This is a Chapter 2 summary of “Clinical Neurodynamics” by Michael Shacklock. Intro Specific neurodynamics include local effects of body movements on the nervous system. So today we will go through each body region discussing these. The Spine Here are some interesting tidbits regarding the spine and neurodynamics. When we flex the spine, the spinal canal elongates by about 9 cm. Neck flexion creates significant tension to the lumbosacral nerve roots. Neural structures slide relative to the bony interface differently depending on the location and the movement used. Flexion increases tension, but reduces compression. Extension adds compression, but reduces tension. Lateral flexion increases tension on the convex/contralateral side of the spine. This situation occurs by interface and neural tissue elongation and increased distance between the spine and periphery. Rotation closes on the ipsilateral side and opens on the contralateral side. The spinal cord tends to move towards various specific segments. These areas are termed zones of convergence, and these areas include C5-6 and L4-5. For example, tissues above C5-6 will slide toward this zone, as will tissues below this segment. The midpoint at which tissues diverge is at T6. At this point, tissues below T6 will converge towards L4-5, and tissues above T-6 will converge to C5-6. Gravity can also play a role in neurodynamics. For example, if you perform a SLR in sidelying, the downward side usually has less mobility. This difference occurs because the neural contents are convex on the downward side and convex on the upper side,
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Chapter 1: General Neurodynamics
This is a Chapter 1 summary of “Clinical Neurodynamics” by Michael Shacklock. Concepts When we first started working with the nervous system, oftentimes we called pathological processes adverse neural tension. The problem with this name was that it left out nervous system physiology; it was mere mechanical concepts. Hence, we call the movement and physiology of the nervous system neurodynamics. General neurodynamics account for whole body fundamental mechanisms, regardless of region. Specific neurodynamics, on the other hand, applies to particular body regions to account for local anatomical and biomechanical idiosyncrasies. The System There are three parts to the neurodynamic structure: 1) The mechanical interface 2) The neural structures 3) The innervated tissues The mechanical interface is that which is near the nervous system. It consists of materials such as tendon, muscle, bone, intervertebral discs, ligaments, fascia, and blood vessels. The neural structures are those which make up the nervous system. These structures include the connective tissues that forms the meninges (pia, arachnoid, and dura mater) and peripheral nervous system (mesoneurium, epineurium, epineurium, and endoneurium). The nervous system has mechanical functions of tension, movement, and compression. It also has physiological functions to include intraneural blood flow, impulse conduction, axonal transport, inflammation, and mechanosensitivity. The innervated tissues are simply any tissues that are innervated by the nervous system. They provide causal mechanisms for patient complaints, and are able to create nerve motion. When we have neural problems, sometimes the best treatment is to these structures. You must treat everything affected. Mechanical Functions
Read MoreWhy Everything Works (and Doesn’t Work)
A Great Place to Be I was recently at my home away from home, IFAST. Every time I go here the following occurs: I have an amazing time with amazing people. I learn a ton and realize how little I really know. Prolific discussions are had. I end up purchasing WAY too many books as soon as I get home. As many of you know, Bill Hartman and I appreciate a PRI philosophy. When I go to IFAST, we inevitably experiment with many different things. This weekend, Bill and I were playing with how many different ways we could achieve full right shoulder internal rotation on my good friend Lance and the lovely IFAST intern Liz. Here was everything that gave these people full motion. Soft tissue mobilization to the infraspinatus. Manually assisted breathing. Tickling the right side of the face. Tapping the left hamstring. Smacking the right glute max (yes, I spanked someone). Having someone think about contracting their right glute max as hard as possible. Having someone watch me breathe with a left sidebend. Reflex locomotion. Now of course, that does not mean you should be spanking your patients and clients with shoulder issues (but if you do make sure it is the right glute), but we have to ask why did all of these different techniques–even the weird ones– achieve the same outcome we wanted? Why Things Work Joseph Brence, a gentleman whose material I enjoy, recently posted a blog showing several different techniques and polling his
