Midterm Info Flashcards by Erin Harting

Management of Whiplash- Associated Disorder Addressing Thoracic and Cervical Spine impairments: A case report (population, main purpose, highlights-2)*

Pop: A 34 year old female postal worker

Purpose: describe PT program addressing impairments of the thoracic and cervical spine in patient with whiplash injury from a MVA

Highlights:

no studies that show a definitive method of treating whiplash successfully
study suggests in some cases that addressing the thoracic spine first, then the cervical spine in whiplash cases with cervical pain might be a better strategy and result in better patient outcomes

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Whiplash article: Treatment progression (1st, 2nd visits)*

1st: Noticed increase in symptoms/ restriction at the T2 & T4 level with T4 being the most irritable
- treated with soft tissue mobilization to T4, manual joint mobilizations, given 2 home exercises

2nd: 3 days after the first, progress in pain & ROM seen
- treated with soft tissue and joint mobilizations to the t2 area, thoracic manipulation, Reviewed exercises and added one to home program

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Whiplash article: Treatment progression (3rd and 4th visit)*

3rd: 1 week later, continued to progress- returned to work
- soft tissue and joint mobilization and manipulation in upper thoracic spine/ lower cervical, contract-relax procedure to lower cervical spine (superior/ anterior & inferior/ posterior), reviewed and made corrections to HEP

4th: patient reports no pain, disability score of 0, able to return to work and recreational activities

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Whiplash article: patient reported almost complete resolution after _ sessions, in a period of _ weeks. Suggests segmental mobility impairments of the _ _ and _ _ should be assessed in patients with functional limitations associated with neck pain.*

Almost complete resolution after 2 sessions, in a period or 2 weeks.

Suggest mobility impairments of the upper thoracic AND cervical spine should be assessed

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RElationship b/w hip extension ROM and postural alignment: subjects? Purpose was to study the relationship b/w hip extension ROM and _ determinants of postural alignment. Name.*

25 healthy adult volunteers

Purpose: look at relationship between hip ROM and 3 determinants of postural aligment

Determinants: standing pelvic tilt, standing lumbar lordosis and abdominal muscle performance

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Results of study on relationship b/w hip extension ROM and postural alignment: Results indicate there _ relationship b/w variables. And that the current correlation among clinical measures _ _ _. Clinicians _ design treatment plans for stretching shortened hip flexors or strengthening weakened abdominals based on?*

There isn’t a relationship between variables

Current hypothetical correlation among these parameters should be reassessed

Clinicians shouldn’t design tx plans for stretching hip flexors or strengthening Ab’s based on visual inspection of postural alignment

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Effects of exercise on hip ROM, trunk muscle performance and Gait economy: subjects studied? Purposes were to examine effects of passive _ _ _ _ program on hip ROM. Examine the effects of _ _ _ on trunk flexor muscle performance. Examine effects of both on _ and _ _.*

Subjects: 25 healthy athletic male college students

Examined the effects of passive hip extension stretching exercises on hip ROM
examined effects of Trunk flexor exercise program on trunk flexor muscle performance
Examine effects of both on walking and running economy

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Results from effects of exercise on hip ROM, trunk muscle performance and gait economy: Passive hip stretching program? Trunk flexor exercises? Walking/ running economy?*

Passive hip stretching improved hip ROM

Trunk flexor exercises improved muscle performance

Did not produce significant changes in walking & running economy

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Effects of 2 stretching procedures on hip ROM and gait economy: purpose was to compare two commonly practiced stretching techniques to determine which _ _ _ for improving _ _ and to evaluate the effect of these techniques on? Subjects?*

Determine which is the most effective for improving hip ROM and to evaluate the effect of these techniques on gait economy

Subjects: 7 Asymptomatic males ages 18-22

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2 stretching procedures used in hip ROM/ gait economy study? Results?*

