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Monday, 8 June 2015

MUSCLE IMBALANCES

Janda's classification of muscle imbalances

Throughout Janda's observations of patients with neurological disorders and chronic musculoskeletal pain, Janda found that the typical muscle response to joint dysfunction is similar to the muscle patterns found in upper motor neuron lesions, concluding that muscle imbalances are controlled by the CNS (Janda 1987). Janda believed that muscle tightness or spasticity is predominant. Often, weakness from muscle imbalance results from reciprocal inhibition of the tight antagonist. The degree of tightness and weakness varies between individuals, but the pattern rarely does. These patterns lead to postural changes and joint dysfunction and degeneration. Janda identified three stereotypical patterns associated with distinct chronic pain syndromes: the upper-crossed, lower-crossed, and layer syndromes. These syndromes are characterized by specific patterns of muscle weakness and tightness that cross between the front and the back of the body. 


Upper-crossed Syndrome:

Upper-crossed syndrome (UCS) is also referred to as proximal or shoulder girdle crossed syndrome. In UCS, tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Janda noted that these focal areas of stress within the spine correspond to transitional zones in which neighboring vertebrae change in morphology. Specific postural changes are seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae (figure 4.2b). These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988).

lower-crossed Syndrome:

 Lower-crossed Syndrome (LCS) is also referred to as distal or pelvic crossed syndrome. In LCS, tightness of the thoracolumbar extensors on the dorsal side crosses with tightness of the iliopsoas and rectus femoris. Weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius. This pattern of imbalance creates joint dysfunction, particularly at the L4-L5 and L5-S1 segments, SI joint, and hip joint. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension. If the lordosis is deep and short, then imbalance is predominantly in the pelvic muscles; if the lordosis is shallow and extends into the thoracic area, then imbalance predominates in the trunk muscles. Janda identified two subtypes of LCS: A and B. 

Patients with LCS type A use more hip flexion and extension movement for mobility; their standing posture demonstrates an anterior pelvic tilt with slight hip flexion and knee flexion. These individuals compensate with a hyperlordosis limited to the lumbar spine and with a hyperkyphosis in the upper lumbar and thoracolumbar segments. 

Janda's LCS type B involves more movement of the low back and abdominal area. There is minimal lumbar lordosis that extends into the thoracolumbar segments, compensatory kyphosis in the thoracic area, and head protraction. The COG is shifted backward with the shoulders behind the axis of the body, and the knees are in recurvatum. 

Deep stabilizing muscles responsible for segmental spinal stability are inhibited and substituted by activation of the superficial muscles (Cholewicki, Panjabi, and Khachatryan 1997). Tight hamstrings may be compensating for anterior pelvic tilt or an inhibited gluteus maximus. LCS also affects dynamic movement patterns. If the hip loses its ability to extend in the terminal stance, there is a compensatory increase in anterior pelvic tilt and lumbar extension. This compensation creates a chain reaction to maintain equilibrium, in which the increased pelvic tilt and anterior lordosis increase the thoracic kyphosis and cervical lordosis (see chapter 3).

In adults, muscle imbalance begins distally in the pelvis and continues proximally to the shoulder and neck area. In children, this progression is reversed, and muscle imbalance begins proximally and moves distally. 


For further details and treatment options kindly contact our Certified Physiotherapist via our Contact Us page. 

ANATOMY OF THE SPINE

THE HUMAN SPINE



Introduction

The spine is made of 33 individual bones stacked on one another extending from the head down to the hips. Throughout the length of the spine the bones are connected to one another by ligaments and muscles which help keep the spine aligned.The spine provides most of the support your body needs for stable movements, allowing you to stand upright, bend, and twist. Protected deep inside the bones, the spinal cord connects your body to the brain, allowing movement of your arms and legs. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Keeping your spine healthy is vital if you want to live an active life without back pain.


Spinal curves


When viewing the spine from the front it seems straight but in fact when viewed from the side a noticeable natural S-shaped curve is present. The neck (cervical) and low back (lumbar) regions have a slight concave curve, while the thoracic and sacral regions have a convex curve. The curves work like a spring providing stability and allowing normal range of motion.



Cervical (neck) : Highlighted in RED 

  1. The main function of the cervical spine is to support the weight of the head
  2. The cervical spine has the greatest amount of flexibility and range allowing the head to flex, extend, rotate and tilt in multiple directions.


Thoracic (mid back) : Highlighted in BLUE

  1. The main function of the thoracic spine is to hold the rib cage and protect the heart and lungs. 
  2. The thoracic spine has the least amount of range compared to the other regions.


Lumbar (low back) : Highlighted in YELLOW

  1. The main function of the lumbar spine is to bear the weight of the body. 
  2. The Lumbar vertebrae are much larger in size in order to absorb the stress of lifting and carrying heavy objects.
  3. Most back injuries affect the Lumbar region


Sacrum : Highlighted in GREEN 

  1. The main function of the sacrum is to connect the spine to the hip bones (iliac).
  2. The Sacrum together with the ilium bone form a ring called the pelvic girdle.


Coccyx region : Highlighted in PURPLE 

  1. the four fused bones of the coccyx or tailbone provide attachment for ligaments and muscles of the pelvic floor.


Intervertebral discs:


Each vertebra in your spine is separated by an intervertebral disc, preventing the bones from rubbing together. Discs are designed like a radial car tire. The outer ring, called the annulus, has criss-crossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra. Inside the disc is a gel-filled center called the nucleus, much like a tire tube.With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older. Injury and strain can cause discs to bulge or herniate, a condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain as mentioned in the previous post (Herniated Disc). 

