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Cannot post in lecture slides

Ear Anatomy http://www.nlm.nih.gov/medlineplus/magazine/issues/fall08/articles/fall08pg12a.html Stretching Good for Arteries, figure from Kenta Yamomoto et al., Poor trunk flexibility is associated with arterial stiffening. American Journal of Physiology: Heart and Circulatory Physiology, Oct. 2009, Vol. 297. http://ezproxy.library.yorku.ca/login?url=http://dx.doi.org/10.1152/ajpheart.00061.2009 Michael Tetley. Instinctive sleeping and resting postures: an anthropological and zoological approach to treatment of low back and joint pain BMJ VOLUME 321 2330 DECEMBER 2000 http://www.jstor.org.ezproxy.library.yorku.ca/stable/25226542

What is Physical Fitness?

Musculoskeletal Fitness as a Function of Age

Warburton et al. CMAJ March 14, 2006 174(6) http://ezproxy.library.yorku.ca/login?url=http://go.galegroup.com/ps/i.do?id=GALE%7CA143162648&v=2.1&u=yorku_main&it=r&p=AONE&sw=w&asid=712842f bce56fd60eb26f5c8d8c2ffa8

Signals upon which balance is dependent: Semi-circular canals of inner ear Kinesthetic sensors in muscles, tendons and joints Visual perception Co-ordination of the above stimuli (spastic lock coordination)

Golgi Tendon Organs

Image courtesy of Neuromechanics / Wikimedia Commons http://en.wikipedia.org/wiki/Golgi_tendon_organ

Embedded in the tendons, close to the muscle insertions. Detect tension in the tendon of a contracting muscle.

Muscle Spindles

Image courtesy of Neuromechanics / Wikimedia Commons http://en.wikipedia.org/wiki/File:Muscle_spindle_model.jpg

Located muscle between muscle fibres. Provide information on muscle length, tension, and load Highest density in small muscles designed for fine motor control

Muscle Spindles

Image courtesy of Neuromechanics / Wikimedia Commons http://en.wikipedia.org/wiki/File:Muscle_spindle_model.jpg

Function is to resist stretch by stimulating contraction Also send inhibition signal to opposing muscle group After stroke or spinal cord injury the spindles may be oversensitive and cause muscle stiffness

Joint Kinesthetic Receptors

Located in the connective tissue of a joint capsule. Signal the extremes of joint range
Bruce Blaus, Knee Anatomy Side. Wikimedia Commons. http://en.wikipedia.org/wiki/File:Blausen_0597_KneeAnatomy_Side. png#filelinks

Respond to mechanical deformation occurring in the joint capsule and ligaments during dynamic movement. Respond more to passive than active movement

Affecters of Balance Performance: 1. Body weight 2. Strength / Power 3. Center of gravity 4. Fear 5. Co-ordination

Measurement of Balance
CATEGORY CLASSIFICATION DYNAMIC Eyes open Eyes closed Balancing stunts Balancing objects Dizziness tests Beam walk Beam walk Walk on hands Shuttle run balancing object Walk around finger STATIC Squat stand Stork stand Teeter board Stick balance Centrifuge

Improvement of Balance
1. Practice the specific balance test items. 2. Practice basic skills which demand a high degree of balance. 3. Participate in sports which demand a high degree of balance.

Rhphotos | Dreamstime Stock Photos

Image courtesy of arztsamui / FreeDigitalPhotos.net

Image courtesy of chanpipat/ FreeDigitalPhotos.net

Elderly-Loss of Balance & Aging

Balance deteriorates progressively with aging 1/3 of persons over age 70 fall each year & the incidence is 1 - 2 x higher in females than males Due to the concurrent loss of bone mineral density, the incidence of fractures is high 90% of hip fractures are due to falls
Image courtesy of Simon Howden/ FreeDigitalPhotos.net

Image courtesy of njaj/ FreeDigitalPhotos.net

Elderly-Loss of Balance & Aging

Older adults have lower strength a lower rate of strength development (power) than younger adults (males > females) Major difference between individuals and those who fall or who do not is not reaction time- it is the rate of strength development (power) Older adults who engage in strength & power training maintain or improve their power and balance which leads to reduced falls and longer independent functioning

Range of movement about a joint or joints.

Not a general characteristic (site specific) Static (range of motion) Dynamic (stiffness or looseness reflected in speed of movement or power)

Avoiding injuries Enable proper form in certain sports Power development (Plyometric) Muscle relaxation

Limitations of Flexibility
1. 2. 3. 4. 5. Mechanical factors: bone structure and muscle bulk Soft tissue crossing a joint (NB for sports) Injuries and disease - reduced tissue elasticity Inactivity Age: 6 18 increase
18 28 plateau 28 - 35 slight decline 35 on more rapid decline


7. 8.

Temperature (achieved passively or actively): - warming a joint to 113 F increases flexibility by 20 % - cooling a joint to 65F decreases flexibility by 10-20% No difference between males and females when large number of articulations are considered Why is only one measure of flexibility included in health related fitness assessments?

