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.
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
A valuable presentation on myofasical release and muscle energy techniques for sport's and massage therapist's. This presentation is from our workshop event at the St John Street clinic on the 27th February 2016.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Proprioceptive neuromuscular facilitation (PNF) is an exercise technique based on principles of neurophysiology and functional anatomy. It uses patterns of diagonal movements combining flexion, extension, abduction, adduction, and rotation. The 9 principles of PNF include resistance, stretch, timing, and verbal commands. PNF techniques like repeated contractions and hold-relax are used to improve areas like strength, flexibility, and motor control by facilitating agonist and antagonist muscle groups. PNF patterns involve multi-joint diagonal movements of the upper and lower extremities.
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.
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
- The document discusses the biomechanics and pathomechanics of the elbow joint. It describes the ligaments of the elbow, the articulations between the humerus, ulna, and radius, and the range of motion of the elbow joint. It also examines the muscles that flex, extend, pronate, and supinate the forearm, discussing their attachments, actions, innervation, and the effects of joint positioning on their function. Key concepts covered include torque, moment arms, classes of levers, and the screw home mechanism of the elbow.
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
A valuable presentation on myofasical release and muscle energy techniques for sport's and massage therapist's. This presentation is from our workshop event at the St John Street clinic on the 27th February 2016.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Proprioceptive neuromuscular facilitation (PNF) is an exercise technique based on principles of neurophysiology and functional anatomy. It uses patterns of diagonal movements combining flexion, extension, abduction, adduction, and rotation. The 9 principles of PNF include resistance, stretch, timing, and verbal commands. PNF techniques like repeated contractions and hold-relax are used to improve areas like strength, flexibility, and motor control by facilitating agonist and antagonist muscle groups. PNF patterns involve multi-joint diagonal movements of the upper and lower extremities.
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.
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
- The document discusses the biomechanics and pathomechanics of the elbow joint. It describes the ligaments of the elbow, the articulations between the humerus, ulna, and radius, and the range of motion of the elbow joint. It also examines the muscles that flex, extend, pronate, and supinate the forearm, discussing their attachments, actions, innervation, and the effects of joint positioning on their function. Key concepts covered include torque, moment arms, classes of levers, and the screw home mechanism of the elbow.
The document provides an overview of shoulder rehabilitation for impingement and instability syndromes. It discusses the anatomy and biomechanics of the shoulder, common pathologies, and approaches to evaluating and treating shoulder problems. Evaluation involves subjective history, physical examination including range of motion and special tests, and determining the specific injured structures to guide treatment.
articular cartilage present in joint surface of articulating bone .role of articular cartilage in load bearing is important its damage cause arthritis so should know about its biomechanics
Taping is a technique used to support injured soft tissues and joints by restricting motion and providing compression. It has several goals including restricting injured joint motion, compressing tissues to reduce swelling, and supporting injured structures. There are different types of tape including stretch tapes that conform to the body and non-stretch tapes that provide support. Proper skin preparation, tape application technique, and removal are important to avoid further injury and allow for healing. Taping can aid the rehabilitation process and allow safe return to activity.
This document discusses myofascial pain syndrome (MPS), also known as chronic myofascial pain. MPS is characterized by chronic pain caused by multiple trigger points and fascial constrictions. Fascia is a layer of fibrous tissue that surrounds muscles, bones, blood vessels and nerves. Trigger points in fascia can cause focal tenderness and referred pain patterns. Myofascial release techniques aim to relax contracted muscles and stimulate the stretch reflex by applying sustained pressure to fascial restrictions to allow the tissue to elongate. MPS is a common cause of chronic pain that can be treated through myofascial release.
Hamstring strains are common injuries that occur during activities involving sprinting or kicking. They frequently happen during the swing phase of sprinting when the hamstrings are lengthened. Risk factors include age, previous injury, low flexibility, weakness, fatigue, and improper warm-up. Prevention strategies include stretching, strengthening, sport-specific training, and combined programs addressing multiple risk factors.
Ergonomics in Physiotherapy and WorkplaceSusan Jose
We discuss about various risk factors related to causing of cumulative trauma disorders and how to manage each risk factor using bio mechanical principles and physiotherapy knowledge.
posterior curciate liagment injury, machanisum of injury, type of injury, special test, associated injuries ti PCL injury, physiotherapy treatment
posteior sag test, posterior drawer test, abduction stress test, adduction stress test, day wie trsetment
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
Dr. Robin McKenzie developed the McKenzie Method for treating back pain mechanically without surgery or medication. The method involves assessing a patient's pain response to various spinal movements to determine the underlying problem. Treatment focuses on specific exercises that centralize the pain by improving spinal mechanics. Exercises may involve extension, flexion, or lateral movements. The goal is to reduce pain and improve range of motion over several weeks with a home exercise program. Precautions are taken for certain conditions like spinal stenosis or recent trauma. The McKenzie Method provides an alternative to medication for many back pain issues.
Dr. Satyendra Bhattacharyya's document discusses the history and procedure of shoulder arthroplasty. It begins with the first documented shoulder replacement in 1894, but focuses on developments starting in 1951 by Dr. Charles Neer, who created the first hemi-arthroplasty and total shoulder replacement. The document then discusses factors that influence arthroplasty outcomes, indications for the procedure for conditions like osteoarthritis and rheumatoid arthritis, and details each step of the surgical procedure. It concludes by describing postoperative rehabilitation protocols.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Muscle Energy Technique (MET) uses controlled, patient-initiated muscle contractions to improve musculoskeletal function and reduce pain. Developed in 1948, MET employs isometric contractions to induce autogenic or reciprocal inhibition, relaxing muscles and increasing range of motion. There are three main types of MET: post-isometric relaxation, post-facilitation stretching using autogenic inhibition; and reciprocal inhibition MET involving agonist/antagonist muscle pairs. MET is used to treat muscle tightness, pain and limited joint mobility from various musculoskeletal conditions.
This is a presentation I did for the OTAT program at Cuyahoga Community College on flexor and extensor tendon lacerations. I also discuss, briefly, the application of certain aspects of occupational therapy's domain as outlined in the OTPF. I collected data from scholarly as well as non-scholarly resources. I hope you find this to be helpful.
