Wednesday, April 28, 2010

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.

7 comments:

Kev said...

Interesting read to be sure. I am very interested to read the next article that will discuss the alternative approach to the issues of LBP.

I would be really interested to hear what chiropractors have to say about this article as it seems to suggest that chiropractic (as well as traditional assessment/care in the AT and PT worlds) approaches aren't necessarily the correct or appropriate ways to deal with LBP issues.

Is it just me or is this article in some ways contradictory of some of the EBM on LBP?

Joe Przytula said...

I'm not sure this necessarily runs counter to our functional path at all Kev. Remember, Doc Lederman is an ostopathe himself, and uses manipulative medicine in his practice. If I understand him correctly, and although I would never put him on the spot and ask him, I THINK he may be referring to the Janda/NASM approach; and yeah maybe SOME of the structural guys like the Rolfists and SOME chiropractors and manual P.T.'s. The functional approach IS a biomechanical appproach, but has an integrated neuromuscular component threaded through it. As opposed to "facilitating" individual muscles. Let's see what the rest of the gang has to say.

Pete Koeniges said...

I'm interested in the follow up as well. I believe most of us have been trained using the PBS model and if the patient is asymptomatic with asymetries, good for them. I would be interested in understanding why pain always goes back to asymetries, but no pain, the asymetries are disregarded. Even baseball players can't be great without asymetries:) Very interesting article. Thanks for sharing.

Brian Green said...
This comment has been removed by the author.
Brian Green said...

Postural = static assessment
Structural = static assessment
Biomechanical = Can be dynamic however do we do this effectively at the moment?

Perhaps "assessments" that are static in nature(laying supine, standing) to identify assymmetries are not applicable as described in Van Nieuwenhuyse et al)? This lends to this paper's premise to the questionable relationship between structural imbalances and LBP.

Every anatomical structure is at the mercy of gravity and Newtons Laws. Therefore, I don't think we can ignore that load deformation curves are a real thing and can build and break down "the biological organism". Yes we are an adaptable species but we're not perfect. Therefore, we cannot be a perfect biomechanical model. Biomechanics does explain there are kinetics and kinematics that are deleterious to the ACL especially in females. So I dont think the PSB model is completely flawed especially the B in the acronym. The FMS is not the complete answer but perhaps it provides a basis to guide clinicians to appreciate physics during movement, the adaptations that humans undergo to perform a movement and or task, and how this can be positive or negative.
In relation to pain if the medical profession truly understood it then why does it spend gajillions on R&D to alleviate it? Personally I don't think I know a lot about it either but I do know Newtons Laws and I continue to learn and apply how it can help people function efficiently.

sal m said...

Perhaps the problem lies in the "over-selling" - or perhaps more accurately - "over-reliance" on these guidelines as being the be-all, end-all.

From a strength coach/athletic development coach perspective I see trainers trying to address a perceived strength imbalance or weakness by working on individual muscle groups, putting the body into various, unnatural/counter-intuitive positions, trying to get client to control timing pattern of movements,ignoring gravitiy, etc. IMHO, in the attempts at developing this harmony Lederman refers to, people in my profession are acutally contributing to disharmony. Perhaps the same can be said about how the rehab approach, unwittingly, may have a similar effect.

I know trainers who spend an inordinate amount of time having clients perform get-ups and other prone/supine based movements, and it seems that these clients always have some kind of back/hip issues that limits performance. Rather than think the training may be contributing to the problems, these trainers spend more time doing things that ignore gravity.

Once last thing. As I read this I was thinking that if these imbalances and pain are so catastrophic, how is it that elite athletes can perform? Forget about the heroic efforts of a gymnast like Kerry Strug or other cases of an athlete overcoming a severe injury to compete and excel, but what about the day-to-day nagging injuries that all athletes must contend with? Lederman addresses this on page 8 in the first paragraph in the section headed "Conflict within teh PSB model." Not only wouldn't athletes be able to compete, they would never recover from an injury. An injury suffered by a football player in training camp - whether in be high school or the NFL - would set off a series of other issues that would ultimately result in missed time and chronic problems. However, we know that this isn't the case.

JH said...

Joe,
I've tried to post twice on this article but it won't accept it. I may be going over a word limit. It's been rather long both times.