Week 3 (EXAM 2) Flashcards
Define isometric exercise
Define muscle setting
Provide an example of isometric exercise prescription to address edema and inflammation
What are the precautions and contraindications of isometric exercise and muscle setting?
What are the limitations of muscle setting?
What are the Test/Re-test Measures to Consider Using to Assess efficacy in isometric and muscle setting?
Define ROM as it relates to body structure and function
What factors makes one lose ROM?
What are the effects of immobilization on tissue?
Why are ROM interventions helpful?
Define edema
What should be maintaining the pressure balance?
What is the lymphatic system made of?
What are the extrinsic and intrinsic mechanisms of the lymphatic system?
What happens in the lymphatic system during exercise?
Define PROM
List the indications and goals for PROM
Provide an example of PROM intervention to address edema and inflammation
What are the precautions and contraindications of PROM?
What are the limitations of PROM?
What are the test/retest measures for PROM efficacy?
What are the body mechanics when administering PROM?
What is the procedure of applying PROM?
Define AAROM
Provide an example of AAROM
What are the indications of selecting AAROM?
What are the goals for AAROM?
Give an example of an AAROM intervention to address edema and inflammation
What are the precautions and contraindications of AAROM?
What are the limitations of AAROM?
What are the AAROM test/retest measures for efficacy?
Define AROM
What are the indications for AROM?
What are the goals for AROM?
Give an example of an AROM intervention to address edema and inflammation
What are the precautions and contraindications of AROM?
What are the limitations of AROM?
What are the AROM test and retest measures of efficacy?
How can you follow up an intervention with home mobility?
How do you teach self ROM exercises?
Is lymphedema a disease?
Lymphedema is not a disease. It is a result of something that has occurred with the body that has caused a malfunction in the lymphatic system. While you may not be able to cure or fix lymphedema, you can help a patient manage lymphedema to live a full and active life.
Define lymphedema
What are the primary causes of lymphedema?
A) congenital: Presents at birth. May be termed Milroy’s Disease.
B) Praecox: Develops prior to 35 years old.
C) Tarda: Develops after 35 years old.
What are the secondary causes of lymphedema?
This type of lymphedema is much more common to see in the clinic and is most commonly related to comprehensive oncologic management, particularly of the breast, pelvis, and abdomen. Secondary lymphedema is classified by the cause of the injury.
1) Surgery:
Lymph nodes and vessels may have to be surgically removed for primary tumors affecting the lymphatic system or for metastatic tumors that spread through the lymphatic system. The physicians are trying to stop the spread of the tumor cells. Lymph node sampling and subsequent removal (if tumor cells are found) in the upper extremity is common in breast cancer surgeries. Pelvic or inguinal lymph nodes may have to be removed for treatment of pelvic or abdominal cancers.
In order to preserve the major lymph nodes, patients will often have imaging to trace potential tumor development and what is called sentinel nodes. Sentinel nodes are like soldiers on the front line. They are the warning nodes. The main lymph nodes affected all the way to the sentinel nodes have to be removed, because the sentinel nodes are the lymph nodes that have some detectable trace of cancer cells. If these nodes are removed along with any affected main lymph node, there is a much better chance now that the axillary or main lymph nodes may be spared as long as the tumor cells are not there. If tumor cells are found in the major lymph nodes, these nodes must be removed, and the patient has a higher likelihood of developing lymphedema.
2) infection and inflammation:
Lymphangitis is inflammation of the lymph vessels, and lymphadenitis is inflammation of the lymph nodes. Enlargement of the lymph nodes is nermed lymphadenopathy. These can all occur as the result of an infection or local trauma, and they can all cause disruption of lymph circulation.
3) obstruction or fibrosis:
There are a lot of things that can clog up the lymphatic system, including trauma, surgery, and neoplasms. Radiation therapy used to treat malignant tumors can cause fibrosis of lymphatic vessels, even long after the physical treatment has ceased.
4) Combined Venous-Lymphatic Dysfunction:
Chronic venous insufficiency and varicose veins lead to stagnation within circulation. If the venous system is not returning blood, it is certainly not returning lymph very well; this is because the lymphatic system has increased workload imposed over time, which decreases the efficiency of the lymphatic system.
