Podcast
Questions and Answers
What is the primary objective of stress testing during an injury evaluation?
What is the primary objective of stress testing during an injury evaluation?
In active range of motion (AROM) testing, what should be prioritized?
In active range of motion (AROM) testing, what should be prioritized?
Which muscle is most commonly associated with hip flexor strains?
Which muscle is most commonly associated with hip flexor strains?
What is a common mechanism of injury (MOI) for an adductor strain?
What is a common mechanism of injury (MOI) for an adductor strain?
Signup and view all the answers
What does the resisted range of motion (RROM) testing evaluate?
What does the resisted range of motion (RROM) testing evaluate?
Signup and view all the answers
Piriformis syndrome results from pressure on the sciatic nerve caused by which factors?
Piriformis syndrome results from pressure on the sciatic nerve caused by which factors?
Signup and view all the answers
What is a key characteristic of the Rectus Femoris muscle in relation to injury?
What is a key characteristic of the Rectus Femoris muscle in relation to injury?
Signup and view all the answers
Which of the following is least likely to be a contributing factor in the onset of piriformis syndrome?
Which of the following is least likely to be a contributing factor in the onset of piriformis syndrome?
Signup and view all the answers
What is one of the common signs for diagnosing problems related to the tibial tubercle?
What is one of the common signs for diagnosing problems related to the tibial tubercle?
Signup and view all the answers
What are the main factors contributing to Bursitis around the knee?
What are the main factors contributing to Bursitis around the knee?
Signup and view all the answers
Which of the following is NOT a typical symptom of Ilio Tibial Band Friction Syndrome?
Which of the following is NOT a typical symptom of Ilio Tibial Band Friction Syndrome?
Signup and view all the answers
What is an effective treatment approach for Bursitis around the knee?
What is an effective treatment approach for Bursitis around the knee?
Signup and view all the answers
In which age range is it most common to observe symptoms related to the tibial tubercle?
In which age range is it most common to observe symptoms related to the tibial tubercle?
Signup and view all the answers
Which symptom is NOT associated with Bursitis around the knee?
Which symptom is NOT associated with Bursitis around the knee?
Signup and view all the answers
What type of activities might precipitate Ilio Tibial Band Friction Syndrome?
What type of activities might precipitate Ilio Tibial Band Friction Syndrome?
Signup and view all the answers
Which characteristic is common in the demographic of individuals affected by tibial tubercle conditions?
Which characteristic is common in the demographic of individuals affected by tibial tubercle conditions?
Signup and view all the answers
What is the primary goal of clinical assessment in rehabilitation?
What is the primary goal of clinical assessment in rehabilitation?
Signup and view all the answers
Which of the following is NOT a component of clinical assessment?
Which of the following is NOT a component of clinical assessment?
Signup and view all the answers
In the context of field assessment, what does 'H' in HOPS stand for?
In the context of field assessment, what does 'H' in HOPS stand for?
Signup and view all the answers
During palpation, what is the recommended starting point?
During palpation, what is the recommended starting point?
Signup and view all the answers
Which of the following describes the primary function of special tests in clinical assessment?
Which of the following describes the primary function of special tests in clinical assessment?
Signup and view all the answers
What is the purpose of using the SOAP format in documentation?
What is the purpose of using the SOAP format in documentation?
Signup and view all the answers
What does the 'S' in the HOPS assessment framework represent?
What does the 'S' in the HOPS assessment framework represent?
Signup and view all the answers
Which type of injury does NOT fall under the categories listed for mechanisms of injury?
Which type of injury does NOT fall under the categories listed for mechanisms of injury?
Signup and view all the answers
How should the clinician approach the observation of an injured area during assessment?
How should the clinician approach the observation of an injured area during assessment?
Signup and view all the answers
What is the primary concern during a field assessment?
What is the primary concern during a field assessment?
Signup and view all the answers
What is a common result of poor warm-up practices before engaging in physical activity?
What is a common result of poor warm-up practices before engaging in physical activity?
Signup and view all the answers
Which muscle compartment is primarily affected by 'shin splints'?
Which muscle compartment is primarily affected by 'shin splints'?
Signup and view all the answers
What mechanical factor is NOT typically associated with strains of the lower leg?
What mechanical factor is NOT typically associated with strains of the lower leg?
Signup and view all the answers
Which ligament is involved in a lateral ankle sprain?
Which ligament is involved in a lateral ankle sprain?
Signup and view all the answers
Which of the following activities is most likely to aggravate symptoms associated with a gastrocnemius strain?
Which of the following activities is most likely to aggravate symptoms associated with a gastrocnemius strain?