Midrange stretching procedures (STM and PNF) and end-range static stretching

Both techniques are equally effective at improving hip ROM, however 10 minutes of end-range static stretching was found to be the tx of choice for improving hip ROM AND reducing metabolic cost/ gait economy

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Passive v. Active stretching of hip flexor muscles in subjects with limited hip extension: purpose was to determine whether active or passive stretching? Subjects?*

Results in a difference between groups at improving hip extension ROM in patients with hip flexor tightness

Subjects: 33 patients with low back pain and LE injuries who showed a decrease in ROM

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Results of passive v. Active stretching of hip flexors in patients with limited hip extension: 2 methods are? Whether both improve flexibility of _ _ or whether _ _ improves the function of the _ _ is _ _.*

Two methods are equally effective for increasing hip ROM

Whether both improve flexibility of other muscle groups or whether active stretching improves the function of the antagonist muscle is not known

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Muscles and motor control in low back pain: low back pain is a _ _ and currently there _ _ _ of treatment that has _ and _ been able to _ or _ low back pain

Low back pain is a multi-factorial problems and currently there are is no regimen of treatment that has a singularly and successfully been able to prevent or manage low back pain

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No dispute about fundamental role of _ and _ _ in the normal function of the vertebral column

Pelvic and trunk musculature

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The effectiveness and rationales for many standard regimens of back exercises have been? May reflect? Also fail to acknowledge?

Standard regimens have been difficult to substantiate

May reflect problems encountered in testing the validity and efficacy of one treatment for back pain

Also fails to acknowledge interdependence of the CNS and musculoskeletal systems in normal and abnormal function

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Muscles can be a source of both _ and _ _. A _ _ as a defense reaction against _ and _, itself may be _ or be a source of _ _.

Muscles can be the source of local and referred pain

Muscle spasm as a defense reaction against pain and pathology may be itself Asymptomatic or be a source of muscle pain

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The _ or _ of muscles may vary in degree between subjects but rarely in? In general, muscles that are _ to _ are approximately _ _ than those prone to _.

The tightness or weakness may vary amongst subjects but it rarely varies in distribution (follows patterns of weakness/ tightness)

In general muscles that are prone to tightness are approx. 1/3 stronger than those prone to inhibition

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Adequate _ _, _ _ and _ _ of the _ _ has probably been underestimated in pathologies of lower back pain. More highly mechanized and sedentary lifestyles lead to a _ _ _ which in itself may decrease _ _ essential for good motor patterns

Adequate sensory input, proprioceptive control, and proper function of sensorimotor integration has probably been underestimated

More highly . . .lead to a reduction in the variety of movement, which in itself may decrease the proprioceptive stimulation essential for good motor patterns

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2 common syndromes associated with muscle imbalance

Pelvic Crossed syndrome

Layer syndrome

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Clinical experience has shown that attention should first be directed towards? Once their _ influence has been _, activity of _ or _ muscles should be? Finally attention must be directed toward gaining _ and then _ _ of good coordinated muscle activity and movement.

First directed towards gaining normal muscle length in muscles that are overactive or tight

Once their inhibitory influence has been remove need, activity of inhibited/ weak muscles should be actively facilitated

Finally, directed toward gaining voluntary and automatic control of good coordinated muscle activity and movment

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Common postural pattern

Kyphosis- Lordosis posture, flat back posture, sway back posture

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In general people tolerate _ forces more than _ forces.

Tolerate compressive forces more than shearing forces

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In PT_ _ _ are the biggest driver of what treatment is appropriate for the patient

Physical impairment findings

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The key to impairment based findings is to determine?

Physical impairment(s) that are most closely associated with the patients reported limitations and disability

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Restricted mobility, pain at end of range, and shortened muscle length are?

Indications for mobilization

Joint instability at the level of treatment, joint hypermobility, osteoporosis, inflammatory joint disease, metastatic bone disease and pregnancy are all?

