integrative manual therapy for the upper and lower extremities

8/2/2019 Integrative Manual Therapy for the Upper and Lower Extremities

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INTEGRAIVE

MAN UAl TH ERAPY

FO H UPP D LOW XMS

An Itegrated Sysems Appoach Inoducing

. Muscle Energy and 'Beyon Technique For Peripheral Joints

. Syergic Pattern Release wih Strain and Counerstrain

Myofascia Release, Fascial Fulcrum Approach

So Wislfs-Gmmo, h.D

E by Toms Gimmo DC, T

Nr Anic kerkeey ini


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1ntrative Mamla Therapy

for the Upper and Lwer Extreities

Copyrigh 1998 by Shaon Weiselsh-Gammaeo and Thomas Giammaeo. All ighs

eseved No porton of this book, except fo bef eiew may be epoduced stored in a

etieal system, o tansmitted n any fom o by any means---ectonc mechanical photo

copyng ecodng o othewisewthot wien pemssion of the pubshe

Plshed by

North Aantic Books

PO Box 2327Beley Caifornia 947"2

Coer and ook design by Andea DuFlon

Phoography by John Gammaeo

Pnted n the Unied Staes Ameica

Integrative Manua Therapy fr the Upper and ower Extretie s sponsoed y he Soiey

fo the Study of Natie Ats and Siences a nonpot educational copoation whos goals

a to deelop an edcatonal and cossculual pespectie lnking aous scientc socaland atistic elds; to nrtre a holistic ew of ats, sciences hmanities and healng and topsh and dstribute teate on he elationship of mind ody, and natue

2 4 5 6 7 8 9 I 0 00 99 98


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CKOWDMS

u e ae hs ppruniy hank a hse hse nsrun, suppr an enuragemen nribue hs bk My husbanTm Gimmae , T, nribue hs me effr an sk makehs bk pssibe rence jnes ., funer f Srin n unersrain Tehnique s a signican inuence Frank en nribue his

perepin n nsigh fr he eepmen my isening skils A fmy cegues Regn Physi herpy in nnecicu pariipae nhe impemenn f singe sube esgn researh hep rene he ehniques n his bk Ms f , my iens ere aays reay ry anyhing ne hich mgh hep

Mny hans jhn Gamme fr his gf f phography, an oAyee Weisesh an Geneiee Penne fr heir nribuins f ar rk

My appreciain ne agin Mrgare mer, hse reaiiyan s mae hs bk a reaiy.

My sincere ppreciain is eene my bes frien, jy Kin, h

has shre in my research n eepmen f ne meria fr mnyyers.Graiue is eene Rchar Grssnger, puisher, an Anre

uFn esigner My bes effrs cu n hae pruce hs e ihu heir nerenin

My e my nerfu fmy Tm, Nm Ayee, Amir n ebbefr her persn mmmen he success f hs bk

Thank yuShrn Weisesh-Gimmae


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BOU CC SCH D HS X

J o oe t esbe in eph he ii eseh hh gue meo pubsh he onens of hs book Hes of pies he eeie

of he hepeu neenion pesene in his book housns opies he eeie some of he hepy ouie in his book by mysefmy ssoies n ohe piiones of m hepy he mei in

his e is mos unique he ouome synhesis of my knoege,skis, n "isening iies. Epeiee h pien popuiosohope, neoogi hon pi peii n gei, hs geme eepon oppouiy fo eig.

Qune eseh suies he been pefome o fo huneseeey impie ois ih impi pe n pos esg usigMyofs Reese he -pn Fsi Fuum ppoh heise,singe sbe esigs e he ommon eseh ppoh iopoe inomy ini pie I o he pefome qunie eseh suesfo of he unique ehiques pesene i hs ook, u hen i o be

see yes befoe his e ou be pubishe My pefeene s

pbish his ook his ime; ihin i is impon infomion fo heheh e onsume [ sineey hope h piones use his infomo ih he iens o mee hei i nees

Goo uk n hehSho Weisesh-Gimmeo, Ph. P

v


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FOWOD

hae been runae an hnre by a clse wrking relatnship wihharn WeiselshGiammae r many years The eect she has ha nmy persnal an pressinal gwth has been ne in which the status uis rarely saisactry an the ws "cant an "neer hae been eplaceby "anythng s pssible an "aways

The st lecture hear rm harn in 9 was tuy representatie the passin she has r sincety, negrity an truh in a pessinalel where new inrmatin is en rwne n ricue an reuentlyehementy ppse While iscussing a new cncep a systems apprach r eauatin an treatment she inteecte a staemen abutthe cmmn eruse utrasun by many physical therapists I wasamaze t bsere he marity the auence either g cmpletely silentr get eremely gety er the prspec that hey were guilty a cmmn inractin. n ther wrs, ne wante t hear smething hatshk her reality The paraigm shi was great. With tha staemen

an harns hist r cntinue practical knwlege this scenar hasbeen repeate mre ten than can remembe harns wn learningencmpasses a cnstant search r new an bete ways t teat he whepersn ach bit nrmatin she gains is immeiatey integrate intwhat she aleay knws an ue ten new an uniue ways t treatpeple ae ceate

hs uscle nergy tet s the rec esult hat precise learningme. While he rst uscle nergy tet cmprise emnants her earlylearning rm many the es tp sepaths chrpractrs physicaltherapists an allpaths plus her wn esearch this new te encmpasses

ttally new cnsructs aken as an applicatin the bimechanical principes she learne hen an nw newly appies. The pruc s a classc culminatin harns leaning an prcessing sye in regar t appliebimechanics an a natural cmplement r her the integatie wrkharn is the cnsummate stuent reseache an clinician when i cmest ne he greates passns bmechanics he skeletal system Ntsurprsingly his wrk areay ur t e years in prcess has beenene t make its applicain simple pweruly eectie an ecienan nnaggressie t bh the paient an the theapist When masteeang with the cnsructs in he rst et his bk creates a sli crner

stne r the reatment a marity the bys bimechanical ysunctins Her newer research regaring cania an transiinal r Type I

vii


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ADVANCE ITRAN AN OUNRRAN

biomehanis shes een rther insight int the sty strtre anntion o the skeletal ramewrk

harons researh a lnial eorts hae ontine to ast light ntonepaine an neplore areas appie biomehanis an linialknesogy The work s grone in ore ewtonianCartesan physsbt at the same time embraes the onepts o antm physis anbeyon.

harons abiliy t aiitae an reate new earning paraigms in ierent realms wil mst likely ase ritin r thse iniials wh resisthange or ear the nknown Their ale reation wil be to eny the materia b their hallenge will be to pt as mh energy into nerstaning

a growing rm the new knowlege as they wol in ppsing itI lok orwar not nly to the ispersal o ths material b the eite

ment an energy haron wil pt int her et tet an the enthsiasm thatshel epen taking many s n the orney to een greater health harmony an pressinal satisation

ay B. Kain hD, T, AT


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B OF COS

Chapter 1Postural Compensatios of the Upper ad Lowe Extremity jis

Chapte 2nructin Muscle Energy a 'Beyon Technique: A Concepto Biomechaics an the Quantum Enegetic Forces Withi the

lnra-Aricular in Spaces 8Chapte 3

Muscle Energy a Beyon Techique for the Lwer Extremities:Treatmen to Icrease the Vertica Dimensin of the nra-Artculaoin Spaces 6

Chape 4uscle Energy ad Beyon Techque for he Upper ExtremitiesTeatmen t nrease the Verica Dimens f he ra-tcujin Spaces 28

Chapte 5Synergic Patter mprn a Syergic Pattern Reease A Moelfor Treatmen f Protective Muscle Spasm

Chapter 6A Hyphetica Me t Explai the Decrease f Hypertnictywith Manual Therapy

Capter 7The Mucle Barrier 53

Chapter 8Teame f Lwe Quarant Hypetoncity or Synergic ate

Release with Stran an Couerstain Technque 55Chapter 9

Treamet f Upper Quarant Hyeronicity fr Syegc PatternRelease with Stan an Couestain Technque 77

Capte 10Myoascal Reease A 3lana ascial Fulcrum Approach toCorec Soft Tissue an oint Dysfuncton wih DeFacilitateFascial Release

Chape 1Tenn Reease Theapy fr Treament f Tenn Tissue Tensin

with Aance Strain an Cuntersrai Technique

ix


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x AVAN TRAN AND UNTRSRAN

Cper 12igams a Tnsil Forc Gianc Systm: Tratmnt ithigamn Fibr ThrpyO 4

Cper 13Procrs an Proocols to Corrct Uppr n or Extrmityysnction ith ntgrativ Manal Thrapy 120

Cper 14rssr Snsor ThrpyO of th Foot n Ankl Complx 35

Cpte 1Rlx Ambltion ThrapyO ith Synchronizrs 43

Index 5


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CHATER

POSTURAL COMPENSATIONS OF HE

UPER AND LOWER EXREMY JONTS

The esults of a comehesive ostura evaluatio ca facitate a moe effective ad efciettreatmet rocess osture is evaluated o asagittal lae, a coroal ae, ad a trasverselae. It is imortat to stad with a eutraase of suort durig all stadig osture evauatios he feet should e acetaular distaceaart with aoximately 5-0 degrees ofequa exteral rotatio of the feet. t is imortat to ote that oe foot is t sighty i frot

of the other. The kees shoud e equalylexed/exteded f there is recurvatum of oekee it should e maitaied i sagittal laeeutral to reect similar osture to the otherkee.

Phlosophy: Posture Refle(s Movemen Poteniaimitatios of hysiologic motio lexio, extesio rotatios ad side edigs shouldcorelate with static ostue evauatio. Postural deviatios idicate the ody's otetia fordyamic movemet. Cosider there are mildmoderate, ad severe euomusculoskeletaldysfuctios.

Mid, Modeae, o Severe Posa lndiatonsSevere dysfuctio will cause severe limitatios i rages of motio with sevee ositioal imalace of articular sufaces Paiad comesatio atters will e oservedi ier rages of motio. Postua deviatios wil e cosiderale.Modeate dysfuctio will cause moderatelimitatios i hysioogic ages of motioPai ad comesatio atters wil ot e

oserved util midrages of motio. ostural deviatios will e moderate.

gu e lvis wilypi


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2 ADVANCED STAIN AN CUNTERSiAlN

Figur 2. e prximlbo aricula 5rfOcwlar ara

Mild dysfucti wil ly cause mildlmitatios i rages of mti. ai ad

cmesat aers will oly e seredi uer rages f mti. stural deiatis will e sight

Assessment of Posural Dysfncion s peformedto assess he body's cpacy fo ormal jon

mobty, soft sse flexbty and physologicnes of moto.

Pelvc and we Exemiy stue

Osere i sue roe ad stadig Osere ostura deiats hree laes sagitta coral ad taserse. Osere aricularalace of al its. Docume stura deatios f he kees such as shears adratis f rximal iial artcular surface.Osere stural deiatis the feet suato ratio Osere secic deia

ts of all akle ad fot is mallelusaicular cuoid rst ray etc.

A Cmpensay aen

Whe there is o adr soft issue dysfucti the dy wl cmesate i order attai memet gals. Cmesatis tyicalyoccur at it surface ad resu i lss f"articular alace. "Articular alace is theormal eural relatishi f wo articular sur

faces of a thrughut a ful hysiologicmoemet

we Exemiies Typcal Cmpensaty ses

he elis will shear lateral (igure 1). he femora head will e arximaed

caudal adducted ad iteraly rtatedFgure 1

The rximal tiia articular surface willshear lateral ad exteally roate Figure 2


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PP AN LOWE XTMES 3

The disal ibial aricular surface will gide

poserior (igure 3 The alus wil glde aerior (igure 3

The disal bua head wil shif iferior adposerior (igure 4)

The cacaeus will iert (igure 5 The foo wil be proated or supiaed.

