SlideShare a Scribd company logo
1 of 32
Download to read offline
Patterns of function and
dysfunction
Radhika Chintamani, MPT, COMT,
Assistant Professor
KIMSDU-Karad-MAHARASHTRA
Contents
• Definitions
• Concepts of movements dysfunctions
• Fascia and its properties
• Postural Fascial Pattern
• Biomechanical Laws
• Clinical classifications of patterns
• Functional evaluation of fascial postural patterns
• Evaluation of musculoskeletal dysfunctions
Definitions
• Dysfunction: According to Mckenzie it can be defined as shortened
tissues are mechanically deformed by overstretching at end range.
• Pattern dysfunction: In pattern dysfunction, a particular pattern is
affected where while performing certain pattern of motions causes
pain.
• Movement dysfunction: painful movements. Example: Painful arc
syndrome.
• Dysfunction: According to Mckenzie it can be defined as shortened
tissues are mechanically deformed by overstretching at end range.
• Pattern dysfunction: In pattern dysfunction, a particular pattern is
affected where while performing certain pattern of motions causes
pain.
• Movement dysfunction: painful movements. Example: Painful arc
syndrome.
Postural evaluation grid: it’s a
grid placed or mounted on the
wall, which has a capacity of
evaluating antero-posterior aspect
of posture, showing the relative
positions of the landmarks, and
also comparing the bilateral
relative heights of each landmark
Functional restriction grid: it is
same as posture evaluation grid,
but here joints are evaluated for
their range of motion, and also to
compare with opposite side of the
extremity, and also spine can be
evaluated here.
Postural evaluation grid: it’s a
grid placed or mounted on the
wall, which has a capacity of
evaluating antero-posterior aspect
of posture, showing the relative
positions of the landmarks, and
also comparing the bilateral
relative heights of each landmark
Functional restriction grid: it is
same as posture evaluation grid,
but here joints are evaluated for
their range of motion, and also to
compare with opposite side of the
extremity, and also spine can be
evaluated here.
Introduction to musculoskeletal dysfunction:
• Musculoskeletal dysfunction according to WHO consists of
Pain and Fatigue, where Pain is the primary problem for
consulting to a local doctor.
Concepts of Movement Dysfunction
1. Sadman’s concept of role of emotions in musculoskeletal
dysfunctions:
S:S Sadman:Stress
He postulated three theories on the concept as follows
A..StressPoor posture
Slouched forward tissue
extensibility disorder retards
circulatory efficiency
maintained poor posture
accumulation of lactic acid
spasm leading to pain
movement dysfunction.
B..Stress-> sustained metabolic activity increase in neural hyper-
reactivity of muscle reflex vasoconstriction local tenderness
and referred pain musculoskeletal dysfunction.
C..Relative oxygen lack decreased energy supply to the muscle
still performing continues work energy deficient muscle
contraction accumulation of lactic acid as it is formed as a
waste product during the contraction and also, due to reduced
blood flow which is necessary for washing out of the lactic acid
from the muscle spam leading to paindysfunction.
If at this point muscle is stretched(passively or actively),
application of pressure and vibration techniques, leads to increase
in the blood supply, and increase in the distance between actin
and myosin leading to decrease in contraction of the muscle.
2. Latey’s concept: he uses analogy of clenched fist.
The clenched fist determines the fixity, rigidity, over-contracted muscle,
emotional turmoil, withdrawal from communication and so on.
Unclenching the fist correlates with physiological relaxation.
The main theory of clenching and unclenching the fist was: Failure to
express emotion results in suppression of activity and, ultimately, chronic
contraction of the muscles which would have been used, were these
emotions (e.g. rage, fear, anger, joy, frustration, sorrow) expressed.
Latey points out that all areas of the body producing sensations which
arouse emotional excitement may have their blood supply reduced by
muscular contraction.
3. Korr’s orchestered movement concept: the complex
interrelationships between the soft tissues, the muscles, fascia
and tendons and the neural reporting stations, which controls the
tone, and the movement rythmicity, involves the complex
balanced orchestration of the contractions and relaxation of
many muscles.
4. Proprioceptive model of dysfunction: When proprioceptors send
conflicting information there may be simultaneous contraction of the
antagonists, without antagonist muscle inhibition. Strains of joints and
other structures around joints results in reflex pattern which causes
muscle or other tissue to maintain this continuing strain. This strain
dysfunction often relates to inappropriate signaling from muscle
proprioceptors that have been strained from rapid change that does not
allow proper adaptation.
5. Van Buskirks Nociceptive model:
Nociceptors on skin gets activated by minor trauma
 
Transmission of impulses to the other nociceptive axons, and spinal cord
 
Vasodilatation and gathering of immune cells under the injury site
 
Muscular responses involving local or multisegmental changes: shortening of the injured muscle via
synergistic or self-generated action from non-injured fibres/undergoing spasm.
 
Direct mechanical restriction of the affected muscles derives from vasodilatation which, along with
chemicals associated with tissue injury (bradykinin, histamine, serotonin, etc.) causes stimulation
of local nociceptors in the muscle associated with the original trauma, or those reflexively
influenced
 
A new defensive muscular arrangement will develop which will cause imbalance and a shortening of
the muscles involved. These will not be held at their maximal degree of shortening nor in their
previously neutral position.
 
Additional pain and fatigue.
 
Abnormal joint position resulting from defensive muscular activity, commencing when this defensive
posture is sustained for a longer time.
5. Van Buskirks Nociceptive model:
Nociceptors on skin gets activated by minor trauma
 
Transmission of impulses to the other nociceptive axons, and spinal cord
 
Vasodilatation and gathering of immune cells under the injury site
 
Muscular responses involving local or multisegmental changes: shortening of the injured muscle via
synergistic or self-generated action from non-injured fibres/undergoing spasm.
 
Direct mechanical restriction of the affected muscles derives from vasodilatation which, along with
chemicals associated with tissue injury (bradykinin, histamine, serotonin, etc.) causes stimulation
of local nociceptors in the muscle associated with the original trauma, or those reflexively
influenced
 
A new defensive muscular arrangement will develop which will cause imbalance and a shortening of
the muscles involved. These will not be held at their maximal degree of shortening nor in their
previously neutral position.
 
Additional pain and fatigue.
 
