Aerobic exercise results in what amount of O2 consumption?

50-80%

Cyclic movements relying on aerobic energy pathways

Aerobic exercise

Formula for max heart rate?

220 age

Formula for target heart rate?

140 * (# between .6-.9) + resting heart rate

According to Williams most back pain is due to?

Walking in upright posture

 According to Williams normal posture is?

Knees bent, slight forward bend

All activities should be geared to reducing?

Lumbar lordosis (says Williams)

Amount of blood left ventricle pumps per contraction

Stroke volume

Spinal assessment and therapy based on pain and response to dynamic/static loading is?
McKenzie approach

Referring to pain syndromes End range stress of normal structures

Postural

End range stress leading to contracted adherent structures

Dysfunction

Anatomical disruption or displacement of structure

Derangement

 Any exercise which a muscle is contracted eccentrically then immediately concentrically

Pylometrics

Push-up with a clap in between is an example of?

Plyometrics

Concept of power: force * speed = power

Plyometrics

Plyometic exercises enable a muscle to reach:

Maximal force in shortest time

Example of plyometric exercises

Box drills, jumps

 What are the 3 phases of stretch-shortening cycle (SSC) for plyometrics

Eccentric, amortization, concentric

What can be done to stabilize joints?

Muscle strengthening

White fiber muscles, mostly use glycogen

Fast twitch fibers

Red fibers, large concentration of mitochondria

Slow twitch fibers

The first 4 weeks of PT care?

Acute care management

 First 3 days of acute care?

Use RICE

Function of the w system (Pg 2)

Inhibit IML, global muscle tone, inhibit anterior muscles above T6 posterior muscles below

PT care after four weeks?

Recover care

After 12 weeks injury enters?

Chronic phase

How long does remodeling of the injury site last?

Up to 12 months

 Remodeling works best when in conjunction with?

Joint motion

Exercise patterns scar tissue in?

Proper direction

Non-weight bearing exercise where foot/hand is free to move, movement usually occurs at elbow/knee
Open chain exercise

Bench press, bicep curl, leg extensions and straight leg raises are all examples of what type of exercise?
Open chain

 Open chain exercises target?

Single muscles

Exercised where hand/foot in fixed position, weight bearing exercises typically using exercisers own weight
Closed chain exercise

Pushups, squats, lunges, pull ups are examples of what exercises?

Open chain

The better trained a muscle group is

Injury is less likely

 Anterior rotation of pelvis, increased lumbar lordosis, hips in flexion, with knees hyperextended
Lower cross syndrome

What is tight with patelofemoral syndrome?

Tensor facia lata

What muscles are tight/facilitated in lower cross syndrome?

Iliopsoas, rectus femoris, TFL, adductor group, errector spinae, gastrocnemius, soleus

Iliopsoas flexes the hip how?

Flexing femur on trunk (ori) and trunk on femur (ins)

 Abducts, flexes, and medially rotates hip

TFL

What part of the quads flexes the hip?

Rectus femoris

Muscles responsible for extension of vertebral column in lower thoracics

Errector spinae

Muscle plantar flexes ankle joint and assists in flexion of knee

Gastrocnemius

Plantar flexes ankle joint

soleus

 Which muscles are inhibited/weak in lower cross syndrome?

Rectus abdominis, obliques, gluteus max, glut medius, hamstrings

Flexes vertebral column by bringing thorax and pelvis closer anteriorly

Rectus abdominis

Bilaterally flex the vertebral column and support viscera

Obliques

Unilaterally rotate vertebral column bringing thorax forward

Obliques

 Extends and laterally rotates hip

Glut max

Insertions in IT track allow glut max to help with?

Knee stabilization on extension

Lower fibers of glut max aid in?

Adduction

Upper fibers of glut max aid in?

Abduction

Main hip abductor?

Glut medius

 Flex and medially rotate knee?

Semi-membranosus/tendonosus

Flex and laterally rotate knee?

