Exam 1

What form of care requires the patient to take an active role in their treatment?

Active care

Why do we use active care with patients?

Improve self-efficacy, the patient is in control

T/F: Active care promotes pain avoidance behavior

FALSE

What specific disease can benefit the MOST from aerobic and resistance training?

Musculoskeletal conditions

How many minutes of aerobic exercise per week is recommended?

150 min/week

How much resistance training is recommended per week?

Minimum 2 non-consecutive days/week

What is the single best predictor of a senior citizen falling?

Big toe strength (leg strength =2nd)

What is the number 1 predictor of pain?

Previous injury

What may be altered after an injury to avoid further pain or re-injury?

Motor control

What does altered motor control present as?

Dysfunctional movement

What kind of dysfunction is it when there is dysfunctional active and passive movement?

Mobility

T/F: End stage rehab should be more difficult that pre-season demands

True

What are we looking at as part of movement assessment?

Patterns

When should you switch to looking at the parts vs patterns?

When a pattern is dysfunctional

When should functional movement assessments be performed?

First visit (baseline) & ongoing assessments

Why should you perform a functional movement assessment?

• Shorten treatment time

• Improved outcomes

What is upper crossed syndrome?

Tight = pecs → upper traps

Weak = deep neck flexers → lower traps

What is lower crossed syndrome?

Tight = hip flexers → thoracolumbar extensors

Weak = Abdominals → glutes

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

Connective tissue

What is the concept that unrelated impairments may be associated with the primary compaint?

Regional interdependence

What techniques help maintain/restore the optimal state of the muscular system?

• Stretching

• Manual therapies

• Motor control

• Strengthening

What techniques help maintain/restore the optimal state of the nervous system?

• Motor control

• Exercise/loading

• Stabilization

• Regular movement

What techniques can help maintain/restore optimal skeletal function?

• Chiro

• Repeated ERL

• Regular movement

• Exercise/loading

How do you know if a treatment was effective?

• Check and recheck

• Audit and re-audit

What are the 3 R’s of active care?

1. Reset

2. Reinforce

3. Retrain

What are some examples of Reset?

• Chiro

• Manual therapies

• Passive therapies

What is the importance of Reinforce with active care?

Patient education about pain and encourage safe movement

What do you do during the Retrain portion of active care?

Motor control and loading strategies (block/random practice)

Adjustments, stretching, and manual therapies are examples of which of the 3 R’s?

Reset

Motor control exercise is an example of which of the 3 R’s?

Retrain

What is the correct order of the position side of the 4×4 matrix?

1. Supported

2. Suspended

3. Stacked

4. Standing

What is the correct order of the Demand side of the 4×4 matrix?

1. Feedback

2. Demonstrate

3. Capacity w/ feedback

4. Capacity

What position is best for spinal mobility?

Supported (1)

What position is best for the development of pelvis to trunk disassociation?

Suspended (2)

What is the best position to develop a single leg stance?

Stacked (3)

What are the two ways to change the difficulty of any exercise?

1. Change position

2. Change resistance

A cervical spine exercise, supine with no feedback or resistance is an example of what on the matrix?

1×2

T/F: Movement can be used as a method to create adaptation

True

What is passive ROM of a joint and its surrounding soft tissues?

Flexibility

What is the active ROM of a joint under neurological control?

Mobility

What is useless flexibility?

Good passive ROM, poor active ROM

What can reduce ROM via active tension?

• Nervous system tone

• Contracture

• Muscle guarding

What can cause passive tension leading to restricted ROM?

• Muscle viscoelasticity

• Fascia

What happens when a joint is hypermobile?

Brain senses instability → creates stability by increasing neuromuscular tone

A joint that is very flexible is most likely to have what kind of injury?

Joint injuries

A joint that is less flexible is most likely to have what kind of injury?

Connective tissue injuries

There is a __% loss of flexibility per decade from 20-49 yo

10

What is most likely the contributing factors that cause the feeling of muscle tightness?

Fascial and neurological tension

T/F: Tight muscles are usually the stronger muscles

FALSE

What specific types of treatments do physically remodeled/shortened tissues require?

• Stretching/loading tissues to end range

• 2+ minutes

• 8+ weeks

How does fascia communicate and respond to?

Mechanical load

Movement depends on what type of feedback?

Afferent

What is neurological inhibition?

