Spring ICP Exam 1 Flashcards
1
Q
Prospective study on Eccentric Hamstring Strength and BFIh Fascicle length demonstrated that athletes with a shorter BFIH, were how much times more likely to sustain a HSI than those with longer fascicle lengths?
A
4.1 times
2
Q
Athletes with lower eccentric hamstring strength were at how much greater risk of a HSI than stronger players?
A
4.4 times
3
Q
What is the progression for eccentric knee flexor exercises?
A
Bilateral Slider -> Unilateral Slider/Nordic Hamstring -> Unilateral Slider + Load/Nordic Hamstring + Load
4
Q
What is the progression for long hip extensor exercises?
A
Asking Diver/Bilateral 45 degrees hip extension -> Asking Diver + Load/Unilateral 45 degrees hip extension/Bilateral hamstring bridge -> Romanian Deadlift + Load/45 degrees hip extension + Load/Unilateral hamstring bridge
5
Q
What is the progression for short hip extensor exercises?
A
Bilateral hip thrust -> Unilateral hip thrust -> Unilateral hip thrust + speed/Bilateral hip thrust + load
6
Q
What is the progression requirements for the Hip extensor and eccentric knee flexor exercises?
A
When full ROM completed with pain rated less than or equal to 4/10
7
Q
What is the percentage associated with Stage 1 of a progressive running protocol
A
Stage 1 = 0 - 50% of maximal velocity
Low -> Medium -> Decel back to Low.
8
Q
What is the percentage associated with Stage 2 of a progressive running protocol
A
Stage 2 = 50 - 80% of maximal velocity
Low aceler to medium -> Med/High -> Decel back to Low
9
Q
What is the percentage associated with Stage 3 of a progressive running protocol?
A
Stage 3 = 80 - 100% of maximal velocity
Low aceler to High -> High -> Decel back to low
10
Q
Askling Protocol
A
Hamstring Rehab Protocol
Exercise 1 - Lengthening
Exercise 2 - Strength and stabilization
Exercise 3 - Eccentric Strengthening
11
Q
Pain Threshold Protocol
A
Protocol used for RTP
Criteria:
1. No TTP (tender to palpation) pain
2. No pain with active knee extension and SLR within 90% of contralateral limb
3. No pain during maximal effort isometric @ 0/0 and 90/90 degrees of hip/knee flexion
No pain or apprehension during spring @ 100% max effort
12
Q
Pincer Lesion (FAI)
A
Extra bone extends out over the normal rim of the acetabulum. Labrum can be crushed under the rim of the acetabulum
13
Q
Cam Lesion (FAI)
A
Femoral head is not round and cannot rotate smoothly inside the acetabulum. Bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum
14
Q
Combined Lesion (FAI)
A
Both a pincer and cam lesion are present
15
Q
FAI syndrome
A
Motion-related clinical disorder of the hip with a triad of symptoms, clinical signs and imaging findings. Represents symptomatic premature contact between the proximal femur and the acetabulum.
16
Q
Primary symptom of FAI syndrome
A
Motion-related or position-related pain in the hip or groin. Pain may also be felt in the back, buttock or thigh. Pt may also describe clicking, catching, locking, stiffness, restricted ROM, or giving way.
17
Q
When determining a surgeon for a Hip procedure, what criteria should be accounted for?
A
Number of surgeries. training, expertise
18
Q
Phase 1 Characteristics
A
Weight-Bearing as tolerated (WBAT) with crutches for 3 weeks (limit to 20 pds with flat floot)
See ROM restrictions
Avoid Open-Kinetic Chain hip flexor activation + no SLRs in flexion
19
Q
Phase 2 Characteristics
A
Gait Progression
Soft Tissue Work
Begin mobs at Week 5 (posterior and inferior)
WB exercises and strengthening
20
Q
Phase 3 Characteristics
A
Return to function phase
More WB functional strengthening
Avoid WB rotation until Week 10 and agility until Week 16
21
Q
Phase 4 Characteristics
A
Return to sport phase
Running program, agility, plyos initiated and used here
Return to Sport within 6-8 months
22
Q
Problem Solving Approach
A
7 step process
- Understand patient’s participation restrictions and activity limitations
- Establish movement dysfunctions (global) - determine overuse/non-acute
- Establish impairments, tissues and joints involved, (local) identify diffs
- Establish stage of healing, irritability of tissues, problem lists
- Establish goals and plan -> pick tools in toolbox
- Establish baseline measures
- Treat and Reassess
23
Q
The body is a natural cheater, what does this mean?
