exam 3 Flashcards
(215 cards)
1
Q
dynamic process which body position maintained in equilibrium
A
balance
2
Q
at rest
A
static
3
Q
steady state of motion (surface/ person)
A
dynamic
4
Q
COM / COG is maintain over BOS
A
5
Q
corresponds to center of total body mass is point where body is in equilibrium
A
center of mass
6
Q
vertical projection of COM to ground
anterior to S2
55% person height
A
Center of gravity
7
Q
base of support is perimeter of contact area between body & support surface
wider stance/ increase stability
narrow stance / decrease stability
wide stance can increase rate of falling- need good posture
A
8
Q
limits of stability LOS
sway of boundaries in which individual can maintain equilibrium w/o change BOS
A
9
Q
sensory processes are
A
visual
vestibular
somatosensory (proprioception)
10
Q
sensorimotor intergration
motor response
adaptive / anticipatory of posture control
motor- Conscious- plan program excute balance response
A
11
Q
sensation (GTO MSF) mechanorecptors
touch pressure vibration
A
12
Q
contextual / environment
closed predictable - no distractions
open predictable - distractions
support surface
firm vs slippery stable vs unstable
lighting , task - new or learned
A
13
Q
visual
- position of head to environment
-orientation of head to maintain gaze level
-direction/ speed of head
A
14
Q
somatosensory
- muscle spindle
muscle length (joint position sense)
GTO muscle tension
joint receptors (muscle tone, stiff, posture adjustment)
skin receptors
A
15
Q
balance control is visual , vestibular, sensation
A
16
Q
Vestibular SCCs
-semicircular canals
angular/ rotatory accerelation- fast head movement
* head tilts, motion sick bc body going faster than inner ears can keep up
-otoliths (utricle/ saccule)
linear acceleration- slow head movement
*linear - treadmill , walk pad
* vertical - diving board
A
17
Q
neuropathy- can’t feel sensation in feet , systems can compensate
A
18
Q
Vestibulospinal reflex- compensates tilts
vestibulospinal tract- inner ear
helps body adjust for any tilts / changes in posture that body needs
keeps body upright
A
19
Q
vestibulcular reflex : keep eye stabilize
stabilize head during movements from vestibular nuclei
*keep object in focus
A
20
Q
fast to slow is
A
somatosensory
visual
vestibular
21
Q
CNS- turns off / suppress inaccurate input
*selects / combines appropriate sensory input from other 2 systems
A
22
Q
automatic postural reaction
- change in position , need to respond
A
23
Q
activation of postural muscles in perform skill movement
- reach high cup off shelf
have to get on toes
A
anticipatory balance
24
Q
movement occur too fast to rely on sensory feedback
*lose balance before fall
A
reactive
25
infancy some reflexes will intergrate / go away or stay with us
pre program
26
CNS to regain balance after body is perturbed
- reflex (muscle contract, independent)
stretch reflex 1st response <70ms and same response everytime
- autonomic postural reaction
80-120 ms 1st response to falls
- Voluntary movement
80-120ms longest latency , dependent
produce higher variables , motor outputs (reach for stable support )
27
ankle - distal to proximal
forward- gastro/ hamstring
backward- ant tib/ quad/ abs
hip flex
forward- quad/abs
backward- hamstring
stepping * to catch yourself
Weight shift- Lateral either side to accommodate
- abductors and adductors
28
suspension - during balance task
get lower to lower COM
flex knee- flex hip, ankles
combine w ankle / weight shift
29
sensory input impairment - neuropathies, ankle sprain, lack of joint awareness
sensory processing defects- visual loss, peripheral vision
bio mechanical/ motor deficits- posture aging meds
30
reach to touch, catch lift
anticipatory
31
unexpected perturbation, sway
reactive
32
reduce visual / somatosensory cues
sensory
33
stairs specific is Functional
34
gait locomotion balance is for
safety
35
Tell patient to look at external focus for attention while balancing
36
DLS- double limb support
Eyes open / eyes close
SLS- single limb support
Eyes open/ eyes close
tandem walk- feet have to touch, narrow , anterior to posterior
perturbation- gait belt: back up
