Quiz 2 WH, LBP, & Posture Flashcards
(140 cards)
1
Q
Which trunk muscles are activated with posterior pelvic tilt?
A
Anterior trunk muscles (rectus abdominus)
2
Q
With unilateral hip excursion test, identify 3 compensations and causes for each?
A
- Hips dropping on contralateral side (weak glute med)
- Poor lumbo-pelvic disassociation (weak TrA and Multifidus)
- Excessive rotation through the trunk with lateral excursion (weak QL, PM, internal/external obliques)
3
Q
What is the first position the patient should use for TrA activation?
A
Quadruped (both K&C and Hanney)
4
Q
What is the first position the patient should use for multifidus activation?
A
Prone
Quadruped (K&C)
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
6
Q
What are the three key muscle groups to improve core stability?
A
- Pelvic floor muscles
- TrA
- Multifidus
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
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)
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
10
Q
What compensations do you watch for during PFM contraction?
A
- squeeze buttocks together
- adducting legs
- posterior pelvic tilt
- valsalva maneuver
11
Q
What compensations do you watch for during TrA contraction?
A
- posterior pelvic tilts
- rectus abdominus contraction
- sucking stomach in while deeply inhaling
12
Q
What compensations do you watch for during Multifidus contraction?
A
- Extending back
- posterior pelvic tilt
- valsalva maneuver
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
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
15
Q
Name 2 factors (from the clinical prediction rule for patients with LBP) that will benefit from manual therapy/manipulation?
A
- Duration of symptoms of less than 16 days
2. No symptoms of distal to knee
16
Q
Which treatment is most indicated for acute LBP?
A
Manipulations (kamila)
Williams (kaitlin)
McKenzie (overall acute/subacute/chronic)
17
Q
Which treatment is most indicated for subacute/chronic LBP?
A
Trunk coordination, strengthening, and endurance exercises
Directional preference (mckenzie and williams)
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
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)
20
Q
A woman who is 20 weeks pregnant is in her _____ trimester.
What is its range?
A
2nd (13-26 weeks)
21
Q
What are the small LE external rotators?
A
- Obturator Internus/Externus
- Gemellus Inferior/Superior
22
Q
What are 3 broad but shared characteristics that show pelvic floor dysfunction?
A
- Prolapse
- Urinary or Fecal Incontinence
- Pain and hypertonic
23
Q
What are 3 risk factors for pelvic floor pelvic dysfunction?
A
- Childbirth (multiple births)
- Smoking, chronic cough, chronic cough, constipation
- Hysterectomy
24
Q
Which treatment is most indicated for radicular pain?
A
Directional preference (Williams & Mckenzie)
Nerve glides
25
Which treatment is most effective for spinal stenosis?
Williams method
26
Are warm ups and cool downs good for LBP? What are the benefits of it?
Yes
- decreased pain perception
- increase functional status
- decrease risk of associated co-morbidities (DM, HTN, CVD)
27
What patient education will benefit individuals with LBP?
- promote education and understanding of their injury
- encourage active involvement
- positive instructions (more what you CAN do and less what you CANNOT do)
28
What patient education will delay recovery for individuals with LBP?
- bedrest/immobility
| - unnecessary, in-depth jargon
29
What muscles comprise the paraspinals vs the transversospinales?
Erector spinae and multifidus, respectfully
30
What characteristics of the multifidus are present in people with LBP?
- decreased frequency
| - decreased duration
31
What is the assumption made for asymptomatic patients with h/o LBP?
Decreased Multifidus recruitment; Timing and intensity of Multifidus were less
32
Which muscle is an important one joint hip extensor? In order from most to least activation, which activity does glute max have most activation?
Glute max
1. Climbing
2. Rising from seat
3. Running
4. Walking
5. Quiet stance
33
Which exercise demands the most of the superior portion of the gluteus max?
Sidelying clams
34
Which exercise demands the most of the inferior portion of the gluteus max?
Unilateral bridge
35
During walking, the glutei _____ of the grounded limb abduct the pelvis, i.e., tilt it so that the swinging limb can clear the ground.
Medius
36
Which exercise recruit psoas major and quadratus lumborum the greatest?
Side bridge (QL) and elbow toe (PM)
37
What muscles are activated the most during side bridges?
Quadratus lumborum, glute med, and TrA
38
What limited ROM at the hip is a predictor of LBP?
Hip Flexion and Hip IR
39
What hip provocation tests are used to test for hip dysfunction?
