TI 2 Unit 1

FITT VP

Frequency

Intensity

Time

Type

Volume

Progression

Frequency

how often

intensity

how hard/what level

time

how long/duration

type

what kind

volume

total amount

progression

exercise advancement

2x2 rule for exercise progression

If for the last 2 sessions, the patient felt like they could do 2 more reps, time to progress

Warm up

prepare tissues for work

-15 minutes or less

conditioning

exercise portion

-10-60 minutes

cooldown

low-level activity that prepares your body to return to a resting state

-5-10 minutes

SAID principle

Specific Adaptations to Imposed Demands

-train specific to gain specific

Overload principle

Continuous challenge is needed to progress

Principle of Diminished Returns

as we get close to our genetic ceiling, the rate of improvement will slow

reversibility principle

use it or lose it

procedural reasoning

Strategy that requires choice in administration of intervention

-why are we using this specific exercise for this specific patient

reflection on action

reflect after an action

reflection in action

reflection that occurs during

reflection for action

Planning future actions based on past reflections

motor unit activation neural adaptation

more motor units are able to be recruited, increasing strength

-benefits up to 6 weeks (then it decreases)

motor imagery neural adaptation

form of mental practice, mentally practice the task without doing movement

-gets motor cortical areas working

-rapidly increases muscle strength

(physical practice is more effective, but some can't do that)

cross-transfer neural adaptation

contralateral strengthening can improve strength in opposite extremity up to 25%

motor unit activation can increase strength by _____% , firing rate then decreases after ____ weeks

35, 6

when does hypertrophy begin to account for muscle strength

4-8 weeks

mitochondria ratio ______ with resistance training

decreases

how does the decrease in mitochondria impact strength, power and endurance?

doesn't hinder strength or power

-decreases endurance

what are the 4 things connective tissue is made up of?

-collagen

-elastin

reticulin

-ground substance

collagen

strength and stiffness

elastin

extensibility + flexibility

reticulin

bulk

ground substance

hydrates matrix, stabilizes collagen networks, resists compressive forces

how is the collagen oriented in tendons

parallel to resist high tensile loads + transmits muscle force to bone

how is collagen oriented in ligaments

varies to counteract multidirectional force on ligaments

(ligaments that resist major joint stresses tend to be more parallel)

ATP-PC system

An energy system that provides energy very rapidly, for approximately 10-15 seconds, via anaerobic metabolism

-high intensity activity

Glycolytic System

moderate- high intensity activity

-up to 4 minutes

Aerobic System

low-moderate intensity activi

-used for activities greater than 90 seconds

which 2 systems are used in resistance training

ATP PC

Glycolytic

endocrine adaptations to exercise

-decreased fat mass

-decreased stress and depression

-increased cognitive function

-improved insulin secretion

-improved glucose metabolism

-decreased insulin resistance

-decreased inflammation

-increased tumor apoptosis

-increased bone mineralization

how is vo2 max affected by heavy resistance training

no change

true or false, vo2 max is increased with circuit resistance training

true

how does nutrition relate to PT

-influences recovery, performance and can prevent injury

-affects muscle strength, bone density, + wound healing

what are some of the major nutrient deficiencies in the US

vitamins A, B6, B12, C, D, E

folate, calcium, magnesium, iron

3 guiding principles for a healthy diet

-eat more whole, minimally processed food

-limit intake of ultra processed foods

-prioritize diversity + plant based nutrients

what factors influence a person's ability to maintain a healthy diet

-financial status

-nutritional knowledge

-cookiing skills

-cultural view on food

-time

-health constraints

-stress

-taste preference

what are a PT's responsibility with nutrition

-screen for poor nutritio

-educate using publically available resources

-promote healthy eating as part of a normal life

-refer to dieticians

key nutrients in maintaining bone health

-calcium

-vitamin D

-protein

-magnesium

-vitamin K

- phosphorus

-zinc

how does nutrition impact wound healing

protein> essential for tissue repair

vitamin C > needed for collagen production

What are the 6 degrees of motion of the spine

Flexion/extension

Sidebending

Rotation

Anterior/posterior shear

Lateral shear

Compression/distraction

_______ is a term use to denote a posterior curve

kyphosis

where is the spine kyphotic?

