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Physiotherapy Study Guide Questions Review
1. phases of healing: - inflammation
- repair
- remodeling
2. what is the purpose of inflammation: - immobilize the area
- defend against intruders
- remove damaged tissue and debris
3. signs of inflammation: celsus
- heat
- redness
- pain
- swelling
virchow
- loss of function
4. what characterizes inflammation: - vasodilation
- increased capillary permeability
- phagocytosis by neutrophils and macrophages
- growth of new capillaries
5. inflammatory chemicals that cause pain: - bradykinin
- prostaglandins
- serotonin
6. type of secondary injury caused by lysosomal enzymes and healthy tissue is damaged: secondary
enzymatic injury
7. type of secondary injury caused by hemorrhage, clotting, edema, spasms, hematoma: secondary
hypoxic injury
8. what does hemorrhage, clotting, edema, spasms and hematoma lead to in secondary injury:
decreased oxygen and nutrients to the area (secondary hypoxic injury)
9. goal of inflammation phase: preserve ROM
10. what can be done to limit extent of inflammation: PRICE
- protect
- rest
- ice
- compress
- elevate
11. timing of acute phase of ankle sprains: grade 1 - 1-3 days grade 2 - 2-
days grade 3 - 3-7 days
12. goals in acute phase of ankle sprains: - decrease swelling
- decrease pain
- protect from reinjury
- maintain appropriate weight bearing
13. angiogenesis takes place in which phase of healing: repair phase
14. proliferation phase: repair phase
15. mechanoreceptors: - meissner's
16. mechanoreceptors for pressure and touch: meissner's
17. mechanoreceptors for skin stretch/pressure: merkle
18. proprioceptors: - golgi tendon organs
29. characteristics of remodeling phase of healing: - scar contraction
- decrease blood vessels
- type III collagen replaced by type I
- collagen aligns along stress lines
- cross linking continues
30. timing of remodeling phase of ankle sprain: grade 1 - 1 week grade 2 - 2
weeks grade 3 - 3 weeks
31. goals for remodeling phase of healing: - increase pain free ROM
- progress proprioceptive training
- regain full strength
- normal biomechanics
- protect and strengthen any residual joint instability
32. therapeutic exercises for remodeling phase of healing: - stretching
- strengthening
- proprioceptive training
33. average healing times for different tissues in the body: - bone (12 weeks)
- muscle (6 weeks - 6 months for 90% strength)
- tendon (40-50 weeks for 85-95% strength)
- ligament (40-50 weeks for ~100% strength)
34. Ability of a tissue to return to it's previous shape or size
following the application of a force.: elasticity
35. Point of force beyond which tissue won't return to
former shape / size when force is removed.: elastic limit
36. Ability to deform without return to prior shape.:
plasticity
37. Property of a fluid to resist loads that produce
shear and flow: viscosity
38. TRUE or FALSE:
faster movement = higher viscosity: TRUE
39. TRUE or FALSE:
warming muscles reduces viscosity: TRUE
40. Mechanical vibration causes change from gel/solid to
liquid: thixotropy
41. Muscle becomes stiff with disuse and more mobile with
movement: thixotropy
stretch increases the range of motion: TRUE
54. TRUE or FALSE:
warming up increases ROM: FALSE
55. TRUE or FALSE:
Applying ice prior to a static stretch is more effective than heat in increasing range of motion: TRUE
56. TRUE or FALSE:
Icing improves PNF stretching: FALSE
57. how does ice help increase ROM: promotes analgesia
58. how does heat help increase ROM: decreases muscular stiffness
59. PNF: proprioceptive neuromuscular facilitation
60. principals of PNF: - facilitation (techniques to increase motor neuron excitabil- ity)
- inhibition (techniques to decrease motor neuron excitability)
61. Spread of excitation in the central nervous system
that causes contraction of synergistic muscles in a specific pattern: irradiation
62. sherrington's law: reciprocal inhibition
63. Contraction of the agonist simultaneously
inhibits the action of the antagonist: reciprocal inhibition
64. stretching technique utilizing reciprocal inhibition: C.R.A.C
