Special Topics Flashcards
Discuss ballistic stretching.
Cyclically loading a muscle joint complex at or near its limits. May help with preconditioning a muscle joint complex prior to sprinting, high jump, or other events that depend on elastic energy in the MTU
Define creep.
Occurs when MTU is elongated and is allowed to continue to elongate as stress relaxation occurs. Partially responsible for the immediate I bc in joint ROM with stretching
Describe effect stretching has in performance.
Depends on the activity. Typical stretching may decrease performance in elite runners and sprinters bc they depend on stored elastic energy in MTU. Stretching may help performance when economy of gait is involved
What is the optimal number I of stretch reputations and how often should they be performed?
1-4. Usually by the 4th stretch, 80% of MTU length is obtained. Stretches are recommended to be held 15-60 seconds. Gains last approx 24 hours so they should be repeated daily. After 6 weeks (according to Zebas), gains are retained for 2-4 weeks
Does stretching dec injury risk?
Yes, usually. Flexibility imbalances may predispose someone to injury. The goal is to prevent these imbalances.
Effect of warming up on stretches?
Research shows warming up makes no difference.
When to perform joint mobilization vs stretching?
Joint mobilization should be first to minimize effects of abnormal joint compression and distraction on movement patterns
How does age effect flexibility?
Decreases. In regards to normal ambulation, fall prevention, and balance, calf muscle stretching is beneficial
What are physiologic and anatomic barriers?
Physiologic - point where voluntary range of motion in an articulation is limited by soft tissue tension.
Anatomic - final limit to motion, after which any motion would cause damage
What is the pop in a joint manipulation?
Carbon dioxide gas bubbles collapsing or generating. There is no relationship between popping and effectiveness. Typically takes 15 minutes to happen again.
Describe the grading system for joint mobilization.
Maitland has 5 grades:
Grade 1- slow, small amplitude at the beginning of the range
Grade 2 - Slow, large amplitude that don’t reach end range
Grade 3 - Slow, large-amplitude movements to the end range
Grade 4 - Slow, small amplitude movements at the limits of range of motion
Grade 5 - fast, small amplitude high velocity thrusts beyond pathologic limitation
What does the evidence say about manual therapy for spinal conditions?
Low back: better outcomes compared to placebo, McKenzie, medical care, exercises, and soft tissue techniques. Manipulation followed by exercise is the most efficient.
Thoracic pain: limited evidence
Neck pain: effective when combined with exercise. No evidence that manipulation is better than mobilization. When directed at the thoracic region, manual therapy can cause an immediate decrease in pain and increase in neck ROM.
MT is also effective for tension HA when combined c exercise
Is there evidence that MT is effective for extremities?
Hip: Research shows that it is 31% more effective than exercise alone for hip OA
Knee joint: effective when used with TherEx
Shoulder joint: effective with TherEx
Elbow: limited effectiveness
What side effects are associated c with spinal manipulation?
The majority of people (61%) have some SE, with most experiencing stiffness, local discomfort, HA, fatigue, and muscle spasms
How do loose-packed and close-packed positions influence MT Tx?
loose pack is used for joint play testing and to initiate Tx. Close packed is used to avoid joint motion (such as blocking lower spinal segments when attempting to mobilize a superior segment)
What is a capsular pattern?
limited movement in a predictable pattern, which Cyriax suggests is a result of lesions in the joint capsule or synovial membrane (arthritis, arthrosis, immobilization, trauma)
What are the loose-packed, close-packed and capsular patterns for head and spinal joints?
“Loose pack, close pack, capsular pattern”
TMJ: mouth slightly open, teeth clenched, limited mouth opening
Cervical: midway between flex and ext, max ext, limitation in all motion except flexion
Thoracic: midway between flex and ext, max ext, equal limitation of SB and rotation > ext > flex
Lumbar: midway between flex and ext, max ext, equal limitation of SB/rotation/ext>flex
What are the loose-packed, close-packed and capsular patterns for UE joints?
