In-service project for clinical affiliation with Southcoast Hospital Group in December of 2012. Presented by Doctoral Student of Physical Therapy, Amy Rosen
My sections of lecture given to regional ATCs as part of Signature Healthcare's SportSmart program presented on March 31, 2016.
Complete lecture included presentations by orthopedic surgeon Marshal Armitage, MD, FRCSC and athletic trainer Evan Chandra, LAT, ATC. -their sections not included here.
August 2014 in-service presentation for Spaulding Rehabiliation Hospital, Charlestown MA at the competition of clinical affiliation on the SCI unit. Review of current literature for improving evidence based practice.
15 years after I started working in a functional way with athletes of every level, the concept of functional training has become more a buzzword than anything else. In this short introduction to Functional Training for sports I explain the key concept that make this approach so successful...when implementend in the right way!!!
Return to play in rectus femoris muscle injuries. Our experience with profess...MuscleTech Network
Return to play in rectus femoris muscle injuries. Our experience with professional football players
Juanjo Brau & Xavier Yanguas
8th MuscleTech Network Workshop
My sections of lecture given to regional ATCs as part of Signature Healthcare's SportSmart program presented on March 31, 2016.
Complete lecture included presentations by orthopedic surgeon Marshal Armitage, MD, FRCSC and athletic trainer Evan Chandra, LAT, ATC. -their sections not included here.
August 2014 in-service presentation for Spaulding Rehabiliation Hospital, Charlestown MA at the competition of clinical affiliation on the SCI unit. Review of current literature for improving evidence based practice.
15 years after I started working in a functional way with athletes of every level, the concept of functional training has become more a buzzword than anything else. In this short introduction to Functional Training for sports I explain the key concept that make this approach so successful...when implementend in the right way!!!
Return to play in rectus femoris muscle injuries. Our experience with profess...MuscleTech Network
Return to play in rectus femoris muscle injuries. Our experience with professional football players
Juanjo Brau & Xavier Yanguas
8th MuscleTech Network Workshop
With the increasingly popularity of triathlon, we get a better insight in the overuse injuries caused by this challenging discipline. Functional Training, if applied in a structured way, can lower the risk of injuries AND increase performance for every level of athlete.
Overview of the athletic hamstring injury with respect to mechanism, assessment, prognosis, rehabilitation, imaging, management, return to sport and prevention.
This is Dr. Mike Young's presentation on Planning Speed Training for Team Sports from the 2015 Southwest Speed Summit. Dr. Young is the owner and Director of Performance at Athletic Lab sports performance training center. He has served as the fitness coach for 2 North American professional soccer clubs and consults for teams and schools in various other capacities. In this presentation, Dr. Young discussed the best practices for planning speed training sessions in the context of a team setting.
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
Neuromuscular plasticity in quadriceps functions in response to trainingMuscleTech Network
Neuromuscular plasticity in quadriceps functions in response to training and how this might affect sprinting ability and kicking performance
Per Aagaard
8th MuscleTech Network Workshop
With the increasingly popularity of triathlon, we get a better insight in the overuse injuries caused by this challenging discipline. Functional Training, if applied in a structured way, can lower the risk of injuries AND increase performance for every level of athlete.
Overview of the athletic hamstring injury with respect to mechanism, assessment, prognosis, rehabilitation, imaging, management, return to sport and prevention.
This is Dr. Mike Young's presentation on Planning Speed Training for Team Sports from the 2015 Southwest Speed Summit. Dr. Young is the owner and Director of Performance at Athletic Lab sports performance training center. He has served as the fitness coach for 2 North American professional soccer clubs and consults for teams and schools in various other capacities. In this presentation, Dr. Young discussed the best practices for planning speed training sessions in the context of a team setting.
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
Neuromuscular plasticity in quadriceps functions in response to trainingMuscleTech Network
Neuromuscular plasticity in quadriceps functions in response to training and how this might affect sprinting ability and kicking performance
Per Aagaard
8th MuscleTech Network Workshop
This PPT describes neurological gait deviations.