Signup and view all the answers
What is a precaution that should be taken to avoid an anterior compartment syndrome?
What is a precaution that should be taken to avoid an anterior compartment syndrome?
Signup and view all the answers
When returning to activity after a lower leg injury, what is a critical strategy to prevent re-injury?
When returning to activity after a lower leg injury, what is a critical strategy to prevent re-injury?
Signup and view all the answers
What condition can lead to calcification due to chronic irritation of the calf muscle?
What condition can lead to calcification due to chronic irritation of the calf muscle?
Signup and view all the answers
What is a recommended method for treating swelling in a sprained ankle?
What is a recommended method for treating swelling in a sprained ankle?
Signup and view all the answers
Which of the following is NOT a sign of plantar fasciitis?
Which of the following is NOT a sign of plantar fasciitis?
Signup and view all the answers
What is a common mechanism of injury (MOI) leading to Achilles tendonitis?
What is a common mechanism of injury (MOI) leading to Achilles tendonitis?
Signup and view all the answers
What preventative measure can help reduce the risk of developing Achilles tendonitis?
What preventative measure can help reduce the risk of developing Achilles tendonitis?
Signup and view all the answers
Which treatment method is specifically recommended for managing adhesions in Achilles tendonitis?
Which treatment method is specifically recommended for managing adhesions in Achilles tendonitis?
Signup and view all the answers
What foot type is commonly associated with plantar fasciitis?
What foot type is commonly associated with plantar fasciitis?
Signup and view all the answers
Which of the following is a key component of PIER treatment?
Which of the following is a key component of PIER treatment?
Signup and view all the answers
What is a recommended treatment option for an individual suffering from plantar fasciitis?
What is a recommended treatment option for an individual suffering from plantar fasciitis?
Signup and view all the answers
What is the primary characteristic of femoroacetabular impingement?
What is the primary characteristic of femoroacetabular impingement?
Signup and view all the answers
Which treatment is commonly recommended for a meniscus tear?
Which treatment is commonly recommended for a meniscus tear?
Signup and view all the answers
Which symptom is often associated with patellar tendonitis, commonly known as 'jumper's knee'?
Which symptom is often associated with patellar tendonitis, commonly known as 'jumper's knee'?
Signup and view all the answers
What underlying condition can contribute to osteoarthritis of the hip?
What underlying condition can contribute to osteoarthritis of the hip?
Signup and view all the answers
Which of the following is a symptom of a labral tear in the hip?
Which of the following is a symptom of a labral tear in the hip?
Signup and view all the answers
What is the main consequence of a PCL injury?
What is the main consequence of a PCL injury?
Signup and view all the answers
What distinguishes true chondromalacia patella from regular patellar pain?
What distinguishes true chondromalacia patella from regular patellar pain?
Signup and view all the answers
What is a typical symptom of MCL sprain?
What is a typical symptom of MCL sprain?
Signup and view all the answers
What is often a cause of patella femoral pain syndrome?
What is often a cause of patella femoral pain syndrome?
Signup and view all the answers
What is a common cause of knee joint instability during rehabilitation of a sprain?
What is a common cause of knee joint instability during rehabilitation of a sprain?
Signup and view all the answers
Which condition is characterized by the inflammation of the growth plate at the tibial tuberosity?
Which condition is characterized by the inflammation of the growth plate at the tibial tuberosity?
Signup and view all the answers
Which physical therapy approach is integral after ACL surgery for recovery?
Which physical therapy approach is integral after ACL surgery for recovery?
Signup and view all the answers
What bone structure is primarily affected in a complete ACL tear due to hyperextension?
What bone structure is primarily affected in a complete ACL tear due to hyperextension?
Signup and view all the answers
What biomechanical issue can result from previous trauma to the knee joint?
What biomechanical issue can result from previous trauma to the knee joint?
Signup and view all the answers
Study Notes
Lower Quadrant Conditions
- Readings: Andrews, Harrelson, Wilk. Physical Rehabilitation of the Injured Athlete, 4th Ed, Saunders 2012
Objectives
-
Objective 1: Injury Assessment
- Injury assessment is the act of assessing, appraising, and evaluating.
- It also involves classifying people or things.
-
Objective 2: Injuries of the Lower Quadrant
- This objective focuses on examining conditions of the hip.
Mechanisms of Injury
- Strain
- Rupture
- Fracture
- Avulsion Fracture
- Ligament Sprains
- Overuse
- Underuse
Clinical Assessment
-
Clinical Assessment (Starts at clinic)
- Environment: Controlled
- Emergency cleared
- Decisions to make: Further medical attention, tests, orthopaedic consult, orthotics, or bracing.
