Common Muscle Injuries
Transcript of Common Muscle Injuries
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Unraveling the Mystery of Low Back Pain #6:
Common Muscle Injuries
Unraveling the Mystery of Low Back Pain #6:
Common Muscle Injuries
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
[email protected]@benbenjamin.com
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Webinar GoalWebinar Goal
• Gluteus muscles
• Iliopsoas
• Hamstrings
• Quadriceps
• Gluteus muscles
• Iliopsoas
• Hamstrings
• Quadriceps
Explore the assessment, treatment, and balancing of the pivotal muscles in and around the low back:
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PretestPretest1. The psoas muscle is directly attached to the intervertebral discs.
True or False?
2. The psoas muscle is the antagonist to the gluteus maximus. True or False?
3. Chronic muscle tension in all or one of the quadriceps muscles tend to make the pelvis tip anteriorly. a. Allb. One
4. How does stretching affect the neural signal of the muscle being stretched?a. Increases itb. Decreases itc. No effect (signal stays the same)
5. Chronic low back pain felt in the muscles of the low back is generally a good indication that they are the cause of the pain. True or False?
1. The psoas muscle is directly attached to the intervertebral discs. True or False?
2. The psoas muscle is the antagonist to the gluteus maximus. True or False?
3. Chronic muscle tension in all or one of the quadriceps muscles tend to make the pelvis tip anteriorly. a. Allb. One
4. How does stretching affect the neural signal of the muscle being stretched?a. Increases itb. Decreases itc. No effect (signal stays the same)
5. Chronic low back pain felt in the muscles of the low back is generally a good indication that they are the cause of the pain. True or False?
AnatomyAnatomy
The Role of Muscles in Low Back Pain
The Role of Muscles in Low Back Pain
• Injured frequently but heal quickly
• Injuries may recur due to poor alignment, improper exercise, or weak core muscles
• Muscles connecting trunk to pelvis and lower body are particularly vulnerable
• Injured frequently but heal quickly
• Injuries may recur due to poor alignment, improper exercise, or weak core muscles
• Muscles connecting trunk to pelvis and lower body are particularly vulnerable
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Gluteus Muscles: MaximusGluteus Muscles: Maximus
• Largest, most superficial of gluteus muscles
• Origin: ilium, sacrum, coccyx, sacrotuberous ligament
• Insertion: IT band, gluteal tuberosity
• Fascial connections: lumbodorsal fascia, gluteal aponeurosis
• Largest, most superficial of gluteus muscles
• Origin: ilium, sacrum, coccyx, sacrotuberous ligament
• Insertion: IT band, gluteal tuberosity
• Fascial connections: lumbodorsal fascia, gluteal aponeurosis
Gluteus maximusGluteus maximus
Gluteus Muscles: MaximusGluteus Muscles: Maximus
• Powerful hip extensor
• Helps keep the trunk erect
• Helps externally rotate the femur
• Supports the extended knee
• Primary antagonist: iliopsoas
• Powerful hip extensor
• Helps keep the trunk erect
• Helps externally rotate the femur
• Supports the extended knee
• Primary antagonist: iliopsoas
Gluteus maximusGluteus maximus
Gluteus Muscles: Medius & MinimusGluteus Muscles: Medius & Minimus
• Origin: ilium
• Insertion: greater trochanter
• Origin: ilium
• Insertion: greater trochanterGluteus maximusGluteus maximus
Gluteus mediusGluteus medius
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Gluteus Muscles: Medius & MinimusGluteus Muscles: Medius & Minimus
• Origin: ilium
• Insertion: greater trochanter
• Origin: ilium
• Insertion: greater trochanterGluteus maximusGluteus maximus
Gluteus mediusGluteus medius
Gluteus minimusGluteus minimus
Gluteus Muscles: Medius & MinimusGluteus Muscles: Medius & Minimus
• Abduct the thigh
• Internally or externally rotate the thigh
• Support the body in walking (prevent pelvis from dropping to other side)
• Abduct the thigh
• Internally or externally rotate the thigh
• Support the body in walking (prevent pelvis from dropping to other side)
Gluteus maximusGluteus maximus
Gluteus mediusGluteus medius
Gluteus minimusGluteus minimus
Gluteus Muscles: Medius & MinimusGluteus Muscles: Medius & Minimus
• Medius: frequently injured with sacroiliac joint or surrounding ligaments
• Minimus: not frequently injured
• Medius: frequently injured with sacroiliac joint or surrounding ligaments
• Minimus: not frequently injured
Gluteus maximusGluteus maximus
Gluteus mediusGluteus medius
Gluteus minimusGluteus minimus
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Iliopsoas Muscle(s)Iliopsoas Muscle(s)
• Iliacus origin: iliac fossa
• Psoas origin: lumbar vertebrae & discs
• Both insert at the lesser trochanter
• Iliacus origin: iliac fossa
• Psoas origin: lumbar vertebrae & discs
• Both insert at the lesser trochanter
PsoasPsoas
IliacusIliacus
Iliopsoas Muscle(s)Iliopsoas Muscle(s)
• Flex the hip
• Flex the trunk; help us stay erect
• Critical in moving and stabilizing the low back and pelvis
• Flex the hip
• Flex the trunk; help us stay erect
• Critical in moving and stabilizing the low back and pelvis
PsoasPsoas
IliacusIliacus
Iliopsoas InjuriesIliopsoas Injuries
• Compromise low back functioning
• May occur at the attachment or in the muscle belly
• May place stress on discs and ligaments
• Compromise low back functioning
• May occur at the attachment or in the muscle belly
• May place stress on discs and ligaments
PsoasPsoas
IliacusIliacus
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Quadriceps & HamstringsQuadriceps & Hamstrings
• Must be in balance for low back health
• Rectus femoris crosses both knee and hip joints
• Short or tense rectus femoris stresses the low back
• Must be in balance for low back health
• Rectus femoris crosses both knee and hip joints
• Short or tense rectus femoris stresses the low back
Crosses thehip jointand knee joint
Crosses thehip jointand knee joint
Crosses thehip jointand knee joint
Crosses thehip jointand knee joint
AssessmentAssessment
Gluteus Medius Assessment Gluteus Medius Assessment
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Gluteus Maximus Assessment Gluteus Maximus Assessment
Iliopsoas AssessmentIliopsoas Assessment
Iliopsoas Assessment (leg length)Iliopsoas Assessment (leg length)
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TheoryTheory
Direct and Indirect Causes of PainDirect and Indirect Causes of Pain
• Direct: what is causing pain at the moment (ligament sprain, nerve root compression, muscle tear, etc.)
