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Transcript of K Class 1 Intro & Assessment
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CLASS 1:
INTRODUCTION &ASSESSMENT
Kinesiology
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AristotleArchimedes
Galen
Sir Isaac NewtonGuillaume Duchenne
Eadweard Muybridge
History of Kinesiology
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Aristotle
Greek philosopher – Father of Kinesiology(384-322 B.C)
His treatises on muscles of animalsdescribed actions of muscles PARTS OF ANIMALS
MOVEMENT OF ANIMALS
PROGRESSION OF ANIMALS
He was first to analyze & describe walking
He discussed of the problems of pushing aboat under various conditions which was aprecursor of Newton's 3 laws of motion.
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Aristotle
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Archimedes
Greek philosopher(287-212 BC)
His principles ofbuoyancy still used
today. Determined hydrostatic
principles governingfloating bodies that arestill accepted in
swimming. His work may have
included the laws ofleverage & determiningthe center of gravity
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Galen
Roman physician & citizen (129-217 AD)
Because of his work with gladiators, he is
considered to have been the first team physician
in history. His essay DE MOTU MUSCULORUM distinguished
between:
Motor & sensory nerves
Agonist & antagonist muscles
Described tonus
introduced terms such as diarthrosis &
synarthrosis.
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Galen
He taught that muscular contraction
resulted from the passage of "animal
spirits" from the brain through the nerves
to the muscles.
Some writers consider his treatise the first
textbook on kinesiology & he has been
termed "the Father of Sports Medicine."
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Sir Isaac Newton
English
philosopher
(1642-1727)Developed
Newton’s 3
Laws of Motion
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Sir Isaac Newton
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Sir Isaac Newton
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Sir Isaac Newton
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Guillaume Duchenne (1806-1875)
French neurologist
Developed
electromyography
(EMG)
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Electromyography (EMG)
An electrical
recording of muscle
activity that aids inthe diagnosis of
neuromuscular
disease
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Eadweard Muybridge (1830-1904)
English photographer who
lived in the US
Developed motion
photography or
cinematography
Famous for his movie of a
galloping English race
horse in 1887
http://en.wikipedia.org/wiki/
File:Muybridge_race_horse
_animated.gif
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Eadweard Muybridge (1830-1904)
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KinesiologyApplied Kinesiology
Kinesthesia
Biomechanics
Terminology
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Terminology
Study or science ofmovement, which includes
anatomical (structural) &biomechanical(mechanical) aspects ofmovement.
Study of movement thatcombines the fields ofanatomy, physiology,physics, & geometry &relates them to human
movement.
FTM p. 34 Box 2-3
A muscle testingprocedure used by
chiropractors to
evaluate muscles
Developed in 1960s by American chiropractor
Dr. George Goodheart
Kinesiology FES p. 468 Applied kinesiology
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Terminology
Sensory
perception of bodymovement
Study of
mechanicalprinciples & actionapplied to livingbodies
Mechanicalanalysis ofmovement
Kinesthesia Biomechanics FES p. 468
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Who needs Kinesiology?
Anatomists, coaches, strength andconditioning specialists, personal trainers,nurses, physical educators, physicaltherapists, physicians, athletic trainers,massage therapists & others in health-related fields
Should have an adequate knowledge &
understanding of all large muscle groups toteach others how to strengthen, improve, &maintain these parts of human body
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Importance to Massage Therapists
FES p. 469
Understanding principles of biomechanics &
kinesiology helps to assess & observe the body
& in developing treatment plans
Important on 2 levels:Many clients may have pain from poor
posture, restricted movement, or repetitive
motion injuries
If the therapist does not move in a safe &
efficient manner, the therapist risks career-
shortening injuries
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SOAP Notes FTM pp. 138
FTM p. 141 Figure 4-19SOAP Charting Form
S=Subjective:Frequently contains the
client’s informationregarding the pain theyare feeling
O=Objective: You
record information herethat you have observed& obtained throughdifferent assessment
methods
PQRST: used forrecordinginformation about aclient’s pain which is
subjectiveinformation.
