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soft tissue midterm
soft tissue
| Question | Answer |
|---|---|
| What is rectus abdominus prime movement? | flexes the trunk, esp lumbar spine contracts eccentrically to brake trunk extension from an upright position |
| What is rec abd synergisitic movt? | with other abdominals, QL and diaphragm in increasing intra abdominal pressure |
| What are the attachment points of rec abd? | pubic crest and pubic symp to costal cartilage of 5th 6th and 7th ribs and xiphoid prcoess |
| What is the strength test for rect abd? | crunch up, must hold 30 secs against gravity |
| What is the functional test of rect. abd? | dynamic trunk flexion functional test - 50 crunch repetitions |
| How do you locate the TrPs of the upper rect abd? | 2 ribs down and lateral from xiphoid process |
| Where do trps refer from the upper trip of rect abd? | refer across the mid-bacK(bilat lower thoracic pain) |
| What is rect femoris prime movt? | flexes the hip and extends the knee with Quad group |
| What is the synergistic function of rect femoris? | With quads to stabilize the patella, sitting from standing, squatting, backbending, descending stairs. |
| Where are the attachment points of rect. fem? | tendonsattached to AIIS and brim of acetabulum to patella & thru patellar tendon, to tibial tuberosity |
| What is the strength test for rect fem? | like any quad strength test, leg extended forward wt pt seated, PUT HAND UNDER THIGH THO. |
| What is the length test of rect fem? | Thomas test |
| How do you find rect fem trp? | Drop down from asis, and about level of greater troch medially. |
| where does trp of rect fem refer? | refers to the anterior thigh and knee (feels like behind patella) |
| What is the prime movt of the lumbar erectors? | bilaterally extend trunk, increase lumbar lordosis bilaterally contract eccentrically to brake trunk flexion from upright position unilaterally, laterally bend and rotate trunk ipsilaterally |
| Where are the attachment points of lumber erectors (both iliocostalis lumborum and longissiumus thoracis) | Iliocost lumborum: from med and lat crests of sacrum, med iliac crest and sps of t11-L5, to inf borders of lower 6 or 7 rib angles longissiumus thoracis: from thoracolumbar fascia and tps and mamillaries of L1-L5 to lower 9 ribs and thoracic TPs |
| What is the strength test of lumbar erectors? | pt prone, lifts body off table while stabilizing their legs down |
| What is the length test for lumbar erectors? | hold asis as pt rolls head and body down in flexion - lordosis should reverse |
| How do you find lumbar erectors trps? ilicostalis lumborum? | L1/L2 interspace, laterally @ midpoint of 12th rib |
| What is the trp pain referral of lumbar erectors/ilicostalis lumborum? | downward from point of l1/l2 to just lateral to SI, into glut max area |
| What is iliopsoas prime movt? | flexion of the thigh @ the hip |
| What is iliopsoas synergist movt? | with glut med and piriformis in abduction and external rot of the thigh with QL in eccentrically contracting during contralater lateral bending of trunk with QL in eccentrically contracting during contra lateral bending of the trunk |
| What is iliopsoas attachment points? | psoas major: sides of vert bodies, discs and tps of t12-l5 passing in front of the si joint to lesser troch of femur iliacus: upper 2/3rds of iliac fossa to join with psoas tendon to lesser troch |
| What is the strength test for iliopsoas? | pt supine, 30 degrees flex, 30 degrees abduction and 5 degrees ext rot, stablize asis |
| What is the length test for iliospsoas? | thomas test |
| How to find trp of iliopsoas? | Make sure pt's knee is bent. within psoas, bisect between umbilicus and asis, feel later border of rect ab have pt crunch |
| What is the referral pattern of iliopsoas?v | vertical, along the ipsi lumbar spine from lower Thoracics to si region and upper buttock |
| What are the prime movts of ql? | ipsi lat bending of trunk from any position contra brakingoflat flexion from upright position ipsi shruggin/hiking of pelvis |
| what is synergistic movt of ql/ | bilat contraction helps to extend trunk |
| where are ql attachments? | 12th rib and tps of l1-l4 to posterior iliac crest |
| what is ql strength test? | pt prone, grab @ ankle, have them hike hip and resist you with leg slightly abducted |
| what is ql length test? | pt lat bends bilaterally, tests contra mm |
| Where is ql trp? | lateral aspect below the t12 rib |
| What is the referral pattern of ql trp? | to top of iliac crest, hip joint, si joint, lower buttock, lower quadrant of abdomen to groin |
| What is the prime movt of external oblique? | bilaterally flex lumbar spine and torso bilaterally, eccentrically contract to lower legs or torso against gravity from a flexed position unilaterally laterally bend toward and rotate away |
| what is the synergist movt of ext. oblique? | with other abdominals, QL and diaphrgam in increasing intra-abdominal pressure with serratus anterior in abducting the scapula (protracting the shoulder) |
| What are the attachment points of ext oblique? | inf border of the lowest 8 ribs to abdominal aponeurosis (to linea alba and anterior iliac crest) lowest 3 rib attachments connect with lat dorsi, upper 5 with serratus anterior |
| What is the strength test of ext. oblique | crunch test - hold against gravity |
