Understanding Movement

Transcription

1 Understanding Movement Evaluation of The Low Back Hip and Knee Dr. Kevin Kerchansky DC, DACRB, CSCS, CICE Science Research Anecdotal Clinical Philosophy Dogma New Symptoms Treatment Fast Medicine Treatment Side Effects 1

2 Trends and Fads Gingko Biloba, Ginseng, Acai Berry Green Coffee, Creatine, Multivitamin HCG, Atkins, Low-Fat, Paleo, Keto Vegetarian, Vegan, Lacto-Ovo Statins, PPI s, NSAID s, Opioids, SSRI Juicing, Cleanses, Intermittent Fasting Detoxifications Or Good Science? Magnetic Bracelets, Copper Sleeves EMS, Ultrasound, Cold Laser Spinal Manipulation, MRT Meniscus Surgery, Carpal Tunnel Surgery, Spinal Fusion Microdiscectomy, Medial Branch Block, Radiofrequency Ablation Acupuncture, Dry Needling Stretching, Yoga STRUCTURE VS FUNCTION Structure = Pictures 2

3 Structural Approach Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear One year after the procedures, patients in both groups reported similar improvements in pain and quality of life. Researchers concluded the actual procedure did not provide any additional benefit over the sham surgery. New England Journal of Medicine, Dec. 26, 2013 Structure = Pictures Structural Approach A review of more than 3200 cases of acute low back pain suggests that for similar patient presentations, those who had MRI s early on in their care had a worse outcome, more surgeries, higher costs and greater disability. - Journal of Occupational and Environmental Medicine Sep;52(9):

4 Structure v. Function Movement Approach Includes: Load/Gravity Posture Position Muscle Activation Stabilization Compensation Leads to Compression and Shearing Forces Structure vs. Function Neurodevelopmental Model 4

5 Movement First Move Well and Then Move Often. - G. Cook Requirements for Movement Arthrokinetic Capacity Tissue Flexibility Motor Control Strength (Under Increasing Load) Motor Control The ability to actively utilize the vast majority of available passive range of motion with biomechanical efficiency. Uncompensated Movement Efficient Movement Stable Movement Joint By Joint Approach - Cervical S - Thoracic M - Scapula S - Glenohumeral M - Lumbar S - Hip M - Knee S - Ankle M - Foot S S = Stable M = Mobile 5

6 Spinal Stabilization Inner Core: Transverse Abdominis, Pelvic Floor, Multifidus, Internal Obliques, Diaphragm Outer Core: External Obliques, Rectus Abdominis, Latissimus Dorsi, Quadratus Lumborum, Psoas, Gluteals etc Core Concepts Feed-Forward Mechanism 360 Effect Pressure Cooker Analogy Spinal Stability Proximal Stability Before Distal Mobility The Search for Stability One-Joint Theory Two-Hand Rule/Ribs to ASIS - Kinesthetic Diaphragm Importance Creates Top of Inner Core Acts as Postural and Respiratory Muscle Stress Breathing (Apical Breathing) is Improper Stress Breathing Inhibits Re-education of the Nervous System 6

7 Default Positions Default Positions 7

8 Injury Risk and Functional Tolerance Breakdowns In Movement Range of Motion Motor Control Joint Tissues Full Movement Stable Uncompensated Efficient 8

9 Range of Motion Elements Joints Thoracic Spine Sacroiliac Hip Ankle Treatments Manipulation Mobilization Mulligan Mobilizations Range of Motion Elements Tissues Quadriceps Rectus Femoris Psoas Adductors Hamstrings Gastroc/Soleus Piriformis Quadratus Lumborum Erector Spinae Capsules Treatments Myofascial Release Active Release Technique Graston PNF Mashing Foam Rolls Lacrosse Balls Various Soft Tissue Tools Motor Control Elements Motor Control Altered Movement Patterns Dyskinesia Overactive/Inactive Shortened/Lengthened Tonic/Phasic Compensation Patterns Joint Imbalances Treatments Active Rehabilitation Incorporate Increasing Postural Load SFMA 4x4 Matrix 9

10 Mobility First Allows Expression of Ideal Fit Increased Human Performance Injury Prevention Injury Resolution Attenuation of Injury (Ghosting) Improves Areas of Fitness Strength Power Endurance Cardiorespiratory Capacity Balance Agility Speed Stamina Accuracy The Importance of Optimal Mobility Quality Stability Is Driven By Quality Proprioception Quality Proprioception Is Not Possible With Limitations In Mobility Excessive Mobility Require Excessive Control Evaluation Algorithm Movement Evaluations Under Load Breakout Dysfunctional Movement Under Decreased Load Evaluate If Active and/or Passive Range of Motion Is Full If Active or Passive Range of Motion Is Full Under No Load A Motor Control Deficit Exists 10

11 Sample Tests Standing Toe Touch (Multisegmental Flexion) Single Leg Stand Overhead Squat Global Extension (Multisegmental Extension) Lunge Test Step Up/Step Down Tests Single Leg Squat DeadLift Test (Hip Hinge Test) Treatment Algorithm Restore Passive Range of Motion Deficits Joints and Tissues Cement New PROM With Active Exercises If Stretch Psoas to Full Length Follow With Active Hip Extension Exercise Correct Motor Control Deficits ^^^ Restore Movement Patterns Treatment Algorithms Rehabilitation of The Spine C. Liebenson Mobilize Stiff joints Relax Overactive Muscles Facilitate Inactive Muscles Restore Functional Movement Patterns at Subcortical Level 11

12 Treatment Algorithms Functional Exercise Progression P. Page Skill Movement Synergy Balance/Stability Muscle Activation/ Strength Flexibility/ROM Soft Tissue Proprioception and Posture Pain and Inflammation The Range of Motion/Motor Control Continuum Improving PROM decreases motor control. Improving PROM does not improve AROM in the hip. Core or proximal stiffening provides a base for the limb movement. However, this increased prom does not transfer to function; in order for new motor patterns to be adopted, old patterns must be overcome. Lower Extremity Review, Nov 13, Vol 5 Recommended References Movement Gray Cook Anatomy Trains Tom Myers Assessment and Treatment of Muscle Imbalance Phil Page et al Kelly Starrett Functional Movement Systems Selective Functional Movement Assessment (SFMA) 12