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.
Proprioception refers to the sense of the position and movement of the body. It is detected by receptors in muscles, joints, and skin. Proprioceptive signals are sent to the central nervous system. The parietal cortex integrates proprioceptive information. Proprioception can be affected by factors like age, fatigue, injury, and diseases like Parkinson's. Proprioceptive training aims to enhance joint awareness and can help prevent injuries in sports. Body ownership refers to the sense that a body part belongs to one's own body, as shown in experiments with rubber hands.
This document discusses rehabilitation for spastic paresis. It begins by defining spastic paresis and related conditions like spasticity, dystonia, and contractures. It then describes the underlying upper motor neuron lesion pathology. The document outlines rehabilitation goals and assessments. It provides an overview of common physical rehabilitation protocols including stretching, splinting, constraint-induced movement therapy, gait training, strengthening, biofeedback, electrical stimulation, virtual reality, and robotic therapy. It discusses each technique and provides references to support the use of these approaches.
The document discusses the multifidus muscle and its importance for spinal stability and motor control. It provides details on its anatomy and function, explaining how weakness or dysfunction of the multifidus can contribute to spinal issues. The document also discusses approaches to strengthening the multifidus through specific stabilization exercises and motor learning principles to help patients regain control and function.
The document discusses the differences between kinesthetic awareness and proprioception. Kinesthetic awareness is how we move externally, while proprioception is the internal messaging of where our body is in space. Proprioception provides feedback to allow kinesthetic awareness and coordinated movements without thinking. The document also provides examples of techniques to improve kinesthetic awareness and proprioception, such as various balancing exercises, calisthenics, and mirror training. Improving these can provide benefits like increased injury prevention, awareness, performance, and confidence.
SPORTS Rehabilitation to Re- Abilitation -a sketch for sportDr.Kannabiran Bhojan
1. The document discusses sports rehabilitation from a motor ability perspective, focusing on re-abilitation rather than traditional rehabilitation.
2. It explains how injury responses lead to changes in motor organization through effects on parametric abilities like force, velocity, length and endurance as well as synergistic abilities like co-contraction and reciprocal activation.
3. The approach of sports re-abilitation is to help recover lost motor control through targeting parametric, synergistic and composite abilities rather than focusing on individual muscles.
Delayed-Onset Muscle Soreness Alters the Response to Postural PerturbationsNosrat hedayatpour
The purpose of this study was to assess the EMG activity
of knee muscles during destabilizing perturbations performed
before, immediately after, and 24 and 48 h after eccentric
exercise.
STRETCHING IS A COMMONLY
PRESCRIBED EXERCISE ACTIVITY
THAT HAS BEEN APPLIED TO
WARM-UP, INCREASING RANGE OF
MOTION (ROM), AND RECOVERY
FROM TRAINING. THE PRACTI-
TIONER SHOULD UNDERSTAND
THE EFFECTS OF STRETCHING
EXERCISE AND THE INHERENT DIF-
FERENCES BETWEEN TYPES OF
STRETCHING EXERCISES AND
ACTIVITIES DESIGNED TO
ENHANCE "LOOSENESS" AND
FREEDOM OF MOTION. STRETCH-
ING TO ENHANCE ROM MAY BE
CONTRAINDICATED WHEN
APPLIED TO RECOVERY ACTIVITIES.
STRETCHING FOR RECOVERY
SHOULD BE PAIN-FREE MOTION
WITHIN THE CONSTRAINTS OF
MAXIMUM ROM OF A JOINT.
Proprioception refers to the sense of the position and movement of the body. It is detected by receptors in muscles, joints, and skin. Proprioceptive signals are sent to the central nervous system. The parietal cortex integrates proprioceptive information. Proprioception can be affected by factors like age, fatigue, injury, and diseases like Parkinson's. Proprioceptive training aims to enhance joint awareness and can help prevent injuries in sports. Body ownership refers to the sense that a body part belongs to one's own body, as shown in experiments with rubber hands.
This document discusses rehabilitation for spastic paresis. It begins by defining spastic paresis and related conditions like spasticity, dystonia, and contractures. It then describes the underlying upper motor neuron lesion pathology. The document outlines rehabilitation goals and assessments. It provides an overview of common physical rehabilitation protocols including stretching, splinting, constraint-induced movement therapy, gait training, strengthening, biofeedback, electrical stimulation, virtual reality, and robotic therapy. It discusses each technique and provides references to support the use of these approaches.
The document discusses the multifidus muscle and its importance for spinal stability and motor control. It provides details on its anatomy and function, explaining how weakness or dysfunction of the multifidus can contribute to spinal issues. The document also discusses approaches to strengthening the multifidus through specific stabilization exercises and motor learning principles to help patients regain control and function.
The document discusses the differences between kinesthetic awareness and proprioception. Kinesthetic awareness is how we move externally, while proprioception is the internal messaging of where our body is in space. Proprioception provides feedback to allow kinesthetic awareness and coordinated movements without thinking. The document also provides examples of techniques to improve kinesthetic awareness and proprioception, such as various balancing exercises, calisthenics, and mirror training. Improving these can provide benefits like increased injury prevention, awareness, performance, and confidence.
SPORTS Rehabilitation to Re- Abilitation -a sketch for sportDr.Kannabiran Bhojan
1. The document discusses sports rehabilitation from a motor ability perspective, focusing on re-abilitation rather than traditional rehabilitation.
2. It explains how injury responses lead to changes in motor organization through effects on parametric abilities like force, velocity, length and endurance as well as synergistic abilities like co-contraction and reciprocal activation.
