This document discusses the principles and techniques of Dynamic Neuromuscular Stabilization (DNS), which focuses on optimal activation of the diaphragm and integrated spinal stabilization system. DNS is based on developmental kinesiology and aims to achieve correct breathing patterns, joint centration, and core stability before movement. The document outlines DNS assessment methods that evaluate the diaphragm's respiratory and postural functions through various tests of posture, breathing, and isolated limb movements.
- The document discusses the biomechanics and pathomechanics of the elbow joint. It describes the ligaments of the elbow, the articulations between the humerus, ulna, and radius, and the range of motion of the elbow joint. It also examines the muscles that flex, extend, pronate, and supinate the forearm, discussing their attachments, actions, innervation, and the effects of joint positioning on their function. Key concepts covered include torque, moment arms, classes of levers, and the screw home mechanism of the elbow.
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
Physiotherapy for ankle & foot deformitiesSreeraj S R
This document provides information about various foot conditions including pes cavus, pes planus, and their treatment. It defines pes cavus as a foot with an abnormally high arch. Pes planus is defined as flat foot where the arch is lost. Flexible flat foot has an arch when not weight bearing but it disappears with weight bearing. Rigid flat foot lacks an arch with or without weight bearing. Conservative treatments for flexible pes planus include orthotics and exercises while rigid pes planus may require surgery if causing symptoms. Surgical options are also discussed for treatment of pes cavus and rigid pes planus.
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
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
This document provides information on clinical electrophysiological assessment including nerve conduction studies, electromyography, and needle EMG. It discusses the purpose and parameters of these tests in evaluating nerves, muscles, and CNS pathways. Key points covered include the equipment used, recording procedures, physiological principles, and evaluation of evoked potentials through analysis of amplitude, latency, conduction velocity and other parameters.
- The document discusses the biomechanics and pathomechanics of the elbow joint. It describes the ligaments of the elbow, the articulations between the humerus, ulna, and radius, and the range of motion of the elbow joint. It also examines the muscles that flex, extend, pronate, and supinate the forearm, discussing their attachments, actions, innervation, and the effects of joint positioning on their function. Key concepts covered include torque, moment arms, classes of levers, and the screw home mechanism of the elbow.
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
Physiotherapy for ankle & foot deformitiesSreeraj S R
This document provides information about various foot conditions including pes cavus, pes planus, and their treatment. It defines pes cavus as a foot with an abnormally high arch. Pes planus is defined as flat foot where the arch is lost. Flexible flat foot has an arch when not weight bearing but it disappears with weight bearing. Rigid flat foot lacks an arch with or without weight bearing. Conservative treatments for flexible pes planus include orthotics and exercises while rigid pes planus may require surgery if causing symptoms. Surgical options are also discussed for treatment of pes cavus and rigid pes planus.
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
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
This document provides information on clinical electrophysiological assessment including nerve conduction studies, electromyography, and needle EMG. It discusses the purpose and parameters of these tests in evaluating nerves, muscles, and CNS pathways. Key points covered include the equipment used, recording procedures, physiological principles, and evaluation of evoked potentials through analysis of amplitude, latency, conduction velocity and other parameters.
The document provides an overview of the Kaltenborn joint mobilization method. It describes how traditional manipulations have changed over time to reduce risk of injury. Kaltenborn introduced using linear translatoric movements instead of rotational forces to further reduce joint compression. The method evaluates joints for hypomobility and uses grades I-III mobilizations within or at the end of the joint's range of motion to restore normal movement and reduce pain. Precise positioning and understanding concave/convex bone movement aids effective and safe treatment.
This document discusses fatigue assessment, including local and systemic assessments. Local assessment examines muscular fatigue at the site of contraction through techniques like electrophysiological testing, decremental studies, EMG, MMT, and endurance testing. Systemic assessment considers fatigue at the whole-body level through measures of anaerobic capacity, blood lactate levels, aerobic capacity, and energy expenditure. Specific tests discussed include the Katch test, Wingate cycle ergometer test, and VO2 max as determined by the Fick equation. Multidimensional scales are also used to assess fatigue from different perspectives.
The document discusses functional core stabilization and chronic musculoskeletal pain caused by muscle imbalances and weaknesses in the core musculature. It notes that a comprehensive core stabilization program should be included in all lower extremity rehabilitation programs. It describes the anatomy and functions of the core musculature including the lumbo-pelvic-hip complex and how weaknesses can lead to compensation patterns and overuse or chronic injuries.
This document discusses positional release technique (PRT), including:
1. PRT was developed by Dr. Lawrence Jones in 1964 as an osteopathic treatment technique using specific positions to reduce tender points and musculoskeletal dysfunction.
2. Assessment for PRT involves identifying areas of asymmetry, range of motion restrictions, texture changes, and tender points to determine dominant tender points and appropriate positions of treatment.
3. PRT is based on the theory that positions can help "arrest inappropriate proprioceptive activity" and allow tissues to return to a neutral length slowly for pain relief and release of somatic dysfunction.
The document discusses the core and its importance for optimal functioning of the kinetic chain. It defines the core as the lumbo-pelvic-hip complex and describes the muscles involved. Various assessment tests are provided to evaluate core strength, endurance, neuromuscular control and overall functionality. Guidelines are given for developing a comprehensive core stabilization training program with emphasis on progression from stabilization to integrated strength training across multiple planes and functional activities.
manual muscle testing by K Adhi lakshmi vapms copvrkv2007
Manual muscle testing (MMT) involves grading the strength of individual muscles or muscle groups on a scale based on their ability to perform movements against gravity or resistance. Key aspects of MMT include positioning and stabilizing the patient, demonstrating the movement, applying the appropriate grade of resistance, and documenting the results objectively. MMT is useful for assessing muscle weakness from various neuromuscular and musculoskeletal conditions and monitoring the effectiveness of treatment over time. Contraindications include certain neurological or orthopedic injuries or diseases that could be exacerbated by strength testing.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
This document discusses the kinetics and kinematics of human gait. It defines kinetics as the study of forces acting on bodies, and kinematics as the study of motion without regard to forces. The document outlines the major forces involved in gait including externally generated forces like gravity and ground reaction forces, and internally generated forces from muscle contraction. It describes the motions and forces at the ankle, knee, and hip joints throughout the gait cycle. Measurement techniques for kinetics like force plates and for kinematics like motion capture are also summarized.
