Exam 1 Flashcards
(428 cards)
1
Q
Is ballistic stretching really stretching?
A
No, it is more of a contraction. Therefore, the individual is more at risk for injury
2
Q
Definition of creep
A
Tissue continues to deform during stress until the load is balanced, which is known as the creep phenomenon
3
Q
What are some benefits to stretching and flexibility?
A
- Improve balance
- Easier to strengthen and endurance train
- Injury prevention
- Quicker recovery
- Reduce soreness
- Facilitate relaxation
4
Q
What is Tropocollagen?
A
AKA collagen
Provide strength to withstand tension and force of movement
Protein building block in CT
5
Q
Where is collagen found?
A
Bone, tendon, skin, muscle, cartilage, and joints
6
Q
What is Type I collagen?
A
Thick fibers
Most abundant
7
Q
What is Type II collagen?
A
Thinner
Less tensile strength
8
Q
What is Type III collagen?
A
Found in organs
Wound repair
9
Q
What is elastin?
A
Protein in tendons that allow for more flexibility
Assist collagen after stress recovery
10
Q
What is viscoelasticity?
A
Stress strain curve
11
Q
What is elasticity?
A
Ability to return to original state following deformation
12
Q
What is viscosity?
A
Ability to resist change of form or lessen shearing force
13
Q
What is the toe region?
A
Take up slack in tissue
14
Q
What is the elastic region?
A
Linear increase in response to stress
Pulled at different levels
15
Q
What is the plastic region?
A
Plateau on strain and then hit where you have enough stress for injury
16
Q
T/F stiff tissue reach faliure a lot quicker
A
True
17
Q
What does rate of stretch affect?
A
Affect strain
18
Q
What does slower rates of stress affect?
A
Greater strain
19
Q
What does faster rates of stretch affect?
A
Smaller elongation
20
Q
What is stress-relaxation?
A
AKA force-relaxation
No change in length is produced
21
Q
How does temp affect creep?
A
High temp = increase creep
22
Q
How do you produce creep with high temps?
A
High temp and large load over a period of time
23
Q
What are benefits of a warmup?
A
Increase blood flow
Increase Mm temp
Cardiac response improvement
Breakdown of oxyhemoglobin for delivery of O2 to working Mm increased
24
Q
What are advantages to static stretch?
A
Reduce chance to exceed strain
Reduced energy requirement
Reduce potential for Mm soreness
Easy to teach
25
What is ballistic stretching?
Least desirable
Place tissue at risk
Stimulate Mm spindles during the stretch = continuous resistance to further stretch
26
What is dynamic stretching?
Use Mm contraction to stretch
Increase/decrease jt angle where Mm cross = elongate MT unit at the end of ROM
Activity specific movements
27
What is PNF?
Use different techniques to promote neuromuscular response
Increase ROM by decreasing resistance caused by spinal reflex pathways
28
How many weeks is needed of stretching to see significant change in flexibility?
6 weeks
29
How many minutes of light exercise is needed prior to stretching?
About 5 min
30
How to stretch soft-tissue contractures?
Long-duration and low-load
31
How long is immature scar tissue adaptable for?
8 weeks
Becomes less changeable up to 14 weeks after that
32
When do you have a mature scar?
14 weeks
33
What is scar tissue?
Collagen fibers become highly unorganized and randomly arranged
34
What are some critical components of scar tissue?
Time-dependent, stress-reactive nature
Fragility of immature scars
New scar tissue organizes and aligns itself along lines of stress
Low-load with long duration combined with preheating
35
What is the low-load, prolonged stretch technique?
Preheat involved areas
Place structure in comfortable position
Apply MHP 20-60 min
Apply stress or load gradually but minimally
Allow rest and recovery
Maintain heat app for 5-10 min after removal of load
36
What is muscle strength determined by?
- Neural control
- Cross-sectional area
- Mm fiber arrangement
- Mm length
- Angle of pull
- Fiber type distribution
- Energy stores, recovery from exercise, fatigue, age, gender, and state of health
37
When is it least likely that you are strengthening Mm?
At max ROM
38
What are slow twitch Mm fibers?
Type I - red oxidative
Large, numerous mitochondria, triglycerides, enzymes for aerobic work
Low ATPase and glycolytic activity, lower Ca handling ability, shorter speed
Good for ENDURANCE
39
What are fast twitch Mm fibers?
Type II - white glycolytic
Anaerobic, contract at higher speed
High levels of myosin ATPase provides energy for speed of contraction
Low myoglobin and few mitochondria
3 subtypes
40
What are the muscle fiber types from slowest to fastest?
```
Slow twitch
Fast twitch
Fast twitch A
Fast twitch AB
Fast twitch B
```
41
What is isokinetic exercise?
Speed held constant regardless of magnitude of force applied to resistance
42
How do we measure strength?
```
MMT
Cable tensiometry
Dynamometry
One-rep max
Isokinetics
Functional assessment
```
43
What are functional tests that can be done for strength?
One-leg hop for distance
Single-leg triple hop for distance
Timed single-leg hop (MT)
Vertical jump
44
Strengthening exercises from least to most amount of force
Concentric
Isometric
Eccentric
45
Strengthening exercises from most to least ATP released
Eccentric
Isometric
Concentric
46
What is the overload principle?
Application of load that exceeds metabolic capacity of Mm
47
What is SAID principle?
Specific adaptations to highly specific demands
48
What is the progression principle?
Intensity of program must become progressively greater to continue to make gains
49
What is the reversibility principle?
Changes are transient unless training induced improvements are regularly used
50
How do we know when to increase weight?
Gold standard = 1 rep max
Find a weight they can do 8-12 reps with without fatigue
51
What are signs of fatigue?
Poor form
Speed
Shaking
52
What is DOMS?
Pain, swelling, tenderness, reduced ROM, and stiffness
53
What are some theories about DOMS?
```
Lactic acid
Torn tissue
Tonic Mm spasm
CT damage
Tissue fluid
```
Most likely torn tissue
54
What is DeLorme PRE?
3 sets x 10 reps max
| Arbitrary increase in resistance each week
55
What is the Oxford program?
Establish pt 10 RM for first set, move to 75% RM for second set, and 50% of 10 RM for third set
56
What is Knight daily adjustable PRE?
4 sets with variable reps and varying weights
57
What is the rule of tens?
Isometric exercise protocol
10 sec hold for 10 reps with 10 sec rest in between
Should be gradual tension for first 2 sec, max at 6, and decrease for 2
58
What is circuit training?
Predetermined and organized sequence of exercise
General body condition and total fitness
1 or 2 exercises to each body part
30-60 sec rest period between sets
Use resistance and aerobic metabolism
59
What is the proper contraction order?
Isometric - concentric - eccentric
60
What are plyometrics?
Intense power-generating exercise (sport-specific)
Adaptable with general ortho
High-intensity, task specific, dynamic
Based on GTO response and muscle spindle response
IE. Jumping, skipping, hopping, throwing, catching
For power and speed
61
When would you not use CKC exercise?