3. The approach of sports re-abilitation is to help recover lost motor control through targeting parametric, synergistic and composite abilities rather than focusing on individual muscles.
Delayed-Onset Muscle Soreness Alters the Response to Postural PerturbationsNosrat hedayatpour
The purpose of this study was to assess the EMG activity
of knee muscles during destabilizing perturbations performed
before, immediately after, and 24 and 48 h after eccentric
exercise.
STRETCHING IS A COMMONLY
PRESCRIBED EXERCISE ACTIVITY
THAT HAS BEEN APPLIED TO
WARM-UP, INCREASING RANGE OF
MOTION (ROM), AND RECOVERY
FROM TRAINING. THE PRACTI-
TIONER SHOULD UNDERSTAND
THE EFFECTS OF STRETCHING
EXERCISE AND THE INHERENT DIF-
FERENCES BETWEEN TYPES OF
STRETCHING EXERCISES AND
ACTIVITIES DESIGNED TO
ENHANCE "LOOSENESS" AND
FREEDOM OF MOTION. STRETCH-
ING TO ENHANCE ROM MAY BE
CONTRAINDICATED WHEN
APPLIED TO RECOVERY ACTIVITIES.
STRETCHING FOR RECOVERY
SHOULD BE PAIN-FREE MOTION
WITHIN THE CONSTRAINTS OF
MAXIMUM ROM OF A JOINT.
Gait training Strategies to Optimize Walking Ability in People with Stroke: A...chmiel23
This document analyzes gait training strategies to optimize walking ability in stroke patients. Major impairments after stroke include muscle weakness, pain, spasticity, and poor balance. Common gait training approaches are neurodevelopmental techniques, muscle strengthening, task-specific training, body weight supported treadmill training, and intense mobility training. The evidence shows that task-specific training, especially body weight supported treadmill training, and intense mobility training that incorporates functional strengthening, balance, and aerobic exercises improves walking ability in both sub-acute and chronic stroke patients.
This document discusses concepts and applications for knee rehabilitation. It covers several key points, including how injury affects proprioception, gait, and recovery duration. Specifically, it notes that an ACL injury can decrease proprioception for 1-3 years and alter muscle activation timing and recruitment. It also discusses developing a neuromuscular rehabilitation program with a functional focus, using exercises that provide cognitive sensory-motor challenges to facilitate motor learning. Finally, it emphasizes taking a functional approach to rehabilitation by using a patient's own movement patterns whenever possible.
A functional approach to ACL rehabilitation focuses on restoring functional movement patterns rather than isolated muscle strength. It emphasizes proximal hip control and strategies to enhance hip muscle function during knee rehabilitation exercises. Exercises are progressed based on developing motor skills and abilities rather than time-based benchmarks. The goal is to challenge and adapt movement patterns to restore an individual's unique repertoire of functional movements.
This document discusses balance, fall prevention, and balance assessment and training. It defines balance as control of the center of mass over the base of support. Age-related changes and diseases that impact balance components are reviewed. Valid tools to measure balance include the Berg Balance Scale, Timed Up and Go test, and Functional Reach test. Balance training exercises discussed include calf stretches, heel/toe raises, soft surface stance, and exercises using movable surfaces like Swiss balls and tilt boards. Both hard and soft surfaces are used to challenge static and dynamic balance.
This document provides an overview of therapeutic exercise and its impact on physical function. It defines therapeutic exercise as planned bodily movements, postures, or physical activities intended to remediate or prevent impairments, improve physical function, prevent health risks, and optimize overall health. It discusses components of physical function like balance, coordination, flexibility, and muscle performance. It also covers models of disablement including the Nagi model, ICIDH model, and ICF model. Finally, it discusses common physical impairments, risk factors for disability, and types of prevention through rehabilitation.
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.
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.
Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing ...Nosrat hedayatpour
the aim of the study was to assess EMG MPF during
recovery following a fatiguing contraction at multiple
locations of the quadriceps femoris muscle injured
by eccentric exercise.
Kinesiotherapy provides exercise programs for medically stable patients to reverse the effects of illness or injury and improve functional abilities. Kinesiotherapists develop treatment plans including exercises and education based on a physician's referral and patient goals. The goal is to restore strength, endurance, mobility and independence through improving components of physical function like range of motion, balance, and cognition.
Strengthening of lower limbs , Physiotherapy.AmulyaBodke
The document summarizes strengthening exercises for lower limb muscles. It begins by defining muscle strength and the need to progressively overload muscles through exercise. It then outlines indications for strengthening including curative, preventive, preparative and recreational reasons. The document describes assessing muscle strength and selecting an appropriate resistance. It provides examples of exercises categorized by muscle groups of the lower limb and activities to target each group. Finally, it discusses techniques for re-educating weak or paralyzed muscles in a graded manner from passive to active resistance training.
1) The document discusses current evidence on understanding and managing the hemiplegic shoulder.
2) It finds that proper positioning helps avoid subluxation but slings and strapping do not reduce subluxation or improve function. Gentle range of motion exercises are preferred.
3) Electrical stimulation prevents subluxation development while hand edema can be treated with passive motion or electrical stimulation.
Youth Sports Injury Day: The Science of Warm-UpsaamcEvents
Muscle injuries represent over 30% of athletic injuries. Warming up, stretching, and strengthening are widely accepted ways to prevent muscular injuries. Research offers differing views on the effectiveness of warm-up and stretching protocols. Dynamic warm-ups involving moderate intensity exercise are most beneficial for preventing injuries in high-intensity sports like football and basketball. Static stretching held for 20-30 seconds can increase flexibility for up to 24 hours. Sports-specific strengthening at least twice per week with progressive overload best supports athletic performance goals.
