Study Guide Q's: The Athlete

Question 1

What is EMOM?

Answer 1

Every minute on the minute

• Popularized by Crossfit
• Example: 10’ EMOM
  
  • 5 med ball slams
  • 5 squat jumps
• Can utilize rEMOM (rehab every minute on the minute)

Question 2

What is AMRAP?

Answer 2

As many rounds/reps as possible

• Can be applied as a single exercise, used during the session, or used as a finisher
• Example
  
  • As many reps of bent over rows as possible in 1 minute
  • 10 minutes: AMRAP of 10 reps bent over rows, 10 back squats, 10 pushups, and 10 kettlebell swings

Question 3

What is tabatta?

Answer 3

• Designed and published by Izumi Tabata (Japanese speed skating coach)
• Maximum effort exertion for a minimal amount of time
• Traditionally 2:1 ratio of workout to rest time
• Example
  
  • 20” max effort, 10” rest for 7-8 rounds

Question 4

• Powerlifting (squat, bench press, deadlift)- focus

Answer 4

• General focus: most beneficial for developing muscle strength
• High force, low velocity
• Can improve muscular strength and decrease severity and independent of sports injuries

Question 5

Sumo squat indications (3)

Answer 5

• Increases activation of the adductors
• Increases core activation
• Great exercise for tactile athletes due to the weight they routinely lift

Question 6

split squat indications (4)

Answer 6

• Lower body strength
• Muscle hypertrophy
• Balance
• Stability

A must have for post-op ACL patients

Question 7

muscles involved in a front squat (8)

Answer 7

• Glute max
• Hamstrings (Semimembranosus, Semitendinosus, Biceps femoris)
• Quads (Vastus lateralis, Vastus intermedius, Vastus medialis, Rectus femoris)

Question 8

Muscles involved in a back squat (8)

Answer 8

1. Glute max
2. Semimembranosus
3. Semitendinosus
4. Biceps femoris
5. Vastus lateralis
6. Vastus intermedius
7. Vastus medialis
8. Rectus femoris

ie. same as front squat, glute max, quads, and hamstrings

Question 9

points of performance for a squat (7)

Answer 9

1. Stance at shoulder width with feet positioned 0-10 degrees toed out
2. N spine maintained throughout movement
3. Weight balanced at midfoot
4. Knees and hips release at the same time (squat straight down)
5. Hip crease is below the top of the knee
6. Knees track in line with the toes
7. N head position, gaze slightly upward

Question 10

squat mobility assessment looks at which areas? (6)

Answer 10

1. Ankle mobility
2. Hip flexion
3. Knee flexion
4. Hip scour
5. Hip rotation
6. Craig’s Test (femoral anteversion or forward torsion of femoral neck)

Question 11

ankle mobility assessment

Answer 11

• Dorsiflexion
  
  • CKC assessment
  • Foot placed 4” from the wall (1 hand width)
  • Heel remains in contact with the floor
  • Drive knee forward over the toe
  • Full ROM should be able to contact the wall without heel lift
• Lateral tibial glide
  
  • Stabilize midfoot in neutral
  • Actively drive knee out laterally to assess frontal plane motion
  • 20-30 degrees beyond vertical is optimal

Question 12

hip flexion and knee flexion non weight bearing assessment for squat

Answer 12

• Nonweightbearing assessment
  
  • Lay supine and pull the shins to the thigh and knees to chest
  • Monitor to limit pelvic motion
  • Athlete should be able to clear 120 degrees of hip flexion without pelvic motion and shins should contact the back of the thighs
  • If unable, retest hip flexion without knee flexion included

Question 13

hip scour assessment for squatting

Answer 13

• Supine assessment
  
  • Maintaining pelvic position, move femur through straight plane available flexion
  • Assess varying angles of flexion and ER/abd
  • Find position of least resistance and comfort for the athlete
    
    • This may be the ideal squat position

Question 14

hip rotation assessment for squatting

Answer 14

• Supine and prone assessment
  
  • Lay supine and hold the femur in straight 90 degrees of flexion
    
    • Assess available IR (35 degrees)
    • Assess available ER (45 degrees)
  • Lay prone and hold femur in 0 degrees of flexion/add
    
    • Assess available ER and IR

Question 15

craig’s test for squat mobility

• what do the degrees of tibial angle from vertical mean?

