Sunday, March 27, 2011

Sahrmann vs. Lederman

I listened to a recent webcast from Dr. Shirley Sahrmann in which she says a if you can't recruit a specific muscle under a controlled condition, there is little chance it will be beneficial in an integrated manner.  If you read her "movement impairment syndromes" book, a lot of open chain strengthening done on-table with alot of grooving movement patterns to get that muscle working in the real world sort of speak.
Dr. Eyal Lederman, on page 10 of his "Neuromuscular Rehabilitation in Manual & Physical Therapies" he says, "There are several misconceptions about motor control which are likely to make rehabilitation unnecessarily long and complex.  They all originate from the principle of "isolate in order to integrate".  The muscle is NEVER the goal of the movement.  Focusing on tensing, clenching, bracing, or holding specific muscles during movement turns them into the goal of the movement.  Muscles work in complex synergies- they never work alone.  All muscles are equally important, even muscles that are silent.  Muscles which are slow or at low EMG activity are part of the whole control pattern."

Sahrmann's approach is very much, "isolate to integrate".

In her excellent text, "Diagnosis & Treatment of Movement Impairment Syndromes", for the most part she uses very isolated corrective muscle work. On page 32 she says, "the desired muscle action should be practiced under the specific conditions in which it is to be used."

Comments?

5 comments:

The Iron Maven said...

Joe,

The PT/ATC clinicians who ran the seminar I attended this weekend had very much the same view of isolate before integrate. Spent lots of time saying why CC stuff may not be as effective as OC stuff--don't risk compensation or train what they see as "compensatory" patterns.

This is a very strong mindset in the rehab community and may not serve us or our patients well. I'm more of a top-down thinker. I can effect the system at a global level and produce positive changes locally. I don't want to get stuck on EMG readings. I want to see quality movement. Don't always know exactly what is working when, but that's ok. Trying to figure out such detail might actually distract me and keep from letting the inherent wisdom of the body succeed.

Tracy

Joe Przytula said...

Thanks for weighing in Maven. To me, there is quite a disconnect in the isolationist theory. To be specific, you are removing the "neuromuscular" portion of the equation. The fact that MOST (possibly all) muscles in the body behave "ecconentrically"- that is they could be contracting isometrically, eccentrically, and concentrically simultaneously in different planes at the same time, as dictated by the task. HOW do you duplicate that in isolation?? They talk "functional", but yet their approach is very much mechanical. How do you take for example something like walking, which is heavily socially influenced, and instruct some one how to "do it correctly". But even on the mechanical level, we now know 17% of muscle force never makes it to the tendon
("Epimuscular Myofascial Force Transmission Implies
Novel Principles for Muscular Mechanics" Exercise & Sport Science Reviews" 10-10.) There has got to be a biological reason for that; the author feels that it creates the fascial tension that is required for completion of the task. What we speak of here Maven is not new age fuzzy hocus pocus.

Jay V said...

Joe,

I absolutely love your blog!! Great ideas and concepts to think about as well as incorporate right away into practice.

However, I am not sure I am totally going to dismiss the 'isolate' idea.

My thinking is this:

If I have a muscle that is 'not as active as it should be'. Wouldn't that manifest itself in decreased strength, range of motion, proprioception or quality of movement? If that is the case and the athlete is able to be screened through FMS and I see a deficit, why wouldn't I want to isolate whatever muscles may be inhibited by pain or decreased neuromuscular firing for any reason. The body is trying to accomplish a goal and the athlete is trying to compete so in order to accomplish that level of function they are going to find ways to perform whatever maneuver they need to.

If a muscle is not performing as it should and another area of the body (muscle, joint, fascia, etc.) needs to pull extra work, depending on how long this goes on prior to someone seeing a problem, the athlete finally reporting it then a new habit (alternative neuromuscular pattern) may be formed. We need to reestablish the function of the muscle in order to achieve the movement quality that the athlete needs and the body desires. I am unsure how one can break an acquire neuromuscular pattern if we can not isolate the various components that got the athlete there in the first place. Depending on the setting it could be a college kid that has had a back problem for years and it simply never hurt enough to keep them from competing. Then there could be many years of compensatory movement. I believe you are correct that muscles never work in isolation, therefore they need to rely on all other muscles doing their job and if one is not, then others need to work harder and may get over-fatigued and breakdown.

Break down movement patterns to something the athlete can perform correctly, yet forces them to incorporate the deficient muscles and then build back up to the 'flagged movement they were identified with earlier to assess if it is improving.

Please let me know if I am totally off base here, it could be old school 'rehab kool-aid' that I am drinking.

Great discussion!

Jason

Joe Przytula said...

Welcome aboard Jason, and its quite all right to disagree here.

First of all, I don't use the FMS. I won't get into WHY in this blog. But thats where this "corrective exercise" stuff comes from. I know I talk about the PCA here, but I must emphasise it is NOT a movement screen. Rather, it is a base of movement skills that, when lacking, interfere with motor learning/development as per Richard Magill (page 57-58"Motor Learning and Control- Concepts and Applications").

Getting a muscle "to fire better" or "activate" are not really functional terms, because we are not using what Gary Gray calls "authentic drivers" to achieve it. Authentic drivers would produce "integrated isolation". That is, a muscle or group of muscles may be mechanically loaded more than others, but in the context of the entire kinetic chain. The muscle isolation we are speaking of here is "isolated isolation", which is very rarely used in function. We are second guessing the wisdom of the body.

You are correct sometimes faulty movement patterns continue long after they have outlived their usefulness. But if you get your rehab right the first time you can keep this to a minimum. When it does occur, yes you are correct, it is beneficial to break down skills into manageable parts.

In my mind, if you are doing something close chain and you are afraid you are risking compensations, simply shorten your lever arms; or re-orient the body to gravity to get it back inside the envelope of function.

israel said...

Excellent post. Very thought provoking.