muscle physiology final
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Muscle and exercise physiology
The muscle cell is called
• Myofibril
• Muscle fiber
• Sarcomere
• Fascicle
Lecture plan
• Muscle structure
• Muscle types
• Exercise physiology
• Types of exercise
• Prescribing exercises
Muscle fiber structure
Structural unit of myofibril is a Sarcomere
Structure of Sarcomere
Muscle proteins
• Sarcomere proteins– Actin– Myosin– Titin– Nebulin– Tropomyosin– Troponin
• Extra fiber proteins– Vinculin– Dystrophin
Clinical significance
• Myosin: Cardiomyopathy, Coeliac disease, Gluten enteropathy, Chaga’s disease
• Actin: Cardiomyopathy
• Troponin T: Cardiac disease, COPD
• Troponin I : Renal Disease, Inflammatory muscle disease
• Vinculin: Autoimmune skin and liver disease, Duchenne
• Dystrophin: Muscular dystrophies
• Nebulin: Nemaline Myopathy
Muscle fiber types
• Type 1 (Slow Oxidative) 50%
• Type ll A (FOG) Red 35%
• Type ll B (Fast Glycosylated) White15%
Muscle physiology
What is the difference between the muscles of a sprinter vs a long distance runner
Types of contraction
• Isometric
• Eccentric
• Concentric
(Tension developed is most in eccentric then isometric then concentric)
Frank Starlings law
• Force of contraction is proportional to the stretch
Length
Tension
Define
• Hyperplasia
• Hypertrophy
Exercise physiology
What is therapeutic exercise?
• Customised exercise prescribed for specific therapeutic benefit
Vestibular exercises, abdominal exercises
Types of exercises
• Strength building (bulk)• Endurance building• Mobility improving (ROM)• Aerobic exercises • Relaxing (TROM)• Proprioception and balance improvingSpecial exercisesStability improving
Examples• Strength- weight training
• Endurance- repetitive exercises (cycling, jogging, swimming)
• Mobility- ROM exercises, stretching
• Relaxing- Yoga
• Aerobic – rhythmic dance
• Proprioception- Swedish ball, Theraband, inclined plane etc
Stabilisation- core Stabilisation
Composite exercise programmes
• Combine the benefits of all above
• Grade them sequentially– Start with strength, endurance, stabilisation
and ROM– Upgrade to proprioception– Relaxation last
• Ensure that exercise programme is continued
Which is ideal?
– Structured therapeutic exercise– Playing basket ball
Rational of exercise therapyGASS
• Generalized well being and weight reduction removes illness behaviour
• Aerobic activity increases circulation and psychological well being
• Stretching of muscle and ligaments so that they can
stretch with less pain • Strengthening the guy ropes and cantilevers so that
they can bear more load
Am. Academy Neuro Surgeons
Examples
• ACL reconstruction-Goals– Improve range of movement– Strengthen the dynamic stabilisers of the
knee– Improve proprioception of the reconstructed
and natural ligaments
Priority=Stabilization
ACL reconstruction
• ROM: active and passive/ assisted stretching
• Strengthening: increasing weights-Quads, Hams, Gastroc
• Proprioceptive: wobble board, Swedish ball, inclined plane, beech games
Total shoulder replacement
• ROM: active and passive/ assisted stretching
• Strengthening: increasing weights-Deltoid, Spinatii, Subscap, Lats, Pecs, Trapezius
• Endurance: increasing cycles for above
• Proprioceptive: classical dancing
• Priority=Stabilization: limiting TROM
Designing an exercise regime
Time
Intensity
aerobic
strength
endurance
proprioception
• What is the rationale for doing exercises for IVDP?
• Do you recommend Flexion or extension exercises for IVDP?
• Flexion exercises- Williams
• Extension exercises-McKenzie, Cyriax, Maitland
• Core stabilisation exercises
Foraminal stenosis
Guy rope Cantilever
Prescribing exercises for low back pain
• Depends on pain pattern– Fatigue endurance– Mechanical pain stabilisation– TROM pain and stiffness stretching
• Depends on Pathology– Spondylolisthesis no
extension– IVDP sciatic stretch
Goals of exercise therapy in LBP
• Increase stable zone
• Improve mobility
• Improve strength
• Improve endurance (effort tolerance)
• Increase proprioception (prevent injury)
• Empower the patient to help himself
• Prevent deconditioning
Exercise therapy do’s and don’t’s
• Avoid bending
• Avoid lifting
• Sleep on hard bed
• Avoid pillow
• Avoid 2 wheelers
Can back pain patients bend?
References• Mercer• Turek• Campbell• Apley
• Bridwell et al• White et al• Frymoyer • Aebi et al
• S Rengachary• Youman• Benzel E• McCullough
• Harrison• Price• Davidson
“Basic biomechanics of the musculoskeletal system”
Frankel and Nordin; 2001
What bed
Lifting, lying, extension
Pain avoidance behaviour
Pillow ?
Exercise in low back pain
• Should be tailored to the type of pain pattern
• And the pathology
• Eg: – Effort intolerance type of pain– Spondylolisthesis
Effort intolerance
• Example: doing house work; standing for long, sitting for long
Extensor strengthening without extension
• Example: extension of the spine causes impingement of the facets- spondylolysis
• Yet extensor strengthening is important for spondylolisthesis
• How to achieve this?
• Diagonal lifts; Dying bug exercises
Postural LBP
Postural back pain
Bad posture causing back pain is best treated by postural corrective devices (car seat back rest)
Yes
No
Postural LBP
• Of the chronic 80% are P.LBP
• Does not mean bad posture
• Means bad postural muscles
• Reflects urban life style and stressful living
Sagittal trunk alignment
Postural LBPthe person
• Young adult (male> female)
• Obese/ asthenic
• Sedentary employment
• Stressful life style
• Lack of physical activity
• 2 wheeler travel
Postural LBPPain pattern
• Dull aching• Increased by sitting/ standingIncreased by sitting/ standing• Decreased by walking• Not aggravated by bending/ squatting• Bilateral para-spinal pain• No Radiculopathy• Normal or non-contributary investigations
Therapy
• Enhance strength and ENDURANCE of the postural muscles
Core stabilisation exercises
• Improve pain free range of movements
• Prevent recurrent injury by strength and proprioception
Summary
• Exercise therapy is not a random act of ignorance
• Customised, carefully planned, scientific
THANK YOU
Deconditioning syndrome
Illness behaviour
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