Active Care - Exam 1 Part 1: Introduction to Active Care

Active Care is considered a complementary addition to chiropractic care due to what 6 concepts?

1) Reduce pain

2) Restore biomechanics & function

3) Improve strength

4) Stability & Coordination

5) Improve flexibility

6) Improve proprioception & balance

What is the patient taking a role in their treatment, typically in the form of exercise?

Active care

-- pt taking ACTIVE role

Does Passive or Active care work as a more verbal approach with short term fixes , but has the downside of relying on pain avoidance, labels diagnosis, and promotes reliance on others to fix?

Passive Care

NOTE: Don't really like this definition because passive care isn't bad (quote what Kleppe said in class), but just know general differences

Does Passive or Active care work to reduce pain, restore biomechanics and function, improve strength stability and coordination, improve mobility and flexibility, improve proprioception and balance, and involves patient education and advice?

Active Care

What are the 3 roles movement plays in patient care?

1) General health & wellness

2) Assessment

3) Treatment & management

With the general health and wellness role of movement in patient care, we use movement as medicine to optimize ________, ___________, and ____________.

Movement, Function, & Performance

T/F; Static assessment helps to diagnose a movement problem

FALSE

-- does NOT help; need movement screens, tests, and assessments

What is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient's primary complain?

Regional Interdependence

Diseases such as coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems, and musculoskeletal conditions can all benefit from what?

Cardio training / Overall cardiovascular fitness

T/F: For aerobic exercise, we want 75 minutes total of moderate activity or 150 total minutes of vigorous activity.

FALSE

Moderate = 150 total

Vigorous = 75 total

For aerobic exercise, it is recommended to have _____ minutes on ____ or more days for a total of ________ minutes of moderate activity.

30 minutes

5 or more days

150 minutes of moderate activity TOTAL

Diseases such as all-cause mortality, cancer mortality, CVD mortality, insulin resistance, cardiometabolic markers, inflammatory proteins, mental health (depression & anxiety), improved memory and cognitive functioning, immune system function, migraines/headaches, and pain modulation can all benefit from what?

Resistance training & overall strength

______ non-consecutive days of resistance training is recommended each week.

2 non-consecutive days a week

When we ___________ strength, we can ___________ all-cause mortality

Increase strength = Decrease all-cause mortality

(Inverse relationship)

What are the 4 reasons why movement assessment leads to better diagnostics and improved outcomes?

1) Find cause

2) Explain source

3) Determine effective treatment

4) Shorten treatment time

What is the location the individual is feeling pain?

Source

What is the area creating the pain in the individual, and may be different from where the body is feeling the pain?

Cause

Remember not necessarily the same location as the source

What is the #1 predictor of injury?

Previous injury

How are pain, altered motor control, and injury interrelated?

Pain is a protective mechanism, underlying dysfunction can lead to the initial injury, but resultant dysfunction can present following injury

(they can all lead to one another)

What is the necessary input, sufficiently processed, with an acceptable output?

Motor Control

What involves poor timing, sequencing, coordination and sunergy of the neuromuscular system which manifests in dysfunctional mvoement?

Altered Motor Control Problems

What type of dysfunction would be indicated by "I feel stiff", "it's hard to move", "my muscles feel tight", including neural tension, facial shortening, muscle shortening, hypertrophy, trigger point activity, scarring and fibrosis, osteoarthrosis, osteoarthritis uniarticular muscle spasm / guarding, fusion, subluxation, or adhesive capsulitis?

Mobility Dysfunction (MD)

What type of dysfunction would be indicated by "I was moving my head AND my shoulder", "Im not sure how to move my ankle like that", such as a mechanical breathing dysfunciton, high threshold strategy, prime mover or global muscle compensation behavior or asymmetry, local muscle dysfunction or asymmetry, poor static and/or dynamic stabilization alignment, postural control, asymmetry, and structural integrity?

Stability Motor Control Dysfunction (SMCD)

What is the general rule for active & passive ROM with Mobility dysfunctions?

Both Active & Passive dysfunctional

What is the general rule for active & passive ROM with Stability Motor Control Dysfunction?

Active dysfunctional

Passive functional

T/F: Patients can help us not only understand when their symptoms are gone but they also can tell us when their functionality is restored.

FALSE

Patients can help us understand SYMPTOMS, but CANT tell us when functionally restored

We need to see functionality through a discharge criteria

Should we incorporate movement assessment as part of our standard operating procedure to look at patterns or parts?

PATTERNS

When do you have justification to go look at the parts and make sure that anatomy is supporting function?

When a PATTERN is dysfunctional

-- then you can go look at the parts

When should functional movement assessments be performed?

