Paradigm Shift. Biomedical Model. Regional Interdependence Model. Evidence to Support R-I Exam

Transcription

1 A Clinical Approach to Assessing and Addressing Movement Pattern Dysfunction Models of Adverse Health Regional Interdependence Evidence to Support R-I Systematic Assessment Case Studies using System Implementation in Clinical Setting Oregon Athletic Medicine Biomedical Model Early medical science uses a pathoanatomical approach to movement & adverse health - limitations, degeneration and lesions of the anatomical structures were used to explain every movement related pain or deficiency Paradigm Shift Modern medical science is attempting to balance the scales of perspective - consider biomechanics, neuromuscular control and functional symmetry as elements of equal consideration Regional Interdependence Model Evidence to Support R-I Exam Regional Interdependence refers to the concept that seemingly unrelated impairments in remote anatomical region may contribute to, or be associated with, the athletes primary complaint (Wainner et al, 2007) Hip & Low Back Pain (Ellison, 2001; VanDillen, 2001) Hip & Osteoarthritis (Cliborne, 2004) Low Back Manipulations & Hip/Knee (Iverson 2008) Thoracic & Rib interventions for cervical (Cleland, 2005) for shoulder pathology (Strunce et al, 2009), Bang, 2000; Bergman et al, 2004)

2 If not already, it is time to at least consider incorporating regional interdependence approach to current clinical practice A functional assessment that demonstrates posture and movement patterns is crucial to address a more complex regional issue that relates to the location of pain Selective Functional Movement Assessment Create a Road Map Purpose of SFMA is to assess the injured athlete to discover regional movement dysfunctions that may be contributing to local symptoms (pain). Take a complex problem and simplify it We know the pain is there. What we need to find is the cause of the pain. SFMA TOP-TIER ASSESSMENTS Cervical Spine Upper Extremity Patterns Multi-Segmental Flexion Multi Segmental Flexion Multi-Segmental Extension Multi-Segmental Rotation Single Leg Stance Overhead Deep Squat

3 Cervical Patterns Pattern 1: Chin to chest Pattern 2: Face to Ceiling Pattern 3: Chin to Left/Right Shoulder Upper Extremity Patterns Pattern 1: internal rotation, extension, and adduction Pattern 2: external rotation, flexion, and abduction Multi-Segmental Flexion Multi-Segmental Extension Assesses normal flexion in the hips and spine Assesses normal extension of the shoulders, hips and spine Multi-Segmental Rotation Tests for normal rotational mobility in the: neck pelvis hips knees feet Single Leg Stance Evaluates the ability to stabilize independently on each leg in a static posture

4 Overhead Squat Assesses bilateral, symmetrical mobility of the hips, knees, and ankles Hands overhead also assesses bilateral, symmetrical mobility of the shoulders, and extension of the T- Spine SFMA Breakouts The breakouts systematically dissect each of the major patterns dysfunctions The hierarchy will dictate your focus on dysfunctional & non-painful patterns (DN) The assessment helps identify gross limitations in mobility and stability Mobility vs Stability Problems Mobility Subcategories: Tissue Extensibility Dysfunction Joint Mobility Dysfunction Stabilization relies on: Central Nervous System Peripheral Nervous System Motor Programs Timing Joint & Postural Alignment Structural Instability Muscle Inhibition Absolute Strength of Stabilizers Is it Mobility or Stability? Joint stiffness, high muscle tone, trigger points are mobility problems that may actually be poor SMCD Strategy for Restoring Function Identify the most dysfunctional non-painful patterns Follow the hierarchy & address asymmetries Intervention Model - manual lth therapy &/or trigger ti point work - movement oriented exercises focused on correct motor patterns - full movement pattern with emphasis on reinforcing motor patterns Case #1 Sport: Track & Field (Distance, Steeplechase) Clinical presentation: Pain lateral aspect right hip Bilateral genu verum Bilateral genu verum More hip internal rotation than external rotation Previous history 3 rd Metatarsal stress fracture, right Injury Diagnosis: Right Hip Bursitis Diagnostics: None

5 Case #1 Conventional Treatment: NSAID s for inflammation Targeted strength training exercises for hip external rotators Modification in activities (cross training) Clinical Outcome: No resolution of right hip pain Referred for movement based assessment Case #1 (Hip) SFMA Findings: DN Single Leg Stance, left - DN ½ Kneel Stability, left - DN Supine to Prone UE Rolling to left - DN Quadruped Diagonals DN Overhead Squat - No mobility restrictions - Motor patterning issue Case #1 Restoration Isolate Check Breathing Patterns (trigger points) Rolling Patterns Integrate Birddogs (CA Resisted) ½ Kneeling Rotary Stability Functional Russian Deadlift Pattern (CA Resisted) Squat Progressions (Assisted RNT) Case #2 Sport: Football (Lineman) Clinical presentation: Recurrent Intraarticular Effusion Chronic Patello-femoral pain PT Retropatella Injury Diagnosis: Right Knee Tendinopathy Diagnostics: Xrays (-) MRI (+) Stress Reaction Patella Diagnostic Arthroscopy (chrondroplasty) Case #2 Knee Conventional Treatment: Inflammation & Pain management (including viscous supplementation) Soft Tissue Mobilization Eccentric Quad Strengthening/ g Hamstring Strengthening and activity modification Clinical Outcome: Returned to play with decreased knee pain, however recurrent swelling continued. Repeat chondroplasty & lateral release. Referred for movement based assessment Case #2 SFMA Findings: DN Cervical Pattern (extension) DN MS Extension DN Supine Lats Hip Flexed & Extended DN Lumbar Locked Extension, bilateral DN MS Rotation DP Overhead Squat

6 Case #2 Restoration Isolate Clear C-Spine (re-assess) Trigger Points Lats/ Self Mobes T-spine Prone Thoracic Press-ups Integrate Prayer Stretch Butterfly Wings ½ Kneeling Hip Flexor Set (pelvic tilt) Functional Ground up Squat RNT Squat Restoration Progressions with ATC Score a 1 on OHS SFMA Develop Strategy for Restoring Function Rescreen as indicated Dysfunctions addressed in S&C Program PPE/ Rehabilitation Assessment OMS Score 13 or below Score above 14 Maintain current level of function Prescribed self stretches and activation type exercises Normal progression into functionally based S&C Program Rescreen periodically to ensure maintaining level of function or after injury Closing Notes Not advocating ignoring athletes primary area of complaint Pertinent and evidence based to also assess the regions above and below. Source of the pain. SFMA a systematic tool to quickly assess the whole body (Clearer Picture) Leads us to appropriate restoration interventions (creates a road map as we attempt to return to normal ) Reassess! Reassess! Thank You!