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.
Craniosacral manipulation was first introduced into the osteopathic profession in the 1930s. Instruction in the field began in the 1940s.Dysfunctional situations where interference with normal pulsatile activities or soft tissue properties seems to have occurred and which have no easy, 'gross', structural or orthopedic consequence.
The document provides a review of literature on motor control assessment. It discusses various aspects of motor control assessment including history taking, functional activity assessment, body structure and function assessment, outcome measures, and evaluation of specific areas like stability, mobility, strength, range of motion, and functional activity status. It also summarizes various studies that have evaluated methods and tools for motor control assessment like use of dynamometers, goniometers, and activity monitors.
This document discusses postural control and balance. It defines key terms like static and dynamic balance, center of mass, center of gravity. It describes the different sensory systems, motor responses, and strategies involved in maintaining balance. Common balance impairments after stroke are described. Several clinical balance tests are mentioned. The principles of balance training include progressive challenge, use of feedback, and training functional tasks. Safety during balance training is also addressed.
This document provides an overview of spasticity in cerebral palsy from a physiotherapist's perspective. It defines cerebral palsy and spasticity, describes the pathophysiology and clinical evaluation of spasticity, and outlines various management techniques including movement and handling, soft tissue lengthening, electrical stimulation, thermal treatments, advanced techniques like vestibular stimulation and hippotherapy. The goal of management is to reduce spasticity and its consequences through a stepped care approach beginning with more conservative methods.
This document describes a case study of a 15-year-old male patient with 55-degree thoracic kyphosis, chronic lumbar pain, and other postural deviations who was treated with Global Postural Reeducation (RPG). RPG aims to correct morphology and relieve pain through muscle lengthening techniques. After treatment, the patient's thoracic kyphosis decreased by 16 degrees and his lumbar pain was relieved, demonstrating the effectiveness of RPG for treating thoracic kyphosis and its related issues.
The document provides an overview of coordination and its assessment. It defines coordination as the ability to execute smooth, accurate movements through integration of the motor, cerebellar, vestibular and sensory systems. Coordination involves appropriate speed, direction, muscle tension and synergist influences. Coordination deficits are often related to conditions involving the cerebellum, basal ganglia or dorsal columns. Common tests of coordination include finger-to-nose, heel-to-knee, rapid alternating movements and Romberg's test. Treatment focuses on techniques like PNF, balance exercises, and Frenkel's exercises to improve coordination.
History of Manual Therapy and ArthrologyChrisBacchus
The document provides a history of manual therapy, outlining important figures and developments from Hippocrates in 460 BC to current practice. It discusses the evolution of osteopathy, chiropractic, and physical therapy. Key developments include Andrew Still establishing osteopathy in the US in 1874, Daniel Palmer founding chiropractic in 1895, and the establishment of physical therapy programs and professional organizations in the early 20th century. Current manual therapy practice draws from various techniques and philosophies.
Craniosacral manipulation was first introduced into the osteopathic profession in the 1930s. Instruction in the field began in the 1940s.Dysfunctional situations where interference with normal pulsatile activities or soft tissue properties seems to have occurred and which have no easy, 'gross', structural or orthopedic consequence.
The document provides a review of literature on motor control assessment. It discusses various aspects of motor control assessment including history taking, functional activity assessment, body structure and function assessment, outcome measures, and evaluation of specific areas like stability, mobility, strength, range of motion, and functional activity status. It also summarizes various studies that have evaluated methods and tools for motor control assessment like use of dynamometers, goniometers, and activity monitors.
This document discusses postural control and balance. It defines key terms like static and dynamic balance, center of mass, center of gravity. It describes the different sensory systems, motor responses, and strategies involved in maintaining balance. Common balance impairments after stroke are described. Several clinical balance tests are mentioned. The principles of balance training include progressive challenge, use of feedback, and training functional tasks. Safety during balance training is also addressed.
This document provides an overview of spasticity in cerebral palsy from a physiotherapist's perspective. It defines cerebral palsy and spasticity, describes the pathophysiology and clinical evaluation of spasticity, and outlines various management techniques including movement and handling, soft tissue lengthening, electrical stimulation, thermal treatments, advanced techniques like vestibular stimulation and hippotherapy. The goal of management is to reduce spasticity and its consequences through a stepped care approach beginning with more conservative methods.
This document describes a case study of a 15-year-old male patient with 55-degree thoracic kyphosis, chronic lumbar pain, and other postural deviations who was treated with Global Postural Reeducation (RPG). RPG aims to correct morphology and relieve pain through muscle lengthening techniques. After treatment, the patient's thoracic kyphosis decreased by 16 degrees and his lumbar pain was relieved, demonstrating the effectiveness of RPG for treating thoracic kyphosis and its related issues.
