Midterm Flashcards
(161 cards)
1
Q
What are the weak muscles in lower crossed syndrome?
A
"Bag me Deep" biceps femoris lower abs glute max multifidus deep erector spinae
2
Q
What are the tight muscles in lower crossed syndrome?
A
PEAR Psoas erectors (superficial) adductors rectus femoris
3
Q
What is looked at in modified Bierring Sorenson Test?
A
it checks extension, flexion, and lateral flexion of the trunk.
Normal should be that Extension is greater than flexion and lateral flexion.
4
Q
What can be done with a patient who has better trunk flexion in the modified Biering Sorenson Test?
A
trunk extension exercises focusing on the deep lumbar erector spinae
5
Q
What do you expect to find in a patient with a positive pushup test?
A
forward head
protracted shoulders
increased internal shoulder rotation
scapular winging or “tipping”
6
Q
Your patient demonstrates a positive prone active straight leg raiser test with form disclosure dysfunction. Which of the following myofascial stabilizing systems is most likely involved?
A
posterior oblique system
Lats and gluts
7
Q
What is form closure of a ASLR?
A
lateral - medial compression of SI joint
core stabilization with emphasis on posterior oblique (lats/gluts) and temporary application of pelvic (trochanteric) belt
8
Q
What are the goals of the assessment of spinal stability?
A
loss of stability
loss of motor control
loss of aberrant motor patterns
9
Q
What is abdominal bracing?
A
- contracting muscles of the trunk in a hoop like fashion without drawing the abdominal wall INWARD
- Level of contraction should be about 10%
- Continue to breathe while maintaining the brace
10
Q
What is the positive and indicator of lumbar shear stability test?
A
Positive: Pain in resting position that diminishes in active position
Indicates: ability of the lumbar extensors to stabilize against shear instability
11
Q
What are the corrective measures of a positive lumbar shear stability test?
A
spinal stabilization exercises
12
Q
What are the characteristics of postural muscles?
A
short and tight
type 1 muscles
responsible for maintaining posture especially in gait
generally slow twitch muscles
13
Q
What are the type 1 stabilizer muscles?
A
postural; hyperactivity, tightness triceps surae hamstrings adductors rectus femoris TFL Iliopsosas Erector spinae QL Pecs Upper traps SCM Sub occipitals Masticators
14
Q
With exercise design, how do you maintain a positive slope?
A
Add new exercises one at a time after positive progression
Initiate reconditioning process with limited number of exercises 2-4
15
Q
When developing rehabilitation programs for health, what is emphasized?
A
muscle endurance
motor control perfection
maintenance of spinal stability during exercise
16
Q
What is force closure when doing a prone straight leg raise?
A
PRONE: patient extends arm on opposite to side engage lats while Dr. pushes down
**Decreased force closure w/ dysfunction of posterior oblique.
17
Q
What are the indicators of the trunk flexion test?
A
anterior pelvic tilt (anterior innominate) gluteal amnesia decreased abdominal tone asymmetrical lateral grooves in ab wall impaired respiration
18
Q
What happens in the supine ASRL force closure?
A
activation of anterior oblique swing with patient crossing arms across chest and bringing elbow to opposite knee against tester resistance.
19
Q
What is the corrective action with supine ASRL force closure?
A
core stabilization with emphasis on anterior oblique system
20
Q
When doing the side lying hip abduction test, what muscles cause what actions?
A
hip flexion (leg goes out) - TFL Hip external rotation - piriformis hip hiking before abduction - QL
21
Q
What is the normal outcome of the side lying hip abduction test?
A
pure hip abduction to 45 degrees
22
Q
How does the muscular system reflect the status of the sensorimotor system?
A
change in tone within the muscular system is often a refection of dysfunctional status of the sensorimotor system
23
Q
In Janda’s Postural Syndromes, what do we expect of a patient with pes planus?
A
ipsilateral genu valgus ipsilateral coxa varus ipsilateral dropped iliac crest ipsilateral lumbar scoliosis CONTRALATERAL thoracic scoliosis ipsilateral dropped shoulder
24
Q
What complications would cause you to do a side lying hip abduction test?
