FF - Module 2 readings (ACL rehab, Janda crossed syndrome, Mobiliz concave/convex, Adhesive Cap, Stretches, Shoulder joint conditions, Swayback posture, LE conditions, wheelchair positions)

What is the greatest factor influencing ACL surgery candidacy in young girls?

Skeletal maturity (lack of skeletal maturity may contraindicate surgery)

When should postoperative ACL exercises begin?

Immediately on postoperative day 1.

Why must rehabilitation progress cautiously during the first 2-3 weeks after ACL reconstruction?

The tendon graft undergoes necrosis before revascularization

Which graft heals faster after ACL reconstruction?

Bone-to-bone healing (patellar tendon graft) heals faster than soft tissue-to-bone healing (hamstring graft

What strengthening precaution is needed with a hamstring tendon graft?

Be cautious with knee flexor strengthening

What strengthening precaution is needed with a patellar tendon graft?

Be cautious with knee extensor strengthening

Is continuous passive motion (CPM) highly beneficial after ACL reconstruction?

No. It may be used but has limited benefit.

Which open-chain knee extension range is considered safe after ACL reconstruction?

90°-45° of knee flexion

Which strengthening approach is preferred after ACL reconstruction?

Closed kinetic chain (CKC) exercises

Which CKC quadriceps strengthening range should be avoided after ACL reconstruction?

60°-90° of knee flexion

How long is a hinged ACL brace typically worn?

Up to 6 weeks

During ambulation, how is the ACL brace positioned?

Locked in extension

When is a functional ACL brace typically used?

During advanced rehab (11-24 weeks) and return to high-demand sports

What does the ACL resist?

Anterior tibial translation

Medial rotation of the tibia on the femur

What mechanism commonly injures the ACL?

Knee hyperextension

Which special tests assess ACL integrity?

Lachman

Pivot Shift

Anterior Drawer

What are the goals of Phase I (1-4 weeks)?

Protect healing tissues

Prevent quadriceps inhibition

Prevent DVT

Decrease swelling

ROM: 0°-110°

Establish HEP

What interventions occur during Weeks 0-2 after ACL reconstruction?

PRICE

Gait training

PROM/AAROM

Patellar mobilizations

Isometrics

Assisted SLR

PWB → WBAT

When can patients progress to full weight bearing after ACL reconstruction?

When they have:

Full active extension

Adequate quadriceps strength

Pain-free gait

Which exercises begin during Weeks 2-4?

Mini squats

Heel raises

Toe raises

OKC extension (90°-45°)

Stationary bike (≈3 weeks)

Trunk stabilization

What strength is required to progress to Phase II?

60% strength compared with the uninvolved limb

What are the goals of Phase II (4-10 weeks)?

Full pain-free ROM (0°-125°)

4/5 strength

Dynamic knee control

Normalize gait

Improve proprioception

What exercises are emphasized during Weeks 5-6?

Multi-angle isometrics

CKC strengthening

PRE

Bike

Pool

Elliptical

Single-leg balance

Band walks

What activities begin during Weeks 7-10?

Advanced strengthening

PNF

Step drills

Walking

Jogging progression

Balance training

What strength is required before entering Phase III?

75% strength of the uninvolved limb

What occurs during Phase III (11-24 weeks)?

Advanced strengthening

Eccentric training

Plyometrics

Agility drills

Sport-specific activities

Running and cutting drills

When is return to sport expected after ACL reconstruction?

Approximately 6 months to 1 year

What CPM ROM is used immediately after surgery?

0°-70° flexion

What CPM ROM is expected by Week 6?

0°-120° flexion

When is the ACL graft weakest?

Week 6

Which muscles are tight in Upper Crossed Syndrome?

Upper trapezius

Levator scapulae

SCM

Scalenes

Suboccipitals

Pectorals

Latissimus dorsi

Subscapularis

Which muscles are weak in Upper Crossed Syndrome?

Lower trapezius

Serratus anterior

Rhomboids

Longus capitis

Longus colli

Suprahyoids

Infrahyoids

Which muscles are tight in Lower Crossed Syndrome?

Iliopsoas

Rectus femoris

Hamstrings

Lumbar erectors

Tensor fascia lata

Quadratus lumborum

Which muscles are weak in Lower Crossed Syndrome?

Gluteals

Rectus abdominis

Transversus abdominis

Vastus medialis

Vastus lateralis

What are the hallmark features of adhesive capsulitis?

Dense adhesions

Capsular thickening

Capsular restriction

What age group most commonly develops primary frozen shoulder?

40-60 years old

What conditions commonly lead to secondary frozen shoulder?

Rheumatoid arthritis

Osteoarthritis

Trauma

Immobilization

What is characteristic of the Initial Onset stage?

Gradual pain

Worse with movement

Night pain

Loss of external rotation

Duration:

What occurs during the Freezing stage?

Constant pain (even at rest)

Motion limited in all directions

Duration: 3-9 months

What occurs during the Frozen stage?

Pain only with movement

Significant adhesions

Scapular substitution

Muscle atrophy

Duration: 9-15 months

What occurs during the Thawing stage?

