Prep Clinical Exam PDF

MSK LIST OF ALL CONDITIONS HIP Hip Osteoarthritis (OA), Greater Trochanteric Pain Syndrome, Adductor Tendinopathy, Hip Fractures, Femoroacetabular Impingement (FAI), Labral Pathologies KNEE KNEE OA, PATELLOFEMORAL SYNDROME, PATELLAR AND QUADRICEPS TENDINOPATHY, INFRAPATELLAR BURSITIS, ACL, PCL, MCL,...

MSK LIST OF ALL CONDITIONS HIP Hip Osteoarthritis (OA), Greater Trochanteric Pain Syndrome, Adductor Tendinopathy, Hip Fractures, Femoroacetabular Impingement (FAI), Labral Pathologies KNEE KNEE OA, PATELLOFEMORAL SYNDROME, PATELLAR AND QUADRICEPS TENDINOPATHY, INFRAPATELLAR BURSITIS, ACL, PCL, MCL, LCL, ITB SYNDROME, MENISCAL INJURIES, BAKERS CYST, HOFFAS FAT PAD IMPINGEMENT, OSGOOD SCHLATTER DISEASE FOOT AND ANKLE ACHILLES TENDINOPATHY, PERONEAL TENOSYVITIS, HIGH ANKLE SPRQAIN/SYNDEMOSIS INJURY, LATERAL AND MEDIAL ANKLE SPRAIN, MORTONS NEUROMA, TIBIALIS POSTERIOR TENDINOPATHY, Flexor Hallucis Longus Tendinopathy, Plantar Fasciitis/Heel Pain, Compartment Syndrome SHOULDER Shoulder Osteoarthritis (OA), Frozen Shoulder/Adhesive Capsulitis, Rotator Cuff Tendinopathy, Shoulder Impingement, Bursitis, Instability, Dislocation/Subluxation HAND AND WRIST Ganglions, Boutonniere Deformity, Swan Neck Deformity, Osteoarthritis, Dupuytren’s Contracture, Carpal Tunnel Syndrome, Rheumatoid Arthritis, De Quervain’s Tenosynovitis, Scaphoid Fracture, Nerve Dysfunction/Entrapment, FLEXOR TENDON INJURIES, Trigger Finger, EXTENSOR TENDON INJURIES, MALLET FINGER, THUMB EXTENSOR TENDON RUPTURE, COMMON WRIST FRACTURE, FINGER DISLOCATIONS, WRIST SPRAINS, COMPLEX REGIONAL PAIN SYNDROME Elbow Elbow Osteoarthritis (OA), Lateral Epicondylitis, Medial Epicondylitis, Radial Tunnel Syndrome, Cubital Tunnel Syndrome, Elbow Bursitis, Tendinopathies of the Common Extensor/Flexor Origin (Elbow), Distal Biceps Rupture/Tear, Dislocation and Subluxation of the Elbow, Elbow Fractures, Medial Collateral Ligament (MCL) Injury Elbow, Lateral Collateral Ligament (LCL) Injury Elbow, Posterolateral Rotatory Instability Elbow, Elbow Nerve-Related Injury (Impingement/Entrapment) SPINE Spondylitis cervical and lumbar, Spondylolysis, Spondylolisthesis, Facet Joint Dysfunction, Disc Degeneration and herniation, Stenosis, Non-Specific or Primary Neck/Back Pain, Radiculopathy, Sciatica, Thoracic Outlet Syndrome, T4 Syndrome, Cauda Equina Syndrome, Spine Osteoporosis, Spine Osteoporosis, Discitis HIP 1. Joint Degeneration & Dysfunction Hip OA, Labral Pathologies, Femoroacetabular Impingement (FAI) Strength Assessment: → Manual Muscle Testing (MMT) for hip flexors, extensors, abductors, and adductors (patient in seated, supine, or side-lying positions). → Functional tests like single-leg stance, sit-to-stand, or stair climbing to assess strength and endurance. → Trendelenburg Test to identify gluteus medius weakness. ROM Assessment: → Goniometer (if available) or visual assessment of hip flexion, extension, abduction, adduction, and internal/external rotation. → FABER (Patrick’s) Test for mobility restrictions and potential hip joint pathology. → FADIR Test to assess for FAI (pain with hip flexion, adduction, and internal rotation). Treatment: → Strengthening → Gluteus medius and maximus activation (clamshells, bridges, step-ups, hip thrusts). → ROM & Mobility → Gentle hip flexor and adductor stretching. Joint mobilizations (anterior glide to improve extension). 2. Soft Tissue & Tendon Pathologies Greater Trochanteric Pain Syndrome, Adductor Tendinopathy Strength Assessment: --> adductor squeeze ROM Assessment: → Assess hip abduction/adduction for restrictions. → Ober’s Test to check for iliotibial band (ITB) tightness contributing to lateral hip pain. --> FABER Treatment: → Strengthening → Gradual strengthening of hip abductors (clamshells, side-lying leg lifts, banded hip exercises). → ROM & Mobility → ITB stretching, foam rolling, and adductor stretching. 3.Hip Fractures & Post-Surgical Rehab Hip Fractures (Post-Surgical Considerations) Strength Assessment: → MMT for hip flexors, abductors, and extensors (dependent on weight-bearing status). → Sit-to-stand test to evaluate functional lower limb strength. ROM Assessment: → Visual or goniometric assessment of hip ROM (consider surgical precautions). → Log roll test to assess rotational restrictions. Treatment: → Strengthening → Progressive weight-bearing exercises, glute activation (supine bridges), seated knee extensions. → ROM & Mobility → Gentle passive ROM exercises within surgical guidelines. Knee KNEE CONDITIONS – GROUPED BY FUNCTIONAL IMPAIRMENT 1. Joint Degeneration & Chronic Overuse Conditions Knee Osteoarthritis (OA), Meniscal Injuries, Hoffa’s Fat Pad Impingement, Baker’s Cyst Common Features: → Progressive joint degeneration, stiffness, pain with weight-bearing, swelling, reduced ROM, and possible mechanical symptoms (locking/catching). Assessment: → Strength → Quadriceps, hamstrings, glutes (functional squats, sit-to-stand, step-ups). → ROM → Goniometry for knee flexion/extension, joint play tests (posterior glide for flexion, anterior glide for extension). → Functional Testing → Timed up-and-go (TUG), 30-second chair stand. Treatment: → Strengthening → Quadriceps and hip stability (wall sits, mini squats, step-ups). → ROM & Mobility → Joint mobilizations, stretching for quads/hamstrings 2. Patellofemoral & Soft Tissue Pathologies Patellofemoral Syndrome, Patellar & Quadriceps Tendinopathy, Infrapatellar Bursitis, Osgood-Schlatter Disease, IT Band Syndrome Common Features: → Anterior knee pain, pain during squatting/stairs, patellar tracking issues, tendon overload, inflammation of patellar structures. Assessment: → Strength → Quadriceps endurance, VMO activation (resisted knee extension, single-leg squats). → ROM → Patellar mobility testing, quadriceps/hamstring/ITB tightness. → Functional Testing → Step-down test, squat test. Treatment: → Strengthening → Quadriceps eccentric loading (slow squats), hip abductors/glutes. → Stretching & Mobility → ITB, quadriceps, hamstrings. → Pain & Load Management → Ice, McConnell taping for patella alignment, load reduction (for tendinopathy). 