final all information Flashcards
(646 cards)
1
Q
Overall injury incidence ranges from ___% among recreational runners
A
19-78%
This range indicates the variability in injury incidence among recreational runners.
2
Q
Recurrence rates for injuries in runners = ____%
A
20-70%
This percentage reflects the likelihood of previously injured runners experiencing the same injury again.
3
Q
____ pain is considered the most common running-related injury
A
Patellofemoral
Patellofemoral pain syndrome (PFPS) is frequently reported among runners.
4
Q
Incidence of patellofemoral pain in runners = ____%
A
20.8%
This statistic shows how common patellofemoral pain is within the running population.
5
Q
Prevalence of patellofemoral pain in runners = ____%
A
22.7%
This indicates the proportion of runners experiencing patellofemoral pain at any given time.
6
Q
What are the 5 most common injuries in runners?
A
- PFPS
- ITBFS
- Plantar fasciitis
- Tibial stress fracture
- Knee meniscal injuries
These injuries are frequently reported among runners.
7
Q
What 5 circumstances does biomechanics of the runner matter?
A
- With low load/force but high volume
- With high loads/forces
- Pain
- Post-surgical
- Peak performance
These circumstances highlight key factors in running biomechanics.
8
Q
With running injuries, any reduction in _____ load at the site of injury could help reduce pain & potentially maintain running load
A
biomechanical
Reducing biomechanical load can aid in injury management and prevention.
9
Q
What 8 things are you assessing in the sagittal plane during a running analysis?
A
- Trunk sidebend
- Lateral pelvic drop
- Knee center position
- Knee separation
- Foot to COM position
- Rearfoot position
- Forefoot position
- Full gait cycle
These assessments are crucial for understanding running mechanics.
10
Q
An appropriate pelvic drop in males during running = ____ degrees
A
3-5 degrees
This range is considered normal for male runners.
11
Q
An appropriate pelvic drop in females during running = ____ degrees
A
4-7 degrees
This indicates the expected pelvic drop for female runners.
12
Q
What are 3 things you are assessing in the frontal plane during initial contact of a running analysis?
A
- Foot strike pattern
- Tibial inclination
- Knee flexion angle
These factors are key to evaluating initial contact mechanics.
13
Q
With tibial inclination during initial contact, appropriate = ____ degrees
A
5 degrees
This value is essential for evaluating proper tibial alignment.
14
Q
How many degrees of knee flexion should there be during initial contact with running?
A
40 degrees
This angle indicates the degree of knee flexion expected at the initial contact phase of running.
15
Q
What are 2 things you are assessing in the frontal plane during midstance of a running analysis?
A
- Forward trunk lean
- COM vertical excursion
COM stands for Center of Mass, which is crucial for analyzing running mechanics.
16
Q
How many degrees of knee flexion should there be during midstance with running?
A
20 degrees
This measurement is important for understanding the knee’s position during the midstance phase.
17
Q
How many degrees of ankle dorsiflexion should there be during midstance with running?
A
5-10 degrees
Dorsiflexion at this angle allows for proper foot placement and stability.
18
Q
What 2 things are you assessing during the full gait cycle in the frontal plane of a running analysis?
A
- Forward trunk lean
- COM vertical excursion
These factors help in evaluating the overall biomechanics of running.
19
Q
How many degrees of trunk flexion should there be with running?
A
6-8 degrees
This angle is significant for maintaining balance and efficiency in running.
20
Q
How many cm of COM vertical excursion is normal with running?
A
5-10 cm
This range indicates the vertical movement of the center of mass during a running stride.
21
Q
A posterior tibial mobilization is facilitating a ___ glide for limited knee ___
A
posterior; extension
This mobilization technique is used to improve knee extension range.
22
Q
An anterior tibial or posterior femoral mobilization is facilitating a ___ glide for limited knee ____
A
anterior; extension
This is important for addressing restrictions in knee motion.
23
Q
The tibial external rotation mobilization is a ___ rotation force on the femur & a ____ rotation force on the tibia
A
internal; external
This technique is used to address specific knee mobility issues.
24
Q
The tibial external rotation mobilization is for limited knee ____
A
extension
This mobilization helps restore normal movement patterns in the knee.
25
What are 4 red flags at the knee?
* Deep vein thrombosis
* Acute exertional compartment syndrome
* Infection
* Tumor
## Footnote
Recognizing these conditions is vital for timely medical intervention.
26
What are 7 general guidelines for overuse injuries?
* Rest
* Ice
* Improve mechanics
* Strengthening
* Hip/core stability
* Activity modification
* Proprioceptive training
## Footnote
These guidelines help manage and prevent overuse injuries in athletes.
27
Fill in the blank: Strengthening/stretching lower leg is a guideline for ____ injuries.
overuse
## Footnote
Addressing muscle balance can help prevent injuries related to overuse.
28
Fill in the blank: Arch support taping can help with ____ injuries.
overuse
## Footnote
This method is often used to alleviate symptoms associated with foot mechanics.
29
Fill in the blank: Pre-activity dynamic warm-up is recommended for ____ injuries.
overuse
## Footnote
Warming up dynamically prepares the body for activity and reduces injury risk.
30
True or False: The normal range for COM vertical excursion during running is 10-15 cm.
False
## Footnote
The normal range is actually 5-10 cm.
31
What is the first guideline for Acute Periostitis?
Decrease running distance & intensity by 50%
32
What is the second guideline for Acute Periostitis?
Avoid running on hills, uneven, or very firm surfaces
33
What is the third guideline for Acute Periostitis?
Developing core stability
34
What is the fourth guideline for Acute Periostitis?
Footwear/orthotics
35
What is the fifth guideline for Acute Periostitis?
Manual therapy
36
What is the sixth guideline for Acute Periostitis?
Splinting/bracing
37
What is the first guideline for Chronic Periostitis?
Extracorporeal shock wave therapy
38
What is the second guideline for Chronic Periostitis?
Injections
39
What is the third guideline for Chronic Periostitis?
Acupuncture
40
What is the fourth guideline for Chronic Periostitis?
Surgery
41
What are the general guidelines for Exertional Compartment Syndrome in weeks 0-3?
Protection & mobility
42
What are the general guidelines for Exertional Compartment Syndrome in weeks 4-6?
Light strengthening
43
What are the general guidelines for Exertional Compartment Syndrome in weeks 6-8?
Progression of strengthening/return to jogging
44
What are the general guidelines for Exertional Compartment Syndrome in weeks 8-12+?
Return to sport/impact training
45
What is the first guideline for Exertional Compartment Syndrome in weeks 8-12+?
Self limiting may persist for up to 2 years
46
What is the second guideline for Exertional Compartment Syndrome in weeks 8-12+?
Relative rest
47
What is the third guideline for Exertional Compartment Syndrome in weeks 8-12+?
Protective knee pad to protect tibial tuberosity
48
What is the fourth guideline for Exertional Compartment Syndrome in weeks 8-12+?
Hamstring stretching & quad stretching & strengthening
49
What is the fifth guideline for Exertional Compartment Syndrome in weeks 8-12+?
No evidence for injections or surgery
50
What is the sixth guideline for Exertional Compartment Syndrome in weeks 8-12+?
Resolution upon closure of apophysis
51
What is the first guideline for Osgood-Schlatter?
General patellofemoral pain
52
What is the second guideline for Osgood-Schlatter?
Exercise
53
What is the third guideline for Osgood-Schlatter?
Patellar taping
54
What is the fourth guideline for Osgood-Schlatter?
No patellofemoral knee orthoses
55
What is the fifth guideline for Osgood-Schlatter?
Foot orthoses
56
What is the sixth guideline for Osgood-Schlatter?
BFR + high rep knee exercises
57
What is the seventh guideline for Osgood-Schlatter?
No dry needling
58
What is the first guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Relative rest
59
What is the second guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Progressive loading
60
What is the third guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Improved biomechanics
61
What is the fourth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Hip/core stability
62
What is the fifth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Motor control
63
What is the sixth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Strengthening
64
What is the seventh guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Mobility
65
What is the eighth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Maintain ROM
66
What is the ninth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Return to activity with guidance
67
What is the tenth guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Tissue mobility
68
What is the eleventh guideline for Sinding-Larsen Johansson (SLJ) Syndrome?
Monitor pain response
69
What are the general guidelines with muscle tendinopathy/strain?
Not specified in the provided text
70
What is isometric loading?
A type of muscle contraction where the muscle length does not change while contracting.
## Footnote
Commonly used in rehabilitation to build strength without joint movement.
71
What is isotonic loading?
A type of muscle contraction where the muscle changes length while contracting, either shortening or lengthening.
## Footnote
Useful for improving muscle strength and endurance.
72
What is energy-storage loading?
Loading that involves the elastic properties of the muscle-tendon unit to store and release energy during movement.
## Footnote
Often utilized in sports-specific training.
73
What are the 4 rehabilitation stages & progression criteria with patellar or quadriceps tendinopathy?
* Surgical reconstruction
* Post-op rehab
* Conservative management only for partial tear with intact extensor mechanism
## Footnote
Each stage has specific goals and rehabilitation protocols.
74
What are the 3 general guidelines for Patellar or Quadriceps Tendon Rupture?
* Load/reduce pain
## Footnote
Important for managing symptoms and promoting healing.
75
What is stage 1 of rehab for a hamstring tendinopathy?
Load/okay with slight pain
## Footnote
Focus on gentle loading to facilitate recovery.
76
What is stage 2 of rehab for a hamstring tendinopathy?
Strength, hypertrophy, & functional progression
## Footnote
Aimed at building muscle strength and preparing for functional activities.
77
What is stage 3 of rehab for a hamstring tendinopathy?
Return to sport
## Footnote
Focus on sport-specific training to ensure readiness.
78
What is stage 4 of rehab for a hamstring tendinopathy?
* Isometric hamstring load without tendon compression
* Isotonic hamstring load with minimal hip flexion
* Isotonic exercises in positions of increased hip flexion (70-90 degrees)
* Energy storage loading
## Footnote
Each stage progressively increases the load and complexity of exercises.
79
What are 5 general guidelines for a hamstring strain?
* NSAIDs not recommended within first 24-72 hours
* Gentle stretching
* Strengthening
* Heel raises
* Proprioceptive exercises
* Weight-bearing/dorsiflexion delayed until pain decreases
## Footnote
These guidelines help in the effective management of hamstring strains.
80
What are 6 general guidelines for a gastrocnemius tendinopathy?
* Bracing
* Knee ROM exercise
* Strengthening - gastroc, hamstring, quadriceps, popliteus
* Static & dynamic proprioceptive training
* Agility
## Footnote
Important for restoring function and reducing pain.
81
What are 5 general guidelines for a Popliteus strain?
* Post surgical management based on protocols
* Maintain ROM
* Progressive strengthening
* Progressive functional activity
* Hip/core stability
* Improve biomechanics
* Quad/hamstring strengthening
* Gait
* Progressive functional activities
## Footnote
Focused on restoring mobility and strength post-injury.
82
What are 9 general guidelines for joint structure?
TBD
## Footnote
These guidelines typically cover aspects of joint health and rehabilitation strategies.
