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Therex Exam 1
Terms in this set (116)
What is an Indication
A condition which makes a particular treatment or procedure advisable.
What is a contraindication?
a condition which treatment should never be performed
What are the 8 components of Physical function?
2. cardiopulmonary fitness
6. muscle performance
7. neuromuscular control
8. postural control
What are the 6 elements of the Patient/Client management model?
What does the SAID principle stand for?
Specific Adaptation to Imposed Demands
What does SAID mean?
Match a desired goal or outcome to the exercise being prescribed
How can you improve specificity?
-Mode of exercise
-Speed at which being performed
- Position of patient
-resistance relative to limb (moment arm)
What is the overload principle?
in order to improve you must challenge the muscles by exceeding the load. You can do this by increasing intensity and volume
What is the reversibility principle?
use it or lose it
FITT principle is used for?
FITT stands for?
Frequency, Intensity, Time, Type
What are three neural adaptation effects of exercise?
-Muscle or motion specific reactions
What are the effects of exercise on muscle and connective tissues?
-lengthening (long hold stretches)
-hypertrophy (resistance training)
-Increased connective tissue strength (resistance training)
-Increased bone mineral density (weight bearing)
What are the effects of exercise with resistance training on metabolic adaptations?
Decrease in capillary bed density
decrease in mitochondrial density
What are the effects of exercise with aerobic training on metabolic adaptations?
increased capillary bed density
increase mitochondrial density
increase myoglobin concentration
lower blood lactate levels
less reliance on PC and ATP in skeletal muscle
decreased depletion of muscle glycogen (long term)
What are the three specific adaptations to aerobic training?
-Improved O2 extraction
-Increased blood volume
-Decrease in resting pulse and blood pressure
What are the 7 effects of bed rest?
3. Decrease coordination
4. Decrease aerobic capacity
5. Decrease orthostatic tolerance
6. Reduction in blood and plasma volume
7. Decrease in bone mineral density
What are the 4 effects of joint immobilization
4. Decreased coordination
What does SINSS stand for?
The first S in SINSS stands for?
I in SINSS stand for?
What are the 3 things you are asking your pt?
How far into motion/activity does pain begin
How quickly does pain come on
How long does it take to subside
N in SINSS stand for?
mechanical, chemical, psychological?
Second S in SINSS stands for?
Last S in SINSS stands for?
worse, better or staying the same?
Why do we use the SINSS model?
Help determine appropriate intervention, and vigor/dosage
What are 4 goals for PROM?
1. Decrease complications that would occur with immobilizaton
2. Maintain joint/connective tissue mobility
3. Decrease pain
4. minimize effects of contracture
What are 3 limitations to PROM?
1. PROM does not prevent atrophy
2. PROM does not increase strength
3. PROM does not assist circulation
What are 3 goals for AAROM?
1. Maintain elasticity and contraction of muscles
2. Develop motor skills
3. Provide stimulus for bone and joint tissue
What are 4 indications for AROM?
1. Patient is able to contact the muscles actively and move without assist
2. Progression towards resistance training
3. Relives stress from sustained postures
4. Maintain as normal as condition as possible
Grade 1 rom
Small amplitude, out of resistance
Grade 2 rom
Large amplitude, out of resistance
Grade 3 rom
Large amplitude, into resistance
Grade 4 rom
Small amplitude, into resistance
Why are grades important?
2. Stage of healing
3. Goals for patient
PROM is ENTIRELY?
By an external force
AROM is ENTIRELY?
By muscle contraction
By muscle contraction and external force
Purpose of stretching?
Increase soft tissue extensibility with the intent to improving flexibility and ROM by lengthening structures that have adaptive lay shorted or are hypomobile
Possible patient interventions in the form of therapeutic exercise include all of the following EXCEPT?
1. Range of motion
2. Joint mobilization
4. Muscle strengthening
2. Joint mobilization is a form of manual therapy used in possible patient interventions.
In order to appropriately and most effectively preserve stretch gains, the patient should
a) apply ice after stretching to improve range retention
b) strengthen the antagonist muscle of the stretched muscle more than the agonist or stretched muscle
c) Regularly utilize the increased range of motion in functional activities
d) Advise the patient to ignore strengthening protocols and to only focus on stretching the agonist muscle
C - utilizing the patients brew range of motion following stretching is directly rated to getting the individual back to full range of motion
Which of the following would be considered NOT a physiological effect of inactivity of joint immobilization?