Because this is a combination of venous and lymphatic dysfunctions, you might see a combined clinical presentation. Common with venous dysfunction, the patient may have dependent edema, which means the swelling is present when the limb is hanging in a gravity-dependent position. These patients can report a dull aching or tiredness in the affected extremity, and you might see varicose veins and bulging veins. The patient may also have hyperpigmentation of the skin.
For the lymbadema portion of this presentation, the patient may have pitting edema, particularly in the dorsal aspect of the foot with swelling in their toes.
What is the importance of recognizing lymphedema?
Where does most lymphedema start?
Chronic venous insufficiency and varicose veins lead to stagnation within circulation. If the venous system is not returning blood, it is certainly not returning lymph very well; this is because the lymphatic system has increased workload imposed over time, which decreases the efficiency of the lymphatic system.
Because this is a combination of venous and lymphatic dysfunctions, you might see a combined clinical presentation. Common with venous dysfunction, the patient may have dependent edema, which means the swelling is present when the limb is hanging in a gravity-dependent position. These patients can report a dull aching or tiredness in the affected extremity, and you might see varicose veins and bulging veins. The patient may also have hyperpigmentation of the skin.
For the lymphedema portion of this presentation, the patient may have pitting edema, particularly in the dorsal aspect of the foot with swelling in their toes.
List the types of lymphedema from least to most severe?
1) pitting edema
2) brawny edema
3) weeping edema
What is Weeping edema?
This is the most severe and long-duration form of lymphedema, where fluid leaks from cuts or sores. The patient’s ability to heal these wounds is significantly impaired. This usually occurs in the lower extremity.
what is Brawny edema?
Pressure on the edematous area feels hard with palpation, which means that there is development of fibrotic tissues.
what is Pitting edema?
When you press on the edematous tissue with your fingertips, there is an indentation of the skin that persists for several seconds after the pressure is removed. Bad thing is that there is edema, but the good thing is that there is little to no fibrotic changes since the tissue can Rebound
What are the stages?
A) Stage 0 (Latency Stage): The lymphatic system is impaired, but there is no visible swelling. The body compensates, and symptoms like heaviness may be present.
B) Stage 1 (Reversible Stage): Swelling is mild and soft (pitting edema) and reduces with elevation. It’s reversible with proper care.
C) Stage 2 (Spontaneously Irreversible): Swelling becomes more persistent, with tissue hardening (fibrosis). Elevation doesn’t reduce swelling, but management can control it.
D) Stage 3 (Lymphostatic Elephantiasis): Severe swelling, skin changes (thickening, hardening), and a high risk of infections. Management focuses on preventing complications.
What are some other impairments to consider alongside lymphedema?
Explain lymphedema management
What is self manual lymph drainage?
Self-manual lymphatic drainage (MLD) is a gentle massage technique used to stimulate the lymphatic system and promote the movement of lymph fluid, reducing swelling and improving circulation. The process involves light, rhythmic strokes applied in a specific direction, typically toward lymph nodes, to encourage drainage. It’s essential to begin at areas near major lymph nodes, such as the neck, armpits, or groin, to “clear” pathways before addressing swollen areas. For example, to reduce arm swelling, start by massaging the lymph nodes in the neck and underarms with gentle circular motions, then use light sweeping strokes from the fingertips toward the armpit. Always consult a healthcare provider before starting MLD to ensure proper technique and safety.
How do you approach therapeutic exercises to supplement lymphatic drainage?
Give example of UE and LE therapeutic exercises to supplement lymphatic drainage
Why do we use soft tissue techniques?
What are the benefits of STM?
When should you use STM?
Typically, in presence of a joint dysfunction (the joint gets stuck), the muscles and soft tissue can respond with increased reactivity, guarding, and feeling “knotted up.” Once that joint dysfunction is corrected, the soft tissue mobility improves Now consider the other reason that muscles and soft tissues demonstrate reactivity: a chemical build-up. Improvement of the joint mobility in that region can improve the electrochemical balance in the region, as well as improve the neuro reflexes in the region.
