Intro

Question 1

Assessment of joint mechanical capacity is not dictated by the _____, but is performed ______ to assess the surrounding connective tissue which typically limits joint mobility.

Answer 1

Angles of the articular surfaces, but is performed three dimensionally

Question 2

Efficient motor control requires: efficient ____

Answer 2

Efficient mechanical capacity and neuromuscular function

Question 3

Efficient motor control requires: the presence of an ____

Answer 3

An integrated sensory and motor homunculus which can effectively recognize sensory input and activate effective motor output for any given automatic or volitional movement

Question 4

Efficient motor control requires: the presence of _____

Answer 4

Corefirst strategies (proper synergistic activation of local and global muscles) to promote smooth and coordinated patterns of movement

Question 5

Efficient motor control allows for___

Answer 5

Anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) to best adapt to external input or control intentional movement

Question 6

What are the physical effects in the loss cycle?

Answer 6

Shock
- sleep and appetite disturbance
- numbness
- irritability

Question 7

What are the integration factors in the loss cycle?

Answer 7

“Acceptance”
Positive feelings
Lessons learned
Future planning

Question 8

What are the mental effects in the loss cycle?

Answer 8

“Disorganization “
Depression
Social withdrawal, isolation
Feeling of going crazy
Suicidal ideas
Hopelessness

Question 9

What are the emotional effects of the loss cycle?

Answer 9

“Distress”
Flood of feelings
Anger
Sadness
Fear
Difficulty coping
Helplessness, why me?

Question 10

What are the interventions in the loss cycle for the physical effects?

Answer 10

Release of physical tension, normalize breathing patterns
Introduce loss cycle
Goal is patient safety

Question 11

What are the interventions in the loss cycle for emotional effects?

Answer 11

Encourage expression of feelings into words
Pain diary/med monitor
Goal is support and understanding for patient’s emotional hurt

Question 12

What are the interventions in the loss cycle for mental effects?

Answer 12

Engage pt support system
Set clear limits, contract, if needed, on specific issues
Provide information sources
Goal is to assist pt to be active “within” current limits

Question 13

The acute pain experience should be a ____ process

Answer 13

Self-limiting

Question 14

Pain should stop when it no longer has _____

Answer 14

Biological value

Question 15

In a sustained pain experience, _____ , and the pain experience becomes protracted.

Answer 15

Acute processes fail to cycle down

Question 16

When the nervous system and immune system fail to cycle down, _____

Answer 16

Inflammation becomes systemic.

Question 17

Brain hypersensitivity (a central, ____ ____ _____) can generate pain without any input from the body

Answer 17

Glial immune process

Question 18

Chronic hormone and immune activity can lead to ______ and that can cause pain

Answer 18

Auto-immune responses in the body

Question 19

Down regulating chronic central and systemic inflammation requires a multi system approach and includes:

Answer 19

Re-educating the brain on pain process.
Regulating stress.
Replenishing nutrients.
Enhancing antioxidant and anti-inflammatory nutrition.
Restoring hormonal balance
Achieving sleep
Healing the GI system
RESTORING EFFICIENCY THROUGHOUT THE BODYS STRUCTURES AND FUNCTIONS

Question 20

Nutrition of the disc is gained through _____

Answer 20

Fluid imbibition

Question 21

Dropping a leg off the side of the chair assists the pelvis to assume and maintain a neutral position by _____, and helps to distribute weight into the base of support.

Answer 21

Using the tension of the hip flexors to support the spine

Question 22

What are some acute strategies for treating through the basic FM principles?

Answer 22

Gentle gentle oscillations to soft tissues and articulations in NWB
Tone reduction (relaxation and gentle MTT)
Decrease inflammation, swelling, edema - modalities and ice
STM to associated soft tissue restriction
Note if pain is related to associated dysfunction
STM shortened range
Train in self-care and pain reducing exercise

Question 23

What are some subacute strategies to apply for basic FM treatment principles?

