1/16/14. Training & Treating the WHOLE-ISTIC Athlete

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Duane Poole
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1 Training & Treating the WHOLE-ISTIC Athlete ANDREW HAUSER, ATC, RSCC/CSCS, PRT Overview Reciprocal Activity: a new way of looking at the human body. Positioning and transfer to sport The best athlete is a healthy athlete Multi-factoral Objectives for today Provide a new way of looking at what s normal Provide an understanding of positioning Gain an appreciation for reciprocal alternating activity and its role throughout the entire body. Provide some useful tools and thought process for use with your athletes. Stimulate critical thinking & some new ways to help your athletes 1

Postural Restoration 101 PRI was established to explore and explain the science of postural adaptations, asymmetrical patterns and the influence of polyarticular chains of muscles on the human body.

2 Postural Restoration 101 PRI was established to explore and explain the science of postural adaptations, asymmetrical patterns and the influence of polyarticular chains of muscles on the human body. Posture is a reflection of the position of many systems that are regulated, determined and created through limited functional patterns. These patterns reflect our ability & inability to breathe, rotate, and rest, symmetrically with the left and right hemispheres of our axial structure. Asymmetries are natural and okay, management is key! Positioning allows are body to both REST and work optimally Everybody has a body that has unique patterns, but every body has patterns that are similar to everybody. -Ron Hruska STATIC ASYMMETRIES Right hemidiaphragm is larger than the left Liver is positioned in the right abdominal cavity Pericardium is positioned in the left mediastinum Three lobes of the right lung compared to only 2 on the left Hemi-neural position is usually assymmetrical Ex: R vagus nerve is longer than the L vagus nerve 2

Dynamic Asymmetry Postural Patterns as explained by PRI Poly articular chains (AIC, BC, PEC, TMCC) 2 brachial (BC) polyarticular chains lying over the anterior pleura & cervical area influencing

2 anterior interior (AIC) chains that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities.

3 Dynamic Asymmetry Postural Patterns as explained by PRI Poly articular chains (AIC, BC, PEC, TMCC) 2 brachial (BC) polyarticular chains lying over the anterior pleura & cervical area influencing cervical rotation, shoulder dynamics and apical inspirational expansion. 2 anterior interior (AIC) chains that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities. 2 temporal mandibular (TMCC) chains that provide stability for accessory respiratory muscles, provides scapular support, controls range of Cervical activity, directs, mandibular rest position, self-regulates neuromuscular tension and tone. Anterior Interior Chain (AIC) Muscles: Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris (these are ALL in tension). Opposition Muscles: Hamstrings, Gluteals, Internal Obliques 3

deltoidpectoral, Sibson s Fascia, Triangularis Sterni, SCM, Scaleni, Diaphragm (all in tension) Opposition Muscles: Triceps, Lower Trapezius, Abdominal Obliques Prone to impingement issues, upper

4 What this means for us L AIC = R stance E.g. with the pelvis: Sagittal plane L flexed, R ext Frontal plane L inlet abducted, R inlet adducted Transverse plane L inlet ER, R inlet IR Brachial Chain (BC) Muscles: Anterior-Lateral intercostals, deltoidpectoral, Sibson s Fascia, Triangularis Sterni, SCM, Scaleni, Diaphragm (all in tension) Opposition Muscles: Triceps, Lower Trapezius, Abdominal Obliques Prone to impingement issues, upper trap TrP s, bicipital tendinitis, IR deficits To breathe or not to breathe Walking is breathing and breathing is walking. Optimal diaphragmatic excursion happens w/ equal arm and leg swing where the foot, ankle, knee, hip, pelvis, thorax and cranium pronate and supinate through the gait cycle. R BC = R trunk rotation with no contralateral opposition Sagittal plane L rib cage extended, R rib cage flexed Frontal plane L rib cage abducted, R rib cage adducted Transverse plane L rib cage ER, R rib cage IR 4

Abs oppose the diaphragm and help pull the ribs down, which helps to maintain an optimal ZOA.

L AIC always underlying this pattern Muscles: Lats, QL, Posterior intercostals, Serratus Posterior, Iliocostalis Lumborum (in tension) Opposition Muscles: Abdominal Obliques

5 Zone of Apposition What is the ZOA? The portion of the diaphragm that is directly opposed to the inner aspect of the lower rib cage (De Troyer and Estienne, 1988, Reid & Dechman, 1995; Goldman & Mead, 1973). Abs oppose the diaphragm and help pull the ribs down, which helps to maintain an optimal ZOA. Posterior Exterior Chain (PEC) Open Scissors Very common in athletes, you can be successful but for how long? L AIC always underlying this pattern Muscles: Lats, QL, Posterior intercostals, Serratus Posterior, Iliocostalis Lumborum (in tension) Opposition Muscles: Abdominal Obliques (ZOA & Respiratory diaphragm) Prone to being on toes (hamstrings feel tight but holding them up, increased lordosis, toned paravertebrals, over striders. Stuck in the sagittal plane, constant state of extension No Frontal or Transverse plane activity without constant extension BREATH OUT!!! Get your hamstrings & glutes firing! Exhalation in a state of exhalation and inhalation in a state of exhalation, otherwise, we are hyperinflated. INHIBIT! What can we do? 5

Having Movement Competencies FMS? Or your own screen. What s dysfunctional if you don t have a baseline?