Some patients may require soft tissue techniques first. You may find they would benefit from soft tissue techniques first when you try to “wind up” a joint during mobilizations/manipulations and there is not a good increase in tension in the joint. If you do not feel this increase in tension, you know the joint mobilization/manipulation techniques will not be as beneficial as you planned. In that case, you may do a small amount of soft tissue, and then immediately address the joint again. An increase in joint tension is like when you need to pop your knuckles. You bend your finger joint “tightening” the joint until there is a release or “pop.”
Essentially, if possible, treat the cause of the muscle issue which can often be an underlying joint issue. However, at times you need to address the muscle first because it is so restricted that you cannot appropriately address the joint. It is a bit of a
“chicken or the egg” paradox.
What are the contraindications of STM?
How do you prepare and set up the patient for treatment?
List the STM techniques for skin and subcutaneous tissue
List the STM techniques for muscular and other soft tissue
What are the STM treatment techniques?
Describe functional movement pattern
Functional movement pattern techniques in physical therapy focus on integrating passive and active associated movements while addressing mobility restrictions through soft tissue or joint mobilizations. These techniques combine guided passive motions, where the therapist facilitates movement, with active patient participation to engage relevant muscle groups and improve motor control. Simultaneously, therapists may apply soft tissue mobilization (e.g., massage or myofascial release) or joint mobilization to reduce stiffness, enhance range of motion, and optimize the quality of movement. For example, during a squat retraining exercise, a therapist might perform ankle joint mobilizations while the patient actively practices proper squat mechanics to improve mobility and motor patterning simultaneously.
Describe cross friction massage
Describe manual lymph drainage
Describe scar tissue mobilization
What are the prescription guidelines for STM?
Why do people lose mobility?
What are the immobility effects on muscle?
What are the immobilization effects on connective tissue?
What are the immobilization effects on articular cartilage?
What are the immobilization effects on bones?
What are the immobilization effects on nerves?
What is flexibility?
What are the types of flexibility?
How do contractures affect flexibility?
Define and provide an example for 1) myostatic contracture, 2) psuedomyostatic contracture, 3) arthrogenetic contracture
- Myostatic Contracture
A myostatic contracture occurs when a muscle shortens due to a lack of stretching or prolonged immobility, without structural changes in the muscle fibers. It is typically reversible with consistent stretching and strengthening exercises.
Example: A person with tight hamstrings from prolonged sitting can regain normal flexibility through regular stretching routines, such as seated hamstring stretches or dynamic warm-ups.
- Pseudomyostatic Contracture
Pseudomyostatic contracture is caused by increased muscle tone or spasticity due to a neurological condition, like a stroke or cerebral palsy, leading to apparent stiffness. Treatment focuses on reducing tone through techniques like neuromuscular inhibition or botulinum toxin injections.
Example: A stroke survivor with spasticity in the biceps may undergo physical therapy that includes passive stretching and muscle relaxation techniques, such as proprioceptive neuromuscular facilitation (PNF).
- Arthrogenic Contracture
An arthrogenic contracture results from intra-articular pathology, such as joint adhesions, capsular restrictions, or cartilage damage, which limit the joint’s range of motion. Addressing the underlying joint issue is crucial for recovery.
Example: A patient with knee stiffness after surgery may benefit from joint mobilizations and stretching exercises to improve range of motion, such as passive knee flexion and extension stretches.
Define and provide an example for 1) periarticular contracture, 2) fibrotic contracture
- Periarticular Contracture
A periarticular contracture occurs when tissues surrounding a joint, like ligaments or the joint capsule, become stiff and restrict movement. Therapy targets improving soft tissue flexibility and joint mobility.
Example: A frozen shoulder (adhesive capsulitis) may be treated with shoulder mobilizations, passive stretching, and soft tissue work to improve joint capsule flexibility and restore motion.
- Fibrotic Contracture
A fibrotic contracture involves irreversible structural changes in muscle or connective tissue, such as excessive fibrosis or scarring, that permanently restrict motion. While full reversal may not be possible, therapy can focus on improving function and preventing further stiffness.
Example: A patient with chronic Achilles tendon fibrosis may benefit from therapeutic interventions like deep tissue mobilization, eccentric strengthening, and bracing to maximize functional movement.
Define stretching
Stretching is a therapeutic intervention used to increase available range of motion in which a tensile force is applied at the end of motion. This results in elongation of the muscle-tendon unit. This deformation is transient, meaning that the changes due to appropriate stretching will not be permanent just by the stretching alone.
