Why is that muscle so tight?

We often think of neurological reasons (increased facilitation of the agonist, decreased reciprocal inhibition of the antagonist, increase gamma drive, etc), but how about the series elastic element (ie the connective tissue)? Or perhaps the sarcomere (individual contractile unit of the muscle)? How can we fix that? It is easier than you thought!

An oldie but a goodie. A great FREE FULL TEXT paper on sarcomere loss and how to prevent it. Yep, would you have guessed static stretching? Yes, this study was on mice and it seems plausible that it would be applicable to humans as well.

“When muscle is immobilised in a shortened position there is both a reduction in muscle fibre length due to a loss of serial sarcomeres and a remodelling of the intramuscular connective tissue, leading to increased muscle stiffness. Such changes are likely to produce many of the muscle contractures seen by clinicians, who find that such muscles cannot be passively extended to the full length, which normal joint motion should allow, without the production of muscle pain or injury.

…These experiments show that in addition to preventing the remodelling of the intramuscular connective tissue component daily periods of stretch of ½ h or more also prevent the loss ofserial sarcomeres which occurs in mouse soleus muscles immobilised in the shortened position.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf



link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf

#stretching #stretch #stretchingexercises #neurology

Stretching secrets, part 2

If you’re just catching this, go back to days and read the first part of this series and this will make much more sense

How can we use this newfound knowledge?

–How about to inhibit a hypertonic muscle?
-Lets take a common example: You have hypertonic hip flexors. You are reciprocally inhibiting your glute max. You stretch the hypertonic hip flexors, they become more hypertonic (but it feels so good, doesn’t it?) and subsequently inhibit the glute max more. Hmm. Not the clinical result you were hoping for?

–How about this: you apply slow stretch to the glutes (ie “reverse stretch”) and apply pressure to the perimeter, both of which activate the spindle and make the glutes contract more. This causes the reciprocal inhibition of the hip flexors. Cool, eh? Now lightly contract the glutes while you are applying a slow stretch to them; even MORE slow stretch; even MORE activation. Double cool, eh?

-Don’t believe us, try this on yourself, your clients, patients, willing family members and pets.

#reciprocal inhibition #stretching #activestretching #reciprocalinhibition #reflex #lengtheningmuscles

Stretching secrets.

Stretching secrets you need to know

-We know from studies out there that static stretching can lengthen muscle (actually add sarcomeres), but you need to do it 30 minutes per day per muscle; not fast..

-How about taking advantage of the stretch reflex and reciprocal inhibition?

-Reciprocal inhibition is summed up by this diagram. Note the direct Is afferent connection from the spindle to the alpha motor neuron; When the spindle is stretched, and the pathway is intact, the muscle contracts.

-Remember, ANY kind of stretch or anything that changes the length of the spindle will effect it. So what happens when you do a nice, long, slow stretch? You ACTIVATE the spindle, which activates the alpha motor neuron. If you stretch long enough, you may fatigue the reflex. So why do we give folks long, slow stretches to perform? Good question! Certainly not to “relax” the muscle!

-So, how can we utilize this reflex?
-How about to activate a weak or lengthened muscle?

-Did you notice the other neuron in the picture? There is an axon collateral coming off the Ia afferent that goes to an inhibitory interneuron, which, in turn, inhibits the antagonist of what you just stretched or activated. So if you acitvate one muscle, you inhibit its antagonist, provided there are not too many other things acting on that inhibitory interneuron that may be inhibiting its activity. Yes, you can inhibit something that inhibits, which means you would essentially be exciting it. This is probably one of the many mechanisms that explain spasticity/hypertonicity

More tomorrow on how to use this reflex to you and your patients advantage.
#stretch #stretching #stretchingexercises #stretchingexercise #reflex #1aafferent #
Image credit: Wikipedia

Anterior shoulder pain. A case

Can you figure out why this lady has anterior shoulder pain on the left side?

This patient presented with anterior shoulder pain near the deltoid on the left when performing a “downward dog“ type of yoga stretch. She also states she has decreased strength in these muscles.

On examination her shoulder had near full active and passive ranges of motion with some discomfort and restriction at the end point of forward flexion. Motor testing revealed all muscle strong and 5/5 with the exception of the serratus anterior. Can you see the winging of the scapula on the left?

The Serratus anterior is integral for helping position the glenoid with different shoulder motions ( including gait) and in this particular case, she has weakness. He is also involved with “background positioning“ via the basal ganglia and this patient is a Parkinson’s patient. Not that you are directly but are certainly indirectly related through their central connections.

Weakness can often be due to local injury or sometimes pathology effecting the long thoracic nerve at C5,6 and 7. She has moderate osteoarthritic changes in history of a fusion at this level.

Rehab for a start in addition to gentle mobilization included thoracic spine manipulation as well as scapular protraction/retraction exercises in both and against the wall as well as prone position

#shoulderpain #shoulders #serratusanterior #deltoids #deltoid #gait#gaitevaluation #rehabilitation #rehab

Left micro fracture and meniscal repair in a patient with lateral knee pain

-Can you guess why this gentleman has the lateral knee pain on the left side? Q angle is approximately 12°, pain upon valgus stress and compression on the left side. Degenerative changes noted on x-ray. Otherwise negative knee exam. Bilateral femoral retro torsion with bilateral internal tibial torsion and a forefoot supinatus with a forefoot adductus

Let’s look at those mechanics a little closer: Valgus knee stress over time caused increased pain on the lateral condyle. His internal tibial torsion and femoral retro torsion has him externalmy rotate both of his legs which puts him with an increased progression angle and weight bearing somewhat on the outside of his feet. Combine this with the forefoot supinatus and an inability to get the right first ray down and you have the prescription for increasing knee valgus with every step. Overtime, this compression slowly wore away his lateral femoral condyle and tibial plateau

How well do you think this micro fracture and medial meniscus repair will do on its own without intervention to decrease knee valgus and improve internal rotation of the hips?

#Microfracture #Pain#valgus#qangle#gaitevaluation #InternalTibialTorsion #FemoralRetroTorsion #femoralretroversion