Grade 3 Joint Mobilization for Talocrural Joint

What is the primary purpose of stretching exercises according to the text?

What is the first step in properly performing a stretching exercise according to the text?

What should the candidate do if the patient is unable to perform the exercise properly?

What is the purpose of the 'Confirm Target' step mentioned in the text?

What should the candidate do if the patient does not feel the exercise or finds it too simple?

What is the purpose of the 'Pain Check' step mentioned in the text?

How long should the candidate hold the stretch during the demonstration according to the text?

What is the purpose of the 'Questions' step mentioned in the text?

What is the purpose of applying 'overpressure' during a stretching exercise?

What should the candidate do after demonstrating the stretching exercise to the patient?

What is the primary purpose of the 'Warm-Up' step in the general protocol?

Which of the following is NOT recommended for the candidate to include when explaining the exercise to the patient?

What is the primary purpose of having the patient demonstrate the exercise during the general protocol?

What is the recommended approach for the candidate to identify the targeted muscle or joint to the patient?

Which of the following should the candidate NOT include when explaining the exercise to the patient?

What is the primary purpose of the 'Negative Reactions' step in the general protocol?

What is the primary purpose of the 'Demonstration' step in the general protocol?

Which of the following is NOT a recommended component of the candidate's instructions during the 'Demonstration' step?

What is the primary purpose of the 'Monitor Breathing' step during the patient demonstration?

What is the primary purpose of the 'Make Corrections' step during the patient demonstration?

What is the purpose of the grade 3 joint mobilization technique described in the text?

What sensation should the patient expect to feel during the grade 3 joint mobilization?

What is the first step the practitioner should take before performing the grade 3 joint mobilization?

What does the practitioner do during the "Perform the Technique: Sustained Grade 2 Glide" step?

What does the practitioner do during the "Perform the Technique: Grade 3 Oscillation" step?

What does the practitioner do during the "Perform the Technique: Assessment" step?

Which stage of healing is most appropriate for submaximal isometric exercises?

What should the candidate inform the patient about before performing strengthening exercises?

Which of the following is NOT a benefit of strengthening exercises mentioned in the text?

What should the candidate do before demonstrating the exercise to the patient?

Which of the following is NOT a step the candidate should complete during the patient's demonstration of the exercise?

What should the exercise prescription for a strengthening exercise include?

What is the purpose of an isometric contraction exercise?

Which stage of healing is most appropriate for concentric and eccentric exercises?

What should the candidate do if the patient reports negative reactions during the exercise?

Which of the following is NOT mentioned as a step the candidate should complete when demonstrating the exercise?

What is the primary purpose of isometric exercises?

Which type of contraction occurs when a muscle shortens while contracting?

Which stage of healing is best suited for concentric exercises?

What is an example of an eccentric isotonic exercise?

Which type of Range of Motion (ROM) exercise is best for acute injuries?

What is the general purpose of Range of Motion (ROM) exercises?

Which stage of healing is best suited for dynamic Active-Assisted ROM exercises?

What is a potential risk or side effect of ROM exercises?

Which type of contraction occurs when a muscle lengthens while contracting?

Which stage of healing is best suited for eccentric isotonic exercises?

What is the purpose of the warm-up before beginning exercises?

If the patient experiences negative reactions during the exercise, what should the candidate instruct?

What should the candidate do to ensure the patient can perform the exercise safely?

After demonstrating the exercise, what should the candidate do?

While the patient is demonstrating the exercise, what should the candidate monitor?

What information should be included in an exercise prescription for a Range of Motion (ROM) exercise?

During Active Free ROM (AF ROM) exercises, what should the candidate ensure?

What is the purpose of Passive Relaxed ROM (PR ROM) exercises?

During PR ROM exercises, what should the candidate demonstrate if no specific range or condition is specified?

What is the purpose of having the patient outline the alphabet with their hand or foot during Active Free ROM exercises?

What is the main purpose of performing a stretching exercise for the rectus femoris muscle?

Which of the following is NOT one of the steps the candidate should take while the patient demonstrates the exercise?

When is stretching contraindicated according to the text?

What is the recommended duration for holding a stretching exercise according to the text?

Which of the following is NOT included in the exercise prescription for a stretching exercise according to the text?

What is the purpose of the warm-up before performing the rectus femoris stretch?

