Tuesday, October 28, 2008

SM,TA,Pelvic Floor-my turn.

I'm going to let JH's comment answer this one for me:

"Working in an industrial setting we see a lot of back issues. Once pain is controlled we find that they are very strong in the movements they perform daily but very weak in any number of given exercises they do not perform on a daily basis. It is really as simple as giving them a variety of movements that are "new" to the body and the appropriate muscles learn how to respond resulting in a more versatile spine."


If you read the studies on this topic, the subjects are almost entirely involved in repetitive tasks, such as factory workers & cricket batsmen. The same movement patterns are performed sometimes hours at a time. My ART recert classes always begin with a lecture on repetitive stress syndrome, and it's effect on the fascial structures of the body. "Grooving movement patterns" is a popular buzz word in sports and physical therapy today. However, remember Wolf's law from your college AT classes- that is, form follows function. That means you are also molding bone, soft tissue, and the nervous system- for a specific task. There are consequences. Vern Gambetta cautions us not to develop "adapted athletes" over "adaptable" athletes.

There is an interesting topic in Dr. McGill's book regarding an athlete doing a deadlift under a fluoroscope. One vertebral segment appeared to buckle under the stress of the load. What caused an abhorrent movement pattern at one particular level, and no where else? Fatigue from a previous workout? Maybe a sore knee that caused the athlete to push harder with one leg than the other? A rib dysfunction that caused an abnormal rotation? An undiagnosed spondylolysis or pars fracture? The reader is left to wonder. However, we must not jump to the conclusion that a weak multifidus at a specific level, on a specific side, or the TA is the culprit, and the solution is to isolate them with biofeedback.

How can we take JH's clinical work in the industrial setting & apply it to athletics? I think the easiest place to get this started is with recovery/restoration. How about some bat swings from the contralateral side...throwing with the contralateral arm...running backwards, sideways, carioca? If your job requires stooping/lifting to the right, how about standing in a stride stance, alternate over-the-shoulder punches to the left...if you are a cyclist, how about lateral lunges with rotational over-the-shoulder-punches?
There are exceptions. Christina Christie, a P.T. from California, works with women who have bladder control issues resulting from child birth. She describes the pelvic floor as a "trampoline". She points out that beginning the rehab process in the vertical overloads this system. Therefore, her protocols are initiated from the floor. Similar concept as to my idea on wall slides for GH instability.


JH said...

the alst paragraph reminded me about a patient we had when i worked at in NC. She was diagnosed with vaginal prolapse as a result of having just given birth. In her situation bowel movements and urination were issues due to the prolapse. In her situation we could perform exercises with her standing. infact everything we did was standing but only on 1 leg at a time. Even her simple biceps curls were on 1 leg. The upper body, core and lower body were all standing and eventually she got better. her situation wasn't as severe as some prolapse situations can be. the key was to start easy and progress slowly.

bbovee said...

Joe- Any idea on how I can get ahold of Christina Christie. I have a client that needs to see her. Any info would be greatly appreciated.


Joe Przytula said...

Brandon- I'm trying to get in touch with Tina- she doesn't seem to respond to her email. Will keep trying.