Disability Evaluation - Dr Sanjay Wadhwamrinal joshi
The document summarizes the Rights of Persons with Disabilities Act 2016 in India. It outlines the objectives of familiarizing participants with the act and focusing on disability evaluation features. Key points include:
- The act received presidential assent in December 2016 and includes 17 chapters covering rights, entitlements, education, employment and more.
- It expands the definition of disability to include 21 specified disabilities and establishes committees for evaluating autism and developing more objective evaluation criteria.
- Implementing the act faces challenges of low awareness, consensus building, limited resources, and making disability evaluation a higher priority.
- The ACL originates on the lateral femoral condyle and inserts on the tibia, providing primary stability to prevent anterior tibial translation.
- Most ACL tears are non-contact injuries involving sudden deceleration, change of direction, or landing from a jump with the knee near full extension.
- Physical exam includes Lachman, anterior drawer, and pivot shift tests to assess knee stability. MRI is used to confirm ACL tear.
- Treatment options include conservative rehab for partial or low-grade tears or ACL reconstruction surgery using grafts like patellar tendon or hamstring tendons fixed with interference screws. Post-op rehab emphasizes early range of motion and weight bearing.
Kinesio taping is a therapeutic taping method that uses elastic tape to enhance muscular, joint, and circulatory functions. It can be applied for up to 3-5 days. The tape is designed to lift the skin slightly and provide support without restricting movement. Taping can be used to relieve pain, improve joint stability, prevent injury, and correct biomechanics. Different taping techniques are used for specific purposes like lymphatic drainage, pain relief, and positional correction. Proper assessment, skin preparation, and tape application technique are important for effective results. Kinesio taping is intended to complement treatment and rehabilitation rather than replace it.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
Mobility aids are the appliances or devices, which or useful for the mobility as well as stability purpose of an individual who cannot walk independently, these are also referred as walking aids, or Ambulatory assistive devices. There are different types of assistive devices - crutches/ canes/ walkers/ wheel chairs
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
This document provides information on stretching for impaired mobility. It defines key terms like mobility, flexibility, and contracture. It discusses indications and contraindications for stretching, as well as benefits like increased range of motion. It also describes different types of stretching exercises and guidelines for applying stretches safely. The goal is to educate students on properly stretching soft tissues to improve joint motion.
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 provides an overview of shoulder rehabilitation for impingement and instability syndromes. It discusses the anatomy and biomechanics of the shoulder, common pathologies, and approaches to evaluating and treating shoulder problems. Evaluation involves subjective history, physical examination including range of motion and special tests, and determining the specific injured structures to guide treatment.
articular cartilage present in joint surface of articulating bone .role of articular cartilage in load bearing is important its damage cause arthritis so should know about its biomechanics
Taping is a technique used to support injured soft tissues and joints by restricting motion and providing compression. It has several goals including restricting injured joint motion, compressing tissues to reduce swelling, and supporting injured structures. There are different types of tape including stretch tapes that conform to the body and non-stretch tapes that provide support. Proper skin preparation, tape application technique, and removal are important to avoid further injury and allow for healing. Taping can aid the rehabilitation process and allow safe return to activity.
This document discusses myofascial pain syndrome (MPS), also known as chronic myofascial pain. MPS is characterized by chronic pain caused by multiple trigger points and fascial constrictions. Fascia is a layer of fibrous tissue that surrounds muscles, bones, blood vessels and nerves. Trigger points in fascia can cause focal tenderness and referred pain patterns. Myofascial release techniques aim to relax contracted muscles and stimulate the stretch reflex by applying sustained pressure to fascial restrictions to allow the tissue to elongate. MPS is a common cause of chronic pain that can be treated through myofascial release.
Hamstring strains are common injuries that occur during activities involving sprinting or kicking. They frequently happen during the swing phase of sprinting when the hamstrings are lengthened. Risk factors include age, previous injury, low flexibility, weakness, fatigue, and improper warm-up. Prevention strategies include stretching, strengthening, sport-specific training, and combined programs addressing multiple risk factors.
Ergonomics in Physiotherapy and WorkplaceSusan Jose
We discuss about various risk factors related to causing of cumulative trauma disorders and how to manage each risk factor using bio mechanical principles and physiotherapy knowledge.
posterior curciate liagment injury, machanisum of injury, type of injury, special test, associated injuries ti PCL injury, physiotherapy treatment
posteior sag test, posterior drawer test, abduction stress test, adduction stress test, day wie trsetment
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
Dr. Robin McKenzie developed the McKenzie Method for treating back pain mechanically without surgery or medication. The method involves assessing a patient's pain response to various spinal movements to determine the underlying problem. Treatment focuses on specific exercises that centralize the pain by improving spinal mechanics. Exercises may involve extension, flexion, or lateral movements. The goal is to reduce pain and improve range of motion over several weeks with a home exercise program. Precautions are taken for certain conditions like spinal stenosis or recent trauma. The McKenzie Method provides an alternative to medication for many back pain issues.
Dr. Satyendra Bhattacharyya's document discusses the history and procedure of shoulder arthroplasty. It begins with the first documented shoulder replacement in 1894, but focuses on developments starting in 1951 by Dr. Charles Neer, who created the first hemi-arthroplasty and total shoulder replacement. The document then discusses factors that influence arthroplasty outcomes, indications for the procedure for conditions like osteoarthritis and rheumatoid arthritis, and details each step of the surgical procedure. It concludes by describing postoperative rehabilitation protocols.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Muscle Energy Technique (MET) uses controlled, patient-initiated muscle contractions to improve musculoskeletal function and reduce pain. Developed in 1948, MET employs isometric contractions to induce autogenic or reciprocal inhibition, relaxing muscles and increasing range of motion. There are three main types of MET: post-isometric relaxation, post-facilitation stretching using autogenic inhibition; and reciprocal inhibition MET involving agonist/antagonist muscle pairs. MET is used to treat muscle tightness, pain and limited joint mobility from various musculoskeletal conditions.
This is a presentation I did for the OTAT program at Cuyahoga Community College on flexor and extensor tendon lacerations. I also discuss, briefly, the application of certain aspects of occupational therapy's domain as outlined in the OTPF. I collected data from scholarly as well as non-scholarly resources. I hope you find this to be helpful.
