Week 5 Flashcards
(180 cards)
1
Q
What is a therapeutic exercise?
A
Systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to:
• Remediate or prevent impairments
• Improve, restore, enhance physical function
• Prevent or reduce health-related risk factors
• Optimize overall health status, fitness & sense of well being
2
Q
What is CPT code 97110?
A
Therapeutic exercise to develop strength and endurance, range of motion and flexibility
3
Q
What is CPT code 97112?
A
Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
4
Q
What is CPT code 97530?
A
Dynamic activities to improve functional performance, direct (one-on-one) with the patient
5
Q
What are the interrelate components of physical function?
A
- Balance
- Cardiovascular fitness
- Flexibility
- Mobility
- Muscle performance
- Neuromuscular control & coordination
- Postural control, stability, and equilibrium
- Stability
6
Q
What are the levels in the functional movement screen of optimal performance pyramid?
A
- Functional skill (top)
- Functional performance (middle)
- Functional movement (bottom)
7
Q
What are the types of therapeutic exercise interventions?
A
- Aerobic conditioning and reconditioning
- Muscle performance exercises
- Stretching techniques
- Neuromuscular control, inhibition & facilitation
- Posture awareness training
- Posture control, body mechanics, stabilization
- Balance & agility training
- Relaxation exercises
- Breathing exercises & ventilatory training
- Task-specific functional training
8
Q
What are the subtypes of the muscle performance exercises?
A
- Strength training
- Power training
- Endurance training
9
Q
What are the subtypes of the stretching techniques
A
- Muscle-lengthening procedures
* Joint mobilization/ manipulations
10
Q
What is balance?
A
The ability to align body segments against gravity to maintain or move the body or the center of gravity within the available BoS without falling. Our ability to move our body in equilibrium with gravity via the interaction of the sensorimotor systems
11
Q
What are the key considerations to exercise safety?
A
- Level of supervision
- Screening prior to engaging in exercise
- Environmental factors
12
Q
What are the things to screen for prior to engaging in exercise?
A
- Health history
- Current health status
- Medications
- Be cautious with “un-exercised” patients
- May need medical clearance
13
Q
What are the environmental factors to consider for exercise safety?
A
- Adequate space & support
- Lighting
- Noise
- Temperature
- Well-maintained equipment
14
Q
What does the cardiovascular fitness relate to?
A
Our ability to perform moderate intensity or repetitive total body movements over an extended period of time
15
Q
What is flexibility?
A
The ability to move freely without restriction
16
Q
What is mobility?
A
The ability of a structure or segment of the body to move or be moved in order to allow the occurrence of range of motion for functional activities or functional ROM
17
Q
What is passive mobility dependent on?
A
Soft tissue, contractile and non contractile extensibility
18
Q
What is active mobility dependent on?
A
Neuromuscular activation
19
Q
What does muscle performance relate to?
A
The capacity of a muscle to produce tension and do physical work
20
Q
What does muscle performance encompass?
A
Strength, power, and muscular endurance
21
Q
What is neuromuscular control & coordination?
A
The interaction of both sensory and motor systems that enables the function of synergist, agonist, antagonist, and stabilizers/neutralizers to function
22
Q
What does ur body do during a neuromuscular control & coordination?
A
Our body utilizes anticipational response to proprioceptive and kinesthetic information in order to coordinate specific movement.
23
Q
Correct timing and sequence of muscle firing is combined with appropriate intensity, muscle contraction, which leads to ____ of movement. Occurs at a conscious level
A
Correct timing and sequence of muscle firing is combined with appropriate intensity, muscle contraction, which leads to initiation and guiding and grading of movement. Occurs at a conscious level
24
Q
What is stability?
A
The ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during super imposed movement
25
What does stability relate to?
The maintenance of proper alignment of bony partners of a joint by means of both passive and dynamic components
26
What is the optimal performance pyramid?
The way of thinking about how we move as it relates to more functional activities
27
What does functional movement represent?
Our ability to move well without limitations and with balance
28
What does functional movement encompass?
Our fundamental movement patterns including: being well balanced, having static dynamic stability, showing full ROM, good movement control and body awareness and good posture
29
What does each number mean on the functional movement screen that is used to measure functional movement?
3: optimal performance/ movement
2: Some deficits
1: Significant movement pattern deficits
0: Pain
30
What is functional performance?