B. Decreased Coordination
C. Decrease in bone mineral density
C - this is not an effect on joint immobilization but rather an effect of being on bed rest
What physiological change does not occur as a result of immobilization?
B. Initially weaker tissue structure with remodeling over 3 weeks to 1 year
C. Weak collagen bonding between fibers
D. Decreased stiffness and decreased effectiveness of ground substance
B- applies to the physiological affects of the injury rather than immobilization
What is one example of a neuromuscular change that is associated with stretch?
A. Sarcomere give
B. Muscle fiber lengthening
C. Improved flexibility
D. Autogenic inhibition
D- autogenic inhibition is a neuromuscular changes associated with stretch
Which of the following would fall under the N category of SINSS?
1. Pain that comes on after 10 minutes of walking and goes away after 20 minutes of rest
2. Pain that is an 8 out of 10 on the pain scale
3. Psychological pain
4. Chronic low back pain
3. N refers to nature of the pain such as chemical, mechanical, and even psychological pain
Which of the following is a goal of PROM?
1. Provide sensory feedback from the contracting muscle
2. Increase circulation and prevent thrombosis formation
3. Provide a stimulus for bone and joint tissue integrity
4. Maintain joint and connective tissue mobility
54 year old, Susan, works at the local hospital as an environmental services tech. Her duties include cleaning patient rooms thoroughly between patient stays to eliminate any spread of pathogens. She realizes that her shoulder is becoming increasingly more and more painful throughout the work day. She goes to see a physical therapist and discoveres that she has an impinged shoulder due to poor posture and overuse of muscles at work. The therapist prescribes a doorway pec stretch with her arms bent at her elbows at 90 degrees to push into the stretch. She notices that this stretch effectively relieves pain in physical therapy, but doesn't do the same at home. Her therapist notices the next time Susan is in therapy that she is performing this doorway stretch far too low and not stretching the appropriate muscles. Which parameter of stretching does this fall under?
C- alignment, if you are not in correct alignment you are not stretching the correct muscles
John is a high school baseball pitcher who began experiencing sharp hip pain that increasingly got worse throughout every practice and game. He went to his doctor and was diagnosed with femoral acetabular impingement (FAI). It was so severe that he need to get surgery as soon as possible and was put in physical therapy afterwards for a few months to strengthen his muscles to return to sport. After getting clearance from his doctor, his physical therapist started prescribing exercises that put him in the same positions that he would be in during a pitch and he started strengthening the same muscles he would use as a pitcher. John responds well and is cleared to start going back to practice. What principle of exercise prescription is his physical therapist demonstrating?
A. Overload Principle
D. The exercises that his physical therapist is prescribing directly correlates with what his goal is, to return to pitching
A patient is explaining about their knee pain, when the therapist asks about her pain level they respond with 3/10. What is the therapist asking about to help determine the appropriote intervention and dosage for the patient?
C- severity is a pain assesment tool
A patient is still recovering from their injury and has to spend a lot of time recovering in bed. Due to the extended time of bed rest, what is a physiological effect of this?
C) Increase in bone mineral density
D) Increased coordination
B- because the patient is inactive and loosing strength/muscle with the extended time of bed rest
Identify which of the following examples is not physiological effect of inactivity.
B) Increase in blood and plasma volume
C) Decrease in orthostatic tolerance
D) Decrease in bone mineral density
B- there is a decrease in blood and plasma volume with inactivity not an increase
Which of the following is not a reason to use graded PROM?
A. Using graded PROM to help with clinical reasoning in documentation.
B. When a patient has no pain or symptoms.
C. When a patient is in the acute stage of healing
D. when your goal of the treatment is prevent future complications of being immobilized.
B- if the patient has pain or symptoms during PROM then you would use the graded PROM to still get movement in the joint but with different degrees
What does "I" stand for in the SINSS principle? And what does it mean?
A. Irritability and it means how far into activity does pain begin, how quickly does it come on and how long does it subside.
B. Improvement and it means how are the home exercises helping the patient recover.
C. Intense and how intense is the pain.
D. Intelligent and how to describe the pain the patient is having.
A- it stands for Irritability and it is used to describe how far into the activity does the pain begin, how long does it take to subside and how quickly does the pain begin
Hypertrophy is an example of which physiological effect of exercise?