If there is pain, swelling, dysfunction, or weakness
62
What are considerations a PTA should have when helping the elderly strengthen?
Natural decline in Mm performance, force-generating capabilities, and Mm mass
Focus on delaying Mm atrophy, improve function, and increase force-generating capabilities by stimulating Mm hypertrophy
You can see similar gains to younger individuals
63
General recommendations for strengthening older adults?
```
MD approved
Close supervision initially
Monitor vitals
Low resistance, low reps initially
Progress reps
Avoid high resistance to decrease stress
Train 2-3x/wk with 48 hr rst intervals
Use balance of flex/ext exercise
Use supported positions if balance is a problem
```
64
When to start strengthening prepubescent/child
Girls: 11
| Boys 13
65
When to start strengthening prepubescent/adolescents?
Girls: 12-18
Boys: 14-18
66
Define muscular endurance
Ability for Mm to perform at a certain level for prolonged periods of time
67
Define CV endurance
Ability for one's CV system to allow performance for a prolonged period of time
68
Define catabolism
Creates energy for the body
Fuel converted to ATP
3 metabolic pathways
Continuation of endurance-based activity requires constant supply of O2 to produce ATP
69
What is the oxidative system?
Produce 19x the ATP produce in phosphagen energy system
2 ATP
70
What are the guidelines for the talk test?
Moderate intensity - able to talk
- 5 hrs/wk
- IE walk briskly, water aerobics, doubles tennis, cycling at less than 10 mi/hr
Vigorous - pause to talk
- Intensity exercise 2.5 hr/wk
- IE. running, swimming laps, singles tennis, and cycling greater than 10 mi/hr
71
What is the recommended amount of exercise for children?
60 min of mod-intensity exercise each day
Vigorous intensity for 3x/wk
72
How to measure exercise intensity?
VO2 max
Talk test
THR
73
How do you calculate target HR?
THR = MHR x desired intensity
74
What is target HR?
50-70% of one's max HR
75
What is Borg Rating of Perceived Exertion?
Assess exercise intensity based on person's perception of exertion
76
How do you determine HR from Borg scale?
Multiply perceived rating by factor of 10 (loose association)
77
What should someone's Borg scale rate?
Between 12-14
78
How do we perform aerobic muscular endurance?
Sets of high reps
15 reps per set
Each rep should be performed at or below 67% of 1 RM max - 1-2 min rest period between each set
79
What are CV assessments for older adults?
```
6 min walk test
2 min walk test
400 m walk test
1 min sit to stand
2 min step test
3 min step test
```
80
What is the 6 min walk test?
```
Multiple pt pops
Take vitals before
Walk behind them
Provide encouragement
Keep time - can stop and rest, but need to stand
```
81
What is the 2 min walk test?
Mod to severe CP disease, more frail, and those who cannot walk for long periods of time
Similar to 6-min test, but shorter
82
What is the 400 m walk test?
Instruct pt to complete 10 laps
Pt seem more motivated to complete distance
83
What is the 1 min sit to stand test?
Adding endurance component compared to 30 sec
84
What is 30 sec sit to stand test?
More about power and strength
85
What is 2 min step test?
Marching test
Take measurement b/t ASIS and mid-patella - measure on the wall and that is how high they have to march
Adds value of SLS
86
What is 3 min step test?
Faster HR returns to resting = healthier you are
Typically done in healthy adults
Done to metronome
87
What should post-op exercise entail in ortho?
- Lost strength
- Pain
- Swelling
- Flexibility
- Local Mm endurance
- Build CV fitness
- Gait and balance
- Motor control and NM elements of function
88
What is the #1 indication of falls in elderly?
Lack of DF
89
What is the #1 strength indicator in elderly?
Weak quads
90
What factors contribute to balance and coordination?
- Visual
- Vestibular
- Somatosensory
- ROM and flexibility
- Strength
- Posture
91
Why do we look at the ground as we age?
Depend more on visual component of balance = lean forward
92
What is balance?
Ability to maintain COM over BOS
93
What is BOS?
Area within the body to make physical contact with external environment
Base not fixed
94
How do we maintain postural equilibrium?
Postural nervous system and MS system
95
What is the definition of coordination?
Ability to produce patterns of body and limb motions in context with environmental objects and events
96
What is proprioception?
Sensory (afferent) info regarding jt position
Movement (kinesthetic)
Movement resistance and tension
97
What is neuromuscular control?
Subconscious activation of Mm occurring in preparation for and in response to jt motion and loading
98
What are mechanoreceptors?
Sensory receptors that are responsible for converting mechanical events into neural signals that can be conveyed to CNS
Each mechanoreceptor response to specific stimuli and has its own threshold
99
Where are mechanoreceptors located?
Musculotendinous structures
IE. Muscle spindles and GTO
100
What are the mobility tests?
- TUG
- Gait speed
- Backward walk test
- Timed up and down stairs
- Tandem walk test
- 4 square step test
- Dynamic gait index
- Functional gait index
101
What is the benefit of the TUG?
- Good first test
- General mobility of LE function
- Minimal detected change
102
What is a dual task TUG?
Pt is able to do another task while walking
IE subtraction task, carrying glass of water, etc
103
What is the benefit of the gait speed test?
Considered 6th vital sign
Slow gait = #1 predictor of functional decline
Valid for health status, mortality, falling, and fear of falling
104
What is the benefit of the backward walk test?
Helps to see how one's ability is to open doors, open the oven, backup to sit, etc
105
What is the benefit of the timed up and down stairs test?
Functional mobility
Go up/down 4-12 stiars
Can use AD
Do not time the turnaround
106
What is the benefit of the tandem walk test?
Measure of gait, mobility, and balance
Do it with EO vs EC
10 steps on a line
More specific for those with vestibular or peripheral neuropathy issues
107
What is the benefit of the 4 step square test?
Quantify balance in 4 different directions and its reversal
Good cognitive data to follow instructions
Ability to pick up feet
Greater than 15 sec = greater fall risk
Very good specificity and sensitivity
108
What is the benefit of the dynamic gait test?
Used on individuals with vestibular issues
8 and 4 item test - 4 item has same validity as 8
Scored 0-3 - higher the score the better
109
What is the benefit of the functionality gait test?
7 items
110
What are the various balance tests?
- Functional reach
- One-leg stance
- Romberg and sharpened Romberg
- CTSIB and mCTSIB
- Berg Balance Scale
- Four stage balance test
111
What is the functional reach test and its benefits?
Slide hand down the ruler and measure in inches
Look at DF
Look at how the COG of shift is
112
What is the one-leg stance and its benefits?
Portrays static postural control
Help establish fall risk
Very difficult for elderly
Fail = hop, touch of foot to leg, or arms move dramatically
113
What is the Romberg and its benefits?