83
What is the first guideline for early rehabilitation after knee surgery?
Early progressive knee mobilization following surgery
84
What does early rehabilitation include for range of motion after knee surgery?
Early PROM & AROM following surgery
85
What is a guideline for weight bearing after knee surgery?
Early progressive weight bearing following surgery
86
What should be emphasized for return to activity after knee surgery?
Early progressive return to activity
87
What is an important component of post-surgery rehabilitation in a clinical setting?
Exercise as part of in clinic supervised program after surgery
88
What technique is used for quadriceps strengthening after surgery?
NMES for quad strengthening
89
What are the six general guidelines for Meniscus treatment?
* Patellar taping
* No patellofemoral knee orthoses
* Foot orthoses
* BFR + high rep knee exercises
* No dry needling
90
What are five general guidelines for managing Patellofemoral pain?
* Canes can be used for function
* Braces could be used for function, pain, & quality of life
* Topical & oral NSAIDs
* Sustained weight loss
* Acupuncture
91
What are some treatment options that are not recommended for Patellofemoral pain?
* Hyaluronic acid injection not recommended for routine use
* Arthroscopy not recommended
92
What are the twelve general guidelines for Osteoarthritis?
* Limit weight bearing activities
* Modalities
* Bracing
* Surgery
93
What are the four general guidelines for Osteochondritis Dessicans?
* Displacement <4mm & a step of <2mm
* Extensor mechanism intact
* Mobilization ~10th day
* Bracing ~10 degrees flexion
94
What is a guideline for weight bearing with Osteochondritis Dessicans?
Weight bearing in a hinged joint locked in extension
95
What are the eight general guidelines for managing Patellar Fracture?
* Often immobilized
* PROM
* CPM
96
What are the three guidelines during non-weight bearing for a Tibial Plateau fracture?
* AROM
* Closed chain
* Progressive weight bearing
97
What should be focused on during partial weight-bearing for a Tibial Plateau fracture?
* Normalize gait
* Functional activities
* Proprioception
98
What are the three guidelines during full weight-bearing for a Tibial Plateau fracture?
* Ice
* Relative rest
* ROM
99
What are the eight general guidelines for mechanical injuries?
* Progressive strengthening
* NMES to facilitate quad activation
* Full body dynamic movements
* Return to activity
100
What are the four general guidelines for Patellar Subluxation/Dislocation?
* Restore biomechanics of patellar tracking
* Mobility of anterior hip/quads
* Injections
* Surgery
101
What are the four general guidelines for Fat Pad Syndrome?
* NSAIDs
* Surgery
* Aspiration
102
What are the three general guidelines for Pre-Patellar Bursitis?
* Lower extremity stretching
* Knee extension strengthening
* Hamstrings/quads
103
What are the five general guidelines for Plica Syndrome?
* Activity modification
* Progressive strengthening
* ROM
* Mobility
* Improve biomechanics
104
What are the seven general guidelines for global dysfunction?
* Ankle motor control/strengthening
* Hamstring strengthening
* Tibiofibular mobility
105
What are the three general guidelines for proximal tibiofibular joint dysfunction?
* Soft tissue mobilization
* Taping
* BFR
106
What are the seven general guidelines for Iliotibial band syndrome?
* Activity modification
* NSAIDs
* Hamstring/calf-stretching
* Kinesio taping
107
What are the four general guidelines for Pes Anserine Bursitis/Tendinopathy?
108
Modified Stoke Test Scoring: ___ = no wave
Trace
109
Modified Stoke Test Scoring: ___ = small wave
1+
110
Modified Stoke Test Scoring: ___ = large wave with down stroke
2+
111
Modified Stoke Test Scoring: ___ = effusion spontaneously returns
3+
112
Modified Stoke Test Scoring: ___ = unable to remove effusion
Effusion
113
The modified stroke test is used to assess for knee ____
Modified Stroke Test
114
Describe the process of the modified stroke test.
Stroke the medial side of patients knee from inferior to superior direction, then provide a lateral glided stroke from superior to inferior direction
115
Clarke's Sign tests for possible patellofemoral joint ____
Pain
116
What is a positive Patellar compression test?
Clarke's Sign
117
What is the procedure for a positive Clarke's Sign test?
Stabilize the superior aspect of the patella & instruct patient to contract the quadriceps muscle
118
The purpose of an Eccentric Step-Down test is to determine the presence of _____ pathology
Patellofemoral
119
Describe the procedure for the Eccentric Step-Down test.
Instruct patient to stand on the step with hands on hips, lower the opposite foot down to the floor
120
What indicates a positive Eccentric Step-Down test?
Reproduction of symptoms
121
The Patellar Apprehension Test involves flexing the involved leg to what degree?
30 degrees
122
What indicates a positive Patellar Apprehension Test?
Apprehension at end range of lateral glide or patient extends knee to stabilize patella
123
The purpose of the Thomas Test is to assess muscle length & ___ between hip flexors & the lumbar spine
Stiffness
124
What are 3 special tests for a meniscus tear?
1. Apley Compression Test
2. McMurray's Test
3. Thessaly Test
125
What special test would you do for a MCL/LCL injury?
Varus/Valgus Stress Test
126
What indicates a positive varus/valgus stress test?
Laxity/increased mobility
127
What are the 2 positions of the knee you test for a varus/valgus stress test?
1. Full extension
2. 30 degrees
128
What are 3 special tests for an ACL injury?
1. Pivot Shift
2. Anterior Drawer
3. Lachman's
129
The purpose of the pivot shift test is to assess the integrity of the ____
ACL
130
What indicates a positive Pivot Shift test?
Shift or clunk felt around 20 degrees of knee flexion
131
The purpose of the knee anterior drawer is to assess the integrity of the ___
ACL
132
What is the procedure for the Anterior Drawer Test?
Flex knee to 60-90 degrees, sit on patient's foot, provide a firm anterior pull to the knee
133
The purpose of Lachman's test is to assess the integrity of the ___
ACL
134
What is the knee position for Lachman's test?
Flexed to 20-30 degrees
135
An abnormal Lachman's test is ____ mm of translation
6-10
136
What are 3 special tests for a PCL injury?
1. Posterior Sag Sign
2. Posterior Drawer Test
3. Active Quadricep Test
137
The purpose of the Posterior Sag Sign is to assess the integrity of the ____ of the knee
PCL
138
What is the procedure for the Posterior Sag Sign?
Flex patient's hip & knees to 90 degrees, assess tibial tuberosities level
139
The purpose of the Posterior Drawer Test is to assess the integrity of the ___ of the knee
PCL
140
What is the procedure for the Posterior Drawer Test?
Stabilize lower leg, grasp proximal tibia, apply AP force
141
An abnormal posterior drawer test is greater than ___ mm of translation
6
142
The purpose of the active quadricep test is to test for a ____ tear
PCL
143
What indicates a positive active quadricep test?
Anterior translation of the tibia during active quadriceps contraction
144
What are 2 special tests for a multi-ligament injury?
1. Anteromedial Rotatory Instability Test
2. Dial Test
145
The purpose of the Anteromedial Rotatory Instability test is to assess the integrity of the ____ & ____
ACL; MCL
146
What is the procedure for the Dial Test?
Patient in prone, bring feet together & ER feet at 30 degrees & 90 degrees of knee flexion
147
A positive dial test is >____ degrees of ER compared to other side
10
148
What are 4 differential diagnoses of the lower leg?
1. Medial Tibial Stress Syndrome
2. Periostitis
3. Exertional Compartment Syndrome
4. Deep Vein Thrombosis
149
What are 2 objective measures of Medial Tibial Stress Syndrome?
1. Shin palpation test - SP
2. Pain approximately 5cm or greater
150
What are 8 'why's' to consider for lower leg conditions?
1. Increase in activity
2. Decreased tibialis anterior, tibialis posterior, & soleus strength
3. Decreased ankle dorsiflexion ROM
4. Decreased talocrural mobility
5. Decreased hip abduction/external rotation strength
6. Flat feet or high arches
7. RED-S
8. Accumulation of damage
151
What is the pathology continuum of bone-stress injuries when there is an imbalance between damage & remodeling?
Compartment Syndrome
152
What does compartment syndrome involve?
Pain & swelling in the muscles & legs due to a buildup of fluid in the fascia
153
What are the 5 P's that resolve at rest with chronic exertional compartment syndrome?
* Pallor
* Pain
* Paresthesia
* Pulselessness
* Paralysis
## Footnote
These symptoms are commonly referenced in the context of diagnosing chronic exertional compartment syndrome.
154
What are 10 differential diagnoses at the anterior knee?
* Patellar or quadriceps tendinopathy
* Patellar or quadriceps tendon rupture
* Patellofemoral pain syndrome
* Chondromalacia
* Patella subluxation/dislocation
* Fat pad syndrome
* Pre-patellar bursitis
* Plica syndrome
* Osgood-Schlatter
* Sinding-Larsen-Johansson syndrome
## Footnote
These conditions are often considered when evaluating anterior knee pain.
155
Only ___% of all tendon ruptures in the body occur at the patellar tendon?
___%
## Footnote
This statistic highlights the relative rarity of patellar tendon ruptures compared to other tendon injuries.
156
What are 7 risk factors for Patellar Tendinopathy?
* Male
* Increased waist circumference
* Increase in training volume & frequency
* Decreased muscle length of hamstrings, quadriceps
* Decreased foot arch height
* Decreased ankle dorsiflexion
* Increased horizontal braking forces during landings
## Footnote
Understanding these risk factors can aid in the prevention and management of patellar tendinopathy.
157
Quadriceps Tendinopathy is ____ common than Patellar Tendinopathy?
____ common
## Footnote
This comparison is important for understanding the prevalence of these injuries.
158
What are 3 clinical findings of Patellofemoral Pain Syndrome?
* Retropatellor or peripatellar pain
* Reproduction of pain with functional tasks that load the joint in a flexed position
* Exclusion of all other possible causes of pain
## Footnote
These findings are crucial for diagnosing Patellofemoral Pain Syndrome.
159
What are 6 special tests for Patellofemoral Pain Syndrome?
* Patellar Tilt Test - SP
* Compression Test - SN
* Clarke Sign - SP
* Resisted Knee Extension - SP
* Pain with squatting - SN
* Pain with stair climbing - SN
## Footnote
These tests help confirm the diagnosis of Patellofemoral Pain Syndrome.
160
What is the test cluster for Patellofemoral Pain Syndrome?
* Less than 40 years of age AND
* Isolated anterior knee pain OR
* Medial patellar facet tenderness
## Footnote
A positive test cluster aids in the diagnosis of Patellofemoral Pain Syndrome.
161
What is the ICF Classification System for Overuse PFPS?
Dynamic knee valgus during single leg squat
## Footnote
This classification helps in understanding movement patterns associated with Overuse Patellofemoral Pain Syndrome.
162
What are 4 characteristics of Patellar Subluxation/Dislocation?
* Often in lateral direction
* Forceful quadriceps contraction from knee flexed position
* Can generally relocate patella by extending knee
* Positive patellar tilt test - SP
## Footnote
These characteristics are significant for diagnosing patellar subluxation or dislocation.
