Physical health 2

Physical
Health
Part 2
Stephan Betterbodyz van
Breenen

Stability vs Instability
Is stability restrain or control ?
Your greatest stability is in your
mobility.
When you lose the harmony
between stability and mobility you
increases your injury potential

Classification/Categorization of
Muscles
Classification of voluntary and
involuntary muscles.
Most of their activities are
involuntary !
Muscles behaving involuntary is
the problem, they are misbehaving

Voluntary muscle (smooth muscle)
that is normally controlled by
individual volition
and that is supplied by the
autonomic nervous system.
Involuntary muscle (comprises of
long spindle shaped cells without
striations)
And most action are not under

Pennate fascicle pattern of
Muscle
Has short fascicle pattern
Attach to the length of the tendon
Feather appearance
Tendon from the side
Other attachment not far away
Less movement
Advantage of strength, because
more fibres attaching
Shorter axis of movement

Fusiform Fascicle pattern of
Muscle
Long fascicle pattern
Attach at the top of tendon
On the other end similar
Different function and role of
muscle
Advantage of large excursion of
movement
Role as a move

Pennate and Fusiform muscle
fascicle pattern working together
Leverage makes the arrangement
so strong
All operate together, never on their
own

Physiology of Muscle contraction
can’t make up for the power of
Mechanics
Physiology through evolution try to
make a mans for the variation in
Mechanics, but never got
anywhere close

When the angle of pull is less then
90 degrees, some of the muscle
movement is wasted to overcome
a biomechanical disadvantage,
rotate and drive.
When the angle of pull is 90
degrees, it has a perfect angle of
pull and perfect rotation.

The line of pull of muscle
contraction tend to move it, but
depends on what else is around.
The sticking point is that point
where muscles can’t make up for
the mechanical strength.

By changing the climbing muscle
brachioradialis it’s mechanics,
you change it’s function.
By changing the origin and
insertion around you increase the
angle of the humerus, and has a
longer angle of pull
Flexion of the humerus now is not
the lever arm, but the humerus is

Movement is accompanied by
a powerful rotation
Running is an aggressive
movement, because movement
occurs on both sides at the
same time
Movement is a multi-planar

It’s important to quantify
conditions by measuring
change
Sometimes only small amount
of mechanical change can
have great outcomes

It’s important to quantify
conditions by measuring
change
Sometimes only small amount
of mechanical change can
have great outcomes
An optimal spine functions in
an ipsy-lateral rotation

A structural defect causes
adaptation in connective
tissue and structure
A negative change allows
the condition to progress,
leading to an excessive
curve in the thoracic, what
causes an increase in
compressive stresses on the

Structural Scoliosis underlying
causes:
-The vertebrae hasn’t formed
properly
-There is a wedging to one side
-A developmental change caused
by
obstruction
-A dysfunctional lumbar causing
uneven

Comparing results between people
is difficult to validate
Because of differences in height,
sex, body composition and
previous injuries make it difficult to
compare
In measurement there is a
standard deviation and a margin
of error

Written protocol to control
measurement:
-Placement
-Lateral aspect
-Position
-Time of measurement
-Shoes off/on
-Knees fully flexed

Recognize Asymmetry
What is happening here ?
One side isn’t working as well as
the other side
What is the good side ?
What is the bad side ?
Causal philosophy of the link
system theory and the capacity to

What is Inertia ?
Inertia is the resistance to
movement
Where the bigger muscle have to
work harder to initiate movement
and the smaller muscles come on
after movement is initiated

Changes and adaptations of
structure effects the functionality of
rotation to the right.
Caused by:
-Adaptations in functionality,
exhausting
the movement
-Left rotation adaptation of
cumulative

Are we trade marked with
certain muscle types ?
Mechanics have driven the
physiology

Is the condition reversible ?
It’s biological, so it’s
changeable
(Wolff’s law)
The principle that changes in
the form and function of a bone
are followed by changes in its
internal structure

Pain is very subjective and
hard to quantify
The perception of pain is with
every person different
Perception, definition and
tolerance of pain vary
individually because of its
subjective character

Are we trade marked with
certain muscle types ?
Mechanics have driven the
physiology
Movement in the body is produced
by a system of levers. These
series of levers work together to
produce coordinated action, some
by actual movement (dynamic)

Principles of Bodymechanics
1.The wider the base of support
and the lower the center of gravity,
the greater is the stability of the
object.
2. The equilibrium of an object is
maintained as long as the line of
gravity passes through its base of
support.

