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Running head: MOVEMENT ANALYSIS Therapeutic Exercise: Movement Analysis Assignment Brittany Martino & Thu Dang Humber College Institute of Technology and Advanced Learning Tuesday, November 18, 2014 1 MOVEMENT ANALYSIS 2 Darts is an activity that requires minimal power but sufficient understanding of body mechanics and is comprised of multiple simultaneous movements that are more complex than one would think. One of the factors for a successful game involves technique of how to hold the dart and how to release it. The phases of throwing a dart consist of aiming, backward move, acceleration, release, and then the follow through (Zöchling,1998). The act of throwing a dart not only requires balance, but precision as well, and consists of slight shoulder flexion, flexion at the elbow, extension at the elbow, wrist pronation, ulnar deviation, wrist flexion as well as flexion of the interphalangeal and metacarpophalangeal joints. The shoulder is at a fixed movement of approximately 90 degrees with the primary responsibility of stabilizing the arm. The elbow joint generates the primary acceleration as it goes into flexion and transitions into extension when releasing the dart. Subsequently, when releasing the dart, a snapping motion occurs at the wrist that is accompanied by ulnar deviation and slight wrist pronation. Furthermore, the interphalangeal and metacarpophalangeal joints form a stable position as their role is to lightly grip the dart, specifically the thumb, in addition to the second and third digits. The range of motion required to hold a dart is flexion of the second and third metacarpophalangeal joints, flexion at the interphalangeal joint of the index finger as well as extension and opposition of the thumb. Refer to figure 1a, which summarizes the position of the arm before launching the dart. Analyzing the movement of playing darts incorporates many specific details. In addition to the joints involved, muscles play an important role to move these joints and to recreate their actions. Not all muscles in the arm are involved, but the ones that are, must either possess strength, flexibility, or a combination of the two. Beginning with the shoulder, the muscles involved are anterior fibres of deltoid, coracobrachialis, and the rotator cuff muscles: MOVEMENT ANALYSIS 3 supraspinatus, infraspinatus, subscapularis, and teres minor. The anterior fibres of deltoid and coracobrachialis are mainly in charge of producing minor flexion, whereas the rotator cuff muscles stabilize the glenohumeral joint. Triceps brachii is the primary muscle involved during elbow flexion and therefore requires a lot of strength for the follow-through phase when the elbow slightly straightens. The same action goes for biceps brachii and brachialis but the concept is reversed. These two muscles must also possess strength to create elbow flexion and control of the movement to gain sufficient power. In addition, they also need flexibility when releasing the dart and progressing into the follow-through phase. Until the dart is released, pronator teres enables the forearm to be placed in a pronated position. Furthermore, the muscles involved during the aiming and preparation of releasing the dart (elbow extension), include the strength of extensor carpi ulnaris, extensor carpi radialis longus and brevis, and extensor digitorum communis. When releasing the dart and transitioning to the follow through phase, a wrist snapping technique is incorporated. For the dart to gain acceleration, the primary muscle involved in this technique is the strength of flexor carpi ulnaris. Working along the arm, the muscles that are involved with holding a dart are extensor pollicis longus, adductor policis longus, and flexor digitorum. The following muscles need to possess some strength because they are responsible for gripping the dart against gravity. To summarize the phases of throwing a dart, the stages encompass aiming, backward move, acceleration, release, and follow through (Zöchling,1998). When proceeding through the steps altogether, this movement happens fairly quickly. Some techniques that allow the dart to move swiftly consist of hand gripping and wrist snapping. The grip needed to grasp the dart does not require much strength as it will be launched. The wrist snapping helps with the acceleration of the dart and to perform the full movement once, the phases are completed simultaneously, but MOVEMENT ANALYSIS 4 repeatedly. For an overall visual layout of throwing a dart, refer to figure 2a. A general strength involved with dart throwing is to be able to hold up the weight of the arm, as well as the dart, against gravity while being able to maintain a stable position for ideal focus and overall concentration. Playing a game of darts can seem quite simple. During a recreational match for example, not much thought is invested as to how important position, strength, flexibility, and ranges of motion are. When analyzing each segments of one quick throw, body mechanics, in addition to math, are shown through how well a dart may be thrown A common impairment associated with throwing a dart is tendonitis, more specifically Extensor Carpi Ulnaris Tendonitis, which involves inflammation of the tendon that runs along the back of the wrist and is caused by repetitive twisting and backward flexion of the wrist (Israel, 2014). Whether the individual is a competitive dart thrower, or just plays for fun, the constant motion of aiming the dart and flicking the wrist can cause this painful injury to occur at any given time. To treat this impairment directly following the injury, the wrist can be put in a cast where the arm is placed in slight extension and radial deviation for a duration of four weeks. Once the tendon is found stable, the individual may choose to wear a wrist brace while attending rehabilitation (Patterson, S, 2011). The exercise program to address Extensor Carpi Ulnaris Tendonitis would include a few exercises to help maintain their wrist range of motion which is comprised of wrist flexion, extension, radial deviation and ulnar deviation. Exercises would consist of the patient going through these ranges interchangeably to help maintain those motions. To do these stretches, they can use their own hand to passively hold the stretch (refer to figure 1) or they could use a wall to MOVEMENT ANALYSIS 5 reinforce the position (refer to figure 2). An isometric strengthening exercise would consist of using a one pound free weight and doing wrist flexion and extension; 3 sets of 10 repetitions with a 15 second rest period in between each set (refer to figure 3). They would do this twice a day until improvement is seen, in which case more challenging exercises would be assigned until the full strength of the wrist has been regained. One progression would be to move into a two pound free weight in place of the one pound. An isotonic strengthening exercise would consist of using a theraband flex bar and with a firm grip, the patient would twist it back and forth. They would do this motion 3 times, 30 seconds each time. One progression would be to do a concentric contraction in which they would perform the movement each muscle does. For example, twisting the bar into flexion to target the wrist flexors, as well as twisting the bar into extension to target the wrist extensors (refer to figure 4). A proprioception exercise would consist of using a theraband flex bar and shaking it repeatedly for 30 seconds (refer to figure 5). This will aim at increasing the patients grip strength as well as stability of maintaining the movement for a consecutive time frame. One progression would be to continue onto a weight bearing proprioception exercise, or to use a more advanced flex bar, such as a black one for harder resistance. Rehabilitation exercises are extremely beneficial, but must be used with precaution when dealing with an acute injury. Some precautions may include inflammation, infection, pain with movement or hypermobility. In terms of the above example of extensor carpi ulnaris tendonitits, a wide variety of equipment can be used to help the individual incorporate motions of the wrist back into their everyday life at a pace most suitable for their recovery. Subsequently, this patient will be able to get back to playing darts once all the forearm strength has successfully been regained and once it is safe to resume previous activity. MOVEMENT ANALYSIS 6 7 MOVEMENT ANALYSIS References Israel, B. (2014). Hand and Wrist Injuries. Retrieved March, 2014, from www.bidmc.org/YourHealth/BIDMCInteractive/HealthyIs/BonesandJoints/HandandWris t/MostCommonInjuries.aspx N/A. (2007). Common Sports Injuries: Dart & Golfers Elbow. Retrieved 2007, from www.commonsportsinjuries.com/elbow/dart-and-golfers/ Patterson, S. (2011). Conservative Treatment of an Acute Traumatic Extensor Carpi Ulnaris Tendon. Retrieved October, 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/ Zochling, K. (1998). The Mechanical Basics of throwing darts. Retrieved February, 1998, from www.dartbase.com/technics.htm