ACE : Chapter 9

Lack of mobility

Attributed to numerous favors, reduced levels of activity & actions Conditions promote muscle imbalance Loss of mobility leads to compensations in movement & potential losses to stability at subsequent joints. Muscle imbalances alter physiological & neurological properties of muscles = Dysfunctional movement

Heel-strike instant gait

Chain reactions originating from ankle dissipate forces upward through knee & beyond Help tolerate these forces, foot normally moves into pronation as a person bears weight onto foot

After 15 degrees of abduction

Deltoid takes over as primary abductor, rotator cuff muscles continue to depress & stabilize humeral head, along w/ anterior & posterior deltoid. Deltoid acted alone, pure superior glide would occur, Impinge humeral head against coracoacromial arch at 22 degrees of abduction

Technology

Dysfunctional movement, Advance complex of exercise equipment, Exercises & drills have become equally technical Ex: Intro of free-standing , dual stack, low high pulley cable systems that move in multiple directions, Advanced exercises like the wood chop are now common practice in most fitness settings Individuals exhibit limited mobility & stability resort to compensated movement when performing complex exercise or using advanced equipment. Raises potential concern of whether exercise w/o regard for an individual's levels of stability & mobility Throughout kinetic chain is actually doing more harm than good, advancing concept of "dysfunctional fitness"

Integrated movements

Effects of external loads, gravity, & reactive forces all increase, thereby necessitating a greater need to stabalize the spine. McGill introduced bracing discussed previously, explaining how it improved spinal ability by providing a wider BOS

Movement compensations

Inability to maintain muscle balance & neutrality at joint. Periods of inactivity when joints are held passively in shortened positions result in muscle shortening One muscle shorten (agonist), opposing muscle (the antagonist) at the joint tends to lengthen. Muscle shortening & lengthening alter both physiological & neural properties w/in muscle

During squat movement

Inability to stabalize lumbar spine or maintain a straight or slightly extended thoracic spine increases compressive & shear forces on lumbar vertebrae Lacks adequate mobility in thoracic spine, Frequently occurs is a movement compensation involves increased lumbar extension (increased lordosis) Squatting (w/ external loads) w/ excessive lumbar extension dramatically increases compressive forces on lumbar spine: 2-degree increase in lumbar extension from neutral can increase compressive forces on vertebral discs by 16% over a neutral spine

Delayed activation of TVA

Inadequately stabilize lumbar spine during movements of upper & lower extremities, Increasing potential for injury. Individuals lacking appropriate TVA function may need to rely on synergistic muscles to assume role of stabilizing spine Altering roles of these muscles for purposes of stabilization increases potential for compromised function

Pushing Movements

Shoulder flexion & overhead presses: Movement to 180 degrees achieved by collaborative effort of scapulae rotating against rib cage & humerus rotating w/in glenoid fossa. Movement requires : 60 degrees of scapulae rotation 120 degrees of glenohumeral rotation Scapulae require degree of mobility to perform various movements of arm, Fundamentally need to remain stable to promote normal mobility w/in glenohumeral joint During movements, Insufficient, premature, or excessive activation of specific scapular muscles will compromise scapulae stability, In turn affects ability of muscles around glenohumeral joint to execute function effectively. Ex: Scapulae cannot sink slightly while arms extended overhead, interfere w/ scapular rotation & scapulae stability Forces glenohumeral joint to assume greater loads, Reducing its force-generating capacity & increasing potential for injury

Kinematic within the body

Specifically w/in lower extremity, understand logic behind some of exercises presented here Important relationship exists among ankle, knee, & hip

Single-Leg Stand Patterns

Standing efficiently on a single leg mandates stability in the stance-leg, hip, torso, Exhibiting mobility in raised leg if stepping is involved. Weakness in hip abductors reflects an inability to control lateral hip shift, Placing additional stress on knee Client's strengthen muscles in isolation before integration full-body, weight-bearing movements Before learning any single-leg movements, Client's should learn how to effectively control hip adduction Individuals demonstrate control of lateral shift during gait, Feet positioned 3.0 to 3.5 inches apart Trainers should teach exercise from feet together position before progressing to normal gait-width distance.

Foot

Unique, level of stability varies during gait cycle, Provide a solid platform to force production against the ground during push-off, it is stable Transitions from heel strike to accepting body weight on one leg, Ankles moves into pronation & foot forfeits some stability exchange for increased mobility to help absorb impact forces Foot prepares to push off, ankle moves back into supination , (w/ accompanying calcaneal inversion that decreases space between tarsal and metatarsal bones) , Becoming more rigid & stable again to increase force transfer into motion

Activation of TVA draws

Abdomen inward toward spine, Movement termed "centering" , "hollowing" , "drawing-in" in many training disciplines. Exercises performed during stage are designed to achieve isolated muscle action. McGill states: Centering services essential motor re-education purposes, Doesn't ensure same degree of stability as an activation pattern = "Bracing" Bracing: Co-contraction. Of core & abdominal muscles to create a more rigid & wider base of Support (BOS) for spinal stabilization Client's compare BOS w/ feet positioned close together to stance w/ feet wider apart, Greater stability Co-contraction of outer layer of trunk muscles during bracing movements widens BOS Client's should implement bracing when loading spine w/ external loads, Greater stability to spine. "Centering" should be mastered first, Reestablishing Core's reflexive function, Before introducing concept of "bracing".