What should the candidate do if the patient experiences discomfort that surpasses a normal stretch during the exercise?

How often should the patient perform the rectus femoris stretch?

What is the main reason the candidate should monitor the patient's breathing during the rectus femoris stretch?

What is the primary reason the candidate should confirm the target muscle being stretched is the rectus femoris?

The candidate should use ______ language for the patient to follow.

Best practice includes using both the anatomical term and the ______ term to demonstrate the candidate's knowledge.

Identify to the patient which muscle or joint is to be ______.

The candidate must state why the muscle/joint is being addressed and what the particular ______ does.

It is recommended to show the patient the general area of the muscle or ______.

When talking to the patient about an exercise targeting the glenohumeral joint, the candidate should say something like: 'I am going to give you an exercise so that we can work on improving your ability to raise your arm at the shoulder, or what is also called the ______ joint.'

Before stretching the rectus femoris muscle, it is important to ______ it up.

In subacute stages, submaximal isometric exercises can be ______.

Concentric and eccentric exercises are indicated for the ______ stage of healing.

Strengthening exercises help to enhance the muscle’s performance and reduce stress on the ______ that the muscle crosses.

A potential side effect of strengthening exercises is muscle ______.

A risk associated with strengthening exercises is muscle ______ or re-injury.

Muscles become stronger and more efficient, reducing the risk of injury or a ______ of injury.

The purpose of a warm-up before strengthening exercises is to ______ the muscle.

Strengthening exercises can help reduce the risk of soft tissue ______.

Isometric exercises are indicated for ______ injuries.

During Active Free ROM (AF ROM) exercises, the candidate should ensure the movement is always controlled and _____.

The exercise prescription for a Range of Motion (ROM) exercise should include Sets, Repetitions, Frequency, and _____.

The patient should engage the muscles crossing the tested joint to move the joint in multiple directions during the Active Free ROM (AF ROM) _____

Passive Relaxed ROM (PR ROM) exercises involve the patient using their hands or the opposite hand to move the affected joint through the necessary _____.

The ranges performed during Active Free ROM (AF ROM) exercises should always be kept within the patient’s ____ range and performed without compensation.

The patient can perform a more dynamic active ROM exercise instead of individual ranges, for example, outlining the alphabet with the hand or foot for wrist or ankle range of motion, wall slides, wall angles, or the YTWL exercise for the shoulder _____.

An isometric contraction is when a muscle contracts but remains the same ______.

Concentric isotonic contraction is efficient in producing muscle mass and is best suited to the late subacute ______ of healing.

Eccentric isotonic contraction is effective in improving muscle force production and is best suited to the final stages of a ______ program.

Isometric exercises are ideal for the early stages of ______ and rehabilitation.

The lack of movement or handling of heavy objects minimizes the risk of injury or re-injury while helping to maintain the firing action of motor neurons and muscle ______.

An example of an isometric exercise is placing one's palm under a heavy/immovable table and then attempting to bring the palm up towards the ______.

Concentric contraction is most commonly used in dynamic strengthening ______.

Eccentric isotonic exercises have a higher likelihood of causing re-injury if done improperly or when the muscle is not in the appropriate ______ of healing.

Eccentric isotonic exercises are effective in improving muscle force production and are best suited to the final stages of a ______ program.

Isometric contraction does not shorten or ______.

