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Description
Chapter 5 Notes
Transcript
Therapeutic Kinesiology Instructor Manual: Ch05 p.1
TK INSTRUCTOR MANUAL: CHAPTER 5
The Neuromuscular System
Chapter manuals include:
Objectives
Lecture Notes
Suggested Classroom and Student Development Activities
For other chapter-by-chapter resources, see:
Key Term Quizzes
Muscle Origin and Insertion Worksheets
Muscle OIAs List by Chapter
MyTest Test Bank
For additional resources see “Teaching Tips and Tools”:
7 research-based learning principles for kinesiology courses in massage
5-step self-directed learning cycle for body mechanics courses
Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories
OBJECTIVES
Describe and compare the major divisions of the nervous system.
Define a neuron, list and describe three types of neurons in the neuromuscular system.
List and describe the peripheral nerves and associated connective tissues.
Define neural tension and explain its implications in movement and bodywork.
Define a sensorimotor loop and describe how it works in faulty movement patterns.
Define and compare proprioception and perception.
Describe the stretch reflex and a reflex arc.
Describe the proprioceptor in tendons and two proprioceptors in joint capsules.
Describe specialized proprioceptive organs in the labyrinth of the inner ear.
Define the law of reciprocal inhibition and describe how it works in reflex movements.
List three types of movement assessments and three conditions they are used to assess.
Describe how to make a general assessment about whether a client’s pain pattern is generated by contractile or noncontractile tissues.
List the reasons for using resisted motion during a session, then describe the steps for performing resisted motion with a client.
Define a trigger point and its effects and describe the process of trigger point therapy.
List two muscle energy techniques and describe the steps for each.
Describe the dynamics of a stretch injury.
LECTURE NOTES
NEUROMUSCULAR (NM) SYSTEM
Introduction
Not actual body system: NS + muscular system
System that coordinates movement
Overview of nervous system
Central nervous system (CNS) = brain and spinal cord
Peripheral nervous system (PNS)
Autonomic nervous system (ANS): involuntary
Parasympathetic
Sympathetic
Somatic nervous system (SNS): voluntary
Neuron: nerve cell
Three parts: cell body, axons, dendrites
Three types: sensory, interneuron, motor
Synapse: Where nerves connect to nerves or end organs
Neuromuscular junction
Synapse between motor nerve and muscle
Also called motor end plate.
Motor points: Junction between motor nerve and muscle
In belly of muscle, area of greater electrical activity
Correspond with trigger points
c. Nerves: Groups of nerve fibers bundled into cords
Tracts: Nerves in brain or spinal cord
Peripheral nerves: Nerves in body
Extend out from brain and spine at nerve roots
Include cranial and spinal nerves
Include nerve plexus: intersecting nerve roots
Fascicles: Bundles of nerves
d. Function of CTs around peripheral nerves
CT makes nerves flexible and elastic
Help nerves slide and bend during motion
Pads nerves to withstand compression
Three layers
Epineurium: Wraps a single nerve
Perineurium: Wraps a nerve fascicle
Endoneurium: Wraps a single nerve fiber
Neural tension
Nerves can elongate 820% of resting length
Neural tension equalizes tension along nerve
Loss of extensibility in one area increases in another
Neural tension test
Example: slump test checks gliding motion of peripheral nerves
Entrapment restricts gliding, can cause symptoms
Neuromuscular patterns: Organization of movement pathways
NM patterns are stored in motor cortex
Myelin speeds conduction of impulses
Well-used NM pathways have thicker myelin
Sensorimotor loop: Continuous loop in NM system
Sensory input (feedback) ? motor output (responses)
95% of SM processes are subcortical
NM patterning method to change faulty habits
SENSORY RECEPTORS
Three types
Interoceptors (proprioceptors):
Pick up sensory information from muscles
Are the "eyes and ears of body"
Embedded in musculoskeletal tissues
Exteroceptors: Pick up sensory information from five senses
Visceroceptors: Pick up sensory impulses from organs
Proprioception
Awareness of posture and movement
Awareness of location of body in space
Proprioceptive organs found in muscles, tendons, joints
Perception
How the brain interprets proprioceptive input
Influences how brain coordinates motor responses
Can be subjective
Not always accurate, can become habitual.
