Test 2 Flashcards
(135 cards)
1
Q
Exercise and response in cardiac output
A
Direct relationship
2
Q
Exercise and response in Vo2 (Oxygen uptake)
A
Direct correlation
Increase with exercise
3
Q
Vo2 max does what with training
A
Increases
The amount of oxygen that can be taken in and utilized per kg/min
4
Q
EPOC
A
Excess post-exercise oxygen consumption
Due to initial depletion when starting the exercise
5
Q
RQ
A
Volume of CO2 expired: volume of oxygen consumed
6
Q
What is RQ an indicator of
A
Metabolic fuel use in the tissues
Carb 1
Lipid 0.7
Protein 0.8
Usually only fat and carbs are used to calculate
7
Q
Exercise and response in RQ
A
Increases with exercise
8
Q
Changes in BP with dynamic, low force exercise
A
Increase in systolic
No change in diastolic BP
***good predictor of CAD if diastole increases
9
Q
Increase in diastole BP during dynamic, low force exercise is a good predictor of what? How much of a change is significant?
A
CAD
> 15mmHG or above 110mmHG
10
Q
Weight lifting and BP
A
Systolic and diastolic pressure increase.
Systolic of 450mmHg have been reported
11
Q
total peripheral resistance and local factors (CO2/lactate)
A
CO2/lactate cause dilation in the working muscles and decrease TPR
12
Q
Lactate threshold
A
Point during exercise where lactic acid begins to accumulate in the blood
Max level of sustained activity
13
Q
How do you know you’re at the lactate threshold
A
Can carry on a conversation but cannot sing
14
Q
Vo2 max level and lactate threshold start
A
Around 60% vo2 max is when lactate starts to increase in the body
Untrained people: 55%
Endurance athletes: 70%
15
Q
What other changes occur when lactate threshold is met?
A
Increase in mitochondria and capillary density
16
Q
Ways to monitor the patient and rate their perceived level of exertion
A
Borg Scale
Talk test
17
Q
What its the talk test and what is it used to measure
A
Determining patients ability to respond in conversation
Reflects:
HR
Vo2
Lactate threshold
18
Q
Anaerobic threshold
A
Point where shift toward anaerobic metabolism where excess CO2 is expired
19
Q
Endocrine changes with exercise. What increases and decreases?
A
Increase: cortisol, catecholamines, endorphins, growth hormone, testosterone
Decrease: insulin
20
Q
Physiologic changes with training
A
- decreased resting HR
- increased SV at rest
- max CO increase
- increase in BV
- static lung volumes UNCHANGED
- HDL increase
- cholesterol decrease
21
Q
What is the PAR-Q form?
A
Physical activity readiness questionnaire
Screen for exercise contra-indications
22
Q
What is the minimum requirement before starting an exercise program. Screening wise
A
PAR-Q form
Ages 15-69
23
Q
What are the 7 ACSM risk factors?
A
- Family history of atherosclerotic disease
- Smoker
- HTN (>140, 90 or antiHTN meds)
- Dyslipidemia (LDL>140, HDL<40, cholesterol> 200)
- Prediabetes >100
- Obesity >30BMI
- Sedentary lifestyle
If HDL> 60 take away one risk factor
24
Q
Major S/S of CVD, Pulmonary or metabolic disease
A
- pain/discomfort in UE
- shortness of breath
- dizzy
- orthopnea
- ankle edema
- palpitations/tachycardia
- intermittent claudication
- heart murmur
- unusual fatigue/shortness of breath
25
ACSM risk stratification
| Low risk
Men< 45
Women <55
With no more than one risk factor
26
ACSM risk stratification
| Moderate risk
Men>45
Women >55
With two or more risk factors
27
ACSM risk stratification
| High risk
Have a major risk factor
(Pain in UE, shortness of breath, dizzy, orthopnea, ankle edema, palpitations, intermittent claudication, heart murmur, unusual fatigue)
Or CVD, pulmonary or metabolic disease
28
Is an exam/exercise testing required? For low, moderate and high risk patients with moderate intensity and vigorous intensity
Moderate intensity/low risk: no
Moderate intensity/moderate risk: no
Moderate intensity/high risk: yes
Vigorous/low risk: no
Vigorous/moderate risk: yes
Vigorous/high risk: yes
29
Is physician supervision recommended during the exercise test for low, moderate and high risk patients for both submax testing and max testing
Submax testing:
Low risk: no
Moderate: no
High: yes
Max testing:
Low risk: no
Moderate: yes
High: yes
30
What is VO2 for moderate intensity
40-59%
31
What is Vo2 for vigorous intensity
60%+
32
What are examples of submaximal tests?
