Muscle Activation Techniques (MAT)

• Normal muscle function
• Stretch
• the muscle (extrafusal fibers) are placed under stretch
• the muscle spindle (infrafusal fibers) sense tension under stretch
• relays it back to the CNS
• CNS stimulates the alpha motor neurons
• stimulates the muscle to contract and resist the tension
• Contraction
• the muscle (extrafusal fibers) shorten in contraction
• the muscle spindle (infrafusal fibers) slacken
• lack of contractile force regulation
• CNS stimulates gamma motor neurons 
• gamma motor neurons stimulates the muscle spindle to contract
• infrafusal fiber contraction stimulates alpha motor neurons
• stimulates the muscle to contract and resist tension
• Traumatized muscles decrease the sensitivity of the muscle spindle
• muscle becomes less capable of regulating tension relative to stretch or load
• decreased gamma motor neuron stimulation during contraction
• more contraction, greater slack, less responsive spindle
• actin and myosin crossbridges overlap excessively = inefficient 
• biomechanically inefficent as well 
• Reciprocal Inhibition and MAT
• If proper neurological input is not being sent to an agonist muscle, proper inhibition is not occurring of the antagonist muscle as well
• the antagonist muscle is more active consistently becoming hypertonic
• becoming tight
• thus muscle tightness caused by traumatized weakened muscles

PT Volunteer 6/29/12

• articulations and joints of TUB test
• glenohumeral joint
• acromial clavicular joint
• sternoclavicular joint
• scapular thoracic joint (not synovial capsular joint)
• scapular thoracic - anterior tip (when inferior angle of scapula wings out and away from ribcage)

PT Volunteer 6/14/12

• unilateral vs symetrical pain
• palpating the spine?
• upper traps on fire with shoulder injuries, protects the shoulder
• stretch muscles along scapula to loosen the shoulder joint in order to manipulate humerus head and manipulate the deep labrum
• joint mobilization - physically pushes the humerus head inside the glenoid fossa to stretch labrum and muscles
• muscle grade system
• 5 strong perfect uninjured
• 4 + motion w/ resistance
• 4 motion with some resistance
• 4- motion but breaks under resistance
• 3 motion w/out resistance
• creative ways to exercise quad w/out leg extension?
• dry needling - trigger point therapy
• laxity? - loose ligaments

PT Volunteer 6/13/12

• Biomechanics of throwing a boxing punch
• muscles utilized - posterior leg, hip internal rotation, elevation of scapula, contraction of pectoralis min/maj and anterior serratus and latissimus dorsi, extension at shoulder, internal rotation of shoulder,
• hook - over use of shoulder? 
• hyperextension of knee normal range for general population?
• orthotics
• arch height
• heel height
• heel depth
• Premod is for muscle contraction
• interferential is for swelling/inflamation
• traction is used with gapping 
• 0-18 kg of pressure - muscle stretch
• 18-20 kg of pressure - cervical pulling apart
• helps w/ degenerative disc diseases and neurological diseases
• Lunge technique form? (most people over lunge and place excessive force on their knee)
• 3 partial squat
• combines eccentric, concentric, and isometric exercises in one
• plica - appendage of knee, normal tissue not scar
• correcting airplane form 
• hips and pelvis  forward 
• avoid external rotation of pelvis
• add stability 
• bend support knee
• use pole for support
• decrease rear leg raise height
• hold (isometric) vs higher leg raise height

Physical Therapy Volunteer 6/22/12

• Neck strain testing
• restricted motion on one side during lateral neck flexion + restricted motion on opposite side during neck rotation
• unstuck shoulder - unstable shoulder joint
• reinforce neuromuscular with isometric exercises 
• passive ROM isn't enough on its own
• muscle function reverses when joint axis is crossed
• MAT (Muscle activation technique) - targets weak muscles, range of motion
• injury caused by muscle tightness caused by weak stabilizing muscles, strengthen the weak muscles and the tightness will resolve itself
• reciprocal inhibition
• ART (activation release technique) - targets scar tissue (soft tissue adhesion)
• applies tension to scar tissue while moving limb/joint through range of motion
• Tommy Johns surgery - ulnar collateral ligament replacement
• palmaris longus (not everyone has one)
• trauma vs long term straining
• volume and rotation
• different pitches - different ROM angles, wrist flexion and rotation, finger contraction
• http://www.orthonurse.org/portals/0/youth%20pitching.pdf
• 
  

