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CATA 263 > ROM, Flexibility, and Manual Muscle Testing > Flashcards

ROM, Flexibility, and Manual Muscle Testing Flashcards

1
Q

Diagnostic Sign

A

Objective & Measurable
- what you hear, feel, see or smell when you assess the patient

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2
Q

Symptom

A

Subjective, provided by patient
- their own perception of the problem

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3
Q

Acute injury

A

Sudden onset of symptoms

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4
Q

Chronic injury

A

Slow insidious onset of symptoms

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5
Q

Microtrauma

A

Multiple small stimuli that culminate to a painful reaction

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6
Q

Macrotrauma

A

Large stimuli that leads to an instantaneous painful reaction

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7
Q

Why evaluate the uninjured side?

A
  • Have a baseline to compare to for evaluating the extend of the injury
  • Determine RTP
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8
Q

What is HOPS

A

History
Observation
Palpation
Stress tests/physical assessment

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9
Q

Evaluation process: History

A

Primary complaint, cause or MOI, signs/symptoms, past injuries, changes in training, etc

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10
Q

Evaluation process: Observation

A

Posture, gait, deformities, bruising, swelling, etc.

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11
Q

Evaluation process: Palpation

A

Deformities, tenderness, heat, etc

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12
Q

Evaluation process: Stress tests/physical assessment

A

AROM, PROM, RROM, flexibility, ligament testing, neurological exam, etc

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13
Q

What is the funnel approach to the evaluation process

A
  • Patient interview (subjective history)
  • Observation
  • Triage/screening/sensitivity: “Rule Out” (Decide to treat or refer athlete)
  • Special tests: “Rule In”
  • Determine diagnosis + Tx approach
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14
Q

Which side do you start with for physical tests?

A

Uninjured side to establish a baseline

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15
Q

What should you assess in the case of neuromuscular injuries where a nerve can be the source of pain (neuralgia/reffered pain)

A

Spine

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16
Q

ROM assesses what type of mvmt?

A

Osteokinematic

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17
Q

Motion available at a single jnt is affected by:

A
  • Jnt arthokinematics: bony structures
  • Soft tissue (muscles, ligaments, capsules)
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18
Q

What is flexibility/mobility?

A

The ability to move freely w/o restriction

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19
Q

Can flexibility affect ROM?

A

Yes

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20
Q

When measuring jnt ROM in a jnt where 2 jnt muscles are involved what do you do?

A

2nd joint should be in a shortened position

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21
Q

When measuring muscle length or flexibility of a 2 jnt muscle, what do you do?

A

Muscle should be in an elongated position across all jnts

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22
Q

AROM

A
  • voluntary mvmt
  • assess for muscle fcn
  • total amplitude, willingness, and fluidity of mvmt
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23
Q

PROM

A
  • performed by professional w/o participation of patient
  • assess for inert/noncontractile structures
  • assess for end feel sensations and amplitude
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24
Q

RROM

A
  • Muscle contraction against a resistance
  • assess for muscle function at specific locations
  • assess for strength/endurance of a muscle
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25
Q

What are the was of measuring ROM?

A
  • Visual estimation
    Tools:
  • Goniometer
  • Electronic goniometer
  • Inclinometer
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26
Q

When should you estimate ROM?

A

Gross mvmts, sideline assessment, lack of tools

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27
Q

When should you measure ROM?

A

Post-op, precision in rehab, outcome measures

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28
Q

Which is better, measurement or estimation for ROM?

A

Measurement

29
Q

Explain goniometer use.

A
  • Standing/sitting/laying down
  • “zero starting position” or baseline positioning
  • anatomical landmarks
  • goniometer positioning + starting position angle
  • end position angle
  • measurement: 0-180 (0 is starting position)
30
Q

What is closed pack?

A

When 2 structures fit precisely, and accessory mvmt not possible
- pain usually related to bone/lig injuries

31
Q

What are the accessory mvmts?

A

Distraction, sliding, compression, roll and glide

32
Q

How do you assess for capsular/lig limitation?

A

Accessory mvmts

33
Q

What is open pack?

A

Allows for accessory mvmt to occur
- usually done w/ PROM
- decreased accessory mvmt has a direct impact on AROM and PROM

34
Q

What is stretching?

A

Requires a segment ot go to a point of resistance in the ROM

35
Q

What is active stretching?

A

Person stretching supplies the force of the stretch

36
Q

What is passive stretching?

A

External force causes or increases a stretch

37
Q

What are the proprioceptors in stretching?

A
  • Muscles spindles
  • Golgi Tendon Organs
38
Q

Where are the muscle spindles located?

A

Within intrafusal muscle fibers

39
Q

What is the role of muscle spindles?

A
  • monitor changes in muscle length
  • creates stretch reflex when sensory neuron from muscle spindle innervate a motor neuron
40
Q

What do the muscle spindles cause w/ rapid muscle lengthening?

A

Muscle contraction
- want to avoid activation in stretching

41
Q

Where are the golgi tendon organs located?

A

Near musculotendinous junction

42
Q

What do the golgi tendon organs do?

A
  • sensitive to changes in muscle tension
  • when stimulated causes a muscle to reflexively relax
43
Q

What is autogenic inhibiton?

