HEMME APPROACH TO SOFT-TISSUE THERAPY

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The difficulty in using this scale is knowing whether to grade a muscle as normal (5) or good (4). A strong patient with serious disability may sometimes test higher than a weak patient with a minor disability. A strong patient can lose a greater percentage of strength than a weak person and still hold against gravity and give the appearance of normal strength. Bilateral comparison is one way to cross-check the results of muscle testing. If only one side of the body is involved, check the muscles on the impaired side before checking muscles on the opposite side. If the muscles on the impaired side are the weakest, a grade of 5 for the impaired side may be too high. If muscles on both sides of the body test the same, a grade of 4 for the impaired side may be too low. Because of handedness, the tendency to use one hand in preference to the other, dominant side muscles are normally stronger than weak side muscles. Since most people are right-handed, the left side testing stronger than the right side may indicate weakness on the right. Muscle testing is based on the premise that no two muscles perform exactly the same function. According to theory, each muscle can be tested separately if direction of force, amount of force, and position of patient are correct. The direction of force is normally opposite the direction of pull for the muscle being tested. Deviation from this direction allows the patient to substitute other muscles for the muscle being tested. The amount of force used will vary with size and condition of the patient. Examiners will learn how much force to use by experience. Since leverage normally favors the examiner, using too much force is more likely to cause inaccuracy than using too little force. Three types of positioning are used in muscle testing: (1) positioning to prevent substitution, (2) positioning to reinforce fixator muscles, and (3) positioning to create active insufficiency. (1) Positioning to Avoid Substitution Positioning isolates the muscle being tested by using stabilization to prevent substitution. If the muscle being tested is weak, stabilization prevents other muscles from contributing to the same movement by not allowing the body to change position. If the initial body position favors the 34 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
pull of the muscle being tested, other muscles cannot be effective without repositioning the body to change their direction of pull. An example of stabilization is holding the elbow in place when testing the biceps brachii. If the elbow joint moves, upper arm flexors may substitute for elbow flexors. (2) Positioning to Reinforce Fixator Muscles Positioning combined with body weight and manual force can be used to reinforce fixator muscles that allow the insertion to move by locking the origin of a muscle in place. When a muscle contracts, tension pulls equally on both the origin and insertion. To produce movement, stabilizing the origin leaves the insertion, and the bone the insertion attaches to, free to move. If fixator muscles are weak, muscle testing will not be accurate. Fixator muscles are often antagonistic to the muscles being tested. If the muscles that stabilize the scapula (trapezius and serratus anterior) are weak, manual force should be used to fixate the scapula when testing the deltoid. (3) Positioning to Create Active Insufficiency Active insufficiency is the failure of any muscle to generate normal tension because the origin and insertion are too close. In certain positions, muscles that cross two joints cannot exert enough tension to produce a full range of motion in both joints simultaneously. If one- and two-joint muscles both perform the same function, placing the two-joint muscle at a mechanical disadvantage can be used to isolate the one-joint muscle. Twojoint muscles can be mechanically neutralized by using positioning to bring their origin and insertion closer together. Since muscles produce movement by generating tension, the slack created by approximating origin and insertion prevents the two-joint muscles from generating adequate tension to move both joints through their entire range of motion at the same time. As an example, both the one-joint gluteus maximus muscle and the twojoint hamstring muscle extend the hip. When the knee is flexed, the hamstring muscle cannot generate sufficient tension to extend the hip. This means that when the knee is flexed, the hamstring muscle is neutralized and the gluteus maximus can then be tested by using hip extension. 35 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
Page 1 and 2: HEMME APPROACH TO SOFT-TISSUE THERA
Page 3 and 4: iii HEMME APPROACH SOFT-TISSUE ANSW
Page 5 and 6: v HEMME Approach to Soft-Tissue The
Page 7 and 8: vii TABLE OF CONTENTS Section Page
Page 9 and 10: ix Section Page NEUROMUSCULAR THERA
Page 11 and 12: 1 INTRODUCTION Soft-tissue therapy
Page 13 and 14: These conditions point out three ch
Page 15 and 16: (D) Although pain cycles are seldom
Page 17 and 18: and protective muscle shortening ar
Page 19 and 20: Although "train, don't strain" is m
Page 21 and 22: The same trend applies to allopathi
Page 23 and 24: 13 CHAPTER SUMMARY THREE SIGNS OR S
Page 25 and 26: 15 HEMME APPROACH Soft-tissue thera
Page 27 and 28: whereas MODALITIES, MANIPULATION an
Page 29 and 30: 19 CHAPTER SUMMARY FIVE STEPS IN TH
Page 31 and 32: Since little can be done to change
Page 33 and 34: 23 MECHANISM OF INJURY F FORCE Dire
Page 35 and 36: 25 CHAPTER SUMMARY THREE WORDS THAT