Measurement of Flexibility
1. Goniometry
Modified protractor Overhead- projected goniometer Electrogoniometer- (developed for horses to train stride length) Criticism; body proportions How to avoid? Usually only used for research

2. Performance measures

3. Flexometer (Leighton)

Important of Flexibility
How: Types of Stretching 1. Slow, static, passive 2. Active, dynamic, bouncing, ballistic 3. Proprioceptive neuromuscular facilitation (PNF). Maximal isometric contraction of the muscle being stretched relaxes the antagonistic muscle.
Image courtesy of -Marcus/ FreeDigitalPhotos.net

PNF is superior to static and ballistic in increasing flexibility. However, these exercises are complicated and often require a trained partner Static stretches are an effective compromise. Ballistic stretches are generally not recommended.

Golgi Tendon Organs

Image courtesy of Neuromechanics / Wikimedia Commons http://en.wikipedia.org/wiki/Golgi_tendon_organ

Activation causes inhibition of contracting muscle (relaxation)

Importance of Flexibility
Considerations 1. Too much flexibility could reduce the stability of a joint and increase the susceptibility to injury. 2. Hold passive stretches for 10 to 30 sec 3. Daily 4. Develop strength about the joint at the same time. 5. The optimum flexibility of a joint for a specific sport may mean decreasing its flexibility. 6. Optimal flexibility for normal living?

Benefits of a Flexibility Training Program

Sit-and-reach flexibility & Risk of Lower Body Musculoskeletal Injuries

Table 18 from David Cowan et al., The Epidemiology of Physical Training Injuries in U.S. Army Infantry Trainees: Methodology, Population, and Risk Factors. Defence Technical Information Center Nov. 1988. http://oai.dtic.mil/oai/oai?verb=getRecord&metadataPrefix=html&identifier=ADA206551

Stretching and Injuries

Inconclusive Most studies in jogging say no Studies in football or handball say yes Likely speaks to differences between sports and the importance of flexibility in preventing injuries.

Stretching and Performance

Static stretching may be negative for strength Static stretching may be negative for sprinting and jumping Dynamic stretching does not appear to change sprint or jumping performance More negative effect in lower body as compared to upper body

Low Back Pain

~39% of individuals will experience low back pain at some time in their lives Costs $50 billion per year in the US Low back pain is the single leading cause of disability worldwide (Global Burden of Disease 2010).

Hoy DG, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R: A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012, 64(6):20282037. Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the top 10 physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med 2003;45:514. http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68

Causes of Back Pain

1. 2. Herniated, ruptured or bulging disc (slipped disc) Degenerative changes: wear and tear arthritis (rheumatoid osteoarthritis) inflammatory 3. 4. Vertebral misalignments; pinched nerve Osteoporosis; deterioration of bone density leading to vertebral fractures or collapse 5. 6. 7. Tension and emotional problems Poor posture, lack of exercise or overeating Back sprains; overuse, twisting bad lifting habits

Proper Posture Neutral Spine

Muscle and other soft tissues help to absorb forces on body

Force on spine from walking impact per day:

Hypolordosis Lordosis Neutral Spine

700, 000 to 2,100,000 kg

Spine load from Matt Wallden, The neutral spine principle, Journal of Bodywork and Movement Therapies Oct. 2009, 13(4), pp. 350-361 http://ezproxy.library.yorku.ca/login?url=http://resolver.scholarsportal.info/resolve/13608592/v13i0004/350_tnsp.xml

Herniated Disc
Spinal Disc Herniation

Annotated diagram of preconditions for Anterior cervical discectomy and fusion. Wikipedia. http://en.wikipedia.org/wiki/File:ACDF_coronal_english.png

- Disc herniation can result in no symptoms to debilitating pain - Can be corrected by surgery


Large Hernia. Wikipedia. http://en.wikipedia.org/wiki/File:Lagehernia.png.


Image Courtesy of Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. Osteoporosis is an age-related disorder that causes the gradual loss of bone density and strength. When the thoracic vertebrae are affected, there can be a gradual collapse of the vertebrae. This results in kyphosis, an excessive curvature of the thoracic region. Assessed on http://en.wikipedia.org/wiki/Osteoporosis

Image Courtesy of BruceBlaus. Osteoporosis was assessed on http://en.wikipedia.org/wiki/Osteoporosis

Proper Lifting Techniques

Lifting Techniques. US Army Center for Health Promotion and Preventative Medicine. http://www.yorku.ca/dohs/documents/armylift.pdf

Proper Lifting Techniques

Lifting Techniques. US Army Center for Health Promotion and Preventative Medicine. http://www.yorku.ca/dohs/documents/armylift.pdf

Proper Lifting Techniques

Lifting Techniques. US Army Center for Health Promotion and Preventative Medicine. http://www.yorku.ca/dohs/documents/armylift.pdf

Active Hip Abduction and Low Back Pain

Starting Position

Score = 0 Score = 1 Score = 2 Score = 3 No Loss Minimal Loss Moderate Loss Severe Loss of of Frontal of Frontal of Frontal Frontal Plane Plane Position Plane Position Plane Position Position

Nelson-Wong, E., T. Flynn, and J. P. Callaghan. 2009. Development of Active Hip Abduction as a Screening Test for Identifying Occupational Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy 39 (9): 649657.