A
  • relaxation in the same muscle experiencing muscle tension
  • active contraction of muscle immediately before passive stretch
  • tension during contraction stimulates GTO causing a reflexive relaxation during passive stretch
44
Q

What is reciprocal inhibition?

A
  • relaxation in muscle OPPOSITE to muscle experiencing tension
  • when one simultaneously contracts the muscle opposing the muscle being stretched
    -Tension in contracting muscle stimulates GTO causing a reflexive relaxation of stretched muscle
45
Q

What is static stretching?

A
  • SLOW constant stretch that holds at end of ROM for 15-30s
  • when muscle is tight
  • DON’T WANT TO ACTIVATE MUSCLE SPINDLES!
46
Q

What is dynamic stretching?

A
  • Functionally based stretching
  • Use sport/activity specific mvmts to prepare the body for warm up
  • Promote dynamic flexibility (ability to actively move through ROM needs for activity w/ proper muscle activation)
47
Q

What is ballistic stretching?

A
  • Involves active muscular effort and uses bouncing-type mvmt
  • end position NOT held
  • Used pre-exercise (if not controlled, can cause injury to muscles and connective tissue)
  • Usually triggers stretch reflex
48
Q

What is proprioceptive neuromuscular facilitation stretch? (PNF)

A
  • relax muscles w/ increased tone or activity
  • facilitates muscular inhibition
  • either isometric/concentric contraction of ANTAGONIST muscle (muscle being stretched) used prior to passive stretch of antagonist muscle
  • autogenic inhibition
  • 1 version: uses AGONIST contraction to achieve reciprocal inhibition
49
Q

What is hold-relax? (PNF)

A
  • Passive stretch (10s)
  • Isometric contraction (6s): autogenic inhibition
  • relax + passive stretch in new ROM (30s)
  • repeat until no further gain in ROM (3-6x)
50
Q

What is contract-relax? (PNF)

A
  • passive stretch (10s)
  • concentric contraction through full ROM: autogenic inhibition
  • athlete relaxes + passive stretch performed in new ROM (30s)
  • repeat until no further gain in ROM (3-6x)
51
Q

Hold-relax w/ agonist contraction, slow reversal hold-relax (PNF)

A
  • passive stretch (10s)
  • isometric contraction (6s)
  • athlete relaxes then contracts AGONIST muscle to bring new ROM
  • repeat until no further gain in ROM (3-6x)
52
Q

Which method of stretching is the most effective and why? (PNF)

A

Hold-relax w/ agonist contraction (slow reversal hold-relax): autogenic AND reciprocal inhibition

53
Q

What is Manual Muscle Testing (MMT) for?

A

Determine the integrity of muscular tissues (damage)

54
Q

Why is MMT important?

A
  • RTP
  • Prescribing exercises
55
Q

What is muscle strength testing?

A

Determining the capability of muscles to fcn in mvmt and their ability to provide stability/support

56
Q

What are the causes of muscle weakness?

A
  • Muscle imbalances: posture, repetitive mvmts
  • Fatigue
  • Injury (lig, muscle, nerve, jnt)
  • Pain
  • Stretch weakness
  • Disuse atrophy
  • nerve involvement
57
Q

Return of muscle strength may be due to:

A
  • recovery following disease process
  • return of nerve impulse
  • after trauma and repair
  • hypertrophy of unaffected muscle fibers
  • muscular development resulting from exercises to overcome disuse atrophy
  • return of strength after the tightness/stretch have been relieved
58
Q

What is the break test? MMT

A
  • apply resistance at end of ROM
  • patient holds position
59
Q

What is the active resistance test? MMT

A
  • gradually apply manual resistance until you reach max resistance that patient can tolerate
  • requires skill/experience
60
Q

What is the MRC scale for MMT?

A

0: no visible or palpable contraction
1: visible or palpable contraction
2: Full ROM gravity eliminated
3: Full ROM against gravity
4: Full ROM against gravity, moderate resistance
5: Full ROM against gravity, max resistance

61
Q

What are 2 tools for muscle testing?

A
  • Dynamometer
  • Biodex
62
Q

What is the optimal position for muscle testing?

A
  • End of ROM for 1 jnt muscles
  • Midrange of overall length for 2 jnt muscles
63
Q

Explain in 8 steps the basic rules of applying MMT

A
  1. Place subject in position w/ best fixation of body (supine/prone/sidelying)
  2. Stabilize part proximal/adjacent to tested part
  3. Place tested part in antigravity test position if appropriate
  4. Use test mvmts in horizontal plane for muscles too weak to fcn against gravity
  5. Apply pressure directly opposite to line of pull of muscle
  6. Apply pressure gradually, allow patient to “get set and hold”
  7. use a long lever when possible
  8. use a short lever if muscles don’t provide sufficient fixation for use of long lever
64
Q

Muscles that are excessive in length:

A
  • usually weak
  • allow adaptive shortening of opposing muscles
65
Q

Muscles that are too short:

A
  • usually strong
  • maintain opposing muscles in lengthened position
66
Q

Pain in passive ROM indicates lesion to:

A

Ligaments, jnt capsules

67
Q

Pain in AROM and RROM indicates lesion to:

A

muscles

68
Q

Pain in closed pack position indicates:

A

Bone or lig injury

69
Q

Nerve paralysis ROM abnormalities:

A

AROM and RROM: abnormal

CATA 263 (6 decks)

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