It describes Hemiplegic/circumductory gait, Spastic Diplegic gait, Parkinson gait, Myopathic & Ataxic gait in detail along with its causes and management in with Physiotherapy treatment. detail
SI Joint a stable joint , it is the cause of pain during pregnancy in many women during antenatal and postnatal period ,in this slideshare some exercises for SI joint during pregnancy ,the assesment and the basic relaxation exercise is given
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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Hot Selling Organic intermediates
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Muscle activity during functional coordination training:
implications for strength gain and rehabilitation2
• Evaluate if different types, body positions, and levels of progression of
functional coordination exercises can provide sufficiently high level of
muscle activity to improve strength of the neck, shoulders, and trunk
muscles
• 9 untrained women performed 7 exercises 12 times during 4weeks, 3
sessions of 20 mins/wk, before testing
• EMG testing of Rectus Abdominus, Erector Spinae, External Oblique, &
Trapezius during 2-4 levels of progression for each exercise
• Maximal Voluntary Contractions (MVCs) were recorded for each subject for
each muscle being investigated
• >60% of MVC will indicate exercises for strength gain
Exercises
Bracing
Bridge Prone Plank
4-pt. Kneeling Vertical Plank
Horizontal Side Support Body Blade
4.
5. Muscle activity during functional coordination training:
implications for strength gain and rehabilitation2
• Muscle activity above 60% MVC max
▫ Rectus Abdominus
▫ Upper Trapezius
Horizontal unilateral bodyblade: 73.9± 5.1% Prone Plank Level 1: 87.7 ±10%
Horizontal bilateral bodyblade: 84.9± 7.5% Horizontal side support: 70.1 ± 10.1%
Body positions had significant differences in ▫ Erector Spinae
Prone Plank, Vert. Plank, & Bodyblade 4-pt. kneeling: 79.0± 11.7%
▫ External Oblique Horizontal bilateral bodyblase: 77.7 ±8.1%
Prone Plank Level 1: 124.2± 24% Verical bilateral bodyblade : 71.7 ±7.3%
Prone Plank Level 2: 88.9 ± 22.4% Bridge: 76.3 ±6.3%
Horizontal side support: 64.9 ± 7.8% Horizontal side support: 71.6 ±10.2%
Standing & Sideways exercises had higher
activity than Prone & Supine
Conclusion: “…depending on type, body position, and level of progression,
functional coordination training can be performed with a muscle activity
sufficient for strength gain. Functional coordination training may therefore be a
good choice for prevention or rehabilitation of musculoskeletal pain or injury…”
6. Motor training of the lumbar paraspinal muscles induces
immediate changes in motor coordination in patients with
recurrent low back pain7
• Chronic LBP is associated with altered motor coordination of lumbar
paraspinal muscles
• To understand if these muscles can be modified with motor training
• 20 Participants with unilateral LBP randomly divided into 2 groups
▫ To cognitively activate lumbar multifidus independently from other low back
muscles- skilled training
▫ To activate all paraspinal muscles with no attention to any specific muscles-
extension training
• EMGs of Deep & Superficial Multifidus, Superficial Abdominal & Back
Muscles
• Multifidus activity increased with slow trunk movements
• Superficial trunk muscles activity was reduced only after skilled training.
• There is potential to alter motor coordination with motor training.
• Training-induced changes in motor coordination are not only related to
muscle activation but are related to the TASK.
7. Functional movement training for recurrent low back
pain: lessons from a pilot randomized controlled trail.5
• 60% of Pt. have recurrence of LBP
• “…to compare disability, physical functional capacity, and pain outcomes at
2, 6, & 12 months for 2 conventional & 1 novel P.T. intervention”
• Randomized, controlled feasibility trial
• 61 Participants into 3 groups
▫ G1: single session consisting of standard back pain education
▫ G2: 6 sessions in 8 wks of conventional P.T.