A
It will sacrifice quality for quantity
24
Q
What does Sahrmann argue when it comes to Biomechanical muscle imbalance
A
Repeated movements and sustained postures can lead to adaptations in muscle length, strength, and stiffness
25
What do joints develop in the case of biomechanical muscle imbalance
Directional Preference
26
Changes in muscle length does what when it comes to biomechanical muscle imbalance?
Affects length-tension curve leading to stretch weakness and active insufficiency
27
What does Janda believe about Neurological muscle imbalance?
CNS and musculoskeletal system are interdependent
28
The muscular system is at a functional crossroads, True or False?
True
29
Characteristic patterns of muscle tightness and weakness lead to what in neurological muscle imbalance?
Pain and pathology of peripheral joints
30
Note to Kadin for Review
Look at Slide 9 of the Movement and Function Quality powerpoint because I can't put the pic in the notecards
31
Janda's Chronic Musculoskeletal Pain Cycle
Pain and inflammation -> Muscle imbalances -> Impaired movement patterns and posture -> Faulty motor programming -> Altered joint forces and proprioception -> Joint changes -> Repeat
32
Stable Joints of the body
Foot, Knee, Low Back, Scapula, and Elbow
33
Mobile Joints of the body
Ankle, Hips, T-spine, Neck, Shoulder, and Wrist
34
Mobility dysfunction can be broken down to 2 unique subcategories:
Tissue Extensibility Dysfunction and Joint Mobility Dysfunction
35
Tissue Extensibility Dysfunction
Involves tissues that are extraarticular.
36
Joint Mobility Dysfunction
Involved structures that are articular or intraarticular
37
Active or Passive Muscle Insufficiency
Tissue Extensibility Dysfunction
38
Osteoarthritis
Joint Mobility Dysfunction
39
Neural Tension
Tissue Extensibility Dysfunction
40
Subluxation
Joint Mobility Dysfunction
41
Fascial tension
Tissue Extensibility Dysfunction
42
Adhesive capsulitis
Joint Mobility Dysfunction
43
Muscle Shortening
Tissue Extensibility Dysfunction
44
Intraarticular loose bodies
Joint Mobility Dysfunction
45
Scarring
Tissue Extensibility Dysfunction
46
Fibrosis
Tissue Extensibility Dysfunction
47
Order of Evaluation
Dynamic to Static and Global to Local
48
Dynamic to Static Evaluation
Functional Movement Assessment
Gait
Static Posture Assessment
49
Global to Local Evaluation
Use Dynamic to Static assessments to identify joint specific assessments
Length/Tension/Strength of Tissues
Joint Motion and end feels of joints
50
Janda's Approach
Normalize the Periphery
Restore Muscle balance
Increase afferent input to facilitate reflexive stabilization
Increase endurance in coordinated movement patterns
51
Athletes with an FMS composite score at 14 or below combined with a self-reported past history were at what risk of injury?
15 times increased risk
52
Before starting an FMS, what are steps to complete?
Measure tibia length, floor to top center of tib turberosity
Measure the hand length, distance from the distal wrist crease to the tip of the longest digit
53
How to score the FMS
Completed perfectly as verbally described, score of 3
Completed with compensation(s), score of 2
Unable to perform the pattern as described, score of 1
If there is pain with the movement pattern, score of 0
54
FMS steps
Squatting -> Stepping -> Lunging -> Reaching -> Leg Raising -> Push-Up -> Rotary Stability
55
Limitations with FMS
Not developed to be predictive (Causation versus association)
Limitations with reliability
More specific than sensitive (Better at ruling in than out)
56
Step Down Task
Have the patient step down from a 20 cm step and lightly touch the heel to the ground. Maneuver is repeated for 5 reps
57
Pt positioning for Step Down Task
Pt stands SL support with the hands on the waist, the knee straight and the foot positioned close to the edge of the step. Pt bends the tested knee until the contralateral leg gently contacts the floor and then re-extends the knee to the starting position.
