DOCSLIB.ORG

Altered Muscle Activation Following Hamstring Injuries

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Altered Muscle Activation Following Hamstring Injuries Downloaded from bjsm.bmj.com on March 28, 2011 - Published by group.bmj.com BJSM Online First, published on March 10, 2011 as 10.1136/bjsm.2010.079343 Original article Altered muscle activation following hamstring injuries G i s e l a S o l e , 1 S t e p h a n M i l o s a v l j e v i c , 1 H e l e n N i c h o l s o n , 2 S J o h n S u l l i v a n 1 1 Centre for Physiotherapy A B S T R A C T and knee-joint 25 26 injuries have been associated Research, University of Otago, O b j e c t i v e The purpose of this study was to compare with altered electromyographic (EMG) activity of Dunedin, New Zealand 2 Department of Anatomy and the electromyographic (EMG) activity of gluteal and lumbopelvic and lower-limb muscles. Specifi cally, Structural Biology, University thigh muscles of sportspeople with a recent hamstring increased hamstring activity while walking has of Otago, Dunedin, New injury with uninjured controls during a weight-bearing been observed in individuals with lower-back Zealand task. pain (LBP) 27 and anterior cruciate ligament (ACL) Study design Cross-sectional. defi ciencies. 28 Increased hamstring activity has Correspondence to Dr Gisela Sole, Centre of S e t t i n g University laboratory. also been observed during an experimental task of Physiotherapy Research, P a r t i c i p a n t s 16 participants with a hamstring injury change from double- to single-leg stance in indi- University of Otago, Box 56, (hamstring-injured group, HG) and 18 control participants viduals with pelvic pain, 24 and decreased activa- Dunedin 9054, New Zealand; (control group (CG)) participated in the study. tion of the gluteus maximus (GMa), and increased g i s e l a . s o l e @ o t a g o . a c . n z Main outcome measure The EMG activity of gluteal, activation of hamstrings has been observed clini- 29 Accepted 3 February 2011 quadriceps and hamstring muscles was recorded during cally in patients with hamstring injuries. a movement from double- to single-leg movement using Verrall et al 14 suggested that following an injury surface electrodes. of the knee or groin, the biomechanical proper- R e s u l t s The EMG onsets of biceps femoris and medial ties of the lower limbs may change, thereby con- hamstrings were signifi cantly earlier for the HG injured and tributing towards increased susceptibility of a the uninjured sides in preparation for single-leg standing future hamstring injury. We have hypothesised when compared with the CG average. There were no that changes in neuromuscular control associ- differences in onsets for the gluteal and quadriceps ated with other injuries, in particular, increased muscles when comparing the injured or uninjured legs of hamstring muscle activation, could potentially the HG to the bilateral average of the CG. lead to increased cumulative loading for these C o n c l u s i o n The earlier onset of the injured and the muscles, thereby increasing their risk for injury. 30 uninjured hamstrings in preparation for single leg stance However, neuromuscular control as evidenced by of the HG in comparison with the CG suggests an EMG activation patterns of the agonist, syner- alteration in the motor control of these muscles. Altered gist and antagonist pelvic and lower-limb muscles neuromuscular control following a hamstring injury has not been investigated in sportspeople with may be a factor to be considered in the rehabilitation of hamstring injuries. Investigation of this poten- hamstring injuries. tial injury mechanism may contribute towards a better understanding of neuromotor control of the hamstrings and lead to studies to determine I N T R O D U C T I O N whether exercise that focuses on neuromuscular Non-contact hamstring injuries are common in control reduces the incidence and risk of ham- sports that include sprinting, acceleration and string injury. kicking, and have a high rate of recurrence and The aim of this study was to compare the decreased performance levels. 1–5 Traditional recruitment patterns of gluteal and thigh muscles rehabilitation and prevention strategies for this during transition from double to single leg stance injury have used outcome measures that include in participants with and without a recent ham- hamstring muscle strength and fl exibility. 6–9 string injury. The secondary aim of the study is Interestingly, recent research has suggested that to compare the between-trial variability of EMG exercises focusing on improving neuromuscular onsets in participants with and without a recent control around the lumbar spine and pelvis, 10 as hamstring injury. well as sports-specifi c skills and enhanced bal- ance performance, may also reduce recurrence. 