Advanced Stabilization and PNF 23 Full Slides PDF

Stabilization Advanced motions and engagement Functional Classification of Muscles Mobilizers – Global – Phasic Stabilizers – Local – Tonic generates torque – movement tension to control joint alignment...

Stabilization Advanced motions and engagement Functional Classification of Muscles Mobilizers – Global – Phasic Stabilizers – Local – Tonic generates torque – movement tension to control joint alignment producer minimal length change – isometric concentric power continuous activity with shock absorption movement high kinematic input Stabilizer – Global - mix Comerford (2001); Rood, Janda, Sahrmann (1993); Sahrmann (2000, 2001); Bergmark (1989) Function Classification with Spinal Muscles – pg. 423 Mobilizers – Global – Phasic Stabilizers – Local – Tonic Lumbar spine Lumbar spine Rectus abdominis Transversus abdominis External/internal obliques Multifidus QL QL - deep portion Erector spinae Cervical spine Iliopsoas Cervical spine Rectus capitis anterior and lateralis SCM Longus colli Scalenes Levator Upper trap Erector spinae Stabilization Progression – for trunk Through more challenging Through action in that posture posture or environment or environment For example Attain Sitting to standing to standing on one leg Maintain Firm surface to compliance surface to Sustain moving surface Single plane to multiple planes Stability Training Dynamic exercises within an equilibrium. ATTAIN: Joint positioning Postural Training External tape and bracing Internal muscle bracing and holding Isometric muscle contractions Endurance Stability Training MAINTAIN: Midrange motions Co-contractions Eccentric antagonist contractions Stability Training SUSTAIN: Outside base of support External perturbation Closed kinetic chain Open kinetic chain Emphasize ballistic forces Emphasize random forces General Movement Concepts - PNF Mobility Stability Controlled Mobility Skill Proprioceptive Neuromuscular Facilitation (PNF) Manual methods of promoting the response of neuromuscular systems. Methods are employed for altered or inefficient patterns of motion or posture. PNF (Ch 6; pgs. 215-223) Developed by physical therapists PNF use external stimuli to augment motor response Tactile Proprioceptive Visual Auditory Patterns of Facilitation …”the stronger muscle groups of a diagonal (p 215) pattern facilitate the responsiveness of the weaker muscle groups.”  Diagonals of Movement Innate path in which maximal response of the trunk and extremities can be facilitated. Head & neck, upper & lower trunk, upper and lower https://www.wikihow.com/Start-a-Lawn-Mower#/Image:Start- a-Lawn-Mower-Step-8-Version-2.jpg extremities. https://www.themanual.com/outdoors/how-to-split-wood/  “Normal coordinated patterns of motion are diagonal in direction with spiral components – Diagonals of Facilitate strongest Movement output.” Reflects functional relationship of trunk and extremities.  Mobility Stability Movement Controlled Requirements Mobility Skill  1. Impaired mobility 2. Impaired muscle Indications performance for PNF: 3. Impaired endurance 4. Impaired balance/ stability 5. Impaired posture 6. Pain impairments  Stand in the diagonal plane whenever possible. 1. Body Forearms will move within the Positioning and plane. Mechanics Manual contacts: Maximize to decrease pressure, specific to direction  Clear and concise. Begin by providing information about full response. 2. Verbal and Change to more simple cues for subsequent repetitions. Visual Cuing Alter tone according to goal Have patient follow motion with eyes  Resistance to motion enhances muscle activation. 3. Manual Manual contact always on the muscle contracting Contact and The direction, quality, and Maximal quantity of resistance are adjusted according to Resistance treatment goals. Resistance should allow full ROM.  Enhance muscle performance 4. Approximation prior to treatment. and Traction Traction – inhibition Approximation - facilitation 5. Stretch and Timing Quick stretch (used in Timing of firing through repeated contraction) cues and amount of enhances muscle firing. resistance for coordinated movement.  Techniques of Facilitation Techniques for Mobility Rhythmic initiation Techniques for Rhythmic rotation Controlled Mobility Repeated contractions Reversals of antagonists Slow reversal Hold and relax (prior lab) Slow reversal holds Contract and relax (prior Dynamic reversals of lab) antagonists Quick reversals Techniques for Stability Alternating isometrics Techniques for Skill – Timing for emphasis Rhythmic stabilization Stability – 1. Isometric Holds Resist antagonists in a predictable pattern; don’t release pressure until opposite direction is contacted Improve strength of antagonists. Improve balance of antagonists. Improve stability. Increase active and passive ROM following technique. Decrease pain. Stability – 2. Rhythmic Stabilization Resist from proximal to distal segments alternate in unpredictable pattern or rotation (co-contraction) Improve balance and stability. Improve strength. Integrate a new posture or ROM into function. Controlled Mobility – 1. Reversals of Antagonists Mid-range motions Slow Reversal; Slow reversal / hold To facilitate agonist. Improve balance between agonist and antagonist. Controlled Mobility – 2. Dynamic Reversals of Antagonists (Two movements – opposite directions) Improve strength in the available ROM. Improve balance and coordination of antagonist. Improve endurance of antagonistic patterns.  PNF is a manual therapy approach to therapeutic exercise. Treatment is based on Summary improving motions that are used for functional activities. PNF techniques are appropriate for different types of impairments.  Summary Stabilization Regional – check joints above and below Progressive development Attaining – just holding any position Closed chain or open chain Maintain – internal perturbations Person controls the motion within the base of support Sustain – external perturbations Person controls position against external forces or movement outside of base of support