Define muscle stiffness
What happens when we stretch?
What is the stress/strain curve?
Define static stretching
This is the most common method of stretching we think of. The soft tissues are elongated just beyond the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time.
Benefits: Safer than ballistic stretching with less tension created in the muscles; can be performed manually or mechanically
Down-sides: Does not seem to trigger the GTOs (Golgi Tendon Organs) to inhibit the muscle like we would like to think that they do
Define static progressive stretching
A static stretch where the tissues are held in a comfortably lengthened position until a degree of relaxation is felt by the patient or therapist. The shortened tissues are then incrementally lengthened even further and again held in the new end-rage position for an additional duration of time.
In other words, you take the patient to where they feel a stretch, hold it in that position until the tissues relax or give a little, then take the joint/segment into further range in the same direction. Repeat as needed. This method takes advantage of the viscoelastic properties creep and stress-relaxation.
Benefit: Maximum effectiveness for static stretching
Downside: Takes a lot to control the stretch into new ranges of motion; takes still to be able
Define dynamic stretching
Dynamid stretching involves controlled movement through the active ROM for each joint. These are different from ballistic stretches because of the controlled movement and the decreased velocity.
Benefits: Can lead to enhanced muscle performance if the dynamic stretch is performed for more than 90 seconds. Beneficial for athletes, and may have an appropriate role in general fitness and rehabilitation programs.
Downside: Can be very difficult to teach patients how to do this at an appropriate speed with appropriate control.
Define Cyclic (Intermittent) Stretching
Short-duration stretch that is repeatedly but gradually applied, released, and then reapplied multiple times during a single treatment session. The endrange force is applied at a slow velocity, in a controlled manner, and at a relatively low intensity.
What makes it different from static-progressive stretching (hold 30-60 seconds) is that cyclical stretching is only held for about 5-10 seconds each time. What makes it different from ballistic stretching is the low intensity and slow velocity.
Benefits: As effective or more effective than static stretching in the literature, and tends to be more comfortable. One study showed decreased tissue yield with cyclical stretching, and another study hypothesized that the heat given off with cyclical stretching caused the soft tissues to stretch more easily.
Define ballistic stretching
Ballistic stretching is a rapid, forceful intermittent stretch. It has high-velocity and high-intensity. I like to think about it as getting a “running start” to the stretch.
Benefits: Improves flexibility equally to static stretching
Downside: Causes greater trauma to stretched tissue and greater residual muscle soreness; not recommended for elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures. See page 99 for reasoning.
Define Proprioceptive Neuromuscular Facilitation Stretching Techniques
(PNF Techniques)
PNF stretching is also called active stretching or facilitative stretching. We try to integrate active muscle contractions into stretching to inhibit or facilitate muscle activation. This increases the likelihood that the muscle to be lengthened remains as relaxed as possible during stretching. The thought is that this technique works to increase ROM because of proprioceptive input to the muscues to allow it to move. The other thought is that there is autogenic inhibition of the same muscle thorugh muscle spindles in the affected muscle OR there is reflexive inhibition by asking the antagonist muscles to work. Again, more of this will come at the end of the semester. You need to know that PNF techniques will ask the antagonist or the agonist muscle to work a little bit to get the joint to move better
Describe the modes of stretch as it relates to muscle, nerve glide, and contracture
What are the benefits and downsides of manual stretching?
Give an example for manual stretching prescription for muscle, nerve glide, and contracture
What are the benefits and downsides of self stretching?
Give an example for self stretching prescription for muscle, nerve glide, and contracture
What are the benefits and downsides of mechanical stretching?
Give an example for mechanical stretching prescription for muscle, nerve glide, and contracture
What are the benefits and downsides of PNF?
Give an example of ACSM prescription
What are the indications for stretching?
what are the contraindications for stretching?
What are the main steps to take with the patient?
What you should see if the stretching is the appropriate or inappropriate intervention at the right or wrong dose?
Explain regressing and progressing
You are treating a patient who is recovering from a period of immobilization due to a non-displaced humerus fracture 12 weeks ago. Your goal is to increase the patient’s elbow flexion ROM.
