Week 4

Question 1

richards splint/zimmer splint (EPD) are used for:

Answer 1

• during phase 1 rehab programs (0-2 weeks)
• patella dislocation
• ACL rupture

Question 2

motion limiting brace is used for:

Answer 2

– during phase 1 rehab programs (0-2 weeks)
- common for grade 2 MCL tears

Question 3

rigid taping techniques for the knee

Answer 3

• Box deload taping.
• Medial Collateral Ligament taping
• Patellofemoral joint taping
  
  • medial tilt tape, medial glide tape
• Fat pad / patella tendon deloading

Question 4

patella dislocation phase 1

Answer 4

POLICE, maintain knee extension, control swelling and pain, exercises targeting VMO.

Question 5

patella dislocation phase 2

Answer 5

2-6 weeks
- increase ROM and strength, VMO progression, exercises and functional tasts. ensure pain free exercises

Question 6

acute condition of knee and application of forces - pain only

Answer 6

Grade I: small amplitude movement at
beginning of the available range
Grade II: large amplitude movement within a resistance-free part of available range
dosage: 1-2 sets of 30 seconds to a minute dependent on pain

Question 7

acute condition of the knee and application of forces - pain and stiffness

Answer 7

Grade III: large amplitude movement performed into resistance or up to the limit of avaliable range
dosage: 2-3 sets or > of 1 min or > dependent on changes in tissue resistance and/or pain

Question 8

overuse/chronic condition of the knee and application of forces - stiffness

Answer 8

Grade IV: small amplitude movement performed into resistance or up to limit of available range
dosage: 2-3 sets or > of
1 min or > dependent on changes in tissue resistance and/or pain

Question 9

overuse/chronic condition of the knee and application of forces - stiffness (locked joint)

Answer 9

Grade V: small amplitude, high velocity movement at end of available range (not taught in PHTY 206)

Question 10

passive physiological treatment techniques for the knee - OA and end range knee extension stiffness

Answer 10

TFJ extension through grades (III - IV)
TFJ extension (Gr III only)
TFJ extension Gr IV
TFJ flexion (Gr III)
TFJ flexion (Gr IV)
Clinical Application: Osteoarthritis, end range knee flexion stiffness+/- pain

Question 11

passive accessory treatment techniques for the knee

Answer 11

TFJ AP (grades I-IV)
TFJ PA (grades I-IV)
TFJ < medial in a degree of flexion/extension
TFJ > lateral in a degree of flexion/extension
Clinical Application: Medial or lateral knee pain and decreased ROM of flexion or extension

Question 12

PILL

Answer 12

Pain free, Instant, Long Lasting

Question 13

passive accessory treatment techniques for the superior tibiofibular joint

Answer 13

STFJ AP (Grades I-IV)
STFJ PA (Grades I-IV)
Clinical Application: STFJ pain +/- stiffness eg: post immobilization.

Question 14

passive accessory treatment techniques for the patellofemoral joint

Answer 14

• Medial patella tilt in neutral and relevant flexion angle (supine)
• Medial patella glide in neutral and relevant flexion angle (supine) (Grades I-IV)
  Clinical Application: Patellofemoral maltracking and pain, PFPS
  Cephalad/caudad longitudinal glides (Grades I-IV)
  Distraction (Grade IV)
  Clinical Application: PF stiffness +/- pain e.g., post immobilization, chronic knee swelling, post TKR

Question 15

Manual therapy treatment techniques to improve knee flexion:

Answer 15

• PP knee Flexion Gr 3 and/or 4
• PAM of tibia AP in neutral, Gr 1 and 2 if pain is limiting range.
• PAM of tibia AP in flexion range close to the onset of symptoms, Gr 3 and 4
• PAM PF caudad glide, any grade
• Massage techniques for improving range of quadriceps muscle group length.

Question 16

Manual therapy treatment techniques to improve knee extension:

Answer 16

• PP knee Extension Gr 3 and/or 4
• PAM of tibia PA in neutral, Gr 1 and 2 if pain is limiting range.
• PAM of tibia PA in extension range close to the onset of symptoms, Gr 3 and 4
• PAM PF cephalad glide, any grade
• Massage techniques for improving range of hamstrings and gastroc-soleus muscle groups length.

Question 17

principles of management of overuse/chronic injuries

Answer 17

4 weeks - 12 months

Question 18

Overuse injuries

Answer 18

An injury of the musculoskeletal system that results from exposure to a repetitive force beyond its abilities to withstand such a force

Question 19

Overuse injuries: goals of management: non/mild - moderate irritability

Answer 19

➢ Not affecting ADLs
➢ Pain during the activity
➢ Pain may reduce with warming up
➢ Pain may continue during the activity and after stopping the activity
➢ Treat and train while de-loading tissues

Question 20

over use injuries: goals of management : Moderate - Severe Irritability

Answer 20

➢ Pain is affecting or limiting ADLs
➢ May have constant symptoms
➢ Cease activity that produced/aggravates pain/injury
➢ Attend to pain +/- inflammation as priority
➢ De-load tissues to relieve pain & encourage normal function