Disability Evaluation - Dr Sanjay Wadhwamrinal joshi
The document summarizes the Rights of Persons with Disabilities Act 2016 in India. It outlines the objectives of familiarizing participants with the act and focusing on disability evaluation features. Key points include:
- The act received presidential assent in December 2016 and includes 17 chapters covering rights, entitlements, education, employment and more.
- It expands the definition of disability to include 21 specified disabilities and establishes committees for evaluating autism and developing more objective evaluation criteria.
- Implementing the act faces challenges of low awareness, consensus building, limited resources, and making disability evaluation a higher priority.
- The ACL originates on the lateral femoral condyle and inserts on the tibia, providing primary stability to prevent anterior tibial translation.
- Most ACL tears are non-contact injuries involving sudden deceleration, change of direction, or landing from a jump with the knee near full extension.
- Physical exam includes Lachman, anterior drawer, and pivot shift tests to assess knee stability. MRI is used to confirm ACL tear.
- Treatment options include conservative rehab for partial or low-grade tears or ACL reconstruction surgery using grafts like patellar tendon or hamstring tendons fixed with interference screws. Post-op rehab emphasizes early range of motion and weight bearing.
Kinesio taping is a therapeutic taping method that uses elastic tape to enhance muscular, joint, and circulatory functions. It can be applied for up to 3-5 days. The tape is designed to lift the skin slightly and provide support without restricting movement. Taping can be used to relieve pain, improve joint stability, prevent injury, and correct biomechanics. Different taping techniques are used for specific purposes like lymphatic drainage, pain relief, and positional correction. Proper assessment, skin preparation, and tape application technique are important for effective results. Kinesio taping is intended to complement treatment and rehabilitation rather than replace it.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
Mobility aids are the appliances or devices, which or useful for the mobility as well as stability purpose of an individual who cannot walk independently, these are also referred as walking aids, or Ambulatory assistive devices. There are different types of assistive devices - crutches/ canes/ walkers/ wheel chairs
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
This document provides information on stretching for impaired mobility. It defines key terms like mobility, flexibility, and contracture. It discusses indications and contraindications for stretching, as well as benefits like increased range of motion. It also describes different types of stretching exercises and guidelines for applying stretches safely. The goal is to educate students on properly stretching soft tissues to improve joint motion.
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.
Mobility and Flexibility of soft tissues (muscles, tendons, fascia, joint capsule, and skins) surrounding the joint along with adequate joint mobility, are necessary for normal ROM.
Mobility: is the ability of segments of the body to move through range of motion for functional activities.
Flexibility: is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain –free ROM.
STRETCHING FOR IMPAIRED MOBILITY - Copy - Copy (1).pptxeyobkaseye
This document provides information about stretching, including definitions, types, components, and techniques. It defines stretching as a maneuver to increase soft tissue extensibility and flexibility. There are various types of stretching, including static, cyclic, ballistic, and PNF. Key components of stretching include proper alignment, stabilization, intensity, duration, speed, and frequency. Effective stretching follows guidelines for these components and integrates modalities like heat and exercises. The document demonstrates examples of stretches for various body parts.
Definitions of terms related to mobility and stretchingmoon Khan
Stretching involves extending a muscle or tendon to improve elasticity and muscle tone. The document defines terms related to stretching including mobility, flexibility, dynamic flexibility, passive flexibility, hypomobility, contracture, and types of contractures. It provides details on myostatic, pseudomyostatic, arthrogenic, periarticular, and fibrotic contractures. The indications and contraindications for stretching exercises are also outlined.
Stretching involves extending a muscle or tendon to improve elasticity and muscle tone. The document defines terms related to stretching including mobility, flexibility, dynamic flexibility, passive flexibility, hypomobility, contracture, and types of contractures. It provides details on myostatic, pseudomyostatic, arthrogenic, periarticular, and fibrotic contractures. The indications and contraindications for stretching exercises are also outlined.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
NASM Integrated Flexibility Continuum
Corrective Flexibility: This phase is designed to correct common postural dysfunctions, muscle imbalances, and joint dysfunction. It includes: SMR and static stretching (and neuromuscular stretching if trained in technique). ... This includes SMR and dynamic stretching.
Dr Pooja Joshi presented on motor control in ankle instability. The ankle is a stable hinge joint made unstable by injury or repeated trauma. Assessment of ankle instability includes history, physical exam testing ranges of motion and ligaments, and evaluating proprioception and neuromotor control. Treatment focuses on reducing pain and swelling followed by motor control training using techniques like motor imagery, mirror therapy, and bracing to prevent further injury and give closed loop feedback to the central nervous system.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
1) Lumbar spine mobilisation involves skilled passive movement of the spinal joints performed by a physical therapist to decrease pain and increase mobility. It includes techniques like joint mobilisation and manipulation.
2) Mobilisation techniques for the lumbar spine include central and unilateral posteroanterior glides, lateral/transverse glides, longitudinal glides, and anterior pressure to improve flexion, extension, lateral flexion and rotation.
3) Mobilisation techniques described include Maitland oscillatory techniques and grades as well as Mulligan techniques like natural apophyseal glides, sustained natural apophyseal glides, mobilisation with movement, and spinal mobilisation with leg movement.
Passive movement involves moving a body part without active muscle contraction. There are several types: relaxed passive movements where a therapist smoothly moves a joint within its pain-free range; accessory movements which are small rotational or gliding motions in a joint; and passive manual techniques like joint mobilizations and manipulations. Controlled stretching can also be applied to tight muscles and tissues. Passive movements help maintain range of motion, prevent adhesions, reduce swelling, and stretch contracted structures. They are important for patients who cannot actively move due to injury or condition.
The manual muscle testing procedure was described in this power point, indications, contraindications, limitations of MMT was included. the MMT grading system (scale) was explained well in this PPT.
Stretching involves lengthening muscles and connective tissues to improve flexibility and range of motion. There are several types of stretching including static, dynamic, and PNF stretching. Static stretching is a slow, controlled stretch held for 15-30 seconds. Dynamic stretching uses repetitive motions to increase range of motion. PNF stretching combines contraction and relaxation of muscles. The document provides details on the physiological effects and mechanisms of different stretching techniques.