3. Ligament Injuries (Acute & Chronic Instability) ACL, PCL, MCL, LCL Injuries Common Features: → Instability, swelling, reduced weight-bearing tolerance, limited ROM, potential for long-term functional deficits. Assessment: → Strength → Quadriceps and hamstrings activation, assess compensatory strategies in weight-bearing tasks. → ROM → Limitations in knee flexion/extension, check end-feel. → Ligament Stability Tests → ACL → Lachman’s, Anterior Drawer. PCL → Posterior Drawer, Sag Sign. MCL → Valgus Stress Test. LCL → Varus Stress Test. Treatment: → Early Rehab → Quadriceps isometrics, protected weight-bearing, step-ups → Strength & Stability → Closed-chain exercises, proprioceptive drills (balance work). Foot and Ankle 1. Tendinopathies & Soft Tissue Overuse Injuries Achilles Tendinopathy, Tibialis Posterior Tendinopathy, Peroneal Tenosynovitis, Flexor Hallucis Longus (FHL) Tendinopathy, Plantar Fasciitis Common Features: → Gradual onset pain, worse with activity, tenderness along tendon or fascia, stiffness after rest, possible swelling. Assessment: → Strength → Resisted plantarflexion for Achilles, inversion for tibialis posterior, eversion for peroneals, big toe flexion for FHL. → ROM → Assess ankle dorsiflexion & plantarflexion, 1st MTP movement (for FHL). → Functional Testing → Single-leg heel raises, Windlass Test (for plantar fasciitis). Treatment: → Strengthening → Eccentric heel drops for Achilles, tibialis posterior & peroneal activation with resistance bands, toe strengthening for FHL. → ROM & Mobility → Stretching for gastroc-soleus, plantar fascia stretching (rolling foot on a ball). 2. Ligament Injuries & Instability Lateral & Medial Ankle Sprains, High Ankle Sprain Common Features: → Swelling, bruising, difficulty weight-bearing, instability, tenderness over ligaments. Assessment: → Strength → Resisted dorsiflexion & plantarflexion → ROM → Measure dorsiflexion/plantarflexion (goniometer), assess ligament mobility. → Ligament Tests → ATFL (anterior talofibular ligament) → Anterior Drawer Test. CFL (calcaneofibular ligament) → Talar Tilt Test. Deltoid Ligament (medial sprain) → Eversion Stress Test. High Ankle Sprain → Squeeze test syndesmosis , proximal fibula and tibia Treatment: → Acute Phase → RICE (rest, ice, compression, elevation), protected weight-bearing if needed. → Strengthening & Proprioception → single-leg stance, resisted ankle eversion/inversion. 3. Compartment Syndromes & Nerve Entrapment Chronic Exertional Compartment Syndrome (CECS), Morton’s Neuroma Common Features: → Pain, numbness, tingling, weakness with activity, can mimic other musculoskeletal conditions. Assessment: → Strength → Weakness in foot dorsiflexion (anterior compartment), toe flexors (posterior compartment). → ROM → May be normal but restricted during activity. → Special Tests → CECS → Assess pain with exertion, muscle tightness, check for elevated post-exercise compartment pressures (clinical setting). Morton’s Neuroma → Mulder’s Click Test (compress metatarsal heads together to reproduce pain). Treatment: → CECS → Load modification, soft tissue techniques, mobility drills, surgery (if severe). → Morton’s Neuroma → Footwear modification (wide-toe box), metatarsal pad placement, nerve gliding techniques. Shoulder 1. Rotator Cuff & Tendon Pathologies Rotator Cuff Tendinopathy, Shoulder Impingement, Bursitis Strength Assessment: o Test rotator cuff strength through resisted external rotation, resisted abduction. o Assess for weakness in scapular stabilizers (e.g., serratus anterior and lower trapezius). o Test shoulder abduction strength and flexion. ROM Assessment: o Measure shoulder flexion, abduction, and internal/external rotation using the goniometer. o Assess for painful arc during abduction (between 60°–120° indicates impingement). o Perform Hawkins-Kennedy and Neer’s impingement tests for rotator cuff tendinopathy. Treatment: o Strengthening → Isometric and eccentric rotator cuff exercises (e.g., external rotation, internal rotation, scapular stabilization exercises). o ROM → Stretching the anterior capsule and rotator cuff muscles, gentle joint mobilizations. 1. Tendinopathies & Overuse Injuries Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfer’s Elbow), Tendinopathies of the Common Extensor/Flexor Origin, Distal Biceps Rupture/Tear Common Features: → Pain, tenderness, reduced grip strength, aggravated by repetitive wrist/elbow movements. Assessment: → Strength → Resisted wrist extension (Tennis Elbow – ECRB involvement) & flexion (Golfer’s Elbow – FCR involvement). Hook Test for Distal Biceps Tear → Unable to palpate the biceps tendon at elbow crease.  Grip Strength Test → Reduced due to pain inhibition. → ROM → Assess active/passive elbow flexion/extension, supination/pronation. → Special Tests → Cozen’s & Mill’s Test (Lateral Epicondylitis) → Resisted wrist extension or passive wrist flexion elicits pain. Reverse Cozen’s (Medial Epicondylitis) → Resisted wrist flexion aggravates pain. Biceps Squeeze Test → No forearm supination when squeezing biceps. Treatment: → Eccentric loading exercises (wrist curls for Golfer’s Elbow). → Progressive strengthening (isometrics, resistance bands). 2. Ligament Injuries & Instability Medial Collateral Ligament (MCL) Injury, Lateral Collateral Ligament (LCL) Injury → Pain, valgus or varus instability, difficulty with weight-bearing on arms. Assessment: → Strength → Weakness with resisted elbow flexion/extension due to instability. → ROM → Painful end range in valgus (MCL) or varus (LCL) stress. → Special Tests → Valgus Stress Test (MCL Injury) → Pain/laxity with valgus force at 30° elbow flexion. Varus Stress Test (LCL Injury) → Pain/laxity with varus force at 30° flexion. Treatment: → Bracing/taping to protect ligament during early healing. → Proprioceptive & neuromuscular control drills (weight-bearing stability exercises, perturbation training). → Gradual strengthening (isometrics progressing to resistance exercises for elbow stability). 