Update of Concepts Underlying Movement System SyndromesZinat Ashnagar
This document discusses key concepts underlying movement system syndromes and musculoskeletal pain. It proposes that dysfunctions of the movement system can be classified into syndromes that provide guidance for diagnosis and treatment. The syndromes are based on directions or alignments that cause pain, associated with movement impairments, and improved by correcting impairments. Most musculoskeletal pain results from cumulative microtrauma from repeated movements in specific directions or sustained alignments. Understanding these concepts enables practitioners to develop appropriate movement system diagnoses and treatment programs focused on correcting movement patterns rather than just treating tissues.
The document discusses neuro-developmental physiotherapy (NDT) offered at King Edward Preparatory for children with low muscle tone (LMT). NDT is an advanced hands-on physiotherapy approach used to address challenges with posture, movement, motor skills, muscle weakness and coordination. Children with LMT may exhibit poor posture, delayed motor skills, difficulty remaining upright, restlessness, tiring easily and avoiding physical activity. The physiotherapist works with the child, family, physicians and teachers to develop a comprehensive treatment program involving weekly sessions for 6 months to strengthen muscles and improve stability, movement and performance.
This document discusses spasticity after stroke. It defines spasticity as an abnormal muscle tone with increased resistance to passive stretch. There are different types of spasticity including lead pipe, cogwheel, and clasp knife. The pathophysiology involves loss of inhibitory control in the spinal cord. Treatment options include rehabilitation therapy, oral medications, neurolysis, orthopedic procedures, and neurosurgery. Measurement tools include the Ashworth scale and pain scales. The goals of treatment are to improve function and mobility while decreasing pain.
Therapeutic exercise is planned physical activity intended to improve function and health. It includes aerobic conditioning, strength training, stretching, neuromuscular control exercises, balance training, and functional tasks. Common physical impairments addressed include muscle weakness, limited range of motion, balance issues, incoordination, and decreased endurance. Impairments can be primary from a health condition or secondary from preexisting issues. The goal of therapeutic exercise is to improve impairments and functional abilities.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
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.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
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.
Gait training Strategies to Optimize Walking Ability in People with Stroke: A...chmiel23
This document analyzes gait training strategies to optimize walking ability in stroke patients. Major impairments after stroke include muscle weakness, pain, spasticity, and poor balance. Common gait training approaches are neurodevelopmental techniques, muscle strengthening, task-specific training, body weight supported treadmill training, and intense mobility training. The evidence shows that task-specific training, especially body weight supported treadmill training, and intense mobility training that incorporates functional strengthening, balance, and aerobic exercises improves walking ability in both sub-acute and chronic stroke patients.
This document discusses concepts and applications for knee rehabilitation. It covers several key points, including how injury affects proprioception, gait, and recovery duration. Specifically, it notes that an ACL injury can decrease proprioception for 1-3 years and alter muscle activation timing and recruitment. It also discusses developing a neuromuscular rehabilitation program with a functional focus, using exercises that provide cognitive sensory-motor challenges to facilitate motor learning. Finally, it emphasizes taking a functional approach to rehabilitation by using a patient's own movement patterns whenever possible.
A functional approach to ACL rehabilitation focuses on restoring functional movement patterns rather than isolated muscle strength. It emphasizes proximal hip control and strategies to enhance hip muscle function during knee rehabilitation exercises. Exercises are progressed based on developing motor skills and abilities rather than time-based benchmarks. The goal is to challenge and adapt movement patterns to restore an individual's unique repertoire of functional movements.
This document discusses balance, fall prevention, and balance assessment and training. It defines balance as control of the center of mass over the base of support. Age-related changes and diseases that impact balance components are reviewed. Valid tools to measure balance include the Berg Balance Scale, Timed Up and Go test, and Functional Reach test. Balance training exercises discussed include calf stretches, heel/toe raises, soft surface stance, and exercises using movable surfaces like Swiss balls and tilt boards. Both hard and soft surfaces are used to challenge static and dynamic balance.
This document provides an overview of therapeutic exercise and its impact on physical function. It defines therapeutic exercise as planned bodily movements, postures, or physical activities intended to remediate or prevent impairments, improve physical function, prevent health risks, and optimize overall health. It discusses components of physical function like balance, coordination, flexibility, and muscle performance. It also covers models of disablement including the Nagi model, ICIDH model, and ICF model. Finally, it discusses common physical impairments, risk factors for disability, and types of prevention through rehabilitation.
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.
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.
Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing ...Nosrat hedayatpour
the aim of the study was to assess EMG MPF during
recovery following a fatiguing contraction at multiple
locations of the quadriceps femoris muscle injured
by eccentric exercise.
Kinesiotherapy provides exercise programs for medically stable patients to reverse the effects of illness or injury and improve functional abilities. Kinesiotherapists develop treatment plans including exercises and education based on a physician's referral and patient goals. The goal is to restore strength, endurance, mobility and independence through improving components of physical function like range of motion, balance, and cognition.
Strengthening of lower limbs , Physiotherapy.AmulyaBodke
The document summarizes strengthening exercises for lower limb muscles. It begins by defining muscle strength and the need to progressively overload muscles through exercise. It then outlines indications for strengthening including curative, preventive, preparative and recreational reasons. The document describes assessing muscle strength and selecting an appropriate resistance. It provides examples of exercises categorized by muscle groups of the lower limb and activities to target each group. Finally, it discusses techniques for re-educating weak or paralyzed muscles in a graded manner from passive to active resistance training.