proprioception - stable vs unstable
vestibular
static vs dynamic
37
use strength / speed to increase Power
plyometrics
38
stretch shortening drill
high velocity eccentric to concentric activation
Plyometrics
39
time beteeen stretch and shortening should be quick is
Amortization phase
*eccentric to concentric
40
Work produced by muscle per unit of time
power
41
more intense, less time= more
power
42
taking up elasticity energy to create force to move us it enhances
physical performance / decrease injury
easy- difficult
slower progress w rest in between sessions
plyometrics be high function, no injuries
43
48-72 hrs between plyometrics
eccentric to concentric is doms
usually 6 different activities and change Reps/ time
for 2x 8/10 weeks
44
cartilage between bodies and disc
intervertebral disc
45
synovial joints between superior / inferior articular process
zygopophyseal
46
DJD in common in ____ joints
zygopophyseal/ facet / synovial
47
most anterior ligament
hyperextend injury
anterior longitduinal
48
posterior to anterior longitudinal
posterior longitudinal
49
intervertebral process
ligamentum flavum
50
in between transverse processes
intertransverse ligament
51
most posterior
whiplash
- ligamentum nuchae
supraspinous
52
two structures in intervertebral disc
annulus fibrosis
nucleus pulposus
53
annulus fibrosis- collage rings, compress/ shear forces
nucleus pulposus- fluid filled
54
Plumb line:
head- COG anterior to AO joint
trunk- LOG through Cervical/ Lumbar vertebrae
hip- LOG posteoor to hip joint, through greater trochanter
knee- LOG anterior
ankle- LOG anterior
55
without trunk stabilizing muscles then the spine would ____
collapse
56
superficial muscles are
global
57
deep muscles are
core
58
cross segments
help produce motion: provide guy wire function
Compress load with strong contact
Global
59
Global:
lumbar- rectus abd. obliques. QL. erector spinae. iliopsoas
cervical-SCM. levator scap. scalene. upper trap. erector spinae
60
attach to each vertebrae segment
control segmental motion
segmental guy wire
greater % of type 1 muscle fiber for endurance
Core
61
Core:
lumbar- transverse abd. multifudus. QL. deep rotators
cervical- rectus capitis ant/ lay. longus colli
62
tight hip flex
weak abs
tight trunk ext
Anterior pelvic tilt
excessive Lordosis
63
faulty lumbar poor sitting excessive tip of head
forward head
64
weak abs/ obliques
tight pect
tight trunk ext
relaxed slouched posture
65
excessive flexion, weak trunk ext, tight trunk flex. hip ext
flat back
66
exaggeration of correct posture - military
flat neck
67
protract scapulae
rounded back
osteoporosis / congenital/ postural
pain/ increase thoracic
Increased kyphosis posture
68
abnormal lateral curvature
named for convexity of curve
S curve
right thoracic
left lumbar
scoliosis
69
congenital / irresversible scoliosis
posterior rib hump w forward flexion
Structural scoliosis
70
reversible , diminishes w postural changes. stretch concave . strengthen convex . stand tall, pull umbilical towards spine
functional / postural
71
convex -
concave -
strengthen
stretch
72
sitting bending forward w weight - 185+
- sitting picking up load is worst pressure
HNP L4-L5 Posterior Lateral
slipped disc - does not slip out, just pushed in certain direction
73
nucleus bulges against intact annulus fibrosis
protrusion
74
hernation; jelly pushing out against annulus within PLL
extrusion
75
hernation; jelly going into spinal canal, leaking
Sequestration
76
long term flexed posture
sustain loading of joint/ disc/ ligament
disc pressure increases - fluid movement
cannot move back into ext bc can cause injury
Fluid Stasis
77
narrowing of spinal canal (central stenosis)
nerve root canal or forman (lateral stenosis)
congenital / acquired
caused by soft tissue structure / fibrotic scars
ext motions increase symptoms
spinal stenosis
78
vertebral degeneration of OA of spine
Spondylosis
79
pars interarticularis fx “scotty dog”
Spondylolysis
80
can occur as Spondyloylosis
anterior slippage of vertebrae onto the one directly below bc fracture
Spondylolis
81
Neck; 66% of population affected by cervical spine