HOST & HOPST:used for recordingobjectiveinformation
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PQRST
P = Provocation and Palliation
Q = Quality and Quantity
R = Region and RadiationS = Severity and Scale
T = Timing and Type of Onset
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P = Provocation and Palliation
What causes o r tr iggers i t?
Examples: stress, position, certain activities,arguments
What makes it better?Examples: changing diet, changing position,taking medication, being active, resting
What makes i t wo rse?
Does i t seem to be gett ing bet ter or worse
or does i t remain the same?
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Q = Quality and Quantity
Try to let the client describe the pain in their
own words since sometimes they will say what
they think you would like to hear.
How does i t feel , look or sound?
Is i t sharp, du l l , stabb ing , bu rning,
crush ing?
How much of i t is there?
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R = Region and Radiation
Where is i t?
Is i t in one place?
Does it go anywhere else?
Examples: down the back, down your arm, up
your neck, down your legs
Did i t s tar t somewhere & is now local ized
to one spot?
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S = Severity and Scale
Does i t inter fere with your act iv i t ies?
How does i t rate in sever i ty?
How bad is i t at i ts worst?
Does i t force you to s i t dow n, l ie down, s low
down?
How long does an episode last?
Pain Scales:
Visual Analog Pain Scales – Black & White &
Color Wong-Baker FACES Pain Rating Scale FTM p.
391 Figure 11-3
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Visual Analog Pain Scales
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Color Visual Analog Pain Scale
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Wong-Baker Faces Pain Scale
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T = Timing and Type of Onset
When did i t begin?
How long does i t last?
How o f ten does i t occu r?
Examples: hourly, daily, weekly, monthly
Is i t sudden o r gradual?
What t ime did i t begin?
When was the f i rst date i t happened?
What were you doing when you not iced i t?
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T = Timing and Type of Onset
When do you usual ly exper ience i t?
Examples: daytime, night, in the early morning
Are you ever awakened by i t?
Does it lead to anyth ing else?
Is i t accompanied by other s igns &
symptoms?
Does it ever occu r before, du ring or after
meals?
Does i t occu r seasonally?
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Other possible questions
Any medicat ions o r al lerg ies?
Does i t hu rt on breath ing or deep
inspirat ion?
Any history of pain?
Any fam i ly h is tory of s imi lar pain?
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HOST & HOPST
H = History (medical)
O = Observation
P = PalpationST = Specialized Testing
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H=History
Can include:
Health history
Reason for massage
History of current problemHistory of past illness & health
History of family illness
Current health practicesClient’s goals for therapy
Medical clearance recommendations
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O=Observation
FTM p. 386 How to Observe
Also called Visual Assessment
Uses all the senses including intuition in assessment
Things you observe which can include:
General mood
Body language
Breathing: shallow or abdominal
Sitting & standing postures
Gait or manner of walking
Try to observe without client noticing so can get ‘real’picture of their current condition
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Is the Client in ‘fight or flight’ or
Sympathetic Dominance?
Restless
Anxious Fearful
Angry
Agitated Elated
Initially yourapproach andstrokes used needto match the client
Then you can work
to slow or calmclient down duringmassage
Signs can include: Solution
I th li t l th i i
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Is the client lethargic or in
Parasympathetic Dominance?
Generally relaxed
appearance Slowness
Depression
Your initial approach
needs to matchclient
Then your actions
can increase as the
client’s energylevels increase
Signs can include: Solution
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How clients indicate problems on their bodies
Body language & non-verbal communication
FTM p.387 Gesturing
Example: If a client grabs at his shoulder
while he talks about it, he could beindicating a shortened muscle or fascia
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P=Palpation
Definition: use of touch to examine tissues
FTM p. 404 - Assessment by Palpation
Main considerations:
Differentiate between different types of tissue
Detect differences in texture in same tissue types
Ability to palpate through tissue layers fromsuperficial to deep
Hot and cold areas
Skin color
General skin condition
Body rhythms including breathing
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Mechanism of Palpation FTM p. 405
Proprioceptors & mechanoreceptors in our
hands, arms & shoulders send information
to the brain where the sensations are
interpreted.