Read MoreChapter 15: In Conclusion
This is a chapter 15 summary of the book “Movement” by Gray Cook. The Goal The goal of movement retraining is to create authentic unconscious movement at acceptable levels. We can develop many methods to achieve our goals, but working under sound principles is paramount. Some of the principles Gray advocates include: Focusing on how we move. Look to movement to validate or refute your intervention. Movement is always honest. When designing a movement program, we must operate under the following guidelines: Separate pain from dysfunctional movement patterns. Starting point for movement learning is a reproducible movement baseline. Biomechanical and physiological evaluation do not provide a complete risk screening or diagnostic tool for comprehensive movement pattern understanding. Our biomechanical and physiological knowledge surpass what we know about fundamental movement patterns. Movement learning and relearning follows a hierarchy fundamental to the development of perception and behavior. Corrective exercise should not be rehearsed outputs. Instead, it should be challenging opportunities to manage mistakes on a functional level near the edge of ability. Perception drives movement behavior and movement behavior modulates perception. We should not put fitness on movement dysfunction. We must develop performance and skill considering each tier in the natural progression of movement development and specialization. Corrective exercise dosage works close to baseline at the edge of ability with a clear goal. The routine practice of self-limiting exercises can maintain the quality of our movement perceptions and behaviors and preserve our unique adaptability that modern conveniences erode. Some things cannot
Read MoreChapter 14: Advanced Corrective Strategies
This is a chapter 14 summary of the book “Movement” by Gray Cook. Inputs Corrective exercise is focused on providing input to the nervous system. We are allowing the patients and clients to experience the actual predicament that lies beneath the surface of their movement pattern problem. It is okay for mistakes to be made, for these errors help accelerate motor learning. Minimal cueing should be utilized, as we want to patient to let them feel the enriching sensory experience. Motor Program Retraining There are several different methods in which we can achieve a desired motor output. 1) Reverse patterning – Performing a movement from the opposite direction. 2) Reactive neuromuscular training – Exaggerating mistakes so the patient/client overcorrects. Use oscillations first, followed by steady resistance. 3) Conscious Loading – Using load to hit the reset button for sequence and timing. 4) Resisted exercise – Makes patterns more stable and durable. When you can deadlift that much, most anything is stable and durable.
Read MoreMovement Chapter 12: Building the Corrective Framework
This is a chapter 12 summary of the book “Movement” by Gray Cook. A Whole Lotta P When we build our corrective framework, we must take into account the 6 P’s: 1) Pain – Is there pain with movement? Staying away from pain improves motor control. 2) Purpose – What movement pattern are we targeting with corrective exercise and what problem are we addressing (i.e. mobility, stability, dynamic motor control)? 3) Posture – Which moderately challenging posture is the best starting point for corrective exercise that allows for reflexive activity? 4) Position – Which ones demonstration mobility/stability problems and compensatory behaviors? 5) Pattern – How is the dysfunctional movement pattern affected by corrective exercise? 6) Plan – How can you design a plan based on findings? The goal when designing the correction is to stay in the middle ground of the autonomic nervous system while providing a rich sensory experience. Movement pattern dysfunction is a behavior that needs to be addressed and changed.