You are treating a patient who is recovering from a period of immobilization due to a non-displaced humerus fracture 12 weeks ago. Your goal is to increase the patient’s elbow flexion ROM. What adaptations do you expect to occur?
Give an example of what this could be
If you intend for this to be a muscle self-stretch for the triceps/elbow extensors, your prescription would be:
* Mode: Self-stretch to muscle
* Intensity: Moderate stretch sensation
* Duration: Hold 45-60 seconds, 4-5 repetitions
* Frequency: Daily
Give an example of what this could be
From all the phases of healing, which phase is characterized by the patient feeling pain at the first point of tissue resistance?
proliferative
Describe the intensity of a stretch that is intended to be a low-load long duration intervention?
Minimal to the first point of feeling stretch
If the range of motion is being demonstrated to its full capacity actively and passively, what category of interventions should the therapist target next?
Motor coordination
While assessing a patient, you notice the scapular position is in excessive adduction and downward rotation. What muscle should be stretched first?
Rhomboid major
During the earliest phases of motor learning, a patient is using a cuff to stabilize the low back when performing lower extremity movements. What type of practice would be most beneficial at this level?
Blocked order practice
A patient comes in for right subpatellar pain and clicking due to excessive compression of the patella against the femur (patellofemoral pain syndrome). The therapist examines the whole right lower extremity, and notices that the patient has a loss of strength/motor coordination in the right hip abductors and external rotators. This loss of hip muscle strength and motor coordination leads to the patellofemoral pain. Describe these impairments?
The right patellar pain is the primary impairment, and the loss of hip strength/motor coordination is the secondary impairment.
Primary impairment: direct impairment as a result of the issue
Secondary impairment: abnormalities due to primary intervention
Composite impairment: combo of both
Is decreased ROM a sign that shows an increased inflammatory response to an intervention, indicating that the therapist should decrease the intensity of an intervention or regress the intervention?
yes
Diagnosis for a patient is radiating pain secondary to an L3-4 disc lesion with nerve root irritation, what is the primary, overarching goal the therapist should consider with treatment planning?
Reduce sensory input from tissues
Where are the hinge points in an AROM side bend?
What is the procedure for PROM elbow extension/flexion?
What is the procedure for PROM ankle?
What is the procedure for PROM knee?
What is the procedure for PROM cervical?
Explain
Explain
Explain
Explain
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Explain
Is discomfort in the muscles a sign that shows an increased inflammatory response to an intervention, indicating that the therapist should decrease the intensity of an intervention or regress the intervention?
not necessarily
When considering the addition of a strengthening intervention to a Physical Therapy plan of care (PT POC), a therapist decides to use bridging (laying supine, knees bent, feet on mat; patient lifts hips off mat) instead of repeated sit to stands.
The therapist made this decision because the patient repeatedly states that putting too much weight through their leg felt like their “scar was going to rip open.” There were no post-operative contraindications given by the physician. Which of the following ICF elements did the therapist consider when making this decision?
Personal factors because there in no proof of physiologic issues causing the feeling (otherwise activity limitation)
What is joint mobility assessment?
What are joint mobilizations? How do you grade it?
Explain joint manipulations
What are the 3 main effects of joint mobilizations?
1) Mechanical: Joint mobilizations can restore joint play, stretch out taut capsules, stretch out adhesions, snap adhesions, and alter positional relationships.
2) Neurophysiological: Remember how Grade I and Il mobilizations are best at addressing pain and muscle guarding? The reason that they address pain so well is because they activate Type I (Ruffini) and Type II (Pacinian) mechanoreceptors. This repeated activation decreases pain. Type Ill mechano receptors (Golgi) are activated either by joint manipulation or a strong, endrange stretch to the capsule, thereby providing reflex muscle relaxation.
3) psychological: The actual act of laying your hands on a patient with confidence helps calm a patient and assures them that something good will result. This is NOT a reason that we would choose to use a mobilization or manipulation, but we have to consider it.
Think about it like this, most people appreciate or sense confidence with a solid handshake or firm hug. Most people feel creeped out by a floppy, weak handshake or hug. The same is true with joint mobilizations and manipulations. What you need to take home from this is that you need to be confident in yourself in order to effectively deliver a manual therapy technique.
How do you assess joint mobility?