Nek ad Uppe Exemiy stue

Obsere i supe proe, siig ad stadigObsere posural deiaios o hree plaes

sagial coroal ad raserse. Obsere aricuar balace a he oi surfaces ocume / posural deaios of he eck shoudergirde elbow forearm wrs had humb adgers Obsere a he oi surfaces

Uppe Extemiies ypa Cmpesay Pstues

The eck is side be away from or owardshe sde of shouder girdle obliquiy (eeaedshoulder girde.

The head is roaed oppose he drecioo he side bedig of he ec.

There is a eleaed shouder girdle (shouldergrde oblquiy (igure here is a protraced shoulder grdle(igure here is a abduced scapula (Figure 6he humeral head is cauda aerior adcompressed i he gleoid fossa (igure 6

he humerus is adduced exed ad ieral

roaed (igure he elbow is exed.

The ula is abduced (igure 7 The proximal radius head is aerior

(igure 7 The dsal ula head is aerior.

The disal radius head is poseror.

The forearm is proaed

The proxima carpal row is aerior.

The wris is i aerior shear durg

exesio.

Fge 3 he disa ibia ides pseri, whle als lides anerir The person ndin in plnar feion eended ankle) Eesion 10"l anibedp he le din din and amba


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4 ADVANCED SRAN AN CUNERRAN

Figure 4 he da il ea 0 hymile sc nferioand eior

The thumb is exed, nteal rtated, andadducted.

he proximal head of te 1st metacarpais in anterior shear and cmpressed

Mvmn Cpd wi Pa Dvain

Oserve deviatins during movement from midlne neutra Assess right-let symmetry, and imitatins in ranges f mtion. "Fixate t inhiitcmpensatry "trick movements wich ccurecause of poor articuar alance imtationsof ranges f motion shoud correspond withcompensatory patterns served during staticpostura assessment. For example, a prtractedshoulder, oseved in a static posture assessment, will present limitation n horizontal aduction during dynamc movemen testing

Articular Balance of ll ue and lower exremjos assres ose and oen keic cha fuction

Pstural Deviations wArticuar Imaances(Hard Joints and Soft intsSft issue t Sft issue(eg lver t daphragm)Soft Tissue to Bony Structure(eg cecum to right iliumBony Structure to Bony Structuree.g. humeral ead t genoid fssa

w Comprmised nt Moility and

Limitation f Soft issue Elongatin w

Limitations n Ranges f Motin w

Cmprmised Function

Hypmbiliy nd Hypmbiy

n the eld of Manual Therapy, hypermily s

not typicaly an issue t e addressed. True hypermili, with ligamentus laxty, in cases


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PER AN WR EXTREMTE

such as regacy ad rheumaoid arhris are

o he commo causes of euromuscuoskeeadysfcio reaed ih maa heray fhere s a geohumera joi ferior dsocaioor suuxaio his o is o hyermoie imaua heray coces. he hmera head ishyermoe o oe ae i oe direco oy:cada. a oher aes sueror gde oserior gide ec) ad i a direcos of hysioogc moveme exio exeso aducoaddcio ad roaios here is hyo moiiyThe hmera head s hyomoe. A disocaed

geohumera oi is herefore a hyomoieroem Maua heray shod address heeuromuscuoskelea dysfucio causig hehyomoiiy. The resu of heray for a caudadisocao of he shouder oi shoud e orma arcuar aace of he gleohumera oi.e. a more orma suerior osiio of hehmera head i he geoid fossa

Auar Balae and Aessoy Moveen

Whe here is a comromise of aricuar alace h osura dysfucio here il e amiaio i he accessory movemes ad heoi ay of he oi srfaces As a exameh a roraced shouder girde here i ehyomoiiy o moiiy esig of a oshich coriue o he shouder grdecomex cosoverera ois cosorasverseserochodra os cosochodra scaohoracic o geohumera o acromio

cavicar oi ad serocavicar oi.

Aessoy Jo Moveet and PhysologiRages of Moto

Wheever here s hyomoiiy of he accessorymovemes ad oi ays of a oi here mUe correaig imiaios hysioogic rages

of moo. There may aso e hyeroicyroecive musce sasm) of he muscuaure

surrodig ha oi There may e fasciadysfcio of he coecve issue srroudig

I

Figre S "kal v

5


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6 ADVANCE mAN AN CUNmAN

gur .e hOlde i enB i h dnionl ern: Ade pl; Bevae holer rle; C proroe holer irle; Deo, cl, compreed hmerl he; E ued Red, nenl rooehe

that oit. Yet i the ody receives a coadfro the rai cortex to ove the oit the per

so wil attept to ove ad to reac the"oveet goal i spite of the ypooiltyI order to atta the "oveet goal theody wil overcoe the ostacle preseted y

oit dysfctio ad liitatios of otio stead of utiiig the ecessary rage o otioat te oit required to achieve the oveetgoal, the ody ivoltarly will eed to coproise his coproise wll occr at the accessory oveets of the oit with "trick

ad copesatory oveetsor exaple a teis payer with a pro

tracted right shoulder girde ust acieve flsolder extesio wth horizota adctioWhe there is geohueral ot dysfuctioi order to attai ths oveet goa thehueral head wll sulux ateriorly durig theoveet i order to allow the "coproseto reach the ed oveet target which required ore rage of physiologic exteso ta

avaiale to this teis payer This "pseudo extesio acieved via excessive aterior shear ofthe hueral ead is ot withi the oralhealty costraits of ot oveet e accessory oveets at the oit surface are owpatologcal ad as a rest of this copesato the gleoheral oit capse wil ecoedysfctoal possily developig fascial dysfctio at the aterior aspect of te oit capsue ad a tighteig of the posteror oitcapsule Assesset is copex. Rage of otio should e evaluated while aitaiig oral articular alace etwee the gleoid fossaad the huera head or exaple gross physiologic extesio is easred wile evaatgexcessive pathoogic aterior gide of te ueral head Te therapist ca thus discover thetotal dysfctoal patter whic requires structural rehailitatio ad fuctioa reeducatioad traiig.

Postural dysfunction indicate articular im

balance, joint hypomobility and imitations in


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UPP AN LOWE XTMTES 7

phyilgical ange f mtin. Ml terpyehiques be performed t res of posurl

dysfutio i order to improve rtiur ble rese oi mobility d rges ofphysiologi motios ostur devtios o yd ll ples re idto for treme

e geerl sequee guideles for Mlherpy re s folows

Assess postrl dysfutio o ll treeples sgittl orol trsverse

Tret proximl to dis

Tret re of gretest posrl dysuto

rst Tret ordig to sti postur dysfu

tio rst Tret ordig to dym postrl

dysfuto fter sti posurl dysutio

figur 7. Typcl lbow cmpns nd: Aanr prx rl ha;Bct a 0 Ix w


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CHTER 2

MUSClE ENERGY AND 'BEYOND TECHNIQUE

A CONCEPT OF BIOMCHANCS AND TH QUANM ENRGEC FORCESWTHN E NTRA-ARTICULAR JONT SPACES

e nAiu S o S ons

atnt o biohania dyunton i nouniqu. Fo a ong ti any diipin haattptd to ahi longlating t on jointdyuntion pially at th luboaa juntion LS/. Th attpt ha bn unu

ul i.. th do not appa to b on goodolution o th tn o thouand o pon atd by low bak pain and iata. Motpinal ugy ou at thi LS/ juntonwhih t that thi pobl au igniant pain and diability a wll a hgh ot ohalth a ipint and taxpay

h luboa juntion ha alway bn a-d until ntly o ign o liitd obil-ity ntially LS at th uboaal juntion

ha bn ad lik y oth pinal gnt hi aluation i no adquat. h i adin btwn LS and oh uba gnt th luboaal juntion ha ipoalotion pnt on th plan whih i notpnt bwn L through LS

What i thi ipoal on at thluboaal junton? Duing agittal plan o-tion th ba o au glid n th oppoitdition o LS ont: LS l dung po

tio aal glid and LS xtnd duing ant-o aal gld. n th tn pln LSotat th ight whl au otat to thlt and LS tat th lt whl au otat to th ight Dung otion on a oonalplan th i iila poal otion i.. thau id bnd in th oppoit dion oL id bndng.

h i a unqu onpt und intigation by Lown and WilhGaatto and

oth pobl o aal bohani a inat pob o h intaaiula pa. A

8

quantu phyi xplanation ha bn dlopd xplaning why th a litation ooton at th luboaal juntion. Th ngy withn th joint pa uoundingau inluding wthin th aoilia jointLS and h aal ba and btwn th at

o LS and 1. h ay b a opo othi ngy whih i a dituban o th quantu ngti o wthin th joint pa.hi ngy in th jont pa aound aupnt itl a a un plana dituban withinth anitd litation o otion

An addtional onpt whih qui u-th xplanation o a phyi ppti gad ax. Whn th i ont whih iantio to idlin th hypothial axi o o

tion i poitond anio to th body pat inoton Whn th i potio on hax o oton i poitond bhind ha bodypat wh th ont o a ditd.Ax although onptual a o whih adynai n natu and t otion o oingpat. Th dion o h ont i igniant th dition opond wth th poitiono th axi on al th plan: agttal oonaland tan.

agittal plan ont at th luboaajuntion i lxion and xtnion. Thi ont i dint than luba pn xion andxtnion bau o ipoa otion At thluboaa unton whn LS lx t i di-plad in an antoinio dition whi thaal ba glid potio. Luboaal xioninlud both th antio otion o LS and thpoto otion o th aal ba. Wh i hax o oton o luboaa xion? I tha paat antio axi o LS with a dint

poto axi o ? Thi i not aonabl


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R AND OW XR 9

beaue lboaral exion i a ojoine o-

tion o S toether with 51 The axi o otion nether n ron o S, nor behin 51 The axo otion r boaral exin between San 51 throuh the i, with the penetrationbein iine throuh the i. Vario phe-noena o the L i have been oun on etion The ajr part the i to beoniere appear to be the ile o the nulear ateria, whih ener. here are le e-vation ro iline at the entra portion othe i urin oveent

When there i a ojone otion n thehuan boy between 2 truture, ilar to theotion at the lboaral juntion, the ove-ent i reexive in natre Thi neroreex-eniinue apaity or reiproal otion atthe lboral ntion alow reater oveent rather than eer. Thu the aount oavalable otion on any one o the three planeor LS an 51 i h reater than at any othervertebra eent

Whle exion an extenion our at theboaral ntion, oveent our at botharoilia oint. hu there ut be a ojoineotion apaity o LS5 toether with the 5ont, whh are neroreexoenially able tooperate with S an 5. he aropinou li-aent appear to be invove in thi partiipa-ton o ooperate atvity.

