Exam 3 - ATS 700

Therapeutic exercise, nomenclature, ergo-dynamics, equipment fitting

open kinetic chain exercises

extremity is not in contact with anything

closed kinetic chain exercises

extremity is in contact with the ground/surface

Archimedes principle

the upward force that is exerted on a body immersed in fluid is equal to the weight of the fluid displaces

compare assisted, supported, and resisted buoyancy

assisted: buoyancy is helping the body motion

supported: activity takes place in the plane of the water

resisted: buoyancy is directly opposed to the body motion

pascal’s law

at any given depth, liquid is exerting equal pressure on all surfaces

weight bearing percentages and anatomical landmarks for neck, torso, and hips

seventh cervical vertebrae: 8%

xiphoid process: males - 35%, females - 28%

ASIS: males - 54%, females - 47%

viscosity

the amount of internal friction of a fluid (how thick the fluid is)

laminar vs. turbulent flow

laminar - smooth, all molecules flowing in the same direction

turbulent flow: interrupted, positive pressure on anterior side and negative pressure on posterior side

factors that contribute to ROM limitations

joint capsule tightness

ligamentous adhesions

muscular tightness/spasm

myofascial tightness

pain/joint effusion

bony blocks

muscle spindles vs. golgi tendon organs

muscle spindles: react to sudden stretch

GTOs: detect tension over time (tell muscles to relax after 6 seconds)

autogenic inhibition

reflexive relaxation that allows tissues to continue to stretch (the point where GTOs overtake muscle spindles)

reciprocal inhibition

contracting the agonist to force antagonist to relax

PNF meaning

proprioceptive neuromuscular facilitation

contraindications to stretching (full list in slides)

limitation of joint motion by bony block

recent fx

inflammation or infection around joints

hematoma or other tissue trauma

sharp, acute pain with joint movement

PNF stretching techniques

contract-relax: stretch passively, isotonic contraction of agonist, then stretching further

hold-relax: stretch passively, isometric contraction of agonist

slow reversal hold-relax: passive stretch first, contract in antagonist pattern before contracting agonist (similar to contract relax but with an added contraction of the agonist)

joint mobilization purposes

help with lost accessory motion (!)

facilitate healing

reduce disability

relieve pain

restore full ROM

3 accessory motions

rolling: multiple surfaces of bone hitting multiple surfaces of another bone

spinning: multiple surfaces of the first bone hitting one surface of the second

gliding: one surface of the first bone hitting multiple surfaces of the second

grade 1 joint mob

small movements at the beginning of the ROM

grade 2 joint mob

large movements within the midrange of motion

grade 3 joint mob

large movement up to the pathological limit of ROM

grade 4 joint mob

small movements at the very end of ROM

grade 5 joint mob (and its caveat)

quick thrust delivered at the end of the ROM and usually accompanied by a popping sound

(this is typically not legal for ATs to perform)

primary purpose for each grade of joint mob

grades 1 & 2: decreasing pain

grades 3 and 4: increasing mobility

open vs. closed packed position

open: joint is going to be the loosest (usually mid-range)

closed: joint is the tightest (usually at end range)

convex-concave rule

if concave is stationary and convex is mobilized, move in the opposite direction of the limitation

if convex is stationary and concave is mobilized, move in the same direction of the limitation

ex: if shoulder flexion is limited, since the scapula is concave and the humerus is convex then the joint should be mobilized posteriorly

ex: if knee flexion is limited, since the femur is convex and the tibia is concave then the joint should be mobilized anteriorly

how are we trying to present information about injuries?

PRECISE and CONCISE (!)

use specific information in as few words as possible

give as much quantitative info as possible

examples of what we use grades for

sprains

strains

examples of what we use levels for

trauma centers

spinal cord injuries

examples of what we use types for

growth plate injuries

acromion process shapes

fractures

tensile forces

pulling or traction on a tissue

compression

pressing down on a tissue

(ex. contusion, lumbar spine discs)

shear forces

forces in 2 opposite directions

(ex. secondary concussive injury)

torsion

twisting

(ex. knee getting twisted and causing torn ligaments)

direct blow

direct hit to a specific area

common tissues that can get injured

skin, muscle, tendon, fascia, joint capsules

ligament, bursae, cartilage (CT), nervous tissue

tendinitis vs. tendinosis vs. tendosynovitis

tendinitis: more acute pain/inflammation

tendinosis: more chronic, moving past the subacute phase of tissue repair

tenosynovitis: synovial membrane (tendon sheath) is inflamed

break down heterotopic ossification

hetero: other or different

topic: position or place

ossification: bone development

ecchymosis

coloration of tissue (skin)