Question 21

training errors

Answer 21

• Excessive volume
  
  • Too high of a training intensity
  • Rapid increases in volume/intensity

Question 22

Late stage rehabilitation

Answer 22

① Time constraints for soft tissue healing
② Pain-free full ROM
③ No persistent swelling
④ Adequate strength & endurance
⑤ Good flexibility
⑥ Good proprioception/balance
⑦ Adequate cardiovascular fitness
⑧ Function/sport specific skills regained

Question 23

Reinjury risk

Answer 23

• Inadequate rehabilitation
  
  • Build up too quickly
  • Inadequate healing time
  • Client not listening
  • Fitness not fully restored
  • Predisposing factors not fully addressed
    Previous risk patterns not recognised & managed accordingly (Bittencourt et al, 2016)

Question 24

What causes tendinopathy?

Answer 24

overuse, altered lower limb function/biomechanics, intrinsic factors

Question 25

Reactive tendinopathy

Answer 25

- Non-inflammatory - Occurs with acute tensile or compressive overload - Short-term adaptive thickening of tendon that reduces stress (stress = force/unit area)

Question 26

Tendon dysrepair

Answer 26

- Worsening pathology - Attempt at healing - Chronically overloaded tendon - Spectrum of ages & load environments - Thicker Some reversibility with load management is possible

Question 27

Degenerative tendinopathy

Answer 27

- Generally older person - Possible in younger person or elite athlete with chronically overloaded tendon - One or more focal nodular areas +/- general thickening - Hx repeated bouts of tendon pain - Tendon is heterogeneous – degenerative pathology interspersed with other stages of pathology and normal tendon - Little capacity for reversibility at this stage “End stage”

Question 28

Treatment of tendinopathy - reactive tendinopathy and early dysrepair

Answer 28

- patients goals - Load management (reduction!) ○ Allows tendon time to adapt ○ Cells become less reactive ○ Matrix resumes more normal structure Reduces pain

Question 29

Late dysrepair/degenerative tendinopathy - treatment

Answer 29

- Load reduction not generally helpful - Load modification - address contributing factors - Lower limb biomechanical issues ○ E.g. Ankle joint mobility, muscle length, foot posture - Training & technique factors ○ Volume ○ Technique (running, jumping) - Kinetic chain function ○ Coordination, strength & endurance Lumbopelvic and hip stability

Question 30

Isometric exercise - Patellar Tendinopathy (PT)

Answer 30

- Isometric contractions used to reduce pain without a reduction in muscle strength - Isometrics could be used pre-sport for pain relief without producing fatigue - Isotonic exercise effective for tendon rehabilitation, not appropriate prior to activity

Question 31

Mobilisation

Answer 31

Passive movement technique applied to a spinal or peripheral joint performed within control of patient - Assessment and treatment - Physiological or Accessory movements ○ Oscillatory small/large amplitude ○ Sustained stretching +/- oscillations at limit of range

Question 32

Manipulation

Answer 32

- Sudden movement or thrust performed at the limit of joint range such that patient is unable to prevent movement: ○ Treatment only ○ High velocity ○ Small amplitude

Question 33

Physiological movement:

Answer 33

- Movements that a person can carry out actively E.g. ankle dorsiflexion

Question 34

Accessory movement

Answer 34

- Movements that a person cannot perform independently but are necessary for joint movement ○ Roll, spin, slide/glide ○ Distraction, compression - E.g. anteroposterior glide of talus during ankle dorsiflexion

Question 35

3 types of joint 'play:

Answer 35

gliding, traction, compression

Question 36

application of forces - grade I

Answer 36

small amplitude movement at beginning of the available range

Question 37

application of forces - grade II

Answer 37

- Grade II: large amplitude movement within a resistance-free part of available range

Question 38

application of forces - grade III

Answer 38

large amplitude movement performed into resistance or up to the limit of available range

Question 39

application of forces - grade IV

Answer 39

small amplitude movement performed into resistance or up to limit of available range

Question 40

application of forces - grade V

Answer 40

small amplitude movement at end of available range

Question 41

Application of forces - rhythm

Answer 41

- Stationary holding (sustained) - Slow, smooth movement/oscillation Fast/sharp, staccato movement/oscillation

Question 42

Dosage parameters

Answer 42

- Techniques designed to have an immediate modulating effect on severe or irritable movement related pain: - Grade I or II - Slow smooth rhythm - Short duration (< 2 minutes) - Repeated only 1-2x in a session - Techniques designed to have an effect on movement related stiffness & pain: ○ Grade III or IV ○ Quicker, sharper staccato rhythm ○ Performed for several minutes Repeated several times within a session

Question 43

AP talar glide

Answer 43

- Green, Refshauge, Crosbie, Adams (2001) A RCT of a passive accessory joint mobilization on acute ankle inversion sprains PhysTher 81:984-94. - speeds up recovery