Flashcards in Neuromuscular Deck (40)
What is a motor unit?
A single motor neuron and the multiple muscle fibers it innervates
What are myofibrils?
Multiple bundles of small fibers that make up muscle cells
What are myofilaments?
Smaller fibers inside the myofibril that are made up of the proteins actin and myosin
What are sarcomeres?
Short segments of actin and myosin
Characteristics of Skeletal muscle contraction
A minimum amount stimulus is needed to initiate a muscle contraction
All fibers contract one a stimulus is applied (all or none)
Muscle contractions stop once the stimulus is removed
There is a change in the number of motor units stimulated based on the need (graded response based on activity)
What is Reciprocal Inhibition?
Smooth movement requires a coordinated contraction in the agonist an a slight relaxation in the antagonist (but not complete inhibition)
What is the Stretch Reflex?
When a rapid lengthening of a muscle occurs, a concentric contraction is signaled ( to protect muscle from tearing) by the muscle spindles
What are the two types of muscle spindles?
Alpha afferents: sensitive to lengthening of the muscle
Gamma afferents: sensitive to the rate of lengthening
What is gamma gain?
Increased sensitivity of the muscle spindle to a sudden lengthening after a muscle has been static for an extended period
What is the Inverse Stretch Reflex?
The Golgi tendon organ (a proprioceptive sensory receptor that is at the origins or insertions of muscle fibers) monitors the force of contraction to protect muscles from tearing
GTOs are sensitive to tension in the muscle and respond to increased tension by inhibiting contraction
What are postural adaptation?
Muscles held in shorter or longer than normal positions for extended periods of time that cause reduced muscle performance
What are the characteristics of Upper Crossed Syndrome?
Forward head, depressed chest, rounded shoulders, and increased kyphosis
Causes: headaches, thoracic outlet syndrome, scapular dyskinesis, and shoulder impingement
What are the characteristics of Lower Crossed Syndrome?
Excessive lordosis and protruding belly
Causes: Sciatica, SI dysfunction, chronic low back pain
What is muscle hypertrophy?
Increase in size and strength of the muscle fibers in response to exercise
Takes several weeks to build muscle
What is muscle atrophy?
Decrease in size and strength of the muscle fibers from lack of use or denervation (use it or lose it)
Occurs quickly and could impede circulation to the area
What are muscle cramps?
Acute involuntary muscle contractions caused by muscle fatigue or metabolic imbalances (involuntary)
What are muscle spasms?
Involuntary muscle contractions sustained for hours, days, weeks, or months that restrict the blood vessels and compress the free nerve endings
They can lead to faulty biomechanics and movement patterns
they can reduce blood flow if left untreated and cause ischemia
What are trigger points?
Hyperirritable nodules (or Knots) within a muscle that give rise to pain with compression
It feels like a tight rope-like band and radiates pain when pressed
**only treat a trigger point when it is the cause of the symptoms
What are some causes of Trigger Points?
Increased mechanical strain
Impaired circulation (ischemia)
Trauma/local inflammatory response
What are tender points?
Hypersensitive small zones of tense and tender myofascial tissue caused by a small neurologically generated local muscle spasms (due to false stretch reflex signal)
Treated by muscle relaxation, not stretching
What is neuromuscular Release (NMR)?
Includes any technique that is directed at reducing muscle tension and spasm that restricts ROM and/or makes that movement painful
What are the three categories of NMR?
What is Direct Treatment?
Treatment that confronts the pain and tension with some type of opposing force or reverse soft tissue manipulation
Proprioceptive techniques and Trigger Point Release Techniques
What is indirect treatment?
Treatment that moves away from the restriction and into a position of comfort
Positional Release techniques
When can/should neuromuscular techniques be used?
any limited and/or painful movement
What are the contraindications of neuromuscular techniques?
Don't perform during the acute phase when "splinting" is occurring
Open wounds or sutures
Acute rheumatoid arthritis
What is the purpose of Proprioceptive techniques?
Effective and fairly easy to administer to patients
Reduces muscle tension by stimulating specific neuromuscular reflexes (GTO) that control tone using active muscle contraction
What are the goals of Proprioceptive techniques?
to inhibit muscle spasm that restricts ROM and causes pain
Enhance the effectiveness of trigger point and positional release techniques
What are the types of Proprioceptive techniques?
Contract Relax Active Contraction (CRAC)
Tight muscle is passively lengthened within pain free ROM until PT notes slight tissue tension then back off slightly
less then 25% contraction of the target muscle is provided against PT resistance
Hold for 5-10 s then have patient relax
Move to new ROM then repeat up to 6 times then reassess
Tight muscle is passively lengthened w/in pain free ROM until PT notes tissue tension
less than 25% contraction of the antagonist to the target muscle against PT resistance
Hold 5-10 seconds then relax
PT moves to new range and stops at next tissue barrier
Contract-Relax Active Contract (CRAC)
Same as Contract-Relax but instead of PT moving pt into new range after contraction, the pt actively move to new range and holds for 10 s before contraction
What is an active trigger point?
A trigger point that reproduces the symptoms and may have a local twitch response when compressed
What are some of the different types of trigger points?
Associated: TrP in one muscle that occurs concurrently with a TrP in another
Attachment: TrP located at the musculotendinous junction of muscle
Central: TrP located near center of muscle
Key: TrP responsible for activating one or more satellite TrPs
Satellite: Central TrP that develops in response to a key TrP
Latent: Painful only when paplated
How do you find trigger points?
sweeping cross-fiber movement of muscle believed to have a trigger point; once a taut band is located, a pincer grip is used along the band to locate the nodule
What is the maximum pain a trigger point release should cause?
What is the approximate time it may cause a trigger point to release?
What should you NOT do to relieve a tenderpoint?
Use compression or stretching
How much should the immediate reduction in tenderness be after treating a tenderpoint?