Thought Provoking

http://www.cpdo.net/jour/jour1.html

Download the first PDF on the top of the page. It's called, "THE FALL OF THE POSTURAL–STRUCTURAL–BIOMECHANICAL MODEL IN MANUAL AND PHYSICAL THERAPIES: EXEMPLIFIED BY LOWER BACK PAIN".

I would enjoy everyone's take on this. I guess it's no secret I'm not really a fan of the Functional Movement Screen, and this articulates my point of view much better than I could. Hey, I realize I am in the minority. After all, even Phil Donley uses the FMS to figure out how the kinetic chain influences the shoulder in throwers; so who the hell am I to dispute it.

But, it does leave me scratching my head.

Dr. Coughlan & others- keep fighting the good fight

Chronic Ankle Instability Alters Central Organization of Movement- Hass et al, AJSM- 5-10.

"Deviations from a normal COP (center of pressure) during gait trace similar to those seen in older adults and Parkinson disease patients were seen in subjects with CAI when the data were normalized to an individual's stance width".

"We speculate that centrally mediated decreases in COP excursion during GI (gait initiation) represents a more constrained sensory motor system that will decrease the individual's ability to cope with changing task demands, and in addition is a leading cause of post traumatic osteoarthritis in the ankle".

See why I chose this topic as my first book?

Good Quotes from Eyal Lederman

Began reading his new book, "Neuromuscular Rehabilitation in Manual & Physical Therapies- Principles to Practice" So far, it kicks ass.

"Interestingly, most of the proprioceptors in our body are tension receptors. It seems that during movement the nervous system "sees" areas of varying tensions rather than individual tendons, joint capsules, or muscles".

-a nod to the body's fasica system.

On EMG studies- "Muscles which are silent or at low EMG activity are part of the whole control pattern. Normal movement would be impossible if thsese muscles were over active, as in stroke patients."

-remember, EMG's are not the end all. All they tell you are which muscles are screaming the loudest.

The tough part

I was just going over "Knee Stability & Movement Coordination Impairments: Knee Ligament Sprain" in this months JOSPT.

Several references are made to "increased body mass index" as a risk factor- and the fact that it is more difficult to modify than other risk factors.

Numerous studies also support this theory as a risk factor in patellofemoral disorders & ankle sprains.

If your athlete is overweight, address it in your rehab protocol. Personally, I don't tell them they're overweight. I just throw in plenty of spin workouts, slide board work, and sprint workouts in the pool when it's convenient. They'll start looking & feeling better and that will keep them coming back for more.

My previous post- technical glitch

Coach Martin & Kevin M. asked some good questions I have answered; but in the comments section you see it only says "1 comment" for some reason. If you click on it however, you will see all 3.

Posterior Lower Leg Strengthening in Running

Remember in gait as in running, the posterior lower leg muscles don't plantar flex the ankle- momentum is giving you that for free. Rather, they extend the knee by decelerating the tibia.
So if you are doing eccentric heel drops or single leg standing while tossing a med ball into a plyoback, they probably won't help with your chronic calf strains. You've got to get the knee to translate beyond the toes if you are looking to load it ecconcentrically.

Here are two of my favorite exercises; they would be placed in the latter phases of rehab if you are returning from a strain because I'm using an ankle cuff & powerballs to increase the load.

The lower extremity motion is the same for both; that is an anterior to posterior pivot balance and reach. In the top photo I'm doing a BUE posterior @ overhead reach to anterior toe touch and return. Be sure to keep the front leg slightly bent and the foot slightly plantar flexed so the exercise does not become a standing slump test. You don't need to reach the hands all the way to the foot as I did either.


In the bottom pics I'm using opposing arm drivers to simulate running.

Begin in the sagittal plane and advance to right and left diagonal. In the early phases of rehab it is easy to tweak down by standing horizontal to a wall and allowing the inside hand to touch as necessary to assist in balance. The free hand would go through the same motions as in the picture.

If you're new to them, your going to feel a deep burn in posterior lower leg, the VMO of the knee, and the low back. Exactly how these muscles are integrated in running. Begin with 3 sets of 10, but work up to 4 sets of 20-30.

Sports Injuries: Tough it out?

Thanks fellow GAINer Phillip Bazzini for bringing this NY Times article to my attention. In my mind, this is the stuff that defines the ATC from the rest of the health care professionals.

http://www.nytimes.com/2010/04/01/fashion/01best.html?pagewanted=2

Musings from the '09 Fascial Congress

*Great quote from Jaap van der Wal: "Ligaments do not exist, because they are so emeshed with connective tissue that the pictures we see in anatomy texts are science fiction". He feels the term "dynament" is more appropriate.

Something we tend to forget; that ligaments are alive & kickin' proprioceptively rich structures that communicate with the rest of the body and are indeed continuous with fascia.

*Carla Stecco's continuing research on the intra-fascial nervous system: These nerves are primarily oriented perpendicularly, and more likely to be stimulated by collegen stretch.

