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Therapeutic Exercise > Test 1 Review > Flashcards

Test 1 Review Flashcards

1
Q

Therapeutic Exercise

A

The systematic, planned performance of body movements, postures, or physical activities intended to prevent injuries, improve/enhance/restore physical function, prevent or reduce health risk factors and optimize overall health.

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2
Q

Effect of Immobilization on Muscle

A

-Decrease in muscle fiber diameter
-Decrease in number of myofibrils
-Decrease in contractile ability due to decrease in motor unit recruitment
-Increase in fibrous and fatty tissue in the muscle
=Result: Atrophy/weakness after 2 weeks of Immobilization

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3
Q

Flexibility

A

The ability to move a single or multiple joints smoothly and easily through unrestricted PAIN FREE ROM

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4
Q

Elasticity

A

Ability to return to normal length after elongation

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5
Q

Extensibility

A
  • Ability of muscle or tendon to take on a new length

- Occurs with repeated stretching for >30 seconds

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6
Q

Plasticity/Plastic Range

A

Tendency of soft tissue to assume a new and greater length after a stretch force removed

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7
Q

Failure

A

Tearing of tissue

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8
Q

Toe Region

A

Collagen wavy: where most functional activities occur

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9
Q

Elastic Region

A

Fibers stretch: complete recovery from deformation and tissue returns to its original size and shape when the stress is released = NORMAL ROM

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10
Q

Yield Point

A

Stress loads CT beyond elastic range and into plastic range

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11
Q

Flexibility Facts

A
  • Individually variable
  • Join-Specific
  • Decreases with age
  • Can be modified through training
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12
Q

Muscle Spindle

A
  • Stretch Receptor
  • located in parallel to extrafusal m. fibers(m.belly)
  • Sensitive to changes in length and velocity
  • Quick stretch=contraction(protection)
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13
Q

Golgi Tendon Organ

A
  • Detects tension and sends messages to CNS for REFLEXIVE RELAXATION
  • located near musculotendinous junctions(PA and DA) of extrafusal m. fibers
  • Stretch >8seconds allows GTO impulses to override the muscle spindle= relaxation
  • Autogenic inhibition
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14
Q

Duration of Stretch

A

Cipriani et al. stated 2x30 most beneficial

-2 min for increased flexibility

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15
Q

PNF: Hold-Relax

A
  1. Muscle in light stretch position
  2. Isometric contraction of tight muscle at end range(stim Gto = inhibition of agonist, AKA autogenic inhibition)
  3. Hold for 8 seconds
  4. Relaxation of agonist and new range is taken up
  5. Repeat steps 2-4
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16
Q

PNF: Hold-Relax with agonist contraction

A
  1. Muscle in light stretch
  2. Isometric contraction
  3. hold for 8 seconds
  4. Pt. concentrically contracts the opposite to move joint through increased ROM
  5. Repeat steps 2-4
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17
Q

PNF: Contract-Relax

A
  1. Muscle in light stretch
  2. Pt. pushes (submax) into clinicians hand extending muscle against mild resistance
  3. Pt. relaxes and the clinician takes up slack in new range
  4. Repeat steps 2-3
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18
Q

Factors that influence muscle force production

A
  1. Motor unit recruitment
  2. Cross-sectional area
  3. Speed of Contraction
  4. Angle of Pennation
  5. Muscle length
  6. Length Tension Relationship
  7. Pre-stretching
  8. Energy stores and blood supply
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19
Q

Sarcomere

A

The smallest contractile unit of a muscle

-Made of myofilaments termed actin and myosin that overlap causing cross bridging

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20
Q

Arrangement of Actin/Myosin

A

-Z line: end of actin filaments(z line to z line = sarcomere)
-I band: actin only that straddles the z line
-A band: runs length of myosin filament
-H zone: only myosin filament w/ no overlap of actin
M line: very center of myosin in the H band

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21
Q

All or None Principle

A
  • When a threshold stimulus is reached, the muscle will contract
  • All the muscle fibers in the unit will contract
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22
Q

Type I Muscle Fibers

A

=Aerobic/slow oxidative fibers

  • Slow twitch
  • slow to fatigue; used for endurance
  • Use oxygen for energy
  • Prevalent in postural mm.
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23
Q

