Dear team, Quick post today, but I had the pleasure and honor of being interviewed by my man Erson Religioso of The Manual Therapist fame. You can check the interview here http://www.themanualtherapist.com/2013/12/interview-with-zac-cupples.html
Read MoreAuthor: Zac Cupples
Treatment of Shredded Cheese of the Hip: A Case Report and Rant
A Long Day I officially eclipsed my longest work day ever. Started seeing patients at 7:30 am and finished training my last client at 10 pm. So exhausting, but the bright side is my new schedule prevents me from waking up that early ever again! Hooray for sleeping in…sort of. I figured while I had some time in the airport before my next course, I would write a little something about a patient I evaluated right before my lunch break on this long day. Needless to say, I didn’t get much of a break. Her Story This lovely lady is a nurse with a history of chronic left hip pain. She has predominately been treated surgically via labral repairs and muscle reattachment. Her most recent symptom exacerbation involved putting on her socks about a month prior. She heard a pop as she bent over and could not walk. She initially saw two ortho docs. One specializes in total hips, the other in scopes. Since she was not appropriate for a total hip, this doc referred this lady to his associate. After some imaging was done, she found out that she could not have surgery because she had several muscle tears. Or in the language that the doctor used: “I have nothing to work with. Your hip is shredded up like cheese.” This lady knew no other treatment but surgery, and hearing this news was devastating for her. Thoughts of a brutish life and an end to her fulfilling job flooded
Read MoreChapter 5: Interaction of Psychological and Emotional Effects with Breathing Dysfunction
This is a chapter 5 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below. Intro This chapter is dedicated to showing the connection between the body and consciousness; how our psyche is influenced by breathing and vice versa. This chapter was easily my favorite out of the entire book. Breathing Strategies Optimal breathing involves moderate abdominal expansion, some intercostal involvement, and minimal involvement of accessory muscles. Conversely, chest breathing is dominated by accessory muscle use. These two breathing styles are merely end points on a continuum rather than discrete categories. In terms of which strategy is used, chest breathing is often the preferred route for consciously mediated intentional breathing; whereas abdominal breathing is the main route for relaxed, automatic breathing. One reason you would want to override automatic breathing is to prepare for sudden action. At the onset of exercise, ventilation immediately jumps. This change occurs via three phases, with the first phase occurring independent of exercise load. This phase is a conscious exercise preparatory action. The other increases occur as exercise demands increase. When we are in an emergency situation, these breathing phases change. Prior to the initial pre-action deep breath comes a breath holding phase, which helps increase sensory organ stability. These preparatory breathing changes are great for imminent danger or action, but problematic when threats are non-physical and in the future. While
Read MoreCourse Notes: PRI Impingement and Instability
Soooooooooo Dense It has been a long, busy, and great few weeks for me. After attending a cluster of courses, playing around with some new jobs, moving, and working, I got some time to settle down and review PRI’s I&I material. I traveled to Phoenix to take this course. My man James Anderson taught and several good friends attended. James did not disappoint. I&I was easily one of, if not the best course I have ever taken. You did it again PRI! The only real disappointment was leaving Arizona. The temperature was in the 80’s and the sun was shining. Now here I am in the Midwest with the temp in the mid-20’s. Why did I stay here again? 🙂 This course combined and fleshed out the concepts of respiration and myokin, and added so many more layers onto what we previously learned. I&I was what DNS C should have been. I left the course with many answers, but double the questions. You truly cannot appreciate how complex the nervous system is, and how the total body responds to perceived threat until you delve into this material. I am so excited to learn more. This course had so much information regarding the entire body that there is no way I could post all the relevant info and do it justice. It really was a 4 day course done in 2. So here are a few of the gems I got from this weekend. The PRI Basis The course started off
Read MoreCourse Notes: FMS Level 2
Mobility, Stability, and the Like I recently attended the FMS Level 2 course after rocking the home study. In my quest to take every con ed course known to man, I got into the functional movement people because the idea of improving movement over isolation exercise interests me. I find the way they build up to the patterns very logical, namely because they liberally use PNF and developmental principles; and they do so quite eloquently. But really, I wanted to go to this class so I could meet and learn from Gray Cook. And his segments did not disappoint. While I may not agree with everything he says, he is a very brilliant man and knows movement. The only disappointment I have to say about this course was that I did not get enough Gray and Lee. I would say I probably saw them teach 30% of the time, with another FMS instructor just running us through their algorithms. I am sorry, but if you are going to advertise Gray Cook and Lee Burton as the instructors, then I want Gray and Lee instructing me! A lot of these exercises were review for me, but there were definitely some tweaks that I liked a great deal. I think if you are new to more motor control-based exercises, this course is great for you. Just make sure you are taking it from Gray and/or Lee. Why Screen? The FMS is predominately used to manage risk and prioritize exercise selection. They look
