This document discusses evidence and convention regarding lumbar spine rehabilitation and functional instability. It questions the dogmatic approach to lumbar spine care and exercise, noting that function is context-specific. True functional exercise does not exist, and motor skill training is more important than focusing on stability alone. The document advocates moving from isolated to integrated and slow to fast exercises based on the principle of specificity of adaptations to imposed demands (SAID).
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.
Toyota of Irving has for sale the 2010 Toyota Tacoma for customers living in Irving, TX. Call 972-793-6528 or visit: http://toyota-irving.com/2011-Toyota-Tacoma/
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.
Toyota of Irving has for sale the 2010 Toyota Tacoma for customers living in Irving, TX. Call 972-793-6528 or visit: http://toyota-irving.com/2011-Toyota-Tacoma/
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.
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!
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?
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
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!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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