Stabilization Strategies (Exam 3) Flashcards by Dani Weinreis

Deep muscles or deeper portion of muscle. Attach directly to vertebrae. Control stiffness of spinal segments. Ineffective for control of spinal orientation. Spinal Stabilization.

Local Muscle System

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Large, superficial muscles. Do not have a direct vertebral attachment. Cross multiple spinal segments. Control spinal orientation. Balance external loads. Larger motions, balance loads.

Global Muscle System

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Support/decrease cervical lordosis. Flex occiput on the atlas. Are postulated to assist in cervical segment stability. Rich in mechanoreceptors.

Local Stabilizers (Deep Neck Flexors)

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Deep neck flexors play important role in spinal stability. Deep Neck Flexors include.

Rectus Capitus Anterior
Longus Colli
Longus Capitis

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Short flat muscle that runs from atlas to occiput. Flexes the head on the neck and stabilizes the AO joint during movement.

Rectus Capitus Anterior

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Deep Local Stabilizers (Extension) Neck

Posterior Suboccipitals
Multifidus (Main)
Interspinalis

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Have a little segmental attachments. Move head on the trunk. Tend to become overactive and tighten.

Superficial Layer Global Mobilizers

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Superficial Layer Global Mobilizers (Flexors) Neck

Anterior Scalenes
Suprahyoids
SCM

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Superficial Layer Global Mobilizers (Extensors) Neck

Erector Spinae - (Splenius Cervicus, Splenius Capitis)
Upper Fibers Trapezius (UFT)
Levator Scapulae

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Most superficial of the neck extensors (Erector Spinae Muscles). Each attach the head and cervical spine.

Splenius Capitis

Splenius Cervicis

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These muscles have no segmental attachments. Not active during return from flexion or retrusion.

Erector Spinae Muscles

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Tend to be overactive instead of shortened. Over dominant when scapular stabilizers are weak.

Upper Trapezius

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Pt’s with whiplash associated disorder (WAD) have trouble relaxing ______.

Upper Trapezius

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With forward head posture.

SCM shortens. Deep anterior cervical muscle lengthen (functionally weak). Posterior group of cervical extensors shortens.

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Sustain posture. Greater capacity for sustained work/endurance. Mostly slow-twitch fibers (Gin/Tonic).

Tonic Muscles AKA Postural

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More suited for movement. Fatigue easily. Mostly fast-twitch fibers (Beer Bong).

Phasic Muscles

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With headlamp, return head to neutral head position from various head movements with eyes open.

Training Cervical Position Sense

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Progressions with headlamp.

Eyes closed. Increase speed. Perform in standing. Perform on uneven surfaces.

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Osseous structures. Joint capsules and surfaces. Ligaments. Discs.

Passive Musculoskeletal Subsystem

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Muscles and their fascial bands.

Active Musculoskeletal Subsystem

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Neural and feedback system. Motor planning. Influenced by descending control from the CNS.

Control Subsystem

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Spinal Stability System. 3 Component Subsystems. (Three Legged Dog)

Passive Musculoskeletal SubsystemActive Musculoskeletal Subsystem
Control Subsystem

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If local muscles are inactive, _____ muscles alone are unable to stabilize spine segmentally.

Global

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Small deficiencies in one system may be compensated by the other systems.

(3 Subsystems)

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Dysfunction of one system can lead to tissue breakdown by exhausting the joint's ability to sustain loads and stresses.

(3 Subsystems)

Provides segmental stability through all 3 subsystems to match the external and internal demands on the spine.

(3 Subsystems)

Adjacent vertebrae, disc, ligaments, muscles. Each segment has up to 20 degrees of motion. Local muscles control motion at each segment.

Spinal/Intervertebral Segment

Disturbances of motion and stability at individual spinal segmental levels appear to play a role in many causes of back pain.

Spinal/Intervertebral Segment

Can result in a temporary decrease in intersegmental muscle activation. Single spinal joint to rotate far enough into the elastic zone to the point at which tissues become stressed or injured.

Motor Control Error

Spinal instability is associated with an increase in the neutral zone.

Passive Subsystem Instability

Contraindications/Precautions To Stability Training | Red Flags

Fractures, Cauda Equina, Ankylosing Spondylitis, Spinal Infection, or Metastases

Contraindications/Precautions To Stability Training | Yellow Flags

Hypermobility, Pregnancy, Joint Effusion, Inflammation, or Weak Connective Tissue

How to determine clinical instability?

Assess Passive Subsystem (Ligaments, Discs, Joint Capsule) Assess Active Subsystem (Specific Muscle Assessment)

Exercises should be selected that allow the lowest load on the spine. Low shear or compressive forces. Focus initially on local muscles. Global muscle training once local muscles are working appropriately without excessive global activation.

Stabilization Exercises

Facilitate accuracy of movement and motor control. Facilitate optimal efficient pain free functional movement. Initially focus on muscle coordination and endurance, not strength.

