Flexibility and Core Stability Flashcards
define instability
excessive range of movement which there is no protective muscular control
what scales do we use for hyper-mobility ? what is it scored out of?
beighton scale
out of 9
mechanical instability
disruption of the passive stabilizers and decreased structural integrity
functional instability
lack of neuromuscular control of the joint during activities
what makes up Panjabi’s spinal stability system
passive subsystem (spinal column) active subsystem (spinal muscles) control subsystem (neural )
causes of hypermobility
can be traumatic or non -traumatic (genetic, adjacent hypomobility, habitual movements
explain the treatment process for hypermobility
1) mobilized hypomobile tissues or joints (manuel therapy, massage, IMS, stretching)
2) activate & strengthen to stabilize the hypermobile/unstable area
3) control excessive movement
4) facilitate co-contraction of muscles surrounding the joint
5) provide feedback & focus on quality
Other aspects of treatment of hypermobility
movement re-education & motor control
postural training
patient education
supportive devices
what are the purposes of bracing/taping?
restrictive of movement
proprioceptive - tells joint where it is in space
precautions to hyper mobility treatment
ensure patient has adequate control when exercises are performed
monitor fatigue of dynamic stabilizing muscles
educate patient to monitor control & precision of movement
define neutral zone
small range near neutral position of every joint where there is minimal resistance provided by the passive system
increase with injury
what are some inner unit muscles?
TA, multifidus, pelvic floor, diaphragm
segmental control
which unit controls during strengthening first
always inner unit
what does the outer unit consist of
anterior oblique sling
posterior oblique sling
lateral sling
what makes up the anterior oblique sling?
internal and external obliques, abdominal fascia & contralateral adductors
what makes up the posterior oblique sling?
latissimus dorsi, contralateral glut max & biceps femoris
what makes up the lateral sling?
glute med & min and contralateral adductors
where can you find TA to palpate
2.5 cm medial to ASIS
describe some characteristics of TA
anticipatory not direction specific active continuously inhibited by pain / fear not affected by cognitive processes
what works with TA?
pelvic floor muscles
active in lifting
what are some recruitment strategies
position (supine,prone, sidelying)
palpation
verbal cues
visualisation and imagery
explain how to use the PFM
patient supine knees bent relax butt and thighs palpate TA contract PFM note the ability to recruit & holding time
what is the rationale for using the SLR
test for failed load transfer through lumbopelvic region , positive test means failed load transfer
what should we look for in the ASLR
note: ability to ASLR 5 cm pelvic tilting or rotation muscle fasciculation any symptoms get PT to contract TA any difference? compare side to side
describe exercise prescription for inner unit
prolonged static hold
low load
25% max voluntary contraction
10 sec holds 10 reps
how can we progress this exercise prescription?
increase holding time & reps add simple leg movements add simple arm movements combine arm and leg movements stable -unstable base
Most important Goal of exercise prescription
focus should be on local control of the inner unit should be achieved prior to global stabilization
define hypo-mobility
decreased ROM, mild muscle shortening - irreversible contractures
what are the factors that contribute to hypomobility
prolonged immobilization
- extrinsic/intrinsic factors
- postural faults
- habitual faults
- paralysis & tonal abnormalities
- aging
define contracture
adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch & limitation of ROM
list out the types of contracture
myostatic pseudomyostatic arthrogenic periarticular fibrotic
explain what relative flexibility is
stiffness in one muscle group that causes another part of the body to compensate for that lack of movement
what happens when you immobilize muscle?