“Loose pack, close pack, capsular pattern”
Sternoclavicular: arm by side, max elevation, limited elevation with pain
ACJ: arm by side, arm at 90, limited elevation with pain
GHJ: 55 shoulder abd and 30* horizontal abd (or simply 55* scap), max abd and ER, loss of ER > abd > IR
HUJ: 70* flex and 10* supination, full ext and supination, loss of flex > ext
HRJ: ext and supination, 90* flex and full supination, loss of flex > ext
Prox RUJ: 70* flex, 35* supination, loss of pronation equal to supination
Distal RUJ: 10* supinaiton, 5* supination, loss of pronation = supination
RCJ: neutral and slight ulnar deviation, full ext and radial deviation, limited flex = ext
Hand: not reviewed
What are the loose-packed, close-packed and capsular patterns for LE joints?
“loose pack, close pack, capsular pattern”
Hip: 30* flex and abd and slight ER, ful ext and abd and IR, flexion and IR > abduction > adduction > ER
Knee: 25* flex, full ext and ER, limited flex > ext
Ankle: 10* PF and neutral rotation, full DF, PF>DF
Foot: don’t worry about it.
What are some effects of STM?
Improves lymphatic drainage, decreases depression, improves blood flow, improves chronic tension HA. Research does not show improvement in the immune system
How does massage aid in sports performance?
increases perception of recovery, reduces soreness post injury or post workout
How does massage relieve pain?
possibly pain gaiting, possibly increases stimulation of descending pain inhibitory system beginning in the periaqueductal gray matter (PAG) and continuing to the dorsal horn of the spinal cord. Activates opioid receptors in PAG
What is the purpose of Cyriax TFM?
Induces traumatic hyperemia in order to stimulate healing. Tendon is put on stretch, muscles is put in a relaxed position. Chanes should be noted within the first 2 Tx sessions
What are contraindications for spinal Txn?
structural disease, RA, acute strains (relative), fusion less than 1 year old
What is the optimal force for traction?
Cervical spine: approx 30-50 lbs.
Lumbar spine: 40% to 50% of BW
Is time a factor when treating a herniated disk?
Tx time should be relatively short If it is too long, decreased pressure will cause fluid to enter the disk and worsen bulge when Txn is released. 3-5 minutes may be effective, up to 10 to 15 min
What are average walking times and velocities in adults?
Typically walk about 80m/min, 115 steps per min (girls slightly more than guys), with declines of up to about 10% in adults over 60. Approx 60% of gait is with contact, 40% is swing phase
Describe key motions and muscular activity patterns during gait:
During initial contact, the ankle moves into 5 degrees of PF, with the knee moving into 15* of flexion and hip staying in 20* of flexion Eccentric control is critical for this. Without eccentric control, the forces may get transmitted to the joint and cause pain, or joint may collapse. THe knee flexes to approx 60* of flexion during swing phase of gait
Describe subtalar joint movements during gait.
eversion occurs at initial contact to allow unlocking of midtarsal joints and create a flexible foot to adapt to uneven surfaces. During SLS, eversion is reduced to create a rigid lever for the BW to progress over.
Describe PF contracture or tightness on walking.
This disrupts normal advancement, causing compensatory mechanisms such as premature heel rise, forward trunk lean, or knee hyperextension
What are the energy costs associated with various assistive devices?
Crutches: 30-80% energy demand increase
Standard walker: 200% increase in oxygen consumption
RW: less demand than SW
Cane: no change
Even with the increase in demand, it may actually make walking easier and less demanding in the presence of gait pathology because it allows more normal gait patterns
What are the typical extra energy expenditures of amputations during level walking?
25% increase for transtibial
41% for BKA
65% for AKA
Define Neurapraxia, axonotmesis, and neurotmesis.
Neurapraxia: conduction block, often caused by a problem with myelin but not axon damage. Usually recovers in 6 weeks.
Axonotmesis: injury results in nerve degeneration of involved fiber distal to site of injury. Nerve fibers regenerate about 1mm per day (3cm per month)
Discuss optimal time frame to perform EMG and NCS tests.
EMG should take place 2-3 weeks after injury because it takes 14-21 days for degenerative potentials to occur.
NCV: it requires 5-10 days for injured nerves to deteriorate distal to the suspected site of injury
What are common myotomes tested during screening?