```
Run/walk (1.5 mile run) (rockport 1 mile walk)
Step tests (Queens college step test—steps for 3 min...men 24/min, women 22)
Bike tests (Blake treadmill test)
```
33
What is the submaximal walking test called?
Blake treadmill test
3.3 mPH @0% grade and increase incline 1% each minute
Measure time till exhaustion
34
What is the Karvonen?
Heart rate reserve formula
Take into account available heart range due to varying resting heart rate baselines
35
Heart rate and VO2 have a _____correlation
Direct
36
What is the Karvonen formula
220-age=max HR
Max HR - Resting HR= Heart rate reserve
HHR x moderate/vigorous %’s to get HR range target
Mod: 40-59
Vig: 60-80
37
S/s of concussion
```
HA
Fog feeling
Changes in personality
LOC/amnesia
Gait changes
Irritable
Slow reaction times
Sleep disturbance
```
38
Red flags of concussion
```
Neck pain/tender
Double vision
Weak/tingling/burning in extremities
HA (severe/increasing)
Seizure
LOC
Vomit
Increased restlessness/combative
```
39
SCAT-5 cognitive screening sections
Immediate memory
Digits backwards
Months in reverse
40
SCAT 5 neurological screen
- read outloud directions and follow instructions
- full range of pain free passive C-movement
- without moving head can they follow your finger without vision changes
- finger to nose
- tandem gait
41
SCAT 5 balance testing
Aka modified Bess
20 second trials
Double, single and tandem stance
```
Errors: hands on crest
Open eyes
Step/stumble
Moving hip further into flexion
Lifting forefoot/heel
```
42
Return to play protocol after concussion
1. Symptom-limited activity
2. Light aerobic
3. Sport specific exercises
4. Non-contact training drills
5. Full contact practice
6. Return
43
Symptom limited activity post concussion (1)
24-48 hours
Gradual reintroduction of work/school activities
44
Light aerobic exercise post concussion stage
When no concussion related symptoms present and can perform at or above pre-injury levels of motor and neurological function
45
What activities are allowed during light aerobic exercise stage post concussion
Walking, swimming, running, stationary bike
<70% max HR
No resistance training
46
Sport specific exercicse stage post concussion
When no concussion symptoms, performing normally and no return of symptoms with any prior activity
47
What is done during sport specific exercise post concussion
Movement drills, simple without much decision making
NO head impact activities
Add movement to increase HR
48
Non-contact training drill stage post concussions
No related symptoms, performing normally, no return of symptoms
49
What is done during non-contact training drills post concussion (4)
Tasks requiring complex physical/cognitive demand
MAY start resistance training
Exercise,cognition, coordination
50
Full contact practice activities post concussion
Normal team training activities while monitored my coach
51
Return to school strategy post concussion
1. Daily activities that do not recreate symptoms
2. School activities
3. Return part-time
4. Return full-time
52
Daily activities that do not recreate symptoms-return to school
Allow gradually:
Screen, reading, texting
53
School activities-return to school
Homework
Reading
Other cognitive activities PUTSIDE classroom
54
Minimal screening exam for concussion
```
Mental status (alert/memory/behavior)
Cranial nerves (2-12)
Motor
Strength
Reflexes
Sensory
```
55
Do LOC, amnesia, or seizures predict outcome of concussion?
No
56
Possible predictors of delayed recover (14+ days)
```
Migraine
Reaction time
Visual memory
Verbal memory
Dizziness
```
57
Other management options for concussions
Vestibular rehabilitation techniques
1. Gaze stabilization exercises
2. Standing balance exercises + progression
3. Walking balance challenges
4. EPLEY MANEUVER
5. Subsystem threshold exercise -Increasing PSNS, decrease SNS
6. Blake maximal aerobic treadmill test
7. Cervicovestubular rehabilitation (adjustments plus gaze stabilization)
58
EPLEY maneuver
```
Turn head towards involved ear
Quickly lie back
Turn 90 degrees opposite direction
Turn head&body another 90
Side upright on opposite side
```
59
Who is most likely to get c-spine pain
- females
- middle aged
- sleep disorders
- smoking
- sedentary lifestyle
- catastrophization
60
Diffuse neck pain increased with movement
Mechanical neck pain
Facet syndrome
Sprain/strain
61
Pain in certain postures alleviated by positional change
Upper cross
62
Traumatic mechanism of injury or non-specific symptoms exacerbated by upright position and relieved when head and neck are supported
Cervical instability