| What is the functional test of ext. oblique? | 50 reps of crunch |
| Where are trps for ext oblique? | above asis, one superomedial to it, the other is superior slightly lateral |
| What is the referral pattern of ext oblqiue trps? | heartburn like sx, or epigastric pain, in lower lateral wall refer pain to the groin |
| what is the prime movt of glut max? | extend the hip joint |
| what is the synergistic movt of the glut maz? | assist abduction and external rot of hip joint |
| What are the attachment points of glut max? | post iliac crest, edge of sacrum, coccyx, sacrotuberous and sacroiliac ligs to gluteal tuberosity and it band |
| What is the strength test for glut maz? | pt prone, stabilize above iliac crest, have pt bring leg up, press down |
| What is the functional test of glut max? | hip extension test |
| Where is the glut max trp located? | out laterally from s3 tubercle, inferior to psis |
| what is the pain referral from glut max trp? | local to buttock region |
| what is the prime movt of glut med? | abduct the hip joint |
| what is glut med's synergistic motion | anterior fibers assist with hip flexion and internal rotation post fibers assist with hip extension and external rotation |
| what are the attachment points of glut med? | from lateral surface of ilium, along iliac crest, between anterior and posterior gluteal lines to the greater troch |
| What is the glut med strength test? | have pt in side post, abduct their leg and resist you |
| What is glut med functional test? | pt in side posture, have them abduct leg out and watch OR 1 leg standing test |
| where is the glut med trp? | Near iliac crest attachment |
| what is the referral pattern of glut med? | pain along posterior crest of ilium, to sacrum, and posterolateral aspect of buttock, occasionally extends to proximal posterolateral thigh |
| What is the prime movt of the tfl? | None, no joint motion, it's primary function is to tighten IT band |
| what is the synergistic movt of tfl? | with rectus femoris, ilipsoas for hip flexion and swing phase of gait with glut med and min for abduction with med hamstrings & pectineus for medial rotation of thigh |
| what is the attachment points of tfl? | from anterior part of outer lip of iliac crest and asis to the it tract |
| What is the strength test for TFL? | Pt supine,30, 30,internally rotated pt abducts against resistance with doctor intemally rotating while adducting |
| what is the functional test for TFL? | obers test |
| where the trp located within the tfl? | inferiorlateral to asis |
| What is the referral pattern of TFL? | pain in the hip, with referred soreness over the trochanter, downward to lateral aspect of thigh, occasionally to the knee |
| What is the prime movt of hamstrings? | keep trunk erect, in foward bending from upright stance, contract eccentrically to control hip flexion against gravity |
| what is the prime movt of medial hamstring? | flexes the knee, medially rotates the flexed knee, tilts the pelvis posteriorly |
| what is the prime movt of the lat hamstring? | flexes the knee laterally roatates the flexed knee tilts the pelvis posteriorly |
| What is the synergistic movt of both med and lat hamstrings? | med: with glut max, extend and medially rotate the hip lat: with glut max, extend and laterally rotate the hip |
| What are the hamstring attachment points, semitendinosus, semimembranosus, and biceps fem? | semitendinosus: isch tuberosity to shaft of tibia @ pes anserinus tendon biceps fem: isch tube and linea aspera to head of fibula semimembranosus: isch tube to medial condyle of tibia |
| What is the strength test of the hamstrings? | pt prone, knee bent.. med: foot started out, and lat foot started in... |
| What is the hamstring length test? | raise leg up |
| where is trp of med and lat hamstring? | pt prone MediaHl S:just proximal to posteriormedial knee lateral: bout5 inchesproximalto posteriorknee, slightlylatera |
| where is pain referral in med and lat hamstring? | med: pain goes upward from trp location to region of gluteal fold, can spill over entire post thigh, back of knee, and postero-med calf lat: to the bank of knee, with spill over upward as high a glut fold or a short distance downard to prox post calf |
| What is the prime movt of piriformis? | externally rotate the femur when hip joint is neutral abduct femur when hip joint is flexed |
| What is the synergistic movt of piriformis? | stabilizes the hip joint by helping to hold femoral head in acetabulum |
| What are the attachment points of piriformis? | from anterior surface of sacrum to superior surface of greater troch |
| What is the strength test of piriformis? | pt seated push on lateral thigh, while pushing outward on calf that is already brought inward a little bit |
| What is the length test of piriformis? | ask someone |
| Where is the trp location in piriformis? | lat to 2/3 of the way from sacrum to trochanter |
| what is the referral of a trp in piriformis? | to si region, posterior hip joint, with spill over to buttock and post thigh |
| what is glut med anatonistic to? | Hip adductors |
| what is the nerve supply to glut med? | superior gluteal n |
| what is the most powerful abductor of the thigh? | glut med |
| what stabilizes the pelvis during one-limb stance phase of gait? (about 10% MVC) | glut med |
