Friday, March 18, 2011

Yankee Candle Use Dpg

Instability Lumbar Cervical Vertigo (Part III) Lumbar Instability



The analysis of movement dysfunction is a system of assessment and treatment in a manual (whose name I remember) is directly related to dysfunction of stability.

This measurement system evaluates the effectiveness of the recruitment of stabilizers by the ability to make a move correctly and without causing movement in an adjacent area (to be stable diamonds).

As an excess of movement, a movement pattern is altered not in itself a dysfunction of stability, whether it is a dysfunctional process compensatorio.La adaptatorio instability involves a change of control engine that generates a symptom, usually pain.

The same test to assess the stability serve as exercises: Keep the column "neutral" while performing movements such as knee extension (without lumbar flexion occurs), hip external rotation (no rotation occurs back), thoracic extension, hip extension and knee flexion in the prone position (without causing lumbar extension) ...


Panjabi neutral zone defined as the place within the ROM (Range of motion or joint range) where resistance to joint movement is minimal. In other words, the ROM before coming to R1 (the first tough) in any direction.

spontaneous position for many patients show an increase in the neutral zone. The area of \u200b\u200bleast resistance is more extensive due to laxity (passive component failure of osteo-capsule-ligament), muscle imbalance (failure of active component: extensibility / relative stiffness) and neural (poor motor control).


Here, a model of objectivity and measurement of the neutral zone.


" recently an Australian group showed that the TrA is not always active and symmetrical prior to limb movement and uphold the answers in advance of TrA are directionally specific and act asymmetrically (GT Allison et al 2008).
For example, Hodges et al. (1999) showed that 3 out of 8 control subjects without pain, had no anticipatory responses in 70% of studies during the bilateral lifting of the arms. Allisson G and Morris (2008) suggested that this was due to a less than optimal stability, but being a normal variant of motor control. The studies of Dr. Stuart McGill are also in line with these findings.
In summary, we can not say that the inner core (TrA, multifidus, diaphragm and pelvic floor) is activated before the outer core (erector spinae, rectus abdominis, obliques) or other muscles if you look at the evidence " .


Translated from Bret Contreras Blog In an interview with Jurdan Mendigutxia

In one study at McGill, it was found that the contraction of TrA did not provide greater stability, and instead co -contraction of all abdominal muscles if he did. However, it is considered that the co-contraction generates excessive rigidity and is not stable enough for the role.

The culture of GYM and fitness section of the industry have reduced the Stability core training to get tummy and strengthen your abs in an isometric fashion, and some authors caution that excessive rigidity can cause back pain, incontinence and respiratory blockage. Stability of core Critics argue that not only help relieve back pain but can increase if done at high load.

For others, no exercise progression is able to create exercises connection with activities of daily living, and indeed, the exercises at low load, it falls short on a sporting level. It is necessary to use high-load exercises. Strengthening the core can be appropriate if the function requires that rigid stability, as is the case with boxers, for example.

Some experts have serious doubts about whether we can retrain the neuromuscular system to improve the timming of the stabilizers, at both low and high load.

in gyms is still used to strengthen the abdominals, but not used as dynamic exercises as classic muscle shortening, more trains on the role of stabilization in the line of Mc Gill .






 




Some references of comments through the investigation of Lederman:

Wednesday, March 9, 2011

How Many Cc's In An Insulin Syringe

(Part II)




Validation studies for the diagnosis of lumbar instability test are all based on bias by the absence of "gold standard", since none can compare their results with those obtained with another test that is universally accepted reference.

In Critical reading of a study on diagnosis , there are 10 questions to assess the validity of the study:
  1. Is there a test compared to "gold standard"? (Bias due to lack of gold standard)
  2. Amount of sample (bias interpretation / selection bias)
  3. Is there an adequate description of the test? (Reporting bias)
  4. Is a blind study? (Confirmation bias / selection bias)
  5. Is an independent study? (Confirmation bias)
  6. Is there data specificity, sensitivity and predictive value?
  7. What is the accuracy of the results?
  8. "The test is applicable in the clinic?
  9. Is it acceptable to do it? (Risks, discomforts, costs generated by the diagnosis)
  10. diagnose Is it a benefit?

