Random Ortho Flashcards
1st class lever
fulcrum/axis is located BETWEEN the force and resistance
designed for balance
examples:
- head on C1 moving into flexion/extension
- playground seesaw
2nd class lever
The axis is at one end, the resistance is in the middle and the force is at the other end
designed for power
Examples:
- closed chain PF
- a wheelbarrow
3rd class lever
The axis is at one end, force is in the middle and resistance is at the other end
**most common lever in the human body- advantage for ROM
Examples:
-elbow or knee flexion
Plumb line description
Should fall through:
- external meatus of ear
- acromion process
- hip joint
Posterior to the patella
Anterior to the lateral malleolus
(in this position, the soles muscle is the most active muscle to maintain the body’s balance. it contracts to counter the forward moment of the tibia around the ankle joint)
What is a capsular pattern?
a restriction of motion that results when the length and flexibility of the capsular fibers are impaired
if a lesion causes a restriction of movement that is not characteristic of the pattern, it is known as a non capsular pattern
What are 4 possible causes of non capsular patterns?
ligaments
adhesions
internal derangements
extra-articular lesions
Glenohumeral capsular/restriction pattern:
ER>abduction>flexion>IR
elbow capsular pattern:
flexion>ext
radioulnar capsular pattern:
pronation=supination
wrist capsular pattern:
flexion=extension
interphalangeal capsular pattern:
flexion>extension
hip capsular pattern:
flexion>IR>abduction
knee capsular pattern:
flexion>extension
ankle capsular pattern:
PF>DF
toe capsular pattern:
extension>flexion
arthrokinematics=
movement between joint surfaces
1-roll
2- slide
3- spin
osteokinematics=
movement between 2 bones (flex, ext, etc)
Slow twitch (type I) muscle fibers:
red oxidative muscle fibers
allow for aerobic work and specialize in muscular endurance activities
resistant to fatigue, contract slowly and are highly efficient for aerobic activities
description: tonic/postural
more common in: extensor muscles
Fast twitch (type II) muscle fibers:
white glycolytic muscle fibers
anaerobic and are not as vascular as type I, although they do contract at a higher speed and with more force than type I
*fatigue rapidly
these fibers are larger in diameter than red fibers and are used for activities that require speed, strength and power
Can be further broke down into IIA, IIAB and IIB
-differ mostly in regard to endurance and are falsified as intermediate fiber types with both an aerobic and anaerobic capacity
description: phasic/mobility
more common in: flexor muscles
Isometric exercise
a static contraction at a particular point in the ROM
development of strength is highly specific to the position at which the muscle contracts
useful if desired to limit joint motion following injury or surgery or if painful
resistance is accommodating, variable and controlled by patient
patients with vascular or cardiac disease should refrain from isometric due to the sharp rise in BP and workload on the heart. Valsalva’s maneuver should be avoided
Isotonic exercise
disadvantages?
exercise occurs throughout the ROM with the same resistance or weight and variable speed of movement
resistance is fixed at the max load that allows the completion of the movement and should be no greater than that of the weakest joint position
Disadvantages:
- lack of aerobic conditioning
- no development of quickness
- no accommodation to fatigue or pain
- increased muscle soreness with eccentric contractions
Concentric vs eccentric
Closed vs. open chain
Concentric exercise
shortening
contraction occurs when the muscle shortens as it contracts to overcome the external resistance or weight
Eccentric exercise
lengthening
contraction occurs when the muscle lengthens while developing tension and lowering the external resistance in a controlled manner. it generates considerable muscle force and can cause significant muscle fiber trauma
Isokinetic exercise
occurs at a constant, preset speed in which the resistance is variable and accommodates as the force of contraction varies throughout the ROM
safe, objective measurements and max tension at all points in the ROM
slow speed settings generally result in strength gains that are specific to that particular velocity
exercising at high speeds increases muscular endurance with some muscle hypertrophy
TORQUE = the amount of F used times the perpendicular distance from the axis of rotation
-As the angular velocity of the apparatus is increased, the peak torque generated by the patient is decreased.
Manual resistance exercises are really a form of isokinetic exercise due to the variable resistance provided by the PT.
Aerobic exercise:
performed at a target HR for at least 20 minutes and involving large muscle groups in rhythmical movements (jogging, walking, biking, swimming)
what are training effects of aerobic exercise?
CARDIAC:
- resting and submax HRs are decreased
- systolic and diastolic pressures are reduced at rest
- CO and SV are increased during submax exercise
PULMONARY
- tidal volume is increased
- ventilation rate is decreased during submax exercise
- oxygen extraction from the blood is increased
How is target HR calculated?
estimated HRmax= 200-age
THR = HRmax x 70% (to increase aerobic capacity)
How is Karvonen’s formula calculated?
uses RHR to determine THR
THR = (HRmax - RHR) x % of desired training intensity +RHR
Aquatic exercise
promotes relaxation, ambulation, WB and exercise
Intense training should take place between 81-83 deg F
Rehab exercises require water temp between 91-93 deg C
To increase WB- shallow water
To increase strength
- use higher-velocity exercises (due to water viscosity)
- items that increase surface area (due to turbulence)
- move toward the bottom of the pool (due to buoyancy)
buoyancy can be used to:
used as assistance to move a limb toward the surface of the water, support to hold a limb on the surface with flatten devises, or resistance when moving a limb toward the bottom of the pool
Hydrostatic pressure can be used to
reduce effusion or to allow the patient to exercise an injured extremity without increasing effusion
deeper water increases hydrostatic pressure
viscosity=
causes resistance to flow so that increasing the speed of an exercise or movement will increase resistance
what are cardiopulm responses to water immersion at rest and during exercise?
changes are the result of hydrostatic pressure and include a cephalad redistribution of blood flow
both the SV and CO will increase while the HR will remain the same or slightly decrease
changes in HR are related to the water’s depth, position of the patient, and exercise efficiency
hydrostatic pressure on the chest challenges chest expansion, can decrease the inspiratory reserve volume and may reduce the forced vital capacity. this may be a problem for individuals with reduced lung capacity or breathing difficulties
THR should be established in the pool due to lower heart rates during deep water exercise compared to land based exercise
What are factors that affect training?
Frequency: usually 3-5/week for aerobic or strength gains
Intensity: based on the amount of resistance used, THR, and the number of METs prescribed or the speed of exercise
*changing intensity is the most effective way to improve aerobic fitness
Time: usually ranges from 15-60 min
Type: aerobic, isometric, isokinetic, isotonic, aquatic, etc
Special considerations:
- obesity: should exercise at longer duration with lower intensity; intensity set so patient can speak without gasping and doesn’t have muscle ache or burn from lactic acid accumulation
- diabetes
Aging changes and physiological functioning by system:
CARDIAC:
- aging sedentary individuals have twice the rate of VO2 max decline
- age predicted HRmax declines with age
- CO ma decline unless there is an increase in SV
MUSCULAR: >65 y/o muscle strength decreased 24-45%, muscle mass is reduced and fiber size decreases
NEURO:
- nerve conduction velocity declines 10%.
- # of spinal cord axons declines and reduces reaction time
PULMONARY:
-static and dynamic pulmonary functions decline with age
SKELETAL: >60y/o: bone mass may reduce 30-50% causing osteoporosis