Read MoreChapter 4: Biomechanical Influences on Breathing
This is a chapter 4 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below. Loose-Tight Chaitow likes to use the loose-tight concept as a way of visualizing the body’s three-dimensionality while assessing. He likes to look at comparing structures as tight or loose relative to one another. Those areas which are loose are often prone to injury and more likely to be nociceptive. If we try to see which muscles have a tendency towards tightness or looseness, stabilizers tend towards laxity and mobilizers to increased tone. Obviously, all muscles function in both capacities, and some even stay more towards the middle (scalenes). But the tendency depends on which function is more dominant. Posture and Respiration (Not PRI, Peepz) Taking the previous concepts, Janda’s crossed syndromes can have a role in ones breathing function. With an upper crossed posture, the slumped upper body position negatively influences breathing function. Lower crossed syndrome will put the diaphragm in an anterior facing position, thus affecting diaphragm length-tension and breathing function. Facilitation Facilitation is an osteopathic term for a process involved in neural sensitivity. There are at least two forms of facilitation: spinal (segmental) and local (trigger points). Once facilitation occurs, any additional stress the individual undergoes can increase neural activity in the segment. There are several ways to observe facilitated segments. You can observe these via palpation: Goose flesh
Read MoreCourse Notes: DNS C
It was a Long Week After an incredibly long 5 days, I finally got the chance to assimilate what I learned from the Prague folks at the C level DNS course. Despite coming out with a few good exercise tweaks, I left disappointed. I will need some extreme convincing to continue on with their course work. A man I respect a lot, Charlie Weingroff, likes asking a question regarding interventions: “Can your treatments beat my tests?” With that in mind, I looked at DNS’s capability to beat my tests, which are predominately making changes to PRI objective measures. The answer: Mostly no. I felt a lot of activity with many of the exercises, but if we cannot make measurable changes, then the intervention is not effective. And with the DNS “objective” measures, positive change is attributed visually only. I don’t care how good your eyes are, you can never know if a joint achieves maximal bony congruency by just watching movement. Granted, I did get a few things that I will use regularly. But to get 4 or 5 takeaways for a $1000 price-tag, I feel there are better ways to spend money. Like on shawarma and stuff. Here are my likes and dislikes. Days 1 & 2 aka DNS A & B The first two days were predominately review of the A and B courses; looking over developmental positions and reflex locomotion. It was nice to review old concepts, but does it really have to take two days to
Read MoreCourse Notes: DNS Summit
Why? In my short time out I have gotten heavily into the influence that breathing has on the nervous system. Obviously PRI has been my favorite explanation thus far, but the DNS approach had me intrigued. The summit is the first of two DNS courses that I took this past week. This summit was the first of its kind, and was an amalgamation of many different speakers. Unfortunately, this summit was mostly review and wrought with little innovation. Here are some of the big points I got from a few of the speakers. “Developmental Kinesiology: Three Levels of Motor Control in Assessment and Treatment of the Motor System” by Dr. Alena Kobesova There are three levels of development: spinal, subcortical, and cortical Spinal level of motor control is primitive reflexes; subcortical motor control is core stability; cortical motor control includes individual patterns. DNS suggests inhibiting primitive reflexes instead of facilitating them for function. Core stabilization occurs first at 4.5 months development, then locomotion follows. All movement patterns are either ipsilateral or contralateral. The former develops in supine, and the latter in prone. “DNS Among Elite Athletes – MLB” by PJ Mainville Didn’t get much out of this one except PJ dancing around PRI 🙂 Recommended using theratube around the wrist so you can perform hand movements with PNF patterns as such. “DNS in Gynecological and Obstetrics Disorders” by Martina Jezkova When in quadruped, the pelvic floor does not create a base for the trunk and had no postural function. The
Read MoreChapter 3: Biochemical Aspects of Breathing