Anterior hip impingement, FABER test, and log roll test
40
What are the weeks associated with Trimester changes?
1st: 12 weeks
2nd: 13-26 weeks
3rd: 27-42 weeks (uterus large)
41
Which trimester is the most challenging?
3rd Trimester
42
What is the most common complaint in the 3rd Trimester of pregnancy?
Low Back Pain
43
Where and what are some of most of the issues in the 3rd Trimester?
Below the trunk
- LBP
- Leg Edema
- Constipation
- Fatigue and SOB
44
What is considered full term for a pregnant individual?
38-42 weeks
45
By the 3rd Trimester, what is the amount of weight typically gained?
25-27 pounds
46
What could be one of the reasons for kidney enlarging during pregnancy?
Shared Filtration
47
The ureters become perpendicular as a physiological change in pregnancy. What are the side effects?
- Increase UTI risk
| - Increased Urgency to urinate
48
What are some musculoskeletal system changes during pregnancy?
- Rib position (diaphragm elevation = 4cm)
- Linea Alba put on stretch (abdominal muscles)
- Joint Laxity via hormones ( decreased trunk support)
49
What is a thermoregulatory system change during pregnancy?
Increased metabolic weight in general (Weight gain)
50
What are some posture and balance changes during pregnancy?
- Lumbar and Cervical lordosis increase
- Internal Rotation and Scapular Retraction
- Foward Head
- Genuine Recurvatum
- Wide BOS, external LE rotation
51
How does an increase in cervical and lumbar Lordosis present in a pregnant woman? What should be stretched and strengthened?
```
Anterior Pelvic Tilt
- Stretched : Multifidus
- Strengthened : Pelvic Floor
Forward Head
- Stretched : Suboccipitals
```
52
What are the changes in posture that cause change in the center of gravity?
- Lumbar/Cervical Lordosis (pelvic tilt/forward head)
- IR and Scapular Protraction
- Genu Recurvatum (hyperextension of knee)
53
What changes in pregnancy cause changes in balance?
Wide BOS (ER of LE)
Also, because of the enlargement of the breast and belly, COM is more anterior and superior
54
What small muscles are tight with a a Wide BOS?
- Gluteus Minimus
- Obterator Internus/Externus
- Gemellus Inferior/Superior
55
The pelvic floor ligaments are less fibroelastic than most ligaments. T/F
False (more fibroelastic; weight causes stretch of these ligaments in pelvic area).
56
The uterosacral ligament is a round, broad ligament that attaches _____ of sacrum to _____ of uterus. The innervation to this level is _____.
- Anterior; Posterior
| - Sacral (S1-S2; Anal Sphincter. S2-S4; Uterus)
57
True or False: is it normal for the lumbar to be in lordosis?
True: there is a natural lordosis. Its only unnatural when there is excessive lordosis
58
Where is the plumb line relative to ASIS? Knee? Ankle?
- 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
What movements does the Anterior longitudinal ligament limit?
Extension or excessive lordosis
60
What movements does the Ligamentum flavum ligament limit?
Excessive flexion
61
What deep muscles flex the head and neck?
Longus capitis, longus colli, and scalenes
62
What deep muscles laterally flex the head and neck?
Scalenes(head and neck) and oblique capitis superior(only head)
63
What deep muscles tilt head in extension?
Suboccipitals:
oblique capitis superior
oblique capitis inferior
64
What are the objectives of patient treatment for spinal posture?
1. Increase kinesthetic awareness
2. Stretching to achieve neutral spine
3. Strengthen core
65
For proper sitting posture, why is it important for the knees to be slightly lower than the hips?
- prevents posterior pelvic tilt
| - prevents overpressure to ischial tuberosity
66
For proper sitting posture, what happens when the armrest is too high? Too low?
Too high: overuse traps
| Too low: wrist at short position, causing carpal tunnel
67
True or false: during shoulder flexion, TrA is activated before anterior deltoids
True
68
True or False: Flexion/Extension decreases in a cranial-to-caudal direction
False
Correct: Flexion/Extension INCREASES in a cranial-to-caudal direction
69
True or False: distal mobility before proximal stability
False
Correct: proximal stability before distal mobility
70
True or False: Patients with LBP cannot long sit
True
Because it can aggravate symptoms
71
Restricted hip flexion would involve ______ lumbar flexion, based on the lumbo-pelvic rhythm.
Increased
72
Restricted lumbar flexion would involve ______ hip flexion, based on the lumbo-pelvic rhythm.
