18 - HUMAN MVT SYSTEM

Question 1

Noncommunicable disease:
- Definition
- common types
- risk factors
- roles of pt

Answer 1

Definition
= chronic conditions that are not infectious & cannot be spread from person to person
- Primarily caused by combination of genetic, physiological, environmental & behavioral factors
- Generally, conditions progress slowly & persist over long time
- Responsible for majority of deaths worldwide (41000000 people/year & 91% of people died in UE)

Common types
- Cardiovascular
- Chronic respiratory
- Cancer
- Neurologic …

Risk factors
- Physical inactivity
- Tobacco
- Unhealthy diet
- Alcohol
- Genetic
- High blood pressure
- Obesity …

Role of PT
- Promote physical activity & exercise across all age groups
- Addressing modifiable risk factors (like obesity & inactivity)
- Assisting with rehabilitation for patients with CV or respiratory diseases
- Educating patients on lifestyle modifications to improve overall health

Question 2

DALY:
- acronyme
- definition
- components
- formula
- numbers

Answer 2

Disability adjusted life year

Definition
= measure used in public health to quantify overall burden of disease
- Reflects total number of years lost due to ill-health, disability or premature death within
population
- Measure how disability affect

Components
- Years of Life Lost (YLL): measures years lost due to premature death
- Years Lived with Disability (YLD): measures years lived with disability or disease
Formula
DALY = YLL + YLD

Numbers
- 87% of noncommunicable disease are in DALY
- 394 000 000: people / year that have disease who benefits to healthcare…
- 369 years even 1000 people due to no physical activity
DALY causes human costs, because someone must take care of ill people
Neoplasms number has % increase due to medicine progress, life expectancy increase => change in goals
of treatment, not only saving life but also improve QoL

Question 3

Health behavior def

Answer 3

Health behavior
= actions taken by individuals affecting health or mortality
- May be intentional or unintentional
- Promote or detract from health of actor or others

Question 4

Unhealthy behavior def

Answer 4

Unhealthy behavior
= actions that can lead to chronic conditions & noncommunicable diseases (NCD

Question 5

PTs as exercise & physical activity experts across life span

Answer 5

• Imperative that effective strategies for exercise & PA across lifespan implemented
• As experts in movement & exercise and with thorough knowledge of risk factors & pathology and their effects on all systems, PT are ideal professionals to promote, guide, prescribe & manage physical activity & exercise activities and efforts

Question 6

Difference between PT and personal trainer

Answer 6

PT = movement experts: what difference with personal trainer?
- Prevention & injury management
- Optimize physical activity & improve quality of life
- Patients want to see immediate improvement not in many years
- Education

Question 7

Evolution of PT théories

Answer 7

1975: pathokinesiology
1995: movement continuum theory
2000: kinesio pathology
2013: human movement system

Question 8

Description patho kinesiology & year

Answer 8

1975: Patho-kinesiology
- PT amid crisis of identity, profession in search of identity
- Hislop’s proposal: patho-kinesiology as distinguishing clinical science of physical therapy
- Study of anatomy & physiology as relate to abnormal human movement
- Pt can claim unique privilege of placing role of exercise in health & disease in its proper scientific
focus & perspective
- Not recognized for expertise in exercise except with post-surgical & paralyzed patients

Question 9

Description movement continuum theory & year

Answer 9

1995

Image

Question 10

Description kinesio pathology & year

Answer 10

2000

Image

Question 11

Human movement system
- year
- def
- why mvt = essential
- why promote mvt system
- components
- assessment

Answer 11

2013

Definition
- System as foundation for optimizing movement improving health of society
- Physical therapy profession promotes movement system as foundation for optimizing movement to improve health of society
- Movement system = integration of body systems generating & maintaining movement at all levels of bodily function
- Recognition & validation of movement system essential to understand structure, function &
potential human body
- Body system for which PT are responsible
- System of expertise as PT our identity
Human movement = complex behavior within specific context & is influenced by social, environmental & personal factors