A
lateral shift/rotated pelvis
asymmetrical height of iliac crest
adducted hips (coxa varus)
positive trendelenburg
25
A lateral shift of the pelvis and associated aberrant movement patterns found on the above named test (trendelenburg) is associated with what?
gluteus medius
26
Your patient has an anterior pelvic tilt with a noted positive Ely's sign and a positive Thomas Test. What is an expected associated finding?
positive prone hip extension test
Ely's sign - tight rectus femoris
Thomas Test - tight iliopsoas
27
What is the estimated percentage of muscle maximal volitional contraction (MVC) for spinal stability?
In neutral posture, 5-10% of abdominal and paraspinal muscles required for stability.
28
The increased muscle activation necessary to provide stability in spinal segments damaged by ligamentous laxity or disc disease?
results in greater compressive force
segments that have ligament laxity or disc disease require greater muscle activation, which results in greater compressive force.
Needs 15-20% instead of 5-10%
29
What are abnormal patterns of neck flexion test?
extension of occiput on atlas
| chin poking towards ceiling meaning SCM
30
Which of the following contributes to the force closure stability of the SI joint?
anterior oblique myofascial sling
31
What muscle is primarily responsible for force closure?
glut max
32
What are consequences of compensations and adaptions occurring as a result of dysfunction in a component within the kinetic chain?
tissue overload
decreased performance
predictable patterns of injury
33
Since ligaments have sensory and mechanical properties, they have the ability to control:
muscle stiffness and coordination - sensory
joint stability - mechanical
moment and position sense - sensory
34
What test can prove that there may be kinetic chain deficits long after symptomatic recovery from injury?
Saharan Core stability test
35
With the patient in the modified thomas position we are able to assess the appropriate/inappropriate muscle length. When assessing the one joint adductor length, the patient:
should achieve passive hip abduction
| Gracilis is 2 point abductor
36
During a cranio-cervial flexion test, what is the normal pressure the patient should be able to exert?
2mmHg for 6-10 seconds
37
A positive cranio-cervial flexion test would indicate?
decreased activation of deep segmental cervical stabilizing structure
38
A 42 year old female is training for her first 10k and has developed searing right lateral knee pain. Your findings include but are not limited to positive finding in the modified thomas test (decrease in passive adduction) and Ober's Test. What aberrant movement pattern might you expect on Janda's Abduction Test?
Hip flexion because of Tensor Fasica Lata - Ober's Test
39
With a positie Ober's Test what happens with the TFL?
TFL contracture which pulls laterally on upper and lower leg bowing the knee inward
Right Genu VALGUS
40
When testing muscle length of the levator scapula, which is a type _____ muscle fiber, the examiner passively flexes the neck laterally flexing away from the side being tested and rotation _____ tested side while depressing tested side shoulder.
II, away from
41
What are the type II muscle fibers?
```
phasic muscles; weak/inhibited
tibialis anterior
glut max/med
rectus abdominus
lower/mid traps
scalenes
longus colli
deltoid
digastrics
```
42
Motor control in what muscles is shown to become dysfunctional with posterior neck or low back injury?
transverse abdominus
mulfifidus
longus capitis/colli
43
What aberrant movement pattern do you expect to see on hip extension test when a patient has a decreased limb posture during terminal stance gait?
```
anterior pelvic tilt
lumbar lordosis
ilipsosas
lumbar erector spinae
hyperactive erectors
knee flexion = hamstrings
```
44
What are the lateral line muscles?
```
peroneal muscles
anterior ligament of fibular head
ITB
TFL
Glut Max
Abdominal obliques
intercostals
splenius capitis
SCM
```
45
What are the spinal line muscles?
```
Splenius capitis/cervicis
rhomboids
serrates anterior
external oblique
linea alba
internal oblique
TFL
ITB
tibialis anterior
peroneous longus
biceps femoris
sacrotuberuous ligament
```
46
How do you test midsternal division of pec major?
the GH must be abducted to 90 degrees and externally rotated
47
How do you test the lower division of pec major?
the GH must be abducted to 150 degrees and externally rotated
48
What is anatomical overload?
tissue injury or overload complex (chronic)
49
What is clinical alteration?
acute injury
50
A patient with pronation distortion may need to do which exercise on a regular basis?
short foot/ foot crunches
51
What muscles are being tested in cranio-cervical test?
deep flexors:
recrus capitis anterior
rectus capitis lateralis
deep multifidus
52
What muscle is a huge knee stabilizer?
glut max
53
When doing the ankle dorsiflexion test, how far should the knee be able to clear the foot?
