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PTA 218 Clinical App For PTA > Quiz 2 WH, LBP, & Posture > Flashcards

Quiz 2 WH, LBP, & Posture Flashcards

1
Q

Which trunk muscles are activated with posterior pelvic tilt?

A

Anterior trunk muscles (rectus abdominus)

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2
Q

With unilateral hip excursion test, identify 3 compensations and causes for each?

A
  1. Hips dropping on contralateral side (weak glute med)
  2. Poor lumbo-pelvic disassociation (weak TrA and Multifidus)
  3. Excessive rotation through the trunk with lateral excursion (weak QL, PM, internal/external obliques)
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3
Q

What is the first position the patient should use for TrA activation?

A

Quadruped (both K&C and Hanney)

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4
Q

What is the first position the patient should use for multifidus activation?

A

Prone

Quadruped (K&C)

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5
Q

What piece of equipment can you use to encourage TrA activation?

A

Blood pressure cuff - placed at the lumbar spine (must stay within +/-10mmHg

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6
Q

What are the three key muscle groups to improve core stability?

A
  1. Pelvic floor muscles
  2. TrA
  3. Multifidus
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7
Q

What are the verbal cues that help activate the pelvic floor muscles?

A
  • contract the mm as if cutting off the flow of urine
  • contract as if holding bad gas
  • contract as if placing firm pressure around a tampon
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8
Q

What are the verbal cues that help activate the TrA?

A
  • While maintaining your pelvic floor contraction, gently pull your belly button towards your spine (DO NOT suck in stomach)
  • Without tilting your pelvis, contract your pelvic floor and move away from my hand (hand is around belly button)
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9
Q

What are the verbal cues that help activate the Multifidus?

A

While contracting the PFM and TrA, swell your back muscles towards my thumb

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10
Q

What compensations do you watch for during PFM contraction?

A
  • squeeze buttocks together
  • adducting legs
  • posterior pelvic tilt
  • valsalva maneuver
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11
Q

What compensations do you watch for during TrA contraction?

A
  • posterior pelvic tilts
  • rectus abdominus contraction
  • sucking stomach in while deeply inhaling
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12
Q

What compensations do you watch for during Multifidus contraction?

A
  • Extending back
  • posterior pelvic tilt
  • valsalva maneuver
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13
Q

What is the recommended frequency of exercises for core training? Why?

A

5 mins
3-5x/day

For endurance. These muscles are postural muscles that are used every time we move

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14
Q

What are the 4 phases of exercise for Core stability?

A

Phase 1: core initiation - neuromuscular control of deep stability muscles

Phase 2: static core control - core control with movement of the extremities but no motion through the spine or core

Phase 3: dynamic core control - core control during movement of the core

Phase 4: reactive core control - core control reaction during unexpected environmental influences

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15
Q

Name 2 factors (from the clinical prediction rule for patients with LBP) that will benefit from manual therapy/manipulation?

A
  1. Duration of symptoms of less than 16 days

2. No symptoms of distal to knee

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16
Q

Which treatment is most indicated for acute LBP?

A

Manipulations (kamila)

Williams (kaitlin)

McKenzie (overall acute/subacute/chronic)

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17
Q

Which treatment is most indicated for subacute/chronic LBP?

A

Trunk coordination, strengthening, and endurance exercises

Directional preference (mckenzie and williams)

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18
Q

What are 3 key ideas in patient education for pelvic floor musculature? What is this meant to do for our pts?

A
  • The fibers create a figure 8
  • The fibers are sling/hammock like (sling moves up toward head)
  • A funnel configuration towards the Inferior outlet

Helps them conceptualize and isolate muscles

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19
Q

What is the prime mover of the pelvic floor? What are the parts grouped with it?

A 
Levator Ani
- Puborectalis (aids in rectum closure)
- Pubococcygeus
- Illiococcygeus
Coccygeus (flexes the coccyx)
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20
Q

A woman who is 20 weeks pregnant is in her _____ trimester.

What is its range?

A

2nd (13-26 weeks)

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21
Q

What are the small LE external rotators?

A
  • Obturator Internus/Externus

- Gemellus Inferior/Superior

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22
Q

What are 3 broad but shared characteristics that show pelvic floor dysfunction?

A
  • Prolapse
  • Urinary or Fecal Incontinence
  • Pain and hypertonic
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23
Q

What are 3 risk factors for pelvic floor pelvic dysfunction?

A
  • Childbirth (multiple births)
  • Smoking, chronic cough, chronic cough, constipation
  • Hysterectomy
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24
Q

Which treatment is most indicated for radicular pain?