Type II Muscle Fibers

A

=Anaerobic/fast oxidative fibers

  • Fast twitch
  • more powerful
  • Capable of generating high amount of force in short amount of time
  • Predominant in explosive mm contractions
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24
Q

Type IIa Fast-twitch fibers

A

=fast oxidative

  • Transition between type I and IIb; uses both O2 and glycogen for energy
  • Power and endurance
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25
Q

Type IIb Fast-twitch fibers

A

=Fast glycolytic

  • Gylcogen for energy
  • No endurance
  • Power
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26
Q

Strength:

A
  • Max force that a muscle can develop in a single contraction
  • Functional strength = the ability of the neuromuscular system to produce, reduce, and control forces, during functional activities, in a smooth, coordinated manner
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27
Q

Power:

A

Power = Force x distance/time

-Incorporates both strength and speed

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28
Q

Endurance:

A

The ability to perform low intensity, repetitive, or sustained activities over a prolonged time (a less than max load)

  • Dependent upon status of energy systems and mount of force
  • Greater the force, the more quickly fatigue will occur
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29
Q

Goals of Training

A 
Endurance = 15-20/set + <30 secs rest
Hypertrophy = 8-12/set + 30-90 secs rest
Strength = 6-8/set; no more than 10 reps + 2+ mins rest
Power = 1-5/set + 2-5 mins rest
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30
Q

Length-Tension Relationship

A

-A muscle’s ability to generate tension depends on the position= Peak force production is at or near mid-range

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31
Q

Active Insufficiency vs. Passive Insufficiency

A

Active: Muscle too short to generate force
Passive: muscle too long to generate force

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32
Q

Isotonic Exercises(2):

A

Concentric: Shortening of muscle during contraction
Eccentric: Lengthening type of contraction
-More tension (2:1) can be generated than concentric

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33
Q

Isokinetic Exercise

A

=”Accommodating Resistance”

  • Exercise at a constant velocity, resistance will vary
  • Speed is constant no matter how much force is generated by muscle (concentric or eccentric)
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34
Q

Delayed Onset of Muscle Soreness (DOMS)

A
  • Occurs 24-72 hrs post exercise
  • Torn tissue: Myofibrillar disturbances 2 days post eccentric exercise(z band disturbance/disruption
  • Connective tissue damage: Overstretching muscle elastic components
  • No evidence for “lactic acid buildup”
  • Eccentric may cause more DOMS
  • Incorporate rest and also light aerobic exercise may help to relieve symptoms
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35
Q

SAID Principle

A

=Specific Adaptation to Imposed Demands

  • Muscle adapts over time to stresses that are placed on them
  • Exercises should mimic those of anticipated functional activities
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36
Q

Overload Principle

A

=Muscle must be challenged to perform at a level greater than what is accustomed
-PROGRESSIVE INCREASE

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37
Q

Reversibility Principle

A
  • Functional gains are not maintained unless exercise consistently performed
  • Occurs within 1-2 weeks (Use it or Lose it)
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38
Q

Delorme’s PRE: Exercise Progression

A

Set 1. 50% of 10 RM: 10 Reps
Set 2. 75% of 10RM: 10 Reps
Set 3. 100% of 10RM: 10 Reps

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39
Q

Oxford’s PRE: Exercise Progression

A

Set 1. 100% of 10RM: 10 Reps
Set 2. 75% of 10RM: 10 Reps
Set 3. 50% of 10RM: 10 Reps

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40
Q

Daily Adjusted Progressive Resistive Exercise(DAPRE) Technique:

A 
Set 1: 50% of 6RM x 10 Reps
Set 2: 75% of 6RM x 6 Reps
Set 3: as many reps as possible with 6RM
Set 4: adjusted working weight x as many reps as possible
-Finding the adjusted weight for Set 4 by determining what happened on set 3:
- 0-2 reps = decrease 5-10lbs
-3-4 reps = decrease 0-5lbs
-5-6 reps = keep same
-7-10 reps = increase 5-10lbs
->11 = increase 10-15lbs
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41
Q

Duration of Training

A
  • True strength gains take at least 6-8 weeks

- Improvements within first 2-3 weeks are neural adaptations

42
Q

Janda’s Lower Crossed Syndrome:

