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34 terms

Functional Rehab Midterm (Lecture 3)

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Ability of spine to maintain neutral zone

Ability of spine to resist bucking or unwanted displacement

Ability of the body to control the whole ROM of a joint so that there is no major deformity, neurological deficit, or incapacitating pain
Spinal stability
10.5 N

1/5 to 1/4 weight of the average head
Osteo-ligamentous cervical spine buckles with how much axial compression?
90 N

Normal loads in standing 2-3 times body weight
Osteo-ligamentous lumbar spine buckles with how much axial compression?
5-10% MVC
What is the requirement of spine stability in neutral posture co-contraction of abdominal and paraspinal muscles?
Endurance (vs. strength)
What is most important quality of muscles to maintain spinal stability?
Those damaged by ligamentous laxity or disc diseases
What type of spinal segments require greater muscle activation?
Loss of both feedfoward and feedback motor control
What was a finding in patients with lumbar and cervical pain?
Transverse abdominals

Multifidus

Longus Capitus

Longus Colli
What muscles involved in muscle control have been shown to become dysfunctional post neck and low back injury?

Changea are also seen in muscle structure
Identify the loss of stability, motor control, and aberrant recruitment patterns

Results provide data for reeducation or faulty motor patterns and creating dynamic stability in the presence of mechanical compromise
Goal of assessing spinal stability
LPHC Muscle Imbalances

Abdominal Bracing

Shear/Prone Instability

Neuromuscular Control (NMC)

Endurance

Force transfer from lower to upper extremities
Spinal Stabilization Assessment
Stiffening or tightening the muscles of the midsection to prepare for a punch

Begins with contraction muscles in trunk in a hoop-like fashion without drawing abdomen inward

Level or contraction should be low (10%)

Continue to breath while maintaining the abdominal brace
Abdominal Bracing
10% of MVC
How tight should muscle be tightening with abdominal bracing?
Patient lies prone with body on table and feet on floor

Clinical applies P->A pressure onto painful segments

Positive test: Pain with resting position that diminished in active position

Indicates ability of lumbar extensors to stabilize against shear stability

Corrective action: Spinal stabilization exercise training
Lumbar Shear Stability Test
Begin in supine, crook-lying position while bracing abdomen

Slowly raise 1 leg to 100 degrees of hip flexion with comfortable knee flexion

Opposite leg brought up to same position
Sahmann Core Stability Test Level 1
From hip-flexed position, slowly lower 1 leg until heel contacts ground

Slide leg out to fully extend the knee

Return to starting position (flexed)
Sahmann Core Stability Test Level 2
From hip-flexed position, slowly lower 1 leg until heel is 12cm above ground

Slide leg out to fully extend
Sahmann Core Stability Test Level 3
From the hip-flexed position, slower lower both legs until heel contacts ground

Slide out legs to fully extend the knees

Return to starting flexed position
Sahmann Core Stability Test Level 4
From hip-flexed position, slowly lower both legs until heels are 12cm above the group

Slide out legs to fully extend the knees

Return to starting flexed position

In order to attain next level of stabilization, must maintain pressure change +/- 10 mm pressure
Sahmann Core Stability Test Level 5
Patients used visual feedback to maintain target pressure during hip abduction

Pressure changes of 5mmHg from the target pressure are allowed to accommodate changes induced by breathing
Hip Abduction Test pressure changes
Behind neck, baseline is 20 mmHg

Patient attempts to nod to increase cushion pressure by 2mm for 6-10 seconds

Progressively increases to 30mm

Positive: Inability to achieve desired pressure change

Indicates: Decreased activation of deep segmental cervical stabilizing musculature

Corrective Action: Reactivation of deep neck flexors via craniocervical flexion exercises
Craniocervical Flexion Test
Patient supine, tuck chin and lift head 2cm and hold

Test ends when chin tuck no longer maintained

Males: 18.2 seconds
Females: 14.5 seconds
Assessment for Deep Neck Flexor Endurance
Trunk extensor endurance
Trunk flexor endurance
Trunk lateral flexion endurance

Ration as percentage of trunk extensor (Flexor % extensor, lateral flexors % extensors)

Normal: trunk extensor endurance greater than flexor and/or lateral flexor endurance
Modified Biering-Sorenson Test
Trunk extensor endurance greater than flexor/lateral flexor endurance
Normal result for Modified Biering-Sorenson Test
Patient prone with lower body fixed to table at ankles, knees, hips

Parient rests upper body on floor or stool before exertion

Exertion...At first upper limbs held across chest with hands on opposite shoulders...Upper body lifted off floor until upper torso was horizontal

Patient holds as long as possible

Endurance recorded in seconds
Modified Biering-Sorenson Test: Extensor Endurance Time
Patient sits on table with upper body against a support with an angle of 60 degrees and hips flexed to 90 degrees

Patient's arms are folded across the chest with the hands placed on the opposite shoulder and toes were placed under the toe straps

Patients instructed to maintain the body position while supporting wedge is pulled back 10cm

Test terminated when the upper body fell below 60 degrees
Modified Biering-Sorenson Test: Flexor Endurance Time
Patient sidelying on a table with legs extended

Top foot placed in from of lower foot support

Patient instructed to lift hips off table to maintain a straight line over their full body length supported on one elbow and both feet

Uninvolved arm held across the chest with hand placed on the opposite shoulder

Test ended when the hips returned to the table
Modified Biering-Sorenson Test: Lateral Flexor Endurance Time
Assesses force transfer from lower extremities to upper extremities through the pelvic girdle

Patient supine, flex hip and elevate leg off table noting: Degree of possible right vs left, Ease of performance (subjective and objective), compensatory pelvic or trunk rotations
Supine Active Straight Leg Raise (ASLR)
Degree of possible right vs left

Ease of performance (ob and sub)

Compensatory pelvic/trunk rotations
What to note with straight leg raiser
Form closure augmentation: Passive compression of SI joints with medially-directed force applied to lateral innominate as patients attempts ASLR

Improvement in any assessment criteria is a positive sign

Corrective Action: Temporary application of pelvic/trochanteric belt, core stabilization training with emphasis
Form vs Force Closure in ASLR
Passive compression of SI joints with medially-directed force applied to lateral innominate as patients attempts ASLR
Form closure augmentation:
Activation of anterior oblique sling with patient reaching UE toward opposite knee against tester resistance as patient attempt ASLR

Improvement in any assessment criteria indicates a positive test

Corrective action: Core stabilization training with emphasis on anterior oblique system
Force Closure Augmentation
Assesses force transfer from lower extremities to upper extremities through pelvic girdle

Patient prone, extend hip and elevate leg off table

Note: Degree possible right vs left, Ease of performance, compensatory pelvic or trunk rotations
Prone Active Straight Leg Raise (ASLR)
Core stabilization with emphasis on POSTERIOR oblique stabilizing system

Application of tro
Form Closure with ASLR
Core stabilization with emphasis on POSTERIOR oblique system
Force Closure with ASLR