women affected more than man
results in quadriplegic
acute strains/ sprains- Whiplash (extreme flex / ext)
82
compression of nerve root with numb, tingling, pain in UE
disc hernation / spondylosis
peripheral pain/ cervical scap pain
reduce pain / swell, control muscle spasm, centralize symptom
83
facets stick together
not in alignment
can do mob to get into alignment
cricks can be impingement
cervical facet syndrome
84
partial/ fall removal of lamina in order to relieve pressure form disc protrusion/ stenosis
laminectomy
85
-spinal stenosis
- pinched nerve
can be by
laminectomy
86
due to pain/ instability/ OA
reduces mechanical stress, eliminates segmental motions
cause hyper mobility
eliminate hyper mobility
Fusions
87
faulty posture
TMJ dysfunction
allergies / sinuses
vascular / hormonal headaches (Migranes)
Tension/ cervical headache
88
chin tuck is
capital flexion
cervical extension
89
direct contact (contusion activities)
or indirect (overstretch/ contraction of thoracic muscles) - control pain/ swell
treat as acute injury
90
activating muscles to pull bones (ribs) back into place
muscle energy technique
91
traumatic / insidious onset localized pain to region may include radiopafbg
relived with rest/ off loading joint
- muscle energy techniques
- core stabilization
- high velocity thrust- not covered leg pull
work on stabilization
92
most common in thoracolumbar from sudden compression, fall/ trama doing ADLs
losing bone mass
plopping down
low back pain/ ab pain w/o radiopathy
thoracic kyphosis (dowagers hump)
pain dictates exercise level - avoid flexion
surgical intervention- Vertebroplasty
93
compression fx more female elderly bc
osteoporosis
94
flexion opens up more
space
95
Fracture- realign and stabilize / close space
ankylosing spondylitis- ossification of soft tissue around spine. joints fused. ALL and PLL facet joints
pain in SI/ thoracolumbar/ shld/ foot
96
making area more hupomobile
more acceptable to fx
in flex, shift position
ankylosing spondylitis
97
rare congenital weakening of vertebral endplated
T10-T12
nucleus pulposus protrudes vertically into vertebral end plates cause bony necrosis (schmoris nodes)
vertical instead of ant/ post
seen in teens/ growing pains
Scheurmanns Disease
98
increasing in surface area
peripheralization
99
recede up leg/ arm and become localized
ask pain location/ level of pain prior to intiate fx
centralization
100
increases size of forman
decrease nerve root irritation
to create more space
- spondylosis- OA within spine
- spinal stenosis - narrow spinal canal
- extension load injures
- facet joint inflammation
- ext posture w increased spinal lordosis
Williams flexion: pelvic tilt- mobility not strength
single / double knee to chest
partial sit up
flexion bias
101
closing space
HNP
intervertebral disc lesion
flexion injury
flexed postural dysfunction
fluid status - fluid stagnant there
vertebral compression fx
flex posture / lat devation posture
Mckenzie:
prone lying 5 to 10 min
prone on elbows 5 to 10 min
prone press ups 10x
standing extension hold for 20sec
extension bias
102
spinal instability
hyper mobile
muscle ligament laxity
spondylolisthesis - anterior vertebral slippage
spondylolysis- pars articularis fx
excessive lordosis , prefer ext posture to relieve pain
activate TA/ multifuids
rectus abdomins/ erector spinae like to take over
stabilization
103
forward head doing
capital extension and cervical flexion
104
ext mob- up towards you
lat flex mob- push from same side
rot mob- horizontal / upwards
for good posture do an anterior pelvic tilt
segmental/ cat cow- each vertebrae moving at once
thread the needle- rotational thoracic
reach opp and pull arm up
open the book
foam roller/ ball- side stretch Scolosis
thoracic roller/ foam roller parallel with spine retract/ protect
105
P AM I Add
displace posterior : anterior medial force : ipislateral: resist horz add
A PL C Abd
displace anterior: posterior lateral force: contra lateral : resist horz abd
106
myelopathy affects the entire spinal cord. In comparison, radiculopathy refers to compression on an individual nerve root.
