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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
Risk factors for patella tendinopathy
risk in men - late tendon maturation and training volume
26
Common impairments for patella tendinopathy
Common impairments - Strength o Hip ABD/ER/EXT o Calf muscles (impact absorption) - Flexibility o Lower limb - Mobility o Excessive foot pronation
27
Treatment of patella tendinopathy
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
Exercise prescription Patella tendinopathy
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
Treatment pitfalls for patella tendinopathy
Not addressing; isolated muscle deficits, kinetic chain deficits, landing biomechanics Dealing with highly irritable tendons in season athletes young jumping athletes
30
Fat pad impingement diagnosis
pain with activities in passive/active knee extension palpation of pat pad pain at EOR flexion when fat pad swells
31
Which actions will cause fat pad impingement
standing for long periods of time activities with long periods of extension Activities at end of range flexion --> bulgarians
32
Difference between fat pad and PFP
long periods of standing painful for fat pad impingement but not PFP
33
Treatment of fat pad impingement
- 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
Taping for fat pad impingement
- Fat pad de-load tape - Extension block taping
35
What is the compression zone for ITBS
20-30 degrees knee flexion
36
What action can you minimise to help ITBS
minimise compression of area, particularly in positions of ADDuction
37
Exercise program for ITBS
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
Treatment options for ITBS
often proximal hip and trunk/weakness gait retraining --> midline striking occurs
39
Taping for PFP
patella taping - medial glide
40
what does a PA glide do for the tibiofemoral joint
improves knee extension and pain relief
41
what does an AP glide do for the tibiofemoral joint
improves knee flexion and pain relief
42
what does a Lateral rotation of the tibiofemoral joint do
improves knee extension and external rotation of tibia Pain relief
43
what does a medial rotation of the tibiofemoral joint do
improves knee flexion and internal rotation of tibia Pain relief
44
what does tibiofemoral traction do
General ROM improvement Compression issues – knee OA
45
what does STM of hamstring do
helps with hamstring guarding and improves ROM

Core Practice Quiz 1 Sean (6 decks)

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