Muscle Hypertrophy and Achilles Tendinopathy Quiz
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Questions and Answers

What is the primary principle for muscle hypertrophy according to the summary?

  • Reduce comfort during workouts.
  • More volume leads to more hypertrophy. (correct)
  • Train with low volume.
  • Focusing solely on aerobic activities.

    • Which approach is recommended for loading to strengthen bones?

  • Begin with slow, higher reps and progress to fast reps. (correct)
  • Load moderately and slowly at all times.
  • Train consistently at the same intensity.
  • Focus exclusively on endurance training.

    • What is indicated about training to failure in the context of muscle loading?

  • Training to failure is crucial for muscle growth.
  • Training volume should always be maximized.
  • Consider keeping 1-3 reps in reserve. (correct)
  • It is essential to push beyond personal limits.

    • How is the likelihood ratio (LR) calculated according to the diagnostic interpretation?

    <p>Probability of a finding in patients with a disease compared to those without. (D)</p> Signup and view all the answers

    What does the phrase 'loading should exceed activity' refer to?

    <p>More of the same training will not result in stronger bones. (B)</p> Signup and view all the answers

    What is the primary goal of load management in the treatment of Achilles tendinopathy?

    <p>To enable continued activities (D)</p> Signup and view all the answers

    What test is commonly associated with diagnosing an Achilles tendon rupture?

    <p>Thompson test (A)</p> Signup and view all the answers

    What treatment approach is taken for managing subclinical tendon pathology in Achilles tendinopathy?

    <p>Progressive loading and controlled motion (C)</p> Signup and view all the answers

    Which of the following is NOT a recommended strategy for treating Achilles tendon issues?

    <p>Inactivity and rest for all patients (C)</p> Signup and view all the answers

    When are forces on the Achilles tendon typically the greatest?

    <p>During rapid running (C)</p> Signup and view all the answers

    What is a recommended heel lift height to reduce load on the Achilles tendon?

    <p>6-9 mm (D)</p> Signup and view all the answers

    Which modification should be avoided to help reduce strain on the Achilles tendon?

    <p>Hill running (A)</p> Signup and view all the answers

    In a biomechanically informed rehabilitation program, which type of exercises should be prioritized first?

    <p>Heavy resistance training (C)</p> Signup and view all the answers

    Which shoe feature is mentioned as a beneficial option for managing Achilles tendon loads?

    <p>Rocker sole (B)</p> Signup and view all the answers

    Which of the following activities should be reduced to aid in recovery from Achilles tendon issues?

    <p>Jumping exercises (C)</p> Signup and view all the answers

    At what age does the risk for tendon issues notably increase?

    <blockquote> <p>40 years old (A)</p> </blockquote> Signup and view all the answers

    Which demographic is more commonly affected by tendon problems?

    <p>Males (D)</p> Signup and view all the answers

    What is the sensitivity of the Royal London Hospital Test?

    <p>0.54 (D)</p> Signup and view all the answers

    What does a positive result in the pinch test indicate?

    <p>Pinch pain decreases with dorsiflexion (B)</p> Signup and view all the answers

    Which nerve involvement is assessed through hip flexion pain?

    <p>Sural nerve (C)</p> Signup and view all the answers

    What are the criteria for a positive likelihood ratio (LR) in the context given?

    <p>+LR ≥ 5.0, -LR ≤ 0.2 (D)</p> Signup and view all the answers

    What is the minimal clinically important difference (MCID) for Achilles tendinopathy according to the given data?

    <p>6.5 points (C)</p> Signup and view all the answers

    Which of the following is NOT a component of the sural nerve provocation test?

    <p>Ankle hyperextension (D)</p> Signup and view all the answers

    What pain level is considered safe during tendon-loading exercises?

    <p>0-3/10 (C)</p> Signup and view all the answers

    What is the acceptable pain level range during tendon rehabilitation?

    <p>3-5/10 (B)</p> Signup and view all the answers

    Which phase involves bilateral to unilateral progression in plyometric exercises?

    <p>Phase III (C)</p> Signup and view all the answers

    What is the recommended action if a patient experiences pain greater than 5/10 during exercises?

    <p>Adjust the exercise intensity downwards (B)</p> Signup and view all the answers

    What is the main observation regarding prior Achilles tendon pain and future injury risk?

    <p>It does not impact the risk of future ruptures (A)</p> Signup and view all the answers

    What does the pain monitoring model indicate for levels of 6-10/10?