The ability to sustain quality of movement and repeated work without fatigue. Gross athleticism
31
How is gross athleticism measured?
By factors of movement, strength, power, endurance, and ability to do things like run or jump
32
What is functional skill?
A sports specific skill, which looks at how well you perform a particular sport or skill. Also looks at competition stats and any specific testing related to the sport
33
Asides from athletes, who else does a functional screen look at?
Anyone looking to engage in improving their cardiovascular capacity
34
What is the 1st thing to consider when matching an intervention to an impairment?
What does THIS patient need?
35
What should you start an exercise intervention with?
Isolating muscle groups
36
Match therapeutic level based on the ____
Match therapeutic level based on the *patient's ability*
37
Avoid floor effects by being
| able to ____
Avoid floor effects by being
| able to *start where the patient is*
38
Avoid ceiling effects by being able to ____
Avoid ceiling effects by being able to *get your patient to where they need to be*
39
What is the order in which you do therapeutic exercise?
1. General warm-up
2. Dynamic mobility
3. Skill training
4. Power
5. Strength
6. Metabolic conditioning
7. Balance
8. Static mobility
40
What are the considerations for HEP?
* Understand your patient
* Frequency of treatment, commitment, engagement, etc.
* Give patient long-term battles (eg. flexibility, strength)
* Dynamic process requiring constant needs assessment
41
What are the methods of delivery for an HEP?
* Handwritten
* Computer generated
* Online program
* emailed, printed
* video component
* Selfies!
42
What are the PT's responsibilities for adherence to HEP?
- Giving reminders
- Providing clinical knowledge
- Monitotring adherence
- Promoting feedback
43
What is the role of the selection of HEP as it relates to the adherence to HEP?
- Time consumption
- Exercise effects
- Complexity of exercises
44
What are the things to think about if a patient is not complaint with their HEP?
- Where they too easy or hard?
- Did they cause pain?
- Was it explained well enough?
- Were they sold as the best exercises specifically for that patient?
45
What are the things that your HEP should be?
- Achievable
- Simple
- Appropriately challenging
- Patients should know what they should be feeling
- Safe for incase the patient messes up
46
What are the phases of acute wound healing?
- Hemostasis
- Inflammatory phase
- Proliferative phase
- Remodeling phase
47
How long does the hemostasis phase of wound healing last?
Seconds to hours
48
How long does the inflammatory phase of wound healing last?
Hours to days
49
How long does the proliferative phase of wound healing last?
Days to weeks
50
How long does the remodeling phase of wound healing last?
Weeks to months
51
What occurs in the hemostasis phase of healing?
- Vasoconstriction
- Platelet aggregation
- Leukocyte migration
52
What occurs in the inflammatory phase of healing?
- Early neutrophil
- Chemoattractant release
- Late macrophages
- Phagocytosis and removal of foreign body/ bacteria
53
What occurs in the proliferative phase of healing?
- Fibroblast proliferation
- Collagen synthesis
- Extra-cellular matrix (ECM) reorganization
- Angiogenesis
- Granulation tissue formation epithelialization
54
What occurs in the remodeling phase of healing?
- Remodeling
- Epithelialization
- ECM remodeling
- Increase in tensile strength of wound
55
___ is our body's mechanism to protect itself from bleeding out
*Hemostasis* is our body's mechanism to protect itself from bleeding out & prevent infection
56
What are the POC in the acute stage: protective phase of wound healing?
1. Educate the patient
2. Control pain, edema, and spasms
3. Maintain soft tissue and joint integrity and mobility
4. Reduce joint swelling if symptom are present
5. Maintain integrity and function of associated areas
57
How do we educate the patient in the acute stage: protective phase of wound healing?
Inform patient of anticipated recovery time and how to protect the part while maintaining appropriate functional activities
58
How do we control pain, edema, and spasms in the acute stage: protective phase of wound healing?
- Cold, compression, elevation, and massage within 48hrs
- Immobilize the part (rest, splint, tape, and cast)
- Avoid positions of stress to the part
- Gentle (grade 1 or 2) joint oscillations with joint in pain-free position
59
How do we maintain soft tissue and joint integrity and mobility in the acute stage: protective phase of wound healing?
- Appropriate dosage of passive movements within limit of pain, specific to structure involved
- Appropriate dosage of intermittent muscle setting or E-stim
60
How do we reduce joint swelling if symptom are present in the acute stage: protective phase of wound healing?
