Anatomy - Fit and Functional

Anatomy
Introduction:
Structures and Movement
Structures
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Bones
Joints
Muscles
Nerves
Blood vessels
Bones
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The human body
contains 206 bones
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5 different types of
bone
{
{
{
{
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Long
Short
Flat
Sesamoid
Irregular
Anatomical Landmarks of Bone
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Tuberosity: Large bump on
the bone
Process: Projection from
the bone
Tubercle: Smaller bump on
the bone
All 3 of these prominences
usually serve as
attachment for other
structures
Spine or Spinous process:
Typically a longer and
thinner projection of bone,
unlike any of the other
prominences.
Anatomical Lanmarks Cont.
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Condyle: The long bony knobs at either end of a
lone bone.
Epicondyles: Small bony knobs that sometimes
appear just above the condyles of a bone.
Fossa: A smooth, hollow surface on a bone, usually
functions as a source of attachment for other
structures.
Facet: A smaller flatter smooth surface that
functions as a source of attachment for other
structures.
Notch: An area of bone that appears to be cut out
and allows for the passage of other structures such
as blood vessels or nerves.
Joints
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A joint (articulation) is the place where
two or more bones join together.
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Two major forms of joints.
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Diarthrodial
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Synarthrodial
Diarthrodial Joints
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Also known as synovial joints.
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These are the joints where the
most movement occurs.
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Divided into six different
subdivisions by their shape.
{
{
{
{
{
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Hinge
Ball and Socket
Irregular
Condyloid
Saddle
Pivot
Diarthrodial Joints Cont.
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Hinge Joint: This joint has one concave surface,
with the other surface looking like a spool of thread.
The elbow joint is an example of a hinge joint.
Ball and Socket: This joint consists of the rounded
head of one bone fitting into the cuplike cavity of
another bone. It is capable of movement in 3 planes
of motion about three axes. Both the hip and the
shoulder joint are examples of a ball and socket.
Irregular joint: This joint consists of irregulary
shaped surfaces that are typically either flat or
slightly rounded . The joints between the bones of
the wrist (carpals) are an example of an irregular
joint.
Diarthrodial Joints Cont.
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Condyloid Joint: This type of joint consists of one
convex surface fitting into a concave surface, it is
similar to the ball and socket but the condyloid joint
is only capable of movement in two planes about
two axes.
Saddle Joint: This type of joint is often considered a
modification of the condyloid joint. Both bones
hhave a surface that is convex in one direction and
concave in the opposite direction like a saddle.
These joints are rare, and the best example is th
joint between the wrist and thumb.
The Pivot Joint: This joint consists of one bone that
rotates about the other bone. An example of a pivot
joint is the radius bone rotating on the humerus.
Synarthrodial Joints
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Unlike diarthrodial joints, synarthrodial joints have
no seperation or joint cavity.
There are three subdivisions of synarthrodial joints.
{
Sutured
{
Cartilaginous
{
Ligamentous
Synarthrodial Joints Cont.
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Sutered Joint: This joint has no detectable
movement and appears to be sewn together like a
seam in clothing. The bones of the skull are the
classic examples of a sutured joint.
Cartilaginous Joint: This joint allows some
movement, but cartilaginous joints other than those
of the spinal column do not play a major role in
movement. This type of joint contains fibrocartilage
that deforms to all movement between bones and
also acts as a shock absorber between them.
Ligamentous Joint: This joint ties together bones
where there is very limited or no movement. The
joints between two structures of the same bone, like
between the shafts of the forearm and the lower leg
are example of ligamentous joints.
Muscles
Muscle tissue is often categorized into 3 types.
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Smooth: Muscle tissue which occurs in
various internal organs and vessels.
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Cardiac: Muscle tissue which is unique to
the heart.
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Skeletal: Muscle tissue which causes
movement of the bones and the joints.
Skeletal Muscle
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There are 7 types of skeletal muscle
{
Fusiform - a muscle that has the shape of a spindle, which is wider in the middle and narrows at both ends.
Greater range of motion, limited strength.
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Quadrate - a muscle that is square shaped with directly parallel fibers
Triangular – a wide origin that converges to a narrow insertion resembling a triangular shape.
Unipennate - fibers are on the same side of the tendon
Bipennate - fibers on both sides of the central tendon
Longitudinal - parallel fibers consisting of tendinous intersections that run perpendicular to the direction of the
{
{
{
{
fibers.
