Visual criteria of statics and dynamics of the musculoskeletal system

Visual diagnostics is one of the methods used to identify the visible criteria of musculoskeletal system disorders, the degree of their manifestation, variability under the influence of irrational physical loads during physical education and sports, as well as therapeutic measures (during the recovery period).

Each time, solving certain tasks, the doctor compares the statics and dynamics of the athlete with the normative model. This not only facilitates the diagnosis of disorders of the musculoskeletal system (ODD), but also makes it possible to offer an optimal program of restorative treatment in the shortest possible time.

Optimal statics is a spatial arrangement of the elements of the musculoskeletal system, in which the balance of the ODA in the vertical position of the person is maintained with a minimum energy expenditure of the postural (truncated) muscles.

Optimal statics includes op optimality static stereotype consisting of the regional balance of postural muscles of the trunk and limbs regions. The postural balance of muscles in the region, in turn, consists of the postural balance of the antagonist muscles, the optimal statics of the joint-ligament apparatus.

The spine and extremities are divided into regions in accordance with the difference between the static and dynamic tasks that they perform.

A region is a set of vertebral motor segments (PDS) or bones (for limbs) performing the same static and dynamic functions. The borders of the regions are the attachments of the basic postural and phasic muscles.

To assess the optimality of the statics, mentally conducted vertical lines (perpendicular to the support) are used: through the common center of gravity (common median plumb line) and the center of gravity of the regions of the spine and extremities (regional median plumb line); horizontal lines through the bones of the regions and through the transverse processes of the vertebrae. Their relative position between themselves and the plane of support is evaluated consistently in three planes:

• Front view (rear view and front view);
• sagittal (side view) and
• horizontal (top view).

For example, the criterion for the optimality of statics as a whole in the frontal plane - a plumb line dropped from the middle of the distance between the occipital tubercles, passes through the middle of the distance between the patient's stops. The criterion of the postural balance of the muscles of the cervical region - the plumb line, lowered from the middle of the distance between the occipital tubercles, passes through the body of C ₇. The criterion of the postural balance of the muscles of the lower limb as a whole - the plumb line, lowered from the angle of the scapula, passes through the heel of the heel bone.

The horizontal lines that pass through the boundaries of the regions of the spine and limbs are normally parallel to each other and to the support plane. For example, the upper border of the cervical region is a line that passes through the lower edges of the auricles or the lower margins of the occipital bone. The lower border coincides with the upper border of the thoracic region - the line connecting the upper boundaries of the acromioclavicular joints.

Non-optimal statics is the asymmetric interposition of articular elements of the musculoskeletal system, accompanied by an increase in the gravitational burden of the postural muscles, in which the body is in a state of "stopped fall" and / or movement stopped at a certain stage.

Visual criteria for non-optimal statics:

• displacement of the projection of the common center of gravity relative to the median plumb (forward, backward, sideways) relative to the midpoint of the distance between the stops;
• violation of parallelism between horizontal lines passing through the boundaries of regions.

Regional postural imbalance of muscles is a violation of the tone-strength balance of the shortened and relaxed muscles of the region, as a result of which an asymmetric interposition of the constituent elements of the region arises and their gravitational burden is distorted.

Visual criteria for regional postural muscle imbalance:

• displacement of the projection of the regional median plumb line relative to the location of the projection of the general median plumb line;
• violation of the parallelism of horizontal lines running across the boundaries of the region;
• changes in the bending of the spine (lordosis, kyphosis): its increase, smoothness, deformation, the appearance of curvature in the frontal or horizontal plane. For example, the combination of hyperlordosis of the upper cervical region and kyphosis of the middle and lower sciatic regions, the combination of hyperlordosis in the thoracolumbar junction with the kyphosis in the lumbar region or the formation of lordosis in the middle thoracic region.

Pathobiomechanics of postural and physical muscles is represented in the form of the basic forms - shortening and relaxation of the muscle.

The main forms of postural muscle imbalance:

Hypertonic, shortened muscle, accompanied by a decrease in its threshold of excitability with the preservation of the neuromotor apparatus. Its visual signs:

• convergence of attachment points;
• increase and deformation of the muscle contours in the area of its location;

Hypotonic, relaxed muscle, accompanied by an increase in the threshold of its excitability with the preservation of the neuromotor apparatus. Its visual signs:

• removal of attachment points;
• flattening (smoothing) of the muscle contours in the zone of its location.

A dynamic stereotype is a complex motor act consisting of an evolutionarily elaborated sequence and parallelism of inclusion of simple motor patterns of the joints of the regions of the spine and extremities. For example, walking, running, breathing, lifting gravity, etc.

Pattern (model, figure) is a temporary spatial relationship of excitatory and inhibitory processes, manifested in a qualitative and quantitative characteristic of the statics and dynamics of man. A typical motor pattern is the motor act of the region of the spine and / or limbs, which arises from the evolutionary regularity of the sequential or parallel inclusion of the five major muscle groups with appropriate contraction types (agonists, synergists, neutralizers, fixatives, antagonists). Visual criteria for a typical motor pattern:

• making movement in a specific direction;
• smoothness of movement with preservation of constancy of speed;
• the shortest trajectory and sufficient volume of motion.

A non-optimal dynamic stereotype is a violation of parallelism and the sequence of inclusion of motor patterns, switching off one pattern and replacing it with another one.

Visual criteria for a non-optimal dynamic stereotype:

• the appearance of additional compensatory synkinesis in neighboring or remote regions of the spine and extremities.

Atypical motor pattern is a violation of the evolutionarily elaborated sequence and the type of inclusion and deactivation of the main muscle groups.

Visual criteria for an atypical motor pattern:

• appearance of additional movements;
• change in traffic volume;
• distortion of the trajectory and speed of movement.

Patients in the period of exacerbation can be divided into the following stages of the change in the motor stereotype : generalized, poly-regional, regional, intraregional, local.

• The generalized stage of changes in the motor stereotype (DS) is characterized by the functioning of the spine as a single biokinematic link. At this stage the movements are mainly possible in craniovertebral PDS, hip and ankle joints (without movements in the knee joints), the deformations of the ODA are located in the same plane. This is made possible by changing the relationship between the pelvis and lower limbs. Such a system is unstable: the predominance of the static component over the statokinematic is typical.
• For the poly-regional stage of DS changes, the appearance of new links in the biokinematic chain "spine-limbs" is characteristic. There are movements in the middle thoracic spine, as well as in the region of the knee joints. The spine is divided into two biokinematic links (upper - in the cervical and upper thoracic parts and lower - in the lower thoracic, lumbar and sacral).

In such situations it is extremely undesirable to conduct mobilization receptions and active physical exercises to restore the full volume of movements in the affected spine. This leads to disruption of the folding DS, which will increase the load on the affected PDS. In addition, this situation can lead to a new aggravation.

• For the stage of regional changes in the DS, the appearance of movements in new sections of the ODA is typical. Due to this, new pairs of links appear in the biokinematic chain of the spine - it is divided into five biokinematic links (cervical - upper thoracic - lower thoracic - lumbar - sacral). In this case additional deformations arise in those planes in which there were no curvatures. All this contributes to the formation of a stable new posture.
• For the intraregional phase of the DS changes, the appearance of movements in the PDS, located within the regions, is typical. For the cervical spine, these are transitional PDS: the upper cervical level in the mid-tine and the mid-tidal in the lower cervical; for the thoracic region - the appearance of movements in one of the upper thoracic PDS and in one of the lower, and in the lumbar - in the places of transition of the upper to the lower lumbar level.
• For the local stage of DS changes, there is a complete "block" in the affected PDS and a simultaneous combination of hypermobility with hypomobility in different planes in all unaffected PDS of the spine.