3-31 Lower Body Exercise Rx Flashcards
Explain the relationship between gait speed and life expectancy.
Gait speed of 1.0 m/s suggests healthier aging
◦Life expectancy > 5-10 years
Gait speed of 0.5 or 0.6 m/s suggests frailty and greater risk of death
Life expectancy < 5 years
What stance is heel-toe gait, mostly? What can contribute to problems with it?
Heel-toe gait is 80% 1-legged stance
◦Poor balance, muscle weakness contributes to falling
How do most people stand up? What body parts & mm are used?
Most people lean forward and use back and neck mm to help them ‘push off’ from seat
What is the ‘elephant feet’ technique? Why is it healthier?
Stand up with “elephant feet”
Elephant feet standing is performed by quickly raising both knees toward the chest and then stomping feet on the ground.
Uses more leg and gluteal mm to help stabilize and move the body, as opposed to the frequently hypertonic and stabilizing back mm
If contralateral hip drops while standing on 1 leg, what does that indicate?
◦poor glut max strength
What is indicated if weight shifts to ipsilateral side while standing on 1 leg?
◦poor glute strength and relying on adductors for posture
What is static stretching?
stretch is held in a challenging but comfortable position for a period of time, usually somewhere between 10 to 30 seconds
What are the pros/cons of static stretching?
most common form of stretching
considered safe and effective for improving overall flexibility
May be much less beneficial than dynamic stretching for improving range of motion for functional movement
What is dynamic stretching?
stretch is performed by moving through a challenging but comfortable range of motion repeatedly, usually 10 to 12 times.
What are the pros/cons of dynamic stretching?
requires more thoughtful coordination than static stretching (because of the movement involved)
more benefits in improving functional range of motion and mobility in sports and activities for daily living.
Not the same as old-fashioned ballistic stretching
What is passive stretching? What can be used to assist?
using some sort of outside assistance to help achieve a stretch:
your body weight
a strap
leverage
gravity
another person
a stretching device
the muscle to be stretched is relaxed and relies on the external force to hold person in place
What is a risk with passive stretching?
risk that the external force will be stronger than muscle is flexible
What is active stretching?
Active Stretching:
stretching a muscle by actively contracting the muscle in opposition to the one being stretched
relax the muscle that’s being stretched and rely on the opposing muscle to initiate the stretch
What are the pros/cons of active stretching?
does not use body weight, a strap, leverage, gravity, another person, or a stretching device
generally considered lower risk because the stretch force is controlled with person’s own strength rather than an external force
can be challenging because of the muscular force required to generate the stretch
frequently requires assistance from another person to direct the motion or create muscle awareness
What are toe lifts good for?
Good for forefoot pronation or pes planus, plantar fasciitis, lower extremity dysfunction
What do toe lifts actually do?
strengthens intrinsic mm of the foot
How are toe lifts done?
Stand with neutral pelvic rotation (tail tucked) and neutral position of femur on tibia (knees soft)
Lift heels off floor 1 inch keeping all 10 toes on the floor
Hold for up to 30 seconds
If toes lift up during toe lifts, what do they indicate?
Toes that lift up indicate specific muscle dysfunction
What are the passive & active forms of the piriformis stretch?
Cross one foot over opposite knee
Hold for 10-30 seconds
Active
Cross one foot over opposite knee
Use opposite leg to push ipsilateral leg cephalad
Hold for 10-30 seconds
What is more advanced form of the passive piriformis stretch?
(Pigeon Pose)
Flex hip and knee and place leg in front of you
Extend other leg behind
Increase stretch on piriformis by dropping torso onto forearms
Describe 2 passive forms of hamstring stretching.
What is the dynamic form of a hamstring stretch?
Bend hips to 90 degrees and flex knees
Keep pelvis in anterior tilt
Extend knees and push ischial tuberosities up to the ceiling
How is the static form of the psoas stretch done?
How is the active form of the psoas stretch done?
Start by kneeling on floor with one leg flexed at knee.
Invert foot on floor. Keep torso erect with neutral pelvic
rotation. Contract gluteus maximi muscles and
advance into lunge. Hold for 30 seconds.
What is the role of muscle spindles? How do they fire or remain silent?
Control of muscle length by muscle spindle
Stretching muscle causes spindle to discharge more = muscle is lengthening
Contracting muscle causes spindle to be silent = muscle is shortening
What do GTOs respond to? What do they do?
Golgi tendon organ responds to stretch and contraction & initiates inhibitory reflex arc to prevent overloading the muscle
How are joints stabilized?
Stimulating limb flexor and extensor muscles = joint stabilization
What mm work when a joint extends, flexes, or when an ipsilateral joint moves?
Joint flexes, flexor contracts, extensor lengthens
Joint extends, flexor lengthens, extensor contracts
Occurs ipsilaterally & contralaterally
Ipsilateral flexor contracts, contralateral flexor lengthens
Describe slow twitch muscles in terms of function, metabolism, vascularized, speed and makeup.