This document provides guidance on checking various aspects of a lower limb prosthesis. It discusses checking the prosthesis and patient's stump in general, as well as when sitting, standing, walking, and with the prosthesis removed. Checks include ensuring proper fit and alignment of socket components, comfort and stability of the patient, and identification of any potential issues. The document focuses on checkouts for above knee prosthetics but also briefly discusses below knee prosthetics. The goal of prosthetic checkouts is to assess proper functioning and make any necessary adjustments before training the patient.
1) Articular cartilage is a specialized tissue found at the ends of bones in synovial joints that allows for movement with minimal friction. It is composed of chondrocytes and an extracellular matrix of collagen and proteoglycans.
2) Collagen provides tensile strength while proteoglycans attract water and provide compressive stiffness. Water content allows the tissue to withstand loads and provide nutrients to chondrocytes.
3) Articular cartilage functions through fluid-film lubrication provided by synovial fluid and boundary lubrication involving lubricin at the surface to prevent wear during movement of synovial joints.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
This document provides an overview of the biomechanics of the knee complex. It describes the anatomy of the tibiofemoral and patellofemoral joints, including the femoral condyles, tibial plateaus, and alignment of the femur and tibia. It also discusses how weight-bearing forces are distributed between the medial and lateral compartments during activities like standing, walking, and with conditions like genu valgum or genu varum. The complex biomechanics of the knee allow for both mobility and stability through interactions of its bones, cartilage, ligaments and muscles.
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
This document summarizes a workshop on safe exercise for people with osteoporosis or osteopenia. It provides information on the team leading the workshop, aims to give guidance on helpful and harmful exercises. It discusses common problems for this patient group like stiffness, weakness, and falls. It defines osteoporosis and sites of common fractures. Modifiable risk factors for osteoporosis like weight, smoking, diet and exercise are outlined. The physiotherapist discusses types of exercises and provides guidance for low, medium and high risk patients. Case scenarios are presented and discussed. A nurse consultant discusses common queries to their helpline and a new focus on developing protocols for strengthening bones safely through exercise.
Assessment of contractile & inert tissuesSreeraj S R
This document discusses musculoskeletal assessment and clinical examination techniques. It describes examining tissues through patient history, observation, palpation, and special tests. Selective tissue tension testing is explored, distinguishing between contractile tissues like muscles and inert tissues like ligaments. Range of motion, including active, passive, and resisted movements are examined. The significance of end feels and findings are discussed to interpret strength and pain responses and identify potential soft tissue lesions.
This document discusses methods for assessing cardiorespiratory endurance through measurement of maximal oxygen uptake (VO2 max). It describes both submaximal and maximal exercise testing protocols using equipment like bikes, treadmills, and step tests to determine VO2 max either directly through gas analysis or indirectly through heart rate monitoring. Key indicators for assessing cardiorespiratory fitness include VO2 max, respiratory exchange ratio, workload, and heart rate response to exercise.
This document provides an overview of biomechanics of the sacroiliac joints. It discusses the osteology, articulating surfaces, ligaments, blood and nerve supply, factors promoting stability, kinematics, and functional considerations of the sacroiliac joints. It also covers clinical anatomy and sacroiliac dysfunction. The sacroiliac joints connect the sacrum to the iliac bones and allow for slight motion including rotation and translation while maintaining stability through interlocking surfaces and strong ligaments. Proper functioning of the sacroiliac joints is important for load transfer and movements including those related to childbirth.
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
Cyriax, a manual therapy technique, used to treat the soft tissue related pain. invented by James Cyriax who also coined the term "orthopedic medicine". There are various techniques described by Cyriax under the concept which are; infiltration, deep friction massage, manipulation and traction.
Posture is maintained through a balance of muscle contractions regulated by reflexes. The key reflex is the stretch reflex, where muscle spindles detect changes in muscle length and signal the spinal cord to contract or relax muscles. There are two types of postural reflexes - static and statokinetic. Static reflexes maintain posture against gravity, while statokinetic reflexes allow for voluntary movement. Multiple areas of the central nervous system integrate these reflexes, including the spinal cord, brainstem, cerebellum and cerebral cortex. Vision and vestibular signals also provide important inputs. Together this network allows humans to maintain an upright stance through low levels of continuous muscle contraction adjusted by reflexes.
Posture is maintained through a combination of muscle tone and reflexes. The muscles that maintain posture contain a high proportion of slow-twitch fibers to allow for sustained contraction. Postural reflexes integrate inputs from proprioceptors, the vestibular system and visual system to make continuous corrections to muscle activity and maintain balance. The spinal cord, brainstem and cerebellum are involved in regulating these reflexes. Upright human posture relies on minimal muscle activity but reflex adjustments of antigravity muscles in response to sway to oppose the effects of gravity.
The document provides an overview of the Kaltenborn joint mobilization method. It describes how traditional manipulations have changed over time to reduce risk of injury. Kaltenborn introduced using linear translatoric movements instead of rotational forces to further reduce joint compression. The method evaluates joints for hypomobility and uses grades I-III mobilizations within or at the end of the joint's range of motion to restore normal movement and reduce pain. Precise positioning and understanding concave/convex bone movement aids effective and safe treatment.
This document discusses fatigue assessment, including local and systemic assessments. Local assessment examines muscular fatigue at the site of contraction through techniques like electrophysiological testing, decremental studies, EMG, MMT, and endurance testing. Systemic assessment considers fatigue at the whole-body level through measures of anaerobic capacity, blood lactate levels, aerobic capacity, and energy expenditure. Specific tests discussed include the Katch test, Wingate cycle ergometer test, and VO2 max as determined by the Fick equation. Multidimensional scales are also used to assess fatigue from different perspectives.