The document provides an overview of coordination and its assessment. It defines coordination as the ability to execute smooth, accurate movements through integration of the motor, cerebellar, vestibular and sensory systems. Coordination involves appropriate speed, direction, muscle tension and synergist influences. Coordination deficits are often related to conditions involving the cerebellum, basal ganglia or dorsal columns. Common tests of coordination include finger-to-nose, heel-to-knee, rapid alternating movements and Romberg's test. Treatment focuses on techniques like PNF, balance exercises, and Frenkel's exercises to improve coordination.
History of Manual Therapy and ArthrologyChrisBacchus
The document provides a history of manual therapy, outlining important figures and developments from Hippocrates in 460 BC to current practice. It discusses the evolution of osteopathy, chiropractic, and physical therapy. Key developments include Andrew Still establishing osteopathy in the US in 1874, Daniel Palmer founding chiropractic in 1895, and the establishment of physical therapy programs and professional organizations in the early 20th century. Current manual therapy practice draws from various techniques and philosophies.
Co-ordination Exercise,Definitions,Nervous control,Motor pathway,Cerebral cortex,Kinesthetic sensation,Causes of Incoordination,Flaccidity
Spasticity ,Cerebellar ataxia,Loss of kinesthetic sensation,Types of coordination,Posterior column,Test for Incoordination.
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Balance involves maintaining the center of mass within the base of support through coordinated muscle activity and sensory input. Impaired balance can result from issues with the sensory, musculoskeletal, or vestibular systems. Balance is evaluated through static and dynamic tests with or without assistive devices or altered sensory input. Treatment involves graduated balance exercises focusing on posture, weight shifts, and introducing movement to challenge stability limits. Precautions are taken to avoid pain or unsafe movements.
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.
Recognising features (contracture and spasticity)Richard Baker
This document discusses contractures and spasticity in individuals with neuromuscular impairments. It defines contracture as a shortening of the muscle belly through atrophy or loss of fascicles and increased muscle stiffness from an enlarged extracellular matrix. Spasticity is described as a velocity-dependent increase in muscle tone due to hyperreflexia of the stretch reflexes following an upper motor neuron lesion. The Modified Ashworth Scale and Modified Tardieu Scale are presented as clinical measures of tone and spasticity, respectively, with the latter assessing the angle at which a joint catches during a rapid stretch.
1. The document discusses various postural reflexes that help maintain upright posture and balance. It describes segmental, tonic, and righting reflexes in detail.
2. Segmental reflexes like the stretch reflex and crossed extensor reflex act at the spinal cord level. Tonic reflexes like the tonic neck reflex integrate signals at the medulla. Righting reflexes like the labyrinthine righting reflex restore posture at the midbrain level.
3. Experimental preparations are used to study the postural reflexes at different levels, including spinal, decerebrate, midbrain, thalamic, and decorticate preparations. Decerebrate animals exhibit decerebrate
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
This document defines thoracic kyphosis as an excessive backward curvature of the spine in the thoracic region. It is caused by factors like poor posture, arthritis, lung issues, and diseases affecting the vertebrae. There are different types including round and angular kyphosis. Management involves exercises to improve mobility, posture training, manual mobilization, and bracing for more severe cases. Rehabilitation approaches aim to stretch tightened areas and strengthen weakened muscles to reduce the deformity.
This document discusses poliomyelitis (polio), including its clinical manifestations, stages, and common muscle involvement. It then focuses on the causes and management of progressive deformities that can result from polio, such as muscle imbalance, unreleived muscle spasm, growth issues, gravity, and posture. Specific deformities at the hip, knee, ankle, and foot are described. The management of polio involves addressing these deformities through reconstructive surgery, physiotherapy, orthotics, tendon transfers, and arthrodesis.
I gave this lecture way back, when I was invited to Poland.
In retrospect, it's not that good looking, but hey, in 20o6 it was pretty slick ;-)
https://www.linkedin.com/in/paulfiolkowski/
This document provides an overview of balance, including definitions, components, and assessment strategies. It defines balance as controlling the center of gravity over the base of support. The major sections discuss the sensory, central processing, and effector systems involved in balance, as well as age-related changes. Assessment strategies examined include self-report measures, clinical balance tests under various sensory conditions, and functional scales to evaluate mobility and gait. Comprehensive assessment involves testing balance under different contexts to evaluate the underlying sensory, motor, and cognitive systems.
This document discusses posture, evaluation of posture, and physiotherapy. It defines normal and abnormal posture and outlines objectives of postural screening and evaluation. It describes factors that can influence posture like poor habits, aging, injury, and environmental factors. Evaluation methods are explained including using levels of the horizontal plane, photography, measurements, and tools like a flexicurve ruler. Different types of postures are classified. The document concludes with discussing management of postural issues through education, exercises, bracing, and biofeedback.