A
  • A short/contracted muscle inhibits/weakens it’s antagonists
  • “Reflex Inhibition”
43
Q

Spine ROM Exercises: General

A
  • Cat-camel(paraspinals)
  • L/S flexion in chair(paraspinals)
  • Knee-Chest(paraspinals)
  • Lumbar rock
  • Pelvic tilt
44
Q

Williams’ Flexion Exercises

A
  1. Pelvic tilt (posterior)
  2. Single Knee to chest
  3. Double knee to chest
  4. Hamstring stretch
  5. Partial sit-up
  6. Hip flexor stretch
  7. Squat
45
Q

McKenzie Extension Exercises

A

“Theory of Centralization”

  1. Prone lying (pillow if uncomfortable)
  2. Prone on elbows
  3. Prone Press-ups: 10 reps 6-8x/day
  4. Standing extension: 10 reps, 6-8x/day
46
Q

Trunk Stabilization

A

The most important aspect of core performance is obtaining the control that is necessary to:

  1. Stabilize the spine
  2. Maintain alignment and movement relationships between pelvis and spine
  3. Prevent excessive stress and compensatory motions of the pelvis during movements of the extremities
47
Q

Lumbar Stabilization Exercises: The principles

A

Goals:
- Gain dynamic control of the spine
- Maintain “Neutral Spine” position during functional activities
- Hold posture against internal and external forces
Stabilizers:
-Lumbodorsal fascia, lats, IOA, TrA, gluteals

48
Q

Lumbar Stabilization Exercises:

A
  1. Hollowing first (TrA)
  2. bracing (bearing down)
  3. Bracing with BP cuff
  4. Bracing + UE and LE movement
  5. Supine: Dead bugs - progression
  6. Bridging - progression (dorsiflexion on heels - LE movement - swiss ball)
  7. Prone: Planks - 3 levels
  8. Prone: Concrete lifts - swiss ball - bird dogs
  9. Sidelying: Side Bridges - Progression(EO and QL)
49
Q

Multifidus Strengthening

A
  • Multifidi activated with pelvic floor mm. (kegels + TrA exercises)
    1. concrete lifts
    2. Prone arch
    3. Quadruped - Bird dogs - wts. - perturbations
    4. Standing: swell the muscle
    5. Standing with theraband
50
Q

Lumbar Stabilization Exercises: Sitting

A
  • Hips above knees
  • On swiss ball
  • Lift UE/LE
  • Trunk Rotations
  • Progression = add weights + perturbations
51
Q

Core Stabilization: Kneeling

A
  1. Half Kneel
  2. Kneel on balance beam
  3. Kneel on balance beam with rotation
  4. Perturbations
52
Q

Lumbar Stabilization: Standing

A
  1. Slight knee flexion to allow pelvic tilt
  2. Trunk rotation - Diagonal with tubing, cables, ball throwing - lunges
  3. Progress to a functional position
53
Q

Primary Hip Flexors

A

Hip flexor tightness may also cause the pelvis to tilt ANTeriorly and increase lumbar lordosis:

  • Iliopsoas
  • Sartorius
  • TFL
  • Rectus Femoris
  • Pectineus
  • Adductor Longus
54
Q

Primary Hip Extensor

A
  • Gluteus Maxiumus

- Hamstrings

55
Q

Hip External Rotators

A
  • Gluteus maximus
  • piriformis
  • Obturator Internus
  • Gemellus Sup&Inf
  • Quadratus femoris
56
Q

Hip Abductors

A
  • Gluteus medius (all fibers)- Actions: Concentrically abducts hip; isometrically stabilizes the pelvis; Eccentrically controls hip adduction IR
  • Gluteus Minimus
  • TFL
57
Q

Gluteus Medius Weakness

A

=Trendelenburg gait

-Step down test: active side

58
Q

Hip Adductors

A
  • Adductor longus, magnus, brevis
  • Gracilis
  • Pectineus
59
Q

Hip Flexor Stretch

A
  • Thomas Test position: Tightness will present with inability of the pelvis to be parallel to the table
  • Kneeling position: rectus femoris
60
Q

Hamstring stretch

A
  • Doorway stretch
  • Active stretch with hand behind knee (keep contralateral leg straight)
  • Passive stretch with band around foot
  • Standing with rotation of trunk
61
Q

