Download Understanding Muscle Dysfunction and Movement Impairments in Physical Therapy and more Quizzes Health sciences in PDF only on Docsity!
How has PT progressed through
history?
- Dysfunction of Peripheral Neuromuscular and Musculoskeletal Systems2. CNS Dysfunction3. Joint Dysfunction4. Movement System TERM 2
What types of injuries can occur to ligaments
and tendons?
DEFINITION 2 Sprain tear Stretch instability Rupture avulsion TERM 3
What kinds of injures can occur to bone?
DEFINITION 3 Break Congenital defect Osteoporosis TERM 4
What kinds of injuries can occur to muscle?
DEFINITION 4 Tear lengthwise Muscle shortens loses sarcomeres or adaptive shortening (positional or actively created) ex working out biceps and creates adaptive shortening but then triceps get long and weak TERM 5
History of PT in 40's-50's
DEFINITION 5 Dysfunction of the Peripheral Neuromuscular and Musculoskeletal Systems war injuries and poliomyelitis manual muscle test shows a clear relationship between loss of muscle function and impairment of movement Contribution of nervous system masked by wide prevalence of lower motor neuron involvement
History of PT in 50's-70's
50-60's : eradication of polio, no warstrokes, TBI or SCI and cerebral palsy Previous methods (MMT, stretching, strengthening) no longer applicable and, in fact, could be deleterious by increasing spasticity shift to CNSLack of guidelines led to eclectic practices based on loosely constructed hypotheses and anecdotal successMedical diagnoses provided no guidanceMotor control not yet clearly understood TERM 7
History of PT in the 80's
DEFINITION 7 Philosophical shift: identification of soft tissue or joint restriction as source of dysfunction, rather than simply relieving pain through use of modalities Manual therapy techniques developed in Australia and New Zealand Change in practice from use of modalities and general exercises to examination of joints followed by specific treatments to improve mobility Common language developed and PTs developing professional identity away from physicians. Changing role of the therapist: previously relied on MD rx Development of physical therapy diagnosis Minimal consideration given to the role of muscle or motor control in causing dysfunction TERM 8
History of PT in the 90's-present
DEFINITION 8 People move in specific ways that create impairment and pathological conditions Get ahead of those movement impairments before they get worse Recognize normal range of movement and then whats abnormal Musculoskeletal pain Treatment addressing only one system (muscular, neurologic, skeletal) is incomplete and inadequate APTA identifies PTs as movement scientists with movement as our central focus Identification of a movement system TERM 9
What is a movement system?
DEFINITION 9 A system is a group of interacting, inter-related, or interdependent elements forming a complex whole Movement is produced by a set of interacting organs and systems TERM 10
How is the human movement system
visualized?
DEFINITION 10 Integumentary system envelopes:Nervous system + musculo
- skeletal envelopes:pulmonary + cardiovascular + endocrine
Localized Musculoskeletal Pain includes what?
MSK disorders MSK dysfunction Myofascial syndromes Overuse syndromes Cumulative trauma Repetitive strain Microtrauma Excessive load -- high load, short duration or low load long duration may include articular tissues, periarticular or myofascial TERM 17^ tissues
Localized MSK pain does not
include?
DEFINITION 17 Major trauma Tumors Systemic diseases TERM 18
List the order of the patient management
process ****
DEFINITION 18 Patient interview examination evaluation plan of care reassessment TERM 19
Patient interview
DEFINITION 19 Develop a hypothesis of causal and contributing factors TERM 20
Patient Examination
DEFINITION 20 Perform a specific and systematic examination to identify causal and contributing factors
Patient evaluation
Formulate a diagnosis to direct PT treatment TERM 22
Patient plan of care
DEFINITION 22 Provide a well-designed treatment strategy based on the diagnosis and contributing factors TERM 23
Patient reassessment
DEFINITION 23 evaluate outcome of treatment TERM 24
Two major sources of pain
DEFINITION 24
- Structural2. Process TERM 25
Structural pain includes?
DEFINITION 25
- myofascial Muscle Fascia
- Periarticular Extra-articular ligaments Bursae Tendons
- Articular
3 types of models used when describing
movement
- kinesiologic2. pathokinesiologic3. kinesiopathologic TERM 32
What is the difference between the
pathokinesiologic and the kinesiopathologic
models
DEFINITION 32 pathokinesiolofic model says that pathology has informed movement ex. RA deforms a joint kinesiopathologic model says that movement informs pathology TERM 33
Commonly Weak Muscles***
DEFINITION 33 Low traps (upper traps strong) External oblique abdominals Gluteus maxiumus Posterior gluteus medius TERM 34
Which muscles are used in hip
extension?
DEFINITION 34 Glute Max and Piriformis OR Hamstrings and Tensor Fascia Lata TERM 35
What is the appropriate kinesiologic
movement for hip extension?
DEFINITION 35 Glute max and piriformis produce hip extension since their proximal attachments control the femoral head in the acetabulum glute max, though the IT band attaches to the tibia distally to control movement and maintains a relatively constant position of the femoral head in the acetabulum during hip extension
Why are the hamstrings not hip extensors?
Hamstrings dont attach to femur so doesnt make sense to rely on them for hip extension leading to pathology TERM 37
Example of kinesiopathologic movement in
hip extension
DEFINITION 37 Weakness of iliopsoas and glute max typical of long distance runners leads to TFL, rectus femoris, hamstrings become dominant Alters precision of movement Resultant hamstring strain Anterior migration of femoral head TERM 38
What happens when there is anterior
migration of the femoral head?
DEFINITION 38 Hamstring muscles originate from ischial tubes and insert into tibia (except short head BF) Without attachment on femur, cannot control movement of the proximal end of femur Femoral head moves anteriorly during hip extension creating stress on anterior capsule Aggravated by stretched and weak iliopsoas unable to restrain femoral head TERM 39
What happens to a muscle when it atrophy's?