A) Cardiovascular changes
B) Neural changes
C) Metabolic changes
D) Muscle fiber changes
D- connective tissues and muscle fiber change because are you bear weight or resistance train there is a stress that pulls on the muscle fibers and connective tissues. This stress causes actual damage to the tissues and muscles which then signal to the body that it is time to heal
Which of the following is a contraindication for stretching?
a. Known or suspected osteoporosis
c. Muscles that are weak in supporting bony structures
D. All of the above
B- hypermobility because stretching a hyper mobile joint, you could decrease stabilization and put the patient at risk for injuries
Which is not an element of the patient/client management model?
The management model consists of examination, evaluation, diagnosis, prognosis, intervention and outcomes
What is an example of a contraindication for stretching?
a. Pre-existing hypermobility at that joint.
b. Muscular tightness across a joint that is restricting ROM.
c. Generalized stiffness or hypomobility that negaively impacts function.
d. Muscle pain that is relieved with the correct dose of stretching.
A - a joint that is already hyper mobile, whether due to muscular weakness, ligament laxity or loose capsular structures has the potential to become even more unstable with stretching
In what setting would ballistic/dynamic stretching be appropriate?
A. A 65 year old male who is experiencing tight hamstrings and pain in the hip.
B. A 45 year old woman who just had a total knee replacement three weeks ago.
C. A 22 year old elite soccer athlete who is coordinated and at high functioning level
D. A 13 year old uncoordinated athlete who just recently joined a football team.
A patient with low back pain tells the therapist that her back pain comes on at work when she has been sitting for a long period of time, but typically goes away after getting up and moving around for fifteen minutes. This is an example of what letter in SINSS?
What factors are important in monitoring safety during stretching a musculotendinous restriction?
a.) Pain Level
b.) Location of Pull
c.) All of the answers are correct.
d.) Effort of Stretch
c- The pain level is important because we don't want to push into pain and cause mroe damage then good. The location of stretch is important becuase if we are elongating fibers that are not in the specific muscle we are tragetting there is no benefit to the stretch in direct correlation to the tight fibers. The effort of the stretch is important to be aware of because we want the patient to be at a comfortable amount of exertion.
Dan a 45 y.o. male who had a fracture of the lateral condyle of the humerus the in the elbow joint is experiencing a limit in his ROM. He can reach about 60 % of his full expected range in elbow extension. The contacture that is associated with this impairement is:
a.) Elbow flexion contracture
b.) Elbow extension contracture
c.) Brachioradialis m. contracture
d.) Triceps m. contracture
What is the definition of a precaution?
A. condition which makes a treatment advisable
B. Purpose of applying specific intervention or treatment
C. Condition which may make a treatment inadvisable
D. Condition which the treatment should never be preformed
When using SINSS to assess patient presentation, which category is in relation to an acute or chronic issue?
C- the stage of an issue or injury can be described as acute, fairly recent, chronic and ongoing
What of the following is NOT a metabolic adaptation to aerobic training?
A) Increased capillary bed density
B) Decreased mitochondrial density
C) Decreased depletion of muscle glycogen
D) Lower blood lactate levels
B- this is an adaptation to resistance training, not aerobic training
Bertha was in an accident and is now in the hospital on bedrest. What are some physiological effects Bertha will start to see within the first few days?
B. Decrease in bone mineral density
D. Decrease in orthostatic tolerance
D- with bed rest bertha will not be able to regulate blood pressure due to inactivity which is dependent on blood plasma and volume
What is Contract-relax (hold -relax) stretching?
1. The range limiting muscle is lengthened to the point of limitation.
2. The patient then performs an isometric contraction of the tight muscle for at least 6 seconds. ("Hold, do not let me move you. Hold, Hold, Hold, Hold, Hold, Hold.")
3. The patient then relaxes the tight muscle.
4.The limb is then moved into the new range.
This sequence (1-4) is repeated until diminishing returns are achieved. After diminishing returns are achieved the stretch is held for 30 seconds.
What is an agonist contraction using method 1?
The patient concentrically contracts the muscle opposite the range limiting muscle and then holds the end range position.
What is an agonist contraction using method 2?
1. The range limiting muscle is passively lengthened to the point of limitation.
2. The patient concentrically contracts the agonist muscle (the muscle opposite the range limiting muscle)
3. The limb is held at the new range as the patient relaxes the agonist muscle
What is an agonist contraction using method 3?