11 M E T H O D S Impaired movement discrimination during open P a r t i c i p a n t s chain movements of the lower limb have also been Seventeen male participants clinically diagnosed associated with an increased risk of hamstring as having a hamstring injury and 19 non-injured injury. 12 Thus, disturbed sensory input and inhib- healthy male controls volunteered to participate ited neuromuscular control may need to be con- in this study. All participants read the informa- sidered in the evaluation of hamstring injuries. tion sheet and signed a consent form, which was Not only previous hamstring injury 4 13–17 but approved by the University of Otago Human also knee injury, osteitis pubis 14 and calf-muscle Ethics Committee. Inclusion criteria for the ham- injury 18 appear to place the sportsperson at risk string-injured group (HG) were sportspeople who of either a new or recurrent hamstring injury. had: (1) sudden onset of non-impact posterior Anecdotal evidence suggests that lumbar 3 19 20 and thigh pain during a match, competition or train- sacro-iliac disorders 21 can also predispose people ing within the previous 12 months; (2) an injury to hamstring injuries. Low-back, 22 groin, 23 pelvis 24 severe enough to have required intervention by a SoleCopyright G, Milosavljevic Article S, Nicholson author H, et al. Br(or J Sportstheir Med employer) (2011). doi:10.1136/bjsm.2010.079343 2011. Produced by BMJ Publishing Group Ltd under licence.1 of 6 Downloaded from bjsm.bmj.com on March 28, 2011 - Published by group.bmj.com Original article health professional; (3) an injury severe enough to have caused it was lifted. 33 This appeared as an increase in the vertical the sportsperson to miss at least one offi cial match, competi- ground force (at T1) of that leg before the force decreased tion or at least 1 week of regular training; 15 31 and (4) returned until it reached zero when the foot lifted off the force plate at least partially to sports training. The inclusion criteria for (T2) ( fi gure 1 ). The start of the APA (T1) was determined for the control group (CG) were (1) no known history of ham- each trial using a Microsoft Excel graph ( fi gure 1 ). 24 All muscle string injury in the past that required intervention by a health onsets for the hip-fl exion task were expressed relative to T1, professional and (2) currently participating fully in their regu- with a negative value indicating onset of activity prior to the lar sports training. Exclusion criteria for both groups were (1) APA and a positive value indicating onset following the APA. knee or lumbo-pelvic injury that required health professional The time at which the foot lifted off the force plate (T2) was intervention and (2) known neurological, cardiorespiratory or computed by using the LabVIEW version 5.0 program as the systemic disorder. point at which the z-force reached zero (fi gure 1 ). The reaction time was defi ned as the difference between the times of the EMG recordings visual signal and the start of the APA (T1), and the movement EMG activity was recorded bilaterally using pairs of Ag/ time was defi ned as the difference between the time of the AgCl surface electrodes (Blue Sensor disposable electrodes; visual signal and the time at which the foot lifted off the force Medicotest A/S, Ølstykke, Denmark), which were placed on plate (T2). the following muscles using Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles guidelines: 32 vastus Statistical analysis lateralis, vastus medialis, rectus femoris, biceps femoris (BF), Mean differences (95% CI) between groups were calculated medial hamstrings (MH), gluteus medius and GMa, with a for EMG onsets. Within-group differences were analysed centre-to-centre distance of 25 mm. The ground electrode was using paired t tests, comparing injured with uninjured sides positioned on the sternum. The skin was prepared by shav- of the HG, and the CG preferred with non-preferred sides. ing and cleaning with alcohol swabs, and abraded fi rmly with Preliminary analysis showed no signifi cant side-to-side dif- a hand towel to reduce the electrical impedance to less than ferences for variables of the controls. For the between-group 10 kΩ (1% of the system’s input impedance). analyses, the variables of the preferred and non-preferred sides EMG data were collected with an eight-channel TeleMyo of the controls were thus averaged. The variables of the HG telemetric hardware system (Noraxon USA, Scottsdale, injured and the uninjured sides were compared respectively Arizona). The system’s amplifi er has a gain of 2000 and an with the controls’ bilateral average using independent t tests.