107
Hip- decrease flexibility from WB forces form hip joint up into spine/ down into knee
tight hip ext, increase lumbar flex, when thigh is flexed
muscle weakness/ imbalance - increase stress being transferred to other joints
* affected by strength, length, proprioception, neuromuscular facilitation
108
weak hip abd
IT band takes over
patellofemoral impairment
109
weak hip ext during loading
ACL strain
110
weak hip ext and abd lead to overuse piriformis
Piriformis syndrome
111
APT slouch back/ flat back/ overuse IT band at knee , trochnateric buristis
Short TFL / Glute max
112
TFL can take over Glute med
two joint hip flexor over iliopsoas
hamstring over glute max
lateral trunk over hip abd
unilateral short leg
coxa valga +125
coxa vara -125
113
genu valgum knock knees and short limbs is
coxa vara
114
genu varum bow leg and leg length discrepancy with wider side being longer
coxa valga
115
ankle beteeen shaft and neck of femur
Coxa vara / valga
116
rotated in too much cause toe in
increased angle 35+
anteversion
117
rotated out too much cause for out
decreased angle 10-0
retro version
118
angle at torsion at head and neck of femur
anteversion/ retro version
119
sciatic nerve compression, acute/ enlarge piriformis
course of sciatic nerve , pain in butt with sitting/ radioculopathy
RO lumbar spine and SI
stretch piriformis
SI- Fabre test is hip flex / abd/ ex rot
thomas and ely
120
osteoarthritis / RA/ Fx/ pain, no walking, JRA. decrease in ADL
no flex past 90, no add past midline, no joint in rot
posterior lateral approach
femoral head w acetablum cup replaced
most common/ Cemented
THR
121
allow gone stock to grow into place
younger and more NWB time
Uncemented
122
glued in place
cemented
123
THR will have thigh pain, Anatalgic gt- limp
loosing of hardware 10-40% by 10 yes
profascility - ahead of time decrease risk of clot of Blood thinners
Thromboembolic disease- clot do muscle pump and get OOB
dislocating 1-4% (hardware/surgery/fixation/ patient compliance)
124
avoid hip add / in rot / flex past 90
posterior lateral and lateral
125
avoid hip add / ex rot/ hip ext
anterior approach
126
procedure is replacing head of femur and replacing socket of pelvis acetablum
127
signs of loosening/ ORIF
- constant pain / increase WB
- surgical leg shorter than others
- persistent ER of limb
- positive trendelenburg that doesn’t get better
128
MAX PROTECT THR
rice mods joint mobs 1&2
isometrics at hip
ROM of hip w precautions
ROM at ankle knee pelvis
balance seated if WB
gait wb status and Ad train
assess incision
education on precautions / procedures
bed mobility / transfers
ankle pumps quad sets / Glute sets
active knee flex not beyond 90 AAROM
129
to move to mod phase must
decrease pain and inflammation
130
MOD THR
arom of hip w precaution
open chain - isolate glute med
stretch TFL to not compensate
closed chain- overall
check incision- scar mobilization
gait train w WB status treadmill
have to keep up w speed so no limb (3.0)
joint move 3/4 w no precautions
131
to move to Min phase must be
full ROM no pain
132
MIN THR
12-16 weeks after surgery
functional activities stairs w weight
plyomeyrics
discontinue hip precautions
max resitsnace exercise - med ball slams (picking up kids)
PLOF activities
133
bridge up set pelvis
lay supine and look for malleolus to line up for leg length discrepancy
then look at ASIS supine
then look at PSIS prone
* do they line up or is one side rotated more
PPT- hip flexors (quad)
APT- hip extensors (hamstrings)
134
intracaspsular feacture- risk of avascular necrosis bc it cuts off blood supply
extracapsular - great trochanter to lesser
subtrochanteric- malunion, delayed union, non union - poor blood supply
135
patients put on blood thinners - 40-90% DVT w/o Prophylatic meds
ORIF- rods screws plates
THA- total hemi arthroplasty
hip fractures are most common in elderly women bc osteoporosis
136
lesser trochanteric fx- less common common in adolescents treatment depend on amount of fragment displacement