4-6 inches
54
What is an indicator of scar tissue around the anterior lateral portion of the ankle?
tightness of the gastrocs
55
What is one basic exercise to activate gluteus medius?
clamshells have patient open legs 4-6 inches laying on side
56
Name one low level neuro development exercise for glut medius, transverse abdominus, and closed shoulder kinetic chain.
Side plank from knees
57
One is one large muscle that is prone to tightness and what muscle test can be used?
psoas
| modified thomas test
58
What is triceps surae differentiation?
- Flex the patients knee while maintaining calcaneal distraction and dorsiflexion.
- Increase in dorflexion following knee flexion indicates tight gastrocnemius
- No increase in dorsiflexion following knee flexion indicates tight soleus
59
Weak muscles of upper cross syndrome:
deep flexor muscles
rhomboids
serratus anterior
60
Strong muscles of upper cross syndrome:
trapezius
levator scapula
tight pecs
61
Weak muscles of pronation/distortion syndrome:
```
posterior tibialis
anterior tibialis
VMO
biceps femoris
glut medius
```
62
Tight muscles of pronation/distortion syndrome:
```
peroneals
adductors
medial hamstrings
TFL/ITB
Psoas
```
63
Neuromuscular dysfunctions with pronation/distortion syndrome:
decreased pronation control of foot and ankle
decreased frontal and transverse plane control at knee
increased compensation in the LPHC
64
What is an essential function of locomotion?
balance
65
___________ was the first to suggest straining for peripheral sensory deficit following ____________.
Freeman; ankle sprains
66
What are the 3 Janda contributions to sensorimotor training?
-normalize peripheral proprioceptive structures - chiro adjustments/ joint soft tissue mobilization
-correct postural/muscular imbalance
-facilitate correct motor program
sensorimotor training
67
What are the two stages of motor learning according to Janda?
- voluntary control of movement
| - automatic control of movement
68
Voluntary control of movement requires:
(stage of motor learning Janda)
-cortical integration and patient concentration
-constant feedback from positive and negative experiences.
Feedback motor control
Inefficient for creating motor programs
69
What makes up automatic control of movement?
(stage of motor learning Janda)
- coordinated movement pattern programmed in subcortical region
- requires less conscious processing, therefor quicker
- feedforward motor control
- Essential to protect joints for dynamic functional stability.
70
What is essential to protect joints for dynamic functional stability?
automatic control of movement
71
What are indications for sensorimotor training?
post traumatic; postoperative
chronic neck, back pain
faulty posture especially w/ respiratory dysfunction
generally hyper mobility and/or instability
muscle imbalance
prevention of falls in seniors
maintenance of general fitness
72
What are key postural areas according to Janda?
```
-foot
cutaneous and intrinsic muscle
proprioceptive input
small (short) foot
-pelvis especially SI joint
proprioceptive input
neutral lumbopelvic position
-cervical spine
proprioceptive input
```
73
The small (short) foot movement:
patient draws metatarsal heads towards calcaneous thus raising medial longitudinal arch and "shortening foot" without flexing toes.
74
Progression in the small "short" foot:
tactile stimulation
passive remodeling NWB
active-assisted remodeling NWB
active-remodeling NWB - partial WB - WB
75
What is level 1 of the sensorimotor training?
static phase
76
What is the static phase of sensorimotor training?
maintain posture stability on progressively unstable surfaces.
77
What are some exercises for the static phase of sensorimotor training ?
single leg balance eyes open
single leg balance eyes closed
single leg balanced eo and ec on labile surfaces
balance board, wobble board, air-ex cushion, dynadisc, foam roller
78
What is a program design for static phase of sensorimotor training:
1-2 exercises
1-3 sets x 10-30 seconds or 10-20 repetitions
rest period 30 seconds
3-5 sessions/week
79
What is the level 2 dynamic phase of sensorimotor training?
add arm and leg movements while maintaining postural stability on progressively unstable surfaces.
80
What are exercises for the dynamic phase of sensorimotor training?
reaches on stable surface
| reaches on unstable surface
81
What is program design for dynamic phase of sensorimotor training?