Abnormal joint position resulting from defensive muscular activity, commencing when this defensive
posture is sustained for a longer time.
6. Janda’s primary and secondary responses:
• Any symptom has both local and general affect on the human
body.
Eg: Knee pain in osteoarthritis
Intitially contributes to severe local knee pain on weight bearing and
movement
Change in the line of gravity of the knee joint from centre of the knee
joint to passing through the lateral aspect of knee joint in OA which
is modified by patient due to avoidance of weight bearing on the
medial aspect of the knee joint due to pain
Development of Bow leg deformity due to change of LOG: Further it
leads to knee deformity if left untreated
which further causes back pain due to altered weight bearing strategy.
6. Janda’s primary and secondary responses:
• Any symptom has both local and general affect on the human
body.
Eg: Knee pain in osteoarthritis
Intitially contributes to severe local knee pain on weight bearing and
movement
Change in the line of gravity of the knee joint from centre of the knee
joint to passing through the lateral aspect of knee joint in OA which
is modified by patient due to avoidance of weight bearing on the
medial aspect of the knee joint due to pain
Development of Bow leg deformity due to change of LOG: Further it
leads to knee deformity if left untreated
which further causes back pain due to altered weight bearing strategy.
Fascia and its properties**
Fascia is a single structure,
repercussions of it in the human
body is difficult. Fascial divisions
within the cranium, the tentorium
cerebelli and falx cerebri which are
commonly warped during birthing
difficulties (too long or too short a
time in the birth canal, forceps
delivery, etc.) and which are noted
in craniosacral therapy as affecting
total body mechanics via their
influence on fascia (and therefore
the musculature) throughout the
body (Brookes 1984).
Fascia is a single structure,
repercussions of it in the human
body is difficult. Fascial divisions
within the cranium, the tentorium
cerebelli and falx cerebri which are
commonly warped during birthing
difficulties (too long or too short a
time in the birth canal, forceps
delivery, etc.) and which are noted
in craniosacral therapy as affecting
total body mechanics via their
influence on fascia (and therefore
the musculature) throughout the
body (Brookes 1984).
• According to Rolf,
• Any degree of degeneration however minor, changes the bulk of
the fascia. This modifies its thickness and draws it into ridges in
areas overlying deeper tensions and rigidities. Conversely, as this
elastic envelope is stretched, manipulative mechanical energy is
added to it, and the fascial colloid becomes more ‘sol’ and less
‘gel’; meaning the fascia gets solidified. Solidification of the fascia
leads to shortening or lengthening of the muscles leading to posture
mal-alignment. Once this extra energy is released: the fascia attains
its flexible nature and the posture is aligned back to normal.
• According to Rolf,
• Any degree of degeneration however minor, changes the bulk of
the fascia. This modifies its thickness and draws it into ridges in
areas overlying deeper tensions and rigidities. Conversely, as this
elastic envelope is stretched, manipulative mechanical energy is
added to it, and the fascial colloid becomes more ‘sol’ and less
‘gel’; meaning the fascia gets solidified. Solidification of the fascia
leads to shortening or lengthening of the muscles leading to posture
mal-alignment. Once this extra energy is released: the fascia attains
its flexible nature and the posture is aligned back to normal.
Cathie 1974 suggests that Fascia:
• Is richly endowed with nerve endings.
• Has the ability to contract and relax elastically.
• Provides extensive muscular attachments.
• Supports and stabilises all structures, so enhancing postural balance.
• Is vitally involved in all aspects of movement.
• Assists in circulatory economy, especially of venous and lymphatic
fluids.
• Will demonstrate changes preceding many chronic degenerative diseases.
• Will frequently be associated with chronic passive tissue congestion
when such changes occur.
Cathie 1974 suggests that Fascia:
• Is richly endowed with nerve endings.
• Has the ability to contract and relax elastically.
• Provides extensive muscular attachments.
• Supports and stabilises all structures, so enhancing postural balance.
• Is vitally involved in all aspects of movement.
• Assists in circulatory economy, especially of venous and lymphatic
fluids.
• Will demonstrate changes preceding many chronic degenerative diseases.
• Will frequently be associated with chronic passive tissue congestion
when such changes occur.
• Will form specialized ‘stress bands’ in response to the load demanded of it.
• Commonly produces a pain of a burning nature in response to sudden stress-
trauma.
• Is a major arena of many inflammatory processes.
• Is the tissue which surrounds the CNS.
 Cathie also points out that many ‘trigger’ spots correspond to sites where
nerves pierce fascial investments. Stress on the fascia can be seen to result
from faulty muscular patterns of use, altered bony relationships, altered
visceral position and postural imbalance, whether of a sustained nature or
violently induced by trauma.
• Will form specialized ‘stress bands’ in response to the load demanded of it.
• Commonly produces a pain of a burning nature in response to sudden stress-
trauma.
• Is a major arena of many inflammatory processes.
• Is the tissue which surrounds the CNS.
 Cathie also points out that many ‘trigger’ spots correspond to sites where
nerves pierce fascial investments. Stress on the fascia can be seen to result
from faulty muscular patterns of use, altered bony relationships, altered
visceral position and postural imbalance, whether of a sustained nature or
violently induced by trauma.
• Fascia and posture: The specialised fascial structures – plantar,
iliotibial, lumbodorsal, cervical and cranial – stabilise the body and
permit an easier maintenance of the upright position, and these are
among the first to show signs of change in response to postural
defects.
• Cisler (1994) summarises the commonest factors which produce
fascial stress as:
• Faulty muscular activity.
• Altered position of fascia in response to osseous changes.
• Changes in visceral position (ptosis).
• Sudden or gradual alterations in vertebral mechanics.
• Fascia and posture: The specialised fascial structures – plantar,
iliotibial, lumbodorsal, cervical and cranial – stabilise the body and
permit an easier maintenance of the upright position, and these are
among the first to show signs of change in response to postural
defects.
• Cisler (1994) summarises the commonest factors which produce
fascial stress as:
• Faulty muscular activity.
• Altered position of fascia in response to osseous changes.
• Changes in visceral position (ptosis).
• Sudden or gradual alterations in vertebral mechanics.
Postural Fascial Pattern
• Zink & Lawson (1979) have described patterns of postural patterning
determined by fascial compensation and decompensation.
1. Fascial compensation: commonly involve useful, beneficial, and above all
functional adaptations (i.e. no obvious symptoms emerge) on the part of the
musculoskeletal system. Compensation offered by the body for short time
purpose. Eg: in response to anomalies such as a short leg, or to overuse.
2. Fascial decompensation: the same phenomenon, but only in relation to a
situation in which adaptive changes are seen to be dysfunctional, to produce
symptoms evidencing a failure of homeostatic adaptation. Compensation
occurred such that facial anatomy undergoes changes affecting further
aggravation of the deformity. Eg: Deformity
• Zink & Lawson (1979) have described patterns of postural patterning
determined by fascial compensation and decompensation.
1. Fascial compensation: commonly involve useful, beneficial, and above all
functional adaptations (i.e. no obvious symptoms emerge) on the part of the
musculoskeletal system. Compensation offered by the body for short time
purpose. Eg: in response to anomalies such as a short leg, or to overuse.
2. Fascial decompensation: the same phenomenon, but only in relation to a
situation in which adaptive changes are seen to be dysfunctional, to produce
symptoms evidencing a failure of homeostatic adaptation. Compensation
occurred such that facial anatomy undergoes changes affecting further
aggravation of the deformity. Eg: Deformity
Biomechanical laws
• Wolff’s law states that biological systems (including soft and hard
tissues) deform in relation to the lines of force imposed on them.
• Hooke’s law states that deformation (resulting from strain)
imposed on an elastic body is in proportion to the stress
(force/load) placed on it.
• Newton’s third law states that when two bodies interact, the force
exerted by the first on the second is equal in magnitude and
opposite in direction to the force exerted by the second on the
first.
• Wolff’s law states that biological systems (including soft and hard
tissues) deform in relation to the lines of force imposed on them.
• Hooke’s law states that deformation (resulting from strain)
imposed on an elastic body is in proportion to the stress
(force/load) placed on it.
• Newton’s third law states that when two bodies interact, the force
exerted by the first on the second is equal in magnitude and
opposite in direction to the force exerted by the second on the
first.
Clinical Classification of Patterns
1. Ideal fascial pattern: Minimal adaptive load transferred to other
regions
2. Compensated patterns: which alternate in directions, from area
to area (e.g. atlanto-occipital– cervicothoracic–thoracolumbar–
lumbosacral), and which represent positive adaptive
modifications
3. Uncompensated patterns: which do not alternate, which are
commonly the result of trauma, and which represent negative
adaptive modifications
1. Ideal fascial pattern: Minimal adaptive load transferred to other
regions
2. Compensated patterns: which alternate in directions, from area
to area (e.g. atlanto-occipital– cervicothoracic–thoracolumbar–
lumbosacral), and which represent positive adaptive
modifications
3. Uncompensated patterns: which do not alternate, which are
commonly the result of trauma, and which represent negative
adaptive modifications
Functional Evaluation of Fascial Pattern
• Myers’ fascial trains (Myers 1997, 2001):
• The connections between different structures (‘long functional
continuities’) which these insights allow should be kept in mind
when consideration is given to the possibility of symptoms arising
from distant causal sites. They are of particular importance in
helping draw attention to (for example) dysfunctional patterns in
the lower limb which impact directly (via these chains) on
structures in the upper body.
• Myers’ fascial trains (Myers 1997, 2001):
• The connections between different structures (‘long functional
continuities’) which these insights allow should be kept in mind
when consideration is given to the possibility of symptoms arising
from distant causal sites. They are of particular importance in
helping draw attention to (for example) dysfunctional patterns in
the lower limb which impact directly (via these chains) on
structures in the upper body.
Superficial Back Line
• The superficial back line involves a chain
which starts with: The plantar fascia,
linking the plantar surface of the toes to
the calcaneus Gastrocnemius, linking
calcaneus to the femoral condyles
Hamstrings, linking the femoral condyles
to the ischial tuberosities Subcutaneous
ligament, linking the ischial tuberosities
to sacrum Lumbosacral fascia, erector
spinae and nuchal ligament, linking the
sacrum to the occiput Scalp fascia,
linking the occiput to the brow ridge.
• Inferior to Superior
• The superficial back line involves a chain
which starts with: The plantar fascia,
linking the plantar surface of the toes to
the calcaneus Gastrocnemius, linking
calcaneus to the femoral condyles
Hamstrings, linking the femoral condyles
to the ischial tuberosities Subcutaneous
ligament, linking the ischial tuberosities
to sacrum Lumbosacral fascia, erector
spinae and nuchal ligament, linking the
sacrum to the occiput Scalp fascia,
linking the occiput to the brow ridge.
• Inferior to Superior
Superficial Front Line • Starts from: The anterior compartment
and the periosteum of the tibia, linking
the dorsal surface of the toes to the
tibial tuberosity Rectus femoris,
linking the tibial tuberosity to the
anterior inferior iliac spine and pubic
tubercle Rectus abdominis as well as
pectoralis and sternalis fascia, linking
the pubic tubercle and the anterior
inferior iliac spine with the
manubrium Sternocleidomastoid,
linking the manubrium with the