    <p>It is categorized as excessive pain (B)</p> Signup and view all the answers

    During which phase should heavy slow resistance exercises be continued?

    <p>Phase IV (C)</p> Signup and view all the answers

    What is the best barometer for assessing recovery during tendon rehabilitation?

    <p>Increase in usual pain upon waking (A)</p> Signup and view all the answers

    What is one of the primary functions of the foot and ankle during movement?

    <p>Base of support (A)</p> Signup and view all the answers

    Which technique involves the subtalar joint locking out during movement?

    <p>Windlass mechanism (A)</p> Signup and view all the answers

    What type of examination is scheduled for Tuesday, 12/3?

    <p>Mobilization techniques (A)</p> Signup and view all the answers

    What specific physical activity has a measured speed of 1.3 m/s?

    <p>Walking (B)</p> Signup and view all the answers

    Which of the following is NOT one of the diseases discussed in the foot and ankle schedule?

    <p>Arthritis (A)</p> Signup and view all the answers

    What is the primary focus during the lab session on 11/21?

    <p>Tendinopathy examination (C)</p> Signup and view all the answers

    Which muscle forces are measured as part of the data on muscular contributions to running?

    <p>Calf and thigh muscles (D)</p> Signup and view all the answers

    What is the purpose of the lab scheduled for Wednesday, 12/04?

    <p>Proprioception skills check (B)</p> Signup and view all the answers

    Which date corresponds to the FOOT AND ANKLE WRITTEN EXAM?

    <p>Tuesday, 12/10 (B)</p> Signup and view all the answers

    What is the significance of the rigid lever arm function of the foot and ankle?

    <p>To assist in propulsion (C)</p> Signup and view all the answers

    Flashcards

    Foot and Ankle Function

    The foot and ankle support the body, adapt to weight, and act as a rigid lever for movement (e.g., toe-off).

    Tendon Injuries

    Conditions affecting tendons, including tendinopathies (inflammation), fasciopathy (inflammation), and tendon ruptures, in the foot and ankle.

    Ankle Sprains

    Injuries to the ligaments supporting the ankle joint.

    Ankle Fractures

    Broken bones in the ankle.

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    Bone Stress Injuries

    Repeated stress leads to micro-fractures in bones (repetitive stress).

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    Foot Injuries

    Problems affecting the bones, joints, muscles, tendons, and ligaments of the foot. Includes repetitive micro-trauma.

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    Subtalar Joint

    Joint in the foot important for stability and movement, particularly in locking during toe-off.

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    Windlass Mechanism

    Mechanism involving foot arches that stiffens the foot during toe-off.

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    Muscle Forces during Running

    Muscles generate forces to propel the body during running.

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    Foot and Ankle Examination

    Assessing the joints, muscles, tendons, and ligaments to diagnose problems and injuries.

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    Muscle Hypertrophy

    Increased size of muscles, achieved through higher volume training.

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    Bone Loading

    Bone strengthening achieved through heavy, fast loading. Start slow, then increase reps and speed.

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    Likelihood Ratio (LR)

    A ratio comparing the probability of a finding in patients with a disease versus patients without it.

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    Training to Failure

    Not crucial for muscle building; aim for 1-3 reps in reserve.

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    Achilles Tendinopathy

    Pain and stiffness around the Achilles tendon, often with increased workload or after rest.

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    Achilles tendinopathy risk

    Higher risk of Achilles tendinopathy after age 40, often in males.

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    Tendon swelling

    A possible symptom of Achilles tendinopathy, may present as a lump.

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    Pinch test sensitivity

    The pinch test for diagnosis has a sensitivity of 0.54.

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    Pinch test specificity

    The pinch test for diagnosis has a specificity of 0.91.

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    Positive pinch test

    Pinch pain decreases with dorsiflexion.

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    Sural nerve involvement

    Pain increase correlates with hip flexion.

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    VISA-A score

    Outcome measure in Achilles tendinopathy, range 6.5-8.

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    Dorsiflexion in test

    Dorsiflexion is part of the pinch test and sural nerve tests

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    Achilles Tendon Load Reduction

    Strategies to lessen stress on the Achilles tendon, aiming to promote healing and prevent further injury.

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    Heel Lift

    Adding a heel elevation (6-9mm) to footwear, effectively reducing tension on the Achilles tendon.

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    Activity Modification

    Adjusting physical activities to minimize stress on the Achilles tendon.

