29 Questions
In acetabular protrusion, where is the femoral head in relation to Kohler's line?
Medial
What is the defining characteristic of protrusio acetabuli?
Shallow socket
What does the alpha angle measure in the context of femoral neck deformity?
Transition of femoral head into neck
What does an alpha angle greater than 60 indicate in a patient?
Presence of cam impingement
Why should a high alpha angle in an asymptomatic patient be considered an incidental finding?
Suggests a potential bony anomaly
What is the recommended duration to hold a sub-maximal contraction when correcting an anterior rotated pelvis?
15 seconds
What is the primary reason for activating transverse abdominis to facilitate multifidus activation?
To help with segmental instability
Which type of muscle activation is preferred for lumbar stabilization according to the text?
Segmental (local) muscle activation
Why is an anterior neutral spine important in lumbar stabilization?
To maintain normal lordotic curve
What is the goal of using an assistive device to correct a posterior rotated pelvis?
Facilitate a simultaneous correction on both sides
Which type of training is lumbar stabilization described as in the text?
Motor control and neural input combination training
What is the primary goal of performing repeated movements during assessment or treatment for stenosis?
To centralize or reduce leg pain
During a prone press up, what instructions are typically given to the patient?
Breathe out and sag your hips while pressing up
Which special test is considered indicative of adverse neural tension when back pain is triggered during leg raise?
Straight leg raise with dorsiflexion
What is the purpose of strapping a patient to an iron board as part of home exercise?
To mimic pressing down to straighten neural tension
In what position might a patient experience pain while performing a special test involving different positions like 'C' and 'D'?
'A' position
Which nerve is involved in knee extension, plantar flexion, and inversion according to the SLR variation described in the text?
Peroneal nerve
What is the goal of therapy intervention when dealing with radicular pain?
Centralization of pain
Which technique can help reduce adverse neural tension according to the text?
Flossing
What is neural tension defined as in the context of the text?
Inability of the nerve to slide and glide through the tissue
Why should one be cautious with nerve pain according to the text?
Nerve pain can have latency
What is the recommended starting position for treating radicular pain according to the text?
Laying position
In the context of acetabular inclination, what is considered normal for the angle in degrees?
33-38 degrees
What are some contributing factors to hypomobility in the lumbar spine and pelvis?
Facet issues and neural tension
Why is hypermobility considered a contraindication for manipulation in the lumbar region?
Hypermobility may result in neural tension
What should be done with hypermobility in the lumbar area before proceeding with mobilization?
Conduct a lumbar roll screen
Which technique involves imparting a force on the low lumbar region or SI?
Manipulation
What intervention should be used for a patient experiencing directional preference for extension?
Gradual increase in mobility through flexion exercises
Which factor is NOT considered a contributing factor to hypomobility in the lumbar spine and pelvis?
Overstretching
Study Notes
Hip and Pelvis Abnormalities
- DDH (developmental dysplasia of the hip): characterized by acetabular inclination >25 degrees
- Acetabular protrusion: femoral head is medial to Kohler's line (ilioischial line)
- Protrusio acetabuli: shallow socket with femoral head medial to Kohler's line
- Alpha angle: formed by a line parallel to femoral neck axis and a line from the center of the femoral head to the transition of the femoral head into the femoral neck
- Alpha angle >60 indicates a bony anomaly
Femoral Neck Deformity and Cam Impingement
- Femoral neck deformity: excessive curvature of the femoral neck
- Cam impingement: femoral head/neck profile exceeds the radius of curvature of the acetabulum
Chronicity and Contributing Factors
- Chronicity: duration of symptoms
- Contributing factors:
- Adjacent joint mobility (too mobile or too stiff)
- Occupational hazards
- Posture
- Psychosocial factors (fear of movement, fear of getting better, fear of coming in)
Prognosis and Exercise Prescription
- Prognosis: determined by knowledge of stages of healing
- Exercise prescription:
- Choose exercises the patient will do (e.g., walking, sit-to-stand)
- Make exercises specific to the current presentation (not diagnosis)
- Provide accountability techniques (diary, check-ins)
- Consider aquatic exercise as an alternative
Hypermobility and Hypomobility
- Hypomobility: lack of movement contributing to pain and stiffness
- Contributing factors:
- Facet issues
- Muscle tension
- Neural tension
- Inflammatory issues
- Pain
- Lifespan/age considerations
- Compensatory movements
- Mobilization and manipulation techniques:
- Treat with appropriate grade III and IV moves
- Combine movements
- Screen for hypermobility contraindications
- Get consent and screen for lumbar roll
Lumbar and Pelvic Mobilization
- Pelvis mobilization: mobilize the hemipelvis in sidelying
- Lumbar mobilization: impart a force on the low lumbar region or SI joint
- Be specific with mobilization techniques (e.g., gapping between vertical segments, rotation of thoracic spine)
- Stepping up/down curbs, stairs) - self-correction (e.g., thumb closer to the ground when checking ASIS)
Anterior and Posterior Rotated Pelvis
- Anterior rotated pelvis: pull leg up on the side that is anteriorly rotated
- Posterior rotated pelvis: want to activate hip flexors
- Provide resistance with the hand as you push out toward the wall
- Hold sub-maximal contraction for 10 seconds, repeat 3 times
Local and Global Muscles
- Muscle activation should be segmental (local)
- Global muscles will not assist segmental instability
- Teach in various positions
- Activation of transverse abdomens will then facilitate multifidus
- Emphasis should be 'up & in' not flat back or posterior pelvic tilt
Test your knowledge on techniques for correcting pelvic misalignments including anterior and posterior rotated pelvis and maintaining an anterior neutral spine. Questions cover methods like palpating ASIS, providing resistance, and activating hip flexors.
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