63
Nonspecific with radiating symptoms to one arm
Cervical radiculopathy
64
Neck pain with bilateral UE symptoms and potential balance issues
Cervical myelopathy
65
Evaluating for disc derangement and management
End range loading
Antalgia based criteria
End range loading
66
Evaluating and management joint dysfunction
Palpation, extension-rotation, flexion-rotation
Adjust, traction.mobilize, end range loading
67
Evaluate and manage radiculopathy
Brachial plexus tension, <60 cervical rotation, distraction, foraminal compression
ERL, traction, nerve flossing
68
Evaluate and manage myofasical trigger point
Palpation
Ischemic compression, dry needling, IASTM
69
ROM of C-spine
Flex: 60
Extend: 75
Rotate: 80
Lat flex: 45
70
Where does most rotation come from in C spine
45 from C1-C2 (of the 80)
71
Rotation under what degree is considered dysfunctional
60
72
Where does most lateral flexion come from
Low C spine
35 of total 45
73
Non-neural contributors to C spine stability
20% osseoligamentous
| 80% musculature
74
Deep muscles control what
Segments
75
Superficial muscles produce
Movement
76
Deep muscles aka
Local or intrinsic
77
Superficial muscles aka
Global or extrinsic
78
Global vs local muscles in upper cross
| Extrinsic vs intrinsic
Local/intrinsic are weakened/inhibited in UC
Global/superficial are tight/facilitated in UC
79
Global/superficial muscle are what in upper cross
Tight/facilitated
Ex: SCM, scalene, suboccipitals
80
Local/intrinsic muscles are what in upper cross
Weak/inhibited
Ex: longus colli/capitals
81
What are the deep neck flexor muscles
Longus capitis
Longus coli
Rictus capitis anterior
82
What do the deep neck flexors do/main function
Postural and provide dynamic stability
Along with ALL
83
Reduced neck strength correlated with
Neck pain
84
Stability triangle
NS (control subsystem)
Muscles (active subsystem)
Spinal column (passive subsystem)
85
Local/intrinsic muscles of the C spine
| Anterior
Longus capitis
Longus colli
Rectify capitis lateralis/anterior
86
Local/intrinsic c spine muscles
Posterior
```
Rictus capitis posterior major/minor
Oblique capitis inf/sup
Semispinalus capitis/Cervicals
Splenius capitis/cervis
Longissimus capitis/Cervicis
```
87
Longus coli
Retraction of the C-spine
Deep to the cervical viscera/trach/esophagus
Act as a dynamic ALL
C1-T3
Counteract buckling forces of lordotic curve
88
Global/extrinsic C-spine muscles
| Anterior
SCM
| Ant/med scalene
89
Global/extrinsic muscles of C spine
| Posterior
Upper trap
| Lavatory scapulae
90
Exercises to relieve neck/shoulder pain in office workers
Isometric holds unilaterally
Eccentric lowering from a shoulder shrug (increases proprioception)
91
Common joint dysfunction with upper cross
sternoclavicular
AV
C and T facets
92
Potential injuries with upper cross
```
Rotator cuff
Shoulder instability
Bicep tendonitis
TOS
HA
```
93
Method of movement evaluation
```
Functional patterning (flex-rotate test & ext-rotate test)
Motor control (C-flex pattern, quadruped rocking, flexor endurance test)
Passive ROM (passive and active ROM)
```
94
Method of management of motor control
```
Mobility (A/PROM)
Motor control (C-flexion pattern, quadruped rocking, flexor endurance(
Functional patterning (flex/ext-rotate)
```
95
Posterolateral assessment observation. What are you typically looking for pattern wise in weak patient
1. Rounded shoulders (facilitated-tight pecs)
2. Anterior head carriage (F-SCM)
3. Head extension (F-suboccipitals)
4. Elevated shoulders (F-trap/levators
5. Winging scap (I-serratus ant)
96
Cervical flexion motor pattern-part of what step and explain
Motor control
Have patient look at the feet
Fail: chin protrudes 1st, overactive SCM, shaking
97
Neck flexion motor evaluation
Dysfunction is chin lying flat on the chest and excessing forward translation without coupled Sagittarius rotation
Leads to approximation of facets
Usually means hypomobile upper and lower C spine and hyper middle
98
Quadruped rockback—motor control
Head extends back—mean what
Poor anterior stability and tight posterior chain—lavatory and upper trap
99
Craniocervical flexion test.
Put BP cuff behind occiput/neck and inflate to 20 mmhg
Nod head “yes” while maintaining hold
Test of precision not strength
100
Flexor endurance test
Hold flexed position as long as possible
Men: 40
Women: 30
101
Cervical extension rotation test—what part and what is it?
Functional patterning
increased pain= +
Identifies facet joint involvement in pain on ipsilateral side
102
Cervical flexion rotation test. Part of what and what is it?