A

Directional preference (Williams & Mckenzie)

Nerve glides

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25
Q

Which treatment is most effective for spinal stenosis?

A

Williams method

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26
Q

Are warm ups and cool downs good for LBP? What are the benefits of it?

A

Yes

  • decreased pain perception
  • increase functional status
  • decrease risk of associated co-morbidities (DM, HTN, CVD)
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27
Q

What patient education will benefit individuals with LBP?

A
  • promote education and understanding of their injury
  • encourage active involvement
  • positive instructions (more what you CAN do and less what you CANNOT do)
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28
Q

What patient education will delay recovery for individuals with LBP?

A
  • bedrest/immobility

- unnecessary, in-depth jargon

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29
Q

What muscles comprise the paraspinals vs the transversospinales?

A

Erector spinae and multifidus, respectfully

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30
Q

What characteristics of the multifidus are present in people with LBP?

A
  • decreased frequency

- decreased duration

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31
Q

What is the assumption made for asymptomatic patients with h/o LBP?

A

Decreased Multifidus recruitment; Timing and intensity of Multifidus were less

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32
Q

Which muscle is an important one joint hip extensor? In order from most to least activation, which activity does glute max have most activation?

A

Glute max

  1. Climbing
  2. Rising from seat
  3. Running
  4. Walking
  5. Quiet stance
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33
Q

Which exercise demands the most of the superior portion of the gluteus max?

A

Sidelying clams

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34
Q

Which exercise demands the most of the inferior portion of the gluteus max?

A

Unilateral bridge

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35
Q

During walking, the glutei _____ of the grounded limb abduct the pelvis, i.e., tilt it so that the swinging limb can clear the ground.

A

Medius

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36
Q

Which exercise recruit psoas major and quadratus lumborum the greatest?

A

Side bridge (QL) and elbow toe (PM)

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37
Q

What muscles are activated the most during side bridges?

A

Quadratus lumborum, glute med, and TrA

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38
Q

What limited ROM at the hip is a predictor of LBP?

A

Hip Flexion and Hip IR

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39
Q

What hip provocation tests are used to test for hip dysfunction?

A

Anterior hip impingement, FABER test, and log roll test

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40
Q

What are the weeks associated with Trimester changes?

A

1st: 12 weeks
2nd: 13-26 weeks
3rd: 27-42 weeks (uterus large)

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41
Q

Which trimester is the most challenging?

A

3rd Trimester

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42
Q

What is the most common complaint in the 3rd Trimester of pregnancy?

A

Low Back Pain

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43
Q

Where and what are some of most of the issues in the 3rd Trimester?

A

Below the trunk

  • LBP
  • Leg Edema
  • Constipation
  • Fatigue and SOB
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44
Q

What is considered full term for a pregnant individual?

A

38-42 weeks

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45
Q

By the 3rd Trimester, what is the amount of weight typically gained?

A

25-27 pounds

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46
Q

What could be one of the reasons for kidney enlarging during pregnancy?

A

Shared Filtration

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47
Q

The ureters become perpendicular as a physiological change in pregnancy. What are the side effects?

A
  • Increase UTI risk

- Increased Urgency to urinate

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48
Q

What are some musculoskeletal system changes during pregnancy?

A
  • Rib position (diaphragm elevation = 4cm)
  • Linea Alba put on stretch (abdominal muscles)
  • Joint Laxity via hormones ( decreased trunk support)
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49
Q

What is a thermoregulatory system change during pregnancy?

A

Increased metabolic weight in general (Weight gain)

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50
Q

What are some posture and balance changes during pregnancy?

A
  • Lumbar and Cervical lordosis increase
  • Internal Rotation and Scapular Retraction
  • Foward Head
  • Genuine Recurvatum
  • Wide BOS, external LE rotation
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51
Q

How does an increase in cervical and lumbar Lordosis present in a pregnant woman? What should be stretched and strengthened?

A 
Anterior Pelvic Tilt
- Stretched : Multifidus
- Strengthened : Pelvic Floor
Forward Head
- Stretched : Suboccipitals
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52
Q

What are the changes in posture that cause change in the center of gravity?

A
  • Lumbar/Cervical Lordosis (pelvic tilt/forward head)
  • IR and Scapular Protraction
  • Genu Recurvatum (hyperextension of knee)
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53
Q

What changes in pregnancy cause changes in balance?

A

Wide BOS (ER of LE)

Also, because of the enlargement of the breast and belly, COM is more anterior and superior

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54
Q

What small muscles are tight with a a Wide BOS?