DEFINITION 39 decreased cross sec. area and firmness leading to reduced number of sarcomeres and decreased CT TERM 40
What are the implications of atrophy?***
DEFINITION 40 Decreased active and passive tension: Passive tension affects joint alignment Affects dynamic and static support exerted on each joint crossed Less stability of joint Diminished capacity for development of active torque
What is the value of hypertrophy?
Increased tension-generating capability Increased passive tension in muscle Increased stiffness of tendons and ligaments Increased stability of joints TERM 47
Describe an impairment in muscle length
DEFINITION 47 Prolonged elongated position Ex. Erector spinae Injurious strain Sustained stretching TERM 48
Cause of over-stretch
weakness
DEFINITION 48 Maintain a lengthened position, particularly during long periods of rest TERM 49
Characteristics of over stretch weakness
DEFINITION 49 Poor postural alignmentMuscle tests weak throughout ROM (vs. only in shortened position) TERM 50
Examples of over stretch weakness
DEFINITION 50 Lengthened dorsiflexors with prolonged bed rest Lengthened low traps from sleeping sidelying with lower shoulder shoved forward Lengthened gluteus medius in women with broad pelvis who sleep in side-lying with top leg adducted, flexed, and medially rotated : Apparent leg length discrepancy
Describe Increased Muscle Length Secondary
to Strain
Strain is a minor form of tearInterferes with tension- generating abilityReduces passive tension TERM 52
Diagnosis of increased muscle length
secondary to strain
DEFINITION 52
- Observation Postural alignment may suggest lengthened muscle (strain) Quality of movement and ROM impairment at joint
- Pain When palpated or when resistance is applied Pain with resistance anywhere in range
- Muscle length Important to differentiate whether cause of pain is shortness or excessive length Lengthened muscles can be painful and should not be stretched Strained muscles may be painful because they are under constant tension Never presume shortness due to spasm Pain is attributed to spasm in the shortened muscle, but often the actual length of the muscle is not assessed MMT Inability to support tested extremity against gravity when positioned at end range TERM 53^ Unable to take resistance anywhere in range
Treatment of increased muscle length
secondary to strain
DEFINITION 53 Avoid excessive loads 3-4 weeks Strain repairs more readily when not subject to strong resistance or constant tension Support muscle at normal resting length TERM 54
Cause of Lengthened Muscle Secondary to
Anatomic Adaptation addition of sarcomeres
DEFINITION 54 sustained postures training errors TERM 55
Diagnosis of Lengthened Muscle Secondary to
Anatomic Adaptation addition of sarcomeres
DEFINITION 55 observation: length change changes movement of joint MMT Muscle cannot support the joint in the shortened test position, but can tolerate strong pressure after it is allowed to lengthen slightlyNot weak due to compromised contractile capacity, but has undergone maladaptive length changeMay be as stronger or stronger than typical muscle at resting lengthImprove muscles performance in shorter normal length
Example of Shortened Muscle Caused by
Anatomic Adaptation loss of sarcomeres
Ex. Casting losing sarcomeres since you use the muscles while casted but they are shortened so the body thinks that they dont need the sarcomeres so they are lost TERM 62
Describe a Dissociated length changes in
synergistic muscles
DEFINITION 62 One muscle can become shortened where on its synergists may remain normal length or even become lengthened Careful testing of muscle length required to assess individual members of movement groups TERM 63
Examples of Dissociated length changes in
synergistic muscles
DEFINITION 63 Hamstring length assessed in sitting Knee found to be in 15 degrees flexion If hip is allowed to medially rotate, knee flexion decreases If hip is allowed to laterally rotate, knee flexion increases Medial hamstrings are shortened vs. lateral hamstrings which are normal Difference in length of synergistic muscles may cause malalignment and movement impairment TERM 64
What is muscle stiffness?
DEFINITION 64 Stiffness = Resistance present during passive elongation of muscle and connective tissue NOT limited ROM Major contributor to movement patterns and impairment syndromesIncreased stiffness of one muscle group can cause compensatory movement at an adjoining joint that is controlled by muscles that are less stiff TERM 65
What is positively correlated with stiffness?
DEFINITION 65 Cross sectional area is positively correlated with stiffness throughout elongating ROM (not at end range)Hypertrophy increased stiffness Titin a large connective tissue protein 6 titin : 1 myosin Increased myosin = increased titin Atrophy decreased stiffness
What is thixotropy?
Thixotropy: the property of a tissue that causes it to become stiff and resistant to flow after being static for a period of time TERM 67
For joints in a series, why will motion occur
earlier at the joint with the lesser degree of
stiffness?
DEFINITION 67 (ex: low back vs. hip, low back vs. shoulder)Compensatory relative flexibility movement occurs at a joint when it should remain stable TERM 68
When testing motion for muscle stiffness
what may be observed?
DEFINITION 68 When testing motion, you may observe movement at another joint before the muscle you are testing is fully elongated (ex. Quads and lumbar spine, lumbar spine and latissimus dorsi) Passive stiffness of hamstring muscles is significantly greater in patients with low back pain than in control subjects (Taffazzoli,
Does NOT imply shortness Does NOT imply greater ROM TERM 69
Examples of Skeletal Structure Variation in
Joint Alignment
DEFINITION 69 hip antertorsion hip retrotorsion genu varum genu valgum tibial torsion supinated rigid foot short trunk and long extremities long trunk and short extremities wide shoulders TERM 70
Hip anterotorsion
DEFINITION 70 Angle of the neck of the femur is rotated > 15 anteriorly Excessive medial rotation (IR) Limited lateral rotation (ER) No change with hip flexion/extension
