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 MoreAuthor: Zac Cupples
Chapter 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 MoreChapter 11: Lumbar Spine
This is a Chapter 11 summary of “Clinical Neurodynamics” by Michael Shacklock. Physical Exam The slump is the big dog for assessing lumbar spine complaints. Deciphering which movements evoke the patient’s symptoms can tell you a lot about the nervous system’s dysfunction: Neck flexion increases symptoms – Cephalid sliding dysfunction. Knee extension/dorsiflexion increases symptoms – Cauded sliding dysfunction. Both neck flexion and knee extension increase symptoms – Tension dysfunction. The straight leg raise is another important test that can help determine the nervous system’s state. Treatment The treatment parallels similar tactics as previous body areas. For reduced closing dysfunctions We start level 1 with static openers, progress to dynamic openers, then work to close. For opening dysfunctions, we progress toward further opening/contralateral lateral flexion. Neural Dysfunctions We treat these mechanisms based on which dysfunction is present. For cephalid sliding dysfunctions, we approach with distal to proximal progressions; and for caudad sliding dysfunction, we work proximal to distal Tension dysfunctions are started with off-loading mvoements towards tensioners Complex Dysfunctions Sometimes you can have interface dysfunctions that simultaneously have contradictory neurodynamic dysfunction. There are several instances of the case. Reduced closing with distal sliding dysfunction – Treat by combining closing maneuvers while perform active knee extension. Reduced closing with proximal sliding dysfunction – Address by closing maneuver with neck flexion. Reduced closing with tension dysfunction – This is treated with adding closing components to tensioners Reduced opening with distal sliding dysfunction – Here we add a dynamic opener along with leg movements. Reduced
Read MoreCourse Notes: PRI Myokinematic Restoration
What a Class Wow. That’s all that really needs to be said. I have had a great deal of exposure to PRI in the past, but I have only had one formal class under my belt. Needless to say, I was looking forward to learning more. James Anderson and the PRI folks did not disappoint. Myokinematic Restoration was easily the best class I have taken all year. It also helped having another like-minded group attending. You learn so much more when you are surrounded by friends. Here is the course low-down. Disclaimer for the Uninitiated I know there are a lot of misconceptions about PRI on the interwebz. Even though posture is in the name, PRI has little to do with posture in the traditional sense. We know posture does not cause pain, and PRI agrees with this notion. But it’s not like they can change the name of the organization now. What? Do you think Ron Hruska is Diddy or something? After discussions with James and his mentioning this aloud in class, the target of PRI is the autonomic nervous system. Not posture, not pain, not pathoanatomy, but the brain. Essentially, they have figured out a window into the autonomic nervous system via peripheral assessment. Moreover, PRI is not in the pain business, though many think this is the case. Hell, even in the home studies they mention pain quite a bit. But realize those were done in 2005. Would you like me to hold you to things you have
Read MoreChapter 10: Upper Limb
This is a Chapter 10 summary of “Clinical Neurodynamics” by Michael Shacklock. Thoracic Outlet Syndrome (TOS) When discussing TOS pathoneurodynamics, you must talk about breathing. The brachial plexus passes inferolaterally between the first rib and clavicle. When inhalation occurs, the plexus bowstrings over the first rib cephalidly. So breathing dysfunctions can contribute to one’s symptoms. Excessive scapular depression can also contribute because the clavicle approximates the plexus from above. Clinically, TOS often presents as anteroinferior shoulder pain, with some cases passing distally along the course of the ulnar nerve. A resultant upper trapezius/levator scapula hyper or hypoactivity can occur that may affect the neural elements. Treating the Interface Level 1 – Static Opener with breathing Level 2 – Static opener with rib mob during exhalation; progressing with scapular depression. Level 3 – Rib depression with sliders and tensioners. Pronator Tunnel Syndrome This syndrome consists of pain in the anteromedial forearm region with or without pins and needles. Symptoms are usually provoked by repetitive activities such as squeezing, pulling through the elbow, and pronation movements. From an interface perspective, pronator syndrome deals with excessive closing. So we will use openers to treat. Level 1 – Static opener combining 60-90 degrees of elbow flexion with forearm pronation Level 2 – Dynamic opener Treating neural components depends on the present dysfunction. There are the following possible dysfunctions: Distal sliding dysfunction – symptoms decrease with contralateral cervical flexion. Proximal sliding dysfunction – Symptoms increase with contralateral cervical sidebend and finger flexion. Tension dysfunction –
Read MoreChapter 9: Cervical Spine
This is a Chapter 9 summary of “Clinical Neurodynamics” by Michael Shacklock. Physical Exam The key tests you will want to perform include: Slump test. MNT 1. You can tier your testing based on one’s dysfunctions, such as opening or closing, as well as using sensitizers for less severe problems. Reduced Closing Dysfunction Level 1a – Static opener to increase space and decrease pressure in the intervertebral foramen. In the picture below, we would open the right side by combining flexion, contralateral sidebend, and contralateral rotation. Level 1b to 2b Reduced Opening Dysfunctions For these impairments, they are treated just the same as closing dysfunctions. The major difference is rationale. In closing dysfunction, the goal is to reduce stress on the nervous system. With opening dysfunctions, however, we are trying to improve the opening pattern. Static openers will generally not be used because these treatments could potentially provoke symptoms. Neural Dysfunction The gentlest technique is the two-ended slider, in which an ipsilateral lateral glide and elbow extension are performed. For tension dysfunctions, we go through the following progression:
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