the patella wears down
Contributing factors: tight ITB
with PFPS the femur is often rotated
internally
what imbalance do you need to investigate for PFPS
quad vs gluts (which is dominant)
who are more apt to have quad dominance with PFPS
athletic males
If you notice a person medially drifting (at the knee) when they do a SL squat, how do you tx
work on abd and ER
what must you incorporate into tx for PFPS (strengthen what)
abd and ER
what can you do to “influence” the distal extremity of the knee for a person with PFPS
talocrural
do post joint mobs to increase dorsiflexion
remember, if one joint is hypomobile (ex at the ankle) the joint above or below is prob hypermobile
what tissue is the px generator with PFPS
cart
always look ___ and ___ the knee with any knee issue
above and below
tendonitis is aka
jumpers knee
itis vs osis
itis - acute, warm, inflammed
osis -collagen issue
patellar tendon issue, where you watch them squat and you think quads are too weak, what is a good exercise
put them on a wedge with small side towards toes and squat
purpose of tendons
store and release energy = power
plyo helps with this
3 insertions of ITB
Patella
Gerdy’s tubercle
Fibular head
the ITB decelerates ____ of tibia
IR
criteria of dx for knee OA
• Knee pain plus 3 of the following: o Age > 50 years o AM stiffness less than 30 min o Tenderness with no warmth o crepitus o osteophytes on imaging
generals of strength vs power vs endurance
strength and power are typically higher load lower rep
endurance is opp (low load high rep)
there is an impingement zone with the ITB at 20-30 degrees of flexion as the ITB rubs the lateral femoral condyle, what test mimics this
noble compression
ant vs post portion of ITB
ant = TFL post = glut max
what (that is under the IT band) can often get irritated and inflamed and need injections
fat pad
4 biomechanical factors that can cause ITB syndrome
Prominent LFC (lateral condyle)
Weak hip abductors
ITB tightness
Genu varum
what 2 surgeries are common for serious ITB issues
shaving the lateral femoral condyle
clipping the band itself
what strengthening is essential for knee OA
quad
would you use open or closed ex for knee oa
both
open isolates quad better though
what part of knee is often most affected with OA (lateral or medial)
medial
general ideas for OA activities (knee)
closed chain or water good
some open chain for experienced
no jumpy/plyo activities
order of muscle firing with glut med test
glut med first
TFL
QL later (after full abd of 45)
for testing of glut max, how to differentiate what might be weak/strong
- If the patient is unable to tolerate maximal resistance anywhere = glut max is weak.
- If the patient tests weak in the standard position, but tests strong when the hip is allowed to move forward 10º-15º, the gluteus maximus is long.
- If the hip rolls into medial rotation and/or flexion upon resistance, the TFL is dominant.
- if pelvis hikes QL is dominate
proper firing pattern of hip ext should be
(1) gluteus maximus
(2) hamstrings,
(3) contralateral paraspinals,
(4) ipsilateral paraspinals.
max, ham, contra, ipsi
prone quadriceps length test
prone foot to buttock
if pelvic motion is detected there is an imbalance
if you can lock down pelvis and take foot all way to buttock then abs are weak
if you lock down pelvis and cannot take foot to buttock quads are tight
TA and multifidus are ___ stabalizers
local
RA, the obliques, thoracis’s and QL are ___ stabalizers
global
TORQ
T or F, even if the forces generated by global muscles were adequate, the spine was unstable if local muscles were not sufficient.
T
these stabalizers stabalize the spinal SEGMENT
local
these stabalizers have to do with the entire vertebrae and trunk movement
global
The main function of the global muscles is to balance ______to the trunk so that the local muscles can handle the residual forces transferred to the spine (primarily lumbar).
external loads
if iliacus is tight, it can do what to pelvis
Iliacus
Although this muscle is a hip flexor, by reverse pull it can create anterior pelvic tilt if tight.