58
Heel Raise
Testing for Forefoot Control
Normal - Some Varus
Abnormal - Excessive varus
59
Articular Chain Reactions
Biomechanical interactions of different joints
60
Postural Chain Reactions
Structural and Functional interactions of different joints
61
Brugger's Cogwheel
Placeholder answer
62
Notable keystone postural positions
Pelvis, Ribs, Scapula
63
Muscles that have stabilizing functions (postural/tonic) will do what when stressed
Shorten
64
Active muscles will do what when stressed
Will not shorten but will become weak
65
Upper Crossed Syndrome
Inhibited Muscles: Deep Cervical flexors, Lower neck flexors, Middle and Lower trap, Serratus Ant, Rhomboids
Facilitated Muscles: SCM, Pectoralis, Upper Trap, Levator Scap, Suboccipitals
66
Lower Crossed Syndrome
Inhibited Muscles: Rectus Abdominals, Gluteus Min/Med/Max
Facilitated Muscles: Rectus Femoris/iliopsoas, Hip Adductors, Hamstrings, TFL, Piriformis, Thoracolumbar Extensors, Quad Lumborum
67
What leads to subtalar pronation
Tibial IR leading to a flattening of the arch
68
What leads to subtalar supination?
Tibial ER leading to a raising of the arch
69
Leg Length Discrepancy Compensation
Pronation/Supination, Knee Ext., ER of hip, Lateral curve of the spine
70
What to lengthen and strengthen for UCS
Lengthen: Pec Major, Upper Trap, Lev Scap, SCM
Strengthen: Deep Cervical Flexors, Scap Stabilizers (Rhomboids, Traps, Serratus Anterior)
71
What are the two strength assessments for UCS
Cervical Flexion Test and DNS test for scapular stabilization
72
What to Lengthen and Strengthen for LCS
Lengthen: Hip Flexors (Thomas Test), Hamstrings, Hip Adductors, QL
Strengthen: Abdominal Muscles, Glute Max and Min
73
Low Back Pain Characteristics
Prevalent concern across age groups and activity levels. Finding the structural cause is difficult, Testing is inconsistent, Presence of other factors such as fear avoidance and depression make exam difficult
74
Up to how many individuals experience one episode of LBP?
80%
65% of patients still experience LBP one year after initial onset
10-15% of athletic injuries occur to lower back
75
The lumbar spine forms what kind of curve anteriorly?
Convex curve (Lordosis)
76
Lumbar lordosis is good at what and needs what?
Structurally strong for dissipating forces
Needs stability
77
How many Lumbar, fused sacral, and fused coccygeal vertebrae are there?
5,5,4
78
The sacrum articulates with what? What does this form?
Articulates with the ilium, forms the sacroiliac joint
79
What are the 4 kinds of ligaments responsible for articulation with sacrum?
Iliolumbar ligaments, Posterior sacroiliac ligaments, Sacrospinous ligaments, and Sacrotuberous ligaments
80
What do the multifidi do?
Contract bilaterally to cause extension
Contract unilaterally to cause ipsilateral side flexion and contralateral rotation
81
Inner Core Muscles
Local Muscles, Deep Muscles, Stabilizers, Trunk Stabilizers
82
Outer Core Muscles
Global muscles, superficial muscles, movers, trunk movers
83
Outer Core of the Trunk
Erector Spinae (Iliocostalis, longissimus, spinalis), Rectus abdominis, External oblique, Gluteal muscles, Thoracolumbar fascia
84
Inner core of the trunk
Transverse abdominis, Diaphragm, Pelvic Floor Muscles, Internal Oblique, Multifidus
85
Lumbopelvic-Hip Stability
Stable pelvis serves as a platform for lumbopelvic-hip stability and extremity performance
86
When is the pelvis stable?
When pelvis is in pelvic neutral
87
Abdominal Hollowing
Abdomen drawn in to facilitate transverse abdominis and multifidus. Does not activate core muscles.
88
Abdominal Bracing
Abdominal and back muscles activate to co-contract. Activates outer core muscles.
89
While both abdominal bracing and hollowing are used during core exercises, abdominal bracing provides what better than hollowing?