Slow-twitch
Function is tonic/postural
Uses oxidative metabolism
High capillary density
Twitch speed is slow
Type I myosin heavy chain (MHC) isoform
Describe fast twitch muscles in terms of function, metabolism, vascularized, speed and makeup.
Fast-twitch
Function is phasic, muscles react by shortening and tightening
Uses glycolytic metabolism
Fatigue rapidly
Low capillary density
Twitch speed is fast
Type II MHC isoform
Describe the makeup of the psoas muscle in terms of fiber type.
Type I muscle fibers have the largest cross-sectional area over Type II fibers
Fiber types differ in level of the muscle with Type I mostly in the cephalad portion starting from L1 to L4
◦Therefore, more postural and stabilizes the lumbar spine, controls disc space anterolaterally
Type II fibers are more predominant in the caudal portion of the muscle
◦Therefore, more dynamic as main flexor of the hip
What is a method of dynamically stretching the psoas?
Stand with feet 18” apart
Flex knees and hips
Round spine, particularly lumbars
Use glut max to push pubes anteriorly
Keeping pubes anterior, extend knees, hips
Straighten spine by rotating at hip joints
Keep lordotic curve minimal
Repeat 3 more times
Describe the ‘pelvic clock’ exercise.
Naval is center of clock
Using multifides, rotatores, erector spinae, move naval to each position on clock
Do not use legs to push pelvis
Monitor via ASIS
Describe Janda’s theory of mm dysfxn.
Postural/tonic muscles become facilitated, hypertonic, shortened
Dynamic/phasic muscles become inhibited, hypotonic, weak
What is a typical pattern of mm dysfxn in the hip region?
Hip region:
weak = glut med & max
tight = iliopsoas, rectus femoris, piriformis, adductors and TFL
What other regions does hip region mm dysfxn extend into?
Extends into:
weak abdominals
tight erector spinae
What is a typical pattern of mm dysfxn in the shoulder region?
Shoulder region:
weak = supra & infra-spinatus, deltoid, rhomboids, lower traps, serratus ant.
tight = levator scapula, upper traps, pectorals
Where can shoulder region mm dysfxn extend to?
Extends into weak longus colli
Describe the patterns of weakness, mobility, and posture in lower crossed syndrome.
Weak gluteus maximus and tight hip flexors
Weak abdominals and short lumbar erector spinae
Weak gluteus medius and minimus and short tensor fascia latae and quadratus lumborum
Anterior pelvic tilt and increased lumbar lordosis
Hypermobility in the lowest lumbar levels
Describe upper crossed syndrome in terms of Muscle Imbalance Syndrome.
Describe Lower Crossed Syndrome in terms of Muscle Imbalance Syndrome.
This is the result of the lower crossed syndrome:
Anteriorly rotated pelvis
Tight erector spinae,
iliopsoas, rectus femoris
Weak abdominals, glut max & med
If pelvis is in an anterior tilt due to mm dysfxn, what do you do to put it back in a neutral tilt?
Strengthening glut max & med
Lengthens iliopsoas, rectus femoris
Engages abdominals
Causes pelvis to move into neutral tilt
What are some clinical ‘Pearls’ from Janda in terms of ordering strength training?
Janda advocated proprioceptive balance training to precede stretching or retraining.
Janda advocated that all retraining be done with the “short foot”. A short foot requires the patient to be able to shorten the foot, elevating the medial arch without curling the toes.
Dynamic and static stretching both do…?
increases the length in tendon tissues and increases joint flexibility
What is the relationship between strength training and mm stiffness?
Strength training resulted in increased muscle stiffness, which was unaffected by daily stretching.
With repeated stretches muscle stiffness declined, but returned to baseline values within 1 hour.
Increased stiffness may be associated with increased isometric and concentric force generation.
What can stretching and heat do in terms of mm stiffness and stress?
Heat increase the ROM in tissues, although heat + stretching creates the bigger increase than just heat alone
A single static stretch resulted in a 30% viscoelastic stress relaxation
With repeated stretches muscle stiffness declined, but returned to baseline values within 1 hour.
What is the relationship between stretching and injury?
There is evidence that pre-participation stretching reduces the incidence of muscle strains but…
There is basic scientific evidence to suggest that active warm-up may be protective against muscle strain injury but clinical research is equivocal on this point.
No scientifically based prescription for stretching exercises exists and no conclusive statements can be made about the relationship of stretching and athletic injuries.
What are the benefits of stretching?
Typically, specific flexibility patterns are associated with specific sports and even positions within sports. The relationship of flexibility to athletic performance is likely to be sport-dependent. Decreased flexibility has been associated with increased in-line running and walking economy.
Regular stretching increases joint ROM (mean increase in ROM = 8 degrees; 95% CI 6 degrees to 9 degrees) for more than one day after cessation of stretching and possibly that the effects of stretching are greater in muscle groups with limited extensibility.