surgery required for more than 2cm
137
dislocations fx or isolated event
ant/ post
anterior avoid Abd and ex rot
posterior avoid Add and in rot and flex
138
hemi arthroplasty is just changing of femoral head
itis- do eccentric training stretch while strengthen
139
MAX HIP FX
strengthen surround areas
Prom
wound care check incision
isometrics
NO SLR AND SUPINE GLUTE BRIDGE
dislocation restriction
rice mods balance aerobic
transfers gait train AD
education - piccolo
wb restriction
140
MOD HIP FX- 6 to 8 weeks
Arom
resistance, gt, train AD
PRE
strengthen hip/ knee
stretch balance / aerobic
141
MIN
functional ADLs w resistance
plyometrics
aerobic / balance
142
fracture ischial tuberosity need surgery
risk of malunion and pain
stable -AVULSION fx non surgical
where muscle is inserted
don’t strengthen at tissue
muscle tears away pieces of bone
Unstable/ rotational unstable - rotational and vertically unstable
143
Legg Calve Perthes Disease LCP
coxa plans at WB
flattened femoral head/ acetablum
disrupts a vascular necrosis
young boys- DJD
treatment-Put femoral head into acetablum for abduction position
144
Bursitis: fluid filled sac that absorbs / prevents friction
can inflame bursa
strains / contusions - bruise form hit
145
______ bursitis is excessive compression/ repated friction as IT hand snaps over bursa superior - greater trochanter
Obtubers stretch ITB
hams quad add - strengthen & stretch wo stress
Rest TFL bc ITB
Trochanteric bursitis
146
________ bursitis is pain or radiating in anterior thigh caused by overextension or tight hip flexors
stretch ham/ add/ ITB
Strengthen quad
Iliopectinal
147
_________ bursitis pain over ischial tiberosity under glute max (tailor/weaver)
Contusion/ extended sitting
will mimic hamstring strain
pinpoint ischial tuberosity to see
stretch hams ; strengthen Quad
Ischial (ischiogluteal)
148
__________strain is sudden force contraction by decelerating lower leg during running
avoid full knee ext w forward trunk flexion
and full leg flexion - put ham on stretch
= supine sleep with pillow under both knees
Hamstring
149
not enough flexibility so it strains
make sure you warm up tissue
plasticity: stretch to get ROM
stretched past range - strain elasticity
150
________ muscle strain adductor longus
avoid stretching
pain subsides active hip flex/ abd/add
Adductor
151
_________ muscle strain hip flexor pull
extreme hip ext by forced hip flex
against resistance
Avoid hip ext, slow static - hurdler stretch
iliopsoas
152
Contusion with ________ hit to iliac crest from ext force
rest no WB/ avoid stress/ rice
Hip pointer
153
Tramua , larval impingement, laxity in capsule dysplasia ,
catching of tear between femoral head and acetabulum
clicking/ locking groin pain for Ant tear and butt pain for post tear
impingement
154
Toe in, large angle is
Antervsion
155
Toe out, smaller angle is
Retro version
156
Symmetry of SI TEST
toward bend test
touch toes
shot gun - leg length dis. / pubic symphysis
157
ANTERIOR ROTATED
supine to sit
supine- leg longer
sit - leg shorter
POSTERIOR ROTATED
supine to sit
supine- leg shorter
sit- leg longer
158
MET- Activate hamstring on Ant rotated and have them push against hand/ shoulder into PPT
MET - Activate iliopsoas on Post rotated and have them pull against hand / shoulder into APT
159
Anterior rotation can also be prone and pull quad up then push down
Prone push outward on ASIS for hypomobile
PRESS ON ASIS FOR POSTERIOR TILT IT OPENS SPACE
PRESS ON SIDE OF ASIS FOR ANTERIOR TILT TO CLOSE SPACE
piriformis syndrome- strengthen glute max
160
anterior rotated - push with hand on hamstring to bring it back neutral
posterior rotated- push with hand on thigh to bring it back neutral
161
knee 130 flexion- soft tissue
O extension - important for WB
stairs- 80/90
sitting-90
walking-60
high activities - 115
knee flexion- concave tibia on convex femur
ext lag- amount of ext actively vs passively
162