decreased muscle fibre cross-sectional area
decreased number of myofibrils in a muscle fibre
decreased motor unit recruitment
muscle atrophy & weakness
what happens when the muscle is immobilization in a shortened position
decreased number of sacormeres muscle shortening increased atrophy length-tension curve shifts LEFT have stretch weakness
what happens when the muscle is immobilized in a lengthened position
increased number of sarcomeres
decreased atrophy
length tension curve shifts right
adaptive shortening
stretch weakness
weakness in mid and inner range
what happens to tendon post immobilization
decreased tensile strength
what happens with ligaments post immobilization
decreased tensile strength
adhesions and stiffness
bony resorption at entheses
what happens to articular cartilage post immobilization
decreased lubrication
softening and fragmentation
what happens to bone post immobilization
decrease bone mass and bone mineral content
possible events that happen to our flexibility when we age
connective tissue tensile strength decreases
decreased elasticity
increased adhesions
what are the 3 categories we need to think about that could be limiting movement
myofascial
articular/periarticular
dural
define creep
increased length of the tissue as it becomes warmer
stress relaxation
slow application of force will allow the tissue to move farther into its range
indications for stretching
limited ROM due to loss of soft tissue extensibility
restricted motion that may lead to structural deformities that are otherwise preventable
presence of muscle weakness & shortening in opposing tissues
part of pre-hab maintenance program
enhance performance
what are some key considerations for stretching?
does lack of muscular flexibility contribute to their dysfunction?
is there less than normal ROM noted on muscle length/flexibility testing?
is there an appropriate (muscular) end feel?
What are the contraindications for stretching
bony end feel acute inflammation/active infection recent fracture/bony union incomplete hematoma specific surgeries shortened tissue enables functional skills that otherwise are not possible
precautions for stretching
recent corticosteroid injection
joint effusion & edematous tissue
osteoporosis & long term steroid use
newly united fracture
frail elderly
avoid vigorous stretching of recently immobilized tissues
when you are prescribing stretching exercises make sure you think about :
alignment stabilization intensity (tightness or slight discomfort) duration frequency speed of stretch (slowly applied, dynamic, ballistic) mode of stretch integrate function with stretching
What should be the volume per session/week/days per week
better increased time per session (60 seconds vs 60-120 s vs >120 s
time -5-10 mins & >10 min
More times a week the better
reasonable stretching guildeline for clinical populations
slowly applied, low intensity total dose >120 sec - 30-60 sec -2-4 reps at least once daily 6 days per week better
active strategies of stretching
PNF
dynamic
muscle energy
eccentric exercise
passive strategies of stretching
static stretch/self stretch
partner stretching
manual methods
mechanical
when would u use mechanical stretching
chronic contractures
low load, long duration
Continuous passive motion (serial casting)
What are some adjunctive agents for stretching
active warm-up heat massage/ soft tissue techniques biofeedback & relaxation training joint traction /mobs ice/cold
describe a muscle imbalance
certain muscles can be facilitated/overactive & inhibited/under active
what can these muscle imbalances create
change in recruitment patterns
strength
length
when the muscle is in a normal range where is it strongest
mid range
what happens when a muscle is habitually shortened/lengthened muscle
tests strongest in a position closest to inner range or if lengthened outer range
what are some sources for muscle imbalance?
injury/trauma muscle inhibition due to pain/inflammation
disease
repetitive stress
postural habits
explain the price the body has to pay for muscle imbalances
altered joint motion& movement patterns
dysfunctional movement
tissue breakdown
pain
tonic muscle
always on
ex multifidus
phasic muscle
turns on and off when needed
biceps
local stabilizer muscle
close to the joint single joint stability tonic non-direction specific anticipatory
dysfunction of local stabilizers
atrophy
phasic
inhibition
global stabilizer muscle
single joint stability & angular motion tonic decelerative direction specific
dysfunction of global stabilizer muscles
inhibition
atrophy
lengthen
phasic
global mobilizer
multi-joint
phasic
accelerative
creates movement
dysfunction of global mobilizer
hypertrophy
shorten
tonic
what direction should we test muscle length
take the muscle in the opposite direction that it would contract
one end is fixed while insertion moves passively
considerations for muscle length testing
dont do if patient has acute pain
dont put in contraindicated positions
watch for cheats to move in the least amount of resistance
how do we correct muscle imbalances
1) inhibit the overactive muscles
2) lengthen short overactive muscles
3) activate weak under active muscles
4) integrate into function