Movement = an essential
- Essential function of life at all levels of living organisms, from ions moving through membranes to moving limbs to moving environment
- Movement system = core of physical therapist practice, education & research

Why promote movement system
- Clarifies PT’s responsibility on body system: respected health professions identify with system of body
- Provides context for diagnoses that PT make: no recognition for being able to identify pb unless there is label
- Informs other health professionals of existence of movement-based syndrome
- Physicians identify NMSK problems based on patho-anatomy: treatment by drugs & surgery
- PT identify NMSK pbs based on Patho kinesiology or kinesio-pathology: treatment by movement

Patho-kinesiology = have a pathology, so move differently
Kinesio-pathology = move differently so develop a patho logy

Human movement = complex behavior within specific context & is influenced by social, environmental & personal factors

Components
Movement induces adaptative changes in components:
- Brain
- Muscles
- Shape

Assessment
- PT identify NMSK problems based on patho-kinesiology or kinesio-pathology

Question 12

Why do we care about mvt

Answer 12

Why do we care about movement?
 Care about pattern movement
- Force distribution on joint: not too much force on specific structures
- Possibility to have tissue trauma

p extension:
Back extension: lead to increase the lever → increase load on back
Ankle sway: low distribution:
Standing upright in neutral position, 80% of weight applied on body of vertebrae and 20% on spinous
processes & facet joints
If degeneration of IVB & decrease space → change space between facet joints → Joint space in nerve
roots (narrowing, compression) → change load on facet joints ➔ more load posteriorly, exchange
between 80 & 20%
 Extension pb of back

Question 13

Relation between movement & MSK pain

Answer 13

Schema

Question 14

MSK pain (working theory) description

Answer 14

MSK pain (working theory):
- Related to lifestyle like many other health conditions
- Progressive condition
o Starting with acute pain, 1st indication of tissue damage
o High reoccurrence rate, leading to chronic problem
- Result of tissue changes associated with
o Aging related degeneration
o Activity induced tissue injury from impaired joint movement

Theories: “just” our best explanation of reality
- Lower-dimensional interpretations can only approximate true nature of multidimensional
phenomenon

Question 15

Challenges of human system

Answer 15

Prevention
Treatment
Avoid chronicisation

Question 16

Description of how avoid chronicisation:
- Acute symptoms subside
- recurrence is common
- to minimize recurrences
- develop treatment program including

Answer 16

Avoid chronicisation
Acute symptoms subside
- With time
- With variety of interventions addressing symptoms

Recurrence is common
- Pathoanatomic structures considered cause
- Impaired movement is not considered cause
 Therefore, not been identified & addressed

To minimize recurrences
- Identify movement cause & contributing factors

Develop treatment program including:
- Patient specific exercises
- Correction of performance of basic daily activities
- Correction of performance of work, recreation, fitness & sports activities
 Repetition of impaired movement accelerate development of osteoarthritis
o May caused in long-term

Question 17

OA mechanical mechanism

Answer 17

OA mechanical mechanisms
Cartilage degeneration can be correlated with abnormal excessive articular contact stress

Weakened joint
- Could be ligament laxity, periarticular muscle weakness or reduced
proprioception
- May all lead to articular instability, exposing joint to sudden impulsive joint to sudden impulsive loads & finally to high peak pressure

Experimental induced OA
- Surgical destabilization of medial meniscus (DMM) model of OA in
129/SvEv mouse
- OA development in novel experimental mouse models induced by knee joint instability

Question 18

Movement system impairment syndrome:
- definition
- description

Answer 18

Definition
Movement impairment different than movement impairment syndrome
Movement impairment syndrome: when symptoms in relation to syndrome
Description
Little things mean a lot
Underlying problem: micro-instability:
- Wobble condition
- Accessory motion (spin, slide & roll) becomes excessive in one or more directions
(hypermobility/micro-instability)
- Micro-trauma from sheer force & points of high contact pressure becomes macro-trauma