Low back Pain

Affect 80% of U.S. population, Possible well-conditioned core reduce incidence of low back pain Individuals spend time seated using supportive devices = Similar neural-control deficits. Prevelance of inactivity & obesity In adults, Recommended training phase begin w/ establishment of stability w/in lumbar spine Exercise emphasize TVA activation & re-education of potentially faulty motor patterns. Obese clients find it uncomfortable to lie on their backs or adopt on all-fours position due to extra girth centered around abdomen. Standing or upright options for teaching core activation techniques to obese clientele

Compromised joint movement

Alters neuromuscular control & function, Promoting additional postural misalignments Faulty loading at joints inevitably increases overload & likelihood for further injury & pain Imperative trainers work to restore & maintain normal joint alignment , joint movement , muscle balance, & muscle function, all of which critical for optimal health & longevity Effective programming & attention to exercise technique will help trainer achieve this goal.

Hips typically exhibit between 100 & 135 degrees of flexion

Amount of hip flexion required during squat averages 95 degrees Shift pelvis posteriorly during downward phase to facilitate adequate hip flexion Hip-hinge exercise discusses later in section teaches clients how to shift their hips backward, Not only promote additional hip flexion, Reduce shearing forces across knee joint

Supine Drawing In - Centering

Ask client to assume a supine, bent-knee position, Align knees & second toe w/ anterior superior iliac spine (ASIS), Hold this position throughout the exercise Instruct client to place hands immediately medial to ASUS in line w/ umbilicus (belly button), Rest fingers over TVA All muscle contractions should be of a moderate intensity Throughout exercises, should be no movement of pelvis , low back, or rib cage Movement of these joints indicates activation of Rectus abdominis Inability to activate TVA was in an isolated manner Have client follow exercise progression outlines TVA contractions: Client should feel some tension develop under fingers. Not be possible w/ heavier individuals Purpose of these exercises to re-educate faulty neural pathways, Appropriate exercise volume conducted via perfect exercise technique will help regain reflexive function of core musculature Teach client how to perform these exercises by providing a demonstration of progressions & instructing him or her to perform them as frequently as possible for one or two weeks

Bend-Lift maneuver

Begins w/ a solid platform of good posture & bracing of abdominal region Movement-training sequence presented in Figures 9-53 through 9-55 follows part-to-whole teaching strategy

Five primary movements are:

Bend-and-lift movements Single-leg movements Pushing movements Pulling movements Rotational (spiral) movements Ex: Woman picking up her child, turning place the child in a high chair for dinner, Perform following: Bend-and-lift movement; Rational movement; a Single-leg movement to walk Pushing movement while extending her arms to place her child in high chair; Pulling movement to resist gravity while lowering her child into high chair. A track-and-field athlete execution a shot put performs the following: Bend-and-life & rotation movements coupled w/ a pushing movement while coming out of his or her explosive stance; Single-leg movement to slow down after release

Bend-And-Lift-Patterns

Bend-and-lift movements associated w/ squats = One of most prevelant activities used in strength training & throughout most individuals' ADL. Movement subject to much controversy given its potential for harm to knees & low back Faulty movement patterns associated w/ poor technique will disrupt muscle function & joint loading, Compromising performance & ultimately leading to overload & potential injury Evaluate lack of ankle mobility, Trainer can have client place one foot on a low riser [< 12 inches (30 cm)], positioning tibia perpendicular to floor Client leans slowly forward, Dorsi flexing ankle until heel lifts off floor or ankle falls into pronation Trainer can determine degree of motion achieved. Mobility of less than 15 degrees merits a need to improve ankle flexibility prior to teaching full bend-and-lift movement

Outermost layer

Consist of larger, more powerful muscles that span many vertebrae & are primarily responsible for generating gross movement & forces within the trunk. Muscles I region: Rectus abdominis erector spinae, External & internal obliques, Iliopsoas & Latissimus Dorsi Relationship between vertebrae & core muscles linked to segmented flagpole w/ guy wires controlled by neural subsystem. Segmented pole = vertebrae, Guy wires = core layer. Balanced tension w/in guy wires increases tension to stiffen flagpole & enhance spinal stability

