FUNCTION TRANSVERSUS ABDOMINUS SUPPORT OF ABDOMINAL CONTENTS VIA CIRCUMFERENTIAL ARRANGEMENT...
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Transcript of FUNCTION TRANSVERSUS ABDOMINUS SUPPORT OF ABDOMINAL CONTENTS VIA CIRCUMFERENTIAL ARRANGEMENT...
FUNCTION TRANSVERSUS FUNCTION TRANSVERSUS ABDOMINUSABDOMINUS
SUPPORT OF ABDOMINAL CONTENTS VIA CIRCUMFERENTIAL ARRANGEMENT
BILATERAL CONTRACTION CAUSES DRAWING IN OF ABDOMINAL WALL
CAN WORK WITH MULTIFIDUS VIA TENSION OF THORACOLUMBAR FASCIA
CONTRIBUTES TO BOTH SUPPORTING AND TORQUE ROLES
MULTIFIDUSMULTIFIDUS
MultifidusMultifidus
FUNCTION (MULTIFIDUS)FUNCTION (MULTIFIDUS)
Provides control of shearing forces of intervertebral motion segments
Unique segmental arrangement of multifidus suggests capacity for fine control of movement
Control anterior rotation translation in trunk flexion Continuously active in upright posture compared with
recumbency Provides anti gravity support Active in both ipsilateral and controlateral trunk rotation Stabiliser rather than prime mover
Gluteal StabilizersGluteal Stabilizers
Hip MusculatureHip Musculature Psoas Closed chain vs. open chain
functioning
Works with erector spinae, multifidus & deep abdominal wall
Works to balance anterior shear forces of lumbar spine
Can reciprocally inhibit gluteus maximus, multifidus, deep erector spinae, internal oblique & transverse abdominus when tight
Extensor mechanism dysfunction
Synergistic dominance during hip extension
Hamstrings & superficial erector spinae
May alter gluteus maximus function, altering hip rotation, gait cycle
•Gluteus medius: provides frontal plane stabilization, decelerate femoral adduction , assist in deceleration femoral internal rotation (during closed chain activity)
Gluteus MediusGluteus Medius Provides frontal plane stabilisation in walking
cycle Prevents downward rotation of the pelvis
(Trendelenburg) Allows unsupported leg to swing clear of the
ground Decelerates femoral adduction and internal
rotation Anterior fibres assist the iliotibial tract to flex hip
and stabilise the extended knee
Hip MusculatureHip Musculature Gluteus medius Frontal plane stabilizer
Weakness increases frontal & transverse plane stresses (patellofemoral stress)
Controls femoral adduction & internal rotation
Weakness results in synergistic dominance of TFL & quadratus lumborum
Gluteus maximus Hip extension & external rotation
during OKC, concentrically Eccentrically hip flexion &
internal rotation Decelerates tibial internal
rotation with TFL Stabilizes SI joint Faulty firing results in decreased
pelvic stability & neuromuscular control
Hamstrings Concentrically flex the knee, extend the hip & rotate the
tibia Eccentrically decelerate knee extension, hip flexion &
tibial rotation Work synergistically with the ACL to stabilize tibial
translation
All muscles produce & control forces in multiple planes
Neuromuscular efficiency Ability of CNS to allow agonists, antagonists, synergists,
stabilizers & neutralizers to work efficiently & interdependently
Established by combination of postural alignment & stability strength
Optimizes body’s ability to generate & adapt to forces Dynamic stabilization is critical for optimal neuromuscular
efficiency Rehab generally focuses on isolated single plane strength gains in single
muscles Functional activities are multi-planar requiring acceleration & stabilization
Inefficiency results in body’s inability to respond to demands Can result in repetitive microtrauma, faulty biomechanics & injury Compensatory actions result
Functions & operates as an integrated unit Entire kinetic chain operates synergistically to produce force,
reduce force & dynamically stabilize against abnormal force In an efficient state, the CORE enables each of the
structural components to operate optimally through: Distribution of weight Absorption of force Transfer of ground reaction forces
Requires training for optimal functioning! Train entire kinetic chain on all levels in all planes
The COREThe CORE
Core Stabilization ConceptsCore Stabilization Concepts A specific core strengthening program can:
IMPROVE dynamic postural control Ensure appropriate muscular balance & joint arthrokinematics in
the lumbo-pelvic-hip complex Allow for expression of dynamic functional performance
throughout the entire kinetic chain Increase neuromuscular efficiency throughout the entire body
Spinal stabilization Must effectively utilize strength, power, neuromuscular control &
endurance of the “prime movers” Weak core = decreased force production & efficiency
Protective mechanism for the spine Facilitates balanced muscular functioning of the entire kinetic chain Enhances neuromuscular control to provide a more efficient body
positioning
Postural ConsiderationsPostural Considerations Core functions to maintain postural alignment &
dynamic postural equilibrium Optimal alignment = optimal functional training and
rehabilitation
Segmental deficit results in predictable dysfunction Serial distortion patterns
Structural integrity of body is compromised due to malalignment Abnormal forces are distributed above and below misaligned segment
Neuromuscular ConsiderationsNeuromuscular Considerations Enhance dynamic postural control with strong stable
core Kinetic chain imbalances = deficient neuromuscular
control– Impact of low back pain on neuromuscular control– Joint/ligament injury neuromuscular deficits
Arthrokinetic reflex – Reflexes mediated by joint receptor activity– Altered arthrokinetic reflex can result in arthrogenic muscle
inhibition Disrupted muscle function due to altered joint functioning
Optimum Dynamic FunctionOptimum Dynamic Function
Integrated proprioceptively enriched multi-directional movement controlled by
an efficient neuromuscular system
PROPRIOCEPTIONPROPRIOCEPTION
“Nerve impulses originating from the joints, muscles, tendons and associated deep tissues which are then processed in the central nervous system to provide information about joint position, motion, vibration and pressure”. (Bruckner & Khan 1999)
WHY IS PROPRIOCEPTION WHY IS PROPRIOCEPTION IMPORTANT?IMPORTANT?
–Sub-cortical systems are not under conscious control
–Stabilization response needs to be second nature.
–Sub-cortical systems act faster - rapid muscle reaction times.
–More rapid reaction times can be learnt which may lead to increased stability of the lumbar spine.
•To improve the proprioceptive system in dynamic joint stability it must be challenged.
•Pain-free does not mean cured.
•If the proprioceptive deficit has not been addressed a complete rehabilitation has not been accomplished.
•Mechanically stable joints are not necessarily functionally stable ( eg. ACL reconstruction)
WHAT HAPPENS WHEN THE WHAT HAPPENS WHEN THE SYSTEM GOES WRONG?SYSTEM GOES WRONG?
The Theories
“MUSCLE PAIN SYNDROMES ARE SELDOM CAUSED BY ISOLATED
PRECITATING FACTORS AND EVENTS BUT ARE THE
CONSEQUENCES OF HABITUAL IMBALANCES IN THE MOVEMENT
SYSTEM” (Sahrmann 1993)
REPEATED MOVEMENTSREPEATED MOVEMENTSSUSTAINED POSTURESSUSTAINED POSTURES
ALTERS MUSCLE LENGTH ALTERS STRENGTH ALTERS STIFFNESS ALTERS FLEXIBILITY ALTERS CARTILAGE AND BONE
STRUCTURE – BY OVERLOADING AT COMPENSATORY SITES OF MOVEMENT
POSTURAL DYSFUNCTION
MUSCULAR DYSFUNCTION
STRUCTURAL/SEGMENTAL DYSFUNCTION
PAINPAIN
POSTURE AND PAINPOSTURE AND PAINPoor posture can lead to increased stress on the
stabilising system of the joints (Chek P 1999)Multifidus dysfunction occurs after first
episode acute unilateral LBP (Hides et al 1994)
Multifidus dysfunction does not spontaneously restore following resolution of pain and disability (Hides et al 1996)
Specific retraining does restore dysfunction (Hides et al 1996)
TrA contraction is delayed during normal movements in subjects with low back pain (Richardson et al 1999)
Mulifidus function can be affected by spinal surgery
Atrophy of multifidus has been shown to be more prevalent in post operative patients (Jull, et al 1999)
Sherington’s Law of Reciprocal Inhibition:
Tight Muscles inhibit the functional antagonist.
Leads to Positive Cross Syndromes of the lower or upper limb
Gluteus Maximus and minimus are inhibited in most athletes due to tight psoas (Summer, 1988).
Poor recruitment in the local stabilisers can lead to over-
activity of the global stabilisers to compensate.