3. Nerve Entrapment & Neuropathies Radial Tunnel Syndrome, Cubital Tunnel Syndrome, Elbow Nerve-Related Injuries (Impingement/Entrapment) Common Features: → Numbness, tingling, weakness, pain along affected nerve pathway. Assessment: → Strength → Weakness in specific muscle groups (radial nerve – wrist extensors, ulnar nerve – grip strength). → ROM → Possible pain with resisted movement. → Special Tests → Radial Nerve Compression (Radial Tunnel Syndrome) → Pain 4–5 cm distal to lateral epicondyle, exacerbated with resisted middle finger extension. Elbow Flexion Test (Cubital Tunnel Syndrome – Ulnar Nerve) → 60 seconds of elbow flexion reproduces numbness in 4th & 5th digits. Tinel’s Sign → Tapping over radial/ulnar nerve reproduces symptoms. Treatment: → Nerve gliding exercises (ulnar & radial nerve mobilizations).. → Splinting (night splints for cubital tunnel syndrome). 4. Joint Degeneration & Arthritis Elbow Osteoarthritis (OA) Common Features: → Progressive stiffness, pain, crepitus, loss of function. Assessment: → Strength → Weakness due to pain inhibition. → ROM → Limited elbow flexion, extension, pronation, supination. Treatment: → Isometric strengthening to reduce joint stress. 5. Fractures & Dislocations Elbow Fractures (Radial Head, Olecranon, Distal Humerus), Dislocation & Subluxation of the Elbow Common Features: → Acute pain, swelling, deformity, loss of function, history of trauma (FOOSH – fall on outstretched hand). Assessment: → Strength → Unable to actively move in acute phase. → ROM → Painful & restricted, avoid forced movement if fracture suspected. Treatment: → Early immobilization in acute phase. → Gradual ROM & strengthening once cleared (focus on grip & elbow flexion/extension recovery). → Surgical fixation if severe displacement or instability. 6. Bursitis & Soft Tissue Swelling Elbow Bursitis (Olecranon Bursitis) Assessment: → ROM & Strength → Typically preserved, but painful with direct pressure or end-range flexion. → Palpation → Soft/fluctuant swelling at olecranon process. Stretching & Mobilization: Once inflammation decreases, gentle stretching and mobilization of the elbow joint can help prevent stiffness. Strengthening: After pain reduction, focus on strengthening the surrounding muscles, including the triceps and forearm muscles, to help stabilize the elbow and prevent reoccurrence. HAND & WRIST CONDITIONS – GROUPED BY FUNCTIONAL IMPAIRMENT 1. Tendinopathies & Overuse Syndromes De Quervain’s Tenosynovitis, Trigger Finger, Thumb Extensor Tendon Rupture (EPL Rupture) Common Features: → Pain, swelling, difficulty gripping, tenderness along tendons, movement restriction. Assessment: → Strength → Resisted thumb abduction & extension (for De Quervain’s), finger flexion & extension (for trigger finger & thumb extensor rupture). → ROM → Active & passive thumb and wrist movement. → Special Tests → Finkelstein’s Test (De Quervain’s) → Thumb in fist, ulnar deviation → reproduces pain. Trigger Finger Test → Palpate flexor tendon while patient actively flexes/extends fingers. Thumb Extensor Rupture → Inability to extend the thumb at IP joint. Treatment: → Tendon gliding exercises & eccentric strengthening. 2. Ligament Injuries & Joint Instability Wrist Sprains, Finger Dislocations Common Features: → Pain, swelling, instability, loss of function, possible deformity. Assessment: → Strength → Weak grip, pain with resisted wrist movement. → ROM → Measure wrist flexion, extension, and deviation (goniometer if available). Treatment: → Early protection (splinting, taping, RICE for acute phase). → Progressive grip & wrist strengthening (therapeutic, resistance bands). → Proprioceptive & functional drills (weight-bearing tolerance, wrist stability exercises). 3. Fractures & Bone Pathologies Scaphoid Fracture, Common Wrist Fractures (Colles’, Smith’s, Barton’s), Finger Fractures Common Features: → Swelling, bruising, deformity, limited ROM, tenderness at fracture site. Assessment: → Strength → Weakness in grip, pain with resisted wrist/finger movement. → ROM → Check wrist extension, flexion, radial & ulnar deviation, assess finger ROM. → Special Tests → Scaphoid Fracture → Snuffbox tenderness, pain with axial compression of the thumb. Treatment: → Grip & wrist strengthening once stable (theraputty, dumbbell wrist curls). → ROM restoration (passive & active mobilization once cleared). 4. Nerve Entrapment & Neuropathies Carpal Tunnel Syndrome (CTS), Nerve Dysfunction/Entrapment, Complex Regional Pain Syndrome (CRPS) Assessment: → Strength → Weakness in affected nerve distribution (grip strength, thumb abduction for CTS). → ROM → Possible stiffness due to chronic irritation. → Special Tests → Tinel’s Test (CTS) → Reproduce symptoms with wrist flexion/tapping. Treatment: → Nerve gliding exercises & sensory desensitization (for CRPS). 5. Rheumatologic & Degenerative Joint Conditions Osteoarthritis (OA), Rheumatoid Arthritis (RA), Dupuytren’s Contracture Assessment: → Strength → Weak grip, difficulty with fine motor tasks (buttoning, writing). → ROM → Check finger flexion/extension, wrist mobility. → Special Features → Dupuytren’s Contracture → Progressive flexion deformity, thickening of palmar fascia. Treatment: → Joint protection strategies (adaptive grips, pacing activities). → Gentle ROM & strengthening (isometric & eccentric to maintain function). 6. Flexor & Extensor Tendon Injuries Flexor Tendon Injuries, Extensor Tendon Injuries, Mallet Finger, Boutonniere Deformity, Swan Neck Deformity Common Features: → Loss of active flexion or extension in fingers, potential deformities. Assessment: → Strength → Weakness in affected flexor/extensor muscles. → ROM → Check active & passive movement of fingers/wrist. → Special Features → Mallet Finger → Inability to extend DIP joint. Boutonniere Deformity → PIP flexion with DIP hyperextension. Swan Neck Deformity → PIP hyperextension with DIP flexion. Treatment: → Gradual tendon mobilization & strengthening after repair. → Functional hand exercises (grip training, object manipulation drills). 