It is often tight, as with an ilial inflare.
psoas major can cause ___ tilt
anterior
TFL can cause ___ tilt
ant (in full knee ext)
primary goal of dry needling
• The Primary goal of Dry Needling is to desensitize supersensitive structures and restore motion and function.
goal of dry needling is to ilicit a
local twitch response
active vs latent trigger point (dry needling)
active -feels like “my pain”
latent-not familiar to the pt
ART is for ___ tissue
soft
ART tension is applied in what direction
Tension is usually applied longitudinal to the mm and with venous flow.
principles of ART
soft tissue is taken in position from short to long
ART formula
Insult to tissue = Number of reps x Force of rep/ Amplitude x Relaxation time between reps
NF/ARt
meaning, large reps large force without relaxation = injury
professions that can do ART
ATCs OTs PT MD Massage
trigger pts produce ___ px
referred
Anchor the tape to the coracoid process and pull posteriorly, caudally, and medially (pull away from pec minor)
This is what scapular tape job
post tilt
similiar to post tilt tape but start at clavicle, and extended posteriorly, caudally, and medially (perpendicular to the course of the upper trapezius) to the area just distal to the spine of the scapula.
inhibit upper trap
put arm in scaption
anchor the tape slightly medial to the spine of scapula. Passively elevate the shoulder into full “flexion” (scaption) to fully upwardly rotate the scapula. Pull the tape medially and caudally toward the lower thoracic spine. Remember the lower trapezius attaches at T12
taping for UR
if you ever tape scap for elevation it must be done
B
Apply the tape to the lateral edge of the acromion process and passively elevate the scapula, making sure the acromial end rotates upward. Pull the tape medially toward the cervical spine in the suprascapular space, following the direction of the upper trapezius. Apply a piece without forceful elevation to the opposite side. Tape to – but not over – the spinous processes.
scap elevation
Begin at the spinous process of the upper segment and pull the tape in the opposite direction you want the vertebral body to rotate. Anchor the next strip at the lower segment and pull it in the opposite direction of the first strip.
(This might be a technique you use after performing manual joint mobilization. The tape is useful in maintaining the corrected position.)
tape for rotated segment
what pathologies go with lat femoral glide syndrome
bursitis
snappy hip
piriformis syndrome
with femoral lateral glide syndrome, is it more capsular or ligg issue
capsular
different outcomes for thomas test
bent knee is iliopsoas tight,
straight knee is RF
if they IR = tight TFL
if they ext rotate then tight sartourious
what is difference in 30 vs 5 degrees when do MCL/LCL valgus/varus test
5 degrees and pos it tells you other structures are involved = more serious
if pos only at 30 it’s just the MCL or LCL
Mcmurrays tests for
meniscus
IR -tests ext fibers
ER -tests internal fibers
Thessaly’s tests for what
meniscus (twist)
aply’s is for
meniscus
prone as you grind
hx of clicking, locking, joint line px is prob
meniscus
explain Clarke’s test
clark is uncomfortable
they do quad set as you push on sup aspect of patella
explain noble compression
find lat fem condyle and push as they ext knee
kleigers is for the ___ lig
deltoid
push laterally
talar tilt tests
CF and ATF
ant drawer (ankle) tests
ATF
what should you do before doing taping of knee
do a medial mob of the patella first. You should be able to expose the lateral femoral condyle: if you can’t, it suggests that the lateral retinacular structures are too tight. so Mobilize the retinaculum first before considering taping.
when forward bending, men typically do what and women do what
men bend at lumbar and women bend with hips
good exercise for QL
side plank
most support to the spine is the ___ sx
the ligamentous structures (PASSIVE) provide the most support to the spine at the end ranges of motion where they check excessive mobility
ligg are ___ sx
passive
the active sx is the
myo/fascia
what is the control sx
feedback (proprioception)
taping of the scap into UR looks
backwards from what you would think
diff btwn scap taping for taping into post tilt vs taping to inhibit upper traps
post tilt - it goes ant to post and stops at the spine of scap
inhibit upper traps goes past the spine of scap and distal some.
bakers cyst is where
popliteal fossa
doing stairs and feeling like their knee will buckle or give out is a sign of
meniscus
this hip pathology is Commonly felt in the anterior superior region of the hip; c/o of anterior hip pain;
FAI
Medial wrist pain distal to the ulna Think what (pronation and supination hurt)
TFCC
disc btwn carpals and ulna
structures in the carpal tunnel
4 FDP tendons, 4 FDS tendons, Median N, FPL tendon.
if short, the psoas major causes
inc lumbar lordosis, ant translation/ant issues of the hip
often times if the hip medially rotates what is tight
TFL
if QL is tight what might occur
hip hike
what posture accompanies tight hip flexors
ant pelvic tilt
what posture accompanies tight hams
post pelvic tilt
and will have stretched hip flexors
what posture accompanies genu recurvatum
post pelvic tilt
explain RF, VL, VM functions other than knee extension
The rectus femoris also flexes the hip. The vastus lateralis pulls the patella more laterally; the vastus medialis pulls the patella more medially
why would weak abductors contribute to ITBS
if other abductors are weak ITB will try to take over but it’s not meant to be the primary abductor
