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147 Cards in this Set
- Front
- Back
What is the indication for HVLA treatment?
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Somatic dysfunction with articular restriction
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Articular restriction is often accompanied by:
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A reflex muscle guarding response
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Articular Restriction may be generated by:
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Acute Trauma; Sustained Muscle Hypertonicity; Repetitive Microtrauma; Fascial/Ligamentous Contracture; Poor Posture
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What maintains Articular restriction?
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1. Thin layer adherence
2. Muscle guarding 3. Fascial contracture 4. Desiccation of the facet joint |
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A process where 2 congruent surfaces are "glued" together by a typically lubricating substance when said substance is spread thinly enough.
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Thin Layer Adherence
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All joint surfaces are in complete contact with each other in anatomic position.
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Congruent surfaces
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SYNOVIAL FLUID + CONGRUENT FACETS + COMPRESSIVE FORCES = ?
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Articular Dysfunction
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Where does the synovial fluid go in an acute injury?
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It is squeezed out into the joint capsule with subsequent capsular distention and pain
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Where does the synovial fluid go in a chronic injury?
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It is absorbed into the surface of the cartilage and removed from the surrounding tissues via the lymphatics
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A sound similar to a loud thud.
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Articular Clunk
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Artciular clunk is a noise that is normally present from the ____ joint and may emanate from any _________ joint
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Sacroiliac;
Osteoarthritic |
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Popping noise expressed as a single modal curve on a sound frequency scale
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Articular Pop
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A "breaking" noise; may exhibit on sound wave analysis as a bimodal or multimodal peak
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Articular Crack
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Sound that is emitted most frequently when the wrist is placed in lateral extension.
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Crepitus
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A crackling sound akin to rubbing hair between fingers
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Crepitus
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Sound that results from a tense ligament or fascial structure rolling over a bone or solid prominence.
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Ligamentous Strums
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Example of a ligamentous strum
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a snapping ankle
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A high-pitched, non-repeatable "tearing" sound; similar to peeling Velcro apart
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Torn Adhesion Sound
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Example of a torn adhesion sound
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Frozen Shoulder
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A sound similar to 2 hard surfaces being rubbed together
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Tendinous Click
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With articular release, there is a ___%-___% gain in joint range of motion
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5-10%
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Articular release occurs with about ____kg of tension.
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8 kg
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Sudden separation that doesn't return to baseline
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Articular release
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What are 3 theories of articular popping?
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1. Bone being put back into place
2. Snapping of adhesions 3. Breaking of joint seal or thin layer adherence. |
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(Fill in the blank with "more" or "less")
The larger the joint, the _____ likely it will "pop." |
LESS
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What are some results of too frequent articular mobilization?
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Hypermobility;
Ligamentous & capsular hypertrophy |
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Most effective way to mobilize a small joint
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Combination of:
Gapping force & Gliding force |
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What is the refractory period for which a joint must be left unattended before an articular pop can again be obtained?
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20 minutes (range 17-22 minutes)
Although spinal articulation seem to range from one to several hours |
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When external barometric pressure is _____, it makes joints easier to crack.
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LOW
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When external barometric pressure is ___, it makes joints more difficult to crack.
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HIGH
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Refers to number of new cases
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Incidence
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Refers to the number of cases currently existing
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Prevalence
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10 years after onset of neck pain, 79% of patients had ______ neck pain.
(FIll in the blank: NO, DECREASED, SEVERE) |
DECREASED
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10 years after the onset of neck pain, 43% of patients had _____ neck pain.
(FIll in the blank: NO, DECREASED, SEVERE) |
NO
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10 years after the onset of neck pain, 32% of patients had ______ or ______ neck pain
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MODERATE OR SEVERE
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What are some red flags for possible infection for the cause of neck pain?
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Under 20 and over 50;
Fever or Chills; Pain worse supine; Recent UTI; IV Drug Abuse; Immune Suppression (HIV, diabetes, organ transplant, stress) |
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At what level is spinous process percussive pain indicative of a possible infection as a cause for neck pain?
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C7 & T1
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What are some possible causes for neck pain?
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Trauma; Infection; Tumor; Vertebrobasilar Artery Compromise;
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Injury caused by sudden, forceful hyperextension of the neck with flexion recoil
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Whiplash injury
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Other terms describing whiplash injury
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Cervical strain/sprain;
Neck sprain; Acceleration-deceleration injuries |
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Whiplash "high risk groups"
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Women;
Elderly; Significant underlying degenerative disc disease |
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In whiplash, body parts INITIALLY move _____ the point of impact and then recoil.