Load more

Recommended publications
  • Piriformis Syndrome: the Literal “Pain in My Butt” Chelsea Smith, PTA
    Piriformis Syndrome: the literal “pain in my butt” Chelsea Smith, PTA Aside from the monotony of day-to-day pains and annoyances, piriformis syndrome is the literal “pain in my butt” that may not go away with sending the kids to grandmas and often takes the form of sciatica. Many individuals with pain in the buttock that radiates down the leg are experiencing a form of sciatica caused by irritation of the spinal nerves in or near the lumbar spine (1). Other times though, the nerve irritation is not in the spine but further down the leg due to a pesky muscle called the piriformis, hence “piriformis syndrome”. The piriformis muscle is a flat, pyramidal-shaped muscle that originates from the front surface of the sacrum and the joint capsule of the sacroiliac joint (SI joint) and is located deep in the gluteal tissue (2). The piriformis travels through the greater sciatic foramen and attaches to the upper surface of the greater trochanter (or top of the hip bone) while the sciatic nerve runs under (and sometimes through) the piriformis muscle as it exits the pelvis. Due to this close proximity between the piriformis muscle and the sciatic nerve, if there is excessive tension (tightness), spasm, or inflammation of the piriformis muscle this can cause irritation to the sciatic nerve leading to symptoms of sciatica (pain down the leg) (1). Activities like sitting on hard surfaces, crouching down, walking or running for long distances, and climbing stairs can all increase symptoms (2) with the most common symptom being tenderness along the piriformis muscle (deep in the gluteal region) upon palpation.
    [Show full text]
  • Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis T
    Donald and Barbara Zucker School of Medicine Journal Articles Academic Works 2014 Rehabilitation of soft tissue injuries of the hip and pelvis T. F. Tyler Northwell Health T. Fukunaga Hofstra Northwell School of Medicine J. Gellert Follow this and additional works at: https://academicworks.medicine.hofstra.edu/articles Recommended Citation Tyler TF, Fukunaga T, Gellert J. Rehabilitation of soft tissue injuries of the hip and pelvis. 2014 Jan 01; 9(6):Article 1396 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/articles/1396. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. INVITED CLINICAL COMMENTARY REHABILITATION OF SOFT TISSUE INJURIES OF THE HIP AND PELVIS Timothy F. Tyler MS, PT, ATC1 Takumi Fukunaga DPT, ATC, CSCS1 Joshua Gellert DPT IJSPT ABSTRACT Soft tissue injuries of the hip and pelvis are common among athletes and can result in significant time loss from sports participation. Rehabilitation of athletes with injuries such as adductor strain, iliopsoas syn- drome, and gluteal tendinopathy starts with identification of known risk factors for injury and comprehen- sive evaluation of the entire kinetic chain. Complex anatomy and overlapping pathologies often make it difficult to determine the primary cause of the pain and dysfunction. The purpose of this clinical commen- tary is to present an impairment-based, stepwise progression in evaluation and treatment of several com- mon soft tissue injuries of the hip and pelvis.
    [Show full text]
  • Effects of a Gluteal Muscles Specific Exercise Program on the Vertical
    International Journal of Environmental Research and Public Health Article Effects of a Gluteal Muscles Specific Exercise Program on the Vertical Jump Tomás Gallego-Izquierdo 1, Gerardo Vidal-Aragón 2, Pedro Calderón-Corrales 2, Álvaro Acuña 2, Alexander Achalandabaso-Ochoa 3,* , Agustín Aibar-Almazán 3 , Antonio Martínez-Amat 3 and Daniel Pecos-Martín 1 1 Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, 28801 Madrid, Spain; [email protected] (T.G.-I.); [email protected] (D.P.-M.) 2 Physical Therapist, Department of Physical Therapy, University of Alcala, 28801 Madrid, Spain; [email protected] (G.V.-A.); pedrocalderon.fi[email protected] (P.C.-C.); [email protected] (Á.A.) 3 Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain.; [email protected] (A.A.-A.); [email protected] (A.M.-A.) * Correspondence: [email protected]; Tel.: +34-953213651 Received: 9 June 2020; Accepted: 23 July 2020; Published: 27 July 2020 Abstract: The vertical jump is a complex movement where many factors are involved in the final result. Currently, how a specific exercise program for gluteal muscles can affect the vertical jump is unknown. So, the aim of this study was to examine the effect of a specific exercise program for the gluteal muscles on a vertical jump. Forty-nine amateur athletes completed an 8-week program. The experimental group received a specific gluteal muscle training program in addition to their regular training routine, whereas the control group received their regular training routine. Jump height, flight time, speed and power were assessed (baseline, postintervention, and 4-week follow-up).