{
Multipennate - central tendon branches within a pennate muscle
*Most skeletal
muscles are either
fusiform or pennate
fibers.
General Stucture of Skeletal Muscle
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Skeletal muscle is encased by a form of connective
tissue known as the epimysium.
Within the epimysium are numerous bundles fo muscle
fibers thar are individually wrapped in a fibrous sheath
known as the perimysium.
Within the perimysium are muscle fibers, which are in
turn enclosed in a connective sheath known as the
endomysium.
Skeletal Muscle Structure Cont.
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A muscle fiber consists of a number of myofibrils,
which are the contractile elements of muscle.
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Individual myofibrils are enclosed by a viscous
material known as sarcoplasm and wrapped in a
membrane known as the sarcolemma.
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Lengthwise, myofibrils consist of bands of
alternating dark and light filaments of contractile
protein known as actin and myosin.
Skeletal Muscle Structure Cont.
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A myofibril is divided into a series of sacromeres, which are
considered the functional units of the skeletal muscle.
Sarcomeres contain and I-band, the light colored portion
where the protein filament actin occurs.
Sarcomeres also contain an A-band, the dark colored area
where the protein filament myosin occurs.
A sarcomere is that portion of a myofibril that appears
between two Z-lines.
Skeletal Muscle Fibers
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There are two primary types of skeletal
muscle fibers, fast twitch and slow
twitch.
Most muscles contain both types of
fibers, but depending on heredity,
function, and to a lesser degree,
training, some muscles may contain
more of one type of fiber than the
other.
Skeletal Muscle Fibers Cont.
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Fast Twitch Muscle Fibers:
These muscle fibers are
large and white and appear
in muscles used to perform
strength activities.
Slow Twitch Muscle Fibers:
These muscle fibers are
small and darker(red) in
than the fast twitch fibers.
They are slow to fatigue
and are prevalent in
muscles inolved in
performing endurance
activities.
Nerves
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The body has three main nervous
systems.
{
Autonomic Nervous System
{
Central Nervous System
{
Peripheral Nervous System
Nerves Cont.
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The Central Nervous System: This system
consists of the brain and spinal cord.
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The Peripheral Nervous System: This
system constists of 12 pairs of cranial
nerves and 31 pairs of spinal nerves.
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The Autonomic Nervous System: This
system is involved in the function of the
glands and smooth muscle tissue of the
body.
Nerves Cont.
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The nerve, or neuron consists of a nerve cell body and projections
from it, which are known as the dendrite and axon.
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The dendrite recieves information from the surrounding tissue and
conducts the nerve impulse to the nerves cell body.
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The axon conducts the nerve impulse from the cell body to the
muscle fibers.
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Motor nerves carry impulses away from the central nervous system.
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Sensory nerves carry impulses to the central nervous system.
Blood vessels
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The blood vessels bring nutrients to the muscle
tissue and carry away the waste products
produced by the muscle tissues expending energy.
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When the heart pumps, blood moves through a
huge vasculear tree consisting of arteries,
arterioles (smaller arteries), capillaries, veins, and
venules (smaller veins)
Blood Vessels Cont.
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The arteries and arterioles distribute blood to the tissues.
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Capillaries provide the blood directly to the cells.
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The veins and venules collect the blood from the capillaries
and return it to the heart. The veins contain small valves that
permit blood to flow in only one direction.
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Because the veins have to work against gravity, the skeletal
muscles act as muscular venous pumps that squeeze blood
upward past each valve.
Other tissues
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Other types of tissues associated with bones, joints
and muscles are fascia and bursa.
Fascia is another form of fibrous connective tissue
of the body that covers, connects, or supports other
tissues. One form of fascia is the sarcolemma of
muscle.
Bursa is a saclike structure that contains bursa fluid
and protects muscle, tendon, ligament, and other
tissues as the cross the bony prominences
described earlier. The bursa also provides
lubricated surfaces to allow tendons to glide directly
over bone without being worn away over time from
friction.
Motor Unit
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A motor unit is defined as a motor nerve and all the muscle
fibers it supplies.
The structural parts of the motor unit are the motor nerve and
the muscle fiber.
All of the motor units together are referred to as the body’s
neuromuscular system.
