TRIGENICS FOR THE CORRECTION OF MUSCLE IMBALANCES IN LOWER CROSSED SYNDROME. Submitted by: Dr. Clayton Gibson III

Transcription

1 TRIGENICS FOR THE CORRECTION OF MUSCLE IMBALANCES IN LOWER CROSSED SYNDROME Submitted by: Dr. Clayton Gibson III

2 Postural distortion patterns refer to the state in which the structural integrity of the kinetic chain is compromised because components of the kinetic chain are out of alignment. For example, the lumbar spine in lower crossed syndrome, other movement segments have to compensate in attempts to balance the weight distribution of the dysfunctional segment (6). Trigenics is an advanced neurological muscle assessment, treatment and training system which instantly reprograms the way the brain communicates with the body to immediately relieve pain, amplify strength and movement and augment muscular performance. To avoid postural distortion patterns and the chain reactions that one misaligned segment creates, a Trigenist emphasizes optimum state and dynamic postural control to maintain the structural integrity of the kinetic chain during functional activities. Ideal functional posture maintains the structural integrity and optimum alignment of each component of the kinetic chain. This promotes optimum length-tension relationships, force-couple relationships and joint kinematics (21). There is an optimum length at which the muscle is capable of developing maximal tension (length-tension relationship). Muscles develop maximal tension because the actin and myosin filaments are positioned so that the maximum number of cross bridges can be formed. If muscles are shortened or lengthened beyond the optimal length, the amount of tension that the muscle is able to generate decreases (1, 3, 5-11, 15-19, 21-25). A Trigenist can alter the length-tension relationship and timing pattern of the myoneurological system through the Trigenics Strengthening () and Trigenics Lengthening () protocol (43). Optimum length-tension relationships ensure maintenance of normal joint kinematics (10, 16, 19). Neuromuscular efficiency is the ability of the neuromuscular system to allow agonists, antagonists, synergists, neutralizers and stabilizers to work together to reduce force, stabilize and produce force efficiently in all three planes of movement (sagittal, frontal and transverse). However, as mentioned earlier, if the kinetic chain is out of alignment, the result is decreased structural efficiency, functional efficiency and performance. This effect alters proprioceptive input to the central nervous system (9, 10). Proprioception is the cumulative neural input to the central nervous system from all mechanoreceptors of the entire kinetic chain (24). Other neuromuscular phenomenons occur including, postural dysfunctions, reciprocal inhibition, synergistic dominance, and arthrokinetic inhibition (1, 3, 5-10) Postural dysfunction cannot occur without causing reciprocal inhibition. This is the process whereby a tight muscle (facilitated) causes decreased neural drive to its functional antagonist (1, 3, 5, 9). Causes of postural dysfunction and muscle imbalances are postural stress, pattern overload, repetitive movement, lack of core stability, and lack of neuromuscular efficiency (11). Lower crossed syndrome is a prime example of a postural dysfunction. This condition is characterized by the imbalance between shortened/facilitated/tight hip flexors and lumbar erector spinae, and weakened/inhibited gluteal and abdominal muscles. The facilitated muscles cause a slight flexion of the hip, an anterior pelvic tilt, and an increased lumbar lordosis

