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OS IV Exam II SG > Review: Muscle Imbalance > Flashcards

Review: Muscle Imbalance Flashcards

1
Q

The property of skeleton structures that employ continuous tension members and discontinuous compression members in such a way that each member operates with maximum efficiency and economy; explains how forces are dispersed through the body diffusely

A

Tensegrity

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2
Q

Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with rounded shoulders and anterior pelvic tilt?

A

Hypertonic pectorals

Hypertonic quadriceps, QLs, and iliopsoas

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3
Q

Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with posterior pelvic tilt?

A

Hypertonic iliopsoas and piriformis

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4
Q

Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with rounded shoulders and posterior pelvic tilt?

A

Hypertonic pectorals

Hypertonic iliopsoas and piriformis

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5
Q

3 planes associated with postural decompensation

A

Coronal plane — scoliotic changes

Horizontal plane — rotational changes

Sagittal plane — kyphotic and/or lorditic changes

[postural change in one plane modifies posture in other 2 planes]

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6
Q

Risk factors for muscle imbalance and/or postural decompensation

A

Gravitational strain

Congenital (pelvic tilt, short leg syndrome, scoliosis)

Altered proprioceptive input (trauma, sedentery lifestyle, poor exercise technique, muscle weakness)

Stress: emotional and physical

Hormonal imbalances/changes

Nutritional deficiencies

Aging — metabolic chnages

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7
Q

Biomechanical/pathophysiologic effects of gravitational strain

A

Accentuation of postural curves

Stress on postural soft tissues

Reflex muscle imbalance

Reduced diaphragmatic functions

Usual presenting symptoms are musculoskeletal

Over time can lead to multiple systemic symptoms

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8
Q

Sherrington’s law

A

When a muscle receives a nerve impulse to contract, its antagonists receive (simultaneously) an impulse to relax

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9
Q

Effects of pseudoparesis on postural muscles vs. movement muscles

A

Postural muscles — facilitation, shortening, hypertonicity

Movement muscles — inhibited, stretched, hypotonicity

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10
Q

Compensatory patterns in postural pseudoparesis

A

Common compensatory pattern (80% of people) = L/R/L/R

Uncommon compensatory pattern (20% of people) = R/L/R/L

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11
Q

Lower crossed syndrome involves the hip, pelvis, and low back. Associated with tight erector spinae, inhibited gluteals, weak abdominals, and tight iliopsoas. What are signs/sx of lower crossed syndrome?

A

Increased sacral flexion between ilia

Increased lumbar lordosis (increased loading of facet joints)

Increased flexion of the hip and knees — altered loading characteristics

Hypermobility in the sagittal and coronal planes in the L4-5, L5-S1 levels

Sitting up from supine and forward bending are dysfunctional

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12
Q

Hypertonic vs. hypotonic muscles in lower crossed syndrome

A

Hypertonic: iliopsoas, quadratus lumborum, TFL, hamstrings, rectus femoris, piriformis, adductors, gastrocnemius, soleus

Hypotonic: gluteals, abdominals, vastus medialis, anterior tibialis, peroneals

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13
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Inability to stand straight — knee(s) flexed; L1-2 SD; pain referral to back and groin

Positive thomas test

A

Iliopsoas

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14
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Pain referral to groin and hip

exhalation 12th rib SD

Diaphragm restriction

A

Quadratus lumborum

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15
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Pain sitting or walking

Pain disturbs sleep

Pain referral to posterior thighs; limited straight leg raise

A

Hamstrings

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16
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Pain down posterior thigh

May entrap sciatic n.; Perpetuated by SI dysfunction

Associated with pelvic floor dysfunction, dyspareunia, prostadynia

A

Piriformis

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17
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Pain referred to inguinal ligament, inner thigh and medial knee

A

Adductors

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18
Q

What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:

Nocturnal leg cramps; pain referral to upper calf, instep, and heel

A

GastrocSoleus complex

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19
Q

Symptoms and PE findings associated with inhibition of gluteal muscles

A

Gluteus minimus: pain when arising from a chair; pain referral to butock, lateral and/or posterior thigh, “pseudosciatica”, antalgic gait, +Trendelenberg

Gluteus medius: pain with walking; pain referred to posterior iliac crests and SI joints; +Trendelenberg

Gluteus maximus: restlessness; pain sitting or walking up hill; antalgic gait

20
Q

Symptoms and PE findings associated with inhibition of vastus medialis, rectus abdominis, and tibialis anterior muscles

A

Vastus medialis: buckling knee, weakness going up stairs, thigh and knee pain; chondromalacia patellae

Rectus abdominis: increased lordosis; constipation

Tibialis anterior: pain referral to the great toe and anteromedial ankle; foot may drag or trip when tired

21
Q

5 models dx of postural decompensation

A

Biomechanical: postural visual inspection and gait analysis; ROM testing

Neuro: balance and strength testing

Resp/circ: zinks patterns, lymphatic palpatory exam

Metabolic and behavior: H and P

22
Q

Common diagnoses related to lower crossed syndrome

A 
Chronic LBP
Sacroiliac pain
Osteoarthritis L-spine
Spondylolisthesis
Osteoarthritis hips/knees
23
Q

Self-locking mechanism is critical for resistance against shear and is a result of form closure and force closure. What is the difference between form and force closure?