(FILL IN THE BLANK WITH "TOWARD" or "AWAY FROM") |
TOWARD
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Facet joints are innervated by:
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Posterior primary ramus of nerve root of both that segment, the segment above and the segment below
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Recurrent meningeal nerve innervates:
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the posterior longitudinal ligament and outer 1/3 of the annulus fibrosus posteriorly
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Visceral afferents from the sympathetic nervous system make up the sensory supply for the:
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anterior longitudinal ligmanet and the outer 1/3 of the annulus fibrosis anterolaterally
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Spinal facet joints are also called the_____________ joints
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Zygapophyseal joints
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The spinal facet joints, the sacroiliac joints and the Joints of Lushka in the C-spine are all what types of joints?
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Synovial joints
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What is the sequence of events of osteoarthritis of a synovial joint?
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1.Articular Dysfunction; 2.Facet Synovitis;
3.Cartilage Degenerates; 4.Capsular Laxity; 5.Subluxation; 6.Osteophyte Formation; 7.Facet and Laminar Enlargement |
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What is a major contributor to cartilage nutrition?
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synovial fluid
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The compression and adherence of the joint surfaces results in what?
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It impairs the flow of synovial fluid across the joint
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Simple joint immobility leads to:
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Thinning of the hyaline cartilage of a joint.
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Joint immobility leading to thinning of hyaline cartilage of joint is believed to be due to:
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Reduced trophic support from decreased blood flow, both arterial and venous
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What is considered to be a non-inflammatory arthropathy?
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Osteoarthritis
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In this arthropathy, there is a small amount of joint inflammation that occurs and can be more painful than very advanced arthritic changes in the cartilage proper
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Facet Synovitis (of osteoarthritis)
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When cartilage break off into the joint and "sand away" at the joint surface and invokes a more intense inflammatory response.
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Cartilage Degeneration
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A result of this results in the inability to maintain normal apposition of the joint surfaces leading to hypermobility.
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Capsular Laxity
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What is the term for partial dislocation of a facet joint?
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Facet Subluxation
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Commonly referred to as bone spurs
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Osteophyte Formation
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Nature's way of attempting to restabilize a joint
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Osteophyte formation (bone spurs)
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Site where the joint capsule and ligament attach into bone is referred to as the ______.
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Enthesis
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Diseases and disorders at the site of a bone where the joint capsule and ligament attach
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Enthesopathies
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What is Wolff's Law?
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Bone will remodel in accordance with the stresses placed upon it.
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Likely due to traction on the periosteum where the joint capsule and ligaments attach into the bone.
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Bone spurs
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Pain which follows a nerve root distribution
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Radiculitis
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This "event" of osteoarthritis, though not painful in and of itself, may encroach on neighboring pain sensitive structures.
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Facet and Laminar Enlargement (bone getting bigger)
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Circumferential (annular) micro tears in the annulus fibrosus leads to:
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Disc degeneration
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If a radial tear involves the _____ 1/3 of the annulus fibrosus or the annular ligament, it can produce pain.
(Fill in the blank: INNER or OUTER) |
OUTER
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The nucleus itself and the _____ 2/3 of the annulus fibrosus contain no free nerve endings.
(Fill in the blank: INNER or OUTER) |
INNER
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Pain in the case of a radial disc tear is presumed to be due to:
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The leakage of the nucleus pulposus into the pain sensitive area of the disc (which is the outer 1/3 of the disc)
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This disc "dysfunction"--which can occur if the annulus is weakened enough--is much like the bubble that can form on a weakened tire.
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Focal disc bulging
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Nerve root distribution pain without identifiable neurological deficits; can be caused by a disc bulge rubbing against a nerve root
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Radiculitis
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Nerve root distribution pain with neurological deficits
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Radiculopathy
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Caused by the deterioration of the disc architecture, leading to further weakening of the annulus
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Circumferential disc bulging
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By age 40, the nucleus pulposus is no longer gelatinous but has taken on a more _____ consistency.
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FIBROUS
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Volume loss is produced by desiccation and the loss of muccopolysaccharides.
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Disc narrowing
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The __________ enlarge with age alone, but this process is accelerated and worsened by degenerative disc disease
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VERTEBRAL BODIES
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What is the challenge in spinal osteoarthritis?
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To identify the pain generator. It is common for a single patient to have both facet joint and disc disease together.
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What are the stages of Spinal Degeneration?
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I: Stage of dysfunction
II: Stage of instability III: Stage of restabilization & stenosis |
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For Stage I of spinal degeneration, what are the basic principles of treatment?
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OMT and Exercise
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For Stage II of spinal degeneration, what are the basic principles of treatment?