Define arthrokinematics
List closed (blocked) and open (relaxed) chain positions for joints and their capsular pattern
How do you document joint mobility findings?
In acutely irritated tissue, do you start with open or closed chain?
In tissues that are acutely irritated, have high levels of pain, or early on in the rehabilitation processes, you will want to plan to start joint mobilizations in the open-packed joint position. As the patient’s pain decreases, joint mobility increases, or time has passed, you can progress joint mobilizations into more of a closed-packed position to take advantage of the tissue wind-up.
What are the steps to mobilize?
Explain distraction
What would the joint mobilization MIDF look like for acute vs chronic conditions
What are the contraindications of joint mobilizations?
What are the precautions of joint mobilizations?
What are musculoskeletal METs?
A muscle energy technique (MET) refers to any mobilization that involves the voluntary use of the patient’s muscles. Think about it like PNF combined with joint mobilizations (see videos of soft tissue lower extremity techniques).
Why do we use METs?
- “Restore mobility of a joint segment,
- Retrain movement patterns
- Reduce edema,
- Stretch fibrotic tissue,
- Retrain the stabilizing function of intersegmental muscles”
When do we use METs?
- “When the endfeel is predominantly muscular and not capsular
- To relax patient i.e. prior to manipulation
- Following manipulation (direct action)
- Prevent further joint stiffness”
How do we use METs?
To restore joint mobility, the technique involves accurate localization of the motion barrier and specific muscle activation to encourage a joint to move either into the barrier of motion or away from the barrier of motion. The resistance provided by the therapist is very gentle, and the dosage involves about 3 repetitions for a 6-8 second hold. This is really, really important to know!
How METs came to be?
Explain MET
MET, How do you know which muscle to use?
MET, explain dosing
1) Mode: Muscle Energy Technique, either agonist or antagonist muscle involvement.
2) Intensity: Very, very light resistance (ounces, not pounds of force). PT needs to be sure the opposite or additional surrounding muscles are not trying to fire and help, which can lead to excessive compression.
3) Duration: Hold 6-8 seconds, performing 3-4 repetitions. Recheck your objective measure.
4) Frequency: As needed depending on if patient meets one of the criteria for when to use the technique:
* When the endfeel is predominantly muscular and not capsular
* To relax patient i.e. prior to manipulation
* Following manipulation (direct action)
* Prevent further joint stiffness”
Define METs
“A muscle energy technique is applied from a precisely controlled position, in a specific direction and against a distinctly executed counterforce. The counterforce is in the region of ounces, not pounds. For a muscle energy technique to be successful, proper localization is key. This makes MET’s not the easiest techniques to do as palpation skills need to be fairly well advanced.”
Explain
Define joint mobilizations and its grades
How do you clinically assess and take a decision to apply joint mobilizations?
What are the Neurophysiological Effects of joint mobilizations?
What are the precautions and contraindications of joint mobilizations?
Explain how to mobilize the hip (coxofemoral) joint by long axis distraction
Explain how to mobilize the hip (coxofemoral) joint by lateral distraction
Explain how to mobilize the hip (coxofemoral) joint by posterior glide
Explain how to mobilize the hip (coxofemoral) joint by anterior glide
Explain how to mobilize the hip (coxofemoral) joint by inferior glide
Explain how to mobilize the hip (coxofemoral) joint by medial glide
Explain how to mobilize the patellofemoral joint by inferior (distal) glide
Explain how to mobilize the patellofemoral joint by superior glide
Explain how to mobilize the patellofemoral joint by medial glide
Explain how to mobilize the patellofemoral joint by lateral glide
Explain how to mobilize the tibiofemoral joint by long axis joint traction
Explain how to mobilize the tibiofemoral joint by tibiofemoral distraction
Explain how to mobilize the tibiofemoral joint by posterior glide of the tibia
Explain how to mobilize the tibiofemoral joint by anterior glide of the tibia
Explain how to mobilize the tibiofemoral joint by posterior glide of the femur
Explain how to mobilize the tibiofemoral joint by anterior glide of the femur