Drin toron o the luboaral juntionthere i alo ojoine tion between the lu-

boaral jntion an bilateral aroilia jointTorin are the aor LS5 oveen rinabulation Thee otion are triplana anonoitant on 3 plane aittal, oronal antranvere. When heel trike our, there areextenion ore aetin the le in tanephae, whih aue a teneny o the aru toexten on the ie o hee trke. Yet the aruannot exten, beae the piriori i plainan anterior ore on the aru on that ie

he pll o the piriori will rotate the arutowar the ie o win phae, an a the

aru rtate, ie benin o the aru o-

ur to the ae ie. Durin itane, there ia reater ore o the pirior, auin axia rotatin o the ar towar the e oiwn phae hi en rane o rotation wilpll the ar in a tranvere pane poteroron the ie o wn phae. The horiontal libo the artiuar rae o aru aoo-ate n orer t ipae aru n thi anner

The Forces of Abuon ou e

nArur Spes of the lwer QudnDurin itane towar toeo there atraner o ore ro the le in tane phaetowar the le in wn phae. The extennore are erean throhout tane towar toeo While the extenion ore ereae, the teneny o the aru to exten ielinate he piriori pull i ereae, othe rotation ore towar the ie o winphae i reue. When thee rotation ore are

ree, the ie benin o ar on the ieo win phae ereae. A the ore o rta-tion towa the win phae ie are reue,the tranvere otion o ar on the ie owin phae in a poterior iretion ubie.The artiular rae o ar wil no loner betranlate on a tranvere plane alon the hori-onta lb o the oint rae When the oreo extenion are elinate a oon a toeoour, there will be an initiation o oentu-

nue ore whih aet the le whih inow beinnin win phae. Thee oentuore o the boy are epenent n enery, thelie ore, the proution o ATP, an etabolirate. Requreent or oentuine o-tin inlue ule ber trenth, reritento ule ber, neurona health, an ore

Footrun ontat our urin tanephae. hi ontat i iilar to the onat othe win wth water o the oean. The win ha

a ore, a veoity, an an aplite the watero the oean tranribe the ore Typially, the


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10 DD i D DRl

evidence of this foce occrs on shoe whenthere coud be a tidal wave if the strength of this

force and the ampitde is intense. When theshore begins to erode there is an environmentalexplanation for this erosion A simiar circm-stances occurs in the body. When the wnd andwater meet there are dispacements of energyon three panes When the foot and groundmeet dring standing and ambuaton there aredisplacements of energy on three planes whchare simiar in natre t the displacement of theforces on the water hese forces are transcrbed

up the leg within the inraartclar spaces. Themost signicant intraarticlar spaces are thetibiotalar, tibiofemoral and the femoroacetab-uar spaces. An accommodation to these forcesoccrs at the sacrum wthin the nraarticlaroin spaces of the sacroiliac joints and thembosacral jncton

The accommodation footgrond forcesat the sacrl oint spaces is a major fnction ofsacrum he 3planar forces within the sacra

joint spaces the sacroiliac jons and the lum-bosacral junction are further displaced andtranscrbed from those oint spaces throughotthe body. The forces which converged in thejoint spaces of scrum in a 3panar manner arenow transcribed throughot the joint spaces ofthe body. hese forces are transcribed throghthe spinal jont spaces and also throgh theintraarticlar spaces of the soft joints Thesesoft joints inclde for example the oint spaces

between the iver and the diaphragm betweenthe heart and the pericardm and between themscle belies of different mscles. his transcrption of forces occrs between cels andbers as wel as between those larger structreswhich have a roe of functional organzation.

In order that the forces reach the sacrum in amanner that will not case erosion of the sacraljoin srfaces the lower extremity joints mustbe aligned with good articuar balance andgood joint mobility and most of all adequateinraarticular join spaces. The nature of the

joint space is similar to the nature of the oceanwhich is affected by the wind and is able to tran

scribe the forces of the wind in a manner thatwill promote healthy shores rather than causeerosio. The intraarticlar spaces of the legs areable to transcribe the footground forces n a 3panar manner and these forces are transcribedthrough every jont space (between muscle bel-ies between mscle and bone between boodvessels and m ces and between cells andbers) he most signicant join spaces whichwl determine the qality of forces affecting

sacrum are the tbiotaar oint spaces thetibofemoral jont space and the hip jont between the femora head and the aceabum

Muscle Energy and Beyond' Technue is anapproach t correct the dysfunction of ntraar-ticular spaces and is aght n ialogues inCoemporary Rehabiltation courses The tech-niques for the ower extremty are goalorientedintended to mprove the vertical dimensions ofthe intraarticlar joint space his approach

thereby faciltates transcription of footgroundforces which are transcrbed up the leg to thesacral joint spaces for redistrbtion The jontspaces of sacrum are treated to accommodatethese forces here is less force withn the sacraljont spaces becase there is no acceleration(force eqals mass times acceleration. The transcription of forces in sitting is simlar o thetranscription of forces during standing (ascompared to the forces during ambulation and

running which are characterized by increasedamplitde of force as the reslt of accelerationhe transcription of these sacrum forces andground forces drng sitting has less erosioncapacity becase the displacement forces onthree planes are not as intense hese forces aretranscribed through the body's inraarticuarspaces. There is an accommodation to theseforces withn the sacral jont spaces which arethen dstributed throughot the body

What is the character of trascription offorces? There is a particle and a wave motion


21/166

UPPE AND LW EXTEMIES

of energy hih iplae ui iilar t theplaeent of oean ater hen the energy ofhe in i ranribe on the ter r thehre. Thi prtile n aveike otin f energy r fogrun fore an fr arugrun onat i.e in ing) requre nlypae The ui a eu of ranrpionil be ore aooatng f i i le viuan le ene. The re the ui ithin thejoin pae of ilar enty t aer theore norl the trnription of fore hughth eiu of ui an our

he upper extreity jont alo requireinraartiular pae of perfet alignent anenion. Thee pae are "energeti foretorque for oenu an preureiplaean inue oton. When Mule Energy nBeyn ehnique i ue t orret the vertl enin f he upper exrety irartiulr pae the vee are perulrequiring le rength for ore tranatn anrtatin ipaeent of the ar n runk.

An nteretng onept i the perpeutionof fore hrough the boy. What i the natureof preure an itane of tranription? ouh preure i require ihn he joinpae? Exeive preure il apparenly inhibhe tran ripin of thee fore hrough thejint pae beue of the inherent retnehih preue provie t energy ithn n enapue re. oo lie preure ill be inufie r eiu oniteny reure

regulon ihn he joint pae i prtantu be nvetige n often ree ih apern h require treent of joint pae.

Mule Energy an Beyon' Tehniquereahe inie the join beyon he prble oariuar bne an join oblty Mule En-ergy an Beyon' Tehnique i he exepionaltherpeui poe hih aree vertial i-enion ithin the joint pae The peron iprvie a retrtion of the yte of energy

hih thrugh the joint pae hi energy re hin the join pae or aite

nane of vertal ienion During ret here i ati prtle oveent of the energy hh through the join pae iilar t heon of ter leule n he oen. Duringoveent there an inree n the velketion f energy ithn the join pae iirt the oean afete by in

Regarding is Bok

Thi book inroue Mule Energy an Beyon ehnique ith thnk t he ho n

ribute founation for thi unertaninginluing re Mithell r. D.O. ooverD.O. uy DO. an ther. Withut theirfunation th apprah ul nt haveevolve. hi boo nue the ppah Mule Energy an Beyn ehnique fr heperiphera jin the upper an er extreitie An approah or preure nralizinhin the ntaariular pae of the leg introue. Abulain ailatin ith ue

ynhronizer hh are relex gveingehn ierne by Len an WeielhGaateo i nlue The bai tehnquefor upper an ler extreiy nralizatn fartiular baane h train an Counertrainehnique evelope by arene Jone DOi preente Thi rain an Cuntertrainpproh il orret the ynergi ate print in hrni an neurlgi len. Theehnique re expee t ttain noral nt

obily iprove the aery vee fhe pelvi eg n ar oint. An inrouton toenn elee herapy an of Tiue anArtiular Myfaial eleae t rea he aialretrition of he ar an leg an to proveapular an igaentu tenion are inlue.An apprah to are oplex ligaen yuntin th Lgaent Fiber eee i inr-ue. he ontent o thi book ill provealeative for the pern he funton i in

hibe by phyal an energet yfuntin afetng he ar an leg


22/166

12 AVAC mA A cTmAI

Mus Egy a 'By Tchqu:A 3-Paa Appach am f ItraAcua

J Spacs f Egy Dsrbu ad VcaDims

hese thee ccepts ae equally iptat althugh thee ae aiables f sgicace f diffeet cliets.

i Miiy

he j lty f the j sufaces f ayjit is iptat fo eet f that jRages f ti ccu thee plaes: sagit-tal cal ad tasese. Of cuse thee is,e tha just the plaa u idiectia aduplaa eet f a it Whe jt tis ae cied the wds whe itscpeate f the pducti f eet ate jit thee is eceptal j bility attaied beyd the thee plaes

Flei ad etesi ae uidiectalsagittal plae ees bducti ad ad-duci ae uidiectia cal pae eets. Eteal ad Iea rtatis aeu idiectial tasese pae eetsHoia abducti ad hztal adductif the glehueal jit ae als uidiectia ee a tasese plae bt e-que the cjied cpeate oeets fthe elbw wit had ad ge jits Theit bility f al iled aticua sufaces isaffected

The glides f the jit sfaces affect jit

obiity. These glides ccu because f thepushes ad the puls f uscle bes which at-tach t the bes. Thee ae als tatiswhich ccu at the jt sufaces which ae theesults f eegetic dispaceet secday ttesectig fce which ae caused by eet hee ae appiatis which ccu atjoit sfaces ad disactis that ae the esult f echaical pushes ad puls the oitsuface which ae the tasdced it ee-

getic dispaceet

P f j Mby

It is iptat t fcus actie ad passie

physigic ages f i as they petai tjt suface blty. Pef assisted acteages f i while papatig accessy jiblity close t the jit suface f the oigsuface F eaple duig assisted actieshulde abducti palpate f sth caudalgide f the huea head i the gleid fssa

Remember tha most "noms ve eenmesued and docmented o aerage

(dysutional) odies. I yo qeston henformtion i tis text s ncore, plese rea

you ciets in the mne preseted i thisbook Then re-ssess Look or "norms.I

Acc M:

Whe the ig suface is ce with the sta-ble ad ed ig suface ccae (f

eaple the gehueal jit) the accessygides ae as flws: Flei: stei glide

tesi: tei glide bducti: Cauda gide dducti upeio gide xtea tati ad a eta as:

tei glide with distacti Iteal otato aoud a etcal ais

Pstei gide with distacti

Hiztal bducti: te glide withappiat Hial ddcti Pstei glide wth

appiatiWhe the ig j suface is ccae

a coe ed ad stable jit suface f eaple the tibifeal (kee) jit the accessy glides ae as fllws

Fe tei glde tesi Pstei glde ducti Medial glide ad appia

ti the jt side f abducti


23/166

P AND OW MIIS 13

Adducon aea gide and appomaion on e join ide of adducion

Eenal oaion aeal glide Inenal oaon: Medial glide

Join pa i a em ued fo unimied moion opion wiin e join pace paivelpefomed b mecanical pue and pullTee moion ae no piologic

