Compare and contrast the spinal curves of a laboratory partner sitting

erect with those of one sitting slouched in a chair. Which muscles are
responsible for maintaining good sitting posture?
• Sitting with good posture results in lumbar lordosis, thoracic kyphosis, and cervical lordosis
• Spinal curves of person sitting erect are more normal than when slouching
• Normal positions are maintained by erector spinae activity

Do muscle contractions or tightness (or flexibility) change the spinal

curves?
 These normal spinal curves can change for several reasons, egpoor posture and abnormal
pelvic position.
 Increased curves (typically cervical or lumbar) are known as lordosis
 Lumbar and cervical curves can also flattenor reverse
 Kyphosis is an exaggerated convexity, common in the thoracic curve of the spine. (produces
“humpback”)
 It is common to have thoracic kyphosis associated with cervical lordosis (to maintain head
position) and altered lumbar curve.

Lumbar Curve abnormalities

 Lumbar lordosis is associated with exaggerated anterior pelvic tilt.

 Conversely a flat or reversed lumbar curve is associated with an excessive posterior pelvic
tilt.
 The pelvic position can develop because of a change in the lumbar curve, or the lumbar
curve can occur because of a change in the pelvic position
 Flexibility of the hip flexors and extensors is key to maintaining normal pelvic alignment
 In hip flexion, shortened hamstrings can cause flattening or reversal of the lumbar curve.
 Extremely short hamstrings can cause flattening of the lumbar curve in normal standing

Why is good abdominal muscular development so important? Why is

this area so frequently neglected?
• Good abdominal strength essential to provide balance in core of body
• If abdominals are not relatively strong in comparison to erector spinae, imbalance leads to poor
posture and
less core stability than needed for many activities
• Routinely, we bend forward and our trunk is moving with gravity utilizing erector spinae
eccentrically in
bending over and then concentrically in straightening up
• Consequently, abdominals are not worked much during our daily activities
Sit ups vs Leg Lifts
 Proper leg-lifts depend on abdominal muscles contracting isometrically to maintain a slightly
flexed and stable lumbar spine so that the hip flexors can lift the legs through hip flexion

 Sit-ups use isotonic activity of abdominals, first with concentric activity during sitting up
phase, followed by eccentric activity through the lowering phase

 Normal sit-ups exercise muscles through greater ROM than do leg-lifts and are therefore
more beneficial for total abdominal strengthening

In groups discuss why tight hamstrings will not allow you to achieve a
normal lumbar curve when sitting, even with the lumbar pad.
Its going to push you forward due to posterior tilted pelvis

Pelvis-anterior tilt due to tight hamstrings

What can you do to try to achieve normal lumbar curve?

Stand up desks, tilt seat downwards, kneeling chairs

If client has 90°hip flexion in right leg but can only achieve 85 °hip
flexion on his left side, the left side of his pelvis will raise up. How
could you adjust his chair to compensate?
Symmetrical, back would go further back to decrease

Quentin is retired farmer in a wheel chair. He has a waist seatbelt, but

always tries to unbuckle it or slide under it. He has seriously abraded
the skin on his sacrum from shear force by sliding down in his chair,
placing him at risk of pressure sores. What are some options of
alterations you could try with Quentin?
Common restraint straps

Bernice is a quadriplegic. You need to prevent her body’s forward

momentum in case her wheelchair makes a sudden stop. What are
some of the options you could try with her?
4 point harness over the shoulders.

Tilt the chair back

GH Flexion Muscles
Anterior Deltoid, Pectoralis Major, coracobrachialis, biceps
GH Abuctors Muscles
Supraspinatus

Deltoid

GH Internal Rotation Muscles

Subscapularis

Latissimus dorsi

Pectoralis Major

Anterior Deltoid

GH Extensors Muscles
Posterior Deltoid

Teres major

Latissimus dorsi

Triceps long head

Scapular elevation Muscles

Elevation is defined as the movement of the entire scapula superiorly on the thorax
Upper trapezius

Levator scapula

Scapular protraction Muscles

Protraction is defined as the entire medial border of thescapula moving away from the
vertebrae
Serratus Anterior

Splinting
Dominant action of all splints is to apply force to the limb to:
– position;
– move; or
– prevent movement
Force may be:
– compression (push)
– tension (pull)
Function of splints:
– immobilisation;
– mobilisation;
– restriction on a body part.
A splint is a series of related systems of force
application. The types of forces applied by
splints to the limb are:
1.Stabilising forces
2.Manipulatory forces
3.Actuating forces
• Need to make best use of the available forces
& use minimal force to minimise pressure.

Minimisation of Pressure
Assess tissue tolerance to pressure and shear stress.
Reduce pressure – increase application area

Reduce pressure – provide maximum contour

Reduce pressure – protect areas of risk

Reduce shear stress – avoid large sudden changes in pressure

Tenodesis release
Wrist flexion & finger extension combination that occurs when the passive tension forces the
fingers to extend & release an object
Tenodesis grasp:
wrist extension stretches the flexor digitorum profundus, producing finger flexion

Active insufficiency
• Multi-joint muscles act across more than one joint:
– One joint must be stabilised (by other muscles or by contact with and external object) if the muscle is to move the other joint
through its maximum range.
• When a muscle’s full excursion cannot complete ROM at all joints we call this active insufficiency

Passive insufficiency
• restricts motion (eg flexion) because the antagonistic muscles (eg extensors)
cannot stretch adequately to permit full movement