The document discusses functional core stabilization and chronic musculoskeletal pain caused by muscle imbalances and weaknesses in the core musculature. It notes that a comprehensive core stabilization program should be included in all lower extremity rehabilitation programs. It describes the anatomy and functions of the core musculature including the lumbo-pelvic-hip complex and how weaknesses can lead to compensation patterns and overuse or chronic injuries.
This document discusses positional release technique (PRT), including:
1. PRT was developed by Dr. Lawrence Jones in 1964 as an osteopathic treatment technique using specific positions to reduce tender points and musculoskeletal dysfunction.
2. Assessment for PRT involves identifying areas of asymmetry, range of motion restrictions, texture changes, and tender points to determine dominant tender points and appropriate positions of treatment.
3. PRT is based on the theory that positions can help "arrest inappropriate proprioceptive activity" and allow tissues to return to a neutral length slowly for pain relief and release of somatic dysfunction.
The document discusses the core and its importance for optimal functioning of the kinetic chain. It defines the core as the lumbo-pelvic-hip complex and describes the muscles involved. Various assessment tests are provided to evaluate core strength, endurance, neuromuscular control and overall functionality. Guidelines are given for developing a comprehensive core stabilization training program with emphasis on progression from stabilization to integrated strength training across multiple planes and functional activities.
manual muscle testing by K Adhi lakshmi vapms copvrkv2007
Manual muscle testing (MMT) involves grading the strength of individual muscles or muscle groups on a scale based on their ability to perform movements against gravity or resistance. Key aspects of MMT include positioning and stabilizing the patient, demonstrating the movement, applying the appropriate grade of resistance, and documenting the results objectively. MMT is useful for assessing muscle weakness from various neuromuscular and musculoskeletal conditions and monitoring the effectiveness of treatment over time. Contraindications include certain neurological or orthopedic injuries or diseases that could be exacerbated by strength testing.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
This document discusses the kinetics and kinematics of human gait. It defines kinetics as the study of forces acting on bodies, and kinematics as the study of motion without regard to forces. The document outlines the major forces involved in gait including externally generated forces like gravity and ground reaction forces, and internally generated forces from muscle contraction. It describes the motions and forces at the ankle, knee, and hip joints throughout the gait cycle. Measurement techniques for kinetics like force plates and for kinematics like motion capture are also summarized.
This document provides guidance on checking various aspects of a lower limb prosthesis. It discusses checking the prosthesis and patient's stump in general, as well as when sitting, standing, walking, and with the prosthesis removed. Checks include ensuring proper fit and alignment of socket components, comfort and stability of the patient, and identification of any potential issues. The document focuses on checkouts for above knee prosthetics but also briefly discusses below knee prosthetics. The goal of prosthetic checkouts is to assess proper functioning and make any necessary adjustments before training the patient.
1) Articular cartilage is a specialized tissue found at the ends of bones in synovial joints that allows for movement with minimal friction. It is composed of chondrocytes and an extracellular matrix of collagen and proteoglycans.
2) Collagen provides tensile strength while proteoglycans attract water and provide compressive stiffness. Water content allows the tissue to withstand loads and provide nutrients to chondrocytes.
3) Articular cartilage functions through fluid-film lubrication provided by synovial fluid and boundary lubrication involving lubricin at the surface to prevent wear during movement of synovial joints.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
This document provides an overview of the biomechanics of the knee complex. It describes the anatomy of the tibiofemoral and patellofemoral joints, including the femoral condyles, tibial plateaus, and alignment of the femur and tibia. It also discusses how weight-bearing forces are distributed between the medial and lateral compartments during activities like standing, walking, and with conditions like genu valgum or genu varum. The complex biomechanics of the knee allow for both mobility and stability through interactions of its bones, cartilage, ligaments and muscles.
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
This document summarizes a workshop on safe exercise for people with osteoporosis or osteopenia. It provides information on the team leading the workshop, aims to give guidance on helpful and harmful exercises. It discusses common problems for this patient group like stiffness, weakness, and falls. It defines osteoporosis and sites of common fractures. Modifiable risk factors for osteoporosis like weight, smoking, diet and exercise are outlined. The physiotherapist discusses types of exercises and provides guidance for low, medium and high risk patients. Case scenarios are presented and discussed. A nurse consultant discusses common queries to their helpline and a new focus on developing protocols for strengthening bones safely through exercise.
Assessment of contractile & inert tissuesSreeraj S R
This document discusses musculoskeletal assessment and clinical examination techniques. It describes examining tissues through patient history, observation, palpation, and special tests. Selective tissue tension testing is explored, distinguishing between contractile tissues like muscles and inert tissues like ligaments. Range of motion, including active, passive, and resisted movements are examined. The significance of end feels and findings are discussed to interpret strength and pain responses and identify potential soft tissue lesions.
This document discusses methods for assessing cardiorespiratory endurance through measurement of maximal oxygen uptake (VO2 max). It describes both submaximal and maximal exercise testing protocols using equipment like bikes, treadmills, and step tests to determine VO2 max either directly through gas analysis or indirectly through heart rate monitoring. Key indicators for assessing cardiorespiratory fitness include VO2 max, respiratory exchange ratio, workload, and heart rate response to exercise.
This document provides an overview of biomechanics of the sacroiliac joints. It discusses the osteology, articulating surfaces, ligaments, blood and nerve supply, factors promoting stability, kinematics, and functional considerations of the sacroiliac joints. It also covers clinical anatomy and sacroiliac dysfunction. The sacroiliac joints connect the sacrum to the iliac bones and allow for slight motion including rotation and translation while maintaining stability through interlocking surfaces and strong ligaments. Proper functioning of the sacroiliac joints is important for load transfer and movements including those related to childbirth.
Kinetics and Kinematics of Gait summarizes gait terminology, phases, joint motion, determinants, and the kinetics and kinematics of the trunk and upper extremities during gait. It describes the six determinants of gait including pelvic rotation and tilting, knee flexion in stance, and foot and knee mechanisms which function to minimize center of gravity displacement. The document also outlines the muscle activity, internal joint moments, and energy requirements including potential and kinetic energy exchange during the gait cycle.
Cyriax, a manual therapy technique, used to treat the soft tissue related pain. invented by James Cyriax who also coined the term "orthopedic medicine". There are various techniques described by Cyriax under the concept which are; infiltration, deep friction massage, manipulation and traction.