7. Ganglion Cysts & Soft Tissue Lumps Ganglions Common Features: → Painless (sometimes painful) swelling near wrist or finger joints, can fluctuate in size. Assessment: → ROM & Strength → May have mild restriction or discomfort in wrist/finger movement. Treatment: → If asymptomatic → No treatment needed. → If painful → Aspiration, surgical removal if persistent. Spine 1. Degenerative & Structural Conditions Spondylitis, Spondylolisthesis, Disc Degeneration o Strength Assessment: ▪ Core strengthening exercises, such as planks and leg raises to test abdominal and lumbar stability. ▪ Hip flexor strength assessment through hip raises or resisted hip flexion. o ROM Assessment: ▪ Assess spinal flexion/extension, lateral flexion, and rotation with the goniometer (if possible). ▪ Test for pain or stiffness in any direction. o Treatment: ▪ Strengthening → Core stabilization exercises (e.g., bridges, leg raises, planks, bird dogs).  ▪ Stretching → Hamstring stretches, quadratus lumborum stretches, gentle spinal mobilizations for mobility. ▪ Pain relief → Ice/heat therapy, posture correction, ergonomic advice for daily activities. Goniometry: Upper limb: Shoulder Flex Pec Major Ant Deltoid Coracobrachialis = GM 160-180 Extension Posterior Deltoid, Pec major Lat Dorsi, Teres Major, Long Head tricep = GM 50-60 Abduction Deltoid Supraspinatus = GM 180 Adduction Pec Major Lat Dorsi + teres Major = GM 30-50 Internal Sub scap, pec mai pec min, anterior delt, Lat dorsi, teres major = GM 70-90 External Infraspinatus Teres Minor = GM 90-100 Elbow Flexion Brachialis, BB, Coracobrachialis, Brachio-radialis, Pronator Teres = GM 140-150 Extension = 0 - 5 Pronation Bracho-radialis Pronator Teres, quadratus FCR= GM 80-90 Supernation Supinator BB = GM 80-90 Wrist and Hand Wrist Flexion FCRFCU = GM 60-80 Wrist Extension ECU ECRL ECRB, = GM 60-75 Ulnar Deviation ECU FCU = GM 20-25 Radial Deviation Extensor Pollicus Longus + brevis, ECRB ECU FCR = GM 20-40 LOWER LIMB HIP FLEXION – 110-120 --> Psoas Major, Psoas Minor, Illiaçus, Sartorius, Rec Fem, Pectineus, Adductors + Gracilis TFL EXTENSION – 10-20 --> Glute Max, Med, Min, Biceps Fem Semitendinosus, Semimembranosus ABDUCTION – 30-50 --> Glute Max, Med, Min Adductor Magnus (Deep) Gluteal muscles ADDUCTION- 20-30 --> Gracilis, Adductor Magnus, Brevis, Longus Pectineus, Adduction IR – 30-40 --> Sartorius, Glute min + med, TFL pectineus adductor mag, semimembranosus ER – 40-60 --> Iliopsoas, glute max, Deep gluteal, sartorius, adductors KNEE FLEXION – 130-140 --> Gastrocnemius, Biceps Femoris, Semitendinosus, Semimembranosus EXTENSION – 0-5 --> Vastus Lat, Med, inter, Rectus Fem TFL ANKLE DORSI FLEX – 10-20 --> TA FHL FDM PLANTER FLEX – 40-60 --> TP Gastro Soleus Plantaris, Fib Long, Fib Brex EVERSION – 5-30 --> EDL Fib Longus Brevis, Soleus G INVERSION – 30- 50 --> FDL, FHL, TP, TA NEURO Dermatomes → light touch, Blunt touch, pin prick, two point discrimination Upper Body C2-Temple, Forehead C3-Entire Neck, Posterior cheek, Temporal Area, Prolongation forward under mandible C4- Shoulder Area, Clavicular Area, Upper Scapula C5- Deltoid anterior aspect of entire arm to base of thumb C6- Anterior Arm, Radial side of hand to thumb and index C7- Lateral Arm and forearm to index, long and ring fingers C8- Medial arm and forearm to base of little finger T1-Medial side of forearm base of little finger 12- Medial side of the upper arm to medial elbow Lower body L1-Back, over trochanter and groin L2-Back, front of thigh to knee L3-Back, upper buttock, anterior thigh and knee, medial lower leg L4-Medial buttock, latera thigh, medial leg, dorsum of foot, big toe L5-Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes 81-Buttock, Thigh, and Leg Posterior 82-Buttock, Thigh, and Leg Posterior 63-Groin, medial thigh to knee 64-Perineum, genitals, lower sacrum Myotomes Upper extremity C 5 - S h o u l d e r Abduction C6- Elbow Flexion + Wrist Extension C7- Elbow Extension C8- Thumb Extension, Ulnar Deviation T1 - Finger Abduction Lower extremity L2-Hip Flexion L3-Knee Extension L4- Ankle Dorsiflexion L5- Big Toe Extension S1-Ankle Plantar Flexion S2-Knee Flexion Brachial plexus Dorsal scapular nerve c4,c5 Medial Pec- c8-11 Lat Pec= c5-c7 Suprascapula and Subscapular- c5-c6 Long Thoracic- c5-c7 MSC-c5-c7 Subclavian-cS thoracodorsal-c7 Axillary c5- с 6 Radial c5-t1 Medin - c6-t1 Ulnar c8-t1 Lumbosacral Plexus Nerve Roots Iliohypogastric nerve → T12, L1 Ilioinguinal nerve → L1 Genitofemoral nerve → L1–L2 Lateral femoral cutaneous nerve → L2–L3 Obturator nerve → L2–L4 Femoral nerve → L2–L4 Superior gluteal nerve → L4–S1 Inferior gluteal nerve → L5–S2 Sciatic nerve → L4–S3, L5–S2 Common fibular nerve → L5–S2 Deep fibular nerve → L4–S2 Quadratus femoris nerve → L4–S1 Perforating cutaneous nerve → (No root values provided) Pectineal nerve → L2–L4 Tibial nerve → L4–S3 Cranial Nerves Olfactory- sensory smell Optic- sensory Oculomotor- movement Trochlear - moving eyes up and down or back and forth Trigeminal - maxillary (cheek, lower eyelid mandibular (chin puscules of mastication), ophthalmic (scalp forehead nose) Abducens- M, eye movement Facial - S+M muscles of facial expression, taste on tongue Vestibulocochlear - Sensory, Hearing and balance Glossopharyngeal- S+M Tongue, sinus Vagus- S+M Neck, Chest, Heart, Lungs abdoment and digestive tract Ack.essory-M Tap.Sterneclenomasteid Hypoglossal-M Intrinsic and extrinsic tongue muscles NEUROLOGICAL CONDITIONS Meningitis (Bacterial and Viral) Ataxia (Including Spinocerebellar Ataxia) Dementia (Including Vascular, Frontotemporal, etc.) Myasthenia Gravis (MG) Spinal Cord Injury (SCI) Guillain-Barré Syndrome (GBS) Amyotrophic Lateral Sclerosis (ALS) Cerebral Palsy (CP) Traumatic Brain Injury (TBI) Stroke (Cerebrovascular Accident - CVA) Multiple Sclerosis (MS) Huntington’s Disease (HD), Parkinson’s Disease (PD), Alzheimer’s Disease (AD) 1. Motor Control & Coordination Deficits Ataxia (including Spinocerebellar Ataxia), Huntington’s Disease (HD), Parkinson’s Disease (PD), Multiple Sclerosis (MS), Cerebral Palsy (CP) Strength Assessment: → Manual Muscle Testing (MMT) for proximal and distal muscles to assess weakness distribution. → Functional tests (sit-to-stand, stair climbing, grip strength) to evaluate overall motor function. → Assess for muscle tone using Modified