This document discusses evidence and perspectives on lumbar spine rehabilitation and functional instability. It questions conventional approaches and dogma, advocating instead for individualized exercise based on context and motor skill training. Specific muscles are not singled out as most important for stability; rather, coordinated muscle activation through motor patterns is key. Low levels of co-contraction can provide adequate stability without undue load.
Bryan English - classification of muscle injuries in sportMuscleTech Network
Bryan English
Medical Director Middlesbrough Football Club. Member of Technical Advisory Group in Sports Science. The English Institute of Sport
-
Terminology and classification of muscle injuries in sport: a Munich consensus statement
(6th MuscleTech Network Workshop)
14th October, Barcelona
The presentation describes a new manual rehabilitative approach to activate the “Integrated Stabilizing System of the Spine, Chest and Pelvis” and achieve exciting levels of improved function of the locomotor system
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke patients. In this sharing session, Ms. Yvonne will share the proven physio exercises and tips on how to prevent and treat shoulder subluxation after stroke.
Webinar Link : https://www.youtube.com/watch?v=tvDoEeaRzYk
Speaker : Ms. Yvonne Khor, Senior Physiotherapist
Ms. Yvonne is a senior physiotherapist as well as the founder of YK Natural Physio & Academy. She has a Master in Rehabilitation Technology and has 8 years of experience in physiotherapy field including treating stroke patients, Parkinson patient, sports patients, etc.
this ppt only focus on the pieces of evidence of swiss ball use in rehabilitation and to build the base so that one can frame effective rehab protocol.
RockTape and Crossfit: Keeping the Athlete 'In The Game'RockTape
CrossFit athletes are different from average weekend warriors. They are of all sizes, ages, and athletic back- grounds. They like to train for fitness and make it a lifestyle. Unlike those who work out in a big box gym, these athletes surround themselves with like-minded individuals, which creates a cool community and “team.”
Muscle tears are extremely common and are often recurrent. They are not as simple as we used to think and the advent of better imaging has proven that the site, size and location of the tear, together with the presence or otherwise of the tendon is crucial information especially for elite or professional athletes, who need accurate information about return to play. Traditional treatments of electrotherapy are simply placebos. The challenge ahead is to optimise treatments for the various diagnostic categories.
PhD Dissertation Defense - Melissa Mazzo - Estimates of neural drive and the ...Melissa Mazzo
A brief background on motor unit physiology and some of the findings from my PhD research projects involving quantification of the neural command to the calf muscles and adjustments in neural drive in response to stretching.
Bryan English - classification of muscle injuries in sportMuscleTech Network
Bryan English
Medical Director Middlesbrough Football Club. Member of Technical Advisory Group in Sports Science. The English Institute of Sport
-
Terminology and classification of muscle injuries in sport: a Munich consensus statement
(6th MuscleTech Network Workshop)
14th October, Barcelona
The presentation describes a new manual rehabilitative approach to activate the “Integrated Stabilizing System of the Spine, Chest and Pelvis” and achieve exciting levels of improved function of the locomotor system
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke patients. In this sharing session, Ms. Yvonne will share the proven physio exercises and tips on how to prevent and treat shoulder subluxation after stroke.
Webinar Link : https://www.youtube.com/watch?v=tvDoEeaRzYk
Speaker : Ms. Yvonne Khor, Senior Physiotherapist
Ms. Yvonne is a senior physiotherapist as well as the founder of YK Natural Physio & Academy. She has a Master in Rehabilitation Technology and has 8 years of experience in physiotherapy field including treating stroke patients, Parkinson patient, sports patients, etc.
this ppt only focus on the pieces of evidence of swiss ball use in rehabilitation and to build the base so that one can frame effective rehab protocol.
RockTape and Crossfit: Keeping the Athlete 'In The Game'RockTape
CrossFit athletes are different from average weekend warriors. They are of all sizes, ages, and athletic back- grounds. They like to train for fitness and make it a lifestyle. Unlike those who work out in a big box gym, these athletes surround themselves with like-minded individuals, which creates a cool community and “team.”
