Knes 330 Final

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FlexibilityDefined:

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Flexibility is the ability of a joint, or series of joints, to movefluidly (smoothly and easily) through a full range of motion (ROM) without painor undue strain on the joint.

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ROM

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The measured beginning and terminal angles, as well as the total degrees of motion, traversed by a joint moved by active muscles contraction or by passive movement.ROM : QuantitativeFlexibility: is the Qualitative

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Laxity:

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Loosenessor freedom of movement in a joint, normal or excessive· Casued by acute or chronic injury· Congenital: Ehlers Danlos Syndrome,Marfan Syndrome – abnormal connective tissue, loose joints

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Instability

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The stateof being unstable, or lacking stability.Theabnormal tendency of a joint to sublux or dislocate with normal activities andstresses.Laxity:objectiveInstability:subjective

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Relative Compensatory Flexibility

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take path of least resistance

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Static Flexibility

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Movement is held in one position for an extended period of time• Self propagated or assistance Used to increase tissue length (creep)

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Ballistic Flexibility

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Bouncing/bobbing/out of control type motion High Velocity – uses momentum Movements may go beyond normal Range of Motion

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Dynamic

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Full Range of motion at normal or fast speeds This requires muscle activation to move the joint• E.g. Arm Circles

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Flexitest:

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Identify areas of hypoflexibility (tightness) or hyperflexibility (laxity) to set GOALS

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Determinates of fitness

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1.Muscularstrength2.Cardiovascular3.Flexibility

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Hypermobility:

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• Ehlers-Danlosand Marfan Syndromes (ligaments)

• DownSyndrome

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Hypomobility:

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• diabetes,fibromyalgia, growth

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1941

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Cureton’s Tests· Floor Touch · Trunk Extension· Trunk Forward Bend

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1952

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– Wells andDillon· Sitand Reach

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Geniometers:

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1920’s, measure the angle between bony segments Looks like protractor

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Abby’s Scratch Test:

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Upper arm limited: tight pectoralismajor, lattisimus dorsi,anterior deltoid, teres majorLower arm limited: rotator cuff muscles tightTeres minor, infraspinatus, posterior deltoid

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Psoas major:

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flexes hip and flexes vertebral column

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Iliacus

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flexes thigh at hip joint

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Hip Flexors and rotators and knee Extensors

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· Psoas major and Iliacus (iliopsoas)· Rectus Femoris· (Sartorius, Pectineus)· Tensor Fascia Latae (TFL)· Iliotibial band (ITB)

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Thomas Test

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Tests for: Rectus femoris, iliopsoas, and ITB tensionExaminer: ROM of hip flexion, ITB, ABD, and knee extension

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Elys test

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Ely’s TestTests for: Tight rectus Femoris

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Tensor Fascia Latae

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assists with abduction, medial rotation, flexion of thigh,makes the IT band taut

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Thomas Test / kendall

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Tests for: Rectus Femoris, Iliospoas, and ITB tension Patient: Supine with one leg to chest Examiner: Notes the ROM of Hip Flexion, ITB ABD, and Knee Extension (Magee, 1987)

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Ober’s Test

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Tensor Fascia Latae Tightness

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Flexibility training:Stretching Recommendations

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Frequency: 4-7 sessions per weekDuration : hold for 10-30 sec, 5-10 min per session

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How do Passive-staticstretching work?

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Goal is to overcome stretch reflex to allow a wider range ofmotion about the joint Don’t stretch too far or too fastPlastic response- creep and stress relaxation

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Myostatic Stretch Reflex

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Proprioceptor involved: Muscle spindles · Senses changes in length and rate of change ofmuscle fibres (reflex occurs when muscle stretched too far or too fast)· When muscle spindles stimulated, musclescontract, resisting the stretch

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creep

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mechanical stretching of a material under a constant loadover timeOccurs because of water displacement form the collagennetwork and micro fragmentation of elastic fibres

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PNF:

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: proprioceptive NeuromuscularFacilitationProprioceptive: involves sensory receptorsNeuromuscular nerves and muscles involvedFacilitation: to make easier

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The Golgi TendonOrgan:

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Tiny sensory receptors located within muscleSenses muscle tensionProtective mechanism

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Golgi Tendon Organ:

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· Inverse (Myostatic) Stretch Reflex-aka Autogenic InhibitionReflex causes muscles to relax· Load in tendon either from:o Intense stretcho Contraction

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Musculo tendinousJunction

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Where the Golgi Tendon Organs located· Tension on MTJ stimulates an increase in musclelength (inverse Myostatic Stretch Reflex)· Increase in sarcomeres occurs at MTJ· Prone to injury

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PNF history

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Dr Herman Kabat-neuro physiologist physicianMargaret Knott- physio/ assistantDorothy Voss- physio/ assistant – added neuro muscular

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PNF- How does it work?

