Cumulative injury cycle/Postural deviations

1. Cumulative injury cycle/Postural deviations (Content derived from NASM-CES/PES)

2. Introduction Our ability to move is one of the most important aspects of our existence. Recognizing optimum movement requires a thorough understanding and application of Human Movement Science, specifically, functional anatomy, kinesiology, biomechanics, physiology, and motor control. Understanding normal movement allows identification of abnormal movement which can indicate possible muscle imbalances and corrective strategies.

3. Movement cont. Movement represents the integrated functioning of many systems within the human body, primarily the muscular, articular, and nervous systems. These systems form an interdependent triad which, when operating correctly, allows for optimum structural alignment, neuromuscular control (coordination), and movement. Each of these outcomes is important to establishing normal length-tension relationships, which ensure proper length and strength of each muscle around a joint. This is known as muscle balance.

4. Movement cont. Muscle balance is essential for optimal recruitment of force-couples to maintain precise joint motion and ultimately decrease excessive stress placed on the body. For many reasons such as repetitive stress, impact trauma, disease and, sedentary lifestyle, dysfunction can occur in one or more of these systems. When this happens, muscle balance, muscle recruitment, and joint motion are altered leading to changes in structural alignment, neuromuscular control (coordination), and movement patterns of the human movement system. The result is a human movement system impairment and, ultimately, injury.

5. Typically Overactive Muscles Gastrocnemius Soleus Adductors Hamstrings Psoas Tensor Fascia Latae Rectus Femoris Piriformis Quadratus Lumborum Erector Spinae Pectoralis Major/Minor Latissimus Dorsi Teres Major Upper Trapezius Levator Scapulae Sternocleidomastoid Scalenes Typically Underactive muscles Anterior Tibialis Posterior Tibialis Vastus Medialis Oblique (VMO) Gluteus Maximus/Medius Transverse Abdominus Internal Oblique Multifidus Serratus Anterior Middle/Lower Trapezius Rhomboids Teres Minor Infraspinatus Posterior Deltoid Deep Cervical Flexors

6. Cumulative injury cycle Tissue Trauma Inflammation Muscle imbalance Muscle Spasm Altered Neuromuscular Control Adhesions

7. Postural Deviations • Postural deviations can occur for one or a combination of the following reasons: • Repetitive movements • Repetitive environment (single plane dominant) • Injury • Poor form and technique • Poor muscular control/lack of spatial awareness

8. Postural deviations cont. • Try to factor in work environment-how active is your client while working, what positions/postures is your client typically in while working, what movements does their job entail? • Use assessments-OHSA, SLSA, Rockport walk test, 3 rep max conversion, etc. • Factor in movement assessments and work environment to program design.

9. Postural deviations cont. • Use progressions • Know your force-couple relationships • Incorporate tempos (injuries typically occur in the eccentric or isometric phase) • Avoid overtraining of shortened muscles