Rehabilitation Anatomy: Changes in the Anatomical Structure of the Lumbo-Pelvic Region - Essay Example

Running Head: Rehabilitation Anatomy: Changes in the anatomical structure of the lumbo-pelvic region as a contributing factor in the development of a common upper or lower limb injury Name of the student Admission Number Course Name Course code Name of the professor Date done Date submitted Word count Outline Abstract Key terms Introduction Discussion Conclusion Appendix Figures and A table Reference list (Harvard style) Abstract The sharing of ideas by interdisciplinary teams has led to the discovery of new models o the low back and pelvic pain that has really worked towards a greater understanding of the lumber pelvic region. It incorporates both the impact of the structure that utilises the form and the anatomy while the function handles the forces and the motor control of the bones which relatively are in control from the brain via the mind that creates awareness and emotions on human performances. This in focus has the capacity to generate answers to so many questions related to the structure causing the pain. However, one major aspect that ought to be looked into very keenly is how the forces come to be controlled and transferred throughout the body. This concept is referred to as the effective load sharing that has synonyms of effective force closure or at times also referred to as effective load transfer. These are the transitions that take place at all the times during static and dynamic motions. Stability is therefore a demand of a specific load with an adequate tailored joint compression by the muscles, fascia and the bones ligaments. Injuries have been observed during dynamic motions especially during the hyper mobility in dancers. But special prediction can also be made for developing a lower limb and/ or lumbar spine injuries. Clinical techniques are also present for control of the lumber pelvic movement during the hip movement. Key words: Lower back pain, movement control, dance, hyper-mobility, dynamic motion, static Introduction Stability in all bones is usually when both the passive, control and the active system work as unit to ensure a safe transfer of the load and efficiently. This is a complex action and requires intact bones, joints and ligaments which has oftenly been referred to as the first components. The muscles must also be able to contract tonically in a manner that can be sustained which should translate to the motor communication such that the resultant force is a resultant of the compression through articular structures at appropriate point. This ability of muscles to contract is what has been referred to as the second components while the co-ordination association is referred to as the third component. This will stimulate appropriate neural controls which relay the communication through the motor control. It is a dependent reaction of a continuous input of signals from the mechanical receptors in the joint which are composed of the joint and tissues, the required interpretation of the afferent information and the efferent feedback which are majorly emotions and awareness responses; this is what constitutes the fourth component. Discussion: Summary of the discussion Common occurrences of lumbo pelvic stability Achieving lumbo-pelvic stability Lumbo pelvis functioning at the normal state. Evaluation of the lumbo-pelvic dysfunction Rehabilitation treatment by exercise Common occurrences The most common occurrences of the lumber pelvic movement dysfunction is based on the evaluator mechanisms by palpation and spring tests. This has been the general mechanism through which such analysis of the lumber pelvic dysfunction can be analysed. Most patients with the sacral ilial joint dysfunction have also a dysfunction at the lumber spine. Eight major and most prevalent components pattern include the following: Left posterior pubic bone, left sacral rotation, left sacral side bending fixation, right anterior Ilium, left posterior Ilium, type I right in flare, type I left out flare and finally, type II left lumber flexion movement dysfunction. As for the left posterior pubic bone, it is a positional dysfunction in which the anterior surface of the left pubic bone is posterior in relation to the right. Spring test has well adaptations for the movement dysfunction at the symphysis pubis. Palpatory findings have however been found to correlate with the spring test. Ergonometric and lumbo-pelvic dysfunction has been widely investigated and considerable work has already been done. However, the effect of core stability and function together with peripheral injury has shown some contrast. ‘In spite of all this, simple biomechanical principle associated with stress and strain has been found to have effect on the human tissue’ (Lee & Vleeming2000, pp2). This leads to a cumulative effect especially when a tissue is continuously loaded and creates an alteration of the initial state. This alteration may have a destructive effect or a constructive influence on the individual. If it can lead to osteoporosis, progressive loading of the bone tissue will have a positive effect on the bone tissue by increasing the bone mineral density. In case of misalignment of the limbs that will spread beyond the natural threshold, that varies from individual to individual and has potentially very undesirable impacts on the tissue. It relies on the location that can cause either tissue hypertrophy or necrotic breakdown due the wringing out of the vascular supply in Achilles tendonosis Lumbo-pelvic function at the normal state A detailed study of the pelvic region through the components will tell as the complexity in the lumber pelvic dysfunction. The first component that is the form closure takes place at the sacroiliac joint and transfers large loads and its shape has a good adaptation for the task. The articular surfaces are flat which counteracts the compression