Provides greater pelvic and spinal stability. Progress from hollowing to bracing
90
Core Activation and Stabilization Steps
Find and Maintain pelvic neutral
Abdominal hollowing exercises to recruit transverse abdominis
Activation exercises to recruit multifidus
Abdominal bracing to activate local and global muscles
- Engage abdominal bracing while performing simple ADLs and sport/work related activities
91
The facet joint assists the vertebral body in bearing how much of the compressive loads, especially during what form of motion
30%, hyperextension
92
The facet joints with the intervertebral discs aid the spinal column to resist what with about how much contribution from the facet joints
Shear and rotational torsion, 40%
93
Fryette's Laws
Created by Harrison Fryette and describes spinal motion
94
Fryette's Laws 1 and 2 pertain to
Thoracic and Lumbar Spine movement
95
Fryette's 3rd Law pertains to
The entire spine
96
Fryette's Law 1
When the spine is in neutral, sidebending to one side will be accompanied by horizontal abduction to the OPPOSITE side
97
Fryette's Law 2
When the spine is in a flexed/extended position (non-neutral) sidebending to one side will be accompanied by rotation to the SAME side
98
Fryette's Law 3
When motion is introduced in one plane, it will modify (reduce) motion in the other two planes.
Frontal - Sidebending
Sagittal - Flex/Ext
Transverse - Rotation
99
Pelvis
2 bones, sacrum, and 3 joints (R/L SI and Pubic symphysis)
100
How many muscles attach to the pelvis?
45
101
Form Closure
Pelvic ring stability provided by joint shape and structure
Reduced with ligament or bone injury/closure
102
Force Closure
Stability provided by dynamic forces on pelvis
Reduced with muscle (core) injury
103
Neuromotor control
Proper activation and sequential recruitment of muscles
Dysfunctional recruitment following injury
104
Components of the Lumbopelvic-Hip Complex
Pelvis, Sacrum, Lumbar Vertebrae, Hip Joints
105
Nutation
Anterior movement of the sacrum base (forward and downward). Happens with posterior pelvic tilt (sacrum takes a drink). Iliac crests move closer together. Isch Tubes move father apart.
106
Counternutation
Posterior movement of the sacrum base (backward and upward). Happens with anterior pelvic tilt (sacrum leans back to take a nap). Iliac crests move farther apart. Isch tubes move closer together.
107
During Lumbar flexion
Sacrum counternutates. Isch Tubes move closer together. Iliac Crests move apart.
108
During Lumbar extension
Sacrum nutates. Isch tubes move apart. Iliac crests move closer together.
109
Neutral to forward flexion:
During the first degrees of the flexion, the lumbar spine flexes until lumbar lordosis is neutral then the pelvis starts to rotate anteriorly.
Total Motion:
Lumbar Spine = 45 degrees
Pelvis = 60 degrees
110
Forward flexion to neutral:
When returning to extension, the pelvis will rotate posteriorly first, then the lumbar extends to normal lordotic curve
111
Pelvis rotates on a diagonal axis:
If one hip moves into flexion while the other maintains an extended position, the sacral base on the flexed-hip side rotates posteriorly (counternutation) while the extended-leg sacral base rotates anteriorly (nutation)
112
Stabilization for Sacroiliac Joint Motion
Important in relieving pain and in transmitting forces
113
Dysfunction for Sacroiliac Joint Motion
A lack of stabilization, cause of back and pelvic pain
114
Sacroiliac dysfunction results from one of two conditions
SI dysfunction or IS dysfunction
115
SI dysfunction
Sacrum motion restricted on the ilium
116
IS dysfunction
ilium motion restricted on the sacrum
117
Regional mechanical LBP
Non-specific mechanical LBP, Facet dysfunction, or deformity leading to spondy or spondylolisthesis. More than 90% of all cases
118
Initial onset of LBP or subsequent acute episodes create a
One-sided, one level atrophy of the multifidus muscle
119
Facet Joint Pathology may involve?
Subluxation/Dislocation of the facet (rare)
Facet Joint syndrome
Degeneration of the facet
Exact patho is unclear
120
Facet Joint Syndrome presents as?