▫ G3: 6 sessions in 8 wks of a new method of functional movement training
• Outcome Measures Used:
▫ Continuous Scale Physical Functional Performance Test (CS-PFP)
▫ A measure of actual physical functional capacity
▫ Oswestry Disability Index
▫ A measure of pain-related disability
▫ Roland Morris Disability Questionnaire
▫ Standard Visual Analogue Pain Scale
8. Functional movement training for recurrent low back
pain: lessons from a pilot randomized controlled trail.5
• Results
▫ 67% of participants provided data at 2 months; 44% at 12 months
▫ NO statistical significance was reached with any of the outcome
measures
▫ Trends suggested little change for G1
▫ Trends suggested greatest improvement for G3
• Conclusion:
▫ “A large-scale randomized, controlled trial is warranted to determine
whether an intervention based on functional movement training is
superior to conventional, impairment-based intervention for individuals
with recurrent LBP”
9. The effectiveness of a functional training programme
for patients with chronic low back pain- a pilot study8
• Purpose: Investigate the effect of an individualized functional training
program for Pt. with LBP
• Randomized, controlled trail; single-blind design
• Participants had to have non-specific LBP for at least 3 months
▫ 13 Training Group; 12 Control Group
• Measures taken initially and at end of program: rating impairment due to
pain-3 aspects with 0-10 scale, Oswestry Disability Index (ODI) and
Functional Capacity Evaluation (FCE)
• Both groups maintained their current rehabilitation program
▫ Training group underwent additional exercises
Warm-up (Jogging/walking), strengthening, work/activity
sim, fitness/endurance training
Strengthening focused on trunk stabilization (TA & MF), Superficial & Deep
with extremities.
Control TA & MF in static and dynamic before progressing with extremities , ROM and
added weight.
Work/ Activity Simulation included push, pull and lifting
Total 100 hours of training over 2-3 months
10. The effectiveness of a functional training programme for
patients with chronic low back pain- a pilot study8
• Results:
▫ FCE
12 items significantly improved with Training Group
1 in Control Group: 1-min walking distance
▫ Rating determining impairment associated with pain (0-10 Scale)
Severity of pain, activity limitation for pain and emotional disturbance by pain
ALL significantly decreased in Training Group
No significant change in Control Group
▫ ODI
Significant reduction in Training Group
No significant change in Control Group
• Conclusion
▫ “An individualized functional training programme benefits chronic LBP
patients”
14. Anterior Oblique System1,6
• Oblique Plane
▫ External Oblique
▫ Internal Oblique
▫ Anterior abdominal fascia
▫ Adductors
▫ Rectus Abdominus
• Rotates the pelvis forward during the
swing phase of ambulation, pulling the leg
through.
http://www.activeanatomy.com/UserFiles/5797-
Files/file//CORE%20AND%20PELVIS%20HANDOUT%20Sample.pdf
15. Exercising Anterior Oblique System
What we do now… Progress and Vary
• Crunch • “Hula Crunch”
• Tri crunch • Oblique crunch with ball
• Forward T-Band Punch squeeze
• Bicycle Crunch
• Side Plank
• Seated Ball Leg Transfer
• Cross Half Clams
▫ on BOSU
http://www.the-fitness-motivator.com/ab-exercises.html
16. Progress with more function
• Torso Twist Against Wall1 • “Throwing” Standing Crunches1
▫ Standing few inches from wall ▫ T-Band anchored on wall
▫ Knees bent ▫ Back to anchor
Can add ball squeeze ▫ Take T-Band in one hand
▫ Lean back (EXT) towards wall ▫ Arm EXT
▫ Rotate shoulder ▫ Bring forward across body
▫ Slowly return to NEU ▫ Slowly return back to start
▫ Repeat with other shoulder position
▫ Repeat
• Standing Russian Twist
▫ Anterior rotation
▫ Medicine Ball, Kettlebell or
Dumbbell
▫ Elbows bent or extended
▫ Lunge, Squat or Ball Squeeze
17. Posterior Oblique System1,6
• Oblique Plane
▫ Latissimus Dorsi
▫ Gluteus Maximus
▫ Thoracodorsal Fascia
• With ambulation, the Glut. Max
contracts on foot strike simultaneously
with contralateral Lat., creating a
counter-rotation.