The candidate should state the general purpose of stretching exercises, which is to keep muscles ______, strong and healthy by increasing blood flow, boosting oxygen levels, and delivering nutrients to the muscles. Where possible, the candidate should provide a specific purpose for the stretching exercise being performed. The candidate should inform the patient of the associated benefits, risks, and side effects of stretching exercises. BENEFITS RISKS & SIDE EFFECTS Stretching exercises can: Help increase length, flexibility, and circulation Encourage muscle relaxation Assist in increasing the range of motion of the joint Help to align the fibers of scar tissue. The candidate should complete all steps required for the instructions, including: Warm-up - the candidate should inform the patient that a warm-up is required before beginning exercises. Negative reactions - the candidate should inform the patient to discontinue use if any negative reactions. Modifications - the candidate should teach the patient how to modify the exercise safely. Candidate demo - the candidate should demonstrate by completing the exercise themself. The candidate demonstrates the exercise to the patient. The candidate should provide the patient an opportunity to ask any questions. Procedure To Complete A Stretching Exercise Step 1 Bring the muscle to the first tissue barrier and ensure that this action is pain-free. Step 2 Overpressure is applied until the anatomical limits are met, or the muscle cannot stretch further without pain or significant discomfort. Step 3 Once an appropriate overpressure is achieved, this position should be held for at least 30 seconds. There should be no bouncing, oscillation, or movements of the joint that this target muscle crosses while the stretch is being held. For the exam, the stretch should be held for at least 5-7 seconds while stating it should be held for at least 30 seconds. After the candidate describes and demonstrates the exercise to the patient, the candidate should ask the patient if they have any questions about the demonstration and understand the instructions given. The candidate should now ask the patient to demonstrate the exercise. As the patient demonstrates the exercise, the candidate should complete the following: Make corrections - the candidate should ensure that the patient is completing the exercise properly and make any necessary corrections. Monitor breathing - the candidate should monitor the patient's breathing Confirm target - the candidate should confirm that the muscle that is supposed to be targeted by the exercise is where the patient feels the stretch. Pain check - the candidate should check in with the patient about their pain level. Questions - the candidate should provide the patient another opportunity to ask questions about the exercise. Patient performing a stretch. Stretching is often contraindicated for muscles that are crossing a joint which is in the acute stage of injury. Following the patient demonstration, the candidate should provide an exercise prescription. The exercise prescription for a stretching exercise should include the following information: Duration of hold (eg. 30 seconds; 1 minute) Repetitions (eg. 3 times each side) Frequency (eg. 2 times a day, once in the morning and once in the evening; 4 times per week; etc.) Sample Script Rectus Femoris Static Stretch This is a sample script to review the steps required to complete Station 1: Therapeutic Exercise. Introducing the Exercise “I will be showing you how to do a stretch for your rectus femoris, which is the muscle here (points to the muscle), on the front of your thigh; it’s a part of your quadriceps muscle group.” Purpose and Benefits “A tight rectus femoris can cause pain or restrictions in your range of motion.

Negative reactions - the candidate should inform the patient to discontinue use if any ______

Once an appropriate overpressure is achieved, this position should be held for at least 30 seconds. There should be no bouncing, oscillation, or movements of the joint that this target muscle crosses while the stretch is being held. For the exam, the stretch should be held for at least 5-7 seconds while stating it should be held for at least ______ seconds.

Following the patient demonstration, the candidate should provide an exercise ______.

The exercise prescription for a stretching exercise should include the following information: Duration of ______ (eg. 30 seconds; 1 minute) Repetitions (eg. 3 times each side) Frequency (eg. 2 times a day, once in the morning and once in the evening; 4 times per week; etc.) Sample Script Rectus Femoris Static Stretch This is a sample script to review the steps required to complete Station 1: Therapeutic Exercise. Introducing the Exercise “I will be showing you how to do a stretch for your rectus femoris, which is the muscle here (points to the muscle), on the front of your thigh; it’s a part of your quadriceps muscle group.” Purpose and Benefits “A tight rectus femoris can cause pain or restrictions in your range of motion.

The candidate should provide the patient an opportunity to ask any ______.

The candidate demonstrates the exercise to the ______.

The candidate should inform the patient that a warm-up is required before beginning ______.

The candidate should complete all steps required for the instructions, including: Warm-up - the candidate should inform the patient that a warm-up is required before beginning ______.

The candidate should ask the patient to ______ the exercise.

The bicep ______ and contracts to maintain the controlled and slow lowering of the weight.

ROM exercises are often used as the warm-up for stretching and strengthening exercises, and therefore may be exempt from the need to warm up the ______.

Determining whether to prescribe AF ROM or PR ROM exercises depends on the stage of the condition and healing. Acute Stage of Healing PR ROM is best for acute injuries of the ______.

General Protocol for ROM: The candidate should state the general purpose of Range of Motion exercises, which is to move the joint and soft tissues through the available ranges of motion. This is to prevent the development of adaptive muscle shortening, contractures, and shortening of the capsule, ligaments, and ______.

Range of Motion exercises can: Help maintain current range within a joint. Improve joint health and nutrition. Prevent the loss of movement within a ______.

