Prognosis and Plan of CareClinical examination and additional historical information confirmed the suspicion of intra‐articular involvement. The patient is deemed appropriate to treat with physical therapy interventions.Due to time‐constraints, an initial home program was provided based upon impairments observedduring examination. The patient was instructed to perform the exercises daily or every other day astolerated for 1 week, before following up in clinic to begin a more involved course of clinical and home‐based physical therapy.   InterventionNon‐weight bearing exercises to strengthen the hip extensor and abductor muscles wereprescribed and performed in clinic to confirm therapeutic tolerance. Flexibility exercises for thehamstring muscles were taught, using the popliteal angle position. Patient education was provided forpostural recommendations and joint unloading strategies to be utilized during acute symptom episodes.   What is the most appropriate intervention to initiate to decrease stiffness and improve passiveand active hip flexion and internal rotation ROM?  

The exercise that most selectively and effectively activates the tibialis posterior is:

The patient is a 43-year-old man who works in a factory where he is responsible for operating a drill press and lifting heavy (25kg) cases of metal plates over his head several times throughout the day. He presents with a chief complaint of chronic low back pain that ranges from 3/10 at rest to 9/10 at the end of the day. He denies lower limb pain; he also denies lower limb numbness or muscle weakness. His symptoms began several years ago when he tried to stop a pallet of metal plates from falling off a truck. He felt a tearing sensation in his back and indicates that it has not been “right” since that time. He has had several periods of lost work time due to low back pain and has currently been out of work on a worker’s compensation claim for one month. This patient has had 2 lumbar magnetic resonance imaging examinations that revealed mildly degenerative, bulging disks at L4-5 and L5-S1. His previous physical therapy treatment has been centered on pain control approaches using moist heat and ultrasound. He indicates that he was instructed in the performance of sit-up exercises but stopped doing them after a couple of days because they increased his pain. He has avoided physical activity and exercise since that time. During your physical examination of this patient you note that, surprisingly, he has full range of motion of his lumbar spine and lower extremities. However, he has great difficulty controlling the position of his spine and pelvis when trying to perform a simulated lift that is similar to his job requirements. This task also increases his pain intensity but does not cause it to peripheralize. Given only this currently obtained information, which of the treatment approaches listed below is most supported by the literature?

The patient is a 43-year-old man who works in a factory where he is responsible for operating a drill press and lifting heavy (25kg) cases of metal plates over his head several times throughout the day. He presents with a chief complaint of chronic low back pain that ranges from 3/10 at rest to 9/10 at the end of the day. He denies lower limb pain; he also denies lower limb numbness or muscle weakness. His symptoms began several years ago when he tried to stop a pallet of metal plates from falling off a truck. He felt a tearing sensation in his back and indicates that it has not been “right” since that time. He has had several periods of lost work time due to low back pain and has currently been out of work on a worker’s compensation claim for one month. This patient has had 2 lumbar magnetic resonance imaging examinations that revealed mildly degenerative, bulging disks at L4-5 and L5-S1. His previous physical therapy treatment has been centered on pain control approaches using moist heat and ultrasound. He indicates that he was instructed in the performance of sit-up exercises but stopped doing them after a couple of days because they increased his pain. He has avoided physical activity and exercise since that time. Which of the factors listed below is LEAST likely to contribute to a poor prognosis for improvement of this patient’s functional capacity?

Which of the following would be considered the most appropriate treatment for this case example based on the best available evidence?

You decide to assess hip joint mobility and level of joint irritability by performing a long‐axisdistraction mobilization technique. What is the optimal position of the hip to maximizedistraction of articular surfaces?  

You begin study of a T2w sagittal knee study with 4-millimeter slices that begins laterally and progresses medially. What structure will you encounter last as you study the images in chronological order?

The patient is a 79-year-old woman referred to the clinic 3 weeks after a left total knee arthroplasty. She had received home physical therapy for 4 visits to initiate range of motion and strengthening after surgery. At the time of the initial evaluation, she complained of intermittent central knee pain with walking; she denied pain at rest. Her goal was to be able to walk through a large mall without pain in order to shop with her daughter. She had a right total knee arthroplasty 2 years ago. Comorbidities include hypertension and gastroesophageal reflux. disease. Upon evaluation, the patient’s involved leg active range of motion was lacking 2° extension and she was able to flex her knee to 128°. Active range of motion on the uninvolved was 0° to 132°. Her incision was well healed with puckering at rest; hypomobility of the scar was noted with palpation. Her patellar mobility was slightly decreased superiorly and inferiorly. Measurements at mid-patella revealed a girth 5 cm greater on the left. A quadriceps lag was observed with straight leg raise. Quadriceps maximum voluntary isometric contraction testing at 60° was 425 N on the right and 202 N on the left, indicating the left quadriceps force was 48% of the right. Strength testing of the hip flexors, abductors, and ankle dorsiflexors was 4/5. She was utilizing a rolling walker for ambulation. The authors noted her stance time was equal, but decreased weight bearing on the left was observed. In addition, she ambulated with a flexed knee gait. Her Knee Outcome Scale was 66%. Functional testing included the Timed Get Up and Go Test, measured at 9.8 seconds, and the Stair-climbing test, which she performed in 25.6 seconds. Your initial tactics to address the range of motion impairments would include:

The key physical exam finding in a patient with anklyosing spondylitis is:

17 yo male was playing quarterback during high school game.  During the cocking phase of a throw he was hit from behind and suffered an anterior dislocation. What ligamentous structure was most likely torn in this position of the shoulder?