mastoid process of the temporal bone.
• Inferior to superior
• Starts from: The anterior compartment
and the periosteum of the tibia, linking
the dorsal surface of the toes to the
tibial tuberosity Rectus femoris,
linking the tibial tuberosity to the
anterior inferior iliac spine and pubic
tubercle Rectus abdominis as well as
pectoralis and sternalis fascia, linking
the pubic tubercle and the anterior
inferior iliac spine with the
manubrium Sternocleidomastoid,
linking the manubrium with the
mastoid process of the temporal bone.
• Inferior to superior
Lateral Line• Starts from: Peroneal muscles, linking the 1st
and 5th metatarsal bases with the fibular
headIliotibial tract, tensor fascia lata and
gluteus maximus, linking the fibular head with
the iliac crestExternal obliques, internal
obliques and (deeper) quadratus lumborum,
linking the iliac crest with the lower
ribsExternal intercostals and internal
intercostals, linking the lower ribs with the
remaining ribsSplenius cervicis, iliocostalis
cervicis, sternocleidomastoid and (deeper)
scalenes, linking the ribs with the mastoid
process of the temporal bone.
• Inferior to Superior
• Starts from: Peroneal muscles, linking the 1st
and 5th metatarsal bases with the fibular
headIliotibial tract, tensor fascia lata and
gluteus maximus, linking the fibular head with
the iliac crestExternal obliques, internal
obliques and (deeper) quadratus lumborum,
linking the iliac crest with the lower
ribsExternal intercostals and internal
intercostals, linking the lower ribs with the
remaining ribsSplenius cervicis, iliocostalis
cervicis, sternocleidomastoid and (deeper)
scalenes, linking the ribs with the mastoid
process of the temporal bone.
• Inferior to Superior
Spiral Line
Spiral Line
• Starts from: Splenius capitis, which wraps across from one side to the other, linking
the occipital ridge (say on the right) with the spinous processes of the lower cervical
and upper thoracic spine on the left Continuing in this direction the rhomboids
(on the left) link via the medial border of the scapula with serratus anterior and the
ribs (still on the left), wrapping around the trunk via the external obliques and the
abdominal aponeurosis on the left, to connect with the internal obliques on the right
and then to a strong anchor point on the anterior superior iliac spine (right side).
From the ASIS, the tensor fascia lata and the iliotibial tract link to the lateral tibial
condyle Tibialis anterior links the lateral tibial condyle with the 1st metatarsal and
cuneiform. From this apparent end point of the chain (1st metatarsal and
cuneiform), peroneus longus rises to link with the fibular head. Biceps femoris
connects the fibular head to the ischial tuberosity. The sacrotuberous ligament links
the ischial tuberosity to the sacrum. The sacral fascia and the erector spinae link the
• Starts from: Splenius capitis, which wraps across from one side to the other, linking
the occipital ridge (say on the right) with the spinous processes of the lower cervical
and upper thoracic spine on the left Continuing in this direction the rhomboids
(on the left) link via the medial border of the scapula with serratus anterior and the
ribs (still on the left), wrapping around the trunk via the external obliques and the
abdominal aponeurosis on the left, to connect with the internal obliques on the right
and then to a strong anchor point on the anterior superior iliac spine (right side).
From the ASIS, the tensor fascia lata and the iliotibial tract link to the lateral tibial
condyle Tibialis anterior links the lateral tibial condyle with the 1st metatarsal and
cuneiform. From this apparent end point of the chain (1st metatarsal and
cuneiform), peroneus longus rises to link with the fibular head. Biceps femoris
connects the fibular head to the ischial tuberosity. The sacrotuberous ligament links
the ischial tuberosity to the sacrum. The sacral fascia and the erector spinae link the
sacrum to the occipital ridge.
Deep Frontal Line
• The anterior longitudinal ligament, diaphragm, pericardium,
mediastinum, parietal pleura, fascia prevertebralis and the scalene fascia,
which connect the lumbar spine (bodies and transverse processes) to the
cervical transverse processes, and via longus capitis to the basilar portion
of the occiput Other links in this chain might involve a connection
between the posterior manubrium and the hyoid bone via the subhyoid
muscles and The fascia pretrachealis between the hyoid and the cranium/
mandible, involving suprahyoid muscles The muscles of the jaw linking
the mandible to the face and cranium.
• The anterior longitudinal ligament, diaphragm, pericardium,
mediastinum, parietal pleura, fascia prevertebralis and the scalene fascia,
which connect the lumbar spine (bodies and transverse processes) to the
cervical transverse processes, and via longus capitis to the basilar portion
of the occiput Other links in this chain might involve a connection
between the posterior manubrium and the hyoid bone via the subhyoid
muscles and The fascia pretrachealis between the hyoid and the cranium/
mandible, involving suprahyoid muscles The muscles of the jaw linking
the mandible to the face and cranium.
Back of ARM
• The superficial front line involves a
chain which starts with: The anterior
compartment and the periosteum of
the tibia, linking the dorsal surface
of the toes to the tibial tuberosity
Rectus femoris, linking the tibial
tuberosity to the anterior inferior
iliac spine and pubic tubercle
Rectus abdominis as well as
pectoralis and sternalis fascia,
linking the pubic tubercle and the
anterior inferior iliac spine with the
manubrium Sternocleidomastoid,
linking the manubrium with the
mastoid process of the temporal
bone.
• The superficial front line involves a
chain which starts with: The anterior
compartment and the periosteum of
the tibia, linking the dorsal surface
of the toes to the tibial tuberosity
Rectus femoris, linking the tibial
tuberosity to the anterior inferior
iliac spine and pubic tubercle
Rectus abdominis as well as
pectoralis and sternalis fascia,
linking the pubic tubercle and the
anterior inferior iliac spine with the
manubrium Sternocleidomastoid,
linking the manubrium with the
mastoid process of the temporal
bone.
Front of ARM
• The superficial front line involves a
chain which starts with: The anterior
compartment and the periosteum of
the tibia, linking the dorsal surface of
the toes to the tibial tuberosity
Rectus femoris, linking the tibial
tuberosity to the anterior inferior iliac
spine and pubic tubercle Rectus
abdominis as well as pectoralis and
sternalis fascia, linking the pubic
tubercle and the anterior inferior iliac
spine with the manubrium
Sternocleidomastoid, linking the
manubrium with the mastoid process
of the temporal bone.
• The superficial front line involves a
chain which starts with: The anterior
compartment and the periosteum of
the tibia, linking the dorsal surface of
the toes to the tibial tuberosity
Rectus femoris, linking the tibial
tuberosity to the anterior inferior iliac
spine and pubic tubercle Rectus
abdominis as well as pectoralis and
sternalis fascia, linking the pubic
tubercle and the anterior inferior iliac
spine with the manubrium
Sternocleidomastoid, linking the
manubrium with the mastoid process
of the temporal bone.
Musculoskeletal Dysfunction
• (Guyton 1987, Janda 1985, Lewit 1974)
• The normal response of muscle to any form of stress is to
increase in tone (Barlow 1959, Selye 1976).
Stress factors leading to musculoskeletal dysfunction:
• Acquired postural imbalances (Rolf 1977)
• ‘Pattern of use’ stress (occupational, recreational, etc.)
• Inborn imbalance (short leg, short upper extremity, small
hemipelvis, fascial distortion via birth injury, etc.)
• The effects of hyper- or hypomobile joints, including arthritic
changes
• Repetitive strain from hobby, recreation, sport, etc. (overuse)
• (Guyton 1987, Janda 1985, Lewit 1974)
• The normal response of muscle to any form of stress is to
increase in tone (Barlow 1959, Selye 1976).
Stress factors leading to musculoskeletal dysfunction:
• Acquired postural imbalances (Rolf 1977)
• ‘Pattern of use’ stress (occupational, recreational, etc.)
• Inborn imbalance (short leg, short upper extremity, small
hemipelvis, fascial distortion via birth injury, etc.)
• The effects of hyper- or hypomobile joints, including arthritic
changes
• Repetitive strain from hobby, recreation, sport, etc. (overuse)
• Emotional stress factors (Barlow 1959)
• Trauma (abuse), inflammation and subsequent fibrosis
• Disuse, immobilisation
• Reflexogenic influences (viscerosomatic, myofascial and other
reflex inputs) (Beal 1983)
• Climatic stress such as chilling
• Nutritional imbalances (vitamin C deficiency reduces collagen
efficiency for example) (Pauling 1976)
• Infection
• Emotional stress factors (Barlow 1959)
• Trauma (abuse), inflammation and subsequent fibrosis
• Disuse, immobilisation
• Reflexogenic influences (viscerosomatic, myofascial and other
reflex inputs) (Beal 1983)
• Climatic stress such as chilling
• Nutritional imbalances (vitamin C deficiency reduces collagen
efficiency for example) (Pauling 1976)
• Infection
• A chain reaction will evolve as any one, or combination of, the stress factors
listed in Box 2.3, or additional stress factors, cumulatively demand increased
muscular tone in those structures obliged to compensate for, or adapt to them,
resulting in the following events:
1. The muscles opposite to the hypertonic muscles become weaker (gets inhibited).
The stressed muscles develop areas of relative hypoxia, simultaneously, there
will be a reduction in the efficiency with which metabolic wastes are removed.
The combined effect of toxicity and hypoxia of these muscles leads to irritation,
sensitivity and pain which feedbacks into a loop. This feedback loop becomes
self-perpetuating. Initially, the soft tissues involved will show a reflex resistance
to stretch and after some weeks a degree of fibrous infiltration may appear as
the tissues under greatest stress mechanically, and via oxygen lack, adapt to the
situation.
• A chain reaction will evolve as any one, or combination of, the stress factors
listed in Box 2.3, or additional stress factors, cumulatively demand increased
muscular tone in those structures obliged to compensate for, or adapt to them,
resulting in the following events:
1. The muscles opposite to the hypertonic muscles become weaker (gets inhibited).
The stressed muscles develop areas of relative hypoxia, simultaneously, there
will be a reduction in the efficiency with which metabolic wastes are removed.
The combined effect of toxicity and hypoxia of these muscles leads to irritation,
sensitivity and pain which feedbacks into a loop. This feedback loop becomes
self-perpetuating. Initially, the soft tissues involved will show a reflex resistance
to stretch and after some weeks a degree of fibrous infiltration may appear as
the tissues under greatest stress mechanically, and via oxygen lack, adapt to the
situation.
2. Because of excessive hypertonic activity there will be energy wastage and a
tendency to fatigue – both locally and generally (Gutstein 1955).
Functional imbalances occurs due to the chain reaction of hypertonic induced
fatigue. Muscles will become involved in ‘chain reactions’ of dysfunction. A
process develops in which some muscles will be used inappropriately as
they learn to compensate for other structures which are weak or restricted,
leading to adaptive movements, and loss of the ability to act synergistically
as in normal situations (Janda 1985). Over time, the central nervous system
learns to accept altered patterns of use as normal (compensatory
movements), adding further to the complication of recovery since
rehabilitation will now demand a relearning process as well as the more
obvious structural (shortness) and functional (inhibition/weakness)
corrections (Knott & Voss 1968).
2. Because of excessive hypertonic activity there will be energy wastage and a
tendency to fatigue – both locally and generally (Gutstein 1955).
Functional imbalances occurs due to the chain reaction of hypertonic induced
fatigue. Muscles will become involved in ‘chain reactions’ of dysfunction. A
process develops in which some muscles will be used inappropriately as
they learn to compensate for other structures which are weak or restricted,
leading to adaptive movements, and loss of the ability to act synergistically
as in normal situations (Janda 1985). Over time, the central nervous system
learns to accept altered patterns of use as normal (compensatory
movements), adding further to the complication of recovery since
rehabilitation will now demand a relearning process as well as the more
obvious structural (shortness) and functional (inhibition/weakness)
corrections (Knott & Voss 1968).
Thank you