The document describes tests that can be used to evaluate coordination, balance, gait, and posture in patients. It explains how to test for coordination by having patients perform rapidly alternating movements with their hands and point-to-point movements touching their nose and the examiner's finger. The Romberg test is described to test balance by having patients stand with their eyes closed. Gait is evaluated by having patients walk normally, heel-to-toe, on their toes, and on their heels. The wall test is provided to assess posture.
Physiotherapy plays an important role in managing poliomyelitis through various techniques. It focuses on maintaining joint mobility through active and passive movements. Splinting and bracing help prevent deformities while teaching relatives muscle stretching techniques. As patients recover, physiotherapy aids in teaching walking and exercises. For post-polio syndrome, strength training through isokinetic exercises and progressive resistance training can help improve muscle strength over time.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
Shoulder joint Bio-Mechanics and Sports Specific RehabilitationFabiha Fatima
This document provides information on the anatomy and biomechanics of the shoulder joint. It describes the sternoclavicular joint, acromioclavicular joint, scapulothoracic joint, and glenohumeral joint. It discusses the tissues that stabilize each joint and their range of motion. Common injuries in overhead athletes like throwers and swimmers are described. Rehabilitation protocols focus on reducing pain, regaining range of motion, strengthening the rotator cuff and scapular muscles, and integrating the kinetic chain.
Balance problems can make you feel dizzy, as if the room is spinning, unsteady, or lightheaded. You might feel as if the room is spinning or you're going to fall down. These feelings can happen whether you're lying down, sitting or standing.
Many body systems — including your muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart and blood vessels — must work normally for you to have normal balance. When these systems aren't functioning well, you can experience balance problems.
Many medical conditions can cause balance problems. However, most balance problems result from issues in your balance organ in the inner ear (vestibular system).
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.
Co-ordination Exercise,Definitions,Nervous control,Motor pathway,Cerebral cortex,Kinesthetic sensation,Causes of Incoordination,Flaccidity
Spasticity ,Cerebellar ataxia,Loss of kinesthetic sensation,Types of coordination,Posterior column,Test for Incoordination.
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Balance involves maintaining the center of mass within the base of support through coordinated muscle activity and sensory input. Impaired balance can result from issues with the sensory, musculoskeletal, or vestibular systems. Balance is evaluated through static and dynamic tests with or without assistive devices or altered sensory input. Treatment involves graduated balance exercises focusing on posture, weight shifts, and introducing movement to challenge stability limits. Precautions are taken to avoid pain or unsafe movements.
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.
Recognising features (contracture and spasticity)Richard Baker
This document discusses contractures and spasticity in individuals with neuromuscular impairments. It defines contracture as a shortening of the muscle belly through atrophy or loss of fascicles and increased muscle stiffness from an enlarged extracellular matrix. Spasticity is described as a velocity-dependent increase in muscle tone due to hyperreflexia of the stretch reflexes following an upper motor neuron lesion. The Modified Ashworth Scale and Modified Tardieu Scale are presented as clinical measures of tone and spasticity, respectively, with the latter assessing the angle at which a joint catches during a rapid stretch.
1. The document discusses various postural reflexes that help maintain upright posture and balance. It describes segmental, tonic, and righting reflexes in detail.
2. Segmental reflexes like the stretch reflex and crossed extensor reflex act at the spinal cord level. Tonic reflexes like the tonic neck reflex integrate signals at the medulla. Righting reflexes like the labyrinthine righting reflex restore posture at the midbrain level.
3. Experimental preparations are used to study the postural reflexes at different levels, including spinal, decerebrate, midbrain, thalamic, and decorticate preparations. Decerebrate animals exhibit decerebrate
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
This document defines thoracic kyphosis as an excessive backward curvature of the spine in the thoracic region. It is caused by factors like poor posture, arthritis, lung issues, and diseases affecting the vertebrae. There are different types including round and angular kyphosis. Management involves exercises to improve mobility, posture training, manual mobilization, and bracing for more severe cases. Rehabilitation approaches aim to stretch tightened areas and strengthen weakened muscles to reduce the deformity.
This document discusses poliomyelitis (polio), including its clinical manifestations, stages, and common muscle involvement. It then focuses on the causes and management of progressive deformities that can result from polio, such as muscle imbalance, unreleived muscle spasm, growth issues, gravity, and posture. Specific deformities at the hip, knee, ankle, and foot are described. The management of polio involves addressing these deformities through reconstructive surgery, physiotherapy, orthotics, tendon transfers, and arthrodesis.
I gave this lecture way back, when I was invited to Poland.
In retrospect, it's not that good looking, but hey, in 20o6 it was pretty slick ;-)
https://www.linkedin.com/in/paulfiolkowski/
This document provides an overview of balance, including definitions, components, and assessment strategies. It defines balance as controlling the center of gravity over the base of support. The major sections discuss the sensory, central processing, and effector systems involved in balance, as well as age-related changes. Assessment strategies examined include self-report measures, clinical balance tests under various sensory conditions, and functional scales to evaluate mobility and gait. Comprehensive assessment involves testing balance under different contexts to evaluate the underlying sensory, motor, and cognitive systems.