Biceps femoris

Core stabilizers of the back

Quad. Lumborum, rectus ab, multifidus, rotatores, intratransversaris

Tight muscles in upper cross syndrome

Pec major/minor, upper traps, ant. Delt, SCM, scalenes

Fixed origin, abbducts and medially rotates humeerus

Pec major

 Insertion fixed assists in forced inspiration

Pec major

Origin fixed tilts scapula anteriorly

Pec minor

Scapula stabilized, assists in force inspiration

Pec minor

Origin fixed, elevates scapula

Levator scapulae

Internal rotation, adduction and extension of shoulder

Teres major

 Fixed origin, adducts scapula, elevate scapula

Upper trap

Elevation of clavicle
Upper trap

Abduction of shoulder joint

Anterior delt

Fixed origin, internally rotates, adducts, extends shoulder joint

Lats

 Fixed insertion, assists in tilting pelvis ant/lat?

Lats

Acting bilaterally may assist in hyperextension of spine

Lats

Bilaterally facts to flex head, unilaterally acts to rotate head

SCM, Scalenes, rectus capitus anterior, longus coli

Long/weak muscles in upper cross syndrome

Rhomboids, lower traps, pos. delt, teres minor, longus coli/capitus

 Adducts and elevates scapula

Rhomboids

Adduction, depression and assistance with lateral rotation of scapula

Lower trap

Fixed origin, abducts scapula rotates inferior angle laterally

Serratus anterior

Fixed insertion, scapula stabilized, may act in forced inspiration

Serratus anterior

 External rotation of shoulder joint, stabilizes head of humerus in glenoid cavity

Teres minor, infraspinatus, subscapularis

What are the contraction types?

Isometric, isotonic, isokinetic

Scapular winging involves?

Serratus anterior

 Muscle contraction with no change in muscle length and no joint movement

Isometric

Patient clasps hand and pull in opposite direction is an example of what contraction type?
Isometric

Muscle contraction where length changes, joint movement against constant weight
Isotonic

Weight lifting is an example what contraction type?

Isotonic

 What are the two isotonic contraction types?

Eccentric, concentric

Shortening of the muscle as in flexing the forearm is what type of muscle contraction
Concentric

Muscle lengthens while tension is maintained is what type of muscle contraction

Eccentric

Muscle changes length while a constantly changing pressure/resistance is applied

Isokinetic

Exercises with cybex machine generates what muscle contractions?

Isokinetic

 Dynamic splints allow for?

Physiological movements

Series of exercises administered to patients with vascular disease

Buerger-Allen

Exercise involves supporting legs in an elevated position until extremities blanch, pt dorsiflex/plantarflex throughout
Buerger-allen

Seconds stage of this exercise has patient hang legs over the edge of bed
Buerger-allen

 At what degree are the patients legs elevated I the buerger-allan exercise?
60-90 degrees

What reaction is trying to be achieved during the second stage of buerger-allen?

Hyperemia

Flexion based exercise based on?

Williams exercises

Extension exercise for LBP and can be used for acute phase
McKenzies

 Pelvic rocks, ab crunches, and knee to chest are examples of what exercises?
Williams

Codmans exercises AKA

Pendular execise

Exercise created to strengthen shoulder girdle without use of supraspinatus

Codmans/pendular

Exercise good for frozen shoulder and rotator cuff rehabilitation

Codmans/pendular

Pelvic floor exercises

kegels

 Systemic muscle strengthening by gradually increasing resistance

DeLormes exercises

Stress exercises to relax muscles?

Jacobsons

Shoulder impingement <25 YOA, Reversible, swelling, tendonitis, no tears, conservative treatment
Type 1

Shoulder impingement 25-40 YOA, Permanent scarring, tendonitis, no tears, SAD

Type 2

 Shoulder impingment >40 YOA, Small RTC tear, SAD with debridement/repair
Type 3

Crawling exercises to mobilize the spine and exercise muscles in scoliosis

Claytons exercises

Exercises for ataxic motion and to develop coordination, wobble board used
Frenkels

Brace worn for scoliosis, worn 23hours a day

Milwaukee brace

 Milwaukee brace used on?