163
What is 1 characteristic of Fat Pad Syndrome?
Pain with end-range knee extension ROM
## Footnote
This symptom is a key indicator of Fat Pad Syndrome.
164
What are 2 characteristics of Plica Syndrome?
* Anteromedial pain exacerbated with squatting
* Clicking & popping
## Footnote
These characteristics can assist in identifying Plica Syndrome.
165
What are 5 differential diagnoses at the posterior knee?
* Hamstring tendinopathy
* Gastrocnemius tendinopathy
* Popliteus strain
* Baker's cyst
* PCL sprain
## Footnote
These conditions should be considered when evaluating posterior knee pain.
166
What are 4 differential diagnoses at the lateral knee?
* Twisting injury
* Tearing sensation at time of injury
* Delayed effusion
* History of 'catching' or 'locking'
## Footnote
These symptoms are commonly associated with lateral knee injuries.
167
What are 9 clinical findings of a Meniscus tear?
* History of catching or locking
* Pain with forced hyperextension
* Pain with maximum passive knee flexion
* Pain or audible click with McMurray's maneuver
* Joint line tenderness
* Discomfort or a sense of locking or catching during the Thessaly test
* Pain with maximum passive knee flexion
* Pain with forced hyperextension
* Pain or audible click with McMurray's maneuver
## Footnote
These findings are essential for diagnosing a meniscus tear.
168
What are the 5 meniscal pathology composite score?
* McMurray's Test - SP
* Thessaly Test - SP
* Apley's Compression Test - SN/SP
* Joint line tenderness - SN/SP
* Deep squat test - SN
## Footnote
This composite score helps in assessing the likelihood of meniscal pathology.
169
What are 2 characteristics of Proximal Tibiofibular Joint Dysfunction?
* Hypermobility
* Hypomobility
## Footnote
These characteristics are important for diagnosing proximal tibiofibular joint issues.
170
What are 2 characteristics of Iliotibial Band Syndrome?
* Medial meniscus tear
* MCL tear
## Footnote
These conditions are often associated with Iliotibial Band Syndrome.
171
What are 3 differential diagnoses at the medial knee?
* Medial knee pain after recent increase in activity
* Often seen in patients recovering from lower extremity surgical intervention
* Valgus force
## Footnote
These factors can help identify issues at the medial knee.
172
What are 3 characteristics of Pes Anserine Tendinopathy/Bursitis?
* Osteoarthritis
* Osteochondritis dessicans
* Ostechondral defect
## Footnote
These conditions are relevant when assessing Pes Anserine Tendinopathy/Bursitis.
173
What are 7 other differential diagnoses at the knee?
* ACL sprain
* Multi-ligament instability
* Fractures
* Referred pain
* Osteoarthritis
* Osteochondritis dessicans
* Ostechondral defect
## Footnote
These diagnoses should be considered in a comprehensive knee evaluation.
174
The greatest concern with knee osteoarthritis is loss of ___?
Mobility
## Footnote
Loss of mobility is a critical issue affecting the quality of life in patients with knee osteoarthritis.
175
Riding a bike = ____ degrees of knee flexion?
110 degrees
## Footnote
This degree of flexion is relevant for understanding knee function during cycling.
176
Gait = ____ degrees of knee hyperextension?
0-5 degrees
## Footnote
This range is important for assessing normal gait mechanics.
177
Gait = ____ degrees of knee flexion?
60 degrees
## Footnote
Understanding knee flexion during gait is essential for evaluating mobility.
178
Ascending stairs = ____ degrees of knee flexion?
80 degrees
## Footnote
This degree of flexion is necessary for functional mobility tasks like stair climbing.
179
Descending stairs = ____ degrees of knee flexion?
117 degrees
## Footnote
This information is critical for understanding the demands on the knee during descent.
180
Raising from a chair = ___ degrees of knee flexion?
85 degrees
## Footnote
The degree of flexion required for this activity is important for assessing functional mobility.
181
Donning socks = ____ degrees of knee flexion?
120 degrees
## Footnote
This degree of flexion is significant for activities requiring high knee flexion.
182
What is the 6 items in the test cluster for Knee Osteoarthritis?
* Age >50 years
* Knee crepitus
* Palpable bony enlargement
* Bony tenderness to palpation
* Morning stiffness that improves in less than 30 minutes
* No palpable warmth of the synovium
## Footnote
This cluster aids in the diagnosis of knee osteoarthritis.
183
If Knee Osteoarthritis' test cluster - <____ = SN?
<____
## Footnote
This sensitivity threshold is important for diagnostic accuracy.
184
If Knee Osteoarthritis' test cluster = >____ = SP?
>____
## Footnote
This specificity threshold helps confirm the diagnosis of knee osteoarthritis.
185
What are 2 articular cartilage lesions at the knee?
* Osteochondritis Dessicans
* Osteochondral Defect
186
What are the 5 items in the Articular Cartilage Lesion test cluster?
* MOI = deceleration or acceleration motion with non-contact valgus load at or near full extension
* Hearing or feeling a pop
* Hemarthorsis within 0-12 hours of injury
* History of giving way
* Positive Lachman test
* Positive pivot shift test
187
What are 6 clinical findings with an ACL sprain?
* Posterior-directed force on proximal tibia, fall onto flexed knee, or sudden/violent hyperextension injury
* Localized posterior knee pain with kneeling or decelerating
* Posterior sag sign of proximal tibia - SP
* Positive posterior drawer test at 90 degrees knee flexion - SP
188
What are 4 clinical findings with a PCL sprain?
* Rotational trauma
* TTP over MCL
* Trauma by force applied to lateral aspect of lower extremity
* Medial knee pain with valgus stress test - SN
* Laxity with valgus stress test - SN
189
What are 5 clinical findings with a MCL sprain?
* Varus trauma
* Localized swelling over LCL
* TTP over LCL
* Lateral knee pain with varus stress test - 0-30 degrees of knee flexion
* Laxity with varus stress test - 0-30 degrees of knee flexion
190
What are 5 clinical findings with a LCL sprain?
* Posterior Rotatory Instability
* Anterior Rotatory Instability
* Knee Dislocation
191
What are 3 multi-ligament injuries?
* Tibial plateau
* Segond
* Tibial spine avulsion
* Patellar
* Bipartitie patella
192
What are 5 common fractures that occur at the knee?
* Acute fall or blunt trauma
* Inability to ambulate
* Age <12 years or >50 years
193
What are the 3 Pittsburgh Knee Rules - SN?
* Age 55 years or older
* TTP at fibular head
* Isolated TTP of patella
* Inability to flex to 90 degrees
* Inability to weight-bear both immediately & in the ED
194
What are the 5 Ottawa Knee Rules - SN?
* Slipped Capital Femoral Epiphysis
* Avascular Necrosis
* Hip Osteoarthritis
195
Grade ____ mobilization = small amplitude movement performed at the beginning of the range
I
196
Grade ____ mobilization = large amplitude movement performed within the range but not to the limit of the range
II
197
Grade ____ mobilization = large amplitude movement performed up to the limit of the range
III
198
Grade ____ mobilization = small amplitude movement performed at the limit of the range
IV
199
Grade ____ mobilization = manipulation: high velocity thrust at the end of the range of movement
V
200
The anterior talar mobilization helps with ____
Plantarflexion
201
You want the joints in ____-pack position when mobilizing
Open
202
The posterior talar mobilization helps with ____
Dorsiflexion
203
The tibiofibular mobilization helps with ____
Dorsiflexion
204
What are 3 special tests for a Syndesmotic injury (high ankle sprain)?
* Kleiger Test = SN
* Squeeze Test = SP
* Fibular Translation Test = Negative = SN & Positive = SP
205
What is the Distal Tibiofibular Stress Test testing?
Stability
206
Increased pain with added pressure during the Force Dorsiflexion Test indicates ____
Positive
207
What are 4 indications of a posterior ankle impingement?
* Pain with PF activities
* Pain with weight-bearing
* Superficial ankle pain
* Positive heel thrust test
208
What are 2 special tests you could do for an Achilles Tendinopathy?
* Royal London Hospital Test
* Arc Sign
209
A positive Royal London Hospital Test = ____
Decreased pain in dorsiflexion
210
A positive Arc Sign = ____
Swelling moves with tendon
211
A positive Windlass Test = ____
Increase pain at the origin or insertion of the plantar fascia
212
What are the 3 main ligaments of the lateral ankle?
* Anterior Talofibular ligament (ATFL)
* Calcaneofibular ligament (CFL)
* Posterior Talofibular ligament (PTFL)
213
What are the 4 main ligaments of the deltoid ligament of the medial ankle?
* Posterior Tibiotalar ligament
* Anterior tibiotalar ligament
* Tibiocalcaneal ligament
* Tibionavicular ligament
214
Ankle sprain grade ____ = no laxity
1
215
Ankle sprain grade ____ = mild laxity
2
216
Ankle sprain grade ____ = moderate laxity
3
217
Ankle sprain grade ____ = gross laxity
3
218
What are 2 stress tests for the ATFL ligament of the ankle?
* Anterior Drawer Test
* Reverse Anterior Drawer Test
219
Is the Anterior Drawer Test SN or SP?
SN
220
What is the procedure of the anterior drawer test at the ankle?
* Supine or long sitting - heel of edge of plinth
* 20 degrees of plantarflexion - clearing the tibia
* Stabilize anterior tibia
* Grab heel - pull anteriorly
221
A positive anterior drawer test at the ankle = ____ cm of movement compared to the uninvolved foot
1
222
Is the reverse anterior drawer test SN or SP?
SP
223
What is the procedure for the Reverse Anterior Drawer Test?
* 10-15 degrees of plantarflexion
* Stabilize dorsum of foot - as close to joint as possible
* Push tib/fib posteriorly
224
Is the Lateral Talar Tilt Test SN or SP?
SP
225
What are the 2 primary things you are assessing with distal tib-fib joint mobility?
* Joint play - accessory motion
* End feel
226
What is the 1 secondary thing you are assessing with distal tib-fib joint mobility?
Reproduction of symptoms
227
By the end of your subjective examination, you should have accomplished the following (5):
* Initiated the process to build patient trust & support
* Identified chief complaint
* Specified patient's goals
* Narrowed hypothesis list to 2-4
* Identified SINSS
228
What are 7 questions to ask a patient during a subjective?
* Subjective
* Aggravators
* Eases
* Meds
* Past medical history
* Imaging
* Occupation
229
How intense are the symptoms/pain? How does it impact the patient? When do the symptoms/pain occur? Are pain medications required?
Severity
230
How much activity is required to aggravate the symptoms/pain? How long does it take for the symptoms/pain to subside? What is the ratio of aggravating activities/factors to alleviating factors?
Irritability
231
What is the specific diagnosis? What is the specific nature or type of symptoms? Remember to consider Biopsychosocial factors that impact symptoms/pain?
Nature
232
What is the PTs assessment of the timeframe of the patient's condition?
Stage
233
How have the symptoms/pain progressed over time? Are the symptoms/pain improving, worsening, not changing, or fluctuating?
