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NPTE-Musculoskeletal (Josh) > TherEx > Flashcards

TherEx Flashcards

1
Q

ROM

what is it

A

Mobility avail @ single jt

affected by structure of jt OR connect tissue ext. surrounding jt

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2
Q

Gen CONTRAINDICATIONS to ROM

A
  1. If motion is detrimental to healing (ex. post-op) BUT early, controlled motion w/in pain free range shown beneficial in early stage healing
  2. Incd pain or inflamm==ROM too aggressive
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3
Q

ROM intervention

PROM

ex. pulleys

A
  • NO mm activation
  • only performed w/in avail end-range (beyond=stretching)
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4
Q

ROM intervention

PROM

Indications:

A
  • pt unable to move jt (paralyzed, coma)
  • cog impaired
  • AROM contraindicated (post-op)
  • AROM painful
  • prepping jt for stretch
  • Teaching active mvmt
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5
Q

ROM intervention

PROM

Bennies:

A
  • INC mobility connect. tissue & mm’s
  • prevent contractures
  • INC circulation
  • INC synovial fluid==cart. health
  • DEC pain
  • INC awareness of mvmt
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6
Q

ROM intervention

AAROM

A

mm contraction w/ assist
ex. dowel OH shoulder flex

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7
Q

ROM intervention

AAROM

Indications

A
  • Pt unable to FULLY contract mm (paresis, pain)
  • Full AROM contraindicated (post-op)
  • prior to AROM
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8
Q

ROM intervention

AAROM

Bennies

SAME AS PROM +

A
  • INC mobility connect. tissue & mm’s
  • prevent contractures
  • INC circulation
  • INC synovial fluid==cart. health
  • DEC pain
  • INC awareness of mvmt
  • **INC NMSK ACTIVITY
  • INC PROPRIO/KINESTHSIA**
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9
Q

ROM INTERVENTION

AROM

A

ACTIVE mm contraction

ex. standing knee flex

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10
Q

ROM intervention

AROM

Indications

A
  • able to contract, but weak (3/5)
  • ## PRIOR to resistance to teach mvmt
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11
Q

ROM intervention

AROM

Bennies

SAME AS PROM/AAROM +

A
  • INC mobility connect. tissue & mm’s
  • prevent contractures
  • INC circulation
  • INC synovial fluid==cart. health
  • DEC pain
  • INC awareness of mvmt
  • **INC NMSK ACTIVITY
  • INC PROPRIO/KINESTHSIA**
  • INC strength in weak mms
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12
Q

Stretching

A

INC Jt ROM and MM flexibility

inc extensibility of musculotendinous unit and connective tissues

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13
Q

Stretching

Indications

A

DECd Jt ROM OR DEC mm flexibility

2 diff things!!!!!!

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14
Q

Stretching

CONTRAINDICATIONS (LOTS)

A
  • Acute inflam
  • during tissue healing (post-op tendon repair)
  • ROM limtd bc bone-bone contact
  • recent fx
  • hypERmob
  • hypOmob that allows for more improved function (ex. Tenodesis)
  • Acute pain w/ stretch
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15
Q

Stretching Principles

Elasticity

A

tissue returns to PREV length AFTER stretch released

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16
Q

Stretching principles

ViscoElasticity

*Time dependent

A

Time dep
- initial resistance to stretch BUT elongates AFTER stretch HELD
- eventually returns to prev length

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17
Q

Stretching principles

Plasticity

A

Tissue elongates even **after stretch released **

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18
Q

stretching principles

Stress-Strain Curve

Think INC stress==INC strain

3 Regions: Toe, Elastic, Plastic

A

Amt force (stress) applied & Amt deformation (strain) experienced

see pic in notes

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19
Q

3 Regions to Stress-Strain Curve: Toe, Elastic, Plastic

Toe Region

A

Initial stress== wavy collagen fibers straighten and align

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20
Q

3 Regions to Stress-Strain Curve: Toe, Elastic, Plastic

Elastic region

A

INC stress== INC deformation, though tissue returns to ORIG length if stretch not maintained
tissues w/ greater stiffness have steeper slope here

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21
Q

3 Regions to Stress-Strain Curve: Toe, Elastic, Plastic

Plastic region

A

ADDITION of more stress== permanent deformation even after stretch no longer applied
*test-retest applies here

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22
Q

Stretching principles

Creep

*the BASIS for stretching!!!