- May require medical intervention if swelling is rapid (blood).
- Provide protection (splint, cast)
61
How do we maintain integrity and function of associated areas in the acute stage: protective phase of wound healing?
- Active-assistive, free, resistive and or modified aerobic exercises, depending on proximity to associated areas and effect on the primary lesion.
- Adaptive or assistive devices as needed to protect the part during functional activities
62
What are the precautions in the acute stage: protective phase of wound healing?
The proper dosage of rest and movement must be used during the inflammatory stage. Signs of too much movement are increased pain, or inflammation
63
What are the contraindications in the acute stage: protective phase of wound healing?
Stretching and resistance exercises should not be performed at the site of the inflamed or swollen tissue
64
What are the POC in the subacute stage: controlled motion phase of wound healing?
1. Educate patient
2. Promote healing of injured tissues
3. Restore soft tissue, muscle, and or joint mobility
4. Develop neuromuscular control, muscle endurance, and strength in involved and related muscles
5. Maintain integrity and function of associated areas
65
How do we educate the patient in the subacute stage: controlled motion phase of wound healing?
- Inform patient of anticipated healing time and importance of following guidelines.
- Teach HEP and encourage functional activities consistent with plan
- Monitor and modify HEP as patient progresses
66
How do we promote healing of injured tissues in the subacute stage: controlled motion phase of wound healing?
- Monitor response of tissue to exercise progression; decrease intensity if pain or inflammation increases
- Protect healing tissue with AD, splints, tape or wrap; progressively increase amount og time the joint is free to move each day and decrease use of AD as strength in supporting muscles increases
67
How do we restore soft tissue, muscle, and or joint mobility in the subacute stage: controlled motion phase of wound healing?
- Progress from passive to active-assistive to active ROM within limits of pain.
- Gradually increase mobility of scar, specific to structure involved.
- Progressively increase mobility of related structures if limiting ROM; use techniques specific to tight structure
68
How do we develop neuromuscular control, muscle endurance, and strength in involved and related muscles in the subacute stage: controlled motion phase of wound healing?
- Initially, progress multiple-angle isometric exercises within patient's tolerance; begin cautiously with mild resistance.
- Initiate AROM, protected weight bearing and stabilization exercises.
- As ROM, joint play, and healing improve, progress isotonic exercises with increased repetitions
- Emphasize control of exercise pattern and proper mechanics
- Progress resistance later in this stage
69
How do we maintain integrity and function of associated areas in the subacute stage: controlled motion phase of wound healing?
- Apply progressive strengthening and stabilizing exercises, monitoring effect on the primary lesion
- Resume low-intensity functional activities involving the healing tissue that do not exacerbate the symptoms
70
What are the POC in the Chronic Stage: Return to Function phase of wound healing?
1. Educate the patient
2. Increase soft tissue, muscle and or joint mobility
3. Improve neuromuscular control, strength, muscle endurance
4. Improve cardiopulmonary endurance
5. Progress functional activities
71
How do we educate the patient in the Chronic Stage: Return to Function phase of wound healing?
- Instruct patient in safe progressions of exercises and stretching
- Monitor understanding and compliance
- Teach ways to avoid re-injuring the part
- Teach safe body mechanics
- Provide ergonomic counseling
72
How do we increase soft tissue, muscle and or joint mobility in the Chronic Stage: Return to Function phase of wound healing?
Stretching techniques specific to tight tissue
73
What are the stretching techniques specific to joint and selected ligaments?
Joint mobilization/ manipulation
74
What are the stretching techniques specific to ligaments, tendons, and soft tissue adhesions?
Cross- fiber massage
75
What are the stretching techniques specific to muscles?
- Neuromuscular inhibition
- Passive stretch
- Massage
- Flexibility exercises
76
How do we improve neuromuscular control, strength, muscle endurance in the Chronic Stage: Return to Function phase of wound healing?
Progress exercises
77
How do we improve cardiopulmonary endurance in the Chronic Stage: Return to Function phase of wound healing?
Progress aerobic exercises using safe activities
78
How do we progress functional activities in the Chronic Stage: Return to Function phase of wound healing?