| what happens with glut med to lead to asymmetrical LCS? | become imbalanced relative to each other and to the adductors in asymmetrical lcs |
| Pts with active glut med trps will complain of 3 things | 1. low back pain 2. increased pain on walking 3. difficulty sleeping on inovolved side |
| what is glut max antagonistic to? | hip flexion and internal rotation |
| what is the nerve supply to glut max? | inferior gluteal |
| glut max is __ times the wt of glut med and min combined | two times the wt, very heavy mm |
| what was the glut max important for evoluntionly? | for upright posture development |
| what does glut max tend towards in LCS? (3) | inactivation inhibition and stretch weakening in lcs |
| In LCS the function of hip extension by glut max is compromised by what? | by recruitment of lumbar and or tl erectors |
| what trp is assoicated with restlessness and pain with prolonged sitting, increased pain walking uphill? | glut maz |
| what commonly activates glut max trps? | sudden overload during an eccentric contraction |
| patient with a glut max trp may have what gait? | antalgic gait |
| What is the antagonistic movt of iliopsoas? | hip extension (glut max) |
| what is the nerve supply to psoas? | lumbar plexus |
| what is nerve supply to iliacus? | femoral nerve |
| What 2 mms trps are often responsible for failed back surgery? | ql and iliopsoas |
| what does iliopsoas play a significant role in? | stnading and gait |
| in standing what's active and inactive within iliopsoas? | psoas: active, iliacus inactive |
| in walking what are the iliopsoas mms separately doing? | iliacus continuosusly active psoas only during early swing phase (accelerates forward movt of leg) |
| whats mms tend towards overactivation in lcs? | postural mms |
| in LCS iliopsoas is recruited for what? | trunk flexion |
| What is secondary referral area of iliopoas? | anteromedial thigh just below groin ipsilaterally |
| How may a pt show where their trp is referring with iliopsoas? | running hand up and down back |
| What is soleus prime movt? | plantar flexion of foot w/ gastroc (triceps surae) |
| unlike gastroc, soleus plantar flexion is? | is independent of knee angle |
| What is the synergistic movt of soleus? | gait with gastroc in controlling (restraining) rotation of tibia |
| what is soleus antagonistic to? | foot dorsiflexors |
| what are the attachments points of soleus? | soleal line on pst surface of tibia and prox post surface of fibula to calcaneus, by calcaneal tendon |
| what is the nerve supply of soleus? | tibial |
| what does soleus contribute to during gait? | knee and ankle stability |
| soleus serves as an effective....? | msuculovenous pump, due to large venous sinuses and tough fascial covering |
| what is soleus prone to? | delayed onset soreness after unaccustomed vigorous exervise, NOT due to trps |
| what is soleus trp misgiagnosed as? | achilles tendinitis or thrombophlebitis |
| what is the most common activating factor for soleus trps? | acute overload during forceful, quick eccentric contraction (slip during toe-off, loss of balance) |
| where is the MC trp of soleus found and where does it refer? | found medially in dist 1/3 of mm and refers to plantar surface and pst aspect of heel and dist achilles tendon |
| where is the 2nd mc soleus trp (2nd most, but not very common) and referall | below fibular head, produces diffuse pain in mid to upper calf |
| where is the very rare trp of soleus? and refers? | lateral trp, refers deep, narrowly focued pain in the IPSI SI joint |
| what is antagonistic movt of piriformis? | internal rotators and adductors |
| what is the nerve supply to piriformis? | branch of sacral plexus |
| Trps of what mms can SOMETIMES mimic uti sx, including pressure pain, urenecy, frequency, and urinary leakage (incontinence) with sneezing or laughter | piriformis |
| When both myofascial pain or piriformis trp and the sciatic nerve is entrapped by piriformis along with SI dysfunction what is it? | piriformis syndrome |
| what is piriformis syndrome easily confused with? | disc lesion (nerve root compression) |
| What are the sx of piriformis syndrome? | pain and paresthesia in low back, groin, buttock, hip, posterior thigh and leg, and foot |
| what is piriformis syndrome aggravated by? | sitting, rising from sitting, prolonged standing, and prolonged hip flexion, adducton and medial rotation |
| What gives rise to buttock pain in piriformis syndrome? And what may be seen if severe? | compression of sup gluteal nerve and blood vessels, may see gluteal atrophy if severe |
| weakness on resisted hip abduction in 90 derees flexion with palpable taut bands in mm belly of piriformis is? | piriformis syndrome |
| if pain from piriformis syndrome is bilateral what should be considered? | spinal stenosis |
| piriformis may be secondary to what? | to sacroilitis, and may be bilateral |
| piriformis is more common that _____ and seen more in what sex? | more common than disc leson and seen 6:1 in females |
| A Pt with piriformis syndrome will have what sx while sitting? and a difficulty doing what? | pts will often squirm and shift position in seat and have a difficult time crossing legs |
| in prone position what may a pt with piriformis syndrome show? | functional short leg on involved side |
| what restriciton may be seen with piriformis syndrome? | counter-rotation restriction around ipsi oblique axis of sacrum |