Friday, 5 June 2015

HERNIATED DISC (SLIPPED DISC)

Herniated discs rather known as slipped discs or even prolapsed discs are serious conditions that can affect many people around the world regardless of age or gender.  A slipped disc occurs when the jelly like structure called the disc begins to compress the spinal nerves.



Ever wondered why we have discs and what they do? Without discs humans wouldn't be able to bend backwards, forwards or in any given direction. Discs allow flexibility and also act as shock obsorbers for the back. Discs are made up of strong rubber like tissue mainly forming the outer layer of the disc known as the Anulus Fibrosis. The inner portion of the disc is called the nucleus pulposus. The secrect to all disc prolapses is the nucleus pulposus. 

Although it is called a slipped disc, in fact the disc does not move from its original position, the key element is the shifting of the nucleus pulposus within the disc. If you refer to the first image it is noticable that the disc body is still in the same position but the only difference is the shifting of the nucleus pulposus from the inner certer of the disc body to the outer section possibly causing nerve compression causing radiating pain either in the upper or lower extremities. 

The reason for the dispositioning of the nucleus can be caused by several factors including;

1. Bad sitting posture
2. Incorrect lifting methods
3. Heavy labor
4. Following accidents, or fall injuries.

Most people ask the question, can it be repaired without surgical intervention? The answer is most definitely yes. There are many modern and afordable techniques developed over the past years that can help relieve pain and correct the position of the nucleus pulposus which in most cases leads to 80% pain relief in most patients.

The most noticable technique known is the Mckenzie treatment method used by many physiotherapists including our highly trained therapists.

To understand further on the mckenzie treatment method feel free to contact our specialised physiotherapists via our CONTACT US page for further details.

Thursday, 4 June 2015

POSTURE AND BACK PAIN

DOES BAD POSTURE CONTRIBUTE TO BACK PAIN

When surfing the internet to understand the causes of back pain the first likely thing you are going to come across is "posture". Thousands of websites and articles all talking about your body's posture when you sit, stand or even when you are lying down exhausted and just trying to get a good nights rest.

Yes! posture most certainly plays one of the biggest roles in both neck and back injuries, but unfortunately it is not the only factor that causes back pain. almost all individuals suffering from back pain injuries will have a certain level of postural dysfunction and telling an individual to sit straight will not solve the problem. Let us take a small journey to further understand posture and how it may leads to back pain. 

The simplest definition for the word posture is basically the position of the human body either in standing or sitting. Posture is based on several factors involving the head, shoulders, upper back, lower back and hip position. the above mentioned factors respectively have major influences on the posture of the human body.

Figure 1 (Types of Postures)

WHAT IS IDEAL POSTURE

To have a better understanding of Ideal posture kindly refer to Figure 1 on the far left side labeled 'IDEAL'. comparing this image with the remaining four concentrate on the vertical line that runs through the body, this line is called the vertical center of gravity line which is a virtual line used by all qualified clinicians and physiotherapists to help assess a patient's posture. As seen clearly in the first figure the virtual line shows that the above mentioned structures are all in line with the center of gravity passing through the center of the body.

Why be within the center of gravity. The reason is that all objects are at its most stable form when being within the center of gravity. This allows most of the muscles of the body to stay in a relaxed state, Unlike the other 4 images. Once the human body begins to sway away from the center of gravity certain muscle groups begin to activate and the reason for that is VERY SIMPLE. Your muscles are simply counteracting the force of gravity to stop you from falling over, but unfortunately over time this automatic mechanism causes unnecessary added stress on certain muscle groups leading to muscle fatigue, weakness and tightness. 


We have understood the fact that posture is a main contributor to back pain and in a brief paragraph how it does so, but the big question here is 'What causes bad posture?' and 'How do we treat bad posture?'. 

Most postural dysfunctions arise from a combination of previous injuries and environmental factors but the good news here is that almost all of these factors are treatable under conservative (non-surgical) management. In most cases poor posture occurs due to:

  1. History of accidents, injuries and falls
  2. incorrect sleeping posture
  3. Obesity (overweight)
  4. Weak muscles or muscle imbalances
  5. Work related stress
  6. Old sitting habits
  7. Genetic Deformities

All Physiotherapy treatments come in stages. the initial stage is called the assessment stage, this stage is divided in to two main sections:

  1.  Subjective: In this stage the therapist will take time to ask a set of question to further understand the patient's medical history and other complaints directly or indirectly related to the current condition
  2. Objective: In this stage the therapist will take a hands on approach applying several techniques and special tests to both locate the affected area and rule out any possible injuries.
The above mentioned is a vital key of any treatment approach and without sufficient information an adequate treatment plan that most suits the patient will not be met. The next phase will be the treatment plan. upon completing the assessment the therapist will have the sufficient amount of information to begin a treatment plan which should comprise of short term goals and long term goals.

The treatment method will be a combination of several techniques involving stretching and strengthening certain muscle groups and postural correction followed by postural awareness to help the patient understand the correct form of posture. 

CONCLUSION

We have come to understand that posture plays one of the biggest roles in back pain due to the negative impact it has on the muscle groups, but the root cause of the pain can be from several factors and not just from bad sitting habits. IDEAL posture can be achieved by consulting a physiotherapist that will conduct a thorough assessment and provide the patient with awareness and specific exercises.