The somatosensory region of the brain
devoted to the hand is very large
Ability is mainly sense of comparison –this tissue feels softer than that tissue
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Activity: Palpating on Yourself
Bones
Ligaments
Muscle
Tendon
FasciaSkin
Blood vessels
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Palpating on Yourself - Bone
Hold arm in front of you with elbow bent. With pads of fingers, find pointy end of elbow (olecranon
process)
Still palpating, bend & straighten arm. The bone shouldretain its shape as you move.
Keep your arm bent & move fingers toward sides of elbow tofeel 2 hard bumps, one on each side (epicondyles ofhumerus)
Bend & straighten elbow while holding these bumps. Theywill retain their shape as you move.
Explore these structures. Follow the epicondyles proximallytoward shoulder & the olecranon process distally towardwrist.
Other areas: clavicle, patella, & malleolus
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Olecranon Process & Epicondyles
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Palpating on Yourself - Ligaments
Ligaments are static stabilizers so do not move.
Ligaments are present at the ends of bones wherethey help form joints. Sometimes a network ofligaments will wrap around a joint, creating a joint
capsule. Interosseous membranes are related to ligaments but
are thinner & connect bones along the length of theirshafts. They are in the forearm & lower leg but aretoo deep to palpate.
Tendons & ligaments often appear in the samelocations. Tendons will move & change shape as the joint moves. Ligaments remain relatively constant.
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Palpating on Yourself - Ligaments
Remove your shoes & socks & cross your legs with one footresting on the opposite knee.
Find the inside ankle bone (medial malleolus) with pad ofyour thumb.
Move your thumb to the bottom edge of the malleolus &
slightly anteriorly. Actively move your foot around in circles as you press with
your thumb, locating the space between the ankle & footbones.
You should notice the gap between the bones opening &
allowing the deltoid ligament to come closer to the surface &be more easily palpated.
There are several ligaments in the ankle. You can practice tofeel the difference between bone, tendons & ligaments.
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Deltoid Ligament
Deltoid Ligament Ankle Tendons
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Ankle Ligaments
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Palpating on Yourself - Muscle
Skeletal muscle made up of distinct bundles ofparallel fibers giving them a corrugated feel.(Tendons feel ‘smoother’.)
The parallel fibers have distinct direction of alignment.If you know the direction of the fibers of a muscle, itcan help you distinguish it from surrounding muscles.
Muscles change shape as the body moves. When itis stretched, it becomes longer & the fibers feel taut,like a tightened rope.
When a muscle contracts, it becomes thicker in thecenter & firmer throughout.
You can see this by viewing your own arm whenrelaxed & then with your fist clenched.
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Palpating on Yourself - Muscles
Wrap your hand around your opposite forearm, justdistal to the elbow. With your forearm relaxed, theflesh should feel soft & pliable.
Slowly bend your wrist back & forth. Notice how theflesh under your palm changes as you move yourother wrist.
Notice the movements that make the muscles feelstretched & taut & which makes the muscles feelcontracted & thick.
Wrap your hand around different places on yourforearm & move your wrist. Are there locations thatmove more than others?
Other places to practice are around shoulder & knee
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Palpating on Yourself - Tendons
Tendons come in a variety of shapes & sizes.
They can be broad & flat like those in the small ofthe back or long & cable-like such as those in arm& wrist.
Tendons, like muscle, change shape as theystretch & contract.
They tend to be denser & smoother than muscles.
When palpating tendons, it helps to find a muscle& follow the fibers until they become smootherprior to attaching to a bone.
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Palpating on Yourself - Tendons
Lay the pad of your thumb across the inside of
your opposite wrist.
Gently strum your thumb back & forth, feeling
the tendons just under the skin. Hold your thumb still as you open & close your
hand. Do the tendons move & change?
Continue to hold your thumb still as you wiggle
your fingers. Do the tendons move & change?
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Palpating on Yourself - Tendons
Follow the tendons with the pad of your
thumb proximally toward the elbow. Can you
feel when the tendon changes to muscle?
Follow the tendons distally to the hand. Canyou feel where they insert on the bone? This
is more easily felt on the back of the hand.