Functional motor patterns
Isolated for c1-c2
Range should be 40-44 degrees
Under 32= +
Connects to patient with cervicogenic headache
If patient has overall increased ROM, but is low ROM on this, tells you the ROM is coming from other areas that it shouldn’t
103
Corrective exercise continuum
```
Inhibit techniques (myofascial release)
Lengthen techniques (stretching)
Activate techniques (positional isometrics/strengthen)
Integration techniques
```
104
Phases of healing and corrective exercises that go with
| Acute inflammatory
Inhibit and lengthen techniques
| 0-3 days
105
Phases of healing and corrective exercises that go with
Subacute/proliferative
Lengthen and activate
| 3days-3weeks
106
Phases of healing and corrective exercises that go with
| Chronic remodeling
Activate and integration techniques
| 3+ weeks
107
Corrections for anterior head carriage
Posterior glide
| Facilitates upper C flexion and lower C extension
108
When making corrections make sure the patient is engaging what muscles
Intrinsic/local muscles
109
Characteristics of C-extension syndrome
```
Forward head
Pain with extension
Translation greater than Sagittarius rotation
Weak intrinsic flexors
Pain with prolonged posturing
HA in suboccipital
```
110
Characteristics of cervical flexion syndrome
Decrease in cervical lordosis
Decreased thoracic kyphosis
Loss of flexion in T spine (may cause increased flexion in C spine)
111
What joints are prone to mobility restrictions
```
Ankle
Hip
Thoracic
Gleno-humeral
Upper cervical
```
112
What joints are prone to stability restrictions
Knee
Scapula
L
Lower cervicals
113
Shoulder pain and ROM improvement with?
Rib manipulation
114
Primary muscles for inhalation
Diaphragm
Pasta sternal internal intercostal
Scalenes
Levatores costarum
115
Primary muscles for exhalation
Elastic recoil
Diaphragm
Pleura/costal cartilage
116
Diaphragmatic/abdominal/belly breathing
Diaphragm down
Lower rib cage moves down laterally, ventral and dorsal
Sternum moves ventral while intercostal spaces expand minimally at end of inhalation
117
Paradoxical breathing
Abdomen draws in during inhalation and out during exhalation
118
Chest/apical breathing
Excessive upward movement of sternum and shoulder girdle. Minimal abdominal movement
Pts will have very developed paraspinals and little rib expansion. Just extending through lumbars
119
Secondary issues due to faulty breathing patterns
Asymmetrical motion
Shallow breathing
Tension in face/jaw
Sighs/yawns frequently
120
Exercises to improve breathing
Blowing up ballon
Clamshell
Crocodile breathing
121
Blowing up a balloon
Help to diaphragm breathe
Right arm above head, inhale through nose, exhale through mouth.
Posterior pelvic tilt with flat back
Hold air in balloon 3 seconds and repeate 4x
122
Clamshell
Help with breathing
Post exhale patient holds breath and then abducts top knee keeping heels together. Found 3 open, 3 closed.
Then inhale.
123
Crocodile breathing
In sphinx inhale and exhale through nose making sure abdomen expands into ground
124
Evaluating shoulder mobility
Apley’s scratch
(Grab hands behind back)
Fists should be within hands length
To do this, should retract neck and extend T-spine. People compensating will flex forward
125
Thoracic rotation
50 degrees
126
Wall angel—for what and how
Thoracic mobility
Against wall with arms abducted 90 degrees and elbows bent at 90.
Have patient tuck chin.
FAIL=T-L junction does NOT flatten
127
Wall slide for and what
Thoracic mobility
Squatting down while raising arms
Lat and pec stretch felt. Tight lats may cause hyperextension/shoulder to elevate
=inhibited/weak ant stabilization and facilitated/tight posterior chain
128
Arm elevation. What adn when
Against a all should raise arm up and keep pelvis on wall and maintain normal lumbar curve.
Increased hyperlordotic curve= facilitated lat and pec
129
Thoracic extension mobilization
Cat-camel
| Foam roller
130
Trunk stability push-up
| What and how
Motor control
Everything should elevate as a unit. Recall straight line. This tests stability/control not strength.
131
Quadruped for t-spine. What and how
Motor control
Extension of head means levator scap
132
Brugger
Posture focused exercises
“Posture breaks”
“Cog wheel”
How poor posture in one can have affect on other areas
133
What is brugger posture break
Sit at edge of chair with feet out slightly and wider than hips
Tuck chin
Deep belly breath
Slowly exhale and rotate arms out, spread fingers wide and “tall spine”
134
Poor posture can lead to
Decreased cervical motion
Increased lumbar motion
Poor breathing capacity
Extremity involvement
135
Scoliosis management
Triplanar involvement
VB rotates to concavity in C/L
VB rotates to convexity in T
Do rotation, lateral flexion and progressive flex/extension