Standing with legs together and test EO/EC
Test integrity of proprioceptive pathway and vestibular function
114
What is the Sharpened Romberg and its benefits?
Same as Romberg, but in tandem stance
115
What is the CTSIB and mCTSIB and what are their benefits?
Putting a dome on pt head. Don't normally do in mCTSIB
Done a lot in home health
1st test feet together EO
2nd test feet together EC
3rd test feet together on foam EO
4th test feet together on foam EC
116
What are self reported scales on balance?
- Activities specific balance confidence scale
- Modified gait efficacy scale
- Falls efficacy scale
- Fear of falling avoidance behavior questionnaire
117
What is the Y Balance Test?
Test a person's risk for injury
Can be used for UE and LE
AKA star excursion
118
What are the factors that contribute to balance dysfunction?
- Perception
- Behavior
- ROM
- Biomechanical alignment
- Weakness
- Sensory
- Synergistic organization strategy
- Coordination
- Adaptability
119
What is the definition of mobilization?
Restore joint motion or mobility, or decrease pain associated with joint structures
120
What is closed packed position?
When a joint is most congruent
121
What is close packed good for?
Testing integrity and stability
122
What is loose-packed position?
Joint capsule and ligaments are most relaxed and least congruent
123
What is loose-packed position good
Ideal for joint mobs
124
Which joint mob grades are used for pain?
Grades I and II
125
Which joint mob grades are used for ROM?
Grades III and IV
126
What is a grade I mob?
Small oscillations
127
What is a grade II mob?
Start to midway
128
What is a grade III mob?
Midway to end
129
What is grade IV mob?
All the way and knock on the door
130
What is a grade V mob?
PTA does not do
High velocity thrust of small amp at the end of available ROM
131
What is joint play?
Motion available within the joint
132
How long are joint oscillations involved?
3-6 sets of oscillations
Perform 2-3 oscillations per second
Last 20-60 sec for tightness
Last 1-2 min for pain with 2-3 oscillations per second
For painful joints apply distraction for 7-10 sec with few sec rest in between
133
How long should mobs be done for restricted joints?
Apply min of 6 sec stretch, followed by partial release and then repeat with slow, intermittent stretches at 3-4 sec intervals
134
What is a muscle spasm end feel?
Pain with sudden halt of movement that prevents full ROM
135
What is a springy block end feel?
Internal derangement - full motion limited by soft springy sensation with pain
136
What is a loose end feel?
Min resistance is felt at end range - jt hypermobility
137
What is capsular end feel?
Normal tissue stretch before normal ROM
138
What are absolute contraindications to joint mobs?
Osteoporosis, RA, jt hypermobility, and neurologic symptoms
139
How long are Grade I or Grade II mobs?
1-3/sec or 60-180/min
Applied for 0-60 sec (only 4-5x)
Treat painful conditions daily or until pain is reduced
140
What are the 4 stages of pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
141
What is half-life?
Amount of time it takes to reduce the drug's blood concentration to half
Liver metabolism and renal clearance can slow a half-life and impair secretion
142
What is duration of action of a drug?
Length of time it is active in the body
Longer half life = longer duration
143
What are pharmacodynamics?
Describes what the med does in the body
IE. Dose-response relationship, therapeutic window, adverse effects, toxicity, tolerance, and dependency
144
What is the therapeutic window of a drug?
Min needed for therapeutic use without toxicity
145
What causes someone to be dependent on a drug?
Withdrawal symptoms
146
What is considered a 5th vital sign?
Pain
147
What is nociceptive pain?
Pain resulting from tissue damage
Inflammatory, noninflammatory, or both
IE. Bone pain, sprains, and postsurgical pain
148
What treats inflammatory pain?
Antiinflammatory
NSAIDS
Cox-2 inhibitors
149
What is neuropathic pain?
Pain resulting from damage or dysfunction of nerves
Relatively resistant to opioids, acetaminophen, and antiinflammatory agents
Use meds that will cross BBB and target CNS
Use meds to slow or block nerve conduction (antidepressants and anticonvulsants)
- IE. Cymbalta, Lyrica, Tegretol, Lidocaine, Ultram
150
How to treat acute pain?
Round the clock dosing
| - IE. opioids, acetominophen, NSAIDS (quick onset)
151
How to treat chronic pain?
May be prescribed long-acting release meds
152
What is "breakthrough pain"?
Pain can be treated with short-acting meds
153
What do opioid analgesics do?
Work by blocking CNS transmission of pain and create a euphoric feeling
IE. Morphine, oxycodone, hydrocodone, codeine
154
What are common side effects of opioids?
Nausea, vomiting, allergic reaction, sedation, drowsiness, dizziness, constipation, impaired judgment, risk of injury from falling
155
What is acetaminophen?
Most commonly used OTC fever reducer and analgesic
Used for HA, sinus pain, back pain, OA, and toothaches
No strong antiinflammatory properties
Can contain other meds
Can be given to someone with GI bleed, CHF, and HTN
156
What is the max dosage of acetaminophen?
No more than 4000 mg/day
157
What happens if you overdose on acetaminophen?
Hepatotoxicity
158
What are NSAIDS?
OTC - IE. aspirin, ibuprophen, naproxen, and kefoprofen
Fever reducer and antiinflammatory
Found in cold meds and some sleep aids
159
Can you use NSAIDS in children?
NEVER = could cause fatal illness (Reye's Syndrome)
160
What are Cox-2 inhibitors?
Lower risk of side effects compared to NSAIDS
Inhibit production of prostaglandins by inhibiting COX enzyme
Fewer bleeding and stomach related side effects
161
Who would not be eligible for COX-2 inhibitor?
Someone with an allergy to sulfonamide antibiotics
162
What are corticosteroids?
Glucocorticoids produced naturally by adrenal cortex
Powerful antiinflammatory and immunosuppressuant used in RA, OA, gout, CTS, bursitis, and lupus
163
What should happen after corticosteroid injection?
Pt should minimize activity and stress for several days
Pain decrease within 24-72 hr after injection
Can benefit for 4-8 weeks
164
What are side effects of corticosteroids?
Elevated blood glucose
Edema, cataracts, glaucoma, stomach ulcers
Insomnia, risk of infection, and mood changes
165
What is the most common joint to get corticosteroid injection?
Knee
166
Who would not receive a corticosteroid shot?
Someone with diabetes
167
What are examples of CV meds?
- Beta blockers
- Ca channel blockers
- Digitalis
- Bronchodilators
- Diuretics
- Lipid-lowering drugs
168
What are beta blockers?
Blunts HR and BP response
169
What are Ca channel blockers?
Decrease resting and exercise BP response
170
What is Digitalis?
May cause dysrhythmias and/or tachycardia
171
What PT/INR level would not get exercise?
Less than 3
172
What is a Grade I ligament injury in the knee?