More Related Content

What's hot

Kinesio Taping
Kinesio TapingKinesio Taping
Kinesio Taping
ckeat
 
Vertebral manipulation (2)
Vertebral manipulation (2)Vertebral manipulation (2)
Vertebral manipulation (2)
Simba Syed
 

What's hot (20)

MFR manual
MFR manualMFR manual
MFR manual
 
Kinesio Taping
Kinesio TapingKinesio Taping
Kinesio Taping
 
Vertebral manipulation (2)
Vertebral manipulation (2)Vertebral manipulation (2)
Vertebral manipulation (2)
 
Myofascial Release Presentation
Myofascial Release Presentation Myofascial Release Presentation
Myofascial Release Presentation
 
Trigger Point Therapy Slides
Trigger Point Therapy Slides Trigger Point Therapy Slides
Trigger Point Therapy Slides
 
Meckenzie approach
Meckenzie approachMeckenzie approach
Meckenzie approach
 
CYRIAX TECHNIQUES.pptx
CYRIAX TECHNIQUES.pptxCYRIAX TECHNIQUES.pptx
CYRIAX TECHNIQUES.pptx
 
Neurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilizationNeurodynamics, mobilization of nervous system, neural mobilization
Neurodynamics, mobilization of nervous system, neural mobilization
 
THE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptxTHE KALTENBORN MOBILIZATION.pptx
THE KALTENBORN MOBILIZATION.pptx
 
MULLIGAN TECHINIQUE.pptx
MULLIGAN TECHINIQUE.pptxMULLIGAN TECHINIQUE.pptx
MULLIGAN TECHINIQUE.pptx
 
Positional release technique
Positional release techniquePositional release technique
Positional release technique
 
Mayofacial release technique
Mayofacial release techniqueMayofacial release technique
Mayofacial release technique
 
Trigger Point Manual
Trigger Point ManualTrigger Point Manual
Trigger Point Manual
 
Kinesiotaping
KinesiotapingKinesiotaping
Kinesiotaping
 
Mulligan Concept .ppt
Mulligan Concept .pptMulligan Concept .ppt
Mulligan Concept .ppt
 
Balance
BalanceBalance
Balance
 
Cyraix 23rd jan
Cyraix 23rd janCyraix 23rd jan
Cyraix 23rd jan
 
Balance
BalanceBalance
Balance
 
Kaltenborn manual mobilization srs
Kaltenborn manual mobilization srsKaltenborn manual mobilization srs
Kaltenborn manual mobilization srs
 
Mc Kenzie Method (MDT)
Mc Kenzie Method  (MDT)Mc Kenzie Method  (MDT)
Mc Kenzie Method (MDT)
 

Similar to Patterns of dysfunctions

Stretching for impaired mobility chap 4 lec 1
Stretching for impaired mobility chap 4 lec 1Stretching for impaired mobility chap 4 lec 1
Stretching for impaired mobility chap 4 lec 1
KhazimaAsif
 
Contracture management
Contracture managementContracture management
Contracture management
cheryl1230
 
Exercise physiology 2011
Exercise physiology 2011Exercise physiology 2011
Exercise physiology 2011
natjkeen
 
Fundamentals of biomechanics
Fundamentals of biomechanicsFundamentals of biomechanics
Fundamentals of biomechanics
Springer
 

Similar to Patterns of dysfunctions (20)

Traction
Traction Traction
Traction
 
Conservative Management of Joint Pain
Conservative Management of Joint PainConservative Management of Joint Pain
Conservative Management of Joint Pain
 
MET: Muscle Energy Technique
MET: Muscle Energy TechniqueMET: Muscle Energy Technique
MET: Muscle Energy Technique
 
Post Micro Lumbar Disectomy
Post Micro Lumbar DisectomyPost Micro Lumbar Disectomy
Post Micro Lumbar Disectomy
 
Muscle Energy Technique
Muscle Energy TechniqueMuscle Energy Technique
Muscle Energy Technique
 