PT Volunteer 6/20/12

• Ar - different stride walks
• purpose
• patient has tendency to externally rotate femur (decreased quad contraction, uses hip adducters instead) and vault over leg (decreased knee flexion)
• retrain gait biomechanics - stride w/ increased knee flexion with hips in line
• Ek - high intensity low duration exercises
• * limitations of strength tests - variability? functional sports testing?
• Joint mobilization - ankle 
• biomechanics of ankle dorsiflexion - talus slides back and anterior rotates superiorly
• spine alignment exercises 
• lower trunk (lumbar spine) rotations (LTR) - supine, knees flexed at 90, lower body rotates left and right
• thoracic rotations (book openings) - supine, knees flexed at 90 laying on one side of floor, rotates upper body from hands together twisting the upper body and reaching the other side of the body. 
• FMS (Function movement screen) - whole body movement exercises that looks at big picture of a patient's function/rom/strength
• Florence Kendall 
• manual muscle tests 
• isolate 1 muscle
• id nerve problems, strains, specific
• not designed for what is commonly used for today
• tests motion not muscle strength

Physical Therapy Volunteer 6/27/12

• Florence Kendall - developed the modern strength tests. 
• ? Sick Scapula - 
• S- Scapular malposition, I- Inferior medial scapular winging, C - Coracoid tenderness K- scapular dysKinesis
• Scapular malposition - When arms are at side, one scapula (usually the throwing side) is significantly lower, rises higher when arms are elevated to the side or overhead
• often misdiagnosed as rotator cuff injury
• increased tightness of the posterior shoulder capsule changes the axis of the shoulder causing decreased ROM w/ internal rotation and increased ROM w/ external rotation
• often leads to a SLAP (Superior Labrum Anterior Posterior) lesion due to increased ROM in external rotation causing the long head of biceps brachii to peal the cartilage off the bone
• Inferior medial scapular winging - Inferior tip sticks out from rib cage caused by
• weak mid, low traps, serratus anterior
• tight pectoralis minor
• Scapular DysKinesis - the inferior tip gets stuck in the lower position
• Treatment 
• stretch the posterior glenohumeral capsule
• stretch relax tight anterior muscles (pect minor)
• strengthen the posterior weak muscles (blackburn exercises)
• Passive stability - can't control
• bone, capsule, ligament, labrum,
• Active stability - control
• muscles
• anterior flexors of the shoulder
• anterior deltoid
• subscapularis
• biceps brachii
• coracobrachialis
• supraspinatus

Judo Review

• Pinning Techniques (Osaewaza)
• kata-gatame - shoulder side mount
• kami-gatame - north south mount
• tate-gatame - mount
• yoko-gatame - side cradle
• kesa-gatame - head and arm mount
• Throwing Techniques ( Nagewaza)
• Hand Throwing (Te-waza)
• Ippon Seoinagi - one arm shoulder throw
• Hip Throwing (Goshi-waza)
• O goshi - full hip throw

Physical Therapy Volunteer 6/7/12

• ACL rupture - knee graft
• patellar tendon - sensitive pain on anterior patella
• hamstring - protect the hamstrings post surgery
• recovery is similar otherwise
• ? Physical therapy's purpose prior to surgery
• lengthening the extensor muscles
• Physical therapy routine post surgery 
• Most surgeons keep patients locked out post surgery, some are starting to unlock immediately
• Good morning exercises
• dead lift like exercise with bar racked behind shoulders
• ? Sitting versus standing
• effect on exercises' form and muscles used

Physical Therapy Volunteer 6/6/12

• New eval 
• gait analysis
• rigid upper body
• significant pelvic rotation
• small steps
• weak abdominal
• outer hip abducters
• posterior hip extensors
• lack of hip flexion causes rotation of hips to cheat the movement
• ?Traction - Purpose?
• inflamed femoral patellar joint
• ? 3 partial squat ? 
• deep squat, low squat, middle squat
• ? pain @ night/morning/rest 
• non musculoskeletal - red flag, go see a pain/neural specialist
• musculoskeletal - inflammatory joint stiffens over rest
• IT band friction syndrome - The iliotibial band gets inflamed and causes friction and it causes more inflammation
• previous back problems
• pelvic is common factor
• ? Airplanes - how to correct form?
• ? PTA school?