90% of patients with low back pain have an accurate diagnosis. There is great difficulty in establishing the structure involved in pain, so some authors propose to classify on the basis of movement dysfunction in them.

The detailed description and classification of lumbar instability is far from Peter O'Sullivan.

clinical O'Sullivan directional
Based on observation and scientifically invalid
Common to all: the lack of control in the movement.

Pattern Bending (most common)
- Central pain
- Vulnerability in flexion + rotation activities
- Inability to maintain semi-flexed postures (making the bed, brushing teeth in the sink, etc.).
- Loss of lumbar lordosis in segmentp, which is accentuated in sitting, prone to subsequent pelvic scale and visible loss of extension in lumbar extension movements.
- Increased tone of the erector spinae in lumbar and thoracic high low to compensate.
- Need to rest your hands on your knees to return the trunk flexion.
- Inability to dissociate lumbar extension, pelvic anterior scale and thoracic extension.
- Inability to control segmental flexion movements such as squat, sit with your knees straight or hip flexion, "from sitting to standing, prone to bending of the segment, posterior pelvic scale and thoracic extension compensation.
- Inability to activate the multifidus at that level in co-contraction with the TrA.
- Many are not able to maintain the neutral segment fours and sitting.
- Increasing mobility in flexion and rotation of that segment.



Extension Master
- central pain.
- Vulnerability in extension activities + rotation (standing or bring your arms up, throw something, running, swimming).
- Increase in the unstable segment lordosis
- Increased muscle activity at that level often anterior pelvic scale.
- Associate to sway back posture.
- Test of hip extension and knee flexion in prone position shows a loss of control of abdominal and lumbar lordosis increased.
- Tendency to maintain lordosis in trunk flexion and hiperlordosar back from the position.
- Return of trunk flexion is often painful and need to assist the movement with his hands on his knees.
- Inability to start the subsequent scale pelvic and hip flexion independent activation of buttocks, rectus abdominis and external oblique.
- Muscle Test. Inability to contract the multifidus TrA unstable segment next to the neutral position rebound tendency to block the column.
- Increasing mobility in extension / rotation on the symptomatic level.



pattern Shift Lateral (Lateral Displacement)
- Unidirectional
- unilateral pain.
- Vulnerability in rotation + flexion activities
- Loss of lordosis at that level, associated with a lateral shift of the segment.
- Palapación standing multifidus inhibition reveals a side of the shift, and a decrease in tone / atrophy contralteral
- The shift is more pronounced in ipsilateral monopodal support and transfer weight to that side.
- Arco pain halfway through the trunk flexion.
- Loss of control in rotation and lateral shift in the direction of the supine leg raising, to make the bridge supported by one leg (unilateral bridge), in fours flexing an arm, "sitting to stand "and the squat (squat) usually reveal a trend toward the side of the shift.
- Inability to contract the multifidus bilaterally in co-contraction with the TrA, with dominance of the quadratus lumborum, erector spinae and ipsilateral lumbar multifidus and an inability to activate multifidus contralteral, associated with increased wall tone abdominal and respiratory blockage.
- Palpation revealed an increase of bending on that side (increased rotation and tilt in the direction of shift).



Multidirectional pattern
- Associated trauma.
- High level of pain and dysfunction.
- All weight loads are painful and hard to find relief.
- Locking in flexion maintained rotation or extension.
- The patient assumes a posture in flexion, extension, or lateral shift.
- Difficulty to assume the neutral lordotic.
- Irritability.
- Do not tolerate compressive loads.
- usually require IQ, poor prognosis with conservative treatment (exercise condition).