Contraindications for mobilization

What are the 10 fundamentals of soft tissue techniques: 3 m's

Maintain alignment of COM over BOS Maintain mid-range position of joints Maintain alignment of segments

What are the 10 fundamentals of soft tissue techniques: U's

utilize appropriate velocity Utilize appropriate depth Utilize adequate base of support

What are the 10 fundamentals of soft tissue: 2 D's, and NP

Determine ROM limitation Determine tissue Hypomobility Position patient Neutral weight shift

If muscle is in a shortened position for a prolonged period of time you will see? If muscle has been lengthened/ stretched?

Shortened: decreased number of sarcomeres Lengthened: increased number of sarcomeres

In a lengthened position there is a _ overlap between actin and myosin. In a shortened position there is? Difficulty of each?

Lengthened: decreased overlap so it more difficult to contract Shortened: increased overlap so it is difficult to lengthen

Shortened muscles are tested by? Lengthened? Treatment

Shortened ROM/ Muscle length tests: stretch Lengthened ROM/ MMT: strengthen

Myofascial shortening is more pronounced in?

One joint muscles

Common postural pattern

Kyphosis- Lordosis posture, flat back posture, sway back posture

In general people tolerate _ forces more than _ forces.

Tolerate compressive forces more than shearing forces

In PT_ _ _ are the biggest driver of what treatment is appropriate for the patient

Physical impairment findings

The key to impairment based findings is to determine?

Physical impairment(s) that are most closely associated with the patients reported limitations and disability

Restricted mobility, pain at end of range, and shortened muscle length are?

Indications for mobilization

Joint instability at the level of treatment, joint hypermobility, osteoporosis, inflammatory joint disease, metastatic bone disease and pregnancy are all?

Contraindications for mobilization

What are the 10 fundamentals of soft tissue techniques: 3 m's

Maintain alignment of COM over BOS Maintain mid-range position of joints Maintain alignment of segments

What are the 10 fundamentals of soft tissue techniques: U's

utilize appropriate velocity Utilize appropriate depth Utilize adequate base of support

What are the 10 fundamentals of soft tissue: 2 D's, and NP

Determine ROM limitation Determine tissue Hypomobility Position patient Neutral weight shift

If muscle is in a shortened position for a prolonged period of time you will see? If muscle has been lengthened/ stretched?

Shortened: decreased number of sarcomeres Lengthened: increased number of sarcomeres

In a lengthened position there is a _ overlap between actin and myosin. In a shortened position there is? Difficulty of each?

Lengthened: decreased overlap so it more difficult to contract Shortened: increased overlap so it is difficult to lengthen

Shortened muscles are tested by? Lengthened? Treatment

Shortened ROM/ Muscle length tests: stretch Lengthened ROM/ MMT: strengthen

Myofascial shortening is more pronounced in?

One joint muscles

If a muscle is too lengthened/ hypermobile what treatment is best?

Strengthen in range

_ and _ affected side in stroke patients in addition to _ _ is important when treating

STRETCHING and MOBILIZING affected side in stroke patients in addition to NEURO COMPONENTS is important when treating

When assessing a patient you should check for _ _ and then look for?

Should check for ANY ABNORMALITY Then look for cross patterned tension or lengthening

A trigger point must have? (2)

Referred and localized pain

3 treatments to elongate muscle fibers?

Manual pressure Passive stretching Contract/ Relax

In a patient with shortened and contracted fibers, decreased range of motion and strength, and referred pain treatment should focus on: _ _ _, restoring _ _ (restarting _ _ uptake), and providing instruction to _ _.

Elongating muscle fibers Restoring optimal circulation (restarting Ca pump uptake) Providing instruction to prevent re-occurrence

What are 3 strategies that can be used to provide instruction on preventing re-occurrence of injury/ pain?

PEP - posture re-education - ergonomic set-up/ adjusting (computer, chair, etc) - proper body mechanics

Contraction of muscle fibers is due to? Similar to?