Motor Unit Cont.
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The motor unit functions by the impulse from the motor nerve crosses
the synapse at the myoneural junction and activates the release of
calcium through the sarcoplasmic reticulum and transverse tubules
causing the cross-bridges of the myosin protein filament to contact
the actin protein filaments and produce movement of the actin
filaments toward the center of the sarcomere, thus shortening the
sarcomere.
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Motor units differ widely in the number of muscle fibers innervated by
one motor nerve. The ratio of muscle fibers per motor nerve can
range from as low as 10 muscle fibers to as high as 2000 muscle
fibers per one motor nerve.
Movement
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Anatomical
Locations
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Superior
Inferior
Lateral
Medial
Anterior
Posterior
Proximal
Distal
Movement Cont.
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Planes: Human movement that takes
place from a starting(anatomical)
position.
{
{
{
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Sagittal
Horizontal(transverse)
Frontal
Axes: A straight line around which and
object rotates.
Movement Cont.
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Sagittal Plane: Passes from the front through the back of the
body, creating a left and a right side of the body.
Horizontal(transeverse) Plane: Passes through the body
horizontally to create top and bottom segments of the body.
Frontal Plane: Passes from one side of the body to the other,
creating a front side and a back side of the body.
Fundamental Movements
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There are three planes and
three axes with two
fundamental movements.
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In the sagittal plane, the
fundamental movements known
as flexion and extension.
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Flexion: Decreasing the angle
formed by the bones of the
joint.
{
Extension: Increasing the
angle formed by the bones of
the joint.
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In the frontal plane, the
fundamental movements are
abduction and adduction.
{
Abduction: Movement away
from the midline of the body.
{
Adduction: Movement
towards the midline of the
body.
In the horizontal (transeverse)
plane the fundamental
movement is simply rotation.
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Internal rotation: Rotation
towards the midline of the
body.
{
External rotation: Rotation
away from the midline of the
body.
Part 2:
Importance of Functional
Evaluation Test
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Balance
Coordination
Posture
Muscle Imbalances
Muscle Strength/Endurance
1 Leg Squat
-Client
squats down as far as possible on one leg.
-Check for lack of balance or instability due to decreased proprioception or
weakness in gluteus maximus
- Hip dropping due to weakness in gluteus medius
- Hip hikingdue to weak TFL and tight QL
- Hyperpronation of the foot due to weakness in the intrinsic foot muscles and lack
of proprioception
- Heel raise( due to tight calves)
-Tibial torsion - weakness of popliteus
-Hyperpronation exists the knees will “knock” or genu-valgus
-Pelvic tilt due to tight psoas and hamstrings
- Patella femoral shear due to tight quad, psoas and weak glute max
Fukuda Unterberger
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Testing the tonic neck reflex
Have client cover their ears/eyes
March 30 steps, if they turn more then 30 degrees
then it’s positive
Positive indicates balance and proprioceptive
dysfunction
Postural Foot Reaction
(Vele’s)
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Have the client take their shoes/socks off
Have the client lean forward without
bending at the waist
Looking for delay in toes gripping floor
Butler’s Slump Test
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Have patient sit at the edge of a table keeping the
spine in neutral
Extend knee (straighten leg) and have them feel
the tension
Now have them slump and tuck chin to chest. If
tension is greater or there is pain/tingling, this
indicates nerve entrappment.
Respiratory Patterns
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Lying down with hand on stomach and hand on chest,
Ask client to take a deep breath.
Notice where they breathe . If they breathe from the chest
they have poor core control and will have a harder time
squatting with a bar on their back.
Indicates inhibition of the diaphragm. Diaphragm is
important part of the core, so if it is weak, core strength
cannot be optimal.
