Physio Flashcards - W/ XTRA

Critical Appraisal is the process of carefully and systematically examining research to judge both its value and trustworthiness
- What is the research question / hypotheses
- What is the study population
- What are the outcome factors (dependant variables)
- What are the study factors (independant variable)
- Are the results statistically significant

Postural stability is the state when all forces acting on the body are balanced so that the centre of mass is within the boundaries of the Base of support

Kyphosis – Outward curvature (protrusion forwards) of the thoracic spine leading to a rounded upper back curve. Hyperkyphosis = more than 45 degrees (hunch back)

Lordosis – Inward curvature (protruding forwards) of the cervical and lumbar spine, leading to a more outward / puffed chest appearance known as way back.

Scoliosis – lateral curvature of the spine

Abnormal posture can be:

Adaptive – Adopting of certain positions in order to relieve load on painful tissues

Maladaptive – a chronic or habitual poor alignment of the body, often caused by factors like prolonged sitting, repetitive motions, or carrying heavy bags, which can lead to pain, fatigue, and muscle imbalances

Ultimately, long-term faulty posture may cause shortening of some muscles and lengthening of others, contributing to muscle imbalance. Muscle imbalance can alter the load on tissues, leading to pain or weakness.

For muscles that cross two or more joints we must exlcude any joint restriction to ensure it is a muscle length issue rather than a joint ROM issue.

- Take time to introduce yourself, your role and why you are there
- Warm, Respectful and open body language
- Avoid medical jargon
- Have an openess and willingness to learn and listen
- Make use of ATSI interpreters, health workers or friends and family

I - Introduction (HAIDET)
Can - Current History (why are they here)
Please - Past History (Reocurring injury, previous injuries, medical conditions, surgeries etc)
Patients - Pain and Irritability (Pain out of 10, type of pain, how often, what flares it up)
Getting - General Health (medications, health conditions, lifestyle eg; smoker, drinker etc)
Real - Relevant Investigations (past surgeries)
Stories - Social History (employment, family, hobbies and transport)

I can please patients getting real stories

Red Flags: Clinical signs and symptoms suggestive of possible serious pathology that contraindicates physiotherapy.
- Fracture
- Cancer
- Infection
- Inflammatory disease
- Serious spinal disorders
- Serious Medical disorder (stroke)

Yellow Flags: Psychosocial risk factors shown to be obstacles to recovery.
- Patient beliefs or compliance (stubborness, or I know better attitude)
- Coping strategies
- Counterproductive behaviours (fear-avoidant behaviour, or boom-bust (exercise really hard and over do it) )
- Work or Family stresses

Ataxic Gait – Most commonly seen in cerebellar disease, this gait is described as clumsy, staggering movements with a wide-based gait. (Looks like drunk walking)

Antalgic Gait – A limp on the affected side due to pain, inflammation or injury

Festinating/Parkinsonian Gait – a walking pattern characterized by short, hurried steps and a tendency to lean forward. It's a common symptom in Parkinson’s disease

1. Trendelenburg Gait (Hip Drop Gait)
Cause: Weakness or paralysis of the gluteus medius and minimus (hip abductors) on the stance leg side.

Observation: The pelvis drops on the contralateral (swing) side during single leg stance.

Compensation:
• The person may laterally shift the trunk towards the weak side to reduce demand on the abductors. Looks like Waddling
• This is called a compensated Trendelenburg gait. Remember 'Guilt to the Tilt'

Remember IMAX - Inferior gluteal Nerve = glute max therefore superior = med and min

2. Foot Drop (Steppage Gait)
Cause: Weakness or paralysis of dorsiflexors (primarily tibialis anterior) due to common fibular nerve injury or neuropathy.

Observation: Foot slaps the ground after heel strike or drags during swing.

Compensation:
• The person exaggerates hip and knee flexion during swing phase to lift the foot higher (steppage gait).

Biomechanics – the study of forces and the effects of those forces on and within the human body. Kinetics and Kinematics are two sub disciplines of this

Kinematics – description of movement independent of the forces that produce the movement

Kinetics – description of forces that produce movement

Reach to grasp is a basic human movement of extending the arm to intercept and grab an object. It serves as an indication for functional ability of an individual as the movement involves continuous integration of visual, proprioceptive and other sensory information.