Ashworth Scale (spasticity) or pendulum test for rigidity (PD). Coordination Assessment: → Finger-to-nose and heel-to-shin tests for cerebellar ataxia. → Rapid alternating movements (dysdiadochokinesia in PD, MS). → Romberg’s test to differentiate sensory ataxia from cerebellar ataxia. Gait & Balance Assessment: → Timed Up and Go (TUG) to assess fall risk. → Berg Balance Scale or Functional Reach Test. → Observational gait analysis (look for shuffling in PD, ataxic wide-based gait in cerebellar conditions). Treatment: → Strengthening → Progressive resistance training for weak muscle groups, postural control exercises. → Coordination & Balance → Frenkel’s exercises for ataxia, task-specific training for PD (e.g., cueing strategies). → Gait Training → Walking with external cues (metronome, floor markings) for PD, balance drills for MS. 2. Neuromuscular Weakness & Fatigue Myasthenia Gravis (MG), Guillain-Barré Syndrome (GBS), Amyotrophic Lateral Sclerosis (ALS), Spinal Cord Injury (SCI) Strength Assessment: → MMT for key muscle groups (focus on progressive weakness in MG, distal-to-proximal weakness in GBS, asymmetry in ALS). → Functional strength testing (grip strength, chair rise test). Fatigue & Endurance Assessment: → 6-Minute Walk Test (functional endurance). → Fatigue Severity Scale (FSS) for MG, MS, ALS. → Borg Scale for perceived exertion. Respiratory Assessment (if applicable): → Peak cough flow and forced vital capacity (FVC) in ALS, GBS. → Breathing pattern observation (paradoxical breathing in high SCI). Treatment: → Strengthening → Low-rep, high-rest strengthening for MG (avoid fatigue), graded progressive strengthening for GBS and SCI. → Fatigue Management → Pacing strategies, energy conservation. → Respiratory Support → Breath stacking, inspiratory muscle training (SCI, ALS). 3. Cognitive & Functional Decline Dementia (Vascular, Frontotemporal, Alzheimer’s Disease - AD), Stroke (CVA), Traumatic Brain Injury (TBI) Cognitive & Functional Assessment: → Montreal Cognitive Assessment (MoCA) for dementia and mild cognitive impairment. → Functional Independence Measure (FIM) to assess ADLs. → Mini-Mental State Examination (MMSE) for cognitive screening. Motor Assessment: → Motor control screening (Brunnstrom’s stages of recovery for stroke). → Hand function tests (9-Hole Peg Test for dexterity). → Balance & mobility (TUG, Berg Balance Scale). Treatment: → Functional Rehab → Task-oriented training for ADLs, compensatory strategies. → Strength & Balance → Falls prevention, dual-task training. → Cognitive Stimulation → Memory tasks, problem-solving activities in therapy. Cardiorespiratory Respiratory Failure (Acute and Chronic) Pleural Effusion Pulmonary Arterial Hypertension (PAH) Myocardial Infarction (MI) Cardiogenic Pulmonary Edema Pulmonary Embolism (PE) Post-Operative Cardiac and Pulmonary Rehab Acute Respiratory Distress Syndrome (ARDS) Pneumothorax Post-Operative Cardiac and Pulmonary Rehab Pneumonia Heart Failure (HF) Pulmonary Fibrosis Asthma, copd 1. Peak Flow Measurement: It helps assess airway obstruction and monitor asthma control by measuring the maximum airflow that can be generated during forced expiration. Procedure: The patient stands upright and takes a deep breath, then exhales forcefully into the peak flow meter, which measures the maximum airflow in liters per minute. Interpretation: Lower PEFR values indicate airway obstruction, while higher values suggest better airway function. Monitoring changes in PEFR over time can help assess the effectiveness of asthma management and guide treatment adjustments. Maximum Value: In healthy adults, peak flow rates can range from around 400-700 liters per minute (L/min) or even higher in some cases, depending on factors like age, sex, and height. Minimum Value: While there's no strict minimum value, a peak flow rate below 80% of the predicted or expected value for an individual's age, sex, and height may indicate airway obstruction or reduced lung function. This could be around 200-300 liters per minute in adults. 2. Spirometry: ENSURE DIDN’T TAKE BRONCHODILATOR BEFORE TEST Description: Spirometry is a pulmonary function test that measures lung volume and airflow parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio. Purpose: It aids in diagnosing and monitoring respiratory conditions such as COPD, asthma, and restrictive lung diseases by assessing lung function and airflow limitation. Interpretation: Spirometry provides objective data on lung function. Reduced FEV1 and FEV1/FVC ratio are indicative of airflow obstruction, while decreased FVC suggests restrictive lung disease. A ratio below 0.70 is considered indicative of airflow obstruction goes same for copd and cf. The severity of airflow obstruction in COPD is often categorized based on this ratio: Mild: FEV1/FVC ≥ 0.70 Moderate: 0.50 ≤ FEV1/FVC < 0.70 Severe: 0.30 ≤ FEV1/FVC < 0.50 Very severe: FEV1/FVC < 0.30 CONDITIONS 1. Impaired Gas Exchange & Ventilation Acute Respiratory Distress Syndrome (ARDS), Respiratory Failure (Acute & Chronic), Pneumonia, Pulmonary Fibrosis, COPD, Asthma Assessment: → Breathing Pattern → Observe for paradoxical breathing, use of accessory muscles (COPD, ARDS). → Auscultation → Reduced breath sounds (fibrosis), wheezing (asthma, COPD), crackles (pneumonia, pulmonary edema). → Cough Assessment → Strength, effectiveness, secretion volume. Treatment: → Breathing Techniques → Pursed-lip breathing for COPD, diaphragmatic breathing for restrictive conditions. → Airway Clearance → Active Cycle of Breathing (ACBT) for mucus clearance (pneumonia, COPD). → Positioning → Upright for lung expansion, side-lying for unilateral lung pathology. → Pulmonary Rehab → Interval-based walking for breathlessness, incentive spirometry post-op. 2. Circulatory & Perfusion Disorders Pulmonary Embolism (PE), Pulmonary Arterial Hypertension (PAH), Myocardial Infarction (MI), Heart Failure (HF), Cardiogenic Pulmonary Edema Assessment: → Cardiac Auscultation → S3/S4 heart sounds (HF), murmurs (PAH). → Peripheral Edema → Check for pitting edema (HF, pulmonary hypertension). → Exercise Tolerance → 6-Minute Walk Test (6MWT), Borg Scale for dyspnea. → Blood Pressure & HR Monitoring → Look for hypotensive responses in MI, exaggerated HR in PAH. Treatment: → Cardiac Rehab → Interval training, gradual resistance exercise. → Circulatory Exercises → Ankle pumps, seated marches for venous return. → Postural Adjustments → Head elevation for pulmonary edema relief. → Breathing Techniques → Paced breathing to manage exertional dyspnea. 