Exam #2 EVAL

What can cause a deficit in somebodies motion?

• Pain

• swelling

• guarding/spasms

• joint injury

• surgery

• Inactivity, shortening if connective tissue

• Combination of these

What is joint mobility

The ability of a joint to move through its full available ROM

• Affected by joint surfaces such as arthrokinematics/accessory motion

What is Muscle flexibility?

The ability of a muscle or muscle groups to lengthen passively through its full available ROM

• Affected by joint mobility

What is active ROM exercises?

Movement of body part through an arc of motion by themselves

what is Active Assistive ROM exercises?

Movement of a body part through an arc of motion with a combination of an active contraction and external force.

• When muscles are weak or when joint motion causes pain

What is the 3 part sequence of AROM, PROM, and AAROM?

1. Start with AROM is patient can perform w/o pain or inflammation

2. Start with AAROM if patient cannot perform AROM

3. Start with PROM if cannot perform AAROM or if muscle contraction is contraindicated due to injury or surgery.

What are anatomical limitations to flexibility

• Muscle, tendons, surrounding fascial sheaths

• Connective tissue

• Bone

• Adipose tissue

• Skin

• Neural tissue

• All except bone, age, and gender can be altered to increased joint ROM

What is efferent

Motor; away from teh spinal cord

WHat is afferent

Sensory; towards the spinal cord

What is facilitatory

Excites; increases makes easier

What is inhibitory

Depresses; decreases; makes more difficult

What is a muscle spindle

Sensory receptors found in the muscle fibers; sensitive to stretch; facilitates contraction

What are Golgi tendon organs(GTOs)

Sensory receptors found in the muscle tendons; sensitive to increased tension (muscle contraction); inhibits further contraction

what is the monosynaptic stretch reflex?

A reflex action in which a muscle contracts in response to its own stretch, involving only one synapse in the spinal cord.

What is autogenic inhibition?

Relaxation of the muscle that is contracting

• Contracts during the push phase, causing increased tension

• Stimulates GTOs to produce reflex relaxation before more placed of stretch

What is reciprocal inhibition?

Contraction of agonist causes a reflex to relax

What is a hold relax PNF

technique used in proprioceptive neuromuscular facilitation (PNF) that involves contracting a muscle, followed by relaxation and stretching of the same muscle, enhancing flexibility and range of motion.

What is a Contract relax PNF

A technique in proprioceptive neuromuscular facilitation (PNF) where a muscle is contracted maximally, then relaxed and stretched, promoting greater flexibility and range of motion.

What is Slow Reversal Hold relax PNF stretching?

A PNF technique that combines alternating contractions of the antagonist and agonist muscles, often followed by a hold phase to enhance flexibility and stability.

What are the recommendations for stretching?

• Between 3-6x/week

• Muscle needs to be maximally relaxed

• Deep breathing

• Visualization

• Conscious relaxation

• change location of treatment if patient is not comfortable

What are precautions for stretching

• Overload necessary however always keep stage of healing in mind; re injury

• Educate patient — discomfort i ok but pain isn’t

• Stretching with acute injury OK as long as tissue stretching is not injured

• Contraindications; bony block, fracture, infection, acute injury, sharp pain with muscle stretch, acute hematoma

ROM deficits

• Accessory movements not occurring properly

• Physiological motion affected(decreased visible ROM)

• Capsular patterns noticed

Join Hypomobility potential causes include

• Pain, muscle spams/guarding, effusion, joint contractures, capsule adhesions, ligament contractures, bony misalignment

Joint mobilization

• Targets the cause, which is poor accessory motion, such as kinematics and accessory movements

Physiological motions

• Osteokinematics

• - Result of concentric or eccentric active muscle contractions

• To treat deficits(stretching techniques, AROM, PROM, AAROM)

• Most effective at the end of range

Accessory motions include

Motion of joint surfaces relative to one another is not under voluntary control

Can be hypo, normal, or hypermobility

What is hypermobility?

Hypermobility refers to an excessive range of motion in a joint beyond normal limits, often leading to instability or potential injury.

What is hypomobility?

Hypomobility refers to a decreased range of motion in a joint, which can lead to stiffness, reduced flexibility, and functional limitations.

What are capsular patterns?

The pattern of limitations exhibited by specific joints when inflamed

• If ROM deficits occur as a result of capsular tightness, causing hypomobility in accessory motion, a predictable pattern of motion can be seen

What are mobilizations?

Slower speeds, occurs throughout the

range, may be a small or large amplitude movements

What is manipulations?