Flexor Endurance
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Spine must remain in neutral
Have the patient sit up 3-4 inches
Make sure client does not poke chin forward
See how long they can stay up
This will reveal the strength of the abdominal flexors
Normal: 136 seconds male, 134 seconds female (ratio 0.84 extensors)
Vleeming’s Active
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Patient lies supine and flexes the hip
Watch for opposite leg lifting and/or lumbar rotation
Use form and force closure, shouldn’t be harder
Vleeming’s Resisted
Same as Active, except you lightly resist the patient
This test will reveal instability of the pelvis
Neck Flexion
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Patient lies supine
Instruct patient to lift head (flex neck)
Check to see if they poke their chin first or if they
have any neck shaking
Trunk Curl
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Have client lay supine
Check to see if they clear their scapula
Look for heel elevation
Look for abdominal yoking
This test will reveal the strength of the abdominal flexors
Squat
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Client squats down as far as possible
Dorsiflexion in the toes – indicates tight calves and eccentric weakness in tibialis anterior
Check for lack of balance or instability due to decreased proprioception or weakness in
gluteus maximus
- Hip dropping due to weakness in gluteus medius
- Hip hiking due to weak TFL and tight QL
- Hyperpronation of the foot due to weakness in the intrinsic foot muscles and lack of
proprioception
- Heel raise( due to tight calves)
Tibial torsion - weakness of popliteus
Hyperpronation exists the knees will “knock” or genu-valgus
Pelvic tilt due to tight psoas and hamstrings
Look for point of break when “buttocks tuck under”
- Patella femoral shear due to tight quad, psoas and weak gluteus maximus
1 Leg Stance
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Test for Gluteus Medius
To test: stand on 1 leg and hold position. Client has to have the foot high
enough so that it isn’t touching the floor and far enough away from the
opposite leg so it doesn’t rest on it. This should be repeated with eyes
closed
Looking for pelvic shifting (hip dropping)
Hyperpronation of foot
Pelvic swaying
Knee shaking
Gluteus Medius is very important in cases of low back pain. Client with
LBP will almost always have a weak glute medius on opposite side
Hip Extension
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Patient lies face down, have them extend the hip back for a few
controlled reps
Erector activation
Pelvic rotation
Scapulo-thoracic movement
Lumbo-sacral hyperextension, from compensation patterns
Decreased hip extension (tight psoas)
Compensating with knee flexion due to hamstring overload, weak
glute max and tight hip flexors
Check to see with form/force closure
Form closure is done with shoulder internal rotation (palms out)
Push-Up
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Have the patient perform a push-up
Delayed scapular movement due to tight rhomboids and traps, weak serratus
anterior
Trap elevation due to weak depressors and hyperactive upper traps
Scapular winging (full medial border) - weak serratus anterior
Scapular winging (inferior angle) - weak rhomboids
Scapular adduction – tight traps and rhomboids, weak pec major and anterior
delts
Poor lumbopelvic stability – weak core
This test will reveal shoulder insufficiencies, muscle imbalance, lack of core
strength
Sorenson’s Extensor
Endurance Test
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Have patient lie at the end of a table, pelvis on the edge
Have them extend lumbar spine (watch for
hyperextensions)
Time how long they are able to stay in that position
{
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Less than 60 seconds indicates dysfunction
This test will reveal weak extensor endurance capabilities.
Lumbar Joint P-A Test
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Have patient sit over the edge
Legs are curled together
Lightly press down starting at L5 to L1
If they have slight pain, have them straighten their legs
then retest
This test will reveal lumbar disc problems
Hip Abduction
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Patient lies on side
Have them perform a few repetitions of hip abduction with foot
internally rotated, slow and controlled.
Hip flexion (during first 40 degrees) due to psoas tightness orTFL overload
Hip hiking – weak glute med and overactive QL
Pelvic rotatation – weak core and glute med
Hip external rotation – piriformis tightness
Lack of hip abduction – tight adductors and weak glute med
Side Plank Endurance Test
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Have patient on side with elbow directly below the shoulder and hold body up
Test to see how long they can hold
Look for hip dropping – weak obliques
Hyperextension of low back – weak trunk
Shoulder shrugging – weak trunk and poor shoulder stability
Inability to extend hip – tight psoas
Kyphosis – tight pecs and lackj of T3/4 extension
Shoulder pain
This test will reveal core and shoulder weakness
Plank Endurance Test
Plank
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Lie face down on mat resting on the forearms, palms flat on the floor.
Push off the floor, raising up onto toes and resting on the elbows. Make sure
elbows are underneath shoulders.
Look for lumbar hyperextension – weak rectus abdominus
Inability to extend hip – tight psoas
Shoulder shrugging – weak trunk and poor shoulder stability
Kyphosis – tight pecs and lackj of T3/4 extension
Shoulder pain
Average time is about 45-60 sec.