3. Post-Surgical Cardiac & Pulmonary Rehab Post-Operative Cardiac and Pulmonary Rehab (CABG, Valve Replacement, Lung Resection, Thoracotomy) Assessment: → Surgical Wound Inspection → Sternotomy precautions for CABG, chest drains post-thoracic surgery. → Lung Expansion → Incentive spirometry effectiveness, breath-holding techniques. → Pain & Mobility → Thoracic movement restrictions post-op, pain-limited breathing depth. → Functional Testing → Bed mobility, chair transfers, early ambulation tolerance. Treatment: → Early Mobilization → Sit-to-stand, progressive walking within tolerance. → Airway Clearance → Huffing techniques to clear secretions. → Breathing Strategies → Deep breathing with supported coughing to prevent atelectasis. → Sternal Precautions → No pushing/pulling >5kg for 6 weeks post-CABG. 4. Pleural & Lung Volume Abnormalities Pneumothorax, Pleural Effusion, Pulmonary Fibrosis Assessment: → Chest Expansion → Reduced unilaterally (pneumothorax, pleural effusion). → Auscultation → Absent breath sounds (pneumothorax), dullness to percussion (pleural effusion). → Oxygenation & Work of Breathing → Pulse oximetry, respiratory rate. Treatment: → Positioning → Side-lying on the unaffected side for improved ventilation. → Gradual Mobilization → To prevent post-drainage lung collapse. → Breathing Control → Slow, deep breathing to encourage lung re-expansion EXAM BRIEF Musculoskeletal Example 1 a) Demonstrate how you would assess strength in the quadriceps muscles in your patient following total hip replacement. Describe how you will document your findings. b) Demonstrate a treatment technique to strengthen the quadriceps following a total hip replacement (THR). Demonstrate one progression or regression. Example 1: Strengthening the Quadriceps After THR a) Strength Assessment for the Quadriceps After THR → Position the patient → Sitting on the edge of a plinth with knees at 90° flexion or in long sitting with legs extended. Ensure proper posture and support. → Verbal instructions → Ask the patient to extend the knee against resistance while keeping the thigh in place. → Assess strength using the Manual Muscle Testing (MMT) scale: Grade 5 (Good) → Full ROM against gravity and full resistance. Grade 4 (Good) → ROM against gravity with some resistance. Grade 3 (Fair) → ROM against gravity but no resistance. Grade 2 (Poor) → Movement with gravity eliminated Grade 1 (Trace) → Visible muscle contraction but no movement. Grade 0 (Zero) → No contraction. b) Treatment Techniques for Quadriceps Strengthening post total hip replacement Initial Technique: Quadriceps Isometrics (Regression for Weak Patients) → Normal Position → Long sitting with a rolled towel under the knee.→ Instructions → Ask the patient to press the back of the knee into the towel, activating the quadriceps without moving the leg. → Hold for 5–10 seconds → Repeat 10–15 times. Progression: Resisted Knee Extensions → Position → Seated on a chair, resistance band around the ankle.→ Instructions → Ask the patient to extend the knee against resistance until full extension is reached, then slowly lower.→ Repeat 12–15 reps → Increase resistance as tolerated. Regression: Reducing Load or Switching to Isometric Holds → If SLR is too difficult, return to quadriceps isometric contractions. → If resisted knee extensions cause pain, start with short arc quads (mini knee extensions from 30° flexion instead of full movement range). Treatment 2 Sit to Stand Normal: Wall sits Progression: bodyweight Squat with weight Regression: Sit to Stand on a chair Example 2 a) Demonstrate how you would assess shoulder flexion in a patient with suspected subacromial impingement. Describe what is being done (e.g., passive, active or active assisted) b) Demonstrate a treatment technique to improve range of motion in a patient with subacromial impingement. Demonstrate one progression or regression a) Assessment of Shoulder Flexion in a Patient with Suspected Subacromial Impingement → Patient Positioning: The patient is seated or standing, ensuring good posture with a relaxed shoulder. → Active Flexion Assessment: Ask the patient to actively raise their arm straight in front of them, aiming for full shoulder flexion (180°). Observe for pain, compensations (scapular elevation, trunk lean), or a painful arc between 60°–120°, which suggests subacromial impingement. → Passive Flexion Assessment: If the patient experiences pain during active movement, assess passive motion. Support the arm at the elbow and passively lift it into flexion while keeping the scapula stabilized. Pain during passive flexion suggests subacromial impingement or capsular tightness, while pain-free passive motion indicates muscular involvement. Additional Special Tests: If impingement is suspected, perform Hawkins-Kennedy Test or Neer’s Test to confirm subacromial involvement. b) Treatment Technique to Improve ROM in Subacromial Impingement (Including Resistance Band Progression) → Initial Technique (Pendulum Exercises – Passive Mobilization): Instruct the patient to lean forward, allowing the arm to hang freely. Encourage them to gently swing the arm in small circles to promote joint mobilization with minimal muscle activation. Perform for 30 seconds per direction, 2–3 times daily. Why? → Reduces stiffness, promotes pain-free movement, and avoids impingement by maintaining subacromial space. → Progression (Active-Assisted Shoulder Flexion): Use a stick/weight/resistance band: The patient holds the stick with both hands and lifts it overhead using the uninvolved arm to assist. Perform 10–15 reps, ensuring smooth movement without compensations. Why? → Encourages active ROM while minimizing