Muscle Energy Technique.(soft tissue mobilization)
Muscle Energy Technique.(soft tissue mobilization)Muscle Energy Technique.(soft tissue mobilization)
Muscle Energy Technique.(soft tissue mobilization)
 
Muscle physiology (2)
Muscle physiology (2)Muscle physiology (2)
Muscle physiology (2)
 
Rehabilitation of sciatica
Rehabilitation of sciatica Rehabilitation of sciatica
Rehabilitation of sciatica
 
BIOMECHANICS AND PATHOMECHANICS OF SKELETAL MUSCLE
BIOMECHANICS AND PATHOMECHANICS OF SKELETAL MUSCLEBIOMECHANICS AND PATHOMECHANICS OF SKELETAL MUSCLE
BIOMECHANICS AND PATHOMECHANICS OF SKELETAL MUSCLE
 
Muscle physiology /certified fixed orthodontic courses by Indian dental academy
Muscle physiology /certified fixed orthodontic courses by Indian dental academy Muscle physiology /certified fixed orthodontic courses by Indian dental academy
Muscle physiology /certified fixed orthodontic courses by Indian dental academy
 
Physical Therapy: Function & Dysfunction
Physical Therapy: Function & DysfunctionPhysical Therapy: Function & Dysfunction
Physical Therapy: Function & Dysfunction
 
Stretching for impaired mobility chap 4 lec 1
Stretching for impaired mobility chap 4 lec 1Stretching for impaired mobility chap 4 lec 1
Stretching for impaired mobility chap 4 lec 1
 
Contracture management
Contracture managementContracture management
Contracture management
 
Exercise physiology 2011
Exercise physiology 2011Exercise physiology 2011
Exercise physiology 2011
 
Fundamentals of biomechanics
Fundamentals of biomechanicsFundamentals of biomechanics
Fundamentals of biomechanics
 
Update of Concepts Underlying Movement System Syndromes
Update of Concepts Underlying Movement System SyndromesUpdate of Concepts Underlying Movement System Syndromes
Update of Concepts Underlying Movement System Syndromes
 
MET.pptx
MET.pptxMET.pptx
MET.pptx
 
Pathophysiology of Spasticity
Pathophysiology of SpasticityPathophysiology of Spasticity
Pathophysiology of Spasticity
 
Delayed-Onset Muscle Soreness Alters the Response to Postural Perturbations
Delayed-Onset Muscle Soreness Alters the Response to Postural PerturbationsDelayed-Onset Muscle Soreness Alters the Response to Postural Perturbations
Delayed-Onset Muscle Soreness Alters the Response to Postural Perturbations
 
Temporomandibular joint/ dental courses
Temporomandibular  joint/ dental coursesTemporomandibular  joint/ dental courses
Temporomandibular joint/ dental courses
 

More from Radhika Chintamani

More from Radhika Chintamani (20)

Craniosacral therapy
Craniosacral therapyCraniosacral therapy
Craniosacral therapy
 
Physical fitness assessment
Physical fitness assessmentPhysical fitness assessment
Physical fitness assessment
 
Traction
TractionTraction
Traction
 
Reflex symapathetic dystrophy
Reflex symapathetic dystrophyReflex symapathetic dystrophy
Reflex symapathetic dystrophy
 
Biofeedback
BiofeedbackBiofeedback
Biofeedback
 
Hip joint biomechanics and pathomechanics
Hip joint biomechanics and pathomechanicsHip joint biomechanics and pathomechanics
Hip joint biomechanics and pathomechanics
 
Ankle anatomy and biomechanics
Ankle anatomy and biomechanicsAnkle anatomy and biomechanics
Ankle anatomy and biomechanics
 
Cervical spine: anatomy, biomechanics and pathomechanics
Cervical spine: anatomy, biomechanics and pathomechanicsCervical spine: anatomy, biomechanics and pathomechanics
Cervical spine: anatomy, biomechanics and pathomechanics
 
Lumbar Spnine: Anatomy, Biomechanics and Pathomechanics
Lumbar Spnine: Anatomy, Biomechanics and PathomechanicsLumbar Spnine: Anatomy, Biomechanics and Pathomechanics
Lumbar Spnine: Anatomy, Biomechanics and Pathomechanics
 
Thoracic and rib cage anatomy, biomechanics, and pathomechanics
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsThoracic and rib cage anatomy, biomechanics, and pathomechanics
Thoracic and rib cage anatomy, biomechanics, and pathomechanics
 
Knee joint anatomy, biomechanics, pathomechanics and assessment
Knee joint anatomy, biomechanics, pathomechanics and assessmentKnee joint anatomy, biomechanics, pathomechanics and assessment
Knee joint anatomy, biomechanics, pathomechanics and assessment
 
Shoulder anatomy__biomechanics__pathomechanics
Shoulder  anatomy__biomechanics__pathomechanicsShoulder  anatomy__biomechanics__pathomechanics
Shoulder anatomy__biomechanics__pathomechanics
 
Therapeutic massage
Therapeutic massageTherapeutic massage
Therapeutic massage
 
Mcconnell taping technique
Mcconnell taping techniqueMcconnell taping technique
Mcconnell taping technique
 
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapy
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapySacroiliac joint biomechanics, dysfunctions, assessment and its manual therapy
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapy
 
Group exercise
Group exerciseGroup exercise
Group exercise
 
Neurodynamics III
Neurodynamics IIINeurodynamics III
Neurodynamics III
 
External fixators
External fixatorsExternal fixators
External fixators
 
Sarcomere a-contractile_unit (1)
Sarcomere  a-contractile_unit (1)Sarcomere  a-contractile_unit (1)
Sarcomere a-contractile_unit (1)
 
Internal fixators
Internal fixatorsInternal fixators
Internal fixators
 

Recently uploaded

Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
palsonia139
 
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Abortion pills in Kuwait Cytotec pills in Kuwait
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
MedicoseAcademics
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
MedicoseAcademics
 
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait CityIn Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
Abortion pills in Kuwait Cytotec pills in Kuwait
 

Recently uploaded (20)

Get the best psychology treatment in Indore at Gokuldas Hospital
Get the best psychology treatment in Indore at Gokuldas HospitalGet the best psychology treatment in Indore at Gokuldas Hospital
Get the best psychology treatment in Indore at Gokuldas Hospital
 
Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stock
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
 
Tips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in IndoreTips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in Indore
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
 
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and NightVIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
VIP Pune 7877925207 WhatsApp: Me All Time Serviℂe Available Day and Night
 
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
 
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdfSEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
 
VVIP Hadapsar ℂall Girls 6350482085 Scorching { Pune } Excellent Girl Serviℂe...
VVIP Hadapsar ℂall Girls 6350482085 Scorching { Pune } Excellent Girl Serviℂe...VVIP Hadapsar ℂall Girls 6350482085 Scorching { Pune } Excellent Girl Serviℂe...
VVIP Hadapsar ℂall Girls 6350482085 Scorching { Pune } Excellent Girl Serviℂe...
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answers
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Quality control tests of suppository ...
Quality control tests  of suppository ...Quality control tests  of suppository ...
Quality control tests of suppository ...
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
 
Capillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete GuidebookCapillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete Guidebook
 
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door StepBangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
 
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait CityIn Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 

