BTM III PFYZ 0104C Muscle Tone Changes PDF

BTM III PFYZ 0104C Doc. Dr. Dagmar Pavlů, CSc. Katedra fyzioterapie UK FTVS  07.10. 2024 Changes in muscle tone Diagnostic and therapeutic procedures  Muscle tone ⚫ Variable tension in the muscle depending on the state of the CNS, related by palpati...

BTM III PFYZ 0104C Doc. Dr. Dagmar Pavlů, CSc. Katedra fyzioterapie UK FTVS  07.10. 2024 Changes in muscle tone Diagnostic and therapeutic procedures  Muscle tone ⚫ Variable tension in the muscle depending on the state of the CNS, related by palpation to the consistency of the muscle and the turgor of the surrounding tissues ⚫ The variable tone is closely related to the consistency (elasticity) of the muscle, which is a constant property ⚫ Rheological properties of fibrous tissue also participate in muscle tone / tension (Véle 2006)  Control of muscle tone Knowledge: subjects of physiology, anatomy,…..1.year - regulation of muscle tone, different levels of control,..  Muscle tone - quantitative assessment ⚫ Atonia (complete loss of muscle tone) ⚫ Hypotonia (decreased muscle tone) ⚫ Eutonia (normal muscle tone) ⚫ Hypertonia (increased muscle tone)  Assessment of muscle tone ⚫ aspection (basic orientation - muscle relief, joint position, body posture - basic information) ⚫ palpation = basic, most important procedure ⚫ passive movement ⚫ instrumental methods, algometers  Changes in muscle tone ⚫ Local tone changes ⚫ mostly signal damage in the peripheral area ⚫ Overall (resting) tone changes ⚫ subcortical regulation (RF, basal ganglia, cerebellum) (Véle 2006)  Muscle hyper-tone ⚫ As a result of morphological changes ⚫ spasticity ⚫ rigidity ⚫ As a result of functional changes (according to Janda) ⚫ dysfunction of the limbic system ⚫ impaired function at the segmental level ⚫ affected whole muscle ⚫ affected part of the muscle ⚫ nociceptive irritation ⚫ muscle shortening  TH - muscle hyper-tone ⚫ PHARMACOLOGICAL ⚫ SURGICAL ⚫ PHYSIOTHERAPY  Therapy of functional tone changes - hypertone Dysfunction of the limbic system Global relaxation Autogenic training Yoga Feldenkrais etc.  Therapy of functional tone changes – hyper-tone Impaired function at segmental level - whole muscle - part of a muscle Methods based on the principle of post-facilitation inhibition  Trigger points ⚫ TrP =trigger point, increased irritation in the tissue, increased sensitivity to touch ⚫ Examples of TrP types (according to Travell and Simons) ⚫ active - always spontaneously painful ⚫ latent - soreness only during palpation ⚫ primary - activated by overload ⚫ combined – a response to transferred phenomena, as a result of the activity of other TrPs  Therapy of functional tonus changes - hypertonus Nociceptive irritation Post-facilitation inhibition  Therapy of functional tone changes – hyper-tone Muscle shortening Post-facilitation inhibition - maximum resistance + stretch - Stretching Postfacilitation inhibition ⚫ Lewit: PIR ⚫ Janda: PIR + stretch ⚫ Zbojan: AGR (anti-gravity-relaxation)  PIR = Post-isometric relaxation method ▪ Lewit ▪ Principle: isometric contraction of the muscle is followed by its relaxation Procedure: muscle pre-tension (barrier) isometric muscle contraction ca 10 s (minimum resistance) release /relaxation relaxation phase (waiting for release, „melting phenomenon“) (use of eye sight, breathing)  PIR – principle ▪ autogen inhibition ▪ Golgi system To understand the principles and differences of individual techniques - recommended reading: https://www.physio-pedia.com/Muscle_Energy_Technique  Similar techniques (like PIR) ⚫ Mitchell (1948) ⚫ MET (Muscle energy technique) ⚫ Greenman ⚫ Differences ⚫ duration of isometric contraction ⚫ resistance magnitude ⚫ relaxation time ⚫ the number of repetitions  AGR = Antigravity relaxation method (acc Zbojan) Principle: ▪ isometric contraction of the muscle is followed by its relaxation ▪ both the isometric contraction and the relaxation phase are performed using the force of gravity Procedure ▪ the same as PIR, it is necessary to ensure such positions