Example: habitual off-center posture feels straight
Muscle cells: Two types
Motor cells: extrafusal fibers
Contractile fibers in muscles
Larger, more abundant muscle cells
Innervated by large-diameter alpha motor neurons
Sensory cells: intrafusal fibers
Smaller, less abundant muscle fibers
Innervate by small-diameter gamma motor neurons
Two types
First type registers muscle length changes
Second type registers rate of length change
Muscle approximation technique
Mechanical shortening and lengthening of muscle
Triggers relaxation and lengthening response
Thought to reset muscle spindles
REFLEXES AND MOVEMENT PATHWAYS
Reflex: Automatic movement response to stimuli
Reflex arc
The circuitry for simple reflexes
Example: knee-jerk test
Stretch reflex
Protective reflex that prevents overstretching
Stretch triggers muscle contraction
Regulated by muscle spindle
Two types
Tonic stretch reflex
Results in slow contraction
Activates postural response/”antigravity reflex”
Phasic stretch reflex
Elicited by quick stretch of muscle
Results in quick, protective contraction
Stretch injuries
Occur in two different ways
Muscle put on stretch while contracting
Example: punting hamstring strain
Muscle contracts while being elongated
Example: biceps pull when dropping heavy object
Golgi tendon organs (GTOs): Proprioceptive organ in tendons
Embedded along musculotendinous junction
Register increased tension on tendon
Triggers inhibitory relaxation response
Spindles and GTOs control rate/degree of motion
Joint proprioceptors: three types
Pacinian corpuscles
Found in joint capsules
Detect rapid changes in pressure and vibration
Ruffini endings
Embedded in skin around joints
Detect slow changes in position and angle of joint
Nociceptors
Sensory nerve ending that acts as pain receptor
Joint proprioceptors function as nociceptors when registering extreme
temperatures or pressures
Labyrinth: three-part equilibrium apparatus inside inner ear
Vestibule: Registers changes in position and velocity
Contains saccule and utricle
Inside are nerve cells, otoliths, and fluid
Semicircular canals: Register angular movement
Three fluid-filled canals in each plane
Maintain spatial orientation
Cochlea: Snail-shaped hearing apparatus
Reciprocal inhibition: Sherrington's law of muscle response
Describes firing pattern of opposing muscles
Opposing muscles share reciprocal innervation
One muscle relaxes when opposing muscle contracts
Explains how muscles work in reflexes
Protective reflexes
Extensor thrust reflex: Extends limbs when falling
Flexor withdrawal reflex: Protective flexion away from danger
Crossed extensor reflex: Lifts one foot while extending other
Kinetic chains: Functional series of successive joints and muscles
Are predictable movement pathways (e.g., extensor chain)
Can be open or closed chains
Continuity of tone along chain reflects muscle balance
Myofascial meridian
Term coined by Rolfer Tom Meyers in "anatomy trains"
Myofascial meridians originated in Rolfing recipe
Assessing kinetic chains
Determine three-dimensional integrity of myofascial system
What part of body moves in open/closed chain?
Is height, width, depth proportional/symmetrical?
Where are muscles along chain shortened/overstretched?
Are weight-bearing joints centered/balanced in extension?
Is tone along pathways even?
Is tone along bilateral pathway symmetrical?
Assessing inside line: Kinetic chain along inner leg and thigh
Obvious in movement of skiers and skaters
Imbalances in inside line
Genu valgum: knock-kneed pattern
Genu varum: bow-legged pattern
Three assessment channels to assess overall muscle and joint patterns
Palpatory assessment
Postural observation
Movement observation
MOVEMENT APPLICATIONS IN NM TECHNIQUES
Two general applications
Local applications
To elicit relaxation in specific muscle
To facilitate contraction in specific muscles
Global applications
To improve overall posture
To improve overall NM and movement efficiency
Active, passive, and resisted motion assessments
Used to assess source of musculoskeletal pain
Determine whether pain is coming from contractile or noncontractile tissues
Active motion: Client actively moves
Passive motion: Practitioner moves client
Resisted motion: Client moves against practitioner's resistance
Direct technique
Moves in direction that stretches tissues
Pulls tissues out of shortened position
Example: myofascial release techniques
Indirect technique
Moves in direction of shortened tissues
Takes client into pattern, creates slack in tissues
Example: straincounterstrain or positional release
Hold shortened position for 90 seconds
Slowly return area to neutral position, then stretch
Gives muscles time to reorganize resting tone
Active motion skills: Elements to assess
Alignment of joint in starting position
Where movement initiates, occurs, or is guarded
Range, pathway, and quality of motion
Client's willingness/reluctance to move
Where and what symptoms occur with motion
Client's reaction to symptoms
Reasons for using passive motion skills
To assess range of movement
To figure out which tissues generate pain
To stretch adaptively shortened tissues
To improve range of motion
Reasons for using resisted motion skills
To facilitate contraction of inhibited muscle
To organize and improve neuromuscular patterns
To perform muscle energy techniques
To determine treatment effectiveness with retesting
Trigger points (TrPs): Localized irritable and painful nodule in muscle
Active TrPs: Cause pain even in absence of movement
Latent TrPs: Only cause pain when under direct pressure
Active TrPs have four cardinal features:
Palpable nodular or band-like hardening in muscle
Localized spot of extreme tenderness in taut band
Digital pressure
Reproduces symptoms
Triggers jump sign: Protective reflexive movement
Direct pressure on trigger point relieves pain
Muscle energy techniques (MET)
Post-isometric relaxation (PIR)
Three steps: contractrelaxstretch
Have client contract target muscle against resistance
Have client relax target muscle
Stretch target muscle (should stretch further due to PIR response)
Reciprocal inhibition (RI)
Use PIR to stretch muscle
While stretching, have client contract antagonist to enhance stretch
Active pin and stretch steps
Have client contract target muscle against resistance
Pin one end of target muscle and hold
Have client stretch muscle away from pinned end
As client stretches, apply linear stripping along muscle
SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES
PROVIDE AN OVERVIEW OF THE CLASS
Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example:
Today's class covers:
Overview of the nervous system
Sensory receptors
Reflexes and basic movement pathways
Movement applications in neuromuscular techniques
Activities: Review, lecture, NM skills lab, recap, and homework
GOING OVER GUIDELINES EXERCISES
Elements to track while observing active movement (p. 118)
Steps for using passive motion (p. 118)
Steps for using resisted motion (p. 119)
EXPLORING TECHNIQUE EXERCISES
Muscle approximation (p. 107)
Slow movement to relax head and neck muscles (p. 110)
Trigger point therapy (p. 121)
Muscle energy stretch techniques (p. 122)
MOVEMENT EXERCISE: Post-Isometric Relaxation (PIR) and Reciprocal Inhibition in Stretching
Break students into small groups of three. Have each group come up with two stretching exercises that use both PIR (contractrelaxstretch) and RI (antagonistcontract). Then have one student from each group lead the class through both stretches.
© 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology
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