Incomplete stretch of collagen ligament fibers resulting in min pain, swelling, no loss of joint function, and no instability
173
What is a Grade II ligament injury in the knee?
Partial loss of ligament fiber continuity; few torn, moderate pain, swelling, some loss of function and stability
174
What is a Grade III ligament injury in the knee?
Rupture of ligament, profound pain, intense swelling, and loss of joint function and instability
175
What is the function of the ACL?
Prevents hyperextension and rotational movement of the knee
176
What occurs when ACL is injured?
Joint effusion
177
Who tears ACL more?
Females
- Weaker quads
- Weaker pelvis
- Wider Q angle
- Increase genu valgum
- More ligament laxity
- Poor landing mechanics
178
What are PT diagnostic tests for ACL tear?
Lachman
Anterior Drawer
Pivot shift test
179
What is involved during conservative management of ACL?
- Safe environment to protect knee
- Therapeutic exercise and proximal strengthening
- LE strengthening with CKC
- OKC exercise
180
What are types of surgical management?
- Autograft reconstruction (from pt body) - use gracilis, TFL, semitendinosis, etc
- Bone-patellar-bone
- Allograft from human cadaver
- Arthroscopic central 1/3 BTB autograft
181
What considerations do you need when the repair is done with semitendinosis?
- Rehab quads AND HS
| - Limit HS strengthening early on
182
What considerations need to be made with quad tendon repair?
Limit ROM early
183
What are post-op considerations with ACL?
- Avascular necrosis risk for 6-8 weeks
- Early mobs
- Fragile first 2 months
- Graft undergoes periods of necrosis, revascularization, and remodeling
- Grafts may take up to a year to fully mature
- Need to get ROM back early
- Only accelerate WB when improved results are seen
184
What is the goal of post-op rehab for ACL?
Protect graft
Reduce pain and swelling
Increase joint motion
Improve strength and endurance
Flexibility and proprioception
185
What is the sequence for ACL repair?
Immediate post-op rehab phase
Return to function phase
Return to sport phase
186
T/F you do OKC for quad repair?
F - need to protect graft
187
T/F you use SAQ and LAQ with ACL?
F - no you do not
188
What progressions should pt expect with ACL repair?
Need good quad and HS strength before progressing
Progress to w/o crutches pretty quickly
Goal of 120 degrees of flexion
CKC and proprioception exercise early
Do not return to sports for 6-9 months
Make sure they meet criteria before next phase
189
What activities can occur in phase 1?
Hip PRE
Isometric
Gait training
Proprioception training
190
What activities can occur in phase 2?
SLS
| Initiate step up/step down
191
What activities can occur in phase 3?
Agility training
192
What is the function of the PCL?
Restrict posterior tibial translation
193
What are common causes of PCL injury?
Trauma to knee
MVA
Hyperextension injury
194
What do you experience if you tear PCL?
Do not hear a pop or tear
Mild to moderate knee effusion, limp, pain in back of knee, and lack full ext
195
What PT eval tests can be performed for PCL?
Posterior drawer test
Godfrey posterior tibial sag test
196
What is conservative management for PCL?
Combat effects of inflammation and inhibition
Open brace, crutches, and cryotherapy
197
What is done if there is surgery on a PCL?
Autologous grafts
Achilles allograft
198
What happens during post-op rehab for PCL?
Begin day 1 post op
Knee immoblizer or hinged knee brace
Max protection = Avoid HS Iso greater than 30 degrees and flexion 60-90 degrees
199
When does moderate protection phase occur for PCL?
6-12 weeks
200
When can you return to sport after PCL repair?
8-12 months
201
What kind of rehab would you expect with non-op PCL?
Isolated grade I or II PCL tear
Knee immobilizer or hinged knee brace and crutches
Begin therapy immediately - maintain quad tone, decrease inflammation, restore ROM
202
When can someone with non-op PCL return to sports?
Between 6-8 weeks for low grade sprains
203
What is MCL injury?
Most common
Common cause is vagus force applied to knee
204
What sx/sx do you see with MCL injury?
Swelling, ecchymosis, walk with limp, hesitant to fully ext knee
205
What PT test can be done on a MCL injury?
Valgus stress test
206
What does rehab look like for MCL injury ?
Isolated grade 1-3: non-op
Crutches and knee brace
Apply correct therapeutic intervention at right time
Increase quad tone up to 2 weeks
Decrease inflammation and restore ROM
207
When can someone return to sports with MCL injury?
Grade 2: 3-5 weeks
Grade 3: 8-12 weeks
208
What is done with grade I MCL tear?
Introduce isometrics, no brace needed, OKC/CKC, ice, etc
209
What is done with grade II MCL tear?
Hinged brace
210
What is done with grade III MCL tear?
Longer periods of immobilization, bracing, and crutches
211
What is the terrible triad?
Torn ACL, MCL, and medial meniscus
212
What is the normal function of the meniscus?
Stability
Shock absorption
Load transmission
Nutrition
Lubrication
Reduce joint stress
213
What kind of CT is the meniscus made out of?
Type I collagen
214
What kind of tear patterns occur with the meniscus?
Horizontal
Longitudinal
Degenerative
Radial
215
Which portion of the meniscus gets blood supply?
Lateral
216
What is the cause of meniscus tear?
Sudden trauma or gradual degeneration
Can be subtle with some activity preceding pain, swelling, and locking of the knee
217
What clinical examinations can be done for meniscus tear?
Apley's compression test
McMurray test
Steinman test
Thessaly test
Joint line tenderness
218
How to manage meniscus tear conservatively?
Cryotherapy, quad sets, AAROM, and so forth
219
How would surgery benefit a meniscus tear?
Causes bleeding to help initiate natural repair/growth
220
What are the zones of meniscus tears?
I: red on red (vascular on both sides)
II: red on white (vascular on one side)
III: white on white (no vascular side) - cannot heal itself
221
What does post-op rehab look like with someone who had a meniscus repair?
Rehab guidelines are controversial
Strict protection phase: 4-6 weeks
222
When can someone return to running after a meniscus repair?
No sooner than 4 months
223
What is a meniscal transplantation?
Replaced by allografts
Excellent results in reducing pain
224
What are indications for a meniscal transplantation?
Prior menisectomy, continued pain, normal alignment, and joint stability
225
What does post-op rehab look like after meniscal transplantation?
Conservative approach - NWB and ROM limitations in flex
226
When can someone return to sports after meniscal transplantation?
9-12 months
227
What is the function of articular cartilage?
Protects subchondral bone and reduce friction with in a joint
228
What is the goal of articular debridement?
Stimulate bleeding = stimulate natural healing and more cartilage is laid down
229
What is the goal of microfracture surgery for articular cartilage?
Poke holes in subchondral bones
Stim bleeding = stim natural healing and growth
NWB 2-8 weeks
230
What does post-op rehab look like for someone who had articular cartilage lesions?