A
  • Gluteus Minimus
  • Obterator Internus/Externus
  • Gemellus Inferior/Superior
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55
Q

The pelvic floor ligaments are less fibroelastic than most ligaments. T/F

A

False (more fibroelastic; weight causes stretch of these ligaments in pelvic area).

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56
Q

The uterosacral ligament is a round, broad ligament that attaches _____ of sacrum to _____ of uterus. The innervation to this level is _____.

A
  • Anterior; Posterior

- Sacral (S1-S2; Anal Sphincter. S2-S4; Uterus)

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57
Q

True or False: is it normal for the lumbar to be in lordosis?

A

True: there is a natural lordosis. Its only unnatural when there is excessive lordosis

58
Q

Where is the plumb line relative to ASIS? Knee? Ankle?

A
  • plumb line is posterior to ASIS
  • plumb line is anterior to mid joint of knee but posterior to patella
  • plumb line is anterior to ankle
59
Q

What movements does the Anterior longitudinal ligament limit?

A

Extension or excessive lordosis

60
Q

What movements does the Ligamentum flavum ligament limit?

A

Excessive flexion

61
Q

What deep muscles flex the head and neck?

A

Longus capitis, longus colli, and scalenes

62
Q

What deep muscles laterally flex the head and neck?

A

Scalenes(head and neck) and oblique capitis superior(only head)

63
Q

What deep muscles tilt head in extension?

A

Suboccipitals:
oblique capitis superior
oblique capitis inferior

64
Q

What are the objectives of patient treatment for spinal posture?

A
  1. Increase kinesthetic awareness
  2. Stretching to achieve neutral spine
  3. Strengthen core
65
Q

For proper sitting posture, why is it important for the knees to be slightly lower than the hips?

A
  • prevents posterior pelvic tilt

- prevents overpressure to ischial tuberosity

66
Q

For proper sitting posture, what happens when the armrest is too high? Too low?

A

Too high: overuse traps

Too low: wrist at short position, causing carpal tunnel

67
Q

True or false: during shoulder flexion, TrA is activated before anterior deltoids

A

True

68
Q

True or False: Flexion/Extension decreases in a cranial-to-caudal direction

A

False

Correct: Flexion/Extension INCREASES in a cranial-to-caudal direction

69
Q

True or False: distal mobility before proximal stability

A

False

Correct: proximal stability before distal mobility

70
Q

True or False: Patients with LBP cannot long sit

A

True

Because it can aggravate symptoms

71
Q

Restricted hip flexion would involve ______ lumbar flexion, based on the lumbo-pelvic rhythm.

A

Increased

72
Q

Restricted lumbar flexion would involve ______ hip flexion, based on the lumbo-pelvic rhythm.

A

Increased

73
Q

True or False: maintenance of lordosis is crucial in protecting the posterior elements during tasks such as lifting

A

True

74
Q

What is lumbo-pelvic dissociation?

A

Dissociation between hip and lumbar spine; lumbar spine maintains extension while the patient flexes hip

75
Q

True or False: During lumbo-pelvic extension (bent over to upright), the lumbar extensors are activated throughout the motion.

A

False

Correct: lumbar extensors do not start until the trunk is close to upright

76
Q

What muscles are most activated when sidestepping with the theraband at the toe?

A

Glutes

77
Q

What muscle is most activated when sidestepping with the theraband at the ankle?

A

Tensor fascia latae

78
Q

When sidestepping with a resistance band, which leg is working more?

A

The leg thats is on the ground and stable (the following leg)

79
Q

What is the number 1 risk factor for pelvic floor dysfunction?

A
  • Multiple Child Births
80
Q

What are symptoms of uterine prolapse?

A
  • Heaviness in abdomen
  • Falling Out
  • Lump coming down
  • symptoms worsening at end of day ( urgency/frequency, incomplete emptying, UTIs)
81
Q

What should be avoided with a pt prolapse during activity?

A

Valsalva Maneuver

82
Q

Surgery is often suggested for a uterine prolapse. T/F

A

False (unless older; 80’s-90s)

83
Q

What muscle groups are involved with a weak pelvic core?

A
  • Weak core

- Weak Pelvic floor

84
Q

What should be prevented besides the valsalva for a weakened pelvic floor or prolapse?

A
  • Prevent downward pressure
85
Q

What common activities create increased abdominal pressure?

A
  • Smoking
  • Coughing
  • Sneezing
  • Valsalva
  • Constipation
86
Q

What is the percentage of women who have had children with some degree of prolapse?

A

50%

87
Q

What can happen with weakness in the supporting structures of the pelvic floor?

A

Pelvic Organ Prolapse

88
Q

What is the best option for a person who can’t have surgery involving a uterine prolapse? What is it called?