| What is the antagonist movts of ext oblique | unilaterally to isilateral internal oblique and contra ext oblique bilaterally to lumbar erectors |
| what is the nerve supply of ext oblique? | branches of 8th thru 12th intercostal n and iliohypogastric and ilioinguinal n |
| trps referral patterns of ext oblique are more what than most mms? | more inconsistent from pt to pt |
| what trps produce epigastric/heartburn type pain? | ext oblique |
| What trp may produce bedwetting in older children? | ext oblique |
| what trp has the belch-button? and wheres the location? | ext oblique found just below angle of 12th rib |
| ext oblique trp has ___ effects | has somatovisceral/viscerosomatic effects |
| what is rect abdominus antagonist to? | tl erector spinae |
| what is the nerve supply to rect ab? | branches of intercostal nerves |
| what does rect ab tend to in LCS? | underuse --- > hypotonicity ---> stretch weakening |
| What trp can produce fullness, bloating, dysmenorrhea, appendicitis @ mcburnys? | rect ab |
| which unilat trps can produce bilat pain? | rect ab and ext ab |
| what might lateral and periumbilical trps in rect ab cause? | sensations of cramping or colic or diffuse abdominal pain |
| what is the antag movt of rect fem? | to hip extenders knee flexors |
| what is the nerve supply to rect fem? | femoral nerve |
| what does rect fem tend toward in lcs? | overactivation, recruited for trunk flexion |
| what is pain and or autonomic phenomena referred from active myofascial trps wit assoicated mm dysfunction? | myofascial pain syndrome |
| trps give rise to what when compressed? | referred pain and tenderneesss, and sometimes autonomic phenomena, and distortion of proprioception, remote from its source with or w/o external stimulation |
| what is the def of a trp? | a myofascial trp is a focus of hy[erirritability in mm or fascial tissue |
| what is the reference zone? and what is it stated as? | area of pain referral, and is stated as essential(solid) and spill over (stippled) |
| Referral patterns for specific mms are _____ and _______ | are predictable and reproducible |
| trps are NOT ____ but mayu be found near them | are not motor points |
| if trps are found in other tissues (cutaneous, ligamentous, periosteal) they are distinguished from? | from myofascial trps |
| Active trps: refers whether mm is ____ or _____ and referral pain worsens when ___ | @ rest or in motion worsens when pressing on them |
| active trps: always _____ to palpation prevents what of mm? ____ the mm mm _____ easily | always tender to palpation prevents full lengthening of mm weakens the mm mm fatigues easily |
| what is tricepts surae? | gastroc and soleus |
| what is gastroc prime movt? | with soleus is prime plantar flexor of foot |
| what is the most electrically active mm in erect standing (maintain balance)? | gastroc - eccentrically contracts to prevent forward drift |
| what is gastroc synergistic movt? | durng gait with soleus in controlling (restraining) rotation of tibia with hamstrings in flexing the knee |
| what is gastroc anatag? | ankle dorsiflexors and knee extensors |
| what are the attachment points of gastroc? | condyles of the femur to calcaneus via calcaneal tendon |
| what is the nerve supply to gastroc? | tibial n |
| trps may produce nocturnal calf cramps?> | gastroc, MC source of noct. leg cramps d/t mm being held in shortened position |
| what should pts with gastroc trps avoid? | high heel shoes, long, over-calf socks with tight band @ top |
| what shouldone with a gastroc trp do if seated for a long time? | use footrest |
| how can gastroc trps be aggravated? | by walking uphill, long drives in a car with a stiff gas pedal |
| where are the gastroc trp locations? | clustered from just below attachment points on condyles to just above the widest part of the mm belly |
| where do prox and distal trps of the lateral gastroc head refer? | essential directly over trp spill over close by |
| where does the distal mdeial gastroc trp refer to | essential instep and plantar arch of footwith spillover extending from lower post thigh, over back of knee, and down posteromedial calf to medial malleolus |
| latent trps are painful and refer only when? | compressed |
| latent trps how no ____ pain, the ____ mm and ____ full lenghtening, mm still _____ easily | latent trps have no spontaneous pain, they still weaken mm and hampers full lengthening, mm still fatigues easily |
| staellite trps becomes active because its mm is located ______ of another active trp | located within the zone of referrance of another active trp |
| secondary trps become active because its mm is part of the same _____ of another active trp | the same original mms (myotatic unit) of another active trp |
| secondary trps are usually in the ____ or _____ | synergist or antag |
| are trps more common in males or females? | slightly more in females (55%), but IN old age, NO gender difs |
| pain syndromes can occur @ any age, but likelihood and frequency increases with what? | maturity, adulthood |
| what % of pts that present with pain have trps as the cause? | 85-95% contributed to that pain, 75% had all or most of the pain casued by their trps |
| trps produce a local ______ of firbous band to a snapping palpation | twitch response |
| trps have characteristic ______ of trp to palpation | spot tenderness |