Answer 23

Decrease tone and inflammation, improve soft tissue and articular mobility.
More aggressive STM and more directed. Progress shortened to lengthened.
Promote healing, initiate rehab, exercises and training in efficient posture and movement.

Question 24

What are some strategies for FM treatment in sustained pain situations?

Answer 24

Decrease tone, inflammation and central sensitization.
STM to area and all associated areas, more toward lengthened range.
Treat compensations - progress to weight bearing postures.
Aggressive rehab and training in full return to work and activity.

Question 25

In preparation for treatment, what factors need to be considered for positioning?

Answer 25

Irritability of symptoms, type of dysfunction and tenderness of tissues palpated. Begin in shortened range and progress to mid and lengthened ranges.

Question 26

When is vertical compression contraindicated in sitting?

Answer 26

Pt is highly irritable to loading. Increase in painful symptoms with just placing hands on shoulders. Do not add more force after beginning to produce symptoms or after segmental displacement occurs. Anyone with delayed onset of symptoms after being treated (subjective evaluation). Symptoms, fracture, etc. of upper quadrant may be exacerbated with application of vertical pressure.

Question 27

When is VCT contraindicated/use precaution in standing?

Answer 27

Same as sitting as well as: Acute lumbar shift (derangement) - correct derangement first. LE dysfunction may be exacerbated by compression.

Question 28

When is EFT contraindicated/use precaution?

Answer 28

UE problem - elbow/shoulder fracture or pain which may be exacerbated by compression. TOS symptoms which are increased by minor elbow flexion resistance. Irritable cervical symptoms

Question 29

When is LPM contraindicated/should use precaution?

Answer 29

Highly irritable pt - or if increased symptoms are experienced. Pt must be supported or test avoided if marked balance disturbance exists. If mild VCT increased symptoms, only test in corrected position.

Question 30

List the contraindications for superficial fascia:

Answer 30

Finger glide through friable or irritable skin such as fresh incision, burn, grafted area, psoriasis and elderly; easy bruising of PVD or enervated regions. Skin glide often can be done in these cases, except with recent skin graft.

Question 31

When should you use caution with treating bony contours of the iliac crest?

Answer 31

Hypermobile innominate into anterior torsion Acute nerve root pain or clinical nerve pain may be exacerbated with firm pressure to iliac crest.

Question 32

When should you use caution with treating bony contours of sacral sulcus?

Answer 32

Hypermobility of sacrum. Use less force and cascade of techniques.

Question 33

When should you use caution with bony contours of 12th rib?

Answer 33

Steroid use, osteoporosis, fracture. Patients with kidney and spleen problems and all transplant patients. Unstable thoracic lumbar region.

Question 34

When should you use caution with associated oscillations?

Answer 34

Vestibular symptoms or vertigo. Caution with hyper mobility. Contraindicated on side of nerve root pain. Caution with highly irritable articular or myofascial structure in region used for oscillation.

Question 35

When should you use caution with treating bony contours of groove of spine?

Answer 35

Suspect or confirmed fracture of spine; work superior to inferior direction first to avoid lymph stains in upper thoracic region. Osteoporosis. Caution to maintain neutral during Rx of: acute hypermobile segment or acute nerve root

Question 36

What are the 5 concepts related to sustained pressure for skin/superficial fascia mobilization?

Answer 36

Pressure - fingertips/thumbs, medial border middle finger tip Tension - specific direction of restriction Therapist’s body position - in line with restriction Maintain pressure on the same layer - follow path of release Re-evaluate for remaining tissue restrictions

Question 37

In both shortening and lengthening tissues for skin/superficial fascia, the specific direction is identified by the _______.

Answer 37

enhanced release of the tissues

Question 38

Who influenced the unlocking spiral technique?

Answer 38

G. Johnson (1981)

Question 39

When do you begin to use unlocking spiral?

Answer 39

When a restriction is not responding to the sustained pressure technique and Assisting Hand tissue lengthening/shortening.

Question 40

When an unlocking spiral has been used but the restriction has not resolved, what should be done next?

Answer 40

Repeat the technique with unlocking spiral in direction of greatest tension.