Increased
73
True or False: maintenance of lordosis is crucial in protecting the posterior elements during tasks such as lifting
True
74
What is lumbo-pelvic dissociation?
Dissociation between hip and lumbar spine; lumbar spine maintains extension while the patient flexes hip
75
True or False: During lumbo-pelvic extension (bent over to upright), the lumbar extensors are activated throughout the motion.
False
Correct: lumbar extensors do not start until the trunk is close to upright
76
What muscles are most activated when sidestepping with the theraband at the toe?
Glutes
77
What muscle is most activated when sidestepping with the theraband at the ankle?
Tensor fascia latae
78
When sidestepping with a resistance band, which leg is working more?
The leg thats is on the ground and stable (the following leg)
79
What is the number 1 risk factor for pelvic floor dysfunction?
- Multiple Child Births
80
What are symptoms of uterine prolapse?
- Heaviness in abdomen
- Falling Out
- Lump coming down
- symptoms worsening at end of day ( urgency/frequency, incomplete emptying, UTIs)
81
What should be avoided with a pt prolapse during activity?
Valsalva Maneuver
82
Surgery is often suggested for a uterine prolapse. T/F
False (unless older; 80's-90s)
83
What muscle groups are involved with a weak pelvic core?
- Weak core
| - Weak Pelvic floor
84
What should be prevented besides the valsalva for a weakened pelvic floor or prolapse?
- Prevent downward pressure
85
What common activities create increased abdominal pressure?
- Smoking
- Coughing
- Sneezing
- Valsalva
- Constipation
86
What is the percentage of women who have had children with some degree of prolapse?
50%
87
What can happen with weakness in the supporting structures of the pelvic floor?
Pelvic Organ Prolapse
88
What is the best option for a person who can't have surgery involving a uterine prolapse? What is it called?
Pessary (Gellhorn or Doughnut)
89
What is the name of a prolapsed bladder?
Cystocele
90
What is the name of a prolapsed rectum?
Rectocele
91
A prolapse doesn't have to be external and can put pressure on other areas. T/F
True (Can take up other organ area)
92
What is a name of a prolapse of the small bowel?
Enterocele
93
What is known as a growth adhesion with cellular activity in lesions, cyst, and nodules outside of the uterine cavity?
Endometriosis
94
How is endometriosis treated?
Birth control (BCP)
95
Endometriosis has an average age onset of ____ and is known to be a ________ diagnosis.
28; Younger
96
What other less used treatment is utilized for endometriosis? What does it do?
- LUNA (laparoscopic uterine nerve ablation)
| - Decrease pain
97
What organs can have prolapse?
- Uterus
- Bladder
- Rectum
- Small Bowel
98
Verbal queuing with patient is the best education. T/F
False (Tactile education is also important)
99
What are interventions used for impairment of the pelvic floor?
- 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
What are 4 characteristics of correct pelvic floor activity?
- Ventral/Cranial perineum movement
- Upward/Anterior together organ movement
- Closing of the urethra, anus, and vagina
- Inhibits Detrusor Activity*
101
____ and below will have flaccid bladder and _____ and above will be at risk for Autonomic Dysreflexia.
T12; T6
102
Smooth muscle of the bladder is termed?
Detrusor
103
What is the triangular section on the internal bladder floor called (3 openings)? What are the 3 areas consist of?
Trigone
- 2 ureters
- Spinal innervation
- Neck of bladder
104
The detrusor ____ to store urine and ____ for urination.
Relaxes; Contracts
105
How is the innervation of the bladder once full controlled? How does bladder stop from releasing urine?
```
Stretch Receptors (send a spinal level reflex signal)
Brain (stops releasing)
```
106
Which accessory muscles should NOT be used for the Levator Ani/Kegel Muscles? What does it's small group do?
- ER
- Adductors
- Growing when lifting elevator
Lift Abdominal Content
107
What should be done and tried first in the pt education portion of pelvic floor awareness, training, and strengthening?
- Empty Bladder
| - Gravity Assisted/Eliminated position (Hips higher than heart)
108
What should only initially be performed in the pt education portion of pelvic floor awareness or identification of muscles?
What is the que?
- Contract Relax ( 3-5 Sec contract/3-5sec relax for 10min)
| - "Act is if you are holding back urine or bad gas"
109
What should be done in the pt education portion of pelvic floor awareness, training, and strengthening?
- 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
For pelvic motion training in the dynamic trunk exercises clock method, what is the beginning position and what should be avoided?