Scoliosis 20-40 degrees

Brace used for SI hypermobility?

Sacroiliac girdle

Inversion ankle sprain affects which ligament?

Anterior talofibular ligament

What muscles should be strengthened after an inversion ankle sprain?

Peroneous brevis/longus

Brace for inversion ankle sprain?

Figure eight

 Figure eight brace AKA?

Louisiana strap

Brace for a knee sprain?

Lennox-hill

The above AKA?

Derotation brace

Brace for carpal tunnel syndrome?

Cockup splint

When using a cane for OA of hip which hand should cane be in?
Opposite side

 What is the crutch fitting rule?

2-10-30

Top of crutch should be how far from axilla?

2 below

Tip of crutch should be how are from malleolus?

10

What is the proper angle of the crutch?

30 degrees

What are the contra-indications of all modalities?

HIM

 Contras for all heating modalities

Decreased theremal sensation active TB Low back/pelvis during pregnancy Encapsulated swelling Diabetes (late stage)

Contras to all electrical modalities

Pacemaker Low back/pelvis during pregnancy Decreased sensation (LVG only) Eyes Transthoracic Carotid sinuses

 What is the frequency of high frequency modalities?

>100,000 Hz

What are the high frequency modalities?

UV, IR, SWD, MWD, US

What is the range of medium frequency modalities?

2,000-10,000 Hz

What are the medium frequency modalities?

Inferential, russian stim

What is the frequency range for low frequency modalities?

1-2,000 Hz

 What are the low frequency modalities?

LVG, HV, Sine Wave0, faradic, TENS

Frequency of ultra-low modalities?

< 1Hz

What are the ultra-low current modalities?

microcurrent

What does microcurrent do?

Increase ATP and protein production, decreases pain

Massage has a great effect on?

Vascular system

 Massage will decrease?

Edema, congestion, nerve activity

Massage can increase?

Blood/lymph flow, heart rate, BP temporarily

Massage helps break up?

Adhesions

Massage may help with removal of?

Lactic acid

Indications for massage

Strains, sprains, bruises, tendonitis, bursitis

 Contraindications of massage?
Phlebitis, thrombisis, varacosities, ulcerations, local acute conditions

All massage contraindications can fall under the category of?

Vascular problems

Stroking massage, begins and ends every massage

Effleurage

Deep kneading massage, for muscle tissue

Petrissage

Percussive massage
tapotment

 Deep rubbing massage

Friction

Shaking massage, for extremities only

Vibration

Nimmo acupressure massage

Deep pressure

Type of tapotment massage for children?

Finger tips

Type of tapotment massage for cystic fibrosis

Cupping

Massage not recommending for calcific tendonitis/bursitis

Transverse friction massage

 When massaging edema where do strokes start?

Start proximal, stroke towards heart

What massage technique decreases chemical cross linking?

Transverse friction massage

The action of massage is?

Mechanical (kinetic/friction)

The action of traction is?

Mechanical

What are the two types of tractioning?

Constant/intermittent

 Intermittent tractioning is good for?

Breaking adhesions, breaking muscle spasms

Continuous tractioning good for?

Straightening curves

What does both types of traction do?

Decrease intradiscal pressure, increase IVF space

Indications for traction?

Disc syndromes IVF encroachment, Hyperlordosis chronic muscle spasms fibrous adhesions

 Contraindications for traction

Bone weakening diseas Pregnancy RA Acute muscle spasms Fracture Hypertension

What is the exception to fractures with tractioning?

Healed compression fracture

What is the exception to RA and tractioning?

Intact transverse ligament seen on ext/flex films

 With cervical traction what is the maximum pounds used?

50lbs

What is the starting weight of cervical tractioning?

5% of body weight

What is the patient positioning for cervical traction

Flexion 25-28 C2-7

How much weight needed to overcome skull?