• The countered contraction creates
tension on the thoracolumbar fascia,
stabilizing the sacroiliac joint (force-
closure).
• Spring System- stores energy in
thoracolumbar fascia which is release in
the next contraction
▫ Minimizes action & metabolic cost
http://www.activeanatomy.com/UserFiles/5797-
Files/file//CORE%20AND%20PELVIS%20HANDOUT%20Sample.pdf
18. Exercising Posterior Oblique System
What we do now… Progress and Vary
• T-Band Rows • Walk Outs with Physioball
• Lat. Pull Down • Side Planks
• Prone I, T, Ys • Prone Arm/Leg lifts
• Bird-Dog ▫ Contralateral
http://www.oguiadacidade.com.br/video/quadruped+pilates+exercise/
19. Progress with more function
• T-Band Squat & Row1 • T-Band Pull1
▫ Anchor T-Band above waist ▫ Anchor T-Band low
▫ Facing anchor ▫ Facing anchor
▫ Stand with arms EXT ▫ Position for oblique pull
▫ Squat ▫ Pull up, across & over head
▫ Stand and Pull ▫ Add contralateral SLS
▫ Add
Static & Dynamic Arms • Dumbbell on Table1
Contralateral SLS ▫ Place DB on table
▫ Reach, Pick-up, Bring to self or
overhead
▫ Return DB to table
▫ Return to standing
▫ Add contralateral SLS
▫ Lower placement table
Dreamstime.com
20. Deep Longitudinal System1,6
• Saggital Plane
▫ Erector Spinae
▫ Deep lamina of
Thoracolumbar Fascia
▫ Sacrotuberous Ligament
▫ Hamstrings (BF)
▫ Peroneals
• End of the swing phase: Hams.
ecc. contract to control hip
FLEX & knee EXT. BF
contraction strains the
sacrotuberous lig, assisting in
stabilization of SIJ, force
closure. KE is dispersed by the
Erector Spinae through rotary
action on the spinal column. http://www.activeanatomy.com/UserFiles/5797-
Files/file//CORE%20AND%20PELVIS%20HANDOUT%20Sample.pdf
21. Exercising Deep Longitudinal System
What we do now… Progress and Vary
• Controlled Pick up • Unilateral Bird-Dog
• Supermans (Trunk EXT) • Quadruped Arm EXT
• Prone Arm/Leg Lifts • Quadruped Leg EXT
• Bridge
• Side Plank
http://whatchiro.com/?page_id=2
22. Progression with more function
• Toe Touch1 • T-Band Squat & Row1
▫ Slowly reach to the floor ▫ Anchor T-Band above waist
▫ Touch ▫ Facing anchor
▫ Return to stance position ▫ Stand with arms EXT
▫ Squat
▫ Unilateral/Bilateral
▫ Stand and Pull
▫ Ipsilateral SLS
▫ Add
Static & Dynamic Arms
• Dumbbell on Table1 Ipsilateral SLS
▫ Place DB on table • T-Band Pull1
▫ Reach, Pick-up, Bring to self ▫ Anchor T-band low
or overhead
▫ Facing anchor
▫ Return DB to table
▫ Position for straight pull
▫ Return to standing
▫ Add ipsilalateral SLS ▫ Pull up & over head
▫ Lower placement table ▫ Add ipsilalateral SLS
23. Lateral System1,6
• Frontal Plane
▫ Gluteus Medius
▫ Gluteus Minimus
▫ Adductors
▫ Quadratus lumborum
▫ Sacroiliac Joint
• SLS, hip ABD & ADD of the
supporting leg work with the
contralateral QL & ipsilateral
Glut. Min. to stabilize the
pelvis
http://www.activeanatomy.com/UserFiles/5797-
Files/file//CORE%20AND%20PELVIS%20HANDOUT%20Sample.pdf
24. Exercising Lateral System
What we do now… Progress and Vary
• Side-lying ABD • Bridge Unilat & Ball Squeeze
• Monster Walks • Side-lying Bilateral Leg Lifts
• Single Limb Stance • Side Plank
▫ Toe Taps ▫ Leg Lift
• Wall Squats & Ball Squeeze
• Bridge
▫ Unilateral
▫ Ball Squeeze
▫ T-Band ABD
http://www.fitsugar.com/Side-Plank-Leg-Lift-2385791
25. Progression with more function
• Grapevine • SLS with Other Hip at 90°1
▫ a.k.a. Karaoke ▫ Stand as described
▫ Stand legs hip width apart
▫ Lift and drop hip that is at 90
▫ Cross one leg in front of other
▫ Return to stance Keeping hip at 90° of flexion
▫ Cross the same leg behind the ▫ Repeat with other side
other ▫ Vary by changing hip’s
▫ Return to stance
▫ Repeat till desired distance is
position
traveled ER, IR, etc.