that it is possible to use the force of gravity  PIR followed by stretching ⚫ Janda (Post Facilitation Stretch) ⚫ Principle ⚫ the isometric contraction of the muscle is followed by its relaxation, which is used for subsequent manual stretching Procedure: ⚫ position between max stretch and max relaxation ⚫ isometric muscle contraction resistance ca 10 s (resistence medium to large) ⚫ release + immediately perform a stretch ⚫ use of eye sight, breathing  Reciprocal inhibition ⚫ Antagonist activation ⚫ Brügger: AEC (agistic - eccentric contraction procedures) ⚫ Other special techniques, e.g. PNF (3rd year bc. studies)  AEC = Agistic eccentric contraction procedure (technique) Principle ▪ Brügger (Concept of diagnostic and therapy of functional disorders of the locomotor system) ▪ reciprocal inhibition (activation of the antagonist leads to relaxation of the agonist)  AEC - technique ⚫ 1. phase: ⚫ concentric contraction without resistance, performend by antagonistic muscle groups (antagonists to muscles which are shortened; the shortened muscle is elongated) ⚫ 2. phase: ⚫ eccentric contraction (against manualy applied resisatance to the antagonists of the shortened muscle group)  Other procedures ⚫ Active movements (pendulum, swing, thrust) - characteristics see biomechanics, health TV,. ⚫ Passive movements, positioning - see 1st year ⚫ Manual techniques (massage, pressure, etc.) ⚫ Physical therapy modalities (see 1st year) – application of heat, application of cold,…….  Stretching - notes ▪ Different types ▪ PT – static stretching Principles position duration approx. 15 – 45 s respiration Decreased muscle strength introduction to therapeutic procedures Repetition 1st year ⚫ examination procedures evaluating muscle strength ⚫ manual testing ⚫ instrumental ⚫ special tests  Strength training ⚫ Static strength training (static strengthening) ⚫ Dynamic strength training (dynamic strengthening) ⚫ concentric ⚫ eccentric ⚫ Isokinetic training  Static strength training ⚫ early initiation of therapy ⚫ atrophy prophylaxis ⚫ selective choice of muscle groups ⚫ dosing option ⚫ coordination elements are not taken ⚫ no movement is performed ⚫ "non-physiological" form of training ⚫ slow fiber training, no effect on the "speed component"  Static strength training ⚫ Method of isometric contractions ⚫ Hettinger Recommendation / dosing ⚫ Intensity (50 – 70% of max. strength = optimal) ⚫ Duration of isometric contractions ⚫ 5 – 10 s (50 – 70% max. power) ⚫ 2 – 3 s (100% max. power) ⚫ number of repetitions ⚫ according to the condition of the patient Dynamic strength training ⚫ physiological and complex form of movement ⚫ variable load parameters ⚫ frequent application of devices and possible overload from incorrect instruction Dynamic strength training ⚫ concentric / eccentric Recommendation / dosing ⚫ number of repetitions ⚫ resistance (load)  Isokinetic training ⚫ testing and therapeutic options ⚫ precise dosing option ⚫ training recording and analysis ⚫ wide area of use ⚫ eccentric and concentric training option ⚫ requirements for service personnel ⚫ cost effectiveness  Strengthening hypotonic, hypoactive and weakened muscles ⚫ 1st stage hypertonic and shortened muscle groups treatmet minimal resistance training do not activate hypertonic and shortened muscles ⚫ 2nd stage strengthening in simple muscle interactions ⚫ 3rd stage strengthening and training of daily movements  IN PRACTICAL lectures evaluation of fascia evaluation of periosteal points  KNOWLEDGE ⚫ Definition of muscle tone ⚫ Changes in muscle tone - description ⚫ Therapeutic procedures to influence increased / decreased muscle tone ⚫ Characteristics and principles of therapeutic procedures: ⚫ PIR ⚫ PIR+stretch ⚫ AGR ⚫ AEC ⚫ other general procedures  SKILLS ⚫ Evaluation of muscle tone changes ⚫ Evaluation od fascia ⚫ Evaluation of periosteal points ⚫ Application of procedures for any muscle / group of muscles ⚫ PIR ⚫ PIR+stretch ⚫ AGR ⚫ AEC ⚫ other procedures (see 1st year of study – advanced methods, physical therapy) QUESTIONS ?