10lbs

 With lumbar tractioning what weight do you start with?

25% of body weight

That is the maximum weight used for tractioning the lumbar spine?
150lbs or 50% of body weight

How much do you increase the weight for lumbar traction each visit?
5lbs

What is the patient position for lumbar traction?

Supine, legs and knees flexed

What are the two names of lumbar traction positions

90/90, gouchers

 What is the advantage of gouchers position?

Relaxes mm, flattens lumbar curve

What reduces tissue temperature and removes heat?

Cryotherapy

Systemic effects of cryotherapy

Increased blood flow, decreased blood flow

Local effects of cryotherapy

Vasoconstriction, decreased capillary pressure, edema reduction, decreased nerve metabolism, anesthetic

 Contras to cryotherapy
Circulatory compromise (Raynauds, buergers) Hypersensitivity to cold Frostbite Chilblains High blood pressure

Sensory reaction two cryotherapy

CBAN Cold, burning, aching, numb

Cryotherapy with max treatment 20 minutes with one layer of towel

Ice pack, blue ice

 What is the treatment time for ice immersion?

10-15 minutes

What is the treatment time for ice massage?

5 minutes

How far from skin should vapocoolant spray be from skin?

14-18

What chemicals used for vapocoolant?

Fluromethane, ethyl chloride

Ice massage for 5 minutes through ROM is what?

cryokinetics

 Types of heat transmission?

Convection, conversion, radiation, conduction

Transmission of heat by gas or liquid

Convection

With regards to high BP and traction

Non-intensive tractioning

Transfer of heat by a solid?

Conduction

Transfer of electrical energy into heat

Conversion

Transmission of heat without intervening medium?

radiation

 Infrareds action is?

Thermal

Infrared increases?
lymph flow, circulation, vasodilation

Infrared decreases?
Blood pressure, muscle spasms

What are the main indications for infrared?

Beurgers and raynauds, bells palsy, musculoskeletal

What are the musculoskeletal conditions for infrared?

Synovitis, tenosynovitis, sprain, strains, bursitis

 What are the 2 types of infrared?

Long and short wave

Type of infrared emitted by heated bodies?

Long wave

Type of IR emitted by incandescents?

Short wave

Distance shortwave lamps from skin?

14-18

Distance longwave from skin?

Direct contact with towel layers

Types of short wave?

Luminous, non-luminous, sunlight

 Sunlight therapy is AKA?

Heliotherapy

What are the types of non-luminous short wave IR?

Wire bound, carborundum

What are the types of long wave IR

Hydrocolators, hotware bottle, electric pads

How many layers of towel beteen skin and hydrocollator?

6

Frequency of short/long wave IR?

High

 Intensity of long wave IR?

170 F

Redness that lasts ~1 hour?

Erythema

Mottled skin in area habitually exposed to heat

Erythema Ab igne

Packs providing moist heat?

Hydrocolator

What is the temperature of hydrocolator pack?

150-170 F

What is the temperature of a cold bath?

55-65 F

 What is the effect of a cold bath?

Increases muscle tone

What is the temperatur of hot bath?

98-105F

What is the effect of hot bath?

Decrease BP, vasodilation, pain relief

What are the specific bath types?

Contrast, whirlpool, sitz, paraffin, fluidotherapy, hubbert tanks

When using a contrast bath what bath is used first?

Hot

 What is the ratio of hot/cold?

3:1, hot more than cold

What is the effect of contrast bath?

Pumping vascular system

Whirlpool is what temperature?

Hot

What is the length of time in a whirlpool bath?

20-30 minutes

What is the effect of whirlpool bath?

Vasodilate, sedate

Sitz bath treats what area?

Umbilicus to thigh

 What is the temperature of sitz bath?

98-105F

Sitz bath good for?

Hemmeroids, dysmenorrhea, coccydynia, prostatitis

Paraffin good for?

Pain relief of OA or RA

Paraffin bath should not be used with?

Open wounds

How many times should dipping in parrafin occur?