A

Pessary (Gellhorn or Doughnut)

89
Q

What is the name of a prolapsed bladder?

A

Cystocele

90
Q

What is the name of a prolapsed rectum?

A

Rectocele

91
Q

A prolapse doesn’t have to be external and can put pressure on other areas. T/F

A

True (Can take up other organ area)

92
Q

What is a name of a prolapse of the small bowel?

A

Enterocele

93
Q

What is known as a growth adhesion with cellular activity in lesions, cyst, and nodules outside of the uterine cavity?

A

Endometriosis

94
Q

How is endometriosis treated?

A

Birth control (BCP)

95
Q

Endometriosis has an average age onset of ____ and is known to be a ________ diagnosis.

A

28; Younger

96
Q

What other less used treatment is utilized for endometriosis? What does it do?

A
  • LUNA (laparoscopic uterine nerve ablation)

- Decrease pain

97
Q

What organs can have prolapse?

A
  • Uterus
  • Bladder
  • Rectum
  • Small Bowel
98
Q

Verbal queuing with patient is the best education. T/F

A

False (Tactile education is also important)

99
Q

What are interventions used for impairment of the pelvic floor?

A
  • Patient education (teach 3 key visualizations with function; Provide instruction I performance)
  • Neuromuscular Re-Education (Facilitate Activation)
  • Exercise and Biofeedback
  • Manual Treatment and Modalities
100
Q

What are 4 characteristics of correct pelvic floor activity?

A
  • Ventral/Cranial perineum movement
  • Upward/Anterior together organ movement
  • Closing of the urethra, anus, and vagina
  • Inhibits Detrusor Activity*
101
Q

____ and below will have flaccid bladder and _____ and above will be at risk for Autonomic Dysreflexia.

A

T12; T6

102
Q

Smooth muscle of the bladder is termed?

A

Detrusor

103
Q

What is the triangular section on the internal bladder floor called (3 openings)? What are the 3 areas consist of?

A

Trigone

  • 2 ureters
  • Spinal innervation
  • Neck of bladder
104
Q

The detrusor ____ to store urine and ____ for urination.

A

Relaxes; Contracts

105
Q

How is the innervation of the bladder once full controlled? How does bladder stop from releasing urine?

A 
Stretch Receptors (send a spinal level reflex signal)
Brain (stops releasing)
106
Q

Which accessory muscles should NOT be used for the Levator Ani/Kegel Muscles? What does it’s small group do?

A
  • ER
  • Adductors
  • Growing when lifting elevator

Lift Abdominal Content

107
Q

What should be done and tried first in the pt education portion of pelvic floor awareness, training, and strengthening?

A
  • Empty Bladder

- Gravity Assisted/Eliminated position (Hips higher than heart)

108
Q

What should only initially be performed in the pt education portion of pelvic floor awareness or identification of muscles?
What is the que?

A
  • Contract Relax ( 3-5 Sec contract/3-5sec relax for 10min)

- “Act is if you are holding back urine or bad gas”

109
Q

What should be done in the pt education portion of pelvic floor awareness, training, and strengthening?

A
  • Contract relax (awareness)
  • Quick contractions (15-20 endurance; type 2 fibers)
  • Elevator Exercise (“visualize 3-5 level elevator”)
  • Pelvic floor relaxation (“return to basement”; correlation to facial muscles)
110
Q

For pelvic motion training in the dynamic trunk exercises clock method, what is the beginning position and what should be avoided?

A
  • Hooklying Supine (12-6 o’clock, 3-9 o’clock-clockwise)

- Excessive pelvic tilt

111
Q

When should trunk curl training in the dynamic trunk exercises not be performed?

A

If with Diastasis Recti

112
Q

What is ideal positioning and preparation for pelvic floor?

A
  • Gravity Assisted/Hooklying
  • Breathing
  • Pelvic tilt or Clock
113
Q

How many branches are involved in the Levator Ani?

A

4

114
Q

Sucking in the belly button is a good idea. T/F

A

False

115
Q

What is a pt education bladder training technique? What should we education out pt to avoid?

A
  • Timed Voiding (may use journal)
  • Avoid Irritants ( Coffee, Tea, Alcohol, non acidic raw fruits and vegetables)
  • Avoid Smoking ( Increases Intra Abdominal Pressure, Urinary tract symptoms in men, and Urinary urgency in women)
116
Q

What is at risk when having a Diastsis Recti?

A

Abdominal Hernia

117
Q

A Diastasis Recti is a separation of the Rectis abdominus ___ or greater due to weakening of the connective tissue in the ___ trimester.