Stability
234
What are the 3 categories of severity?
Mild, Moderate, Severe
235
Pain ____ = mild
1-3
236
Pain ___ = moderate
4-7
237
Pain ____ = severe
8+
238
What are the 3 categories of Irritability?
Low, Medium, High
239
What are the 3 categories of Nature?
Nociceptive, Neuropathic, Nociplastic
240
What are the 3 categories of Stage?
Acute, Subacute, Chronic
241
Stage ___ = ~2 weeks
Acute
242
Stage ___ = 2-6 weeks
Subacute
243
Stage ____ = >6 weeks
Chronic
244
What are the 3 categories of Stability?
Improving, No change, Worsening
245
By the end of your functional analysis, you should have accomplished the following 5:
* Evaluated current functional level
* Identified asterisk sign
* Identified body regions that need further assessment
* Increased patient perception of value of PT
* Build patient trust
246
What is an Asterisk Sign?
A functional task that recreates the patient's symptoms
247
The asterisk sign needs to be (2):
* Test asterisk sign
* Perform intervention
248
What are the 4 steps of the Asterisk Sign?
* Test asterisk sign
* Re-test asterisk sign
* Test again next visit
249
The goal of the ____ is to efficiently understand the patient as a whole & direct your specific testing
Scan
250
The scan should cover what 5 things?
* Willingness to move
* ROM
* Strength
* Neuro integrity
* Recognition of pain provoking activities
251
The scan is NOT ____
Formal testing
252
During the ____, the PT collects a thorough history followed by a physical examination, including a systems review & specific tests & measures
Examination
253
The examination includes what portion(s) of the SOAP note?
Subjective & objective
254
What 3 things should be done during the examination?
* Conduct an orthopedic assessment
* Define SINSS
* Identify an asterisk sign based on functional analysis
255
The ____ is the interpretation & synthesis of the examination findings that lead to a diagnosis, prognosis, & management plan specific to the individual or community
Evaluation
256
PTs interpret & synthesize the history & the physical examination findings to (4):
* Establish a diagnosis from which a management plan is developed
* Determine a prognosis, including goals for physical therapist management
* Develop a management plan or plan of care if indicated
* Develop a working diagnosis list as part of the process used to determine whether a referral to or consultation with another health care provider is indicated
257
What are the 2 categories of Nociceptive pain?
Somatic, Visceral
258
What are 8 characteristics of Nociceptive pain?
* Localized
* Proportionate pain
* Mechanical signs & symptoms
* Acute injury
* Inflammation
* Responds well to NSAIDs
* Clear & consistent
* Resolution of symptoms
259
Exercise induced muscle injury = _____ healing time
0-3 days
260
Grade 1 muscle injury = _____ healing time
1-4 weeks
261
Grade 2 muscle injury = _____ healing time
3-12 weeks
262
Grade 3 muscle injury = _____ healing time
1-6 months
263
Tendonitis = _____ healing time
3-7 weeks
264
Tendonosis = _____ healing time
3-6 months
265
Grade 1 sprain = _____ healing time
2-8 weeks
266
Grade 2 sprain = _____ healing time
2-6 months
267
Grade 3 sprain = _____ healing time
6-12 months
268
Meniscus/Labrum = _____ healing time
3-12 months
269
What are 2 categories of Neuropathic pain?
Central, Peripheral
270
What are 8 characteristics of Neuropathic pain?
* Pain along nerve path
* Positive neurodynamic tests
* History of nerve injury
* Other neuro signs & symptoms
* Higher tissue irritability
* Pattern of symptom onset
* Paresthesia
* Hyperalgesia or allodynia
271
What are 2 categories of Nociplastic pain?
Central Sensitization, Peripheral Sensitization
272
What are 9 characteristics of Nociplastic pain?
* Disproportionate pain
* Unpredictable symptom onset
* Diffuse tenderness to palpation
* Severe pain levels
* High tissue irritability
* Maladaptive behaviors
* Pain lasting beyond typical tissue healing time
* Hyperalgesia or allodynia
* Hypersensitive to environment
273
What are 3 maladaptive behaviors?
* Kinesiophobia
* Catastrophizing
* Fear-avoidant behaviors
274
What is Cognition?
Interaction between working memory & long-term memory, critical thinking, & decision-making
275
What is Psychomotor?
Conducting tests & measures - analyzing movement
276
What is Affective?
Emotional intelligence & awareness of biases
277
____ bias = associating the unknown with the closest known thing
Representative
278
____ bias = inclination to find what is known or familiar
Availability
279
____ bias = performs only tests that rule in a hypothesis
Confirmation
280
____ bias = creating a relationship that does not really exist
Illusory
281
____ bias = overestimating one's own knowledge base; considered the most destructive
Overconfidence
282
What are 6 things to reduce biases?
* Identifying your own biases
* Creating a list of hypotheses
* Ruling out hypotheses
* Discussion with colleagues
* Reduce time pressures
* Metacognition & reflection
283
When developing a hypothesis list, consider what 4 things?
* Location of pain
* Mechanism of injury
* Age
* Prevalence of that condition
284
What is a Capsular Pattern?
Limitation of movement in a joint specific ratio - usually present with arthritis, or following prolonged immobilization
285
What is a Noncapsular Pattern?
Limitation of a joint in any pattern other than a capsular one - may indicate the presence of either a derangement, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion
286
Tibiofibular joint capsular pattern =
PF > DF
287
Talocrural joint limitation capsular pattern =
Supination > pronation; inversion > eversion
288
Subtalar joint limitation capsular pattern =
DF > PF; adduction > IR
289
Midtarsal joints limitation capsular pattern =
Extension > Flexion
290
1st MTP joint limitation capsular pattern =
Fibula glides posteriorly & superiorly on tibia
291
Arthrokinematics of the distal tibiofibular joint during dorsiflexion:
Fibula glides anteriorly & inferiorly on tibia
292
Arthrokinematics of the distal tibiofibular joint during plantarflexion:
Dorsal glide & dorsal roll
293
What are the arthrokinematics of the MTP joints during extension in open kinetic chain (OKC)?
Dorsal roll & plantar glide
294
What are the arthrokinematics of the MTP joints during extension in closed kinetic chain (CKC)?
Plantar glide & plantar roll
295
What are the arthrokinematics of the MTP joints during flexion in open kinetic chain (OKC)?
Plantar roll & dorsal glide
296
What are the arthrokinematics of the MTP joints during flexion in closed kinetic chain (CKC)?
1. Bone tenderness at the lateral malleolus
2. Bone tenderness at the medial malleolus
3. Inability to bear weight both immediately & in emergency department
297
When is an ankle x-ray series required?
Only if there is any pain in malleolar zone & any of the following findings:
* Bone tenderness at the base of the 5th metatarsal
* Bone tenderness at the navicular
* Inability to bear weight both immediately & in emergency department
298
When is a foot x-ray series required?
Only if there is any pain in midfoot zone & any of the following findings:
299
What is the mechanism of injury (MOI) for an eversion ankle sprain?
Ankle eversion
300
What are two findings in a subjective exam for an eversion ankle sprain?
1. Swelling
2. Ecchymosis
301
What are two findings in an acute injury with an eversion ankle sprain?
1. Limited ankle ROM, especially eversion
2. Limited ankle strength, especially inversion
302
What is the special test for an eversion ankle sprain?
Assessment for nerve injury, syndesmosis injury, or fracture
303
What are the three main tendinopathies at the medial ankle?
1. Tibialis Posterior
2. Flexor Digitorum Longus
3. Flexor Hallucis Longus
304
What are the early stage characteristics of Posterior Tibialis Tendon dysfunction?
1. Pain along tendon
2. Rearfoot valgus; forefoot abduction
3. Weak SL calf raise
4. Increased mobility of subtalar joint
5. Weak inversion strength tests
305
What are the middle stage characteristics of Posterior Tibialis Tendon Dysfunction?
1. Lateral ankle pain
2. Severe arch collapse
3. Unable to perform SL calf raise
4. Loss of subtalar mobility
306
What is a Syndesmosis Injury also known as?
High Ankle Sprain
307
What are the indications during examination of an Inversion Ankle Sprain?
1. Fracture - distal fibula, distal tibia, 5th metatarsal, navicular
2. Bone contusions
3. Epiphyseal plate injuries
4. Cuboid subluxation
5. Nerve injury
308
What are the three classifications of Chronic Ankle Instability?
1. May or may not have pain
2. Report of instability or 'giving way'
3. History of at least 1 significant ankle sprain
309
What are the risk factors for an Achilles rupture?
1. Long-term corticosteroid use
2. Hypercholesterolemia
3. Gout
4. Rheumatoid arthritis
5. Long-term dialysis
6. Renal transplant
310
What are the grades of an Osteochondral Defect?
0. Normal cartilage
I. Soft indentation or surface lesions
II. Less than 50% of cartilage depth
III. Lesions more than 50% of depth
IV. Lesions extend through subchondral bone; loose fragment
311
What are the clinical prediction rules for anterior ankle impingement?
If you have 5 out of 6 CPRs, then positive for anterior ankle impingement.
312
What are the findings in a subjective exam for Osteoarthritis?
1. Decreased ROM - capsular pattern
2. TTP along joint line
313
What are two objective findings with Osteoarthritis?
1. Pain with plantarflexion activities
2. Pain with weight-bearing
314
What are the characteristics of a Posterior Ankle Impingement?
1. FHL injury
2. Gradual onset
3. Pain with first few steps in the morning
4. Onset of pain occurs earlier in the activity
315
What are the stages of Achilles Tendinopathy?
1. No pain during activity; soreness in AM; minimal crepitus
2. Pain during activity; no loss of function; TTP; crepitus present
3. Pain limiting function; soreness throughout the day; crepitus
4. Unable to function due to pain; soreness throughout the day; crepitus
316
What are the indications of an ankle impingement?
1. Anterolateral joint tenderness
2. Anterolateral joint swelling
3. Pain with forced dorsiflexion
4. Pain with single leg squat
5. Pain with activity
6. Absence of ankle instability
317
What findings would you expect in a subjective examination with an Achilles Rupture?
1. Positive Thompson Test
2. Positive Matles Test
3. Palpation of gap
318
What are the objective examination findings with an Achilles Rupture?
1. Positive Thompson Test
2. Positive Matles Test
3. Palpation of gap
319
What is the MOI for an Osteochondral Defect?
Traumatic
320
What are common subjective exam findings for an Osteochondral Defect?
* Pain with weight-bearing
* Acute injury: swelling observed
* TTP to talar dome
321
What are three objective examination findings with an Osteochondral Defect?
* Trimalleolar
* Triplanar
* Maisonneuve
322
What is a Trimalleolar fracture?
3-part ankle fracture: medial malleolus, posterior malleolus, & lateral malleolus
323
What is a Triplanar fracture?
Vertical fracture through epiphysis, horizontal fracture through physis, & oblique fracture through metaphysis
324
What is a Maisonneuve fracture?
Proximal fibula with unstable ankle injury, ligamentous injury, and/or fracture of medial malleolus
325
What is Sever's Disease?
Calcaneal apophysitis in children ages 7-14 years & active
326
What causes Sever's Disease?
