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pt1 final exam questions
written by: admin


Date Written: 6/7/07 Last Updated: 3/11/10

Final Exam

Begin Slide 8

1. Compressive loading causes what response in the vertebral column? endplate bulging inward, (nucleus pressurizes) nucleus is incompressible fluid.  Bulge of endplate blood from perivertebral endplate is ejected.  Cancellous bone is deformed as a result of structural shape. Transverse trabeculae fracture.

2. How does the Loss of transverse trabeculae affect the bodies ability to withstand compressive forces? decreases it.

3. What patient population should be more concerned with ability to withstand compressive forces? females, esp, those with osteoporosis.

4. What is the innate adaptive response seen in patients with more physically demanding jobs (regarding transverse trabeculae)? the thickness of the trabeculae increases.

5. What is an example of a vertical herniation? schmoral's node.

6. Can a schmorls node be clinically significant?. explain. decrease integrity of body allowing herniated nuclear disc.  yes, it is significant.  annulus intact, so it may be a source of pain, cause decreased disc height. Increased compression of nerve root in foramen.

7. How does the disc structure allow it to resist twisting loads? fibers are oriented in concentric rings, half oblique to the others.  only half of fibers are involved in each direction, which reduces strength.

8. Why is the disc strength with twisting reduced compared to flexion extension? because half of fibers are in each direction, reducing strength (concentric rings, half oblique)

9. Be able to describe the difference in disc response to loading when "normal" vs DDD.  normal: compression causes deformation of endplate and outward bulging of annular fibers.  DDD: causes hydrostatic pressure is decreased, disc becomes dehydrated, causes double convex bulging, separation of laminae where inward fibers bulge inward and outward fibers bulge outward leading to a path for herniation to take place.

10. Explain what happens in loading response with a DDD that can lead to progressive disc injury. the disc is dehydrated and loses hydrostatic pressure.

11. What is the pain hypothesis regarding vertebral discs (normal pressure vs DDD). normal: pressure is too high for blood vessels and nerves.  DDD: pressure is lost and blood vesssels and nerves can invade the disc allowing for pain.

12. Does fatigue failure apply to disc tissue? yes, repeat loading leads to tissue fatigue.repeat flexion under pressure is easiest to herniate a disc.

13. From the literature what was the easiest way to cause disc failure? sedentary with prolonged seated posture, flexed.

14. Damage to the annulus appears associated with what? fully flexing the spine for prolonged repeated periods of time.

15. With DDD do you typically have an increase or decrease in
segmental motion? increase.

16. Rotators and intertransversarii are highly rich with muscle spindles suggesting their role as position sensors, length transducers, proprioception. muscle spindles and position sensors

17. From a functional perspective the thoracic and lumbar groups of these muscles should be grouped.  thoracic 75% slow twitch, lumbar evenly mixed, longissimus thoracics greatest lumbar extension with minimal compression

18. Thoracic sections differ from the lumbar sections for these reasons.  minimal compression in the thoracics.

19. This group of extensors have the greatest ability to cause lumbar extension for these reasons. Pars thoracis.  It has a greater moment arm.

20. Orientation of the lumbar portions is important to resist this force produced from typical lifting technique.  anterior sheer.

21. How is this functional ability compromised during lumbar flexion? becomes a spinal compressor due to loss of orientation.

22. During rehab of the spine why is it important to exercise the abdominals, spine, shoulder muscles as well as breathing technique?

23. What is the bead effect? enhances abdominal flexion/extension.  transfers force from obliques.  prevents fibers from being separated by lateral stress.

24. Can training of the rectus be accomplished with one exercise? yes.

25. What effect does the psoas have on spinal compression? ~ How does this affect a patient with hypertonic psoas? increases spinal compression.

26. How should the QL be trained based on its contraction characteristics and function.  Isometrically, because the QL does not change length during spinal motion.

27. Drawing of this ligament is often misrepresented ~ Has an effect on posterior sheer and facet congruency.  interspinous ligament connects spinous processes and runs obliquely.  It helps to resist full flexion and keep spinouses connected.

28. This type of walking can decrease spinal loads. Arms swinging while walking faster.

29. Is there a best sitting posture? no.  alternate sitting positions to avoid risk of overload.

30. Why is the traditional situp a poor exercise for LBP patients? it is done in a flexed position.

31. Was there a difference with a bent knee situp? no.

32. This exercise is the preferred exercise for obliques/QL.  Side Bridge

33. List 2 other common back/abdominal exercises that create large spinal compression and should not be used with patients.  Torso extension with the feet locked and upper body cantilevered.  Double leg and arm extension.

34. Why should exercise not be performed first thing in the am? increased risk of injury in the am due to decreased hydrostatic pressure.

35. What is spinal memory? Function of the spine is modulated by previous activity

Begin Slide 6

36. What is the neutral zone? A region of laxity around the neutral resting position of a spinal segment.

37. When is the TA (transverse abdominus) contracted when doing arm abduction? Before doing any motion of the upper or lower extremity.