Total knee arthroplasty - removing femoral condyles/ replace
shaving tibia plateau and replace
cut patella sometimes / replace
unicomparent- femoral condyle
Most common is bicompartment/ fem con/ tibia plateau
tricomparyment- fem con/ tib pla/ patella
163
increase mobility , decrease pain, got stability/ realign
Constrained- get surfaces close together and take out ACL PCL and get stability - more stable , less mobility
ligaments stabilize knee while moving
usual should be Semi Constrained
- get rid of ACL/ keep PCL balance between stable and mobile
non constrained- save PCL ACL or replaced
cemented - cement pieces together/ more WB
uncemented- porous/ wanting bone to grow in PWB NWB
164
contraindication- osteoporosis not enough bone stalk for strength
obesity cormobities for surgery (heart disease , circulatory )
neurological dysfunction: complication- contracture infection neuroma
more people have harder time in Ext
165
fractures : immobilization, restrict WB, ORIF, mal union / non union —
soft tissue injury
epipsheal fx - change in growth plate Kids
patella fx- linear break can fixate can be vertical break
direct not to patella / falls possible necrosis
might have limit flexion
166
patellar tracking- soft tissue injury, train VMO bc imbalance
ITB syndrome pulls patella lateral from overuse or tight
Q angle ASIS to middle patella 13-19
females wider - cause pull bow string affect
middle patella to tibial tuberiostu
167
miserable mal alignment- femoral anteversion, proximal ext rot of tibia
int rot of femur
168
ORIF
TKR
max phase:
prom
quad flute ham sets
patellar mobilization
strength train above / below
hamstring stretch
gait 60 flex
cardio
can stretch strengthen just not involved tissue
169
MOD
PRE QUAD
stretch
JM
gait
walk - cane - none transfer
scar mobilization
hep
170
MIN
functional adl’s cardio endurance
171
High Tibial Osteomy- VARUS knock knees, inward rotation
taking piece of bone out & put wedge in there to make stable.
delays getting TKA
172
lateral tracking: fire VMO
strengthen Hip Abd/ Ext/ ER
saq- TKE quad insufficiency
3 levels of SLR w 45 hip ER toe out
patellar mobilization/ taping
valgus with wb
MAX- SLR & SAW
mod - strengthen abd/ ext/ er
173
Patellar tendonitis- front knee pain (overuse of extension of patellar tendon)
LE PAIN FREE CLOSED CHAIN ONLY
hip condition : SLR w profess resist / hamstring stretch / balance / endurance / aerobic / skill
IT BAND SYNDROME: runners / leg length discrepancy Obers
lateral side pain; overdue of IT
transition to ITB at 30 knee flexion , strengthen IT / hip and
174
Osgood Schlatters 11-18 males more
growth spurt
stress of quad contraction / avulsion fx at tibial tuberosity
pain with run : jump : squat RICE & quad stretch
Plica- peripatellar thickening of synovial tissue
tender to touch, trama caused or patella tendonitis
medial to patella - alar ligament
suprapatellar plica
inferior plica
175
Bursitis inflammation in synvoial fluid filled sacs excessive motion/ infection
Pes anserinus - runners
deep to sartorius / gracilis / semitendinous
Pre patella - housemaids superficial to patella
Posteromedial -meniscal tear
deep to gastro and semimembranous
stretch hams / quads ,compress
176
Non operative rehab of Ant Knee Pain
strengthen : sub max isometrics
VMO stabilize and superior medial
Stretch tight lateral structure
stretch hams / IT band
closed chain/ shallow step up
Quad strength use open chain
hamstring stretch / strengthen
Wb balance
177
Postoperative Proximal distal realignment
establish ext function/ reduce patellofemoral force
178
Meniscus: shock absorption, transfer load even across area, nurtuon/ lubrication
collagen type I , extension of tibia
Catching with meniscus
younger active
5 types of tears
medial / C shape
Lateral Circle
Menisectomy total or menisectomy partial
Younger - longitudinal 50-90%
Older - horizontal
non contact/ knee flexion / compress / shear “lock and catch swell”. or contact
last test- bounce home - blockage with rubbery spring end feel