1-2 exercises
2-3 sets x 10-12 repetitions
rest period 30 seconds
3-5 sessions a week
82
What is the level 3 functional phase of sensorimotor training?
perform functional movements on progressively unstable surfaces.
83
What are some exercises for level 3 functional sensorimotor training?
single leg squat
single leg deadlift
single leg resisted movements
balance sandal training
84
What is a program design for functional sensorimotor training?
1-2 exercises
2-3 sets x 10-12 repetitions
rest period 30 seconds
3-5 sessions/week
85
What is increased in clinical application of balance sandals?
- significant increases in gluteal activation and decreases in time to 75% MVC in 7 days.
- increased leg EMG activity particularly ankle everters and inverters in 11.6 - 14.9 weeks.
- improved medial-lateral postural stability in stable and unstable ankles after 8 weeks of functional balance training.
86
What is the initial stage in Janda balance sandal protocol?
stance training with support
| sandals in horizontal position
87
What is the second stage in Janda balance sandal protocol?
- walking with support
| - start with walking in place then progress to shoulder support only.
88
What is the third stage in Janda balance sandal protocol?
- short steps, a few meters forward and backward walking, sidestepping
- 1-2 minutes several times a day up to 15 minutes total.
89
What is the clinicians goal in active active care?
modify patient health behavior in direction of reactivation
90
What are the six things to help understand active care management?
- back pain traditionally viewed as acute, self limiting condition
- now recognized as involving frequent reoccurrences and/or chronic course
- many approaches for spine injury concerned only with diagnostic triage and pain management.
- pain relief modalities will always be accepted treatment
- patient education about about self-care through gradual reactivation rapidly gaining scientific traction.
- becoming standard of care for prevention of disability associated with spinal disorders.
91
What are the keys to active self-care?
reassurance and advice
cognitive behavioral approach
multidisciplinary biopsychosoicial approach
92
What are examples of reassurance and advice in active self-care?
- identify patient's concerns and goals
- reassurance regarding seriousness of condition
- specific reactivation advice
93
What are the key points in initial report of findings in reassurance and advice in active self-care?
- identify spine related worries and fears
- provide assurance that there is no serious disease
- explain that injuries and degeneration can be pain precipitators but likey pain perpetuators are controllable factors.
- provide specific activity modification and reactivation advice.
- pain relief options
- recovery expectations
94
What is the cognitive behavioral approach in active self-care?
more structured approach involving cognitive behavioral classes/sessions
- address patients worries and fears
- teach methods to reduce fear and apprehension
95
When is cognitive behavioral approach in active self-care more appropriate?
subacute patients at heightened risk for chronic pain
"yellow flag" patients
chronic pain patients
96
What is multidisciplinary biopsychosocial approach in active self-care?
comprehensive, multidisciplinary approach that combined CB model with strategies that address return to work obstacles.
- employer issues
- compensation issues
97
Multidisciplinary biophychosocial approach in active self-care may be appropriate for?
chronic patients if step 1 and step 2 are not successful
98
What is the patient centered approach in active self-care?
- patient is not a diagnosis or label
| - report of findings shifts model from biomedical/HCP-centered fix to biosocial/patient-centered cope and adapt model.
99
How to enhance patient motivation to resume activity in active self-care?
- collaboratively establish functional goals
- reassurance that the spine is not damaged
- education that gradual reactivation will enhance recovery whereas rest will inhibit recovery.
- consistant verbal and written messages
- make exercises simple enough to be performed at home without significant equipment needs.
- establish realistic expectations regarding possibility/probability of "flare-ups"
100
What are tips for enhancing patient compliance in active self-care?
- education that hurts does not necessarily equal harm.
- education that fitness is the key to prevention.
- make exercises simple enough to be performed at home without equipment needs.
- link exercises to specific functional goals.
- encourage patients to work at an exercise level that is somewhat hard for them.
- realistic expectations regarding possibility of "flare-ups"
101
What are neurodynamic sites of injury?
```
soft tissue, osseous, fibro-osseous tunnels
sites of nervous system branching
sites to relative fixation to interface
areas with high possibility of friction
tension points
```
102
What are the neurodynamic tensioners?
- neurodynamic test that increase tension in neural structures.
- relies on natural viscoelasticity of nervous system and does not exceed elastic limit.