1. The range limiting muscle is passively lengthened to the point of limitation.
2.The patient isometrically contracts the agonist muscle (the muscle opposite the range limiting muscle) against resistance provided by the therapist.
3.The limb is held at the new range as the patient then relaxes
4.Optional addition: The patient now concentrically contracts the agonist muscle and holds this new stretch position
What are three considerations when stretching the UE?
-smaller muscle mass
-shoulder is highly mobile including the scapulothoracic complex
What physiological change would Corticosteriods have on connective tissue?
A. Increase in tensile strength of connective tissue
B. Increase stiffness
C. Allow for tissue to repair in over 3 weeks to a year.
D. Decrease in tensile strength of connective tissue
D- corticosteroids make connective tissue decrease in tensile strength
Which of the following shows correct documentation for an intervention?
A. Right Leg heel slide for knee AROM. 3 x 10. Patient is directing motion by pain tolerance.
B. Right Shoulder Flexion PROM. 2 x 10. No pain during motion. Stopped at end of motion.
C. Right Shoulder Flexion PROM 3 x 10. Cued to avoid shoulder shrug.
D. Right Leg Heel Slide AROM. 3 x 10. Patient directed the motion according to pain tolerance. Pain terminates after exercise. Cued to avoid hip external or internal rotation. Performed exercise to improve knee flexion and extension ROM.
To achieve lasting effects of stretching, what range do you need to stretch the connective tissues to according to the stress-strain curve?
C- the connective tissues stretched to this range are moving past their normal capacity and therefore lengthen more permanently
What are the indications for PROM?
1. Body region where there is acute, inflamed tissue
2. Patient is not able to or not supposed to move actively
3. Assessment of joint motion, joint stability, and muscle length
4. To show pt the desired movement pattern
5. Used to prepare for stretching
What are the 3 ways to preserve stretch gains?
-MOST effective = regularly utilizing increased range
-training motor control in strength in new range
-cold after stretching MAY improve range retention
What happens to connective tissue with immobilization?
-weak collagen bonding between fibers
What happens to connective tissues with inactivity?
-weakening of tissue
-decrease in collagen/ more elastin (weaker)
What is the Type of stretching according to the FITT model?
Static stretching, cyclic stretching, ballistic, active stretching, passive stretching, manual, self, and mechanical.
What is the specific stretch parameter for frequency and time?
stretch needs to occur for prolonged periods in order for change to occur: REST PERIODS are required to avoid injury
What tests do you use for impairments in muscle flexibility?
-active ROM testing
-passive ROM testing
-muscle length tests
if an impairment in ROM is found make sure to confirm that it is...
associated with a soft tissue restriction
How can you test for impairments in joint mobility?
-active ROM testing
-passive physiologic ROM
-Passive accessory ROM
What are the keys for effective stretching prescription?
-patient assessment before stretches
-Determine the appropriate parameters to match impairment
-Monitor patient for safety
-Safely perform manual stretches
-determine the effects of stretching
-preserve the effects of stretching (using new range)
What are 6 additional parameters of stretching?
1. alignment (most important)
5. speed (slow and controlled)
What is the specific stretch parameter for type of stretching?
each type has different effectiveness based on patient preference
What is the specific stretch parameter for intensity?
stretch needs to move into plastic ranges without leading to injury
What type of stretching is the most dynamic/kicking motion
What type of stretching is safest for adults?
What is the Time for stretching according to the FITT model?
total of 60 seconds for each muscle: may be completed in 15s, 30s, or 60s cycles
What is the intensity for stretching according to the FITT model?
Low grade to the point of tightness (moderate or 3-4/10 intensity)
What is the frequency for stretching according to the FITT model?
-At least 2 sessions a week and able to complete up to daily for normal
-2/3x daily for impairment in muscle length
What happens to connective tissue with Injury?
Initially weaker tissue structure with remodeling over 3 weeks to 1 year
What is the neuromuscular change that occurs with stretch?
stretch reflex/reciprocal inhibition
autogenic inhibition (how much stretch to give)
What is the mechanical change that occurs with stretch?
sarcomere give & muscle fiber lengthening
What happens to connective tissue with corticosteroids?
decrease in tensile strength of connective tissues (damage such as osteoporosis)
What happens to connective tissue with increase in age?
decreases max tensile strength of connective tissues (less rebound)
why do we care about the physiology?
Physiology determines why changes occur with stretching or with inactivity as well as WHAT PARAMETERS are necessary to effect desired changes.