Aica aance

Aicula balance i e elaionip of e woaiculaing join uface fom anaomical neu-

al ougou a full piologic movemenAicua balance will be viewed fom a non-piologic obevaion fo eample:

wen ee i a cadal ubuaion of eumeal ead in e glenod foaeconda o eceive one of elaiimu doi wic depee eumeal eadwen ee i a aea ibia ea a epoimal ibial plaea econda o an

nappopiae balance of ligamenou en-ion of e igamen uonding e neeoin.Wen ee i fau aicula balance e

w aiculaing join face do no mainainnoma elaionip ougou e ange ofpiologic movemen euling in limiaionof pave and acive ange of moion e jonmobil ma no be affeced e. ee ma beful glde aaned wi mobii eing. ong

em poblem of acula balance a a jonpicall eul in capula enion wc eun join pomobili. Join pomobili pobem wic ae conic picall el in liga-menou ain wic caue moe aiculabalance poblem. i u common o dicovebo join mobii dfuncion a wel a aic-a balance dfuncon wen ee ae jonpoblem

igamen ae connecive iue. Hioogic

aemen a dicoveed diffeen ligamenbe pe. One pe of be appea o be lon

gudinal wile anoe pe appea o be o-izonal. e oizonal o longiudinal oiena-on of e be of e ligamen appea opla an impoan ole. Te auo poe-ize fom evidence duing clinical eeacudie a e longiudina be ae fo gid-ance and diecion of e dial bone o wice igamen i aaced e oizonal be ofe igamen appea o connec e wo negboing bone in ode o povde feedbac fopopiocepon a o wee e wo bone aewoing ogee in an appopiae manne du-

ing eing ae and dung dnamic moione inabii of a join w igamenou

poblem ma be moe evee fo a peon anjoin pomobil poblem econda o capule dfuncion. Bo e diecion of e mov-ing pa a wel a e coodinaed acivi ofe aaced wo bone wil liel be affecedwi ligamen enion poblem i caue inabili wic ma pedipoe a peon moeofen o inju.

naacula pace an Vica Dmenon

i i a unque concep wic i unde clinicalinveigaion b owen and WeielGiam-maeo egading e em of inaaculapace (eical dimenion a been dicuedofen in lieaue abou empoomandibuladiode.) e affeced em of inaacuapace appaen undelie all join poblemand epecuion aociaed wi dfncional

inaaicula pace include capule dfunc-ion a wel a ligamenou poblem Capulepoblem caue join pomobii. igamen-ou dfuncion caue lo of aicula balanceof e join uface.

Te pace win e join ae mainainedw eneg a a a vibaional molecuapaicle moion. i eneg i enapped wine fuid of e pace Wen e uid becomeexceive vicou and dene e eneg doe

n ciculae oug e em of inaaic-ula pace e enapped eneg wiin e


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14 AVANE STRAIN AD COUNTRlRA

aaila spae il e fee fo ex adey as og as hee is lid. This ld is he

syoia lid hi he joi spae, hih iefaes h he maix of he oee isseWhe hee ae ieases he desy of hisld, poeis, log hai fay aids, ad oisl e apped side he oi spaes, as he iesiim is affeed This iease i desiy affes he meaoism, hih ildes passage ofes io he els, ad also deliey ofase pods ildg poeis, log haifay aid, ad oxis fom he els io he

ymph apillaies This aspo of ase pod-s il e dysfioal he hee s i-eased isosy of he ids. Thee ae lymphodes eah jo spae of eah peipheal joito ese ha he ymph oad of ase podsis pied so ha hese jo spaes ae oylled ih pe sole d ad eegy

Whe hee dyfio of h a-la spae, he oal sysem of eegy lohogh he ody's joi spaes is affeed

Teatment of Biomehani ysuntion o heExemy Jons; reatment o Jon Hypomobity

Today hee is a eogiio of mipe oimoilizao potoos These poedes eedeeloped y may dffee pofessioas, i-ldg aley Pas, eddy Kaleo, JohMeell, Geoffey Maiad ad ohes ho deeoped iplaa msoseeal ehiqesfo easg jo moliy. These appoahes

ee deeloped o addess iaapsla as elas lgameos dysfio "Capsla pa-es ee eogzed y pofessioas hooseed osise aiales i hei les'ypal maifesao of joi dysfos.Ofe apsla polems ee osdeed igameos dysfios. The majoiy of he moiizaio poedes ee sehoieed,alhogh Maiad deeloped a eoogiased appoah aled "paifl ehiqe fo

eame of ae oi dysfio, sig eylo amplde osllaio molzaios.

These moiliaio ehiqes ae sll sedoday, ad ee ies h dysfios

of he apsle, espeially he hee ae adhe-sios of elasoolageos es These desehlike mehods ae also effeie o addessiaaila adhesios Ye he ed of maalheapy is moig oads less die ap-poahes, ookig fo deeased essae fomody isses. Bease joi moly polemsae dysfios of he apse, hih ae fas-ia poems, fasal elease ehiqes ae paialy effee ad efie The of Tisse

Myofasial Release Tehiqe, a 3plaa fasial fm appoah deeloped y WeiselshGiammaeo, il oe he maoiy ofpoems hih ae fasial esiios affeigjoi moily seoday o exaala dysfo The Aila Fasial Reease Tehiqe, a 3plaa appoah fo oeio ofapsa ad lgameos adheees is peseed as el i his ook. Whe he joi moiliy s ompomised ease of msle eso

of he saomee e, poeie msle spasm,hee is a emakale appoah fo eeioai ad Coesai Tehe, deeopedy Laee oes, O

eatment o Artua Baane ysfuntion

Aa alae is he elaioship eeeo ala sfaes of a joi hogho afll physioogi age of moo. Ofe hee saila alae dysfio a es, ad dg

e ages of moio This od e se-oday o seee hypeoiiy of he mslees aahed o he oes of ha jo, o deo sigia exaaia o aia fasiaesios. These aia fasia esiosmay e apsle o igame Whe he alaalae polem is eide oly dg moe-me, ahe ha a es, he polem sfaesdig mid ad oe ages of moo Thesepolems ae less seee, ad ae also seoday

o poeie msle spasm ad apsle/ga-me dysfo


25/166

PPE A WER XMITS 15

he lgmes e specl. Rhe hn be-g olly eced by scil eese echniqueshee e ohe mehods o eese o lgmenesions which wil be pesened in his bookhe igmes e "sysem. All o he lgmes unco ogehe he body s wholebu lso s uis hei iecommuicionsysem when hey wok s uncionl com-pee sysem s o ye uesoo Whe nyone igme seches, ligmes o he bodyespod o hs esponse hee mus be neuoeexogenic sysem o communicion.

This possiby occus spin eex leve bumus lso hve highe leve neul eex nvove-me o his o boy esponse

Anohe eesing phenomeno is he longu lgme bes whch uncon s singe ui o hei indivul oin ye lso wowih l he ohe ogudinl igme beso he body s whole hese bes ppe obe esponsible o iecion o movemenThe logiuinl bes e consiee by he

uho s he Guidnce ysem. compisonhe hoiol bes o he lgmens do oppe o wok ogehe s o body uncio uni bu he ppe o be esicein ucio s indivul igme bes whichocus o hei own individu joi hese ho-ionl bes e ppely he coodin-os o moio bewee he wo boy suces

whch hey cojoin. ooinio ppes o be mjo uncion o hese hoionl ligmenbes; hey coodine he civies o neighbo-ing bones

he ppoch o elese o igmenous ension o gunce d coodinon o joinsnd o mpoved icul blnce is ncudein his ex

Tratmnt Dad Via Dmoo ntaarua Spa

his poblem when i ecs one joi ecsll he jons o h eemy Aso when heeegy ow is eced in he exemiy obody ow o enegy hough he nicuspces s compomise The 3pn ppocho coecion o he dysuncionl join spce isMuscle negy d eyond echnique deveoped by Weiselsh-Gammatteo. When there is adisubnce o he qunum enegeic oceswihin he oi spce, hee s unipl pe-

senio o his disubnce This emen p-poch consides he plne o peseno; posiionl dgosis s deemied e-men posio is ssumed o ddess his pe-seo; d he emen echique ispeomed he veic dimenson wh hejoin spce c be esoed so h ges o mo-on e incesed.


26/166

CHP 3

MUSCE ENERGY TECHNIQUE AND 'BEYOND

FOR THE LOWER EXTREMIES

TYPE II MOVMENS

/ - Mvm leon en Roo Abcon Fleon Inenl Roon Aco eon enl Roo

Abcon eon Inenl Roon

Acon

-j v Mvm enl Roon ly occ h

Abcon Inel Roon ly occ h

Acon

- Mvm e Mvm Fleon n eno e Sgl Plne

moemen el n en Roo e

nee Plne moemen Abcon n Aco e oonl

Plne moeme

Laws of Biomechanis

Type movement moemen n neutral oee o eene) Ro eeg e occ o oppoe e Th mengh oo occ h le e beg nnel

Type moement moeme n fexion r extenso. Roon ebenng n e een occ o he me e h megh o occ h gh e eg nleo eeno.

Type II Movement o he Perpheral Jonts

The cnc eech f he ho h peeence h pephe jon he only Type II

moeme here no Type

movement at theextemty jont.

ipa jons av only Typ ovn


27/166

PPER OW EXTREMTE

Type Movement of HisHp jo ae femoal/aceabula jo Phyoogc mveme f he hp ae fexo exeo agal pae); abduco adducocooal plae); exeal oao eal oao avee plae)

Dec acceoy moveme of he femoahead ae

Aeo glde fo exeoPoeo glde fo exaudal glde fo abducoephalad glde fo adduco

Ae glde pu cephalad gde fo e-a oaoPoe glde plu caudal glde fo exealaoype moveme occu heeve he hp

exed o exededhe Type Dyfuc ae

exedxededype II moveme dyfuco ae 3paa

dyfuco.ou poble ype II dyfuc ca ccu

a he hp femoaaceabua) o. lexed Adduced Ieal Roaed lexed Abduced xeal Roaed xeded Adduced ea Roaed xeded Abduced xea Roaed

nteral Rotaio occurs wih Adducionin Type Moveme

Exena Roaion occs wit Abdconi Type I Moveme

Assessmet o Type I Hp Dysfuto

1 Palpae he glde of he femoal head dug phyologc hp exo ad exeo

Palpae a he geae ochae3 Thee hould be o apprman o ds

racn f he femoal head dug hplexo ad exeo.

0'Fge The hip jOinl is pled he 9,ele Irochnler fo Type dysunctin. Ppe A mei pu (omresso ole eor he!or Boero scti o he feo

1


28/166

18 AVA( SRA A OTSRA

4 I h mrl hd rxm thri mdil l ltd t h grtr

trchntr. I h mrl hd drct hr i

ltrl ditrctin d th grrtrchntr.

6 I h mrl hd arxmates, dt th grr trchnr mdil l,th hi i tc addcted nd ntealrtated

7 I th mr hd laterally dstracts, td t th grr rchntr ltrl

dircin h h c abdcted ndexteal rotated

8 th mvmn dynctn i ld th grtr trchnr drng fexo:te cant fex hrr th sstck extended.

I th mvmn dyncin i ld th grtr rchnr drng extensn th cannt extend thrr th s stcfexed.

ina Diagn f ye II Dyfucn

EADIR Fnd n lxn ExnddArximin mrl hd:Ddcd, Intrnly Rtd

EABER ind in lxin Exnddtrl ditratn mrl hddcd Extrnly Rd

ADIR ind in xnin: FxdArximin mrl hdDdctd, nrnly Rtd

FABER Find n xtnin Fxdtr drcin mr hd:dcd, Extlly Rttd

Memet Baie f ye II Dyfctn

EADIR e stnal dagnss Extndd,

Addctd nd Inrnly Rtd.

e I1veme1t barrers FABER:Flxn, Abdcd nd Extl

Rtin

EABER e stnal dagnss ExtnddAbdctd nd Extlly Rd

e movement barrers ADIRlxin Addctn nd InRtn.

