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physical fitness requires what three things?
- proper cardiovascular functioning
- muscle strength and endurance
- muslce and joint flexability
what is vo2 max?
when an individual reaches max effort, the max amont of oxygen consumed per minute
what is the oxygen consumed by the myocardial tissue?
myocardial 02 consumption/ mV02
what 4 things affect the mV02?
- heart rate
- blood pressure
- myocardial contractiity
what is afterload?
ventricular force reqired to open the aortic valve
what the the to types of endurance?
- muscle endurance
- ardovasuclar endurance
waht is the ability to perform large muscle dynamic exercise for long period of time?
what is augmentation of energy uitlization of muscle or muscle groups by means of an exercise program?
what are the three major energy systems?
- anarobic glyolytic
energy is released when the atp becomes ADP by breaking down the bond of one phosphate. does this process require oxygen?
no, it requires water.
what is the primary energy source for short, quick bursts of activity, typically in the first 30 seconds of intense exercise?
is there a higher cellular concentration of atp or cp?
cp-3-5x the amount
what is the primary energy source for ativity of moderate intenity and short duration, from 30-90 seconds?
glycolosis breaks down to form pyruvic acid and atop. how much of each are produced in the process?
2 pyruvic acid, 2 atp (net 4 gross)
what occurs to pyrubi acid if there is not enough oxygen available to cells?
converted to lactic acid
what is predominant energy system after the 1st to 2nd minutes of exercise?
how many molecues of atp are created by the krebs cycle?
required rest to replenish energy stores?
2. glycogen in muscle
3. glycogen in liver
5. lactic acid removal
- 1. 2-5 min
- 2. 10-46 hrs
- 3. 12-24 hrs
- 4. 10sec-1min
- 5. 30min-2hrs
what are kilocalories and MET's?
measurements of energy expenditure while engaging in physical activity
what do all the different settings have in common?
- they're a human
- central motor control
- target tissue
- specific functional goals
overview of the individual session
- warm up
- remedy for ROM limitation
- motor control learning in the new ROM
- functional movements
how do you know when to make a specfic exercise easier?
- unable to maintain form
- causes or increases pain
- true muscle fatigue
how do you know when to make a specific exercise more challenging?
- patient performs with ease and no fatigue
- patient has mastered form
what are the four stages in the develpment of motor control?
- initial mobility
- controlled mobility
in which stage of motor control are postural and antigravity control typically lacking?
in which stage of motor control is the patient able to maintain a steady position in weight bearing antigravity posture?
explain the controled mobility stage of motor control?
ability to change position or move in weight bearing while maintaing postural stability
what is sensory information that results from movement?
what is information sent in advance of an anticipated motor command to ready for the incoming sensory input?
what are 3 things to consider when creating a prescription?
- tissue involved
- stage of healing
what is defined as seemingly unrelated impairment in remote anatomical regions of the body that may contribute to and be associated with patients primary report of symptoms?
what is the primary goal for inpatient settings?
get them up and moving!
what is the main priority when treating a patient post-op? why?
reduce pain and swelling
because it interfers with motor control
true or false: you will always have a problem with motor control when pain is present?
true or false: treating the uninvolved side can help the involved side?
false! there is no uninvolved side!
how ccan orthopedic injury impact motor control?
- proprioception is damaged when tissue is damaged
- increase in muscle tone at rest
- decrease of muscle tone when activated
what stage of tissue repair does nueromuscular reeduation start?
where do patients goals go in soap notes?
what can occur of only the pain generator are addressed?
chronic reinjury because you have to treat the causitive factors also. If movement dysfunctions are not corrected then the injury will just keep happening.
how do you know if you can progress to the next phase when treating a patient?
by a combo of the target tissue timeline and how the patient is responding to treatment
if a muscle imbalance occurs, what can happen to a joint?
a shift in the axis of rotation tht can iltimately lead to break down over time.
what is the overall goal of ther-ex?
to achieve symptom free movement and function
what are the componets of physical function? (9)
- neuromuscular control
- postural control, stabillity and equilibrium
- cardiopulm fitness
- muslce performance
what are the areas of fitness?
- cardiopulm fitness
POC implementation inclues what 3 steps?
- carry out the POC
- assess the treatment
how can we assess the treatment effectiveness
- outcome measures
- comparable signs
who can put together a POC?
what is muscle endurance?
ability of a muscle to contract repeatedly over a period of time.
what is the ability of an individual to sustain low intensity exerise over a period of time called?
total body endurance
what is the ability of soft tissues to elongate and or shorten durning movement?
what is the ability of a muslce to relax and yield to a stretch?
what is the conscious effort to relieve tension in muslces?
what is the ability to perform muscle contraction in appropriate sequence and at appropriate intensity to accomplish a task smoothly?
what is the an ability that is learned through repetion and requires reciprocal movements and approprate stability?
what are the 3 stages of adaptation syndrome?
failed adaptation over time can result in what type of inury?
what are 3 types of contraction?
3 types of muscle fibers?