forces and the bending moments. Despite this, it is very susceptible to shear forces. It has the protection from this force by the sacrum which is wedge shaped in both the anterior posterior and the vertical planes. Secondly it has an irregular cartilage than the smooth cartilage. Finally, it has the cartilage protruding bone extension into the joint at the frontal dissection. All this have complimentary function and work to stabilize the bone during compression. This ensures stability called the form closure. Some people have always thought of this to be some kind of an immobile joint due to the close fitting of the joints. This has the neutral zone which only allows a small range of movement. We also have the elastic zone that allows motion from the neutral end to the physiological limit. Laxity in the neutral zone and stiffening towards the range of the allowable motion leads to the dysfunction of the sacroiliac joint. The neutral zone has been found to increase with injury, articular degeneration, and weakness of the surrounding muscle tissues. The dysfunction of the neutral zone is affected by altering the compression forces. The second component involves the articular surfaces of the sacrum and the in nominate, they fit together to form a perfect closure. Mobility at the point can be achieved by the increasing anatomical structures involved in this which are ligaments, muscles, and fascia. During compression the sacroiliac joint becomes compressed, friction of the joint increases and hence augments the force closure. This has the integrated sling system that comprises of several muscles. The muscle may participate in more than one and to a great extend may even overlap and interconnect. Muscle dysfunction may present as weakness and tightness which is necessary when restoring the force closure. ‘Exercise has been found to restore the specific muscle length and strength’ (McLean2006, pp2). Muscles that retain these components in tensegrity require the third component failure of which is a serious dysfunction. The motor control that constitutes the third component involves muscle activation that is a well coordinated communication system. Proper communication is supposed to ensure that there is proper action and interaction between the muscle and the loads transferred which is supposed to be carried effortlessly. This usually can be restored with an integrated sequence of exercises that work to coordinate the motor control The fourth component works to ensure that your emotion and awareness are at the right point during muscle activation. Awareness has it that the emotional state and the dramatic movements of the bone impacts on the functional outcome of the bones. Achieving stability It has now been seen that for stability to be achieved, it has to be a complex of the individuals anatomical and/or biochemical factors which include the connective tissue extensibility, muscle strength, body weight, joint surface shape, motor control patterns, psycho social factors and the loads that derive the forces. ‘How well an individual can be able to control the movements is the major concern for stability rather than the amplitude’ (Leetun2004, pp927). If the motion control by any chance is too little or too much. In both cases, too much will lead to shearing and wearing out of the joints and this is the direct cause of the osteoarthritis. Too little pressure will lead to collapse due to weaknesses generated or episodes of giving away. Evaluation of the lumber pelvic dysfunction Mobility test and the joint spring tests can be general or specific. For instance, force directed from the anterior position on the left of the left of the sacrum at the level of the joint and which induces a positive right rotational force and this is a joint spring test. On the other hand, a mobility test will be a right active lumber and pelvic rotation. These are a general way of evaluating a patient with the sacroiliac joint dysfunction. Conducting a spring test gives information of the joint and ligament functionality. But generally it is expected to deduce the general patterns of motion which can be as a result of joints and muscles groups that are well coordinated by the motor components. Other motion test that can be conducted includes; the common standing flexion test, standing hip flexion test, sitting flexion test, and the long sit test. The motion test grossly finds out information of the pelvis as unit but however cannot be deemed specific. Joint spring test are performed while the patient is supine and prone. ‘The sacroiliac joints major function is to serve as a shock absorber and hence the spring test can quantitatively find out that information of its function’ (Goudzward et al1998, pp16). It must be remembered that sacroiliac joint does not exist in isolation especially as it relates to anatomy and function. All motion also happens through the sacroiliac joint. Proper function of the pelvic relies on the ability of the sacroiliac joint to translate the forces though the articulations and to dissipitate forces which takes place via the viscoelastic properties. This can be ascertained by the articulate spring tests. Clinical application In clinical applications, the impaired pelvic function is stated as the inability to transfer effectively forces through the pelvis. All the test that include the spring test are methods that find out the general association of the form and force closure, motor control and the emotional states that is required. In this technique, pain has never been a criterion from which a biochemical diagnosis cannot be done. This technique ought to answer these questions of; what? Causes the pain as we look for the no inceptive generating structures. The third world interdisciplinary congress on the low back and pelvic pain approved some of the procedures. Quebec back pain disability scale was the basis for the collection of data and it is still being used for