Goals of Stabilization Exercises

Cervical spine has a large neutral zone. Due to lack of tension in capsular and ligamentous structures. Muscular system must be recruited to control motion with in the neutral zone.

Cervical Neutral Zone

Deep (Local) Layer Segmental Stabilizers Flexors, Extensors Middle and Superficial Layers Global Stabilizers

Active Subsystem

Bowl model similar to hinge joint. The marble is the ROM of the joint. The sides of the bowl are the passive structures at end range. (End range will tear and hurt joint)

Bowl Model (Potential Energy and Stability)

Damaged passive tissue or a muscle with inappropriate force can upset this system and cause instability.

Bowl Model(Potential Energy and Stability)

The portion of intervertebral ROM where passive structures provide little resistance to movement.

Neutral Zone

Near a joints's neutral position. Joint capsule and ligaments are enough on slack to not affect motion.

Neutral Zone

From either end of the neutral zone to the physiological end of ROM. The further one goes into the elastic zone the more the joint capsule and ligaments tighten and limit motion.

Elastic Zone

ROM repeatedly getting to the end of the neutral zone can cause shear forces which can cause acute buckling or instability if forces are repeated over a prolonged period of time.

Elastic Zone

If the passive joint structures lengthen, the size of the neutral zone will increase. A greater degree of ROM can then occur without tightening of articular structures. Muscles and motor control systems must then work overtime to maintain stabiltiy. Example: Bowl, Baseball Player (Flexible but not instability)

Hypermobility

Joint structures contribute to ____ especially at and near end range.

Passive Stability

Keep joints stable through muscle activation and by placing joints in positions where passive structures protect the joint.

Motor Control Systems

Can lead to inappropriate muscle force, causing a gully and allowing the "ball to roll out" of the bowl. Joint can buckle or undergo shear translation.

Faulty Motor Control System

Occurs when there are significant decreases in the ability of the stabilizing system to maintain the neutral zone. Often due to an increase in the size of the neutral zone.

Clinical/Functional Instability

Easiest place for the most patients to learn motor skill.

DNF Contraction in Standing

DNF with back of head on wall. No superficial activity. Palpate SCM and scalene.

DNF Contraction in Standing

Designed to test the DNF's with minimal superficial muscle activity. Use a PBU.

Craniocervical Flexion Test (CCFT)

Towel roll under neck. Supine after upright position is mastered. Palpate SCM and scalenes.Tongue in roof of mouth to decrease hyoid muscle activity.

DNF Training Progression

Supine Segmental Flexion. Supine Quadrant Flexion. DNF in 4 Point Position.

DNF Progression

Nod to point of C spine neutral, then lift head off surface. Progress to 10 x 10 seconds. Watch for anterior translation of chin. Slowly lower incline to horizontal.

DNF Progression Nod-Lift Off

Perform at wall to decrease anterior translation of cervical spine. Auto-resistance (Hand). Ball-resistance (Ball Under Chin).

DNF Nod with Resistance

Add limb load after patient has ability to isolate deep muscles. Progressive Programs.

Unilateral Shoulder Flexion. Bilateral/Alternating Shoulder Flexion. Alternating UE, LE Movement.

Initially facilitate the deep cervical flexors with low intensity, high repitition exercises. Focus on endurance, not strength. Variety of positions. Facilitate the deep neck extensors. Variety of positions. Decrease facilitation of SCM and scalenes. If need be: Strengthen Lower Trapezius, Serratus Anterior, Rhomboids, Pectoralis Major.

Cervical Progression Summary

Large degree of mechanoreceptors are found in the lumbar ligaments.

Passive Subsystem

Local Stabilizers Active Subsystem (Back)

Transverse Abdominis Multifidus Quadratus Lumborum

Global Stabilizers Active Subsystem (Back)

``` External Oblique Internal Oblique Rectus Abdominis Latissimus Dorsi Gluteals ```

Acts as a corset for the lumbar vertebrae. Attaches to transverse abdominis and internal oblique. With muscle activation, acts a s proprioceptor.

Thoracolumbar Fascia

Does not stabilize spine during bending and twisting.

Hollowing

Does stabilize spine during bending and twisting.

Bracing

Performs segmental stabilization. Tonic fibers.

Multifidus

All assist in resisting stress and transmitting forces from one area of the torso to another. All can contribute to stability. Especially in active populations.

Abdominal Wall

Signs of problems with passive structures.

Painful arc during flexion/extension. Gower's Sign Aberrant motion during flexion.

Right Side Bending

Males 95 seconds. Females 75 seconds.

Flexion

Males 135 seconds. Females 134 seconds.

Extension

Males 161 seconds. Females 185 seconds.

Local Muscle Progression (Back)

Isolate contractions. Train local muscles in antigravity positions to provide segmental stability, without additional loads. Patients should be able to breathe normally.

MgGill's Big Three Exercises (Ensure stabilizing patterns are being developed and minimal loading occurs).

Curl-Up Bird-Dog Side Plank