- Continue using supportive and/or ADs until the ROM is functional with joint play, and strength n supporting muscles is adequate
- Progress functional training with simulated activities from protected and controlled to unprotected and variable
- Continue progressive strengthening exercises and advanced training activities until the muscles are strong enough and able to respond to the required functional demands
79
What type of exercises are best for degenerative/chronic conditions?
Eccentric exercises
80
What are the pros of NWB immobilization?
- Helps with acute phase of healing
- Prevents further damage
- Minimizes acute pain
81
What are the cons of NWB immobilization?
- Delayed soft tissue
- Contractures & adhesions
- Loss of articular cartilage
- Muscle atrophy
- Shortening & thickening of capsular tissue
82
Optimal fracture healing appears to require at least some ___, which helps stimulate bone formation and improve ROM
Optimal fracture healing appears to require at least some *cyclical loading*, which helps stimulate bone formation and improve ROM
83
What are the benefits of controlled WB and partial immobilization?
• Improved ROM
• Decrease pain
- locally and regionally
• Reduced long-term rehab
84
What is continuous passive motion (CPM)?
A constant PROM provided by an external device, with no breaks
85
What are the benefits of CPM?
* Prevents joint stiffness
* Increase synovial fluid lubrication
* Quicker return of ROM
86
Why is CPM seen less in modern day?
There's literature that states that it doesn't have as much effect on ROM as we once thought
87
What is PROM?
Constant movement provided by either the patient or the PT
88
What are the benefits of PROM?
* Prevents joint stiffness
* Prevent contractures
* Increase synovial fluid lubrication
* Quicker return of ROM
* Pain relief
89
Is a person ever going through PROM?
No, unless under anesthesia
90
When should a patient be progressed to AAROM?
Begin as soon as safe and patient is able
91
What is AAROM ideal for?
Ideal for unilateral weakness or paralysis
92
What are some types AAROM apparatus?
* Wand (for overhead)
* Finger ladder/wall climbing
* Ball rolling
* Pulleys
* UBE
93
Which ROM is the most functional?
AROM
94
AROM can go against __ in order to improve strength
AROM can go against *gravity* in order to improve strength
95
When should a patient be progressed to AROM?
Begin as soon as safe and patient is able
96
What are the goals of PROM?
- Maintain, not increase mobility
| - Inhibit pain, increase kinesthetic awareness
97
What are the goals of AAROM & AROM?
* Increase circulation (decreased risk of thrombus)
* Sensory feedback
* Functional activities
98
What are the indications for PROM?
* Acute, inflamed tissue
| * Active movement contraindicated or impossible
99
When is active movement contraindicated or impossible?
When patient is comatose, paralyzed, or on bed rest
100
What are the indications for AAROM & AROM?
* When patient is able to assist or activity contract muscles
* Weak muscles
* Part of aerobic program
* Joints surrounding immobilized areas
101
___ will NOT increase strength, endurance, prevent atrophy, or improve circulation to the extent of volitional muscle contraction
*PROM* will NOT increase strength, endurance, prevent atrophy, or improve
circulation to the extent of volitional muscle contraction
102
___ will NOT increase strength or maintain strength in strong muscles, or develop skill or coordination except in the specific movement patterns used
*AROM* will NOT increase strength or maintain strength in strong muscles, or develop skill or coordination except in the specific movement patterns used
103
When should ROM be avoided?
Avoid ROM when disruptive to healing process
104
___ is a sign of too much ROM or wrong motion
*Increased pain* is a sign of too much ROM or wrong motion
105
What is a warm-up?
The mental and physical preparation of a patient for exercise
106
What are the physiological responses of a warm-up?
* Increased muscle and core temperature
* Enhanced neural function
* Improvement in force development and reaction time
* Improved muscle strength and power
* Lowered viscous resistance in muscles & joints
107
What is the key to any warm-up?
The structure of the warm-up influences potential improvements; as such, the warm-up needs to be specific to the activity to be performed
108
What should a PT be doing while the patient warms-up?
Connect with your patient, find out whats going on with your pt. Have a conversation
109
What are the classic phases of a warm up?
- General aerobic warm-up
- Stretching
- Specific-warm up
110
What are the problem associated with the classic warm-up?
* Static stretching
* Decreased force production
* Decreased running speed
* Decreased reaction/movement time
* Decrease strength and endurance
* No clear link between static stretching and injury prevention
111
What is the modern approach to a warm-up?
RAMP method
112
What does RAMP stand for?