    [Show full text]
  • Myofascial Pain Syndrome of Gluteus Minimus Mimicking Lumbar Radiculitis -A Case Report
    Anesth Pain Med 2015; 10: 16-20 http://dx.doi.org/10.17085/apm.2015.10.1.16 ￭Case Report￭ Myofascial pain syndrome of gluteus minimus mimicking lumbar radiculitis -A case report- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea Joong-Ho Park, Kwang-Suk Shim, Young-Min Shin, Chiu Lee, Sang-Gon Lee, and Eun-Ju Kim Myofascial pain syndrome (MPS) can be characterized by pain difficult. Delays in making the correct diagnosis can result in caused by trigger points (TrPs) and fascial constrictions. Patients longer hospital stays, higher hospital fees, and unnecessary with MPS of the gluteus minimus muscles often complain of diagnostic tests and inadequate treatments. The authors have symptoms such as hip pain, especially when standing up after sitting or lying on the affected side, limping, and pain radiating down to successfully diagnosed and treated a patient with MPS of the the lower extremities. A 24-year-old female patient presenting with gluteus minimus initially diagnosed with lumbar radiculitis. motor and sensory impairments of both lower extremities was With thorough physical examination and injection of TrPs referred to our pain clinic after initially being diagnosed with lumbar radiculitis. Under the impression of MPS of the gluteus minimus under ultrasonography guidance, the patient was relieved of her muscles following through evaluation and physical examination of symptoms. We report this case to emphasize the importance of the patient, we performed trigger point injections under ultrasonography physical examination in patients presenting with symptoms guidance on the myofascial TrPs. Dramatic improvement of the suggestive of lumbar radiculitis.
    [Show full text]
  • X X X X X X X X X X Xx X
    INJURY PREVENTION THE forward arm swing lean (torso and upper body) x lateral Whole trunk lean x x trunk x rotation hip x extension pelvic drop Body vertical displacement (head to toe) I’m lying facedown on an exam table at a state-of-the-art running clinic in New heel whip York City, about to perform a basic exer- cise for professional analysis. “Okay, Katie, I’d like you to lift your right leg in knee the air, using your glutes,” says Colleen x flexion at mid- Brough, P.T., M.S., the physical therapist stance who’s there to check my strength and x x form. No problem, I think. She places her x hand on my right hamstring—my achy, troublesome one—as I lift and then FIX lower my leg back down to the table with knee Chronically injured and disheartened, x flexion minimal effort and an attitude of That’s cadence at initial contact a Runner’s World editor sought holistic all? “You contracted your hamstring as dynamic well as your back,” Brough says gently. knee alignment help from a team of therapists. Her “Try again, but this time, power the move with your glutes by squeezing your butt diagnosis (sleeping glutes?) and hard- before and while doing the lift.” Okay, got won lessons (master the clamshell!) it. Simple enough. But it isn’t. Impossible, actually. I lie there motionless, slowly can help you, too, stay healthy, happy, coming to the realization that clenching your face doesn’t help you clench your foot initial BODY BREAKDOWN contact and on the road butt cheeks.
