Oral Practical

Question 1

foam roller for thoracic extension

Answer 1

1. client should be in a position where they can comfortably shift from a sitting position to a lying position, place foam roller perpendicular to their spine behind them as they sit with knees bent
2. client will hug their shoulders and lean back over the foam roller, using their heels to push the roller to the part of the spine they wish to extend
3. to progress, client can hold their arms up overhead

Question 2

cow for spinal extension

Answer 2

1. modified cow; sitting up tall with arms crossed, hands on shoulders, lift head and upper spine up through the elbows, keeping lower spine tall to get thoracic extension
2. cow; hands and knees stacked below shoulders and hips, bring stomach towards the group while retracting shoulders and extending the neck

Question 3

cobra for spinal extension

Answer 3

1. low cobra: lying prone on the ground, elbows bent and tucked by sides in push up pos, lift only chest above the ground while neck extends to emphasize thoracic
2. high cobra: like low cobra but lift stomach and chest off the ground with elbows fully extended to emphasize lumbar

Question 4

cat for spinal flexion

Answer 4

1. modified cat; can use if have knee inj, sitting tall hugging shoulders and lean forward bringing shoulders into abdomen without flexing the hip
2. cat; on hands and knees, bringing chest towards the celing with some shoulder protraction

Question 5

child’s pose for spinal flexion

Answer 5

1. sitting on heels, knees pointed forwards, slide hands as far away from body as possible as you press chest to ground
2. for those with lower extremity pathology, hip flexion may be limited, therefore point knees outwards for greater lumbar flexion

Question 6

spine rotation

Answer 6

1. seated spinal twist, sitting upright, hugging self, rotate through the spine without moving hips; progress by sitting with one knee up, opp hand holding ankle of bent knee and twist spine towards bent knee without twisting hips
2. modified archer; lying on side, stack legs together arms out to side, arm on top will cross chest to open up the spine as neck rotates to follow it
3. archer; lying on side, opp side knee bent, same side straight, same side arm holding bent knee, other arm cross chest to open up the spine as neck rotates to follow it

Question 7

spine lat flexion

Answer 7

1. seated lat flexion; sit up with one arm raised, other holds opp ribcage to prevent flare, use overhead arm as guide to bring ear to hip
2. lat flexion lunge; in lunge postition, lat flex towards back knee
3. banana stretch; lying supine, optional cross legs, arms overhead, bend arms towards one side as legs follow to open up opposite side, lifting ribcage away from iliac crest

Question 8

cervical lat flexion

Answer 8

1. independent; sit on one hand and bend neck towards opp side, use other hand to help pull ear towards shoulder
2. therapist assisted; client lying supine, one hand on client’s occipital bone, other on their shoulder, gently flex neck towards other side until they feel stretch
3. watch for dizziness or headache

Question 9

dead bug variations

Answer 9

1. used train abdominal brace (abdominal strength and stabilty); start by lying supine and bracing core by making sure low back is pressed into ground, begin with shoulders, knees and hips flexed 90 deg, start with single limb extension with heel taps
2. progression into single limb heel slide > opposite leg and arm > same leg and arm > both legs and arms

Question 10

chin tuck variations

Answer 10

1. trains upper cervical flexion and lower cervical extension; sit with spine straight, can use a dowel at sacrum, upper thoracic spine, and back of skull to maintain straight spine, make double chin
2. to regress do this supine, to progress do this in table top pos (hands and knees)

Question 11

tall sitting

Answer 11

1. train anti-flexion abdominal extensors; sit on chair, can use dowel for guidance, chin tucked, sternum lifted up, keep ribs tucked, and shoulders relaxed
2. progression: criss crossed legs on the ground > legs straight on the ground

Question 12

bird dog variations

Answer 12

1. train anti-flexion and anti-rotation; start braced in table top postion, can use dowel for guidance, start with single limb
2. progression: opp leg and arm > feet up opp leg and arm > same side leg and arm > feet up same side leg and arm

Question 13

front plank variations

Answer 13

1. abdominal strength; high plank on knees; bear plank is adj to plank; start in tabletop position, protract shoulders and lift knees up with toes to hover, can use dowel for guidance; progression by incorporating movement (bear crawl)
2. progression: low plank on knees > incline high or low incline planks, the greater the incline, the easier > full high plank > full forearm plank

Question 14

side plank variations

Answer 14

1. train anti-lat flexion; side lying start with arm outstretched in high plank with legs stacked togther with knees bent, lifting the hips and thighs off the ground with knees as support; watch for rotation, maintain body in one plane
2. progression: low plank with legs stacked > high plank with legs extended, one foot in front of the other > high plank with extended stacked legs > low plank with extended legs