-
Clinical Assessment (Needs of rehabilitation)
- Determine athlete's goals
- Determine therapists goals
- Return athlete to daily living activities and competition.
-
Clinical Assessment (Components):
- History
- Observations (includes reflexes, sensation, etc.)
- Rule outs
- Functional assessment
- Special tests
- Palpation
- Documentation Format: SOAP
Field Assessment
-
Field Assessment:
- Observe mechanism of injury.
- Environment: Uncontrolled
- May need to assess within rules of the game
- Primary Survey (ABC)
- Secondary Survey
- Components: History (H), Observations (O), Palpations (P), Stress/Special tests (S)
HOPS Assessment
-
History:
- Primary complaint
- Mechanism of injury (if not seen)
- Areas & nature of the pain
- Functional ability ("I can't feel my fingers")
- Symptoms associated with injury
- Previous history of injury
- Ask relevant, NON-LEADING questions (open-ended), listen attentively
- Allow athlete to describe injury
-
Observations:
- Survey entire injured area
- Look for obvious signs of injury
- Note general body alignment
- Observe functional abilities
- Inspect injured area
- Be alert for signs of trauma
- Watch athlete's face and/or eyes
- Compare bilaterally
-
Palpation:
- Avoid unnecessary pain.
- Ensure injured area is relaxed
- Demonstrate care.
- Encourage cooperation.
- Start away from the site of injury, moving toward the injured area.
-
Palpation Key Information:
- Areas/pain/tenderness
- Deformity
- Distal circulation, skin temperature, muscle spasm
- Swelling
- Crepitus
- Sensory function
-
HOPS Assessment Palpation (Additional Info):
- What do you feel? (crepitus, bogginess, etc.)
-
HOPS Assessment Stress Testing:
- Determine nature of injury
- AROM
- PROM
- RROM
- Specials
Stress Testing
-
Begin testing carefully, slowly and gently.
- First assess the uninjured structures bilaterally.
- Increase testing intensity as tolerated.
- Explain procedure to the athlete, promote trust and cooperation.
-
Always Begin with Functional Testing.
- Active, passive and resisted ROM.
- Active Testing: Take note of quality and quantity of movement in the pain-free range; address most painful ranges.
- Passive Testing: Therapist moves the joint through its full, pain-free range of motion.
-
Resisted Testing: Strong, static isometric voluntary muscle contraction with joint in neutral position, athlete meets resistance.
- Evaluate on a 0-5 grading scale; consider possible attributing factors (Upper motor neuron lesion, Injury to peripheral nerve, Pathology at NMJ, Injury to muscle itself).
Hips
-
Common Hip Injuries
- Hip Flexor Strains
- Adductor Strains
- Piriformis Syndrome
- Osteoarthritis of the Hip
- Labral Tears
- Femoroacetabular Impingement
Knee
-
Knee Movements: flexion (range 0–135°), extension (0–15°), medial rotation (20–30°), lateral rotation (30–40°).
-
MCL Sprain
- Symptoms: based on severity, pain, instability, swelling, discoloration, disability.
- Treatment: acute stages-immobilization (Zimmer splint, crutches, PIER), healing stages-CKC exercises (as soon as weight-bearing, NMES with CKC squats @ 30°), strengthen adductors to help re-enforce joint stability.
- Grades vary from small tear showing stability (Grade 1) to complete tear and instability (Grade 3).
-
LCL Sprain
- Symptoms: sharp lateral pain, subtle instability, non impressive swelling
- Treatment: acute immobilization; healing stages-CKC exercises, NMES with CKC squats @ 30°, strengthen adductors to help re-enforce joint stability.
-
ACL Sprain
- Symptoms: pop/snap, pain, effusion/hemarthrosis (often immediate), patient c/o instability, tender anterior tibial plateau, limited ROM.
- Treatment: PIER, immobilize knee, crutches, referral to orthopaedic surgeon for further management, hamstring strengthening is key. Post-op treatment; bracing for RTS recommended for first year post-op
-
PCL Sprain
- Symptoms vary.
- Treatment: assess posterior instability, acute treatment as per ACL, re-establish quad strength/function (60% body weight goal), proprioception exercise.
-
Meniscus Tears
- Symptoms: knee swelling (synovial irritation), occasional “giving way”, pain on same side as injury (joint line), Recurrent swelling with use, positive McMurray’s test, recurrent “clicking”, quads wasting, unable to perform bilateral deep squat, locking.