When patient is capable of general movement w/o pain or a tolerable level of pain

In what 3 cases is a functional movement assessment beneficial?

1) 1st baseline visit

2) Post intervention check

3) Ongoing assessment

Why should we perform functional movement assessments?

Find the CAUSE to EXPLAIN the source, DETERMINE effective treatment and SHORTEN TIME

-- This improves outcomes & reduces treatment plan errors

Our nervous system establishes programs that control human posture, movement and gait, largely established in the first few years of life to develop the _____________ system.

Locomotor system

When there is a deficit locomotor system stability, this will trigger what compensatory mechanism? With this, there is a(n) ______________ activity and a(n) _______________ flexibility that may lead to a pathological chain of reactions within the musculoskeletal system.

Stabilizing function overtaken by mobilizing muscles

Increase activity

Decrease flexibility

Why do functional muscle imbalances occur? (3)

1) Disuse & lack of stimulation

2) Adaptation to highly repetitive movement and stabilization patterns

3) Dysfunction/pain/injury

What are the commonly weak muscles in upper crossed syndrome? (4)

1) Deep neck flexors

2) Lower trapezius

3) Serratus Anterior

4) Rhomboids

What are the commonly tight muscles in upper crossed syndrome? (4)

1) Upper Trap

2) Levator scapulae

3) Suboccipital

4) Pectoralis Major & Minor

What are the commonly weak muscles in lower crossed syndrome? (2)

1) Abdominals

2) Gluteus maximus

What are the commonly tight muscles in lower crossed syndrome? (2)

1) Hip flexors

2) Thoracolumbar extensors

What describes how the body can be considered in terms of interrelated links or segments, and is a group of body segments connecting joints, muscles, and fascia all across different regions, so when one part moves the body as a whole responds?

Kinetic Chain

What is the primary tissue/system that mediates the interconnectedness of the kinetic chain?

Connective Tissue

What are joints that move primarily in 1 plane categorized as?

Stable

What are joints that move relatively equally in 3 planes of motion?

Mobile

Which joints/regions are meant to be mobile and are therefore more prone to mobility restrictions? (6)

1) Ankle

2) Hip

3) Thoracic

4) Glenohumeral

5) Wrist

6) Upper Cervical

NOTE: Remember stabile & mobile joints alternate every other moving up the body

Which joints/regions are meant to be stable and are therefore more prone to stability limitations? (5)

1) Knee

2) Lumbar

3) Scapula

4) Elbow

5) Lower cervical

According to the hierarchy of movement, what is the order for management and treatment of a dysfunctional movement?

Mobility --> Motor Control --> Functional Pattern

NOTE: For treatment/management, Functional Pattern LAST

According to the hierarchy of movement, what is the order for movement evaluation?

Functional Pattern --> Motor Control --> Mobility

NOTE: For movement evaluation, Mobility LAST

T/F: Rehab plans can be based on generalized guidelines, but should be modified to fit each patient individually and be adaptable

TRUE

-- Rehab plans need to be individual & adaptable

What should be the primary focus of treatment based on dysfunctional movement findings?

Identify relevant dysfunctional movement patterns and improve them

-- MUST post check to know if you improved them

When we first treat the movement patterns and relevant dysfunctions, we find the underlying dysfunctions that are present and address them by ________ which can mobilize, __________ which can inhibit, and/or _________ which can activate.

Adjust = mobilize

Stretch = Inhibit

Strengthen = Activate

What techniques can help restore optimal length-tension relationship within the muscular system? (4)

1) Stretching

2) Manual therapies

3) Motor control

4) Strengthening

What techniques can help restore optimal force-couple relationship within the nervous system? (4)

1) Motor control

2) Exercise/Loading

3) Stabilization

4) Regular movement

What techniques can help restore optimal arthrokinematics within the skeletal system? (4)

1) Chiropractic

2) Repeated ERL

3) Regular movement

4) Exercise/Loading

What are the 6 goals of evidence-inspired active care?

1) Education & Empowerment

2) Reduce Pain & Sensitivity

3) Determine cause & Treat the source

4) Address dysfunctional movement patterns

5) Restore function (mobility, stability, and overall movement patterns)

6) Build resiliency and capacity through load management & reintroduction of meaningful and/or feared activities

How do you know if a treatment was effective?

Post Check

What are the 3 R's of active care?

Reset

Reinforce

Retrain

What R of active care is hands on treatments and applied therapies including passive & active therapies, restoring mobility to a joint or soft tissue, reducing pain and inflammation, normalizing the nervous system, chiropractic adjustments, and manual therapies?

Reset

What R of active care includes resting and reducing recurrent episodes with education and advice, protection and biofeedback (taping/lumbar roll), and motor control retraining, neurodevelopmental perspective (patterns), and passive therapies (heat/stim/manual therapies)?