Peripheral joint mobilization and manipulation refers to manual therapy techniques used to treat joint impairments and range of motion limitations. Techniques include passive movements, self-mobilization exercises, and mobilization with movement performed by a therapist. Variables like speed, amplitude, and direction are used. Mobilization techniques are classified by grade based on factors like oscillation rate and amplitude. Precautions are taken with certain conditions, and techniques are selected based on a patient's examination and evaluation.
This document discusses passive range of motion exercises. It defines passive movement as movement produced by an external force with little voluntary muscle contraction. It describes different types of passive movements including relaxed manual movements, forced movements like joint mobilization/manipulation, and mechanical movements like continuous passive motion. Key goals of passive movements are to maintain joint mobility and flexibility while preventing contractures. The document provides guidelines for different passive techniques as well as indications, contraindications, and precautions.
Stretching for impaired mobility by Sayed MurtazaFakhryDon
The students should be able to know Impaired mobility stretching, and they also understand contractures, types of contractures, defining the mobility, flexibility, and hypo-mobility. THANK YOU
Occupational therapy focuses on improving range of motion, strength, and endurance through exercise. Biomechanics analyzes human motion through kinematics, which describes movement, and kinetics, which describes the forces behind movement. The musculoskeletal system uses levers and torque generated by muscles to enable motion. Muscles contain contractile filaments that slide past each other to generate force through motor unit recruitment and firing rates. Understanding biomechanics and physiology allows occupational therapists to design effective treatment programs.
The document discusses concepts related to physical therapy and musculoskeletal function and dysfunction. It describes how small mechanical changes can have large outcomes and how mechanics drive physiology. It discusses concepts like creep, hysteresis, and plastic deformation of ligaments in response to loading and stresses over time. Maintaining mobility is important for stability, and corrective exercises are recommended to encourage positive plasticity and freedom of movement by overcoming negative blocks.
Similar to Update of Concepts Underlying Movement System Syndromes (20)
This document discusses the anatomy and biomechanics of the ankle joint and foot. It describes the key bones and joints that make up the ankle and foot complex, including the talocrural joint, subtalar joint, and joints of the midfoot and forefoot. It explains how the medial longitudinal arch supports the foot during standing and how structures like the plantar fascia and windlass mechanism help maintain the arch during gait. Common foot types like pes planus and pes cavus are also summarized. The document outlines the motions of the ankle and subtalar joints during gait and identifies the most and least stable positions of the talocrural joint. Muscles acting on the ankle and foot are identified along with their
This document provides an overview of the ankle and foot complex, including:
- The ligaments of the talocrural joint (medial and lateral collateral ligaments)
- Movements at the talocrural and subtalar joints
- The transverse tarsal joint, which includes the talonavicular and calcaneocuboid joints
- Key ligaments like the deltoid ligament, spring ligament, and plantar ligaments
- Axes of rotation and movements like pronation and supination at the various joints
- Muscles involved in supination and pronation like the tibialis posterior and fibularis longus
This document provides an overview of the ankle and foot complex, including:
- The bones, joints, ligaments, and movements of the ankle and foot. The talocrural joint, subtalar joint, and transverse tarsal joints are described.
- Descriptions of the tibia, fibula, talus, calcaneus, navicular, cuneiforms, and cuboid bones along with their articulating surfaces.
- Explanations of the ligaments that reinforce the talocrural and subtalar joints, including the deltoid ligament and lateral collateral ligaments.
- Definitions of the fundamental movements of plantarflexion, dorsiflexion, inversion, e
This document discusses the structure and function of the knee. It covers:
- The kinematics and movements that occur at the knee joint during flexion and extension.
- The role of the patella and various patellar kinematics like tilt, tracking, and glide.
- Forces acting on the patella from the quadriceps muscle and their relationship to the Q-angle.
- Flexor-rotator muscles of the knee and their actions of flexion and rotation.
- Abnormal knee alignments like genu varum and valgus and their relationship to osteoarthritis.
This document discusses the kinesiology of the knee joint, including:
- Anatomy and function of ligaments like the ACL, MCL, and LCL
- Biomechanics that put the ACL at risk for injury during landing or cutting motions
- Gender differences in ACL injury rates related to neuromuscular control and strength
- Muscles that act on the knee joint like the quadriceps and hamstrings
- Patellofemoral joint mechanics involving the patella tracking in the femoral groove
- Internal and external torque demands on the quadriceps muscle throughout knee flexion
The document discusses the kinesiology of the knee joint. It describes the anatomy and functions of the medial and lateral menisci, which act as shock absorbers within the knee. The cruciate ligaments (ACL and PCL) are discussed, with the ACL preventing anterior translation of the tibia and the PCL limiting posterior translation. Injuries commonly involve tears to the menisci from torsional forces on the knee, while ACL injuries often occur when rapidly changing directions or landing from a jump. The knee allows for flexion/extension in the sagittal plane and internal/external rotation when flexed, with the axis of rotation migrating through the ranges of motion.
The knee joint consists of two joints - the tibiofemoral joint and the patellofemoral joint. The tibiofemoral joint is formed by the femoral condyles articulating with the tibial plateau. The patellofemoral joint is formed by the patella articulating with the femoral groove. Stability is provided by ligaments, the joint capsule, menisci and muscles rather than bony structure. Motion occurs in flexion/extension and internal/external rotation planes. Knowledge of knee anatomy and function is essential for understanding injury mechanisms and treatment.
Echogenicity: Implication of Rehabilitative Ultrasound Imaging for Assessing ...Zinat Ashnagar
The accumulation of connective and adipose tissues in the muscles may result in changes of muscle quality or composition. The computed tomography imaging serves as a gold standard for the assessment of muscle quality and shows reduced attenuation coefficient due to augmented fat infiltration. Muscle quality can also be assessed by using musculoskeletal ultrasound imaging.