Question 19

Assessment of intra-joint-micro-instability & relative flexibility

Answer 19

Assessment of intra-joint-micro-instability & relative flexibility
Joint micro-instability
- Characterized by accessory motion moving
o Range that is more than optimal (joint surfaces not optimal during movement)
= points of high contact stress & sheer force
o More often than optimal
o More readily in specific directions
Accessory motion micro-instability can progressively increase. With physiological motion that is: normal,
excessive or limited
- Assess by physiological motions: active & passive
- Manual proprioception of precise joint motion “going along for ride”
- Manually correct during physiological active & passive motion

Question 20

MSIS: diagnosis

Answer 20

Diagnosis
- Because of kinesiological relationships tissue adaptations result in definable patterns
- Prevailing movement direction will induce pain that is related to combination of impairments in
NMSK systems

• Adaptations set up vicious cycle contributing to high repetition of movement in painful direction
• If pain becomes severe enough then movement is further adapted

Question 21

MSIS: key concepts

Answer 21

y concepts
- Path of least resistant for motion
- Relative stiffness & relative flexibility
- You get what you train (many strategies to create moments at joint or within limb, varying motor
patterns)
- Presence of muscle does not mean that it is being appropriately used
- No magic in exercise except if desired motion evident
- Way everyday activities performed is critical issue
- Hypermobility (accessory / arthrokinematics motion) causes degeneration & pain

Question 22

Description of path at least resistance concept

Answer 22

Path of least resistance
= tendency of body to use compensatory, less efficient movement patterns due to weakness, stiffness or
imbalance.
- Compensations follow easiest path for motion, which often stresses vulnerable tissues, leading
to pain or dysfunction over time

Question 23

Description of relative flexibility:
- intra joint
- inter joint

Answer 23

Relative flexibility
Intra-joint
Accessory motion occurs more readily in 1 or 2 directions & exceeds optional ROM
Occurs with greater frequency of occurrences

Inter-joint
Motion occurs at one joint more readily than at another contiguous joint
For example, more readily at lumbar spine than hips
Occurs with greater frequency of repetitions
Contributes to development of excessive ROM either osteokinematic or arthrokinematic

Question 24

Relative muscle stiffness:
- description
- definition

Answer 24

Relative muscle stiffness
Hypertrophy of muscle increases passive stiffness
Daily activities can induce different degrees of hypertrophy of muscle on either side of joint
Definition
Given 2 springs in series of different degrees of stiffness (change in tension / unit change in length)
- When tension applied simultaneously to each spring
- Least stiff spring will elongate more than stiffer spring
Given flexible spine
- When moving motion will occur at most flexible joint

Question 25

Inter-join relative flexibility & relative stiffness description

Answer 25

Vertebral joint moves readily during motion that should be occurring at another joint “

Question 26

Optimal relative stiffness description

Answer 26

Optimal relative stiffness
Muscle = springs in series & in parallel
Passive stretch of muscle crossing joint & joint properties no motion of joint with elongation of less stiff muscle
Most important: flexibility of spinal segment not stiffness or shortness
of muscles

Question 27

Impaired relative stiffness:
- description
- key concepts

Answer 27

Impaired relative stiffness
Passive stretch of rectus femoris tilts pelvis anterior & that extends Lx happens before reaching limit of
muscle length
Lumbar extension or extension-rotation syndrome
Key concepts
Way everyday activities performed is critical issue:
- Repeated movements
- Sustained alignments
 You get what you train, many strategies to create moments at joint or within limb
- Presence of muscle does not mean appropriate use
- No magic in an exercise except if desired motion evident

Question 28

Life span practitioner description

Answer 28

Life span practitioner
Monitoring & guiding development of movement system
- Alignment, movement patterns, strength, endurance
- Identifying structural variations

Question 29

Movement system impairment syndromes of Lx:
- criteria
- syndromes

Answer 29

Movement system impairment syndromes of LX
Criteria: identified with movement exam
- Movement alignment / direction that is impaired & most consistently causes pain
- When movement is corrected, pain is decreased or eliminated
Syndromes
- Flexion: flexion-rotation
- Extension: extension-rotation
- Rotation: primary & secondary