Motor reorganization in shoulder injuries-a sketch for sport
specific skills
Dr .B.KANNABIRAN,M.P.T,Ph.DConsultant manipulative sports
physiotherapistProfessor in physiotherapy-RVS college of
physiotherapyTigger point dry needling , Spinal, fascial, cranial
& visceral manipulation practioner
What's new??????????????Sports Rehabilitation to Sports
Re-Abilitation on Motor Ability Perspective
Motor reorganization in sports injuries-a pathway for
Re-AbilitationWhat's new????????????????
To understand role of sports physio in rehabilitation
Role of sports physioTo understand role of sports physio in
rehabilitation
Re Abilitation & rehabilitationRe-AbilitationA therapeutic
approach that targets the various motor abilities will be termed in
this short lecture as Re- abilitation.
Rehabilitation The focus in this form of movement recovery is on
the overall skill of performing the particular movement. This will
be loosely referred to as skill rehabilitation
Much of the rehabilitation promoted in this lecture isthe
marrying of the three concepts discussed 1. The focus on functional
movement2. The principle of skill/ability level rehabilitation3.
The code for motor adaptation
Rehabilitation levels: skill andability level rehabilitationIn
functional rehabilitation we identify five such elements that
optimize neuromuscular adaptation:cognition, being active,feedback,
repetition similarity
Conditions with an intactmotor system
Neuromuscular changes associated with musculoskeletal injuries,
sports injuries, post surgery, back pain and other musculoskeletal
pain conditions Conditions where certain behaviors impede recovery
or may lead to injury or pain Non-traumatic pain conditions, such
as trapezius myalgia, chronic neck pain and painful jaw .
What do we aim at? Why?Because localized, joint/muscle-specific
rehabilitation may not be as effective in recovering control losses
as rehabilitation of whole movement patterns.The aim in
neuromuscular re-abilitation is to help the person recover their
losses to the best of their ability, rather than improving their
personal best.
The injury response-intro
The standard injury response-protection strategy turning down
four movement parameters
INJURY RESPONSE & MOTOR ABILITIESFORCE CONTROL
LENGTH CONTROL
VELOCITY CONTROL
NEUROMUSCULAR ENDURANCE
small changes in movement parameters can have aprofound and
complex influence on muscle recruitment.
The motor system in injury
Motor organization for preventingfurther damage after
injury.
ARTHROGENIC INHIBITION
SYNERGISTIC PROTECTION
Impingement- bilateral(painful and non-painful sides)decrease in
the time to peak tension during medial rotation of shoulder.
Mattiello-Rosa et al
Frozen shoulder-reducedendurance in deltoid. Sokk J, etal
Impingement reduced endurance of trapezius,
deltoideus,infraspinatus,and supraspinatusDuring submaximal
contraction,not related to pain. Bandholm T et al
JOINT BRACING SYNERGISTIC CO-CONTRACTION
Active range depends on control of shortening andlengthening of
the synergistic pairs.
ACUTE INJURY-MOTOR REORGANISATION AS A POSITIVE PROTECTIVE
FUNCTION
SENSITIZATION CONDITIONS-PROTECTIVE MOVEMENT STRATEGY
PHYSICAL CONSTRAINTS /IMMOBILIZATION LEADS TO DYSFUNCTIONAL
MOTOR ADAPTATION
PSYCHOMOTOR REORGANIZTION THAT RESEMBLES INJURY RESPONSE
The Aetiology and progression of A, non-traumatic pain
conditions and B, musculoskeletal injury.
CHANGES IN TIMING & DURATIONTHINK MOVEMENT NOT MUSCLES
Facts INJURY RESPONSE IS A POSITIVE HEALTHY RESPONSERESPONSE IS
HIGHLY INDIVIDUALISTICACUTE MUSCULOSKELTAL INJURIES ARE LEFT
ALONE-BODY KNOWS THE BESTREHABILITATE WHEN INJURY RESPONSE FAILS
PARAMETRIC & SYNERGISTIC ABILITIES ARE AFFECTEDCOMPOSITE
ABILITIES (COORDINATION ,BALANCE & TRANSITION TIME) MAY CHANGE
AS A KNOCK ON EFFECTTHINK MOVEMENT NOT MUSCLES
In the injury response the parametricabilities are affected
within a synergistic levelIt will also have a knock-on effect on
the composite abilities.
Motor complexity model
Motor complexity model
Motor complexity model
Context principle
Context principle
Context principle
Context principle
Some features of the cognitive and autonomous phases.
PARAMETRIC ABILITIES FORCEVELOCITYLENGTHENDURANCE
SYNERGISTIC ABILITIES CO-CONTRACTION RECIPROCAL ACTIVATION
PARAMETRIC ABILITIES/SYNERGISTIC & COMPOSITE ABILITIES
Sports Re-Abilitation
CO-CONTRACTION
CO CONTRACTION / FORCE/.AP CONTROLLATERAL CONTROLROTATION
CONTROL CO CONTRACTION / LENGTH.CO CONTRACTION / VELOCITY.
RECIPROCAL
ACTIVATIONRESISTANCEFORCELENGTHVELOCITYCO-ORDINATION
DYNAMIC CONTROLCO CONTRACTIONLATERAL CONTROLAP CONTROLRECIPROCAL
ACTIVATIONAP FORCEMULTIPLEMOVEMENT PLANES /LENGTH +
FORCEVELOCITYLENGTH(MMP)
AP CONTROL
LATERAL CONTROL
ROTATION CONTROL
Co-contraction & reciprocal activation
Rotational control reciprocal activation
Reciprocal activation
Transition time in reciprocal activation
Reciprocal activation velocity/ hip/ coordination
Reciprocal activation length/ hip Rotation & lateral
control
MULTIDIRECTIONAL CONTROL
LENGTH + FORCECo-ordination
MULTIPLEMOVEMENT PLANES / LENGTH + FORCE
TRANSITION TIMELENGTHRECIPROCAL TO CO CONTRACTION CONTROL
DYNAMIC- CONTROL
To concludeSports ( neuromuscular) Re-Abilitation is to help
individuals to recover their control movement. If rehabilitation
would confer protective function against progressive tissue damage
in the future is unknown.Functional movement is individual specific
There is no need to know the complex and exact anatomy of
musclesThe focus is on movement capacity and not on individual
muscles
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steadiness,muscle activity, and maximalmuscle strength in subjects
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