Sunday, September 7, 2008

Hit Takers & Trouble Makers, Part 1

The manual therapy journals keep coming to the same conclusion, that thoracic spine manipulations are useful to increase range of motion & decrease pain in athletes with neck pain. Once again, this is support for the kinetic link principal. However, you are probably asking what this has to do with the high school athletic trainer.

Martin Lambert, a physical therapist in Hamburg, New York invented the idea of "hit takers 'n trouble makers" in the human musculoskeletal system. C2-C7 are stuck between two trouble makers: the O/A joint and the T-Spine. The lower T-spine has mostly sagittal plane motion, the upper mainly rotation, with frontal plane motion pretty evenly distributed. However, if motion in any one plane is inhibited, it will reduce motion in the other two. So, when it runs out of motion, it will quite often go up or downstairs to steal more...because it can. So, that sprained neck may have been set up for failure by a hypomobile T-Spine.

The photos above illustrate an exercise I am using now on a football player who sprained his neck. Diagnostic films have ruled out serious injury, but the athlete was left with a type 2 dysfunction of C3-4. It is stuck FSR, that is flexed, side bent & rotated right. Simply put, the kid has pain/stiffness extending & rotating/sidebending his head left.

I'm using my RLE & arms to create relative left rotation & left side bending in my neck. I choose a right stride stance as not to place my neck at end range left rotation. I begin with eyes fixed forward, BUE extended at shoulder height, left hand supinated, right rotation, then go to BUE right lateral reach toward the floor in one smooth motion. Kind of like a oarsman rowing. I'll repeat it 4x20 reps.

What I've done is used my arms to drive my T-spine in the direction I want as to mobilize my neck. I'll avoid using my head as a driver for the time being, as it will be too painful. I'll use massage & other modalities to relax the muscle spasm & work around the injury for the time being.

In conclusion, we're applying the new evidence based practice stuff coming out of the research journals, and giving it the good old fashioned ATC twist.


Kev said...

Type 2 dysfunction? So I would assume there is a Type 1, possibly a Type 3, etc ... can someone help me out?

Brian said...

Type 1and type 2 dysfunction are ways to describe spinal dyfunctionrelating to Freyetes Laws...Am I assuming that maintaing the head forward on a trunk that is rotating to the right that your causing cervical left SB/rot? I'm not sure why the foot placement though?