Always at end of range, small amplitude, quick thrust

What is concave convex?

If concave joint is moving on stationary convex surface, glide occurs same direction as role

What is the convex concave rule?

If convex surface moving on stationary concave surface, gliding occurs in the opposite direction to roll

What is Compression?

Compression – decreased jt space

 Improved jt stability

 Associated with WB activities or muscle contraction around a

joint

 Important for joint nutrition

 Abnormally high loads problematic

What are Distractions?

Distraction – when jt surfaces are separated

 Helpful to relieve joint pain

 Most commonly used

 Precedes most manual therapy techniques (including joint mobs)

What is open pack position?

Max. jt play - position in which jt cap/ligs most

relaxed

• Articulating surfaces maximally separated

• Position used for joint mobilization

What is closed pack position?

Max contact of articulating surfaces

Should not be used haphazardly (avoid)

• Inflammatory arthritis

 Malignancy

 Bone disease

 Neurological involvement

 Bone fracture

 Congenital bone deformities

 Vascular disorders

What is pelvic neutral

Position in which pelvis is neither anterior(flexed) or posterior (extended) tilted position

Why is muscle strength and endurance essential in rehab

• Prevent PREVENT ATROPHY, REGAIN

  MUSCLE STRENGTH,

  POWER, & ENDURANCE

• SAFE AND EFFECTIVE

  RETURN TO FUNCTION

What is muscle strength?

-The muscle’s ability to generate F against some resistance

 normal for healthyliving

 Imbalance/weakness impairs normal function

 Higher load, lower reps (<10)

What is muscle endurance?

Ability to perform repeated muscular activity against an external resistance over an extended period of time

 Important in everyday activities/ADLs

 Lower load, high reps (>10); shorter rest (<1 min)

What is muscle power?

Ability to generate F quickly

 Strength & speed

 Applying a greater force over a given distance in the same time OR applying the same force over the same distance in a shorter time

Isometric Contraction (prevent) muscle tension with no viable changes in length

Often initial exercises after injury/ surgery

 Safe

 Pt controls amt of resistance

 No jt motion

 Can perform at multiple angles throughout range

 Strength gains are specific to the joint angles, however there is a

20% overflow

 Use positional or functional ex – if possible, work at multiple angles

thru-out ROM

 Hold ~6sec for 8-10 reps

 May produce spikes in systolic BP… Breath!

Overload principle

The concept that to increase strength, muscle endurance, or power, the workload must be progressively increased beyond what the muscles are accustomed to.

the SAID principle

(Specific Adaptations to Imposed Demands) states that the body will adapt specifically to the demands placed on it, including strength training or cardiovascular conditioning.

What is open chain?

non-weight bearing

exercises; distal joint not in

contact with ground

What is closed chain?

compressive forces applied to the fixed distal joint (foot or hand), and forces progressively transmitted up the kinetic chain

 Proximal joint motions influenced from the ground up

 Functional due to weight bearing component

Whata re closed kinetic chain exercises?

fixed distal segment) – best for functional, multi-joint, weight-bearing stability

 Improve functional movement and joint stability; reduce shear on healing joints (esp. knee/ACL rehab).

 Effective for knee OA (short-term), lower-extremity rehab, and stability.

 Why: Muscle co-contraction reduces joint shear stress.

What are open kinetic chain exercises?

free distal segment) – best for isolating muscles and early rehab when WB must be limited

 Useful post-op when avoiding full WB or targeting isolated weakness.

 Good for muscle hypertrophy, mobility, and strengthening muscles like the rotator cuff.

 Why: Greater control of single-joint movement with less whole-body stabilization

What are progressive resistive Exercises(PRE’s)

Goal is to continually overload muscle as strength and endurance improve

 Essential to every rehabilitation program

 Be sure the program is individualized

 Repetitions usually b/t 8-15

 Sets usually b/t 1-4

What are isokinetic exercises?

Isokinetic Exercise

 constant velocity/ accommodating resistance

 Max. resistance throughout ROM

 Variety of machines/ manufacturers

 Eccentric, concentric

 Conditioning

 Max. effort = max. gains (cheating)

 Not cost effective

 Rehab Tool

 Objective evals

 Fast vs. slow speeds

 Functional???

What are plyometric exercises

tch followed by rapid concentric contraction

 facilitates explosive power

 >er stretch relative to resting l = >er resistance m can overcome

 Speed of stretch emphasized over magnitude

 to develop ecc. control of dyn. mvmts

 should be performed technically correct