Page 37 and 38: The sensitivity of the hand varies
Page 39 and 40: 29 MUSCLE TESTING Manual muscle tes
Page 41 and 42: 31 (1) Active Range-of-Motion Testi
Page 43: 33 (4) Resisted Range-of-Motion Tes
Page 47 and 48: knows nothing of individual muscles
Page 49 and 50: 39 cardiac decompensation Failure o
Page 51 and 52: 41 PAIN Pain is often defined as th
Page 53 and 54: cases of soft-tissue pain and disab
Page 55 and 56: The distribution of pain within a s
Page 57 and 58: 47 CHAPTER SUMMARY FOUR CLASSICAL M
Page 59 and 60: 49 ALTERNATIVES The HEMME APPROACH
Page 61 and 62: First, separate the problem into pa
Page 63 and 64: 53 MODALITIES Modalities are used i
Page 65 and 66: changes in temperatures. This expla
Page 67 and 68: The term hunting reaction implies t
Page 69 and 70: Contraindications specifically for
Page 71 and 72: 61 CHAPTER SUMMARY FOUR INDICATIONS
Page 73 and 74: 63 MANIPULATION Soft-tissue therapy
Page 75 and 76: 65 B. Reciprocal Inhibition: when t
Page 77 and 78: experience another cycle: (1) pain
Page 79 and 80: 69 Table of Figures Figure 1: Belly
Page 81 and 82: HEMME Approach to Soft-Tissue Thera
Page 83 and 84: HEMME Approach to Soft-Tissue Thera
Page 85 and 86: 75 TRIGGER POINT THERAPY Trigger po
Page 87 and 88: cause spontaneous contraction of th
Page 89 and 90: • Third, trigger point therapy re
Page 91 and 92: pressure that normally causes pain
Page 93 and 94: 83 TRIGGER POINT THERAPY VS. CROSS-
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The immediate goal of neuromuscular
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Facilitation techniques can reverse
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89 FOUR WAYS TO INHIBIT A MUSCL
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In situations where muscles are sho
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antagonist, (2) relax the antagonis
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stretch. The technique of stretchin
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97 FACILITATORS Activation of Stre
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concentration of muscle spindle cel
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101 CONNECTIVE TISSUE THERAPY Of al
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103 substance that limits tissue mo
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105 Range-of-motion stretching and
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107 the skin away from the patient'
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109 STRETCHING Unlike the stretchin
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111 Although measurements can be ta
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113 The recommendations for regular
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115 Whenever heat is used to facili
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117 stretching be done slowly becau
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119 CHAPTER SUMMARY THREE HEMME LAW
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121 FOUR TYPES OF FORCE USED IN SOF
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123 FOUR GOALS OF CONNECTIVE TISSUE
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125 overstressed. Even though an ea
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127 great enough to overcome extern
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129 The most recent theories now su
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131 Complete positive transfer is n
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133 OBJECTIVES SATISFIED OR NOT SAT
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135 SELECTED BIBLIOGRAPHY Alter, Mi
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137 Clemente, Carmine D. 1981. Anat
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139 Fryette, Harrison H. 1954. Prin
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Kendall, Florence Peterson, Elizabe
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143 Licht, Sidney, ed. 1965. Therap
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145 Noback, Charles R., and Robert
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Shriber, William J. 1975. A manual
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149 GLOSSARY acute Short duration,
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151 cocontraction Mutual contractio
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153 exteroceptor A sense organ rece
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155 hypomobility Decreased mobility
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157 myofascial Involving muscles an
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159 rebound tenderness Pain or disc
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161 synergist A muscle functioning
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163 6. What does the first letter o
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165 16. Which structures are least
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167 26. What is another name for st
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169 36. Which concept explains why
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171 46. Which word defines loss of
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173 Hilton's law 43, 64, 74 Hooke's
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I QUICK REFERENCE GUIDE FOR NEUROMU
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III RECIPROCAL INHIBITION (RI) Prac
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