Quiz 3 Flashcards
irritable vs non irritable pt neural dynamics (technique)
with irritable pts you want to load away from the tract being isolated (be distal to that nerve) and you don’t sustain the hold you ossilate
no irritable, you want to load near the tract you are isolating (be proximal to that nerve)
dosing of irritable vs non for neural dynamics
non - can do 1- 3 min
irritable - do 15 -60 sec
post hip glide helps improve
flexion and IR
inf hip glide helps improve
abd
ant hip glide helps improve
ext
lateral hip glide helps improve
IR and adduction
explain the loose body hip manip/mob
“hup hup hup”
pt position: supine with the ankles/foot off the end of the table. (The table should be in a very low position to allow for proper positioning of the treatment leg.)
Therapist position: standing btwn pt’s legs & grasps the ankle above the malleoli with both hands (1 hand ant & 1 post)
With L LE → therapists L leg braced against end of table (therapist turned slightly toward LE being manipulated)
*If possible, use assistant to stabilize both ASIS
Starting Position: Lift leg to ~ 60º flexion & slight abduction, start in full IR of the hip/LE,
A quick distraction/ER force is applied three times as the LE is lowered
Between each thrust, return LE to IR before next thrust
Once lowered, return LE to neutral & gently remove the traction force
explain manip for labral reposition
Pt position: supine on a lowered treatment table, with the patient’s treatment leg close to the edge of the plinth.
hip & knee is flexed to 90º (80º of hip flexion is acceptable if 90º is uncomfortable)
Pt lower leg rests on the thigh of the therapist
Therapist Position: foot up on the table, hip and knee flexed to about 90º.
An assistant is again needed to stabilize both ASIS.
Starting: therapist places cephalid hand on the pt’s anterior knee & caudal hand on ankle
A traction force is added when therapist adds DF or PF with his/her ankle.
Once the traction force has been applied, assistant may then stabilize at both ASIS
Stabilization should not be applied before the therapist tractions the joint
Force is increased by flexing the knee more, and adding hip ER in a series of three “scooping” motions.
explain what you might find in femoral ant glide syndrome
Insufficient posterior glide during flexion
Stiff hip extensors, posterior hip capsule
Excessive flexibility of anterior capsule
explain curved glide for IR
pt prone
knee bent and you passively pull lower leg out as you push medially/osscilating on the buttock
force goes caudal, dorsal, and medial
mvmt ends by having pt push into your hand (in IR)
explain curved glide for ER
pt prone
knee bent and you passivley pull lower leg in as you laterally ossilate and push out on the buttock
force goes cranial, ventral and lateral
mvmt ends by having pt push into your hand (ER)
phases post op rehab knee ACL
Phase I - Immobilization / Protection
Minimize immobilization time (tx other joints or non-injured tissues)
Phase II - Rehabilitation
Phase III - Function (sports/life/job)
goals acl rehab
Initiate quad extension
Gain Full Extension ASAP
Off crutches ASAP
ROM/ ROM exercises
0-90 Week 1
0-120 Week 2
0-Full Week 3-4
Patella mobility
Proprioception / Balance
ottowa ankle rules
Pain on palpation: distal 6 cm of fibula (posterior, midline)
Pain on palpation: distal 6 cm of tibia (posterior, midline)
Pain on palpation: base 5th metatarsal
Pain on palpation: navicular tubercle (medial aspect)
Unable to bear weight immediately after injury
Over age of 18 and below age of 55
what is edurep
EURCP: can be used for achilles tendinosis-
Educate- that it is not inflammatory and pain is not directly associated with the pathology (Kennedy Stages)
Unload- heel lift (to put ankle/foot in a more pf position to decrease forces on achilles tendon), active rest with alternative exercise
Reload- make tissue stronger- eccentric program- slow progression of load and speed over 12 weeks
Want to do ex on a step so pt can go beyond horiz (dont have to wait until pain free- can do if 2-3/10 pain)
Caveat: insertional achilles tendon does not respond to ecc loading as well: do NOT go beyond horiz
Prevent- hip strength, lumbar spine, normal foot mechanics- hip can be a big component in distal injuries
talus position during ankle sprain
Talar position: talus can get stuck anteriorly (bc ATFL attaches to ant talus and when this ligament is stressed during forceful inv/pf it can pull the talus ant→ creating ant impingement
best evidence for tx for plantar fasciopathy
PF stretching and orthotics
manual therapy and exercise was superior over E stim and exercise (eversion MT) And the exercise was intrinsic foot strengthening working to increase arch in WB position.
biomechanics of talocrural jt
Convex Talus moves on concave Tibia (open chain)
In gait, Tibia moves anteriorly on a relatively fixed Talus
biomechanics subtalar jt
Bicondylar: movements occur at both joints simultaneously
Anterior joint: GLIDE: concave Calcaneus moves on convex Talus
Posterior joint: ROTATION: convex Calcaneus moves on concave Talus
biomechanics distal tib fib jt
As wedge-shaped Talus comes back (or Tibia comes forward,) the Tibia and Fibula have to ‘splay’ or widen.