1) The document discusses current evidence on understanding and managing the hemiplegic shoulder.
2) It finds that proper positioning helps avoid subluxation but slings and strapping do not reduce subluxation or improve function. Gentle range of motion exercises are preferred.
3) Electrical stimulation prevents subluxation development while hand edema can be treated with passive motion or electrical stimulation.
Youth Sports Injury Day: The Science of Warm-UpsaamcEvents
Muscle injuries represent over 30% of athletic injuries. Warming up, stretching, and strengthening are widely accepted ways to prevent muscular injuries. Research offers differing views on the effectiveness of warm-up and stretching protocols. Dynamic warm-ups involving moderate intensity exercise are most beneficial for preventing injuries in high-intensity sports like football and basketball. Static stretching held for 20-30 seconds can increase flexibility for up to 24 hours. Sports-specific strengthening at least twice per week with progressive overload best supports athletic performance goals.
Update of Concepts Underlying Movement System SyndromesZinat Ashnagar
This document discusses key concepts underlying movement system syndromes and musculoskeletal pain. It proposes that dysfunctions of the movement system can be classified into syndromes that provide guidance for diagnosis and treatment. The syndromes are based on directions or alignments that cause pain, associated with movement impairments, and improved by correcting impairments. Most musculoskeletal pain results from cumulative microtrauma from repeated movements in specific directions or sustained alignments. Understanding these concepts enables practitioners to develop appropriate movement system diagnoses and treatment programs focused on correcting movement patterns rather than just treating tissues.
The document discusses neuro-developmental physiotherapy (NDT) offered at King Edward Preparatory for children with low muscle tone (LMT). NDT is an advanced hands-on physiotherapy approach used to address challenges with posture, movement, motor skills, muscle weakness and coordination. Children with LMT may exhibit poor posture, delayed motor skills, difficulty remaining upright, restlessness, tiring easily and avoiding physical activity. The physiotherapist works with the child, family, physicians and teachers to develop a comprehensive treatment program involving weekly sessions for 6 months to strengthen muscles and improve stability, movement and performance.
This document discusses spasticity after stroke. It defines spasticity as an abnormal muscle tone with increased resistance to passive stretch. There are different types of spasticity including lead pipe, cogwheel, and clasp knife. The pathophysiology involves loss of inhibitory control in the spinal cord. Treatment options include rehabilitation therapy, oral medications, neurolysis, orthopedic procedures, and neurosurgery. Measurement tools include the Ashworth scale and pain scales. The goals of treatment are to improve function and mobility while decreasing pain.
Therapeutic exercise is planned physical activity intended to improve function and health. It includes aerobic conditioning, strength training, stretching, neuromuscular control exercises, balance training, and functional tasks. Common physical impairments addressed include muscle weakness, limited range of motion, balance issues, incoordination, and decreased endurance. Impairments can be primary from a health condition or secondary from preexisting issues. The goal of therapeutic exercise is to improve impairments and functional abilities.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
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.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
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.
Conference of the Tense Active Motor Control in the Shoulder. XIVth Federation of European Societies for Surgery of the Hand, FESSH Congress 3rd to 6th of June 2009 Poznan, Poland. The author explain how the connective system is determinant to control the motions in the shoulder, an special joint deeply dependent of the tissue deformation of the connective and sof tissues to build the adequate movements. Are the connective tissues a passive sub system? Dr. López proposed a new vision how understand the role of Fascias, ligaments, Capsules and other connective tissues during the movements and posture.
Various types of muscle imbalance occurs in human body due to either articular, fascial or neural causes. as described by Janda this slide show elaborates on the same aspect and also differentiates two schools of thoughts on muscle imbalance, its assessment and treatment in the view of physiotherapy.
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.
This study investigated how localized muscle fatigue of the ankle plantarflexors affects spatial electromyography (EMG) patterns in the medial gastrocnemius muscle during walking and running. The researchers recorded high-density EMG from the medial gastrocnemius before and after subjects performed a calf raise task to induce fatigue. They found that after fatigue, peak EMG activity decreased but mean power frequency increased during locomotion. Additionally, the location of peak EMG shifted proximally compared to the pre-fatigue location, suggesting altered motor unit recruitment to distribute muscle loads. Despite these EMG changes, lower limb biomechanics were similar before and after fatigue.
Application of fascial manipulation technique in chronic shoulder painAdam Glowacz MCSP
This pilot study examines the application of the Fascial Manipulation technique in 28 patients with chronic shoulder pain. The technique involves deep kneading of fascial points along myofascial sequences to reduce pain. Patients underwent 3 treatment sessions and reported pain levels before, after, and 3 months post-treatment using a visual analogue scale. Results suggest the technique may effectively reduce pain in chronic shoulder dysfunctions. The study also discusses the anatomical basis of fascial continuity and the biomechanical model of the Fascial Manipulation technique.
a little dated, about 5 years, but still a great starting point for those interested in performance or rehab of the athlete's lumbar spine, more to come!
This document discusses evidence and perspectives on lumbar spine rehabilitation and functional instability. It questions conventional approaches and dogma, advocating instead for individualized exercise based on context and motor skill training. Specific muscles are not singled out as most important for stability; rather, coordinated muscle activation through motor patterns is key. Low levels of co-contraction can provide adequate stability without undue load.
This document discusses evidence and convention regarding lumbar spine rehabilitation and functional instability. It questions the dogmatic approach to lumbar spine care and exercise, noting that function is context-specific. True functional exercise does not exist, and motor skill training is more important than focusing on stability alone. The document advocates moving from isolated to integrated and slow to fast exercises based on the principle of specificity of adaptations to imposed demands (SAID).
