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Muscle physiology final
This document discusses muscle structure and function, different types of muscle fibers, and exercise physiology. It provides details on muscle fiber components like myofibrils, sarcomeres, and proteins. It also covers topics like muscle fiber types, contraction types, Frank-Starling law, and therapeutic exercises for conditions like low back pain, shoulder replacement, and ACL reconstruction. The key goals of exercise therapy are to increase mobility, strength, endurance, and proprioception while preventing deconditioning. Exercises must be tailored based on a person's pain pattern and underlying pathology.
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Muscle physiology final
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- 2. The muscle cellis called • Myofibril • Muscle fiber • Sarcomere • Fascicle
- 3. Lecture plan • Musclestructure • Muscle types • Exercise physiology • Types of exercise • Prescribing exercises
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- 6. Structural unit ofmyofibril is a Sarcomere
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- 9. Muscle proteins • Sarcomereproteins – Actin – Myosin – Titin – Nebulin – Tropomyosin – Troponin • Extra fiber proteins – Vinculin – Dystrophin
- 10. Clinical significance • Myosin:Cardiomyopathy, Coeliac disease, Gluten enteropathy, Chaga’s disease • Actin: Cardiomyopathy • Troponin T: Cardiac disease, COPD • Troponin I : Renal Disease, Inflammatory muscle disease • Vinculin: Autoimmune skin and liver disease, Duchenne • Dystrophin: Muscular dystrophies • Nebulin: Nemaline Myopathy
- 11. Muscle fiber types •Type 1 (Slow Oxidative) 50% • Type ll A (FOG) Red 35% • Type ll B (Fast Glycosylated) White 15%
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- 16. What is thedifference between the muscles of a sprinter vs a long distance runner
- 17. Types of contraction •Isometric • Eccentric • Concentric (Tension developed is most in eccentric then isometric then concentric)
- 19. Frank Starlings law •Force of contraction is proportional to the stretch
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- 23. What is therapeuticexercise? • Customised exercise prescribed for specific therapeutic benefit Vestibular exercises, abdominal exercises
- 24. Types of exercises •Strength building (bulk) • Endurance building • Mobility improving (ROM) • Aerobic exercises • Relaxing (TROM) • Proprioception and balance improving Special exercises Stability improving
- 25. Examples • Strength- weighttraining • Endurance- repetitive exercises (cycling, jogging, swimming) • Mobility- ROM exercises, stretching • Relaxing- Yoga • Aerobic – rhythmic dance • Proprioception- Swedish ball, Theraband, inclined plane etc Stabilisation- core Stabilisation
- 26. Composite exercise programmes •Combine the benefits of all above • Grade them sequentially – Start with strength, endurance, stabilisation and ROM – Upgrade to proprioception – Relaxation last • Ensure that exercise programme is continued
- 27. Which is ideal? –Structured therapeutic exercise – Playing basket ball
- 28. Rational of exercisetherapy GASS • Generalized well being and weight reduction removes illness behaviour • Aerobic activity increases circulation and psychological well being • Stretching of muscle and ligaments so that they can stretch with less pain • Strengthening the guy ropes and cantilevers so that they can bear more load Am. Academy Neuro Surgeons
- 29. Examples • ACL reconstruction-Goals –Improve range of movement – Strengthen the dynamic stabilisers of the knee – Improve proprioception of the reconstructed and natural ligaments Priority=Stabilization
- 30. ACL reconstruction • ROM:active and passive/ assisted stretching • Strengthening: increasing weights-Quads, Hams, Gastroc • Proprioceptive: wobble board, Swedish ball, inclined plane, beech games
- 31. Total shoulder replacement •ROM: active and passive/ assisted stretching • Strengthening: increasing weights-Deltoid, Spinatii, Subscap, Lats, Pecs, Trapezius • Endurance: increasing cycles for above • Proprioceptive: classical dancing • Priority=Stabilization: limiting TROM
- 32. Designing an exerciseregime Time Intensity aerobic strength endurance proprioception
- 33. • What isthe rationale for doing exercises for IVDP?
- 34. • Do yourecommend Flexion or extension exercises for IVDP?
- 35. • Flexion exercises-Williams • Extension exercises-McKenzie, Cyriax, Maitland • Core stabilisation exercises
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- 41. Prescribing exercises forlow back pain • Depends on pain pattern – Fatigue endurance – Mechanical pain stabilisation – TROM pain and stiffness stretching • Depends on Pathology – Spondylolisthesis no extension – IVDP sciatic stretch
- 42. Goals of exercisetherapy in LBP • Increase stable zone • Improve mobility • Improve strength • Improve endurance (effort tolerance) • Increase proprioception (prevent injury) • Empower the patient to help himself • Prevent deconditioning
- 43. Exercise therapy do’sand don’t’s • Avoid bending • Avoid lifting • Sleep on hard bed • Avoid pillow • Avoid 2 wheelers
- 44. Can back painpatients bend? References • Mercer • Turek • Campbell • Apley • Bridwell et al • White et al • Frymoyer • Aebi et al • S Rengachary • Youman • Benzel E • McCullough • Harrison • Price • Davidson
- 46. “Basic biomechanics ofthe musculoskeletal system” Frankel and Nordin; 2001
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- 51. Exercise in lowback pain • Should be tailored to the type of pain pattern • And the pathology • Eg: – Effort intolerance type of pain – Spondylolisthesis
- 52. Effort intolerance • Example:doing house work; standing for long, sitting for long
- 53. Extensor strengthening without extension •Example: extension of the spine causes impingement of the facets- spondylolysis • Yet extensor strengthening is important for spondylolisthesis • How to achieve this? • Diagonal lifts; Dying bug exercises
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- 55. Postural back pain Badposture causing back pain is best treated by postural corrective devices (car seat back rest) Yes No
- 56. Postural LBP • Ofthe chronic 80% are P.LBP • Does not mean bad posture • Means bad postural muscles • Reflects urban life style and stressful living
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- 60. Postural LBP the person •Young adult (male> female) • Obese/ asthenic • Sedentary employment • Stressful life style • Lack of physical activity • 2 wheeler travel
- 61. Postural LBP Pain pattern •Dull aching • Increased by sitting/ standingIncreased by sitting/ standing • Decreased by walking • Not aggravated by bending/ squatting • Bilateral para-spinal pain • No Radiculopathy • Normal or non-contributary investigations
- 62. Therapy • Enhance strengthand ENDURANCE of the postural muscles
- 63. Core stabilisation exercises •Improve pain free range of movements • Prevent recurrent injury by strength and proprioception
- 64. Summary • Exercise therapyis not a random act of ignorance • Customised, carefully planned, scientific
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