Research Roundup: November 2019
Nov 29, 2019
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COPD and Lower Limb Biomechanics
Wai-Yan Liu, Kenneth Meijer, Jeannet Delbressine, Paul Willems, Emiel Wouters, and Martijn Spruit. "Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD." Journal of Clinical Medicine 8, no. 4 (2019), 459. doi:10.3390/jcm8040459.
Although this is a small study, the paper contributes to our knowledge base around the gait variations that are seen in people with chronic obstructive pulmonary disease. The paper concludes that “subjects with COPD walked with less consistent organization of movement patterns of the lower extremities across walking speeds. These findings suggest the presence of neuromuscular deterioration in the locomotor system, reflecting less healthy movement patterns in subjects with COPD,”1 (p.2).
The authors comment on the role of biomechanical joint limitations, as well as other factors in the discussion, section (and they do a good job of acknowledging the study’s limitations).
- Patients with COPD often present with static and dynamic lung hyperinflation, a consequence of which is maximally shortened muscle fibres in the diaphragm; as a result, tidal volume expansion is limited.
- Movement of the diaphragm and pelvic floor are linked to control thoracic and abdominopelvic pressures.
- Obturator internus connects to the pelvic floor through fascia of the pelvic bowl; the pelvic floor connects to biceps femoris via the sacrotuberous ligament.
- Piriformis and the other rotator cuff muscles of the hip control femoral head position in the acetabulum
- Femoro-acetabular position effects tibio-femoral position, etc down the chain!
Clinically: Pilates in Practice
- Spend time teaching diaphragmatic breathing techniques, including posterior diaphragm expansion; use props to set up for success!
- Integrate pursed lip breathing/breath control exercises; hundreds – careful with breath-stacking for hyperinflated lungs!
- Focus on centring the femoral head + work on the rotator cuff muscles of the hip; integrate the rotator discs; hip circles; leg springs/feet in straps side lying for posterior hip support.
- Footwork integrating breath techniques.
1. Liu, W., Schmid, K., Meijer, K., Spruit, M. and Yentes, J. (2019). Subjects With COPD Walk With Less Consistent Organization of Movement Patterns of the Lower Extremity. Respiratory Care, p.respcare.06743.
2. O'Donnell, D. and Laveneziana, P. (2006). Physiology and consequences of lung hyperinflation in COPD. European Respiratory Review, 15(100), pp.61-67.
Closed Kinematic Chains and Motor Control
Olsen, Aaron M. "A mobility-based classification of closed kinematic chains in biomechanics and implications for motor control." The Journal of Experimental Biology 222, no. 21 (2019), jeb195735. doi:10.1242/jeb.195735.
In the author’s words, “this Commentary encourages the study of mobility both as a potential explanation for different motor control strategies and as a useful concept for comparing otherwise seemingly disparate musculoskeletal systems” (p.7).
- CKCs have fewer degrees of freedom than OKCs.
- There is a trade-off between stability with a closed kinematic chain vs mobility with an open kinematic chain (increased degrees of freedom).
- An isometric muscle contraction can conditionally decrease the mobility of a CKC; this is controlled neurally (vs the mechanical nature of a ligament becoming taut or slack).
- Passive/accessory movements play a role in mobility, as motion observed is a combination of movements.
Clinically: Pilates in Practice
- Be aware of how pseudo-closed kinematic chains will change degrees of freedom through the necessity of an isometric muscle contraction; feet in straps/leg springs; hands in straps.
- Joint position in a CKC will affect ligament length, and thus the degrees of freedom available for movement; when cueing knee alignment for footwork on the Reformer, note that the collaterals are taut in lateral tibial rotation but this will not be true if there is a ligamentous injury.
- Cueing can help to elicit an appropriate muscular contraction for stability around a joint. If the contraction is too strong/inappropriate for the force input, this can irradiate and decrease mobility at other joints.
- If accessory mobility (rolling, gliding, sliding) is limited, it will affect overall movement quality (CKC and OKC); if necessary and appropriate, use manual therapy to address restrictions – it’s okay to use your other tools!
Motor Imagery and Neuroplasticity
Yoxon, Emma, and Timothy N. Welsh. "Rapid motor cortical plasticity can be induced by motor imagery training." Neuropsychologia 134 (2019), 107206. doi:10.1016/j.neuropsychologia.2019.107206.
While not without its flaws, this small study is relevant for those working with movement-based therapy, and especially has implications for working with pain populations (acute or persistent). The authors were able to demonstrate that motor imagery training can induce changes in a training direction.
- Significant changes can be made with physical training after approximately five minutes.
- Similar changes can be made with motor imagery training, but after a longer duration, and to a lesser extent.
- The authors hypothesise that “MI [motor imagery] networks activated during imagery of the movement facilitated the activation of motor cortex, but at a level below the threshold for actual movement” (p.26).
- Neuroplastic changes in the motor cortex are facilitated through links between motor imagery and motor execution networks.
Clinically: Pilates in Practice
- Utilise motor imagery for clients post-operatively, acutely post-injury, and for those clients experiencing persistent pain.
- Demonstrate an exercise (which can excite mirror neurons), and then ask clients to visualise the movement if they are immobilised or their range of motion is restricted, eg braces/splits/casts post-fracture, tendiopathy, etc.
- Integrate specific motor imagery (specific mental rehearsal of movement), with visualisations and alternative imagery, to help clients connect to this movement.