Transport (Reach Phase)
• Displacement: Hand moves from starting position toward the target object.
• Velocity: Follows a “bell-shaped” velocity profile (accelerates rapidly, peaks about halfway, then decelerates smoothly as hand nears the target).
• Goal: Position the hand in space near the object.

Grasp (Pre-shaping Phase)
• Displacement: Fingers open wider than the object (maximal aperture), then close around it.
• Velocity: Finger opening peaks early, then slows as aperture is shaped to match object size/shape.
• Goal: Form grip type appropriate for the object (precision grip, power grip, etc.).

150 Mins of moderate exercise (walking)

75 Mins of vigorous activity (running)

2x of Strength training per week

The inflammatory response is the bodies natural reaction to injury and infection. It involves vasodilation of the affected area, which increases white blood cells to clean up debris and fight infection.

1. The acute inflammation phase (acute – < 5 days):
o Pain, redness and swelling around the area
o Loss of function and mobility
o Vasodilation
o Role is to manage inflammation, and avoid escalation/excessive tissue loading

2. The repair and regenerative phase (3 days to six weeks):
o Elimination of debris
o Formation of new fibres
o Production of scar tissue
o Role is to protect collagen healing while regaining normal ROM, commencing strengthening and functional exercise


3. The remodelling phase (six weeks to many months):
o Increased production of scar tissue
o New functional body tissue is developed and strengthened.
o Balance of exercise and rest is important – rehabilitation if necessary

TSECE
1. Teaching
2. Safety and effectiveness (patient is monitoring self symptoms and overuse, irritability)
3. Empowerment of the patient (involvement in decion making, goal making)
4. Clinician-patient communication
5. Engagement with exercise (what motivates them?)

Goal setting must be SMART
S – Specific
M – Measurable
A – Achievable
R – Relevant
T – Time dependent

EG: Achieve Knee ROM improvement in 2 weeks or increase Quadriceps strength from MMT

Cognitive
The stage where the athlete gains an understanding of the task required
• Characterised by mental processes
• Frequent errors
• Coach needs to provide lots of feedback
• Frequent, short periods of exposure are best for development
• E.g. frequently dropping the balls and learning to coordinate hands properly when initially learning to juggle

Associative
The stage with an emphasis on practice
• Athlete is thinking about how the skill is performed and focussed on refining it for more efficiency
• The movement becomes more fluid and smoother
• Errors still occur and improvement becomes slower
• Athlete can provide some of their own feedback, but still benefit from the feedback of a coach. Avoid manual guidance encouraging problem solving
• Requires lots of practice and takes lots of time
• E.g. the athlete is becoming more fluid at juggling, frequency of dropping balls decreases

Autonomous
Characterised by the ability to automatically execute the skill
• Execution is now properly sequenced and performed instinctively
• Can provide their own feedback, though external feedback on skill execution may be beneficial
• Stimulating competition; under pressure drills
• E.g. rarely drops the balls, does not have to actively think about timing and coordination of hands when throwing and catching the balls.

1. Mental practice
2. Massed vs Distributed
3. Part vs Whole
4. Blocked vs Random
5. Constant vs Varied
6. Open or Closed
7. Self-monitored

Imagery refers to the repetition of a movement or sequence to increase the minds familiarity with desired motion
Specifically:

- Mental rehearsal = imagining the entire task
- Visualisation = imagining a particular part of routine

This will trigger some neuronal circuitry

Massed Practice is a continuous practice session with smaller periods of rest than practice (Practice > Rest). It works well for skilled and motivated athletes and for rapid and discrete skills. EG; STS and football passing

Distrubuted Practice has shorter periods of practice with longer breaks from skill rehearsal (Practice < Rest). This is often used for less skilled and less motivated athletes but also is used for the more difficult tasks that need to be broken up (serial skill) and / or require feedback where necessary. Ultimately, Distrubuted practice may be better for long term retention and continuous tasks such as walking or for more complex tasks requiring feedback

Whole practice is when the skill is practiced in its entirety and is often used for discrete and continuous skills

Part practice is when the skill is broken down into its smaller parts and each part is practicd in isolation before being joined together. Often used in teaching serial skills which are skills that involve multiple smaller skills that accumulate to form that larger skill, EG; basketball lay up

Open occur in unpredictable and frequently changing environments. This requires adapting behaviour. EG: Sit to Stand on a moving bus
- Affected by a variety of factors e.g. weather, opposition

Closed occur in a predictable and stable environment with little variation and is much more conducive to learning
- Skills can be planned well in advance