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OMT; Exercise; Bracing; Pain Mgmt Strategies; Rhizotomy; Fusion Surgery; Disc Replacement Surgery
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For Stage III of spinal degeneration, what are the basic principles of treatment?
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OMT; Exercise; Pain Mgmt Strategies; Surgical Decompression
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Form of OMT in which the patient's muscles are actively used on request, from a precisely controlled position, and against a distinctly executed counterforce
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Muscle Energy Technique
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What are the goals of muscle energy techniques?
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Decrease muscle hypertonicity; Lengthen muscle fibers; Reduce the restraint of movement; Produce joint mobilization; Improve respiratory and circulatory function; Strengthen the weaker side in the event of muscle asymmetry
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Contraction in which the muscle contracts against resistance, but the distance between origin and insertion remains static
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Isometric
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The most common form of muscle contraction used in muscle energy technique.
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Isometric
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Type of contraction in which the patient contracts the muscle against resistance, however, the physician applied force overcomes the muscle force.
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Isolytic contraction
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This type of contraction is used to lengthen muscles shortened by contracture
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Isolytic contraction
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Type of contraction in which the muscle contractile force remains constant while the proximal and distal attachments of the muscle approximate.
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Concentric isotonic contraction
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This type of contraction is used to increase muscle strength in muscles reflexly weakened by somatic dysfunction.
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Concentric isotonic contraction
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Type of contraction in which the muscle contractile force remains constant while the proximal and distal attachments of the muscle are permitted to separate.
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Eccentric isotonic contraction.
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This type of contraction is used to strengthen weak muscle.
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Eccentric isotonic
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What are the physiologic principles of muscle energy technique?
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Post-isometric relaxation; joint mobilization using muscular force; respiratory assistance; oculocephalogyric reflex; reciprocal inhibition; crossed extensor reflex
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What is the goal of post-isometric relaxation?
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To accomplish muscle relaxation
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What state is the neuromuscular appparatus in immediately after a sustained muscle contraction?
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A refractory state
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When the neuromuscular apparatus is in a refractory state, what can be done to the muscle?
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The muscle may be passively stretched without encountering reflex opposition.
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After a sustained contraction, the _______________ system depletes ALL the available neurotransmitters needed to function normally.
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PROPRIOCEPTIVE
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When can the muscle be lengthened slightly without reactivating the proprioceptive system?
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During the refractory period.
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What is the goal of joint mobilization using muscle force?
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To accomplish restoration of joint motion in an articular dysfunction.
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The patient offers a muscle contraction against a physician counterforce which accomplishes this:______________
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JOINT MOBILIZATION USING MUSCLE FORCE
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What is the force used for joint mobilization?
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Maximum muscle contraction that can be comfortably resisted by the physician (30-50 lbs of pressure)
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What is the goal of respiratory assistance?
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To improve body physiology usint the patient's forced respiratory motion.
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The muscular forces produced in this technique are generated by the simple act of breathing.
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Respiratory assistance
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What is the goal of oculocephalogyric reflex?
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To effect reflex muscle contraction using eye movement.
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Functional muscle groups are contracted in response to voluntary eye motion on the part of the patient. Generally used in the neck and upper trunk
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Oculocephalogyric Reflex
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What is the goal of reciprocal inhibition?
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To lengthen a muscle shortened by acute cramp or spasm
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When a gentle contraction is initiated in an agonist muscle, there is a reflex relaxation of that muscle's antagonistic group.
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Reciprocal inhibition
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What is the goal of crossed extensor reflex?
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To treat muscle dysfunction in the extremities where the muscle requiring treatment is in an area so severely injured that it is directly unmanipulable or inaccessible.
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This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the CNS. When a flexor muscle in one extremity is contracted voluntarily, the same muscle in the contralateral extremity relaxes and the extensor contracts.
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Crossed extensor reflex
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What point of the barrier should be reached for muscle energy treatment?
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Only the "feather edge" of the restrictive barrier should be engaged for maximal efficacy of the technique
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What is a contraindication of post-isometric type techniques?
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Post-isometric type techniques should NOT be applied to muscles that are acutely injured or exceptionally painful. These would be better treated with a reciprocal inhibition technique.
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What is a contraindication of muscle energy techniques?
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Should NOT be performed on a patient who is so debilitated that the patient's health could be further compromised by the effort. (e.g., post-op patient or patient in ICU recovering from myocardial infarction)
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What are the 3 steps of the osteopathic structural exam?
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1. Screen
2. Scan 3. Segmental Definition |
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When is it most appropriate to use INDIRECT techniques?
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In an acute injury;
If there is significant inflammation or edema present |
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When is it most appropriate to use DIRECT techniques?