    [Show full text]
  • The Absence of Piriformis Muscle, Combined Muscular Fusion, and Neurovascular Variation in the Gluteal Region
    Autopsy Case Report The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region Matheus Coelho Leal1 , João Gabriel Alexander1 , Eduardo Henrique Beber1 , Josemberg da Silva Baptista1 How to cite: Leal MC, Alexander JG, Beber EH, Baptista JS. The absence of piriformis muscle, combined muscular fusion, and neuro-vascular variation in the gluteal region. Autops Case Rep [Internet]. 2021;11:e2020239. https://doi.org/10.4322/ acr.2020.239 ABSTRACT The gluteal region contains important neurovascular and muscular structures with diverse clinical and surgical implications. This paper aims to describe and discuss the clinical importance of a unique variation involving not only the piriformis, gluteus medius, gluteus minimus, obturator internus, and superior gemellus muscles, but also the superior gluteal neurovascular bundle, and sciatic nerve. A routine dissection of a right hemipelvis and its gluteal region of a male cadaver fixed in 10% formalin was performed. During dissection, it was observed a rare presentation of the absence of the piriformis muscle, associated with a tendon fusion between gluteus and obturator internus, and a fusion between gluteus minimus and superior gemellus muscles, along with an unusual topography with the sciatic nerve, which passed through these group of fused muscles. This rare variation stands out with clinical manifestations that are not fully established. Knowing this anatomy is essential to avoid surgical iatrogeny. Keywords Anatomic Variation; Anatomy; Buttocks; Muscle; Piriformis Muscle Syndrome. INTRODUCTION The gluteal region contains important Over the years, these variations have been neurovascular and muscular structures that may classified and distributed into different groups. impose diverse clinical and surgical approaches.
    [Show full text]
  • Gluteal Region and Back of Thigh Doctors Notes Notes/Extra Explanation Editing File Objectives
    Color Code Important Gluteal Region and Back of Thigh Doctors Notes Notes/Extra explanation Editing File Objectives Know contents of gluteal region: Groups of Glutei muscles and small muscles (Lateral Rotators). Nerves & vessels. Foramina and structures passing through them as: 1-Greater Sciatic Foramen. 2-Lesser Sciatic Foramen. Back of thigh : Hamstring muscles. Movements of the lower limb Hip = Thigh Knee=Leg Foot=Ankle Flexion/Extension Flexion/Extension Flexion/Extension Rotation Adduction/Abduction Inversion/Eversion Contents Of Gluteal Region: Muscles / Nerves / Vessels 1- Muscles: • Glutei: 1. Gluteus maximus. 2. Gluteus medius. 3. Gluteus minimus. Abductors: • Group of small muscles (Lateral Rotators): 1. Gluteus medius. 2. Gluteus minimus. 1.Piriformis. Rotators: 2.Obturator internus 1. Obturator internus. 3.Superior gemellus 2. Quadratus femoris. 4.Inferior gemellus Extensor: 5.Quadratus femoris Gluteus maximus. Contents Of Gluteal Region: Muscles / Nerves / Vessels 2- Nerves (All from Sacral Plexus): 1. Sciatic nerve. 2. Superior gluteal nerve. 3. Inferior gluteal nerve. 4. Post. cutaneous nerve of thigh. 5. Nerve to obturator internus. 6. Nerve to quadratus femoris. 7. Pudendal nerve. Contents Of Gluteal Region: Muscles / Nerves / Vessels 3- VESSELS: (all from internal iliac vessels): 1. Superior gluteal 2. Inferior gluteal 3. Internal pudendal vessels. Greater sciatic foreamen: Greater sciatic notch of hip bone is transformed into foramen by: sacrotuberous (between the sacrum to ischial tuberosity) & sacrospinous (between the sacrum to ischial spine ) Structures passing through Greater sciatic foramen : Nerves: Vessels: Greater sciatic foramen Above 1. Superior gluteal nerves, 2. Superior gluteal piriformis vessels. Lesser sciatic foramen muscle. 3. Piriformis muscle. Belew 4. Inferior gluteal nerves 10.