▫ Repeat going the other way
• Inch Worms1
▫ Power –stance, squat position
▫ Small steps
▫ One way and then back
▫ ER, IR, and Staggered Stance
26. It’s All Connected
• Gluteus Maximus works equally in ALL 3 planes1
• Each system connects to the next
• Importance of each in Gait/Ambulation & every day activities
• Able to Muscle Test each system1
▫ AS- Contralateral Shoulder & Hip
▫ PS- Contralateral Shoulder EXT & Hip EXT
▫ DLS- Ipsilateral Shouler EXT & Hip EXT
▫ LS- Ipsilateral ABD & ADD
• Make sure trunk is held tight during ALL exercises
• All exercises are to be performed pain-free
• Have Pts. exhale during movement
▫ Don’t hold breath!
• KEEP IN MIND:
▫ LBP/ Trunk Instability Pts. have long histories
▫ Education, description of their pain, varying types of pain, and understanding
pain levels
▫ 4-6 weeks for muscle to build
▫ Not an easy fix
• Pt. has to put in effort & be committed to feeling better (HEP)
27. HOW THE “CORE” AFFECTS THE WHOLE
Recent applicable patients seen at Southcoast Rehabilitation
Service’s Truesdale Clinic
28. Case Pt. A: Initial Evaluation
• 51 y.o. female with 6 mo. history of LE pain; R heel pain & L knee pain.
• MD dx: R Plantar Fascitis
• Pt. underwent bladder surgery for incontinence 1.5 years ago
▫ Hip & Back pain since & Incontinence con’t.
▫ Was seeing Women’s Health PT specialist but stopped bc of LE pain
• Pain 0-8/10
▫ Intermittent
▫ Better with anti-inflammatory meds and ice (both 2x/day)
▫ Has been wearing boot at night- better
• Standing Tolerance: 15 mins Walking Tolerance: 40 feet
• Hobbies: Has stopped Line Dancing. Been out for 2 mo.
▫ Prior status: 2-3 hrs Twice a week
• LLE : All 5/5 and Full ROM
• RLE: Pain with all Ankle MMT (3+ - 5-)/5
▫ ROM: DF -5, PF 80, Ever 20, Inver 45
• Increase Tissue Density R Plantar Surface
• No increased discomfort with combine DF & Hallux EXT on R
• Positive ASLR with R–sided weakness
• LEFS: 55%
29. Pt. A
• STGs: Pain, ROM, Strength, Standing & Walking Tolerance, Return
1day/wk to dancing, LEFS
• Treatment
▫ US Right Plantar Surface Soft Tissue: Cross Friction
▫ Ankle T-Band Circuit Gastroc/Sol. Stretch
▫ SLS (with hip drop) Wall Squats with Pelvic Tilt
▫ T-Band Squat Rows
• Pt. was seen for total of 6 visits.
• Placed on hold Nov. 20th
▫ “My foot feels really good”
▫ ROM: DF 10
▫ MMT: 5/5 No Pain
▫ Standing Tol: 15 mins Walking Tol: 2 blocks
▫ Went to dance class 11/19 but not 100% of participation
▫ Assuming she will return to Women’s Health P.T.
