3 - movement and motor control lecture - northwestern ... · • anatomy trains –tom myers •...
Post on 27-May-2018
219 Views
Preview:
TRANSCRIPT
1/5/2015
1
Understanding Movement Evaluation of The Low Back
Hip and Knee
Dr. Kevin Kerchansky DC, DACRB, CSCS, CICE
www.frseminars.com
www.frseminars.com
Science Research
Anecdotal Clinical
Philosophy Dogma
www.frseminars.com
Fast Medicine
New Symptoms
Treatment
Side Effects
Treatment
1/5/2015
2
www.frseminars.com
Trends and Fads Or GoodScience?
Gingko Biloba, Ginseng, Acai Berry Magnetic Bracelets, Copper Sleeves
Green Coffee, Creatine,Multivitamin
EMS, Ultrasound, Cold Laser
HCG, Atkins, Low-Fat, Paleo, Keto Spinal Manipulation, MRT
Vegetarian, Vegan, Lacto-Ovo Meniscus Surgery, Carpal Tunnel Surgery, Spinal Fusion
Statins, PPI’s, NSAID’s, Opioids, SSRI
Microdiscectomy, Medial Branch Block, Radiofrequency Ablation
Juicing, Cleanses, Intermittent Fasting
Acupuncture, Dry Needling
Detoxifications Stretching, Yoga
STRUCTURE VS FUNCTION
www.frseminars.com
Structure = Pictures
www.frseminars.com
1/5/2015
3
Structural Approach
“Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear”
– “One year after the procedures, patients in both groups reported similar improvements in pain and quality of life.”
– “Researchers concluded the actual procedure did not provide any additional benefit over the sham surgery.”
– New England Journal of Medicine, Dec. 26, 2013
www.frseminars.com
Structure = Pictures
www.frseminars.com
Structural Approach
“A review of more than 3200 cases of acute low back pain suggests that for similar patient presentations, those who had MRI’s early on in their care had a worse outcome, more surgeries, higher costs and greater disability.”
- Journal of Occupational and Environmental Medicine. 2010 Sep;52(9):900-7
www.frseminars.com
1/5/2015
4
Structure v. Function
• Movement Approach Includes:
– Load/Gravity
– Posture
– Position
– Muscle Activation
– Stabilization
– Compensation
• Leads to Compression and Shearing Forces
www.frseminars.com
Structure vs. Function
www.frseminars.com
Neurodevelopmental Model
www.frseminars.com
1/5/2015
5
Movement
• “First Move Well and Then Move Often.” - G. Cook
• Requirements for Movement– Arthrokinetic Capacity
– Tissue Flexibility
– Motor Control
– Strength (Under Increasing Load)
www.frseminars.com
Motor Control
“The ability to actively utilize the vast majority of available passive range of motion with biomechanical efficiency.”
• Uncompensated Movement
• Efficient Movement
• Stable Movement
www.frseminars.com
www.frseminars.com
Joint By Joint Approach
- Cervical – S
- Thoracic – M
- Scapula – S
- Glenohumeral – M
- Lumbar – S
- Hip – M
- Knee – S
- Ankle – M
- Foot – SS = Stable
M = Mobile
1/5/2015
6
Spinal Stabilization
www.frseminars.com
Inner Core: Transverse Abdominis, Pelvic Floor, Multifidus, Internal Obliques,
DiaphragmOuter Core:
External Obliques, Rectus Abdominis, Latissimus Dorsi, Quadratus Lumborum, Psoas, Gluteals etc
Core Concepts
• Feed-Forward Mechanism
• 360 Effect
• Pressure Cooker Analogy
• Spinal Stability
• Proximal Stability Before Distal Mobility
• The Search for Stability
• One-Joint Theory
• Two-Hand Rule/Ribs to ASIS - Kinesthetic
www.frseminars.com
Diaphragm Importance
www.frseminars.com
� Creates Top of Inner Core
� Acts as Postural and Respiratory Muscle
� Stress Breathing (Apical Breathing) is Improper
� Stress Breathing Inhibits Re-education
of the Nervous System
1/5/2015
7
Default Positions
www.frseminars.com
Default Positions
www.frseminars.com
www.frseminars.com