FADIR e stonal dagnss lxd,Addctd nd tlly Rttd

e mvement barrers EABER:Exnn, Abdcin ExtlRttin.

ABER e stnal dagnss FlxdAbdcd nd Exrnlly Rd.

e mvement barers EADIRExtnin Addctn nd InrnRtin.

Chc th hyigic imittin mtin.

h hld crrt with h mvmbrrir

in f reament f Tye II i Dyfuctn

EADIR Th iin digni : Exndd,Addctd nd Inrnly Rtd

Th mvmnt brir i FABER

h in trm i h m h mvmn brrr ABER lx,Abdc nd Extlly Rt h ht h irbrrir zn N: Rrt Chtr Svn

EABER Th itinl dign i ExtnddAbdctd nd Exrnly Rttd

Th mvmnt brrr i FADIR.

Th itin trmn i th m th mvmn brrir. FADR Flx

Addct nd Inly R h hit h intrb rrir zn


29/166

PPER LWER EXTREMTE 19

Tree r DR: ii f1x bduct exle ro Treatet r BER i exo aductio iter rla

Treaet or FDR o i exeo abducti extera otati Treate fo FBR i i exteo aducti itero rolalo


30/166

20 AVA SRA D URSTR

FADIR Th positinal diagnsis is: FlxdAddctd and Intrnaly Rotatd.

Th vnt barrr is A

h psitin of tratnt is th saas th vnt barrir: AR:xtnd Abduct and xtrnaly Rotatth hip to th intrbarrir zons.

AR Th postional diagnsis is FlxdAbductd and xtrnally Rotatd.

Th vnt barrir is ADIR.

Th psitin of tratnt is th saas th vnt barrir: ADIRxtnd Adduct and Intrnaly Rotatth hip to th intrbarrr zons

Teatmet Type ip Jt ysct

. Palpat th scl ba at h gratrtrochantr in pron or spin fr xtnddTyp [[ hip dysfnctins fnd in lxion.

Papat th uscl barrir at th gratrtrochantr in pron or supin for lxdTyp hip dysfnctins fnd n xtnsion

2. Mv th hip and lg passivly t th ntrbarrir zns n all 3 plans t a 3planarintrbarrir zn.

3 or Flxd dysfnctions fnd n xtnsinrsist any vnt of th hp.r xtndd dysfunctins found in xnrsist any vnt f th hip.

4Rsistanc istric;

5gras rsstanc

6

sconds rsistanc; unidirctinal!uniplanarrsistancRlaxatin Prgrss to nxt 3planar ntrbarrir zon.

S 3 rptitions.6 Rassss

T K i ihr ar Fexed and Exteded Typ [[ Kn

Jont Dysfunctions. Physiolgic ovnts f th kn joint

ncd lxion and xtnsion Sagittapan).Dirct Accssory ovnts of th proxia tbial articlar surfac ar: Antrior gld for xtnsion2 Pstrior glid for xinLatral glids ar dysfunctional if thyoccur bfr h last dgrs f xion

and xtnsion.Rotatins ar dysfunctiona if thy occurbfr th last 5 dgrs of lxin andxtnnyp I vnts ccur whnvr th n

int is 1 xd 2) xtndd.Whn th n ji is hyprxtndd r

cuvat thi i dyfunctionalNora yp vnts f th n

ccr in xon

Muse Barer r ype" Kee Jt Dysi

Th scl barrir for assssnt f Typ IIkn dysfnctns can b palpatd at th proxi-al tibial had n th atra surfac. Papate(o meda and atera gdes o( the proxma tba head Latera gdes are more ommon

ype Kee i Mvemes

During xin if th proxial tibia hadglids latraly it as xtrnally rtats

During lxion if th proxial tibial hadglds dial t also ntnally rtats.Durng xtnsin .. whn th kn ovsfr xd twards anatoc nra ifth proxial tibial had glids atraly taso xtrnaly rotats.

Dring xtnsin i.. whn th kn vs

fro xd towards anatic ntralf th

prxial tibial had glids dia it alsontrnaly rtats


31/166

UE W EXEMES

APLCATION

Consider knee join exonrom antomic zero o fl lexionConsider nee joint extenson

rom ll lexion o anatomic zero.

Co-joied Tasvese ad Cooal PlaeMovemets

xtrnal rotaion occur wh atral gld. In-ta rotaion occr wh Mdial glid.

Typical ype II Knee Dysncion:Flexed, ael Glide, xernally Roted

Regadg "Glde

Glid (mdial and laa) ar th modid andnatura coonal an idbndingabdctonaddcion motion for h kn.

Assessme of Type Knee oin Dysfion

o or wih low g of thbd a o o h oi

A kn jont movmnt with alaton ofth roxmal ibial had. Obrv if h i lat-ra or mdal gld of th roximal ibial hadbfor th at 5 dgr of nd rang kn flx-on Latral glid modid n abducion.Mdial glid i modid n adduction If hr

aral gid of th roxima tibial had th alo xtrnal rotaion of th roximal tibiahad. If hr i mdial glid of h roximal tib-ial had thr i ao inrna roation of hroximal tibial had

wth th lg o th dg of th a to of th oi

A kn joint movmnt fom full flxon to-ward a traight lg wth alation of th roxi

mal tibial had. Obrv if thr i lara ormdial gid of th oximal ibial had bfor

o,ig. 9 Pae f ei gie Ber gie e prima iiead 10 O" ype kee jindfunin

1


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22 AVACE mA A CEiAH

the lat egree of en range knee etenonatera gle oie knee auton Meial

gie oie knee aution f there i ateral gie of the roial tiial hea, there ialo external rotation of the roxal tiialhea f there i ea gle of the roxia tiial hea, there alo nternal rotaton of theria tial hea

osiiona iagnoss of Type IInee Jont ysntion

If yfuntional glie an rotation our nknee leion

the knee annot ex the knee tuk in etenion

there i an Extended Type II Knee Jointyfuntion

If yfuntional glie an rotaton our nknee etenon (aee fro ful lexion towar a traight knee)

the knee annot exten the knee i tuk ee

there a Flexed Type Knee Jointyfuntion

If a lateral gie/externa rotaton our eforethe lat egree of enrange knee eonan/or uring en range extenion: the knee tuk Aute an Eternally Rotate.

f a eial glie/inteal rotaton our eforethe lat egree of enrange knee eonan/or uring en range extenion: the knee tuk Aute an Internally Rotate

There are four possible Type Knee Joint dysfnctions

FABER lexed Abdced and Exenaly RotaeFADR lexe, Adced ad ntenall y Rotaed

EABER Exended, Abdced ad Exeraly RoatedEADR Exened, Adced ad ntenal ly Rotaed

Te mos commo Tye ee Jondysction is ABR

Moveen Baies o Type IInee Joi ysfunios

FAER The knee i tuk Flexe, Aute(lateral glie) an Etealy Roate.

The oeent arrer EAIR theknee annot Exten Aut (gleeial) an Inteally Rotate

FAR The knee i tuk Flexe Aute(eial gle) an Internally Rotate

The oeent arrier EAER: the

knee annot Exten, Aut (glelateral) an Eternaly Rotate

EAER The knee i tuk Extene Aute(ateral glie) an Externally Rotate.

The oeent arrier FAIR theknee annot Fle, Aut (gieeial) an nternally Rotate

EAIR The knee i tuk Etene Aute

(eial gle) an nternaly Rotate.The oeent arrier FAER theknee annt Fle, Aut (gieateral) an Eternally Rotate

Posto o Teame of ype Iee Jont yscions

FAER The otiona iagnoi: Flee,Aute (latera gie) an Eternally

Rotate.

The oeent arrier EAIR

he otion of treatent i the aea the oeent arrier EAR:Eten Aut an Internaly Rotatethe knee to the interarrier zone.

FAIR The otional agnoi FleeAute (eial glie), annternally Rotate


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UPPER AD LOWI EXTEMTES 23

The oveent b: EABE.

he postion of tetent i the ses the oveent bie: EABER.Etend Abdt nd Etenlly Rottthe knee o th inteb ones

EABER Th psitionl dignosis is: EtendedAbdtd ltel glid nd EtnlyRttd.

The ovnt AD

The position o tetent i the s

s the vent b: ADR: leAddut nd ntenly ott the kne the intebie n

EAD Th positionl dignosis: EtendedAddutd nd ntenly Rotted

Th oveent bie ABER.

Th pitin o tetent i the e the oveen bie: ABE leAbdt (put n t glide ndEtenlly Rotte th knee o thinte bie one.

Treamen Type I nee Jn Dysncn

1 .Tet leed Typ Kn Jon Dysfuntions in pon n supn ith knee fth bed kep hip ignd in ntl (notbduted no otted

2 et Etended Type Knee int Dy-fntin n pone in pin ith kneeff the bed keep hip igned in netlnot bdted not tted.

3 Plpte f th Mule Bie t the pi tbil hd u n the ltel petf the ibil hed

4 Move th le leg pvely on l plneo 3-pla1ar 1erbarrer ZO1e. Cn d te glid insted of bdution Cn do edi glde insted f ddution

5 o leed dysfuntions ove nto ten-sion. etended dyfntns v inoeon

6 Reit knee etenn f kne eion.7 sistne: soeti 5 gs esstn

ndietionlnipn estne, 6 nd etne etin oge nt 3pln intebie one

8 3 epettin

essess


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24 DVED SR UTERTRt

Tretet r FBER itio in extedig dducto ine rion Tetet r FDR n i exteding bductio exer rttion

Tetmel or BR io i exio dductio inern ottio Treme or OR io i fexion obductio exe otton


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UPP AND OW EXTREMIES 25

Type Ankle Jont Dysfuctons(Tba Tor Jot)This joint reqires slightly different orienttionsine it is dependent on the subtlr tolnel joint for obility nd rtilr blneThe sbtr joint freently hs intrrtilrdhesions here is no effetie usle energytehnique for the subtlr tlolnel jointMnipltion nd Strinonterstrin ndMoblition re ore effetie pprohes forthe subtlr joint. rior to or fter tretenofType Tibiotlr Joint dysfunton, tret thesbtlr joint o restore obilty nd rtiulrblne.

Dorsiexion is wys lited there is neerliittion of plnr flexion.

Dorsiexion ittions re xtended ype dysntions of the tibiotlr joint. henle is stu pntr exed xtended.

The nle nnot ex dorsiex. The positionl dignosis is lwys

xtended. nersion is dduted ersion is bduted version ors with internl rottion

erson ours with extern ottion

Potol Dgo of Typ IIAk (bo Jot Dycto

The ype torsion pttes of the tibiotrjon will be

R xtended ddted d nernlyRotted

BR xtended bduted nd xtellyRotted

he m mmn anle jnt dyfnin i EADR


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ADVNC SAIN N UNHTN

A.

Figur. 10 Md gid cr dr ig ioi d dduto o i" J dtoB Lr gid cr drig tr ro ndbducti o b" J dfo

Assessent o Type II Ankle(ibiolr) oin ysncon

A vnt bai at th upiuac f talu at th ank t

2 ter gde of tus occurs durng nter

n rotton nd dducton A med gdeof tus occurs durng exte rotton nd

bducton

Moveen Bries of Type IIAnkle (ToTlr Jont ysfunctons

ADIR h tbiala joint i tuck: xtndd(plana xd) Adductd andIntnaly Rtad (invtd

AR

h ovn bai FAR hank jint cannt Flx (dixAbduct and xtnaly Rat (vt).

h tibitala jin i tck xtndd(pana xd) Abductd andxnaly Rtatd (vtd)

h vn bai: FADIR thank jn cannt Fx (dixAdduct and Inaly Rta (invt.