Patterns of dysfunctions

  • 1. Patterns of function and dysfunction Radhika Chintamani, MPT, COMT, Assistant Professor KIMSDU-Karad-MAHARASHTRA
  • 2. Contents • Definitions • Concepts of movements dysfunctions • Fascia and its properties • Postural Fascial Pattern • Biomechanical Laws • Clinical classifications of patterns • Functional evaluation of fascial postural patterns • Evaluation of musculoskeletal dysfunctions
  • 3. Definitions • Dysfunction: According to Mckenzie it can be defined as shortened tissues are mechanically deformed by overstretching at end range. • Pattern dysfunction: In pattern dysfunction, a particular pattern is affected where while performing certain pattern of motions causes pain. • Movement dysfunction: painful movements. Example: Painful arc syndrome. • Dysfunction: According to Mckenzie it can be defined as shortened tissues are mechanically deformed by overstretching at end range. • Pattern dysfunction: In pattern dysfunction, a particular pattern is affected where while performing certain pattern of motions causes pain. • Movement dysfunction: painful movements. Example: Painful arc syndrome.
  • 4. Postural evaluation grid: it’s a grid placed or mounted on the wall, which has a capacity of evaluating antero-posterior aspect of posture, showing the relative positions of the landmarks, and also comparing the bilateral relative heights of each landmark Functional restriction grid: it is same as posture evaluation grid, but here joints are evaluated for their range of motion, and also to compare with opposite side of the extremity, and also spine can be evaluated here. Postural evaluation grid: it’s a grid placed or mounted on the wall, which has a capacity of evaluating antero-posterior aspect of posture, showing the relative positions of the landmarks, and also comparing the bilateral relative heights of each landmark Functional restriction grid: it is same as posture evaluation grid, but here joints are evaluated for their range of motion, and also to compare with opposite side of the extremity, and also spine can be evaluated here.
  • 5. Introduction to musculoskeletal dysfunction: • Musculoskeletal dysfunction according to WHO consists of Pain and Fatigue, where Pain is the primary problem for consulting to a local doctor.
  • 6. Concepts of Movement Dysfunction 1. Sadman’s concept of role of emotions in musculoskeletal dysfunctions: S:S Sadman:Stress He postulated three theories on the concept as follows A..StressPoor posture Slouched forward tissue extensibility disorder retards circulatory efficiency maintained poor posture accumulation of lactic acid spasm leading to pain movement dysfunction.
  • 7. B..Stress-> sustained metabolic activity increase in neural hyper- reactivity of muscle reflex vasoconstriction local tenderness and referred pain musculoskeletal dysfunction. C..Relative oxygen lack decreased energy supply to the muscle still performing continues work energy deficient muscle contraction accumulation of lactic acid as it is formed as a waste product during the contraction and also, due to reduced blood flow which is necessary for washing out of the lactic acid from the muscle spam leading to paindysfunction. If at this point muscle is stretched(passively or actively), application of pressure and vibration techniques, leads to increase in the blood supply, and increase in the distance between actin and myosin leading to decrease in contraction of the muscle.
  • 8. 2. Latey’s concept: he uses analogy of clenched fist. The clenched fist determines the fixity, rigidity, over-contracted muscle, emotional turmoil, withdrawal from communication and so on. Unclenching the fist correlates with physiological relaxation. The main theory of clenching and unclenching the fist was: Failure to express emotion results in suppression of activity and, ultimately, chronic contraction of the muscles which would have been used, were these emotions (e.g. rage, fear, anger, joy, frustration, sorrow) expressed. Latey points out that all areas of the body producing sensations which arouse emotional excitement may have their blood supply reduced by muscular contraction.
  • 9. 3. Korr’s orchestered movement concept: the complex interrelationships between the soft tissues, the muscles, fascia and tendons and the neural reporting stations, which controls the tone, and the movement rythmicity, involves the complex balanced orchestration of the contractions and relaxation of many muscles. 4. Proprioceptive model of dysfunction: When proprioceptors send conflicting information there may be simultaneous contraction of the antagonists, without antagonist muscle inhibition. Strains of joints and other structures around joints results in reflex pattern which causes muscle or other tissue to maintain this continuing strain. This strain dysfunction often relates to inappropriate signaling from muscle proprioceptors that have been strained from rapid change that does not allow proper adaptation.
  • 10. 5. Van Buskirks Nociceptive model: Nociceptors on skin gets activated by minor trauma   Transmission of impulses to the other nociceptive axons, and spinal cord   Vasodilatation and gathering of immune cells under the injury site   Muscular responses involving local or multisegmental changes: shortening of the injured muscle via synergistic or self-generated action from non-injured fibres/undergoing spasm.   Direct mechanical restriction of the affected muscles derives from vasodilatation which, along with chemicals associated with tissue injury (bradykinin, histamine, serotonin, etc.) causes stimulation of local nociceptors in the muscle associated with the original trauma, or those reflexively influenced   A new defensive muscular arrangement will develop which will cause imbalance and a shortening of the muscles involved. These will not be held at their maximal degree of shortening nor in their previously neutral position.   Additional pain and fatigue.   Abnormal joint position resulting from defensive muscular activity, commencing when this defensive posture is sustained for a longer time. 5. Van Buskirks Nociceptive model: Nociceptors on skin gets activated by minor trauma   Transmission of impulses to the other nociceptive axons, and spinal cord   Vasodilatation and gathering of immune cells under the injury site   Muscular responses involving local or multisegmental changes: shortening of the injured muscle via synergistic or self-generated action from non-injured fibres/undergoing spasm.   Direct mechanical restriction of the affected muscles derives from vasodilatation which, along with chemicals associated with tissue injury (bradykinin, histamine, serotonin, etc.) causes stimulation of local nociceptors in the muscle associated with the original trauma, or those reflexively influenced   A new defensive muscular arrangement will develop which will cause imbalance and a shortening of the muscles involved. These will not be held at their maximal degree of shortening nor in their previously neutral position.   Additional pain and fatigue.   Abnormal joint position resulting from defensive muscular activity, commencing when this defensive posture is sustained for a longer time.
  • 11. 6. Janda’s primary and secondary responses: • Any symptom has both local and general affect on the human body. Eg: Knee pain in osteoarthritis Intitially contributes to severe local knee pain on weight bearing and movement Change in the line of gravity of the knee joint from centre of the knee joint to passing through the lateral aspect of knee joint in OA which is modified by patient due to avoidance of weight bearing on the medial aspect of the knee joint due to pain Development of Bow leg deformity due to change of LOG: Further it leads to knee deformity if left untreated which further causes back pain due to altered weight bearing strategy. 6. Janda’s primary and secondary responses: • Any symptom has both local and general affect on the human body. Eg: Knee pain in osteoarthritis Intitially contributes to severe local knee pain on weight bearing and movement Change in the line of gravity of the knee joint from centre of the knee joint to passing through the lateral aspect of knee joint in OA which is modified by patient due to avoidance of weight bearing on the medial aspect of the knee joint due to pain Development of Bow leg deformity due to change of LOG: Further it leads to knee deformity if left untreated which further causes back pain due to altered weight bearing strategy.
  • 12. Fascia and its properties** Fascia is a single structure, repercussions of it in the human body is difficult. Fascial divisions within the cranium, the tentorium cerebelli and falx cerebri which are commonly warped during birthing difficulties (too long or too short a time in the birth canal, forceps delivery, etc.) and which are noted in craniosacral therapy as affecting total body mechanics via their influence on fascia (and therefore the musculature) throughout the body (Brookes 1984). Fascia is a single structure, repercussions of it in the human body is difficult. Fascial divisions within the cranium, the tentorium cerebelli and falx cerebri which are commonly warped during birthing difficulties (too long or too short a time in the birth canal, forceps delivery, etc.) and which are noted in craniosacral therapy as affecting total body mechanics via their influence on fascia (and therefore the musculature) throughout the body (Brookes 1984).
  • 13. • According to Rolf, • Any degree of degeneration however minor, changes the bulk of the fascia. This modifies its thickness and draws it into ridges in areas overlying deeper tensions and rigidities. Conversely, as this elastic envelope is stretched, manipulative mechanical energy is added to it, and the fascial colloid becomes more ‘sol’ and less ‘gel’; meaning the fascia gets solidified. Solidification of the fascia leads to shortening or lengthening of the muscles leading to posture mal-alignment. Once this extra energy is released: the fascia attains its flexible nature and the posture is aligned back to normal. • According to Rolf, • Any degree of degeneration however minor, changes the bulk of the fascia. This modifies its thickness and draws it into ridges in areas overlying deeper tensions and rigidities. Conversely, as this elastic envelope is stretched, manipulative mechanical energy is added to it, and the fascial colloid becomes more ‘sol’ and less ‘gel’; meaning the fascia gets solidified. Solidification of the fascia leads to shortening or lengthening of the muscles leading to posture mal-alignment. Once this extra energy is released: the fascia attains its flexible nature and the posture is aligned back to normal.