Repetitive stress to the heel, often during growth spurts
327
What are three indications of Sever's Disease?
* Pain & swelling over posterior heel
* Pain with walking
* Pain with resisted plantarflexion
328
What is Hallux Valgus?
Metatarsal head moves medially; proximal phalanx moves laterally
329
What are three structural changes associated with Hallux Valgus?
* Loss of integrity of medial 1st MTP joint structures
* Development of bursa or callus on medial side of joint
* Intrinsic & extrinsic muscles become adductors due to change in the line of force
330
What are three mechanisms of Hallux Valgus?
* Imbalance between intrinsic & extrinsic muscles
* Altered forces through MTP joint cause metatarsal to move medial & dorsal
* Repeated stress to medial capsule & medial collateral ligament causes them to lose integrity & eventually rupture
331
What are six indications of Hallux Valgus?
* Redness at 1st MTP joint
* TTP to medial 1st MTP joint
* Pronation & valgus deviation of the proximal phalanx
* Varus deviation of 1st metatarsal
* Tingling or burning on dorsal aspect of joint
* Decreased MTP joint sagittal plane ROM
332
What is the normal Hallux Valgus angle?
Hallux Valgus angle <15 degrees = normal
333
What are five 'why's' that need to be assessed with Hallux Valgus?
* Talocrural or subtalar joint mobility restrictions
* Gastrocnemius muscle length
* Forefoot/rearfoot varus or valgus
* Tibial torsion
* Hip/core weakness
334
What is Hallux Rigidus?
Decreased mobility of 1st MTP joint - loss of extension more than flexion
335
What are three indications of Hallux Rigidus?
* 1st MTP joint pain with walking
* May or may not have swelling
* Decreased ROM, especially extension, of 1st MTP joint
336
What is Sesamoiditis?
Inflammation of great toe sesamoid(s)
337
What are three indications of Sesamoiditis?
* Gradual onset
* Increased running or jumping activities
* Plantar 1st MTP joint pain
338
What are two risk factors for Sesamoiditis?
* Foot alignment: Pes cavus, hindfoot varus, equinus
* Poor shoewear
339
What is a Lisfranc Injury?
Dislocation of tarsometatarsal joint - often separation of 1st & 2nd cuneiforms
340
What are two subjective examination findings for a Lisfranc Injury?
* Pain with weight-bearing or push-off activities
* Pain with passive forefoot abduction, pronation
341
What are two objective examination findings with a Lisfranc Injury?
* Ecchymosis on plantar aspect of foot
* Fracture
342
What is Metatarsalgia?
Pain on plantar aspect of metatarsal heads - often due to disruption of plantar plate
343
What are two indications of Metatarsalgia?
* Pain with MTP joint extension
* Swelling if soft tissue injury, especially at 2nd metatarsal head
344
What is Turf Toe?
Hyperextension injury of the 1st MTP joint - disrupts capsuloligamentous structures and/or plantar plate of the flexor hallucis brevis
345
What are four indications of Turf Toe?
* Pain with MTP joint extension
* Limited MTP joint ROM
* Weakness with 1st MTP joint flexion strength tests
* MOI - gradual or traumatic
346
What are eight indications of Cuboid Dysfunction?
* Lateral foot pain
* History of ankle sprain
* Pain along calcaneocuboid joint
* Pain with push-off phase of gait
* TTP along cuboid
* Altered segmental mobility of calcaneocuboid joint
* Pain with resisted eversion & inversion
* 'Feels like walking on a pebble'
347
What are four indications of a Metatarsal Stress Fracture?
* No MOI - gradual onset
* Pain along dorsal aspect of forefoot - often 2nd or 3rd metatarsals
* May or may not have swelling, ecchymosis
* Signs & symptoms of RED-S
348
What does RED-S stand for?
Relative Energy Deficiency in Sport
349
What is a Jones Fracture?
Fracture of the 5th metatarsal - metadiaphyseal junction & high rate of non-union
350
What are two indications of a Jones Fracture?
* MOI - adduction force on plantarflexed ankle
* TTP along base of 5th metatarsal
351
What are six key clinical findings of Plantar Heel Pain (Plantar Fasciopathy)?
* Plantar medial heel pain
* Pain most noticeable with initial steps after period of inactivity or prolonged weight-bearing
* Reproduction of pain with palpation to proximal insertion on calcaneus
* Positive windlass test
* Negative neurodynamic tests
* Negative screens for referred pain from other regions, such as lumbar spine
352
What are the five rehabilitation progressions?
* Movement quality
* Work capacity
* Strength
* Power
* Speed
353
What are seven common 'why's' in altered movement patterns?
* Pain
* Inflammation
* Range of motion
* Muscle activation
* Flexibility
* Balance
* Motor control
354
What are six intervention types?
* Therapeutic exercise
* Therapeutic activities
* Patient education/self-care
* Manual therapy
* Neuromuscular re-education
* Modalities
355
When outlining your session, assign a ______ to the necessary interventions that you will use to address the patient's condition & impairments.
Percentage
356
What does Zone 1 refer to in intervention?
Effects on joint or muscle & effects of patient & provider beliefs
357
What does Zone 2 refer to in intervention?
Effects on nervous system & nociception
358
What does Zone 3 refer to in intervention?
Effects on pain & emotional state
359
What are ten absolute contraindications to manipulation?
* Decreased bone integrity
* Fracture
* Absence of working diagnosis
* Ligament rupture
* Severe pain levels or significant muscle guarding
* Empty end feel
* Acute episode of rheumatoid arthritis
* Central sensitization
* Overreliance on manual therapy for relief
* No consent
360
What are four regional contraindications to manipulation?
* Compromised transverse ligament
* Vertebral artery dysfunction
* Cauda equina syndrome
* Post-surgical care
361
What are eight relative contraindications to manipulation?
* Disc herniation
* Pregnancy
* Inflammation
* Decreased overall general health
* Advanced diabetes
* Adverse event with previous manual therapy
* Children or teenagers
* Severely worsening condition
362
What are three signs of over-manipulation or ineffective technique?
* Increased pain
* Increased swelling
* Reduced mobility
363
What are five other considerations to manipulation?
* Your safety is important too
* Visualize the joint surface
* The patient should be relaxed
* Grip lightly, but move the patient confidently
* Apply the minimum force necessary to achieve the goal
364
What is Mobilization grade I?
Small amplitude movement performed at the beginning of the range
365
What is Mobilization grade II?
Large amplitude movement performed within the range but not to the limit of the range
366
What is Mobilization grade III?
Large amplitude movement performed up to the limit of the range
367
What is Mobilization grade IV?
Small amplitude movement performed at the limit of the range
368
What is Mobilization grade V?
Manipulation: high velocity thrust at the end range of movement
369
Mobilization Grades I & II are used for:
Pain relief
370
Mobilization Grades III & IV are used for:
Structure response
371
What are the three steps for restoring function after a lateral ankle sprain?
* Progressive weight-bearing as soon as possible
* Restore ankle dorsiflexion ROM
* Strengthening
372
What muscles should be targeted in strengthening after a lateral ankle sprain?
* Gastroc/soleus
* Fibularis longus
373
If a lateral ankle sprain is chronic, what three structures need evaluation?
* Nerve integrity
* Fibularis longus/brevis integrity
* Distal tibiofibular mobility
374
What are the four steps for restoring function after chronic ankle instability?
* Restore ankle dorsiflexion ROM
* Proprioception & balance
* Motor control & correction of movement patterns
* Hip abduction & external rotation strengthening
375
What is a Medial Ankle Sprain grade I?
Immobilization
376
What is a Medial Ankle Sprain grade II & III?
Possible surgery
377
What is a High Ankle Sprain grade I?
Immobilization
378
What is a High Ankle Sprain grade II & III?
Possible surgery
379
What are three common tendinopathies of the LE?
* Tibialis posterior
* Achilles
* Fibularis
380
What are three other tissues that could be affected with a tendinopathy?
* Joint dysfunction
* Stress fracture/fracture
* Articular cartilage
381
What are three categories of foot alignment?
* Neutral foot
* High arch
* Flat foot
382
What does Pes Cavus refer to?
High arch
383
What are two considerations with high arch (Pes Cavus)?
* Underpronation
* Decreased shock absorption at the foot & ankle
384
What does Pes Planus refer to?
Flat foot
385
What are two considerations with Flat Foot (Pes Planus)?
* Overpronation
* Excessive shock absorption at the foot & ankle
386
What are four clinical examinations of foot alignment?
* Assess posterior glide
* Proximal & distal tib-fib joint restriction
* Gastrocnemius length
387
What are three 'whys' to limited dorsiflexion?
* Assess dorsal glide
* FHL length
388
What are two 'whys' to limited great toe extension?
* Assess tibialis posterior
* Foot intrinsics
389
What are four factors of biomechanics & fatigue?
* Load
* Intensity
* Volume
* Duration
390
What is reflection in human activity?
Important human activity in which people recapture their experience, think about it, mull it over & evaluate it
391
What is metacognition?
Thinking about one's thinking
392
What is Reflection in Action?
Ongoing metacognitive activity that is occurring during patient therapist interaction
393
What is Reflection on Action?
Looking back on an interaction that results in a revised insight of the patient interaction or their clinical reasoning
394
What does high specificity mean in testing?
Finds true negatives
395
High specificity tests have _____ false positives and _____ false negatives.
Fewer; More
396
What does it mean if a patient has a negative specificity test?
Patient likely has that condition
397
What does it mean if a patient has a positive specificity test?
Patient likely does not have the condition
398
What does high sensitivity mean in testing?
Finds true positives
399
What does it mean if the patient has a negative sensitivity test?
Need to do more digging
400
What does it mean if the patient has a positive sensitivity test?
Patient likely does not have the condition
401
What is prevalence in medical testing?
Pre-test probability - patient needs to be similar study population
402
What does a larger Positive Likelihood Ratio indicate?
Increased confidence that they do have the condition if the test is positive
403
What does a Negative Likelihood Ratio closer to 0 indicate?
Increased confidence that they do not have the condition if the test is negative
404
What are two characteristics of Intra-articular Hip Pathology?
* Most often anterior or peritrochanteric hip pain
* Can report buttock pain
405
What are seven key findings with Osteoarthritis?
* Moderate anterior or lateral hip pain with weight-bearing activities
* Stiffness reported for less than 1 hour after waking
* Hip IR PROM <25 degrees
* Hip IR ROM: 15 degrees less than non-painful side
* Hip flex ROM: 15 degrees less than non-painful side
* Increased hip pain with hip IR ROM
* Age greater than 50 years
406
What is a finding associated with hip internal rotation passive range of motion (PROM) in osteoarthritis?
Hip IR PROM <25 degrees
407
How much less is hip internal rotation range of motion (ROM) on the painful side compared to the non-painful side in osteoarthritis?
15 degrees less
408
What is a key finding regarding hip flexion ROM in osteoarthritis?
Hip flex ROM is 15 degrees less than non-painful side
409
What symptom increases with hip internal rotation ROM in osteoarthritis?
Increased hip pain
410
What is the age threshold that is considered a key finding in osteoarthritis?