• Indirect: what made the back get hurt in the first place (weak abdominal muscles, hyperlordosis, short psoas, pelvis misalignment, etc.)
• Direct: what is causing pain at the moment (ligament sprain, nerve root compression, muscle tear, etc.)
• Indirect: what made the back get hurt in the first place (weak abdominal muscles, hyperlordosis, short psoas, pelvis misalignment, etc.)
Guest InstructorGuest Instructor
• Vincent Cambrea• Vincent Cambrea
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Concepts in Muscle InnervationConcepts in Muscle Innervation
• Agonist: prime mover
• Antagonist: opposes prime mover
• Synergist: helper muscle
• Agonist: prime mover
• Antagonist: opposes prime mover
• Synergist: helper muscle
Neural DriveNeural Drive
• The number and amplitude of innervation to a muscle
• Increases as muscles shorten and decreases as muscles lengthen
• Shared between agonist and antagonist muscles
• The number and amplitude of innervation to a muscle
• Increases as muscles shorten and decreases as muscles lengthen
• Shared between agonist and antagonist muscles
Reciprocal InhibitionReciprocal Inhibition
• A shortened muscle inhibits its functional antagonist by decreasing its neural drive
• A shortened muscle inhibits its functional antagonist by decreasing its neural drive
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Synergistic DominanceSynergistic Dominance
• A synergist (helper) muscle becomes the prime mover due to weakness or inhibition of the agonist
• Increases demand on the synergist muscles
• Decreases neuromuscular efficiency
• May lead to premature breakdown
• A synergist (helper) muscle becomes the prime mover due to weakness or inhibition of the agonist
• Increases demand on the synergist muscles
• Decreases neuromuscular efficiency
• May lead to premature breakdown
Implications for Low Back PainImplications for Low Back Pain
• Psoas: agonist
• Gluteus maximus: antagonist
• Hamstrings: synergist
• Psoas: agonist
• Gluteus maximus: antagonist
• Hamstrings: synergist
When spinal mechanics are altered and/or the psoas is in a chronically shortened position, the gluteus maximus will become neurologically inhibited — thereby placing increased demand on the hamstrings. This includes the attachment of biceps femoris on the sacrotuberous ligament.
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TreatmentTreatment
TreatmentTreatment
Watch the video at the end of the WebinarWatch the video at the end of the Webinar
Psoas Technique Iliacus Release
Gluteus Medius Release
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Massage Therapy Massage Therapy
Exercise TherapyExercise Therapy
• Active Isolated Stretching & Strengthening (AIS)• Active Isolated Stretching & Strengthening (AIS)
Psoas
Iliacus
Gluteus maximus
Exercise TherapyExercise Therapy• IMAP: Trains low back strength
in an aligned neutral position• IMAP: Trains low back strength
in an aligned neutral position
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QuestionsQuestions
Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin
Post-testPost-test1. The psoas muscle is directly attached to the intervertebral discs.
True or False?
2. The psoas muscle is the antagonist to the gluteus maximus. True or False?
3. Chronic muscle tension in all or one of the quadriceps muscles tend to make the pelvis tip anteriorly. a. Allb. One
4. How does stretching affect the neural signal of the muscle being stretched?a. Increases itb. Decreases itc. No effect (signal stays the same)
5. Chronic low back pain felt in the muscles of the low back is generally a good indication that they are the cause of the pain. True or False?
1. The psoas muscle is directly attached to the intervertebral discs. True or False?
2. The psoas muscle is the antagonist to the gluteus maximus. True or False?
3. Chronic muscle tension in all or one of the quadriceps muscles tend to make the pelvis tip anteriorly. a. Allb. One
4. How does stretching affect the neural signal of the muscle being stretched?a. Increases itb. Decreases itc. No effect (signal stays the same)
5. Chronic low back pain felt in the muscles of the low back is generally a good indication that they are the cause of the pain. True or False?