Min WB if surgery was done (2-8 weeks)
CPM machine
FWB around 8-10 weeks and hopefully limp free - progress exercise from bilateral to unilateral
Normal gait, full ROM in 2-6 months
Return to sports 6-12 months (high impact closer to 12 months)
231
What is the etiology of PFPS?
Difference in flexibility, strength, and neuromuscular control
232
What are the symptoms of PFPS?
Ant knee pain with prolonged sitting, stair amb, and squats
233
What causes baja PFPS?
Tight HS
234
What causes alta PFPS?
Tight quads
235
What is femoral anteversion?
IR and ABd - femur sits anteriorly
See valgus
During squats knee goes medial
236
What are physical examinations that can be done for PFPS?
Femoral anteversion, genu valgum, genu recurvatum
TIbia varum, rearfoot pronation
Q angle - (ASIS, mid patella, and tibial tuberosity)
Tightness of quads and IT band
Observe gait, squat, SLS, and step down
237
What is meant by squinting patella?
Patella turns medially
238
What is important to strengthen with PFPS?
ABD
239
What does non-op rehab look like for someone with PFPS?
Initially focus on pain and swelling
Avoid activities that cause pain
Ice and NSAIDS in acute phase
Strengthen quads with isometrics
Use clamshells and s/l hip abd
Address core to floor
Manual treatment of lateral tight structures
CKC strengthening exercise to promote higher level of function, hip strength, ROM, resistance, step height, modified to perform without pain
Supportive device with tape
240
What occurs during phase one of post-op management for PFPS?
Between 0-6 weeks
Joint homeostasis
Reduce pain, inflammation, and joint effusion
Focus on ROM
Patella mobs and flexibility
Quad re-ed
WB
241
What occurs during phase 2 of post-op management for PFPS?
Between 7-12 weeks
Gait training
ROM
Strength and balance
Flexibility
242
What occurs during phase 3 of post-op management for PFPS?
Weeks 13-17
Maintain full ROM and patellar mob
243
What occurs during phase 4 of post-op management for PFPS?
Weeks 18-25
Functional return to sports
244
What occurs during distal realignment?
Osteotomy of tibial tubercle
245
What are complications with distal realignment?
Associated fixation, wound healing, and DVT
246
What are the phases of rehab for distal realignment?
```
Phase I (0-6 wk): ROM and WB
Phase II (7-14 wk): gait, ROM, and strength
Phase III (15-22 wk): Strength and endurance
Phase IV *36-44 wk): return to sports
```
247
What is chondromalacia?
Degeneration or softening of retropatellar cartilage
248
What surgery is performed with chondromalacia?
Arthroscopic procedure to smooth rough surfaces and stimulate inflammatory response
249
What does acute management look like for chondromalacia?
```
Ice
Elevation
Compression
NSAIDs
Protected WB
CPM
```
250
What causes patellar fractures and what is a complication?
Direct or indirect trauma
Avascular necrosis in transverse fracture
251
What happens during non-op rehab for patellar fracture?
Immobilized in full ext for 4-6 weeks with limited WB
Nondisplaced fractures treated conservatively
Unaffected limb can maintain strength
252
Which fracture is most serious in a patellar fracture?
Horizontal
253
What management occurs with post-op patellar fracture?
Knee immobilized at 20 degrees
1 week post-op = active knee et, submax quad sets, and SLR
Knee flex limited up to 6 weeks to allow healing
FWB at 6 weeks
Focus on normalizing gait through CKC step ups and squats like non-op
254
What is a supracondylar femur fracture?
Muller's AO classification system
255
What is non-op management of supracondylar femur fracture
Incomplete or nondisplaced fractures
Nondisplaced = hinge brace for 6-12 weeks
Displaced = ORIF
256
What is non-op management for tibial plateaus?
Hinged knee orthosis in ext
Focus on ROM and isometrics
257
What occurs in post-op management of tibial plateaus?
AAROM between 1-2 weeks
FWB at 12 weeks
258
What is a high tibial osteotomy?
Used in pt with advanced degeneration of one compartment of knee
Bow-legged
Done 10 years before TKA
More successful in pt under 60
AAROM can start right away
FWB at 8 weeks
259
What are indications of a TKA?
Obesity, hemophilia, RA
260
What are contraindications of TKA?
Active infection, compromised vascularity, and recurvatum deformity
261
What is the goal of a TKA?
ROM
Relieve pain
Restore soft tissue
Max strength
Restore gait
Proprioception and balance
262
What occurs during the acute phase of TKA?
Days 1-5
- Blood thinners to prevent DVT
- Avoid prolonged sitting, standing, and walking
- Remedial exercises for quads, HS, glute, ankle pumps
- CPM to improve ROM
- WB depends on type of fixation
- Start general conditioning
263
What occurs in phase 2 of TKA?
Weeks 2-8
- Focus on ROM, decrease swelling, improve strength, gait, and amb
- Prevent athrofibrosis
- Gastroc stretching
- OKC and CKC exercises
- Focus on normalizing gait, balance, and proprioception
- TUG test
- 6 min walk test
264
What occurs in phase 3 of TKA?
Weeks 9-16
- Focus on ROM, decrease swelling, improve strength, gait, and amb
- 125 degrees flex
- Strengthen and balance (bilateral and unilateral)
- Focus on normalizing gait, balance, and proprioception
- TUG test
- Hydrotherapy
265
What occurs in phase 4 of TKA?
16+ weeks
- Return to sport with MD approval
- SAID principle
- Progress from bilateral to unilateral in strength and balance
- Precautions when returning to golf, tennis, and other sports with more rotational force
266
What are muscle length tests for the hip?
Thomas test
Ober test
SLR test
267
What is the limiting factor of a positive Thomas test?
- If more mobile in ext = rectus femoris is limiting
- If leg goes into ER and Abd = sartorius is limiting
- If leg goes into ABd and IR = TFL is limiting
- If leg goes into ADD = pectineus and adductors are limiting
268
What is the most common and significant complication of a hip fracture?
Osteonecrosis
269
What are the types of hip fractures?
- Malunion
- Delayed union
- Nonunion avascular necrosis
270
What are treatment options for hip fractures?
Depends on person's age, location and severity, quality of bone, activity level, associated soft-tissue injuries, specific goals for pt return to health
ORIF
Bed rest and protected WB and limited exercise for 3-4 weeks
271
What are treatment options for hip dislocation?
Treated conservatively with bed rest, traction, protected WB up to 12 weeks
272
What are the levels of mortality for hip fractures?
20% after 1 year
50% after 3 years
60% after 6 years
77% after 10 years
273
What occurs during the max protection phase of post-op hip fracture?
1-21 days
Protect fracture site, reduce pain and swelling, isometric exercise, gentle protected ROM, and limited WB
274
What occurs during mod protection phase of post-op hip fracture?
3-6 week
WB depended on bone healing and focus on improving strength
275
What occurs during the late healing phase?
