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The locomotor system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
With the patient supine on the couch, assess straight leg raising: Lift the leg by placing your hand underneath the ankle and passively flex the hip, keeping the knee extended. When the limit is reached, perform the sciatic stretch test by passively dorsiflexing the ankle. The test assesses irritation of the low lumbar and upper sacral nerve roots. The result is positive if the patient complains of sensory disturbance (pains, pins and needles, or numbness) anywhere below the knee.Now ask the patient to turn over. Remove the pillow from the head of the couch and place it under their pelvis and abdomen. This slightly flexes the lumbar spine and is a comfortable position for the patient. Palpate down the spinous processes in turn and along the erector spinae muscles, looking for tenderness.Then perform the femoral stretch test. This is the counterpart of the sciatic stretch test and assesses irritation in the upper lumbar nerve roots, which contribute to the femoral nerve. Passively flex the person’s knee and, holding the foot, gently extend the hip. If this provokes spasm of the quadriceps and the patient complains of sensory disturbance over the front of the thigh, the test is positive.
Fascial Syndromes
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Second treatment – Subjective: The patient reported “feeling great” for 1 hour past treatment, followed by a gradual onset of symptoms. Pain remained at 6–7. She reduced the heat in the hot yoga classes by 5° and reported a 50% reduction in burning sensation post class. The patient also shared information regarding a “difficult childbirth” in 2012 when a tailgut cyst was removed post-partum. Treatment: Left quadriceps in a cephalad direction. Lower deep front line. Deep posterior compartment released with slow active flexion/extension of foot bilaterally. Left thigh anterior intermuscular septum treated in cephalad direction, posterior septum caudally. Right thigh septa treated cephalad and differentially to free adhesions caused by compression due to favoring. Left quadratus. Supported erector spinae. Quadratus lumborum. Results: While no visible changes were present, the patient reported feeling “different” with ease in overall tension.
Biomechanics of the Spine
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Amir Ali Narvani, Arun Ranganathan, Brian Hsu, Lester Wilson
The main extensors are erector spinae, multifidus and intertransversarii muscles. The main flexors are psoas, rectus abdominis, internal and external oblique and the transverse abdominal muscles. The first 50–60° of spinal flexion occurs in the lumbar spine, with the maximum percentage occurring in the L5–S1 region. Further flexion is caused by tilting of the pelvis, which is controlled by the posterior hip muscles. In complete flexion, the erector spinae become inactive due to the flexion–relaxation phenomenon. There is residual activity in the quadratus lumborum and lateral lumbar erector muscles when the superficial erector spinae are inactivated. The sequence of muscular activity is reversed in extension, with posterior rotation of the pelvis being caused by the gluteus maximus and the hamstrings.
An ergonomic welding torch reduces physical load response and improves welding quality in novices: a pilot study
Published in International Journal of Occupational Safety and Ergonomics, 2022
Christian Pilat, Christopher Weyh, Torsten Frech, Karsten Krüger, Emil Schubert, Frank-Christoph Mooren
Use of the ergonomic welding torch resulted in a lower relative muscle load of the trapezius pars descendens m. in both EVWT positions (1G: 14.86 ± 8.6 vs 21.49 ± 9.45%MVC, p = 0.048, g* 1.5, 95% CI [0.1, 2.9] (Figure 3a); 4G: 12.74 ± 6.94 vs 21.98 ± 12.09%MVC, p = 0.010, g* 2.4, 95% CI [0.7, 4.0])(Figure 3b)). Furthermore, the relative muscle load of the erector spinae m. (15.1 ± 6.93 vs 19.9 ± 4.96%MVC, p = 0.037, g* 1.4, 95% CI [−0.1, 2.8]) (Figure 3a) and the infraspinatus m. (13.7 ± 13.14 vs 17.8 ± 13.88%MVC, p = 0.030, g* 1.5, 95%CI [0.1, 2.9]) (Figure 3b) was lower in position 1G and 4G, respectively, in favour of the ergonomic welding torch. Regarding all other investigated muscles there were no differences (Figure 3a and b).
Asymmetric atrophy of the multifidus in persons with hemiplegic presentation post-stroke
Published in Topics in Stroke Rehabilitation, 2021
Wookyung Park, Jongwook Kim, MinYoung Kim, Kyunghoon Min
We observed that in the chronic phase (>9 months) post-stroke, asymmetric atrophic change occurred in the multifidus muscle of the weak, more-affected side in persons who could independently ambulate (average mRS score 2.6) (Figure 4). The multifidus is a local stabilizer of the lumbar spine that is responsible for tonic trunk control.28 When the paraspinal muscle properties were compared between the less chronic and chronic phases, the erector spinae on the more-affected side and the multifidus on the less-affected side significantly increased in size in the chronic phase (Figure 5). The erector spinae is a phasic and dynamic muscle producing muscle torque, whereas the multifidus is a postural and tonic stabilizer.28 The larger size of the erector spinae on the more-affected side in the chronic phase could be interpreted to result from compensatory phasic muscle activation.15 On the less-affected side, the chronic phase group showed an increased size of functional multifidus muscle, which is responsible for spinal stability. These results suggest that the recovery pattern of the trunk muscles in unilateral hemiplegia could differ between sides.
A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises
Published in Disability and Rehabilitation, 2023
Sena Özdemir Görgü, Zeliha C. Algun
Postural corrective exercise group (PCEG [n = 21]): Participants in this group underwent an exercise program consisting of 16 sessions twice per week for 8 weeks in the presence of a specialist physiotherapist [36,37]. Each participant performed 8 to 12 exercises, and each training session lasted an average of 1 h. In the postural corrective exercise program, exercises for strengthening the erector spinae and postural muscles, stretching the pectoral and hip flexor muscles, and breathing was performed. The number of repetitions was gradually increased. The details of the program are summarized in Supplementary Appendix A and examples of these postural corrective exercises are shown in Figure 3.