Posture is maintained through a balance of muscle contractions regulated by reflexes. The key reflex is the stretch reflex, where muscle spindles detect changes in muscle length and signal the spinal cord to contract or relax muscles. There are two types of postural reflexes - static and statokinetic. Static reflexes maintain posture against gravity, while statokinetic reflexes allow for voluntary movement. Multiple areas of the central nervous system integrate these reflexes, including the spinal cord, brainstem, cerebellum and cerebral cortex. Vision and vestibular signals also provide important inputs. Together this network allows humans to maintain an upright stance through low levels of continuous muscle contraction adjusted by reflexes.
Posture is maintained through a combination of muscle tone and reflexes. The muscles that maintain posture contain a high proportion of slow-twitch fibers to allow for sustained contraction. Postural reflexes integrate inputs from proprioceptors, the vestibular system and visual system to make continuous corrections to muscle activity and maintain balance. The spinal cord, brainstem and cerebellum are involved in regulating these reflexes. Upright human posture relies on minimal muscle activity but reflex adjustments of antigravity muscles in response to sway to oppose the effects of gravity.
The document discusses the relationship between diaphragm function and core stability. It states that a weak diaphragm does not provide proper support for the spine, leading to postural issues. Good diaphragm function requires coordinated activity of the abdominal wall and intra-abdominal pressure during breathing to support the lumbar spine. Evaluating diaphragm and breathing function is important for assessing core stability and treating low back pain. Treatment should address bony, articular, ligamentary, muscular and fascial aspects of the core to improve coordination between structures like the diaphragm and pelvic floor.
The document discusses the neural control of human locomotion. It states that locomotion requires progression, postural control, and adaptation. It is controlled by the coordinated actions of the neurologic, muscular and skeletal systems through various chains including sensorimotor chains. The nervous system generates locomotor patterns and coordinates multi-limb movements while accounting for environmental factors. Both lower motor neurons and supraspinal centers receive convergent input which allows locomotion to be adapted based on context.
The core consists of 29 pairs of muscles that stabilize the spine, pelvis, and kinetic chain during movement. These muscles work together to distribute forces and generate mobility with minimal stress on joints. Core stability exercises are important for spinal stability by maintaining normal spinal displacement under load. Stability relies on neuromuscular control as well as passive bone and ligament support and active muscle contraction. A complete core program addresses both sensory and motor aspects to optimize stability through coordination of local and global muscles.
This document discusses posture and postural alignment. It defines posture and describes the development of spinal curvature from birth. Good posture is defined as a position with stability, balance and minimal effort. Poor posture results from deviations from good alignment. Factors like muscles, nerves, reflexes and the central nervous system contribute to postural control. Techniques for assessing and correcting posture include exercises, stretching, strengthening, taping and myofascial release. Maintaining mobility, muscle balance and retraining awareness can help improve poor posture.
BALANCE
BALANCE SYSTEM
TYPES OF BALANCE
MECHANISM
CORRELATION
BALANCE TRAINING
MANAGEMENT
STRATEGIES
PHYSIOTHERAPY INTERVENTION
BALANCE TRAINING IN ELDERLY
OUTCOME MEASURES
Detailed explanation about balance and balance training.
Balance refers to an individuals ability to maintain their line of gravity within their Base of support (BOS). It can also be described as the ability to maintain equilibrium, where equilibrium can be defined as any condition in which all acting forces are cancelled by each other resulting in a stable balanced system.
BALANCE SYSTEMS:
The following systems provides input regarding the body's equilibrium and thus maintains balance.
Somatosensory / Proprioceptive System
Vestibular System
Visual System
The Central Nervous System receives feedback about the body orientation from these three main sensory systems and integrates this sensory feedback and subsequently generates a corrective, stabilizing torque by selectively activating muscles. In normal condition, healthy subjects rely 70% on somatosensory information and 20% Vestibular & 10% on Vision on firm surface but change to 60% vestibular information, 30% Vision & 10% somatosensory on unstable surface.
SOMATOSENSORY SYSTEM:
Proprioceptive information from spino-cerebellar pathways, processed unconsciously in the cerebellum, are required to control postural balance. Proprioceptive information has the shortest time delays, with monosynaptic pathways that can process information as quickly as 40–50 ms and hence the major contributor for postural control in normal conditions.
VESTIBULAR SYSTEM:
The vestibular system generates compensatory responses to head motion via:
Postural responses (Vestibulo-Spinal Reflex) - keep the body upright and prevent falls when the body is unexpectedly knocked off balance.
Ocular-motor responses (Vestibulo-Ocular Reflex) - allows the eyes to remain steadily focused while the head is in motion.
Visceral responses (Vestibulo-Colic Reflex) - help keep the head and neck centred, steady, and upright on the shoulders.
VISUAL SYSTEM:
For non-impaired individuals, under normal conditions the contribution of visual system to postural control is partially redundant as the visual information has longer time delays as long as 150-200 ms.
Friedrich et al. observed that adults with visual disorders were able to adapt peripheral, vestibular, somatosensory perception and cerebellar processing to compensate for their visual information deficit and to provide good postural control.
In addition, Peterka found that adults with bilateral vestibular deficits can enhance their visual and proprioceptive information even more than healthy adults in order to reach effective postural stability.
The influence of moving visual fields on postural stability depends on the characteristics of the visual environment, and of the support surface, including the size of the base of support, its rigidity or compliance.
TYPES OF BALANCE:
Balance can be classified in to :
Static Balance:
Dynamic Balance
The document discusses low back pain, including its prevalence, causes, types (acute, subacute, chronic), and potential pain generators. It describes the biomechanics of the lumbar spine, including the vertebrae, intervertebral discs, zygapophyseal joints, ligaments, and muscles. Potential causes of low back pain with leg pain greater than back pain and management options are provided. Specific conditions like lumbar spinal stenosis, spondylolysis, and pregnancy-related back pain are explained. The role of ergonomics and lifestyle factors like backpack weight are also summarized.