  • 14. Cathie 1974 suggests that Fascia: • Is richly endowed with nerve endings. • Has the ability to contract and relax elastically. • Provides extensive muscular attachments. • Supports and stabilises all structures, so enhancing postural balance. • Is vitally involved in all aspects of movement. • Assists in circulatory economy, especially of venous and lymphatic fluids. • Will demonstrate changes preceding many chronic degenerative diseases. • Will frequently be associated with chronic passive tissue congestion when such changes occur. Cathie 1974 suggests that Fascia: • Is richly endowed with nerve endings. • Has the ability to contract and relax elastically. • Provides extensive muscular attachments. • Supports and stabilises all structures, so enhancing postural balance. • Is vitally involved in all aspects of movement. • Assists in circulatory economy, especially of venous and lymphatic fluids. • Will demonstrate changes preceding many chronic degenerative diseases. • Will frequently be associated with chronic passive tissue congestion when such changes occur.
  • 15. • Will form specialized ‘stress bands’ in response to the load demanded of it. • Commonly produces a pain of a burning nature in response to sudden stress- trauma. • Is a major arena of many inflammatory processes. • Is the tissue which surrounds the CNS.  Cathie also points out that many ‘trigger’ spots correspond to sites where nerves pierce fascial investments. Stress on the fascia can be seen to result from faulty muscular patterns of use, altered bony relationships, altered visceral position and postural imbalance, whether of a sustained nature or violently induced by trauma. • Will form specialized ‘stress bands’ in response to the load demanded of it. • Commonly produces a pain of a burning nature in response to sudden stress- trauma. • Is a major arena of many inflammatory processes. • Is the tissue which surrounds the CNS.  Cathie also points out that many ‘trigger’ spots correspond to sites where nerves pierce fascial investments. Stress on the fascia can be seen to result from faulty muscular patterns of use, altered bony relationships, altered visceral position and postural imbalance, whether of a sustained nature or violently induced by trauma.
  • 16. • Fascia and posture: The specialised fascial structures – plantar, iliotibial, lumbodorsal, cervical and cranial – stabilise the body and permit an easier maintenance of the upright position, and these are among the first to show signs of change in response to postural defects. • Cisler (1994) summarises the commonest factors which produce fascial stress as: • Faulty muscular activity. • Altered position of fascia in response to osseous changes. • Changes in visceral position (ptosis). • Sudden or gradual alterations in vertebral mechanics. • Fascia and posture: The specialised fascial structures – plantar, iliotibial, lumbodorsal, cervical and cranial – stabilise the body and permit an easier maintenance of the upright position, and these are among the first to show signs of change in response to postural defects. • Cisler (1994) summarises the commonest factors which produce fascial stress as: • Faulty muscular activity. • Altered position of fascia in response to osseous changes. • Changes in visceral position (ptosis). • Sudden or gradual alterations in vertebral mechanics.
  • 17. Postural Fascial Pattern • Zink & Lawson (1979) have described patterns of postural patterning determined by fascial compensation and decompensation. 1. Fascial compensation: commonly involve useful, beneficial, and above all functional adaptations (i.e. no obvious symptoms emerge) on the part of the musculoskeletal system. Compensation offered by the body for short time purpose. Eg: in response to anomalies such as a short leg, or to overuse. 2. Fascial decompensation: the same phenomenon, but only in relation to a situation in which adaptive changes are seen to be dysfunctional, to produce symptoms evidencing a failure of homeostatic adaptation. Compensation occurred such that facial anatomy undergoes changes affecting further aggravation of the deformity. Eg: Deformity • Zink & Lawson (1979) have described patterns of postural patterning determined by fascial compensation and decompensation. 1. Fascial compensation: commonly involve useful, beneficial, and above all functional adaptations (i.e. no obvious symptoms emerge) on the part of the musculoskeletal system. Compensation offered by the body for short time purpose. Eg: in response to anomalies such as a short leg, or to overuse. 2. Fascial decompensation: the same phenomenon, but only in relation to a situation in which adaptive changes are seen to be dysfunctional, to produce symptoms evidencing a failure of homeostatic adaptation. Compensation occurred such that facial anatomy undergoes changes affecting further aggravation of the deformity. Eg: Deformity
  • 18. Biomechanical laws • Wolff’s law states that biological systems (including soft and hard tissues) deform in relation to the lines of force imposed on them. • Hooke’s law states that deformation (resulting from strain) imposed on an elastic body is in proportion to the stress (force/load) placed on it. • Newton’s third law states that when two bodies interact, the force exerted by the first on the second is equal in magnitude and opposite in direction to the force exerted by the second on the first. • Wolff’s law states that biological systems (including soft and hard tissues) deform in relation to the lines of force imposed on them. • Hooke’s law states that deformation (resulting from strain) imposed on an elastic body is in proportion to the stress (force/load) placed on it. • Newton’s third law states that when two bodies interact, the force exerted by the first on the second is equal in magnitude and opposite in direction to the force exerted by the second on the first.
  • 19. Clinical Classification of Patterns 1. Ideal fascial pattern: Minimal adaptive load transferred to other regions 2. Compensated patterns: which alternate in directions, from area to area (e.g. atlanto-occipital– cervicothoracic–thoracolumbar– lumbosacral), and which represent positive adaptive modifications 3. Uncompensated patterns: which do not alternate, which are commonly the result of trauma, and which represent negative adaptive modifications 1. Ideal fascial pattern: Minimal adaptive load transferred to other regions 2. Compensated patterns: which alternate in directions, from area to area (e.g. atlanto-occipital– cervicothoracic–thoracolumbar– lumbosacral), and which represent positive adaptive modifications 3. Uncompensated patterns: which do not alternate, which are commonly the result of trauma, and which represent negative adaptive modifications
  • 20. Functional Evaluation of Fascial Pattern • Myers’ fascial trains (Myers 1997, 2001): • The connections between different structures (‘long functional continuities’) which these insights allow should be kept in mind when consideration is given to the possibility of symptoms arising from distant causal sites. They are of particular importance in helping draw attention to (for example) dysfunctional patterns in the lower limb which impact directly (via these chains) on structures in the upper body. • Myers’ fascial trains (Myers 1997, 2001): • The connections between different structures (‘long functional continuities’) which these insights allow should be kept in mind when consideration is given to the possibility of symptoms arising from distant causal sites. They are of particular importance in helping draw attention to (for example) dysfunctional patterns in the lower limb which impact directly (via these chains) on structures in the upper body.
  • 21. Superficial Back Line • The superficial back line involves a chain which starts with: The plantar fascia, linking the plantar surface of the toes to the calcaneus Gastrocnemius, linking calcaneus to the femoral condyles Hamstrings, linking the femoral condyles to the ischial tuberosities Subcutaneous ligament, linking the ischial tuberosities to sacrum Lumbosacral fascia, erector spinae and nuchal ligament, linking the sacrum to the occiput Scalp fascia, linking the occiput to the brow ridge. • Inferior to Superior • The superficial back line involves a chain which starts with: The plantar fascia, linking the plantar surface of the toes to the calcaneus Gastrocnemius, linking calcaneus to the femoral condyles Hamstrings, linking the femoral condyles to the ischial tuberosities Subcutaneous ligament, linking the ischial tuberosities to sacrum Lumbosacral fascia, erector spinae and nuchal ligament, linking the sacrum to the occiput Scalp fascia, linking the occiput to the brow ridge. • Inferior to Superior
  • 22. Superficial Front Line • Starts from: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone. • Inferior to superior • Starts from: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone. • Inferior to superior
  • 23. Lateral Line• Starts from: Peroneal muscles, linking the 1st and 5th metatarsal bases with the fibular headIliotibial tract, tensor fascia lata and gluteus maximus, linking the fibular head with the iliac crestExternal obliques, internal obliques and (deeper) quadratus lumborum, linking the iliac crest with the lower ribsExternal intercostals and internal intercostals, linking the lower ribs with the remaining ribsSplenius cervicis, iliocostalis cervicis, sternocleidomastoid and (deeper) scalenes, linking the ribs with the mastoid process of the temporal bone. • Inferior to Superior • Starts from: Peroneal muscles, linking the 1st and 5th metatarsal bases with the fibular headIliotibial tract, tensor fascia lata and gluteus maximus, linking the fibular head with the iliac crestExternal obliques, internal obliques and (deeper) quadratus lumborum, linking the iliac crest with the lower ribsExternal intercostals and internal intercostals, linking the lower ribs with the remaining ribsSplenius cervicis, iliocostalis cervicis, sternocleidomastoid and (deeper) scalenes, linking the ribs with the mastoid process of the temporal bone. • Inferior to Superior
