Muscle Length Slides PDF

MUSCLE LENGTH DPT 722: Therapeutic Skills II Haley Juber PT, DPT  Appreciate basis of muscle length as related to range of motion, strength, and function. OBJECTIVES Understand relationship of posture, alignment, and movements associated with...

MUSCLE LENGTH DPT 722: Therapeutic Skills II Haley Juber PT, DPT  Appreciate basis of muscle length as related to range of motion, strength, and function. OBJECTIVES Understand relationship of posture, alignment, and movements associated with muscle length restrictions. Accurately perform muscle length testing. Provided a patient scenario, correctly list the muscles contributing to identified deficits. ABNORMAL END FEELS  ABNORMAL END-FEELS Help determine type of pathology Possible causes: Immobilization Trauma Malalignment Disease  ABNORMAL END-FEELS Soft Occurs sooner or later than usual within ROM or in a joint that normally has a firm or hard end-feel. “Boggy” When might this type of end-feel occur?  ABNORMAL END-FEELS Hard Occurs sooner or later than usual within ROM or in a joint that normally has a soft or firm end-feel Bony grating or bony block When might this type of end-feel occur?  ABNORMAL END-FEELS Firm Occurs sooner or later than usual within ROM or in a joint that normally as a soft or hard end-feel When might this type of end-feel occur?  ABNORMAL END-FEELS Empty No real end-feel because pain prevents reaching end of ROM No resistance is felt except for individual’s protective muscle splinting or spasm When might this type of end-feel occur?  CYRIAX ABNORMAL END FEELS Bone-to-Bone Springy Block Empty Capsular Muscle Spasm MUSCLE LENGTH  MUSCLE LENGTH Maximum extensibility of a muscle-tendon unit. Joint range of motion is affected by muscle ___________ and ___________. Abnormal length can lead to diminished joint ROM, abnormal movement patterns, pain, and compensatory postures. Prolonged positions can lead to shortening or lengthening of muscles  MUSCLE LENGTH Stretch weakness: Adaptive shortening:  MUSCLE LENGTH Head and Shoulders Lower Leg and Ankles  MUSCLE LENGTH FUNDAMENTAL CONCEPTS Tonic muscle: maintain upright posture Prone to tightness Phasic muscle: higher propensity to atrophy Prone to weakness  MUSCLE LENGTH PROCEDURE Requires maximal separation from the origin and insertion along a muscle’s line of pull One joint held in full ROM while the second joint is moved through full ROM Educate patient on purpose and process as being placed in full stretch can become uncomfortable Active or passive length assessment can be performed Depending on need (passive ankle dorsiflexion for adequate motion)  TECHNIQUES OF ASSESSING MUSCLE LENGTH OF UPPER QUARTER  UPPER QUARTER MUSCLE LENGTH Suboccipitals Pectoralis major – clavicular fibers Cervical Paraspinals Pectoralis minor Scalenes Pectoralis group Sternocleidomastoid Latissimus dorsi Levator Scapula Triceps Upper trapezius Biceps Pectoralis major – sternal fibers Wrist and finger flexors Wrist and finger extensors  TECHNIQUES OF ASSESSING MUSCLE LENGTH OF LOWER QUARTER  LOWER QUARTER MUSCLE LENGTH Piriformis Iliotibial band Iliopsoas Gastrocnemius Rectus femoris Soleus Hamstrings FUNCTIONAL RANGE OF MOTION  Activity Lumbar Hip Knee Ankle Shoe tying 120° flexion 106 – 117° flexion 120° flexion, 20° Foot on abduction, 20° lateral opposite thigh rotation 13 – 31° dorsiflexion Sitting and 35° flexion to 112° flexion 90 – 95° flexion (seat height rising from chair rise dependent) 20 -24° dorsiflexion, Ascending stairs 47 - 67° flexion 83 – 105° flexion 24 – 30° plantarflexion 20° (21 – 36°) Descending 36° flexion 86 – 107° flexion dorsiflexion, 26 – 31° stairs plantarflexion Putting on pants 90° flexion 60° to pick up 115° flexion, 20° 157° flexion Squatting object from abduction, 20° medial (with heels up) floor rotation 32° dorsiflexion, Tailor sitting 37° lateral rotation 33° medial rotation 26 – 29° plantarflexion Kneeling 144° flexion  DOCUMENTATION Objective: Posture (standing): forward shoulders, increased thoracic kyphosis; partially correctable with verbal/tactile cueing but patient unable to sustain longer than 30 seconds due to fatigue. Muscle length: tightness of bilateral suboccipitals, cervical paraspinals, pec major and minor with firm resistance at end range and patient reporting discomfort upon stretch.  REFERENCES Fairchild SL, O’Shea RK, Washington RD. (2018). Pierson and Fairchild’s Principles & Techniques of Patient Care. 6th ed. Elsevier: St. Louis, MO. ISBN-13: 978- 0323445849. Fruth SJ. (2018). Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures. 2nd ed. Jones & Bartlett Learning: Burlington, MA. ISBN-13: 978-1284099621. Norkin CC, White DJ. (2016). Measurement of Joint Motion: A Guide to Goniometry. 5th ed. F. A. Davis: Philadelphia, PA. ISBN-13: 978-0803645660.