7-10 times

 Maximum temperature of mineral oil in paraffin?

117 F

What use is mineral oil in paraffin bath?

Lowers paraffin melting point, eases removal

Ground up cellulose used to generate dry whirlpool?

Fluidotherapy

Effects of fluidotherapy?
Vasodilation

Hubbert Tanks are?

Stainless steel tanks

 Action of UV?
Thermal/photochemical

UV can be used for what other than PT?

Diagnosis

Metabolic effects of UV?

Vit D synthesis, antibacterial, antifungal

UV causes what reactions?

Tanning, erythema

What are the 2 common fungi UV is used for?

Tenia pedis, tenia capitus/ringworm

Main conditions UV is good for?

Skin and bone

 What bone conditions can UV treat?

Rickets, osteomalcia

What skin conditions can UV be used for?

Acne, herpes zoster, fungal infections, chronis ulcers

Depth of UV penetration?
Superficial (1-2mm)

Short wave length UV AKA?

Near

What is the wavelength of shortwave?

180-270nm

 Long wave UV AKA?

Far

The wave length of UV is?

270-390nm

What is the maximum treatment time and intensity for UV?

3 minutes at 18

Water cooled UV device, kromayer

Hot quartz

Most common UV device?

Cold quartz

 UV used to treat sore throats?

Orificial

UV used for fluoresence?

Woods light

What is the above filter made of?

Nickel oxide glass

 Optimum treatment effect at right angles?

Cosines law

Intensity inversely related to distance?

Inverse square law

Halfing the distance of UV lamp to skin increases intensity by?

4 times

SED is what level of UV burn?

0

Swelling, blistering, and sunburn is what UV burn?

4

 SWD and MWD act how?

Thermal

SWD good for?

Chronic conditions

SWD/MWD decreases?
BP, nerve pain, muscle cramps/spasms

MWD good for?

Hip conditions, strain, myalgia, myositis, fibrositis

Contras for SWD/MWD

Same as heat, metallic implants, surface metal, over epiphysis, brain, edema, vascular issues

 Contras for MWD not SWD?

Sinitus, otitis media

What is the distance for SWD?

Direct contact

What is the distance for MWD?

1-5

Intensity for SWD?

Patient tolerance

Treatment time for SWD?

20-30 mins

Treatment time for MWD?

10-20 mins

 SWD works from?

Outside-in

MWD work from?

Inside-out

SWD treats sinusitis using?

Butterfly electrodes

What must by used with MWD?

Mesh goggles

How does ultrasound act?

Thermal, mechanical, chemical, neural

What is the main use of ultrasound?

micromassage

 Thermal action of ultrasound?

Deep heat, reduces muscle spasm

Mechanical effects of ultrasound?

Dispersion of fluids and exudates

Chemical effects of ultrasound?

Aids in healing, increases chemical oxidation

What are the neurological effects of US?

Mild anesthesia

Indications for US?

Joint and musculoskeletal inflammation

 Aside from heat contraindications for US what are the other contras?
Spinal cord, plexuses, ganglia, over epiphysis, fracture, bony prominence

Treat bony prominences with US?

Underwater

How deep does US penetrate?

4-8cm

Frequency of ultrasound?
High, (.7-1.1 MHz)

What is the therapeutic US intensity range?

0.5-2.5 watts/sq cm

 How far is the US head when using underwater?

1

What is the treatment time for acute stage?

4 mins

What is the treatment time for subacute?

6 mins

What is the max treatment time for chronic?

10 mins

Ultrasound effects peak at?

Bone/muscle interface

 Pulsed US decreases?
Heat generated

What US frequency head penetrates the deepest?

3 MHz

Process to drive lotions into skin using US?

Phonophoresis

What are the DC modalities?

Galvanic, microcurrent, highvolt

What are the AC modalities?

Sine wave, faradic, IF

 Constant waveform, unidirectional, monophasic with strong polarity

LVG

Twin peaked pulse waveform, unidirectional, monophasic

HVG

HVG is used for?

