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History
Vidar Vindal, Gitle Kirkesola ,
Silvia Kollos[PT from Norway, Austria and Germany]
Hannspeter (Hape) Meier
Australian research group -
Hodges [1990]
S-E-T concept
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global and
local stabilizers
Muscle classification
Anatomic basics
. to control segments and joints
segment system
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back muscles [m. erector spinae]
abdominal muscles [different parts]
Global muscles [lumbar area]
Abb. Delavier 2006 Abb. Platzer 2005
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tonic contraction
optimal compression of joint
surfaces
feed-forward
Local stabilizers [lumbar area]
Properties and abilities
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Feed forward mechanism
Cresswell 1999, Hodges 1997 and 1999
Transversus abdominis contracts in all
quick movements of the trunk, upperextremities, and lower extremities,
before the muscles producing the
motion are activated.
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Moseley GL, Hodges PW, Gandevia SC :
Deep and superficial fibers of the lumbar multifidus
muscle are differently active during voluntary arm
movements.
Spine 2002;2:E29-E36
Feed forward - mechanism
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For 75%, the m. multifidus is the most
important muscle for stabilization of the
segment L4 - 5, during movement in theneutral zone!
Wilke 1995
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Local stabilizers first order [lumbar area]
diaphragm
m. transversus abdominis
mm. multifidi
pelvic floor
The collective of lumbar stabilization
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m. quadratus lumborum
[medial portions] m. psoas major [posterior portions]
m. latissimus dorsi
m. obliquus internus u.
externus abdominis
Local stabilizers second order
Abb. Prometheus, Schnke u.a., 2005
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Global muscles
back muscles [m. erector spinae]
abdominal muscles[m. rectus abdominis]
Abb. Delavier 2006 Abb. Platzer 2005
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globalglobal
musclesmuscles
locallocalstabilizersstabilizers
diaphragmdiaphragm
pelvicpelvicfloorfloor
LumbarLumbarstabilizationstabilization
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1] ..... muscles
2] ..... tendons
3] ..... joints
4] sensors for movementand acceleration
5] sensors for pain andinjuries
6] sensors of the skin
SensorsSensors ..
This stabilizing system depends on theperformance of the sensorimotoric system!
Meissner's corpuscles
Merkel cell
Pacini's corpuscles
Ruffini's corpuscles
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Labile und unstable training devices
SensorimotoricSensorimotoric trainingtraining
Abb. Hape Meier 2007
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high sensorimotoric activity based on .
fast, aggressive und unstable stimuli
Unstable training devices
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Unstable training devices
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Injury prevention and performance
development:
Hypertrophy and
synchronous activity of
the local stabilizers
coordinated interaction
SensorimotoricSensorimotoric trainingtraining
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..... reduced information from the sensori-
motoric system and
reduced local stabilization
reduced strength
shear forces
Chronic injuries or pain in the locomotorsystem means ....
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passive control
system
active control
systemnerval control
system
[Panjabi 1991]
Functional instability[motor control deficit]
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reduced sensorimotoricinformation ...
Paradoxical innervationRelieving posture: Muscles don`t get
enough information and correct incoming
information to be abel working or reacting
in an normal way!
..... from the
- muscle sensors- tendinous sensors
- liagemental sensors
- capsule and
- skin sensors
Emergency programm/ paradoxic innervation
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mainly takes the stabalizing control
tries to limit painful movement
hypertension
coordinated interaction is disordered
structural muscle shortening
Emergency programm/ paradoxic innervation
The global muscle system
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Summary
Without sensorimotoric activity no motoric!
Pain reduces the flow of information from the
sensors
Feed forward mechanism does not work at
peak level!
paradoxical innervation/relieving posture
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Methodological approach
Reactivation of neuromuscular response!
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The REHAPE concept
reduce pain
reduce tension
Increase metabolism in the global muscle system
sensorimotoric training
Methodological approach
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REHAPE Sling Trainer
I. First, activate the local stabilizers.
II. Second, the global muscle system.
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Remember: methodological approach
high sensorimotoric activity based on . fast, aggressive und unstable stimuli with and on
unstable training devices and
pain free
open and closed kinetic chains
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Open and closed kinetic chains
Closed kinetic chain:
The distal end of the body segment is fixed,the proximal segment of the body moves.
For example: push up, squats
Open kinetic chain:
The proximal part of the body is fixed and thedistal end oft the body segment moves.
For example: bench press, leg extension
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injuries [pain]:
Reactivation of neuromuscular response!
Hypertrophy and
synchronous activity of the local stabilizers
coordinated interaction
SensorimotoricSensorimotoric trainingtraining afterafter
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SLINGTRAINING
Speaking about the shoulder
Erwin Reiterer
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Anatomic basis
Abb. Prometheus, Schnke u.a., 2005
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art. glenohumerale
art. subacromiale
art. acromioclaviculare
art. sternoclaviculare
art. scapulothoracale
Anatomic basis
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Scapula thoracal rhythm
Anatomic basis
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Scapula thoracal rhythm
University of Washington
Anatomic basis
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Coordinated interaction in the moment of
scapula thoracal moves
- concentric and
- excentric activity
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Local stabilizers: rotator cuff
University of Washington
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1] ..... muscles
2] ..... tendons
3] ..... joints
4] sensors for movementand acceleration
5] sensors for pain andinjuries
6] sensors of the skin
SensorsSensors ..
Scapula/arm moves and the stabilization dependson the performance of the sensorimotoric system!
Meissner's corpuscles
Merkel cell
Pacini's corpuscles
Ruffini's corpuscles
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I. Feed-forward
II. centering
III. control distance
Methodological approach for stabilzing
the shoulder
Abb. Prometheus, Schnke u.a., 2005
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The feed-forward-activity depends on the
performance of the sensorimotoric system!
I goal: Feed-forward
Training with and onunstable devices!
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II goal: centering [rotator cuff]
University of Washington
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10 mm
III goal: distance holder
Abb. Prometheus, Schnke u.a., 2005
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Impingement - injurie
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Chronic injuries or pain in the locomotor
system means ....
Feed forward mechanism does not work at
peak level!
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passive control
system
active control
systemnerval control
system
[Panjabi 1991]
Functional instability
[motor control deficit]
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reduced sensorimotoricinformation ...
..... from the
- muscle sensors- tendinous sensors
- liagmental sensors
- capsule and
- skin sensors
Emergency programm/ paradoxic Innervation
Paradoxical innervationRelieving posture: Muscles don`t get
enough information and correct incoming
information to be abel working or reacting
in an normal way!
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Scapula thoracal[relieving posture] Impingement - injury
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m. levator scapula m. pectoralis minor
scapula thoracal muscles don`t work together
structural muscle shortening
University of Washington
Chronic injuries or pain in the locomotor
system means ....
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Chronic injuries or pain in the locomotor
system means ....
Feed forward mechanism does not work at
peak level!
scapula thoracal muscles dont`t work together
structural muscle shortening
decentration caput humerus
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Gleno humeral
Ventral position of the caput humerus
Shear forces
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The REHAPE concept
reduce pain
reduce tension
increase metabolism in the global muscle system
sensorimotoric training
Methodological approach
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REHAPE Sling Trainer
I. First, activate the local stabilizers.
II. Second, the global muscle system.
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Remember: methodological approach
fast, aggressive und unstable stimuli with and on
unstable training devices and
pain free
closed kinetic chains
muscles of the thoracic spine
scapula thoracal muscles
gleno humeral muscles
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