Lumbar Segmental Instability : clinical presentation and specific Stabilizing Exercise management. O'Sullivan PB. Manual Therapy (2000) 5 (1), 2-12

O'Sullivan clinical patterns are described in terms of impaired movement. Are themselves altered patterns of movement. With the Panjabi definition of instability and loss of the neutral zone, any alteration of the movement and seems to assume a static instability. Any lack of control seems to be an instability. Any person who benefits from the exercise of instability appears to be stabilizing.

ends not be clear that everything revolves around instability. O'Sullivan patterns seem very successful, and I think they are signs, symptoms and common findings in each of the patterns described, but do not seem very different from other patterns of movement disorder, described by other authors. In fact, O'Sullivan subdivides the extension pattern of active extension pattern and the pattern of passive extension. The pattern described above correspond to extension active. The pattern of passive extension is described in other texts as "sway back".

Is it useful to treat a disorder of movement and posture stabilization exercises to regain the "neutral zone"? I am sure it is.

Are these patterns are used to diagnose lumbar instability specifically? And beyond that, is it useful and specific classification of instability as a subgroup of patients with low back pain? Perhaps, in order to answer these questions, first we should agree on the definition of instability back, which is not the same as it is radiologically, for example.

Thursday, March 3, 2011

Boils From Shaving In Groin

lumbar instability (Part I)



The development of research on stabilization exercises to relieve back pain caused the "strengthening" of the transverse come to the gyms, and sponsors beauty and aesthetics. In some gyms advertised by asking:
"swollen abdomen? The solution is to "transverse abdominals" ... Yeah!

"All pregnant, undergoing inguinal and obese in the world have back pain? Provided that the transverse "not working well there back pain? Some argue that the cross is nothing more important than other trunk muscles to stabilize the trunk. There is no single, universal exercise to control body which serves to the specific needs of all activities. Trunk control will depend on the activity undertaken and how prepared you are that person for that activity.
Do better exercises core stabilizers than other trunk exercises?
Here , a Cochrane review concluded that the motor control exercises are more effective than general exercises to reduce pain.

instability and hypermobility are different concepts. There may be an excess of movement (hypermobility) without compromising stability (Good control) of a segment. And there may be no excess movement and if a bad motor control, which determines the loss of the neutral zone.

lack or excess of motion is not a finding in itself. Excessive movement associated with pain is what determines the status of clinical instability (Kirkaldi-Willis), although hypermobility is not a prerequisite.

Panjabi established the concept of neutral zone. Poor motor control may involve the loss of the neutral zone and the inability of the musculaura to stabilize the area. Panjabi also CLASFICADO stabilizer system of the spine in active, passive, and neural.

Following the classification of Steady Panjabi, lumbar instability may result from a loss of system:
  • Liabilities: When there is an alteration in the anatomy osteoligamentous (trauma, degenerative process , etc)
  • Active: alteration of the muscles due to lack of extensibility (relative stiffness) or weakness
  • Neural : loss of motor control (poor recruitment, or alteration timming in the sequence of recruitment).

No doubt the ligamentous support and the very morphology of the vertebra of the passive stabilizing system determines the mobility of the spine, but the loads on the passive system would not be possible without the muscles.

" We are only stable because we" Paul Hodges

osteoligamentous The passive stabilizing system can only support up to 80-90 N. During ADL endure forces to 6000 N and 18000 N in sports. Muscles are those that guarantee the stability of the lumbar spine. The exercise of the superman is compression forces on the lumbar spine of 6000N (McGill)

The natural history of instability by a degenerative process tends to drive its decision on the re-stabilization phase. This process can take up to 10 years, but after this period there will be no pain. Therefore, the spinal fixation with osteosynthesis degenerative processes is disliked is because it tends to resolve spontaneously, but during that time what to do? To a pattern of disc degeneration, is it better mobilize or stabilize? As the study concludes, for now, that stabilizing exercises better results, and as shown by a button.