Piriformis stretch

A

Piriformis reverses its rotary action and becomes a hip IR as the hip is flexed past 90 degrees

  • foot over knee
  • quadruped stretch
62
Q

Iliotibila band/Tensor Fascia Lata stretch

A
  • Scissoring positon (Ober’s test)
  • Flex, abduct, extend, and adduct the hip (clear the hip)
  • standing
  • supine: cross body with band on opposing foot
63
Q

Hip Strengthening: Gluteus Medius

A
  • Prone: active/resisted abduction w/ extension
  • Sidelying: Hip ER (clam shells); Hip abduction with extension (hip wall slides)
  • Standing: hip Abduction against cables/tubing; hip abduction/extension with t-band loop; stand in SLS; single limb squat; single limb deadliest
64
Q

Best Exercise (Distefano) to strengthen hip mm.

A

Side-lying hip abduction exercise

65
Q

Hip Strengthening: Gluteus Maximus

A
  • Prone: hip extension with knee flexed(open chain); hip extension with knee extended(open chain)
  • Quadruped: donkey kicks (open chain)
  • Supine: bridging
  • Standing: squats(single limb i. e. bulgarian); lunges; hip ext against tubing;
66
Q

Hip Strengthening: Adduction

A
  • Sidelying: SLR
  • Standing: adduction against t-band; multi hip machine
  • Seated: Nautilus machine
67
Q

Hip Strengthening: Flexion

A
  • Supine: SLR
  • Prone: Walk outs/ins on swiss ball(jack knife)
  • Seated: marches with ankle weights
  • Standing: flexion against tubing/cables
68
Q

Advantages of Manual Resistance

A
  • Most effective during early stages of healing when muscles are weak
  • allows sensory feedback for ATC
  • Resistance may be adjusted
  • Max muscle workout through ROM
  • ROM controlled by ATC
  • ATC prevents compensatory patterns
  • Various positions
  • Cost effective
  • Direct interaction
69
Q

Disadvantages of Manual Resistance

A
  • Exercise load is subjective by ATC
  • Resistance limited by ATC
  • Min value for strong muscles
  • May not carry over to functional activities
  • Cant take home
  • Labor and time intensive
  • ATC possible injury
70
Q

Proprioceptive Neuromuscular Facilitation(PNF): Principles

A
  • Combines functional diagonal patters
  • Improves neuromuscular control and function
  • Develops: strength, endurance, stability, mobility, coordination
  • May be used throughout rehab process from acute inflammatory through maturation phases
71
Q

PNF Principles

A
  • Sequence: Distal to proximal
  • Verbal commands
  • Visual cues
72
Q

Diagonal Patterns: D1 and D2

A
  • I.D. by motions at proximal joints
  • Flexion and Extension patterns
  • Flex/Ext are coupled with ABD/ADD and IR/ER
73
Q

Hip Biomechanics: Gait

A
  1. Initial contact
  2. Loading Response
  3. Midstance
  4. Terminal Stance
  5. Preswing

a. Initial Swing
b. MidSwing
c. Terminal Swing

74
Q

Gait: 1. Initial Contact

A
  • 25 Degrees Hip flexion
  • Hamstrings contract in reaction to hip flexion torque
  • All hip extensors active in preparation for LR (glute max and hamstrings)
75
Q

Gait: 2. Loading Response

A
  • 25 Degrees hip flexion
  • Glute max, hamstrings and adductor magnus contract due to flexion torque
  • Glute med, min and posterior TFL contract to stabilize in frontal plane
76
Q

Gait: 3. Midstance

A
  • Hip extends to Neutral(0 degree flex/ext)
  • No muscle activity in sagittal plane
  • Pelvis is stabilized in the frontal plane by the hip abductor group, primarily glut med
77
Q

Gait: 4. Terminal Stance

A
  • 20 Degrees hip extension
  • Ext torque keeps hip stable
  • Adduction torque decreases
  • TFL fires to restrain hyperextension of the hip
78
Q

Gait: 5. Preswing

A
  • 5 degrees extension
  • Thigh falls forward, aided by adductor longs
  • Hip ext torque diminishes
  • Limb advancement begins
79
Q