Quadruped Drawing In (Centering) With Extremity Movement

Client effectively demonstrates his or her ability to activate core & pelvic floor muscles independent of diaphragm (during breathing) , Trainer can have him or her follow exercise progression for core stabilization Exercises train clients to stabilize lumbar spine w/ minimal loading on spine during movements of hips & shoulders Activate core muscles by working against gravity, Placing small loads on spine by moving hips & shoulders. Client's should activate core muscles as demonstrated in core-activation exercises Client adopt quadruped position w/ knees under hips & hands under shoulders. Client maintain a neutral spine Due to limb-length discrepancies between arms & legs , Slope of spine mat range from parallel w/ floor to a slight incline or decline Goal of this exercise is to elevate one arm and/or leg 0.5 to 1 inch off the floor & perform slow, Controlled extremity movements using a short lever w/o losing control of lumbar spine. Extending limbs too far = Loss of lumbar stability (increases lordosis) or forced hip & shoulder rotation = Lack of mobility w/in joints, & should be avoided Encourage clients to perform this exercise adjacent to a mirror Use visual feedback to monitor & control changes in spinal position, Indicate a loss of core control Purpose of exercises is to reestablish core control w/ minimal loading on supine during hip & shoulder movements. Appropriate exercise volume conducted via perfect exercise technique will help clients regain reflexive control of loading along lumbar spine.

Middle Layer

Consist of muscles & fasciae that encircle lower regions of spine. Envision a box spanning vertebrae from diaphragm to the sarcoiliac joint & pelvic floor, w/ muscles enclosing back, front & sides Box allows Spinal & sarcoiliac joints to stiffen in anticipation of loading & movement, Provides solid, stable working foundation from which body can operate. Muscles include: transverse abdominis (TVA), Multifidi, Quadratus lumborum, Deep fibers of internal oblique, Diaphragm, Pelvic floor musculature, Adjoining fascia Muscular layer = Core

Deep or innermost layer

Core consists of vertebral bones & discs; Spinal ligaments running along front, sides & back of spinal column; Small muscles span a single vertebra generally considered too small to offer significant stabilization of the spine. Segmental Stabilization of each individual vertebra, at end ranges of motion, Small muscles are rich in sensory nerve endings & provide continuous feedback to brain regarding loading & position of Spine

Healthy Individual Free from low-back pain

Core musculature functions reflexively stabilize the spine anticipation of & during voluntary or involuntary loading w/o need for conscious muscle action Creswell & Thortensson discovered TVA is key muscle works reflexively w/ neural system. Activation of core muscles, TVA produces "hoop tension" effect similar to cinching a belt around waist Contraction pulls on libia alba, Drawing abdominal wall inward & upward, Compressing internal organs to push upward against diaphragm & downward against pelvic floor musculature Increases Intraabdominal pressure, Creating lift pressure against diaphragm has attachments on second & third lumbar vertebra. Pulling upward & increasing traction between lumbar vertebrae Reduces joint & disc compression in lumbar discs by creating a rigid cylinder to stabilize spine against loading forces Hodges & Richardson found delayed or minimal activation of TVA Limited co-contraction of core muscles in individuals suffering from low-back pain Indicating neural control deficits

Joint movement

Dependent on nerve activity , Impulses are transmitted to intended muscles . Help stabilize & control movement within joint, Some degree of simultaneous co-contraction of antagonist also occurs Muscle becomes shortened, this increases tonicity within that muscle, Implying muscle now only requires a smaller or weaker nerve impulse to activate a contraction Individual tries to activate antagonist at joint, Reduced irritability threshold of agonist prematurely activate muscle & in turn inhibit action of antagonist Hypertonic muscles decrease neural drive to opposing muscle via reciprocal inhibition. Both muscles on either side of joint demonstrate weakness due to their altered length-tension relationship, Reciprocal inhibition of opposing muscles contributes to further weakening of antagonist, Reducing ability to generate adequate levels of force to move the joint. Body has to call on other muscles at the joint, assume the responsibility of becoming the prime mover , "Synergistic dominance" Ex: A tight hip flexor may inhibit & weaken gluteus Maximus , forcing hamstrings to assume a greater role in hip extension Hamstrings are not designed for function & suffer from overuse or over load , Increasing likliehood for tightness & injury. Hamstrings do not offer same degree of movement control of femoral head during hip extension as gluteus Maximus does, Increase likelihood for dysfunctional movement & injury to hip over time

Type 1 muscle fibers

Enhance stabilize muscle's capacity for endurance, Allows muscle efficiently stabalize joint for prolonged periods w/o undue fatigue Ex: Core muscles protect spine during loading & movement throughout day have higher concentrations of type I fibers Muscles primarily responsible for joint movement & generating larger forces generally contain greater concentrations of type II muscle fibers Muscles better suited for strength & power-type training (higher-intensity, lower volume)

Specific static-balance exercises performed over a fixed BOS that imposes small balance challenges on body's core