The candidate should inform the patient that a warm-up is required before beginning exercises. Negative reactions - the candidate should inform the patient to discontinue use if any negative reactions. Modifications - the candidate should teach the patient how to modify the exercise safely. Candidate demo - the candidate should demonstrate by completing the exercise themself. The candidate should provide the patient an opportunity to ask any ______.

After the candidate describes and demonstrates the exercise to the patient, the candidate should ask the patient if they have any questions about the demonstration and understand the instructions given. The candidate should now ask the patient to demonstrate the ______.

As the patient demonstrates the exercise, the candidate should ensure that the patient is completing the exercise properly and make any necessary ______.

During the patient demonstration, the candidate should monitor the patient's ______.

The candidate should ensure that the patient is completing the exercise properly and make any necessary corrections. The candidate should monitor the patient's breathing. The candidate should confirm that the muscle that is supposed to be targeted by the exercise is where the patient feels the ______.

The candidate must explain the benefits of the exercise, the associated risks of the exercise, and any side effects. The candidate should provide detailed instructions on how to perform the particular exercise. The instructions should include the four elements described below: WARM-UP NEGATIVE REACTIONS MODIFICATIONS ________ The candidate should inform the patient that an appropriate large muscle group warm-up around the target joint or muscle is necessary to help prevent injury or re-injury.

The candidate should inform the patient that they should discontinue its use if the exercise causes any negative reactions. It is also beneficial for the candidate to let the patient know they can modify the exercise if it does cause any negative reactions. It is best to provide suggestions for safe ways to modify the exercise. The candidate must describe and demonstrate the appropriate protocol for the exercise. This can be done simultaneously. Layperson's terminology should be used to ensure maximum comprehension by the patient as they may not understand terms like abduction, lateral rotation, or concentric/eccentric/isometric contraction. The candidate demonstrates a stretch. This can include light jumping jacks for 2 to 3 minutes, a brisk 5-10 minute walk, or a range of motion exercise to the joint for 2-3 minutes. The candidate instructs the patient to perform a warm-up of light jumping jacks. The candidate must have the patient demonstrate the exercise to ensure that they understand the directions and can complete the exercise safely and effectively on their own. Note that the procedure for the patient demonstration of a PNF stretch differs from that of a stretch, strength, or ROM exercise. Further details are provided in the relevant section of this course. The patient demonstrates the stretch. During the patient demonstration, the candidate must monitor a variety of criteria. The topics listed below should be addressed by the candidate during the patient demonstration. Make Corrections The candidate must make any corrections, if necessary, to how the patient is performing the exercise. This is important in ensuring patient safety. Monitor Breathing The candidate needs to remind the patient to breathe appropriately and demonstrate/guide them if necessary. Confirm Target The patient must be asked where they are feeling the exercise in order to ensure the correct joint or muscle is being targeted. Pain Check The patient must be asked if they are experiencing any pain or discomfort during the exercise. Questions Before getting the patient to perform the exercise, the patient must be asked if they have any questions and if they have understood the instructions and the exercise demonstration. The candidate should be prepared with a modification if the patient is unable to do the exercise properly. The candidate should also be prepared with a progression if the patient does not feel the exercise or finds it too simple. The candidates description and demonstration will depend on the indicated anatomical structure and exercise. The candidate must provide a basic prescription to ensure the patient does not overwork/underwork the tissues while performing each exercise. Download the General Procedure for Station 1 below: General Procedure for Station 1.pdf 185.3 KB Lesson 5 - Stretching Exercise Protocol Additional content has been loaded Top of page SKIP TO LESSON Lesson 4 - General Protocol Lesson 5 of 22 Stretching Exercise Protocol To appropriately and safely apply a stretch to a muscle, it is important to understand muscle actions, origins, and insertions. To stretch a muscle, it should be manipulated passively such that it is performing the direct opposite of its action. The muscle's insertion should be moved away from the origin for the muscle to lengthen. The candidate should inform the patient and examiners what exercise is being performed and what muscle it targets.

It is recommended to use both anatomical terms and layperson's terms when instructing the patient about the exercise.

The patient should not be asked to outline the alphabet during Active Free ROM exercises.

The candidate should monitor the patient's breathing during the 'Perform the Technique: Sustained Grade 2 Glide' step.

The exercise prescription for a Range of Motion (ROM) exercise should include Sets, Repetitions, Frequency, and Intensity.

Isometric exercises are only indicated for chronic injuries.