Pain control

Sine wave is used for?

Muscle contraction

Faradic wave used for?

Muscle contraction

 IF is used for?
Pain control, edema reduction, muscle contraction

Use of electricity to drive salts into body?

Iontophoresis

What electrical modality is used for the above?

LVG

Minimum stimulation to cause contraction

Rheobase

Minimal amount of time to cause a contraction at 2@ rheobase

Chronaxie

 Ionophoresis salts good for adhesions

KI, colloidal iodine

Ionophoresis salts good for bursitis

Na, colloidal iodine

Ionophoresis salts good for edema

MgSO4

Positive pole of LVG acts like?

Ice

LVG positive pole effects

Vasoconstriction, hardens tissues, acidic

LVG negative pole effects

Vasodilation, basic, softens tissue

 Things only LVG can do?

Electrodiagnosis, iontophoresis

What is the treatment time for LVG?

5-20 mins

What is the penetration depth of LVG?

Deep

What is LVG intensity?

.5-1 mA/in squared

LVG electrodiagnosis tests for?

Reaction of degeneration (RD)

What modalities presently used to test for nerve degeneration?

EMG, NCV

 Size of active LVG pad?

Smaller

Prognosis for absolute RD?

No recovery

Prognosis for partial RD?

Recovery within 2 weeks

Prognosis for full RD?

Recovery 3 weeks 1 year

RD AKA?
LMN lesion

EMG measures?
Muscle activity

 High volt controls pain by?

Enkephalin (HIGH) or endorphin(LOW) production

Enkephalin production desired for what stage of injury?

Acute

Endorphin production desired for what stage of injury?

Chronic

TENS controls pain how?

Gate pain control, opiate pain control

 Pain Gate theory based on activation of?

Large A beta fiber stimulation

What type of pain cant be addressed by TENS

Visceral

Penetration depth of TENS?

Superficial

What is the treatment time for TENS?

Minutes hours

IF is good for?
Acute injuries, swelling muscle spasm, mm atrophy

 Penetration of IF?
Deep

Frequency of IF?
2,000 10,000Hz

IF treatment time?
20-30 mins

IF set at 70+ produces?

Enkephilins

IF set at 1-10 produces?

Endorphins

 Russian stim is premodulated to?

10:50

IF modulation is a means of?

Constant changing of frequency

The purpose of modulation is?

Decreasing accommodation

Vectoring is used with IF to treat?

Large area

Micro current good for?

Healing effect, pain, bone healing

 What are the indications for microcurrent?

Musculoskeletal injuries, fractures

What effect does microcurrent have?

Increase ATP, increase AA production, decrease pain

What is the frequency of microcurrent?

.5 or .3 Hz

The intensity of microcurrent?

Below patient perception

Tissue healing setting for microcurrent?

200 and 800 uA

 Cold lasers do what?

Decrease inflammation and pain

Cold laser increases?

ATP

Two basic types of primary supports:

Soft collar, lumbar support

Soft collar primarily used for?

Soft tissue injuries

Lumbar support should be removed when?

Not lifting

Lumbar support increases what?

Intra-abdominal pressure

 Contraindication to bracing?
If it promotes adhesions or atrophy

Indications to vibration therapy?

Adhesions, edema, bronchial congestion, spasticity

Contras to vibration therapy?

Acute inflammation, adv heart disease, fractures, hemorrhagic conditions

For localized pain vibration therapy treatment time?

Less than 10 mins

Trigger point vibration therapy treatment time?

6-8mins

 For muscle relaxation vibration therapy treatment time?

2-10 mins

For postural drainage vibration therapy treatment time?

3-15 mins

For body relaxation vibration therapy treatment time?

3-5 mins

vibration therapy with cold treatment time?

10-12 mins

 Williams exercises primarily strengthen?

Abs and gluts

Williams exercises could be used for?

Lower cross syndrome

McKenzies exercises target 3 syndromes

Postural, dysfunctional, derangement