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Core Practice Quiz 1 Sean > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Which activities often elicit pain for PFP

A

activities that load the patella
- squatting
- activities with knee flexion
- sitting down for long periods of time

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2
Q

Orthotics and PFP

A

Good for short term benefit but not long term

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3
Q

Running re-education for PFP

A

Remove poor biomechanics
Push patients to forefoot strike instead of heavy heel strike in front of body

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4
Q

Potentially beneficial treatments for PFP

A

Exercise
Patellar taping
braces
orthoses
gait retraining

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5
Q

Ineffective treatments for PFP

A

Manual therapy (standalone treatment)
Biofeedback
Dry needling
Electrotherapies/biophysical agents

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6
Q

Demographic risk factors of PFP

A

Sex - more likely in females

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7
Q

Local Risk factors of PFP

A

Reduced quad strength or hypermobility of patella, different sized patella, patella alter

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8
Q

Proximal risk factors of PFP

A

hip strength not a risk factor, reduced ABD/ADD

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9
Q

Distal risk factors of PFP

A

inconclusive evidence on role of foot mechanics
Flexible flat foot more likely to respond to orthotics

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10
Q

Common impairments of PFP

A

Hip strength: reduced ABD/ADD/ER/IR/Ext
Knee strength: reduced quadriceps strength
Foot mechanics
Patella hypomobility; maltracking
Decreased flexibility: hamstrings, ITB, quads, gastroc, soleus
Calves: reduced DF (can’t absorb impact)

Want to treat individual impairments

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11
Q

Education for PFP

A
  • Too much load through knee cap than it was ready to handle
  • Load vs capacity. Want to use a gradually overloading progressive program
  • Important tool to help patient understand what movements aggravate knee and to discuss the amount of load their body can handle (envelope of function)
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12
Q

Key biomechanical factors to address in PFP

A

Poor function and weakness of hip and thigh muscles
Too much foot roll (pronation)

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13
Q

Key treatment options for PFP

A

Exercises to improve strength and function of hip and thigh muscles
Taping knee to reduce pain in short term
Foot orthotics if you have too much foot roll (pronation)

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14
Q

Crepitus in PFP

A

Doesn’t matter too much (not related with function, physical activity or pain) but is common in PFP

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15
Q

Psychological features in PFP

A

increased levels of anxiety, depression, pain catastrophising and pain related fear in people with PFP

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16
Q

Open kinetic chain vs closed kinetic chain exercise for PFP

A

similar clinical effects
Biomechanical differences, each one with advantages and disadvantages

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17
Q

What does a deeper squat do to the patella

A

puts more load on it

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18
Q

Forward trunk, forward shank position on PFP joint load

A

best for trail limb

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19
Q

Forward trunk, vertical shank position on PFP joint load

A

best for lead limb

20
Q

Hip + Knee strengthening vs knee strengthening alone for PFP

A

Hip + Knee Strengthening is better
hip exercise targeting posterolateral hip musculature

21
Q

Exercise program for PFP

A
  • Combined hip and quad strength
    o Quad strength
    o Abduction strength
  • Progress to single leg exercises
  • Movement control
    o Single leg stands
    o Trunk lean
    o Knee valgus
    o Single leg lunge with some flexion
    o Single leg bridges
22
Q

Taping and PFP

A

short term benefits when combined with exercise
Helps to perform activities without pain

23
Q

Knee braces and PFP

A

no evidence for pain/function/physical activity levels
May be helpful for people with fear of movement

24
Q

Foot orthoses and PFP

A

useful for people with excessive pronation
clinical outcomes variable and only in short term

25
Q

Risk factors for patella tendinopathy

A

risk in men - late tendon maturation and training volume

26
Q

Common impairments for patella tendinopathy

A

Common impairments
- Strength
o Hip ABD/ER/EXT
o Calf muscles (impact absorption)
- Flexibility
o Lower limb
- Mobility
o Excessive foot pronation

27
Q

Treatment of patella tendinopathy

A

Education
- Activity modification
- Load management
- Pain monitoring  traffic light
o No exacerbation after exercise
o No residual pain after 24h
- Realistic rehabilitation time frames
- Address wrong beliefs about pain
- Passive treatments are low-value care
- Active change in motion or any exercises where the tendon acts as a spring – jumping, hopping

