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Flashcards in Random Ortho Deck (35)

1st class lever

fulcrum/axis is located BETWEEN the force and resistance
designed for balance

- head on C1 moving into flexion/extension
-playground seesaw


2nd class lever

The axis is at one end, the resistance is in the middle and the force is at the other end
designed for power

-closed chain PF
- a wheelbarrow


3rd class lever

The axis is at one end, force is in the middle and resistance is at the other end
**most common lever in the human body- advantage for ROM

-elbow or knee flexion


Plumb line description

Should fall through:
-external meatus of ear
-acromion process
-hip joint

Posterior to the patella

Anterior to the lateral malleolus

(in this position, the soles muscle is the most active muscle to maintain the body's balance. it contracts to counter the forward moment of the tibia around the ankle joint)


What is a capsular pattern?

a restriction of motion that results when the length and flexibility of the capsular fibers are impaired

if a lesion causes a restriction of movement that is not characteristic of the pattern, it is known as a non capsular pattern


What are 4 possible causes of non capsular patterns?

internal derangements
extra-articular lesions


Glenohumeral capsular/restriction pattern:



elbow capsular pattern:



radioulnar capsular pattern:



wrist capsular pattern:



interphalangeal capsular pattern:



hip capsular pattern:



knee capsular pattern:



ankle capsular pattern:



toe capsular pattern:




movement between joint surfaces

2- slide
3- spin



movement between 2 bones (flex, ext, etc)


Slow twitch (type I) muscle fibers:

red oxidative muscle fibers

allow for aerobic work and specialize in muscular endurance activities

resistant to fatigue, contract slowly and are highly efficient for aerobic activities

description: tonic/postural
more common in: extensor muscles


Fast twitch (type II) muscle fibers:

white glycolytic muscle fibers

anaerobic and are not as vascular as type I, although they do contract at a higher speed and with more force than type I

*fatigue rapidly

these fibers are larger in diameter than red fibers and are used for activities that require speed, strength and power

Can be further broke down into IIA, IIAB and IIB
-differ mostly in regard to endurance and are falsified as intermediate fiber types with both an aerobic and anaerobic capacity

description: phasic/mobility
more common in: flexor muscles


Isometric exercise

a static contraction at a particular point in the ROM

development of strength is highly specific to the position at which the muscle contracts

useful if desired to limit joint motion following injury or surgery or if painful

resistance is accommodating, variable and controlled by patient

patients with vascular or cardiac disease should refrain from isometric due to the sharp rise in BP and workload on the heart. Valsalva's maneuver should be avoided


Isotonic exercise


exercise occurs throughout the ROM with the same resistance or weight and variable speed of movement

resistance is fixed at the max load that allows the completion of the movement and should be no greater than that of the weakest joint position

-lack of aerobic conditioning
-no development of quickness
-no accommodation to fatigue or pain
-increased muscle soreness with eccentric contractions

Concentric vs eccentric

Closed vs. open chain


Concentric exercise


contraction occurs when the muscle shortens as it contracts to overcome the external resistance or weight


Eccentric exercise


contraction occurs when the muscle lengthens while developing tension and lowering the external resistance in a controlled manner. it generates considerable muscle force and can cause significant muscle fiber trauma


Isokinetic exercise

occurs at a constant, preset speed in which the resistance is variable and accommodates as the force of contraction varies throughout the ROM

safe, objective measurements and max tension at all points in the ROM

slow speed settings generally result in strength gains that are specific to that particular velocity

exercising at high speeds increases muscular endurance with some muscle hypertrophy

TORQUE = the amount of F used times the perpendicular distance from the axis of rotation
-As the angular velocity of the apparatus is increased, the peak torque generated by the patient is decreased.

Manual resistance exercises are really a form of isokinetic exercise due to the variable resistance provided by the PT.


Aerobic exercise:

performed at a target HR for at least 20 minutes and involving large muscle groups in rhythmical movements (jogging, walking, biking, swimming)


what are training effects of aerobic exercise?

-resting and submax HRs are decreased
-systolic and diastolic pressures are reduced at rest
-CO and SV are increased during submax exercise

-tidal volume is increased
-ventilation rate is decreased during submax exercise
-oxygen extraction from the blood is increased


How is target HR calculated?

estimated HRmax= 200-age

THR = HRmax x 70% (to increase aerobic capacity)


How is Karvonen's formula calculated?

uses RHR to determine THR

THR = (HRmax - RHR) x % of desired training intensity +RHR


Aquatic exercise

promotes relaxation, ambulation, WB and exercise

Intense training should take place between 81-83 deg F
Rehab exercises require water temp between 91-93 deg C

To increase WB- shallow water

To increase strength
-use higher-velocity exercises (due to water viscosity)
-items that increase surface area (due to turbulence)
-move toward the bottom of the pool (due to buoyancy)


buoyancy can be used to:

used as assistance to move a limb toward the surface of the water, support to hold a limb on the surface with flatten devises, or resistance when moving a limb toward the bottom of the pool


Hydrostatic pressure can be used to

reduce effusion or to allow the patient to exercise an injured extremity without increasing effusion

deeper water increases hydrostatic pressure



causes resistance to flow so that increasing the speed of an exercise or movement will increase resistance


what are cardiopulm responses to water immersion at rest and during exercise?

changes are the result of hydrostatic pressure and include a cephalad redistribution of blood flow

both the SV and CO will increase while the HR will remain the same or slightly decrease

changes in HR are related to the water's depth, position of the patient, and exercise efficiency

hydrostatic pressure on the chest challenges chest expansion, can decrease the inspiratory reserve volume and may reduce the forced vital capacity. this may be a problem for individuals with reduced lung capacity or breathing difficulties

THR should be established in the pool due to lower heart rates during deep water exercise compared to land based exercise


What are factors that affect training?

Frequency: usually 3-5/week for aerobic or strength gains

Intensity: based on the amount of resistance used, THR, and the number of METs prescribed or the speed of exercise
*changing intensity is the most effective way to improve aerobic fitness

Time: usually ranges from 15-60 min

Type: aerobic, isometric, isokinetic, isotonic, aquatic, etc

Special considerations:
-obesity: should exercise at longer duration with lower intensity; intensity set so patient can speak without gasping and doesn't have muscle ache or burn from lactic acid accumulation


Aging changes and physiological functioning by system:

-aging sedentary individuals have twice the rate of VO2 max decline
-age predicted HRmax declines with age
-CO ma decline unless there is an increase in SV

MUSCULAR: >65 y/o muscle strength decreased 24-45%, muscle mass is reduced and fiber size decreases

-nerve conduction velocity declines 10%.
-# of spinal cord axons declines and reduces reaction time

-static and dynamic pulmonary functions decline with age

SKELETAL: >60y/o: bone mass may reduce 30-50% causing osteoporosis