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PMA Study Guide
Contraindications
| Question | Answer |
|---|---|
| Anterior Cruciate Liagment Knee Injuries (ACL) are most commonly caused by | A blow to the lateral side of the knee or rotation of the femur on a planted tibia/foot |
| What are the additional injuries that accompany an ACL injury | additional inuries to the Medial Collateral Ligament and the Medial Meniscus |
| ACL Contraindications without sergical repair | Open chain terminal knee extension (60 to 0 degrees) with resistance to the distal leg, and squatting between 60 and 90 degrees causes increased anterior translation of the tibia on the femur and subsequent stress to the ACL |
| ACL Contraindications with sergical repair | Maximum protection phase - up to 10 weeks should be handled by a physical therapists. Minimum protection phase is 10 to 24 weeks - avoid feet in straps or leg spring work |
| What is Facet Joint Syndrome characterized by? | segmental hypomobility (facet lock) causing secondary hypermobile segments with pain and pain referral. |
| What are the symptoms of Facet Joint Syndrome? | Occures with or because of disc degeneration. Painful with extension combined with rotation and sidebending |
| What are the contraindications of Facet Joint Syndrome? | Avoid extension of the spine |
| What is Herniated Nucleus Pulposis - HNP? | herniated or bulging disc where annular fibers are weakened and nucleus loses volume and narrows |
| What are the 3 stages of HNP | Disc Bulge, Prolapsed Disc and Sequestration |
| What are the characteristics of Disc Bulge? | Posterior annular fibers tear due to repeated loading in flexion and/or flexion and rotation and the nucleus may bulge sufficiently to cause pressure on the Posterior Longitudinal Ligament (PLL) csuding pain. |
| What are the characteristics of a Prolapsed Disc or extruded nucleus? | Outer annulus and PLL fibers give way, allowing nucleus to bulge into spinal cord. |
| What are the characteristics of Sequestration? | Nuclear material has separated from the nucleus allowing it to be free in the neural canal. |
| What are the contraindications of HNP? | In acute stage or symptoms are present avoid all exercises that include spinal flexion or vertical loading (seated, standing or inverted positions) of the spine. Avoid straight leg raise and strong spinal rotation |
| What is Spondylolisthesis? | An instability most often at L5-S1 or L4-L5 due to a defect in the laminae causing anterior vertebral displancment. |
| What are the symptoms of Spondylolisthesis? | Typically aggravated by extension activity. Minor injury causes acute pain with diffuse radiation into buttocks. Major injuries cause fractures in the laminae and can also cause serious spinal cord injuries. |
| What is Stenosis? | narrowing of the spinal canal (central stenosis) or nerve root canals (lateral stenosis), compromising the spinal cord or nerve roots. Occurs in the lumbar spine can occur in the cervical or thoracic spine |
| What are the contraindications of Stenosis? | Always avoid extension of the spine. |
| A total hip replacement includes | Acetabulum and /or Femoral Head to be removed and replaced with mechanical components due to fracture or osteoarthritis |
| Posterior contraindications of a hip replacement include | avoiding hip flexion above 90 degrees, hip adduction and internal rotation - females should avoid sitting in a crosssed leg position |
| Anterior contraindications of a hip replacement include | permanently avoiding all hip extension, abduction and external rotation - can cause dislocation of the hip joint |
| What is Adhesive Capsulitis or frozen shoulder? | capsular tightening of the glenohumeral joint |
| What are the precautions for Adhesive Capsulitis? | Avoid agressive stretching of the shoulder joint and endrange loading of the shoulder joint |
| What is Carpal Tunnel syndrome? | sensory loss and motor weakness that occurs when the median nerve is compressed in the carpal tunnel. |
| What are the symptoms of Carpal Tunnel Syndrome? | Increasing pain in the hand that comes with repetitive use, weakness in the thenar muscles, and / or sensory loss in the thumb or 1st and 2nd fingers. |
| What are the precautions for Carpal Tunnel syndrome? | Avoid resistance training of the upper body, wrist flexion, forearm supination, and pressure to the base of the palm that occurs in weightbearing during periods of flare-up |
| What is Plantar Fasciitis? | chronic inflammatory syndrome characterized by pain on the bottom of the heel and/or arch. Pain usually occurs in the heel, it can also radiate throughout the bottom of the foot toward the toes. |