179
McMurray/ medial valgus force with external tibial rotation
lateral varus force with internal tibial rotation
both with Knee extend
180
Apley’s distraction > ligament tear
compress > meniscal tear
check for ligament laxity
terrible triaid / acl mcl and medial meniscus
181
10-30% repair itself , the rest is avascular / a neural
I red on red - outer 1/3 vascular repairable
II red on white- partial avascular / repairable
III white on white- avascular no repair (menisectomy)
Red on Red meniscal repair (suturing torn meniscus together)
total menisectomy - DJD have to replace
182
MENISECTOMY - strengthen quad
it is arthroscopic, Will be WB
do SLS for proprioception awareness and brings surfaces more closer together
183
Meniscal repair will be NWB bc suture
increase amount of flexion in brace
Ligament injuries / degree of sprain/ rupture that lead to loss of function
ACL- limits anterior translation of tibia
PCL/ limits posterior translation of tibia
MCL- provides medial stability
LCL/ provides lateral stability
I- microtear stretched
II partial tear start rice
III- complete tear go into surgery
184
MCL- direct external force contact from Valgus (lateral side)
no contact/ abduction w rotation
tibia exteranl rot and valgus force on knee
can tear unhappy triad
Acl feeds into medial meniscus so it tears
will feel unstable and gap if tore
do 30 knee flexion
VALGUS STRESS TEST- most sensitive for MCL
avoid valgus / rotational
Valgus MCL
Varus LCL
do SLR and ankle pump
185
ACL strengthen quad , stretch hams
non contact tibia external rotated on planted foot
forceful hyperextension
injury: usual no contact / deceleration / closed chain
develop hemartnrosis require arthrocentesis- removal of blood indicates tear
synovial fluid w/o blood - meniscus tear
blood w fat drops/ fx or ligament sprain
intracapsular - cruciate (fluid trapped within capsule)
extracapsular - easy to be removed - collagen rings
Hughston/ 3 degrees of instability
Lachman/ displace ant post femur on knee * gold standard for instability
anterior drawer- like JM
measures anterior translation
Lachman- 25 flex w one hand stabilize bone
186
ACL STRNEGTHEN HAMS QUADS IN KNEE FLEX DO GASTRO
Replacement/ hamstring or patellar tendon
autograph - patient own tissue
(patellar tendon)
allograft/ another body (risk disease / infection)
synthetic- high failure (chronic synovitus )
187
ACL DO NOT DO OPEN CHAIN TKE
bc it goes through Avascular necrosis
* No LAQ SAQ
ACL: open chain - no full knee extension
PCL: open chain- no full knee flexion
PCL DO NOT DO OPEN CHAIN KNEE FLEX
once it gets to MOD you can do hamstring curl (limit flexion 60-90)
188
PCL allows knee not to go into hyperextension
direct force on anterior aspect of flexed knee
Pt falls on flexed knee
landing on tibial tuberosity
forced posterior translation
-hyper flexion of knee
ACL/ PCL involve knee hyperextension w foot planted
Tibia sags if PCL tears
godfrey- supine 90 hip knee flex and tibia will drop posterior
QUAD STRENGTH
use achilles tendon for surgery
MCL- full ext with stability - grade III tear
189
IT BAND SYNDROME
SIDE LYING ADDUCTOR WORKOUT
STRENGTHEN GLUTE MED BC TFL DOMINANTS
-banded bridge clams
IT stretch standing / side lying / prone
190
ACL
hamstring curls
SLR w cuff
hamstring stretch
Meniscal tear
quad stretch prone w band
band around feet do marches
PCL
leg raise with theraband and around foot then step on it w other foot
-strengthen quad
Prone : thera and around ankle / foot
- hamstring curl
- gastro stretch
191
PF/ DF convex over concave
triceps surae- primary PF
insert at calcaneal tuberosity
posterior tibialis- investor / flex digitorum longus/ hallicus
- primary flexor of toe
push off
peroneus/ fibularis longus- brevis primary evertor, PF
anterior tibialis- DF, invertor
ext hallicus longus/ brevis
plantar fascia - helps to support
192
Lateral/ Inversion sprain
anterior talofibular
calcaneofibular
posterior talofibular
what motions when injuried?