Rehabilitative Ultrasound Imaging: A musculoskeletal PerspectiveZinat Ashnagar
This presentation provides basic introduction to Rehabilitative Ultrasound Imaging, and applications in rehabilitation. this presentation also review the applications of other imaging methods such as MRI & CT, and compare them to USI. It also review the other formats of ultrasound imaging such as Elastography and High-frame-rate USI. Finally the RUSI of Abdominal muscles reviewed here to provide an example of applications of RUSI.
Reaction time measures are common in many sport settings; an example is the interval between the starter’s gun and the first movement in a swimming race. Reaction time measures are also studied extensively in the laboratory as measures of information-processing speed.
The relationship between surface EMG (sEMG) and muscle force is complex, depending on factors like motor unit recruitment and firing rates, muscle fiber type composition, fatigue, and dynamic conditions. In general, sEMG amplitude and muscle force increase proportionally with recruitment and higher firing rates. However, the exact shape of the sEMG-force relationship can vary between linear and non-linear depending on the individual muscle and contraction conditions. Dynamic contractions and muscle fatigue can further impact this relationship. While sEMG can provide an estimate of relative muscle force, many factors must be considered for accurate quantification.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Update of Concepts Underlying Movement System Syndromes
1. Update of Concepts Underlying
Movement System Syndromes
Presented by: Zinat Ashnagar
2. An important physiological system of the body
is the movement system and that
dysfunctions of this system can be classified
into syndromes.
These syndromes provide direction for
diagnosis, treatment, and pursuing
underlying kinesiopathology.
2
3. The syndromes for orthopedic conditions causing
musculoskeletal pain are:
(1) based on the movement directions or
alignments that cause pain
(2) associated with movement impairments
(3) improved by correction of the movement
impairment that decreases or eliminates the
symptoms.
3
4. Key concepts of the movement system that
contribute to the development of pain
syndromes are proposed.
Understanding key concepts and their
application to patients with musculoskeletal
pain will enable the practitioner to develop an
appropriate movement system (MS) diagnosis
and treatment program.
4
5. 1. The majority of musculoskeletal pain
syndromes both acute and chronic are the
result of cumulative microtrauma from stress
induced by repeated movements in a specific
direction or from sustained alignments,
usually in a nonideal position.
5
6. • Musculoskeletal pain is the result of a progressive
condition that is related to lifestyle and
degenerative changes in tissues.
• The transition from tissue microtrauma to
macrotrauma is influenced by a variety of
intrinsic (genetics, sex, and age) and extrinsic
(amount and type of fitness, work activity)
factors.
• These repeated movements and sustained
alignments occur during the performance of daily
activities.
6
7. 2. The site (joint region) that is moving or stressed
in a specific direction is the site of pain
generation.
3 . The stress occurs most often during the
initiation or earliest phase of the motion rather
than at the end of the physiological motion.
7
8. 4. Hypermobility, usually accessory motion
hypermobility, is the cause of the pain.
Therefore the offending motions are most often
very subtle, and the more chronic the condition
or the older the subject, the more subtle the
motion.
8
9. 5. The body follows the law of physics and takes
the path of least resistance for motion, which
contributes to the hypermobility.
9
10. 6. The path of least resistance is affected by
variation in the stiffness or relative flexibility
of tissues attached to adjoining joints.
Most activities involve movement across several
contiguous joints that are arranged in series
and one of these joints moves more readily in
a specific direction than the other joints.
10
11. 7. The predisposition of a joint to move readily
in a specific direction contributes to the
development of a movement pattern.
8. Insufficient muscle stiffness (because of
greater relative flexibility) and increased
resting muscle length are more problematic
adaptations than specific muscle weakness and
shortness.
11
12. 9. The way everyday activities are performed is
the critical issue.
For efficiency, the body establishes a pattern
of motion that reinforces the relative
hypermobility and participation of specific
joints, including the joint that moves the most
readily in a specific direction.
Hypermobility is reinforced and becomes
habitual.
12
13. 10. The relative participation of some muscle
groups (disuse or overuse) is the result of
movement patterns and biomechanical
influences.
• In the swayback posture, if the pelvis is tilted
posteriorly and the hip is extended, the use of
the gluteus maximus muscle is minimized.
13
14. 11. Muscle performance is determined by the
pattern of movement.
Correction of faulty patterns is best
achieved by training the correct pattern and not
by isolated "strengthening" of a muscle.
14
15. 12 . The human body is highly capable of motor
equivalency, which is the ability to realize the
same motor outcome with different effectors.
Stopping the offending motion at the joint that
moves the most readily and redistributing the
motion to other adjoining segments expands
one's ability to vary patterns of motion.
15
16. 13 . The most important treatment is correcting
the movement pattern that is causing the tissue
to become painful or irritated rather than
directing treatment to the affected tissue.
16
17. 14. The critical issue is how an activity is
performed not just performing the activity.
• Proper movement strategy can optimize
performance and minimize tissue injury.
Faulty strategy can compromise performance
and lead to tissue injury.
17
18. 15 . An exercise is not effective unless the exercise
limits or corrects the movement at the painful
joint and produces the desired appropriate
movement at adjoining joints.
• Redistributing the movement to appropriate
joints is the goal.
• The same exercise can be used for contrasting
problems, depending on the instruction and
performance (quadruped rocking to either
increase or decrease lumbar flexion).
18
19. 16. If a muscle contributes to the impaired
motion of a painful joint, stretching the muscle
will not stop the motion causing pain, but
stopping the motion may stretch the muscle.
If the tensor fascia lata-iliotibial band
contributes to tibiofemoral rotation, stretching
the band will not stop the impaired motion
during the stretch or functional activities.
19
20. If the tibiofemoral rotation is controlled and the
hip joint does not medially rotate or abduct, the
tensor fascia lata iliotibial band can be stretched
during walking.
17. Training movement patterns will induce
appropriate muscular and biomechanical
adaptations that will reinforce the development
of optimal neuromuscular action.
20
21. 18. All neuromuscular adaptations can contribute
to and correct problems. Thus "indiscriminate"
core strengthening exercises can become a
cause of pain as readily as a lack of muscle
strength can contribute to pain problems.
19. Every patient with musculoskeletal pain
should have a MS diagnosis.