    [Show full text]
  • Your Guide to Open Gluteus Medius Repair
    WWW.AMERICANHIPINSTITUTE.ORG Please bring this booklet with you to your pre-operative appointment Your Guide To Open Gluteus Medius Repair American Hip Institute Date of Surgery: 999 E. TOUHY AVE. SUITE 450 9615 KEILMAN ST. DESPLAINES, 60018 ST. JOHN, IN 46373 (833) USA-HIPS Location of Surgery: North Shore Surgical Suites 8400 Lakeview Pkwy Pleasant Prairie, WI (262) 455-7548 Munster Specialty Surgery Center 9200 Calumet Avenue, Ste 100 Munster, IN 46321 (219) 595-0789 St. Alexius Medical Center 1555 Barrington Road Hoffman Estates, IL 60169 (847) 843-2000 Lutheran General Hospital 1775 Dempster Street Park Ridge, IL 60068 847-723-2210 Your testing and clearance must be performed within 30 days of your surgery date. Please have all results faxed to 630.323.5625. Your pre-operative appointment on at will be at our office in DesPlaines. At this appointment you meet with a Nurse Practitioner or Physician Assistant to receive medical clearance for your upcoming surgery. You will then be seen by our physical therapists to be fitted for your hip brace, and provided a walker or crutches if needed. Your post-operative appointment on at will be at our office in DesPlaines with a Nurse Practitioner or Physician Assistant. Please be sure to assign yourself a Surgical Coach. A Surgical Coach is the person who should help you throughout the care process. You will be provided with a vast amount of information regarding your surgical procedure and recovery. Your Surgical Coach will serve as additional support throughout this process. You are entering a mutual relationship in which we are committed to improving the quality of your life.
    [Show full text]
  • Gluteus Medius Tendon Repair
    Mufaddal M. Gombera, MD Orthopedic Surgery and Sports Medicine Fondren Orthopedic Group (713) 799-2300 POSTOPERATIVE REHABILIATION PROTOCOL HIP ARTHROSCOPY with GLUTEUS MEDIUS REPAIR OVERVIEW Phase I (Weeks 1-6): Hip brace with ambulation x 4 weeks, 20# weight bearing with Foot Flat pattern during walking x 6 weeks, avoid hip Flexor irritation, PROM and AROM exercises within limitations, isometric strength gains to Focus on muscle Firing patterns, encourage prone lying 2-3 hours a day Phase II (Weeks 7-9): Wean From crutches, normalize gait pattern, restore Full AROM and PROM gradually, initiate closed chain exercises and weight shiFting exercises Phase III (Weeks 10-15): Begin resisted biking, progress strengthening exercises From double to single leg, Focus on return to prior activities without pain or irritation, progress lower extremity strength and endurance Phase IV (Months 4-6): Begin return to running program; Functional strengthening and agility; return to sport exercises Home program: Continue through 1 year Progression of activities: • Crutches: 20# WB with Foot Flat walking pattern x 6 weeks, then progress to full WB • Hip brace: Wear hip brace while ambulating x 4 weeks • Driving: Avoid driving until you are no longer taking narcotic pain medication, are able to actively liFt leg (around 3 weeks) and have the necessary limb control to perForm all driving tasks. • Aqua therapy: May begin aFter week 3 once incisions have healed • Running: Wait until 3 months beFore beginning running progression • This protocol is non-linear • Patients may progress at different rates. Do not push through the pain • Please use clinical judgement and tailor to each patient’s needs 7401 S.
    [Show full text]
  • Pelvis & Thigh
    Pelvis & Thigh 6 After meeting a stranger, you soon begin to palpate their piriformis Topographical Views 276 muscle (located deep in the posterior buttock). You certainly wouldn’t try Exploring the Skin and Fascia 277 this in “everyday life,” but in patient care settings this level of familiarity is Bones of the Pelvis and Thigh 278 commonplace—and welcomed by a client with a hypercontracted piriformis. Bony Landmarks of the Pelvis Touch is a unique privilege afforded to health care providers. As such, we and Thigh 279 need to be mindful of the trust our clients have in us. One way to insure this Overview: Bony Landmark Trails 284 is through good communication skills. For instance, working the adductors Overview: Muscles of the and gluteal region requires a practitioner to provide ample explanation as to Pelvis and Thigh 296 the rationale, need, and goals of working these intimate areas of the body. Synergists—Muscles Working This chapter might pose new challenges for you, as we will be palpating Together 302 structures close to intimate areas. Muscles of the Pelvis and Thigh 306 Ligaments and Other Before proceeding, consider the following questions: Structures of the Pelvis and Thigh 336 E Have you ever been anxious to undergo a physical exam? Was there anything the practitioner did or could have done to alleviate this anxiety? Consider multiple elements, including both verbal and nonverbal communication, draping, physical pressure, and pace. E Tissues and landmarks found in the pelvis and thigh tend to be significantly larger than those discussed in previous chapters. How might your palpation techniques need to change? E Also, how might you properly and comfortably position your patient to access structures needing to be palpated.