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-Inverse Myostatic Stretch Reflex-PNF has analgesic affect

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Guidelines for PNF

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CommunicationPreceedwith 10-15 in moderate intensity exercise 2 setshold each10-30 sec48 hrsrecovery

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Corect Technique(CRAC) PNF

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· Contract Relax with Agonist,Antagonist Contract, also called Hold Relax Contract or CRC· Lengthen muscle to point of comfort· Sub maximal contraction ofantagonist for 6-15 sec· Contraction of agonist for 6-15 secwhile lengthening antagonist

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Goal of PNF:

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: increasemuscular flexibility and strengthUnderstanding of Muscle Physiology Stretch Reflex: facilitates contraction of muscle when stretched· Golgi Tendon Organ Reflex: facilitatesrelaxation of muscles

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Chronicflexibility training leads to:

Structural adaptions:

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:alterations to the physical makeup of the muscle/ supportive tissues

serialsarcomere addition· Selective expression of titinisoformsFascia- semi permanent change

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Functional adaptations

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alterationsin the supporting systems or “usability” of the joint

· Reset critical point of StretchReflex· Lubrication of connective tissuefibres· Increase in stretch tolerance

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Musclehierarchy:Large tosmall

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Large tosmall· Muscle· Fascicles· Fibres· Myofibril· Sarcomere· Myofilaments (actin, myosin, titin)

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2. Selectivetitin expression

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· Molecular spring, possible calciummodulation, provides passive stiffness of the sarcomere· Less stiff titin= greater ability ofmuscle to stretch

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3. Fascia adaption

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Latin wordmeaning band or bandage Definition:A complex network of tissue that spreads throughout the entire body creating athree- dimensional matrix of support

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Connective Tissue

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Mostabundant tissue in the bodyConnectivetissue is 30% of muscle massTendons,ligaments and fascia significant for flexibility

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Main components connective tissue

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collagen,elastin, and waterMuscle andfascia accounts for 41% of total resistance

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Connectivetissue : ContentsExtracellularMatrix (ECM)

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· Loosely arranged cells in a fluid· Also called ground substance· Nerves and blood vessels travelthrough it

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Crimp-

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thestraightening of the collagen fibers

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Elastin-

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Can stretch up to 50% it’s length

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4 Types ofConnective Tissue1.Supporting connective Tissue

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· Gives strength, support, andprotection to the soft parts of the body· Cartilage· Bone

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2. Bindingconnective Tissue

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· It binds body parts together· Tendons: connect muscle to bone· Ligaments: attach one bone toanother

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3. Adiposetissue

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fat

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4. Fibrousconnective tissue

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· Packing and binding material formost of our organs · Fascia binds muscle together andbinds the skin to the underlying structures (3 types)· Collagen, elastic and other proteinsare found in the matrix

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3 Types ofFascia

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...

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1. Superficial-

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directly below dermis

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2. External or deep fascia-

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surroundsand interfuses with the muscles/ tendon bone, nerve, blood/lymph vesseland organs to the cellular level, creates broad sheaths such as the ITB

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3. Subserous fascia

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around the body cavity

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Friction Syndromes

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-lateralknee pain (runner’s knee)snappingsensation approx. 30 degrees flexion IT bandtightnessStretchingand strengthening Snappinghip- ITB snaps over trochanter

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Fascitis

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· Inflammation of the fascia· Small tears of the fascia due tooversu or overloading · Can develop spurring if close toperiosteum

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TriggerPont (TP)

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Also knownas tender pojntsHyperirritablespot usually within a tight band of skeletal muscle fasciaPainful oncompression Referredpain, tenderness and impeded motion

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Myofascial Release:

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“A method of manipulative treatment aimed atrelaxation of the soft tissue of the body. It focuses on muscles and fasciathat are abnormally tense or contracted, and involves the use of pressure andstretching those tissues to relax/release them”

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IntramuscularStimulation (IMS) Acupuncture?