Age greater than 50 years
411
What are 5 key findings with Osteoarthritis?
* Pain aggravated with squatting
* Lateral hip pain with hip flexion AROM
* Lateral hip or groin pain with Scour test
* Pain with hip extension AROM
* Hip IR PROM <25 degrees
412
What is the positive likelihood ratio (+LR) if a patient has 3 out of 5 clinical prediction rules for osteoarthritis?
+LR = 5.2
413
What is the positive likelihood ratio (+LR) if a patient has 4 out of 5 clinical prediction rules for osteoarthritis?
+LR = 24.3
414
What are the 4 types of acetabular labral tears?
* Radial flap labral tear
* Radial fibrillated labral tear
* Longitudinal peripheral labral tear
* Unstable labral tear
415
What are 5 key findings associated with Labral Tears?
* C-sign
* Anterior groin pain that worsens with prolonged standing, sitting, or walking
* Most often anterior groin or peritrochanteric pain
* Pain with squatting
* Younger to middle-aged adults
416
What are 5 key findings associated with Labral Tear and/or Femoroacetabular Impingement?
* Associated with other hip pathologies
* Anterior hip pain
* Mechanical signs & symptoms
417
What are 3 key findings associated with Loose Bodies?
* Inconsistent
* Findings can be variable due to movement
418
What is the treatment for Loose Bodies?
Associated with corticosteroid use, alcoholism, & sickle-cell anemia
419
What are 3 key findings associated with Avascular Necrosis?
* Hip extension ROM <15 degrees
* Pain in groin
* Pain in thigh, buttock, or knee
420
What is the percentage of patients with Avascular Necrosis experiencing pain in the groin?
55%
421
What is the percentage of patients with Avascular Necrosis experiencing pain in the thigh?
57%
422
What is the percentage of patients with Avascular Necrosis experiencing pain in the buttock?
71%
423
What is the percentage of patients with Avascular Necrosis experiencing pain in the knee?
22%
424
What are 3 other differential diagnoses at the intra-articular hip?
* Osteochondral lesions
* Ligamentum teres tear
* Hip dislocation/subluxation
425
What is a positive Maximal Squat Test?
No pain during the squat
426
What does a negative Maximal Squat Test indicate?
Femoral Acetabular Impingement
427
What does the Maximal Squat Test assess?
Visual functional assessment
428
What is the purpose of the Single Leg Squat Test?
Look for pain in the groin, reproduction of symptoms, with or without a click, or apprehension
429
What is a positive FADIR Test associated with?
* Femoroacetabular Impingement
* Labral Tear
* Hip OA
430
What are 2 conditions that could cause SIJ pain on hip ER with FABER?
* Iliopsoas strain
* Intraarticular hip disorder
431
What are 2 conditions that could cause groin pain on hip ER with FABER?
* Impingement
* Labral Tear
432
What are 5 possible Intraarticular Hip Disorders?
* Loose Body
* Chondral Lesion
* OA
* Posterior Hip Impingement
433
What is a positive Scour Test indicated by?
* Crepitus
* Different end feel
434
What do you look for when performing a Scour Test?
Reproduction of pain in ER or IR at end range
435
What is a positive Ligamentum Teres Test indicative of?
Effusion
436
What are 2 special tests for a hip stress fracture?
* Fulcrum Test
* Pain with resisted Straight Leg Raise
437
What condition is indicative of gluteus medius tendinopathy or tendon tear?
Greater Trochanteric Pain Syndrome
438
What are 5 key findings with Greater Trochanteric Pain Syndrome?
* Older population
* Positive FABER test
* Positive Trendelenburg sign
* Tenderness to palpation to gluteal muscles or tendons
* Resisted external derotation test
439
Internal Snapping Hip = ____ tendon over a bony prominence
Iliopsoas tendon
## Footnote
The Iliopsoas tendon can snap over various bony prominences.
440
With Internal Snapping Hip, the Iliopsoas tendon could be snapping over what 3 bony prominence?
* Iliopectineal eminence
* Lesser trochanter
* Femoral head
441
Internal Snapping Hip = snapping with hip extension from _______ position
flexed position
442
External Snapping Hip = ____ or ____ tendon over the greater trochanter
* TFL
* ITB
443
What are 2 possible conditions that can cause External Snapping Hip?
* IT Syndrome
* Hip bursitis
444
What are 3 treatments for Snapping Hip Syndrome?
* Correct movement patterns
* Joint mechanics
* Muscle performance - strength vs. flexibility
445
What are 3 key findings with Muscle Strains?
* Sudden onset of pain during specific activity
* May feel or hear a pop
* Pain, swelling, & ecchymosis
446
Grade ____ muscle strain = small number of fibers involved with minimal to no loss of muscle performance
I
447
Grade ____ muscle strain = greater number of fibers torn with pain, swelling, diminished muscle performance
II
448
Grade ____ muscle strain = complete tear with significant pain, loss of anatomic muscle continuity, loss of muscle function
III
449
What are 2 common muscle contusions at the hip?
* Quadriceps contusion
* Hip pointer - TFL
450
What are 4 key findings with a Muscle Contusion?
* Immediate pain & swelling at point of impact
* Difficulty weight-bearing
* Firm hematoma within 24 hours
* Pain & weakness with muscle activation
451
What are 3 key findings with Myositis Ossificans?
* Firm region with increased warmth
* Palpable mass
* Decreased muscle flexibility and/or strength
452
What are 4 key findings with Groin Pain?
* Increased pain with running, cutting, sit-ups
* Relieved with rest
* Pain with resisted hip flexion and/or hip adduction
* Positive resisted sit-up test
453
What muscle(s) are affected with an iliac crest Apophysitis & Avulsion Injury?
* Abdominal Obliques
454
What are 2 MOIs with an iliac crest Apophysitis & Avulsion Injury?
* Direct impact, as in lacrosse or hockey
* Forceful trunk rotation
455
What are 2 tests that elicit pain with an iliac crest Apophysitis & Avulsion Injury?
* Resisted Hip Flexion
* Resisted Trunk Flexion or Rotation
456
What are 2 muscles that are affected with an ASIS Apophysitis & Avulsion Injury?
* Sartorius
* TFL
457
What are 2 MOIs with an ASIS Apophysitis & Avulsion Injury?
* Sudden hip extension
* Knee flexion during running or sprinting
458
What is 1 test that elicits pain with an ASIS Apophysitis & Avulsion Injury?
Active or resisted adduction or hip flexion
459
What is 1 muscle that is affected with an AIIS Apophysitis & Avulsion Injury?
Rectus Femoris
460
What are 3 MOIs with an AIIS Apophysitis & Avulsion Injury?
* Kicking
* Overloading the rectus femoris
* Sprinting
461
What are 2 tests that elicit pain with an AIIS Apophysitis & Avulsion Injury?
* Resisted hip flexion with extended knee
* Passive hip extension
462
What is 1 muscle that is affected with an Ischial Tuberosity Apophysitis & Avulsion Injury?
Hamstrings
463
What is 1 MOI with an Ischial Tuberosity Apophysitis & Avulsion Injury?
Maximal hamstring contraction with the knee extended & hip flexed
464
What are 2 tests that elicit pain with an Ischial Tuberosity Apophysitis & Avulsion Injury?
* Passive knee extension with hip flexed
* Resisted hip extension
465
What is 1 muscle that is affected with a Lesser Trochanter Apophysitis & Avulsion Injury?
Iliopsoas
466
What is 1 MOI with a Lesser Trochanter Apophysitis & Avulsion Injury?
Sudden, forceful hip flexion
467
What is 1 test that elicits pain with a Lesser Trochanter Apophysitis & Avulsion Injury?
Resisted hip flexion with knee in flexion
468
What is the treatment for Hip Dysplasia?
Hip resurfacing
469
What are 7 key findings with Slipped Capital Femoral Epiphysis (SCFE)?
* Femoral head slips at physis (growth plate)
* Ages 9-15: males = 14 & females = 12
* Referral to physician - can lead to avascular necrosis
* Associated with obesity or endocrine disorders
* Trendelenburg gait or antalgic gait pattern
* Holds leg in hip ER
* ROM limitations: capsular pattern
470
What are 5 key findings with Legg-Calve-Perthes Disease (LCPD)?
* Avascular necrosis of the femoral head
* Males - under age 12
* First sign = trendelenburg or antalgic gait
* Holds leg in hip ER
* Hip pain that can refer to knee
471
What are 8 general guidelines for Articular Dysfunction at the hip?
* Manual therapy
* Trunk stability
* ROM
* Hip/trunk strengthening
* Stretching
* Joint mobility
* Functional training
* Neuro re-education
472
What are 5 general guidelines for OA at the hip?
* Activity modification
* Postural correction
* Balance
* Movement pattern training
* Activity specific training
473
What are 6 general guidelines for Femoral Acetabular Impingement (FAI)?
* Activity modification
* Postural correction
* Balance
* Movement pattern training
* Surgery
474
What are 4 general guidelines for Labral Tears at the hip?
* Activity modification
* Postural correction
* Movement pattern training
* Surgery
475
What are 4 general guidelines for Loose Bodies at the hip?
* Protected weight-bearing (crutches, walkers, canes)
* Activity modification
* Targeted stretching - progressive
* Ice, heat, ultrasound, e-stim
476
What are 5 general guidelines for Avascular Necrosis at the hip?
* Absent of mechanical symptoms
* Patient education
* Pain medication
* Symptom control
* NSAIDs
477
What are 12 general guidelines for Osteochondral Lesions at the hip?
* Treat based on associated pathology - rarely happens in isolation
478
What is 1 general guideline for a Ligamentum Teres Tear?
Minimize risk of osteonecrosis
479
What are 6 general guidelines for Hip Dislocation?
* Progressive resistance training
* Balance training
* Functional mobility
* Weight bearing exercises
* Treadmill training
* ROM
480
What are 13 general guidelines for stress fractures at the hip?
* Relative rest
* Activity modification
* Core stability
* Manual therapy
* Functional training
* Progressive strengthening
* Correction of biomechanics
481
What are 8 general guidelines for muscle dysfunction at the hip?
* STM
* Isometric hip abduction
* Heaving loading eccentric abduction
* Heavy slow resistance
* Prolonged isometric contractions
* Modalities
* Stretching
482
What are 7 general guidelines for Greater Trochanteric Pain?
* Steroid injections
* NSAIDs
* Activity modification
* Surgery
483
What are 4 general guidelines for Snapping Hip Syndrome?
* Ice massage
* Hip strengthening
* Addressing kinetic chain impairments
484
What are 3 general guidelines for Muscle Strain at the hip?
* RICE
* Position of flexion for 24 hours to limit hematoma
* Gentle active pain free ROM
485
What are 9 general guidelines for a Muscle Contusion at the Thigh?
* Indomethacin (NSAID)
* Stretching
* ROM
* Progressive return to activity
486
What are 5 general guidelines for Myositis Ossificans at the hip?
* Core stabilization
* Pelvic stability exercises
* Hip strengthening
* Glute strengthening
* Proprioceptive training
487
What are 5 general guidelines for Groin Pain?