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In a chronic condition;
If the cardinal signs of inflammation are ABSENT |
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What are the cardinal signs of inflammation?
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1. Rubor
2. Calor 3. Tumor 4. Dolor |
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What is the goal of respiratory assistance?
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To improve body physiology usint the patient's forced respiratory motion.
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The muscular forces produced in this technique are generated by the simple act of breathing.
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Respiratory assistance
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What is the goal of oculocephalogyric reflex?
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To effect reflex muscle contraction using eye movement.
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Functional muscle groups are contracted in response to voluntary eye motion on the part of the patient. Generally used in the neck and upper trunk
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Oculocephalogyric Reflex
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What is the goal of reciprocal inhibition?
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To lengthen a muscle shortened by acute cramp or spasm
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When a gentle contraction is initiated in an agonist muscle, there is a reflex relaxation of that muscle's antagonistic group.
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Reciprocal inhibition
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What is the goal of crossed extensor reflex?
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To treat muscle dysfunction in the extremities where the muscle requiring treatment is in an area so severely injured that it is directly unmanipulable or inaccessible.
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This form of muscle energy technique uses the learned cross pattern locomotion reflexes engrammed into the CNS. When a flexor muscle in one extremity is contracted voluntarily, the same muscle in the contralateral extremity relaxes and the extensor contracts.
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Crossed extensor reflex
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What point of the barrier should be reached for muscle energy treatment?
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Only the "feather edge" of the restrictive barrier should be engaged for maximal efficacy of the technique
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What is a contraindication of post-isometric type techniques?
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Post-isometric type techniques should NOT be applied to muscles that are acutely injured or exceptionally painful. These would be better treated with a reciprocal inhibition technique.
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What is a contraindication of muscle energy techniques?
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Should NOT be performed on a patient who is so debilitated that the patient's health could be further compromised by the effort. (e.g., post-op patient or patient in ICU recovering from myocardial infarction)
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What are the 3 steps of the osteopathic structural exam?
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1. Screen
2. Scan 3. Segmental Definition |
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When is it most appropriate to use INDIRECT techniques?
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In an acute injury;
If there is significant inflammation or edema present |
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When is it most appropriate to use DIRECT techniques?
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In a chronic condition;
If the cardinal signs of inflammation are ABSENT |
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What are the cardinal signs of inflammation?
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1. Rubor (redness)
2. Calor (Heat) 3. Tumor (Swelling) 4. Dolor (Pain, NOT tenderness) |
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If muscle tone is most responsible for the somatic dysfunction, what techniques are appropriate?
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Soft tissue;
Myofascial release; Counterstrain; Muscle Energy |
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If fascial contraction/contracture is most responsible for the somatic dysfunction, what techniques are appropriate?
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Myofascialrelease;
Ligamentous Articular Strain/Balanced Ligamentous Tension |
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If facet joint restriction & disc disease are most responsible for the somatic dysfunction, what techniques are appropriate?
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Articulatory;
HVLA Thrust; Muscle Energy |
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If edema is most responsible for the somatic dysfunction, what techniques are appropriate?
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Lymphatic techniques
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If tenderness is most responsible for the somatic dysfunction, what techniques are appropriate?
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Counterstrain;
Indirect myofascial release; LAS/BLT |
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What does the Wallenberg Test test for?
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Vertebrobasilar Artery Compromise
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Name the test: Pt supine, flex neck and hold 10 sec, then extend neck and hold 10 sec, then rotate right, rotate left. Positive if pt complains of dizziness, visual changes, lightheadedness, or nystagmus
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WALLENBERG'S TEST
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What are some red flags for possible tumor?
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Under 20 and over 50; Unexplained weight loss; pain worse when supine; severe nocturnal pain
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Any sense of acute anxiety or panic on the part of the patient during any part of the examination or treatment can be an indicator of:________
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Cerebral Ischemia
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The thyroid is level with what vertebrae?
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C4-C5
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Whiplash avulsion most common at what 2 spinal levels?
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C2 and T1
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What are 2 congenital anomalies that can cause a significant loss in cervical range of motion?
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Klippel-Feil Syndrome;
Block Vertebrae |
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1/2 of cervivcal motion occurs where?
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At the atlanto-axial joints
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If a distraction test decreases pain, what could be the cause?
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Neuroforaminal Compromise;
Facet Joint |
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If a distraction test increases pain, what could be the cause?
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Myoligamentous
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Compression test increases pain in the presence of: _______
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Disc herniation; Neuroforaminal Compromise; Facet Joint Disease
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Spurling test (cervical extension and rotation) reproduces pain of: ______ and _______
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Neuroforaminal compromise
and pain of facet joint origin |