strain on painful structures. Why? → Activates the anterior deltoid, supraspinatus, and serratus anterior, reinforcing proper scapular control and shoulder stability. → Regression (Table Slides – Gravity-Assisted Motion): Ask the patient to place their hand on a table with a towel underneath. They gently slide the hand forward, allowing the body to lean forward while keeping the arm relaxed. Perform 10 reps to gradually increase flexion. Why? → Reduces muscular demand and allows gradual ROM restoration. Cardiorespiratory Example a) Demonstrate lung auscultation. Describe how you would document what you hear - giving an example of an adverse finding → Position the patient: Have the patient sit comfortably with their upper body exposed or partially undressed, ensuring they are relaxed. → Auscultate: Use a stethoscope and auscultate the lung fields systematically: Start at the upper lobes (anterior chest), moving down to the lower lobes. Listen to both sides, comparing the right and left lung fields. Normal: Vesicular breath sounds → Soft, breezy → No adventitious sounds. Crackles (Rales): Popping, crackling → Fluid in airways → Pulmonary edema (heart failure), pneumonia, atelectasis, fibrosis. Wheezes: High-pitched, whistling → Airway narrowing → Asthma, COPD, bronchitis. Bronchial Breath Sounds (abnormal location): Harsh, hollow → Lung consolidation → Pneumonia, lung mass, fibrosis. Pleural Rub: Grating, creaky → Inflamed pleura → Pleuritis, pulmonary embolism. Stridor: Loud, crowing → Upper airway obstruction → Croup, foreign body, anaphylaxis. Documentation: Note lung region, timing (insp/exp), and suspected pathology. b) Demonstrate how you would teach the active cycle of breathing techniques to a patient with bronchiectasis. Describe how you would modify this technique if the patient had a large volume of secretions in their left lung. The Active Cycle of Breathing Techniques (ACBT) is an effective method to assist patients with bronchiectasis in clearing airway secretions. According to the British Thoracic Society guidelines by Bott et al., ACBT comprises three main components: 1. Breathing Control: Encourage the patient to breathe gently through the nose, allowing the abdomen to rise and fall naturally. This helps prevent bronchospasm and reduces airway narrowing. 2. Thoracic Expansion Exercises: Guide the patient to take deep breaths in, expanding the chest, and then hold for 2–3 seconds before exhaling. This technique aids in loosening secretions and improving lung ventilation. 3. Forced Expiration Technique (FET): Instruct the patient to perform a controlled huff, which involves taking a medium-sized breath in and then breathing out forcefully through an open mouth, as if trying to fog up a mirror. This helps move secretions from the smaller to the larger airways, facilitating their clearance. Modification for Left Lung Secretions: If the patient has a significant volume of secretions in the left lung, consider the following adjustments: Positioning: Place the patient in a right side-lying position to utilize gravity in draining secretions from the left lung. This technique, known as postural drainage, can enhance the effectiveness of ACBT. Increased Thoracic Expansion on the Left Side: Encourage the patient to focus on expanding the left side of the chest during deep breathing exercises. This targeted approach can help mobilize secretions in the affected area. Neurology Example 1 a) Demonstrate how you would assess tone in the upper limb for a patient following a hemiplegic stroke. Describe what is being done and possible findings. Assessment of Tone in the Upper Limb for a Patient Following a Hemiplegic Stroke 1. Patient Positioning: Ensure the patient is relaxed and comfortable → Ideally seated or lying supine to minimize voluntary movements. Support the limb fully to reduce effort from the patient. 2. Explanation to the Patient: Explain: "I am going to move your arm to check the muscle tone. Try to stay as relaxed as possible and let me do the work." Observe for voluntary movement or associated reactions when instructing relaxation. 3. Passive Movement Assessment: Start by gently moving the shoulder, elbow, wrist, and fingers through their full range of motion (ROM). Move the limb slowly at first, then increase the speed to assess resistance to movement. 4. Possible Findings: Normal Tone → Smooth movement with no resistance or stiffness. Hypotonia (Low Tone) → Limb feels heavy, floppy, and offers little to no resistance (early post-stroke stage or cerebellar involvement). Hypertonia (Increased Tone) → Stiffness or resistance to movement, common in spasticity (UMN lesion) or rigidity (e.g., Parkinsonian features). Spasticity (Velocity-Dependent Resistance): o Minimal resistance initially, followed by a sudden catch (spastic catch or “clasp-knife” response). o Typically seen in a flexor pattern (e.g., elbow flexion, wrist flexion, finger flexion in stroke). Rigidity (Velocity-Independent Resistance): o Lead pipe rigidity → Continuous resistance throughout the ROM. o Cogwheel rigidity → Jerky, ratchet-like movements (seen in Parkinson’s). 5. Modified Ashworth Scale (MAS) for Spasticity Grading: 0No increase in muscle tone. 1Slight increase → "Catch" at the end of ROM. 1 Slight increase → "Catch" with minimal resistance through ROM. 2More marked increase in tone → Limb moves easily but with more resistance. 3Considerable increase in tone → Passive movement is difficult. 4Rigid limb → No movement possible. 