- Raise
- Activate
- Mobilize
- Potentiate
113
What are the goals of raise in the RAMP method?
* Practice techniques at lower intensity
| * Raise body temperature and recruit proper musculature
114
What are the goals of activate and mobilize in the RAMP method?
* Active key muscle groups
| * Mobilize key joints and ranges of motion used in the sport or activity
115
What are the goals of potentiate in the RAMP method?
* Increase intensity to a point where subsequent activities can be performed at maximal level
* Select activities that can contribute to a supra-maximal effect via utilization of a post activation potentiation effect
116
When or why might we stretch a patient?
* Adhesions, contractures, scar tissue limiting ROM
* Weakness secondary to shortened muscle length
* Part of total fitness program
* Post exercise
117
What are the factors affecting flexibility?
* Joint structure
* Age & sex
* Muscle & connective tissue
* Stretch tolerance
* Neural control
* Resistance training
* Muscle bulk
* Activity level
118
How long does it take for stretching to have an effect on muscles?
6-8 weeks
119
What is a contracture?
Static shortening of a muscle
120
What are the ways that a contracture can present?
* Tonic spasm
* Fibrosis
* Loss of muscle balance
* Hypomobile antagonists
* Paralysis
* Loss of motion at adjacent joint
121
How are contractures named?
• Named for action of the shortened muscle
- eg. tight elbow flexors—> can’t fully extend elbow—>
elbow flexion contracture
122
What are the different types of contractures?
- Myostatic
- Pseudomyostatic
- Arthrogenic & Periarticular
- Fibrotic & Irreversible
123
What do you see in a myostatic contracture?
* shortening of muscle tissue unit, decreased number of sarcomeres in series
* eg.people who don’t stretch!
124
What do you see in a pseudomyostatic contracture?
There's an underlying neurologic condition like spastic diplegia and results in hypertonicity and/or rigidity
125
Can a pseudomyostatic contracture be influenced?
Yes, but there will less of an impact given the underlying neuromuscular origin of the contracture
126
What is an arthrogenic & periarticular contracture?
A contracture that is secondary to some sort of under-lying MSK intra-articular pathology. "OA"
127
What is a fibrotic & irreversible contracture?
A contracture that results from some sort of underlying medical condition that may or may not be an underlying neurologic condition. EX: poland syndrome
128
What is poland syndrome?
The condition where you are born without a pec major. There will be webbing from the chest wall to the shoulder
129
How long do the short term benefits of stretching usually last?
3 mins- 24 hrs
130
How long should a dedicated stretching program be?
• 2-3x a week, minimum of 5 weeks
131
How long should a stretch be held?
• 30 seconds likely ideal or else you get diminished returns thereafter
132
What should be felt during a stretch?
Sensation of gentle stretch, not pain
133
What region of the stress- strain curve should we be stretching in?
In the plastic region, within its limits. A bit past the yield point. 5-6%
134
What is the creep phenomenom?
The physical property of materials that results in progressive deformation when a constant load is applied over time
135
What does creep allow?
Allows soft tissues to tolerate applied loads by lengthening
136
What are muscle spindles?
Sensory receptors within the belly of a muscle, whose primary job is to detect the the changes in the length of a muscle
137
What is the golgi tendon organ?
A proprioceptive sensory receptor that changes in muscle tension
138
Where does the golgi tendon organ lie and what is its job?
It lies in the origins and insertions of skeletal muscle fibers. Its job is to control for autogenic and reciprocal inhibition
139
What is autogenic inhibition?
A sudden relaxation of a muscle upon development of higher tension
140
___ is a self induced, inhibitory negative feed back lengthening reaction that protects a muscle against a tear
*Autogenic inhibition* is a self induced, inhibitory negative feed back lengthening reaction that protects a muscle against a tear
141
___ is responsible for perceiving the rapid stretch created by an autogenic inhibition
*Golgi tendon organ "GTO"* is responsible for perceiving the rapid stretch created by an autogenic inhibition
142
What is reciprocal inhibition?
The process of muscles of one side of a joint relaxing to accommodate a contraction on the other side of a joint
143
Reciprocal inhibition is controlled by the ___
Reciprocal inhibition is controlled by the *GTO*
144
When does stretching have the best effect?
Directly after activity
145
What are the types of stretching?
- Static
- Ballistic
- Dynamic
- Proprioceptive Neuromuscular Facilitation (PNF)
146
What is static/passive stretching?