A

Due to viscoelastic properties– soft tissue stretch for sustained duration will elongate and NOT return to orig length after load removed

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23
Q

Stretching principles

Stress-Relaxation

A
  • Longer the force maintained== more tension DECs
  • Less force reqd to maintain same tissue length==INCd flexibility (can get to that “range” easier!!)
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24
Q

Methods of stretching:

Static

hold stretch prolonged pd

ex. doorway

A
  • LOW int, LONG duration
  • safest, greatest gains
  • LESS mm spindle activation (less resistance to stretch)
  • 30s is KEY
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25
Q

Methods of stretching

Ballistic

Bouncing

A
  • quick, jerky–rapid changes in mm length (back and forth)
  • HIGH int, SHORT duration
  • better for warm-ups
  • INCd mm soreness and injury due to intensity

bouncing mvmts bw elongating/shortening mm’s

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26
Q

Methods of stretching

PNF

Proprioceptive Neuromuscular Facilitation

A
  • autogenic vs reciprocal inhibition (see neuro notes)
  • ACTIVE mm contraction + stretch
  • more effective for ROM limits due to mm spasm vs tightness
  • reqs ACTIVE mm contract (NOT for spasticity, paralysis)
  • Incd pt tolerance to stretch

Contract-relax, Agonist-contract, Contract-relax w/ agonist-contract

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27
Q

Methods of stretching

Dynamic

Active mm segment to end range but NOT beyond–Antag relaxes/stretches

A

Mostly used for “warm-ups”
“explosive mvmts”

Dynamic is “movement based”

28
Q

Resistance Training

Sarcomeres and what is located IN sarcomeres

SMALLEST UNIT

A
  • Smallest unit of a muscle gives it its ability to contract
  • ## Myofilaments: Actin & Myosin–> Attach and slide together (contract) and apart (relax)
29
Q

Resistance training

a Muscle is broke down into _ and _ that surround it

A

Mm fibers + connective tissue that surrounds it

30
Q

3 Layers of the mm fiber

Inner–>Outer

A
  1. Endomysium: covers fibers
  2. Perimysium: groups the bundles of mm fibers (Fasciculus) together
  3. Epimysium: surrounds entire mm
31
Q

Breakdown from mm fibers–> _ –> _

A

Mm fibers–> myofibrils–> sarcomeres (myofilaments)

32
Q

Resistance Training

Isometrics

A
  • NO change in mm length
  • Usually against immov. obj
  • ## SUBmax isos trad. used in PT
33
Q

Resistance Training

IsoTonics

Constant Tension/Load

A
  • Constant Tension/load
  • Against resistance
  • 2 types: Concentric (shortening) vs Eccentric (lengthening)
34
Q

Resistance Training

Isokinetic

Constant speed (kinetic)

A
  • Constant max speed w/ variable load
  • Rxn force identical to force applied to equipment–constant speed
35
Q

Parameters of resistance training

Intensity

think LOAD/Wt

A
  • Amt of wt.–det’s # of reps youll do
  • Can be 1RM %
  • ## Depends on GOALS (strength, endurance, power)—other slide
36
Q

Parameters of resistance training

Intensity and GOALS

Strength vs Endurance vs. Power

A
  • Strength== LOW rep (6-12) w/ HIGH int load (wt)
  • Endurance== HIGH rep (20+) w/ LOW int load (wt)
  • Power== LOW rep (1-3) w/ HIGH int load (wt)
37
Q

Parameters of resistance training

Volume

Think Wt x Reps

ex. 100lb squat 10sets of 10reps ==100x100= 10,000lbs total volume!

A
  • Total WORK
  • # reps inversely related to intensity (wt) Ex. heavy wt=less reps
  • 2-4 sets is common BUT #reps depends on goals
38
Q

Parameters of resistance training

Frequency

Think #x/week

A
  • Depends on intensity, volume, fitness lvl
  • MORE intense=LESS freq (2-3x/week), or if pt has low fitness lvl
  • Pts in rehab programs==several times/day @ low intensities
39
Q

Parameters of resistance training

Exercise Sequence

Think Programming

In General….but DEPENDS!

A
  • Lg mm groups BEFORE Sm mm groups
  • Multijoint before Single joint ex’s
  • HIGH int before LOW int
  • Can disregard if pts goals conflict w/ this
40
Q

Parameters of resistance training

Rest Interval

Use your common sense…

A
  • High intensity== longer rest (3+ mins)
  • Low intensity== shorter rest (1-2mins)
  • ## LOW fitness lvl== Longer rest durations
41
Q

Parameters of resistance training

Open Chain Ex

Give an example

A
  • Distal segment moves freely in space

Ex. kick ball

42
Q

Parameters of resistance training

Close Chain Ex

Give an Ex.

A
  • Body moves over FIXED distal segment

Ex. squats, push-ups

43
Q

Resistance training programs

DeLorme (goes UP) vs Oxford (goes DOWN)

A
  • DeLorme: 10 reps @ 50%10RM, 75%10RM, 100%10RM
  • Oxford: 10 reps @ 100%10RM, 75%10RM, 50%10RM
44
Q

Principles of Resistance Training

Overload

think “overloading” mm

A
  • ## In order for mm to adapt/become stronger–> load must be > than what normally accustomed to

Manipulate volume (reps, sets), intensity (load) to do this!

45
Q

Principles of Resistance Training

SAID

Specific Adaptation to Imposed Demands

Exactly what it sounds like

A
  • Body adapts to specific type of training
  • In order to improve function–> training **type ** should mirror specifically desired goal

Ex. want power? Train/focus on power!!