This document outlines Brunnstrom's approach to motor recovery following stroke. It describes the general principles, stages of recovery, evaluation procedures, and training techniques. Key points include:
- Recovery follows stereotypical stages that parallel normal motor development.
- Early recovery is characterized by basic limb synergies that gradually give way to more independent voluntary movements.
- Evaluation and treatment are based on the current stage of recovery rather than traditional strength tests.
- Procedures utilize reflexes and primitive movement patterns to facilitate recovery to the next stage.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
This document provides an overview of posture, including definitions, types, mechanisms, patterns, principles of re-education, and presentation of good posture. It defines posture as the body's position either at rest or during movement. There are inactive postures for rest and active static and dynamic postures that require muscle coordination. Posture is maintained through complex reflexes involving muscles, eyes, ears, and joints. Good posture is efficient with minimal effort, while poor posture is inefficient and causes unnecessary muscle strain. Re-education of posture focuses on identifying and treating causes, gaining patient cooperation, relaxation/mobility exercises, and establishing new posture habits through repetition and education.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
Introduction, definition, purposes of maintaining proper body mechanics,terminology related to body mechanics, factors influencing body mechanics, principles of body mechanics, procedures for moving lifting and positioning of patients, general instructions of moving and lifting patients, after care of the patient, complications of improper body mechanics, conclusion
This document provides an overview of posture biomechanics, including:
1. Definitions of static and dynamic posture, and descriptions of optimal sagittal and frontal plane alignment.
2. Explanations of how posture is controlled through sensory inputs, muscle activity, and strategies like fixed support and changing support.
3. Analyses of deviations from optimal posture, including positions of the foot, knee, spine, and effects of sitting and lying postures. Factors like age, gender, and occupation are also discussed.
This document discusses motor control and postural control. It defines motor control as the study of movement, which arises from the interaction of perception, cognition, individual characteristics, task constraints, and environmental factors. Postural control maintains stability and orientation through steady-state, reactive, and proactive balance. Steady-state balance involves alignment and muscle tone to counteract gravity. Reactive balance uses strategies like ankle/hip adjustments or changing support when perturbed. Proactive balance anticipates forces through sensory information and experience to stabilize movements like lifting objects. Environmental constraints and cognitive loads also influence balance control.
Balance, or postural stability, is the process by which the body maintains equilibrium by keeping its center of mass over its base of support. It requires integration of sensory inputs from the visual, vestibular, and somatosensory systems and appropriate muscle responses from the nervous and musculoskeletal systems. When any of the sensory systems are impaired, the central nervous system compensates by increasing reliance on the other intact systems through a process called sensory organization. Different tasks require different types of balance control, including static balance to maintain a stable position at rest and dynamic balance during voluntary movements.
This document discusses posture and different types of posture. It describes active posture which can be static or dynamic, and inactive posture which is adopted for resting. Postural mechanisms involve muscles, eyes, and ears which help maintain erect posture and detect body position changes. Good posture involves good alignment to reduce stress on the body, while bad posture results from tight or shortened muscles and can increase risks. Specific postural deformities like hyperlordosis, scoliosis, and kyphosis are also defined.
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8. CONTRAINDICATIONS: MOVEMENT IN YOGA
8. Introduction to Contraindications
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2. • Dynamic Neuromuscular stabilization is an evolving concept in the field of
rehabilitation.
• It works on the entire stabilizing system of the spine along with optimal activation
of the diaphragm enabling the appropriate movement of the extremities.
• It is based on the principles of developmental kinesiology focus on correct breathing
pattern and stabilizing role of the diaphragm and correct activation of the integrated
spinal stabilization system before any movement at the extremities.
• The concept of reflex locomotion explains that specific involuntary motor
reactions/ movement patterns are seen on giving firm pressure stimulation over
certain zones in the muscles
3. • These movement patterns are generic and were termed “global patterns”.
• The global pattern evoked from prone position is called “reflex creeping” while the
one from supine or sidelying is called as “reflex rolling”
• According to Wickstrom RL, in healthy (free of developmental disorders) newborns
certain motor movements like grabbing, turning, crawling and eventually walking are
developed automatically without any specific training.
• Evidently, the neuronal circuitry that guides these complex developmental behaviors
may be activated by stimulating peripheral areas, or zones.
4. • These zones are generally derived from balance and stabilizing points during an
infant’s development.
• Concept for the treatment and rehabilitation and termed it as Dynamic
Neuromuscular Stabilization (DNS).
• DNS works on the principles of Developmental Kinesiology (DK)
• According to DNS the posture, breathing pattern and joint centration (posture
which influences the joints to be in maximum congruency) should be studied and
treated from neurodevelopmental perspective.
• In this approach the main focus is on core stability which is provided mainly by the
neck flexors and extensors, diaphragm, transverse abdominis and multifidus.
5. • Great emphasis is put on the correct activation of the diaphragm, breathing pattern
and core stability before any purposeful movement.
• Nowadays, DNS is used successfully for the rehabilitation of various neurological,
musculoskeletal, pediatric and sports injury cases
6. Principles of DNS
Dynamic neuromuscular stabilization involves precise co-activation of the
intrinsic muscles of the spine which forms the Integrated spinal stabilization
system (ISSS) and includes cervical flexors and extensors, diaphragm,
transversus abdominis, multifidus and pelvic floor.
Fundamentally, the concept of DNS is derived from the principles of
developmental kinesiology (DK), highlighting the existence of central
movement patterns which exists innately.
Following are the basic principles on which DNS works:-
7. Developmental Kinesiology
The developmental kinesiology is based on the three levels of sensorimotor control
i.e.,
(1) brainstem and spinal level at which general movements are displayed with gross
movement of body parts at variable speed and amplitude,
(2) subcortical level in which synergistic activation of the diaphragm, pelvic floor,
abdominal wall and spinal extensors occur before any movement of the
extremity/ head/ neck and
(3) the cortical level of motor control in which development of locomotor pattern
occur
8. • Development of human motor function in early childhood is genetically
predetermined and follows a predictable pattern.