- slow oxidative
- fast oxidative gycolytic
- fast glycolytic
describe the velocity-tension relationship that is present in a concentric contraction. what about eccentric?
- concentric: the relationship is inverse
- eccentric: tension and velocity increase together
what factors affect velocity of contraction?
- motor unit recrutment
- type of muscle fibers
- length of fier (longer fibers have higher shortening velocities)
name the muscles by function
- force generators
what is co-contraction?
activation of all muscles arond the joint
how many weeks does it take to truly increase strength?
improvements prior to that time are due to changes in what?
what are the 4 signs of fatigue
- unable to complete ROM
- substitution patterns
according to cyriaxs rules of resisted movement what does wak and painful motion indicate?
weak and painless?
painful on reptiton?
if passive and active ROM are limited in the same direction what does that indicate?
capsular restriction or bony changes
if there is a difference of greater than 5* from active and passive ROM what does that indicate?
what are the functions of reinforcing ligaments?
- support the joint
- assist in giuding motion passively
is it normal to have an increase in temperature locally and initally?
what is normal body temp?
what can affect temp?
- time of day
- immune system function
- drug use
what are the characteristics of pain? (6)
- frequency and duration
- pattern of pain (cyclic or waves)
- aggravating and easing factors
what are typical desriptors for musculoskeletal issues?
aching, sore, deep, dull, cramping, heavy, hurting
pain descriptors for neurogenic?
sharp, shooting, burning, pulling, stinging, electriacl, prickly, pinching, gnawing
vascular pain descriptors?
throbbing, pulsing, beating, pounding
and emotional pain desriptors?
cruel, punishing, torturing, miserable, dreadful, tiring, exhausting
what are the pain descriptors that increase suspicion of systemic issues?
boring, deep aching, knifelike, stabbing (from the inside out) comes in waves
behavior of s/s during ther ex where pain spreads to areas outside or distant from the immediate are of involvement is called?
what is centriliazation?
increasing s/s in immediate area of lesion.
would centralization or peripheralization indicate a worsening or progressive condition?
what is the normal 02 range?
what 02 range indicates that activity should be haulted?
if it drops below 90 in acutely ill, 86 in COPD pt's.
what are the 2 catorgies of fatigue?
localized and generalized
what are the 3 catogories of the effects of joint mobilizations?
- neurophysiological effects
- psychological effects
what are the 3 normal joint end feels?
- bone on bone
- soft tissue
- hard/springy tissue stretch
what are the 4 abnormal joint end feels?
- springy block
- muscle spasm
what is defined by decrease in joint spae between bones?
what is defined by separation of joint spaces?
what is the difference between traction and distraction?
distaction occurs perpendicularly between joints, traction doesnt always distract the joint surfaces perpendicular from on another
how many stages of traction are there?
briefly describe the stages of traction using one word.
- 1. loosen
- 2. tighten
- 3. stretch
does a stage 1 traction create a force strong enough to separate joint surfaces?
no, but it can relive some pressure
name some non contractile tissue
fasica, tendon, ligaments, skin, capsule
does stretching prior to an athleti activity decrease risk of injury?
no, it can cause damage!
what is the ability of a muscle to relax and yield to a stretch?
what are the two types of flexibility?
passive and dynamic
what is defined as therapeutic techniques that lengthen shortend tissue and increase ROM?
what are the causes of hypomobile joints?
- chronic postural mal alignment
- prolonged immobilization
- sedentary lifestyle
- muscle weakness or poor recruitment
- tissue trauma
what are indicators for hpermobility?
- excessive rom
- aberrant motion
- hinging of spine
- compression and movement feels better
what are the three general types of ROM exercises?
passive, active, and active assistive
when you would you use PROM?
- if the patient is unable to move the body part
- if the patient is not allowed to move the body part on their own
- if doing it activly causes pain due to inflammation
which componet of connective tissue provides strength to withstand high leels of tensiona nd force during movement?
which compnet of connective tissue assists in the recovery of tissue after stess?
what is the proportional degree of elongation that occurs during stress?
if there is crosslinking in soft tissue, what is the goal according to the stress strain curve?
to apply enough stress and stain upon the tissue to cause microfiber tears in the plastic zone. this will prevent the tissue from going back to its previous size.
what is defined as a non-specific term sed to desrive mild restricted motion>
how do adhesion occur?
results from healing or union of two injured or torn parts as a result of the inflammatory process
what are the 5 types of contractures
- arthogenic (perarticular)
which contracture occurs in patients with CNS issues?
which type of contractue usually occurs as a result of chronic inflammation and is very difficult to regain normal ROM
how long do you stretch contractures?
how can you make the stretching of a contracture more effective?
what are the two types of passive stretching?
what is a stretching technique that require and active contraction of a muscle to elicit relaxation?
precautions for stretching?
- force applies should not cause pain
- immobilized tissue
- cortiocosteroid use in 15 mts
- dont exceed normal limits of ROM
- balance strength in new ROM with stretching
- muscle weakness
what are the contraindications for stretching?