Foam Roller Balance Test
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Have client remove shoes/socks
Walk straight on half foam rollers
This test will reveal core balance weakness, glute
med (lateral walk), and glute max issues
Wall Angel
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The client moves his feet a foot away from the wall. Shoulders are put into
abduction and externally rotated. Slide arms downward keeping entire back
flat against the wall then back to start position
Looking for chin poking – tight SCM and lack of T4 extension
Cannot keep pelvis against wall – lack of thoracic mobility
Cannot get forearms and hands against wall – tight pecs and delts , lack of T4
extension
This tests reveals shoulder and thoracic immobility, low back and neck
dysfunction
Wall Slide
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The client moves his feet a foot away from the wall. Shoulders are
put into abduction and externally rotated. Slide body downward
keeping entire back flat against the wall keeping hands stationary,
then back to start position
Chin poking – tight SCM and lack of T4 extension
Can’t keep pelvis against wall – lack of thoracic mobility
Can’t keep forearms and hands against wall – tight pecs and delts ,
lack of T4 extension
This tests reveals shoulder and thoracic immobility, low back and
neck dysfunction
Side Hop
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Hop from one foot to the other
Watch how client generates force to come off the ground.
Watch landing of each foot
Watch for buckling of the knee
Rolling of the ankle or any instability
Pain
Unable to balance during or after landing
Lunge
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Start with feet shoulder width apart. Step forward with front knee bent and lower back
knee toward floor keeping neutral spine. Then return to start.
Knee adduction – tight adductors, weak glute med and TFL
Knee shaking – weak quads, glutes and hamstrings
Pronation of foot - weak intrinsic muscles of the foot and poor proprioception
Leaning forward – tight psoas, weak core
Pause on return – weak posterior chain, imbalances
Knee pain
Cant reach floor with back knee – tight psoas and quad
Excessive knee over toe – lack of control
Lateral lean – weak core
Crossover
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Push up position with legs wider than shoulder width. Keeping back neutral
touch one hand to another and return to start position without shifting body.
Immediately repeat with opposite hand and continue to alternate.
Can’t keep neutral spine – weak core
Trap hiking – overactive traps
Scapular winging – weak serratus anterior
Hip rotation – weak trunk and glutes
Spinal Motion
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Test Standing extension
Test lateral Flexion
Test Flexion
These are only tests for pain and obvious restrictions
Hip Hinge
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Stand with feet shoulder width apart and knees slightly bent
Hold a pole from your head past your tail bone
Bend from the hips without letting the pole separate from the body
If pole moves from body you are going to far, Stay in a safe range of motion
Look for rounding the lower back: tight hamstrings or psoas
Going up on toes: poor core stability and poor motor control
Rounding upper back: tight pecs and lack of motor control throughout spine
Pain: can be a disc injury
This is an exercise that every client must master!!!!!!!!!
Foam Roller Supine Extremity raise
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Place roller along spine
Plant both feet on floor with knees bent
Pick up one foot and stabilize with the other
Knee or trunk shaking: weak glutes, core, calf and or lack of proprioception
Cant hold position: All around weakness/imbalance
REFERENCES
1. McGill SM. Spine instability. In: Liebenson C (ed) Rehabilitation of the Spine: A
Practitioner's Manual, 2nd edition. Lippincott/Williams and Wilkins, Baltimore,
2003 (sched pub).
2. Liebenson C, Hyman J, Gluck N, Murphy D. Spinal stabilization. Top Clin Chiro
1996;3(3):60-74.
3. Liebenson CS. Advice for the clinician and patient: Functional exercises. Journal
of Bodywork and Movement Therapies 2002;6(2)108-116.
4. Janda V, Va' vrova' M. Sensory motor stimulation. In; Liebenson C (ed). Spinal
Rehabilitation: A Manual of Active Care Procedures. Baltimore, Williams and
Wilkins, 1996.
5. McGill S. Stability: from biomechanical concept to chiropractic practice. J Can
Chiro Assoc 1999;43:75-87.
6. Janda V, Va' vrova' M 1996. Sensory motor stimulation. In Liebenson C (ed)
Spinal Rehabilitation: A Manual of Active Care Procedures. Williams and
Wilkins, Baltimore.
7. McGill, S, Ultimate Back Fitness and Performance: Ontario. Wabuno Publishers.
2004.