4. Equilibrium is maintained with
least effort when the base of
support is broadened in the
direction in which movement
occurs.
5. Stooping with hips and knees
flexed and the trunk in good
alignment distributes the work load
among the largest and strongest

5. Stooping with hips and knees
flexed and the trunk in good
alignment distributes the work load
among the largest and strongest
muscle groups and helps to
prevent back strain.
6. The stronger the muscle group,
the greater is the work it can

7. Using a larger number of
muscle groups for an activity
distributes the work load.
8. Keeping center of gravity as
close as possible to the center of
gravity of the work load to be
moved prevents unnecessary

9. Pulling an object directly toward
(or pushing directly away from) the
center of gravity prevents strain on
back and abdominal muscles.
10. Facing the direction of
movement prevents undesirable
twisting of spine

11. Pushing, pulling, or sliding an
object on a surface requires less
force than lifting an object, as
lifting involves moving
the weight of the object against the
pull of gravity.
12. Moving an object by rolling,
turning, or pivoting requires less
effort than lifting the object, as

13. Using a lever when lifting an
object reduces the amount of
weight lifted.
14. The less the friction between
the object moved and surface on
which it is moved, the smaller is
the force required
to move it.

15. Moving an object on a level
surface requires less effort than
moving the same object on an
inclined surface because
the pull of gravity is less on a level
surface.
16. Working with materials that
rest on a surface at a good
working level requires less effort

17. Contraction of stabilizing
muscle preparatory to activity
helps to protect ligaments and
joints from strain and
injury.
18. Dividing balanced activity
between arms and legs protects
the back from strain

19. Variety of position and activity
helps maintain good muscle tone
and prevent fatigue.
20. Alternating periods of rest and
activity helps prevent fatigue

Lever Arm Length
Resistance Arm: distance between
axis and point of resistance
application.
Force Arm: distance between axis
and point of force.
Lever characteristics
Long resistance arm: speed and
range of movement

Lever Arm Length
Resistance Arm: distance between
axis and point of resistance
application.
Force Arm: distance between axis
and point of force.
Formula
F x FA = R x
RA
Force x Force Arm = Resistance
x Resistance Arm
Fx2cm=10kgx9cm 2F=90kg F=45kg

Long resistance arm: speed and range
of movement
Short resistance arm: force
Mechanical advantage
Motive force arm length / Resistive
force arm length
No mechanical advantage if quotient =
1 (same length):
If quotient >1: mechanical advantage in
force
If quotient <1: mechanical advantage in

Lever length of resistive forces
Center of gravity of body segment (eg:
forearm in arm curl, body during push-
up, etc.)
Center of gravity of any additional
weight. (eg: handle on barbell, sand
bag on back, etc.)

Perpendicular distance from fulcrum
When calculating forces applied to
levers, the Perpendicular Distance
from the fulcrum needs to be
measured.
Torque = Force x Perpendicular
Distance.
The physical distance and the
perpendicular distance are the same
only when force is being applied at a
right angle (perpendicular) to the lever.
Perpendicular distance can be

Variable Resistance Levers
Resistive force (R) is initially relatively
short [close to fulcrum (A)].
As motive force (F) acts on lever,
resistive arm becomes physically
longer, yet its perpendicular distance
remains constant. In contrast, motive
torque diminishes, requiring
progressively greater motive force
throughout movement.

First Class Lever
axis is placed between force and
resistance
examples: crowbar, seesaw, scissors
examples in body:elbow extension
triceps applying force to olecranon (F)
in extending the non-supported
forearm (R) at the elbow (A)
flexing muscle
agonist (F) and antagonist (R) muscle
groups are simultaneously contracting

First Class Lever
lever characteristics
balanced movement
Axis is midway between force and
resistance
e.g.: seesaw
Speed and range of motion
axis is close to force
e.g.: elbow extension
Force
axis is close to resistance

Second Class Lever
Resistance is between axis and force
classic examples: wheelbarrow,
nutcracker
complex example: rowing
paddle in water acts as slipping axis
(A)
boat resistance is resistive force (R)
rower is motive force (F)

Second Class Lever
relatively few examples in body
Plantar flexion of foot to raise body up
on toes
ball of foot
(A)serves fulcrum as ankle plantar
flexors apply force to calcaneus
(F) to lift resistance of body at tibial
articulation (R) with foot.