Swing Gait: a. Initial swing

A
  • 15 degrees of hip flex (foot clearance)

- Iliacus, gracilis, sartorius and adductor longus are active concentrically

80
Q

Swing Gait: b. Midswing

A
  • 25 degrees of hip flex
  • Iliacus, gracilis and sartorius stop firing
  • Hamstrings fire eccentrically to control hip flex
81
Q

Swing Gait: c. Terminal Swing

A
  • 20 Degrees of hip flex
  • Hamstrings peak to decelerate limb
  • Glut max and adductor magnus prepare to stabilize at IC
82
Q

Proprioception

A

Body’s ability to transmit afferent infer to the brain to elicit a motor response to allow for appropriate posture and movement

83
Q

Components of Proprioception

A
  • Agility to change direction
  • Balance to maintain stability
  • Coordination to perform the activity correctly and consistently
84
Q

Functional Ankle Instability

A
  • Following acute later ankle sprains = Chronic lateral instability develops in 20-30% of pts
  • Increased risk of sprain recurrence due to delayed proprioceptive response of the peroneals
85
Q

Lephart et al, 1997

A
  • Important to understand role of proprioceptively mediated NMC after joint injury and its role during rehab
  • Proprioception provides:
    1. Dynamic joint stability
    2. Motor control
86
Q

Cutaneous(skin) Receptors

A
  • Fast-adapting: respond to mechanical deformation such as touch, vibration, or any pressure against skin
  • Slow-adapting: Respond to stretch of skin
87
Q

GTO

A
  • Detects tension
  • Respons to both contraction and stretch
  • Stimulation = muscle relaxation
88
Q

Muscle Spindle

A
  • Responds to stretch

- Stimulation = contraction

89
Q

Joint Receptors

A
  • Located within connective tissue of joint capsule and surrounding ligaments
    1. Ruffini endings
    2. Pacinian corpuscles
90
Q

Ruffini endings

A
  • Located in joint capsule on flex side of joint
  • Respond to extreme ROM into ext with rotation
  • Protect unstable joints
91
Q

Pacinian corpuscles

A
  • Located throughout joint capsule, joint and periarticular tissues
  • Very fast adapting
  • Respond more to compression forces across joint esp during high velocity changes (ex. cutting, landing)
92
Q

Ligament Receptors

A
  • Not active in mid range of motion (muscle stability)
  • Stimulated when joint nears end range of motion to protect ligament
  • inhibit continued agonist contraction so that stress decreases on ligament
93
Q

Role of CNS in Proprioception: Spinal Cord

A
  • Simplest form of efferent response: Spinal Reflex
  • Used to adjust for minor changes in joint stress to protect joint integrity
  • Occurs subconsciously
94
Q

Role of CNS in Proprioception: Brainstem

A
  • Medulla, Pons, and midbrain
  • Used primarily to detect changes in posture and balance
  • If spinal reflex is insufficient afferent info will travel until it reaches brainstem
95
Q

Role of CNS in Proprioception: Cerebral Cortex

A
  • Highest level of brain
  • Responsible for volitional control of movement
  • Movement is consciously controlled and learned before it becomes subconscious movement: i.e. repeatedly practicing an activity
96
Q

Balance

A

Brainstem receives sensory info from:

  1. Vision (eyes)
  2. Vestibular system (ears)
  3. Proprioception or somatosensory system
97
Q

Motor Strategies for Balance Control

A
  1. Ankle strategy - min amount of perturbations so balance is maintained distal to proximal
  2. Hip strategy - Rapid or large perturbations; proximal to distal
  3. Stepping strategy - force displaces COM
98
Q

Strategies to Restor NMC

A
  1. Biofeedback - hearing when to contract muscle
  2. Mirrors
  3. Touch
  4. Tape
99
Q

Neuromuscular Control

A
  • Progressive: static to Dynamic
    1. distracters (ball toss)
    2. Surfaces
    3. visual input
    4. predicted vs unpredicted perturbations
100
Q

Lower Extremity Techniques

A
  • Focus on muscle groups that require attention (no wt. to wt.)
  • Use of closed-chain activities is encouraged
  • *Star Excursion test great predictor

Therapeutic Exercise (3 decks)

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