Exercises engage core musculature (centering, hollowing, or drawing-in) performing each exercise Exercises performed in seated positions using stable surfaces or unstable surfaces to impose small challenges to baldness centers Exercise progressively manipulate training variables to challenge the body's balance centers & LOS Exercises are most static in nature, implying once balance challenge is imposed, Postural control maintained for 5 to 10 seconds

Need for thoracic mobility

Greater during these movements than pushing & pulling movements, 3-D nature of movement patterns. Performing exercises w/o thoracic mobility or lumbar stability may comprise shoulders & hips, & increase likelihood for injury. Instructions provided for wood chop similar to those for performing hay baler. Mechanical are similar , Differences: Moving from low starting position to high ending position, Assuming staggered stance w/ opposite leg forward.

Proximal Mobility: Hips & Thoracic Spine

Improve mobility of two joints immediately adjacent to lumbar spine. Observations made during postural assessments & movement screens, Limitations in mobility w/in two areas in any of three planes should become focus. Trainers should follow fundamental principles when programming to improve mobility in regions: Two regions should exhibit good mobility in all three planes, prone to poor mobility. Static stretching improve muscle flexibility (or extensibility) precede dynamic mobilization exercises Improve muscle flexibility or joint mobility, Client's must avoid undesirable or compensated movements at successive joints Trainers should familiarize themselves w/ muscle anatomy & differentiate between mono- or uniarticulate muscles & biarticulate muscles Monoarticulate muscle crosses one joint, Biarticulate muscle crosses two joints Stretching a biarticulate muscle, Joint movement controlled both ends of muscle Avoid any compromise stability at adjacent joints. Ex: Performing a passive straight-leg raise to stretch hamstrings, Posterior tilting or pelvis must be avoided when hamstrings reach their limit of flexibility, Further stretching forces pelvic rotation & flattening of low back, Comprises stability of lumbar spine Body lacks ability to effectively stabilize entire chain, Supportive surfaces should be utilized while promoting mobility Individual effectively demonstrates ability to stabilize more proximal regions of body, Exercises can become more unsupported in nature. Transition coincide w/ shift from more isolated exercises to more integrated multi-joint & multiplanar movements Muscles contribute to movement in all three planes, trainers should incorporate flexibility exercises that lengthen muscles in all three planes. Important to focus on muscle's primary plans of movement before adding complexity by introducing movement in other planes Ex : When stretching hip flexors using a half-kneeling lunge stretch, Client should stretch muscle in Sagittal plane before incorporating frontal or transverse plane movements into stretch

Strengthening muscles to improve posture

Improve posture should initially focus on placing client in positions of good posture & begin w/ a series of low-grade isometric contractions, w/ client completing two or four repetitions of five to 10 sec each. Condition postural (tonic) muscles typically contain greater concentrations of type I fibers w/ volume as opposed to intensity. Higher intensities require greater amounts of force will generally evoke faulty recruitment pattens. Exercise volume can be gradually increased (overload) to improve strength & endurance & to reestablish muscle balance at joints Deconditioned individuals lack of ability to stabilize the entire kinetic chain, Initial emphasis should be placed on muscle isolation using supportive surfaces & devices prior to introducing integrated strengthening exercises

Proximal Stability of Scapulothoracic Region & Proximal Mobility of a Glenohumeral joint

Improve stability w/in Scapulothoracic region during upper-extremity movements Glenohumeral joint is highly mobile joint Ability to achieve degree of movement is contingent upon stability of Scapulothoracic region Synergistic actions of muscle groups working through force-coupled in region help achieve stability, Considering scapulae only attach to axial skeleton via clavicles Promoting stability w/in joint, requires muscle balance w/in force-couples of joint Muscles crosse Glenohumeral joint, require substantial levels of mobility. Implies program promoting Scapulothoracic stability need to include stretched to promote extensibility of both muscle & joint structures Static stretches improve tissue extensibility Dynamic movement patterns & strengthening exercises

Static Balance on a Single Leg

Individual demonstrates ability to effectively stand on one leg, Trainer introduce dynamic movements of upper & lower extremity over a static base support Trainer introduce various forms of resistance Increase stabilization demands & potential need for bracing during movement Balance Matrix: Created by Gary Gray, & incorporates both isolated & integrated upper-and lower-extremity movement in all three planes, All over a static base of support

Timeframe needed for five primary movements:

Individual differences, including current conditioning level, past experiences, body type, abilities, attitudes, motivational levels, emotional make-up, learning styles, & maturation levels Abilities: Inherited traits that are stable & enduring & underlie performance of many skills, Skills: Developed & modifies w/ practice

Directional pull of gravity

Intensity of hay baler is greater due to need to lift against force of gravity (concentric) Versus resisting or slowing effects of gravity (eccentric), done during wood chop. Trainers need to remember that thoracic spine offers greater mobility than lumbar spine. Need to emphasize lumbar stability & control of lumbar rotation while promoting movement w/ in thoracic spine

Movement efficiency

Involved a synergistic approach between stability & mobility where "proximal" stability promotes distal mobility Ex: If hips, trunk, & shoulder girdle stable, facilitated greater mobility of legs & arms. All joints varying levels of stability & mobility, tend to favor one over the other, depending on their function within the body Ex: While lumbar spine demonstrates some mobility (15 degrees rotation) , generally stable, protecting low back from injury.

