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PHTH 527 > Flexibility and Core Stability > Flashcards

Flexibility and Core Stability Flashcards

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1
Q

define instability

A

excessive range of movement which there is no protective muscular control

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2
Q

what scales do we use for hyper-mobility ? what is it scored out of?

A

beighton scale

out of 9

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3
Q

mechanical instability

A

disruption of the passive stabilizers and decreased structural integrity

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4
Q

functional instability

A

lack of neuromuscular control of the joint during activities

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5
Q

what makes up Panjabi’s spinal stability system

A 
passive subsystem (spinal column) 
active subsystem (spinal muscles) 
control subsystem (neural )
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6
Q

causes of hypermobility

A

can be traumatic or non -traumatic (genetic, adjacent hypomobility, habitual movements

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7
Q

explain the treatment process for hypermobility

A

1) mobilized hypomobile tissues or joints (manuel therapy, massage, IMS, stretching)
2) activate & strengthen to stabilize the hypermobile/unstable area
3) control excessive movement
4) facilitate co-contraction of muscles surrounding the joint
5) provide feedback & focus on quality

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8
Q

Other aspects of treatment of hypermobility

A

movement re-education & motor control
postural training
patient education
supportive devices

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9
Q

what are the purposes of bracing/taping?

A

restrictive of movement

proprioceptive - tells joint where it is in space

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10
Q

precautions to hyper mobility treatment

A

ensure patient has adequate control when exercises are performed
monitor fatigue of dynamic stabilizing muscles
educate patient to monitor control & precision of movement

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11
Q

define neutral zone

A

small range near neutral position of every joint where there is minimal resistance provided by the passive system
increase with injury

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12
Q

what are some inner unit muscles?

A

TA, multifidus, pelvic floor, diaphragm

segmental control

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13
Q

which unit controls during strengthening first

A

always inner unit

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14
Q

what does the outer unit consist of

A

anterior oblique sling
posterior oblique sling
lateral sling

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15
Q

what makes up the anterior oblique sling?

A

internal and external obliques, abdominal fascia & contralateral adductors

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16
Q

what makes up the posterior oblique sling?

A

latissimus dorsi, contralateral glut max & biceps femoris

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17
Q

what makes up the lateral sling?

A

glute med & min and contralateral adductors

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18
Q

where can you find TA to palpate

A

2.5 cm medial to ASIS

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19
Q

describe some characteristics of TA

A 
anticipatory 
not direction specific 
active continuously 
inhibited by pain / fear 
not affected by cognitive processes
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20
Q

what works with TA?

A

pelvic floor muscles

active in lifting

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21
Q

what are some recruitment strategies

A

position (supine,prone, sidelying)
palpation
verbal cues
visualisation and imagery

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22
Q

explain how to use the PFM

A 
patient supine knees bent 
relax butt and thighs 
palpate TA 
contract PFM 
note the ability to recruit & holding time
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23
Q

what is the rationale for using the SLR

A

test for failed load transfer through lumbopelvic region , positive test means failed load transfer