This document discusses posture, evaluation of posture, and physiotherapy. It defines normal and abnormal posture and outlines objectives of postural screening and evaluation. It describes factors that can influence posture like poor habits, aging, injury, and environmental factors. Evaluation methods are explained including using levels of the horizontal plane, photography, measurements, and tools like a flexicurve ruler. Different types of postures are classified. The document concludes with discussing management of postural issues through education, exercises, bracing, and biofeedback.
The document describes tests that can be used to evaluate coordination, balance, gait, and posture in patients. It explains how to test for coordination by having patients perform rapidly alternating movements with their hands and point-to-point movements touching their nose and the examiner's finger. The Romberg test is described to test balance by having patients stand with their eyes closed. Gait is evaluated by having patients walk normally, heel-to-toe, on their toes, and on their heels. The wall test is provided to assess posture.
Physiotherapy plays an important role in managing poliomyelitis through various techniques. It focuses on maintaining joint mobility through active and passive movements. Splinting and bracing help prevent deformities while teaching relatives muscle stretching techniques. As patients recover, physiotherapy aids in teaching walking and exercises. For post-polio syndrome, strength training through isokinetic exercises and progressive resistance training can help improve muscle strength over time.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
Shoulder joint Bio-Mechanics and Sports Specific RehabilitationFabiha Fatima
This document provides information on the anatomy and biomechanics of the shoulder joint. It describes the sternoclavicular joint, acromioclavicular joint, scapulothoracic joint, and glenohumeral joint. It discusses the tissues that stabilize each joint and their range of motion. Common injuries in overhead athletes like throwers and swimmers are described. Rehabilitation protocols focus on reducing pain, regaining range of motion, strengthening the rotator cuff and scapular muscles, and integrating the kinetic chain.
Balance problems can make you feel dizzy, as if the room is spinning, unsteady, or lightheaded. You might feel as if the room is spinning or you're going to fall down. These feelings can happen whether you're lying down, sitting or standing.
Many body systems — including your muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart and blood vessels — must work normally for you to have normal balance. When these systems aren't functioning well, you can experience balance problems.
Many medical conditions can cause balance problems. However, most balance problems result from issues in your balance organ in the inner ear (vestibular system).
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.
Locomotion which means gait is controlled by various systems. Janda described these systems in three different linkages; articular, muscular and neural. The slide show also, describes in the same the locomotion control as described by Janda in brief.
The document discusses the structure and function of the spine and factors that influence posture. It details the 33 vertebrae and their arrangement into curves. Proper posture depends on balance between the spine's passive (bones/ligaments), active (muscles), and neural control systems. Muscle endurance, limb positioning, breathing, and intra-abdominal pressure all impact spinal stability and alignment. Maintaining stability requires anticipatory muscle activation in response to forces.
This document discusses posture and postural alignment. It defines posture and recognizes the importance of maintaining proper spinal curves and alignment with gravity. The document outlines the objectives of understanding posture, identifies the types of posture, and discusses the factors that can affect posture like age, pregnancy, muscle imbalances, and occupations. It also differentiates the muscles of the spine and explores methods of assessing posture, including X-rays, 3D motion analysis, raster stereography, and physical measurements.
This document summarizes a conceptual model of the spinal stabilizing system consisting of three interconnected subsystems: passive (vertebrae, discs, ligaments), active (spinal muscles), and neural (nerves and central nervous system). It describes how the subsystems normally function in a coordinated manner to provide spinal stability. A dysfunction in any subsystem can lead to compensation attempts by the others to maintain stability, but may result in long-term adaptation or injury if compensation is insufficient. The model proposes that the neural subsystem monitors passive tissue deformation to determine stability requirements and directs the active subsystem's muscle tensions accordingly.
The document discusses physiology related to human balance and equilibrium. It defines static and dynamic equilibrium and describes the key systems and structures involved in maintaining balance, including the vestibular system, cerebellum, and their interconnections. The cerebellum coordinates movement and balance through three main sections. The vestibular system detects head movement through five receptor organs in each inner ear and sends signals to the brainstem and cerebellum through the vestibular nerve and nuclei.
Role of various systems to maintain balance.
Role of sensory systems-vision,proprioceptors,vestibular
Role of Musculoskeletal system
Biomechanics in balance
Contextual factors in balance
Role of nervous system
Strategies-ankle, hip,stepping
The document discusses the neurophysiology of balance, including the role of the sensory systems (vision, proprioception, vestibular), musculoskeletal system, and nervous system in maintaining balance. It defines balance and related terms, and describes how the central nervous system integrates input from the visual, somatosensory, and vestibular systems to generate motor responses that control body position. When one sensory system is impaired, the CNS can suppress the inaccurate input and rely more on the other two systems through sensory re-organization. The musculoskeletal system also contributes through factors like posture, range of motion, strength, and type of muscle contraction.