Blocked Practice is where the same task is repeated in a period of time (usually weeks). This can be effective in improving the patients familiarity with the desired task, however may only produce short term retention depending on how often the patient repeats that task, Can also be boring

Random Practice is whereby several different tasks are practiced in no particular order which has been shown to improve better long term retention and lead to less patient boredom

Constant practices – the same task practices under the same conditions

Varied practice – the same task practices under different conditions eg; environment, speed, distance, fatigue etc

Concurrent feedback is received during the performance of a skill and is relayed throughout the body and proprioceptive mechanism
 e.g. a person performing a headstand sends information from the brain to keep balance

Delayed feedback is information provided to an athlete after they have completed a skill
 e.g. waiting for the result of a free throw in basketball

Knowledge of results is information about the outcome of skill execution
e.g. scoring a goal

Knowledge of performance is the information provided about the process of movement
e.g. a coach giving technical advice for a tennis serve

Contracture is a condition of adaptive shortening and hardening of muscles, tendons, or other tissue, often leading to restricted joint mobility.
There are four types of contracture:
Myostatic
- Adaptive shortening muscle-tendon unit
- ⬇️ length of muscle-tendon unit and muscles become stiffer
- ⬇️ Sarcomeres and ⬆️ increased connective tissue

Pseudomyostatic
- A result of hypertonicity (spasticity associated with CNS tendon)

Arthrogenic and periarticular
- Arthrogenic = bone, cartilage, joint capsule while periarticular = soft tissue surronding the joint eg; tendon, ligaments skin

Fibrotic and irreversible
- Fibrous changes in muscle connective tissue and periarticular structures

The bodies protective mechanism activated by fast muscle stretch causing immediate contraction to resist passive stretch and prevent overstretching. The faster the stretch – the stronger the reflex. This is achieved through Golgi tendon organs (GTO) which are located at the origin and insertion of skeletal muscles fibrers.

Ultimately the inverse of this is true as slow, sustained stretch will cause autogenic inhibition (the process by which muscles relax in response to prolonged tension/stretch via GTO). For example, during a static stretch, after holding for a few seconds, the GTO response allows the muscle to be stretched further because of the temporary inhibition.

a training principle that involves gradually increasing the stress on your body to improve strength, endurance, or muscle size

"Specific Adaptation to Imposed Demands" and is a concept in exercise science stating that the body adapts specifically to the demands placed upon it. This means that to improve a specific skill or quality, you must train it specifically; for example, lifting heavy weights builds strength, while endurance training builds cardiovascular efficiency. It emphasizes that training must be tailored to the desired outcome to be effective.

Is the loss of training adaptions as the individual ceases their training. Can be avoidededuced during off-season or when injured by maintaining some level of training

FITT Principle
F – Frequency – How often we train
I – Intensity – How challenging the activity/load is
T – Time – Duration or number of reps
T – Type – The type of training (strength, cardiovascular, flexibility, balance etc)

- 3-5x a week
- 60-80% of max HR
- 20-60 mins

- Minimum 2x a week
- 70-85% of 1RM
- 8-10 reps, 1-3 sets

Electrophysical Agents (EPAs) are physiotherapy modalities that use different forms of energy like electrical, thermal, mechanical, or light to treat injuries and conditions such as pain, swelling, and inflammation. Common EPAs include electrical stimulation (TENS), ultrasound, laser therapy, and heat/cold treatments (cryotherapy).

A lever is a rigid structure (in this case, bones) that moves around a fixed point called a fulcrum (typically a joint) when a force (muscle contraction) is applied to overcome a resistance (load). Levers allows us to produce movement more efficiently and with mechanical advantage.

Understanding the types of levers in the body can be remembered via the acronym FLEX, where the sequential letters indicate the positioning of the Fulcrum, Load and effort in the different types of levers.

Thus we have First, Second and Third Class Levers

When the Fulcrum is between the Effort and Load. This is the least common type of lever in the body.

EG: Extension of the Neck:

Effort is exerted by the neck extensor muscles (splenius colli)
The Fulcrum is the atlanto-occipital joint
Load is the weight of the head

When the Load (resistance) is between the Effort (applied force) and Fulcrum. Provides the Most Mechanical Advantage because the effort arm is always longer than the load arm. This setup requires less effort to move a heavy load.