6-8 weeks
Normalized gait mechanics without AD
276
What are examples of progressive hip exercises for 3-4 week post op hip fracture?
- Sitting LAQ
- Seated marches
- Forward bend (controversial for elderly)
- Armchair push-up
- Supine hip rotations
- Heel slides
- Knee to chest
- Hip ABd/ADD
- TKE
- Knee flexor stretch
- Knee flexion
- Hip ext
277
What is a proximal femoral osteotomy?
DJD
Goal: reduce pain and improve function related to advanced OA
Change the femoral neck-shaft angle
278
What does rehab look like for someone who had a proximal femoral osteotomy?
- Jt protection (unloading force through hip)
- WB progression with bone healing
- Surgical incision and bone healing
- PWB and underwater T-mill
- Increase exercise after x-ray verify bone healing
279
What occurs in a hip hemiarthroplasty?
When femoral head goes through osteonecrosis or severe fractures
Goal: eliminate pain and improve function
Procedure to replace femoral head
280
What occurs in a THA?
Replace both the femoral head and acetabulum
281
What are indications of THA?
OA or osteonecrosis
RA
Fractures
Pain, reduced amb
282
What precautions do you have with non-cemented THA?
NWB
283
What precautions do you have with cemented THA?
Takes longer for progression of WB and gait
284
What are sx/sx of thrombosis?
- Tenderness
- Swelling
- Redness
- Look if large veins are swollen
285
What are complications of THA?
- Loosening components
- Post-op dislocation
- Surgical site infection
286
What are precautions after posterior THA?
No ADD, flex past 90 degrees, and IR
287
What are precautions of anterior THA?
No ext past normal walking and no ER
288
How long is the recovery period for THA?
Up to 4 months
289
What occurs during max protection phase of THA?
- B ankle pumps, isometric quad sets, gluteal isometrics, active knee flex (avoiding hip flex), universal hip precautions
- Transfer training and bed mob
- Raised toilet seat and rigid w/c seat pad
- TTWB or PWB with crutches or walker
- FWB at 3 weeks
290
T/F you do SLR with hip replacements?
F
291
What occurs during mod protection phase of THA?
- Begins when pt can demo quad control, active knee flex, reduced pain, and compliance with precautions
- More challenging exercises with light resistance
- Standing exercise to stress hip motion
- THA precautions enforced
292
What occurs during min protection phase of THA?
Occurs 12-16 weeks post-op
- MD may discontinue therapy
- Pt return to normal gait without AD
- Rehab address proprioception, coordination, and balance
- Return to higher levels of activity
293
What are the advantages of anterior approach THA?
- Less Mm damage
- Decrease risk of dislocation
- Less post-op pain
- Faster recovery
294
What are the disadvantages of anterior approach THA?
- Harder to view
- Potential nerve damage
- Wound healing issues
- Different approach if repair needed
- Not for everyone
295
What is hip OA?
Focal loss of articular cartilage with variable subchondral bone reaction
296
What is the goal when someone comes in with hip OA?
Relieve symptoms, minimize disability, reduce disease progression, education, modification of activities, and maintain ROM
Evaluate diet, weight control, footwear, and use of AD
297
What is part of the conservative interventions for hip OA?
Gait and balance training, manual therapies, systematically progressed therapeutic strengthening
Use of AD to improve WB function, at least until WB and gait neuroplasticity improves
Flexibility, strengthening, and endurance
298
What is Legg-Calve Perthes Disease?
Hip condition affecting ages 4-8 years old
Non-inflammatory, self-limiting syndrome
Can heal spontaneously
Femoral head becomes flattened at WB surface and disrupts blood supply
299
What is a long term complication of Legg-Calve Perthes Disease?
Incongruous jt surface and advanced DJD
300
What is pubalgia?
Chronic pain of the pubic tubercle and inguinal region
Found in athletic peope
301
What are symptoms of pubalgia?`
Lower ab pain with exertion and minimal to no pain at rest
302
What is the treatment for pubalgia?
Conservative and aimed at addressing what is causing dysfunction
303
What is osteitis pubis?
- Pain and bony erosion of pubis symphysis
- Pain in pubic area that radiates across anterior hip
- Aggravated with striding, kicking, and pivoting
- Pain with resisted ADd, hip rotation, SI dysfunction, and may be present with pelvic obliquity and imbalance
304
What causes hip bursitis?
Irritated and inflamed from excessive compression and repeated friction
305
What is the treatment for hip bursitis?
- Relieve pain and inflammation (rest, ice, and NSAIDs)
- Eliminate activities that make it worse
- Focus on flexibility, strengthening, and stretching
306
What are the types of bursitis?
Greater trochanteric
Ischial
Iliopectineal
307
What has commonly been misdiagnosed as bursitis in the hip?
Glute medial tears
308
What are common causes of ischial bursitis?
Contusion, a lot of sitting, and HS strain
309
What is ischial bursitis?
Pain over ischial tuberosity
Can mimic HS strain
Affects thinner people and cyclists
310
What are tx interventions for ischial bursitis?
Rest, ice, NSAIDs, stretching, and corticosteroid injections
311
What is ileopectineal bursitis?
Local tenderness over iliopsoas and radiate to anterior thigh
Pain in hip flexion and ADd
312
What is the goal with ileopectineal tx?
Reduce pain and irritation
313
What are common tx from ileopectineal bursitis?
Rest, ice, NSAIDs, PT with thermal agents, stretching, and strengthening
314
What muscles are commonly strained in the hip?
HS, iliopsoas, ADd, and rectus femoris
315
How do we manage hip strains?
Initially with cold packs for 20 min 3-5 x/day
Avoid motion that causes pain
Sleep with pillows under both knees to support injured limb
Strength training proceeds with healing - time frame differs with pt
316
What is tx for hip ADd strain?
Protection, ice, compression bandaging, crutches, protected WB during acute phase
317
What intervention should be used after pain subsides?
Active hip flex, gentle hip ADd, and knee ROM
Seated butterfly with no pain
Progress to more dynamic exercises
318
How do you get a iliopsoas strain?
"Hip flexor pull"
Sudden, forceful extreme hip ext or forced hip flex against resistance
319
What is tx for iliopsoas strain?
Protection, rest, ice, compression bandage with crutches and limited WB
320
What PT interventions will you see with iliopsoas strain?
Hurdler's stretch
Stretches slow, static without pain
Correct Mm imbalance and joint dysfunction
321
Where is the most common hip contusion?
Iliac crest
322
What is initial tx for hip contusions?
Protection, rest, ice, gentle compression wraps, crutches, and PWB
Stretching and strengthening when soft-tissue has healed and pain is controlled
323
What is conservative tx with fractures to pelvis and acetabulum?
Rest, hip extended and ER to avoid stress, protect WB at 6 weeks
After bone is healed can progress to flexibility and strengthening
324
Why is a fracture to pelvis and acetabulum so painful?