- does not produce plastic reformation or damage.
103
What are the steps of the median nerve tension?
dorsiflexion of the wrist
extension of the elbow
abduction of the shoulder
104
What are the steps of ulnar nerve tension?
dorsiflexion of the wrist
position of maximal stress of ulnar nerve: elbow flexion
abduction of the shoulder
tilt head to contralateral side
105
What are the steps of radial nerve tension?
```
pronation of the radio-ulnar joint
volar flexion of the wrist
extension of the elbow
abduction of the shoulder
tilting of head to contralateral side
position of maximal stress of radial nerve (at thumb)
```
106
What are neurodynamic sliders?
- nerve flossing
- neurodynamic maneuver whose purpose is to produce a sliding movement of neural structures relative to their adjacent tissues.
- can be thought of as tensioners with one end on slack
107
Median nerve neurodynamic test:
1. patient's thumb and finger tips supported, plus some of the weight on examiner's thigh.
2. shoulder abduction to symptom onset, or tissue tightness, or approx. 100 degrees.
3. Wrist extension, make sure shoulder is stable
4. Wrist supination, make sure shoulder is stable
5. shoulder lateral rotation, to system onset or where the tissues are a little tighter.
6. elbow extension to symptom onset
7. neck lateral flexion away, making sure is is whole neck and not just cervical spine.
8. Neck lateral flexion towards. This should ease evoked symptoms.
108
Ulnar neve neurodynamic test:
1. starting position, with hand under patient's scapula depress shoulder girdle.
2. shoulder abduction
3. lateral rotation of shoulder
4. elbow flexion
5. wrist and finger extension
6. forearm pronation
109
Radial nerve neurodynamic test:
1. the patient lies with their shoulder just over the side of the bed. The therapist uses their thigh to carefully depress the shoulder girdle.
2. elbow extension
3. notice how the therapist has brought his left arm "around" to grasp the patient's wrist in order to medially rotate the whole arm.
4. whole arm medial (internal) rotation
5. wrist and thumb flexion can be added, leave fingers out because extensors will get to tight.
6. adding a few degrees of shoulder abduction will sensitive the test and elevation of shoulder girdle will provide structural differentiation.
110
Slump Test:
1. Patient sits erect
2. Patient slumps lumbar and thoracic spine while examiner holds head in neutral.
3. Patient flexes head and neck
4. Examiner carefully applies overpressure to cervical spine as patient extends knee
5. Patient dorsiflexes foot
6. Patient extends head and neck.
111
Femoral nerve neurodynamic test:
-Prone knee bend
-Slump knee bend:
for the left SKB-
-patient's left leg should be around 90 degrees
-get patient to hold right knee in some hip flexion then extend the hip.
-Use neck flexion/extension for structural differentiation.
-For heavy legs try with test leg downside
-Hip lateral and medial rotation can be added to test groin nerves such as illioinguinal and iliohypogastric
112
What nerves can be tested with the femoral nerve neurodynamic test when you add hip lateral and medial rotation to the leg?
ilioinguinal and iliohypogastric nerves.
113
How to perform obturator nerve neurodynamic test?
Use the same way you would test the femoral nerve with the addition of:
- abduct the hip
- this can be an assessment and treatment technique for neurogenic components to groin and medial knee pain.
- neck used for nerve differentiation
114
Peroneal nerve neurodynamic test:
Patient supine
1. foot held in plantar flexion/inversion
2. as the hip is flexed the dr. arm maintains knee extension
3. In a flexible patient the dr. puts the leg on the dr. shoulder and walks in.
115
Tibial nerve neurodynamic test:
Patient supine
1. foot is held in dorsiflexion/eversion/and pronation
2. Straight leg raise performed with the dr arm on the shaft of the tibia.
3. opposite leg can be flexed
Leg can be put on Dr. shoulder if flexible
116
Sural nerve neurodynamic test:
patient supine
1. the ankle is dorsiflexed and inverted and held firmly
2. Dr. forearm is on the tibia maintaining knee extension during SLR.
117
What are the muscles of the core?
lumbar spine muscles
abdominals
hip muscles
cervical spine muscles
118
What are the muscles of the transversospinalis group?