More evidence of the right/left interdependence of the body both in training and in rehabilitation.

*Serge Gracovetsky quote: "The virtually instantaneous reconfiguration (of fascia) suggests the effect of manual therapy can be immediate & significant. It is a serious challange to the classical representation and modeling of biomechanical systems."

I feel this is a nod to biotensegrity, something I feel is a better model of core stability. I always questioned the concept that it's the core that zooms the rest of the body. Dysfunctions in the limbs can indeed zoom the core and cause hip, back, and neck pain.

*Walter Herzog commented on the disconnect between "doing & explaining"; that is the researcher & the clinician.

But, that's what I'm trying to address in this blog...even though I don't always do a good job.

Hip to Shoulder 101

Here's an athlete who's never been exposed to our brand of condtioning for throwers. He began the season with some elbow and shoulder soreness. The exercises I'm using are typical warmups I use with pitchers: the 3D common lunge series c/ in/out of sync arm drivers. The top one is a RLE diagonal lunge with same side hand reach; the L hand is reaching posterior at shoulder height. The bottom pic is a LLE lunge with an opposite hand reach; L hand reaching posterior at shoulder height.

The sequence is as follows:

3D lunge c/

-BUE reach anterior @ ankle height

-BUE reach posterior @ overhead

-Same side hand reach @ ankle height c/ contralateral posterior hand reach @ shoulder height

-Opposite side hand reach @ ankle height c/ contalateral posterior hand reach @ shoulder height.

4x of each lunge= 1 set.

The Rogoff-Mozgala story: What can we learn?

"Modifying the Effects of Cerebral Palsey: The Gregg Mozgala Story"- JBMT, Spring '10

The scientific followup on this story (a video is included)
http://www.nytimes.com/2009/11/25/arts/dance/25palsy.html?_r=1

Dancers definately speak a different language than we do, it was kind of a weird read but there are lessons to be learned.

Rogoff makes the comment, "His stomach muscles had never served him as the way his upper body met his lower was disconnected from the body's original design". Sounds familiar.

Movers and shakers in the movement therapy profession go on to give their take on the therapy. Tom Myers ("Anatomy Trains"), and Leon Chaitow are included.

Myers makes a beautiful quote, "how wonderful that the method has no name...reminds us that the path to healing is not restricted by specific approaches, but wends it's way upward in switchbacks...sometimes in contrast to our "brand name" bodywork". Cool huh?!

He goes on to say, "Emphasis on the problem, difficulty, lack, and inability, even with a "helpful attitude", can leave a patient frustrated and depressed". Sounds like when we talk about setting them up for success, no?

Eyal Lederman, DO (actually checks in on this blog once and a while) suggests we substitute "rehabilitation" with "re-Abilitation". I like it.

Tomorrow People, where is your past?

http://www.youtube.com/watch?v=xT8Et9vRs-o&feature=related

Haven't heard this song in about 22 years, heard it on the radio this afternoon on a ride down to the Jersey Shore. By Ziggy Marley, Bob's son. More pertinent now than it was then.

Neural Glide, Median Nerve @ the Pronator Teres/Flexor Digit. Superficialis

Phil Donley feels that medial elbow syndrome in pitchers is a result of faulty mechanics elsewhere. If you treat the kinetic chain dysfunctions that created the injury, the elbow will get better without any further intervention(provided of course that the injury has not progressed to an MCL tear etc.). Different from the traditional reductionist approach that focuses on a lot of wrist curls/pronation exercises etc.

I agree with him for the most part; the injury most likely had nothing to do with weak elbow muscles. However, the medial structures have been overloaded to a large degree. If you run your IASTM tools over the area, you'll pick up the myofascial restrictions in the area. A valgus stress test may pick up pain/laxity over the MCL.

I'll do plenty of ART to the distal brachiialis & triceps, flexor muscles and pronator teres. Do some strumming and DTFM with the instuments over the MCL and flexor tendons. And, neural glides to the ulnar and median nerves.

Here I'm using my thumb to hold the pronator teres away from the flex.digit.super. and flossing the median nerve through. At the start, the head is side bent away, while the shoulder is abducted, the elbow is extended & pronated, and the wrist and fingers are also flexed. The athlete side bends his head toward the same side shoulder as I bring the arm into the "waiter" position. At that point I switch my thumb contact distally, holding the flexors away from the pronator teres, as I bring the arm back to the starting position and the athlete sidebends his head to the other shoulder.

All the techniques mentioned above only take a few minutes and feel great.

FMR L Hip in Batting

Doing some work here with the student who sprained his L shoulder on the follow through of a swing. I picked up a L hip internal rotation deficict which could have potentially contributed to the shoulder sprain. He's doing some oscillations at end range mimicking the backswing bookend of a right handed batter. As his hands are coming back, I'm gently accelerating his pelvis into L rotation as I'm mobilizing his L femur into internal rotation.