Explain how to mobilize the tibiofemoral joint by the combined mobilization for endrange knee extension with screwhome mechanism
Explain how to mobilize the tibiofemoral joint by medial tibial glide
Explain how to mobilize the tibiofemoral joint by lateral tibial glide
Explain how to mobilize the proximal tibiofibular joint by anterior glide
Explain how to mobilize the proximal tibiofibular joint by posterior glide
Explain how to mobilize the distal tibiofibular joint by anterior glide
Explain how to mobilize the distal tibiofibular joint by posterior glide
Explain how to mobilize the talocrural joint by joint distraction
Explain how to mobilize the talocrural joint by posterior glide
Explain how to mobilize the talocrural joint by anterior glide
Explain how to mobilize the subtalar joint by joint distraction
Explain how to mobilize the talocrural joint by subtalar medial glide
Explain how to mobilize the talocrural joint by subtalar lateral glide
Explain how to mobilize the intertarsal and tarsometatarsal joints by plantar glide
Explain how to mobilize the intertarsal and tarsometatarsal joints by dorsal glide
Explain the joint mobilization of superior glide, inferior glide, posterior glide, anterior glide, and distraction for sternoclavicular joint
Explain the joint mobilization of anterior glide for acromioclavicular joint
Explain the joint mobilization for the scapulo-thoracic joint
Explain the joint mobilization of long axis traction, lateral distraction, and inferior glide for GHJ joint
Explain the joint mobilization of posterior and anterior glide for GH joint
Explain the joint mobilization of distraction, distal glide, and lateral glide for HU joint
Explain the joint mobilization of medial glide and posterior superior glide for HU joint
Explain the joint mobilization of distraction, and compression for HR joint
Explain the joint mobilization of anteriomedial glide and posterolateral glide for HR joint
Explain the joint mobilization of anteriomedial glide (radius) and posteriolateral glide (radius) of proximal radio ulnar joint
Explain the joint mobilization of dorsal glide (radius) and anterior glide (radius) of the distal radio ulnar joint
Explain the joint mobilization of distraction, dorsal glide, palmar glide, and radial glide for radio carpal joint
Explain the joint mobilization of ulnar glide, individual carpal glides, and pisiform for radio carpal joint
Explain the joint mobilization of distraction CMC, ulnar glide, radial glide, dorsal glide, and volar glide for carpo metacarpal joint of thumb
Explain the joint mobilization of distraction MCP & IP, volar glide, dorsal glide, MCP radial glide/ulnar glide, and MCP & IP rotatory glides of MCP & IP joints
What are the AROM values for the lumbar spine and its capsular pattern
The PPIVM (Passive Physiologic Intervertebral Motion) for lumbar flexion and lumbar extension
The PPIVM (Passive Physiologic Intervertebral Motion) for lumbar side bending/lateral flexion, and rotation
The PPIVM (Passive Physiologic Intervertebral Motion) for PA glide of spinous process, and PA glide of unilateral transverse process
Explain lumbar spine mobilization of distraction and flexion
Explain lumbar spine mobilization of gapping L and lumbar flexion up & forward “breaking the bread”
Explain lumbar spine mobilization of down and back (closing)
What are the 3 primary pathologies of the sacroiliac joint?
Explain pelvic mobilization of PA glide of sacral bases into nutation and PA glide of the sacrum into counter nutation
Explain pelvic mobilization of anterior innominate rotation in prone, and in sideline
Explain pelvic mobilization of posterior innominate rotation in sideline
Explain pelvic mobilization of Ischial uplisp correction and inferior ischial correction
What are the AROM values and capsular pattern of thoracic spine?
The PPIVM (Passive Physiologic Intervertebral Motion) for trunk flexion, mid thoracic flexion, and trunk extension
The PPIVM (Passive Physiologic Intervertebral Motion) for thoracic extension, and trunk side bending/rotation
The PPIVM (Passive Physiologic Intervertebral Motion) for trunk rotation and side bending
The PPIVM (Passive Physiologic Intervertebral Motion) for bilateral PA pressure on the TP and unilateral PA pressure on the TP
The PPIVM (Passive Physiologic Intervertebral Motion) for thoracic extension bilateral PA pressure on the TP
The PPIVM (Passive Physiologic Intervertebral Motion) for gapping thoracic spine or closing
How do you perform 1st and 2nd rib mobility assessment?