Reinforce

What R of active care includes a neurodevelopmental perspective where the movement develops in patterns and is not individual muscles including primary and secondary loading strategies?

Retrain

What type of Loading strategy will desensitize pain generator, build up tolerance for load, focus on simple functional movements, and address mobility and stability dysfunctions?

Primary load strategies/management

What type of Loading strategy will add load beyond pain control, return patient to higher tolerance than they had to begin with, build resilience, complex dynamics comments, and challenging functional patterns?

Secondary load strategies/managment

What type of retraining is a focus on form, constant feedback, and is one exercise, leading to short term skills?

Block

What type of retraining is a focus on feel, variable feedback, result, and the patient determines the movement?

Random

What are the 4 positions of the 4x4 matrix from the neurodevelopmental approach? Which is the easiest and which is the hardest?

1) Supported (EASIEST; laying down)

2) Suspended (on all 4s)

3) Stacked (on a knee)

4) Standing (HARDEST)

Which position in the 4x4 matrix from the neurodevelopmental approach has hallmark patterns of development including spinal curves, cross crawl pattern, and pelvic to trunk?

Suspended

Which position in the 4x4 matrix from the neurodevelopmental approach has hallmark patterns of development including spinal mobility (flex/ext/rotation), segmental stability, cervical patterns, and shoulder?

Supported

Which position in the 4x4 matrix from the neurodevelopmental approach has hallmark patterns of development including beginning of single leg stance, hip and spine loaded stability, and loaded hip extension?

Stacked

What are the 4 different levels of demand according to the 4x4 matrix? Which is the easiest and which is the most difficult?

1) Feedback (EASIEST)

2) Demonstrate

3) Capacity w/ feedback

4) Capacity (HARDEST)

What is anything improving the task allowing for long term learning?

Feedback

What are the 2 ways we can increase (or decrease) the difficulty of any exercise?

Position & Resistance

Which way of changing the difficulty of an exercise is supported (non weight bearing) being the easiest and standing being the hardest?

Position

Which way of changing the difficulty of an exercise is feedback (pattern assistance with no resistance) being the easiest and capacity (resistance without pattern assistance) being the hardest?

Resistance

What is the classification (2x3, 1x1, etc) of half kneeling chop capacity stacked?

3x4

What is the classification (2x3, 1x1, etc) of supine to prone rolling?

1x1

What is the classification (2x3, 1x1, etc) of split stance lift with resistance?

4x4

What is the most logical progression of a given exercise, starting at 1x1?

1x1

1x2

2x1

2x2

3x1

3x2

4x1

4x2

1x3

1x4

2x3

2x4

3x3

3x4

4x3

4x4

NOTE: Each number (1-4) goes 1 & 2, then start over and each number (1-4) goes 3 & 4

What are th eprimary goals int he 1st step of evidence-inspired active care?

CALM SHIT DOWN

- Pain neuro education

- Desensitize pain generator

- Micro load management through localized tissue loading

- Focus on simple functional movements

NOTE: put out fire and stabilize foundation before you rebuild house

Which types of treatments are recommended or ideal during the 1st step of evidence-inspired active care in order to accomplish the goal of calming shit down? (4)

1) Adjustments

2) Manual therapies

3) Passive therapies

4) Pain reducing interventions

Pain reducing interventions followed by or combined with ___________________ enables more effective motor control retraining

Motor control exercises

What are the primary goals in the 2nd step of evidence-inspired active care?

Rebuild the damn house and restore function

- load management

- utilize strength & conditioning

- continue to educate

- encourage self-efficacy

Which types of treatments are recommended or ideal during the 2nd step of evidence-inspired active care in order to accomplish the goal of rebuilding the damn house and restoring function? (4)

1) Early stage rehab (Primary load management; heavy slow resistance)

2) Late stage rehab (secondary load management)

3) Strength and conditioning (SAID, progressive overload)

4) Educate, encourage elf efficacy

Pain reducing intervensions followed by or combined with _______________ exercises enables more effective motor control retraining

Motor control exercises

What is the similarities between rehab and training? What is the difference?

Both are progressive overload, specific adaptations to imposed demands (SAID principle) to increase *strength & resistance

-- their goals are the same, but the STARTING POINT IS DIFFERENT

Rehab has a lower level starting point while Training has a higher level starting point!

What are the 4 movement principles that should guide selection of active care exercises?

1) Within patients CAPACITY or injury risk

2) FUNCTIONAL to pt (when dysfunction is present may increase injury)

3) Helpful even when PAIN IS PRESENT

4) Method to create an ADAPTATION