A decrease in Ca uptake, therefore muscle fibers do not release and they stay attached (actin/ myosin) Similar to rigor Mortis

What type of dysfunction more often results in surgery? Age range in which most back surgeries occur?

Hypermobility more often results in surgery Age range: mid 30's to early 40's

Any increase in pain with a SLR plus Dorsiflexion of the ankle will include?

Nerve involvement

Less then _ during a SLR is indicative of hamstring tightness?

60 degrees

Explaining _ and _ trends to patients may increase _ with treatment program

Explaining SURGICAL and FINANCIAL trending to patients may increase COMPLIANCE with treatment program

According to Godges article: In the rehab of patients with shoulder impairments regaining adequate _ _ _ is believed to be essential for restoring the ability to _ _.

Regaining adequate GLENOHUMERAL EXTERNAL ROTATION is believed to be essential for restoring the ability to REACH OVERHEAD.

Godges article: Common limiters of GH external rotation are the _ _ and the shoulder _ _, such as?

GLENOHUMERAL CAPSULE and the shoulder INTERNAL ROTATORS such as SUBSCAPULARIS

According to Godges article: _ _ _ deficits are responsible for GH ER limitations in the lower ranges of abduction. What is responsible in the higher ranges (90 degrees)?

SUBSCAPULARIS MUSCLE FLEXIBILITY deficits are responsible for limitations at lower ranges of abduction At higher ranges of abduction limitations are most likely due to CAPSULE RESTRICTONS

In Godges article: All subjects were limited in _ _ as well as _ _ when measured at _ degrees of abduction.

Limited in OVERHEAD REACH as well as GH ER when measured at 45 DEGREES of abduction

In Godges article: Immediately after the intervention the treatment group showed? (2)What was the intervention? (3)

A gain of 16.4 degrees of external rotation A Mean increase of 9.6 cm in overhead reach Intervention included: soft tissue mobilization of the subscapularis for 7 minutes 5 reps of contract relax to the Internal rotators PNF facilitation of F-AB-ER diagonal

According to Godges article: use of this treatment intervention may be useful in patients where traditional _ _ _ may cause discomfort, muscle guarding or are otherwise contraindicated.

Traditional END RANGE STRETCHING may cause. . .

Godges article: suggests that examining the amount of _ _ at _ of _ may be useful in guiding a clinicians plan of care for patients with shoulder disorders

Examining the Amount of GH ER at 45 DEGREES OF ABDUCTION may be useful . . .

In Ellison/ Rose article: Looked at _ _ _ in healthy subjects and those with low back pain. Divided into _ patterns, generally described?

Hip Rotation ROM in healthy vs. low back subjects Divided into 4 patterns: 1A: All ROM measurements were equal (within 10 degrees) 1B: Total ER and IR were equal but one or more of individual measurements were unequal 2: Total IR was greater than total ER 3: Total ER was greater than total IR

In Ellison/ Rose article: what pattern did the majority of patients with low back pain fall into? Healthy subjects? Which was the least frequently demonstrated pattern?

Low back pain: ER was greater than IR (pattern 3) Healthy: IR was greater than ER (pattern 2) Pattern 1B - total ER and IR were equal but one or more of the individual measurements were unequal

Ellison/ Rose article: results suggest and association between _ _ _ _ and the presence of low back pain. What could be causing?

Association between HIP ROTATION ROM IMBALANCE and the presence of back pain. May be caused by poor seating posture

Ellison/ Rose article: A pattern in which ER is greater than IR may predispose a person to _ _ or may be the result of _ _ or _.

May predispose a person to BACK PAIN, or may be the result of BACK PAIN, or BOTH.

Ellison/ Rose article: healthy subjects and patients which low back pain who participated in this study had _ _ than has been reported as _.

LESS ROM than has been reported as STANDARD (45 degrees)

Johnson article: Dental hygienist routinely maintain static postures for extended periods of time and as result often suffer from _ _ _ including _ _.