6. Additional Tests: Pendulum Test (for Hypotonia): Swing the arm and observe excessive floppiness. Clonus Test (for Hypertonia): Rapidly stretch the wrist or fingers into extension and look for rhythmic, involuntary contractions. Clinical Relevance: Early stroke → Flaccidity/hypotonia Later stages (UMN lesion) → Spasticity and flexor synergy patterns Severe cases → Contractures if untreated. Documentation Example: "Increased tone in the left upper limb with a spastic catch at mid-range during fast passive movement, MAS score 2/5, flexor pattern observed." b) Demonstrate a left sided upper limb PNF technique for a patient following a hemiplegic stroke. Demonstrate how the technique could be modified. PNF (Proprioceptive Neuromuscular Facilitation) techniques use specific movement patterns with manual resistance to improve neuromuscular control, coordination, and functional movement. PNF Upper Limb (Arm) – Easy Instructions D1 Flexion ("Grab the seatbelt") Start: Arm down by your side, palm facing back. Move: Bring your arm up across your body towards the opposite shoulder, turning your palm up. D1 Extension ("Put the seatbelt on") Start: Arm up near the opposite shoulder. Move: Push your arm down and away, turning your palm down. D2 Flexion ("Draw the sword") Start: Hand near the opposite hip, palm down. Move: Lift your arm up and out, turning your palm up. D2 Extension ("Put the sword back") Start: Arm up and out. Move: Bring it down and across your body, turning your palm down. → Modification: For patients with increased spasticity or limited range, reduce the resistance or break down the movement into smaller parts (e.g., focus on just shoulder flexion and abduction first). PNF Lower Limb (Leg) – Easy Instructions D1 Flexion ("Cross your legs") Start: Leg straight, slightly out. Move: Lift your knee up and across your body, toes pointing up. D1 Extension ("Push away") Start: Knee up and across. Move: Straighten your leg down and out, toes pointing down. D2 Flexion ("Step out") Start: Leg across your body. Move: Lift your knee up and out to the side, toes up. D2 Extension ("Cross back") Start: Leg lifted out. Move: Bring it down and across, toes down. Super simple: Grab → Put on, Draw → Put back, Cross → Push, Step → Cross. Example 2 a) Demonstrate how you would assess sitting balance in a patient with Multiple Sclerosis (MS). Describe what is being done. Assessing Sitting Balance in a Patient with Multiple Sclerosis (MS) Using Berg Balance Scale What it is about: The Berg Balance Scale (BBS) is a widely used tool to assess static and dynamic balance in patients. It includes specific tasks that help evaluate sitting and standing balance, coordination, and postural control. For this assessment, we focus on the sitting balance component. 1. Positioning the Patient → Ensure the patient is seated on a firm, stable surface with feet flat on the ground. Arms resting on their lap or sides. 2. Sitting Balance Assessment (Berg Balance Scale Item) → Task: Ask the patient to sit with arms crossed and observe their ability to maintain balance. → Scoring Criteria: 4 points: Able to sit independently without using hands. 3 points: Able to sit independently, but with minimal sway. 2 points: Needs assistance or uses hands to support sitting balance. 1 point: Unable to maintain sitting balance without assistance. 3. Static Sitting Balance (Posture Control) → Ask the patient to maintain an upright sitting posture without hand support. Observe any excessive leaning or loss of balance. → Document if the patient maintains their posture for more than 10 seconds or requires support. 4. Dynamic Sitting Balance (Reaching & Shifting Weight) → Task: Ask the patient to reach forward, sideways, or cross midline to test control during dynamic movement. → Scoring Criteria: 4 points: Able to reach and move without losing balance. 2 points: Loss of balance or need for assistance when reaching. 5. Perturbation Test (Optional) → Gently apply force in different directions (forward, backward, and sideways) to assess the patient's ability to recover balance. Possible Findings Normal Balance → Able to sit independently, stable posture, and reaches with minimal sway. Reduced Balance → Uses hands for support, excessive sway, or inability to reach without losing balance. b) Demonstrate a core strength technique using an exercise ball for a patient with Multiple Sclerosis (MS). Demonstrate how this technique can be progressed or regressed. Basic Pelvic Tilt on Ball (Initial Technique) Setup: Sit on the exercise ball with your feet flat on the floor, knees at a 90-degree angle, and hips aligned. Place your hands on your hips for stability. How to do it: Engage your core, slowly tilt your pelvis backward (posterior pelvic tilt), flattening your lower back against the ball. Then, return to neutral spine position. Repeat this motion 10-15 times. Focus: Ensure a slow, controlled motion with smooth transitions from tilt to neutral. Progression 1. Increase Range of Motion: o Tilt your pelvis further back (posterior pelvic tilt) to increase the stretch in the lower back. Hold for 5 seconds at the peak of the tilt before returning to neutral. 2. Add Core Activation: o During the pelvic tilt, engage your core muscles more strongly. Maintain pelvic tilt while drawing in your lower abdominals (as if pulling your belly button toward your spine). This will intensify the core engagement. 3. Increase Hold Time: o Hold the pelvic tilt for 10-15 seconds before returning to neutral. This helps build endurance in your core muscles. 4. Add Resistance: o Hold a light weight (e.g., small dumbbell) in your hands or use a resistance band around your hips while performing the pelvic tilt to add resistance and challenge your core stability. Regression 1. Reduce Range of Motion: o Limit the movement to a smaller pelvic tilt if the full tilt feels too intense. Focus on a slight posterior pelvic tilt with minimal movement. 2. Shorten Hold Time: o Perform the pelvic tilt with a brief hold (3-5 seconds) if holding for longer is difficult. 3. Use Support: o Position yourself closer to a wall or use a stable surface, like a chair, behind you to provide support and prevent falling. 4. Remove Core Activation: o Initially, perform the pelvic tilt without engaging the core (just focusing on the pelvic motion itself). Add core activation as you gain strength and confidence. Safety Tips Make sure the ball is inflated properly to ensure stability. Perform the exercise in a controlled environment, clear of obstacles. Keep your feet flat on the floor and knees at a 90-degree angle to maintain balance and prevent strain. If you feel unsteady or uncomfortable, stop the exercise and seek support.