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
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Chapter 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 13: Movement Pattern Corrections
This is a chapter 13 summary of the book “Movement” by Gray Cook. Back to the Basics Mobility deficits ought to be the first impairment corrected. Optimizing mobility creates potential for new sensory input and motor adaptation, but does not guarantee quality movement. This is where stability training comes in. In order for the brain to create stability in a region, the following ought to be present: Structural stability: Pain-free structures without significant damage, deficiency, or deformity. Sensory integrity: Uncompromised reception/integration of sensory input. Motor integrity: Uncompromised activation/reinforcement of motor output. Freedom of movement: Perform in functional range and achieve end-range. Getting Mobility There are 3 ways to gain mobility: 1) Passively: Self-static stretching with good breathing; manual passive mobilization. 2) Actively: Dynamic stretching, PNF. 3) Assistive: Helping with quality or quantity, aquatics, resistance. Getting Stability In order to own our new mobility, we use various stability progressions to cement the new patterns. There are three tiers in which stability is trained: 1) Fundamental stability – Basic motor control, often in early postures such as supine, prone, or rolling. 2) Static stability – done when rolling is okay but stability is compromised in more advanced postures. 3) Dynamic stability – Advanced movement. We progress in these stability frames from easy to further difficult challenges. Assisted → active → reactive-facilitation/perturbations Since stability is a subconscious process, we utilize postures that can challenge this ability while achieving desired motor behavior. We can also group the various postural progressions into 3 categories: 1)
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 7: SFMA Introduction and Top-Tier Tests
This is a chapter 7 summary of the book “Movement” by Gray Cook. Intro The SFMA’s goal is to assess functional capabilities. This system is based on Cyriax differentiation and grading principles. Instead of describing things as strong, weak, painful, or painless; the following descriptors are utilized: Functional nonpainful (FN): Unlimited movement and able to complete a breath cycle at end-range. Called the dead end. Functional painful (FP): Called the marker, reassessed. Dysfunctional nonpainful (DN): Limited, restricted, impaired mobility, stability, or symmetry. Labored breathing with movement also implicates this choice. Called the pathway, where treatment occurs. Dysfunctional painful (DP): Called the logical beehive because we do not know if pain is causing poor movement or vice versa. It is an unreliable place to work unless acute situations. SFMA corrective and manual therapy lie in treating the FP’s and DN’s. The order at which things are treated also matters, so the order listed below for the top tier tests is also typically where treatments should hierarchically begin. Cervical spine patterns (CSP) Upper extremity patterns (UEP) Multi-segmental flexion (MSF) Multi-segmental extension (MSE) Multi-segmental rotation (MSR) Single leg stance (SLS) Overhead deep squat (ODS) We then operate the SFMA in the following fashion:
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)
Read MoreMovement Chapter 1: Introduction to Screening and Assessment
This is a chapter 1 summary of the book “Movement” by Gray Cook. Intro This chapter’s central point, and for that matter the whole book, is that movement needs to standardized just like all other therapeutic and performance measures. Movement is fundamental to who we are. Despite movement being at our center, we continually classify patients and clients by body region. Unfortunately through this reductionism, much is lost. We cannot measure parts and expect that to give us an adequate picture of the whole. Screening Before we begin training, it is advocated that movement be screened to facilitate an optimal training environment. The screen will determine movement as one of the following three areas: 1) Acceptable 2) Unacceptable 3) Painful Movement is screened for many reasons. Gray often states that the number one risk factor for injury is previous injury. A movement screen helps find potential risk factors for re-injury. Moreover, if movement is dysfunctional, then all things built on that dysfunction could predispose one to more risk. The screen also helps separate pain from movement dysfunction. It is widely known that when one undergoes a pain experience, motor control is altered. Because motor control is altered, we may not get the desired training effect secondary to pain. Pain screening gives us an avenue for further assessment a la the Selective Functional Movement Assessment (SFMA). Movement screening is the first step away from quantitative analysis to movement quality; from reductionism to holism. Once we have a basic movement map we
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