Poston o Teten of ype IAnkle (ibiolr) oin ysncion

ADIR h pina dani xtndd(panta lxd) Adductd and

Intaly Rad.h pitin f ant i h a a h

vn bai: FAR: Flx(dix Abdct and xtallyRta th ibaa jn t thinai zn.

AR h pinal dani xtndd(plana xd Abducd andxtaly Rotatd.

h vnt ai i FADIR


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PP N lOW XMS

Th p in f tamt i h am h mmn bai ADR lx

(dx Adduc ad InlyRa h ibial i hinbi zn

eome of Type II AeTboToo Jon Dysfncon

J. T in upin: Dx i h agilpn mmt

2 alpa h mm bi a h m

i: Ob laal and mdal gid fh upi ufc f u A laa glidccu dig adduc nd intl ai A mdi gid ccu duing abduc ad xa ain

3 M h ankl paily i all 3 plat h 3plana inbi z

Ri dixi pan xin.S Rianc Imic S gam fc udi

cial/uipana ianc 6 cd

iancRlaxi6 g t w 3pla ibai z.7 3 pin

reame r R s rfex dn extera ral

Tetet r EBER st drsex ddut er tt

27


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CHAPTER 4

MUSCLE ENERGY ECHNIQUE AND 'BEYOND

FOR TE PPER EXTREMIES

TYPE I MOVEMNS

Type Shoulder (Glenohmera)Joint DysfnctionThe physiologic movements of the shoulderjont re: eion, etenson sgittl plne; b-duction; dduction coronl plne; eternl ro-ttion; internl rottion (trnsverse plne.

Direct ccessory movements of the humerlhed re

Anterior glide for etensonPosteror glde for eionudl glide for bductionCephld glde to neutrl for dductionfrom bduction

Anterior glide pus cudl glide or intelrottion

Posterior glide plus cephld gide for eter-

n rottion Anterior glide for horiontl dduction

Posterior gide for horiontl bductionNote: The lterture does not present thesemovements s "norms. Yet with this therpythese motions re restored.

Type I movements occur whenever theshoulder is leed or etended Type I dysfunc-tons re:

Feed

tendedType I movement dysfunctions re plnr

torsion dysfunctions. our possble ype I dys-functions cn occur t the shoulder glenohumerl jont

Fleed, Adducted, Internl Rotted

Fleed, Abducted ternl Rotted tended Adducted, Intern Rotted tended Abdcted, tel Rotted

nteral Rotatio occrs withAdution i Type Movemet.

Extea Rotato o wihAbutio i Tye Moveme.

Posonal Diagoss of Type Shouder Dysnto

ADR ind in leion tended

Appromtion of humerl hedAdducted, nternlly Rotted.

ABR Find in eion: tended

Lterl distrction of the humerlhed Aducted, ternlly ROtted

FADR Find in etension Fleed

Approimtion of the humerl hedAducted, ntely Rotted

ABR ind in etension leed

terl distrction of the humerlhed Aducted, ternlly Rotted

Assessme o ype II Solder Dyscto

lpte the gldes of the humer hed

durng physiologic shoulder leion ndetension. lpte t the greter tuberosity here should not be ny pproimtion

nor ny distrction of the humer hedduring shouder eion nd etenson.

f the humerl hed pproimtes thereis medil pull ppted t the gretertuberosity

If the humerl hed distrcts, there is

lter distrction plpted t the gretertuberosity.


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R AD lOWER EXREMITE 9

f the humer hed pprmtes, plptedt the greter tubersty s medil pul,

the shulder is stuk dduted nd inter-nly rtted.

7 f the humer hed lterly distrts, pl-pted t the greter tubersty s lterldstrtin, the shulder is stuk bdutednd eternl rtted

8 f the memen dysfuntin is plptedt the greter tubersty during len: theshuder nnt le, therefre the shulderis stuk etended.

9 f the mement dysfuntin is plptedt the greter tubersity during etensinthe hulder nnt etend, therefre theshulder is stuk eed.

Moveme Brer o Type II Shouer Dysfucto

AR The psitinl dignsis: tended,Adduted nd nternly Rtted.

The mement bries e: ABR

lein, Abduted nd ternlRttin

ABR The psitinl dgnsis tendedAbduted nd ternly Rtted

The memen brriers e AR:lein, Addutin, nd nternRttn

AIR The psitnl dgnsis: leed,Adduted, nd Internly Rtted

The mement brriers re: ABRtensin, Abdutin, ternRttin

ABR The psitnl dgnsis: leed,Abduted nd ternly Rtted

The mement brriers re Atensin, Addutin nd [nternlRttin

hek the physgi imittins f mtn

These shuld rrete with the mementbrrers.

r Pale 01 e reaer bosty o Type yfcas of eenouea jai A aproxioion o Ie era ea iico auctiona inerna roio B aeral ;oction of Ie era hea rees abuctiona external rotation


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30 DED R D TEiTiI

n f Teatet Tye II Shlder Dyfn

EADIR Th posiion dgnoss EnddAdducd nd Innly Rod

Th movmn bi: FABER.

Th posion o mn is h sms h movmn bi ABER F,Abduc, nd Elly Ro hshoulds o h intbi zons

EABER Th posonl dgnosis Endd

Abducd nd Ely RodTh mvmnt bai FAD.

Th posion o mnt is h sms h movmnt b FADIR: Fl,Adduc nd Innlly Ro hshould o h n bi zons

ADIR Th posionl dignosis: d,Adducd nd Innlly Rod.

Th mvn bi EABERTh posion o mn is h sms h movmnt bi: EABER:End Abduc nd Enly Roh shoud o h inbi zons.

ABER Th posionl dignosis: Fd,Abducd nd Enlly Rod

Th movmn bi EADIR.

Th posion o mn is h sms h movmnt b EADREnd Adduc nd Innlly Roh should o h inbi zons.

eatent f Tye I Sulder Jn Dyctn

Plp h muscl bi h gubosiy n pon o supn, o EnddTyp II should dysuncions ound n ion. Plp h muscl bi hg ubosiy n pon o supn, old Typ I should dysuncions oundin nsion.

2 Mov h shoud nd m pssivly oh inbi zon on ll 3 plns o 3-planar interbarrier zone.

3 o Fld dysuncons ound in nson

Rss ny movmn o h should.o Endd dysuncions ound in lionRss ny movmn o h should

Rssnc isomic; S gms ssnc; sconds sising; unidcionl!unpnsisnc.Rlion Pogss t n 3pln nbi zon

S. 3 pions

Rssss


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PPE D LWER EXEME 31

reatme for EADR: poin n exion dcio, exena roao reae or EABER ition n lexion adcion iea otation

reatment fo AR: poo i exeio, dcto, exea roao Teatment for FABR: poion i exteno, addutin, iternal rotato


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ADVACED STAI AD DERA

T t This jint is a modied physiolgic jint. Diect

accessoy mvemens ae Cauda glide f the clavicua head duing

abduction of the shoulde Antei gide of the clavcua head duing

extensin f the shuldeRtatin supei/pstei) f the clavicula head duing flexion of the shoulde

Cmpessin/appimation of the clavicua head duing hntal adducin of theshude

Distactin of the clavicula head duinghintal abducion f the shulde

Intea and extena otations ae mini-mally affected/affect the stenoclavcuajoint these movements ae focused at theacomiclavicula joint.

ype I Mvemens e Senclavclar Jn

Abduction and ateal distactin occutgethe.

Adducton and appimatin occutgethe.

Feed has tw pssible Type II vaiationsAbductin and ateal distactinAdduction and appximain

xtended has w pssble Type I vaia-tins

Aduction ad ateal distactin Adduction and appoimatin

stna Dagnss Type II Dysnctns e Sencavcar Jn

FABLD Flexed Aducted, ateal Distacted

FADA Flexed Adducted, Appoximated

ABD xtended, Aducted atealDistacted

ADA xtended, Adducted Appxmated

fo A tel dtcti e poxml i( head aUI wdci B Aroximo o e roxml avi. hed r w adtio

Assessmen ype I Dysnctn te Sencavca Jnt

alpate the movement baie at the pxi-mal head f clavicle

Assess: lateal distactin and appximatin.

atea dstaction occus wh aductinAppximatin ccus with adductin.

FABLD Find in xtensin the stenoclavculajint is stuck Flexed. Teat in shuldextensin.

FADA Find in tensin he stenclavculajoin is stuck Flexed. Teat in shuldextension.

ABLD Find in Flexin the stenclaviculajoint is stuck xtended Teat in

shoulde FlexinADA Find in Flexion he stenclavicula

jint is stuck xended Teat nshulde Fexin.


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AD WE EXREMITES 33

Mvement are f Type II Sencavcular Jnt

FABLD The Stenoclavcula jont s stuckFlexed (supeio/posteio otation),Abdcted and Latea Distacted.

The movement bae: ADA:xtenson Adduction andAppoximation

FADA The Stenocavicula joint s stuckFlexed (speio/posteo oation),Adducted and Appoximated.

he moveme bae ABLD:xtension, Abdction and LateaDistaction

ABLD he Stenoclavca oint s stcktended (anteio glde), Abductedand Lateal Distacted.

The movement baie FADAFlexion, Adduction andAppoimation.

ADA The Stenoclavicua oint is stucktended, Addcted andAppoximated.

The movement bae FABDFleon, Abducton and atealDstaction.

Psn Teament f Type"Sernclavular Jn Dysfunn

To positon the am/shoulde to assess move-ment baies, and fo teatment, follow the ol-lowng pocedes:

Fo Fleed Type II Stenoclavcula Jointdysfnction: n spne; shode off edge ofthe bed staight am; no abduction o ota-tion; passively move into etension.Fo xtended ype II Stenoclavicula Jontdysfunction n supine; staight am; noabduction/adducton o otation. assvely

move nto eion

Fo Abducted and Lateal Distacted TypeII Stenoclavicua Jont dysfunction Use

nges on poxima clavce head Adductthe clavcle by binging distal clavicle cau-dal, and compess the poximal clavicle headtowads the manubim aticula suface

Fo Adducted and Appoximated Type IStenoclavicula Jont dysfunction: Use n

ges on poima clavicle head Abduct theclavicle by bnging dista clavcle supeioand distact the poximal cavcle head awayfom the manubium aticua suface

eatment ypeSenavuar Jnt Dysfunctn

FABD xtend the am off the edge of thetabe unti the movement bae(appoimaton) is palpated at thepoxmal clavicle head. Then adduct

clavcle and appomate the pomalclavicle head ositon at a plana

ntebaie one.FADA tend the am of the edge of the

table unt the movement baie(latea distaction) s palpated at thepomal clavce head Then abduct

clavicle and latealy dstact thepoma clavicle head osition ata pana intebae one.

ABLD Fle the am until the movementbaie (appoximation) is papatedat the poximal clavcle head Thenadduct clavcle and appoximate thepoximal clavicle head. ositon ata plana nte baie one.

ADA Flex the am until the movementbaie (appoximaton) is palpaedat the poximal clavicle head Thenabduct clavicle and atealy dstact

the poximal clavicle head. oston

at a plana intebae one.