Myotomes:
C3-4 shrugs, cervical rotation
C5: shoulder abd and ER
C6: elbow flex, wrist ext
C7 Elbow ext, wrist flex
C8: thumb and finger extensors
T1: hand intrinsic muscles
L2-L3: Hip flexors
L3-L4: knee extensors
L4-L5: Ankle DF
L5: great toe extensors, hip abd
S1: plantar flexors
S2-S3: foot intrinsic musclesWhat are common dermatomes tested during screening?
C1: top of head C2: side of head C3-4: lateral neck and top of shoulder C5: lateral shoulder and arm C6: thumb C7: middle finger C8: pinky finger T1-T2: Medial forearm and arm L1-L2: groin L2-L3: anterior and medial thigh L4: medial lower leg L5: lateral lower leg and top of foot S1: Post lat thigh and lateral foot S2: plantar surface of foot S3: groin
What is the best strength test to determine weakness in the presence of known L3-L4 radiculopathy?
Single leg sit-stand test is the best, followed by knee extensors in flexed positions, then knee ext in full ext if the previous 2 tests are not tolerated
What are commonly tested DTRs?
Jaw jerk: Trigeminal nerve (CN V) Biceps: C5 Brachioradialis: C6 Triceps: C7 Quadriceps: L4 Medial HS: L 5 Achilles Tendon: S1
How useful are the Achilles tendon reflex and the H - reflex in detecting L5/S1 root compression?
not valuable in detecting L5, but it is valuable in S1. H-reflex is the more valuable of the 2.(H reflex requires electrical stimulation)
How accurate is muscle strength testing, sensory testing, and reflex testing in the diagnosis of cervical radiculopathy?
muscle strength testing: weakness agrees with surgical findings 77% of the time. decreased sensation agrees 65% of the time. Reflex testing also agrees 77% of the time if there is a difference in side to side.
What is a “burner” or “stinger”?
A traction or compression injury to a cervical NR or brachial plexus trunk. It causes burning, numbness, tingling, or weakness in the distribution. Injury is caused to distraction of pectoral girdle through excessive shoulder depression or forced hyper lateral flexion of the neck.
What is Horner Syndrome?
A disease where there is an interruption of SNS innervation to the head and face region, usually caused by a brain stem lesion. Common signs and symptoms include Miosis (constricted pupil), ptosis, enophthalmos (sunken eyeball), Anhidrosis, and flushing
Describe some common special neurologic tests.
Babinski sign - indicates UMN lesion
Oppenheim reflex: ant border of tibia is stroked, causing babinski sign
Hoffman’s sign: flick middle finger distal phalanx, indicates UMN lesion
How are different degrees of sprains classified?
Grade 1 - <25% ligament tearing, mild and swelling without instability
Grade 2 - 26-75% ligament tearing, moderate pain and swelling, dec ROM, slight instability
Grade 3 - total ligament tear, severe pain and swelling, severe loss of ROM, joint instability
How are brachial plexus lesions classified?
Grade 1: neupraxia, transient loss of motor and sensory conduction with repair in <2 weeks
Grade 2: significant deficits ranging from 2 weeks to 1 year (avg 3 months)
Grade 3: complete loss for at least one year with no improvement over time
Why do females sustain so many non-contact ACL injuries?
Intrinsic factors: inc valgus at knee, physiologic rotation laxity, smaller ACL size, narrower notch, increased ligament laxity during parts of menstrual cycle
Extrinsic factors: shoes, training, dec strength, females fire quads before HS, females land from jump with straighter knees
How are contusions Tx?
ice, compression, AROM. Avoid heat, massage, US, and PROM because of inc risk of myositis ossificans
How are femoral neck stress fractures ID’d?
One key differentiating factor is limited IR, whereas ER is usually limited in trochanteric bursitis
What are three functional tests that can help determine readiness for return to sport following ACL reconstruction?
Single-leg hop for distance, single-leg vertical jump, cross-over hop test. An LSI (limb symmetry index) can be calculated for the three tests by dividing the involved side by the uninvolved side and multiplying by 100. An LSI 85% or better is ideal.
Discuss athletic tape vs bracing for joints.
Tape may inc proprioception and inc stability but loosens approx 20 min after start of athletic event. Bracing may be easier and reduce long term costs, as well as last longer.
