Monday, March 26, 2012

Home Program Stabilization for the pelvis and lower extremity in supine


Pictured to the Left:

1. In this example the patient has one towel under is lumbar spine and he is trying to pull that towel out laterally. He is, therefore, stabilizing his lumbar spine by holding the towel stationary against his own resistance.

2.The second towel is wrapped under his lower thigh and the patient is pulling it upwards. He is resisting this challenge by activating his hamstrings and foot stabilizers. He is stabilizing with the hip, knee and foot stabilizers.

Pictured Below:
3. The patient now begins to move his free leg and a variety of positions to challenge the stabilization at the lower back and his left leg.

Stabilization for Balance

For Balance the key spots that require stabilization (a isometric contraction, ideally with a rotational bias) are:
1. The pelvis, because it houses our center of gravity.
2. The hips, knees, and feet because these structures act as our base of support in standing.

Remember that balance is control and falling is a uncontrolled displacement of the body that occurs when our center of gravity moves beyond our base of support (tripping) or our base of support moves beyond our center of gravity (slipping). For maximum stability our center of gravity should remain equidistant within our bases of support.

After we have determined the cause of our pt's instability (refer to previous entry for the list of reasons) and the location (through the diagnostic motion evaluation, DME). We will treat the instability and provide home program for carry over.

The following post will provide examples of treatment and home program stabilization techniques.

These are also great exercises for your lower back, hip and SI patients!



Wednesday, March 21, 2012

How to train individuals with Balance Deficits

Balance is the ability to control one’s body either in a stationary position or while moving

Therefore:

Balance = Control

The muscles that are in charge of controlling our bodies and movement are our core muscles.

Therefore:

Balance = Core muscle control

Our Core muscles are stabilizers

Therefore:


Balance equals Stability

Note that we have core muscles in every joint they are:

  1. Deep
  2. One Joint muscle
  3. Oriented in a diagonal fashion
  4. Rotators

Reason’s why core muscles stop working:

  1. Inflammation/Trauma: For every cubic centimeter of inflammation a muscle shuts down by 1 percent.
  2. Alignment: “Alignment dictates function” due to the Length Tension Ratio which states that a muscle will contract with greatest vigor when it is at a particular length.
  3. Upper Motor Neuron Disease/Injury: Including; Stroke, Parkinson’s Disease, Dementia, TBI, etc…
  4. Lower Motor Neuron Disase/Injury: Including; Radiculopathy, Neuropathy, Compression
  5. Severe Atrophy: Someone who has been severely weaken by immobility due to coma, bed rest, inactivity, disease.

The key to treating Balance is to identify the factor or factors causing your patient to have poor core muscle function:

  1. Inflammation/Trauma: Exercise to train core muscles, (see below)
  2. Alignment: Release, Reposition, Re educate or Reposition/Re educate
  3. Upper and Lower Motor Neuron Disease/Injury: Remove Cause of disease if possible, treat symptoms with facilitation techniques, address possible alignment and inflammatory issues, and re educate.
  4. Severe Atrophy: Re education and training (see below)

To train these muscles appropriately we are required to perform an isometric contraction ideally in a rotational direction for a sustained period of time

To train Core muscles (Balance) we should perform exercises that:

  1. Are isometric in nature
  2. Resist a rotational movement
  3. Sustain a contraction for a period of time, up to a minute

Next entry will provide examples for Core muscle training of the lower extremities and abdominal core in Standing, Sitting and Supine.