Muscle tears are extremely common and are often recurrent. They are not as simple as we used to think and the advent of better imaging has proven that the site, size and location of the tear, together with the presence or otherwise of the tendon is crucial information especially for elite or professional athletes, who need accurate information about return to play. Traditional treatments of electrotherapy are simply placebos. The challenge ahead is to optimise treatments for the various diagnostic categories.
PhD Dissertation Defense - Melissa Mazzo - Estimates of neural drive and the ...Melissa Mazzo
A brief background on motor unit physiology and some of the findings from my PhD research projects involving quantification of the neural command to the calf muscles and adjustments in neural drive in response to stretching.
We all want fields to play on with all this rain, is turf the answer? Decide for yourself, use this well done presentation from Mt. Sinai Childrens Hospital as your starting point!
a little dated, about 5 years, but still a great starting point for those interested in performance or rehab of the athlete's lumbar spine, more to come!
with all the rain we all want turf fields for play, but is grass safer? Great presentation from Mt. Sinai Children\'s Hospital on health safety of turf fields, who knew?
Nikos Malliaropoulos - Rehabilitation of hamstring injuries MuscleTech Network
Nikos Malliaropoulos
Director of the Athletics National Sports Medicine Centre Thessaloniki Greece. Consultant SEM Physician Barts and The London Clinical Senior Lecturer QMUL CSEM.
-
The rehabilitation of Hamstring injuries - Can we be more injury specific?
(6th MuscleTech Network Workshop)
14th October, Barcelona
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
(zaid hijab) 4th stage
Rehabilitation of sciatica
Sciatica is a common pain syndrome, considering that ∼10% of low back pain
episodes, which have a lifetime cumulative incidence of 80%, will be accompanied
by sciatica. Nerve root compression by disc herniation is regarded as the most
frequent cause of sciatica.
College of
Health and medical technology
Baghdad
Department of
Physiotherapy & Rehabilitation
The PostureTek system is a state-of-the-art posture aid that provides posture support, improves health and promotes overall wellbeing.
You can wear the PostureTek shirt under your regular clothing whether you’re at home, in your car, at the office or working out at the gym. Your posture support shirt can be worn on a daily basis in order to improve posture over the long term.
To Compare The Effect Of Proprioceptive Neuromuscular Facilitation Program Ve...IOSR Journals
Abstract: Low back pain has been a matter of concern, affecting up to 90% of population at some point in
their lifetime, up to 50% have more than one episode. People of all age group can be affected by this menace
irrespective to their gender and quality of life. It has become one of the leading causes for the visit to physician
thus also puts a heavy burden on the currency of the country. Physiotherapy is the most widely used form of
treatment adopted for gaining relief from low back pain. The exercises include stretching, strengthening, range
of motion exercises, McKenzie therapy and core stability exercises other techniques like Proprioceptive
neuromuscular facilitation program etc. It has been concluded in various studies core stability exercises and
Proprioceptive neuromuscular facilitation are beneficial in low back pain patients but comparison of their effect
needs to be established to provide early and better relief from the disability. Therefore objective of the study was
to compare the effect of Proprioceptive neuromuscular facilitation program and Core stabilization exercises on
low back pain patients. 40 subjects aged 30 – 50 years with low back pain for more than 4 weeks were made
part of the study based on inclusion and exclusion criteria and were then divided into two groups named A, B.
Group A received Proprioceptive neuromuscular facilitation and group B received Core stabilization exercises
and hot pack given initially for 10-15 minutes to the lower back. The exercise program was given for 4 weeks
with a total of 24 sessions and progression of the activity was made within the tolerance of the patient. Pre and
post treatment readings were taken of pain, Oswestry Disability Questionnaire and Functional Reach Test.
Results were analyzed using paired, unpaired t- test. Results showed that there is significant effect on pain,
Oswestry Disability Questionnaire and Functional Reach Test in the two groups but group A was clinically
more significant than groups B. The study concluded that patients with low back pain are benefitted more by
Proprioceptive neuromuscular facilitation program. So, Proprioceptive neuromuscular facilitation program
should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Proprioceptive Neuromuscular Facilitation.
this is a recent patient self report tool published in a peer reviewed journal that I have use to help lend a little clarity the increasing number of young athletes I see with hip labral symptoms or a diagnosis of FAI
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Lumbar Spine Functional Instability
Rehabilitation
Convention or Evidence?