During the patient demonstration of an exercise, the candidate must make corrections if necessary to ensure patient safety.

Stretching exercises can help to increase muscle length and flexibility.

Bouncing or oscillation movements are recommended while holding a stretch.

Stretching exercises are not recommended for muscles in the acute stage of injury.

A warm-up is not required before starting stretching exercises.

The exercise prescription for a stretching exercise should include information about the number of repetitions.

The candidate should not correct the patient if they are not completing the exercise properly during the demonstration.

The purpose of applying overpressure during a stretch is to reach the anatomical limits of the muscle.

Stretching exercises can align the fibers of scar tissue.

It is recommended to hold a stretch for at least 5-7 seconds according to the text.

During the patient demonstration, the candidate should confirm that the muscle being stretched is where the patient feels the stretch.

The candidate should inform the patient that a warm-up is not necessary before beginning exercises.

The candidate should not inform the patient to discontinue exercise if any negative reactions occur.

It is not beneficial for the candidate to let the patient know they can modify the exercise if it causes any negative reactions.

The candidate should provide suggestions for unsafe ways to modify the exercise if negative reactions occur.

The candidate must demonstrate the appropriate protocol for the exercise separately from describing it.

The patient must demonstrate the stretch to ensure they understand the directions and can complete the exercise effectively on their own.

The candidate does not need to monitor a variety of criteria during the patient demonstration.

The candidate should not make any corrections if necessary during the patient's exercise demonstration.

The candidate does not need to remind the patient to breathe appropriately during the exercise demonstration.

Before starting the exercise, the patient should not be asked if they have any questions about understanding the instructions and exercise demonstration.

Eccentric and concentric exercises are indicated for the acute stage of healing.

Isometric exercises are gentle and can be performed with high intensity.

The candidate should hold the stretch for at least 1 minute during the demonstration according to the text.

Submaximal isometric exercises are prescribed in the chronic stage of healing.

During grade 3 joint mobilization, the patient should expect to feel a sensation of warmth.

Passive Relaxed ROM (PR ROM) exercises involve active participation from the patient.

Strengthening exercises can help reduce the risk of soft tissue injuries.

Isometric contraction shortens the muscle while contracting.

The purpose of Passive Relaxed ROM (PR ROM) exercises is to increase muscle strength.

Before demonstrating the exercise, the candidate should inform the patient about potential side effects.

During Active Free ROM (AF ROM) exercises, the candidate should ensure that the patient is compensated for any movements outside the pain-free range.

Isometric contraction exercises are recommended during subacute stages of healing.

During concentric exercises, muscles lengthen while contracting.

The primary purpose of 'Monitor Breathing' step during the patient demonstration is to ensure the patient is breathing correctly and not holding their breath.

An example of an isometric exercise is trying to move an immovable object like a heavy table.

Stretching exercises are always contraindicated for muscles that are in the acute stage of injury.

Eccentric exercises involve the muscle lengthening while contracting.

Active Free ROM (AF ROM) exercises are recommended for acute injuries of the joint.

Isometric exercises are ideal for the final stages of a rehabilitation program.

Negative reactions during an exercise should be ignored by the patient to continue the exercise safely.

The warm-up before ROM exercises is essential to prevent injury or re-injury.

During patient demonstration, the candidate must monitor the patient's breathing.

'Negative reactions' is one of the steps required for instructions before starting exercises.

The lack of movement or handling heavy objects increases the risk of injury or re-injury during exercises.

Isometric contraction is commonly used in dynamic strengthening programs.

'Pain Check' step is not necessary during patient demonstrations of exercises.

An isometric contraction is when a muscle contracts and remains the same length.

Concentric isotonic contractions are best suited for the early stages of recovery and rehabilitation.

Eccentric isotonic contractions have a higher likelihood of causing re-injury if done improperly.

Isometric exercisesare ideal for the final stages of a rehabilitation program.

Passive Relaxed ROM (PR ROM) exercises involve active muscle contraction.

The purpose of monitoring breathing during a patient's demonstration is to ensure proper muscle contraction.

Eccentric isotonic exercises are efficient in producing muscle mass.

Isometric contractions are only indicated for acute injuries.

Concentric isotonic contractions are most commonly used in dynamic strengthening exercises.

'Iso' in isometric contraction refers to 'length'.