Week 1: Quiz 2 Information Flashcards
TERT (total end range time) Formula
(explain it)
- Active exercise of involved area - ~ 10 minutes (active metabolic warm-up to heat the tissue structures to increase elasticity)
- Passive exercise – Heat and stretch in appropriate position to target tissue. (First TERT) [Total End Range Time – 3 sets x 20 minutes = 60 minutes/day] (No “bad” pain). Clinical reality – many times start the stretching for 10 minutes because of patient tolerance
- **(Purpose of 1 & 2 is to prepare the tissues by warming them up. The literature demonstrates all tissues have more elasticity when they are warmer – inside and outside warm-ups)**
- Manual therapy interventions: mobilizations, strain-counter-strain, myotherapy, mobs with movement, etc.) (Whatever seems to work best in your hands)
- Exercises to gain dynamic stability of the newly gained PROM (KEY to maintaining PROM)
- Other: TAS,TLS,TBS
- Passive exercise – Cold and stretch in appropriate position to target tissue. (Second TERT). (No “bad” pain). Clinical reality – many times start the stretching for 10 minutes because of patient tolerance. Purpose is to get the tissue that has been heated, stretched, mobilized, and exercised to remain in the elongated state)
- Third TERT-HEP. Using positional stretching, splints, casts, CPMs, etc. to complement the stretching time in the clinic to total 60 minutes per day. (Example: if 20 minutes of stretching performed in clinic, then 40 minutes in third TERT of HEP. Example: if 30 minutes of stretching performed in clinic, then 30 minutes in third TERT of HEP.)
What are Davies Top 10 Shoulder Ex?
- Scaption with thumb up
- Press downs
- Rowing
- Push up with a plus
- Prone ER with horizontal extension
- Flexion
- RTC IR
- RTC ER
- Elbow flexors
- Elbow extensors
Davies Top 10
Scaption with thumb up: What muscles?
Scaption with thumb up (GH and scapulothoracic joints)
- Muscles: elevators
- Upper traps (ST)
- Supraspinatus (GH)
- Anterior deltoid (GH)
- Middle deltoid (GH)
Davies Top 10
Press downs: What muscles?
Press downs (GH and scapulothoracic joints)
- Muscles - depressors
- Lower traps
- Latissimus dorsi
- Teres major
- Pectoralis minor
- Lower fibers of the pectoralis major
- Lower fibers of infraspinatus (GH)
- Teres minor (GH)
- Lower fibers of subscapularis (GH)
Davies Top 10
Rowing: What muscles?
Rowing (scapulothoracic)
- Muscles - retractors
- Rhomboids
- Middle traps
Davies Top 10
Push up with a plus: What muscles?
Push up with a plus (scapulothoracic)
- Muscles - protractors
- Serratus anterior
Davies Top 10
Prone ER with horizontal extension: What muscles?
Prone ER with horizontal extension (GH)
- Muscles (extensors)
- Infraspinatus (GH)
- Teres minor (GH)
- Posterior deltoid (GH)
Davies Top 10
flexion: What muscles?
Flexion (GH)
- Muscles (flexors)
- Anterior deltoid (GH)
- Coracobrachialis (GH)
Davies Top 10
RTC IR: what muscles?
RTC IR (GH)
- Muscles
- Subscapularis (GH)
- Anterior deltoid (GH)s
- Pectoralis major (GH)
- Latissimus dorsi (GH)
- Teres major (GH)
Davies Top 10
RTC ER: what muscles?
RTC ER (GH)
- Muscles
- Infraspinatus
- Teres minor
- Posterior deltoid
Davies top 10
Muscles for
- Elbow flexors
- Elbow extensors
- Elbow flexors
- Muscles: Biceps
- Elbow extensors
- Muscles: Triceps
Davies top 10: Four for Scapulothoracic recommended by Moseley, et al.
- Scaption with thumb up
- Press downs
- Rowing
- Push up with a plus
**Can think of these as addressing the top, bottom, back and front of the scapulothoracic joint.
Davies top 10: Four for GH joint recommended by Townsend, et al.
- Scaption with thumb up (duplicate)
- Press downs (duplicate)
- Prone ER with horizontal extension
- Flexion
**Can think of these as addressing the top, bottom, back and front of the GH joint.
Davies top 10: what are the two exercises for total arm strengthneing?
Elbow flexion / Biceps
Elbow extension / Triceps
30/30/30 Reasons: 30 degrees abduction
- Prevents the ‘wringing out” effect on the supraspinatus tendon with arm in 90 degrees abducted position,
- with a weak subscapularis, infraspinatus, and teres minor (or pain/reflex inhibition) the deltoid overpowers the lower RTC muscles (which cannot create the dynamic caudal glide) and causes a compression on the bursal side of the supraspinatus tendon causing the “wringing out” effect
- Facilitates the blood flow (nutrients, O2, etc) to the tendon to help with the healing process
- WIth the arm in the adducted position, the humeral head compresses on the articular side of the supraspinatus tendon causing the “wringing out” effect
30/30/30 Reasons: 30 degrees Scaption
- Functional arc of motion of the shoulder
- Decreases strain on the anterior capsule to stress shield it
- Pre-stretches the infraspinatus and teres minor on the physiological length-tension curve to increase power.
30/30/30 Reasons: 30 degree diagonal tilt relative to the transverse plane
- The diagonal plane places the muscle fibers (subscapularis, infraspinatus, teres minor) in direct line of force for power production
- Dr. Davies’ pt’s taught him it was a more comfortable position (allows for “freer” GH motion)
- Prevents iatrogenically created stress (injury) to the posterior shoulder
30/30/30 Reasons: reasons for bolster under arm
- Increases the EMG activity of the posterior shoulder muscles (which are weakest muscles in the kinematic chain) (overflow, irradiation, synergistic co-contraction)
- The adducting muscle activity led to statistically significant increase of the subacromial space width in all arm positions
Explain how to progress exercises from the 30/30/30 position
30/30/30 to
shoulder horn at 90/90 to
no shoulder horn at 90/90
Describe Acromion Morphologies
Type 1- flat
Type 2- Slightly Curved
Type 3- Hook
2 questions to ask yourself when you get an impingement patient
What type of impingement? (classification) and
what is the cause? (more important)
What are the three impingement classifications?
What is one-two words that characterize them or underlying cause?
Primary (hypomobility)
Secondary (hypermobility)
Internal (macro or micro instability)