Three applications of mechanical vibration to the quadriceps muscle for 10 minutes each over three consecutive days improved body balance in subjects who underwent ACL reconstruction, as shown by decreased length of trace, mean speed of shifts, and ellipse area when standing on the operated leg up to 90 days later. While leg force did not differ between treated and untreated groups, treated subjects showed greater confidence standing on the operated leg, suggesting vibration facilitated proprioceptive learning. The long-lasting effects may be due to conditioning of the neural network controlling the muscle and joint from association of voluntary contraction during vibration.
The document summarizes a study that investigated the effects of applying vibratory stimulation to the quadriceps muscle of subjects who underwent anterior cruciate ligament (ACL) reconstruction surgery. The study found that applying short periods of vibration for a few consecutive days led to improved balance and equilibrium over longer periods of time, as measured by various parameters, compared to a control group. While leg force was not significantly different between groups, the treated subjects showed a preference for standing on the operated leg, indicating the vibration helped them regain confidence in using that leg for balance. The long-lasting positive effects are believed to be due to improvements in proprioceptive control and learning in the central nervous system.
2013 ESTABILIZACIÓN NEUROMUSCULAR DINÁMICA Y REHABILITACIÓN DEPORTIVA.pdfRamiro Rebolledo
This document summarizes the Dynamic Neuromuscular Stabilization (DNS) approach for optimizing movement and rehabilitation. DNS is based on principles of developmental kinesiology which recognizes that movement patterns are hardwired in the central nervous system from birth. The DNS approach assesses and trains the intrinsic spinal stabilizers including the diaphragm, pelvic floor, and transversus abdominis to regulate intra-abdominal pressure for optimal joint function and movement throughout the kinetic chain. Precise coordination of local and global muscles is important to transfer force efficiently and prevent overloading or injury. Functional tests identify impairments in the integrated spinal stabilizing system to guide targeted rehabilitation exercises modeling developmental movement patterns.
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 fascial manipulation, a soft tissue technique that addresses myofascial restrictions. It provides background on the evolution of concepts leading to fascial manipulation, including influences from trigger point therapy and acupuncture. The document also discusses the anatomical basis of myofascial sequences and chains, which involve fascial planes connecting muscles. Restrictions in these fascial planes can alter proprioception and motor coordination, potentially causing pain. Fascial manipulation aims to restore the natural sliding of fascia and normalize motor unit recruitment.
This document discusses integrating neuromuscular principles into orthopedic and sports rehabilitation by combining upper extremity PNF patterns known as the "chop and lift" with half kneeling and tall kneeling postures. These techniques can be used for assessment of core stability and as powerful corrective training techniques. When the chop and lift patterns are performed in the kneeling postures, core muscles are highly recruited and any impairments or asymmetries are magnified, allowing for better identification and treatment.
Research 4801-Winter 2015-Sahijwani, Raj-FinalRaj Sahijwani
This case report describes the chiropractic treatment of a 38-year-old female patient experiencing shoulder pain, low back pain, headaches, and loss of cervical lordosis. Pre-treatment x-rays showed a cervical kyphosis measuring -13 degrees. Her treatment included Network Spinal Analysis, somato-respiratory integration, use of a Denneroll orthotic, and diversified adjustments. Post-treatment x-rays after 2 months showed significant improvement, with restoration of cervical lordosis to 0 degrees. The integration of various chiropractic techniques was effective at improving the patient's posture and reducing her symptoms.
Nikos Malliaropoulos - Rehabilitation of hamstring injuries MuscleTech Network
Nikos Malliaropoulos
Director of the Athletics National Sports Medicine Centre Thessaloniki Greece. Consultant SEM Physician Barts and The London Clinical Senior Lecturer QMUL CSEM.
-
The rehabilitation of Hamstring injuries - Can we be more injury specific?
(6th MuscleTech Network Workshop)
14th October, Barcelona
Similar to The stabilizing system_of_the_spine_part_1 (20)
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
The stabilizing system_of_the_spine_part_1
1. Reprinted from JOURNAL OF SPINAL DISORDERS & TECHNIQUES
Vol.5 No.4 August 1992
Copyright @ L992 by Lippincott Williams & Wilkins
Printed in U.S.A.
The Stabilizing System of the Spine. Part I. Function,
Dysfunction, Adaptation, and Enhancement
Manohar M. Panjabi
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticw U.S.A.
Summary: Presented here is the conceptual basis for the assertion that the spinal
stabilizing system consists ofthree subsystems. The vertebrae, discs, and ligaments
constitute the passive subsystem. All muscles and tendons surrounding the spinal
column that can apply forces to the spinal column constitute the active subsystem.
The nerves and central nervous system comprise the neural subsystem, which
determines the requirements for spinal stability by monitoring the various trans-
ducer signals, and directs the active subsystem to provide the needed stability. A
dysfunction of a component of any one of the subsystems may lead to one or more
of the following three possibilities: (a) an immediate response from other subsys-
tems to successfully compensate, (b) a long-term adaptation response of one or
more subsystems, and (c) an injury to one or more components of any subsystem.
It is conceptualized that the first response results in normal function, the second
results in normal function but with an altered spinal stabilizing system, and the
third leads to overall system dysfunction, producing, for example, low back pain.
In situations where additional loads or complex postures are anticipated, the
neural control unit may alter the muscle recruitment strategy, with the temporary
goal of enhancing the spine stability beyond the normal requirements. Key
Words: Spine stabilizing system-Spinal instability-Lumbar spine-Muscle
function-Low back pain.