Read MoreMovement Chapter 11: Developing Corrective Strategies
This is a chapter 11 summary of the book “Movement” by Gray Cook. Autonomics All exercise affects tone and tension. This influence is the basis for movement. The autonomic nervous system determines movement as threatening or not, which determines requisite tone. It is important to nudge movement towards further nonthreatening yet advanced stimuli. FMS Corrections Proceeding to correct under FMS protocol is determined by screen results and changed via exercise. We first correct mobility, next reinforce stability, then retrain movement patterns. Stability training in particular follows a sequence: 1) Challenge posture and position. 2) Build mid-range strength. 3) Develop end-range stability. Movement patterns are corrected in the following hierarchy: ASLR & Shoulder mobility → rotary stability → pushup → Inline lunge → hurdle step → Deep squat SFMA Corrections The SFMA corrective pathway is nonlinear unlike the FMS. The breakouts will tell you which direction to go to restore optimal movement. The options are also increased. Often to gain mobility, you would utilize various manual therapies or other modalities. To alter stability, taping, orthotics, braces, or anything else to increase motor control may be utilized. Movement patterns are corrected in the following hierarchy: Cervical spine → Shoulder →multi-segmental flexion & extension→ Multisegmental rotation →single leg stance → Squat Depending on how movements present, certain therapies are utilized: DN – manual therapy and corrective exercise. DP – Manual therapy and modalities. FP – Modalities and manual therapy. FN – General exercise. Exercise Categories There are several exercise types that can be utilized depending on one’s goal:
Read MoreMovement Chapter 10: Understanding Corrective Strategies
This is a chapter 10 summary of the book “Movement” by Gray Cook. Mistakes, I’ve Made a Few When we are talking corrective exercise design, people often make 4 mistakes: 1) Protocol approach: Exercise based on category. Problem – 1 size fits all. 2) Basic kinesiology: Target prime movers and some stabilizers. Problem – fails on timing, motor control, stability, and movement. 3) Appearance of functional approach – Use bands and resistance during functional training. Problem – If the pattern is poor, adding challenges to it can increase compensation. There is also no pre-post testing. 4) Prehabilitation approach – Prepackaged rehab exercises into conditioning programs as preventative measures to reduce injury risk. Problem – Design is based on injuries common to particular activities as opposed to movement risk factors. There are also certain mistakes that are often made when utilizing the FMS and SFMA: 1) Converting movement dysfunction into singular anatomical problems. 2) Obsessing over perfection in each test instead of identifying the most significant limitation/asymmetry. 3) Linking corrective solutions to movement problems prematurely. The overarching rule is to address these movement deficiencies first, as we do not want to put strength or fitness on top of dysfunctional movement. The Performance Pyramid When designing an exercise program, we look for three areas to improve performance: Movement, performance, and skill. It is important that program design is based on the individual’s needs and has these qualities in a hierarchal fashion. For example, if one performs excellent on functional performance
Read MoreMovement Chapter 9: Analyzing the Movements in Screens and Assessments
This is a chapter 9 summary of the book “Movement” by Gray Cook. While I have broken up these sections into patterns, much of what Gray talks about does not involve the patterns themselves, but are still good points to know. Ergo, much like the book itself, this post may seem a little disjointed 🙂 The Deep Squat One’s inability to squat is not considered a single problem. Instead, a disconnect is present between the body and the brain in the squatting pattern. Our brain sees things in patterns, and the squatting pattern essentially gets smudged. Before performing the squat as an exercise, we must first groove an optimal movement pattern. One interesting point regarding the squat is that as an exercise it is often a top-down based movement. However, when we learn to squat in development, the movement occurs bottom-up. So one way to train the squat is by starting from the bottom of the squat and working to standing. This method ensures full mobility to perform a full deep squat. To relate the SFMA to the squat pattern, Gray is very clear about not training the squat if one cannot touch his or her toes. Hurdle Step and Single Leg Stance These two movements simultaneously test mobility and stability of both legs. Oftentimes in these patterns you will see a high-threshold strategy (HTS), in which a hyper-protective core response occurs. Research demonstrates that this stabilization strategy can cause poor motor control to occur. These tests also are basic
Read MoreMovement Chapter 8: SFMA Assessment Breakout Descriptions and Flowcharts
This is a chapter 8 summary of the book “Movement” by Gray Cook. What to Look For The SFMA breakouts are utilized to determine if one’s movement deficiencies have a mobility or stability origin. There are further possibilities in each of these categories. It Could Be a Mobility Problem There are two subsets of mobility problems that include tissue extensibility dysfunction (TED) and joint mobility dysfunction (JMD). From here, we can break it down even further in each subset. Here are some potential TEDs Active/passive muscle insufficiency Limited neurodynamics (they said neural tension; come on Gray!) Fascial tension Muscle shortening Hypertrophy Trigger points Scarring/fibrosis And here are some potential JMDs Osteoarthritis/arthrosis Single-joint muscle spasm/guarding Fusion Subluxation Adhesive capsulitis Dislocation It could be a Stability Problem These issues are also known as stability or motor control dysfunction (SMCD). Most conventional therapies would treat these complaints by strengthening the stabilizers, but this is problematic. When something works reflexively, how can we train something volitionally and expect changes? To train these muscles we must focus on proprioceptive and timing-based training. There are several examples of SMCD problems. Motor control dysfunction. High threshold strategy. Local muscle dysfunction/asymmetry. Mechanical breathing dysfunction. Prime mover or global muscle compensation behavior or asymmetry. Poor static stability, alignment, postural control, asymmetry, and structural integrity. Poor dynamic stability, alignment, postural control, asymmetry, and structural integrity. Relatedness Mobility and stability can influence one another. If I were to lose mobility at one segment, motor control can be distorted at nearby segments.