Exercise
- Leg extension great for isolating the quadriceps
- Isometric exercises in severe cases

28
Q

Exercise prescription Patella tendinopathy

A

Exercise Prescription
Stage 1 – Isometrics
- Use quad isometrics in isolation
- Reduced quadriceps motor cortex inhibition
- Vary angles
o Mid range might be more comfortable
- No muscle fasciculation in stage 1 – load too high
- Duration: a few weeks (sometimes more)
- Address other kinetic chain issues
- Leg extension
- Wall sit
- Spanish squat
- 5 repetitions of 45 seconds, 2 to 3 times per day

Stage 2: Isotonic
- Avoid extreme angles initially
- Minimal pain (green light) in more irritable cases; can go up to yellow (5/10) as a progression if no residual pain
- Progress to weight bearing (e.g. lunges) when techniques and capacity to tolerate load are adequate
- Leg extension
- Leg press
- Weighted lunges
- 3 to 4 sets at a load of 15RM progressing to a load of 6RM

Pitfall
- Rushing to multi-joint complex exercises and forget to address muscles in isolation (quads specially)
- Watch for compensation signs (e.g. glute fatigue)

Stage 3: Energy Storage Loading
- Turning tendon into spring now
- Adequate strength
o Ability to perform 4-8 reps @ 150% BW
o Symmetrical strength
- Load tolerance
o Minimal pain (green light, up to 3/10
o No exacerbations
- Progress volume (e.g. 6 to 10 jumps) before intensity higher jumps)
- Initial stages: exercises every 3rd day

Stage 4: return to sport

29
Q

Treatment pitfalls for patella tendinopathy

A

Not addressing; isolated muscle deficits, kinetic chain deficits, landing biomechanics
Dealing with highly irritable tendons
in season athletes
young jumping athletes

30
Q

Fat pad impingement diagnosis

A

pain with activities in passive/active knee extension
palpation of pat pad
pain at EOR flexion when fat pad swells

31
Q

Which actions will cause fat pad impingement

A

standing for long periods of time
activities with long periods of extension
Activities at end of range flexion –> bulgarians

32
Q

Difference between fat pad and PFP

A

long periods of standing painful for fat pad impingement but not PFP

33
Q

Treatment of fat pad impingement

A
  • Phase 1: Reduce Inflammation
    o Activity modification
    o Limited active/passive extension
    o Tape
    o Heel Raise (goes into less extension): Heel raise helps by putting knee in a bit of flexion
     Pain worsens in bare foot
    o Ice
  • Phase 2: Rehab
    o Movement patterns/posture
    o Muscular retraining: start out of knee extension and progress through to RTS
34
Q

Taping for fat pad impingement

A
  • Fat pad de-load tape
  • Extension block taping
35
Q

What is the compression zone for ITBS

A

20-30 degrees knee flexion

36
Q

What action can you minimise to help ITBS

A

minimise compression of area, particularly in positions of ADDuction

37
Q

Exercise program for ITBS

A

Exercise Program
Exercises to strengthen the abductor muscles and stabilise the hip can be helpful it clinically indicated
- Hip Bridge with Resistance Band
- Side Lying Hip Abduction
- Lateral Band Walk
- Gait retraining for midline striking

38
Q

Treatment options for ITBS

A

often proximal hip and trunk/weakness
gait retraining –> midline striking occurs

39
Q

Taping for PFP

A

patella taping - medial glide

40
Q

what does a PA glide do for the tibiofemoral joint

A

improves knee extension and pain relief

41
Q

what does an AP glide do for the tibiofemoral joint

A

improves knee flexion and pain relief

42
Q

what does a Lateral rotation of the tibiofemoral joint do

A

improves knee extension and external rotation of tibia
Pain relief

43
Q

what does a medial rotation of the tibiofemoral joint do

A

improves knee flexion and internal rotation of tibia
Pain relief

44
Q

what does tibiofemoral traction do

A

General ROM improvement
Compression issues – knee OA

45
Q

what does STM of hamstring do

A

helps with hamstring guarding and improves ROM

Core Practice Quiz 1 Sean (6 decks)

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