Second Class Lever
Entire body during push-up
foot is axis of rotation (A) When
reaction force of ground pushing
against hands (F)
Lifts weight of body's center of gravity
(R).
lever characteristics
produces force: large resistance can
be moved by a relatively small force
Weight machines: more resistance

Third Class Lever
Force is placed between the axis and
resistance
examples: tongs: food (R) is supported
by grip on handles (F) while axis is on
opposite end.
Shovelling: dirt on shovel (R) is lifted
by force to handle by hand (F) while
upper hand on end of shovel handle
serves as axis (A)
Rowing: oar is moved through water

Third Class Lever
Shovelling and rowing actions can also
be first class lever systems if the hand
closes to the force remains stationary
(A) and the hand on the far end of the
shovel or oar is moved (F).
batting: ball is hit
(R) by moving bat toward ball with
hand of far arm (F) while supporting
lower portion of bat with hand of near
arm (A).

Third Class Lever
example in body
Most levers in body are third class
Elbow flexion
Biceps and brachialis pull ulna (F)
lifting the forearm, hand, and any load
(R) at the elbow (A).
Knee flexion
hamstring contract (F) to flex the lower
leg (R) at the knee (A).

Third Class Lever
Produces speed and range of motion
Requires relatively great force to move
even small resistances
Weight machines: less resistance
required, greater inertia
Harder to start and stop movement

Functionality vs Stability
Functionality should be
maintained
If you don’t know what to
maintain,
how do you know what to do ?

Your greatest stability is in your
mobility
The problem is we don’t move
well
We are jamming up
We are not moving enough and
changing it’s function

Does Hypermobility exists ?
Hypermobility isn’t the problem, the other
side is jamming up too much, what
changes the axis from where it suppose to
be
A lot of therapies focus on the wrong side,
the hypermobile side, by focusing on
stability, instead of what has caused it to
jam up
Where is the lack of optimal movement

The Axial and Appendicular system is
made up of biological material
After an submaximal load there is a time
bridge between it takes to change the
structure to it’s original state after the load
is taking off
Hysteresis is the difference between the
original state to the alternate state after
taking the load off
When leaving the load on the structure it

Ligamentous hysteresis is defined as the
energy lost (as heat) within the tissue
between loading and unloading. When the
ligament is stimulated repetitively with
constant peak load, hysteresis develops
and the ligament length limits increase
with each cycle.
The repetitive use of the same force
produces greater and greater ligamentous
deformation (creep). This is why
postural/structural corrective exercises
work and should always be done first,

The exercises “heat-up” the ligaments,
increase their length and reduce their
internal tension. This “sets-up” the spine to
better receive any corrective spinal
manipulation or traction. Also, if you can
increase the peak load during the patients
corrective exercise session you will
increase tissue hysteresis.

Ligament Creep
Ligament creep is defined as the time
dependent elongation of a ligament when
subjected to a constant stress. Ligament
creep is not linear in nature. Most of the
ligament elongation occurs during the first
15-20 minutes of a traction load.
This is why at least 10-20 minutes of
structural corrective traction is usual
recommended. But how long does is take
the ligament to recover from the

Both creep and tension-relaxation
induced in 20-50 minutes of
loading or stretching a ligament,
respectively, demonstrated 40-
60% recovery in the first hour of
rest, whereas full recovery is a
very slow process which may
require 24-48 hours.

Performing corrective procedures
on patients three times per week
with 48 hours or more between
sessions will not be very
successful if the patient is not also
performing some type of
ligamentous rehabilitation at
home on a daily basis. Having
them re-stretch the soft tissues in-
between the in-office therapy

Frequency or Time-History
Ligament behavior is also dependent on
the frequency of load application and
unloading or strain rate. Cyclic loading of a
ligament with the same peak load, but at a
higher frequency, results in larger creep
development and longer time for the full
recovery of the creep to occur.
So having the patient perform their
corrective exercises in a slightly faster, but
still controlled, manner is better than a

Temperature
Ligament length-tension (strain-stress)
behavior is also temperature-dependent,
exhibiting reduced capability and therefore
increased deformation at higher
temperatures.
The main point to understand from this
statement is to not perform corrective
procedures in a cold room or with a cold
patient. It also re-iterates the importance
of heating-up the tissues with exercise