Joint stability & Joint Mobility

Joint stability: Defined as ability to maintain or control joint movement or position. Achieved by synergistic actions of components of joint & neuromuscular system, Never compromise joint mobility Joint mobility: Range of uninhibited movement around a joint or body segment. Achieved by synergistic actions of components of joint & neuromuscular system, Never compromise joint stability Individuals exhibit optimal levels of stability & mobility Receive & interpret sensory info efficiently regarding movement Elicit necessary motor responses Sensory input & motor output are contingent on collaborative contributions from neurological & physiological systems, Proper joint mechanics

Mobility is compromised

Joint will seek to achieve the desired range of motion (ROM) by incorporating movement into another plane Ex: Client performs a birddog exercise w/ hip extension (sagittal plane movement) & lacks flexibility in hip flexors, Common to see extended leg & hops externally rotate in transverse plane(l thereby producing a compensated movement pattern. Adjacent, More stable joints need to compromise some degree of stability to facilitate level of mobility needed. Ex: Client exhibits kyphosis & attempts to extend thoracic Spine, Increase in lumbar lordosis often occurs as compensation for lack of thoracic mobility

During pushing & pulling movements

Key parascapular muscles co-contract to permit movement of scapulae, Help maintain proximity against rib cage. Thoracic spine lacks appropriate mobility, Results in compensation to stability w/in glenohumeral joint & muscle action w/in joint. Good thoracic mobility & muscle balance in Scapulothoracic region to effectively stabilize scapula & control its movement, More distal mobilizers can generate larger amounts of force Promoting stability w/in Scapulothoracic region requires thoracic mobility in addiction to other key factors: Tissue extensibility (both active & passive structures) Healthy rotator cuff muscle function Muscle balance within the parascapular muscles Ability to resist upward glide & impingement against the coracoacromial arch during deltoid action

Rotational movements

Last of primary movements & are perhaps some of most complex movements, Given how many follow spiral or diagonal patterns throughout body Patterns involve a series of muscle & Tissue arrangements = Anatomy trains or myofascial slings.

Stretch reaches muscle's limit of flexibility

Likelihood of compensated movement w/ further stretching increases. Client is stretching tight calf muscles w/ a forward lean against a wall, Ex: Trainer should be aware of ankle pronation during stretch Represents movement compensation, Create perception that client is stretching muscle further Avoid ankle probation during a calf stretch, Client can focus on keeping outer edge of heel in contact w/ floor or place a small riser under heels to promote ankle Dorsi flexion Reestablishing flexibility w/in calf muscles through SMR & static stretching techniques, Individuals progress to performing body-weight squats & multidirectional weight shifts or lunges to promote good ankle function

Thoracic spine

More mobile to facilitate a variety of movements in upper extremity

Scapulothoracic joint

More stable joint formed by collective muscle attachments between scapulae & rib cage Provide solid platform for pulling & pushing movements at glenohumeral joint Tolerate reactive forces transferred into body during these movements

Static Balance

Movement essential to complete all activities of daily living (ADL), Ability to move efficiently requires control of body's postural alignment or balance Balance is foundational element of all programming & should be emphasized early in the training program Core function established & individual show improvements in mobility & stability throughout kinetic chain. Balance enhances physical performance, but contributes to improving psychological & emotional stages building self efficiency & confidence Balance is subdivided into static balance, or ability to maintain body's COM w/in its BOS, Dynamic balance, or ability to move body's COM outside of BOS maintaining postural control & establishing new BOS

Normal position scapula

Muscle balance & effective force-coupling relationships. Design of shoulder girdle & properly toward bad posture in upper extremity = Myriad of lifestyle-related positions & activities, Compensated movement & shoulder injuries occur very frequently. Problematic movements are associated w/ arm abduction Lack of scapular stability during horizontal push-and-pull movements.