- inflammation or acute infection
- sharp pain with movement
- after recent fx
- bony block
what sensroy nerve receptors located in the muscle belly are sensitive to velocty and change?
are GTO's sensitive to passive stretch?
what happens to ligaments during immobilization?
ligaments lose stiffness and become weaker
what happens to the other structures of the joint due to immobilization?
- connective tissue becomes stiffer
- adesions from
- crosslinking between collagen fibers
what changes occur to a muscle that is immobilized in a shortended state?
sarcomere numbers and sarcomere length are decreased.
what happens to muscles that are immobilized in the lengthened state?
increase in the number of sarcomeres
what affect does temp have on the plastic range of the stress strain curve?
as temp increases the force reqired to attain the plastic range is decreased
what are some potential uses for PNF?
- facilitate neuromuscular control
- develop musclular endurance
- facilitate stability
- facilitate mobility
- coordinated movements
- increase flixibility
- lays a foundation for the resotration of function
at what point during rehab is pnf approprate?
its aailable throught he entirety of the rehab process. it just depends on how it is modified.
what are the PNF techniques used to increase flexibilty?
what PNF techniques works on both concentric and eccentric motor control of a specific muslce/movement?
during agonist reversals PNF do you change handholds?
what are the 5 steps to the progession of stabilizaton activites?
- kinesthetic awareness training
- proper activation of deep stabilizers
- superimpse exremity motion onto core stabilzation
- increase muscle strength and endurance stabilizers
- transitional stabilization training exercise
list the progression of stabilzation positions
- transitional moements
- specific functional movement training
what are the locacl/segmental muscles involved with spine stability?
- pelvic floor and diaphragm
voluntary contraction of the pelvic floor leads to contraction of which muscles?
all the abs
the global muscles involved with spine stability are?
- erector spinae
- external obliques
- rectus abdominus
what occurs with LBP?
- decreased recruitment of segmental muscles
- increased recruitment of global muscles
- changes in neuromotor control
- fat inflitrates the paraspinal muscles and atrohy occurs
What are some other muscles that are commonly trained with spine stabilization?
- deep c- flexors
- LT, MT
what are some stabilization exercises that help with transitional movements?
- hand heel rocks- quadruped
- supine heel slides
- squatting and reaching
- weight shifts and turning
what are some early functional training movements?
- supine to sit
- sit to stand
- in and out of car
what must you always address with cervical and shoulder patients?
- c-t junction segmental mobility
- upper rib mobility
- upper thoracic mobility
what are some outcome measures for L-spine?
what is an open loop system and a closed loop system?
- open loop: a programmed system that does not use feedback to error correct.
- closed loop: a control system that does use feedback to reference for correctness and formulate a correction to achieve the goal.
How are open skills different from closed skills?
open skills are performed in an unstable and often rapidly changing environment. Closed skills are performed in a stable predictable environment.
what is knowledge of performance and knowledge of results?
- performance: related to the nature of movement.
- results: related to the nature of the result produced in relationship to the goal.
what variable would you manipulate to improve:
- strength: load/intensity
- endurance: reps/duration & frequency
- power: plyometrics; strength & speed
what are the grades of mobilizations?
- I- small amp. oss. at very beginning of jt. play
- II- lg. amp. oss. in mid range of jt play
- III- lg. amp. oss into restriction
- IV- sm. amp. oss into jt. capsule
- V- HVLAT-manipulation
What are the healing times for these tissues?
6. peripheral nerves
- 1. 2-4 weeks
- 2. 15-18 months
- 3. 8-9 weeks
- 4. 6-12 weeks (depends on age)
- 5. months; 1000's of reps
- 6. 3x as long as it was damaged!
What does De Lorme regimen say?
- set 1: 10 R @ 50% 10rm
- set 2: 10 R @ 75% 10RM
- set 3: 10 R @ 100% 10RM
what does oxford regimen say?
- set 1: 10R @ 100% 10RM
- set 2: 10R @ 75% 10RM
- set 3: 10R @ 50% 10RM
what are the exercise guidelines for the proliferation phase?
AROM, isometrics, controlled isotonics, soft tissue mobilization, light pain free stretching
what are the exercise guidelines for acute inflammation?
PROM, AROM, (pain freee!!!)
What are the exercise guidelines for remodeling phase?
specificity, eccentric, plyometrics.
what are some things that all synovial joints have?
- articular cartilage
- joint cavity and capsule
- synovial fluid
- reinforcing ligaments
- fatty pads
what is convex-concave rule?
convexities roll and glide in the opposite direction whereas concavities roll and glide in the same direction.
How is referred pain different from radicular pain?
Referred pain is a misinterpritation of where the pain is actually coming from because many tissues share the same neural pathway. Radicular pain however follows a specific neural pathway and the pt. will almost trace a specific never exactly.
what is radiating pain?
pain that moves out or spreads as if to travel from one area to another.
what are some interventions to increase mobility?
- joint mobes
- soft tissue mobilization
- manual/mechanical stretching
- self stretching
what is the intervention sequence?
- warm up
- joint mobe
- neuro re-ed
- address movement dysfunction
What are isometrics?
static exercise with muscle contraction without joint movement