Question 15

static stretch and SMR for pec major and minor

Answer 15

1. target to increase abduction, extension, external rotation, and retraction for posture
2. SS: wall or corner stretch, assisted executive in sitting or supine hands behind head and therapist can gently pull arms back, foam roller lean back supine with roller along length of spine, hands behind head and lean back to stretch; stretching pec can put GH joint in vulnerable position if anteriorly unstable so consider keeping arm in a lowered position
3. SMR: foam roller on floor at 45 deg to midline to roll along fibres or across ball on wall, only use if client is comfortable

Question 16

static stretch and SMR for lats

Answer 16

1. target to increase abduction, ext rotation, and flexion; big muscle also controlling lumbar spine and pelvis
2. SS: chair or wall lat stretch or elevated prayer, thumbs up and sink down by hinging at the hips; modify child’s pose by adding lat flexion by walking hands out to one side, top hand with palm up to int rot and push hip to opp side to open lats
3. SMR: foam roller in side lying, top leg over bottom to drive, thumb up int rot to activate lat

Question 17

static stretch and SMR for long head biceps

Answer 17

1. target to increase shoulder extension and lengthen tendinopathy
2. SS: scootch stretch on floor, lift sternum, ext rot GH with finger pointing post, slide hips forward along floor to deepen stretch

Question 18

static stretch and SMR for post GH capsule

Answer 18

1. target to increase space posteriorly to allow for anteriorly translated humerus to be centered; anchor the scapula to min its motion and max motion of humerus
2. SS: modified sleeper bypasses impingement pos that non-mod puts shoulder into; (mod) cross-body stretch cross flex at GH joint only, no protraction to open post GH
3. SMR: lacrosse or golf ball on wall to open infraspinatus and teres minor, can do with modified crossbody for greater release of retractors when cross body when stretch is not enough

Question 19

dowel shoudler ROM

Answer 19

1. use opp arm to take inj arm through ROM, starting small, progressing through ROM without pain
2. supine or upright, look for compensation using spinal movement
3. flexion, extension, abd: inj arm with palm on the end of the dowel, hold the other hand in middle of dowel
4. ext rot: use dowel to push into ext rot, can progress to active using 90 deg and
5. int rot: push arm without dowel

Question 20

GH rotators resistance

Answer 20

check shoulder instabilty first
1. body pos (supine, side lying, seated) determines how hard due to gravity
2. progress with increasing GH control, start at side 0 deg to 45 deg to 90 deg
3. progress with resistance bands/cable

Question 21

retraction resistance

Answer 21

stay neutral through spine, watch for rotation of spine when doing single arm
1. W postiion with 45 deg of abd with thumbs facing post, squeese shoulder blades together to target rhomboid with a bit of sup rot
2. T position with 90 deg and with thumbs forward to prevent impingement, targeting mid traps
3. progress with prone and resistance bands

Question 22

scaption resistance

Answer 22

1. emphasis on suprapsinatus by abducting along plane of scapula (30-40 deg cross flex) with thumb up (full can), stop at 90 deg abduction since supraspinatus loses traction with after
2. can progress with res bands, stepping on band in half kneel with same side foot

Question 23

scapular tilt/sup rot resistance

Answer 23

watch for compensation with thoracic extension and elevation of shoulder
1. Y position with 120-150 deg abd, thumbs post to emphasize post tilt and retraction while in sup rot, challenge serratus ant and lower traps upright progress to prone and resistance
2. forearm wall slides facing wall with ulnar sides of forearms against wall and lean into wall, ext elbows, for sup rot and post tilt through flexion into full Y pos to challenge serratus ant
3. wall angels with head, thoracic spine, and sacrum flush with wall in partial squat, elbows at 90 deg flex, GH abduction 45-60 deg, bring arms back into wall, retract scapulae and sup rot, stopping where shoulder begins elevation; progress with more up right, flush, and sup rot

Question 24

shoudler press

Answer 24

superior rotation resistance, seated, half kneeling, look for thoracic ext
1. flexion: starting with 90 deg elbow flexion and fully extend while flex shoulder
2. abduct: starting with 90 deg elbow flexion and fully extend while flex shoulder
2. progress with greater ROM and resistance band/cable, weight

Question 25

neuromuscular skills: shoulder

Answer 25

challenge the proprioception and neuromuscular connection for stability, stable/unstable surface, eyes open/closed, noise, other task req concentration, neck rotation 1. four point kneeling on foam, add shoulder taps 2. tripod hold with target arm on ground 3. shoulder taps with full plank

Question 26

SMR for anterior thigh

Answer 26

rolling both or one quads: place foam roller under the quads in a semi-prone position, use hands to walk forward and back to roll the thigh, can add active knee flexion for greater concentration on one spot

Question 27

SMR for lateral thigh

Answer 27

1. rolling lateral thigh (ITB/VL): roller under lateral thigh, cross top leg over other leg and use foot to drive the roller up and down the thigh 2. rolling TFL: is small, use ball on wall to roll behind ASIS

