ORBICULARIS-EXERCISES

Myofunktional Exercise  Collect ion

Application:

no illustration

This chapter gives a general description of a collective group of exercises and details which are sharing the here described facts.

The exercises will mostly be applied in case of an incompetence of the Rima Oris (Oral Fissure) closure. Quite a number of further disorders are regarded as well. These can be subclassified in

(A) preferably physical disorders which are concerning the validity of the neural control or of the textures and those which

(B) presumably are based on habitual dysfunctions.

Again this subclassification seems problematic regarding the fluent transitions but is shown here as well, as it shows a better scheme.

Among (A) insult caused disorders are listed like postoperative situation, rehabilitation problems and congenital tissue damage.

Among (b) disorders will be counted which arose from or represent Habits.

For the exercises noted in the list below each has got a hint in note form to the respective therapy aim.

A further classification  is given through the anatomy of the Perioral musculature, the ‘layout’ of the quite complex muscles in principally two fibre track directions (about this matter see also the detailed description in Volume I, Thiele, E.: Myofunktionelle Therapie in der Anwendung. Hüthig Heidelberg) and (Anatomy: Area I, Page 13).

                1. A circular course are showing those fibres which are summarised under the term ‘mouth lacer’ (Anatomy: Area I, Page 11) and which may be seen as the ‘proper’ lip muscles. They close the mouth slit although they are not located as, in comparison, the string knit in into the edge of the mouth of a bag (TIED-UP SACK)but must be differentiated into, al least, three parties (See drawing 17 a/b). This differentiation is not only of interest under purely scientific-anatomical viewpoints but as well and rather for the application of the exercises respectively of some crucial importance.

If the existing problem is not collated to the very part of the muscles affected consequently there will not the correct exercise be applied. Success fails.

The three muscle partitions mentioned of the circular perioral musculature may roughly be distinguished as the central (c) fibre bundle which is situated farthest to the middle and superficially to the mouth slit, the medial bunch (m) which mostly shapes the lip body and the peripheral fibre bunch (p) representing the outer rim of the lips.

Some fibre tracks are situated more superficially, some more in the deep towards the Vestibulum (“inside”), some show an uniform run which is directly anchored below the covering skin (and, thus, giving the skin a special movability).

A differentiation will here only been carried out as far as the training with the different exercises applicable demands. For this purpose a differentiation in a central, a medial and e peripheral fibre bundle.

             2. In antagonistic action to the ‘Lacers’ are the fibre tracks which gain the opening of the mouth slit and, thus, are running radially away from the ‘Lacer’ in a centrifugal direction into the bordering regions around the mouth. This has lent them the description (wheel-) spokes which are described with the usual terminology  Zygomaticus, Risorius (and so on), as lip levator or depressor.

In their insertion (Insertio) they are well integrated into the ‘Lacer’ part. For all these single tracks there are the respective exercises.

Under special conditions also in antagonism are standing the muscle tracks laterally arranged from the Orbicularis which, together wit it, are forming the ‘Belt’ (Page 11). They are operating in the centrifugal direction related to the centre of the mouth opening (as, for example, in the exercise WIDE GRIN).

As mentioned before, in the synopsis of the available exercises summed up at the end will be hinted towards the respective special application in a short form.

The exercises are arranged after the above described scheme of an anatomical structure as this gives the main designation for the selection of the exercises.

The contents of the exercises strictly depend on the therapy aim.

Materials:

The materials as well are fitted to the therapy contents. Frequently they will serve as REMINDER or even as the training device. Among those will often be used passive appliance or tools as, for example, the vestibular shield or a cotton roll which again raise the frequently discussed question after a function-therapeutic relevance.

Procedure:

- Previous exercises: For an incompetent lip closure exercises for the stretching of the soft tissues will be considered. The

- Procedure again is exercise specific. In complex cases it should be a matter of discussion whether initially the intrinsic orofacial musculature should be worked-out (as tongue, possibly mouth floor) or otherwise the extrinsic, perioral (lips/cheek/chin) be preferred. The tendency will, though, be to, firstly, take under therapy the intrinsic as the dominating component (along with this it is of some relevance that the extern musculature is more readily noticeable and better to be monitored; this would entail that the respective exercises would have to be appointed with the pre-exercises).