```
Rotators
Interspinalis
Semispinalis
Intertransversarii
Mutifidus
```
119
_______ has a poor mechanical advantage relative to movement production.
Transversospinalis group
120
Transversospinals group is made up of mostly _________ fibers.
primarily type I muscle fibers with high degree of muscle spindles 2-6x is normal.
121
Transversospinalis group is designed for ________ and _________.
stabilization
| proprioception
122
What is the transversospinalis primarily responsible for?
providing proprioreceptive information to the CNS
123
What are some of the functions of the transversospinalis group?
- segmental deceleration of flexion and rotation of spine during functional movements.
- inter-intra segmental stabilization
- dynamic stabilization
124
What may be the most important muscle of the transversospinalis and what does it do?
multifidus
| provides intersegmental stabilization in all positions
125
What are the erector spinae and what do they do?
thoracic longissimus and iliocostalis
-Long extension movement arm with minimal compression
-most efficient lumbar extensors
lumbar longisiumus and iliocostalis
-create posterior shear with lumbar flexion
126
What does quadrates lumborum do?
stabilizer in wide variety of tasks involving flexion, extension, and lateral bending.
127
What is the function of the abdominal musculaturei?
- operate as functional unit to help maintain optimal spinal kinematics.
- provide sagittal, frontal, and transverse plane stabilization by controlling forces reaching LPHC.
- enhances regional intersegmental stability
128
What is the bridge between upper and lower extremities?
lats
129
What makes of abdominal musculature?
rectus abdominus
external oblique
internal oblique
130
Where does the abdominal musculature attach?
posterior layer of thoracolumbar fascia
131
Contraction of _________ and _________ create traction and tension forces on TL fascia.
transverse abdominus and internal oblique
132
What is the function of transverse abdominus?
- provide dynamic stabilization against rotational and translational stress
- provide optimal neuromuscular control to entire LPHC
- contraction precedes activation of other abdominal muscles regardless of direction of reactive forces.
- important for dynamic stabilization during all trunk movements.
- active during all trunk movements like multifidus
133
What are the functions of the diaphragm?
- contributes to stability of lumbar spine during inspiration and expiration.
- involved in the control of postural stability during sudden voluntary movement of the limbs.
- cephalad inspiration position is inhibitory of normal function.
134
What are the posterior intersegmental muscles of cervical spine?
mutifidus
| subocciptals
135
What are the deep cervical flexors and what are their function?
longus captis
longus colli
-primary segmental stabilizer
-feedforward contraction with arm movements.
136
What are the lower cervical/upper thoracic extensors?
semispinalis cervicis
| longissimus cervicis
137
What are the scapular mobilizers and stabilizers?
upper, middle, and lower traps
levator scapula
pectoralis minor
serratus anterior
138
What are some of the injury mechanics in the lumbar spine?
- Too many repetitions of force and motion and/or prolonged postures/loads
- Cumulative loading (compression, shear or extensor moment)
- Axial torque with flexion or extension loading
- Cumulative exposure to unchanging work
139
Any abnormal loading conditions (including overload and immobilization can produce________________ and/or adaptable changes that may result in ____________.
tissue trauma
disc degeneration . Adverse
mechanical conditions can be due to external forces, or
may result from impaired neuromuscular control of the
paraspinal and abdominal muscles [emphasis added].
140
Adverse mechanical conditions can be due to external forces or may result from impaired neuromuscular control of the _______ and _______ muscles.
paraspinal
| abdominal
141
In 1999, ______ reviewed the basic science evidence and proposed that properly contracting muscles are the main _________ __________ for the joint, and that muscle dysfunction is the most important modifiable mediating factor for _______ ________.
Hurley
force absorber
primary OA
142
Ways to reduce tissue damage:
- Reduce peak and cumulative spinal compressive loads
- Reduce repeated spine motion to full flexion
- Reduce repeated full-range flexion to full-range extension
- Reduce peak and cumulative shear forces
- Reduce slips and falls
- Reduce length of time in prolonged sitting especially exposure to seated vibration
143
What is abdominal bracing?