• Muscle spindles less excitable

• Greater ROM

• Smooth movement

What is neurological facilitation?

• Muscle spindles hyper-excitable

• Less ROM

Why is performing an adjustment before active care recommended?

Adjustment → neurological inhibition = active interventions more effective

What are 2 major contraindications for stretching?

1. Bony block limiting motion

2. Hypermobility

What does stretching physiologically do?

Targets nervous system & fascia to increase viscoelasticity

T/F: Stretching helps to increase the physical muscle length

False

How long do the effects of stretching last?

5-30 minutes

What factors can you change that would have the largest effect on how long the effects of stretching would last?

Repetition & consistency

During what timeframe of stretching do the majority of increased ROM occur?

First 15 seconds

What is the gold standard for static stretching recommendations?

• 3-4 sets

• 15-30 seconds

• Multiple times per day

• 6-10 weeks

What is the optimal duration for static stretching?

30 seconds, 3-4 sets

How long do you need to stretch to see tendon flexibility increase?

Up to 10 minutes (min 2 minutes)

T/F: Stretching can cause inhibition of maximal force produced by the muscle

TRUE

How can you mitigate the effects of the stretch-induced strength loss phenomenon?

Maximal contraction prior to static stretch

What type of activities does stretch-induced strength loss primarily impact?

Low-velocity, strength-based

T/F: DOMS is caused by a buildup of lactate?

FALSE

T/F: Stretching is contraindicated for DOMS

True

What are some aspects that describe static stretching?

• Passive

• Utilize diaphragmatic breathing

• Isolate stretch to target areas

What is ballistic stretching?

• Bouncing at end range

• Does NOT result in sustained increase in ROM

What 2 types of stretching fall under Muscle Energy Technique (MET)

1. PIR → Autogenic inhibition (GTOs)

2. RI → Reciprocal inhibition (Muscle Spindles)

What type of stretching falls under PNF?

1. Contract-relax

2. Hold-relax

3. CRAC

What is irradiation?

Spread of excitation in the CNS

Post-contraction inhibition (Autogenic inhibition) is utilized by which stretching techniques?

• CRAC

• PIR

• MET

• Hold-relax

• Contract-relax

• Post-facilitation stretch (PFS)

Reciprocal inhibition (Sherrington’s Law) utilizes the contraction of the ___ which simultaneously inhibits the action of the agonist

Antagonist

What anatomy does Sherrington’s Law utilize in the muscle?

Muscle spindles

What techniques utilizes RI?

• CRAC

• MET

What are the parameters when using hold-relax stretching?

• 6 seconds

• 10-20% contraction

What are the parameters when using contract-relax stretching?

• 15 seconds

• Pt contracts muscle being stretched against resistance

What are the parameters when using CRAC stretching?

• 15 seconds passive

• 6 seconds isometric

• Contract antagonist (RI)

T/F: CRAC involves contraction of the opposite muscle to actively pull the body part further into the stretch

True

What is PIR stretching?

• Isometric contraction of muscle being stretched

• 10-20% contraction

• 5-10 seconds

• 2-4 sets

• Autogenic inhibition (GTO’s)

What is RI stretching?

• Isometric contraction muscle opposite that is being stretched

• 10-20% contraction

• 5-10 seconds

• 2-4 sets

• Muscle spindles

Active Isolated Stretching (AIS) utilizes __ __ principle

Reciprocal inhibition

What are the parameters when using AIS?

• Hold stretch for 2 seconds

• 15-20 reps (more = local ischemia)

• 1-2 sets

What is Post-Facilitation Stretching (PFS)?

• Hold muscle between neutral & point of tension

• Contract w/ near maximum effort for 10 seconds

What is the only stretching technique that involves maximal or near-maximal contraction?

PFS (Post Facilitation Stretching)

Which stretches involve a 10-20% isometric contraction?

MET & PNF

Which stretch is considered “gentle” as the doctor only applies 1lb of pressure at end range and the patient performs a short duration (2 seconds) contraction?

AIS (Active Isolated Stretching)

T/F: Static stretching does NOT involve contraction

True

T/F: Ballistic stretching and active dynamic stretching utilize intensity and percentage of contraction

False

What constraints can be modified in relation to the Dynamic Systems Theory (DST)?

1. Environment

2. Task

3. Individual

During PFS, what percentage of isometric contraction are we asking from the patient?

100%