Upper/lower crossed syndrome & Key movement patterns Flashcards
Skeletal muscles that have higher predominance of Type I fibers (myoglobin) and are resistance to fatigue are what kind of muscles
Postural muscles
Note: they shorten and tighten when chronically stressed and/or injured
Skeletal muscles that have higher predominance of Type II fibers (myoglobin and glycogen) and used for quick movements and short bursts of activity
Phasic muscles or arms and legs
Note: They have a tendency to lengthen and weaken when chronically stressed and/or injured
What are the 4 postural trunk muscles
- Cervical and lumbar erectors
- Quadratics lumborum
- Scalenes muscles
- Sternocleidomastoid m
What are the 4 postural shoulder girdle muscles
- Pec major and minor
- Levator scapula
- Upper trapezius
- Bicep brachii
What are the 2 phasic trunk muscles
- Mid thoracic erectors
2. Longus capitus and colli
What are the 4 phasic shoulder girdle muscles
- Rhomboids
- Middle trapezius
- Lower trapezius
- Triceps brachii
Reciprocal inhibition
When a muscle contracts, its direct antagonist relaxes to an equal extent allowing smooth movement.
Why do key movement patterns (KMP)?
Observe AROM and you can see/palpate altered firing patterns within synergistic groups of muscles
Upper crossed syndrome is associated with short ______ and long ________
- Short tight postural muscles
- Long weak/inhibited phasic muscles
Upper crossed syndrome: postural/tight muscles (6)
Cervical erectors Upper traps Levator Pectorals SCM Scalenes Upper extremity flexors
Upper crossed syndrome phasic/weak/inhibited muscles (5)
Mid-thoracic erectors Mid- and lower-traps Rhomboids Serratus anterior Deep neck flexors — longus capitus and colli Upper extremity extensors
What will you see in a lateral postural evaluation for someone with upper crossed syndrome?
- Anterior head carriage
- Forward and rounded shoulders
- Internally rotated humerus
- Thoracic hyperkyphosis
- Protruding abdomen
What muscles are overactive/inhibited in anterior head carriage?
Overactive SCM
Inhibited deep neck flexors
What muscles are overactive/inhibited in forward and rounded shoulders?
Tight pectoralis major/minor
Inhibited rhomboid, serratus anterior
What muscles are overactive/inhibited in internally rotated humerus?
Tight pectoralis major/minor
Inhibited serratus anterior
What muscles are overactive/inhibited in thoracic hyperkyphosis
Facilitated T/L erectors
Inhibited gluts
What muscles are overactive/inhibited in protruding abdomen
Facilitated poses
Inhibited gluts
What are functional movement pattern evaluations for upper crossed syndrome?
Neck flexion
Trunk flexion
Shoulder abduction
Lowering from push-up with a plus
What muscles are inhibited or tight in lower crossed syndrome?
Inhibited: Glut. Max, abdominals, (glut. Med)
Tight: spots, rectus femoris, lumbar erectors, TFL, QL
What will you see in a lateral postural evaluation for someone with lower crossed syndrome?
PELVIS: A/P tilt, torsion, hiking, lateral shift
GLUT MAX: flattened upper-outer quadrant, sagging fold
ADDUCTORS: distal “notch” ipsilateral hip dysfunction
HAMSTRINGS: overactivity in distal 1/3 = inhibited glut
CALF: soleus hypertrophy
LUMBAR ERECTORS: should be > TL erectors
What are some key functional movement patterns to evaluate lower crossed syndrome?
Hip extension
Hip abduction
Trunk flexion
Do you perform key movement patterns (KMPs) on acute patients?
No
What do you evaluate before doing KMPs?
Posture and gait
How do you perform KMPs in general (4)?
- Expose area
- Give minimal verbal cues
- Pt performs 3+ trials
- Observe both sides for comparison
List 4 positive findings for hip extension
- deviations in lumbar spine
- recruitment of upper back musculature
- inability to maint knee extension
- decreased hip extension
List 5 positive findings for hip abduction
Cephalad shift of the pelvis – overactive QL Hip flexion – overactive TFL or psoas Hip ER/extension – overactive piriformis Limited abduction – tight adductors Pelvic rotation – overactive TFL
In hip abduction, what does a cephalad shift of pelvis suggest?
Overactive QL
In hip abduction, what does hip flexion suggest?
Overactive TFL or psoas
In hip abduction, what does hip ER/extension suggest?
Overactive piriformis
In hip abduction, what does limited abduction capability suggest?
Tight adductors
In hip abduction, what does pelvic rotation suggest?
Overactive TFL
In hip abduction, what does faulty patterns suggest?
Inhibited gluteus medius contraction
What are positive findings for the first part of the trunk curl-up?
Trunk flexion versus hip flexion.
WEAK ABS and OVERACTIVE ILIOPSOAS, the flexion movement of trunk is minimal and the movement will be mostly hip flexion. Tsk Tsk
Also, the back may stay straight and pelvis tilt anteriorly
+/- Heel pressure means iliopsoas is dominating
In shoulder abduction, what are abnormal patterns?
Early scapular movement (prior to 60˚) Late scapular movement (after 90˚) Winging Contralateral side bending of the trunk Bilateral assymetry
In shoulder abduction, what might early scapula motion mean? (Movement prior to 60˚ abduction)
Short/tight
- lateral scapula mm: teres, infraspinatus
- Overactive upper trap
Long/weak
- medial scapula mm: rhomboids
- lower trap
In shoulder abduction, what does late scapula motion mean? (Movement after 90˚ abduction)
Reverse.
Short/tight
- medial scapula mm: rhomboids
- lower trap
Long/weak
- lateral scapula mm: teres, infraspinatus
- upper trap
What muscles coordinate to allow upward scapular rotation? What what oppose the motion?
Upper trap
Lower trap
Serratus anterior
Opposers:
Rhomboids
Levator scapula
If upper trap and lower trap are not balanced or if serratus anterior m has portions that are shortened or weak, what will happen to scapular motion?
It’ll be atypical/aberrant because scapula isn’t adequately stabilized
What are abnormal patterns for neck flexion?
Chin protrusion
Shaking
Chin deviation