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    Biomechanically Informed Loading Program

    A structured approach to rehab that gradually increases stress on the injured Achilles tendon, considering its biomechanics.

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    Plyo Prep Exercises

    Exercises that prepare the Achilles tendon for high-impact activities by gradually introducing explosive movements.

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    Achilles Tendon Rupture

    A complete tear of the Achilles tendon, often caused by sudden forceful lengthening or underlying tendon pathology.

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    Treatment for Achilles Tendinopathy

    Focuses on load management to enable continued activity, and often includes exercises targeting strength, flexibility, and proprioception.

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    Thompson Test

    A test performed to assess for an Achilles tendon rupture, where squeezing the calf muscle does not cause plantar flexion if the tendon is torn.

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    Highest Achilles Tendon Force

    Occurs during the stance phase of walking or running, specifically when the foot is flat on the ground and the body weight is fully supported.

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    Pain Monitoring Model

    A framework for guiding exercise intensity based on pain levels. Patients should aim for 0-3/10 pain for safe exercise, 4-5/10 for acceptable discomfort, and avoid 6-10/10 pain, which indicates excessive stress.

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    Tendon Loading Exercise Therapy

    A treatment approach for tendinopathy that involves gradually increasing the load on the affected tendon through specific exercises, aiming to promote healing and improve function.

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    Progressive Tendon Loading

    The gradual increase in load applied to a tendon during exercise therapy, starting with low-intensity exercises and progressing to higher-intensity activities as the tendon heals.

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    Phase III Exercise

    A stage of tendon-loading exercise therapy where plyometrics are introduced to improve power and explosiveness.

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    Phase IV Exercise

    The final stage of tendon-loading exercise therapy, focusing on graded return to activity, incorporating Phase I and II exercises as a warm-up.

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    Isometrics

    Exercises involving holding a muscle in a contracted position for a period of time, helping to strengthen the muscle.

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    Pain upon Waking

    A reliable indicator of tendon health, increased pain upon waking suggests tendon inflammation and the need to adjust exercise intensity.

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    Prior Achilles Pain

    Previous Achilles tendon pain does not necessarily increase the risk of future ruptures, focusing on appropriate management and exercise is key.

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    Study Notes

    Foot and Ankle Pathology: 2024

    • Presented by Evie Tate, DPT, CSCS and Rich Willy, DPT, PhD, School of Physical Therapy and Movement Science, University of Montana
    • Course material includes lectures and labs covering foot and ankle pathologies.
    • Topics include: tendinopathies, fasciopathy, tendon rupture, tendon ruptures and ankle sprains, ankle sprain and fracture, bone stress injuries, foot injuries, mobilization, taping, bracing, and case studies.
    • Schedule includes dates, times, and activities for each lecture/lab session.
    • A 14-hour lecture session is scheduled.
    • A 10-hour lab session is in the schedule.
    • 2-hour exam is scheduled.
    • A written exam for Foot and Ankle is scheduled on Tuesday, 12/10.

    Foot and Ankle: Important Points

    • The foot and ankle play a vital role in movement, supporting a significant portion of total body weight during walking and running. 
    • The foot and ankle possess three crucial functions: base of support, adaptive mechanism, and rigid lever arm (for toe-off).
    • The subtalar joint unlocks, enabling the windlass mechanism, for toe-off. 
    • Muscle forces are substantial during running, with the soleus muscle significantly more active than other muscles.
    • Plantarflexor muscle forces are high due to various anatomical and biomechanical factors.
    • Internal torque in the foot and ankle almost always exceeds external torque. 
    • Dorsiflexion dominates stance phases of both walking and running.
    • Tissue homeostasis is vital in injury prevention, and stress shielding is as detrimental as tissue overload.
    • Loading stimulates cell response in muscles, bones, tendons, and cartilage. 
    • Simple, capacity-building exercises are more effective than complex, unstable-surface exercises for improving force production and strength.

    Quiz

    • The highest Achilles tendon loads occur during the impact or midstance phase in running.

    Tendinopathy

    •  Loss and disruption of collagen structure, thinning of collagen fibers, and fatty infiltration are key characteristics in tendinopathy.
    • Insertional vs. mid-substance tendinopathy requires different treatment approaches.
    • Insertional tendinopathy often arises due to compression, and there are other sources of compression to be considered.

    Paratenonitis

    • Paratenonitis or inflammation of the connective tissue sheath, the paratenon, that surrounds the tendon is a condition involving the tendon sheath, characterized by pain that improves with hopping.