- Treatment (immediate): Do NOT force a locked knee into extension, PIER, NWB, refer to consult; Treatment (surgical): Arthroscopy, day surgery (patient walks out of hospital), 10-14 days post-op possible to RTP, treat for swelling and strengthen around joint.
-
Patellofemoral Pain Syndrome (PFPS):
- Causes: Patellar malalignment, congenital abnormalities, wide hips/Q-angle, knee malalignment (bowlegged), muscle imbalances (tight lateral structures, weak medially)
- Treatment: depends on the cause, strengthen weakness, stretch tightness, hip strengthening, foot alignment.
-
True Chondromalacia Patella:
- Treatment: Find the cause, treat the cause, increase patellar mobility, restore quads synchronicity, restore knee mechanics, strengthen quads, stretch lateral compartment, correct foot biomechanics, and educate.
-
Patellar Tendonitis (“Jumper's Knee”):
- Causes: repetitive or eccentric knee extension activities (running, jumping) location: between inferior pole of patella and tibial tubercle
- Stages of Pain: 1) After activity, 2) During and after activity, 3) During and after activity (performance affected)
- Treatment: PIER immediately after activity, rehab (massage, stretch), tape, brace.
-
Osgood-Schlatter Disease:
- Cause: Apophysitis of tibial tubercle, traumatic fracture. excessive pull of patellar tendon on tibial tuberosity before bony closure.
- Symptoms: Pain on direct pressure (kneeling), pain on active use (climbing stairs, running, jumping), pain extreme at end range of extension; Enlarged tibial tubercle, age 10-15 males, 8-13 females, bilateral (25-30% of the time)
- Treatment: Time, stretching, gradual strengthening, straps.
-
Bursitis Around the Knee:
- Types: Suprapatellar, prepatellar, superficial infrapatellar, deep infrapatellar, and pes anserine.
- General Mechanisms: Direct Blow (repeated or single), friction, poor biomechanics.
- Treatment: PIER, rest (use may irritate condition), Protective padding (donut), Stretch structures over top of bursa, Open space around bursa.
-
Ilio Tibial Band Friction Syndrome:
- Etiology: Lean individuals, varus knee(malalignment), precipitated by contusion, continuous running, training errors, banked surfaces, running downhill, increased training.
- Signs/Symptoms: ↑ pain as activity time ↑, tender epicondyle (2-3 cm above lateral joint line), Crepitus with flex/extn; Stair climbing aggravates; Resisted knee flexion=no pain.
- Treatment: PIER, address mechanics, good warm up/stretches, gradual RTP, stop if pain returns
-
Strains of the Lower Leg:
-
Tibialis Anterior: improper footwear, down hill running, poor warm-up, poor arch support, anterior compartment syndrome
-
Peroneal Strain: Usually secondary; inversion ankle sprain, need to be strengthened in inversion sprain rehab
-
Gastrocnemius Strain: caution necessary; rupture, chronic irritation, poor warm-up stretching, running uphill/poor footwear. Slow return.
-
"Shin Splints":
- Symptoms: Anterior compartment. tibialis anterior tendinosis, Posterior Compartment, tibialis posterior tendinosis; running on hard surfaces, too much too soon, poor arch support, muscle imbalance, poor mechanics of running.
- Pathology (underlying cause): inflammation of muscle belly, tearing of muscle from bone, tear in interosseous membrane.
- Treatment: Rest, change activity, footwear change, stretch, gradually strengthen
-
-
Lateral Ankle Sprain:
- MOI: rolling of the ankle; inversion. Often coupled plantar flexion, landing from a jump, cutting, uneven ground.
- Symptoms: Instability (grade dependant), pain with inversion and plantar flexion, swelling, discoloration, positive anterior drawer test
- Treatment: Keep ankle joint in neutral position to shorten ligaments, PIER, open gibney, crutches (high grade), X-ray, strengthen peroneal group.
-
Achilles Tendonitis:
- MOI: ↓flexibility, foot type (pes planus vs pes cavus), new footwear, changes in training schedules, ↑ mileage, hill training.
- Treatment: find the cause, rest, friction/ultrasound for adhesions, heel lift for shoe, taping, gradual stretching and strengthening, eccentrics.
-
Plantar Fasciitis:
- Symptoms: Point tender medial side of calcaneous, localized pain, stiff in the AM, swelling, unable to walk on toes, pain ↑ with passive toe extension.
- Treatment: PIER (rest, ice), X-ray, ultrasound, stretch Achilles, proper footwear, tape, orthotics, heel cup, balance pelvis, roll/massage tendon.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.