Editor's Comments of low back pain (38), it is not surprising that many of
the present treatments are relatively ineffective.
As co-editor of Journal of Spinal Disorders, I am Spinal instability is considered to be one of the im-
delighted to ofer to our readership this elegant hy- portant causes oflow back pain but is poorly defined
pothesis ofered by Panjabi. I encourage all ofyou to and not well understood (24). The basic concept of
read both the compelling article by Panjabi, and the spinal instability is that abnormally large interverte-
articulate commentary by Krag. Such thoughtful dis- bral motions cause either compression and/or stretch-
course will do much to enhance our understanding of ing of the inflamed neural elements or abnormal de-
spinal stability. In addition, I hope that the areas of formations of ligaments, joint capsules, annular
controversy will provide the impetusforfurther investi- fibers, and end-plates, which are known to have signif-
gations. Manuscripts such as these will be published icant density ofnocioceptors (41). In both situations,
on a periodic basis to offer the concepts, thoughts, and the abnormally large intervertebral motions may pro-
ideas of recognized authorities who are involved in duce pain sensation.
studying spinal disorders. Knutsson (19) was probably the first to propose a
Dan M. Spengler, M. D.
Low back pain is a well-recognized problem of the Address correspondence and reprint requests to Dr. M. M. Pan-
lation and resulting in substantial social loss (2,I I,23, jabi, Department ofOrthopaedics and Rehabilitation, Yale Univer-
37). Because the etiology is unknown for most types sity School of Medicine, New Haven, CT 06510, U.S.A.
383
2. 384 M. M, PANJABI
mechanical parameter as an indicator of spinal insta-
bility: the retrodisplacement (anterior to posterior
translation) of a vertebra observed on lateral radio-
graphs while flexing the spine from the extended posi-
tion. There is some recent evidence to support these
observations of increased motion being related to low
back problems ( 12,20,40). Other studies have found a
mixed set of results. Decreased motion was found by
Pearcy et al. (34) and Dvorak et al. (8) in low back
pain patients with degenerative changes in the spine.
ln the same study, Dvorak et al. (8) reported increased
motion in younger athletic patients with back pain. FlG, 1. The spinal stability system consists of three subsys-
tems: passive spinal column, active spinal muscles, and neural
Both hypo- and hypermobility of the spine' as mea- control unit.
sured by the range of motion without regard to the
direction of vertebral fiiovements, have been pro-
posed by another hypothesis ofspinal instability (18).
In addition to the abnormal magnitudes (larger or DESCRIPTION
smaller than normal), the motion quality is another
parameter. Abnormally large dispersion of the centers The basic biomechanical functions of the spinal
of rotation during flexion, extension, and lateral system are (a) to allow movements between body
parts, (b) to carry loads, and (c) to protect the spinal
bending have been suggested as signs ofspinal instabil-
ity, both in an in vitro model (35) and in low back cord and nerve roots (39). Mechanical stability of the
pain patients (7). Seligman et al. (36), also using the spine is necessary to perform these functions and,
concept of the center of rotation and experimental therefore, it is of fundamental significance to the hu-
results of an in vitro study, suggested that the in- man body. First, the components of the spinal stabi-
creased length of the path of the centers of rotation
lizing system are presented, followed by descriptions
during flexion/extension may be a predictor of spinal of its normal function, dysfunction, and enhanced
instability. There may also be motion quality abnor- function.
malities. Pearcy et al. (33) found coupled axial rota- The spinal stabilizing system is conceptualized as
tions and lateral bending motions during flexion/ex- consisting of three subsystems (Fig. 1). The passive
tension in low back pain patients as compared with musculoskeletal subsystem includes vertebrae, facet
the control group. Similar observations concerning articulations, intervertebral discs, spinal ligaments,
the coupled torques also have been made (32). and joint capsules, as well as the passive mechanical
properties of the muscles. The active musculoskeletal
Thus, there have been several attempts made in the
past to relate the clinical problem oflow back pain to subsystem consists of the muscles and tendons
an abnormality in intervertebral motion. Although surrounding the spinal column. The neural andfeed'
some useful information has been gathered, there are back subsysten consists of the various force and mo-
contradictory observations and hypotheses. To make tion transducers, located in ligaments, tendons, and
progress on this clinically important problem of spi- muscles, and the neural control centers' These
passive, active, and neural control subsystems, al-
nal instability, new hypotheses must be developed,
and, driven from the hypotheses, new types of motion though conceptually separate, are functionally
information must be obtained. A better understand- interdependent.
ing of the workings of the spinal stabilizing system
may also be useful in this respect. Normal Function of the Spinal Stabilizing System
In this part of a two-part article, the purpose is to
present a group ofconcepts concerning the stabilizing The normal function of the stabilizing system is to
system of the spine, including the normal function, provide sufficient stability to the spine to match the
dysfunction, and adaptation/enhancement functions. instantaneously varying stability demands due to
In the second part, the concept ofneutral zone is pre- changes in spinal posture, and static and dynamic
sented. This kinematic parameter is hypothesized to loads. The three subsystems work togethil to achieve
be a functional measure of the spinal stabilizing the goal as described in subsequent paragraphs and
system. schematically shown in Fig. 2.
J Spinal Disord Vol. 5, No. 4' 1992
3. SPINE STABILIZING SYSTEM I 38s
tension is measured and adjusted until the required
stability is achieved. The requirements for the spinal
stability and, therefore, the individual muscle ten-
sions, are dependent on dynamic posture, that is, vari-
ation of lever arms and inertial loads of different
masses, and external loads.