_Abdominal bracing is the act of “stiffening” or “tightening” the muscles of the midsection, as if someone was about to strike you in the trunk
-Begin by contracting the muscles of the trunk in a hoop-like fashion without drawing the abdominal wall inward
The level of contraction should be low, about 10 % of maximum
-Continue to breathe while maintaining the abdominal brace
144
What are the best core exercises:
- Train core stabilizing musculature without focus on any 1 muscle
- Minimize shear and compression
- McGill’s hanging knee, superman, chair back extension
- Shown to train core stabilizing musculature with relatively low compressive loads (Kavcic et al 2004)
- Curl-up
- Side Bridge
- Birddog
145
What is the "hanging" knee up exercise?
- High level of rectus abdominis activation with posterior pelvic tilt
- High level of compression 3,300 N
146
What is the superman exercise?
- High compressive load (6000N)
- Extension load of posterior elements
- Potential damage to interspinous ligaments (McGill 1998)
147
What is Roman chair back extension?
- High compressive load (4000 N)
- Extension load of posterior elements
- Lumbar extensors not designed for powerful extension movements
148
What are corrective exercise training goals?
- Focus on postural control, muscle balance, pain reduction/centralization
- Train coordination and endurance with safe, low-load exercises
- Progress to complex activities and functional exercises once patient learns to move and position spine in fundamental ways
149
What is a good corrective training exercise program?
- Acute Variables
- 1-3 sets X 6-15 reps, up to 8 second holds (McGill et al 2000)
- Start with 1 set 6 reps
- Progress to 1 set 15 reps
- Further progress with reverse pyramid
- 2nd set 12 reps
- 3rd set 8 reps
- At least 1 session per day
- 5-7 sessions/week
- Duration 6 weeks-3 months
150
What are good corrective exercises:
```
cat-camel warmup
leg-loading with biofeedback device
dead bug progression
quadruped/birddog
side-lying bridge (beginner)
side-lying bridge (advanced)
rotation bridge
abdominal curl up
supine bridge
supine bridge progression
clamshell
cranio-cervical flexion (w/wo biofeedback device)
core exercise on labile surfaces
stability ball hamstring stretching/hip extension
stability ball hamstring double leg curl
stability ball hamstring single leg curl
stability ball bridge
stability ball abdominal curl up
```
151
What are functional exercise training goals?
-Core stability trained in exercises mimicking patients
ADLs
SRAs
DE
-Training with movements that are within patient’s functional range while being as functional as possible
-Progressions continue until patient’s functional range includes ADLs, SRAs, and DEs expected to be encountered
152
Functional exercise training program:
- Acute Variables
- 2-3 Exercises
- 2-3 sets X 10-12 reps
- Rest period ~ 45 sec
- 2-4 sessions/week
153
What are some performance exercises?
```
reach and pull
chops
lifts
pulldown
cable power-chops
cable power lifts
medicine ball power training
```
154
What are performance exercise training goals?
- High-level activities with narrow safety/stability margin
- Athletic activity performance enhancement and injury prevention
- Built on a foundation of conscious-kinesthetic awareness of appropriate motor control
155
Performance exercise training program:
- Acute Variables
- 2-3 Exercises
- 2-3 sets X 8-10 reps
- Rest period ~ 60 sec
- 2-3 sessions/week
156
Janda's Lower Crossed Syndrome
Tight: erector spinae and iliopsoas
Weak: abdominal and glute max
157
Janda's Upper Cross Syndrome
Tight: trapezius and levator scap and pectoralis
Weak: deep neck flexor, rhomboids, serratus anterior
158
LCS + UCS = Layer Syndrome
Hypertonic: trapezius, levator scap, thoracolumbar erector spinae, hamstrings
Hypotonic: lower stabilizers of scapula, lumboerector spinae, glute max
159
What are the symptoms with a over-pronated foot?
```
Ipsilateral genu valgus
Contralateral coxa varus
Ipsilateral low crest
Ipsilateral low shoulder
Ipsilateral lumbar scoliosis
Contralateral thoracic scoliosis
```
160
Lateral line muscles of myers myofascial meridian:
```
Peroneous muscles
Anterior ligament of fibular head
TFL
IT Band
Glut Max
Abdominal obliques
Intercostals
Splenus capitis
SCM
```
161
Spiral Line muscles of Myers myofascial meridian:
```
Splenius capitis
Splenius cervicis
Rhomboids
SA
External oblique
Abdominal apaneurosis
Internal oblique
TFL, IT Band
Anterior tibialis
Peroneous longus
Biceps femoris
ST Ligament
Erector spinae
```