65. stretching techniques utilizing postcontraction inhibition: - hold relax
- PIR
- postfacilitation stretch
66. specific PNF techniques to strengthen/facilitate: - rhythmic stabilization
- slow reversal
- fast reversal
67. alternating between isometric contractions of the agonist and antagonist muscles: rhythmic
stabilization
68. Concentric action of the antagonist, followed
by a concentric action of the agonist: slow reversal
69. Concentric action of the antagonist, followed
by a concentric action of the agonist; fast: fast reversal
70. specific PNF technique to inhibit/stretch: - hold relax
71. - Isometric action of the antagonist
**- Followed by relaxation
- Passive stretching antagonist:** hold relax
72. - Maximal concentric action of the antagonist against resistance
**- Followed by relaxation
- Passive movement into the limited ROM:** contract relax
73. Utilizes reciprocal inhibition by having the
agonist contract while stretching the antagonist: C.R.A.C
74. - passively stretched muscle
**- contracted ~25% for 10 seconds
- muscle relaxation is detected and is stretched to next point of tension
- repeat 3-5 times:** PIR
75. describe PIR: - passively stretched muscle
- contracted ~25% for 10 seconds
- muscle relaxation is detected and is stretched to next point of tension
- repeat 3-5 times
- Stretch for no more than 2 seconds
- Return to start position
- Repeat 8 to 10 reps
82. spiral diagonal patterns on page 10: stretching, flexibility, and PNF
83. a rehabilitation method that involves increasing the complexity of the exercises in order to
progress: progressive overload
84. Fulcrum is between the force and resistance arms: first class lever
85. Resistance lies between the force and the fulcrum:
second class lever
86. Force point is between the resistance and the fulcrum:
third class lever
87. surrounds each individual muscle fiber: endomysium
88. surrounds each group of muscle fibers called fasciculus: perimysium
89. surrounds the entire muscle: epimysium
90. type 2a fibers: fast oxidative fibers
91. type 2b fibers: fast glycolytic fibers
92. type 2 fibers that are more aerobic and easily recruited: type 2a
93. type 2 fibers used for high intensity activity: type 2b
94. which paraspinal muscles have high concentrations of type 1 fibers: - lumbar multifidi
- thoracic and lumbar erector spinae
95. Higher oxidative enzyme concentration
than anywhere else in the lumbar spine are in these muscles: multifidi
96. force x distance: work
97. work/time: power
98. power is a function of: strength and speed
99. prime mover: agonist
100. prime mover that opposes agonist: antagonist
101. assists prime mover: synergist
102. how do satellite cells help in the muscular response to loading: the pro- liferate and
differentiate donating their nucleus to the muscle cell and leading to increased protein synthesis
103. committed stem cells of skeletal muscle: satellite cells
104. located on the basal lamina of myofiber: satellite cells
105. exercise principles: - SAID
106. SAID: specific adaptation to imposed demands
107. the initial goal of rehab programs: establish functional ROM
108. contraction with no motion: isometric
109. contraction with motion: isotonic
110. types of isotonic contractions: - concentric
111. contraction with constant velocity: isokinetic
112. contraction that produces the most force: eccentric
113. types of isotonic contractions that lead to more force: - slow concentric
114. DOMS: delayed onset muscle soreness
115. how does DOMS create an inflammatory reaction: eccentric muscles ac- tions damage
the fibers and small peptides are released that
- increase osmosis
- increase pressure
- increase permeability
mesocycle
132. major emphasis is conditioning, progress in weekly microcycles adding intensity while
lowering volume: preparatory period in mesocycle
133. describe the divisions of preparatory period: - hypertrophy phase (high volume, low
intensity)
- strength phase (moderate volume, moderate intensity)
- power phase (low volume, high intensity)
134. - very high intensity