-Timing: Besides the above mentioned question about the general timing here the possibility will have to be taken in account to combine certain exercises to form groups and complexes as ALTERNATIVE EXERCISE, NCREASE-ARRANGEMENTor in form of the UNIT-CONSTRUCTION-SYSTEM.

Characteristics:

A general characterisation of the exercises is not possible as the whole spectrum of characteristics is involved.

Remarks:

The perioral muscle field will certainly and in accordance to its biogenesis react ‘more or less’ in its entirety. As the mimesis, the facial expression, is acting in a highly differentiated manner the described exercises, when executed precisely and under a guarded training work-out offer the possibility to practice special muscle tracks more intensively and preferred.

Discussion:

With a multitude of the ORBICULARIS-EXERCISES within the exercise the BALLOON may be prescribed for intensification. This would mean that two exercises are proceeding simultaneously. The BALLOON in this case requires much more tonicity, in which connection in the respective chapter being hinted at the fact that this exercise may be executed in different ways (blowing up the whole Cavum Oris or the Vestibulum only; special description of the musculature see: Area I, Page 11).

As described above a differentiation can be made with respect to the target musculature between the fibres with a circular route in the two curvations of the ‘Mouth-lacer’ and those leading into it radially as the ‘Wheel-spoke’-fibre-tracks (Fig. 2, Page 03, Fig.17, Page 13).

In respect to their position the circular fibres running in a rounded arc will stand out against each other – the more centrally, running more near the midpoint (of the mouth slit) against those fibres lying more peripheral at the rim of the lips.

Regarding the stretching effect of the ORBICULARIS-EXERCISES it should be differentiated between the muscle tracks that are to be stretched. At one hand the strained circular fibres act on the circular ones in a stretching manner, on the other hand a stretching of the associated ‘Belt’ musculature (Ill. 18, Page 11) can be effected when this is widely excluded during the practicing regarding the working tone.

Exercises which always activate specially these two groups and within these pointedly the different fibre tracks are separately listed in the follow.

Radial fibre tracks:

NOSEWRINKLING, DOGS GROWL, CYNICAL SMILE, WIDE GRIN, ,E'-EXERCISE, ELEVATOR, CONDUCTOR.

Circular fibres:

,O’-EXERCISE, CHERRY MOUTH, TRUNK-EXERCISE, TIED-UP SACK, DUCKBILL. The tonicity of these fibre tracks can be monitored with metering through the TONOMETRE. When the training position is gained mouthpiece tube is pushed gently between the lips while in the oral cavity air-pressure is created. The lip closure around the tube will, then, be as strong, as the metre indicates. This corresponds to the tone which presently exists in during the exercise in the working muscle fibres.

In the following LIST OF EXERCISES the relevant exercises are listed, described with a short explanation and marked with a figure which refers to the later on following list of the main disorders.

As the Orbicularis region does not only include the lips but can not be viewed excluding the leading in muscle tracks (wheel-‘spokes’) the latter are also taken in account.

The subsequently noted complaints can be treated with these exercises, the relevant numbers are set behind the respective exercise in the following list:

(1) Incompetent lip closure,

(2) limp cheeks,

(3) soft lip arcs,

(4) flabby ‘dummy-’)mouth (Hypotone),

(5) Hypomobility,

(6) lip pressing,

(7) cheek pressing,

(8) Mentalis cramping (Hypertonia),

(9) Hypermotility as lip biting. gnawing and sucking  as well as

(10)Hypomotility and a wrong posture of the lips.

The ‘[T]’ behind the description indicates that in the respective exercise the TONOMETRE measuring is possible.

LIST OF EXERCISES

BALLOON

Tone raising in the ‚Belt’-musculature, lip closure under air pressure straining (1 to 4) [T].

BLOW THE BALL

Air stream control, ‚Belt’-musculature (1 to 4, 6).

BABBLE

Relaxation, Orbicularis (6 to 8, 10).

WIDE GRIN

Stretching of the Orbicularis, tone raising within the ‘Belt’ (3, 5 to 7).

CLOWNY

(Lip massaging).

CHUBBY LIP

Manipulated blocking of the lips gliding between the front teeth bows (9).

CONDUCTOR

Pseudo-manipulated Motility exercise (unilaterally) (2 to 5).

,FIRST DAY KIT'

Manipulated action to eliminate the habit finger-sucking (causative for Orbicularis disorders) (1, 3 to 5).

