Be Well Physiotherapy

Be Well Physiotherapy Physiotherapy Clinic Gold Coast Australia

26/07/2022

MUSCLES THAT MOVE THE LOWER JAW

In anatomical terminology, chewing is called mastication. Muscles involved in chewing must be able to exert enough pressure to bite through and then chew food before it is swallowed. The masseter muscle is the main muscle used for chewing because it elevates the mandible (lower jaw) to close the mouth, and it is assisted by the temporalis muscle, which retracts the mandible. You can feel the temporalis move by putting your fingers to your temple as you chew.

Although the masseter and temporalis are responsible for elevating and closing the jaw to break food into digestible pieces, the medial pterygoi and lateral pterygoid muscles provide assistance in chewing and moving food within the mouth.

DID YOU KNOW?
The strongest muscle based on its weight is the masseter. With all muscles of the jaw working together it can close the teeth with a force as great as 55 pounds (25 kilograms) on the incisors or 200 pounds (90.7 kilograms) on the molars.

07/07/2022

🔈 EXTENSOR POLLICIS BREVIS

The belly of the extensor pollicis brevis (EPB), the fusiform short extensor of the thumb, lies distal to the APL and is partly covered by it. Its tendon lies parallel and immediately medial to that of the APL but extends farther, reaching the base of the proximal phalanx. In continued action after acting to flex the proximal phalanx of the thumb, or acting when that joint is fixed by its antagonists, it helps extend the 1st metacarpal and extend and abduct the hand. When the thumb is fully extended, a hollow, called the anatomical s***f box, can be seen on the radial aspect of the wrist.

To test the extensor pollicis brevis, the thumb is extended against resistance at the metacarpophalangeal joint. If the EPB is acting normally, the tendon of the muscle can be seen and palpated at the lateral side of the anatomical s***f box and on the medial side of the adjacent APL tendon.

DESCRIPTION OF THE PICTURE

Anatomical s***f box.

A. When the thumb is extended, a triangular hollow appears between the tendon of the extensor pollicis longus (EPL) medially and the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) laterally.

B. The floor of the s***f box, formed by the scaphoid and trapezium bones, is crossed by the radial artery as it passes diagonally from the anterior surface of the radius to the dorsal surface of the hand.

28/06/2022

🔈 WHAT DO YOUR FEET TELL YOU? OVERPRONATION

👣 The feet tell you a lot about what’s happening above them, at rest and during movement.

↪️ The posture (position) your feet are in is the result of what’s happening upstream. Your foot position is intimately related to how well you control the position of your pelvis and how well your hips are able to function as a result of this.

➡️ The stability, strength, and control of your hips and pelvic musculature determines whether you can maintain control of every joint beneath them, and therefore maintain the desired position of your joints at rest and during movement.

🔑 It comes down to having control over your joints, and attaining/maintaining the desired joint positions as you move.

👣 The feet can grant your body a huge amount of stability IF they are in a good position. If you can use your hips and pelvic control to get your feet where you want them, then they have a huge amount of intrinsic muscles that can work to your advantage. But the feet need to be in a desirable position (posture) in order to work optimally.

🔑 All of this can be worked on and changed. The body changes and adapts to what you expose it to. Learning to control your body requires attention and focus at the start, but is essential for overall musculoskeletal/joint health.

28/06/2022

🔈 SYNOVIAL SHEATHS AND TENDONS OF HAND

A. Observe that the six synovial tendon sheaths (purple) occupy six osseofibrous tunnels formed by attachments of the extensor retinaculum to the ulna and especially the radius, which give passage to 12 tendons of nine extensor muscles. The tendon of the extensor digitorum to the little finger is shared between the ring finger and continues to the little finger via an intertendinous connection. It then receives additional fibers from the tendon of the extensor digiti minimi. Such variations are common. Numbers refer to the labeled osseofibrous tunnels shown in part B.

B. This slightly oblique transverse section of the distal end of the forearm shows the extensor tendons traversing the six osseofibrous tunnels deep to the extensor retinaculum.

28/06/2022

🔈 FASCIA OF UPPER LIMB

Anterior wall and floor of axilla.

A. Axillary fascia forms the floor of the axilla and is continuous with the pectoral fascia.

B. The pectoral fascia surrounds the pectoralis major, forming the anterior layer of the anterior axillary wall. The clavipectoral fascia extends between the coracoid process of the scapula, the clavicle, and the axillary fascia.

The fascia of the pectoral region is attached to the clavicle and sternum. The pectoral fascia invests the pectoralis major and is continuous inferiorly with the fascia of the anterior abdominal wall. The pectoral fascia leaves the lateral border of the pectoralis major and becomes the axillary fascia , which forms the floor of the axilla (compartment deep to skin of the armpit). Deep to the pectoral fascia and pectoralis major, another fascial layer, the clavipectoral fascia , descends from the clavicle, enclosing the subclavius and then pectoralis minor, becoming continuous inferiorly with the axillary fascia.

The part of the clavipectoral fascia between the pectoralis minor and subclavius, the costocoracoid membrane , is pierced by the lateral pectoral nerve, which primarily supplies the pectoralis major. The part of the clavipectoral fascia inferior to the pectoralis minor, the suspensory ligament of the axilla , supports the axillary fascia and pulls it and the overlying skin upward during abduction of the arm, forming the axillary fossa (armpit).

The scapulohumeral muscles that cover the scapula, and form the bulk of the shoulder, are also ensheathed by deep fascia. The deltoid fascia descends over the superficial surface of the deltoid from the clavicle, acromion, and scapular spine. From the deep surface of the deltoid fascia, numerous septa (connective tissue partitions) pe*****te between the fascicles (bundles) of the muscle. Inferiorly, the deltoid fascia is continuous with the pectoral fascia anteriorly and the dense infraspinous fascia posteriorly. The muscles that cover the anterior and posterior surfaces of the scapula are covered superficially with deep fascia, which is attached to the margins of the scapula and posteriorly to the spine of the scapula.

28/06/2022

🔈 FACET CPSULAR IRRITATION

Lumbar facet syndrome refers to a dysfunction at the level of the posterior facet joints of the spine. These joints together with the disc form the intervertebral joint. Changes at the level of the posterior facet joints can influence the disc and vice versa. The term ‘dysfunction’ implies that at a certain level (mostly L4-L5 or L5-S1) these 3 components do not function normally.

The lumbar facet syndrome is a painful irritation of the posterior part of the lumbar spine. Swelling from the surrounding structures, can cause pain due to an irritation of the nerve roots. Little capsular tears can originate at the level of the posterior facet joints due to a trauma. This can lead to a subluxation of the joint. The synovia that surrounds the joint is damaged and leads to a synovitis. Secondly a hypertonic contraction of the surrounding muscles present itself. This is a protection mechanism that increases the pain. These changes lead to a fibrosis and osteophyte formation. The most common cause is repetitive micro trauma and as positive result of this chronic degeneration. In daily living this may occur with repetitive extension of the back. So mostly all movements with the arms above the head. These recurring injuries can happen in sports were it is necessary to make repetitive powerful hyperextensions of the lumbar spine. An irritation can also occur when the intervertebral disc is damaged and the biomechanics of the joint have changed. In this case the facet joints are exposed to a higher loading.

Movements/Activities that decrease pain include:

Walking
Lying with knees bent
Medication
Supported flexion, sitting, standing with weight on hands and elbows
Rest
Lateral bending towards healthy side
Varying activity

Try cat-cow stretch:

Instructions
Begin on your hands and knees in table pose, with a neutral spine. As you inhale and move into cow pose, lift your sit bones upward, press your chest forward and allow your belly to sink.
Lift your head, relax your shoulders away from your ears, and gaze straight ahead.
As you exhale, come into cat pose while rounding your spine outward, tucking in your tailbone, and drawing your p***c bone forward.
Release your head toward the floor — just don’t force your chin to your chest. Most importantly, just relax.

28/06/2022

🔊 SCIATICA

WHAT IS SCIATICA?

💡 Sciatica is the result of a neurological problem in the back or an entrapped nerve in the pelvis or buttock. There are a set of neurological symptoms such as:

➡️ Pain (intense pain in the buttock)
➡️ Lumbosacral radicular leg pain
➡️ Numbness
➡️ Muscular weakness
➡️ Gait dysfunction
➡️ Sensory impairment
➡️ Sensory disturbance
➡️ Hot and cold or tinglings or burning sensations in the legs
➡️ Reflex impairment
➡️ Paresthesias or dysesthesias and oedema in the lower extremity that can be caused by the irritation of the sciatic nerves (the lumbar nerve L4 and L5 and the sacral nerves S1,S2 and S3)

CAUSES OF PAIN

💡 Pain is a result of irritation of the sciatic nerve. it can be constant or intermittend. The pain may be worsened by certain movements like coughing or sneezing (these movements increase the intra abdominal pressure). Sitting, bending, prolonged standing or rising from a sitting position can aggravate or increase the pain.

PAIN PATTERNS

💡 In regards to relief the pain, the supine position decreases the pressure on the herniated disc and will subsequently decrease pain. Pain is located along the distribution of the nerve and can be felt in the back, buttocks, knee and leg. It only radiates to one side of the leg and can result in reduced power, reflexes and sensation in the nerve root. Also gait dysfunction (toe walking, foot drop and knee buckling), paresthesias or dysesthesias are frequent neurological symptoms.

SYMPTOMS BASED ON NERVE COMPRESSION

💡 Sciatica can be caused by the compression or irritation of nerve L4, L5, S1, S2 and S3. The sciatica symptoms depend on which nerve is compressed or irritated.

◾ L4: When the L4 nerve is compressed or irritated the patient feels pain, tingling and numbnessiIn the thigh. The patient also feels weak when straightening the leg and may have a diminished knee jerk reflex.

◾ L5: When the L5 nerve is compressed or irritated the pain, tingling and numbness may extend to the foot and big toes.

◾ S1: When the S1 nerve is compressed or irritated the patient feels pain, tingling and numbness on the outer part of the foot. The patient also experiences weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.

source: B.W Koes, M.W Van Tulder, W.C Peul. Diagnosis and treatment of sciatica. BMJ.

09/03/2022

🔈 DELTOID STRAIN OR AC JOINT INJURY?

DELTOID

The deltoid muscle is a large muscle that encompasses the shoulder joint. The deltoid is divided into three different portions, or heads, the anterior (front), middle, and posterior (back) portions of the deltoid. The deltoid originates on the lateral aspect of the acromion and clavicle and then inserts on the lateral aspect of the humerus. Its major action is to abduct the arm (lift the arm out to the side of the body) as well as assist in forward elevation (lifting the arm out in front of the body).

AC JOINT

The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint.

STRAIN OR SPRAIN?

Strains are injuries to muscles or muscle tendon units. Sprains are injuries to ligaments. Because the deltoid is a muscle, it can be strained, but not sprained.

IS IT THE MUSCLE OR JOINT INJURY?

The signs and symptoms of muscle and joint pain differ since the origin differs. Though some symptoms could be same, the type of pain experienced and the associated symptoms are different. Let's take a look at the differences between these two pains.

SYMPTOMS OF MUSCLE PAIN

▪️Muscle spasms
▪️Weakness in the localised area
▪️Coordination problems
▪️Paralysis in case of severe pain
▪️Stiffness

SYMPTOMS OF JOINT PAIN

▪️Swelling in local areas surrounding joints
▪️A slight warmth and temperature rise in the area
▪️Tenderness in the muscles surrounding the joints.

CAUSES OF MUSCLE PAIN

▪️Muscle Tension or Stress: Too much tension or stress causes severe muscle pain at times. The body creates toxins as a result of stress and tension and this leads to pain in muscle. However, its extent and severity will depend on the level of stress and tension that you are having.

▪️Over-activity: When you overuse your muscles by either exercising or by working too much for a long stretch, it is very likely that your muscles will start aching. Any physically demanding work that engages the muscles to take pressure mostly ends in muscle pain.

▪️Injuries: Sometimes, stressful physical practice or exercise or any other kind of physical work might cause major or minor muscle injuries.

CAUSES OF JOINT PAIN

▪️Injuries on the joints or on the bursae, ligaments and tendons of the muscles surrounding the joints.

▪️Various kinds of diseases like avascular necrosis, gout, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, bursitis, bone cancer, leukaemia, osteomalacia, rickets, tendinitis.

CONCLUSION

The very basic difference between joint pain and muscle pain is that joint pain is local, surrounds only the bruised and affected joints and whereas muscle pain can be widespread throughout the body.

Muscle pain usually sores the area and the ache increases when pressure is applied on the affected muscle. When the muscle is stretched due to some physical activities the pain increases. However, the easiest way to identify muscle pain and differentiate it from joint pain is that the pain reduces when there is not much activity.

The joint pain, on the other is deeper, intense and troubles every movement. In fact, joint pain, unlike muscle pain, can be felt even when there is absolutely no external activity taking place. When you are still, either sitting or laying down on bed, you might feel the joint pain in such an extent that you will not be able to move.

15/06/2021

🔈 NECK PAIN, HEADACHES OR TEMPOROMANDIBULAR JOINT (TMJ) SYNDROME?

[NEUROMUSCULAR INTERACTION BETWEEN SUBOCCIPITAL MUSCLES AND TMJ MUSCLES]

The TMJ is a complex joint that allows us to open/close our mouth. TMJ disorders do not only create pain and limitations with the jaw. Oftentimes, there are associated issues with the neck, face, and ears.

The body is classically divided into systems such as muscular, skeletal, nervous system etc.
However, this is a mirage as these systems are all a part of one super-system that works in unison to create function.
An excellent example of this is the links between the muscles of the suboccipital region, the jaw muscles and the central nervous system.

As you know the suboccipitals are short and have only minor contributions to gross movements of the spine. However, they are loaded with sensory muscle spindles which indicate these muscles have a strong link to the cerebellum and the CNS. Postural distortions that affect the position of the skull and upper cervical vertebrae are immediately relayed to the CNS via these spindle receptors and the ganglion of C2 which is the largest in the body with 49,000 neurons. For comparison, the T4 ganglion has 24 neurons. More neurons = higher speed delivery of information to the brain.

The muscles of the jaw include the masseter as well as the deeper pterygoid muscles. They obviously allow for chewing but also have an interesting link to the CNS. The masseter has been shown to spontaneously activate during periods of stress. The masseter will also activate in unison with the subocciptal muscles during sudden postural changes in order to keep the eyes stable on the horizon.

The suboccipital and TMJ muscles may not be physically linked but they are absolutely “connected” in the cerebellum and in most clinical cases. This relationship tells us these muscles have a large role in stress/sympathetic nervous system syndromes as well as global postural regulation. A patient may present with complaints of neck pain, but now we see how we must look globally at posture, TMJ function, vestibular function and stress management!

Credit: Stefan Duell

01/06/2021

🔈 MUSCLES OF MASTICATION

TMJ movements are produced chiefly by the muscles of mastication. These four muscles (temporal, masseter, and medial and lateral pterygoid muscles) develop from the mesoderm of the embryonic first pharyngeal arch. Consequently, they are all innervated by the nerve of that arch, the (motor root of the) mandibular nerve (CN V 3).

Studies indicate that the superior head of the lateral pterygoid muscle is active during the retraction movement produced by the posterior fibers of the temporalis. Traction is applied to the articular disc so that it is not pushed posteriorly ahead of the retracting mandible.

Generally, depression of the mandible is produced by gravity. The suprahyoid and infrahyoid muscles are strap-like muscles on each side of the neck. They are primarily used to raise and depress the hyoid bone and larynx, respectively—for example, during swallowing. Indirectly, they can also help depress the mandible, especially when opening the mouth suddenly, against resistance, or when inverted (e.g., standing on one’s head). The platysma can be similarly used.

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