PF
inversion
adduction
193
flex knee ankle PF
calcaneus pulled forward
Talar tilt- inversion position cause pain or lax
inversion ankle sprain- take into neutral/ inversion
max- ice, isometric, AROM avoid PF inversion
MOD- rom w/o pain, FWB, conc/ ecc, heel Cord stretch
proprioception/ stand exercise
DF AND EVERSION STRENGTH
PF STRENGTH
min- pylometrics
194
grade 3 sprain is surgery
195
Deltoid ligament sprain- medial
deltoid ligament ruptured occur with lateral ankle fx
partial- therapy
complete- surgery, NWB
Anataglic gait
196
Ligament instablites : swell pain unstable
mechanical:
lax ligaments , chronic unstable bad tissue
might be in boot, passive DF/ PF
stay away from active bc peroneus brevis scar
no DF PF inversion for a while
functional- strength, proprioception, ligament, stability
197
ligament instablites
can reroute peroneus brevis
or shorten cut reattach
198
Subluxing peroneal tendon
passive DF and slight eversion
misdiagnosed for lateral sprain
due to loose retinaculum
shallow groove
treat: deepen groove or bone block, reroute, periosteal fibers
3 weeks after surgery
isometrics active PF DF
be careful with DF / eversion
strength at 80% w ROM to start running
199
achilles tendonitis
repetive use of triceps surae
intrisnic in tissue
extrinsic things you’re doing ;shoes or surface
rice , eccentric load , stretch heel cord and plantar fascia
heel lifts , increase DF
severe put in boot
usually in males 20-50 yes old
can feel gap in distal 3rd tendon
Thompson- squeeze calf and should see achilles tendon if not then it ruptured
200
surgical- immobilize for 6 weeks
get more strength + power
repair 2 ends together
augment with graft
avoid high PF and re rupture small heel lift
theraband
proprioception
progress to closed chain
201
Compartment syndrome
elevated tissue pressure within closed facial space
leads to occlusion of vessels
associated with tibial fx
direct hit
muscle reupture
muscle hypertrophic
circumference burns
emergency acute elevated intracompartment in lower leg
Shiny swelling pain tense parathesis
stretch will increase pain
202
Chronic compartment syndrome is Dull ache tingling numbness
exercise induced
long distance duration
anterior lateral superior posterior deep posterior
acute do Fasciatomy open more space
203
Ankle fractures
unimalleolar
bimalleolar - lateral and medial
trimalleolar- lateral medial and post tib
do ORIF. no surgery -boot
NO inversion/ eversion
2 weeks later do PF/ DF
isokinetic proprioception
204
Total Ankle Arthroplasty
- OA JRA RA
domed compartment resurface talus
how demand still has ligamentous instability
can’t go back to plyometrics bc Stablity over mobility
Stretch posterior muscles
205
Ankle Arthrodesis- fusion of ankle more common than TAA
pain unstable deform
failed TAA
fuse talus go tibia
fuse talus to talonavicular / calcaneocuboid/ subtalar
hallucis rigidus / valgus
206
Distal Tibial compression fx (PILON)
vertical axial loads that drive or compress
tibia into talus
surgery ORIF or external fixation
traction w pin
NWB for 12 weeks
Secondary OA common complication
w severe multi fragment - Compression fx
207
Calcaneal / Talar fx
caused from height and falling on crouched foot
cast in PF ORIF
NWB for 3 months
calcaneal fx get PF back
Talar fx- OA risk
208
Plantar fasciitis - inflammation of plantar aponeurosis
with or without calcaneal heel spur
repetitive microtrauma
cause stiffness
pain on medial border - Calcaneal
stretch gastro soleus and toe flex
209
Arch deformities
Pes planus- flat foot medial longitudinal reduce medial border contact to ground when standing
strengthen intrisnic - pull arch up
210
Pes cavus- abnormal high arch
Neurogenic or structure difference
affects medial / lateral arch
Painful under metatarsal head w callus OA
decrease pressure with pads
stretch tight
211
Morton’s neuroma
burn cramp between 3 and 4 toes
get wider soft shoes
Get rid of neuroma
anterior glide - ext
posterior glides - flex
talocrual PF DF
subtalar Inversion/ eversion
212
hammer toe is
claw toe is
mallet toe is
213
hamstring set bend knees and push heels into table
supine roll witn theraband then bridge up with hall
stool scoots forward hamstring push backward for quad
execsion lag - retro walk forces ext
walking/ heel stroke doing DF
self perturbation
SL balance dynamic
on dominant leg
theraband cable foam tramp
214
ankle joint mobility - stretch soleus knee bent take out gastro insufficiency
215
Inversion pull up heel towards you
eversion push down heel
roll on lateral portion on foot - inversion
roll on medial portion on foot- eversion
can do seated big toe stretch - put pressure through big toe