**- low volume of work
- skill technique and game strategy
- goal is to reach the highest level of performance:** competition period
135. Cessation of regular physical training, not
synonymous with immobilization: detraining
136. since cardiorespiratory endurance is greatly reduced due to detraining, more so than
muscle strength, power, and endurance, what can be done to maintain this endurance: train 3 times a week at 70%
137. which contraction type results in more strength for the contralateral limb: eccentric
actions yield 77% strength to the contralateral limb while concentric and isometric yield 5-30%
138. what is the average strength gain for the contralateral muscle when working the
ipsilateral muscle: 60%
139. TRUE or FALSE:
hypertrophy is likely in the contralateral limb during cross education: FALSE
140. which system of the body is responsible for cross education: nervous system
141. Diffusion of impulses to the
contralateral motor cortex during a unilateral task: supraspinal mechanism
142. Interferential: Two low amplitude alternating currents with one usually being at 4000
Hz and one at 4100Hz. A beat current is produced with a frequency equal to the difference between the two applied currents. The amplitude is equal to the sum of the amplitudes of the
two applied currents; sinusoidal AC - 2 currents are arranged to cross and result in a "beat" frequency as the difference of the two currents - very comfortable
143. Pulsed Current: The flow of the current starts and stops. May be monophasic or
biphasic, Electrical current delivered discontinuously; periods of pulsing followed by periods where no current is flowing (usually off longer that it is on); May be unidirectional or bidirectional
144. Phase duration: How long each phase lasts (microseconds).
145. Pulse frequences: Number of pulses per second. (Hz or pps).
146. Amplitude (intensity): Rate of flow (current) or voltage (mA, volts).
147. modulation: Variation in one of the current parameters (pulse duration, pulse
frequency or Amplitude). wave form
148. Current intensity/amplitude
Pulse Duration Pulse Rate: Total current is changed by...
149. Law of Dubois Reymond: Determines whether there will be a physiological response
when a current is applied. Stimulus must be of adequate intensity, voltage change must be rapid enough, and phase duration must be long enough.
150. Over eye
Pregnant uterus Testes Heart Malignant tumors/cancerous lesions Carotid sinus Absent sensation Demand type pacemaker Circulatory insufficiency Sepsis No transcerebral or transthoracic placement of electrodes, if treating the thoracic region, keep the electrodes in one plane i.e. both electrodes on the chest or both on the back, not through from front
160. Short wave diathermy: Treatment for:
Increase cell metabolism and function—soft tissue healing Increase temperature OA and ankle sprains (inflammation) Treats deep tissue
161. ultrasound: sound wave higher that 20,000 Hz
Increase temperature Enhance cell metabolism, enhancing healing while reducing pain Inflammation
162. Phonophoresis: The use of ultrasound waves to introduce medication across the skin
into the subcutaneous tissues.
163. Ice (cryotherapy): Decrease cell metabolism—decrease secondary cell hy- poxia
Decrease pain Decrease spasm
164. Infrared (radiation): Increase cell metabolism and inc blood flow—promote soft
tissue healing Decrease pain, promote relaxation Warm intra articular fluid—reduce joint stiffness
165. Laser (radiation): Tissue Healing
Pain management, Device that emits light through a process of optical amplification based on the stimulated emission of photons
166. contrast fluid therapy: Promote tissue healing - increased blood flow, in- creased
cell metabolism Skin desensitization Prevent edema
167. piezoelectric effect: is where certain substances can change their physical dimensions
as a result of interactions between the electrical charges inherent within or applied across these substances. An AC current is generated and passed through a crystal. The crystal will expand and contract and generate the ultrasound.