Paul Schoonman, DC
Schoonman Chiropractic and Rehab
Health Science Advisory Board, Merrimack College
Andrew Cannon, MHS, PT, SCS
Dir., Sports Medicine, NRHN
Team PT, Lecturer, Merrimack College
4. Critical consumers of dogmatic
approach to lumbar spine care
and exercise
Disc location
5. Trunk Performance
No such thing as truly
functional exercise
Function is context and
individual specific
GPP, SPP
Input versus outcome?
Motor skill in, stability
out!
Ankle sprain, MDI
Like the trunk, ROM is
poor indicator of overall
ability
6. Shoulder any different?
Phases of Rehabilitation for Shoulder Instability
Phase I
Rest and immobilization
Pain control with nonsteroidal anti-inflammatory drugs and ice applied to the shoulder
Phase II
Isometric strengthening
Isotonic strengthening
Begin exercises with shoulder in adducted, forward- flexed position, progressing to
abducted position
Phase III
Endurance building along with strengthening exercises
Goal: the patient reaches 90% strength in the injured shoulder compared with the uninjured
shoulder
Phase IV
Increase activity to sport- or job-specific activities
7. What is best for people with acute
low back pain with or without
radicular symptoms to do?
8. Bed rest for acute low-back pain and sciatica
People with acute low-back pain who are advised to rest in bed have
more pain and are less able to perform every day activities, on
average, than those who are advised to stay active.
As many people get some relief from low back pain and sciatica (pain
down the back and leg) by lying down, bed rest is often recommended.
However, this review found that, for people with acute low-back pain,
advice to rest in bed is less effective in reducing pain and improving an
individual's ability to perform every day activities than advice to stay
active. For people with sciatica, there were no important differences in
the effects of advice to stay in bed compared with advice to stay
active.
Page 106
Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low-back pain and
sciatica. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.:
CD001254
9. Williams flexion exercises
I have not been able to find one shred
of evidence that they are better than
any other form of exercise or that
specifically they are indicated over other
therapeutic exercise interventions
11. Evidence says pre-exercise does not
Not pre-exercise 3x day does
– 20 seconds, 5-7 reps, comfortable
– Frequency is key
– Limited value in spine care relative to spine
stretching
12. Finally, separate out
what is indicated to do
what seems good to do, “clinical wisdom”
what other people do
what the patient wants to do
what you have time to do
what their parents/employer want them to do
What the insurer will pay you to do
16. What patient is this new path for?
Acute? No. Sub acute and beyond, Episodic
Can they be radicular? Yes!, non progressive,
stable, neurologically improving, weakness
decreasing, reflexes increasing
Change from victim to patient
Pain versus function
17. Neuromuscular Function in Athletes Following Recovery
From a Recent Acute Low Back Injury,
Cholewicki et al, jospt vol. 32 #11, 11:2002
Chronic LBP, delay in shut off of agonist , switch on antagonist with
fewer # of trunk muscles responding
Varsity athletes with hx 1 episode of LBP, >6 months prior
@injury pain 4.4/10, FVAS 30/100, min. 3 days OOP
@testing, avg. 56 days post, pain 0/10, full participation
A shutting off of a fewer number of agonists with an increased latency
as well compared to matched controls
18. Stability
Synergistic coordination
of neuromuscular
system to provide a
stable base for
superimposed
functional movement or
activity
Shoulder MDI and hand
placement
But, the trunk??
19. What Do We Know About Lumbar Spine
Segmental Instability?
Clinical instability is a sagittal plane translation of >
3mm or 9% of vertebral body width on either an
flexion or extension radiograph, and/or sagittal plane
rotation >9 degrees for lumbar motion segments
Clinical instability is a deficit in the end of range
passive restraints
Functional instability is a decrease in the capacity of
the stabilizing system of the spine to maintain the
spinal neutral zones within physiological limits so
that there is no neurological deficit, no major
deformity and no incapacitating pain
Functional instability is a failure of the neural and
contractile units to guide normal segmental motion
within the neutral zone.