Good places to practice are around kneecap(patella) & dorsal surface of the foot.
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Palpating on Yourself - Fascia
Fascia comes in many different forms & isseparated into layers. Multiple layers withindividual collagen fiber directions give it itsunique feel & appearance.
It can feel wavy, dense or smooth dependingon location & health of the tissue.
It also has the ability to be solid & firm as well asliquid or fluid in nature. Which form it takesdepends on temperature, pressure & tension
applied to the tissue. Fascia is more challenging to palpate than other
tissues.
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Fascia
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Palpating on Yourself - Fascia
Slightly flex one arm & grasp the loose skin at the point of yourelbow with the thumb & finger of your opposite hand.
Grasp firmly & see if you can roll the flesh between your fingers.
This is superficial fascia.
Bend & straighten your elbow as you keep hold of the fleshbetween your fingers. Feel the alternating tension & slack?
Grasp in the same way other areas of your forearm. Find a
mark on your skin (freckle, scar) or mark your skin with a pen.
Keeping your eyes on the mark, see if you can cause it to move
by pulling on flesh on different parts of your arm.
Practice at your patella & abdomen. Compare the movement of
the flesh at different locations. Does the amount of movement
change the more you palpate an area?
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Palpating on Yourself - Skin
Pay attention to temperature, pliability & texture of skin as youpalpate.
Place pad of your fingers on the palm of your opposite hand.
Brush your fingertips lightly across the skin without moving it. Isthe skin rough or smooth? Any ridges, bumps or calluses? Is itoil, sweaty, or dry? What color is the skin? Repeat on the backof the hand.
Move back to the palm. Keep both hands relaxed & makesmall, deep circles with your fingertips on your palm. Try tomove the skin.
Open your hand wider & observe if the skin changes.
Return to back of the hand & repeat exercise. How do theydiffer? How are they the same? Does anything change with yourtouch?
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Palpating on Yourself – Blood Vessels
The blood vessels are in a network which iswoven throughout the body, existing side by sidewith lymphatic structures, nerves & structures ofmovement.
Use caution when palpating near these structuresto avoid damaging the blood vessels.
When you palpate a pulse under yourfingertips, you have compressed an artery.
Place your fingers on the inside of your opposite &feel for the radial pulse. Gently roll your fingersover the artery to feel the tube-like structure.
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Radial Pulse Point
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Areas to Palpate – FTM p. 405
Skin
Superficial fascia
Fascial sheaths
Tendons
Ligaments
Blood vessels
Muscle layers
Bone
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How to Palpate FTM p. 405
Use back of hand to detecthot (inflammation,spasm, or increasedcirculation) or cold(reduced circulation) areas
Areas that seem thick,dense or bumpy & pushyou away – hyperactive
Areas that seem thin orthat have ‘holes’ -hypoactive
Dry or damp (feels sticky &can mean activated nervoussystem)
Color: blue (lack of oxygen)or yellow (liver problems)
Moles & growths
Condition of hair & nails
Do gentle, small stretching inall directions & note areasthat are stuck, restricted ortoo loose
In times of stress, epithelialtissues affected first
Near touch (no contact)
p. 405Skin p. 406
H t P l t
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How to Palpate
Area can feel spongy,resilient & springy like
gelatin Since it holds fluids, can
feel like water balloon
Kneading & skin rollingcan help find areas of
binding Look for areas that
become redder thansurrounding tissue or thatstay red longer
Superficial vesselsfeel like soft tubes
Should feel firm butpliable & supported
Feeling for pulses canhelp find this area
Watch for vessels thatbulge, are mushy or areconstricted & refer to aphysician
Superficial Connective Tissue
p. 407Blood Vessels p. 408
H t P l t
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How to Palpate
Lymph nodes feel likesoft gel caps in joint area
If enlarged, refer to aphysician
Tissue should not be bogy& taut from water retention
If person has unexplained& consistent edema, referto a physician
Since they have morecollagen, feel morepliable & less ribbedthan muscle
Should feel pliable &mobile
Under tendons can findbursa which feel like