21
22. 20. MS syndromes consist of multiple contributing
factors or impairments that combine to produce
the principal movement impairment that is the
cause of the symptoms. The syndrome is named
for this principal impairment.
• The contributing factors are movement and
neuromusculoskeletal adaptations.
• A systematic examination is required to identify
all of the contributing factors.
22
23. 21. The examination must include tests and
assessments of all regions of the body,
including a determination of how all regions
affect the movement of the painful joint
because of the biomechanical interactions of
the human body.
23
24. 22 . The movement system needs to be periodically
examined, beginning in childhood and continuing
into old age to:
(1) evaluate optimal tissue development
(2) ascertain the progression of degenerative
changes
(3) determine and guide exercises to maintain the
health of the cardiovascular and metabolic systems.
• Guiding exercise for appropriate use can prevent
disuse, misuse, or overuse.
24
25. THE GENERAL PREMISE: MOVEMENT
SYSTEM IMPAIRMENTS CAUSE
PAIN SYNDROMES
The belief is that correction or modification of
factors altering the precision of motion
(physiological motion but also as much as
possible the accessory/arthrokinematic motion)
alleviates or reduces the tissue irritation and
thus the painful condition.
25
26. A major premise of the model is that pain most
often arises from tissues that are stressed by
subtle impairments in movement or alignment
and that key factors contribute to these
particular impairments.
One important factor is that the body, following
the laws of physics, takes the path of least
resistance for movement.
26
27. The activities an individual performs require
movements of multiple joints that are
contiguous, in the same kinematic chain (i.e.,in
serial arrangement), and all of which have
different flexibility characteristics.
The result is that one joint of those that are
anatomically arranged in series moves the most
easily and most readily when an individual
performs an activity.
27
28. Our research supports the premise that the ease
and rapidity with which a joint moves are more
important factors in a movement pattern
associated with pain than muscle
shortness, soft tissue restrictions, or limited
range of motion (ROM) of an adjoining joint.
28
29. These latter factors may have contributed to the
initial development of the flexibility of the
joint causing the pain, but once established, the
offending motion has to be addressed primarily
and the tissue adaptations, secondarily.
Stretching muscles or soft tissues will not stop
the offending motion. But when the offending
motion is stopped or controlled, the
appropriate tissues will be stretched.
29
30. The motion contributing to the stress occurs
during the first few degrees of motion or with
initiation of an activity.
The primary impairment is believed to be an
accessory rather than a physiological motion,
which is consistent with the problem arising
during the first few degrees of movement.
Accessory motion hypermobility is an underlying
characteristic of degenerative joint disease.
30
31. Example:
Lumbopelvic motion with lower extremity
motions in patients with low back pain is an
example of abnormal early onset joint motion.
In the prone position, lumbopelvic rotation
occurs earlier and to a greater extent during the
first few degrees of knee flexion and hip
rotation in patients with low back pain than in
control subjects, and the pattern was specific to
the MS category.
31
32. The predisposition of these joints to move
readily contributes to the frequency of their
movement and furthers the tendency for
motion.
Thus, a specific joint or joints of the lumbar
spine, for example, develop a tendency or
susceptibility to move readily in a specific
direction (directional susceptibility to
movement [DSM]) during all activities.
32
33. In most joints, the accessory motion impairment is
not clinically observable, thus the physiological
motion associated with the pain is most often
designated as the DSM.
when a joint moves more readily than other joints
in the same kinetic chain, the repeated
movements and prolonged postures associated
with everyday activities can be the precipitating,
as well as the perpetuating, factors of the joint's
DSM.
33
34. As a result, movement in the offending direction
has been associated with pain and is often
impaired
(deviates from the kinesiological standard).
When the movement is corrected, the symptoms
decrease or are eliminated.
Based on the premise that the diagnosis should
direct treatment, the DSM is most often also
the diagnosis.
34
35. Correcting the pattern or stopping the movement
in the painful direction is the focus of
treatment because the symptoms are decreased
or eliminated by this action.
The movement direction or alignment that most
consistently causes or increases the patient's
symptoms and that, when corrected, decreases
or alleviates the symptoms is considered the
diagnosis.
35
36. The complete description of all the impairments
evident as signs or causing symptoms that
contribute to the offending or principal
movement impairment is the syndrome.
Impairment is defined as any disorder in structure
or function resulting from
anatomical, physiological, or psychological
abnormalities that interfere with normal
activities.
36
38. The human movement system is a physiological
system of the body that produces motion of the
body or its component parts, or the functional
interaction of the structures that contribute to
the act of moving.
The physiological actions of other body systems
combine to compose the movement system, with
biomechanics playing an important role as the
interface among the skeletal, muscular, and
nervous systems.
38
41. ELEMENTS OF THE MODEL
Base Elements
Modulator Element
Support Elements
41
42. Base Elements
The components of the base elements are the
muscular and skeletal systems.
These systems are considered the base elements
because they consist of the tissues that provide
the foundation and the structure of the system.
42
43. Modulator Element
The component of the modulator element is the
nervous system.
The term modulator is used to emphasize the
regulator activity of the nervous system.
43
44. Support Elements
The components of support elements are the
cardiovascular, pulmonary, and metabolic
systems.
These systems do not contribute directly to
movement, but as indicated by the term
support, they provide the nutrients and
substances required for maintaining the
viability and health of those systems that do
directly produce movement.
44
45. BIOMECHANICS
The model indicates that biomechanics is an
interface between muscular and neurological
activity.
The pattern of muscular recruitment is highly
influenced by relationships to gravity, as well as
the force required to move the extremity and react
to external forces.
The design of the movement system also provides a
variety of strategies to develop a moment about a
joint. Many of those strategies are determined by
biomechanics.
45
48. TISSUE ADAPTATIONS
The dynamic and biological characteristics of the
components of the movement system enable
tissues to adapt to the demands placed on them.
The specific tissue adaptations are normal
biological responses to forms of stress but may
contribute to deviations from principles of
kinesiology.
48
49. TISSUE ADAPTATIONS
For example, alterations in muscle length,
strength, and stiffness can affect the precision
in joint motion.
In combination, these adaptations can become
problematic.
49
50. Inducers
The repeated movements and sustained
alignments associated with everyday activities
are the inducers of the tissue adaptations.
