BTM III - Basic Movement Patterns (23-09-24) PDF

PFYZ 104C - WS 2024/2025 BTM III Dagmar PAVLU, CSc. Doc. Dr. [email protected]  23.10.2023 Basic movements patterns (stereotypes) (acc Janda)  PROF. MUDR. VLADIMÍR JANDA, DRSC. Functional approach to musculoskeletal pain...

PFYZ 104C - WS 2024/2025 BTM III Dagmar PAVLU, CSc. Doc. Dr. [email protected]  23.10.2023 Basic movements patterns (stereotypes) (acc Janda)  PROF. MUDR. VLADIMÍR JANDA, DRSC. Functional approach to musculoskeletal pain syndromes Muscle imbalance theory upper crossed syndrome lower crossed syndrome layer (stratification) syndrome Evaluation of muscle imbalance evaluation of tight muscles analysis of muscular imbalance in standing analysis of basic movement patterns Treatment strategies  BASIC MOVEMENT PATTERNS ANALYSIS Overall information about movement quality of the particular subject: Hip extension Hip abduction Curl up (trunk flexion) Push up Neck flexion Shoulder abduction  WALKING one of the basic movement patterns Repetition from the 1st year definition walking phases difference between running and walking evaluation - which parameters we evaluate? walking with aids etc. CHARACTERISTICS OF MOVEMENT STEREOTYPES / PATTERNS (LOOSELY ACCORDING TO JANDA) A set of conditioned and unconditioned reflexes that repeat stereotypically A temporally invariant set of stereotypically repeating stimuli. The stereotype is unchanging in the short term  TWO BASIC TYPES OF STEREOTYPES / PATTERNS ACC. JANDA Stereotypes of the 1st order primarily determined by the anatomical structure of our body Stereotypes of the 2nd order developed over the course of life under the influence of many factors, different between individuals (the quality of our movement)  WHY WE DO THE EXAMINATION? an important part of the basic examination by a physiotherapist information about the quality of movement screening – the basis of further considerations during the examination ! incorrect movement stereotypes can lead to painful functional and later structural disorders of the movement system  PROCEDURE OF TESTING movement patterns are individualized typical NORMAL and ABNORMAL patterns can be recognized Testing of habitual way of movement performing: starting position NO verbal instruction NO tactile stimulation (palpation) observation and muscle timing + muscle activation evaluation 3x repetition of movemnt  ELECTROMYOGRAPHY ▪ diagnostic method ▪ sensing muscle action potentials ▪ surface and needle EMG ▪ movement patterns – surface electromyography (with permission from Satrapová, 2015)  6 BASIC MOVEMENT PATTERNS Hip extension Hip abduction Curl up (trunk flexion) Push up Neck flexion Shoulder abduction normal, correct movement wrong movement, deviations from the norm (altered pattern)  HIP EXTENSION one of the most important phases of the gait test is performed with the patient lying prone sequencing and degree of the muscle actication are observed  HIP EXTENSION M. gluteus maximus Hamstrings Spinal extensors L (kontra) Spinal extensors L (homo) Spinal extensors Th-L (kontra) Spinal extensors Th-L (homo) Shoulder girdle muscle (From: Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  ALTERED PATTERN Hamstrings and erector spinae are readily activated during the movement, whereas contraction of the gluteus maximus is delayed, decreased, or absent Erector spinae on the ipsilateral side or even the shoulder girdle muscles initiate the movement and activation of the gluteus maximus is weak and substantialy delayed  HIP EXTENSION (From: Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  HIP ABDUCTION Information about the quality of the lateral muscular pelvic brace and thus indirectly about the stabilization of the pelvis in walking It is tested with the patient in the side-lying position  HIP ABDUCTION M. gluteus medius and minimus M. tensor fascia lata prime movers M. quadratus lumborum pelvic stabilizer (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  ALTERED PATTERN Tensor mechanism compensatory hip flexion is observed instead of pure abduction Quadratus mechanism M.QL initiates the movement through elevation of the pelvis  HIP ABDUCTION (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  CURL UP (TRUNK FLEXION) Interplay between the usually strong iliopsoas and the abdominal muscles Initially, the examiner observes the patient´s spontaneous pattern of sitting up + plantar flexion  ALTERED PATTERN Curling movement of the trunk is minimal and the movement will be performed with an almost straight back and anterior tilt of the pelvis  CURL UP (TRUNK FLEXION) (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  PUSH UP Information about the quality of the stabilization of the scapula Push-up from the prone position  ALTERED PATTERN Excessive scapular rotation, elevation, adduction, or abduction The type of motion depens on what muscles are dominant elevation and downward rotation – dominance of levator scapulae winging of the scapula – not adequately function of m.serratus anterior  PUSH UP (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  NECK FLEXION Information about the interplay between the sternocleidomastoideus and the deep neck flexors this information is essential in estimating the dynamics of the cervical spine and is tested with the patient supine  ALTERED PATTERN When the deep neck flexors are inhibited and the sternocleidomastoideus is overactive, the jaw juts forwarts at the beginning of the movement with hyperextension in the cervicocranial junction  NECK FLEXION (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004)  SHOULDER ABDUCTION information about the coordination of muscles of the shoulder girdle test is performed while the patient is sitting with the elbow flexed to control undesired rotation  SHOULDER ABDUCTION Is a result of three components – abduction in glenohumeral joint, rotation of the scapula, and elevation of the shoulder girdle Movement is stopped at the point at which shoulder girdle elevation commences – usually approx. 60 degrees  ALTERED PATTERN Shoulder girdle elevation starts earlier or may ever initiate the movement Trunk lateroflexion  SHOULDER ABDUCTION (From Janda, V., Pavlů, D., Herbenová, A. et al., 2000 and 2004) THERAPY FOR CHANGES IN THE MOVEMENT PATTERNS cause of movement pattern disorder relaxation / stretching of overactive / shortened muscles mobilization, therapy of functional joint blockages facilitation / strengthening of muscles that are weakened ! Re-education of movement patterns fixation of newly learned patterns at the subcortical level  OTHER MOVEMENT PATTERNS Walking (see 1st year) Bending over Lifting weights Sitting down Getting up from a chair Etc. ANALYSIS – CORRECTION – EXERCISE – TRAINING + KNOWLEDGE of the subject ERGONOMICS  RECOMMENDED LITERATURE Janda V.et al.: Evaluation of Muscular Imbalance. In: Liebenson (Ed.) Rehabilitation of the Spine p.203-226, Lippincot Williams and Wilkins, Baltimore 2007 Lewit K.: Manipulative Therapy, Churchill Livingstone, 2009. ISBN 978-0-7020-3056-7 Kolář P.: Clinical rehabilitation, Praha, 2013, ISBN 978-80-905438-0-5  REQUIRED KNOWLEDGE characteristics of movement patterns / stereotypes according to Janda characteristics of the 6 basic movement patterns according to Janda examination principles reasons for examination examination procedure norm x deviation principles of therapy for changes in movement patterns  REQUIRED SKILLS After completing the practical training, the student must be able to: examine 6 basic movement patterns according to Janda evaluate the movement pattern performed recommend further investigation procedure based on the result of the examination of the movement pattern examine and evaluate any movement pattern, including consideration of the possible consequences of poor movement quality