| trps have characteristic referred pain is ____ and _____ | predictable and reproducible |
| trps can have both the tenderness and the referral increased by _____ | by increased lengthening of the mm passively |
| trp pain is most often described as ___, _____, and ____ | dull, achey, and deep |
| Which trps can produce sharp pain referral? | infraspinatpus and subscapularis |
| trps have NO _____ changes to the mm, physiological signs appear to be due to _____ | trps have no histological changes to the mm, physiological signs appear to be due to oxidative stress (inaqedaute ATP supply for increased demand) |
| Severity and extent of referral pattern does not correlate with _____ of mm | with size |
| trps referall usually project in which direction? | distally (85%) except for hamstrings, and lat gastroc |
| which trps project proximally? | lat gastroc medial hamstring |
| what five things can directly activate a trp? | acute overload chronic overload overstretching direct trauma chiling |
| what 4 things can indirectily activate a trp? | other trps visceral dz chilling during post-exercise viral illnesses |
| intensity of a trp can vary from? | day to day even hor to hour |
| stiffness and weakness of mm is often greated after? | inactivity |
| what autonomic phenomena may occur with a trp? | local vasoconstriction sweating tearing salivating pilomotor activity |
| what proprioceptive disturbances may occur with trps? | imbalance dizziness tinnitus distorted perception of weight of onjects lifted by hand |
| what is composite pain pattern? | a pts total pain pattern may comprise overlapping patterns from dif mms so that the extent of the pattern exceeds that of any 1 mm |
| what are three clinical characteristics of tx of trps? | 1 immediate disappearance of spot tenderness, referred pain and local twitch response with released of restricted motion 2. moist heat after therapy - more rom and less mm soreness 3. relief longer if mm txed are moved thru active rom after therapy |
| what may be a cause of stiffness and restricted motion in the older population? | latent trps wich impair function, but dont refer pain. If txed can help restore some mobility |
| what 3 musculoskeletal disorders must trps be df/dx from? | 1. myopathies 2. arthridities 3. focal inflammation of other musculoskeletal strucs |
| what are 5 other df/dx for trps? | 1. fibromyalgia*** 2. neurological dz 3. visceral dz 4. neoplasm 5. psychogenic pain |
| in regards to viscoelasticity is it a 2 way street? | NOT always a 2- way street, may not be able to restore it, but tissue can move across a continuum |
| elastic deformation created by? how to reverse elongation? temporary? _____ and _____ qualities ______ behavior | elongation created by imposed tensile load remove load, elongation reversed temporary change in length extensibility and retractability spring-like behavior |
| Plastic deformity (viscous) elongation by? if remove the load? ___ but not _____ quality _____, ______ change in length _____ behavior | elongation by an imposed tensile load remove the load NO REVERSAL extensible but NO RETRACTABILITY permanent, non-recoverable change in length puttylike behavior |
| elasticity consists of what two qualities? | extensibility and retractability |
| viscosity consists of what quality? ex tissue? | extensibility only, ex is Bone |
| which mms have excitability? | mms and fascia |
| stress on a tissue can be multidirectional, therefore ___and ___ can change | length and shape |
| what 3 factors influence whether the elastic or plastic properties of a tissue predominate when a force is applied? | 1. amplitude of the force 2. speed of application 3. duration of application |
| What response does a short duration favor? | elastic response |
| what response does a long duration favor? | viscous response |
| what response does a low amplitude favor? | elastic response |
| what response does a high amplitude favor? | viscous response |
| what response does a slow application favor? | elastic response |
| what response does a rapid application favor? | viscous response |
| what are hamstrings antag to? | knee extensors and hip flexors |
| what is the nerve supply to hamstrings? | tibial(all 3) and peroneal (biceps fem only) |
| trp pain is increased by what in the hamstrings? | sitting (direct press on trps) and walking (pt may limp) and often disturbs sleep |
| what movt may be difficult for someone with a hamstring trp? | getting out of a seated position (pt may pish himself out of a chair) |
| trp referal ppaterns ofhamstrings often overlap with what other mms? | piriformis, glut med and min, vast lat, gastroc |
| what can cause a hamstring trp? | ill fitteed chairs |
| what must trp of hamstring be distinguished from? | pain of oa of the knee and hamstring mm tears |
| what is the nerve supply of lumbar erectors? | post primary rami of spinal nn |
| what do lumbar erectors tend towards in lcs? | overactivation, facilitation, adaptive shortening |
| what are lumbar erectors recruited for in lcs? | hip extension |
| what is QL antag to/ | opposite QL |
| although not included in LCS mms often become what? | facilitated along with lumbar erectors, but often asymmetrical hypertonicity because IPSI QL moves to 1 side |
| What does QL also function in? | respiration because fixes 12th rib during inhlaation, and lowers 12th rib during FORCED EXHALATION |