How do you get the ligaments to stay
elongated if they recover so quickly? This
is accomplished by getting the ligament
stretched out to a length that moves it out
of its elastic capability and into its plastic
(viscous) range. Plastic deformation of a
ligament can occur all at once, such as in
athletic injuries where an extremely large
force is applied, or through what is called
“repetitive overwhelm”. Repetitive
overwhelm is when a sub-maximal
physical stress is applied so often, that it
causes a micro-failure of the ligamentous

The main factors that affect plastic
deformation are the amount, duration and
frequency of the applied force.
In one reference involving the posterior
cruciate ligament of the knee, it was found
that “Slow stretching of the ligament
results in elongation up to 30% before any
plastic deformation”

Creep is a concentrated load
causing adaptation fibers of
connective tissue to change
Ligamentous material elongate in
length by Manipulation of
ligaments and connective tissue.
What increase mobility and
function

Creep can end up Negative if your
not be able to utilize it well
By changing posture in the
sagittal plane, you will be able to
change every interrelated joint(s)
as well
Creep because the load has
changed and new adaptations set

Establish Creep and Hysteresis
by overcoming Negative Blocks
-Change the Nature of Function
-Change the Nature of Structure
-Change the Nature of Position
-Change the Nature of Extensibility
-Change the Nature of Pliability
-Change the Nature of Elasticity
-Encouraging a Positive Plasticity
-Encouraging Freedom of Movement

Deal with adaptation, even a small space
around the zygapophyseal joints can have
a positive effect in restoring better function
The biomechanical function of each pair of
facet joints is to guide and limit movement
of the spinal motion segment and
contribute to stability of each motion
segment

Deal with adaptation, even a small space
around the zygapophyseal joints can have
a positive effect in restoring better
function.
The link-system interrelationship in
structure will be effected.
The biomechanical function of each pair of
facet joints is to guide and limit movement
of the spinal motion segment and

Creep in a vertebral disc causes
water lose over time, what
causes:
Change of structure to a more fibrosis
nature
Degeneration: the deterioration of the
cartilage tissues that support the weight-
bearing joints in the body. Once the
cartilage is thinned or lost, the constant
grinding of bones against each other
causes pain and stiffness around the joint.

Creep in a vertebral disc causes
water lose over time, what
causes:
Dysfunction: Joint dysfunction is the gross
anatomical deformity, i.e., subluxation,
contracture, or bony or fibrous ankylosis,
and chronic pain and stiffness of any joint,
with limitation of motion, instability, or
abnormal motion of the affected joint(s)

Musculoskeletal System
Dysfunction
Disorders of the musculoskeletal system
may result from hereditary, congenital, or
acquired pathologic processes.
Impairments may result from infectious,
inflammatory, or degenerative processes,
traumatic or developmental events, or
neoplastic, vascular, or toxic/metabolic
diseases.

Dysfunction
Loss of Function
Loss of function may be due to bone or
joint deformity or destruction from any
cause; miscellaneous disorders of the
spine with or without radiculopathy or
other neurological deficits; amputation; or
fractures or soft tissue injuries, including
burns, requiring prolonged periods of
immobility or convalescence.

Dysfunction
Defining Loss of Function
Functional loss is defined as the inability to
ambulate effectively on a sustained basis
for any reason, including pain associated
with the underlying musculoskeletal
impairment, or the inability to perform fine
and gross movements effectively on a
sustained basis for any reason, including
pain associated with the underlying
musculoskeletal impairment. The inability
to ambulate effectively or the inability to

Dysfunction
Inability to Walk
Inability to ambulate effectively means an
extreme limitation of the ability to walk; i.e.,
an impairment(s) that interferes very
seriously with the individual's ability to
independently initiate, sustain, or complete
activities.
Ineffective ambulation is defined generally
as having insufficient lower extremity
functioning to permit independent

Inability to Walk
To ambulate effectively, individuals must be
capable of sustaining a reasonable walking
pace over a sufficient distance to be able to
carry out activities of daily living. They must
have the ability to travel without companion
assistance to and from a place of
employment or school.