Minimal pain

Gradual ROM improvement

Capsular restrictions remain

Duration: 15-24+ months

Some patients never regain full ROM

What interventions are included in Phase I (Protection)?

Sling

Pendulums

PROM

Grade I-II mobilizations

Posterior-inferior glide

Posterior glide for ER

What interventions occur during Phase II (Controlled Motion)?

Wand exercises

Self-ROM

Grade III-IV mobilizations

Self-mobilizations

Stretching

Posture correction

What interventions occur during Phase III (Return to Function)?

GH internal/external rotation strengthening

Progressive stretching

Progressive strengthening

Vigorous mobilizations if stiffness persists

If joint irritability is high during adhesive capsulitis, in which direction should joint glides initially be performed?

Glide opposite the direction of restriction until pain decreases, then mobilize toward the restriction

Muscle produces force without changing length.

Isometric contraction

Muscle changes length while maintaining relatively constant tension

Isotonic contraction

What are the two types of isotonic contractions?

Concentric

Eccentric

The muscle shortens while producing force.

Concentric contraction

The muscle lengthens while producing force

Eccentric contraction

Muscle contraction at a constant velocity using specialized equipment

Isokinetic contraction

If a concave surface moves on a convex surface, which direction does the glide occur?

Same direction as the roll

Give an example of concave-on-convex movement

Elbow flexion

During elbow flexion, what direction do the roll and glide occur?

Both occur anteriorly

If a convex surface moves on a concave surface, what direction does the glide occur?

Opposite the roll

Give an example of convex-on-concave movement

Shoulder abduction

During shoulder abduction, what direction does the humeral head roll?

Superiorly

During shoulder abduction, what direction does the humeral head glide?

Inferiorly

What type of joint is the thumb CMC joint?

Saddle joint

During thumb radial flexion/adduction, what glide occurs?

Ulnar glide

During thumb radial extension/abduction, what glide occurs?

Radial glide.

Is radial thumb motion concave-on-convex or convex-on-concave?

Concave-on-convex (same direction)

During palmar adduction, what glide occurs?

Volar (anterior) glide

During palmar abduction, what glide occurs?

Dorsal (posterior) glide

Is palmar thumb motion concave-on-convex or convex-on-concave?

Convex-on-concave (opposite direction)

Which thumb motions have roll and glide in the same direction?

Flexion and extension (concave-on-convex).

Which thumb motions have roll and glide in opposite directions?

Abduction and adduction (convex-on-concave)

What is the resting (loose-packed) position?

Minimal joint surface contact with maximal joint play.

When should joint mobilizations be performed?

In the loose-packed position

What is the closed-packed position?

Maximum joint congruency with maximal capsuloligamentous tension.

Should joint mobilizations be performed in the closed-packed position?

No

Which mobilization grades are used when pain or muscle guarding is present?

Grade I and Grade II

Which mobilization grades are used when motion is limited without pain?

Grade III and Grade IV

Describe Grade I mobilization.

Small-amplitude movement at the beginning of range

Describe Grade II mobilization.

Large-amplitude movement within range but not reaching tissue resistance.

Describe Grade III mobilization.

Large-amplitude movement into end range

Describe Grade IV mobilization.

Small-amplitude oscillation at the end of range into tissue resistance

Describe Grade V mobilization.

High-velocity, low-amplitude thrust at end range

What causes a hard end feel?

Bone or cartilage contact

Give an example of a hard end feel.

Elbow extension

What causes a soft end feel?

Soft tissue approximation.

Give an example of a soft end feel.

Elbow flexion

What causes a firm end feel?

Capsular or ligamentous stretching

Give an example of a firm end feel.

Shoulder flexion

What causes a pathological hard end feel?

Heterotopic ossification (HO) or abnormal bony obstruction

What causes a boggy end feel?

Edema or joint swelling

What causes a springy end feel?

Meniscal displacement

What causes a rubbery end feel?

Muscle spasm

What causes a firm end feel with decreased elasticity?

Fibrosis of soft tissues

What causes an empty end feel?

Pain or muscle guarding before tissue resistance

What is swayback posture?

Pelvis neutral or in posterior tilt

Inc pelvic inclination to 40 deg

Thoracolumbar spine exhibits kyphosis

What muscles are short/strong in swayback posture?

Hip extensors

Lower lumbar extensors (short but not strong)

Upper abdominals

What muscles are long/weak in swayback posture?

Hip flexors

Lower abdominals

Lower thoracic extensors

How to stretch the upper trapezius?

Rotation of neck toward the tight side, then SB away from the tight side and then add neck flexion

How to stretch the levator scapulae?

Opposite side flexion and rotation

How to stretch the scalene?

Extension, SB of neck to opp side and rot to same side

How to stretch the SCM?

Opposite SB and same side rotation of neck

What is the ideal pelvic position in the sagittal view?

Neutral to slight anterior tilt

Where should the shoulders be positioned relative to the hips?

Aligned above or slightly behind the hips

What should the spine maintain in proper wheelchair sitting posture?

Natural lumbar, thoracic, and cervical curves