30. Case Pt. B
• First seen 9/7/12-10/3/12
• 20 y.o. female student with increasing L knee pain over the past year
• MD dx: L patella pain
• Pain surround knee that increases with activity: 1-10/10
• MRI & X-Rays Neg.
• L Knee ROM: 140-0-2
• All MMT Hip & Knee 5/5, except L Hip ADD, 4-/5
• Bilat. ITB tightness
• Patella Mobs Bilat. even & painfree
• Equal Bilat. Lateral Tracting. 10/3/12: NO CHANGE in
• Treatment: Pain after 9 visits over 4 wks
▫ SLR, SAQ & LAQ ( Neu & ER) and HEP
▫ s/l Hip ADD Pain 4-10, All MMT 5/5
▫ Bridge & Wall Squats with Ball Sqeeze
▫ Standing Hip ADD T-Band Pt.’s plan is to follow-up with
▫ Kick with Inseam a women’s sport specialist at
▫ Bilat. ITB Stretching Beth Israel in Boston
▫ 3 different KinesioTape Knee Techniques
31. Pt. B Returns
• Return 10/31/12
• Script from MD states: “quad. flexibility, lumbopelvic strengthening, hip
rotational/abductor strengthening, ITB flexibility, alignment (decrease valgus
thrust), hamstring strengthening, gym & HEP”
• MD dx: Chondromalacia of Patella
• Learned: Previous Gymnast & Cheerleader
▫ 3 years ago: 7 days/week training for 4-7 hours each day ROM L R
• Also has 3 bulging disc in low back from cheering H Flex 125 135
accident in 2008
Ext 20 20
• Initial Eval #2
▫ Pain 4-11/10 Continuous and Getting worse ABD 70 60
▫ Unable to maintain sitting/standing for 60 mins.
ADD 35 30
▫ Varying level of pain with walking, limiting distance
▫ Compensation for L with all activities, stairs very painful IR 35 41
▫ Gait pattern unremarkable
ER 40 35
▫ No sign. TTP surrounding L knee; Patella tracking = Bilat.
▫ Increase flexibility through out SLR 93 94
▫ Full bridge with pain in lumbar, Half bring is pain free
K Flex 141 143
▫ Q-Angle R: 23° L: 20°
▫ All MMT 5/5 Bilat, except SLR L 4+/5 with pain Ext +5 +4
32. Pt. B
• STGs: Pain reduction, SLR strength, Ambulation and Stairs
• Treatment Initially
▫ Bike Bridge with Leg EXT
▫ Curl Ups Prone Plank
▫ Side Planks SLS with other at 90
▫ T-Band Squat & Row Torso Twist Against Wall
• Pt. complaint of increase pain & discomfort in LE & back
• Education & Descriptions of Pain
▫ How do you feel? When we start /end? Later that day? Does it resolve?
▫ Is it the same pain as before?
• New Plan
▫ Bike/MHP Walk outs
▫ V-Ball Crunches Serratus Punch with Abdominal Isometric
▫ DB on Table- DLS Left Ball Squeeze with MB pick-up
▫ Quadruped Leg Ext
▫ REQUIRES CONTINUOUS CUEING and CONTROL REMINDERS
33. Case Pt. C: Initial Evaluation
• 26 y.o. female student reports insidious onset of bilat. knee
pain, increasing over past 6wks.