Because the pelvis is a ring
Potentially life threatening
Stable vs unstable
ORIF with avulsion fracture
325
What is an unstable pelvic fracture?
Rotationally unstable
Severe injury treated with external fixator, ORIF, or extended bed rest
326
What does rehab look like in unstable pelvic fracture?
Depends on type and severity
WB deferred for 8 weeks
May exercise UE and limited LE
327
What are complications of a pelvic fracture?
Hemorrhage
GI injury
Diaphragm rupture
Bony malunion
Nonunion
Neurologic damage
DJD
Infection
328
What is involved in conservative rehab for acetabular fracture?
Protected WB at 9 weeks
329
What rehab is involved with post-op acetabular fracture
PWB for 8-10 weeks
LE strength program right away
As bone heals the PT can progress
330
What are symptoms of hip labral tear?
Groin pain, lock, click, catch, stiff joint and ROM
331
What are tx options for hip labral tear?
Conservative
Injection
Surgery
332
What diagnostic test can be done for hip labral tear?
FADDIR
Flexion-IR test
FABER
333
What is femoral acetabular impingement?
Deformity of hip jt that limits ROM
D/t trauma, repetitive movemetns, and bony abnormality
334
What is a Cam type acetabular fracture?
Excess bone around head or neck of femur
335
What is Pincer type of acetabular fracture?
Socket angled in away that abnormal impact occurs between femur and acetabulum
336
What are symptoms of acetabular fractures?
Groin pain after prolonged sitting, walking, dull ache, catch, sharp, popping, pain laterally
337
How do you test for an acetabular fracture in PT?
FADDIR
338
What tx options are there for acetabular fractures?
Conservative and surgery
339
What are the signs of overmobilization?
Increased pain and swelling
Decreased mobility
340
What is the mechanism of an inversion ankle sprain?
PF, inv, and ADd of foot and ankle
IE. Stepping off curb, into a small hole, or stepping on a rock
341
What is the Leach classification of inversion ankle sprain?
First degree: single ligament rupture (ATF)
Second degree: double ligament rupture (ATF and FCL)
Third degree: all three ligaments tear (ATF, PTF, and FCL)
342
What test is performed to see if someone has an inversion ankle sprain?
Anterior drawer test
Talar tilt test
343
What is the intervention for an inversion ankle sprain?
Depends on severity
344
What occurs during max protection phase for inversion ankle sprain?
RICE, jt protection and immobilization (ankle needs to be positioned properly)
WBAT
Isometrics as soon as patient can tolerate and proximal leg strength
345
What occurs during mod protection phase for ankle inversion?
Starts when pt can WB w/o crutches, perform all ROM, and perform isometrics w/o pain and swelling
```
Inv and PF are added
Conc/Ecc contraction added
Toe and heel raise
Stretching
Stationary bike
Proprioception exercises
```
346
What occurs during min protection phase of inversion ankle sprain?
Can start when amb w/o pain or limping, can perform all resistive exercise w/o pain, and swelling is reduced
Maturation can take up to 6-12 months
347
What are ankle deltoid ligament strains?
AKA medial ligament or Spring ligament
Rare
Occur in combo with ankle fracture
348
What are interventions for ankle deltoid ligament strain?
Partial tear = PT
Complete rupture = surgery and NWB for 6 weeks
Rehab focuses on jt protection
Ice, compression, and elevation for pain and swelling
Progressive strengthening
349
What is a high ankle sprain?
Occurs when ankle is forced into DF or rotation with foot in WB position
350
What are interventions for high ankle sprains?
Immobilization
Limit WB
Surgery
351
What tests can help identify high ankle sprain?
Syndesmosis squeeze test
| ER test
352
What are interventions for chronic ankle ligament instabilities?
Immobilizations for 2-6 weeks
Passive DF/PF exercises
When tolerated add AROM with avoiding PF and inversion
Healing time is longer
Isometric stab exercise in all directions
Manual resistance
Isotonic resistance (with ankle wt)
Isokinetic training
Full ROM with eccentric contraction emphasis
Proprioceptive exercise
353
What are interventions for functional ankle instabilities?
CKC resistance, proprioceptive maneuvers, dynamic muscular exercise, and bracing
354
What are subluxing peroneal tendons?
Acute or chronic - passive DF with foot slightly ev. Can be misdiagnosed for lateral ankle sprain
Pt complains of posterior ankle pain and popping sensation in lateral ankle
355
What is the intervention for subluxing peroneal tendons?
Conservative = rigid cast, NWB for 6 weeks
Surgical repair to correct
356
What are post-op interventions of subluxing peroneal tendons?
```
Immobilize for a few weeks
WBAT
PF and DF 3 weeks after surgery
ROM initiated 4-6 weeks post-op
General body conditioning while immobilized
```
As pain, swelling, and strengthen improve DF can be added
Proprioception after mobilization ends
357
What is Achilles tendinopathy?
Overuse injury = repetitive microtrauma and overloading tendon
358
What are signs of Achilles tendinopathy?
Localized pain to midportion, distal 3rd, and insertion to calcaneus
359
What are risk factors to Achilles tendinopathy?
Decreased vascularity, malalignment of rearfoot or forefoot
360
What are extrinsic factors contributing to Achilles tendinopathy?
Running-surface changes, poor or inappropriate footwear
361
What are the interventions for Achilles tendinopathy?
Conservative: NSAIDs, progressive exercise, active rest, ice massage, US, and ionto
Flexibility exercise - active DF and progress towards standing heel cord stretch
Eccentric exercise
Rigid cast for severe cases
General body fitness
362
What causes Achilles tendon rupture?
Sudden eccentric/concentric contraction of gastroc-soleus
363
What test can help rule in or out an Achilles rupture?
Thomphson test
| - Squeeze gastroc and look for PF
364
What are interventions for Achilles tendon rupture?
Surgical or immobilization for 8 weeks
365
What happens if an Achilles rupture is not surgically repaired?
Increased likelihood to rerupture
Loss of power, strength, and endurance
366
What does rehab look like for non-surgical Achilles rupture?
- General body conditioning
- Aerobic exercise
- Slow process regaining full DF and PF
- Progressive exercise using latex band and proprioceptive exercise
- Assess ROM, strength, pain, and swelling daily
- Isokinetic test for PF, DF, ROM, strength, power, and local endurance
- Isokinetic strengthening
367
What does rehab look like post-op for Achilles rupture?
Timing, stability, patient variables differ
368
What causes compartment syndrome occur?
Tibial fractures, muscle ruptures, muscle hypertrophy, burns, and direct trauma
369
What are the symptoms of acute compartment syndrome?
Pain, palpable swelling, tenseness, paresthesias, warm/shiny skin, and tense passive stretching that may produce severe pain
370
What are the symptoms of chronic compartment syndrome?
Dull aching in muscle during and after long term exercise and parasthesias may develop
371
What is the intervention for compartment syndrome?