Vestibular reflexes play an important role in maintaining balance and postural alignment. The two primary reflexes are the vestibulo-ocular reflex (VOR) and vestibular spinal reflex (VSR). The VOR maintains visual fixation during head movement by coordinating eye movements. The VSR generates compensatory body movements through muscle contractions to maintain stability. Concussions can damage structures involved in these reflexes like the brainstem and cerebellum. This can lead to impaired VOR and VSR function, causing prolonged vestibular symptoms like dizziness and instability after concussions.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.
The vestibular system provides important sensory information about head movement and orientation. It consists of semicircular canals and otolith organs that detect rotational and linear acceleration. The vestibular system generates reflexes to stabilize gaze and posture. It feeds information to the brain which processes inputs from vestibular, visual, and proprioceptive systems to coordinate eye movements and maintain balance. The vestibular system is essential for spatial orientation, navigation, and regulating other bodily functions.
The cervical spine consists of seven vertebrae that provide mobility but less stability than other regions of the spine. It has three subsystems that contribute to stability - passive (bones and ligaments), active (muscles), and neural control. Cervical instability occurs when the neutral zone between ranges of motion increases, the stabilizing subsystems can no longer compensate, and motion quality becomes poor. It can result from trauma, surgery, disease, or degeneration and often involves pain.
The document discusses the systems that regulate body balance. There are three main components: 1) the central nervous system which coordinates sensory input, 2) the vestibular system which detects head movement and acceleration using semicircular canals and the utricle and saccule, and 3) proprioceptive sensors and muscle commands which provide feedback on body position. The vestibular system detects both rotational movement via the semicircular canals and linear acceleration via the utricle and saccule. It works with the visual system and reflexes like the vestibulo-ocular reflex to maintain balance and stabilize gaze.
The document discusses the anatomy and biomechanics of the cervical spine. It describes the seven cervical vertebrae, their characteristics, and motion segments. It also covers indications for cervical manipulation, mechanisms of action, and importance of screening for vascular risks prior to cervical manipulation.
The cerebellum is located in the posterior of the brain. It coordinates voluntary movements such as posture, balance, and speech by regulating muscle activity. The cerebellum receives sensory information and provides feedback to control both voluntary and involuntary movements precisely. Damage to the cerebellum results in disturbances to muscle tone, posture, equilibrium, and coordination of movements.
This document discusses current trends in the management of spasticity in hemiplegic patients. It defines spasticity as a velocity-dependent increase in muscle tone caused by damage to the central nervous system. Spasticity can range from mild muscle stiffness to severe, painful muscle spasms. If left untreated, spasticity may lead to muscle contractures, deformities, and other complications. Common treatments discussed include oral medications, botulinum toxin injections, physical therapy, and the modified Ashworth scale for assessing spasticity severity.
The document discusses posture and its importance. It defines proper posture as having an equilibrium line that passes through the earlobes, behind the neck vertebrae, and in front of the sacroiliac joint. Maintaining good posture provides safety to the musculoskeletal system, internal organs, and mental state. Key aspects of good posture include having healthy feet that support the body's weight and balance, as well as an anatomically aligned skeletal structure. The vertebral column plays an important role in protecting the spinal cord, supporting the weight of the body, forming the central body axis, and enabling both posture and movement.
Similar to Spinal Functioning and the Vestibular System_Kauffman_Inservice (20)
2. Spine
Natural curves
Anterior Cervical and Lumbar curve
Posterior Thoracic curve
Good posture maintains these curves
and the integrity of your spine
Bad posture puts stress on soft tissue
structures around the spine and can
compromise the integrity of the spine
leading to back pain.
3. Back pain
Low back pain is the leading cause of disability in the United
States for people under 45 years of age
31 million Americans experience low-back pain at any given time
One-half of all working Americans admit to having back pain
symptoms each year
Americans spend at least $50 billion each year on back pain—
and that’s just for the more easily identified costs
Experts estimate that as many as 80% of the population will
experience a back problem at some time in our lives
4. Vestibular System
Equilibrium
Balance
Spatial orientation
Head & Eye coordination
Upright Posture
Innervated by Cranial Nerve VIII (Vestibulocochlear Nerve)
Sensory Nerve
2 branches
Vestibular and Cochlear
Cochlear Branch
Axons from the organ of corti
Function is hearing
Vestibular Branch
Axons from the semicircular canals, saccule, and utricle
Function is equilibrium
Primary organs
Semicircular canals
Otolithic organs
5. Anatomy: Semi-circular Canals
3 semicircular canals “SCC” (One set in each inner ear)
Anterior (a.k.a superior), posterior, and horizontal (a.k.a lateral)
Contains endolymphatic fluid
Detect angular rotation of the head
By endolymphatic fluid stimulating stereocillia moving it towards or away from the kinocillium.