Dysfunction of the Spinal Stabilizing System
Degradation of the spinal system may be due to
injury, degeneration, and/or disease of any one of the
FlG. 2. Functioning of the spinal stability system. The informa-
tion from the (1) Passive Subsystem sets up specific (2) spinal subsystems (Fig. 3). The neural control subsystem
stability requirements. Consequently, requirements for (3) individ- perceives these deficiencies, which may develop sud-
ual muscle tensions are determined by the neuralcontrol unit. The denly or gradually, and attempts to compensate by
message is sent to the (4) force generators. Feedback is provided
by the (5) force monitors by comparing the (6) "achieved" and (3) initiating appropriate changes in the active subsys-
"required" individual muscle tensions. tem. Although the necessary stability of the spine
overall may be reestablished, the subsequent conse-
quences may be deleterious to the individual compo-
nents ofthe spinal system (e.g., accelerated degenera-
The Passive ( Ligamentous) Subsystem
tion of the various components of the spinal column,
Components of the passive subsystem, (e.g., liga- muscle spasm, injury, and fatigue). Over time, the
ments) do not provide any significant stability to the consequences may be chronic dysfunction and pain.
spine in the vicinity of the neutral position. It is to-
ward the ends of the ranges of motion that the liga-
Adaptation and Enhancement of the
ments develop reactive forces that resist spinal mo-
Stabilizing Capacity
tion. The passive components probably function in
the vicinity ofthe neutral position as transducers (sig- This ability of the spinal system to respond to dys-
nal-producing devices) for measuring vertebral posi- function is one manifestation of its adaptability. In
tions and motions, similar to those proposed for the addition, under circumstances of unusually demand-
knee ligaments (3), and therefore are part of the ing loading conditions, there may be a functional re-
neural control subsystem. Thus, this subsystem is pas- serve that can be called on to enhance spinal stability
sive only in the sense that it by itselfdoes not generate beyond the normal level.
or produce spinal motions, but it is dynamically ac-
tive in monitoring the transducer signals.
The Active (Musculotendenous) Subsystem
The muscles and tendons of the active subsystem
are the means through which the spinal system gener-
ates forces and provides the required stability to the
spine. The magnitude of the force generated in each
muscle is measured by the force transducers built into
the tendons of the muscles. Therefore, this aspect of
the tendons is part of the neural control subsystem.
FlG.3. Dysfunction of the spinal stability system. (1) lnlury, de-
generation and/or disease may decrease the (2) passive stability
The Neural Control Subsystem and/or (3) active stability. (4) The neural control unit attempts to
remedy the stability loss by increasing the stabilizing function of
The neural subsystem receives information from the remaining spinal components: (5) passive and (6) active. This
the various transducers, determines specific require- may lead to (7) accelerated degeneration, abnormal muscle load-
ing, and muscle fatigue. lf these changes cannot adequately com-
ments for spinal stability, and causes the active sub- pensate for the stability loss, a (8) chronic dysfunction or pain may
system to achieve the stability goal. Individual muscle develop.
J Spinal Disord Vol. 5, No.4, 1992
4. 386 M. M. PANJABI
DISCUSSION spinal loads. Thus, the deformations of soft tissues
are capable of providing a comprehensive set of
The main thrust of the proposed biomechanical signals from which stability requirements may be
concept of the stabilizing system of the spine is that determined.
there are two musculoskeletal components and one In addition to the feedback provided by the liga-
neural component. Under normal circumstances, ment deformation, instantaneous muscle tension is
within the physiological ranges of spinal movements probably monitored by the muscle spindles and ten-
and against normal spinal loads, the three subsystems don organs (9) and adjusted by the neural control unit
are highly coordinated and optimized. Compensation in accordance with the requirements for stability.
for dysfunction of the system, within certain limits, Thus, the normal function of the stabilizing system of
may be provided by the system. If the dysfunction is the spine involves monitoring tissue deformations
beyond these limits, then acute or chronic problems and selecting appropriate muscles and adjusting indi-
may arise. In certain situations, the system may be vidual muscle tensions to accommodate changes in
enhanced beyond the normal, if needed. physiological postures, spinal movements, and spinal
loads. The spinal stabilizing system has been de-
signed, developed, and optimized to achieve this goal.
Normal Function
The load-carrying capacity of the passive subsys- DYsfunction
tem, the so-called critical load of the spinal column'
has been determined by in vitro experiments (6,21). Any one or more of the subsystems may not func-
They found that the spinal column specimens buck- tion appropriately, affecting the overall stability ofthe
led (became mechanically unstable) at a load of 20 N spinal system.
(2 kg) and 90 N (9 kg), respectively, for the Tl-sacrum
and L5-sacrum specimens. The normal loads on the The Passive SubsYstem
spine provided by body mass alone in the standing
position (25) are many times larger, about two to The dysfunction of the passive subsystem may be
three times body weight (140-210 kg). Even bigger caused by mechanical injury such as overstretching of
loads may be expected under dynamic situations or the ligaments, development of tears and fissures in the
from carrying external loads. This large load-carrying annulus, development of microfractures in the end-
capacity is achieved by the participation of well-coor- plates, and extrusion of the disc material into the ver-
dinated muscles surrounding the spinal column' tebral bodies. The injury may result from overloading
Thus, the importance of the active subsystem (the of a normal structure or normal loading of a weak-
muscles) in providing the required stability is well ened structure. A structure may also be weakened by
established. degeneration or disease. Degeneration of the disc is
How does the spinal stabilizing system determine known to weaken it in resisting torsional loads (10)'
the forces needed from the muscles? What is the ini- There is some evidence to suggest that other multidi-
tiating signal coming from the transducers located in rectional physical properties ofthe spine are also al-
the passive subsystem? Probably it is the ligament de- tered by degeneration (29). In general, all these factors
formation (strain) and not the force (stress). This is decrease the load-bearing and stabilizing capacity of
based on experimental observations from which we the passive subsystem. This may require compensa-
know that all passive spines (cadaveric spine speci- tory changes in the active subsystem.
mens devoid of musculature) exhibit measurable neu-
tral zones, although the neutral zones are generally The Active SubsYstem
larger after degeneration (31) and injury Q7,28).