  • 25. Spiral Line • Starts from: Splenius capitis, which wraps across from one side to the other, linking the occipital ridge (say on the right) with the spinous processes of the lower cervical and upper thoracic spine on the left Continuing in this direction the rhomboids (on the left) link via the medial border of the scapula with serratus anterior and the ribs (still on the left), wrapping around the trunk via the external obliques and the abdominal aponeurosis on the left, to connect with the internal obliques on the right and then to a strong anchor point on the anterior superior iliac spine (right side). From the ASIS, the tensor fascia lata and the iliotibial tract link to the lateral tibial condyle Tibialis anterior links the lateral tibial condyle with the 1st metatarsal and cuneiform. From this apparent end point of the chain (1st metatarsal and cuneiform), peroneus longus rises to link with the fibular head. Biceps femoris connects the fibular head to the ischial tuberosity. The sacrotuberous ligament links the ischial tuberosity to the sacrum. The sacral fascia and the erector spinae link the • Starts from: Splenius capitis, which wraps across from one side to the other, linking the occipital ridge (say on the right) with the spinous processes of the lower cervical and upper thoracic spine on the left Continuing in this direction the rhomboids (on the left) link via the medial border of the scapula with serratus anterior and the ribs (still on the left), wrapping around the trunk via the external obliques and the abdominal aponeurosis on the left, to connect with the internal obliques on the right and then to a strong anchor point on the anterior superior iliac spine (right side). From the ASIS, the tensor fascia lata and the iliotibial tract link to the lateral tibial condyle Tibialis anterior links the lateral tibial condyle with the 1st metatarsal and cuneiform. From this apparent end point of the chain (1st metatarsal and cuneiform), peroneus longus rises to link with the fibular head. Biceps femoris connects the fibular head to the ischial tuberosity. The sacrotuberous ligament links the ischial tuberosity to the sacrum. The sacral fascia and the erector spinae link the sacrum to the occipital ridge.
  • 26. Deep Frontal Line • The anterior longitudinal ligament, diaphragm, pericardium, mediastinum, parietal pleura, fascia prevertebralis and the scalene fascia, which connect the lumbar spine (bodies and transverse processes) to the cervical transverse processes, and via longus capitis to the basilar portion of the occiput Other links in this chain might involve a connection between the posterior manubrium and the hyoid bone via the subhyoid muscles and The fascia pretrachealis between the hyoid and the cranium/ mandible, involving suprahyoid muscles The muscles of the jaw linking the mandible to the face and cranium. • The anterior longitudinal ligament, diaphragm, pericardium, mediastinum, parietal pleura, fascia prevertebralis and the scalene fascia, which connect the lumbar spine (bodies and transverse processes) to the cervical transverse processes, and via longus capitis to the basilar portion of the occiput Other links in this chain might involve a connection between the posterior manubrium and the hyoid bone via the subhyoid muscles and The fascia pretrachealis between the hyoid and the cranium/ mandible, involving suprahyoid muscles The muscles of the jaw linking the mandible to the face and cranium.
  • 27. Back of ARM • The superficial front line involves a chain which starts with: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone. • The superficial front line involves a chain which starts with: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone. Front of ARM • The superficial front line involves a chain which starts with: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone. • The superficial front line involves a chain which starts with: The anterior compartment and the periosteum of the tibia, linking the dorsal surface of the toes to the tibial tuberosity Rectus femoris, linking the tibial tuberosity to the anterior inferior iliac spine and pubic tubercle Rectus abdominis as well as pectoralis and sternalis fascia, linking the pubic tubercle and the anterior inferior iliac spine with the manubrium Sternocleidomastoid, linking the manubrium with the mastoid process of the temporal bone.
  • 28. Musculoskeletal Dysfunction • (Guyton 1987, Janda 1985, Lewit 1974) • The normal response of muscle to any form of stress is to increase in tone (Barlow 1959, Selye 1976). Stress factors leading to musculoskeletal dysfunction: • Acquired postural imbalances (Rolf 1977) • ‘Pattern of use’ stress (occupational, recreational, etc.) • Inborn imbalance (short leg, short upper extremity, small hemipelvis, fascial distortion via birth injury, etc.) • The effects of hyper- or hypomobile joints, including arthritic changes • Repetitive strain from hobby, recreation, sport, etc. (overuse) • (Guyton 1987, Janda 1985, Lewit 1974) • The normal response of muscle to any form of stress is to increase in tone (Barlow 1959, Selye 1976). Stress factors leading to musculoskeletal dysfunction: • Acquired postural imbalances (Rolf 1977) • ‘Pattern of use’ stress (occupational, recreational, etc.) • Inborn imbalance (short leg, short upper extremity, small hemipelvis, fascial distortion via birth injury, etc.) • The effects of hyper- or hypomobile joints, including arthritic changes • Repetitive strain from hobby, recreation, sport, etc. (overuse)
  • 29. • Emotional stress factors (Barlow 1959) • Trauma (abuse), inflammation and subsequent fibrosis • Disuse, immobilisation • Reflexogenic influences (viscerosomatic, myofascial and other reflex inputs) (Beal 1983) • Climatic stress such as chilling • Nutritional imbalances (vitamin C deficiency reduces collagen efficiency for example) (Pauling 1976) • Infection • Emotional stress factors (Barlow 1959) • Trauma (abuse), inflammation and subsequent fibrosis • Disuse, immobilisation • Reflexogenic influences (viscerosomatic, myofascial and other reflex inputs) (Beal 1983) • Climatic stress such as chilling • Nutritional imbalances (vitamin C deficiency reduces collagen efficiency for example) (Pauling 1976) • Infection
  • 30. • A chain reaction will evolve as any one, or combination of, the stress factors listed in Box 2.3, or additional stress factors, cumulatively demand increased muscular tone in those structures obliged to compensate for, or adapt to them, resulting in the following events: 1. The muscles opposite to the hypertonic muscles become weaker (gets inhibited). The stressed muscles develop areas of relative hypoxia, simultaneously, there will be a reduction in the efficiency with which metabolic wastes are removed. The combined effect of toxicity and hypoxia of these muscles leads to irritation, sensitivity and pain which feedbacks into a loop. This feedback loop becomes self-perpetuating. Initially, the soft tissues involved will show a reflex resistance to stretch and after some weeks a degree of fibrous infiltration may appear as the tissues under greatest stress mechanically, and via oxygen lack, adapt to the situation. • A chain reaction will evolve as any one, or combination of, the stress factors listed in Box 2.3, or additional stress factors, cumulatively demand increased muscular tone in those structures obliged to compensate for, or adapt to them, resulting in the following events: 1. The muscles opposite to the hypertonic muscles become weaker (gets inhibited). The stressed muscles develop areas of relative hypoxia, simultaneously, there will be a reduction in the efficiency with which metabolic wastes are removed. The combined effect of toxicity and hypoxia of these muscles leads to irritation, sensitivity and pain which feedbacks into a loop. This feedback loop becomes self-perpetuating. Initially, the soft tissues involved will show a reflex resistance to stretch and after some weeks a degree of fibrous infiltration may appear as the tissues under greatest stress mechanically, and via oxygen lack, adapt to the situation.
  • 31. 2. Because of excessive hypertonic activity there will be energy wastage and a tendency to fatigue – both locally and generally (Gutstein 1955). Functional imbalances occurs due to the chain reaction of hypertonic induced fatigue. Muscles will become involved in ‘chain reactions’ of dysfunction. A process develops in which some muscles will be used inappropriately as they learn to compensate for other structures which are weak or restricted, leading to adaptive movements, and loss of the ability to act synergistically as in normal situations (Janda 1985). Over time, the central nervous system learns to accept altered patterns of use as normal (compensatory movements), adding further to the complication of recovery since rehabilitation will now demand a relearning process as well as the more obvious structural (shortness) and functional (inhibition/weakness) corrections (Knott & Voss 1968). 2. Because of excessive hypertonic activity there will be energy wastage and a tendency to fatigue – both locally and generally (Gutstein 1955). Functional imbalances occurs due to the chain reaction of hypertonic induced fatigue. Muscles will become involved in ‘chain reactions’ of dysfunction. A process develops in which some muscles will be used inappropriately as they learn to compensate for other structures which are weak or restricted, leading to adaptive movements, and loss of the ability to act synergistically as in normal situations (Janda 1985). Over time, the central nervous system learns to accept altered patterns of use as normal (compensatory movements), adding further to the complication of recovery since rehabilitation will now demand a relearning process as well as the more obvious structural (shortness) and functional (inhibition/weakness) corrections (Knott & Voss 1968).