Collectively the anterior and posterior canals are called the vertical
semicircular canals
Detect flexion and extension of head in sagittal plane
Nodding head to say “yes”
Horizontal Canal
Detects rotation of head in transverse plane
Rotating head to say “no”
Cupula
A cupula is located at the end of each SCC in the ampulla
6. Anatomy: Otolithic Organs
Detect Horizontal and Vertical displacement
Primary Otolithic Organs
Saccule
Responds to vertical displacement as in jumping rope
Utricle
Responds to horizontal displacement
Contains Ottoconia (calcium carbonate crystals ). Utricle is the only
place in the vestibular system that should contain ottoconia.
7. Anatomy: Vestibulospinal Tract
Belongs to the extrapyramidal system of CNS
Modulation/Regulation indirectly through ventral horns
Efferent
Upper Motor Neuron
(one exception which will be covered later)
Pathways of the vestibular system among the
oldest in our body
Myelination of pathways occurs while we are in utero
Two sub pathways
Lateral Vestibulospinal Tract
Medial Vestibulospinal Tract
8. Lateral Vestibulospinal Tract
Location?
Originates in Deiter’s nucleus of Pons
Is located in lateral funiculus
Ipsilateral projects down the spinal cord
Runs the entire length of the spinal cord and terminates in laminae VII and VIII
Function?
Maintains posture and balance
How?
Excites interneurons of anti-gravity muscles
Activates Extensor muscles of the spine and lower extremities
9. Medial Vestibulospinal Tract
Location?
Originates Schwalbe's nucleus
Located in the anterior funiculus
Bilaterally projects down the spinal cord
Extends to the caudal portion of the pons (only in cervical spine and
above)
10. Medial Vestibulospinal Tract cont.
Function #1
Provides cervical and scapular stability, posture,
and mobility.
How?
Controls Neurons involved with C.N. XI (Accessory
Nerve)
C.N XI Innervates the Traps and SCM
Trapezius
Upper Traps: Extend Head and Neck/Elevate and upwardly rotate scapula
Middle Traps: Abduct Scapula
Lower Traps: Depress and upwardly rotate the scapula
SCM
Unilaterally: laterally flexes head and neck to ipsilateral side and rotates
head and neck to contralateral side.
Bilaterally: Flexes the neck and assist to elevate the rib cage during
inhalation.
Function #2
Keeps the eyes
“yoked” together
during rapid
acceleration and
movement of the
head which
ultimately controls
head and whole
body orientation.
How?
Superiorly
projects to
paramedian
pontine reticular
formation which
indirectly
innervates C.N. III
and C.N. VI
11. What does all of this mean?
Majority of back pain treatments fall under two basic
categories:
Mechanical Tx
Manual therapy, increase mm strength, mm endurance, mm imbalance, correcting LLD,
surgery, etc…
Pain and lifestyle management Tx
Injections, medications, modalities, ergonomics, and education, etc…
Back pain and posture are often treated as a mechanical
unit and not a neuro-mechanical
Could strengthening the vestibular system correct the
“mechanical structures” that lead to poor posture, spinal
instability, leading to back pain?
12. Study 1
Abstract
There is evidence to implicate the role of the cervical spine in influencing postural control,
however the underlying mechanisms are unknown. The aim of this study was to explore
standing postural control mechanisms in older adults with neck pain (NP) using measures of
signal frequency (wavelet analysis) and complexity (entropy). This cross-sectional study
compared balance performance of twenty older adults with (age=70.3±4.0 years) and without
(age=71.4±5.1 years) NP when standing on a force platform with eyes open and closed.
Anterior-posterior centre-of-pressure data were processed using wavelet analysis and sample
entropy. Performance-based balance was assessed using the Timed Up-and-Go (TUG) and
Dynamic Gait Index (DGI). The NP group demonstrated poorer functional performance (TUG
and DGI, p<0.01) than the healthy controls. Wavelet analysis revealed that standing postural
sway in the NP group was positively skewed towards the lower frequency movement (very-
low [0.10-0.39Hz] frequency content, p<0.01) and negatively skewed towards moderate
frequency movement (moderate [1.56-6.25Hz] frequency content, p=0.012). Sample entropy
showed no significant differences between groups (p>0.05). Our results demonstrate that
older adults with NP have poorer balance than controls. Furthermore, wavelet analysis may
reveal unique insights into postural control mechanisms. Given that centre-of-pressure signal
movements in the very-low and moderate frequencies are postulated to be associated with
vestibular and muscular proprioceptive input respectively, we speculated that, because NP
demonstrate a diminished ability to recruit the muscular proprioceptive system compared to
controls, they rely more on the vestibular system for postural stability.
13. Study 2
OBJECTIVE:
This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine
and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics of the
postural reflexes by reporting previous observations of subjects during periods of microgravity or weightlessness.