"Relaxed stretching", One where you assume a position and you hold it with some other part of the body or with the assistance of a partner or an apparatus(can be the floor)
147
How long does a passive/static stretch held?
Typically 3 sets of 20-30 seconds
148
What is static/active stretching?
One where you assume a position and no external assistance is provided to hold the stretch other than the strength of the agonist muscles
149
What helps active/static stretching to really work?
Reciprocal inhibition
150
What is ballistic stretching?
When a muscle is forced beyond its normal ROM and is seen when people bounce to strecth
151
What is the thought behind ballistic stretching?
People use muscles as a spring
152
What is the benefit of ballistic stretching?
There is none. It is neither safe nor indicated and can be harmful
153
What are the things associated with ballistic stretching?
Decreased performance, and more muscle injuries
154
What is dynamic stretching?
The involvement of moving parts of the body, gradually moving to increase reach, speed of movement, or both
155
What does dynamic stretching consist of?
Controlled leg and arm swings that take you gently to the limits of ROM.
156
What is PNF stretching?
The integration of active muscle contractions into stretching in order to either inhibit or facilitate muscle activation and increase the likelihood of the muscle to be lengthened while remaining relaxed as its stretched
157
What is the traditional underlying mechanism of PNF?
The reflexic relaxation occurs during the stretching maneuvers as a result of the autogenic reciprocal inhibition, thus leading to decreased tension of muscle fibers, therefore decreased resistance, and increased elongation by the contracture elements of muscle when its stretched
158
What is the modern underlying mechanism of PNF?
Sensorimotor processing, which is a combination of visco-elastic adaptation of the musculo-tendinous unit as well as changes in the patients tolerance of the stretching maneuver
159
What are the basic PNF stretches?
- Hold- Relax
- Contract - relax
- Hold relax with agonist contraction
160
How does hold- relax PNF stretch work?
After assuming a passive stretch, the muscle being stretched is isometrically contracted for anywhere between 6-15 secs, and then the muscle is briefly relaxed for another 2-3 secs, then passively stretch the muscle even further than it was before and hold for the same amount of time
161
How does contract- relax PNF stretch work?
There is a concentric activation of the muscle being stretched, and there is active movement
162
How does hold relax with agonist contraction PNF stretch work?
Identical to hold relax, but in the 3rd phase, there is concentric action of the agonist muscle in addition to passive stretch to add more force. Final stretch should be greater
163
___ and ___ stretching tends to induce small to moderate decreases in performance for short term after stretching
*Static and PNF* stretching tends to induce small to moderate decreases in performance for short term after stretching
164
What are some clinical pearls for stretching a patient?
- Keep them calm
- Know what you are stretching
- Stabilize the proximal joint segment
- Understand genotype (how the patient is naturally built)
- Follow up with active movement
- Don't compartmentalize stretching
- Know your patient's demands
165
What is the envelope of function?
Recognizing how much load a tissue can take and how much deformation is fine for the muscle can encourage improvement
166
___ is a complex interaction between cardiovascular, musculoskeletal, and neuromuscular systems
*Stretching* is a complex interaction between cardiovascular, musculoskeletal, and neuromuscular systems
167
Tightness comes on often as a result of a secondary problem, which is usually a ___
Tightness comes on often as a result of a secondary problem, which is usually 1 a *hyper-mobility or instability relate problem*l
168
What are our more stable joints?
- Foot
- Knee
- Low back
- Scapula
- Elbow
169
What are our more mobile joints?
- Ankle
- Hips
- Thoracic spine
- Neck
- Shoulder
- Wrist
170
What is the normal elbow flexion ROM?
0- 140 deg
171
What is the normal shoulder flexion ROM?
0- 165 deg
172
What is the normal shoulder extension ROM?
0-60 deg
173
What is the normal shoulder medial rotation ROM?
0- 70 deg
174
What is the normal shoulder lateral rotation ROM?
0- 90 deg
175
What is the normal shoulder abduction ROM?
0- 180 deg
176
What is the normal knee flexion ROM?
0-145 deg
177
What is the normal ankle dorsiflexion ROM?
0- 20
178
What is the normal ankle plantar flexion ROM?
0- 50 deg
179
What is the normal hip flexion ROM?
0- 120 deg
180
What is the normal hip extension ROM?
0 - 20 deg