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Use triggerpoint dry needles to stimulate injured tissue Needleinserted into tightest part of the muscle bodyActivatesnatural healing processIncreasesmobility and local blood flow an helps injury preventionMinimalsoreness lasting 2 hrs post treatment

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GratsonTechiniqe

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Use of steeltool contoured to specific body partsUsed forsoft tissue mobilization therapyBreaks downscar tissue

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ActiveRelease massage

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Therapistapplies specific pressure to an area of scar tissue as the patient movesthrough specific motionPressurebreaks down scar tissue Notconsidered relaxation massage

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Ultrasound

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Sends highfrequency sound waves through skin to the musclesSound wavesvibrations causing tissue to heat upDeepertissues the heat packAccelerateinflammation process

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3 cardinalplanesSagital-

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· side to side · Right and left halves· Flexion and extension · Coronal axis

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Coronal(frontal ) –

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· front and back · Motions: abduction and adduction ofthe upper and lower extremities· Anterior- posterior axis : axiswhich abduction/adduction takes place

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Transverseplane

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· Horizontally divides the body intoupper and lower halves· Motions: rotation· Longitudinal axis: extendsvertically in head/ tail direction

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1.FibrousJoint

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· Heldtogether with connective tissue· Immobile(little or no movement)· ie.sutures of skull, interosseus membrane (tib/fib)

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2.CartilaginousJoint

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· Slightlymobile· ie.intervertebral discs, symphasis pubis, rib and sternum

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3.SynovialJoint

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· Freelymovable· Mostcommon

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Single ordouble leg inverted stretch

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Deep kneebendRisk:strain capsule and ligamentsCompresknee capCrushmeniscus

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Limited Flexibility

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— MS— Cerebralpalsy— Musculardystrophy— Arthirits

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Hyper mobility

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down syndrome

ehlers danon syndrome

Marfan syndrome

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NostrilBreathing

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Seal right nostril, exhale through left nostril, inhale through left nostril Seal left nostril, exhale through right nostril, inhale through right nostril Seal right nostril, exhale through left nostril, inhale through left nostril

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Kyphosis

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Hunch back

pelvis anterior

outward curvature of spine

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Lordosis:

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inward curvature of the spine at lumbar - but out

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Scoliosis

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S curvature

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Pelvic crossed syndrome

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Excessive length and weakness in abdominal muscles and gluteals Tightness in spinal extensors and Iliopsoas Pelvis tips forward, lordosis

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UpperCrossed Syndrome (UCS)

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Tight upper trapezius, levator scapulae and pectoral muscles Weak deep neck flexors, lower scapular stabilizers (serratus anterior and lower trapezius) Head forward (poking chin)

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How does Traditional Chinese Medicine Work ?

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Balance of two opposing and inseparable forces: yin and yang Health is achieved by maintaining the body in a "balanced state" Disease is due to an internal imbalance of yin and yang Acupuncture can help re-balance the body via meridians throughout the body Unblock energy

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How does western system of Medicine work?

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Regulate the nervous system Release endorphins which relieve pain Boost immune system cells Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones

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Qi Gong

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Qi- lifeenergyGong- workQi Gong-working with life energy

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Taoism:

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Calm, reflective and mystical view of the world Importance of the beauty and tranquility of nature

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Yin andYang

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Dynamic duality Active/Passive Masculine/Feminine Energy Balance of Yin and Yang

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Tai Chi

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Cardio fitness Muscular strength/endurance Flexibility Functional/Daily Activity• better stand, walk, move, run Balance and Motor Control • alignment, rhythm of movement Posture and Relief of Low Back Pain Prevention of Falls

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1. Chen 2. Yang –

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1. Chen –traditional2. Yang –most popular• 108 forms• 3 months to learn• Research on 24 form• Also shorter forms

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1. Chen –traditional2. Yang –most popular• 108 forms• 3 months to learn• Research on 24 form• Also shorter forms

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restoringand balancing the natural life force energyRei- “Freepassage” or transcendental spiritKi- “Vitallife force energy” or “universal life energy”“Life forceenergy” transferred to the student by the Reiki master

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The 5 Reiki Precepts

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1. Do notanger2. Do notworry3. Befilled with gratitiude 4. Devoteyourself to your work5. Be kindto all people

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EIGHT Limbs of yoga

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...

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Yama

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Yama – Ethical principles, restraints (social)

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Niyama

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Niyama – Rules of Conduct (morals), observances(personal)

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Asana

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Asana – Physical Postures

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Pranayama –

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Pranayama – Controlled Breathing

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Pratyahara –

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Pratyahara – Sensory withdrawal/sense control

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Dharana –

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Dharana – Mental Concentration (mind)

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Dhyana –

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Dhyana – Meditation (Mindfulness)

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Samadhi

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Samadhi – Enlightenment, self-actualization, absorption

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Power Yoga

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Berryl birch (1995)Found in many health clubs Based on AShtanga yoga with Western spinRigorous workout focusing on developing strength andflexibilityDangerous potentially

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Bikram Yoga

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Developed by Bikram Choudbury40 degrees CelciusExpect to sweat – moves toxins out of the body Sequence of 26 traditional hatha postures

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Benefits of yoga

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Strength and flexibilityRelaxation and decrease stress Energy balance Literature