* Avoiding lifting or activities that increase intra-abdominal pressure
* Lumbar/hip mobilization
* Stretching
* Proprioceptive training
* Progressive return to play
488
What are 5 general guidelines for Inguinal-related Hip Pain?
* Core stabilization
* Pelvic stability exercises
* Hip strengthening
* Glute strengthening
* Proprioceptive training
489
What are 6 general guidelines for Pubic-related Hip Pain?
* Activity modification
* Complete immobilization
* Stretching
* Strengthening
* Stability
490
What are 14 general guidelines for Iliac Crest, ASIS, AIIS, Ischial Tuberosity, & Lesser Trochanter Pediatric Apophysitis & Avulsion Injuries?
* Manual therapy
* Trunk stability
* ROM
* Hip/trunk strengthening
* Stretching
* Joint mobility
* Functional training
* Neuro re-education
491
What are 8 general guidelines for Hip Dysplasia?
* Surgery
492
What is 1 general guideline for Slipped Capital Femoral Epiphysis?
Referral to physician
493
What are 4 general guidelines for Legg-Calve-Perthes Disease?
* Stretching
* Strengthening
* Progressive weight bearing
* Limiting high impact sports
494
When performing the resisted hip adduction test, have patient do ____ ROM first, then ____ ROM
Active; Passive
495
What are the 3 degrees you should test the adductor squeeze test in?
* 0
* 45
* 90
496
What degree of the adductor squeeze test should you feel the maximal amount of force?
45
497
A normal knee extension test = ____ degrees from neutral
90
498
With resisted hip extension, bend the knee to ____ degrees
90
499
What is a positive Log Roll Test?
Click or excessive/decreased ROM
500
A click with a log roll test is indicative of ____
Labral Tear
501
Excessive/decreased ROM with a log roll test is indicative of ____
Laxity pain
502
What is a positive FADIR test?
Pain in the groin, reproduction of symptoms, w/ or w/o a click, or apprehension
503
A positive FADIR test could be indicative of what 3 diagnoses?
* FAI
* Labral tears
* Hip OA
504
You should do the FADIR in ____ degrees of hip flexion, before moving to full flexion
90
505
SIJ pain on hip ER with FABER could be indicative of what 2 diagnoses?
* SIJ dysfunction
* Sacroiliitis
506
Groin pain on hip ER with FABER could be indicative of what 2 diagnoses?
* Iliopsoas strain
* Intraarticular hip disorder
507
What are 5 different intraarticular hip disorders?
* Impingement
* Labral tear
* Loose body
* Chondral lesion
* OA
508
What could posterior pain on hip external rotation with FABER indicate?
Posterior hip impingement
## Footnote
Posterior hip impingement is a condition that can cause pain during specific movements of the hip.
509
What are the steps to assess inferior & lateral capsular mobility at the hip?
* Patient prone
* Hold knee at 90 degrees of flexion & support at the gluteal fold
510
How do you assess anterior capsular mobility at the hip?
* Flex knee & adduct hip
* Force downward & lateral
* Use torso to push down - sternum height
511
What are the two diagnoses you are looking for when using the SCOUR test?
* FAI
* Labral tears
512
What is a positive SCOUR test characterized by?
Clicking, catching, & pain
513
What are three tests to perform with muscle/tendon lateral hip pain?
* Trendelenburg's Sign
* Resisted ER derotation
* Ober's Test
514
With the Fulcrum Test, you are checking for ____ fractures.
Hip fractures
515
What does the Patellar Pubic Percussion Test assess?
Sound quality indicating fracture presence
516
What would you hear with the Patellar Pubic Percussion Test if the patient did have a fracture?
Resonant, crisp, clean
517
What would you hear with the Patellar Pubic Percussion Test if the patient did not have a fracture?
Flat, tough to hear
518
What is a positive Ely's Test indicative of?
Anterior pelvic tilt
519
A normal Craig's test is between ____ degrees.
8-15
520
With Anteversion, the patient will have greater ____ rotation.
Internal
521
With a retroverted hip, the patient will have greater ____ rotation.
External
522
When testing functional leg length discrepancy, you assess from ____ to ____.
ASIS; Medial malleolus
523
When testing true leg length discrepancy, you assess from ____ to ____.
Umbilicus; Medial malleolus
524
When doing a long axis hip mobilization/manipulation, the hip should be in ____ degrees of abduction & ____ degrees of flexion.
30; 90
525
When performing a short axis distraction mobilization on the hip, you are working the ____ capsule.
Posterior/inferior
526
You would perform a short axis inferior mobilization when the patient has limited hip ____.
Extension
527
You would perform an anterior mobilization - figure 4 when the patient has limited hip ____.
Flexion
528
Low back pain can be divided into what two categories?
* Acute
* Chronic
529
What is the classification method based on changes in low back pain symptoms in response to direction-specific movements?
Treatment-based Classification
530
What classification method guides initial treatment based on specific assessment findings?
Movement System Impairment
531
What classification method is based on observed lumbar movement or alignment impairments?
Cognitive Functional Therapy
532
What is the classification method that assesses pathoanatomical, physical, psychological, and social factors for low back pain?
Prognostic Risk Stratification
533
What are the two reasons you would use manipulation/mobilization?
* Decreased proximal stability
* Increased segmental mobility
534
What are three movement limitations for specific exercise/directional preference?
* Extension
* Flexion
* Side glide
535
What is one reason you would use traction?
Directional Preference Exercises
536
What are four treatments for symptom modulation?
* Sensorimotor exercises
* Stabilization exercises
* Flexibility exercises
* Pain-reducing manual therapy
537
What are three treatments for movement control?
* Strength & conditioning exercises
* Work or sport-specific tasks
* Aerobic exercises
538
What are four treatments for functional optimization?
* Facet joint restriction/hypomobility
* Spondylosis
* Decreased range of motion
* Segmental mobility
539
What are two differential diagnoses that fall under manipulation/mobilization TBC?
* Fear-avoidance beliefs questionnaire-work score less than 19 points
* Duration of current episode less than 16 days
540
What are the five clinical prediction rules for Manipulation/mobilization TBC?
* Acute or chronic
* Non-traumatic
* 'It feels stuck'
* Localized pain over facet joint
* Decreased ROM
541
What are six clinical considerations for Facet Joint Restriction/Hypomobility?
* Degenerative Disc Disease
* Osteoarthritis
* Spondylosis
* Stiffness in spine upon waking
* May report crepitus
* Decreased ROM
542
What are two components of Spondylosis?
* Older age
* Decreased mobility of facet joints & intervertebral disc
543
What are three clinical considerations for Spondylosis?
* Stiffness in spine upon waking, but resolves within 30 minutes
* May report crepitus
* Decreased ROM
544
What are three symptoms of Spondylosis that are consistent with OA?
* Under age 50 years
* Often traumatic onset
* Radicular pain
545
What are seven subjective findings of extension preference disc pathology?
* Increased radicular pain with spine flexion movements - peripheralization
* Decreased radicular pain with spine extension movements - centralization
* Positive neuro screen
* Muscle weakness is common
* Pain with valsalva
546
What are five objective findings of extension preference disc pathology?
* Age > 50 years
* Gradual onset
* Decreased pain with flexion-biased activities
* Increased pain with extension-biased activities
* Radiating pain and/or neurogenic claudication
547
With Central Stenosis, you will see ____ motor neuron signs depending on the level of the injury.
Upper
548
____ stenosis = narrowing of the spinal canal.
Central
549
____ stenosis = narrowing of the foramen.
Foraminal
550
What are the five clinical prediction rules for Spinal Stenosis?
* Often related to disc dysfunction
* Increased pain with compression
* Decreased pain with distraction or unloading activities
551
What are three clinical considerations with Traction TBC?
* Chronic
* Facet Joint Hypermobility
* Spondylolisthesis
552
What are two differential diagnoses with Stabilization TBC?
* Age less than 40 years
* Positive prone instability test
553
What are the four clinical prediction rules with Stabilization TBC?
* Increased joint glide of a facet joint
* Decreased pain with muscle activation or increased stability
554
What are two clinical considerations with Lumbar Hypermobility?
* Less than physiological range
* Increased tendency to move into elastic/plastic zone during daily activities
555
What are six clinical considerations for Hypermobility (aka instability)?
* Acute or chronic
* If chronic - recurrent, intermittent episodes
* Younger age
* Frequent self-manipulators
* Pain with prolonged static positions
* Decreased pain with movement or change in position
556
What is Spondylolisthesis Type I?
Isthmic
557
What is Spondylolisthesis Type II?
Degenerative
558
What is Spondylolisthesis Type III?
Traumatic
559
What is Spondylolisthesis Type IV?
Pathologic
560
What is Spondylolisthesis Type V?
Dysplastic
561
What is Spondylolisthesis Type VI?
Iatrogenic
562
What are the four criteria that must be met for Chronic Regional Pain Syndrome?
* Pain disproportionate to the nature & extent of injury
* Disproportionate, non-mechanical pattern of pain provocation
* Strong association with maladaptive psychosocial factors
* Diffuse, non-anatomical areas of pain
563
What are the four clinical considerations of 'conditions' of SIJ evaluation?
* Sacroiliitis
* Spondyloarthrides
* Gout
* Infection
564
What is the laterality of Ankylosing Spondylitis?
Bilateral
565
What is the female:male ratio of Ankylosing Spondylitis?
1:3
566
What is the female:male ratio of Psoriatic Arthritis?
1:5
567
What is the female:male ratio of Reactive Arthritis?
Varies
568
What is the female:male ratio of Enteropathic Arthritis?
1:1
569
What are three clinical considerations for 'joint-related conditions' with SIJ evaluation?
* Sacroiliac joint or pubic symphysis
* Joint hypermobility
* Joint hypomobility
570
A ____ rotated innominate = superior PSIS, inferior ASIS, & posterior ischial tuberosity.
Anteriorly
571
A ____ rotated innominate = inferior PSIS, superior ASIS, & anterior ischial tuberosity.
Posteriorly
572
With a superior innominate shear, the ipsilateral leg appears ____.
Shorter
573
With an inferior innominate shear, the ipsilateral leg appears ____.
Longer
574
With acute LBP, is there strong evidence comparing different classification systems & their effectiveness?
No
575
With chronic LBP, what classification systems may help reduce pain & disability?
* MDT (Mechanical Diagnosis & Therapy)
* Cognitive Functional Therapy
* Prognostic risk stratification
576
What are three interventions for chronic low back pain?
* Thrust & non-thrust mobilization
* Pain & disability reduction
* Active rest
577
What are four treatment options for acute low back pain with high irritability?
* Mechanical traction
* Pain-reducing manual therapy
* Nerve mobilization
* Dry needling
578
What is one treatment option you should avoid with acute low back pain with high irritability?
Repeated movements
579
What are three directional preferences with acute low back pain?
* Centralization
* Lateral shift
* Extension
580
What are two mobilization/manipulation interventions to use with facet joint restriction/hypomobility & spondylosis?
* Trust mobilization
* Non-thrust mobilization
581
What is a continuum of skilled passive movement applied at varying speeds & amplitudes within or at the end range of motion of a joint?