Force-Couple Relationships

Muscles rarely work in isolation, Function as integrated groups Function by providing opposing, directional, or contralateral pulls at joints to achieve efficient movement Ex: Maintenance of a neutral pelvic position is achieved via opposing force-couples between four major muscle groups that all had attachments on pelvis. Rectus abdominis pulls upward on anterior, inferior pelvis, Hip flexors pull downward on the anterior, superior pelvis. Posterior surface, hamstrings pull downward on posterior , inferior pelvis while erector spinae pull upward on posterior, superior pelvis. Muscles demonstrate good balance, pelvis holds an optimal position. One muscle becomes tight, alters relationship & changes pelvic position. Changes to pelvic position will affect position of spine above the femur , Below thereby altering posture & loafing on joints along kinetic chain Ex: Force-couple occurs at glenohumeral joint between deltoids & rotator cuff muscles during arm abduction. Deltoid acts as prime mover in arm abduction, it's collaborative action of the rotator cuff muscles, Respect to magnitude & timing of contraction, courses direct upward pull of deltoid to produce rotation. W/o action of rotator cuff muscles allows humeral head to glide inferiority during rotation, isolated, upward pull of deltoid impinge humeral head upward against coracoacromial arch

Lengthened muscle's On opposing side of joint

Muscles undergo an adaptive change & add sarcomeres in series, Shifting length-tension curve to right Demonstrate greater force-generating capacities in lengthened positions Demonstrate reduced force-generating capacity in normal-resisting-length or shortened positions

"Proximal Stability of the Scapulothoracic Region & Distal Mobility of Glenohumeral Joint"

Need for thoracic mobility, Scapulothoracic stability, Glenohumeral Mobility during pushing & pulling movements Primarily target shoulder girdle in a bilateral or unilateral fashion, Using supported backrests, Progress to become unsupported, better mimics most ADL Facilitate scapular stability during pushing & pulling movements, Mobility w/in thoracic spine must first be established. Gary Gray uses his Thoracic Matrix exercise, Moving thoracic spine 3-D Driving movement through each plane w/ arms or by using a dowel or light bar in various standing or lunging positions to integrate entire kinetic chain Gray utilizes Individual & simultaneous movement between planes - Moving body in multiple planes in same direction or moving body in multiple planes in opposite directions

Restoring

Normal length & muscles force-generating capacity = Physiological adaption best achieved by strengthening a muscle in normal-resting-length-positions, Not in lengthened positions Ex: Client exhibits protracted shoulders, Performing high-back rows using a full ROM to strengthen rhomboids Posterior deltoids is not recommended initially. Rhomboids demonstrate good strength in lengthened position, Momentum generated during a full-ROM roe will carry movement through weaker region, Decreasing ability to strengthen muscle where it needs strengthening. More appropriate approach is to perform this same exercise initially with either an isometric contraction in a good postural position or through a limited ROM

Issue of weifht transference

Onto stance-leg during gait Body moves to accept weight onto one leg, Requires weight shift over stance-leg whole preserving optimal alignment among hip, knee & foot Normally involves a 1-to 2-inch lateral shift of hips over the stance-leg, Coupled w/ a small change in hip angle, Tilting that hip upward by 4 to 5 degrees Line of gravity passes through Figure 9-51b, Right hip is elevated (as it would be during fair when be accepts weight onto the right leg) Line of gravity now passes through midline at an angle following angle of vertebrae & sacrum, Shifting LOG toward right femur. As right hip & femur are positioned closer to midline, classified as moving into adduction Movement involves collaborative actions of right gluteal group to control excessive hip tilting (by holding the left hip up) Weakness in any muscle groups can create potential knee issues by allowing excessive hip adduction increases Q-angle & place stress on ACL & medial knee structures

Gluteal bend-and-lift movement

Preserving integrity of knee, more critical to women given their larger Q-angle (Angel formed by the longitudinal axis of the femur & line of pull of the patellar ligament), Increased joint laxity associated w/ hormones , Smaller ligaments & surface area for attachment, & weaker muscles

Autogenic inhibition

Principle stating activation of a Golgi tendon organ (GTO) inhibits a Muscle spindle response. Static stretching is initially performed, Small change in muscle length stimulates low-grade muscle spindle activity & temporary increase in muscle tension Low grade muscle response progressively decreases due to a gradual desensitization of muscle spindle activity as the duration of the stretch progresses. Response = Stress-relaxation After seven to 10 seconds of a low-force stretch, Increase in muscle tension activates a GTO response Under GTO activation, muscle spindle activity & any tension in muscle are temporarily inhibited, allowing further muscle stretching Muscle tension is removed , Holding stretch beyond 10 seconds places stresses along collagen fibers, remodeling them as they pull apart & lengthen the tissue. Lengthen occurs when stretch force is applied = Creep. Reductions in tension & creep are possible explanations for increases in range of motion observed after an acute static-stretching session After terminating stretch , Muscle spindle quickly reestablishes it's stretch Threshold again (70% recovery of muscle spindle within fittest five seconds) Repeating static stretch a finite number of times produces a gradual increase in muscle extensibility Ex: Holding a hamstring stretch for 7 to 10 seconds will inhibit the muscle & allow greater stretching