1/5/2015
8
www.frseminars.com
Injury Risk and Functional Tolerance
www.frseminars.com
Breakdowns In Movement
www.frseminars.com
Range of Motion
Joint Tissues
Motor Control
Full Movement
Stable
Uncompensated
Efficient
1/5/2015
9
Range of Motion Elements
Joints
• Thoracic Spine
• Sacroiliac
• Hip
• Ankle
Treatments
• Manipulation
• Mobilization
• Mulligan Mobilizations
www.frseminars.com
Range of Motion Elements
Tissues
• Quadriceps
• Rectus Femoris
• Psoas
• Adductors
• Hamstrings
• Gastroc/Soleus
• Piriformis
• Quadratus Lumborum
• Erector Spinae
• Capsules
Treatments
• Myofascial Release
• Active Release Technique
• Graston
• PNF
• Mashing
• Foam Rolls
• Lacrosse Balls
• Various Soft Tissue Tools
www.frseminars.com
Motor Control Elements
Motor Control
• Altered Movement Patterns
• Dyskinesia
• Overactive/Inactive
• Shortened/Lengthened
• Tonic/Phasic
• Compensation Patterns
• Joint Imbalances
Treatments
• Active Rehabilitation
• Incorporate Increasing Postural Load
• SFMA 4x4 Matrix
www.frseminars.com
1/5/2015
10
Mobility FirstAllows Expression of
Ideal Fit
• Increased Human Performance
• Injury Prevention
• Injury Resolution
• Attenuation of Injury (Ghosting)
Improves Areas of Fitness
• Strength
• Power
• Endurance
• Cardiorespiratory Capacity
• Balance
• Agility
• Speed
• Stamina
• Accuracy
www.frseminars.com
The Importance of Optimal Mobility
Quality Stability Is Driven By Quality Proprioception
Quality Proprioception Is Not Possible With Limitations In Mobility
Excessive Mobility Require Excessive Control
www.frseminars.com
Evaluation Algorithm
• Movement Evaluations Under Load
• Breakout Dysfunctional Movement Under Decreased Load
• Evaluate If Active and/or Passive Range of Motion Is Full
• If Active or Passive Range of Motion Is Full Under No Load A Motor Control Deficit Exists
www.frseminars.com
1/5/2015
11
Sample Tests
• Standing Toe Touch (Multisegmental Flexion)
• Single Leg Stand
• Overhead Squat
• Global Extension (Multisegmental Extension)
• Lunge Test
• Step Up/Step Down Tests
• Single Leg Squat
• DeadLift Test (Hip Hinge Test)
www.frseminars.com
Treatment Algorithm
• Restore Passive Range of Motion Deficits
– Joints and Tissues
• Cement New PROM With Active Exercises
– If Stretch Psoas to Full Length Follow With Active Hip Extension Exercise
• Correct Motor Control Deficits ^^^
• Restore Movement Patterns
www.frseminars.com
Treatment Algorithms
“Rehabilitation of The Spine” – C. Liebenson
• Mobilize Stiff joints
• Relax Overactive Muscles
• Facilitate Inactive Muscles
• Restore Functional Movement Patterns at Subcortical Level
www.frseminars.com
1/5/2015
12
Treatment Algorithms
• Functional Exercise Progression – P. Page
www.frseminars.com
Soft TissueProprioception and Posture
Pain and Inflammation
Balance/StabilityMuscle Activation/
StrengthFlexibility/ROM
SkillMovement
Synergy
The Range of Motion/Motor Control Continuum
“Improving PROM decreases motor control.”
“Improving PROM does not improve AROM in the hip.”
“Core or proximal stiffening provides a base for the limb movement. However, this increased prom does not transfer to function; in order for new motor patterns to be adopted, old patterns must be overcome.”
Lower Extremity Review, Nov 13, Vol 5
www.frseminars.com
Recommended References
• Movement – Gray Cook
• Anatomy Trains – Tom Myers
• Assessment and Treatment of Muscle Imbalance – Phil Page et al
• Kelly Starrett – www.mobilitywod.com
• Functional Movement Systems
• Selective Functional Movement Assessment (SFMA)
www.frseminars.com
top related