Today there is great difficulty in identifying the lumbar instability and the profile of patients who could benefit from the exercise of stabilization. In fact there is difficulty to unify criteria for the definition, symptoms, diagnosis and treatment.


The patient "unstable" may refer to the feeling of being "party in two. " Bilateral pain; although sometimes unilateral. Small rapid movements cause pain, such as walking or standing. However, if you walk quickly reduce the pain because there is more muscle recruitment. Segment can be seen more extension or flexion than the rest. Typical of women over 40 years are overweight or gymnasts. In some areas they are called "downers" because they tend to find the rest. The pain is relieved at rest and in supine position and increases throughout the day (Eisenstein).

Sahrmann, however, describes a patient with spinal instability with pain in postural changes, but can not hold a position for a period of time and frequency surgical tends to move to achieve remission of symptoms. Often the triggers more sitting than standing symptoms ... ("" Anti-downers "?)

There is some difficulty in identifying the patient with instability. Numerous tests have been proposed and some of them even tried to be validated. These are a few:

Test extensor strength in prone.



normative values \u200b\u200bfor this test are estimated at an average of 173 seconds. McGill (2004).




Test of resistance of the trunk flexors.





Holding the position of the trunk at 60 degrees. Normative values \u200b\u200bare 34 seconds.






Test prone bridge


If the subject is unable to maintain position, it adds support to the his weight on his knees. normative values \u200b\u200babout 60 seconds.


Test side bridge

This exercise involves a significant activity for oblique and very little for the psoas as EMG studies (Juker 1998). It allows for support on the knees. Normative values \u200b\u200bestimated in 86 seconds to the left and 83 seconds to the right.

Bird-dog test






is valued the ability to maintain elevated position opposite arm and leg. There are no normative data for this test.







lumbo-pelvic rhythm
Prone hip extension. If activated initially lumbar and buttocks after it is submitted that the subject is altered when lumbo-pelvic (Liebenson, 1999. Adapted from Sahrmann). This should be considered a sign rather than a diagnostic test.

Test passive accessory intervertebral motion (PAIVM's of Maitland) or testing for Lumbar segmental mobility (Test of lumbar segmental mobility).
Manual pressure posteroanterior and try to feel too much segmental mobility.
sensitivity: 29%
specificity: 89%

passive intervertebral bending test
sensitivity: 5%
specificity 99.5 %

prone instability test or PIT (Prone Instability Test)

This tells the physio-pedia


The test is positive if pain occurs with pressure and decreases your feet off the ground. It is thought that this indicates a temporary pain relief through the spine stability and is a good indication Predictive negative ITP patients would not benefit from a stabilization exercise program.

profit forecast stabilization work (if 3 of the 4 following are present):
\u0026lt;40 years
SLR> 91 º
this aberrant movement
PIT (+)

We can not conclude that any movement dysfunction is due either by a problem of relative stiffness or by a problem of stabilizing local, global or mobilizers. Pain upon movement will result in movement dysfunction and that is the definition of mechanical pain, not instability.

prone The test is not completely reliable to diagnose instability. Used to immobilize the segment concluded that reduces pain, not that it is unstable. If it hurts when you move, if we can move less it hurts less.

same applies to the dressing esabilización McConnell for a lumbar segment. This dressing is designed to download the tissue and reduce pain, and if that involves some restraint in that segment, one can only conclude that this segment hurts when it moves not volatile. Furthermore, it is still unclear exactly what action has the tape of McConnell.

stabilizers Work have demonstrated effectiveness in reducing pain, but I think that not all patients improve with exercise they should be included in the group of instabilities.

posterior lumbar extension test or test PLE (Posterior Lumbar Extension)

sensitivity: 84, 2%
specificity: 90.4%
positive predictive value: 8.84

The PLE test showed be the most reliable in a 2006 study of 122 subjects examined.

Here, the study of the PLE test and here, a review of diagnostic tests for lumbar instability.