| what is the nerve supply of QL? | branches of lumbar plexus from t12-l4 |
| what gives pseudo-disc syndrome? | QL |
| when QL trps active often see satelitte trps where? | in glut min |
| what is the prime movt )non-wt bearing ) of tib anterior? | dorsiflexes the foot @ talocrural joint and supinate (inverts and adducts) foot at subtalar and transverse tarsal joints |
| what is the prime of tib anterior (wt-bearing) | helps maintain contraction to control posterior eccentric contraction to control posterior sway, and concentric contraction to pull leg and body forward over fixed fott |
| what is tib anteriors prime movt in gait? | helps foot clear ground during swing phase, prevents foot-slap after heel strike |
| where are the attachment points of tib ant? | prox lateral surfaceof tibia and interosseous membrance to medial cuneiform and base of first metatarsal |
| what is the nerve supply of tib ant? | deep peroneal |
| where is trp of tib ant located? | prox one third of mm length |
| where is primary pain referal of tib ant trp? | anteromedial ankle and instep, and dorsal and medial surfaces of 1st toe |
| where is spill over in tib ant? | extend from level of trp distally over shin to anteromedial ankle and foot |
| what age group is tib ant trp common in? | children |
| what is the pain of a tib ant trp sometimes described as? | burning or crushing |
| myofascial pain syndrome - onset of pain may be? | may be abrupt or insidious |
| what can pain of myofascial pain syndrome by intensified by? | extreme contraction, esp from shortened or lenghtened position passive mm stretch direct pres on trp holding mm in shortened pos over time sustained/repat conract cold, damp weather nervous stress or tension |
| What can myofascial pain syndrome pain be decreased by? | Decreased by short period of rest moist heat over trp (NOT over referral zone) slow, steady passive stretch (AFTER WARMING) specific forms of myofascial therapy moist heat over trp (NOT over referral zone) slow, steady passive stretch - a |
| What are 6 sx of myofascial pain syndrome? | 1. pain 2. limited ROM 3. weakness 4. depression 5. autonomic phenomena 6. sleep disturbances |
| in myofascial pain syndrome, limited rom is rarely what? and worse when? | rarely the chief complaint and worse on arising or after periods of immobility |
| A high amplitude, rapidly applied force can cause not just non-recoverable change, but _____ | tissue failure (tearing or rupture) |
| When CT strucs are permanently lengthened there will usually be some ______ | mechanical weakening |
| Creep AKA? Immobilizatio will cause a loss of tiss extensibility, due to??? | aka protein creep h20 loss (loss of turgor) and adehesions (collagen-collagen) |
| sometimes a rapidly applied, high amp force is whats needed to do that? | break adhesions |
| creep is opposite of ___ ; ____ tissue | opp of stretch, shortened tissue |
| creep is progessive ___ deformation of proteniaceous tissue under a _____ load or a ____ | creep is a progressive plastic deformation of prot tiss under a sustained load, or a sustained lack of proper loading |
| with creep is there a gradual rearragnement of what? | of collagen, proteoglycans, and loss of water |
| creep effects vary with? | with age, and in response to injurt or dz |
| Hystersis is a loss of? | loss of energy that occurs to viscoelastic tissue that has undergone creep |
| Hystersis changes the ____ of the tissues due to what? | behavior due to continuously applied, sustained load, or repettice cycles of loading and unloading overtime. |
| in hysteresis deformation has become _____ | permanent |
| What is seT? | the difference, of fhance in length or shape of a tissue from its orginial after creep and hysteresis has ocurred |
| if stressor is removed from creep/hysteresis and set there may be some restoration of lengthand shape, and possibly even some ____ | water re-absorption |
| skel mm is _% body wt | 40% |
| funcs of skel mm (4) | movt @ joints protection of joints that they move maintenance of posture heat production (b/c leargest consumer of energy!) |
| what does injury to skel mm often result in (3)? | fibrosis loss of elasticity and strength joint dysfunction |
| we palpate skel mm to assess what? | internal arrangement (direction of fibers,taut bandsm nodules) consistency flexbility response to pressure |
| what does mm tone consist of? | consistency flexibility response to pressure |
| what else can be done to assess mm? | length tests |
| Normal mm should be 4 things? | supple and flexible smooth moderately firm and most importantly painless |
| motor unit def | a single alpha motor neuron and all of the skeletal mm fibers it inneravtes (3-2000, avg of 180) |
| Def of myotatic unit | all mms involved in a specific movt across a given joint including the agonist, synergists and antagonists |
| What are the two types of synergists | 1. extend the line of pull of a prime mover 2. stabilize the prime mover |
| What is a mms tone? | the result of a continuous randon stream of nerve impuleses from the spinal cord (LMNS) |
| MM tone, the sustained partial contraction of skel m is controlled by what? | cortex---ant horn and mm spindle reflex |
| ____ firing of motor units. | asynchronous firing, no motor unit fires continuously |
| All or none principle of mm contraction | no partial contraction of a mm fiber |