Question 28

SMR and stretching for plantarflexors

Answer 28

1. standing heel press: split stance and press heel into ground into dorsiflexion 2. calf wall stretch: put toe on the wall and lean into wall, best done on a corner 3. rolling both sitting with legs out, foam roller under calves, drive forwards and backwards with arms, to roll one cross over one ankle over the other to put more pressure, rotate tibia to target specific spot

Question 29

lunge stretch

Answer 29

1. stretch the hip flexors by going into lunge position, drive knee forward, for greater stretch lift sternum up and arms overhead and contract the glutes 2. progress with couch stretch (elevate posterior leg for greater hip extension 3. stretch the knee extensors by bring heel of back foot to butt in quad stretch 4. watch for compensation with trunk extension and anterior pelvic tilt

Question 30

SMR and stretching for posterior thigh

Answer 30

1. SLR: sit with straight, with band over midfoot, lie down and use the band to pull foot to head with the leg extended; progress with active hip flexion; can bias biceps fem with tibial int rot and hip adduction, bias semimembranosus and semitendinosus with tibial ext rot and hip abduction; watch for compensation with knee flex and pelvic post tilt 2. pyramid stance: legs extended, shoulder width apart in split stance, hinge at the hips to stretch the hamstring, support with block and progress with lower block, more challenging since req good balance 3. SMR hamstrings: both or one at a time with ankle crossed

Question 31

pretzel/figure four/piriformis stretch

Answer 31

1. seated: deep gluteal stretch, cross ankle over knee, using hand to support the crossed knee, hinge at the hips 2. lying: progression, cross ankle over knee, using hand to support the crossed knee, pull non-crossed leg towards torso, progress with active hip flexion

Question 32

adductor rockback + gate stretch

Answer 32

1. table top pos, extend one leg laterally, rocking butt to heel to stretch adductors 2. point heel up to ceiling to target more hamstrings 3. gate stretch: add lateral flexion of spine towards ext leg to deepen adductor stretch

Question 33

resistance: non-weight bearing knee extension

Answer 33

1. short arc quadriceps/quad setting: lie supine with foam roller or towel above the knee, push hamstring into roller to extend the knee, higher up the hamstring the greater knee ext ROM, if can lift the leg then they can work through greater ROM or hold ISO at terminal knee extension 2. terminal knee extension with band: loop band around pole, foot in the band, step back in split stance with foot with the band behind, only toe in contact with floor, extend knee and drive heel into ground; progress with heavier bands, once able to use heavy band can progress to weight bearing, watch for compensation through heel lifting

Question 34

resistance: weight bearing knee extension

Answer 34

for squats check the working depth since deep knee flexion may be irritating to post horn mensicus and PCL while patella will come into contact with the femur at different points in ROM 1. BW squat: start with box squats for ECC motion, progress with lower box and load 2. split squat: to address asymmetries, progress from BW squat with hip ext, progress using active lunges to train ECC 3. step up/down, progressing from split squat, req good balance and train unilateral strength with abductor activation, high load on the anterior knee, and req DF ROM, modify height of step

Question 35

resistance: hamstrings

Answer 35

prone hamstring curl: start unweighted, progress with bands, ankle strap, and machine

Question 36

resistance: hip extension

Answer 36

1. glute bridging: supine with 20 deg GH abduction to plant elbows for support, ankles stacked under knees, push through heels to drive the hip up, progress by slightly ext one leg to load the other, single leg only with ankle stacked under knees, single leg only with slight extension; progress with elevation of one end of base to increase working ROM or with load 2. hip hinging: can use dowel to guide, against the wall, take one step off the wall, slight bend in knee, keeping spine straight, hinge at hips to roll the dowel down the thigh and bring butt to wall or use dowel as guide for spinal neutrality by putting it behind back, hinging at the hips 3. romanian deadlift variations: single leg supported by wall or kickstand, double, and single leg unsupported, progress with load

Question 37

resistance: hip ext rot and hip abduction

Answer 37

1. clamshells: target glute max, side lying, arm out for support, ankles, knees, and hip stacked, pivot off the ankle, small ROM, watch for compensation by rotation of the torso or hip, progress with res band above knee 2. side leg raise: side lying, target glute med, ankle, knees, and hips stacked, abduct leg in small ROM, preventing hip motion 3. pelvic drop and hike: done on a step or box, more functional glute med exercise: drop the pelvis to lower the heel to the ground, keeping other leg on step straight, use pelvic tilt to bring pelvis back to neutral 4. curtsy squat: puts ECC emphasis of abductor and quads of front leg, not very functional but good challenge

Question 38

balance: lower body

Answer 38

1. vary the width of the base of support 2. single or double leg, unstable/stable surface, head rotation, and modifying visual input 3. progress with weight bearing