3-31 Lower Body Exercise Rx

Question 1

Explain the relationship between gait speed and life expectancy.

Answer 1

—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

Question 2

What stance is heel-toe gait, mostly? What can contribute to problems with it?

Answer 2

—Heel-toe gait is 80% 1-legged stance

◦Poor balance, muscle weakness contributes to falling

Question 3

How do most people stand up? What body parts & mm are used?

Answer 3

Most people lean forward and use back and neck mm to help them ‘push off’ from seat

Question 4

What is the ‘elephant feet’ technique? Why is it healthier?

Answer 4

—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

Question 5

If contralateral hip drops while standing on 1 leg, what does that indicate?

Answer 5

◦poor glut max strength

Question 6

What is indicated if weight shifts to ipsilateral side while standing on 1 leg?

Answer 6

◦poor glute strength and relying on adductors for posture

Question 7

What is static stretching?

Answer 7

—stretch is held in a challenging but comfortable position for a period of time, usually somewhere between 10 to 30 seconds

Question 8

What are the pros/cons of static stretching?

Answer 8

—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

Question 9

What is dynamic stretching?

Answer 9

—stretch is performed by moving through a challenging but comfortable range of motion repeatedly, usually 10 to 12 times.

Question 10

What are the pros/cons of dynamic stretching?

Answer 10

—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

Question 11

What is passive stretching? What can be used to assist?

Answer 11

—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

Question 12

What is a risk with passive stretching?

Answer 12

—risk that the external force will be stronger than muscle is flexible

Question 13

What is active stretching?

Answer 13

—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

Question 14

What are the pros/cons of active stretching?

Answer 14

—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

Question 15

What are toe lifts good for?

Answer 15

—Good for forefoot pronation or pes planus, plantar fasciitis, lower extremity dysfunction

Question 16

What do toe lifts actually do?

Answer 16

strengthens intrinsic mm of the foot

Question 17

How are toe lifts done?

Answer 17

—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

Question 18

If toes lift up during toe lifts, what do they indicate?

Answer 18

—Toes that lift up indicate specific muscle dysfunction

Question 19

What are the passive & active forms of the piriformis stretch?

Answer 19

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

Question 20

What is more advanced form of the passive piriformis stretch?

Answer 20

(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

Question 21

Describe 2 passive forms of hamstring stretching.

Answer 21

Question 22

What is the dynamic form of a hamstring stretch?

Answer 22

Bend hips to 90 degrees and flex knees

Keep pelvis in anterior tilt

Extend knees and push ischial tuberosities up to the ceiling

Question 23

How is the static form of the psoas stretch done?

Answer 23

Question 24

How is the active form of the psoas stretch done?

Answer 24

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.

Question 25

What is the role of muscle spindles? How do they fire or remain silent?

Answer 25

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

Question 26

What do GTOs respond to? What do they do?

Answer 26

Golgi tendon organ responds to stretch and contraction & initiates inhibitory reflex arc to prevent overloading the muscle

Question 27

How are joints stabilized?

Answer 27

Stimulating limb flexor and extensor muscles = joint stabilization

Question 28

What mm work when a joint extends, flexes, or when an ipsilateral joint moves?

Answer 28

Joint flexes, flexor contracts, extensor lengthens

Joint extends, flexor lengthens, extensor contracts

Occurs ipsilaterally & contralaterally

Ipsilateral flexor contracts, contralateral flexor lengthens

Question 29

Describe slow twitch muscles in terms of function, metabolism, vascularized, speed and makeup.

Answer 29

Slow-twitch

Function is tonic/postural

Uses oxidative metabolism

High capillary density

Twitch speed is slow

Type I myosin heavy chain (MHC) isoform

Question 30

Describe fast twitch muscles in terms of function, metabolism, vascularized, speed and makeup.

Answer 30

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

Question 31

Describe the makeup of the psoas muscle in terms of fiber type.

Answer 31

—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

Question 32

What is a method of dynamically stretching the psoas?

Answer 32

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

Question 33

Describe the ‘pelvic clock’ exercise.

Answer 33

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

Question 34

Describe Janda’s theory of mm dysfxn.

Answer 34

Postural/tonic muscles become facilitated, hypertonic, shortened

Dynamic/phasic muscles become inhibited, hypotonic, weak

Question 35

What is a typical pattern of mm dysfxn in the hip region?

Answer 35

Hip region:

weak = glut med & max

tight = iliopsoas, rectus femoris, piriformis, adductors and TFL

Question 36

What other regions does hip region mm dysfxn extend into?

Answer 36

—Extends into:

weak abdominals

tight erector spinae

Question 37

What is a typical pattern of mm dysfxn in the shoulder region?

Answer 37

Shoulder region:

weak = supra & infra-spinatus, deltoid, rhomboids, lower traps, serratus ant.

tight = levator scapula, upper traps, pectorals

Question 38

Where can shoulder region mm dysfxn extend to?

Answer 38

Extends into weak longus colli

Question 39

Describe the patterns of weakness, mobility, and posture in lower crossed syndrome.

Answer 39

—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

Question 40

Describe upper crossed syndrome in terms of Muscle Imbalance Syndrome.

Answer 40

Question 41

Describe Lower Crossed Syndrome in terms of Muscle Imbalance Syndrome.

Answer 41

This is the result of the lower crossed syndrome:

Anteriorly rotated pelvis

Tight erector spinae,

iliopsoas, rectus femoris

Weak abdominals, glut max & med

Question 42

If pelvis is in an anterior tilt due to mm dysfxn, what do you do to put it back in a neutral tilt?

Answer 42

Strengthening glut max & med

Lengthens iliopsoas, rectus femoris

Engages abdominals

Causes pelvis to move into neutral tilt

Question 43

What are some clinical ‘Pearls’ from Janda in terms of ordering strength training?

Answer 43

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.

Question 44

Dynamic and static stretching both do…?

Answer 44

increases the length in tendon tissues and increases joint flexibility

Question 45

What is the relationship between strength training and mm stiffness?

Answer 45

—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.

Question 46

What can stretching and heat do in terms of mm stiffness and stress?

Answer 46

—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.

Question 47

What is the relationship between stretching and injury?

Answer 47

—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.

Question 48

What are the benefits of stretching?

Answer 48

—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.