| What are the symptoms of Plantar Fasciitis? | commonly occurs in the morning with weightbearing. Pain also occurs with the onset of activity such as walking or running. pain may decrease as actity progresses but returns after resting and then when activity resumes. |
| Plantar Fasciitis is common in? | runners and dancers, along with individuals who are overweight or have had a sudden gain in body weight who increase their activity level. |
| What are the precautions of Plantar Fasciitis? | Any weightbearing exercise that causes increase in heel or arch pain or shortens the calf muscles as in plantar flexion of the foot. |
| What is Rotator Cuff Impingement? | compression most often of the supraspinatus tendon, infraspinatus tendon or subacromial bursa against the acromion of the scapula due to compromise of the subacromial space |
| What are the symptoms of Rotator Cuff Impingement? | Pain in the glenohumeral joint, deltoid or bicipital tendon. |
| What are precautions of Rotator Cuff Impingement? | Avoid overhead shoulder positoins, internal rotation, or endrange loading of the shoulder joint combined with abduction "impingement position". |
| What is Thoracic Outlet Syndrome? | complex syndrome with 5 main entrapment locations (brachial plexus, subclavian artery and subclavian vein). |
| What is the 1st main entrapment location of Thoracic Outlet Syndrome? | Anterior Scalene tightness - causes compression of the brachial plexus between the anterior and middle scalene muscles. |
| What is the 2nd main entrapment location of the Thoracic Outlet Syndrome? | Costoclavicular approximation - compression in the space between the clavicle and the first rib. |
| What is the 3rd main entrapment location of the Thoracic Outlet syndrome? | Pectoralis minor tightness - compression beneath the tendon of the pectoralis minor under the coracoid process. |
| What is the 4th main entrapment location of the Thoracic Outlet syndrome? | Presence of a cervical rib or elevated 1st rib causes entrapment of the brachial plexus. |
| What is the 5th main entrapment location of the Thoracic Outlet Syndrome? | Inferior glenohumeral joint capsular tightness. |
| What are the symptoms of Thoracic Outlet Syndrome? | Numbness, tingling, ablation of pulse, coldness or pain in the affected upper extremity. |
| What are the precautions of Thoracic Outlet Syndrome? | Avoid any exercises (especially upper body) that produce the symptoms above. |
| Cardiovascular Diseace is? | Any disease of the heart and blood vessels. |
| What are some of the precautions of Cardiovascular Disease? | Clients need to drink water before, during and after pilates sessions. Do not exercise in hot temperatures (over 80 degrees). |
| What precautions should be used for peripheral vascular disease? | Check the feet for cuts, blisters or signs of infection due to decreased sensation of the feet (can wear shoes). If severe avoid weightbearing exercises altogether. |
| What precautions should be used for hypertension? | avoid inversions and high-intensity or heavy resistance exercises and instruct clients to move slowly when rising from a supine, sidelying or prone postition due to increased susceptibility to orthostatic hypotension. |
| Contraindications of Cardiovascular Disease include? | Heart Attack and Stroke Warning signs - stop exercise and call 911 |
| What are Heart Attack Warning Signs? | Uncomfortable pressure, squeezing, fullness or pain in the center of the chest, pain or discomfort in one or both arms, back neck jaw or stomach, shortness of breath along w/ or before chest pains, breaking out in cold sweat, nausea or light headedness. |
| What are Stroke Warning Signs? | Sudden numbness or weakness of the face, arm or leg, especially on one side of the body, confusion, trouble speaking or understanding, trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance or coordination, sudden severe headache. |
| What is Cronic Fatigue Syndrome? | Debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. |
| What are symptoms of Cronic Fatigue syndrome? | Substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, sleep that does not refresh |
| What are precautions of Cronic Fatigue Syndrome? | Pace clients carefully - |
| What is Fibromyalgia? | Cronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness or tender points that are painful when pressure is applied. clients have exercise intolerance and often feel worse after exercising |
| What are precautions of Fibromyalgia? | Exercises for clients must be slow, sustained and low-resistance |