Inability to Walk
Ineffective ambulation include, but are not
limited to, the inability to walk without the
use of a walker, two crutches or two canes,
the inability to walk a block at a reasonable
pace on rough or uneven surfaces, the
inability to use standard public
transportation, the inability to carry out
routine ambulatory activities, such as
shopping and banking, and the inability to
climb a few steps at a reasonable pace
with the use of a single hand rail.
The ability to walk independently about

Inability to Perform
Inability to perform fine and gross
movements effectively means an extreme
loss of function of both upper extremities;
i.e., an impairment(s) that interferes very
seriously with the individual's ability to
independently initiate, sustain, or complete
activities.
To use their upper extremities effectively,
individuals must be capable of sustaining
such functions as reaching, pushing,
pulling, grasping, and fingering to be able

Inability to Perform
Inability to perform fine and gross
movements effectively include, but are not
limited to, the inability to prepare a simple
meal and feed oneself, the inability to take
care of personal hygiene, the inability to
sort and handle papers or files, and the
inability to place files in a file cabinet at or
above waist level.

Pain and other symptoms
Pain or other symptoms may be an
important factor contributing to functional
loss. In order for pain or other symptoms to
be found to affect an individual's ability to
perform basic work activities, medical signs
or laboratory findings must show the
existence of a medically determinable
impairment(s) that could reasonably be
expected to produce the pain or other
symptoms.

Pain and other symptoms
The musculoskeletal listings that include
pain or other symptoms among their criteria
also include criteria for limitations in
functioning as a result of the listed
impairment, including limitations caused by
pain. It is, therefore, important to evaluate
the intensity and persistence of such pain
or other symptoms carefully in order to
determine their impact on the individual's
functioning under these listings.

Diagnosis and Evaluation
Diagnosis and evaluation of
musculoskeletal impairments should be
supported, as applicable, by detailed
descriptions of the joints, including ranges
of motion, condition of the musculature
(e.g., weakness, atrophy), sensory or reflex
changes, circulatory deficits, and laboratory
findings, including findings on x-ray or
other appropriate medically acceptable
imaging.

Medically acceptable imaging includes, but
is not limited to, x-ray imaging,
computerized axial tomography (CAT scan)
or magnetic resonance imaging (MRI), with
or without contrast material, myelography,
and radionuclear bone scans. "Appropriate"
means that the technique used is the
proper one to support the evaluation and
diagnosis of the impairment.

Purchase of certain medically acceptable
imaging. While any appropriate medically
acceptable imaging is useful in establishing
the diagnosis of musculoskeletal
impairments, some tests, such as CAT
scans and MRIs, are quite expensive, and
we will not routinely purchase them. Some,
such as myelograms, are invasive and may
involve significant risk.

The Physical Examination
The physical examination must include a
detailed description of the rheumatological,
orthopedic, neurological, and other findings
appropriate to the specific impairment
being evaluated.
These physical findings must be
determined on the basis of objective
observation during the examination and not
simply a report of the individual's allegation

Alternative testing methods should be used
to verify the abnormal findings; e.g., a
seated straight-leg raising test in addition to
a supine straight-leg raising test. Because
abnormal physical findings may be
intermittent, their presence over a period of
time must be established by a record of
ongoing management and evaluation.
Care must be taken to ascertain that the
reported examination findings are

Examination of the spine should include a
detailed description of gait, range of motion
of the spine given quantitatively in degrees
from the vertical position (zero degrees) or,
for straight-leg raising from the sitting and
supine position (zero degrees), any other
appropriate tension signs, motor and
sensory abnormalities, muscle spasm,
when present, and deep tendon reflexes.

Observations of the individual during the
examination should be reported; e.g., how
he or she gets on and off the examination
table.
Inability to walk on the heels or toes, to
squat, or to arise from a squatting position,
when appropriate, may be considered
evidence of significant motor loss.

A report of atrophy is not acceptable as evidence
of significant motor loss without circumferential
measurements of both thighs and lower legs, or
both upper and lower arms, as appropriate, at a
stated point above and below the knee or elbow
given in inches or centimeters.
Additionally, a report of atrophy should be
accompanied by measurement of the strength of
the muscle(s) in question generally based on a
grading system of 0 to 5 , with 0 being complete
loss of strength and 5 being maximum strength.
A specific description of atrophy of hand muscles

When neurological abnormalities persist.
Neurological abnormalities may not
completely subside after treatment or with
the passage of time.
Therefore, residual neurological
abnormalities that persist after it has been
determined clinically or by direct surgical or
other observation that the ongoing or
progressive condition is no longer present
will not satisfy the required findings