Read MoreMovement Chapter 6: Functional Movement Screen Descriptions
This is a chapter 6 summary of the book “Movement” by Gray Cook. Screening Keys The FMS is not considered a training or competition tool; it simply ranks movements. Here are the keys to a successful screen. First off, know the following bony landmarks Tibial tuberosity ASIS Lateral and medial malleoli Most distal wrist crease Knee joint line 3 repetitions are performed for each movement, and it is important to stand far away so the whole movement can be seen. When testing both sides, take the lowest score if an asymmetry is present. Here are the movements (videos courtesy of Smart Group Training). The Deep Squat Purpose: Full-body coordinated mobility and stability; linking the hips and the shoulders. Here is how it is done. Hurdle Step Purpose: Evaluate stepping and stride mechanics. Here is how it is done. Inline Lunge Purpose: Test deceleration and left/right function utilizing contralateral upper extremity patterns and ipsilateral lower extremity patterns. Here is how it is done. Shoulder Mobility Purpose: Evaluate scapulothoracic rhythm, thoracic spine and rib mobility. Here is how it is done. ASLR Purpose: Tests hip flexion, hip extension, and core function. Here is how it is done. Trunk Stability Pushup Purpose: Tests reflexive core stability. Here is how it is done. Rotary Stability Purpose: Check multi-planar pelvic, core, and shoulder girdle stability. Also looks at reflexive stability and transverse plane weight shifting. Here is how it is done. FMS Conclusions The FMS is designed to give a corrective pathway that may involve
Read MoreMovement Chapter 5: Functional Movement Systems and Movement Patterns
This is a chapter 5 summary of the book “Movement” by Gray Cook. In this chapter, Gray outlines the interconnectedness of the tests and outlines all of the different breakouts. The movements will be demonstrated in later chapters. FMS There are seven movements with different clearing examinations. 1) Deep squat 2) Hurdle step 3) Inline lunge 4) Shoulder mobility 5) Active straight leg raise (ASLR) 6) Trunk stability pushup 7) Rotary stability. The first three movements are often called the big 3, as they are functional movements that check core stability in three essential foot positions. The remaining four are considered fundamental movement patterns. Often these patterns are attacked before the first three. These screens can also be broken up into those that check symmetry and asymmetry: Symmetrical patterns Deep Squat Trunk stability pushup. Asymmetrical patterns Hurdle step Inline lunge Shoulder mobility ASLR Rotary stability. The way we work the FMS is by first attacking asymmetrical patterns before straight patterns, and primitive patterns before functional patterns. The FMS is scored on a four point ordinal scale with the following scoring criteria: 3 – Complete pattern 2 – Complete pattern with compensations/deviations 1 – Incomplete pattern 0 – Painful pattern. There are also three clearing tests that are either positive or negative for pain. 1) Impingement clearing test (shoulder mobility) 2) Prone pressup (trunk mobility) 3) Posterior rocking (rotary stability) The FMS works by creating several filters to catch for compensations and problems. 1) Pain – Signal to a problem. 2)
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