    Achilles Tendinopathy Risk Factors

    • Reduced plantarflexor strength
    • Loss of tendon stiffness
    • Systemic contributors
    • Psychological factors
    • Previous history of injury
    • Male gender >35 years of age
    • Fluoroquinolone use
    • Family history.

    Clinical Reasoning Framework: Achilles Tendinopathy

    • Subjective factors, including patient history and symptoms.
    • Objective factors including provocative tests and physical measurements.

    Clinical Reasoning Framework (General)

    • Subjective data (patient history, symptoms).
    • Objective data (provocative tests, measurements).
    • Pre-test hypothesis
    • Tests to rule in/out hypothesis
    • Post-test hypothesis.

    Treatment Framework

    • Adaptations in load to address the demands on the damaged tissue.
    • Use of mechanotherapy.
    • Gradually return to activities.

    Most common pathologies

    • Tendinopathy (Achilles, plantar fasciitis).
    • Fractures (unimalleolar, bone stress, tibial), nerve injury (tarsal tunnel).
    • Tendon rupture (Achilles)
    • Ligament sprain (lateral ankle).
    • Muscle strain/tears (medial gastrocnemius)

    Relevant Outcome Measures

    • VISA-A
    • ATRS
    • FAAM
    • LEFS, for outcome assessment in foot and ankle injuries.

    Red Flags

    • Bilateral lower-leg pain with associated neural/paresthesia presentations.
    • DVT
    • Rule out plantar fasciopathy, and sural nerve pain.
    • Unilateral leg pain due to lumbar radiculopathy
    • Calf strain/Tennis leg
    • Heel pad syndrome/calcaneal stress fracture
    • Popliteal artery entrapment syndrome.

    Severs Disease

    • A condition in adolescents (7-15 years) characterized by pain in the heel, often exacerbated by weight-bearing activities.
    • Diagnosis often entails evaluating active plantarflexion and passive dorsiflexion, as well as assessing ROM and potential shortened ankle plantarflexors with loading activities.
    • Heel Squeeze test.

    Sever's Disease: Treatment

    • Heel lift (10-12 mm) to reduce plantarflexor loads.
    • Limit activities that exacerbate pain.
    • Active calf stretching
    • Soft tissue mobilization of the calf muscles.
    • Team approach.

    Differentiation Tests (for various injuries)

    • Special or provocative tests, crucial for distinguishing between conditions with similar symptoms.
    • Always rule out other possible diagnoses before definitive treatment decisions.

    Treatment of Specific Condition

    • Address specific etiology and underlying pathology for each diagnosis.
    • Utilize load modifications, mechanotherapy, and graded exposure to increase tissue tolerance.

    Foot and Ankle Specific Outcome Measures

    • Clinicians should utilize clinical findings to grade the condition.
    • Assessment of level of function, presence of hemorrhaging.
    • Point tenderness (for e.g. ATFL or CFL).
    • Total ankle motion, swelling with figure-8 test.
    • Grade based on pain.

    Treatment Goals (for various injuries)

    • Protective phase (immediate post-injury) involves protecting injured structures from re-injury, pain management, swelling control, assessing range of motion, and neuromuscular control/strength.
    • Subacute/Maturation phase, involve gradual movement to progressively bear weight with supports, then strengthening. Re-establishing ROM, proprioception, and agility, including functional, sport-related skill development.

    Physical Agents

    • Cryotherapy (cold), Diathermy (heat), Electrotherapy (other interventions), Low-level laser therapy, Should NOT use Ultrasound.

    Other important topics

    • Various types of injuries, including: -High ankle sprain -Squeeze Test -Klieger's External Rotation Stress Test -Talar Tilt -Dislocation/subluxation of peroneal tendons -Tarsal Tunnel Syndrome -Interdigital Neuralgia -Metatarsalgia -Hallux Rigidus
      • Hallux Valgus
      • Turf Toe.
    • Specific outcomes questionnaires for different conditions.
    • Risk factors for various pathologies.
    • Rehabilitation protocols, including phases and specific exercises.
    • Importance of load management, appropriate pain levels, progressive loading strategies, and other treatment approaches to rehabilitation.

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    Foot and Ankle Pathology 2024 Student Version PDF

    Description

    Test your understanding of key concepts related to muscle hypertrophy and the treatment of Achilles tendinopathy. This quiz covers principles of loading, diagnostic interpretations, and treatment strategies. Enhance your knowledge about effective rehabilitation and injury management techniques.

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