Lecture 5 Flashcards
What is the stage approach to rehabilitation?
- Restore biomechanical integrity
- Groove motor patterns
- Strengthen
- Functional adaptation
Describe functional and structural components of assessment?
Traditional orthopaedic medicine is influenced
by a structural approach to pathology, we
can see it thus X-ray imaging, MRI, or surgery
(damage to soft tissues or bones)
functional approach which is based on
coordinated movement of the muscle in relation
to other structures and takes into account the
stabilizing roles of muscle
An example of structural and functional assessment
A structural approach - Dx by examining structures with
MRI, Ultrasound and X rays. Eg., the hooked acromion
(type III) = structural impingement by reducing the space.
ANSWER . . . . cut it off . . .
Functional impingement presents with normal X-ray
findings, but pain and weakness are typically observed
Weakness is often in the scapular stabilizers, far from the
point of pain
Tx: restoring muscle balance through specific exercises
that work not just the glenohumeral joint but the entire
shoulder complex
Please describe muscle balance?
Muscle balance is the relative equality of
muscle length or strength between an agonist
and an antagonist; it is necessary for normal
movement and function.
Muscles may become unbalanced as a result of what?
adaptation or dysfunction. Such muscle imbalances can be either functional or pathological
Pathological muscle imbalance can result in what?
impairment of function and leads to joint dysfunction and alters movement patterns, which in turn leads to
pain
Pathological muscle imbalance is caused by what?
Cause may or may not result from an initial traumatic event. Posture related?
JUST READ
Pathological muscle imbalance may also be insidious;
many people have these muscle imbalances
without pain
What are the 2 paradigms of muscle imbalance?
Biomechanical: muscle imbalance resulting
from repetitive movements and posture thus
adaptions in muscle length, strength and
stiffness
Neurological : muscles are predisposed to
become imbalanced because of their role in
motor function. Neural control unit may alter the muscle
recruitment strategy to stabilize joints
temporarily in dysfunction
This change in recruitment alters muscle
balance, movement patterns, and ultimately the
motor program
What are 3 concepts or patterns of muscles?
Static or postural muscle tighten as they are
activated more
Dynamic and phasic muscles tend to weaken
with dysfunction
Muscles are the window to the function of the
sensorimotor system as they are labile and
vulnerable structures as the most exposed part
of the neuromuscular system
Pathophysiology of muscles
Muscle imbalance often begins after injury or pathology leads to pain and inflammation.
Imbalance may also develop insidiously from alterations in proprioceptive input resulting from abnormal joint position or motion.
These two conditions lead muscles to either tighten
(hypertonicity) or weaken (inhibition), creating localized muscle imbalance. It’s the normal response of the motor system to maintain homeostasis.
Over time, this imbalance becomes centralized in the CNS as a new motor pattern, thus continuing a cycle of pain and
dysfunction.
Janda; “muscle imbalance is an expression of impaired
regulation of the neuromuscular system that is manifested as a systemic response often involving the whole body”.
Describe Janda’s upper crossed syndrome?
It is a postural syndrome NOT a diagnosis
It explains how antagonistic muscles become imbalanced
It may result in compromised posture
This may leave the patient with altered spinal and shoulder region biomechanics
It increases the risk of associate pain syndromes
One line of the cross demonstrates
hypertrophic (tight) muscle
Other line demonstrates
hypotrophic (weak) muscle
What is the definition of JANDA
“it is an adaptation to the demands imposed upon the
musculoskeletal system, as it is the posture of the deconditioned and of the office worker. It was associated
with concurrent movement dysfunction”
Assessment & Intervention
Janda; address dysfunction in all three systems (FINO)
- First reducing any joint dysfunction or nociception in order to improve the local afferentation
- Normalize muscle imbalances with manual techniques
- Improve muscle firing patterns via sensorimotor training
- Once this was accomplished, specific therapeutic exercises designed to neutralize the chronic dysfunction and improve endurance and strength could be appropriately introduced
What does pelvic tilt tell you about a patient?
Anterior tilt = lower crossed pattern
Post tilt = loss Lx lordosis, tight hamstrings
What does head forward posture tell you about a patient?
Upper crossed pattern impact
tight; levator scaps & pecs
Weak; lower trap & deep Cx flexors
What is involved in a balance assessment?
Single leg balance test
Eyes open
Eyes Closed (+ perturbation: disturbance of motion)
Hip extension movement pattern, Watch for what?
- Lx extension and ant pelvic tilt during hip extension
2. Knee flexion during hip extension
Instructions for hip extension movement patterns
• Place patient prone on the bench
• Instruct “ raise your (right or left) leg toward the
ceiling”
• Watch for ant pelvic tilt, lumbar hyperextension
or trunk rotation in the first 10° of leg raising,
knee flexion to reduce work load
• Also watch for delayed glut max activation
(lower cross issues ?)
• While performing the motion its easy to test for
glut max strength, scale of __/5
Janda’s lower crossed syndrome means what?
tight erector spinae
tight iliopsoas
weak glut max
weak abdominals
Indications for possible Tx for HIP EXTENSION PATTERNS?
• Hip mobilization
• Stretches (PIR) of the psoas, also review rectus
femoris and hamstrings
• Femoral nerve involvement, neuromobilization?
• Sensory motor training – rocker board, balance
sandals?
• “Core” stabilization
• Bridges, squats and lunges to strengthen
Hip abduction movement pattern, Watch for?
- Flex the hip further
2. QL initiated as first movement
Instructions for hip abduction movement patterns?
• Pt side lying with lower leg flexed at the hip and
knee. Pelvis perpendicular to the table
• Instruct Pt – slowly raise your leg straight up to
the ceiling
• Fail if: on initiation of motion, cephalad shift of
pelvis, thus there is QL substitution
• Fail if in first 40°: Hip flexion (TFL substitution),
Hip ER (piriformis sub), pelvic rotation (glut med
weakness), reduced abduction then adductor
tightness
• Also check muscle strength ___/5.
Instructions for Cervical flexion movement patterns?
- patient lays supine head not on pillow
- instruct to slowly raise your head up from the table to your chest
- Fails: if chin protrudes, SCM’S overactivity, shakes from effort
Target: PIR SCM’s, check upper cervical spine, cervical spine and thoracic spine junction, endurance training, functional training, review posture
