Test 1 Flashcards
Explain the physiology behind gate control theory and descending inhibition
Gate control theory refers to when A beta fibres that sense touch fire, they send signals faster compared to A delta and C fibres sensing extreme stimulus (pain) to the enkephalin interneuron, the enkephalin interneuron will send ascending touch signals to the brain and close the gate on A delta and C fibre signals, blocking them from ascending, temporarily decreasing pain sensation
Descending inhibition is when the PAG (midbrain) and raphe nucleus (medulla) send descending signals down to the enkephalin interneuron to close the gate on pain and block pain signals from ascending to the brain and stimulate release of beta endorphins to decrease pain sensation
Explain the specific variables you could manipulate, to influence the effectiveness of a static stretch. By which mechanisms could static stretching influence range of motion?
Static stretching increases ROM in the joint action opposite to the muscle that is being stretched by increasing the muscle extensibility through sarcomereogenesis (adding sarcomeres to make muscles longer) and through plastic CT deformation (permanently lengthen CT).
A higher frequency (more often, higher consistency), greater intensity between 75-100% of stretch tolerance, and a longer duration (short duration increases neurological tolerance to stretch but longer than 8+ minutes stimulates the creep effect, inducing sarcomereogensis and plastic CT deformation) causes more gains in static stretching effects on muscle extensibility.
Explain the physiological effects of foam rolling that have been reported in the literature. If you were to introduce foam rolling for a person with tight hamstrings, which variables
would you prescribe?
Foam rolling increases blood flow for up to 30 minutes and increases CNS pain tolerance threshold (harder to stimulate pain sensation).
I would prescribe 4 seconds of rolling per single direction (hamstrings are a bigger muscle), for 30-120 seconds per set, 3 sets.
What exercise could you prescribe as part of a simple cyclic motion approach to lumbar flexion/extension ROM?
I would prescribe cycling through cat for lumbar spinal flexion and cow for lumbar spinal extension.
A person can laterally flex their cervical spine only 20 degrees to the left. Explain how to use CRAC to improve their ROM. Be specific with your details.
In this case, the right lateral flexors are the muscle group limiting left lateral flexion. To increase right left lateral ROM, target the right lateral flexors which have high muscle tone. I would aask the client to do left lateral flexion until they feel a stretch on the right then ask the client to perform isometric right lateral flexion at 10-30% 1RM for 10 seconds and then relax the right lateral flexors. In the same left lateral flexion position, I would ask them to perform left lateral flexion isometrically at 10-30% 1RM for 10 seconds.
Summarize the two mechanisms that could explain why massage can be helpful for modifying pain. Briefly explain the two techniques commonly used and two factors you need to consider before you begin a massage.
Massage acts on the neuroendocrine effect to decrease SNS activation and anxiety by acting on the emotional dimension of pain. It also increases blood flow and CT extensibility acts on the somatic dimension of pain.
The two techniques of massage are effleurage (long gliding surface strokes) and petrissage (deep, focused, kneading).
Two factors to consider are if you consent to touch the person, know if they have any sensitive areas to avoid, cover uninvolved areas with a cloth, and use a hypoallergenic massage gel to limit friction against the skin.
Design a progression of three balance exercises for a person who has a lower extremity injury (aim for 5 days, 2 weeks, and 5 weeks post-injury). Modify at least three different
variables over this time frame, be specific about what the patient needs to do in each task and include any tools or equipment you want to use.
5 days: early repair phase, don’t want to put too much stress on a single limb to prevent the repairing tissue from tearing thus prescribe tandem walking with eyes open on a hard surface, can place a line of tape on the ground as a guide.
2 weeks: mid-repair phase, can bear more weight thus prescribe squatted toe tap with speed rings, place speed rings of different colour around the client standing on a foam mat, the client will balance on one foot in a slightly squatted position with eyes open and touch the ring with the colour that the therapist calls out with their other foot.
5 weeks: remodelling phase, the goal is to build up more strength thus prescribe squat holds for 5 seconds on a bosu ball (unstable surface) with the flat side up and eyes closed.
A patient has had chronic idiopathic neck pain for the past 10 months. Describe three symptoms they might experience, plus two that specifically suggest an issue of central
sensitization.
3 symptoms that they might experience are shoulder and upper back pain, headache, perceived stiffness in the suboccipitals, levator scapulae, and the upper trapezius, and limited ROM
2 symptoms suggesting central sensitization are allodynia and pain that does not match the mechanical stress
List four serious medical conditions associated with spine pain, and one red flag for each.