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34 ED STRI D DUm

Tremet for FABLD: Exe te m Ad e ve Aprxime the hedf ve

Tretme o EABD n" the m Add e ve Aprxite the hed ve

Tretment for FADA: Exen e m Ad Ihe vicle Loe dr the edo vie

Tretmet o EADA n" the rm Abu he vie oerl it r te ed ofvi.


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PPE D WE EXEMIE

Th 5apuohorai onte Scpltcic ji is psedjiwitt bimecnc pimy dysfunctin. Effecive tement f mbility nd tcur bnce f e scplcc ji is ttinedw StnCntestin; Mblitin Vis

cerl Mbiiin; Myfscil Reese

Th Aroioaviar otis jint des n respnd well t Muse En-ergy nd Beynd Tecnie pispy Excel-lent ticul blnce nd mbility cn bettined wit Stin/Cuntestin: se te Anterir Acrmiclvicl Jn ende Pi nde Jnes stei Acrmiclvicl Jintende int.

Th Ebow otTe Ebw s 3 jins

Rdilnr Rdmerl HmerlnWen te elbw js e teed in is

seqence s bve: rst Rdln; secndRdumerl; tird merun, eMscle Enegy nd Beynd Tecniue isexemey effective nd efcient t resrejin mblity, ricl blnce, nd inrticul vetc dimensin.

Th Radiounar ontimply ssess pntn nd supinin. Pptemsce brie t te di ed Drng supintin, te rdl ed gides ne Dungprntin, e rdl ed glides psteri Dr-ing supintin nd prnin tere sd be nmedi lterl mtin f te rdi ed. P-pte fr medil nd er mtin f te ded during spnin nd pntin

dilhd

Figure 3 Plt dil d h dhd gld ni din uintin Th dilhd gld oto dung nion tl

glid f th dl d hld nt diintion onin

35


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36 DNED RN ND NTERTRN

Posoal Dagoss of Radoua o

SupiaedThe rdi hed is stuck supnted n nteror glide nd cnnot ponte wth posterior glde.

Poaed

The rdil hed is stuck pronted in posterorglide nd cnnot spnte with nteror glide.

Moveet Barrer of Radoua o

Supiaed: Passive poaio should o occuwih laeal glide of adial head

Plpte muscle brrier of Lterl Glide of the r-d hed.

Proaed Passive spiaio should o occwih Medial glide of adial head

Plpte muscle brrier of Medil Glde of the rd hed.

osto of Teae, ad Treaeo te Poxal Radoular Jot

upne or sitting wth ebow feon t 90' shoul-der in bducton leion, nd rottion

Supiaed

o The proxim rdiour joint is stuck

spinted. The moement brrier is prontiono Pssiey pronte the forerm nti the

interbrrier one Ppte for lter glideo the rdl hedResist supntion or pronton Isometric seconds resstnce grms of orce.

Rel. Repet 3 repettons.Ressess.

Poad

The proml rdiounr joint is stuckpronted

o The moement brrer s spintion.

retet fr ited iour joi Pe terl eme o dil edfr brrr

Treet r pted rdlr it lte le moeme o rdil edr brrer

Pssiely supinte the forerm, nl theinterbrrier one. Plpte for ter gldeof the rdi hed

Resist spinton or pronton Isometric seconds restnce grms of orce

Rel Repet repetitons

Ressess


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ER AD OWE EXEMITIE

Te Radioumera JointTh Radiohmal joit i th joint whr lbowxtni occ h Hmrolna joint i thjoint whr lxion occr

Radoueal Jo Type I Dysco

Thi Radiohmral ont t tck Flxd Thmmnt barir i xtnio. Th Radioh-mral oint cannot xtnd.

Posoal Dagnoss of Radoheal

Jo Type II Dysco

Fld oatdFld patd.

Din lbow xtnion which primarilyocc at th Radiohmal oint, thr iantio lid of th radal had.

Di lbow xtnion with pination(aft ntal throh 90 pinatioth i antrior lid of th radal had.

Drin lbow xtnion with proatio(aft tal thoh 90 proatioth i atio id of th adial hadwith lodial ditractio of th adialhad (athr than potor lid whichocc with ponation in xion.xtn i conidrd 0'

Flxo i any bow xion aftr 0Thfo dri lbow xtnio fromxion, in pinato and n ntral (0pination/proation, th radia had ilidin atrior from a potor lidpoition.Dr lbow xtnio aftr 0, which ihypxtio th i antrior lid ofth radial had. Wh piation i prntthr i atrior lid of th hmral had

Wh pronation i pn th i a loni-tdinal ditracto of th adal had

Figure 4 Ple fr med (A) n terl B mn th rd hd r th brr


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38 ADVANCED SAIN AND CiSTAN

Moveme Bae o Raiohumeape I Dsfunto

Ppte the use be t the dil edThee should be no edl o lte oveeno the dil hed duin extension Palate formeal a lateral moto of the raal hea

Flexe, Proate

Te Rdioe oin s st exednd pontedTe ebow nnOt exend nd supteTe oveen bie xtension,

Supntion

Flexe, Suate

The Rdohuel jo is stu exednd supnted

The ebow jo nno extend ndpone

The ovee bie xension,Ponio

Postion o eamet a reatment ohe Raohmera oit e II Dsion

spine o in sttin: Shoude oin t Abdution, Rotto, exo

Position foe t supinion/pontonlex he elbow t % lexon.Pssvely eend te ebow fo 100%eion

Paate he raial hea o meia a aealglie o the aia hea.

f thee ous lel lide of the dhed te position diosis is exed,Poned

f tee ous edl ide of te diled, te position dinosis is: exed,Spinedxtend t te inebe zone befoe

edi o lel ide of te dil ed)

eamen of eed ronoe roiohmerol oi: een e elbo fo ulfleo olae for aero gie of Ihe rodo hed

reame of flee, suinaed rodumero jo eend e elbo rom fuleion Poloe o eda glie of Ie roda hed

Resis: Supinion o ponton sfoe seonds esisne Rel Poessto next intebie zone

Repet epetions


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PPE ND lDWR EREIE

The Humerounr JoinThi oint i th prima xon oint or thbo hror thr ar xn n-tion that prnt lxion.

Psa Dagss HelarJ Type II Dysf

Etended upnated

Th mrounar oin i uk xn anupinat o hat xion an pronaton alimt.

Etended Pronated

h Humroulnar ont i t xtn anpronat o that lxion an upinaion arimit.

Mvee Baes f erlar Type I Dysfc

Etended upnated

Th momnt barri i lxion an Pronation

Etended Pronated

Th momnt bair i lxion an Supna-on

Palpate the mule barrer at the ubtalangle Th hol no ubital anl untl ulxnion. l xnion i O lxion At Ohr i anulation ih a mal ap that oururin th loin mhanim onl Alo pal

pate edal ad lateral glde of the radal head.

. 5 Popoe e ie o he ubio ng ypesenoon of cMo ge beoe 'u exesion efhmeouo oin dsuncon

39


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4 AVANED SRAIN AN COUHSTAN

rlmenl of ned, pronole humeroo joinl. n nelro oreorm, ex heeow e (ilo age ppeor wilh lero gide o e roxima rodiahead

ealmenl o exende sialed herouor onln nelro oreom ex theeow he cba age w apea w a mea gide o e rodia ea

Poso of Tetme, d Tetmeof Humeou Jot Type I Dysfuo

supi r sii. hdr is a O'aduci, O rai, O fi

Psii h frarm O praisupiai.

Psii h ji fu s. Passi f h j. Papa h usle baea h cia

a s s as h cia aicrass h arrir has rachdG h irarrir immdia

fr h cuia a sars appar Whe the cubtal agle appeas wth lateal

gle of the poal aal hea h psi-a diasis is: Etee Poate

Whe the cubtal agle appeas wth ealgle of the poal aal hea h psi-a diasis is: Etee Supate.

Rsis f r si. scds rsisac, ismric rams frcRa. Prrss h irarrir

Rpa: rpiis.

Rassss


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ER AD WR EREE 41

Te Wist

The Radoaral ;ot(s) are the rary;ot(s) of wrst exteso.

he Ulararal ;ot(s) are the rary;ot(s) of wrst exoTh proxim rpl row oin in riul-ion wih h di rpl row join r hprimry jon for rdil nd ulnr di-ion

Th dil rpl row lid mdil forrdil diion

Th dil rpl row lid lrl for ulnrdiionTh rdiorpl oin) nd h ulnrrpl

join) r y o n xlln riulr ln nd ood moiliy wih Mul nryThniqu nd Byond phioophyir Aory Momn r folow

urin phyioloi xnion hr i n-rior lid of h proximl rp ow

urin phyiooi xion hr i poriorld of h poximl rpl row

urin phyioloi rdil diion hr imdil lid of dil rp rowurin phyioloi ulnr dion hr ilrl id o h dil rp row

Pal Dan: Tpe II MvementDncn f he Wrs Jn

Flexed Ular devated

Thi our primrily h rdiorpl join)

lexed Radal devated

Thi our primriy rdiorpl join)

xteded Ulnar devated

hi our primrily ulnrrp join)

Exteded Radal devated

i our primrily h ulnrrp join)

Fur 6_ Ple rwm il ysnn a !he ila rw nr aria evian aniel al ! ila r rwA he il rw gie eiar aia eilian B he la raw ie alea r nar eialin


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42 ADVANED SAIN AND (NRTRAN

oemen Boe o ype II Wrs Jo Dysfuncto

Papae he een ae a he eda andlaeal ape f he dia apal w lexinand exenin he wi jin u wihuulna and adial deiain

Fleed Ulnar Deiated

he wi i uk lexed The dial apalw i k in aeal ide

he een aie Eenin adialDeiain

Fleed, adial Deiated The wi i uk exed he dial apal

w i uk in edial ide The een ae: Exenin and

Una Dean

Etended, Uar Deiated

The wi i uk exended The dia apa w i uk in laeal ide

The een ae: exin and adia

Deiain

Etended, adial Deiated

The w i uk exended The dal apa w i k in edial lide

The een ae: exin and UnaDeiain

oson o reatmet and eameof ype II Wrst ot Dysucto

n upine iin Pin he huldein O adun O ain, O lexin

Piin he elw jin a 90exin Piin he fea in O upnain/

pnan Bein f O neual wi exin/

exeninPapae aea ape f he dia apalw t ae ule aie

Fleed Ulnar Deiated

xend he w Palpae aea lide f he

dial apa w eun he ineaiezne ju efe laeal lide he dia

apal w D adia deian he inea-ie zne ei any wi een eieane, a f fe end eiane elax Pe t nex ineaie zneepea 3 epein eae

Fleed adial Deiated

xend he wi Palpae he edial lde he

dial apa w eu he ineaiezne ju efe edia lide f e dia

apal w D una deiain he inea-ie zne e any wi een eieane a f fe end ei-ane elax Pe nex ineaie zneepea 3 epein eae

Etended Ulnar Deiated

lex he wi Papae laea ide f he dia

apal w eun he neaie zne uefe aeal lde f he dia apa w Dadial deiain he neaie zne eiany w een ei eiane a f fe end eane eaxPe nex ineae zne epea 3epein eae

Etended, adial Deiated

lex he wi Palpae he edal lde he

dia apal w eun he ineaiezne u efe edal lde f he dialapa w D ulna deain he ineae zne ei any wi een eeiane a f fe end ei-ane eax Pe t nex neaie zneepea 3 epein eae