Build fitness, strength & power off of fundamental movement Neutrality 3 S Bones Sphenoid (TMCC) Collaborator, regulates the temporalis, tension, autonomics

lateralization for reciprocal function Neutrality allows for proper transitioning without compensation.

6 Having Movement Competencies FMS? Or your own screen. What s dysfunctional if you don t have a baseline? Use whatever techniques you have in your toolbox and take them back to the screen. Build fitness, strength & power off of fundamental movement Neutrality 3 S Bones Sphenoid (TMCC) Collaborator, regulates the temporalis, tension, autonomics orientation, 90% of neurology runs through Sternum (BC) Chief reference center, stability, respiration (gas regulation) Sacrum (AIC) Integrator, lateralization for reciprocal function Neutrality allows for proper transitioning without compensation. Neutrality plays largely into autonomics and allows the body to rest, recover, restore. Sports will take you out of neutrality, but can you begin and end in a neutral state? Neutrality objectively gives us a way to determine when there is a neuromotor balance between the R and L sides of the body. Some things you may be seeing in your athletes 6

respiratory) Position (can you get neutral?

moving w/alternating reciprocal activity)

7 PRI Exercises Focusing on: Inhibition (turn off) Respiration (use diaphragm as respiratory) Position (can you get neutral?) Tone (systems rest) Integration (get moving w/alternating reciprocal activity) We re doing what??? 3 R s of PRI Treatments Re Position (inhibition) Re Train (Facilitation) Re Store (Reciprocal Alternating Function) 7

Touching your toes (hinging) Important for ALL movement and to efficiently use one s body.

8 Keeping the pattern going Single Leg Stance Don t be afraid of working one side and not the other, as well as, one side only if necessary. Squatting Ability to squat fully (below 90-deg) is a wholistic activity requiring full integration of all systems. Touching your toes (hinging) Important for ALL movement and to efficiently use one s body. Have to be able to tone down your ANS to fully touch. Gait (Lunging, walking, running, etc.) The apex of fully integrated and functional activity Don t let information paralyze you Get moving and find the frontal plane! 8

9 PRI in the weight room PRI on the field 9

Adduction Drop or Ober s Test that is looking at bony positioning of hemi pelvis rather than ITB tightness If

L AIC = (+) L, (-) R PEC = (+) B Extension Drop or Thomas Check for ligamentous integrity of the anterior hip

extensibility in the presence of a neutral pelvis (- adduction drop).

10 Adduction Drop or Ober s Test that is looking at bony positioning of hemi pelvis rather than ITB tightness If hard end-feel found it is indicative of anteriorly tilted hemi pelvis. L AIC = (+) L, (-) R PEC = (+) B Extension Drop or Thomas Check for ligamentous integrity of the anterior hip capsule in the presence of a forwardly tipped hemi pelvis (+ adduction drop test) or for hip flexor extensibility in the presence of a neutral pelvis (- adduction drop). L AIC = (+) L & (-) R PEC = (+) B Test for ligamentous integrity following adduction drop test, will confirm positioning. L AIC pattern will have > SLR on R when compared to L. Straight Leg Raise 10

Assess for integrity of the anterior GH ligaments /

R BC pattern will show > horizontal abduction on R

Horizontal Abduction Assess for the integrity of

a bony limitation to IR SECONDARY to an anteriorly

R BC = R IR < L IR HG IR Reflects ability to

11 Assess for integrity of the anterior GH ligaments / capsule in the presence of an upper thorax rotation. R BC pattern will show > horizontal abduction on R when compared to L. Horizontal Abduction Assess for the integrity of the posterior GH capsule as well as the presence of a bony limitation to IR SECONDARY to an anteriorly tipped scapular positioning. R BC = R IR < L IR HG IR Reflects ability to reciprocate rib cage (use diaphragm as both respirator and postural stabilizer bilaterally). Appical Expansion 11

Let the tests be your guide Case Study #1 Player 1 L) SI pain 35 year old utility player with history of pubalgia and low back pain

12 Hip IR / ER and muscle test What muscle do they feel when actively IR (TFL or glute med)? Tells us story of how they compensate & what position their hips are in. Let the tests be your guide Case Study #1 Player 1 L) SI pain 35 year old utility player with history of pubalgia and low back pain reported with significant SI pain located on the L side (history of bilateral SI pain and pubalgia). Unable to stand up straight, rotate or ambulate without significant discomfort. MRI was negative for structural damage other than minor inflammation. 12