A

2cm; 2nd/3rd (13-26/27-42 weeks)

118
Q

When treating Diastasis Recti the position should start in ______ with arms crossed. What safety should be taken into account if this condition is greater than 2 cm? What queuing should be given?

A

Hooklying Supine

  • Headlifts/Pelvic tilts for approximation (No crunches)
  • Verbal Cues (“breath through exercise”)
119
Q

What are two common issues due to physiological changes in pregnancy and post partum?

A
  • Joint Laxity (3-5 months; up to a year or so if breast feeding)
  • Nerve Compression Syndromes (Increased TOS/CTS)
120
Q

What exercise modifications should be used for pregnant women due to joints?

A
  • Swimming
  • Yoga
  • Elliptical
    (No impact sports for 3-5 months and longer if breastfeeding)
121
Q

What maternal responses do aerobic exercise cause during pregnancy?

A

⬆️ Blood to muscles
⬆️ Respiratory Rate
⬆️ Uterine contractions (risk preterm birth)
⬇️ Blood Sugar (hypoglycemia)
⬇️ Core Temperature during exercise (Healthy Response)

122
Q

What fetal responses do aerobic exercise cause during pregnancy?

A
  • HR Increases (Healthy)
123
Q

What recommendations can we give to the uncomplicated pregnancy before and after birth?

A

Mild to Moderate exercise for first week 15-30 min (most days)

  • Keep intensity low
  • Avoid contact sports
  • Nonweightbearing exercise
  • Balance change awareness
124
Q

What are contraindications to exercise in a pregnant pt?

A
  • DM 1
  • Placenta Privia
  • Preclampsia ⬆️BP
  • Vaginal bleeding
  • Rupture of membrane
125
Q

What are precaution to exercise in a pregnant pt?

A
  • Gestational Diabete
  • Sever Anemia
  • Extreme obesity/Eating disorders
  • Diastasis Recti
126
Q

For postural correction and strengthening what modifications to exercise are critical?

A
  • Standing push up
  • Supine bridging
  • Quadruped Leg Raise (modified)
  • Squatting (modified)
  • Scapular Retraction
127
Q

When doing a quadruped leg raise in a pregnant pt what modifications should be made? What about a modified squat?

A
  • Posterior pelvic tilt or knee/leg slide

- As far as comfort permits (60-90 sec progression in healthy)

128
Q

What does an SI Belt do?

A
  • Promotes Stability
  • ⬇️Back Pain
  • Proprioseption
129
Q

What are deemed unsafe postures and exercises during pregnancy?

A
  • Bilateral Straight Leg Raise (rictus strain)
  • Fire Hydrant (SI strain)(laxity)
  • Quadruped (no full hip extension/hyperextension)
  • Unilateral Weight Bearing-Activiies (hip carry post partum)
130
Q

What activities should we recommend in pt education for a woman with a C Cection?

A 
Exercises
- Breathing techniques 
- Pelvic floor use during milder to use Kah/ Coughing 
Interventions for Gas
Scare Mobilization
131
Q

What type of interventions can PT provide for pelvic floor?

A
  • Vaginal Weights
  • Biofeedback
  • General pelvic strengthening
  • Estim
  • HEP for PFM contractions
  • PT NOW: EBP
132
Q

What is a good visual input for watching introitus narrowing and perineum elevation?

A

Use of Mirror (Visual Input)

133
Q

Important pt education to remember is….

A
  • Manage fluid intake (bladder training)
  • Weight control (avoid pressure to PFM)
  • Relaxation (avoid pressure in intraabdominal; avoid valsalva)
134
Q

PFE Kegels have no consensus on amount of exercise for pelvic floor improvement. T/F

A

True

135
Q

PFE is an endurance activity. What are its sets, reps, and holds?

A

3 Sets, 20 Reps, 3 sec hold

136
Q

Cueing is different for women with the Levator Ani than men.T/F

A

False (cueing is the same)

137
Q

Incontinence in men with BPH can be treated with PFM strengthening. T/F ???

A

False (Urination better but challenging)???

138
Q

What are the zones of benign prostate hyperplasia?

A
  • Central BPH (grows inside out)

- Peripheral (usually site of cancer)

139
Q

Estim has been shown not to be anymore affective than pelvic core exercise. T/F

A

True

140
Q

What are the 3 ways urinary flow is impaired in men?

A
  • Strangulation of Urethra
  • Urinary Retention
  • Incomplete emptying
  • Over active Bladder Syndrome (involuntary urination with/without urge usually with frequency and nocturnal)

PTA 218 Clinical App For PTA (5 decks)

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