Reciprocal inhibition

Principle stating activation of a muscle on one side of a joint coincides w/ neural inhibition of opposing muscle on other side of joint to facilitate movement. Contraction or active movement in agonist is performed for more than six seconds, Antagonist muscle becomes inhibited, allowing it to be stretched Ex: Firing Gluteus Maximus for 6 to 15 seconds reciprocally inhibits hip flexors temporarily, allowing hip flexors to them be stretched

Static balance-training devices

Proactive, dynamic, unstable devices considered reactive & can be utilized to train balance Surfaces offer greater challenge to training balance Both forms of training important developing efficiency w/in proprioceptive, vestibular, & ocular (visual) systems, training surfaces to use Depends on client's needs & goals Balance exercises incorporate dynamic balance training on stable surfaces to mimic ADL. Designing static balance-training programs, Trainer should follow stance-position progressions Trainer should identify which stance position challenges client's balance threshold & then repeat exercises outlined Single-leg stance represents final stance position, Trainers delay introducing balance exercises in this position until next training phase, After client learned how to correctly perform a single-leg stand Failure to do so may only promote further dysfunctional or compensated movement.

Single-Leg Movement Patterns

Progression for single-leg stance involves adding external resistance & increasing balance challenge. Holding a medicine ball or dumbbell, or introducing partial single leg squats, adds resistance to the kinetic chain & increases balance challenge Adding resistance, Increased load merits a reduction in volume , Longer test intervals between sets

Proximal Stability: Activating Core

Promote stability of lumbar spine by improving reflexive function of core musculature essentially serves to stabilize region during loading & movement Core functions to effectively control position & motion of trunk over pelvis , Allows optimal production, transfer, & control of force & motion to more distal segments during integrated movements Term generally refers to muscles of lumbo-pelvic region, hips, abdomen, & lower back.

Appropriate & consistent with clients goals

Reduce points of contact Add additional unstable surfaces

Moving feet closer

Reduces area, consequently BOS, reducing balance control. Body considered stable when it's line of gravity (LOG) falls w/in its BOS. LOG is theoretical vertical line passing through COG, dissecting body into two hemisphere (in sagittal & frontal planes) LOG or COG falls near, or outside of, BOS, when one challenges body's limits of stability (LOS), maintaining balance becomes more challenging. LOS is degree of allowable sway away from line of gravity that can be tolerated w/o need to change BOS

Objective of first phase of functional movement & resistance training

Reeastablish appropriate levels of stability & mobility within body Process begins by targeting an important proximal region of body, lumbar spine , encompasses body's center of mass (COM) & core. Stable, Programming begin by promoting stability of lumbar region through action & function of core. Indivisible demonstrates ability to stabilize this region, Program should progress to more distal segments Adjacent to lumbar spine are hips & thoracic Spine, both of which are primarily mobile. Thoracic Spine Mobility is restored, Program can target stability of Scapulothoracic region m. Once stability & mobility of lumbo -pelvic , thoracic & shoulder regions have been established, Program can shift to enhancing mobility & stability of distal extremities. Improve mobility w/in distal joints w/o developing proximal stability compromise stability w/in segments. Joint lacks stability, Muscles Mobilize joint need to alter true functions to assist in stability Ex: Individual lacks stability in Scapulothoracic joint, deltoids, responsible for glenohumeral movements, Compromise force-generating capacity & assist in stabilizing glenohumeral movement Altered deltoid function decreases force output Increase potential for dysfunctional movement & injury.

Body's COM

Region of core , & controlling COM w/in BOS is critical to balance training, Core conditioning & balance training are fundamentally same thing. Effectively activate & condition core & train balance - Trainers can utilize progressive training program outlined

Length-Tension Relationships

Relationship between contractile proteins of a sarcomere & their force-generating capacity Slight stretching of sarcomere beyond its normal resting length increases spatial arrangement between muscle's contractile proteins & increases its force-generating capacity Stretching of sarcomere beyond optimal length, however, Reduces potential for contractile protein binding & decreases the muscle's force-generating capacity Shortening sarcomere beyond resting length results in an overlap of contractile proteins, Reduces muscle's force-generating potential

COM or center of gravity (COG),

Represents point around which all weight is evenly distributed 2 inches anterior to spine in of first & second sacral joints, Varies in individuals by body shape, size & gender, being slightly higher in males due to greater quantities of musculature in upper body Person's COG shifts as he or she changes position, moves, or adds external resistance. BOS defines as two-dimensional distance between & beneath body's points of contract w/ a surface

Movement

Result of muscle force, Actions at one body segment affect successive body segments along kinetic chain Individual produces forces to move, Body must also tolerate the imposed forces of any external load, Gravity pulling down on body, & reactive forces pushing upwards through body, Remain stable