EG; Calf Raise, Bottle opener, wheelbarrow

The Effort or applied force is the concentric contraction of gastrocnemius and Soleus

The Load is the body weight

The fulcrum is the MTP joint

The most common lever found in the human body where the Effort (applied force) lays between the fulcrum and the Load (resistance)

EG; Bicep Curl
Effort (Applied force) is the biceps brachii
Fulcrum is the elbow joint
Load is the weight of the forearm or object being lifted.

There is a mechanical advantage if only a small effort is needed to overcome to a large resistance. Mechanical advantage (MAd) refers to the efficiency of a lever where:
- MAd = Moment arm of effect force (FA) / Moment arm of the resisting force (RA)

- Larger RA = decreased MAd
- Larger FA = Increased MAd

Torque = Perpendicular distance (moment arm) x force

Look for the distance of the moment arm - A shorter moment arm means that less force is needed to create the same amount of torque, making it easier to lift or move a load. This is because the moment arm is the distance from the pivot point to the point where the force is applied, and a shorter distance is a mechanical advantage

Think of that squat diagram

Buoyancy (Archimedes principle) – The upward force opposing gravity. This will reduce weight-bearing, support weak muscles and enable easier movement

Hydrostatic pressure – pressure exerted by water which increases with depth. This pressure assists circulation, reduces swelling and improves proprioception. Hydrostatic pressure results in compression of peripheral veins to ↑ venous return & stroke volume → ↓ HR (due to hydrostatic pressure). ↑ central blood volume. Hydrostatic pressure on chest wall resists expansion thus ↑ work of breathing (pressure on chest wall), which may aid respiratory muscle training. Ultimately immersion in water will reduce lung volumes temporarily.


Viscosity and resistance – frictional force opposing motion, this provides graded resistances for strengthening, slower movements = less resistance while faster = more

Precautions (use with care):
• Contagious skin disease
• Controlled epilepsy or any seizure disorder (supervision required).
• Open wounds (cover with waterproof dressing) or surgical incision with sutures or staples in place
• Fear of water or poor swimming ability.
• Pregnancy (avoid overheating).
• Incontinence the involuntary loss of bladder or bowel control, ranging from occasional urine leakage to a complete loss of control.

• Uncontrolled cardiac failure or unstable angina.
• Open wounds, uncontrolled incontinence, skin infections.
• Severe peripheral vascular disease.
• Respiratory compromise (severe COPD, low VC).
• Fever or systemic infection.
• Uncontrolled epilepsy.

1. Nociceptive = Pain arising from damaged or perceived damaged non-neural tissue e.g. muscle strain.
- This type of pain is transmitted to the brain via nociceptors (thermal, chemical, mechanical)

2. Neuropathic = Damage to nerve tissue e.g. Traction (burner), shingles
- This type of pain is the result of stretch, cut or traction of somatosensory neurons.

3. Nociplastic = Increases / heightened responsiveness to stimulation e.g. brushing past a stick though it feeling really painful
Two types of Nociplastic
I - Allodynia: pain is felt in response to feelings that shouldn't feel painful e.g. bed sheets feel scratchy or cotton jumper feels like ants.
II - Hyperaglesia: Highly increased responce to painful stimuli e.g. a scratch while bush-walking feels like a snake bite.

- Patient explains pain
- numerical scale
- facial expression scale
- time pain has lasted for
Note: it is good to improve other numerical tangible facets of the patients condition as pain and mood can be subjective from visit to visit.

Medical Management
- Medicines e.g. Paracetamol, anti-inflammatory drugs, surgery, opiods (be careful with these puppy's they are addictive)

Physiotherapy Management
- Education & Self management --> explain their pain and encourage them to find other ways of remaining active e.g. you're in pain because you tore your bicep it will take some time to get better)
- Exercise: this has a hypoalgesic response... ideally try to exercise other parts of the body. (MOTION IS LOTION)
- Manual therapy can be used, this is done adjunct to other physio skills.

Multidisiplinary Management:
- More specialised physiotherapy (titled)
- Doctors
- Physcologists (pain can be derived from past experience)
- Self management

1. Pain is an output from brain
2. Pain is a critical device in signposting damage
3. Pain does not always = tissue damage
4. Pain depends on how much danger the brain perceives you are in
5. Pain is influenced by multiple factors
6. Chronic pain results from hypersenstivity
7. Many treatments can turn down the level of hypersensitiviy within nervous system