3 with a concentration of pressure on the posterior portion of the intervertebral disk and decreased pressure on the anterior disk. The imbalance will overstress especially the L5-S1 region and cause hypermobility, irritation and pain. The hamstrings are often tight in this syndrome in order to lessen the pelvic tilt or compensate for weak gluteal muscles. See Table 1 Dynamically, tight erector spinae and iliopsoas with weak and/or inhibited gluteal muscles will alter the pattern of hip extension during gait. For example, a tight psoas may result in decreased hip extension. For normal function in the body, each moveable joint requires a fixed point above. Normally the pelvis must be fixed to perform normal hip extension, but in this syndrome, in order to extend the hip it becomes necessary to increase the anterior tilt of the pelvis. The lower lumbar should work as the fixed point for the pelvis, but the anterior pelvic tilt during gait may cause hypermobility of the L4 and L5 segments. Because the lower lumbar can no longer function adequately as a fixed point for the pelvis, a new fixed point is established at the lower thoracic/upper lumbar area. This abnormal dynamic pattern can be seen on testing of hip extension in the prone position by the over activity of the muscles in the thoracolumbar area instead of the lower lumbar area (21). Any dysfunction is typically part of a chain reaction that involves key links and in which numerous compensations and adaptations develop. For example, a sacroiliac joint dysfunction causes arthrokinetic inhibition to the deep stabilizing mechanism of the lumbo-pelvic hip complex (transverse abdominus, internal oblilque, multifidus, and the lumbar transversospinals). Arthrokinetic inhibition is the neuromuscular phenomena that occurs when a joint dysfunction inhibits the muscles surrounding that joint. All of these neuromuscular phenomena occur secondary to postural dysfunctions (1, 3, 5-11, 16-19, 29). Once a joint has lost its normal arthrokinematics, the muscles around the joint spasm and tighten in attempts to minimize the stress at the involved segment. Therefore, certain muscles become tight or hypertonic to prevent movement and to prevent further injury, but interestingly actually initiates the cumulative injury cycle. Hence, a joint dysfunction causes altered length tension relationships, which alters normal force-couple relationships, which in turn alters neuromuscular control. Weakness of the gluteus medius and tightness of the ipsilateral quadratus lumborum and/or tensor fasciae latae can alter the lateral lumbopelvic mechanics, affecting gait, stance, and the normal pattern of hip abduction. Without stabilization of the gluteus medius there will be a lateral shift during and the patient literally hangs on the tensor fasciae latae and the iliotibial band. A tight quadratus lumborum could cause an increased elevation of the pelvis during gait. An increased play of the pelvis with an oblique position and lateral tilt could occur (21). Trigenics uses the following corrective treatment protocol for Lower Crossed Syndrome. See Table 2

4 In order to restore optimum alignment, Trigenics is able to establish a corrective muscle imbalance. The key in treating postural distortions is being observant to the static postural dysfunction to allow for the collection of information on how the body is in a defense physiology mode. This means that it is protecting itself and in perfect balance for present time consciousness. A clinical approach to improve recruiting and firing of muscle fibers, chemical disturbances, joint arthrokinematics, proprioception and mechanoreceptor stimulus is the Trigenics treatment system. This manual treatment system synergistically combines a triad of proven treatment methodologies. These methodologies target problem areas of muscle spindles, muscle tendons, trigger points, myofascial points, and meridian points and channels using Propriocetive Dynamic Acupressure (43). This particular system will alter the rate of change in length (spindle) of the muscle, the rate of change in tension (tendon) of the muscle, pain status and an increase in the localized range of motion. The Trigenics system incorporates the muscles, nerves, energy points (meridians) and auto suggestion in order to provide strength to weak or inhibited muscles and length to hypertonic or fascilitated muscles. The and protocol are used to dissolve myopoints and remove the muscle imbalances that result in Lower Crossed Syndrome. The Trigenics Institute offers a novel, innovating, unique and structured approach to the complex process of somatic dysfunction. Any tissue trauma initiates a neurogenic reflex mechanism, the cumulative injury cycle and creates morphological changes in the microenvironment of the neural tissue. This results in intraneural edema, chemical irritation, tissue hypoxia and microvascular stasis. All of these alterations stimulate the nocioceptors and results in pain. The Trigenics approach includes a comprehensive postural and performance analysis, a rapid assessment of muscle strength and weakness (length-tension relationship), and the implementation of corrective muscle imbalance and proprioceptive training. Table 1 Short Muscles Iliopsoas Rectus Femoris Tensor Fascia Latae Short adductors Erector Spinae Gastrocnemius, Soleus Lengthened Muscles Gluteus Maximus Gluteus Medius Hamstrings Transverse Abdominus, Internal Obliques Multifidus Anterior and Posterior Tibialis

