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Muscle physiology final


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Muscle physiology final

  1. 1. Muscle and exercisephysiology
  2. 2. The muscle cell is called• Myofibril• Muscle fiber• Sarcomere• Fascicle
  3. 3. Lecture plan• Muscle structure• Muscle types• Exercise physiology• Types of exercise• Prescribing exercises
  4. 4. Muscle fiber structure
  5. 5. Structural unit of myofibril is aSarcomere
  6. 6. Structure of Sarcomere
  7. 7. Muscle proteins• Sarcomere proteins– Actin– Myosin– Titin– Nebulin– Tropomyosin– Troponin• Extra fiber proteins– Vinculin– Dystrophin
  8. 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. 9. Muscle fiber types• Type 1 (Slow Oxidative) 50%• Type ll A (FOG) Red 35%• Type ll B (Fast Glycosylated) White15%
  10. 10. Muscle physiology
  11. 11. What is the difference between the musclesof a sprinter vs a long distance runner
  12. 12. Types of contraction• Isometric• Eccentric• Concentric(Tension developed is most in eccentricthen isometric then concentric)
  13. 13. Frank Starlings law• Force of contraction is proportional to thestretch
  14. 14. LengthTension
  15. 15. Define• Hyperplasia• Hypertrophy
  16. 16. Exercise physiology
  17. 17. What is therapeutic exercise?• Customised exercise prescribed forspecific therapeutic benefitVestibular exercises, abdominal exercises
  18. 18. Types of exercises• Strength building (bulk)• Endurance building• Mobility improving (ROM)• Aerobic exercises• Relaxing (TROM)• Proprioception and balance improvingSpecial exercisesStability improving
  19. 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. 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. 21. Which is ideal?– Structured therapeutic exercise– Playing basket ball
  22. 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. 23. Examples• ACL reconstruction-Goals– Improve range of movement– Strengthen the dynamic stabilisers of theknee– Improve proprioception of the reconstructedand natural ligamentsPriority=Stabilization
  24. 24. ACL reconstruction• ROM: active and passive/ assistedstretching• Strengthening: increasing weights-Quads,Hams, Gastroc• Proprioceptive: wobble board, Swedishball, inclined plane, beech games
  25. 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. 26. Designing an exercise regimeTimeIntensityaerobicstrengthenduranceproprioception
  27. 27. • What is the rationale for doing exercisesfor IVDP?
  28. 28. • Do you recommend Flexion or extensionexercises for IVDP?
  29. 29. • Flexion exercises- Williams• Extension exercises-McKenzie, Cyriax,Maitland• Core stabilisation exercises
  30. 30. Foraminalstenosis
  31. 31. Guy rope Cantilever
  32. 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. 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. 34. Exercise therapy do’s and don’t’s• Avoid bending• Avoid lifting• Sleep on hard bed• Avoid pillow• Avoid 2 wheelers
  35. 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. 36. “Basic biomechanics of the musculoskeletalsystem”Frankel and Nordin; 2001
  37. 37. What bed
  38. 38. Lifting, lying,extensionPain avoidancebehaviour
  39. 39. Pillow ?
  40. 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. 41. Effort intolerance• Example: doing house work; standing forlong, sitting for long
  42. 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. 43. Postural LBP
  44. 44. Postural back painBad posture causing back pain is besttreated by postural corrective devices (carseat back rest)YesNo
  45. 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. 46. Sagittal trunk alignment
  47. 47. Postural LBPthe person• Young adult (male> female)• Obese/ asthenic• Sedentary employment• Stressful life style• Lack of physical activity• 2 wheeler travel
  48. 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. 49. Therapy• Enhance strength and ENDURANCE ofthe postural muscles
  50. 50. Core stabilisation exercises• Improve pain free range of movements• Prevent recurrent injury by strength andproprioception
  51. 51. Summary• Exercise therapy is not a random act ofignorance• Customised, carefully planned, scientific
  52. 52. THANK YOU
  53. 53. Deconditioning syndrome
  54. 54. Illness behaviour