Explain the joint mobilization of rib springing in the upper ribs and lower ribs
Explain rib mobilization of the 1st and 2nd ribs
Explain joint mobilization of upper anterior rib and lower rib
What are the AROM values and capsular pattern for the cervical spine?
The PPIVM (Passive Physiologic Intervertebral Motion) for cervical flexion, flexion mid cervical spine, and assessment of cervical extension
The PPIVM (Passive Physiologic Intervertebral Motion) for cervical extension mid spine, and axial distraction
The PPIVM (Passive Physiologic Intervertebral Motion) for cervical sidegliding mid cervical spine
The PPIVM (Passive Physiologic Intervertebral Motion) for alar ligament, cervical rotation stress test, and transverse ligament
What is the vertebral artery test?
Explain joint mobility testing of the upper cervical spine for side bending
Explain joint mobility testing of the upper cervical spine for flexion/extension and C1-2
Explain joint mobility testing of the upper cervical spine for distraction
Explain joint mobility testing of the upper cervical spine for flexion and unilateral distraction
Explain joint mobility testing of the upper cervical spine for mobilization C1-2
Explain joint mobility testing of the lower cervical spine for sideglide of the midcervical spine
Explain joint mobility testing of the lower cervical spine for up & forward (opening) of midcervical spine, and down and back (closing) of midcervical spine
Explain the METs of the cervical spine for combined movement technique, and C1-2
Explain the METs of the cervical spine for side glide, and up & forward (opening) of midcervical spine
Explain the METs of the cervical spine for down & back (closing) of the midcervical spine
Provide some examples of home exercises for soft tissue mobilization and self distraction of mid cervical spine
Provide some examples of home exercises for OA release
Provide some examples of home exercises for mid cervical spine up & forward
Provide some examples of home exercises for towel technique of mid cervical extension
Provide some examples of home exercises for hand collar mobilization unilaterally down and back
Provide some examples of home exercises for C-T junction
Provide some examples of home exercises for tennis ball mid T spine, and 1st rib with a towel
Provide some examples of home exercises for rib mobilizations with active lat stretch
Explain the grades of joint mobilization
Grade 1-2 (for pain)
How do you assess for joint mobilization?
What are the technical applications and neurophysiological effects of joint mobilization?
What are the precautions and contraindications of joint mobilization?
What are the types and severity of lymphedema?
How do you manage lymphedema?
- Manual lymphatic drainage
Slow, very light repetitive stroking and circular massage movements in a specific sequence (clear proximal congestion and then stroke distal to proximal toward lymph nodes) with the involved extremity elevated. See lab videos for demonstration. - Compression therapy
Depends on the phase of treatment.
Phase 1 – low stretch bandages are used (low resting pressure) with nonwoven padding with or without foam padding used day and night
Phase 2 – low stretch bandages are used at night, with compression garments during the day
Summary bandages are used to reduce limb volume; garments are used to maintain limb size - Exercise
a. Deep breathing and relaxation exercises
b. Flexibility exercises
c. Strengthening and muscle endurance exercises
d. Lymphatic drainage exercises
Explain lymphatic drainage exercises
List UE/LE lymphedema exercises
Give some example stretches for loss of hip extension
(hip flexor shortness)
Give some example stretches for loss of hip flexion
(hip extensor tightness)
Give some example stretches for rectus femoris shortness
Give some example stretches for hamstring shortness
Give some example stretches for IT band and TFL shortness
Give some example stretches for shortness of distal hamstring/posterior capsule of knee
Give some example stretches for shortness of anterior capsule of knee
Give some example stretches for loss of dorsiflexion (soleus/capsule shortness)
Give some example stretches for loss of dorsiflexion (gastroc tightness)
List example stretches for scoliosis
List examples of shoulder flexion stretches
List examples of shoulder abduction stretches
List examples of shoulder external rotation stretches
List examples of shoulder internal rotation stretches
List examples of shoulder horizontal adduction stretches
List examples of shoulder horizontal abduction stretches
List examples of shoulder extension stretches
List examples of elbow flexion stretches
List examples of elbow extension stretches
List examples of wrist flexion and extension stretches
Extra stretches
How do stretched structures relate to the convex/concave rule?
convex mobilization will have stretch (example joint capsule ant/post) in the same direction of force
concave mobilization will have stretch in the opposite direction of force