Rotator cuff

Rotator cuff muscles play an important role in initiating movement Facilitating an inferior glide of humeral head Glide is critical. Articulations surface of humeral head is almost twice size of glenoid fossa, Cannot operate as a true ball-and-socket joint. Rotator cuff muscles contract in anticipation of deltoid action, Collaborative action of supraspinatus acting as primary abductor for first 15 degrees of abduction & infraspinatus, Subscapularis, & Teres minor depressing head of humerus inferiorly w/ glenoid fossa permit rotation occur

Pulling movements

Same principles as pressing movements w/ regard to stabilizing Scapulothoracic region, Helps promote effective glenohumeral function Trainers need to identify whether they want to train a client to pull from a position of scapular stability. Implying movement is purely from shoulder, or intentionally incorpating scapular retraction into pulling motion Exercise to promote effective pulling can begin w/ more traditional movements primarily target shoulder girdle in a bilateral or unilateral fashion, Using supported packrests, progress to become unsupported which better mimics most ADL

Self-myofascial release & Static stretching

Self-administered, Helpful when recommending to clients they perform daily mobility exercises Client's perform small, continuous, back-and-forth movements on a foam roller or similar device, Covering area of 2 to 6 inches (5 to 15 cm) over tender region for 30 to 60 seconds Technique resets proprioceptive mechanisms of soft tissue Preliminary evidence suggests they SMR helps reduce hypertonicity (tightness) w/in underlying muscles & fascia, Improving ROM Static Stretched: Static stretches should be taken to point of tension, w/ client's performing a minimum of four repetitions & holding each repetition for 15-60 sec. Proprioceptive neuromuscular facilitation: Clients can perform a hold-relax stretch, Holding isometric contraction of agonist for a minimum for six seconds followed by a 10-30 second assisted or passive static stretch Dynamic & ballistic stretches: Type of stretching can be effective for individuals participating in sports that require ballistic activities

Muscle Immobilization, passive shortening, trauma, & aging all shorten muscles,

Shifting length-tension curve to left Represents loss in number of sarcomeres within myofibril of muscle fiber Muscle demonstrate good force-generating capacity in shortened position , Demonstrated reduced force-generating capacity in both normal-resting-length & lengthened positions Muscle can shorten little as two to four weeks when held in passively shortened positions w/o being stretched or used through a full or functional ROM Stretching a tight muscle doesn't immediately restore its normal force-generating capacity due to reduced number of sarcomeres present within myofibril. Passive stretching or elongation of a tightened muscle will gradually add sarcomeres back in line Help restore muscle's normal resting length & its length-tension relationship.

Primary single-leg pattern

Teaching clients how to lunge efficiently, Movement pattern often performs poorly in any plane Lunge mechanics are very similar to squat or bend-and-lift mechanics, Individuals deviate from basic movement principles

Teach client how to brace

Trainer can simply have client stand in a relaxed position & engage core muscles. Client can imagine a person standing in front of him or her who is about to deliver a quick jab to abdomen Anticipation of jab, individual should suffer up trunk region by co contracting both layers of muscles. Represents bracing , unlike centering acts reflexively, is a conscious contraction used for short time periods during external loading on spine Trainer can introduce standing static-balance training on stable surfaces before progressing to static unstable surfaces or dynamic unstable surfaces , Both which gradually increase balance challenge

Enhance tissue extensibility,

Trainers can employ several different stretching modalities. Self-myofascial release using a stick or foam roller-moving across the tender spots - Help increase ROM & reduce hypertonicity. Precede static stretching of shoulder capsule & of specific muscles of scapulae. When stretching the shoulder capsule w/ client, trainers must address inferior, posterior, anterior, & superior components Stretch inferior capsule using an overhead triceps stretch Stretch posterior capsule by bringing the arm across & in front of body. Alternative position for stretch is to stand adjacent to a wall flexion the arm in front of body to 90 degrees Resting full length of arm against wall, slowly rotate trunk inward toward wall Movement produces scapulae abduction, Common for clients have abducted scapulae as l postural deviation, Minimal focus during shoulder stretching Stretch anterior capsule using a pectoralis stretch Stretch superior capsule by placing a rolled-up towel 2 inches above the elbow against trunk, Grasping base of elbow & pulling it downward & inward

Two key movements involving diagonal or spinal pattens of movement within the arms, shoulder, trunks, hips, & legs are the wood chip & the hay baler:

Wood Chops: Exercise involves pulling action initiate movement down across front body, Followed by pushing action in upper extremity as arms move away from body. In addition, Requires stabilization of trunk in all three planes, & weight transference through hips & between legs to gain leverage & maintain balance. Concentric action during downward chop is achieved by using high anchor point Hay Balers: Exercise involves a pulling action to initiate movement up across front body, Followed by a pushing action in upper extremity as arms move away from body. Addition, Requires stabilization of trunk in all three planes, & weight transference through hips & between legs to gain leverage & maintain balance.