| What is Gastric Reflux? | The backward flow of stomach acid contents into the esophagus. Cronic exposure of the esophagus to acid coming up from the stomach (reflux). |
| What are precautions for Gastric Reflux? | Avoid Food consumption 2 hrs before exercise, monitor supine positions, avoid all inversions. |
| What is Glaucoma? | Normal fluid pressure inside the eyes slowly rises, leading to vision loss or blindness. Can damage optic nerve. *Aerobic exercise lowers eye pressure - a major risk factor for glaucoma. |
| Contraindications for Glaucoma. | Partial and full inversions, valsalva maneuvers (trying to exhale with a closed nose and mouth). |
| What is Multiple Sclerosis? | Autoimmune disease that affects the central nervous system. The myelin sheath that coats the verves is damaged in multiple areas, leaving scar tissue. Damaged myelin or nerve fiber destroyes the ability of nerves electrical impulses to & from the brain. |
| Symptoms of Multiple Sclerosis. | Balance and coordination deficits, dizziness and vertigo, temperature sensitivity, depression, fatigue, numbness, pain, sexual dysfunction, visual, bladder and bowel dysfunction. Memory, attention and cognitive deficits. |
| Precautions for Multiple Sclerosis. | Avoid over-exertion, heavy resistance training, fatigue, extreme hot or cold evnironments. Guard carefully with balance exercises. |
| What is Osteoarthritis? | Slow, progressive degeneration of joint structures which can lead to loss of mobility, chronic pain, deformity and loss of function. Affects only few joints. Increasing joint pain w/ weightbearing and strenuous activity. No systemic effects |
| Precautions for Osteoarthritis. | Avoid high impact exercises, low-intensity frequent exercise. reduce exercise intensity/duration during periods of increased inflammation or pain. put all joints through full range of motion at least once a day to maintain mobility and decrease stiffness |
| For a client with Osteoarthritis, how many days of rest should they have if pain increases during or following exercise? | 1 to 2 days of rest and a decrease in intensity of future exercise session. Clients should work only p to the point of pain but not past it. |
| What is Osteoporosis? | Skeletal disease characterized by low bone mass and deterioration of bone tissue - especially affecting the vertebrae, neck of the femur and wrist bones. Leades to bone fragility and increased fracture risks. |
| What is Osteopenia? | Midly reduced bone mass (1-2.5 standard deviations below mean) 2x risk for fracture or about 10 to 25% bone loss. |
| What is the bone mass/loss for Osteoporosis? | compared to osteopenia, siginificantly reduced bone mass (2.5 or more below mean) 4 to 8x the risk for fracture. More than 25% bone loss. |
| Contraindications for Osteoporosis? | Avoid flexion, rotation and side bending of the spine. NO spine flexion in any position for osteoporosis and osteopenia. NO CRUNCHES, hundred position, rollups, rollover positions. No strong external or internal rotation forces at the hip joint. |
| What can clients with Osteoporosis focus on? | Thoracic extension (can do supine posterior pelvic tilts to icrease abdominal strength). |
| Pregnancy - Contraindications during all trimesters. | Avoid moderate to maximal contractions of the adductor muscles due to softening of the pubic symphysis joint. Ex. Horseback on barrel or reformer, light spring side split series on reformer, strong circle work. |
| Pregnancy - Contraindications during 2nd and 3rd trimesters and post-partum. | Avoid inversions |
| Pregnancy - Contraindications after 1st trimester. | Avoid supine positions. Work abdominals in any position except supine. Palpate Linea Alba to check for diastasis recti (seperation of rectus abdominus from linea abla). Modify abdominal work and oblique work until diastasis bulge is under control. |
| Pregnancy - Contraindications | dizziness, nausea, vision disturbances, headache, lightheadedness, vaginal blood, fluid loss, chest pain, muscle weakness, calf pain or swelling, uterine contractions or decreased fetal movement. |
| What is Rheumatoid Arthritis? | Chronic inflammatory systemic disease affecting connective tissue = mild joint symptoms w/ aching, stiffness to abrupt swelling, and progressive deformity. inflammatory changes occur in synovial membrane, articular cartliage, tendon sheaths. |
| Precautions for Rheumatoid Arthritis. | During periods of exacerbation, avoid endrange stretching to swollen joints and heavy resistive exercises. Avoid exercising to the point of exhaustion or extreme fatigue. |
Created by:
Nlockhart
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