- fracture: trauma
- cauda equina syndrome: recent loss of bladder/bowel control
- malignancy: cancer
- infection: fever and chills
List five specific signs and symptoms suggestive of VBI. The vertebral artery may be vulnerable in cervical spine injury because of the path it travels—explain.
vertigo, loss of vision, confusion, headache, ataxia, paraesthesia
the vertebral artery is vulnerable during cervical spine injury since it runs through the foramen of the transverse processes therefore injurious forces to the cervical spine could be transferred to the vertebral artery
Describe the specific tissue-level structural changes associated with disc pathology and connect this to aggravating factors specific to disc issues.
degeneration of the annulus of the disc weakens the fibres thus they are unable to withstand rotational, flexion, or extension forces applied to it as well and the nucleus will dehydrate decreasing its capacity to withstand compressive forces, leading to a bulging of the disc as it spreads outside the perimeter of the body or a herniation which is a bulge focused on the posterolateral sides of the body which can compromise spinal nerves in the area
therefore disc pathologies are aggravated by weight bearing since the disc has a lower capacity to withstand compression, flexion since the disc will get pushed posteriorly which further compromises spinal nerves, lateral flexion since compresses one side and pushes the disc to the other side which will also compromise the spinal nerve on the other side, and valsava maneuvers which put compressive pressures on the disc
List the common reasons for SI joint dysfunction and explain mechanically why the aggravating factors are aggravating.
pregnancy will open up the SI joint to make space for fetus, MVA and trauma damage joint, osteoarthritic changes
the role of the SI joint is to transfer the force from the ipsilateral leg to the spine and will be aggravated when it does its role during asymmetrical stances and movements and lower extremity loading which transfer greater forces to the SI joint
Describe two signs or symptoms that disc pathology and ZA joint arthropathy could have in common, and two differences.
disc pathology and ZA joint arthropathy are both aggravated by weight-bearing/compressive forces and rotational forces
disc pathology is aggravated by flexion while ZA joint arthropathy is relieved by flexion and disc pathology presents central pain while ZA joint pain is unilateral
For each of the muscle group weaknesses, identify the spinal nerve most likely to be impaired.
C5 shoulder abduction
C6 elbow flexion, wrist extension
C7 elbow extension, wrist flexion
C8 finger flexion
T1 finger and thumb abduction
L2 hip flexion
L3 knee extension
L4 ankle dorsiflexion
L5 hallux extension
S1 ankle plantarflexion
S2 knee flexion
List three resistance exercises you would prescribe for the Jesse case study and provide the rationale for your selections.
dead bug for strengthening abdominal flexors to reduce excessive lumbar lordosis (extension) while training abdominal bracing for occupational functional tasks such as lifting/carrying/lowering items
glute bridges to strengthen hip extensors to reduce anterior tilt by increasing posterior tilt
right side plank to strengthen right lateral flexors to increase right lateral flexion
List three things you would put in Sylvia’s program, to address ROM. Provide the rationale for your selections and choose a different technique or approach for each.
simple cyclic motion with cat/cow with emphasis on cow to promote extension for flattened lumbar lordosis
static piriformis/figure four stretch to decrease stiffness in left hip external rotators
CRAC reduces muscle tone in the right lateral flexors to promote greater left lateral flexion
ADL are important functional skills to address. List two you expect to be difficult for a patient with WAD, and two for someone with a disc pathology.
WAD: driving and navigating on foot (both require neck rotation to look at surroundings)
disc pathology: getting dressed (require flexion) and cleaning (requires flexion and lateral flexion to maneuver around house and pick items up)
Explain the whiplash mechanism. Identify the three conditions you need to rule out before you can safely prescribe a program.
whiplash occurs when a force is applied to the body and the head and neck experience an rapid acceleration force as the neck and head tissues absorb the force to decelerate the head, leading to extreme neck stiffness and pain
rule out concussion, cervical disc pathology, and vertebral fracture
List three hip muscle groups (or specific muscles) commonly addressed in a spine rehab program, either for resistance or range of motion. List two muscle groups (or specific muscles) you would need to address in your program for a person with neck pain and a protracted scapula.
hip flexors (iliopsoas) tightness can cause excessive anterior pelvic tilt, weak hip external rotators (gemellus, piriformis, gluteus maximus) cannot stabilize the pelvis well, tight hip abductors (gluteus medius, tensor fascia latae) can cause ipsilateral lateral flexion
cervical lateral spine flexors tightness can cause pain and weak levator scapulae (function as retractors) lead to excessive protraction
Create a question you think should be on this test.
what is the physiological mechanism for simple cyclic motion? how would you use simple cyclic motion to improve knee flexion for a person who is recovering from PCL reconstruction surgery?