Soft Tissue Mobil
582
What is dry needling?
An intervention that uses a thin filiform needle to penetrate the skin & stimulate underlying myofascial trigger points & muscular & connective tissues for the management of pain & movement impairments
## Footnote
Dry needling is often used to address myofascial pain syndromes.
583
What are nerve glides?
Manual therapy techniques intended to enhance the dynamic balance between the relative movement of neural tissues & surrounding mechanical interfaces
## Footnote
Nerve glides help in the treatment of nerve entrapments.
584
What does STM stand for?
Soft Tissue Mobilization
## Footnote
STM techniques include myofascial release and trigger point therapy.
585
What are three interventions for chronic low back pain?
* Thrust mobilization
* Non-thrust mobilization
* Pain & disability reduction
586
What are two mobilization/manipulation interventions for a facet joint restriction/hypomobility & spondylosis?
* Thrust mobilization
* Non-thrust mobilization
587
Define thrust procedures in joint mobilization.
A continuum of skilled passive movement applied at varying speeds & amplitudes within or at the end range of motion of a joint, characterized by low amplitude & high velocity.
588
What is soft tissue mobilization?
Skilled passive movement of soft tissue, including fascia, muscles, & ligaments, to reduce pain or improve range of motion.
589
What is the main purpose of massage in therapy?
To promote relaxation of underlying muscles.
590
What is traction in physical therapy?
An intervention that uses manually or mechanically applied forces with the intention of stretching & distracting the spine.
591
Fill in the blank: _____ manipulation/mobilization is recommended to reduce pain & disability in patients with acute LBP & mobility deficits.
Thrust & Non-Thrust Joint Mobilization
592
Fill in the blank: ____ manipulation/mobilization can improve spine & hip mobility & reduce pain & disability in patients with subacute & chronic LBP.
Thrust & Non-Thrust Joint Mobilization
593
Fill in the blank: _____ manipulation/mobilization can provide short-term relief for LBP.
Dry Needling
594
What are three treatments to retrain faulty movement patterns & improve motor control in patients with facet joint hypermobility & spondylolisthesis?
* Motor control exercises
* Core stabilization
* Movement retraining
595
What is trunk muscle strengthening & endurance exercise?
Exercise training prescribed to restore or improve strength, endurance, or power of trunk muscles or muscle groups.
596
What is specific trunk muscle activation exercise?
Exercise training prescribed to target specific deep trunk muscles using cocontraction to alter or restore control or coordination of the lumbopelvic region.
597
What is movement control exercise?
Exercise training prescribed to alter, restore, or retrain control of functional movements & tasks, with feedback on movement patterns.
598
What is general exercise in the context of physical therapy?
Exercise training prescribed to restore or improve overall strength or endurance of the major muscle groups of the upper/lower extremities & trunk.
599
What is trunk mobility exercise?
Exercise training prescribed to restore trunk range of motion or to repeatedly move the trunk in a specific direction to achieve a reduction of symptoms.
600
What is aerobic exercise?
Exercise training prescribed to restore or enhance capacity or efficiency of the cardiovascular system.
601
What is multimodal exercise?
Exercise training that combines 2 or more of the interventions described above.
602
Grade A (strong evidence) recommends the use of _____ & movement control exercises for patients with chronic low back pain & motor control impairments.
General Exercise
603
Grade A (strong evidence) recommends the use of ____ to reduce pain & disability in older adults with chronic LBP.
General Exercise
604
In patients without generalized back pain, _____ to ____ intensity exercise is recommended.
Low
605
In patients with generalized back pain, _____-intensity, submaximal, endurance-based fitness is recommended for pain management & health promotion.
Moderate
606
What is trunk coordination?
The ability to control the movements of the trunk effectively
## Footnote
Trunk coordination is essential for various physical activities and exercises.
607
What is strengthening?
The process of increasing muscle strength through resistance exercises
## Footnote
Strengthening is crucial for rehabilitation and performance.
608
What are repeated movements?
Movements that are performed multiple times to improve function or strength
## Footnote
Repeated movements can enhance motor learning and muscle endurance.
609
What are flexion exercises?
Exercises that involve bending a joint, decreasing the angle between body parts
## Footnote
Flexion exercises are commonly used in rehabilitation.
610
What is manual therapy?
A hands-on treatment approach to relieve pain and improve function
## Footnote
Manual therapy includes techniques like mobilization and manipulation.
611
What are nerve mobilizations?
Techniques used to improve the mobility of nerves and reduce symptoms
## Footnote
Nerve mobilizations are often used in treating radiculopathy.
612
What is aerobic exercise?
Physical exercise that increases heart rate and improves cardiovascular fitness
## Footnote
Aerobic exercise is important for overall health and endurance.
613
What is trunk mobility?
The range of motion available in the trunk region
## Footnote
Trunk mobility is vital for functional movements and daily activities.
614
What are 9 types of exercises & strategies for LBP?
* Strength & conditioning
* Aerobic conditioning
* High level functional training
* Sport/work specific tasks
## Footnote
These strategies help in managing low back pain effectively.
615
What are 4 treatment recommendations to restore high level function, strength, & endurance for return to sport, work, or activities?
* Surgical precautions
* Exercise
* Returning to activity
## Footnote
These recommendations ensure a safe return to activities post-injury.
616
With patient education on LBP, avoid ____ education.
Fear-Inducing
## Footnote
Fear-inducing education can lead to increased anxiety and avoidance behaviors.
617
What are the 6 key messages to emphasize with patient education on LBP?
* The spine is strong & resilient
* Pain is influenced by the brain & nervous system (pain neuroscience)
* LBP has a good prognosis
* Encourage active coping to reduce fear & catastrophizing
* Resume normal/vocational activities early, even with some pain
* Focus on improving function & activity - not just reducing pain
## Footnote
These messages aim to empower patients and reduce fear associated with LBP.
618
With patient education on LBP, use ____ education strategies.
Active
## Footnote
Active education strategies involve direct interaction and personalized guidance.
619
With patient education on LBP, combine education with ____ or manual therapy.
Exercise
## Footnote
Combining education with exercise enhances treatment effectiveness.
620
With patient education on LBP, deliver pain neuroscience education as part of a ____ treatment plan.
Broader
## Footnote
A broader treatment plan includes various approaches to manage pain and improve function.
621
With patient education for chronic LBP, PTs should prioritize ____ treatments.
Active
## Footnote
Active treatments like yoga and strength training are more effective than passive approaches.
622
What is a positive SIJ compression test?
Reproduction of symptoms at the SI joint
## Footnote
A positive test indicates potential SI joint dysfunction.
623
What is a positive SIJ distraction test?
Reproduction of symptoms at the SI joint
## Footnote
Similar to the compression test, this indicates potential issues with the SI joint.
624
What is Gaenslen's test?
A test where the patient is lying supine, with one leg hanging off the edge of the mat & the other in hip flexion, applying overpressure in both directions
## Footnote
Gaenslen's test helps assess SI joint dysfunction.
625
What is a thrust test?
A maneuver to assess the stability and function of the SI joint
## Footnote
Thrust tests can indicate how the SI joint responds to pressure.
626
What does a positive Prone Instability Test indicate?
No muscular stability
## Footnote
This suggests that the lumbar spine lacks support from surrounding muscles.
627
How many reps do you have the patient perform with the Repeated Flexion/Extension Test?
10
## Footnote
This test assesses the lumbar spine's response to repeated movements.
628
What is the MCID for the Oswestry Disability Index (ODI)?
9.5-15
## Footnote
The MCID indicates the minimum change in score that is meaningful to patients.
629
What are the 10 main categories for the Oswestry Disability Index (ODI)?
* Pain intensity
* Personal care
* Lifting
* Walking
* Sitting
* Standing
* Sleeping
* Sex life
* Social life
* Traveling
## Footnote
These categories help assess the impact of back pain on daily life.
630
What is the Lower Extremity Functional Scale (LEFS) measuring?
Evaluates impairment of a patient with a lower extremity musculoskeletal condition or disorder
## Footnote
LEFS is used to assess functional limitations in lower extremities.
631
Is the QuickDASH an ability or disability scale?
Disability
## Footnote
The QuickDASH measures the impact of upper limb disorders on daily activities.
632
What is the outcome being measured with the FABQ?
Patient's fear-avoidance beliefs about physical activity and how work may affect LBP
## Footnote
The FABQ helps identify psychological factors influencing pain.
633
What are the 2 main categories of questions in the Knee Outcome Survey (KOS)?
* Symptoms
* Functional limitations with ADLs
## Footnote
These categories help assess knee function and the impact of pain.
634
What are 4 safety considerations you should always do post-surgery?
* Maintain integrity of the repaired/reconstructed tissue
* Understand the surgical procedure
* Identify underlying conditions
* Allow for systemic recovery after surgery (up to 1 month)
## Footnote
These considerations ensure safe recovery and rehabilitation.
635
What 2 motions at the hip should be avoided after a hip labral repair?
1. Posterior
2. Anterior
## Footnote
Lateral motion is also mentioned but not included in the answer.
636
What are the 3 approaches for a total hip arthroplasty?
1. Anterior
2. Lateral
3. Posterior
## Footnote
These approaches vary based on surgeon preference and the patient's anatomy.
637
How long should hip restrictions remain after a total hip arthroplasty?
6-8 weeks
## Footnote
Adherence to restrictions is crucial for optimal recovery.
638
What are the 4 phase I goals for post-op knee rehabilitation?
1. Full knee hyperextension
2. Quad activation
3. Decrease swelling
4. Normalize gait
## Footnote
These goals help restore function and mobility.
639
What are 3 meniscus procedures?
1. Meniscectomy
2. Meniscus repair
3. Meniscus transplant
## Footnote
Each procedure addresses different types of meniscal injuries.
640
During the early phases of ankle rehab, what does PEACE stand for?
1. Protection
2. Elevation
3. Avoid anti-inflammatories
4. Compression
5. Elevation
## Footnote
This acronym guides initial management of ankle injuries.
641
During the mid-late phases of ankle rehab, what does LOVE stand for?
1. Load
2. Optimism
3. Vascularization
4. Exercise
## Footnote
This acronym emphasizes progressive rehabilitation.
642
What are 2 clinical considerations for an Achilles tendon repair?
1. Protect repair site
2. Always consider risk vs benefit
## Footnote
These considerations are essential for safe recovery.
643
You would perform a posterior innominate rotation dysfunction mobilization when you have an abnormal finding on the ____ leg lift during the Stork Test.
contralateral
## Footnote
This test assesses functional movement and stability.
644
What is the dosage for innominate rotation mobilizations?
6 x 6sec holds - 2 times a day
## Footnote
This dosage is aimed at improving joint mobility.
645
With an anterior innominate rotation dysfunction, you are pushing the ASIS ___ & the ischial tuberosity ____.
Back; Forward
## Footnote
This mobilization technique helps restore proper pelvic alignment.
646
What 2 things are you assessing with the Pubic Symphysis Shotgun Technique?
1. Joint position
2. Pain provocation
## Footnote
This technique evaluates the pubic symphysis for dysfunction.