• Along with the maturation of the central nervous system these motor patterns or
programs are formed and thus allowing the infant to activate the muscles optimally
which is required to control posture, achieve erect posture against gravity and to
move purposefully
9. Joint Centration
• The subcortical level of the CNS controls the core stability as well as the locomotor
function of the extremity.
• Adequate CNS control and optimal balanced activation of the muscles leads the
joints to come in a functionally centered position during every movement and
posture.
• This centrated position of the joint is a dynamic neuromuscular strategy and
provides mechanical advantage for optimal joint motion throughout the range.
• In a centrated joint, the interosseous contact is maximum allowing adequate transfer
of the load across the joint and optimal functioning of the kinetic chain.
• This infers greatest loading, least strain in the joint capsule and the tendons, and
every joint structure will be protected while loading.
10. Core stabilization- Integrated spinal
stabilization system (ISSS)
• The integrated spinal stabilizing system (ISSS) as described by Kolar, is comprised
of balanced co-activation between the deep cervical flexors and spinal extensors in
the cervical and upper thoracic region, as well as the diaphragm, pelvic floor, all
sections of the abdominals and spinal extensors in the lower thoracic and lumbar
region.
• The diaphragm, pelvic floor and transversus abdominis regulate IAP and provide
anterior lumbopelvic postural stability.
11. • The activity of these spinal stabilizers (cervical
flexors and extensors, diaphragm, transversus
abdominis, multifidus, pelvic floor) must be
preceded by any simple purposeful movement and
these stabilizers work together and not in isolation
• This activation of core before movement is
automatic providing stable base (punctum fixum)
for the movement and known as “Feed forward
mechanism”. Thus, if any one segment of this
stabilizing system is disturbed it affects the entire
stabilizing system, compromising the quality of
purposeful movement.
12. Stabilizing function of the Diaphragm
• Proper stabilization of the spine is provided by the correct breathing pattern.
• During the early phase of development, diaphragm serves respiratory role only
• The antigravity postural role of the diaphragm develops when the infant begins to
lift his head in prone position or lifts the lower extremities in supine.
• The link between the stabilization function and pattern of breathing is provided by
the symmetrical co-activation of all parts of the integrated spinal stabilization
system (dia-phragm, abdominal, back and pelvic muscles).
13. • This combination of the stabilizing as well as the respiratory function is relatively demanding
and is possible when there is perfect motor control i.e., in a healthy CNS.
• It has been demonstrated experimentally that diaphragm is activated tonically while lifting
objects.
• Various researchers have reported the coordinated synergistic activity of the diaphragm,
transverse abdominis, pelvic floor and the multifidus muscles during postural tasks.
• During inspiration the dome of the diaphragm flattens and the degree of flattening
depends upon the breathing pattern and postural task performed.
• This caudal descent of the diaphragm during inspiration and postural task increases the
intra-abdominal pressure while increasing pressure on the internal organs
14. • This caudal descent causes expansion of the abdominal wall eccentrically increasing
the abdominal and thoracic wall volume.
• This eccentric contraction is followed by the isometric contraction of the abdominal
wall in order to maintain the volume of the abdominal wall.
• Under ideal conditions, this ‘eccentric-isometric’ muscle activity occurs in proportion
to the level of work exerted by the muscle and to the motion demands.
• In case of greater muscle activity there is flattening of the diaphragm with smaller
excursions during breathing. Thus, in this condition the postural function is favoured
by the diaphragm.
15. • During inspiration there is eccentric activity of the muscles inserting into the
thoracic and abdominal wall causing the abdominal wall to expand cylindrically in
all directions.
• However, there is concentric contraction of the diaphragm and the pelvic floor
against the abdominal cavity content.
• Once there is optimal eccentric contraction on flattening of the diaphragm, the
isometric contraction of the abdominal muscles serves as a stabilizing role for
the movement of the extremities
16. • Correct alignment of the diaphragm and pelvis- their axis
are parallel to each other
• B. During postural disturbance the pelvic and the
diaphragm axis are not parallel to each other as well as the
diaphragm is at a cranial position and the abdominal
expansion is inappropriate
• C. The abdominal cavity expands during postural activity,
the diaphragm descends downwards, eccentric activation
of the abdominal muscles occurs which is followed by the
isometric contraction.
• D. Inappropriate muscle coordination does not allow the
central tendon to descend downwards, hollowing of the
abdominal wall.
17. DNS Assessment
• In DNS approach the assessment of dual function of the diaphragm i.e., the
respiratory and the postural function are done.
• The assessment is based on the neurodevelopmental postures.
18. Evaluation of the diaphragm
a) Respiratory Function
• The position of patient corresponds to 8 months sitting position, sitting on ischial tuberosities on a
table without feet supported, spine elongated and upper extremities supported on thigh.
• Movement of the ribs and abdominal cavity is observed.
• There should be symmetrical expansion of the thoracic and abdominal cavities.
• During physiological diaphragmatic breathing, the lower aperture of the thorax also expands in addition
to the abdominal cavity and ventral movement of the sternum occurs.
• On palpating the ribs, there is expansion of the intercostal spaces and the lower portion of thorax
expands laterally, ventrally and in dorsal direction in a proportionate manner.
• Thus, as the abdominal cavity expands there should be separation of the ribs which can be identified by
palpating the intercostal spaces.
• During inhalation, the inhalation wave reaches as far as the lower abdominal wall, i.e. the patient can also
breathe into the abdominal wall just above the groin.
• There is no change in the position of the sternum in transverse plane.
• There is minimum expansion of the thorax and no expansion of the intercostal spaces in pathological
conditions.
19. b) Postural function- Activation of the diaphragm
• The position of the patient is sitting at the edge of the table with trunk relaxed, feet
unsupported and the upper extremities should be positioned freely without the
patient leaning on them.
• At first the natural pattern of the patient is observed and then the patient is
instructed and taught to make the required corrections in his pattern.
• Now, palpate the posterolateral aspect of abdominal wall below the lower ribs from
behind and from the front the groin area is palpated above the femoral heads medial
to the anterior superior iliac spine.