Throughout the neutral zone, the reactive forces are The active musculoskeletal subsystem may develop
small. On the other hand, throughout the neutral deterioration ofits ability to receive and/or carry out
zone, the deformations of the ligaments are large (3 1). the neural commands, to provide accurate feedback
This leads to the hypothesis that the deformations in of muscle tension information to the neural control
the ligaments provide a more useful feedback signal unit, or to produce coordinated and adequate muscle
than do the forces for monitoring the requirements tensions; such deformation may result from disuse,
for spinal stability. The stability requirements are also degeneration, disease, or injury. As a result, the stabi-
dependent on the loads carried by the spine. Because lizing capacity of the spinal system may be decreased'
the ligaments deform under load, they can sense the This may compromise the capability of the system to
J Spinal Disord Vol. 5, No. 4, 1992
5. SPINE STABILIZING SYSTEM I 387
both provide compensatory help to the passive sub- tion in complex spinal motions involving lifting and
system when needed, and to withstand unexpected twisting at the workplace.
dynamic or abnormally large external loads. A neural control dysfunction may become chronic.
This has been observed in studies conducted on pa-
tients with spinal stenosis ( 14) and low back problems
The Neural Subsystem (a). In the former study, the patients exhibited greater
body sway after initiation of claudication. In the latter
Dysfunction of the neural subsystem can also de- study, the low back patients, when challenged with
velop. To achieve the required stability at every in- the task of standing on an unbalanced platform with
stance of time, the neural subsystem has the enor- eyes closed, had greater body sway compared with the
mously complex task of continuously and simulta- normal subjects performing the same task. One may
neously monitoring and adjusting the forces in each speculate that the control of the spinal stabilizing sys-
ofthe muscles surrounding the spinal column. Instan- tem was permanently altered in the patients exam-
taneous decisions must be made to redistribute the ined in both ofthese studies.
muscle tensions, if there is a change in the posture
and/or the external loads. The task is made much Adaptation and Enhancement
more complex if the posture and/or loads change dy-
namically, requiring additional considerations for Either chronic dysfunction of components of any
masses, inertias, and accelerations involved. An appre- of the subsystems or increased functional demands on
ciation of the complexity of the task may be obtained them may lead to adaptive changes.
by watching a sophisticated robot trying to walk a
short distance. The robot walks slowly, staggeringly, The Passive Subsystem
and will easily topple if subjected to a sudden external
load, despite being controlled by high-performance, The muscular strength decreases in the later years
state-of-the-art computers. oflife. It has also been observed that the spinal col-
One example of the kind of error that might occur umn stiffness increases in later years of life due to
is that one or more muscles may fire in a manner that osteophyte formation and, possibly, facet hyper-
is undesirable: too small or too large force and/or too trophy (10,15,18). The two phenomena may be re-
early or too late firing. This may happen either due to lated; that is, with aging, the passive subsystem may
the faulty information transmitted from the spinal be attempting to compensate for the decreased stabi-
system transducers or due to the fault ofthe control lizing ability of the active subsystem. In case the
unit itself. Such an error may cause excessive muscle body's own adaptive responses are not enough, thera-
tension, resulting in soft tissue injury and pain. This peutic intervention in the form of surgical fusion and
may explain some of the instances of acute low back external bracing may be used as treatments designed
pain initiations where negligible or maryinal loads are to enhance the spinal stability.
involved (e.g., while picking up a piece of paper from
the floor). Often such an incident may happen while The Active Subsystem
performing a complex maneuver (e.g., combined flex-
ing, bending, and twisting), when the synchronizing A general increased muscle tone by training has
capability of the neural control subsystem may be ex- been shown to decrease the risk for development of
tended to its maximum. Involvement of a heavy ex- low back problems (5). This may be explained on the
ternal load in such a case is not a requirement for basis ofenhanced stability ofthe spinal system in the
producing muscle injury and pain, but may further form of increased capacity to generate muscle ten-
potentiate an injury. sion. Theoretical models of spinal stability have pre-
In addition to damagingthe active subsystem, mus- dicted such an effect (i.e., increased spinal stability
cle force errors might lead to overload of a passive due to increased muscle tension) (6,26). By using the
structure (e.g., disc). With the spine in an awkward contralateral knee as the control, a few clinical studies
posture, a single large overload has been shown experi- have documented the role of muscles in anterior cru-
mentally to produce disc herniation ( l). One may also ciate ligament (ACl)-deficient knees. Hypertrophy of
expect that an awkward maneuver that is repeated the involved side was found in patients who had
many times (e.g., in work environment) would in- adopted best after the injury Q2). In another knee
to occur. Kelsey et al.
crease the chance for an error study, Giove et al. (13) found increased value of the
(17) have documented increased risk for disc hernia- ratio of hamstring strength to quadricep strength to be
J Spinal Disord Vol. 5, No.4, 1992
6. 388 M. M. PANJABI
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