This is a chapter 3 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below. The Focus When talking about breathing biochemically, the focus will be shifted toward oxygen delivery to the tissues and carbon dioxide removal. Maintaining these gases is a complex body task due to their constant fluctuations. Looking at pH is a great way to get a glimpse of the the entire body. We know the pH scale runs from 1 to 14, with the physiological normal being between 7.35 and 7.45. If we have a value at 7.5 or above, our body goes into alkalosis. An example of this would be in the case of hyperventilation. If our pH drops to 7.3, we go into acidosis. Carbon Dioxide (CO2) CO2 determines blood acidity, and comes primarily from the mitochondria. It is the biological equivalent of smoke and ash. CO2 levels can vary with exercise, as more is produced when we are training. However, pH stays balanced because oxygen demand increases. The opposite occurs when we are not exerting ourselves because CO2 is not produced as much. Another example of changing CO2 levels is during breath holding. More is not necessarily produced, but CO2 levels rise because we are not exhaling it away. This rise is what we feel when we hold our breath. Metabolic Alkalosis and Acidosis Aberrant breathing can cause respiratory
Read MoreChapter 2: Patterns of Breathing Dysfunction in Hyperventilation Syndrome and Breathing Pattern Disorders
This is a chapter 2 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below Intro This chapter’s goal is to cover both normal and abnormal breathing patterns. Often, breathing disorders can seem similar to serious disease when in reality the patient may not be getting an adequate breath. In fact, hyperventilation syndrome (HVS) and breathing pattern disorders (BPD) have the following incidence: 10% of general medicine practice patients have HVS/BPD as their primary diagnosis. Female:male is about 2:1 to 7:1; most commonly in the 15-55 year age group. Acute HVS only makes up about 1% of cases. Normal Breathing The normal resting breathing rates equate to around 10-14 breaths per minute, which moves around 3-5 liters of air per minute through the airways. Not so Normal Breathing HVS/BPD can be defined as a pattern of overbreathing where the depth and rate are greater than the body’s metabolic needs. In some cases, such as during exercise and organic disease, hyperventilation is an appropriate response. It is when these causes are not found that we attempt to affect these breathing patterns. There are a large number of symptoms that may coincide with HVS, but none are absolutely diagnostic. Oftentimes these symptoms are exaggerated when one has a hyperventilatory episode. I will break the signs and symptoms into the following categories: Neurological Headache Numbness and tingling Giddiness/dizziness
Read MoreChapter 1: The Structure and Function of Breathing
This is a chapter 1 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below Motivation Breathing has been something I have been interested in very much since I first learned about its power from Bill Hartman and through the Postural Restoration Institute, and this excellent book is a great way to get a full overview. The first chapter covers too much anatomy to go through every little detail in my short blog post. So study up. Here are the highlights. Structure, Function, and You In order to have favorable respiration, structure makes all the difference. Adequate thoracic, ribcage, and breathing muscle mobility must be restored and maintained in order to uptake a quality breath. This can be achieved via re-education and training. Realize too that psychological distress can also play a huge role in how we breathe. Disorders such as anxiety and depression can have corresponding breathing dysfunctions. It may be the way the body responds to ensure survival. Ergo, when attempting to change breathing patterns favorably, one must address both structural and psychological factors. Homeostasis Homeostasis is the body’s process to normalize itself. If too many homeostatic-disrupting tasks are occurring at one time however—such as nutritional deficiencies and toxin ingestion—homeostatic function can become overwhelmed. This systematic stress can lead to breakdown and a switch to heterostasis, in which the body must be treated. We
Read MoreChapter 12: Lower Limb
This is a Chapter 12 summary of “Clinical Neurodynamics” by Michael Shacklock. Piriformis Syndrome Piriformis syndrome often involves the fibular tract of the sciatic nerve. It has the capacity to create symptoms from the buttock down to the anterolateral leg. Testing the neurodynamics with a fibular nerve bias is essential. To attempt to isolate this problem, we must best differentiate interface from neurodynamic components. Using Cyriax principles –palpation, contraction, and lengthening –can be beneficial in this regard. Keep in mind that below 70 degrees hip flexion the piriformis produces external rotation, and above 70 degrees it is an internal rotator. When treating this problem, the goal is to change pressure between the piriformis muscle and the sciatic nerve. Level 1a – Static opener VID – KF, ER Level 1b – Dynamic opener VID – Passive ER Level 2a – Closer mobilization using passive IR. VID – Passive IR Level 2b – We finish with a passive piriformis stretch VID – Tailor stretch If there is a neurodynamic component to things, slightly modify things by using sliders. We start things off with the same opener as the interface above. As the patient progresses, you can add proximal or distal components eventually finishing with a fibular nerve-based slump. VID – Building the slump To combine interface and neural treatments, contract-relax can be utilized. Sciatic Nerve in the Thigh Oftentimes with hamstring strains, sciatic nerve sensitivity can increase. The slump and straight leg raise tests can be utilized to help differentiate a pure
Read More