• The patient is asked to inhale and exhale, after exhalation the breath is hold and the
patient is asked to expand the abdominal wall posteriorly and laterally or caudally and
ventrolaterally while the therapist is giving tactile cues by applying pressure with
thumbs against which the abdominal cavity is asked to expand
20. • During this test, the correct pattern is indicated by symmetrical pressure of the abdominal
wall against the therapist’s thumb.
• During abdominal expansion there is activation of the diaphragm and eccentric elongation of
the abdominal wall which is followed by the abdominal muscles’ isometric contraction.
• The test is considered to be positive if the patient cannot activate the abdominal muscles
freely or there is asymmetric pressure against the examiner’s thumb, upward migration of the
umbilicus, drawing in of the upper half of the abdomen.
• The patient may compensate with a posterior pelvic tilt by activating the lower abdominal
muscles.
21.
22. Intra-abdominal pressure test
• Test Position: Positioned in 3 month supine developmental position with hip, knee and ankle in
90 degree of flexion, mild abduction and external rotation at the hip with legs supported on a
chair or by the therapist. Chest is taken into neutral position passively. Gradually the support
from the legs will be removed and the examiner look for the activation of the abdominal
muscles, chest movement, position of the pelvis, cervical spine and head
• Correct activation: There must be balanced activity of all the abdominal muscles, chest in caudal
position, widening of the lower chest, diaphragm and pelvic floor should remain parallel.
• Incorrect activation : There is hyperactivation of the rectus abdominis, insufficient activation of
the lower abdominal wall, cranial migration of the umbilicus, chest not in caudal neutral
position. There may be hyperextension in thoracolumbar junction, abdominal hollowing above
the groin, shoulder protraction, hyperextension of the cervical spine, overactivity of hip flexors
showing incorrect activation
23. Arm-lifting test
Test Position: The patient is in crook lying or standing position and asked to take the
shoulder in 120 degrees of flexion. The examiner notices for the activation of the
abdominal muscles, movement of chest and thoracolumbar junction stability.
Correct activation: Correct activation indicates isolated flexion of the arms without any
movement at the chest, thoracolumbar junction in stable position, fixed lower ribs
without any flaring of them
Incorrect activation : Cranial movement of the chest with shoulder flexion, increased
lordosis at the thoracolumbar junction and increased activation of rectus abdominis,
upper trapezius indicate incorrect activation.
24. Neck/trunk flexion test
Test Position: Patient is in supine lying with legs extended and is asked to and is asked to
flex the neck and trunk slowly. The movement of the head and chest as well as the
position of the cervical spine and shoulder girdle is observed during the test. The
therapist palpates the abdominal wall and the neck muscles to see whether they are
activating or not.
Correct activation: Correct activation reveals fluent flexion of the cervical and thoracic
spine, activation of the deep neck flexors, balanced activity of abdominal wall and chest
in neutral position.
Incorrect activation : In incorrect activation there will be lateral movement of the ribs,
bulging at the lateral aspect of the abdominal wall, hyperactivation of the rectus
abdominis. There may be cranial movement of the chest, protrusion of the chin
25. Hip flexion test
Test Position: Starting position is 8 months sitting position with spine straight, upper
extremity resting on thigh with palm facing upward. Test is performed by asking the
patient to lift one knee upto 5 cm by flexing the hip. While performing the test the spine
should be maintained in upright position, thoracolumbar junction should be in stable
position i.e no kyphosis or lordosis, chest and pelvis in neutral position.
Correct activation: The spine should be maintained in upright position, thoracolumbar
junction should be in stable position i.e no kyphosis or lordosis, chest and pelvis in
neutral position.
Incorrect activation : During incorrect activation, there will be flexion or extension of
the spine, increased activity of the paraspinal muscles, absent or weak activation of the
posterolateral abdominals, increased activity of the rectus abdominis, pelvis rotation,
internal rotation of the hip. Instability in the thoracolumbar junction may show lateral
shift towards the side of hip flexion, lateral flexion of trunk and posterior shift of the
non-weight bearing hip.
26. Head/neck extension test
Test Position: The assessment position is 3 month prone developmental position, forehead on
the table or in rotation to one side, legs relaxed on the table, feet off edge, arms alongside the
body. Ask the patient to gradually lift the head and upper trunk sequentially.
Correct activation: In correct activation the cylindrical shape of the abdomen should be
maintained, head in elongation of the spine, scapula parallel to spine in neutral position, pelvis
supported on pubic symphysisin neutral position, sacrum in stable position.
Incorrect activation : In case of incorrect activation, there will be anterior pelvic tilt, increased
lumbar lordosis, increased activation of the paraspinal muscles, bulging of lateral sides of the
abdominal wall, stiff thoracic spine kyphosis, increased activation of gluteal muscles and
hamstrings, asymmetrical position of shoulder blades. Incorrect activation also reveals increased
activity of the cervical extensors causing hyperextension at neck showing insufficiency of the
deep neck flexors, elevation/adduction of the scapulae, shoulder protraction, any kind of
asymmetry of the muscles.
27. Quadruped rock-forward test
Test Position: The testing position corresponds to the end of the 6 months prone
developmental position. All the 4 extremities serve for support, upper and lower
extremities perpendicular to the ground. In this test the patient slightly shifts the head
and trunk forward (rocking forward) to load upper extremities more. The therapist
should observe for the hand spport on ground, position of shoulder blades,
thoracolumbar junction stabilization, thoracic spine, cervical spine, pelvis rotation or
shift, hips position.
Correct activation: Correct activation shows centrated stabilized scapulae, balance
support of the hand (thenar and hypothenar), spine and pelvis uprighted (without
lordosis or kyphosis or anterior or posterior tilt of the pelvis), head in alignment.
Incorrect activation : Incorrect activation will depict winging or hyperabduction of
scapula, hand support on hypothenar with fingers flexed, kyphosis or lordosis at spine,
head hanging down, hyperextension at spine.
28. Six month prone test
Test Position: All four extremities serve for support. Support is on open palms and distal
thighs. Observe for the position of the thoracolumbar junction and low back, activity of
the laterodorsal group of abdominal wall, position of shoulder blades, position of the
head.