Lower Back Pain & Smoking

Greater prevalence of LBP in smokers Perhaps a marker for other behaviours???
Smokers are less active Related to anxiety & depression Chronic coughing disc pressure

Possibly hormonal changes leading to a decreased bone mineral density

Lower Back Pain & Smoking

Male 2.0 Female

Odd Ratio

1.5 1.0 0.5 0.0

* *





Prevalent LBP in last month

Incident LBP in last year

Shiri et al Association between Smoking and Low Back Pain. The American Journal of Medicine, Vol 123, No 1, January 2010 http://ezproxy.library.yorku.ca/login?url=http://resolver.scholarsportal.info/resolve/00029343/v123i0001/87e7_tabsalbpam.xml

Lower Back Pain & Fitness

Future LBP 5/17 3/12

Trunk Strength Trunk Endurance

Activation of trunk muscles during standing and walking is minimal / nonexistent (less than 5% MVC even when a 32 kg weight is added to the torso)
(Andersson et al., 1996, White and McNair, 2002).

"Image courtesy of Ambro/ FreeDigitalPhotos.net".

Lederman. The myth of core stability. Journal of Bodywork & Movement Therapies (2010) 14, 84e98 Hamberg-van Reenen et al. A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain 130 (2007) 93107

Lower Back Pain & Fitness

Future LBP 5/17 3/12

Trunk Strength Trunk Endurance

May be differences in motor control instead.

"Image courtesy of Ambro/ FreeDigitalPhotos.net".

Bystrm MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976). 2013 Mar 15;38(6):E350-8.

Obesity and Low Back Pain

Men 2 Women



0 OW Obese OW Obese



Shiri et al. The Association Between Obesity and Low Back Pain: A Meta-Analysis. Am J Epidemiol 2010;171:135154

Preventive Measures For a Healthy Back

1. Proper posture; 2. Avoid frequent bending, twisting and excessive sitting 3. Flexibility of hamstrings and low back 4. Proper lifting and carrying techniques 5. Proper sleeping posture 6. Maintain healthy body weight

The ability to perform a movement in a short period of time Components: Movement Time- the rate at which a person can propel his body or parts of his body through space. Reaction Time- the interval of time between the presentation of the stimulus and the initiation of the response.

Improvements in Speed
Reaction time Technique Strength Power Flexibility

Image Young And Muscular Guy Holding A Barbell. Crossfit Dead Lift Ex" courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Image Young Fit Woman Exercising Stock Photo courtesy of -Marcus/ FreeDigitalPhotos.net

1. Speed of Movement
Total Body Movement- measurement Limb Movement- measurement

2. Reaction Time- measurement

Image Male Runner On Starting Blocks" Courtesy of stockimages / FreeDigitalPhotos.net

Image Athletes Running On Race Track" Courtesy of stockimages / FreeDigitalPhotos.net

Reaction and Movement Time

3. Nelson Reaction Timer; Research Findings:

b. c. d. e. f. g. h. i.

Low correlation between RT and MT Speed improves from childhood to early adulthood, peaks for a decade then declines RT and MT of college males are 14% and 30% respectively greater than that of females and peak MT and RT is maintained longer by males RT is highest in the morning hours and drops off later in the day . A small amount of consumed alcohol slightly improves the reactions of some individuals, but large amounts impair them Athletes have faster RT and MT's than non-athletes Speed of movement is very specific--an individual with fast arm movement may well have slow leg movement Strength training does not result in slower MT MT and RT can be improved with training

Nelson Reaction Timer

Based on the law of constant acceleration of free falling bodies. The timer is scaled in time as computed from the following formula: Time = 2 x Distance the stick falls Acceleration due to gravity

Definition: the rapidity and ease with which an individual can change the direction of movement of the body or its parts Compound motor fitness factor involving speed, coordination and balance

Measurement: a. Running tests- shuttle run, zig zag run b. Non running tests- 4 and 6 count burpee c. Criticisms: shoes, floor, persons height
Pro-agility 20 m Shuttle Run Illinois Test

Start/ Finish



Findings: a. b. Males are more agile than females Agility in males increases to maturity then plateaus For approximately 10 years before declining. However, females stop improving shortly after puberty and begin to decline earlier than males Athletes perform well on agility tests Performance on agility tests has been observed to improve with practice.

c. d.

Improvement: Increasing speed specific to the requirement (e.g. sport) By practicing the sport