5 Table 2 Lower Crossed Syndrome Short Muscles Iliopsoas Rectus Femoris Adductors Latissimus Dorsi Supperficial Erector Spinae Trigenics Lengthening Lengthened Muscles Gluteus Maximus Biceps Femoris Gluteus Medius Transverse Abdominis Internal Obliques Multifidus Pelvic Floor Muscles Trigenics Stregthening Altered Joint Mechanics Increased: Lumbar extension Decreased: Hip extension Possible injuries: Hamstring strain, groin strain, low back strain Arthrokinetics: SI Joint dysfunction, Iliofemoral joint, Proximal tibiofibular joint, Lumbar facet joints Corrective Stretegy Flexibility / Foam roll: Iliospoas, Rectus femoris, Adductors, Latissimus Dorsi, Erector Spinae Core Stabilization: Draw in progression Tube walking Bridging Ball Crunch Balance: Single leg balance progression References: 1. Bullock-Saxon, J. Muscles and Joint: Inter-Relationship With Pain and Movement Dysfunction. Course Manual, Chaitow, L. Soft Tissue Manipulation. Rochester, Healing Arts Press, Chaitow, L. Muscle Energy Techniques. New York, Churchill Livingstone, Clark, M.A. Integrated Kinetic Chain Assessment. National Academy of Sports Medicine. Thousand Oaks, CA, Clark, M.A. A Scientific Approach to Understanding Kinetic Chain Dysfunction. National Academy of Sports Medicine. Thousand Oaks CA, Janda V. Physical Therapy of the Cervical and Thoracic Spine. New York, Churchill Livingstone, Lewit K. Muscular and Articular Factors in Movement Restriction. Manual Medicine 1:83-85, Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor System. London, Butterworth, Liebensom, C.L Rehabilitation of the Spine. Baltimore, Williams and Wilkins, Sarhmann, S. Diagnosis and Treatment of Muscle Imbalances and Musculoskeletal Pain Syndrome. Course Manual, Liebenson, C.L. Manual Resistance Techniques and Rehabilitation. In Chaitow, L. Muscle Energy Techniques. New York, Churchill Livingstone, Edgerton, V.R., S. Wolf, R.R. Roy. Theoretical Basis for Patterning EMG Amplitudes to Assess Muscle Dysfunction. Med Sci Sports Exec 28 (6): , Holt, L.E. Scientific Stretching for Sport. Halifax, Dalhousie University press, Dominiquez, R. H. Total Body Training. Moving Force Systems. East Dundee, IL, Lewit K.D. Simons. Myofacsial Pain: Relief by Post Isometric Relaxation. Arch Phys Med Rehab 65:452, Sarhmann, S. Posture and Muscle Imbalance: Faulty Lumbo-Pelvic Alignment and Associated Musculoskeletal Pain Syndromes. Ortho Div Rev-Can Phys Therapy 12:13-20, Liebenson, C.L. Active Muscle Relaxation Techniques, Part 1. Basic Principles and Methods. Manipulative Physiotherapy 12(6): , Liebenson, C.L. Active Muscle Relaxation Techniques, Part 2. Clinical Application. Manipulative Physiotherapy 12(6): , 1990.

6 19. Lewit, K. Manipulative Physiotherapy in Rehabilitation of the Locomotor. London, Butterworth, Warmerdam, ALA. Manual Therapy. Pine Publications. Wantagh, NY, Hammer, W. I. Functional Soft Tissue Examination and Treatment by Manual Methods. (2 nd Ed.) Aspen Publications. Gaithersburg, MD, Headley, B. J. Muscle Inhibition. Physical Therapy Forum. 24(1), Janda, V. Muscle Function Testing. London, Butterworth, Porterfield, J.A., C. DeRosa. Mechanical Low Back Pain: Perspectives in Functional Anatomy. WB Saunders, Philadelphia, PA, Porterfield, J.A., C. DeRosa. Mechanical Neck Pain: Perspectives in Functional Anatomy. WB Saunders, Philadelphia, PA, 1995.