Core- study material Part – 2 (of 2)

This part contains selective topics that will enhance your understanding to the workshop but
non of these parts will be covered in the workshop

Topic-1: Thoracolumbar Fascia

Thoracolumbar fascia is a deep investing membrane which covers the deep muscles of the back
of the trunk. Above, it passes in front of the Serratus posterior superior and is continuous with
a similar investing layer on the back of the neck—the nuchal fascia.

Figure 1: Layers of Thoracolumbar Fascia

In the thoracic region the Thoracolumbar fascia is a thin fibrous lamina which serves to bind
down the Extensor muscles of the vertebral column and to separate them from the muscles
connecting the vertebral column to the upper extremity. It contains both longitudinal and
transverse fibers, and is attached, medially, to the spinous processes of the thoracic vertebrae;
laterally to the angles of the ribs.

In the lumbar region the fascia (lumbar aponeurosis) is in two layers, anterior and posterior.
The posterior layer is attached to the spinous processes of the lumbar and sacral vertebrae and
to the supraspinal ligament; the anterior layer is attached, medially, to the tips of the
transverse processes of the lumbar vertebrae and to the intertransverse ligaments, below, to
the iliolumbar ligament, and above, to the lumbocostal ligament. The two layers unite at the
lateral margin of the Sacrospinalis, to form the tendon of origin of the Transversus abdominis.
The aponeurosis of origin of the Serratus posterior inferior and the Latissimus dorsi are
intimately blended with the Thoracolumbar fascia.

Figure 2:: Orientation of Thoracolumbar Fascia

 Topic : Motor Control
Motor control is a broad term that describes the general ability of a person to initiate and direct
muscle function and voluntary movements. Motor control is a concept that is distinct from the
many involuntary muscle actions of the body, such as shivering when cold or flinching when an
object is directed at a person without warning. A related expression, "motor skills," refers to
the ability to perform specific physical
physi movements.

Motor control
ol is divided into two subsets.

1. Gross motor control is the ability of a human to move a large muscle group or segment
of the anatomy; the waving of an arm is an example
example of this type of movement.
2. Fine motor control is the ability to manipulate precise movement, such as handwriting.

All motor control is an integrated product of

of three aspects of the human anatomy: muscles,
bones, and the central nervous system.

The voluntary motor system

system, also known as
the somatic nervous system, is the
structure that permits and creates motor
control. The system takes its name from the
part of the brain known as the motor
cortex, from which the signals to initiate
movement originate. The impulse from the
motor cortex travels along pathways
through the brainstem into the spinal cord.
The nerve cells of the spinal cord connect to
a vast and intricate network to control the
skeletal muscle movement. Motor neurons,
the specialized mechanisms that
communicate to the muscles, are a
Figure 3: Pyramidal System continuation from the nerve roots that
branch out from each vertebra in the spinal column to the muscle over which control is
required. There are a number of pathways essential to the function of the voluntary motor
system, of which the pyramidal system is the best known and the most extensive.

Every healthy person will be capable of both gross motor control and fine motor control. In
many sports, athletic success is measured in the fine distinctions between athletes in terms of
their coordination (particularly their hand-eye coordination), balance, and overall body control.
Many aspects of motor control are hereditary; others are linked to the body type of the
individual. Body type and heredity aside, all athletes have the capacity to improve their motor
control through the practice and the repetition of distinct motor skills. In many sports, the drills
that form the basis of improved motor control ability are collateral to the sport itself. Cross
training techniques are often employed to enhance a particular motor ability that is desired for
a sport in an athlete. A notable example is the use of jumping rope in sports such as boxing; the
repeated coordination of the athlete's footwork and hands in the act of skipping improves the
athlete's overall coordination.

"Muscle memory" is a muscular attribute linked to the development of motor skills. When an
athlete is sidelined from an activity due to injury, the athlete will return more quickly to his or
her previous level of motor ability due to the memory preserved in the nervous system as to
how the motion stressed the subject muscle or structure.

A physical injury to any aspect of the voluntary motor system will impair motor control. A
concussion or damage to the spine or spinal column is a frequent cause of such injuries. When a
nerve becomes pinched or otherwise damaged through trauma, such as a carpal tunnel nerve
fracture in the wrist, the pathway for the major nerve ending into the muscles of the hand,
there will be similar limitations of movement.

Motor control can be significantly impaired though stresses imposed on other bodily systems.
When athletes become dehydrated, they will commonly sustain an imbalance in their
electrolyte levels, particularly that of the mineral sodium. A sodium deficiency will impair the
ability of a nervous system transmission to be communicated to the working muscle.
Topic- 3: Rehabilitation Principles
There are seven principles of rehabilitation; principles are the foundation upon which
rehabilitation is based. This mnemonic may help you remember the principles of rehabilitation:

ATC IS IT.

1. Avoid aggravation
2. Timing
3. Compliance
4. Individualization
5. Specific sequencing
6. Intensity
7. Total patient

A: Avoid aggravation. It is important not to aggravate the injury during the rehabilitation
process. Therapeutic exercise, if administered incorrectly or without good judgment, has the
potential to exacerbate the injury, that is, make it worse. The primary concern of the
therapeutic exercise program is to advance the injured individual gradually and steadily and to
keep setbacks to a minimum.

T: Timing. The therapeutic exercise portion of the rehabilitation program should begin as soon
as possible—that is, as soon as it can occur without causing aggravation. The sooner patients
can begin the exercise portion of the rehabilitation program, the sooner they can return to full
activity. Following injury, rest is sometimes necessary, but too much rest can actually be
detrimental to recovery.

C: Compliance. Without a compliant patient, the rehabilitation program will not be successful.
To ensure compliance, it is important to inform the patient of the content of the program and
the expected course of rehabilitation. Patients are more compliant when they are better aware
of the program they will be following, the work they will have to do, and the components of the
rehabilitation process.
I: Individualization. Each person responds differently to an injury and to the subsequent
rehabilitation program. Expecting a patient to progress in the same way as the last patient you
had with a similar injury will be frustrating for both you and the patient. It is first necessary to
recognize that each person is different. It is also important to realize that even though an injury
may seem the same in type and severity as another, undetectable differences can change an
individual's response to it. Individual physiological and chemical differences profoundly affect a
patient's specific responses to an injury.

S: Specific sequencing. A therapeutic exercise program should follow a specific sequence of

events. This specific sequence is determined by the body's physiological healing response and is
briefly addressed in the next section of this chapter.

I: Intensity. The intensity level of the therapeutic exercise program must challenge the patient
and the injured area but at the same time must not cause aggravation. Knowing when to
increase intensity without overtaxing the injury requires observation of the patient's response
and consideration of the healing process.

T: Total patient. You must consider the total patient in the rehabilitation process. It is important
for the unaffected areas of the body to stay finely tuned. This means keeping the cardiovascular
system at a pre-injury level and maintaining range of motion, strength, coordination, and
muscle endurance of the uninjured limbs and joints. The whole body must be the focus of the
rehabilitation program, not just the injured area. Remember that the total patient must be
ready for return to normal activity or competition; providing the patient with a program to keep
the uninvolved areas in peak condition, rather than just rehabilitating the injured area, will help
you better prepare the patient physically and psychologically for when the injured area is
completely rehabilitated.