small water balloon orbubbles
Tendons move withisometric contractions,ligaments don’t
Lymphatic Structures
p. 408 Tendons p. 410
How to Palpate - Skeletal Muscles
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How to Palpate Skeletal Muscles
p. 408
Feel like corded fabric or fine rope
Should feel firm & pliable but can also feel
tense & ropy
Palpate through layers till reach bone with aeven, broad based & slow pressure
Can slide layers to find adhesions
Having client move joint can help identifymuscles
H t P l t Sk l t l M l
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How to Palpate - Skeletal Muscles
Tension in concentrically contracted musclesshows as tissue that is hard & bunched (caves)
Tension in eccentrically contracted muscles showsas long, taut bundles with some shortened
groups (hills) Flexors, adductors, & internal rotators usually
shorten
Extensors, abductors & external rotators palpatetense & taut but are long with eccentric
dysfunctions Musculotendinous junction & belly can contain
trigger points & hypersensitive spots
H t P l t
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How to Palpate
Thin & fibrous layerthat feels like sheets
of plastic wrap orduct tape
Location affects feel
Can feel fascialseparations with fingers
Larger nerves &vessels lie in fascialgrooves
Found around
joints & generallyfeel like bungee
cords
Some feel flat
Deep Fascia p. 410 Ligaments p. 412
H t P l t
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How to Palpate
Careful palpation canreveal space between
bone ends Can feel like hinges
Most assessmentsdone with passive &
active JMs End-feels provide
information
Smaller bones can
feel like young treesaplings &
branches
Important to palpate
bony landmarks thatare attachment sites
Joints p. 412 Bones p. 413
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H t P l t
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How to Palpate
Liver on right, stomach &spleen on left
Liver & LI feel firm Light to moderate stroking
good for large intestine
Refer to physician if anyhard, rigid, stiff or tenseareas
Skin often tighter in areasof visceral referred pain
Hands on lateral lower ribswhile person does 3 ormore complete breaths
Upper abdomen slightlyrounds in relaxedbreathing
Watch for movement inshoulders & upper chest
Tight leg & foot musclescan interfere withbreathing. Test for yourselfby tensing those muscles& taking a deep breath.
Abdominal Viscera (Organs)
p. 413Breathing p. 414
H t P l t
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How to Palpate
Pulse should bebilaterally even – feel
pulse on both sides Vascular refill – press
nail beds till pale &count 3-5 seconds forcolor to return
Lymph have type ofundulating rhythm ofperistalsis
Subtle widening &narrowing of cranial
bones Place hands on both
sides of head & feel forcranial ‘pulse’
Also a subtle back &
forth movement ofsacrum
Rate 10-14 times/min
Circulation p. 414 Craniosacral Rhythm p. 414
ST S i li d T ti
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ST=Specialized Testing
Muscle strength testing FTM p. 417
ROM testing FTM p. 398
Specific dysfunction tests such as:
Adson Maneuver for Thoracic OutletSyndrome
Tinel’s sign for Carpal Tunnel Syndrome.
M l G di
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Muscle Guarding
Definition: a protective reflexive responsein muscle that results from pain or fear ofmovement
The spasm will deter the muscle againstmovement, reducing the likelihood of re-injury.
Muscle guarding is not always localized. Theguarding may come from a distant source as a
referred pain. In most cases muscle guarding will cease
when the painful stimulus is removed.
Intrinsic M scle Spasm
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Intrinsic Muscle Spasm
This type of spasm is caused from circulatorychanges or nutritional deficiency.
Alterations in calcium blood levels can also
lead to muscle spasms. When severe enough, a muscle spasm can
lead into a cramp.
A cramp is a sustained or prolonged spasm.
Character armor
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Character armor
Concept proposed by Wilhelm Reich that thesuppression of emotions causes musculartension
Armoring is the sum total of the muscularattitudes which a person develops as adefense against the breakthrough of emotions,especially anxiety, rage, & sexual excitation.
Character armor is the sum total of all theyears of the muscular attitudes that have alsobeen incorporated in the person's character
Reich’s 7 Body Regions
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Reich’s 7 Body Regions
Ocular
Oral
Neck
Chest
Diaphragm
Abdomen
Pelvis