| length/strength mm relationship | strength of contraction same every time that fiber fires, therefore strength due to number of motor units firing, thickness, and mm fibers inttial length |
| what is resting tone? | a state of readiness to contract if called upon to do so |
| resting tone is the _____ condition of a mm | default, or steady state |
| resting tone is infulenced by the natre of the joints it moves and by ___ | the resting tone of all the other mms in its myotatic unti |
| when resting tone is normal, it is ____ | muscle balance across a joint |
| when does mm imbalance occur? | whens mm of opposing function develop altered levels of resting tone relative to each other, and in most cases DO NOT have the same altered level of tone, they must remain in OPPOSITION |
| what are two types of structural hypertonicity? | 1. pyramidal system dysfunc 2. extrapyramidal syst dysfun |
| extrapyramidal system dysfun leads to increased... | tone on both sides of the joints |
| What are two types of functional hypertonicity? | limbic syst dysfunc and interneuron dysfunc |
| With interneuron dysfun mms are susceptible to? antags will become what? will lead to? | mms susceptible to trps antas become reciprocally inhibited and hypotonic lead to faulty movt patterns as cns overactivates the hypertonic mms |
| Most mm imbalance occurs as predictable responses to the stressful demands of our environment... such as? | sustained loading of mm constrained postures held over time repeat taskes lack of activity lack of variety of activity gravity |
| what is the most important factor in the development of mm imlabace? | time |
| when a mm develops increased resting tone it is ____ | hypertonic |
| hypertonic mms lose ____ | extensibility |
| over timea hypertonic mm will lose | strength |
| overtime a hypertonic mm will ___ more quikcly | fatigue |
| a hypertonic mm's synergist may become | hypertonic too |
| the antag of a hypertonic mm will become | hypotonic and lengthen |
| what is facilitation? | a heightenedstate of readiness |
| hypertonicity = ? | facilitation |
| chronic facilitation leads to? | adaptive shortening |
| what does hypertonicity NOT mean? | spasm |
| chronic or unresolved spasm may lead to? | hypertonicity, and adaptive shortening |
| what do adatively shortened mms develop? | adhesions |
| hypotonicity =s? | inhibition |
| what is inhibition? | comprised state of readiness |
| hyptonic mms are held in a? | elongated position |
| chronic inhibition leads to? | stretch-weakening |
| hypotonic mms may develop? | adhesions |
| muscle imbalance is altered ____ tone | relative |
| in mm imbalance hypertonic mms lose ___ and hypo lose ____ | hyper loses extensibility and hypo loses retractability |
| hypertonic = _______ hypotonic = _____ | hyper - tight hypo - taut (NOT ALWAYS) |
| how is adaptive shortening reversible? | stretch, dont strengthen to break pattern of facilitation, and inhibited mms will regain contractility and tone |
| what does mm imbalance often present as? | abnormal postural alignment |
| what are three ways u can confirm mm imbalance? | 1. palpation of mm 2. length test of mm 3. functional testing of mm |
| what may patterns of imbalance be associated with? | handedness repeat activities occupational activities recreational activities ***familiar modeling |
| which type of mms tend toward overuse, facilitation, and adaptive shortening? | tonic mms, ant-gravity mms postural mms |
| what mms tend toward disuse, inhibition and stretch weakness? | phasic or dynamic |
| whats mms tend towards adaptive shortening? | gastroc and soleus rec fem iliopsoas lumbar erectors QL glut med TFL and IT band piriformis and non dominant adductor group |
| mms that tend toward stretch weakening? | tib ant glut max rect ab and ext ab oblique tfl and it band dominant adductors mid and lower trap rhomboid maj and minor long coli and capitus |
| what are recognizable patterns of mm imbalance? | lower or pelvic crossed syndrome upper or shoulder-girldle crossed synd layered syndrome forward head carriage |
| Hypertropy is an increase in what two things? | size (diameter) of mm fibers and # of myofibrils of each fiber |
| with hypertrophy there is a corresponding increase in what two things? | various nutrient and intermediates metabolic substances |
| mm hypertrophy can only be brought on by? | forceful mm activity done regularly |
| what is mm atrophy? | decrease in size and number of myofibirls |
| what can cause mm atrophy? | immobilization and denervation |
| what can cause a mm spasm? | direct irritation to mm, K+ definicieny, hypothyroidism, seizures, myoclonus |
| What is primary mm spasm? and what may it become? | direct trauma to the mm itself, may become widespread due to pain reflex mechs |
| what is primary mm spasm relief dependent on? | relief of nerve irritation |
| What is secondary mm spasm? | irritation of a nerve root, plexus, or periph nerve also in response to injurt of nearby strucs (lig, tendon, joint, disc, bone) |
| secondary (protective) mm spasm is ____ or ______ | guarding, or splinting |
| What is the tx of mm spasm for primary and secondary??? | immoblilzation, ice. |
| what tx is only applicable for secondary mm spasm? | compression |
| secondary spasm d/t tendon injury is very.... | painful |
