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Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
Muscle physiology final
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Muscle physiology final

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  • 1. Muscle and exercisephysiology
  • 2. The muscle cell is called• Myofibril• Muscle fiber• Sarcomere• Fascicle
  • 3. Lecture plan• Muscle structure• Muscle types• Exercise physiology• Types of exercise• Prescribing exercises
  • 4. Muscle fiber structure
  • 5. Structural unit of myofibril is aSarcomere
  • 6. Structure of Sarcomere
  • 7. Muscle proteins• Sarcomere proteins– Actin– Myosin– Titin– Nebulin– Tropomyosin– Troponin• Extra fiber proteins– Vinculin– Dystrophin
  • 8. Clinical significance• Myosin: Cardiomyopathy, Coeliac disease, Glutenenteropathy, Chaga’s disease• Actin: Cardiomyopathy• Troponin T: Cardiac disease, COPD• Troponin I : Renal Disease, Inflammatory muscledisease• Vinculin: Autoimmune skin and liver disease,Duchenne• Dystrophin: Muscular dystrophies• Nebulin: Nemaline Myopathy
  • 9. Muscle fiber types• Type 1 (Slow Oxidative) 50%• Type ll A (FOG) Red 35%• Type ll B (Fast Glycosylated) White15%
  • 10. Muscle physiology
  • 11. What is the difference between the musclesof a sprinter vs a long distance runner
  • 12. Types of contraction• Isometric• Eccentric• Concentric(Tension developed is most in eccentricthen isometric then concentric)
  • 13. Frank Starlings law• Force of contraction is proportional to thestretch
  • 14. LengthTension
  • 15. Define• Hyperplasia• Hypertrophy
  • 16. Exercise physiology
  • 17. What is therapeutic exercise?• Customised exercise prescribed forspecific therapeutic benefitVestibular exercises, abdominal exercises
  • 18. Types of exercises• Strength building (bulk)• Endurance building• Mobility improving (ROM)• Aerobic exercises• Relaxing (TROM)• Proprioception and balance improvingSpecial exercisesStability improving
  • 19. Examples• Strength- weight training• Endurance- repetitive exercises (cycling,jogging, swimming)• Mobility- ROM exercises, stretching• Relaxing- Yoga• Aerobic – rhythmic dance• Proprioception- Swedish ball, Theraband,inclined plane etcStabilisation- core Stabilisation
  • 20. Composite exercise programmes• Combine the benefits of all above• Grade them sequentially– Start with strength, endurance, stabilisationand ROM– Upgrade to proprioception– Relaxation last• Ensure that exercise programme iscontinued
  • 21. Which is ideal?– Structured therapeutic exercise– Playing basket ball
  • 22. Rational of exercise therapyGASS• Generalized well being and weight reductionremoves illness behaviour• Aerobic activity increases circulation andpsychological well being• Stretching of muscle and ligaments so that they canstretch with less pain• Strengthening the guy ropes and cantilevers so thatthey can bear more loadAm. Academy Neuro Surgeons
  • 23. Examples• ACL reconstruction-Goals– Improve range of movement– Strengthen the dynamic stabilisers of theknee– Improve proprioception of the reconstructedand natural ligamentsPriority=Stabilization
  • 24. ACL reconstruction• ROM: active and passive/ assistedstretching• Strengthening: increasing weights-Quads,Hams, Gastroc• Proprioceptive: wobble board, Swedishball, inclined plane, beech games
  • 25. Total shoulder replacement• ROM: active and passive/ assistedstretching• Strengthening: increasing weights-Deltoid,Spinatii, Subscap, Lats, Pecs, Trapezius• Endurance: increasing cycles for above• Proprioceptive: classical dancing• Priority=Stabilization: limiting TROM
  • 26. Designing an exercise regimeTimeIntensityaerobicstrengthenduranceproprioception
  • 27. • What is the rationale for doing exercisesfor IVDP?
  • 28. • Do you recommend Flexion or extensionexercises for IVDP?
  • 29. • Flexion exercises- Williams• Extension exercises-McKenzie, Cyriax,Maitland• Core stabilisation exercises
  • 30. Foraminalstenosis
  • 31. Guy rope Cantilever
  • 32. Prescribing exercises for low backpain• Depends on pain pattern– Fatigue endurance– Mechanical pain stabilisation– TROM pain and stiffness stretching• Depends on Pathology– Spondylolisthesis no extension– IVDP sciatic stretch
  • 33. Goals of exercise therapy in LBP• Increase stable zone• Improve mobility• Improve strength• Improve endurance (effort tolerance)• Increase proprioception (prevent injury)• Empower the patient to help himself• Prevent deconditioning
  • 34. Exercise therapy do’s and don’t’s• Avoid bending• Avoid lifting• Sleep on hard bed• Avoid pillow• Avoid 2 wheelers
  • 35. Can back pain patients bend?References• Mercer• Turek• Campbell• Apley• Bridwell et al• White et al• Frymoyer• Aebi et al• S Rengachary• Youman• Benzel E• McCullough• Harrison• Price• Davidson
  • 36. “Basic biomechanics of the musculoskeletalsystem”Frankel and Nordin; 2001
  • 37. What bed
  • 38. Lifting, lying,extensionPain avoidancebehaviour
  • 39. Pillow ?
  • 40. Exercise in low back pain• Should be tailored to the type of painpattern• And the pathology• Eg:– Effort intolerance type of pain– Spondylolisthesis
  • 41. Effort intolerance• Example: doing house work; standing forlong, sitting for long
  • 42. Extensor strengthening withoutextension• Example: extension of the spine causesimpingement of the facets- spondylolysis• Yet extensor strengthening is important forspondylolisthesis• How to achieve this?• Diagonal lifts; Dying bug exercises
  • 43. Postural LBP
  • 44. Postural back painBad posture causing back pain is besttreated by postural corrective devices (carseat back rest)YesNo
  • 45. Postural LBP• Of the chronic 80% are P.LBP• Does not mean bad posture• Means bad postural muscles• Reflects urban life style and stressfulliving
  • 46. Sagittal trunk alignment
  • 47. Postural LBPthe person• Young adult (male> female)• Obese/ asthenic• Sedentary employment• Stressful life style• Lack of physical activity• 2 wheeler travel
  • 48. Postural LBPPain pattern• Dull aching• Increased by sitting/ standingIncreased by sitting/ standing• Decreased by walking• Not aggravated by bending/ squatting• Bilateral para-spinal pain• No Radiculopathy• Normal or non-contributaryinvestigations
  • 49. Therapy• Enhance strength and ENDURANCE ofthe postural muscles
  • 50. Core stabilisation exercises• Improve pain free range of movements• Prevent recurrent injury by strength andproprioception
  • 51. Summary• Exercise therapy is not a random act ofignorance• Customised, carefully planned, scientific
  • 52. THANK YOU
  • 53. Deconditioning syndrome
  • 54. Illness behaviour

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