What are 4 indications for AAROM?
1. Patient is able to contract the muscle actively and move with assistance but cannot achieve full rom without assistance
2. Movement above and below immobilized joint if not able to complete without assist
3. Relieve stress from sustained positions
4. Progressions towards resistance training
When we do PROM we are going through...
the available range of the individual
Why are GRADES important?
-stage of healing
-goal of treatment
What test do you use for ROM to see if stretching is appropriate?
muscle lengthening test
What are the indications for isometric exercise
- to prevent muscle atrophy when pt lacks joint mobility due to splint
-to re-establish neuromuscular control without disrupting the healing process of soft tissues (ex quad set)
-promote trunk stability
-develop static muscle strength (ex terminal knee extension post surgery)
GOALS FOR ACTIVE RANGE OF MOTION (AROM)
- Maintain physiological elasticity and contractility of the participating muscles
-sensory feedback from the contracting muscles
-Provide a stimulus for bone and joint tissue integrity
-Increase circulation and prevent thrombus formation (example: ankle pumps)
-Develop coordination and motor skills for functional activities.
Goals for resistance exercise
-improve muscle strength
-improve muscle power
-improve muscle endurance
-increased strength of CT
-greater bone mineral density
-decreased stress on joints
-reduced risk of soft tissue injury during physical activity
-possible improvement in capacity to repair and heal damage soft tissue due
-possible improvement of balance
-enhanced physical performance
-positive changes in body composition
-enhanced feeling of physical well being
-decreased activity limitations & improved participation
What is a precaution?
Condition which increases risk of injury to patient with intervention and indicates increased caution when administering this intervention
GENERAL PRECAUTIONS DURING RESISTANCE EXERCISE
-caution the patient that pain should not occur during exercise
-don't initiate resistance training at a maximum level of resistance, particularly with eccentric exercise to minimize delayed-onset muscle soreness.
-Use light to moderate exercise during the recovery period.
-avoid use of heavy resistance during exercise for children, older adults, & patients with osteoporosis
-don't apply resistance across an unstable joint or distal to a fracture site that is not completely healed
What are the precautions to resistance exercise?
- Must give body time to adapt to new overload before increasing reps or load again
-pt must be given time to recover for long-term muscle performance
-intensity of exercise should never be painful
-As intensity increases, so will aerobic exertion, remind pt to breath
-watch for breath holding
-Not all pt populations are a good fit, estimate load based on active range/ stage of healing
-apply and release resistance gradually
-High-load, open-chain exercise may have an adverse effect on unstable, injured, or recently repaired joints, as demonstrated in the ACL deficient knee.
Contraindications for resistance exercise
-pain with active motion with or without load during muscle contraction
-inflammation (acute, or due to neuromuscular disease)
-High intensity for pt with previous cardiovascular history
Contraindication to stretching
-hematoma or trauma
-contractor/or shortened soft tissue serves as a function for life to pt
-sharp acute pain
What are the 8 determinants of exercise prescription?
What are the three types of isometric exercises?
-Muscle-setting exercise (examples: quad sets, glut sets, hamstring sets)
-Multiple angle isometrics
What is open chain vs closed chain resistance exercise?
one segment is freely moving, vs both ends of segment are fixated
ex: arm raise vs squat
What is the recommended therapeutic exercise dose for Passive range of motion?
10-15 reps for each joint above and below injured tissue
Intensity: very light
frequency 2-3x a day for ROM
What is the recommended therapeutic exercise dose for Active range of motion?
Use dosage that matches goal of AROM
Goals for AROM exercise include
What is the recommended therapeutic exercise dose for Active Assisted range of motion?
Use dose that matches the goal of the AAROM exercise.
Goals for AAROM exercise include
What is the recommended therapeutic exercise dose to increase Muscle Strength?
Rest: 2-3 minutes
Recovery Period: >/= 48 hours between sessions
1x/day; Perform strengthening exercise at least 2x/week for healthy adults.
Intensity: 40-80% of 1RM
Somewhat Hard to Hard
Generally slow and controlled
Matched to desired function
What is the recommended therapeutic exercise dose to improve Muscle Endurance?
Rest: 2-3 minutes
Intensity: 30-70% of 1RM;
RPE- Light to Somewhat Hard
Frequency: 1 x/day; 2-3 x/week for healthy adults. NOTE: May be more for deconditioned patients.
Generally slow and controlled
Matched to desired function
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