Every aspect of an individual's activities,
whether passive or active, also induces
changes in tissues.
50
51. Although the physically active person will
improve and increase the size of muscles and
connective tissues, at the same time, the risk of
injury also increases.
Musculoskeletal pain problems and injuries of
athletes mostly occur from noncontact stress.
Golfers develop back, elbow, wrist, shoulder,
and knee problems.
51
52. The repetitive use of specific segments of the
body combined with high and rapid force
development can exceed tissue tolerance,
resulting in microtrauma.
At the other extreme, even individuals who are
inactive induce changes by the alignment and
movements while sitting and during work
activities.
52
53. Alignments maintained for prolonged periods
can induce changes in muscle length.
Without activity, muscle and connective tissues
are not stressed enough to provide optimal
tissue health.
53
54. Modifiers
The modifiers are factors such as age, sex,
height, weight, and genetic characteristics that
include predisposition to osteoarthritis, benign
general joint hypermobility, structural or
anthropometric characteristics, and the amount
and type of activity.
54
55. Age
In young individuals, tissues are more extensible
and joints more flexible than in older
individuals.
Thus the offending motions are usually of greater
ROM than the motions in an older patient.
55
56. In older individuals or those with a chronic
condition, the movement impairments are
usually more subtle so that the examination
requires careful observation and usually slight
corrections.
The treatment using movement corrections and
stabilizing exercises requires even greater
precision in the older individual than in the
younger patient.
56
57. Gender
Studies of patients with low back pain have
demonstrated a difference in the pain-inducing
movements and alignments between men and
women.
The broader shoulders, higher center of gravity,
and larger and stiffer muscles in men as
compared to women also contribute to
differences in tissue adaptation and movement
patterns.
57
58. Tissue Mobility
Of the genetic factors, benign joint hypermobility
syndrome is one of the important problematic
characteristics.
Individuals with hypermobility seem to be more
disposed to musculoskeletal pain problems than
individuals with tissues that limit joint
excursions; this occurs not only with the
physiological motion but particularly in the
accessory motions.
58
59. Maintaining good alignment and precise motion is
more difficult if the individual is hypermobile
as compared to individuals with tissue stiffness.
Therefore one of the important assessments
during the examination is obtaining information
about the general tissue and joint mobility and
the effects on alignment and movement
patterns.
59
60. Anthropometries
Body proportions are also a contributing factor in
predisposing an individual to musculoskeletal
problems.
For example, a long trunk is usually associated
with depressed shoulders and often neck pain.
60
61. Activity Level
The activity level can range from
excessive, which tends to exacerbate the
development of musculoskeletal pain
problems, to insufficient activity.
61
62. The therapist needs to also factor into the
examination whether the pain condition is
from excessive activity that can be associated
with problems from muscle hypertrophy and
associated stiffness, as well as motor pattern
incoordination, or from a lack of activity in
which a systematic increase in physical
activity and exercise to improve the force
production deficit is necessary.
62
63. Activity Level
In the former situation, part of the treatment may
be to decrease the demands on specific muscles
and increase the extensibility of those muscles.
63
64. Tissue Adaptations of the Skeletal System
Although skeletal structures seem relatively
fixed, bone is a dynamic tissue that is
constantly being modified by the forces acting
on it.
For purposes of this material, the modifications
of skeletal structure and alignment can be
considered both dynamic and static.
64
65. Dynamic conditions are correctable and
sometimes easily modifiable, whereas the
static conditions are relatively permanent or
structural.
Another consideration is the effect of prolonged
forces on the shape of bones and joints.
65
66. Wolff (1836- 1902) proposed that
"changes in the form and function of bones, or
changes in function alone, are followed by
changes in the internal structure and shape
of the bone in accordance with mathematical
laws."
During development, the bones will adopt a
shape according to the forces imposed on
them.
66
67. In mature bone in which the general shape is
established and no changes are made in the
distribution of forces, the change is in the
mass according to the mechanical demands.
67
68. Changes in the shape and alignment of the joint
also affect the characteristics of the ligaments
and the distribution of forces on the articular
cartilage, as well as alter the precision of joint
motion.
A major consideration is how skeletal
alignment, both acquired and structural, affects
the demands on muscle participation.
68
69. The initial observations of a patient with pain
problems should be an assessment of the
alignment and the participation of musculature
based on the relationship to the line of gravity.
69
70. Tissue Adaptations of the Nervous
System
Motor control plays a key role in musculoskeletal
pain.
there are two general theories about changes in
movement in patients with musculoskeletal
pain.
70
71. 1. One theory is that pain causes the change in
movement patterns and alters motor control.
2. The other theory is that changes in movement
patterns cause the problems that result in
pain.
Certainly an acute and intense onset of pain can
affect the patient's alignment and movement
patterns.
71
72. But the major question is, "What precipitated the pain
episode? “
As suggested by the model, the repeated
movements and sustained postures of daily
activities induce the changes in tissues and
movement patterns that cause the pain
problems.
Therefore the pathological changes are
secondary to the altered movement pattern and
motor control and not primary.
72
73. Both concepts require that treatment emphasize
correction of the movement patterns and the
altered motor control.
If altered movement patterns cause the problem,
then guidelines for prevention are possible.
If the pain causes the problem, then the
precipitating factors may not be easy to
identify.
73
74. Clinical experience with correcting movement
patterns and alleviating symptoms supports
the belief that the altered movement patterns
are the key factor in causing pain and that
correcting the movements and the contributing
factors is the most effective long-term
treatment.
74
75. A prevailing characteristic of the human body is
to reduce the degrees of freedom when
establishing a movement pattern, thereby
achieving a degree of efficiency and
minimizing energy expenditure.
Movement patterns become established as they
are repeated, and the pattern is reinforced by
changes in both the nervous and muscular
systems.
75
76. When considering the factors contributing to
musculoskeletal pain problems, the patterns of
recruitment and derecruitment are primary.
The belief is that the patterns are established by
the requirement of the activity, personal
characteristics, and intensity of use.
76
77. Tissue Adaptations of the Muscular
System
The adaptations of muscle are changes in:
( 1 ) length, both increased and decreased;
(2) tension development capacity, hypertrophy,
and atrophy;
(3) stiffness, the resistance to passive elongation.
