MF Unit 6
TFL action, response to dysfunction, and results of dysfunction
Action: Ant. rot. of ilium, hip flex/IR/Abd, BB of L-spine, Assists knee flex Response to dysfunction: tightens Results of dysfunction: Decreased post. rot. of ilium, restricted hip ext./ER/Add, contributes to increased lumbar lordosis
Anterior cervical musculature action, response to dysfunction, and results of dysfunction
Action: Cervical FB (flex) Response to dysfunction: Weakens Results of dysfunction: Weakness in FBing, loss of axial ext., inability to pull out of forward head posture
Abdominals action, response to dysfunction, and results of dysfunction
Action: Flex. of spine Response to dysfunction: weakens Results of dysfunction: Ant. pelvis tilt, increased lumbar lordosis
Glut med. action, response to dysfunction, and results of dysfunction
Action: Hip abd/IR (ant. fibers)/ER (post. fibers) Response to dysfunction: weakens Results of dysfunction: limited hip abd., loss of lat. hip stabilization
Hip adductors action, response to dysfunction, and results of dysfunction
Action: Hip add, assist hip flex, ant. rot. of ilium Response to dysfunction: Tightens Results of dysfunction: Restricted hip abd, restricted post. rot. of ilium
Pectoralis minor (upper part) action, response to dysfunction, and results of dysfunction
Action: Scapular protraction, accessory breathing Response to dysfunction: tightens Results to dysfunction: Scapular abduction with inf. angle outward rot., winging of scapulae inf. border, increased thoracic kyphosis
Upper trapezius, levator scapuale action, response to dysfunction, and results of dysfunction
Action: Shoulder elevation, assists shoulder adduction, cervical BB and SB, shoulder Response to dysfunction: Tightens Results of dysfunction: Scapula elevation/adduction, cervical jt. compression, restricted axial extension, limited cervical SB, Rot.
cervical erector spinae action, response to dysfunction, and results of dysfunction
Action: cervical BB (ext.) Response to dysfunction: tightens Results of dysfunction: Loss of FB, loss of axial ext., holds cervical spine in forward head posture
Erector Spinae action, response to dysfunction, and results of dysfunction
Action: ext. of spine Response to dysfunction: Tightens Results of dysfunction: Increased lumbar lordosis
Glut max action, response to dysfunction, and results of dysfunction
Action: hip ext., post. rot. of ilium Response to dysfunction: weakens Results of dysfunction: loss of hip ext., decreased post. rot. of ilium
Iliopsoas action, response to dysfunction, and results of dysfunction
Action: hip flex, assist in ER/Add, BB of L-spine Response to dysfunction: Tightens Results of dysfunction: restricted hip ext., tight ant. hip capsule, increased lumbar lordosis, decreased post. rot. of ilium, restricted hip ext/ER/Add
Pectoralis major (upper part) action, response to dysfunction, and results of dysfunction
Action: shoulder flexion, humeral horizontal add. Response to dysfunction: tightens Results of dysfunction: Restricted shoulder flex restricted horizontal add.
Rhomboids middle/lower trapzeius action, response to dysfunction, and results of dysfunction
Action: scapular add., fixes scapulae inf. angle to thoracic wall Response to dysfunction: weakens Results of dysfunction: Scapular abduction with inf. angle outward rot., winging of scapulae inf. border, increased thoracic kyphosis
Examples of Environmental (social) effects on posture
Adolescent females, having hit a growth spurt prior to their male classmates, will often assume a slouch position
Where does forward head posture begin
Hypomobile thoracic spine
Cervicothoracic junctional zone/region
Mobile cervical spine transitions to rigid thoracic spine 45 degrees facet orientation of cervical spine transitions to 60 degrees facet orientation of thoracic spine 1st rib articulates with superior demifacet only (all other ribs articulate with superior demifacet only and inferior vertebrae) muscular origin of anterior and medial scaleni to 1st rib, pulling it superior into the thoracic outlet
Example of Janda's treatment sequence
Mobilize mainly soft tissue, the joints if necessary. Stretch tight and shortened muscle using a combination of inhibitory techniques, which influence more muscle fibers and spindles. Strengthen weakened muscles using reflex methods such as PNF. Work/exercise within good/proper movement patterns.
Clinical example of shoulder dysfunction
Pectoralis major and upper trapezius (postural) shorted Pectoralis minor and mid/lower trapezius (phasic) are inhibited To restore muscular balance, first stretch tight/strong postural muscles to minimize phasic inhibition Strengthen phasic muscles and incorporate proper movements to restore balanced shoulder function.