Correct activation: The whole spine should be in centered position, head and pelvis well
centered, proportional activity of all the sections of the abdominal wall, paraspinal
muscles and diaphragm, centration of shoulder blades, minimal activity of the muscles
of dorsal aspect of lower extremity.
Incorrect activation : During incorrect activation there is hyperextension of the lumbar
spine, hypercativation of the paraspinal muscles, elevation of shoulder blades,
protraction of shoulders
29. DNS Treatment
• ore stabilization is pre-requisite which provides a stable base for the movement of extremities.
• Therefore, the exercises must begin by influencing the stabilization of the trunk or integrated
spinal stabilization system before the function of the extremities.
• Before applying the DNS treatment, any tight structure or hypomobile segment must be
released/ mobilized.
• The physiological movement of the diaphragm constitutes an essential part of any movement
or exercise.
• During inspiration the ribs move laterally, lower aperture of chest expands, sternum moves
ventrally and does not elevate with breathing.
• The abdominal muscles serve as a support for the diaphragm.
• It is important for the abdominal wall to expand not only in inferior direction but rather in all
directions i.e., posteriorly and laterally.
• Umbilicus should not move cranially.
30. Following points should be kept in mind for influencing the correct breathing pattern
and stabilization of the trunk :
1. To regulate reduced mobility and dynamics of the thoracic wall.
2. Focusing on straightening of the spine
3. Stabilization of posture
4. Exercising the postural breathing pattern and stabilizing function of the diaphragm
(intra-abdominal pressure control)
5. Exercising postural stabilization of the spine in the positions related to developmental
sequences – in modified positions and versions.
31. Regulating hypomobility and thoracic wall dynamics
• The correct activation of the diaphragm which is responsible for the optimal
expansion of the thoracic wall particularly between the lower ribs is brought about
by releasing the thoracic fasciae especially in the region of the lower intercostal
spaces.
• Other tight or hypomobile structures like costovertebral joints, scalenes,
sternocleidomastoid, pectoral muscles and upper trapezius are released/ mobilized
in order to get the neutral position of the joints and structures.
32. Focusing on straightening of the spine
• For physiological stabilization of the spine straightening of the spine is a necessity.
• In most of the patients, the incorrect stabilization is seen as hypomobile thoracic
segment in which the thorax moves as a rigid unit.
• Thus, the treatment technique includes traction, mobilization of the spine, active
straightening of the thoracic spine and movement of the spinal segments into
extension and rotation.
• In order to achieve this, appropriate stabilization of the scapula is required which can
be adapted in prone position supported on elbows to practice thoracic extension
33. Stabilization in prone. A. 4 month old healthy baby with spine in upright
position, extension and the support is on the both elbows and pubic
symphysis.
B. An adult is positioned in the same way with support on both elbows
and pubic symphysis, spine straight, scapulae in neutral position.
Segmental extension and rotation with proper breathing pattern can be
practiced in this position
34. Exercising appropriate stabilization of the respiratory
pattern by using reflex locomotion
• Optimal synergistic activation between the abdominal muscles (diaphragm, abdominal and
pelvic floor muscles) and the back muscles is achieved by reflex activation during the initial
phases.
• In phase I of reflex rolling, there is stimulation of the thoracic region in which contraction of
the diaphragm occurs as a stretch is transferred to the insertions of the diaphragm.
• This contraction acts on the thorax through the ribs while the intra-abdominal pressure
increases simultaneously.
• This is similar in reflex crawling, during which the first reaction of the stimulated zones elicits
deepening of lower costal breathing and abdominal wall expansion in all directions.
• Individual components required for physiological stabilization are integrated within this
reflexively stimulated model.
35. • These include automatic alignment of the thorax into a neutral position, spinal
straightening, postural diaphragmatic breathing with expansion of the lower thoracic
region, eccentric stabilization function of the abdominal muscles, centrated support
function of the extremities based on positions, symmetrical facilitation of the deep
and superficial muscles, etc.
• The goal of reflex stimulation is to elicit an optimal stabilization muscle synergy and
to facilitate an experience during activation that encourages somato-aesthetic
perception which can later be implemented into exercises with volitional control.
36. Exercising respiratory and postural function of the diaphragm
• The goal is to achieve the respiratory as well the stabilization function of the diaphragm
simultaneously without participation of the accessory muscles of the breathing.
• In order to achieve this, the thorax should be positioned caudally and straight spine.
• The patient is guided verbally and manually to inhale into the lower intercostal spaces and
into the abdomen so that the abdominal wall expands in all directions (anterior, lateral and
posterior).
• There should be no cranial movement of the umbilicus should not move cranially (an
undesirable muscle pull in a cranial direction).
• The correct breathing pattern should be practiced in supine and in sitting positions .
• The training is performed in various positions.
• During this exercise, the patient learns to include the diaphragm, whose function we are
normally not aware of, during stabilization
37. Exercising in various developmental sequences focusing on
the stabilization of the spine
• The starting position is supine with the hips and knees flexed to 90 degrees
(developmental position at 4 months)
The patient is positioned with hip and knee in 90-90 degree flexion corresponding to a
4 month old baby position. Spine should be straight. Patient is asked to inhale against
therapist’s fingers towards the groin. This increases the intra-abdominal pressure and the
spine is stabilized. Initially the legs of the patients will be supported and gradually the
support is removed once he/she learns proper stabilization
38. Postural activation of the diaphragm – practicing intra-abdominal
pressure control
• position as previous, the abdominal wall above the groin is palpated using both thumbs and
the patient is asked to briefly hold their breath after expiration and to push against the
examiner’s thumb.
• This increased intra-abdominal pressure is maintained for several breathing cycles.
• The optimal and symmetrical activation of the abdominal wall is examined by palpating the
posterior abdominal wall under 11 and 12 ribs.
• Once the patient learns the correct coordination of the abdominal wall and the diaphragm,
the movement of the upper or lower extremities against resistance can be incorporated to
increase the demand on the intra-abdominal pressure control.
• This technique can be used in other developmental positions, such as in prone with a
differentiated position of the extremities (5 months), in side-sitting (8 months), in quadruped
(9 months), in a tripod position (10 months), etc. to train the postural function of the
diaphragm.