Often suffer from MULTIPLE MUSCULOSKELETAL DISORDERS including OVERUSE DISORDERS

Johnson article defines muscle performance was operationally defined as a combination of _ _ and _ _. Muscle balance definition?

Defined as a combination of MUSCLE STRENGTH and MUSCLE ENDURANCE Muscle balance: relationship between muscle strength and muscle flexibility

Purpose of Johnson study was to compare _ _ _ _ and _-_ _ between female dental hygienist and other females.

Compare UPPER QUARTER MUSCLE BALANCE and SELF-DISABILITY ASSESSMENT between . . .

In Johnson study muscle flexibility was measured by?(2) Self-disability assessment?

ROM using an inclinometer Muscle length testing Self disability: Northwick Park Neck Pain Questionnaire

In Johnson study: muscle flexibility was tested in which muscles? (7)

MRS PULL Middle traps, rhomboids, serratus anterior Pec minor, upper traps, lower traps, levator scapula

In Johnson article: Muscle performance (strength and endurance) was measure by recording time, in seconds that a subject could?

Could hold specific static exercise positions

In Johnson article: significant differences in muscle flexibility were found with which 3 muscles on non-dominant side? Muscle length on dominant side that was affected?

Non dominant/ flexibility: PUL -Pec minor, upper traps, levator scapula Muscle length/ dominant: Lower fibers of pec minor

In Johnson article: significant differences in _ _ were not found between hygienist and non-hygienists, however they were found between?

Significant differences in MUSCLE PERFORMANCE were not found between hygienist and non-hygienist However they WERE found between hygienist that worked 4 or more days per week compared to those that worked less than four days per week

In Johnson article: significant differences were found between two groups in _ of _ sections of the NPNPQ.

5 of the 9 sections of the NPNPQ

In Johnson article: What section of the NPNPQ found a significant difference in hygienist that worked 4 or more days vs. those that worked less than 4 days per week

Pain intensity while sleeping

In Johnson article: results suggest that dental hygienist are prone to _ _ of the _ _ and _ _ on the non-dominant side. Why?

Prone to DEVELOP TIGHTNESS of the UPPER TRAPS and LEVATOR SCAPULA of the non dominant side Because the non-dominant side is frequently maintained in static positions that elevate the scapula

In Johnson article: it is the primary authors opinion that education relative to _ _ of _ _ _ _ should be part of the hygiene curriculum to help _ _ _ _ associated with the practice of dental hygiene.

Education relative to PREVENTATIVE MAINTENANCE of UPPER QUARTER MUSCLE BALANCE should be part of the hygiene curriculum to help MINIMIZE MUSCULOSKELETAL HEALTH RISKS associated with the. . . .

Godges article on Elderly woman with SI pain: patient complained of constant _ _ _ of varying intensity over the left _, _, _ and _ _, that awoke her _ to _ times nightly following a tripping incident at the mall.

Complained of constant UNILATERAL PAIN of varying intensity over the left BUTTOCK, HIP, GROIN, and UPPER THIGH, that awoke her 2 to 3 times nightly . . .

In Godges study: found elderly patient had dysfunctions including _ _ _ limitations, positional _ _, _ _ _ tenderness with palpation and limitations in _ and _ _ _.

INOMINATE ACTIVE MOBILITY limitations, positional INOMINATE ASSYMETRY, SI LIGAMENT tenderness with palpation and limitations in ER AND IR HIP ROTATION ROM.

In Godges study: how many sessions did it take to resolve the patients pain? Treatment included _ _ _, bilateral _ _ of the hip adductors, _ _ procedure using simultaneous contraction of the hip flexors on left and hip extensors on right and the illiacus and she was given?

4 sessions to resolve pain Treatment included INFERIOR GLIDE MANIPULATIONS, bilateral ISOMETRIC CONTRACTION of the hip adductors, ISOMETRIC MANIPULATION PROCEDURES . . . And she was given a HEP that included exercises and stretching

Midterm Info Flashcards

(85 cards)