168. quartz, ceramic, lead zirconate titanate: Crystals used for piezoelectric effect
169. Frequency 0.
Intensity 0.1-5 W/cm (note, most diagnostic is higher frequency 5MHz, lower intensity (mW)): Ther- apeutic ultrasound: Frequency and Intensity
170. (ultrasound) Thermal effects: Collagen Extensibility
Cellular Metabolism Modulation of pain Increased Blood flow Peripheral nerve conduction Reduction of muscle spasm Decrease in joint stiffness
171. (ultrasound) Mechanical effects: Cellular metabolism Pain
threshold Stimulates bone repair Cavitation Acoustic microstreaming
172. acoustic microstreaming: The circulation of fluid and hydrodynamic forces in the
vicinity of a small vibrating object
173. Power: Total output of the transducer, expressed in Watts/cm
174. 3 MHz: Ultrasound Frequency for superficial tissues
175. 1 MHz: Ultrasound Frequency for deep tissues
176. Continuous waveform: ultrasound with both thermal and mechanical effects
177. Pulsed waveform: ultrasound with mechanical effects only
178. Duty cycle: Percentage of time that electrical current is on in relation to the entire
treatment Duration of pulse (on time) x 100 pulse period (on time + off time)
179. Reflection: reversal of the direction o propagation of the US wave, which occurs when
there is a mismatch of acoustic impedance between two tissue levels. The greater the difference of acoustical impedance between the two tissues, the greater the heat generated
192. continuous/pulse
frequency Duty factor ERA of the transducer Duration of the treatment Number of treatments per week: What to chart for an U/s treatment
193. ampere: The unit of measurement indicating the rate of electrical current flow
194. volt: electromotive force applied to produce flow of electrons
195. impedance: opposition of electron flow in a conducting material
Electrotherapeutic current, when it is low voltage is less than volts
197. NMS/EMS: term should only be used to stimulate muscle
directly
198. Alternating current: Current used as a sine wave For:
Spasm, exercise weak, atrophic or debilitated musculature. Comfortable wave form - easily controlled and modified. No chemical characteristics at electrode surfaces.
199. continuous: direct current for iontophoresis
200. interrupted or pulsed: direct current for neuromuscular components with reaction
of degeneration (RD). Can have a chemical effect (iontophoresis) if intensity is to high.
201. direct current: Constant uninterrupted electron flow from negative to positive. no
oscillations or alternations.
202. Pacemake
rs Infection Malignancies Pregnancy Musculoskeletal problems where muscle contraction would exacerbate the condition: C/I to e-stim
203. >150volts
Usually low frequency (cps), between 1 and 2000 Hz: High Volt Electrical Stimu- lation
204. Faradic: low frequency alternating current with 2 unequal phases. Not used much
anymore, mostly in Europe. Acts like alternating current feels like direct current.
205. Russian: 2500 Hz modulated to yield 50 bursts per second, used in treatment of
athletes. Not really considered superior.
206. Symmetric biphasic: requires less phase charge so is more comfortable.
Research shows that shape is not significant
207. 80-120: High volt electical stimulation frequency for acute cases
208. 1-20 Hz: High volt electical stimulation frequency for chronic cases
209. 50 Hz: High volt electical stimulation frequency that gives smooth muscle
contraction
210. Interferential: waveform produced by interference of two medium frequence
sinusodial ACs of slighlty different frequencies 3,000 to 5,000 Hz Measured in beats per second (usually low frequency 1-200bps)
211. 1000 Hz: Low frequency Hz for interferential
212. 1000-10,000 Hz: Medium frequency Hz for interferential
213. Which fluid is contained by joint capsule, feels like a water balloon, and moves when
palpated then returns?: joint effusion
214. Which fluid is in the interstitial space, and when you press on tissue with finger a dent
remains: edema
215. What does PRICES stand for?: Protect, Rest, Ice Compress, Elevate, Sup- port
216. Wraps should be done which direction?: distal to proximal
217. In addition to PRICES, what other modalities could you add to the acute treatment?:
Pulsed US, Laser, TENS (sensory level- IF, Premod, HiVolt)
218. What is the treatment time for intermittent compression?: 10-30 minutes, up to 3 or 4
hours
219. Intermittent compression can be combined with?: cooling