the determination of the efficacy to evaluate the recovery on pelvic pain patients. The biomechanics of the pelvis to achieve an efficient gait has been established. The validity and the reliability as a diagnostic tool in the posterior pelvic pain as a consequence of pregnancy have been associated with the reduced hip abduction and the adduction strength. It is the reason why patients who experience the peripartum pelvic pain have a waddling gait. On a one leg stance, the abduction strength decreases while the body weight increases and it makes it impossible to keep the pelvis horizontal. Sagittal plane motion involves forward and backward bending. It test the ability of the pelvis and the low back to control the horizontal and the vertical shear forces during segmental sagittal rotating motion on forward and back ward bending. It borrows from the principle that when the legs lengths are equal, the pelvic girdle flexes symmetrically at the hip joint while the sacral is bilaterally nutated throughout the forward bending motion. During the back ward bending, the pelvic girdle extends while the sacral remains nutated bilaterally. ‘These motions are not indicative of any muscular dysfunction because many of the articular and myofascial problems can produce similar findings’ (Thelen2006, pp138). Hence, during instability, the loads cannot be easily transferred to the low back or pelvis. One leg standing with contralateral hip Flexion is also relevant in clinical motion analysis as a useful technique for the analysis of the ability of patients to transfer a load through one lower extremity while flexing the contralateral hip. In this process, the sacral should is supposed to nutate on the side bearing the load and which should take place smoothly with very small adjustments. The active straight leg raise has been adjusted to evaluate the load transfer through the pelvic girdle in the not for the weight bearing side while the patient is supine. One leg is supposed to be raised by the patient with the knee extended. This ought to be done without bulging their abdomen; rotating or bending to the sides of their trunk and the pelvic girdle is observed while their efforts are noted. A gentle compression is then exerted through the pelvis; the active right leg raise test is then done for the second time while keeping special attention on the change of the motor pattern for any indication of the ability to stabilize the pelvic positioning at the neutral position and the influence on the sling muscles (Table 1). Rehabilitation treatment ‘Integrated exercise has been staged as one of the treatment regime for a sequenced muscle regime for motor control’ (Lee2001, pp5). Some of the practices includes: pilates, , somatics, Yoga, Feldenkrais Tai Chi, Janda, Sahrmann, Richardson, Hodges, comerford and O’Sullivan for the muscle balance which basically are fit for the 3rd component (motor system). Practical approach to lumber pelvic stability and that aim for rehabilitation can be achieved in various ways. ‘The goals are usually different and very significant basing on the different approaches being applied for the exercise’ (Chumanova et al2004, pp3557). Injury and pain at the low back are associated with the disruption of the motor control. Rather than isolating different muscle groups, a distinction will need to be made for the fine degrees of coordination and motor control and the more dynamic gross motor tasks. Exercise has been designed for the dynamic core strength training and the separate isometric stabilization exercise. It is recommended to be conducted on a daily basis. It mainly focuses on the deep stabilization and low intensity strengthening of the hip joint and musculature. The key element is that each individual is supposed to hold each posture for a period of time while taking a full breath in and out. ‘This is to emphasize maintenance of the stabilizer muscles by way of breathing’ (Gamble2007, pp60). The daily low intensity lumbo-pelvic stability exercises will include a single leg lower and reach exercise as illustrated In fig 1. Those targeting the deep stabilizer of the muscle training will include the bird dog, kneeling side bridge, single side bridge, single leg raise and reach (fig 1), single leg raise and lateral lower (fig 2). However, stretching needs to be concentrated on the hip muscles as opposed to the lumbar spine. ‘Care must be taken to avoid hyper flexibility in the lumber region which increases the rate of instability’ (Quinn2010, pp95). Hip muscle flexibility include exercises such as the Hip extensors, gluteal stretch basic and advanced (fig 3). ‘Dynamics in the lumbo-pelvic stability training incorporates the neural muscular co-ordinations and proprioception in the rehabilitation process’ (Sole et al 2011, pp.63). It is training that involved a little higher force targeting strength and endurance for muscle of the lumber pelvic stability. This will include the full side bridge, plank with leg raise(fig 4), stability ball plank, stability with ball oblique (fig 5), stability ball Russian twist, stability ball hip rotation and stability ball jack knife and single leg variation. Conclusion An integrated approach to training requires incorporation of the different aspect that targeting the lumber pelvic region. High intensity training on a daily basis should be conducted that should be composed of lumber pelvic and the higher intensity dynamic training exercises. This ought to be specific to the lumbo pelvic region and will require a specific plan that ought to be fulfilled as a requirement and routine on a daily basis. This should also target the needs of the patient basing on the type of injury after the relevant screening procedure has been conducted while putting into consideration the functions and ability of the different anatomical components of the bone tissue foe efficacy and safety in training to avoid causing further injuries. Read More