Postural vs. Phasic muscles
Postural muscles respond to dysfunction by shortening. They are characterized by being genetically older, maintaining a higher resting tone than phasic muscles, being stronger than phasic muscles, maintaining posture during gait. Phasic muscles respond to dysfunction by becoming inhibited and weak. They characterized by having a lower resting tone than postural muscles
Examples of genetics effects on posture
Some things can be changed and some cant. Pt's have OA, diabetes, poor spinal curvature or even baldness. Education and prevention are best in these situations
Cervical/Upper thoracic Agonist/Antagonist Relationships
Tonic (postural) --- Phasic Cervical erection spinae --- Ant. cervical mm. Upper trap/levator scap --- Latiss. dorsi Pec. major (upper part) --- low/mid trap (upper part) Pec minor --- rhomboids
Lumbar/lumbopelvis agonist/antagonist relationships
Tonic (postural) --- Phasic Iliopsoas/TFL --- Glut max Hamstrings --- Quads Hip add. --- Glut med. Gastro/soleus --- DFs Erector spinae --- Abs
Postural effects of forward head posture
backward bending (extension) of the occiput/atlas Shortening of suboccipital muscles, resulting in potential impingement of the greater or lesser occipital nerves Forward bending of midcervical facet joints Cervical imbalance with a tendency toward DJD from C5-C7 Imbalance between the ant. cervical mm. (including suprahyoid and infrahyoid mm.) and post. cervical extensors Hyperactivity of masseters and temporalis to counter mandible's tendency to open Shoulder girdle protraction with internal rotation (latissimus, subscapualis, pectoralis, and teres major involvement) Muscular imbalance leading to abnormal muscle firing (some mm. become facilitated with trigger points) Maintenance of jts. and soft tissues shortened ranges, leading to restriction of jt. capsules and loss of proprioception Elevation of the first rib by increased scalene activity Ant. and post. restriction of the first rib artciulations Tendency toward thoracic outlet symptomatology Increased thoracic kyphosis with decreased lumbar lordosis Increased activity of the accessory respiratory mm. due to poor diaphragmatic breathing and poor expansion of lower rib cage
Treatment sequence according to text
begin treating superficial to deep, regionally to local 1. Apply soft tissue manipulation first; direct before indirect, superficial to deep. 2. Apply joint mobilization after the myofascial tissue has been normalized. 3. Elongate joint and myofascial tissues 4. Provide neuromuscular reeducation exercises. 5. Provide postural instruction for long-term self-care.
Examples of Recreation effects on posture
cyclists with short hip flexors and gymnasts with hypermobile everything
Examples of phasic muscles
longus colli, scalene, longus capitis, latissimus dorsi, middle/lower trapezius, rhomboids, upper extremity extensors, abdominals (rectus, obliques), gluteus maximus/minimus, vastus medialis, gluteus medius, and dorsiflexors
Lumbosacral junctional zone/region
mobile spine transitions to rigid pelvis saggital facet orientation of lumbar to coronal facet orientation of sacrum significant shearing forces at L5/S1 due to sacral flexion, wedging L5/S1 disc Often a region of facet tropism L5/S1 smallest neural foramina Iliolumbar lig. reinforcement to L4 and L5 in women but only L5 in men Most common area for disc herniations, 95% between L4 and S1
Thoracolumbar junctional zone/region
more rigid thoracic spine transitions to more mobile lumbar spine 60 degrees frontal facet orientation of thoracic spine transition to more saggital facet orientation of lumbar spine Costal articulations of ribs 10,11,12 are single attachments similar to 1st rib
According to Janda, What should be treated first when treating dysfunction
opposing shortened agonist muscle inhibits an antagonist muscle. The shortened muscle must be stretched before attempting to strengthen the inhibited muscle based on reciprocal inhibition. In this way the inhibited muscle will not have to work against the passive tension in the shortened muscle.
Subcranial junctional zone/region
rigid occiput transitions to mobile cervical spine transverse facet orientation of O/A and A/A transitions to 45 degrees facet orientation in frontal plane for the cervical spine No disc between O/A or A/A for reinforcement Bi-convex facets at A/A Multiple ligament reinforcement between O/A and A/a with prolific connective tissue
Examples of Occupational effects on posture
static repetitive postures lead to tissue adaptation. Consider the truck driver, secretary, dentist, and PTs
Examples of postural muscles
sternocleidomastoid, upper trapezius, levator scapulae, pectoralis major (sternoclavicular portion), pectoralis minor, upper extremity flexors, quadratus lumborum, erector spinae group, rotators, ilipsoas, rectus femoris, tensor fascia latae, hamstrings, pirformis, one joint hip adductors, and planatr flexors
Upper crossed syndrome
viewed from a lateral view and is the most common clinically. The tight/shorten muscles are typically the posterior tonic muscle group (upper trapezius/levator scapulae) and the anterior postural muscle group (sternocleidomastoid/pectoralis major and minor). The lengthen/inhibited muscles are typically the posterior phasic scapular stablizers (lower/middle trapezius) and deep cervical flexors (longus colli).
lower crossed syndrome
viewed from a lateral view. The tight/shorten muscles are typically the posterior tonic muscles (erector spinae, quadratus lumborum) and anterior tonic muscles (iliopsoas). The lengthened/inhibited muscles are typically the posterior phasic gluteal group (gluteus maximus/medius) and anterior phasic (abdominals)
Layered postural syndrome
viewed from the posterior view from top to bottom. Five layers of affected postural and phasic muscle groups will be affected. This type of syndrome is a sign of poor stabilization in the lumbosacral region. Layer one includes shorten, tight hamstrings (postural). Layer two includes weak gluteal muscles (phasic). Layer three includes tight trunk extensors. Layer four includes weak scapular stabilizers (lower to middle thoracic spine region). Layer five includes tight upper trapezius muscles