thoracic and sacral

______ is a term to denote an anterior curve

lordosis

where is the spine lordotic

cervical and lumbar

stability is improved by _______ center of gravity or _______ base of support

lowering, widening

global muscles of cervical spine

-SCM

-scalenes

-levator scapulae

-upper trap

-erector spinae

deep segmental muscles of the C spine

rectus captitis anterior + lateralis, longus colli

spinal stability is described in terms of what 3 subsystems:

Passive (inert)

active (muscles)

Neural control

what are indications for spinal surgery

patients with radiculopathies caused by nerve root irritations what have failed conservative management (PT, injections)

laminectomy

posterior approach; removal of lamina WITHOUT fusion of spine

fusion goals

(fuses spinal segment together)

-reduces segmental motion

-reduces mechanical stress

-reduces incidence of herniation

anterior cervical disc fusion (ACDF)

horizontal incision at cervical vertebrae by cutting platysma and longus colli

-disc excised + adjacent vertebrae are fixed

whats the most common post op complication of a ACDF

dysphagia

what are signs of dysphagia

drooling, trouble feeding, "lump in throat"

which procedure (laminectomy or fusion) has quicker recovery and sooner return to work?

laminectomy

CPG recommendations for treating acute neck pain with movement coordination deficits

Education

Manual therapy

gentle exercise

CPG recommendations for treating chronic neck pain with movement coordination deficits

education

mobilization

exercise

TENS

True or false, TENS should be used as a stand alone treatment for neck pain with movement coordination deficits

false

CPG recommendations for treating acute neck pain with radiating pain

upper extremity mobilization, centralizing, manual therapy and traction, exercise, education

CPG recommendations for treating chronic neck pain with radiating pain

mobilization, stabilization, educate

cluster for patients likely to benefit from traction:

age 55+

(+) shoulder abduction test

(+) upper limb tension test

(+) distraction test

sx peripheralized w PA testing of lower C spine

CPG recommendations for treating acute neck pain with mobility deficits

thoracic manips

neck ROM exercises

stretching

neck isometrics

scapulothoracic strengthening

CPG recommendations for treating chronic neck pain with mobility deficits

Multimodal!

cervical/thoracic mobs/manips

neuromuscular exercise

stretching

strengthening

aerobic conditioning

modalities

cognitive approaches

true or false, Dr. Boehm has lived in 7 states and 2 countries

true! (she was a travelling PT and lived in Italy for a while)

cluster for patients likely to benefit from manipulations

-sx duration <38 days

-(+) belief that MT will help

-10+ degree difference in cervical rotation

-Pain with PA spring testing of middle cervical spine

CPG recommendations for acute neck pain with headaches

supervised active mobility (self SNAGs)

CPG recommendations for subacute neck pain with headaches

cervical mobs/manips

Self SNAGs

CPG recommendations for chronic neck pain with headaches

cervical/thoracic mobs/manips

shoulder girdle/neck strengthening + stretching

why does stabilization work?

progressive load tolerance, helps with kinesiophobia

muscles involved in control of lumbar spine

rectus abdominis

E/I obliques

quadratus lumborum

erector spinae

iliopsoas

transversus abdominis

multifidus

deep rotators

rectus abdominis origin, insertion, action, innervation

Origin: Pubic symphysis and pubic crest

Insertion: Xiphoid process and costal cartilages of ribs 5–7

Action: Trunk flexion, posterior pelvic tilt, compresses abdominal contents

Innervation: Thoracoabdominal nerves (T7–T11), subcostal nerve (T12)

External oblique origin, insertion, action, innervation

Origin: External surfaces of ribs 5–12

Insertion: Linea alba, pubic tubercle, anterior iliac crest

Action:

Bilateral: Trunk flexion, compresses abdomen

Unilateral: Lateral flexion to same side, rotation to opposite side

Innervation: Thoracoabdominal nerves (T7–T11), subcostal nerve (T12)

Internal oblique origin, insertion, action, innervation

Origin: Thoracolumbar fascia, iliac crest, inguinal ligament

Insertion: Inferior borders of ribs 10–12, linea alba, pubis

Action:

Bilateral: Trunk flexion, compresses abdomen

Unilateral: Lateral flexion and rotation to same side

Innervation: Thoracoabdominal nerves (T7–T11), iliohypogastric and ilioinguinal nerves (L1)

quadratus lumborum origin, insertion, action, innervation

Origin: Iliac crest and iliolumbar ligament

Insertion: 12th rib and transverse processes of L1–L4

Action: Lateral flexion of spine, elevation of pelvis, assists in spinal extension and respiration (fixes 12th rib)

Innervation: Ventral rami of T12–L4

erector spinae origin, insertion, action, innervation

Origin: Broad tendon from sacrum, iliac crest, lumbar and lower thoracic spinous processes

Insertion: Ribs, transverse processes, mastoid process (varies by segment)

Action:

Bilateral: Spinal extension

Unilateral: Lateral flexion to same side

Innervation: Dorsal rami of spinal nerves

iliopsoas origin, insertion, action, innervation

Origin:

Psoas Major: Transverse processes and bodies of T12–L5

Iliacus: Iliac fossa

Insertion: Lesser trochanter of femur

Action: Hip flexion, trunk flexion when femur is fixed

Innervation:

Psoas Major: Lumbar plexus (L1–L3)

Iliacus: Femoral nerve (L2–L4)

transversus abdominis origin, insertion, action, innervation

Origin: Internal surfaces of ribs 7–12, thoracolumbar fascia, iliac crest, inguinal ligament

Insertion: Linea alba, pubic crest

Action: Compresses abdominal contents, increases intra-abdominal pressure, stabilizes trunk

Innervation: Thoracoabdominal nerves (T7–T11), iliohypogastric and ilioinguinal nerves (L1)

multidifus origin, insertion, action, innervation

Origin: Sacrum, PSIS, mammillary processes of lumbar vertebrae, transverse processes (T1–T3), articular processes (C4–C7)

Insertion: Spinous processes of vertebrae 2–4 segments above

Action: Stabilizes vertebrae, assists with local extension and contralateral rotation

Innervation: Dorsal rami of spinal nerves

effects of mechanical stress in sustained poor posture

held positions cause stress to pain sensitive structures (ligaments, joint capsules)

-can cause distention/compression of nerve endings

effect of impaired postural support to trunk muscles with poor posture

It requires a little muscle activity to maintain upright posture

-with total relaxation, curves become exaggerated + passive structures are needed to maintain passive support

-hypermobility

-stretch weakness or tight weakness of muscles

effect of impaired muscle endurance with chronic poor posture

endurance is needed in postural control, as muscles weaken load is shifted to inert tissues which can cause mechanical stress

disc herniation

displacement of disc material beyond normal limits of IV disc space

disc protrusion

displaced material is contained by outer layer of annular fibrosis

disc extrusion

disc displaced beyond PLL

disc sequestration

extruded disc material is a free fragment

Tissue Fluid Stasis and Spinal Discs

sustained flexed postures cause sustained loading on discs, facets, and ligaments leading to creep and fluid transfer. Extension exercises may help to alleviate this

acute stage of healing (inflammation) time frame

0-7 days

subacute stage of healing (proliferation) time frame

10-17 days

chronic stage of healing (maturation + remodeling) time frame

12-18 months

common impairments with joint hypomobility in shoulder

pain w motion

decreased ROM

weakness

increased ST motion

common impairments in RCRPS

-pain

-may have hypomobility (due to pain)

common impairments with shoulder hypermobility

-decreased strength and endurance of RC

-laxity of GH joint in multiple directions

-impaired scapulothoracic rhythm