MC/Strength/Endurance of Trunk Flashcards
(34 cards)
Core Stability Definition
Core stability is a base or platform of musculoskeletal strength (and endurance) that results in (neuromotor)control of the trunk and allows optimal performance of limb activity.
Cervical and scapula stability as well
Stabilization of trunk to advance the function of the limbs.
Phase 1 - Interventions: Motor Function
- MOVEMENT REEDUCATION – Restore ideal movement patterns
- Motor coordination/control exercises (mm activation/ recruitment); deep abdominals, deep neck flexors, etc.
- Submax Isometrics
activation here
Phase 2 - Interventions: Motor Function
- Educate/enhance ideal movement patterns
- Proximal stabilization/recruitment (core stabilization)
- Strengthening of deep stabilizers of the region
- Isotonic strengthening (OKC and CKC)
limb movement here
Factors at play to enhance motor function of the tunk
- Movement coordination (Dissociation of upper and lower ¼) Need dissociation before strengthing
- Motor control: Muscle activation
- Motor Strength: Force production
- Motor Endurance
– Flexibility of tonic muscles
– Proprioceptive awareness
Phasic Muscles are also known as
Joint stabilizers
Tonic muscles are also known as
Primary movers
Lumbo Pelvic hip - phasic vs tonic muscles
PHASIC
* Deep abdominal (TA and IO)
* Quadratus lumborum
* Multifidus
* Pelvic floor
* Gluteus maximus
* Gluteus medius and deep hip rotators (ie: piriformis)
TONIC
* Rectus abdominus
* External oblique
* Erector spinae
* Hamstrings
* Adductors
* Rectus Femoris
* Lattissimus dorsi
Cervical-Thoracic-Shoulder: phasic vs tonic muscles
PHASIC
* Lower Trapezius
* Serratus Anterior
* Deep neck flexors
* Posterior rotator cuff
TONIC
* Lattissimus dorsi
* Pec major
* Deltoid
How do the lumbo-pelvic-hip muscles respond to pain
- Delay in deep abdominal AND multifidus function following back injury
- Dysfunction of pelvic floor and lateral hipmuscles post- pregnancy and SI related conditions
- Weakness of gluteus maximus/medius in response to hip AND knee AND ankle conditions (dysfunction)
What population is most susceptible to SI issues?
Pregnant women
How do the cervical-thoracic-shoulder muscles respond to pain?
- Delay in deep neck flexor function (starting within 2 hours) following neck injury esp. following motor vehicle accident (MVA)
- Serratus anterior and lower trap weakness and endurance deficits in high functioning patients with shoulder conditions (swimmers, volleyball)
- Rotator cuff weakness in chronic shoulder conditions
Which muscles are the most important? Why?
- None of them AND all of them
- No one muscle contributes greater than 30% of the overall stability of the lumbar spine. Stability is dependent on all muscles
- Contibutions from each muscle continually changes throughout a task
Usual Examination findings associated with Trunk Motor Control/Strength Deficits
Subjective
* History of back/hip pain OR neck/shoulderpain
* Especially history of persistent symptoms (“chronic”)
* Symptoms usually associated with static postures and/or asymmetric “loading” of the spine.
* Symptoms increase as the day progresses
Posture: Poor postural awareness (aka body positioning)
AROM: Imparied QUALITY of motion especially with functional motions. “Abberant motion”
Palpation: associated with tenderness of tonic muscles
Motor: Poor activation of muscles and poor endurance
Interventions for the Lumbo-Pelvic-Hip Region
- Enhance Movement Coordination (Femoral and pelvic dissociation).
- Balance and proprioception.
- Interventions to minimize tone of tonic muscles: Stretching and/or Soft tissue mobilization.
- Enhance motor function:
– First: Neuromuscular control (activation) and endurance of the “phasic” muscles
– Second: Strength/Endurance of the phasic and tonicmuscles
With patients with a Hx of back pain, research shows that the integration of ____ therapy has better outcomes.
- manual
- People have less pain and people perceive you as a better therapist
What is the order we provide interventions for muscles?
Activation -> Strength -> Endurance
Applies to lumbo-peliv and cervico-scap
What muscles in the lumbo-pelvic would you consider go from activation into endurance? How do we progress them to endurance?
- Deep abdominal/multifidus/pelvic floor
- Quadratus Lumborous
- Gluteus maximus
- Gluteus Medius
- Progress all to endurance activities by increasing hold times
What are the Interventions for the Cervico-thoracic-scapular region?
- Enhance Movement Coordination(Scapular and humeral dissociation). From previous weeks
- Proprioception and rhythmic stabilization.From previous weeks
- Interventions to minimize tone of tonic muscles: Stretching and/or Soft tissue mobilization. From 1st ½ of semester
- Enhance motor function:
– FIRST: Neuromuscular control (activation) andendurance of the “phasic” muscles
– SECOND: Strength/Endurance of the phasic andtonicmuscles
In this order!
What cervico-scapular muscles need to go from neuromuscular control -> strength -> endurance? How can we progress to endurance?
- Deep neck flexor
- Deep neck extensor
- Lower trap and rotator cuff
- Serratus Anterior
- Progress all to endurance activities by increasing hold times
What is the order for interventions to enhance motor function of the trunk?
- Education
- Dissociation of movement patterns
- Minimize tone/irritability of tonic muscles
- Neuromuscular control, Strength AND endurance
Patient Education for trunk control
- Educate patient that injury and pain affects muscle function
“Your condition (pain, injury, neuro condition, etc.) affects how the muscles function. Because the muscles are not functioning optimally it may be contributing to your symptoms. It is important first to retrain the muscles to function on command and THEN improve strength or endurance of muscles”
Marathoner vs Sprint analogy - Patient Education on phasic/tonic muscles
Marathoner: Deep stabilizers are phasic muscle
Sprinters: Superficial – primary movers, tonic
Sprinters don’t like marathoners. Get sore results in irritability of muscles. Get the irritability to go away by getting the sprinters to train like sprinters not marathoners
Facilitate Femoral and Pelvic Dissociation in Lumbo-Pelvic-Hip
- Pelvic mobility in sagital and horizontal planes is important to establish PRIOR to strengthening exercises (ie: pelvic clocks)
- Once patient has awareness of movement, educate on concept of “neutral pelvis”
What is considered “NEUTRAL PELVIS and NEUTRAL SPINE”?
- Neural position: between anterior and posterior tilt end range. Up to patients decision. Working on maintaining this position.
- Struggles because of lack of proprioception and lack of dissociation.
- Can be found by the patient in supine, sitting and standing