callus vs. corn

callus: thickening of the tissue from repetitive force

corn: focal hyper-keratinization of skin (can present like a deeper callus)

hard corn vs. soft corn

hard: tough, pokey, feels like glass

soft (heloma molle): looks/feels like rotten tissue, most often an interdigit lesion (have to change mechanism or else it will come back)

what does sprain mean (think word/country of origin)

to press out

clinically defined as a traumatic twisting of a joint resulting in a stretching or total tearing or the stabilizing connective tissues

dislocation vs. subluxation

dislocation: joint is forced completely out of its normal and proper alignment (must be reduced)

subluxation: partial dislocation (bone goes back into place after)

osteochondral dissecans (OCD)

delamination of cartilage and bone underneath (both begin to break loose)

open vs. closed fracture (fx)

open: skin is broken

closed: skin is in tact

avulsion fx

tissue separates from the bone

comminuted fx

crushed

greenstick fx

bone is compressed on one side and breaks on the other (common in adolescents)

oblique fx

angular

transverse fx

fracture in the transverse plane

spiral fx

damage to a bone around an axis

compression fx

same as force, pressing down on a bone (like landing hard on feet)

epiphyseal fx

fracture at the growth plate (common in adolescents)

stress fx

fracture from overuse, chronic injury (like shin splints)

diaphysis

main shaft of the bone

epiphysis

growth plate, joint surfaces covered with a layer of articular cartilage

located at the end of long bones

periosteum

dense, white, fibrous membrane, covers long bones except at joint surfaces

contains osteoblasts and blood vessels

concomitant

injury that occurs along with a primary injury

ex. proximal fibula fx in addition to ankle sprain

apophysitis

growth plate irritations from tensile forces

often a precursor to an avulsion fx

hypothesia

diminished sense of feeling

hyperthesia

increased sense of feelings such as pain or touch

paresthesia

numbness, pricking, or tingling

may occur from a direct blow or stretch to an area

neurapraxia

trauma directly affecting nerves

often called a burner or stinger

entrapment

nerve gets pinched within other tissue structures

ex. carpal tunnel

stretch injuries (3)

neurapraxia - contusion

axonotmesis - crushing

neurotmesis - transection

load

external force acting on tissues that causes internal reaction within the tissues

stiffness

relative ability of a tissue to resist a particular load

(more stiffness = more load it can withstand

stress

internal resistance of tissues to an external load

(think wall pillars)

strain

extent of the deformation of tissue when it is loaded

elasticity

property of human tissue that allows a tissue to return to normal following deformation

yield point

when tissue is deformed to the point it no longer reacts elastically

plastic changes

when deformation persists after the load is removed and permanent changes remain

creep

deformation in the shape and/or properties of a tissue that occurs if load stays constant over time

(the point where elasticity changes to plasticity)

mechanical failure

ability of tissue to withstand stress and strain is exceeded

(spot at the end of the chart; where injury occurs)

types of tissue loading that cause strain

compression

tension

shearing

bending

torsion

NOCSAE and what they do

National Operating Committee on Standards for Athletic Equipment

tests and establishes minimal safety requirements

also sets standard for materials and the quality of these materials for safety equipment

certifying bodies for ice hockey helmets

Canadian Standards Association (CSA)

Hockey Equipment Certification Council (HECC)

types of face protection

full face guard (cages)

throat guards

mouth guards

ear guards

eye protection

types of eye protection

protective sport goggles

sunglasses

contact lenses

eye shields

purpose of trunk and thorax protection

to protect against regions that are exposed to the impact of forces

ex. external genitalia, bony protuberances, shoulders, ribs, and spine

2 types of football shoulder pads

cantilevered - bulkier for blocking and tackling

non-cantilevered - does not restrict motion

what is the purpose of socks as protective equipment

to help absorb and distribute shock

(poorly fit socks can cause abnormal stress on the foot)

best practices for socks as protective equipment

clean, dry, and without holes

cotton/polyester blend for less weight and and faster drying

when should shoes be fitted

at the end of the day

(due to gradual increase in volume from weight bearing)

other consideration for shoe selection

toe box

sole/heel

arch support

playing surfaces

mechanism of activities

foot orthotics

assisted devices for ambulation

(inserts are a type of orthotic)

prophylactic definition and which brace its typically used for

preventative

used for knee braces

types of knee braces

rehabilitative

functional

neoprene (with medial and lateral support)

purpose of casting (ISP)

immobilize

stabilize

protect

casting materials

plaster

fiberglass (!)

plastics

what are we checking for after casting (FACTS)

functionality

arterial pulse

capillary refill

temperature

sensation