Faulty Movement Patterns
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- Cynthia Gwen Greer
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1 Faulty Movement Patterns Instructor: Dr. Craig Liebenson, DC Janda s Crossed Syndromes: Lower Crossed Syndrome: L/P T/L Lower Q: SubTalar Knee Upper Crossed Syndrome: C0-C1: Forward head/chin poke GH: Shrugged/rounded shoulders ST: Winged scapulae T-spine: Slumped kyphotic posture Pages: 1 of 9
2 Layer Syndrome: Alternating areas of tightness & weakness Weak feet Stiff ankles Weak & stiff hips Unstable core Stiff Thoracic Weak Scapula-Thoracic Stiff Shoulder Girdle elevators Weak C0-C1 Pages: 2 of 9
3 Faulty Movement Patterns: 1. Hip Abduction 2. Hip Extension 3. Trunk Flexion 4. Arm Abduction 5. Head/Neck Flexion 6. Push-up 7. Respiration Agonist-antagonist-synergist relationship What is related muscle imbalance? Which joint is stiff & which is subject to repetitive strain? Pages: 3 of 9
4 Source of Faulty Movement Patterns: Muscle imbalances alter movement patterns If tight muscles are substituted for weak muscles, does a traditional gym routine increase or decrease muscle imbalance? Regional Interdependence: Distinguish site (hardware) from source (software) of pain Biomechanical energy leak in kinetic chain Movement pattern faults Systems Theory: Interactive Dynamics Site vs. Source of Pain:Site: Pain Generator Segmental Isolated Source: Repetitive strain Insufficient capacity Central Sensitization Pages: 4 of 9
5 Agonist-Antagonist Dysfunction: Muscle response pattern to sudden trunk loading in LBP individuals Delayed activation Over-activation Delayed relaxation Radebold A, Cholewick J, Panjabi M, Patel T. Spine 2000;25: Karel Lewit- He who treats the site of pain is lost. Kinetic Chain Approach: Clinical Symptom Complex: History- where, when, radiation, improving or not, etc. Pain Generator Ortho Exam (painful tissue/movement receives a score- Cook 0) Find the SOURCE of Biomechanical Overload Functional Exam (painless dysfunction - Cook 1,2) Find the faulty Biomechanical movement Pattern. What movements are faulty? (Stepping, running, landing a jump, reaching, etc.) What is the dysfunctional movement pattern? Pages: 5 of 9
6 Assessment Methods: Ortho/Neuro evaluation Janda s Movement Patterns Cook s FMS/SFMA (Score) FCE tests DNS tests Other (Vleeming, Stability Shear, etc.) V Janda- Time spent in assessment will save time in treatment Every Exercise is a Test and every test can be used to treat dysfunction. We assess the FUNCTION. Functional capacity should always exceed demand, and have a substantial margin of error. Pages: 6 of 9
7 Magnificent 7: A Functional Evaluation Is it PAINFUL? Mechanical Sensitivity (MS) Does it reproduce or intensify the pts symptoms Is it DYSFUNCTIONAL? Abnormal Motor Control (AMC) Stability (coordination) or mobility - what the clinician sees Felt in target tissue - what the patient feels The Key Link Initial evaluation PAIN PREDOMINATES & is driven by orthopedics Find the Pain Generator There is a lot of mechanical sensitivity - MS Guarded movements predominate & AMCs are unreliable THINK McKENZIE As pain subsides the Key Dysfunction is typically painless (AMC) THINK JANDA Pages: 7 of 9
8 Gray Cook s Scoring -Functional Movement Screens: 0 - pain 1 - can t perform movement 2 - performs movement w/ compensation (imperfect) 3 - movement performed w/out compensation (perfect) Maximum possible score = 21 Every Exercise is a Test Pain & Asymmetry most important If in doubt give the lower score Any test w/ a 0 score (pain) requires an orthopedic evaluation Any test w/ a 1 (painless dysfunction) requires functional correction Stabilization Mobilization Assess-Correct-Reassess What is Goal? According to Cook, the goal is fastest to 14, not 21. Pages: 8 of 9
9 According to Lewit, the goal is not to teach perfect movement patterns, but to correct the key fault that is causing the trouble. Goal: All 7 tests should achieve a score of 2 A 15 or above w/ some 3 s (& 1 s or 0 s) is worse than a 14 w/ all 2 s When ALL tests score at least a 2 then investigate more challenging or specific functional tests The Magnificent Seven: A Functional Screen 1. Range of Motion of area of chief complaint 2. T4 Postural Mobility - Wall Angel 3. Overhead Squat 4. Single Leg Balance (EO/EC) 5. Single Leg Squat 6. Lunge 7. Respiration Pages: 9 of 9
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