- Hooklying Supine (12-6 o'clock, 3-9 o'clock-clockwise)
| - Excessive pelvic tilt
111
When should trunk curl training in the dynamic trunk exercises not be performed?
If with Diastasis Recti
112
What is ideal positioning and preparation for pelvic floor?
- Gravity Assisted/Hooklying
- Breathing
- Pelvic tilt or Clock
113
How many branches are involved in the Levator Ani?
4
114
Sucking in the belly button is a good idea. T/F
False
115
What is a pt education bladder training technique? What should we education out pt to avoid?
- 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
What is at risk when having a Diastsis Recti?
Abdominal Hernia
117
A Diastasis Recti is a separation of the Rectis abdominus ___ or greater due to weakening of the connective tissue in the ___ trimester.
2cm; 2nd/3rd (13-26/27-42 weeks)
118
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?
Hooklying Supine
- Headlifts/Pelvic tilts for approximation (No crunches)
- Verbal Cues ("breath through exercise")
119
What are two common issues due to physiological changes in pregnancy and post partum?
- Joint Laxity (3-5 months; up to a year or so if breast feeding)
- Nerve Compression Syndromes (Increased TOS/CTS)
120
What exercise modifications should be used for pregnant women due to joints?
- Swimming
- Yoga
- Elliptical
(No impact sports for 3-5 months and longer if breastfeeding)
121
What maternal responses do aerobic exercise cause during pregnancy?
⬆️ Blood to muscles
⬆️ Respiratory Rate
⬆️ Uterine contractions (risk preterm birth)
⬇️ Blood Sugar (hypoglycemia)
⬇️ Core Temperature during exercise (Healthy Response)
122
What fetal responses do aerobic exercise cause during pregnancy?
- HR Increases (Healthy)
123
What recommendations can we give to the uncomplicated pregnancy before and after birth?
Mild to Moderate exercise for first week 15-30 min (most days)
- Keep intensity low
- Avoid contact sports
- Nonweightbearing exercise
- Balance change awareness
124
What are contraindications to exercise in a pregnant pt?
- DM 1
- Placenta Privia
- Preclampsia ⬆️BP
- Vaginal bleeding
- Rupture of membrane
125
What are precaution to exercise in a pregnant pt?
- Gestational Diabete
- Sever Anemia
- Extreme obesity/Eating disorders
- Diastasis Recti
126
For postural correction and strengthening what modifications to exercise are critical?
- Standing push up
- Supine bridging
- Quadruped Leg Raise (modified)
- Squatting (modified)
- Scapular Retraction
127
When doing a quadruped leg raise in a pregnant pt what modifications should be made? What about a modified squat?
- Posterior pelvic tilt or knee/leg slide
| - As far as comfort permits (60-90 sec progression in healthy)
128
What does an SI Belt do?
- Promotes Stability
- ⬇️Back Pain
- Proprioseption
129
What are deemed unsafe postures and exercises during pregnancy?
- 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
What activities should we recommend in pt education for a woman with a C Cection?
```
Exercises
- Breathing techniques
- Pelvic floor use during milder to use Kah/ Coughing
Interventions for Gas
Scare Mobilization
```
131
What type of interventions can PT provide for pelvic floor?
- Vaginal Weights
- Biofeedback
- General pelvic strengthening
- Estim
- HEP for PFM contractions
- PT NOW: EBP
132
What is a good visual input for watching introitus narrowing and perineum elevation?
Use of Mirror (Visual Input)
133
Important pt education to remember is....
- Manage fluid intake (bladder training)
- Weight control (avoid pressure to PFM)
- Relaxation (avoid pressure in intraabdominal; avoid valsalva)
134
PFE Kegels have no consensus on amount of exercise for pelvic floor improvement. T/F
True
135
PFE is an endurance activity. What are its sets, reps, and holds?
3 Sets, 20 Reps, 3 sec hold
136
Cueing is different for women with the Levator Ani than men.T/F
False (cueing is the same)
137
Incontinence in men with BPH can be treated with PFM strengthening. T/F ???
False (Urination better but challenging)???
138
What are the zones of benign prostate hyperplasia?
- Central BPH (grows inside out)
| - Peripheral (usually site of cancer)
139
Estim has been shown not to be anymore affective than pelvic core exercise. T/F
True
140
What are the 3 ways urinary flow is impaired in men?
- Strangulation of Urethra
- Urinary Retention
- Incomplete emptying
- Over active Bladder Syndrome (involuntary urination with/without urge usually with frequency and nocturnal)