    [Show full text]
  • Abductor Repair (Gluteus Medius/Minimus Repair) Protocol
    Abductor Repair (Gluteus Medius/Minimus Repair) Protocol • Pain dominant hip mobilization – grades I, II (used only when hip joint has been affected) Surgery Date:____________________________ • Other: o Upper body ergometer, upper body This protocol should be used as a guidelines for progression strengthening and should be tailored to the needs of the individual patient. o Passive ROM: hip abduction Strict protective weight bearing status for 8 weeks Week 2 Date: ____________________________ • Allow to place weight of leg on ground (neutralizes • Supine marching, modified dead bug joint reaction forces) • Thera band resistance on affected side – Flexion and Extension (start very low resistance) Emphasis on range of motion • Seated hip flexion, IR/ER in pain-free range • Superman • Active assisted (hip flexion)/passive motion (hip • Other: abduction) Standard stationary bike without • Avoid stress to repair site by avoiding passive o resistance (10 min tolerated) adduction, ER/IR for 4 weeks o Pool water exercises – water walking, No active abduction for 2 months to allow healing range of motion (no active abduction or adduction), march steps, backward Pool program to initiate functional exercises in reduced walking, mini-squats, heel raises, weight environment hamstring and hip flexor stretches Soft tissue mobilizations as needed Phase 2: Intermediate Exercises (Weeks 4-6) Emphasis on cycling range of motion without resistance Goals for Phase 2 (as long as this is tolerated by the patient) o Protect ntergrity of healing tissue At 2 months,
    [Show full text]
  • Gluteal Region and Back of the Thigh Anatomy Team 434
    Gluteal Region and Back of the Thigh Anatomy Team 434 Color Index: If you have any complaint or ▪ Important Points suggestion please don’t ▪ Helping notes hesitate to contact us on: [email protected] ▪ Explanation OBJECTIVES ● Contents of gluteal region: ● Groups of Glutei muscles and small muscles (Lateral Rotators). ● Nerves & vessels. ● Foramina and structures passing through them as: 1-Greater Sciatic Foramen. 2-Lesser Sciatic Foramen. ● Back of thigh : Hamstring muscles. CONTENTS OF GLUTEAL REGION Muscles 1- Gluteui muscles (3): • Gluteus maximus. (extensor) • Gluteus minimus. (abductor) • Gluteus medius. (abductor) 2- Group of small muscles (lateral rotators) (5): from superior to inferior: • Piriformis. • Superior gemellus. • Obturator internus. • Inferior gemellus. • Quadratus femoris. CONTENTS OF GLUTEAL REGION (CONT.) Nerves (all from SACRAL PLEXUS): • Sciatic N. • Superior gluteal N. • Inferior gluteal N. • Posterior cutaneous N. of thigh. • N. to obturator internus. • N. to quadratus Vessels femoris. (all from INTERNAL ILIAC • Pudendal N. VESSELS): 1. Superior gluteal 2. Inferior gluteal 3. Internal pudendal vessels. Sciatic nerve is the largest nerve in the body. Greater sciatic foramen Structures passing through Greater foramen: Greater & lesser sciatic notch of -hippiriformis bone are muscle. transformed into foramen by sacrotuberous & Abovesacrospinous piriformis ligaments. M.: -superior gluteal nerve & vessels. Below piriformis M.: -inferior gluteal nerves & vessels. -sciatic N. -nerve to quadratus femoris. -posterior cutaneous nerve of thigh. -internal pudendal vessels Found in the -nerve to obturator internus. lesser sciatic foramen -pudendal N. Lesser sciatic foramen Structures passing through Lesser sciatic foramen: -internal pudendal vessels -nerve to obturator internus. -pudendal N. -tendon of obturator internus. Glutei Muscles (origins) Origin of glutei muscles: • gluteus minimus: Anterior part of the gluteal surface of ilium.
    [Show full text]