BACKGROUND:
Historically, chiropractic has centered around the concept that the nervous system controls and regulates all other bodily systems; and that disruption to normal nervous system function can contribute to a
wide variety of common ailments. Surprisingly, the chiropractic literature has paid relatively little attention to the importance of neurological regulation of static upright human posture. With so much
information available on how posture may affect health and function, we felt it important to review the neuroanatomical structures and pathways responsible for maintaining the spine and posture.
Maintenance of static upright posture is regulated by the nervous system through the various postural reflexes. Hence, from a chiropractic standpoint, it is clinically beneficial to understand how the
individual postural reflexes work, as it may explain some of the clinical presentations seen in chiropractic practice.
METHOD:
We performed a manual search for available relevant textbooks, and a computer search of the MEDLINE, MANTIS, and Index to Chiropractic Literature databases from 1970 to present, using the following
key words and phrases: "posture," "ocular," "vestibular," "cervical facet joint," "afferent," "vestibulocollic," "cervicocollic," "postural reflexes," "spaceflight," "microgravity," "weightlessness," "gravity,"
"posture," and "postural." Studies were selected if they specifically tested any or all of the postural reflexes either in Earth's gravity or in microgravitational environments. Studies testing the function of each
postural component, as well as those discussing postural reflex interactions, were also included in this review.
DISCUSSION:
It is quite apparent from the indexed literature we searched that posture is largely maintained by reflexive, involuntary control. While reflexive components for postural control are found in skin and joint
receptors, somatic graviceptors, and baroreceptors throughout the body, much of the reflexive postural control mechanisms are housed, or occur, within the head and neck region primarily. We suggest that
the postural reflexes may function in a hierarchical fashion. This hierarchy may well be based on the gravity-dependent or gravity-independent nature of each postural reflex. Some or all of these postural
reflexes may contribute to the development of a postural body scheme, a conceptual internal representation of the external environment under normal gravity. This model may be the framework through
which the postural reflexes anticipate and adapt to new gravitational environments.
CONCLUSION:
Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types
of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system structures. This review of the
postural reflex structures and mechanisms adds to the growing body of posture rehabilitation literature relating specifically to chiropractic treatment. Chiropractic interest in tevaluate hese reflexes may
enhance the ability of chiropractic physicians to treat and correct global spine and posture disorders. With the knowledge and understanding of these postural reflexes, chiropractors can spinal
configurations not only from a segmental perspective, but can also determine how spinal dysfunction may be the ultimate consequence of maintaining an upright posture in the presence of other postural
deficits. These perspectives need to be explored in more detail.
14. Study 3
Abstract
INTRODUCTION:
The differences in sagittal spino-pelvic alignment between adults with chronic low back pain (LBP) and the
normal population are still poorly understood. In particular, it is still unknown if particular patterns of sagittal
spino-pelvic alignment are more prevalent in chronic LBP. The current study helps to better understand the
relationship between sagittal alignment and low back pain.
MATERIALS AND METHODS:
To compare the sagittal spino-pelvic alignment of patients with chronic LBP with a cohort of asymptomatic
adults. Sagittal spino-pelvic alignment was evaluated in prospective cohorts of 198 patients with chronic LBP
and 709 normal subjects. The two cohorts were compared with respect to the sacral slope (SS), pelvic tilt (PT),
pelvic incidence (PI), lumbar lordosis (LL), lumbar tilt (LT), lordotic levels, thoracic kyphosis (TK), thoracic tilt
(TT), kyphotic levels, and lumbosacral joint angle (LSA). Correlations between parameters were also assessed.
RESULTS:
Sagittal spino-pelvic alignment is significantly different in chronic LBP with respect to SS, PI, LT, lordotic levels,
TK, TT and LSA, but not PT, LL, and kyphotic levels. Correlations between parameters were similar for the two
cohorts. As compared to normal adults, a greater proportion of patients with LBP presented low SS and LL
associated with a small PI, while a greater proportion of normal subjects presented normal or high SS
associated with normal or high PI.
CONCLUSION:
Sagittal spino-pelvic alignment was different between patients with chronic LBP and controls. In particular,
there was a greater proportion of chronic LBP patients with low SS, low LL and small PI, suggesting the
relationship between this specific pattern and the presence of chronic LBP.
15. Study 4
Abstract
STUDY DESIGN:
A prospective study of the sagittal standing posture of 766 adolescents.
OBJECTIVE:
To determine whether posture subgroups based on photographic assessment are similar to those used clinically and to previous,
radiographically determined subgroups of sagittal standing posture, and whether identified subgroups are associated with measures of spinal
pain.