Pain, Spasm, Swelling, Altered posture, decreased ROM
121
Facet Joint Syndrome management
Modalities, Manual therapies to restore normal motion, Pain control (injections), aggressive rehab
122
Specific Concerns of Facet Joint Syndrome
Avoid painful motions early
Alleviate spasm if present
Increase mobility of hypomobile segment
123
Facet Joint OA is also known as?
DJD - Degenerative Joint Disease
124
Pathology of Facet Joint OA
Localized breakdown of one or more of the synovial joints of the spine.
ALWAYS ASK AGE OF PATIENT
125
Spondylolysis
Present in 4-6% of gen pop.
Unilateral lesion (fx) of the pars interarticularis
Need multiple pain film views to diagnose
"Scotty dog has a collar"
126
Spondy Treatment
Early stage = high chance of healing
Later stage = lower rate of healing
Osseous healing is not necessary to achieve good clinical outcome with full RTP.
127
Spondy Treatment in athlete
No sig diff in brace or rest
No sig diff in rigid or soft brace
No sig diff in 3 vs 6 months of rest
Relative rest is essential in treatment and should continue for at least 3 months after resolution of symptoms in earlier-stage lesions with potential for healing
128
Spondylolisthesis
Forward translation of one vertebral body on another
Requires the bilateral fracture or non-union of the R and L pars interarticularis
129
Most common location of Spondylolisthesis
L5-S1 = Most common site
L4-5 = 2nd most common and so on, up the spine
130
5 types of Spondylolisthesis
Isthmic, Dysplastic, Degenerative, Pathologic, Traumatic
131
Isthmic Spondylolisthesis
Primary lesion is in the pars interarticularis
Fatigue fracture of the pars (pre-teen gymnast)
132
Dysplastic Spondylolisthesis
Congenital abnormality at the lumbosacral junction due to a deficiency of the upper sacrum OR dysplasia of the posterior arch of L5
133
Degenerative Spondylolisthesis
Degenerative arthritis of the facet joints associated with long-standing intersegmental instability
Much more common in females and more common at the L4-5 level than L5-S1 level
134
Pathologic Spondylolisthesis
Due to metabolic bone disease, tumor, or after surgery
135
Meyerding Scale for Grading of Spondylolisthesis Severity
Grade 1-5
1: Less than 25%
2: 25-50%
3: 50-75%
4: 75-100%
5: Greater than 100%
136
Mechanical LBP with neurogenic leg pain
Spinal Stenosis, Intervertebral disc herniation, Spinal stenosis associated with dengen spondylolisthesis
7-10% of all cases
137
Lumbar stenosis
Symptomatic narrowing of the spinal canal or intervertebral foramen in the lumbosacral region
Produces either unilateral (nerve root) or bilateral (spinal cord) symptoms
138
4 types of disc lesions
1: Normal
2: Disk bulge
3: Foraminal disk herniation
4: Extruded disk fragment
139
Non-mechanical spine disorders
Neoplasia -> Metastases, Lymphoid tumors, spinal cord tumors
Infection -> infective spondylitis, epidural abscess, endocarditis, herpes zoster, Lyme disease
Other spondyarthritides
-> ankylosing spondylitis
Less than 1% of all cases
140
Treatments for Acute LBP
Manipulation/Manual Therapy
Stabilization exercises
Motion and Activity (NOT REST)
Medication (Pain = )
141
Clinical Prediction Rule
Pts with 4/5 criteria increased the probability of success from 45% to 95%
Criteria : Duration of more than 16 days of LBP, No symptoms distal to knee, Higher than 19 on FABQ, Greater or equal to 1 hypomobile segment in the lumbar spine, greater or equal to 1 hip with greater than 35 degrees of IR
142
Stabilization Exercises
Core stability: Facilitation of deep muscles of the spine. There are usually neuromuscular deficits in these muscles from LBP. Morphologic changes can be present. Stabilization programs usually focus on low-loads and high reps.
143
Specific Concerns of LBP
Centralize pt pain
Improve posture, body mechanics, and general fitness
Teach pt to move into and maintain pelvic neutral position
Restore muscle balance, flexibility, endurance, and strength of the trunk, pelvis, and hip muscles
Relieve pain and muscle spasm
144
3 parts of Local Mobility
Neural mobility
Joint mobility
Soft Tissue mobility
145
3 parts of Global Stability
Activation
Acquisition
Assimilation