38. The TA causes form closure or force closure? force closure of the SI joint.

39. What is the job of the multifidus?  It functions to
maintain posture and allows controlled rotation of the trunk.


40. Danneels et al found that chronic LBP patients have a poor ability to recruit the MF

41. Know the yoshihara study results. Significant decrease in the size of Type 1 and Type 2 MF fibers along with structural changes in L5 muscle band on affected side.

42. Does muscle imbalance of the Mf automatically recover?no

43. How does the TA function in an anticipatory role?
It creates stiffness in the spine which makes a stable lever for global muscles to act in forced opposition.

44. Can a specific exercise program help to reduce recurrence of LBP?yes.

45. How much intersegmental rotation can causes micro trauma? 2 degrees of intersegmental L-spine rotation

46. Studies have shown that specific exercises )MF,T A, Pelvic floor) can _____ list 4.


Begin Slide 7

47. Does stretching prior to exercise prevent chronic or acute injuries? no

48. What is stretch tolerance? The person feels less pain when the same force is applied


49. How long should I hold a stretch? 30 seconds is optimal

50. Which is more effective at increasing ROM of a static stretch .. heat vs ice.

51. What does PNF mean? Proprioceptive Neuromuscular Facilitation

52. Define irradiation. “Spread of excitation in the central nervous system that causes contraction of synergistic muscles in a specific pattern” Holt, Surburg, 1981.

53. What is reciprocal inhibition? Contraction of the agonist simultaneously inhibits the action of the antagonist


54. What techniques utilize postcontraction inhibition?


55. What is the difference between hold relax, contract relax and CRAC? Contract Relax Antagonist Contract

56. What is cross education? Affecting the contralateral limb through motor activity of the ipsilateral limb.

57. During cross education can more strength be gained with concentrics or eccentrics?

58. What is the average strength gain during cross education? With concentrics the strength gains will be 5%-30% in the contralateral limb.  With Eccentrics the stength gain will be 77% in the contralateral limb.

59. What is facilitated in upper cross syndrome?

SCM,
suboccipitals,
levator scapulae,
upper traps,
internal humeral rotators,
pectoralis


60. What is facilitated in lower cross syndrome?

hip flexors,
spinal erector muscles,
TFL,
QL,
rotators,
hamstrings


61. What is inhibited in upper cross syndrome?

deep neck flexors,
lower and middle trapezius,
external humeral rotators,
serratus.


62. What is inhibited in lower cross syndrome? gluteals, abdominals

63. List and define the three syndromes described by mckenzie.
postural - systems are related to abberant posture.
dysfunction -  related to dysfunctional or shortened soft tissues.
derangement - systems are related to a change in the morphology of the intradiscal material.


64. What must you document to justify therapeutic care? a departure from wellness, improvement.

65. List the names of 3 outcome assessment forms discussed in class notes.  CTS questionaire, fear - avoidance beliefs questionaire, mmpi,  

66. What does ICD9 stand for? international classification of diseases. CPT - current procedural terminology.

67. According to mercy guidelines when is manual procedure no longer indicated? in the absence of documented improvement.

68. What must you have to justify medical necessity of treatment? subjective records consistent with condition, objective findings, management must conform to prevailing guidelines or standards for diagnosis. records should demonstrate improvement.

69. List 3 criteria discussed in class notes to justify supportive care.  evidence of permanent injury, limited improvement in a reasonable amount of time, documented witdrawal of treatment = decrease in condition.

70. What is the goal for maintenance care? to maintain optimal body function.

71. What is the most common cause of patellar femoral pain? poor extensor function causing functionl incongruencey, underloading of medial facet and overloading of lateral facet.

72. What is the function of the VMO? medial stabilizer of the patella.

73. During the passive knee flexion test for quad contusion when should weight bearing be limited? if the patient has less than 90 degrees of flexion.

74. With ITB syndrome, why is there usually less pain running uphill? because leg stays in a more flexed position to avoid the impingement zone.

75. Pes anserinus strain can mimic what other knee diagnosis? medial meniscal tear.

76. Popliteus tendonitis would present at pain in what location of the knee? posterolateral esp, downhill running or walking.

77. Why are terminal arc extension done vs full knee flexion to extension against resistance? full flexion increases stress on joint promoting lateral tracking.  isolates the VMO otherwise reinforcing bad tracking patterns.

78. List 3 progressive exercises for anterior knee pain patients. lunges, press ball against the wall, terminal arc extension, closed terminal arc extension add unstable surface.

79. What are the rotator cuff muscles?
S - supraspiatus
I - infraspinatus
T - teres minor
S - subscapularis


80. What is the function of the rotator cuff muscles? depress and compress the glenohumeral joint

81. What is the first place to start with most shoulders with rotator cuff involvement? stabilize the scapula retraction depression exercises.

82. What is the muscle with shoulder injuries that is usually inhibited? lower traps

83. What muscle would you primarily look to stretch when treating shoulder injuries? upper traps and pecs.

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