20.
21. Cause or Effect??
Functional instability
can be both the cause
of and the result of
injury
Not just tissue based
Motor control aspects
– Coordinated contraction
stiffens the joints and
ultimately determines
functional (in)-stability
22. How much load/shear is too much?
Shear tolerance of vertebral motion segment of
2000-2800N one time loading
Repetitive shear loads may be more likely 500N
The osteoligamnetous spine buckles at 20N!
How do muscles that compress make the spine
more functionally stable?
Luca d e al. Stability of the ligamentous spine. Technical Report #40, Biomechanics Laboratory, San Francisco, University of California
23. So what is stability from a spine
perspective?
Potential energy = PE= mass x gravity x height
Stable equilibrium prevails when the PE of the system is
minimum
A ball in a bowl is stable. At the bottom of the bowl it is at
minimum potential energy
The deeper the bowl, the steeper the sides the more stable
the system
Bergmark A (1989) Stability of the lumbar spine: A study in mechanical engineering. Acta Orthop. Scand 1989; 60:3-53.2
24. The Continuum of Stability
Slope of sides = stiffness
of passive tissues =
mechanical stop/end
point
Width of the bottom of
the bowl = joint laxity
Bergmark A (1987) Mechanical stability of
the human lumbar spine. Doctoral
dissertation, Department of Solid
Mechanics, Lund University, Sweden
25. how many sides does the bowl
need?
Spinal joints can rotate in 3 planes, along 3 axes
Requires a 6 dimensional bowl for each 6 lumbar
spinal joints = 36-dimensional bowl
If the height of the bowl is decreased in any one
of these 36 dimensions, the ball rolls out!
A single muscle having inappropriate force or a
damaged passive tissue can cause instability
26. Potential energy as stiffness and
storage of elastic energy.
stiffness = (k)
deformation = (x)
so stretching a band with stiffness x a
distance x will store energy (PE)
27. Elastic PE = .5 * k * x
Stretching a band with
stiffness (k) a distance (x)
with store energy (PE)
Increase in k = increase in
side of the bowl
Stiffness creates stability to
support larger loads (P)
Most important is stiffness
is balanced
Increased stiffness of just 1
spring will lower PE in one
direction and decrease
ability to bear load
28.
29. Symmetrical Stiffness
Active muscles act like a
stiff spring
Modest levels of muscle
activation create
sufficient stiff and stable
joints
Motor control system
modulates stiffness
therefore stability
through coordinated
muscle co- activation
30. How Much Stability is Enough ?
What is Sufficient?
Too much stiffness and muscle
coactivation imposes a load
penalty/prevents motion
Muscular stiffness necessary for
stability with a modest extra for
margin of safety
How hard do the muscles need to
work to provide adequate stability in
the neutral zone?
5%-20% MVC with ADL to athletic
activities
Strength or endurance?
Remember the bowl needs all its
sides!!
31. Is a single muscle most important
Inappropriate application of “Queensland”
research, did not say tva and mf “more”
important
Was any single string more important?
All muscles play a role in stability, roles vary
based on task at hand and resources
available
33. You need a strong
trunk to protect your
back
10% of MVC abdominal
wall cocontraction
Endurance over strength
Proper daily motion is
“endurance training”
34. What are stabilization exercises
An exercise repeated in a
way that grooves motor
patterns and ensures a
stable spine
Consider loading as to
how good an exercise is
An athlete requires a
stable spine during c-v
demanding, complex
motor skill.
It is not whole body
stability, balance
35. What is the most important muscle
Which wire is most
important to the tower
standing
How can
wires/muscles that add
compression,
decrease
compression?
36. Upper and lower rectus
There is no functional
separation of the rectus
abdominis
Is a separation of neural
drive, rarely!
Once activated, function
as a cable throughout its
length
If you mean, lower abs,
could be TVA, that would
be the lateral ‘V’
37. We give patients lumbar stability
exercises
Input or output?
We train motor skill
They get stability