SUMMARY OF BACKGROUND DATA:
Relatively little research has been performed toward a classification of subjects according to sagittal spinal alignment. Clinical descriptions of
different standing posture classifications have been reported, and recently confirmed in a radiographic study. There is limited epidemiological
data available to support the belief that specific standing postures are associated with back pain, despite plausible mechanisms. As posture
assessment using radiographic methods are limited in large population studies, successful characterization of posture using 2-dimensional
photographic images will enable epidemiological research of the association between posture types and spinal pain. METHODS.: Three
angular measures of thoraco-lumbo-pelvic alignment were calculated from lateral standing photographs of subjects with retro-reflective
markers placed on bony landmarks. Subgroups of sagittal thoracolumbar posture were determined by cluster analysis of these 3 angular
measures. Back pain experience was assessed by questionnaire. The associations between posture subgroups and spinal pain variables were
evaluated using logistic regression.
RESULTS:
Postural subtypes identified by cluster analysis closely corresponded to those subtypes identified previously by analysis of radiographic spinal
images in adults and to those described clinically. Significant associations between posture subgroups and weight, height, body mass index,
and gender were identified. Those adolescents classified as having non-neutral postures when compared with those classified as having a
neutral posture demonstrated higher odds for all measures of back pain, with 7 of 15 analyses being statistically significant.
CONCLUSION:
Meaningful classifications exist for adolescent sagittal thoraco-lumbo-pelvic alignment, and these can be determined successfully from
sagittal photographs. More neutral thoraco-lumbo-pelvic postures are associated with less back pain.
16. Study 5
Abstract
Context: Individuals with vestibular dysfunction are at increased risk for falling. In addition, vestibular dysfunction is
associated with chronic pain, which could present a serious public health concern as approximately 43% of US adults have
chronic pain.
Objective: To assess the incidence of vestibular dysfunction in patients receiving medication for chronic, spinal stenosis,
HNP, spondylolisthesis, spondylosis, degenerative disc disease, or other underlying neurologic disorders and to determine
associated follow-up therapeutic and diagnostic recommendations.
Methods: The authors conducted a retrospective medical record review of consecutive patients who were treated in their
private neuroscience practice with medications for chronic pain or underlying neurologic disorders in 2011. All patients
underwent a series of tests using videonystagmography for the assessment of vestibular function. Test results and
recommendations for therapy and additional testing were obtained.
Results: Medical records of 124 patients (78 women, 46 men) were reviewed. Vestibular deficits were detected in 83
patients (66.9%). Patient ages ranged from 29 through 72 years, with a mean age of 50.7 years for women and 52.5 years
for men. Physician-recommended therapy and follow-up testing were as follows: 32 patients (38.6%), neurologic
examination and possible magnetic resonance (MR) imaging or computed tomography (CT) of the brain; 26 patients
(31.3%), vestibular rehabilitation therapy only; 22 patients (26.5%), vestibular and related balance-function rehabilitation
therapy, further neurologic examination, and possible MR imaging or CT; 2 patients (2.4%), balance-function rehabilitation
therapy and specialized internal auditory canal high-magnification MR imaging or CT to assess for acoustic neuroma; and 1
patient (1.2%), specialized internal auditory canal high-magnification MR imaging or CT to evaluate for possible
intracanalicular acoustic neuroma.
Conclusion: Patients being treated with medications for chronic pain or other underlying neurologic disorders (spinal
stenosis, herniated nucleus pulposus, spondylolisthesis, spondylosis, degenerative disc disease may have a higher-than-
average incidence of vestibular dysfunction. Baseline assessment and monitoring of the vestibular apparatus may be
indicated for these patients.
17. Types of Vestibular Tx for back pain
Pt. must be able to tolerate; no Tx should further aggravate the back.
Case to case basis
Vestibular gain: VORx1/VORx2
Challenge Horizontal canal: Transverse HTS
Challenge Anterior/Posterior canal: Saggital HTS
Linear acceleration: challenge utricle
Verticle acceleration: challenge saccule
EC: eliminates vision causing somatosensory and vestibular to increase
function
Changing surface/narrow BOS: causes vision and vestibular to increase
function
18. Conclusion
Back pain is highly prevalent and most Tx is directed at a mechanical and/or pain modulation
approach.
Because of the ubiquitous nature of back pain, it is questionable how successful the medical industry
is at Tx back pain.
There is no question vestibular functioning plays a significant role in posture.
There is a question as to whether or not postural deficiencies play a role in back pain. Could back pain be causing the
poor posture?...Chicken and Egg?
Vestibular system plays a role in balance which could prevent falls leading to increased incidence of
back pain.
Would focusing on strengthening the vestibular system be the answer to treating back pain? IMO,
no. I do believe it could play a role in assisting mechanical corrections to improve back pain but it
should not be the primary approach to back pain Tx.
Not enough research.
Finally, with the multiple approaches that already exist with treating back pain, why not use
strengthening the vestibular system as another “tool in your tool belt” to. Most people with back
pain respond differently to different approaches so this may be appropriate for some.
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http://www.painmed.org/patientcenter/facts_on_pain.aspx#refer
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