| what does fascia mean in latin.. | connect or bind together |
| what are ligaments and tendons regarded anatomically as? | local thickenings of fascial sheets, with a denser and more parallel fiber arrangement |
| when does fascia begin to develop? | around day 14 of embryo life |
| What are some functions of fascia? | maintain structural integrity support and protect organs and mms shock absorb provide matrix for intercellular communication defense against pathos environment for tis repair |
| what is the largest body in the organ for feeling ourselves (weird) and what is that called | fascia called interoception |
| what was found in fascia that makes it alive? | differentiated fibroblasts called myofibroblasts |
| how does fascia influence biomech behavior? | contracts and relaxes in a smooth mm like manner |
| contraction of fascia results in? and what about prolonged contraction? | stiffening prolonged leads to new collagen being layed down |
| what is fascial remodeling? | fascia adding or reudcing or changing its composition |
| what does fascia help to faciltate/ | movt between adjacent strucs, reducing fricton |
| what stresses does fasica respond to? | postural, mechanical, and emotional |
| what does fascia function to restrict? | restricts mm elongation and joint ROM |
| where is the dermis of the fascia? ( reticular layer) | just below and attached to the skin, comes away with skin when lifted |
| what is another name for the subcutaneous layer of the fascia | areolar |
| the subcutaneous layer of fascia contains what? it is not? it is thicker in which sex? what is allows the skin to? | contains adipose tissue and some wbcs not uniform, or continuous below dermis, tighter, orlooser thicker in women allows skin to be picked up (not always and not in all places) |
| superficial fascia AKA? and is the prime determinant of what? storage medium for what? and passageway for what? protective for? surrouns what? | aka full body leotard prime determinant of body shape storage medium for fat and water passageway for nerves, lymp and bvs protective padding to cushion and insulate surrounds organs and glands neurvasc bundles |
| Epimysium of fascia very ___ layer warps around what? continuity of fibers with _____ | very thin layer wraps around individual mms continuity of fibers with deep fascia |
| what is intermuscular septum of fascia? | two layers of epimysium connecting two contiguous mms |
| what layer of fascia has a cotton candy apperance | perimyseium/endomysim |
| where is perimysium concentrations highest? | in tonic mms rather than phasic |
| perimysium plays an important role in what? | mm imbalances |
| perimysium/endomysium fascia ___ the mm separates what? greatly influences passive mm ___? respsonsive to? high density of what? | fascia thru the mm separates fasicles and individual fibers greatly influences passive mm stiffness (resist elong) responsive to mech stimuli high density of collagen (strength, elastin, extensibility) |
| Perimysium has increased myofibroblast activity which faciltates increased what | resting tone//collagen deposition |
| what is deep fascia specialized for? and what are they? | for the strucs they support or surround (aponeuroses, ligs, joint capsules, retinacula) |
| what are tendons an extension of? | of epimysium, perimysium, and endomysium |
| Periosteum around bone permits? and is comparable to what? | permits musculo-tendinous attachment and is comparable to fascia surrounding visceral organs |
| what does visceral fascia do? | suspends organs within their cavities |
| what is parietal vs visceral layer of fascia? | parietal - outer layer visceral - inner layer, with specialized name for its organ |
| which layers of fascia are most extensible nd highly adaptable? | layers 3 thru 6 not deep and visceral |
| deep fascia is _____, but richly innervated with whattt | avascular innervated by sensory receptors, responsive to pressure tension and manipulation from outsie innervated by nociceptors, thermorecptors mechanoreceptors |
| what is the most common cause of musculosketetal pain in the general population? | chronic myofascial pain |
| healthy myofascia allows for what? | compression and tension |
| what does disruption of fascia allow for? | altered dist b/w fibers cross linking of fibers overgeneration of new fibers altered/haphazard arrangement of fibers |
| what are myofascial therapies intended to do? | break up crosslinkages and restore myofascia to a healthy state |
| what do we observe a pts skin for? | discoloration abrasions scars edema deformities others - moles, carcinoma, skin tags |
| what do we palpate a pts skin for? | tone & texture temperature changes sensitivty to touch mositure excessive dryness motility |
| what skin changes may reflect myofascial problems below? | 1. dermatographia (skin easily gets red) 2. panniculosis (thinkening of skin) |
| LCS syndrome is imbalanced resting mm tone of what? | trunk flexors and extensors(hyper), and hip joint flexors(hyper) and extensors |
| with a deep, short hyperlordotic lumbar curve what is more signif? | pelvic imbalance |
| with a longer, shallower lordosis, what is more signif? | trunk imbalance |
| if lcs asymmetrical where is there imbalance? | between hip joint abductors and adds |
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margaretrhager
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