77
79. A, Patient's hip joint angle is almost 90 degrees with
his knees flexed.
B, With passive knee extension to only 45 degrees,
his pelvis tilts posteriorly, and his lumbar spine
flexes. The position of the pelvis and lumbar
spine indicates that the hamstring muscles are
stiffer than the supporting tissues of the lumbar
spine. The alignment change occurred before the
end of the excursion of the hamstring muscles.
C, when the hip joint angle is maintained at 90
degrees, the knee cannot be fully extended. The
hamstring muscles are short.
79
80. Relative Stiffness/Flexibility
Muscle stiffness is defined as the change in
tension per unit change in length.
Stiffness refers to the resistance present during
the passive elongation of muscle and
connective tissue.
The stiffness is a normal property of muscle and
is the passive tension of a muscle when
stretched.
80
81. When a muscle is being elongated and there is
movement at the proximal attachment of the
muscle, the best explanation is that the tissues
stabilizing the joint are not stiff enough
relative to the stiffness of the muscle being
stretched.
81
83. A, The patient's pelvis is tilted posteriorly, and his
lumbar Spine is flexed when his knee is passively
fully extended.
The position of the pelvis and spine can be the result
of relative flexibility,which indicates that the
hamstrings are stiffer than the supporting tissues
of the lumbar spine but not that the hamstring
muscles are short.
B, The patient's hip joint angle is 90 degrees, and
no motion of the pelvis or lumbar spine occurs
when the knee is fully extended passively. The
hamstring muscles would not be considered short.
83
84. The concept is that the hamstrings and the
tissues (muscles and ligaments) of the lumbar
spine are springs in series.
When the passive tension of the spring being
stretched (hamstrings) is greater than the
passive tension of the spring in series (lumbar
spine tissues), there will be motion at the
intervening joint.
84
86. The earlier the movement at this joint the greater
the indication of the lack of "stiffness or
stability“ of the joint.
A major source of the passive tension (stiffness)
in muscle fibers is an intracellular contractile
protein called titin.
Titin is the largest connective tissue protein in
the body and provides the passive tension for
both striated and cardiac muscle.
86
87. Titin attaches the myosin filament to the Z-line of
the sarcomere and there are 6 titin proteins for
every myosin filament.
Therefore, muscle hypertrophy that increases the
number of sarcomeres in parallel and consequently
the amount of myosin will also increase the
passive tension or stiffness of the muscle.
87
89. Realizing that an intrinsic property of the human
body is the minimization of energy expenditure
when inactive or even when active, the role of
passive tension becomes particularly important.
Passive tension is a primary contributing factor to
alignment, often stability, and even the timing
and effectiveness of the mechanical event
connected with muscle contraction.
89
90. The passive tension provided by muscle plays an
important role in joint stability, alignment, and
in some situations contributes to pain.
Muscle stiffness is an extremely valuable
property of muscle that enables the body to be
supported with minimal energy expenditure.
90
91. Good alignment is indicative of balanced passive
tension of muscles attaching to a joint or
skeletal segment, such as the thorax or pelvis.
The passive tension, which also has a high
correlation to active tension, is the key to the
alignment and stabilizing properties of the joint.
As in all things, stiffness can become excessive or
insufficient.
91
92. The relative stiffness/flexibility properties are
often the contributing factor to:
(1) alignment impairments,
(2) one joint moving more readily than an
adjoining joint,
(3) inadequate stabilization or inappropriate
movement during the passive elongation of a
muscle.
92
93. Muscle Length Adaptations
Increased length
Small changes in muscle length are changes in
passive resting tension,while greater increases
in muscle length are associated with addition
of sarcomeres in series in the muscle fibers.
93
94. Decreased length
The development of true muscle shortness is
associated with loss of sarcomeres in series in
muscle fibers.
There is a lack of clarity in clinical practice
about the various mechanisms involved in
muscle shortness and tissues affected by
stretch or the need to stretch.
94
95. For example:
If the decreased ROM of hip flexion with the
knee extended is only 10 to 15 degrees and
can be regained by stretching for a few
minutes, the alteration can best be explained
by the creep or viscoelastic properties of
muscle.
95
96. In contrast, if the hamstring muscles are limiting
the motion of the joint by 30 to 40 degrees, then
the most likely explanation is that the muscle
fibers have lost sarcomeres in series and the
treatment has to be stretching of long duration
(for example, 30 minutes or more, several
times a day for many days) and as sustained as
possible.
96
97. Stretching should not be forceful because a
reasonable explanation for this condition is
that the muscle has lost sarcomeres in series
and that requires protein synthesis and not just
a change in the conformation of the proteins in
the muscle cells.
97
98. Although muscles can become shortened by loss
of sarcomeres in series, this is not the most
common problem contributing to
musculoskeletal pain.
The most common problem is the relative
stiffness of muscles attaching to the joint.
98
99. Muscle Performance
Performance includes timing, length, passive
tension, and the ability to generate active
tension and endurance.
Assessment of muscle strength provides
information about muscle performance, and the
results of the test can provide at least four
possible determinations about the muscle.
99
100. Manual muscle testing (MMT) can be used to
discern whether the muscle is:
(1) weak because of atrophy and the lack of
sarcomeres in parallel and thus unable to
develop adequate active tension;
100
101. (2) Strained because of being subjected to forces
that have torn or disrupted the Z-lines of the
sarcomeres and unable to develop adequate
active tension;
(3) Too long, having added sarcomeres in series,
and the muscle does not develop the appropriate
tension throughout the ROM,
(4) Normal.
101
102. Joint Mobility
As depicted in the model, the problematic
outcome of the tissue adaptations is the
development of a relative stiffness or flexibility
condition that becomes exaggerated because the
body takes the path of least resistance for
movement.
The result of this cascade of events is that a joint
develops hypermobility.
102
103. Hypothetically, the hypermobility is an accessory
or arthrokinematic motion rather than
physiological or orthrokinematic motion.
One of the consequences of imprecise movement
is the development of points of high contact
stress because of inadequate distribution of
forces within the joint.
103