A

Form closure — due to how joint fits together

Force closure — due to gravity and loading forces (muscles, fascia, ligaments)

24
Q

With the sacrum as the “keystone”, postural muscles may affect SI joint stability. What muscles are associated with the SI joints posteriorly and ventrally?

A

Posteriorly: Lats, thoracolumbar fascia, gluteus maximus, and ITB

Ventrally: abdominal obliques, linea alba, and transverse abdominals

25
Q

3 Medial compression points applied in pseudoparesis perception test

A

The iliac crests (multifidus, lat dorsi, levator scapulae, lumbar vertebrae, lumbosacral junction)

Midway between iliac crests and greater trochanters (gluteals, SI joints, sacrum, innominate)

The greater trochanters (pelvic diaphragm, hamstrings, STL, and structures below the pelvic diaphragm)

26
Q

Interpretation of pseudoparesis perception test with SI joint stabilization

A

In a balanced system, there will be no signs of pseudoparesis

In an unbalance system, external stabilization is necessary to eradicate the signs of pseudoparesis

27
Q

What should the firing pattern be for LE extension?

A
  1. Ipsilateral hamstring
  2. Ipsilateral glut max
  3. Contralateral e.spinae
  4. Ipsilateral e.spinae
28
Q

What should the firing pattern be for LE abduction?

A
  1. Ipsilateral glut medius
  2. Ipsilateral TFL
  3. Ipsilateral QL
  4. Ipsilateral e.spinae
29
Q

A 26 y/o male presents to your office w/ complaints of lower back pain after a triathalon. PE reveals left hip flexors with 4/5 strength. All other neurologic findings are negative. Which of the following diagnostic findings confirms pseudoparesis common to a lower crossed syndrome?

A. Left paracentral disc herniation at L3
B. Left torsion on a left oblique axis
C. Left hypertonic rectus femoris
D. L3-5 N RL SR
E. Left hypertonic QL
A

C. Left hypertonic rectus femoris

30
Q

Signs of upper crossed syndrome

A

Forward head posture

Increased lordosis of upper and mid C-spine

Increased kyphosis at cervicothoracic junction

Protraction of shoulders

Internal rotation of humerus

Tends to stress C4-5, cervicocranial and cervicothoracic junctions

31
Q

Hypertonic vs. weak muscles in shoulder region pseudoparesis

A

Hypertonic postural mm: levator, upper trap, pectorals, lats, SCM, scalenes, subscapularis, UE flexors

Weak movement muscles: deep neck flexors, serratus anterior, deltoid, UE extensors, rhomboids, supraspinatus, infraspinatus, mid and lower trap

32
Q

5 models treatment plan for muscle imbalance

A

Biomechanical: protect osteoarticular system and reduce strain placed on joint capsules and ligaments by restoring ROM

Neuro: Restore neurologic balance by addressing SD induced pseudoparesis

Resp/circ: optimize fluid flow

Metabolic: improve functional capacity with OMT, proper nutrition, hydration, sleep

Behavioral: empower pts with responsibility by giving them specific exercise Rx

33
Q

One study of a hamstring stretching protocol found greatest improvement during initial ____ weeks, but still improving at ___ weeks

A

8; 12

34
Q

How long to hold stretches

A

Either 10s for 9 reps or 30s for 3 reps

[total stretch time of 90s; in this study, each group stretched 6d/week x6weeks]

35
Q

Exercise Rx for stretching in general

A

Perform exercises 2-3x on each side, 2-3x/day

Stretch each side for 12 seconds or 3 deep breaths, unless otherwise prescribed

Once feeling of stretch is no longer appreciated, you can cut down on frequency (must re-asses every week)

36
Q

Exercise Rx for retraining

A

Perform after stretching 2-3x/day

37
Q

Cervical flexion test and positive vs. negative result

A

Supine pt instructed to “flex chin to chest”

Positive test = immediate recruitment of SCM and scalenes with absence of chin nod

Negative test = longus colli activation causes chin nod with SCM and scalenes firing late

38
Q

What does a positive cervical flexion test indicate?

A

Facilitated SCM and scalenes

Inhibition of the deep neck flexors (longus colli)

Substitution by the SCM and scalene muscles

39
Q

Scapular stabilization test

A

Patient in table-top position and lifts one hand from table causing other arm to support all upper body weight

Positive test = scapula on weight bearing UE protrudes away from body —indicates weakness of lower trap, serratus anterior, and rhomboids

40
Q

Negative vs. positive bilateral shoulder flexion test

A

Negative: allows full overhead flexion of b/l UEs at shoulders with minimal influence on thoracic and lumbar spine

Positive: U/l or b/l restriction of overhead flexion with noticeable influence on T and L spine

41
Q

CS position for scalenes

A

F St Rt

42
Q

Levator scapulae CS

A

Grasp pts ipsilateral wrist and extend arm and place under traction or compression, depending on which one relieves TP

Hold x90 seconds

43
Q

Levator scapulae “still-ish” technique

A

Abduction of UE to 180 degrees

Distraction, adduction to 90 degrees and finally to 0 degrees

Hold to back of chair, flex head to opposite knee

3 deep breaths and follow fascial release

44
Q

SCM counterstrain

A

F St Ra

45
Q

CS positions for AC1-8

A

AC-1 = RA

AC2-6 = F SaRa

AC7 = F St Ra

AC8 = F SaRa

46
Q

Pectorals counterstrain

A

Adduct arm across midline

OS IV Exam II SG (21 decks)

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