BLOW THE FLAKE

Fine motor skill air stream monitoring with the Orbicularis (1, 3 to 5, 7, 9, 10).

DUCKBILL

Aimed tonicity raising of the peripheral Orbicularis musculature for the vertical movement. [T]

WEIGHTLIFTING

Motility increase of the lip muscles (1,6,7,9).

GORILLA

Stretching of the chin region and lower lip.

BLOW THE  STRAW

Manipulated tight lip closure around the tube/straw under gross motor tension of the ‘Belt’ (1 to 5).

STRAW SUCKING

 Static tensing of the ‘Belt’, Hold-exercise for the lips (1, 3, 4, 10.

HOLD A MATCH

 Fine motor coordinated tensing of areas aimed at in mouth slit closure (1, 3, 9).

DOGS GROWL

‘Wheel-spoke’ muscles, Mobility or Motility (9,10).

,I'-EXERCISE

Active stretching of the lower-lip-chin-area (8).

CHERRY MOUTH

Coordinated straining of defined Orbicularis areas 1, 3 to 5, 10) [T].

CLOWNY (Lip massaging)

Active stretching of the lip tissues (1, 3 to 5, 10).

,L-M’-POSITION

Stand-by position of lips and tongue tip (1, 3, 6, 8 to 19).

LIP-CLOSURE    

These exercises are listed here repeatedly but only represent a part of the ORBICULARIS EXERCISES. [T]

LIPSTRETCH

see CLOWNY

EASY SWALLOW

Controlling of hyper-tonicity and –mobility (6 to 9).

,M’-POSITION

Stand-by position of the lips, easy lip closure (1, 3, 4, 6, 8, 9).

MENTALIS MASSAGE

Passive stretching exercise (8).

MENTALIS STRETCH

Active stretching exercise (8).

,M-O-I’

Starting position (multifunctional) [T].

MOUTHBREATHING

This exercise complex is also listed here as frequently a secondary incompetent mouth slit closure will occur.

NOSEWRINKLING

Fine motor Motility exercise of fibres leading in (1, 4)

,O'-EXERCISE

Gross motor straining of the complete Orbicularis musculature and active stretching in the cheek region (1 to 5) [T].

UPPERLIP MASSAGING (passive)

Passive extending exercise (1, 3, 4).

UPPERLIP STRETCHING(active)

Active stretching exercise (1, 3, 4).

,P-P-P'-EXERCISE

Fine motor Motility exercise and tonicity increase (1 to 4, (9), 10) [T].

PIPELINE  

Straw sucking exercise (1, 5, 10).

PLATELET-HOLDER   

Fine motor Hold- and posture exercise (1, 6, 8, 9)

TRUMBONE

Preferably gross motor skills for controlling the cheek and lip tonicity (1 to 6).

POO-EXERCISE

Aimed loosening-up (5 to 8).

PEA-SHOOTER

In this case for tonicity control in the ‘Belt’ (1 to 4).

TRUNK- CIRCLING

Mobility exercise for the total Orbicularis (1 to 5).

TRUNK-EXERCISE

Complete Orbicularis musculature with ‘Wheel-Spokes’ (for the latter as a stretching exercise (1 to 5) [T].

PULL-THE-TRUNK

Complete Orbicularis musculature especially the peripheral fibres and ‘Spokes’, Stretching (1,6,8,9).

RESTPOSITION 

Night-time habituation, also Sleep-Apnoea, else:

SALINEKEEPING

Manipulated Hold-exercise (1 to 10).

CROOKED GRIN

Aimed unilateral-exercise for Risorius (11)

TIED-UP SACK

Aimed strengthening exercise for the peripheral Orbicularis portion (1, 3 to 6) [T].

SPECTRE

Lateral stretching exercise for Orbicularis ring (6,9).

HOLD-THE STRAW

Manipulated Hold-exercise for strengthening the Orbicularis (1, 3, 4).

TUG-OF-WAR

Play-, stretching-, strengthening exercise (1 to 4).

COTTONROLL

Manipulation (9).

,ZIP’-EXERCISE

Fine motor skills in the Vestibulum-region , Pre-exercise for the Orbicularis for the swallow function

CYNICAL SMILE

Commissura Labialis lifting oblique-laterally (3 to 5) and Hold-exercise (1 to 10).

Instructions: