Therapeutic Exercise Exam #2

during the subacute phase, pain will occur with/after activity, while in the chronic phase, pain will occur with/after activity

with, after

what motion should be especially avoided in joint mobs with GH anterior-inferior instability?

anterior glide

significant development of muscle weakness normally occurs during what phase of healing?

subacute

true or false: during the acute phase, the PT may begin developing NM control, endurance, and strength

false (subacute)

what type of injury occurs as a result of direct trauma or a sudden overloading of musculoskeletal tissues?

acute injuries

acute injuries are often micro/macrotraumatic

macrotraumatic

true or false: fractures, dislocations, subluxations, sprains, strains, etc. are all examples of chronic injuries

false (acute)

how may you differentiate between a chronic and acute injury?

type of trauma, time course of inflammation, histopathological differences

true or false: acute injuries usually involve a form of mechanical irritant that extends beyond the ability of the tissue to repair itself

false (chronic)

describe the pain-spasm cycle***

***

true or false: those with chronic inflammation could have pain after repetitive activities, during repetitive activities, or the pain could be continued and unremitting

true

how long are those w/ GH instability immobilized?

2-8 weeks

how long does rehab of GH joint instability normally take?

2.5-4 months

what are the 4 stages of adhesive capsulitis?

1. gradual onset of pain (>3 months)

2. freezing stage (3-9 months)

3. frozen stage (9-15 months)

4. thawing stage (15-24 months)

what are the general management guidelines of adhesive capsulitis based on stages?

acute: max protection (stage 1/2)

subacute: controlled motion (stage 3)

chronic: return to function (stage 4)

true or false: with adhesive capsulitis, if there is increased pain or irritability in joint after treatment, either the dosage was too strong or technique should be modified by decreasing PROM or delaying joint mobs

true

what is the main contraindication with treatment of adhesive capsulitis?

if mechanical restrictions limit motions, stretching should only be initiated post-inflammation

what condition develops w/ pain in wrist extensor tendons along lateral epicondyle w/ GRIPPING activities?

lateral epicondylitis (tennis elbow)

what condition develops w/ pain at the common flexor/pronator tendons near medial epicondyle?

medial epicondylitis

when the pelvis is anteriorly tilted, the hip is flexed/extended and the lumbar spine is flexed/extended

flexed, extended

when the pelvis is posteriorly tilted, the hip is flexed/extended and the lumbar spine is flexed/extended

extended, flexed

true or false: putting the hip in anterior rotation turns on the hip extensors and abs

false (posterior tilt)

in lateral pelvic tilt, the hip will be adducted/abducted on the low side and abducted/adducted from the high side. additionally, the lumbar spine will laterally flex away from/towards the low side.

abducted, adducted, away

in anterior pelvic rotation, the ipsilateral hip will IR/ER and the contralateral hip will IR/ER. additionally, the lumbar spine will rotate opposite/in the same direction as the pelvic rotation.

ER, IR, opposite

true or false: legg calve perthes disease, SCEF, OA/RA, and femoral neck/head fractures can lead to a THA

true

what are the hip precautions for an anterior approach?

do not extend hip beyond neutral

no lying in prone

do not ER/extend the hip

no bridging exercises

what are the hip precautions for a posterior approach?

do not flex the hip > 90*

do not IR hip beyond neutral

do not adduct hip beyond neutral

true or false: while they are important to know, hip precautions have muddled evidence of effectiveness

true

what are the signs of a DVT?

lower leg swelling, pain in calf/thigh, redness, pain w/ palpation

true or false: DVTs should be monitored for with THA post op

true

what phase of muscle tears involves the

-disruption of muscle fibers/connective tissue sheaths

-necrosis of tissue

-degeneration/infiltration forming hematoma and edema at site of injury

destruction phase

what phase of muscle tears involves

-hematoma formation in gap b/w ruptured muscle fibers

-matrix formation

-collagen formation

repair phase

what phase of muscle tears involves:

-regenerated muscle maturing and contracting w/ reorganization of scar tissue

-often incomplete restoration of functional capacity of injured muscle

remodeling

what is the location of the vertical projection of the ground reaction force?

center of pressure

what type of balance control maintains a stable antigravity position while at rest in standing or sitting?

static balance control

what type of balance control stabilizes the body when the support surface is moving or when the body is moving on a stable surface (sit to stand, walking)

dynamic balance control

what type of balance control involves maintaining balance in response to external perturbations?

automatic postural control

someone is able to maintain standing on a bus that suddenly decelerates. what type of balance control are they exercising?

automatic postural control

when beginning dynamic resistance with GH anterior-inferior instability, what ROM should be limited?

ER

what are some examples of exercises that can be initiated in the protection phase of adhesive capsulitis?

sliding towel on table top, pulleys, pendulum, submax painfree shoulder isometrics

what are some examples of exercises that can be initiated in the controlled motion phase of adhesive capsulitis?

self mobilization for inferior, anterior, posterior glides

wand/cane shoulder self stretching flexion, abduction, ER, IR

performing multiplanar exercises adding perturbations may be included in what phase of adhesive capsulitis rehab?

return to function phase

what is the difference between primary and secondary rotator cuff impingement?

p: anatomical/biomechanical factors decrease subacromial space

s: mechanical compression due to hypermobility or instability of GH joint and increased translation of humeral head

what tissues are most often involved w/ RTC impingement?

supraspinatus, infraspinatus, subdeltoid/subacromial bursae, long head of bicep tendon

what is perhaps the biggest priority in addressing impingement?

scapular mechanics/stabilization

what part of the spine may be mobilized during the protection phase of RTC impingement?

thoracic

what position should especially be avoided when performing ther ex on shoulder impingement?

impingement position

what are some examples of dynamic RTC exercises that can be performed in the controlled motion phase of RTC impingement?

theraband shoulder flex, ab, ER, IR

prone scapular strengthening

OC alternating isometrics

CC stabilization (quadruped)

progressing eccentric training to max load occurs during what phase of rehab?

return to function

when treating RTC impingement, the PT implements stabilization exercises w/ increased speed in order for the patient to develop quick motor responses to imposed stress. what phase of healing may they be in?

return to function

WBAT = cemented/non-cemented while PWB/TTWB = cemented/non-cemented

cemented, non-cemented

which of the following would likely not be included in the initial interventions of a THA post op rehab plan?

a. sit to stand transfers

b. gait and balance teaching w/ assistive device

c. stationary bike

d. strength assessments

c. stationary bike

what are the criteria for THA home d/c?

independent ambulation > 150 ft. on level indoor surfaces

adherence to hip precautions

achieve basic functional activities of daily living using adaptive equipment

the intermediate phase of a THA generally begins __ s/p surgery

4-6 weeks

strengthening of what muscles is often emphasized during the intermediate phase of a THA?

hip abductors/extensors

true or false: stationary cycling, swimming, and water aerobics are all usually permissible during the intermediate phase of a THA

true

how long can the minimal protection/return to function phase last in THA rehab?

12 weeks to a year

true or false: a low intensity walking program may be appropriate to implement with someone in the return to full activity phase of THA rehab

true

what are the main goals of the first phase of muscle strain rehab?

protect scar development, minimize atrophy

what is done to optimally protect the injury during phase 1 of a muscle strain rehab plan?

avoid excessive active or passive lengthening of the hamstrings

what are some examples of exercises that can be performed during phase 1 of a hamstring muscle strain rehab?

stationary bike x 10 min (pain free)

side step

grapevine

fast feet stepping in place

prone body bridge (plank)

supine body bridge

single leg balance

what are the criteria to progress to phase 2 when rehabbing a hamstring muscle strain?

1. normal walking stride w/o pain

2. very low speed jog w/o pain

3. PF isometric contraction against submaximal resistance during prone knee flexion MMT

what are the main goals of phase 2 of hamstring muscle strain rehab?

regain PF hamstring strength at different progressive lengths

develop NM control of trunk and pelvis w/ progressing increase in movement speed

what is done to optimally protect the injury during phase 2 of a hamstring muscle strain rehab plan?

avoid end range lengthening of hamstrings while hamstring weakness is present

what are the criteria to progress to phase 3 of a hamstring muscle strain rehab plan?

full strength 5/5 w/o pain during prone knee flexion MMT

pain free forward/backward jog at moderate intensity

what are the main goals of phase 3 of a hamstring muscle strain rehab plan?

1. symptom free during all activities

2. normal concentric/eccentric HS strength through full ROM and speeds

3. improve NM control of trunk and pelvis

4. integrate postural control into sport specific movements

what is done to optimally protect the injury during phase 3 of a muscle strain rehab plan?

avoid full intensity if pain, tightness, or stiffness is present

what are the criteria for full return to sport with a hamstring muscle strain?

1. full strength w/o pain

2. 4 consecutive max effort manual strength test in each prone knee flex position (90 and 15*)

3. less than 5% bilateral deficit in eccentric HS and concentric quadriceps during isokinetic testing

4. bilateral symmetry in knee flexion angle of isokinetic concentric knee flexion torque at 60*/sec

5. full ROM w/o pain

6. replication of sport specific movements near maximal speed w/o pain

what VC should be given with a scapular stabilization exercise?

pull scapulas down and back into back pockets to recruit retractors and lower trap

(watch for lumbar extension, cervical protraction, scapular elevation, shoulder extension)

what VC should be given with scapular UR w/ serratus anterior facilitation exercises?

push fingertips toward ground, then perform shoulder flexion, scaption, or abduction w/ VC to continue pushing fingertips forward

(watch out for: increased shoulder elevation, thoracic flexion, cervical protraction, lumbar extension)

scapular activity during shoulder motion is ___ ___

dynamic stabilization

what position should isometric contraction of the shoulder be done in?

loose pack

for isometric contraction of the shoulder, the hand pressure should be put on the same/opposite side of the direction of the PTs motion

same

how many hold/reps/sets are isometric contractions of the shoulder normally done in?

5 s hold 5 x

how many hold/reps/sets are alternating isometric contractions of the shoulder normally done in?

5 s hold 5 x

can be done shorter/faster

for alternating isometric contraction of the shoulder, the hand pressure should be put on the same/opposite side of the direction of the PTs motion

same

what position are alternating shoulder isometric contractions done in?

90* flexion

what action are concentric resisted contractions of the shoulder done in?

IR/ER

what action are eccentric resisted contractions of the shoulder done in?

IR/ER

for concentric contraction resistance of the shoulder, the hand pressure should be put on the same/opposite side of the direction of the PTs motion

same

for eccentric contraction resistance of the shoulder, the hand pressure should be put on the same/opposite side of the direction of the PTs motion

opposite

how many reps are concentric/eccentric contractions of the shoulder done in?

5-10 (until fatigue)

how would a PT direct a patient to perform prone scapular series?

prone w/ arms off plinth

emphasize scapular over shoulder motions

VC/manual cues to squeeze scapula down and back

watch out for: lumbar extension, shoulder IR, cervical protraction

how would a PT direct a patient to perform back to wall arm slides

Consider performing Supine before Standing

Stand with back against wall

Walk feet away from wall to increase hip flex and post pelvic tilt.

Keep knees over heels to prevent patellar compression.

Encourage Scapular upward rotation using manual cues as needed.

Give VC to slide arms up wall, keeping arms and back of hands against wall.

Watch out for: lumbar extension, cervical protraction

VC: "push head toward ceiling and try to keep back against the wall"

how may a patient do independent RTC isometrics?

use towel roll under elbow to maintain LPP

stabilize scapula and emphasize moving only humerus

push shoulder against wall into flex/ext, abd/add, IR/ER

how does the PT perform shoulder elevation (flexion/abduction) w/ manual shoulder UR?

Begin with pt's shoulder below 30 degrees of elevation. With one hand on the body of the scapula, press the scapula into the thorax to correct winging and/or upward tilt. The anterior hand is over the coracoid process, clavicle, and acromion process and is pushing posteriorly

As the pt begins to elevate the shoulder, the scapula MUST upwardly rotate. The PT uses manual pressure to maintain correct scapular position (minimizing winging/upward tilt) while also assisting the scapula with upward rotation.

RTC theraband resistance**

***

when trying to stretch the HSs, the pelvis should be pulled into anterior/posterior tilt

anterior

when trying to stretch the hip flexors, the pelvis should be pulled into anterior/posterior tilt

posterior

quadruped rocking may be used for injuries to what muscle group?

hip flexors

what position can be used to stretch the anterior hip capsule?

figure 4

when a patient is doing a figure 4 stretch, the PT should give VC for the patient to contract what muscle groups?

glutes, ERs

quarter squeezes target what muscle group?

hip ERs

how do you instruct a patient to perform quarter squeezes?

Top of head to ceiling (engages lumbar stabilizers to hold pelvis)

Soften knees (unlock from full extension to allow femur to externally rotate)

"Squeeze quarter" by slightly externally rotating femurs

Should feel deep gluteal muscle contraction

using a theraband with bridges increases the activity of what muscle groups?

hip abductors, ERs

having a patient push their arms into the floor or table with bridges increases recruitment of what muscle group?

lower abdominals

having a patient pushing their feet into the table or floor and away from the buttocks without letting their feet slide creates isometric contraction of what muscle groups?

quads

in sidelying hip abduction, the hip should be slightly __

ERed

heel squeezes work on what muscle groups?

ERs

as the patient presses their heels together when performing heel squeezes, what motions should the hip NOT be doing?

adducting, extending