46
Q

Principles of Resistance Training

Transfer of Training

Think “carry-over”

A
  • Carry over effect from one type of exercise to another
  • Ex. Ex’s to improve mm strength may improve mm endurance

effects w/ this LESS beneficial vs Specific training (SAID)

47
Q

Principles of Resistance Training

Reversibility*

NEVER FORGET THIS ONE

A
  • Adaptations seen w/ resistance training are REVERSIBLE IF body is not regularly challenged w/ SAME lvl of resistance or greater

Can begin 1-2wks after stopping exercise program***

48
Q

Principles of Resistance Training

Length-Tension Relationship

Exactly what it sounds like

A
  • Ability of mm to produce force depends on length of mm
  • MAX force near resting length

Too lengthened or Too shortened== Weak/Less force production

49
Q

Principles of Resistance Training

Force-Velocity Relationship

Conc vs Ecc

A
  • Speed of mm contraction affects force mm can produce
  • Concentric–> as Speed INCs, Force DECs
  • Eccentric–> as Speed INCs, Force INCs
50
Q

Resistance Training Terms:

Endurance

Think over prolonged time

A
  • Ability to contract repeatedly against LIGHT ext. load & resist fatigue over prolonged pd

Type I fibers (slow-twitch)

51
Q

Resistance Training Terms:

Moment Arm

MA

A
  • Linear distance from AOR to site of external load (resistance)
52
Q

Resistance Training Terms:

Power

think fast

A
  • Rate @ which work is performed

Work/Time

53
Q

Resistance Training Terms:

Strength

Think 1RM

A
  • Greatest amt of force production w/in a mm during SINGLE contraction
54
Q

Resistance Training Terms:

Torque

thinking rotation or twisting

A
  • Ability of ext. load to produce rotation around axis

Magnititude of load (wt) x Moment Arm

55
Q

Resistance Training Terms:

Work

Think wt and distance

A

Magnitude of load (wt) x Distance load moved (ROM)

Wt X ROM distance

56
Q

Adaptations

Strength vs Endurance

STRENGTH

A
  • Incd hypertrophy of mm fibers, Type IIB->IIA remodeling, Incd NMSK activity (incd motor units & firing rate, Dec/no change in capillary bed density, Decd mitochondrial density, Incd ATP, PC and other energy sources, Incd tensile strength tendons/ligs, Incd BMD, Incd LBM, Dec BF%
57
Q

Adaptations

Strength vs Endurance

ENDURANCE

A
  • Incd hypertrophy of mm fibers, INCd capillary bed density, INCd mitochondrial density, Incd ATP, PC and other energy sources, Incd tensile strength tendons/ligs, Incd BMD, Dec BF%
58
Q

3 Common Cond’s associated w/ Resistance Training

A
  1. Mm fatigue
  2. DOMS
  3. Valsalva maneuver
59
Q

Cond’s associated w/ resistance training

  1. Mm fatigue

Gen Facts

A
  • dec ability to produce force aginst load w/ incd reps
  • Reversible (strength improves after rest)
  • Depends on fiber type (Type I vs Type II)- other slide
  • DO NOT WORK UP TO EXCESS. FATIGUE! –other slide
60
Q

Cond’s associated w/ resistance training

MM Fatigue

Fatigue depends on MM fiber TYPE… explain

A
  • Type I (slow twitch)–> LOW lvls of force over prolonged pd==resistant to fatigue (endurance)
  • Type II (fast-twitch)–> Lg amt force short duration==prone to fatiuge (power)
61
Q

Cond’s associated w/ resistance training

MM fatigue

DO NOT WORK UP TO EXCESS FATIGUE! S/S:

A
  • Pain/cramp, tremor, slow/jerky mvmts, unable to complete full mvmt patterns, substitution (compensatory) patterns
  • Either DEC LOAD or allow rest break, otherwise INC risk of injury
62
Q

Cond’s associated w/ resistance training

MM Fatigue

Ex’s of Pts/Dx’s where mm fatigue UNpredictable

A
  • NMSK disorders: Myasthenia gravis, MS– fatigue more quickly–pushing to fatigue WORSENS sx’s
  • CV/Pulm Dis: Fatigue quicker/need longer recovery pds
63
Q

Cond’s associated w/ resistance training

DOMS

Delayed Onset Muscle Soreness

A
  • microtrauma to mm & connect. tissue
  • HIGH int, ECC. strengthening OR just started resistance program
  • Peaks @ 2d
64
Q

DOMS

How to MINIMIZE effects

A
  • SLOWLY inc intensity of new program
  • Only CONC/ISO’s significantly reduces DOMS
65
Q

DOMS

Characteristics?

A
  • tenderness to palp @ mm belly or muscle-tendon junction
  • soreness w/ passive stretch or active contract of mm
  • decd ROM and strength
  • soreness diminishes ea training session as mm adapts to high lvls of stress
66
Q

Cond’s associated w/ resistance training

Valsalva maneuver

think “bracing core”

A
  • INCd intraabdom/thoracic pressure during anaerobic mvmt (stabilizes spine)
  • UNdesireable effects produced by valsalva!— AVOID w/ all pts, ESP CV diseases (HTN, CAD, CVA), IVD patho, recent eye sx
  • teach breathing mechanics–ex. Exhale on Exertion

NPTE-Musculoskeletal (Josh) (3 decks)

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