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UPPER AND LOWE XTMITIES 43

Trn 01 l, Uln Diad x.nd t Palt. .rol d. hdisa O row R any t an

Tream. xeded UlnO iad: " te is Palpate aeral lde Ihedistal arl ow Rsist any wist mont

ra.n "ed Radial Deiaed: "nd he. Pal. edial lid 01the SIal Opal ow RHis ny aeen

ran xendd Radia Deiaed " Ih wis Pa. medial id 01 hdista apl row Resist ay wis moemnt


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CHAPTER 5

SYNERGIC PATERN IMPRINT AND SYNERGIC PATERN RElEASE

A MOD FOR TRAMNT O ROTCTV MCL AM

Using a Synergic Pattern Release" (SPR) for elmination and reduction of protective musclespasm, joint mobilty and articular balance itypically restored. This SPR" (Synergic PatternRelease) was discovered by Weiselsh-Gammatteo whle adapting Jones' Strain and Coun

tertrain echnique for the neurologc patientThe author found that typical pattern o mucle n spam repeatedly preented themseve inthe cliets wth neurologc decits These pattern were then tested on populations of clentwho did not manifest pathoneurologic diorders hese patterns ynergic pattern) were present in the nonneuroogic popuaton as wellconistenty. he author hypothesizes that imprins of these synergic patterns are DNA char

acteristcs. She call thi manifetaton: SynergicPattern Imprin"What are Synergc Pattern? his term ha

een preen n pathoneurology literature formany decades Persons wth pasticity presenttypica postural devatons which are the resultof certain muscle n a state of sustaned involunary contraction. ypically the same muscleare away in severe musce pasm contrbutingto similar potural appearances

Synergic Pate Imprt of he lwe xtremty

The typical synergic pattern o( the lowerextremity cosists o( the (ollowing postures:

Flexed lumboacral unction Elevated pelvi Retracted pelvi Flexed hip ont

Intealy rtaed h jint dduced hip

44

lexed knee oint although with closedhead nury client an extended knee preentation i nOt uncommon)

Pantar fexed ankle ontSupnated varus foot is common

The so tissue and ;oi articlar balanceproblems within this manifestation o( the lowerextremity inc/ude the (ollowing:

Approximated femoral headCaudal femoral head

Internal rotated femoral head Lateral gide o the proximal tibia articuar

uface Superior patela External rotation of the gatrocnemiu bely

Aerior dista tbia on tau Flexed calcaneus

Syergc Patter mpnt of the Upper Exremy

The typical synergic patte o( the upperextremity inc/udes the (ollowing postures

Forward head and neck with flexed C7on T

Elevated houlder girdle

Protracted houlder girdleFlexed houlder ointAdducted houlder ointInternally rotated shoulder ointFlexed elbow ointncreased cubital angle

Pronated forearm Flexed writ ont (although the cosed

head inury client often preents anended wrst

nar dvted wst


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UPP AND LWER XTMITES 45

l gr l tum

Aut thum

The o tue and jont artcua baanceprobem wthn th man{etaton o{ the upperextremty ncde the {oowg

Elt t r t th otortrl o Cul humrl h Atror humrl

Aroimt umrl hAtror oiml il h

Mi g o t ul otio it l Atror tl u Atror oiml rl row

Aroimt t roiml mtrlAtior t oximl mt h

Syrgi ttr mt rt il ro Wh ro uroogi

iult th tyi it ttr o yr-

toty will iihit. All o th ur yrtiity wil u. T rut i

th ti yrgi tt wih tyil oy hmilgi tit o wo ut o h iury will rt imilttr o tiity with light tio.

Th utor ot urig my yr o rrh tht th ttr o hyrtoity i tmil uroogi tit wr lmot ty lth ttr o hyrtoiity i th rro i ro Thi timult hr t o mor oy t rlti imro o

to otur rt y l ro oit g irt igo. t m i tht t rtto o th tyil yrgi ttr o ytoiity i r i lo ut iit utl tr i rl othi iitio All ro t romttmt towr l o t yg tt ytiy kow Syg ttr Rl. S Ctr Eigt i Syrgi ttr Rl


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CHAPTER 6

A HYPOTHEICAL MODEl

EXPLAINING THE DECREASE OF HYERTONCT WTH MANUAL THERA

Thi hpter peent the WeielhGmmt-teo model t upport l reult with mnultherpy.

The muulofilkelet ytem reeivemot of the efferent outlow from the entrlnervou ytem the lrget portion of thi effer

en dihrge exit the pinl ord vi he ventrlroOt to the mule he muuofilkeetlytem re lo the oue of muh of the widepred ontnuou nd vrible enoy inputt the S. Thi enory feedbk relyed fromreepor in myofil vierl rtiulr omponen nd the ente the pin ord vithe dol root Thi enory repoting irouted t mny enter throughout the entrlnervou ytem inluding the erebr ortex

the erebellum the brin tem nd the uonom nervou ytem. Th enory input fromthe muulofilkeletl body extenive intenve nd ontnuou nd i dominn n-uene on the enl nervou ytem.

The Premse

iturbne in the enory fferent input fromthe neurmuulokelet ytem whether dif-fue or lol ffet moto funton nd other

funtion Thi premie i ore onept in-lly ignint fo hypertonity potetivemule pm nd ptiity) the filitted eg-ment nd Strutur ehblttion

In 9 enlow tted hypothei whihexpined thi onept

"(An) oteopthi leion repreent filitted egment of the pnl ord min-tined n tht tte by impue of endogenous origin entering the orrepondingdol root Al ttue reeivng efferen

46

neve be from tht egme re therefore potentilly expoed to exeive exttion o inhbition.

The te of thi "endogenous origin i the poprioceptors, epeily the mule pinde Theyre enitive to muulofilkeletl tree.

They re nondpting reeptor utiningtrem of impule for long they re mehnlly timulted. Their inuene i peito the mule ting on the ffeted jointwhh e innervted by orreponding pnegment.

Te Mytac Reflex Ac

The Myotti Reex Ar (lo known the

treth reex r the monoynpti reex rnd the gmm moto neuron loop) h longbeen onidered the bi of mue tone. Theomponent of th reex r inude the muleber whih h the bility to ort nd toelx nd elongte; the mule pinde the pro-prioepor whih i reponve to length ndveloity treth; the gmm neuron whih inner-vte the mule pndle; the fferent neuronwhih trnribe he nformtion regrdng

teth to the pnl od nd the ph motorneuron whih trnibe the impule from thepinl ord to the mule ber eliiting muleontrtion

e Musde

The mue i the fou of dyfuntionl move-me when ondering the hypertonity ofprotetve mule pm nd ptiity. Themule i tive elfenegzed independen in

mton nd pble of deveopng gret wdelyvrble nd pdly hnging fore. ther ti


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AND W XMIIS 47

ue re pively moved, immoilied, puhed,puled, ompreed, nd ltered in hpe y

thoe fore of muur origin. Mle po-dce moo y their ontrtion, thoeme ontrtie fore lo oppose moo.Conrting mule or momentum, ndregte, reit, retrd, nd rret movement.Irvn Korr tte tht thi energyoringfunton of eletl mule i importnt to theontrol of moion it energyimprtng fntion. B the me ellr mehnim re in-volved in thee funtion

oint moility, rnge of motion, nd ee ofntition o tive moton re relt of hethymule funtion Limited pity of muleoten pper to e the mjor impediment tomoilty of dyfuntion jont. Korr ttetht muulr reitne i not ed on nexteniilty, with onnetive tiue, ut onhnge n the degree of tivtion nd detivtion of the ontrtle tie. The hypothetlue for mule to inree or deree t

onrtion nd ring power i vriton inimple ow long the motor on, the lphneuron, whih innervte the mue. h neronl impule trf vre with hngng levelof exittion within the nteror horn ell,whih hnge ordng to vryng fferentinput.

Prpriceptrs

The mle pnde, the proprioeptor withinthe mule er whih repond to treth, i i omponent of the myotti ree r, ndh een implited i omponent ofprotetive mle pm, nd of ptiity Theproprioeptor re the enory end orgn thtgnl phyi hnge in mulofileletltiue. The three min tegorie of proprioep-tor re enitive to joint poition nd moon,to tendon tenion, nd to mule length

The o ecepos re loted n jont p

ule nd ligmen they report jont motionnd potion The Rufni ending in the pue

report diretion, veloity of motion, nd poi-tion very urtely. Thee oint reepor do

not pper o hve ignn inene onmotor tvity vi the treth ree r, lthough thi premie i preently under nveti-gtion.

he Gog edo ecepos re loted intendon loe to the mulotendnou juntonA pul on the tendon e dihrge of m-ple no the pinl ord vi fferent erThi pull i uuly eerted y tive onrtionof the mule. The tendon ending re repon

ive to hnge in fore, not n length. When themule ontrt gint od, or xed ojet,or gint the ontrtion of ntgoniti mule in ptiity nd protetive mule pm,the dihrge of the tendon ending i in proportion to the tenon tht i deveoped The ferent input rom the Golgi tendon vrie with thetenion exerted y the mule on the tendon, re-grdle of the mule length. The dhrge ofthe tendon ending enter the pinl ord y dor

root er, where they exite hboy in-terneuron tht ynpe with motor neuronontrolling the me mule. The effet of theirdihrge inhiitory it tend to oppoe theurther deveopment of tenion y the mle.

The Musde Spnle

The msle spdles re omple Eh pindleh two ind of enory ending with dfferenree inuene, eh with it own mOtor nnervton Spindle re ttered throghout ehmule, the quntity vrying ording to thefntion of the mle nd the deiy of itontro he greter the pindle denity, the nerthe Ontro he omplex ntomy nd phyio-ogy of the mule pindle i well doumented inthe lterture.

Spindle re within the mule telf, rrounded y mule er, rrnged n prllewth them nd tthed o them t oth end.

Strething the mule ue treth o the pin-dle hortening of the mule len the pin


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48 ADVANCE STRAIN AN CUNRiAN

de ach spidle eclosed i a conective tissuesheath about 3 mm long has several thi mus-

cle bers. These are the ntraf/sal bers Thearger ad more powerul extrafsal bers comprse he bul o the muscle. The itrausalbers are attached to the sheath at each end.The ntraf/sal mscle bers are nnervated by

amma mtr nern bers origiatig i thevetral hor passig through the ventral ootThe alpha mtr nerns spply nnervatn tthe extrafsal mscle bers

he sesory edgs o he spidle are i

close relatio to the cetra ucleated oncotracile portio o he irausal bers This sesory eding caled he prmay endn, iswound aroud he itrausa bers described ashe a11lspral endn Secodary wer-spray endns occur o either side o the pr-mary edig ad are coected thiermyeliated axos. Both are sesitive to sretcho the cetra portio o the spindle

There is a static and a dynamic respose ostretch by the muscle: static is proportioa omuscle legth dyamic is proporional o thera o chage in muscle egh The irausamuscle ber is reatively elastic the A aerentedigs which iervate the primary nerve ed-igs ed here Thereore he A ber has a dy-amic and a static respose to stretch The

group aferen bers which iervate he sec-ondary edings ed on the smal uclear chainbers This is at the area o he heart o the my-obril striatios o the itrausa bers a less

elastic sier area. Thereore here is oy a sa-tic respose t stretch which is proporional tomusce egh. Since these bers have o dy-namic respose they wil no carry ceral ervous sysem eedbac regardig the velociy ohe streth.

The prmay endns, or annlspral end-ns, respnd t chane n mscle lenth Whethe musce is stretched beyod its resting eghthe spindle is stretched causing the primary ad

secodary edigs re at increased reque-cies i proporio to he

integrative manual therapy for the upper and lower extremities

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