ABSTRACT
Functional stability is dependent on integrated local and global muscle function. Mechanical stability dysfunction presents as segmental (articular) and multi-segmental (myofascial) dysfunction. These dysfunctions present as combinations of restriction of normal motion and associated compensations (give) to maintain function. Stability dysfunction is diagnosed by the site and direction of give or compensation that relates to symptomatic pathology. Strategies to manage mechanical stabililty dysfunction require specific mobilization of articular and connective tissue restrictions, regaining myofascial extensibility, retraining global stability muscle control of myofascial compensations and local stability muscle recruitment to control segmental motion. Stability re-training targets both the local and global stability systems. Activation of the local stability system to increase muscle stiffness along with functional low-load integration in the neutral joint position controls segmental or articular give. Global muscle retraining is required to correct multisegmental or myofascial dysfunction in terms of controlling the site and direction of load that relates to provocation. The strategy here is to train low-load recruitment to control and limit motion at the site of pathology and then actively move the adjacent restriction, regain through range control of motion with the global stability muscles and regain sufficient extensibility in the global mobility muscles to allow normal function. Individual strategies for integrating local and global recruitment retraining back into normal function are suggested.
Subject(s)
Activities of Daily Living , Movement Disorders/physiopathology , Movement Disorders/rehabilitation , Physical Therapy Modalities/methods , Biomechanical Phenomena , Disabled Persons/rehabilitation , Humans , Movement Disorders/diagnosis , Movement Disorders/etiology , Patient Care Planning , Range of Motion, Articular , Risk FactorsABSTRACT
A good understanding of the control processes used to maintain stability in functional movements is essential for clinicians who attempt to treat or manage musculoskeletal pain problems. There is evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems is presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. Direction related restriction and compensation to maintain function is identified and related to pathology. The local stability muscles demonstrate evidence of failure of adequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology. Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction.
Subject(s)
Movement Disorders/rehabilitation , Musculoskeletal Diseases/rehabilitation , Physical Therapy Modalities/methods , Physical Therapy Modalities/trends , Chronic Disease , Disease Progression , Humans , Movement Disorders/diagnosis , Movement Disorders/etiology , Movement Disorders/physiopathology , Muscle, Skeletal/physiology , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/etiology , Musculoskeletal Diseases/physiopathology , Pain/etiology , Physical Therapy Modalities/standards , Proprioception , Recruitment, NeurophysiologicalABSTRACT
SUMMARY. The ability to position and control movements of the scapula is essential for optimal upper limb function. The inability to achieve this stable base frequently accompanies the development of shoulder and upper limb pain and pathology. Unlike other joints the bony, capsular and ligamentous constraints are minimal at the scapulothoracic 'joint' so stability is dependant on active control. Clinically, it is noted that patients presenting with shoulder and arm symptoms demonstrate poor dynamic scapula control. Scapula setting is an exercise taught by physiotherapists to correct movement dysfunction associated with abnormal scapula positioning and dynamic control. Addressing the dynamic stabilization of the scapula is an essential part of the management of neuromusculoskeletal dysfunction of the shoulder girdle and an appropriate rehabilitation programme is necessary if this issue is to be addressed. Copyright 1997 Harcourt Publishers Ltd.