Too little = limited DF
Too much = patholaxity, inappropriate talocrural contact point / loading, lacking peroneal origin stability
subtalar joint motion
eversion/inversion
what mobs for ankle stiffness
subtalar lat glide
subtalar
difference btwn walking and running gait
running is 3x that of walking
running is faster, ground reaction force is 3x body wt
biomechanical faults are 3xs as detrimental with running
with running knee is flexed upon strike
with running there is a double float (foot off ground) period
with running BOS narrows
running cycle phases
foot strike mid support take off follow through forward swing foot descent
what is happening during foot strike phase
knee is flexed and foot is ahead
goes: heel, midfoot, forefoot
what is happening during mid support phase
prontated foot
hip and knee are flexed and IR
Dorsiflexion of 10-20 deg
if a person doesn’t dorsi properly what might be compensation
overpronation
raise heel, hyper ext knee
what is happening in take off phase
foot is rigid lever
great toe ext 70-90 deg
triple extension (propulsion, hip ext knee ext and PF)
great toe ext does what to the arch
during take off the great toe extends pulling the arch into greater elevation bc the plantar fascia tightens = rigid lever
what are the kennedy stages of tendinopathy
Stage I: if pain begins after an activity has been performed, the patient can continue the activity but should decrease frequency/intensity of performance by 10%
Stage II: if pain begins at the start of activity or after: start cross training and decrease the activity by 30%
Stage III: if pain occurs during and/or after activity but performance is not affected: decrease activity by 50%
Stage IV: if the pain is constant and performance is affected - cut back frequency, intensity, and duration by 75%
**If tendon pain lasts more than 3 months, consider the condition of tendon degradation. (Your treatment of a tendonitis vs. tendinosis is different.)
what are the sensorimotor learning stages
A set of processes associated with practice or experience, leading to relatively permanent changes in the capability for movement.
Stages of motor learning: cognitive (trial and error), associative (reflection of most effective way to do a task), autonomous (integrating clinical activity into functional task)
Ways to enhance sensorimotor learning:
Different environments, distractions, quiet/noisy environment, change order of exercises, surface type, change nomenclature
Somatosensory and psychomotor/functional skills should be integrated (max of 8 ex at a time)
what is ideal percentage for return to sport
10%
figure 8 test is good to test for
post ankle sprain
Palpate anterolateral aspect of the talus
Examiner applies forceful dorsiflexion
Positive = reproduction of pain
this explains test for what
ant impingement of ankle
functional tests to check for readiness for RTP include what motions
hopping side to side over obstacle, doing a figure 8 around 2 objects
what happens in follow through phase of running
push off/hip extension
lacking hip extension would mean you have a decreased ___ during swing phase
push off
what is post tib dysfunction and what will it present like
torn or inflammed post tib tendon flat foot (may look super pronated)
5 essentials chris powers says to look at in gait
- Knee flexion during loading
- Tibial progression (i.e., ankle dorsiflexion during mid and terminal stance)
- Hip extension during terminal stance
- Hip flexion during swing
- Knee extension during terminal swing
SINS
Severity
Clinician’s assessment of the intensity of symptoms and the effect on functional ability
Non, Minimal, Moderate, Maximal
Irritability
The amount of activity to produce an exacerbation of the symptoms, the severity of the symptoms, and the time to subside
Non, Minimal, Moderate, Maximal
Nature
The primary structure responsible for producing the patient’s complaint according to the clinician’s hypothesis
Stage
Clinician’s assessment of the disorder on a time scale
Acute, Sub-acute, Chronic
Stability
Ease with which the condition can be disturbed
Getting worse, better, same
How does current condition compare to previous one?
what are some specifics Megan mentioned for the ACL rehab
get extension quickly
strengthen quad
take into consideration where the graft came from
do eccentric quad 4-6 wks post op
0-90 Week 1
0-120 Week 2
0-Full Week 3-4
Work on Patella mobility
Full extension ASAP
with a brace, ACL pts are in crutches how long
locked in ext x 4 wks: crutches 1 week
without a brace, ACL pts are in crutches how long
2 wks
ACL RTP timeframe
Autograph 4-5 months
Allograph 6-9 months
If working with a young athlete and they have posterior heel pain consider __________ instead of a true Achilles tendon problem.
Calcaneal apophysitis (Sever’s Disease)
WHAT PHASE OF RUNNING IS TRIPLE FLEXION
forward swing
driving foreward is dt hip flexors
what are the swing phases of running
the last 3 make up swing phase
what is one strengthening strategy you can do during acute phase of lat ankle sprain
hip - glut med
often this is weak
clamshells
explain sub acute phase of ankle sprain tx
pain and swelling should be minimal, ROM should be close to full range in all planes.
Strengthening is a big component of this phase – starting with open chain strengthening (isometrics, t-band) and progressing to closed chain exercise- WB
in addition to ant impingement, what can also occur as a result of a lat ankle sprain
On occasion, the cuboid bone can become subluxed . The forced inversion causes the tendon of the peroneus longus to rotate the cuboid plantarly. Symptoms include lateral foot pain at the cuboid, especially with weightbearing.
after treating a cuboid subluxation, what should you do
place a small pad under the cuboid in their shoe to keep it from rotating plantarly again
what tendon is often the cause of cuboid subluxation with a lat ankle sprain
peroneus longus
what nerve can be irritated by lat ankle sprain
superficial peroneal
what is brostrum procedure
Reattachment of ATF and CF
difference btwn plantar fasciitis and opathy
one is chronic and not inflammed
what manual therapy was used in the study for plantar fasciopathy
eversion
what is px generator for PF px syndrome
cart
with PF px syndrome, the patella tracks
lateral
females have PF px due to
weak quads
males have PF px due to
males are quad dominant
what is weak usually with PF px syndrome
VMO
what do you want to strengthen in hip with PFPS
ER
ABD
knees over toes during a squat means
quad dominant
with ITBS, avoid
down hill running
list in order glut med effectiveness exercises
LOW: good mornings, cable walk outs
Mod: bilateral bridge, clam
High: quadruped with a lift, wall squats
Very high: lateral band walk, hib abd
proximal ham strain is ___ and tx with ___
chronic
cross friction massage
for PFPS or patellar tendonopathy, before you can tx you must first determine
are they quad dom or weak
are they glut dom or weak
bird dog/fire hydrant ex is for
glut max