Physical Therapy Volunteer 6/1/12

• Referred pain - can you touch the pain 
• if yes, = not referred
• if no = referred
• referred groin pain often from hip degeneration
• lumbar spine extension - lordosis (vs kyefosis)
• muscle cramps 
• hamstring
• active insufficiency - a bi articulate skeletal muscle that cannot shorten enough to complete the full range of motion across both joints
• passive insufficiency -  a bi articulate skeletal muscle that cannot lengthen enough to complete the full range of motion across both joints
• pelvic rotation and bridge exercises 
• anterior rotation of pelvis reduces lordosis in lumbar spine, preventing cheating while hip extensions/strengthening
• spondelolesthesis - L5 (usually) slides forward on top of the sacrum (s1) (common in dancers and gymnasts) 
• shoulder flexion + abduction
• humerus head depresses and posteriorly rotates
• teres minor, teres major, infraspinatus, subscapularis
• compound movements with multi planar movements
• balances - propioception (static place in space), kinesthetic (dynamic), vestibular, ochular, visual
• Orthothics 

Physical Therapy Volunteer 5/31/12

• Ke - shoulder injury, softball player
• ? Pain sensations? - burning sensations?
• one legged diagonal - hip external rotation - incorporates core into exercise
• airplane/pelvic exercises - tendency to externally rotate 
• weakness and stability - glutes, hip abductors, core
• address first before progression
• tight muscles are weak muscles
• ? loose muscles are weak as well?
• Posterior muscles of the neck ?
• Trapezium, splenius capitis, splenius cervicis, semispinalis capitis, semisplinalis cervicis, 
• longer lever arm = increased torque
• laying suppine, legs extended creates increased torque on the spine, wedge underneath knees to adjust
• Arthritic change in spine - water bbetween disc degenerates, shortens length of spine, affects s curve
• massage - constant pressure - releases the muscle
• I's and T's exercises
• prone reverse flys
• ear to shoulder stretch

Physical Therapy Volunteer 5/24/12

• Dh - shoulder and IT band massaged, rows, elbows bent or in close?
• After program - common with PTs? 
• De - IT band, aggressive treatments not possible with an elderly patient
• By - broken hip neck of femur snap? 
• Cn - achiles loss of ROM, sensitively in heel, inflamation 
• workman comp - system - people fake injuries ruin it for people in need
• doctor shuffle
• Popping sound in joints - CO2 release
• Pilates reformer - squat with board - heel sensitivity, helps with dorsiflexion 
• army eval - where/what muscle
• palpating upper trap, levitar scapula,
• stabilizers weak, strengthen stabilizers
• calm/treat pain symptoms
• strengthen 
• ACL possible tear?
• anterior drawer test
• How to use a goniometer?

Physical Therapy Volunteer 5/17/12

• Patient discretion
• Down time
• Cleaning tables, equipment, and machines
• Laundry
• Familiarize myself with Exercise terminology 
• REF = Reformer
• RIP = Run in Place
• TUB - Thumb up back
• Private clinic needs to emphasize productivity
• my role is not to get in the way of productivity, 
• if questions but PTs are busy, write down notes
• ? - Patient subjectivity 
• asking how a patient feels vs what the PT believes a patient is at
• motivating patients who feel they don't need to do their exercises anymore
• letting a patient know their limitations,
• test 
• ignore patient's subjective opinion 
• ? - Incline setting - how to choose incline setting for patients
• side ways squat jump form
• posture - spine and shins are parallel 
• sound - soft vs hard landing indicates eccentric muscular control (having the strength to lower yourself slowly
• simultaneous landing vs tap tap landing - indicates pressure of landing being shared by both feet
• MCL valgus injury
• adductors
• hamstrings
• quadriceps
• *treat multiple components of the injury
• ? - Q angle - quadriceps angle?
• ? - Massage techniques 
• purpose and techniques
• ? Popping noise in knee - ?
• ? Taichi research - effect on physical therapy and fitness
• New Eval
• athletes - pain tolerance different from other patients
• how running causes back pain (lack of foot plantar flexion)
• head aches - posture and back pain
• standing march - quiver in lumbar spine, weakness
• Ibuprofen and drug use - NSAIDs and Naproxen
• liability concern, a lot of people misuse drugs
• foam rolling alternatives for patients with shoulder pain
• use a rolling pin to manually roll
• Adhesive capsulitis - frozen shoulder 
• SITS - supraspinatus, infraspinatus, teres mminor, subscapularis 
• teres major
• rhomboid major and minor
• trapezius mid
• latissimus dorsi
• ? - Knee valgus - Christopher Powers

Retraining Happiness

Kaye linked me to this 12 minute video that really made me think and reconsider. I've been pretty stressed and depressed lately so it was a breath of fresh air to watch and listen to. The discussion of redefining happiness as a result of success really stroke an accord with me. All my life I've been pressured into succeeding that I actually don't appreciate my own successes, I don't even consider them successes, I'm always thinking about the next goal and while that is commendable to be ambitious, it isn't healthy when it becomes detrimental to your own self confidence. Where you're so focused on falling short of the next goal that you never really appreciate any of your previous successes and so you're never really satisfied or happy with yourself.

I want to try this journal/retraining happiness thing. I'm going to give it a try. We'll see how long it lasts....