• MD dx: Bilat. Knee Pain
• Reports R-sided hip/LBP for past year
• Pt. underwent gastric bypass surgery in April 2010
▫ Has lost over 200#
• Pain 3-8/10, Continuous & Unchanged
• Pain after sitting, standing 30 mins, walking 10-15 mins, Non-recip. Up
and down stairs and lifting/carry backpack (~30#)
MMT L R
• ROM
▫ PROM Hip Flex: L: 132 R: 110* H 5 4+ *
▫ PROM SLR: L: 100 R: 65* Flex
▫ AROM Knee: L: 0-150*R: 0-147* Ext 4 4+*
• R Rectus Femoris Tightness
ABD 5- 4*
• No Pain with Bilat. Patella Mob.; L=R
• Pain under R Patella with Quad. Set ADD 3+* 4+
• Significant crepitus bilat. with supine movement SLR 5- 5-
• Positive ASLR for TA weakness
K Flex 4+ 4+
• LEFS: 36.25%
Ext 5* 5**
34. Pt. C
• STGs: Pain, R Hip/SLR ROM, Strength, Standing & Walking
Tolerance, Stair Climbing, School, LEFS
• Treatment
▫ Bike Abdominal Isometrics
▫ Bridge Bridge with Ball Squeeze/T-Band ABD
▫ Tri- Crunches Plank Circuit
▫ T-Band Squat & Row Wall Squats & Ball Squeeze
▫ Inch Worms Side Squats
▫ Stretch: Quads, Piriformis, Hams, Gastro/Sol.
• Start Pt. with trunk stabilizing exercises and progress to the more
difficult with extremity involvement
• Pt. has only been seen for one visit at this time.
35. Case Pt. D: Initial Evaluation
• 35 y.o. obese female reports first injury back in 2009 when at work, performing slide
board transfer of a large female who was slipping off the board & she stopped her but
fell. Chronic LBP since
• MD dx: L lumbar MPS, SIJ Dysfunction
• Increased pain after having gastric bypass in July 2012
▫ Has lost about 100# since.
• Has tried 2 injections, Chiro., 3 PTs including Aqua PT and Spine Clinic
• Pain 5-25/10, Continuous & Getting worse
• Sitting & Standing 30 min, Walking 20 min (Treadmill 3.0-3.2 with incline), Restless
sleep, Can Stair Climb Recip., 10-15# Lift/Carry limit from MD
• Lumbar ROM all 75% of norm
• SLR L: 85 with LBP R: 90
• LEs MMT all 5/5, except L Hip Flex 5-/5
• Able to bridge
▫ L Unilat. Bridge: discomfort L
▫ R Unilat. Bridge: instability & pain
• Pain with AOS testing: R Shld & L Hip
• Thigh Thrust: Relieve pain but uncomfortable Oswetry: 54%
• Compression of SI: decreased pain Distraction: increased pain
36. Pt. D
• STGs: Pain, Lumbar ROM, Core Strength, Sit & Stance
Tolerance, Walking Tolerance, Oswetry
• Treatment
▫ MHP lumbar SKC/LTR
▫ Pelvic Tilts with alt. hip flex, flys, SLR
▫ Bridge Unilateral and Marching
▫ Wall Pelvic Tilts Wall Squats
▫ T-Band Squat & Row SLS with other hip at 90
• Pt. has been seen for 4 visits
• Continues to report significantly high levels of pain and appears to
be becoming discouraged
• Did not show for last appt.
• Plan: Education similar to that of Pt. B & Closely monitor any
aberrant motions during exercises. Slow and controlled.
37. Bypass Literature
Rapid Changes in gait, Musculoskeletal pain in obese: a
comparison with a general
musculoskeletal pain, and
population and long-term changes
quality of life after bariatric after conventional and surgical
surgery9 obesity treatment4
• Examine whether participants • Compare the prevalence of work-
who had undergone gastric bypass restricting musculoskeletal pain in
an obese and general population &
or gastric banding have investigate changes in the incidence
improvements in joint pain, gait of and recovery from
(7 parameters), mobility, and QOL musculoskeletal pain after bariatric
by 3 month compared with sx or conventional obesity tx.
nonsurgical controls • Conclusion: “Obese subjects have
• Conclusion: “Improvements in more problems with work-
restricting musculoskeletal pain
some, but not all, gait than general population. Surgical
parameters, walking speed, and obesity tx reduces the long-term risk
QOL and of perceived functional of developing WRMSP & increase
limitations occur by 3 months likelihood of recovering from such
after a bariatric procedure.” pain.
38. References
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