Answer 15

• Prone assessment
  
  • Femur in 9 degrees flexion/add
  • Palpate greater trochanter of the femur
  • ER and IR of the hip to expose the most lateral aspect of the greater trochanter
  • Assess the tibial angle from vertical
    
    • 8-15 degrees from N is normal
    • >15 degrees indicates retroverted hip
    • <8 degrees indicates anteverted hip

Question 16

little leaguer’s elbow

• definition
• 4 included injuries
• less likely injuries (3)

Answer 16

• Definition: term commonly used to describe pain and injuries to the medial elbow during overhead throwing
• Includes:
  
  • Epicondyle apophysitis
  • Epicondyle avulsion fractures
  • Growth plate disturbances
  • Ulnar collateral ligament injuries

Less likely injuries:

• MCL injury
• Common flexor tendon pathology
• Ulnar nerve injury

Question 17

little leaguer’s elbow causes

Answer 17

high levels of torque generated during the lack cocking phase and early acceleration phases

Question 18

Medial epicondyle apophysitis S&S

Answer 18

• Medial elbow pain
• Medial elbow swelling
• Decreased throwing distance
• Point tender over medial epicondyle
• Medial epicondyle hypertrophy

Question 19

treatment for Medial epicondyle apophysitis

Answer 19

• 4-6 weeks of rest
• Immobilization not commonly required
• Avoidance of aggravating activities (e.g. pitching, throwing, etc.)
• Correction of biomechanics
• ORIF if avulsion injury is present

Question 20

Panners disease (lateral elbow pain)

• definition
• popuation affected
• which arm does it usually happen to?

Answer 20

• Definition: osteochondrosis dissecans of the capitellum; condition in which the bone underneath the cartilage of a joint dies due to the lack of blood flow; the bone and cartilage can break loose causing pain and limiting motion
• Population: children under 10 years old
• Affects: usually dominant arm

Question 21

Panner’s disease history

Answer 21

History

• Insidious onset
• Diffuse lateral elbow pain
• Can also be due to repetitive trauma
• Can have “locking” in the elbow

Other differential diagnosis

• Traumatic fracture
• Avulsion fracture

Question 22

little leaguer’s shoulder

• population
• cause

Answer 22

Population: usually occurs in adolescents who are between 11-14

Causes:

• high levels of torque generated during the lack cocking phase and early acceleration phases
• Distraction and torsion forces
• During ball release, a distracting force acts across the physis (may reach up to ½ of body weight)
• Throwing also causes significant rotational stresses at proximal humerus

Question 23

Little leaguer’s shoulder conditions (5) and pathophys (2)

Answer 23

• Conditions included
  
  • Osteochondritis
  • Epiphysiolysis of the proximal humeral epiphysis
  • Physeal widening of the proximal humerus
  • Avulsion fracture
  • Fracture to the glenoid rim
• Pathophysiology
  
  • Fatigue fracture
  • Localized inflammatory reaction

Question 24

Little Leaguer’s Shoulder S&S and treatment

• S&S = 2
• Treatment = 3

Answer 24

• S&S
  
  • Decreased speed/accuracy with pitches
  • Shoulder pain
• Treatment
  
  • Cessation of throwing until patient has pain free ROM and normal radiographs
  • Pitching mechanics analysis
  • Patient can then begin gradual return to throwing and increase based on return to throwing protocol

Question 25

how long does an interval throwing program last?

Answer 25

phase 1 = 4-6 weeks

phase 2 = undetermined length

Question 26

What happens if the patient has pain after one of the sessions? Will they still progress? (interval throwing program article)

Answer 26

• Athletes may experience
  
  • Soreness
  • Dull, diffuse aching sensation in muscles and tendons
• If athletes experience sharp pain, should be instructed to STOP all sport activity until pain ceases
• If pain persists, the athlete needs to undergo physical assessment

Question 27

FIFA 11+ (big picture, what is it, why is it useful?)