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24
Q

what should we look for in the ASLR

A 
note:
ability to ASLR 5 cm 
pelvic tilting or rotation
muscle fasciculation 
any symptoms 
get PT to contract TA any difference? 
compare side to side
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25
describe exercise prescription for inner unit
prolonged static hold low load 25% max voluntary contraction 10 sec holds 10 reps
26
how can we progress this exercise prescription?
``` increase holding time & reps add simple leg movements add simple arm movements combine arm and leg movements stable -unstable base ```
27
Most important Goal of exercise prescription
focus should be on local control of the inner unit should be achieved prior to global stabilization
28
define hypo-mobility
decreased ROM, mild muscle shortening - irreversible contractures
29
what are the factors that contribute to hypomobility
prolonged immobilization - extrinsic/intrinsic factors - postural faults - habitual faults - paralysis & tonal abnormalities - aging
30
define contracture
adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch & limitation of ROM
31
list out the types of contracture
``` myostatic pseudomyostatic arthrogenic periarticular fibrotic ```
32
explain what relative flexibility is
stiffness in one muscle group that causes another part of the body to compensate for that lack of movement
33
what happens when you immobilize muscle?
decreased muscle fibre cross-sectional area decreased number of myofibrils in a muscle fibre decreased motor unit recruitment muscle atrophy & weakness
34
what happens when the muscle is immobilization in a shortened position
``` decreased number of sacormeres muscle shortening increased atrophy length-tension curve shifts LEFT have stretch weakness ```
35
what happens when the muscle is immobilized in a lengthened position
increased number of sarcomeres decreased atrophy length tension curve shifts right adaptive shortening
36
stretch weakness
weakness in mid and inner range
37
what happens to tendon post immobilization
decreased tensile strength
38
what happens with ligaments post immobilization
decreased tensile strength adhesions and stiffness bony resorption at entheses
39
what happens to articular cartilage post immobilization
decreased lubrication | softening and fragmentation
40
what happens to bone post immobilization
decrease bone mass and bone mineral content
41
possible events that happen to our flexibility when we age
connective tissue tensile strength decreases decreased elasticity increased adhesions
42
what are the 3 categories we need to think about that could be limiting movement
myofascial articular/periarticular dural
43
define creep
increased length of the tissue as it becomes warmer
44
stress relaxation
slow application of force will allow the tissue to move farther into its range
45
indications for stretching
limited ROM due to loss of soft tissue extensibility restricted motion that may lead to structural deformities that are otherwise preventable presence of muscle weakness & shortening in opposing tissues part of pre-hab maintenance program enhance performance
46
what are some key considerations for stretching?
does lack of muscular flexibility contribute to their dysfunction? is there less than normal ROM noted on muscle length/flexibility testing? is there an appropriate (muscular) end feel?
47
What are the contraindications for stretching
``` bony end feel acute inflammation/active infection recent fracture/bony union incomplete hematoma specific surgeries shortened tissue enables functional skills that otherwise are not possible ```
48
precautions for stretching
recent corticosteroid injection joint effusion & edematous tissue osteoporosis & long term steroid use newly united fracture frail elderly avoid vigorous stretching of recently immobilized tissues
49
when you are prescribing stretching exercises make sure you think about :
``` alignment stabilization intensity (tightness or slight discomfort) duration frequency speed of stretch (slowly applied, dynamic, ballistic) mode of stretch integrate function with stretching ```
50
What should be the volume per session/week/days per week
better increased time per session (60 seconds vs 60-120 s vs >120 s time -5-10 mins & >10 min More times a week the better
51
reasonable stretching guildeline for clinical populations
``` slowly applied, low intensity total dose >120 sec - 30-60 sec -2-4 reps at least once daily 6 days per week better ```
52
active strategies of stretching
PNF dynamic muscle energy eccentric exercise
53
passive strategies of stretching
static stretch/self stretch partner stretching manual methods mechanical
54
when would u use mechanical stretching
chronic contractures low load, long duration Continuous passive motion (serial casting)
55
What are some adjunctive agents for stretching
``` active warm-up heat massage/ soft tissue techniques biofeedback & relaxation training joint traction /mobs ice/cold ```
56
describe a muscle imbalance
certain muscles can be facilitated/overactive & inhibited/under active
57
what can these muscle imbalances create
change in recruitment patterns strength length
58
when the muscle is in a normal range where is it strongest
mid range
59
what happens when a muscle is habitually shortened/lengthened muscle
tests strongest in a position closest to inner range or if lengthened outer range
60
what are some sources for muscle imbalance?
injury/trauma muscle inhibition due to pain/inflammation disease repetitive stress postural habits
61
explain the price the body has to pay for muscle imbalances
altered joint motion& movement patterns dysfunctional movement tissue breakdown pain
62
tonic muscle
always on | ex multifidus
63
phasic muscle
turns on and off when needed | biceps
64
local stabilizer muscle
``` close to the joint single joint stability tonic non-direction specific anticipatory ```
65
dysfunction of local stabilizers
atrophy phasic inhibition
66
global stabilizer muscle
``` single joint stability & angular motion tonic decelerative direction specific ```
67
dysfunction of global stabilizer muscles
inhibition atrophy lengthen phasic
68
global mobilizer
multi-joint phasic accelerative creates movement
69
dysfunction of global mobilizer
hypertrophy shorten tonic
70
what direction should we test muscle length
take the muscle in the opposite direction that it would contract one end is fixed while insertion moves passively
71
considerations for muscle length testing
dont do if patient has acute pain dont put in contraindicated positions watch for cheats to move in the least amount of resistance
72
how do we correct muscle imbalances
1) inhibit the overactive muscles 2) lengthen short overactive muscles 3) activate weak under active muscles 4) integrate into function

PHTH 527 (3 decks)

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