13 1/16/14 Case Study #1 Continued Exercise Prescription: Right Sidelying Adductor Pull Back Left side lying knee toward knee Left sidelying Left flexed adduction concomitant right extended abduction Continued Supine hooklying Right Glute Max with Left glute med Left sidelying IO/TA Left adductor (FA IR) with Right Glute Max (1st 2 days shortened the bottom leg, or lever ) Outcome: Player played 3 days following acute episode with no issues (continued program for 2 weeks) for remainder of season. IR differential and the Diaphragm 13

14 1/16/14 Managing L AIC in Rehab Reference zones (athlete needs to feel these): -L heel -L ischial seat (if seated) -L low back 1st establish sagittal plane w/hamstrings, then frontal plane w/adductors and finally, transverse plane with glute max. Managing R BC in Rehab Reference zones (athlete needs to feel these): -R low trap / R triceps (Sagittal plane) - Exercises are preceeded by AIC exercises L AIC & R BC working out 14

15 1/16/14 Managing the PEC in Rehab Important for PEC s: -MUST FIND THEIR HEELS!!! -Feel their hamstrings -Feel their glutes (stretch feeling) -posterior-lateral expansion of low back upon inhalation -get ALL air out during exhalation and pause as long as they can before inhalation. PEC working out Recommendations Control the controllables We cannot control the rock star factor of our athletes. Educate your athletes (throw some darts and hope one sticks) 15

Energy System Development Aerobic system is large piece of the puzzle (for another presentation) Fatigue resistance Faster 02 uptake Increased muscle re-oxygenation Improved Vagal tone & return to

Joel Jamieson The more aerobic power means that the anaerobic systems can recharge much faster so they can contribute more power when you need them to.

16 Energy System Development Aerobic system is large piece of the puzzle (for another presentation) Fatigue resistance Faster 02 uptake Increased muscle re-oxygenation Improved Vagal tone & return to PNS Improve power output from aerobic side aerobic system has a lot of ways it can improve and you make better. Joel Jamieson The more aerobic power means that the anaerobic systems can recharge much faster so they can contribute more power when you need them to. Your body relies on aerobic systems to clear out byproducts produced by anaerobic mechanisms. Quicker oxygenation of tissues = more efficient, quicker recovery Referenced Joel Jamieson s Ultimate MMA Conditioning Aerobic Power Managing Stress Global changes due to stress Everything you do imposes stress on your body / system (working out, nutritional habits, school work, social life, breathing you get the picture) Not all stress is bad!! As clinicians, how are we helping our athletes manage this and how are they helping themselves? 16

Sleep Sleep affects almost every tissue in our bodies; it affects growth & stress hormones, our immune system, appetite, breathing, blood pressure & cardiovascular health. Dr.

Protein foods each meal should contain protein foods, including lean meats, beans, eggs, etc. Vegetables & fruit each meal should contain 1-2 servings of vegetables and/or fruit.

17 Sleep Sleep affects almost every tissue in our bodies; it affects growth & stress hormones, our immune system, appetite, breathing, blood pressure & cardiovascular health. Dr. Michael Twery, sleep expert at News In Health. Brunt of your recovery occurs while you re sleeping. Nutrition Eating Frequency During injury recovery, it s best to eat every 3 hours or so. Protein foods each meal should contain protein foods, including lean meats, beans, eggs, etc. Vegetables & fruit each meal should contain 1-2 servings of vegetables and/or fruit. Whole grains minimally processed sources are best during injury recovery. Generally, it s recommended to ingest more carbs while training & fewer while not training. Nuts/Seeds/Oils To achieve better fat balance, every day, include olive oil, mixed nuts, avocados, flax oil, ground flax & other seeds Herbs & Phytochemicals For the first 2-4 weeks post-injury, the inclusion of turmeric, garlic, bromelain, and flavanoids from cocoa, tea & blueberries can help manage inflammation. Vitamins & minerals for the first 2-4 weeks post-injury, the inclusion of vitamin A, vitamin C, copper & zinc can assist in the proliferation and remodeling stages of recovery. Super-Nutrients The inclusion of arginine, HMB< and glutamine can also help during the proliferation and remodeling stages. Just be careful with nutritional supplements, using products that are guaranteed free of banned substances. Referenced in article: Eating for Injury Recovery, by John Berardi, PhD & Ryan Andrews, RD of Precision Nutrition Listen 17

18 Thank you to: The Postural Restoration Institute Arizona State Athletic Trainers Association NATA NSCA PBATS Arizona Diamondbacks AND THANK YOU!!! 18

Hyperinflation. Initial Visit

Hyperinflation. Initial Visit Hyperinflation Initial Visit Patient is a 46 year old female who presents to physical therapy with upper back, chest and neck pain. She also reports episodes of lightheadedness and shortness of breath