- Fasciotomy within 12 hr
- Walking as tolerated and PROM to ankle and knee 2 days post-op
- General conditioning and early ROM
372
What are the types of ankle fractures?
- Lateral malleolar
- Medial malleolar
- Bimalleolar
- Trimalleolar (both malleoli + talus)
373
How is a simple malleolar fracture managed?
Immobilization
Other types = surgery
374
What is a diagnostic test PT can do for an ankle fracture?
Ottowa Ankle rules
375
What is a distal tibia compression fracture?
Vertical or axial loads that compress tibia into the talus
376
What is initial tx for distal dibia compression fractures?
ORIF, external fixation, or skeletal traction
377
What interventions occur with distal tibia compression fracture?
WB activities deferred for 12 or more weeks
General conditioning while immobile
378
What interventions occur after immobilization?
Protect articular surface of distal tibia and talus
Recognize that the hardware is at or near jt
Initially NWB and ROM exercise are allowed
Progressive loading with caution
PWB repetitive motion activities
379
What causes calcaneal fractures?
Depression fractures caused by falls from a height
380
What are interventions for calcaneal fractures?
Conservative or surgical
Early ROM to reduce stiffness
Control pain and swelling
381
What are long term interventions for calcaneal fractures?
Isometric PF
Full ROM manual resistance DF and PF
Gait retraining (heel-strike pattern)
382
What causes talus fractures?
Falling from a height and landing in crouched position
383
What are some interventions for talus fractures?
Closed reduction or ORIF
Immobilization
ROM and supportive measures for pain and swelling
384
What is a stress fracture of the foot or ankle?
Partial or complete
| Caused by unrelenting stress and force
385
What are common sites for stress fractures of the foot and ankle?
Metatarsals, lateral malleolus, os calcis, navicular, and sesamoid bone
386
What are symptoms of ankle and foot stress fractures?
Pain - increased with activity and subsides with rest
Occur as a result of continual stress on the bone and/or muscle
387
What is at-risk management for foot and ankle stress fractures?
External support
| Modification to aerobic exercise
388
What is not-at-risk management for foot and ankle stress fracture?
Activity modification, rest and analgesics
Leg, ankle, foot stretching and strengthening
Low impact aerobic exercise
389
What is medial tibial stress syndrome?
Musculoskeletal overuse injury
AKA shin splints
390
What are symptoms of shin splints?
Tenderness over distal posteromedial tibia caused by inflammation, periosteal inflammation, and injury to tibia bone or muscles
391
How do you grade shin splints?
Grade I: after activities
Grade II: during and after activities
Grade III: before, during, and after activities
Grade IV: so significant that no activities can be done
392
What are treatments for shin splints?
```
Ice or ice massage
NSAIDS
Active rest
Gradual stretching to lower leg
Activity level modified to accommodate pain and dysfunction
```
393
What is plantar fasciitis?
AKA heel spur syndrome
Chronic inflammation of plantar aponeurosis
- May be degenerative
- May be related to shortening of gastroc
- May be related to LB injury
Repetitive microtrauma
394
What are symptoms of plantar fasciitis?
Pain along medial border of calcaneus
Pain worse in AM
DF of ankle provokes symptoms
395
What are some interventions to plantar fasciitis?
Conservative PT
Active rest, stretching, manual therapy, exercise and ionto
Arch taping or orthotics
ROM and stretching
Local steroids to decrease pain and swelling
ETPS
Surgery = last resort
396
What is pes planus?
AKA flat foot
Congenital or acquired
Muscular weakness, laxity in ligaments that support arch
397
What is pes cavus?
AKA high arch
Results from neurogenic pathologic process, muscle imbalance, or congenital abnormalities
Complaints of painful calluses and OA change
Tx aimed at pain and shock attenuation
398
What is posterior tibialis tendon dysfunction?
Dysfunction of posterior tib tendon
Results from flat foot
Can cause PF
Posterior tib: Originates on osseous memb of fibula and inserts on tibia
399
What are symptoms of posterior tibialis tendon dysfunction?
Fallen arch
Hx of injury
Pain in foot
Difficult rising onto heel in SLS
400
What are some interventions for posterior tib tendon dysfunction?
Intrinsic Mm exercise - toe curls or marble p/u
401
What is Morton's neuroma?
Ball of nerves between 2nd and 3rd MT
402
What are the symptoms of Morton's neuroma?
Diffuse radiating pain into toes
Occur between 2-3 or 3-4 interspace
Complains of burning, cramping, or catching sensation
403
What interventions are there for Morton's neuroma?
```
MT pad
Wider footwear
Softer shoe
Cortisol shot
Surgical excision
```
404
What is hallux valgus?
AKA bunion
Deviation of great toe with soft tissue and bony deformity
Exacerbated by improper foot wear
Pain relieved by modifying footwear
1st MT ext should be assessed
405
What are the interventions for a bunion?
Bunionectomy
PT after
406
What is the goal of PT after a bunionectomy?
Decrease pain
Improve first MTP ROM
Gait training
407
What are some lesser toe deformities?
Hammer toe
Mallet toe
Claw toe
408
What are interventions for lesser toe deformities?
Nonop = modify activities that cause pain, wider footwear, softer toe box, and padding
Surgical = followed by PT
409
What is hallux rigiditis?
Big toe so rigid = improper gait
Refer to rocker bottom to assist in toe off
410
What is the DVT prediction?
Clinical prediction rule
Cluster of tests - 3 or 4 sx/sx
411
What is Homan's test
Forced into DF and if they have major and minor criteria they may have DVT
412
Definition of reliability
Extent to which the test or measure is free from error
413
What is intra-rater reliability?
Same examiner can repeat test and get similar results
414
What is inter-rater reliability?
Between 2 or more people that can repeat the test with similar outcomes
415
What are dichotomous outcomes?
Test result is positive or negative
High possibility that two people get the same outcome due to chance alone
416
What is Kappa (K)?
Measures amount of agreement beyond what is expected by chance alone
statistic used to adjust for chance agreement
417
What is QUADAS?
AKA Quality Assessment of Diagnostic Accuracy Studies
418
What is internal validity?
Improved when research design minimizes bias
419
What is external validity?
Judged by whether the estimates of diagnostic accuracy can be applied to clinical setting
420
What is a good QUADAS?
Greater than or equal to more than 10 yeses = high quality
421
What is the difference between reliability and quality?
Reliability is measuring accurately
Quality is measuring what it reports to measure
422
Define sensitivity
Probability of a positive test result
423
Define specificity
Probability of a negative test result
424
What is PLR+?
Ration of positive test result with pathology to positive results without pathology
425
What is NLR?
Ratio of negative test with pathology to negative results without pathology
426
What is PPV?
Proportion of people with disease of those with a positive test result
427
What is NPV?
Proportion of people without the disease with negative test results
428
How to remember sensitivity and specificity?
SNout
SPin
As SN increases = SP decreases