Major joints refers to the major peripheral joints,
which are the hip, knee, shoulder, elbow, wrist-
hand, and ankle-foot, as opposed to other
peripheral joints (e.g., the joints of the hand or
forefoot) or axial joints (i.e., the joints of the
spine.)
The wrist and hand are considered together as
one major joint, as are the ankle and foot. Since
only the ankle joint, which consists of the juncture
of the bones of the lower leg (tibia and fibula) with
the hindfoot (tarsal bones), but not the forefoot, is
crucial to weight bearing, the ankle and foot are

Documentation
Musculoskeletal impairments frequently
improve with time or respond to treatment.
Therefore, a longitudinal clinical record is
generally important for the assessment of
severity and expected duration of an
impairment unless the claim can be
decided favorably on the basis of the
current evidence.

Documentation
Documentation of medically prescribed
treatment and response.
Many individuals, especially those who
have listing-level impairments, will have
received the benefit of medically prescribed
treatment.
Whenever evidence of such treatment is
available it must be considered

Documentation
When there is no record of ongoing
treatment. Some individuals will not have
received ongoing treatment or have an
ongoing relationship with the medical
community despite the existence of a
severe impairment(s).
In such cases, evaluation will be made on
the basis of the current objective medical
evidence and other available evidence,
taking into consideration the individual's

Documentation
An individual who does not receive
treatment may not be able to show an
impairment that meets the criteria of one of
the musculoskeletal listings, the individual
may have an impairment(s) equivalent in
severity to one of the listed impairments or
be disabled based on consideration of his
or her residual functional capacity (RFC)
and age, education and work experience.

Evaluation
Evaluation when the criteria of a
musculoskeletal listing are not met. These
listings are only examples of common
musculoskeletal disorders that are severe
enough to prevent a person from engaging
in gainful activity. Therefore, in any case in
which an individual has a medically
determinable impairment that is not listed,
an impairment that does not meet the
requirements of a listing, or a combination
of impairments no one of which meets the

Evaluation
Individuals who have an impairment(s) with
a level of severity that does not meet or
equal the criteria of the musculoskeletal
listings may or may not have the RFC that
would enable them to engage in substantial
gainful activity.
Evaluation of the impairment(s) of these
individuals should proceed through the final
steps of the sequential evaluation process

Consecutive Forces Causes
Fatigue
Asymmetry is always there
Left and ride side are loaded differently, as
well function differently
Left rotation is different from right rotation
Different pulling on structures
Different stresses on structures

When you start to change your
Mechanics, you become more
vulnerable to trauma
If you got it wrong, same
orientation, what overtime breaks
the camels back
Physical fatigue put a strain on the
focus in maintaining proper use of

Incorrect loading of a structure
increases the risk of fatigue
Fatigue doesn’t cause the injury,
changes in mechanics does

Repeatedly badly loading of the
system, causes the body to be
unable to adapt
Don’t load it badly, stop when your
not able to continue with correct
Mechanics
Use training resistance according
to your training level

A negative Mechanical shift has
Negative repercussions
A positive Mechanical shift has
postivie repercussions

Skeletal muscles contract to
produce the force necessary in
everyday life, but can not contract
continuously without impairment in
performance, i.e. they
fatigue
The extent of neuromuscular
fatigue is classically quantified by
the decrease in the maximal

Processes located distal to the sarcolemma
play a major role in fatigue.
Intact single muscle fibre experiments
show
changes in Ca2+ handling and myofibrillar
function that can explain the impaired
contractile function in fatigue
Intramuscular processes limit the duration
of prolonged isometric contractions
performed at relatively high intensity,
central factors
contribute to the failure of maintaining

Muscle cells are important contributors to
the fatigue induced changes in muscular
function in humans.
The cellular mechanisms of fatigue at
sustained continuous or intermittent
submaximal isometric contractions
performed at relatively high (>30%
MVC) intensity
The decrease in MVC induced by a
prolonged isometric contraction can be

Muscle cells are important contributors to
the fatigue induced changes in muscular
function in humans.
The cellular mechanisms of fatigue at
sustained continuous or intermittent
submaximal isometric contractions
performed at relatively high (>30%
MVC) intensity
The decrease in MVC induced by a
prolonged isometric contraction can be
mainly attributed to

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