Answer 27

Notes from slides:

• 20 minute comprehensive warm-up program designed to reduce injuries among soccer players ages 14 and up.
• 3 separate components.

1. Running exercises (8 mins)
2. Plyometric and balance exercises (10 mins)
3. Running exercises (2 mins) to conclude the warm up and optimally prepare the athlete for athletic participation.

Notes from Google:

“11+ is a complete warm-up program to reduce injuries among male and female football players aged 14 years and older. Teams that performed 11+ at least twice a week had 30 – 50% less injured players. The program should be performed, as a standard warm-up, at the start of each training session at least twice a week and takes around 20 minutes to complete. Prior to matches only the running exercises (parts 1 and 3) should or may be performed.”

Question 28

Return to sport after ACL Reconstruction (what Criteria do patients have to meet)

Answer 28

• Criteria for return to sport (list #1)
  
  • Knee flexion ROM >95% of the uninjured side
  • Full active knee extension
  • Minimal to no pain
  • Minimal to no swelling
  • Strength of at least 85% of quad and HS compared to the C/L side
  • Hop tests >70% of the uninjured side
• Criteria for return to sport (list #2)
  
  • 12 weeks post op (minimum)
  • 90% or greater quad strength
  • 90% or greater on all hop tests
  • 90% or greater on KOS-ADL
  • 90% or greater on global rating score of knee function

Question 29

Meniscus Repair Rehab Protocol (What are the major restrictions early?)

Answer 29

• ACL with meniscus repair
  
  • Period of NWB based on MD and location of the tear: 2-4 weeks
  • No WBing squats >45 degrees for 4 weeks
  • After 4 weeks, CKC squats progressed past 45 degrees to 90 degrees
  • After 8 weeks, no restrictions 🡪 resume normal ACL protocol

Question 30

Adolescent 1 RM (PowerPoint Athlete #1: slide with this title: Resistance Training among Youth)

Answer 30

• Positive association between motor performance and mean intensity (1 rep max)
• Resistance training program most effective in eliciting gains among youth:
  
  • 2-3 sets
  • 8-15 reps
  • Loads between 60-80% of 1RM on 6-8 exercises
• Utilize age appropriate, qualified, and enthusiastic instruction

Question 31

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

Hyaluronic acid

Answer 31

• Used primarily for knee OA
• Similar to the substance that occurs naturally in the joints
• Acts like a shock absorber
• One injection or a series of injections
• Mixed results, but 30% of patients become pain-free

Question 33

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

PRP

Answer 33

• Contains a minimum of 200K platelets/µL
• Contains over 300 different molecules, including platelets, plasma, leukocytes, and erythrocytes
• Effects
  
  • Anti-inflammatory effects
  • Stimulates chondrocytes
  • Synovial proliferation
  • Enhanced tissue regeneration
• Evidence
  
  • Could possibly accelerate graft healing (ACL, MCL, rotator cuff, etc.)
  • Autologous PRP with rehab leads to shortened return to sport (up to 2 weeks) compared to rehab alone for Grade II muscle injury
  • Limited evidence for PRP alone for focal articular cartilage defects
  • Variable outcomes with the use of PRP for chronic tendinopathy

Question 34

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

stem cell

Answer 34

• Obtained from bone marrow (usually in the hip/pelvis)
• Once taken from your hip/pelvis, they are spun to separate the stem cells and form a concentrate, and then they are injected at the site of the injury

Question 35

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

Amniotic fluid injections

Answer 35

• Contains: hyaluronic acid, electrolytes, growth factors, amino acids, proteins, enzymes, hormone
• Less invasive and expensive option

Question 36

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

Prolotherapy

Answer 36

• Local injection that usually includes substances such as dextrose/saline
• Used in inflammatory conditions

Question 37

Regenerative Injection options (stem cells vs PRP vs prolotherapy, what are they, why are they helpful or not helpful to patients).

Lipogems

Answer 37

• Taking fat cells from the abdomen to be used to treat pain, arthritis, and swelling
• Used mainly in the knee joint, but has been used in the shoulder
• Fat is loaded with reparative cells that can assist with joints, ligaments, tendons, and muscles