FUNCTIONAL MANUAL THERAPY

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Melinda Gardner
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1 FUNCTIONAL MANUAL THERAPY Structural, Postural, and Functional Evaluation Evidence Related to Postural Evaluation There is very little published regarding and evidence supported evaluation system for posture. FMT has a systematic evaluation approach for assess for efficient posture. The Challenge of Normal The average or mean of a researched subject or population The Challenge of Normal Most research seeks to quantify the Normal state IPA / FMT seeks to identify each individual s Optimal or Efficient state GOAL OF FMT MANAGEMENT To identify and achieve the most efficient/optimal state DEFINITION OF OPTIMAL OR EFFICIENT Producing the Desired Result With the Least Expenditure of Energy The best available option 1

2 STRUCTURAL ENGINEERING Dealing with the analysis and design of structures that support or resist loads Any item where structural integrity affects the item's function or safety Based upon physical laws and empirical knowledge of the structural performance of different landscapes and materials. POSTURAL ASSESSMENT We have a need in Physical Therapy to understand what is the optimal alignment which supports efficient weight distribute and attenuation. We at the IPA have evaluation and observational tools which will assist you in the evaluation of your patients posture. EFFICIENT STATE Integrated Functional Unit Equal Distribution of Weight Shock Absorption and Attenuation Optimal Range of Motion and Tissue Mobility Independent Control Energy Efficient Movement Patterns STRUCTURAL COMPONENTS OF POSTURE Skeletal Muscular (Contractile SoftTissue) Loose Connective Tissue (Fascia) POSTURAL INSIGHTS All of our patients have postural dysfunctions Postural dysfunctions often contribute to the genesis and perpetuation of symptoms Postural dysfunctions contribute to inhibition of core muscles and motor control Management of postural components are a significant element of the FMT approach. TWO MAJOR CATAGORIES OF ALIGNMENT DYSFUNCTIONS STRUCTURAL (MECHANICAL) FUNCTIONAL (NMC or Motor Planning) 2

CAUSES OF DYSFUNCTIONS Response to Dysfunctional Postures Trauma Macro and micro Repetitive Stress o Use of Stressful Postures o Habitual Movement Patterns Postural Perception Aberrant Movement

3 CAUSES OF DYSFUNCTIONS Response to Dysfunctional Postures Trauma Macro and micro Repetitive Stress o Use of Stressful Postures o Habitual Movement Patterns Postural Perception Aberrant Movement Patterns Positional compensations in other movement segments Increase muscular work to maintain the dysfunctional posture Altered motor control capacity Weak Links Chain Reaction of Dysfunction Regions or segments that experience excessive stress due to inefficient (altered) posture and function. Posture and Motion DYSFUNCTION AWARENESS Symptomatic Asymptomatic SKELETAL EVALUATION Posture VERTICAL ALIGNMENT HORIZONTAL ALIGNMENT SKELETAL ALIGNMENT 3

EVALUATION ALIGNMENT AND RELATIONSHIP OF SEGMENTS

ALIGNMENT Indicates the structures ability for

Reveals the structure s s options for and stresses

4 EVALUATION ALIGNMENT AND RELATIONSHIP OF SEGMENTS VERTICAL AND HORIZONTAL ALIGNMENT ALIGNMENT ALIGNMENT Indicates the structures ability for shock attenuation, absorption and distribution Reveals the structure s s options for and stresses of motion Frontal Alignment of Segments Lateral Alignment of Segments 4

5 03/2012 STRUCTURAL COMPONENTS OF DEVIATION Ida Rolf s concepts of structural integration Anterior or Posterior Lateral Shift/Shear Tensegrity Rotational/Spiral Note pattern of compensations of alignment Note lateral compensations in alignment Note components of deviations: Anterior Posterior 5

MECHANICAL STRESS POINTS VERTICAL COMPRESSION TEST

deviations in alignment Transitional zones with sharp

underlying structures May provide valuable information

Mechanical Stress Point Posture at initial evaluation

knees Mechanical Stress Point Effects with cervical

Mechanical Stress Point Mechanical Stress Points With

6 MECHANICAL STRESS POINTS VERTICAL COMPRESSION TEST MECHANICAL STRESS POINTS Generally related to deviations in alignment Transitional zones with sharp angles May cause abnormal stress and wear to the underlying structures May provide valuable information about postural components to presenting symptoms Mechanical Stress Point Posture at initial evaluation Patellofemoral pain Note especially lumbar spine and knees Mechanical Stress Point Effects with cervical rotation Note especially lumbar spine and knees Mechanical Stress Point Mechanical Stress Points With extension Note knees, lumbar spine and scapula With forward bending, note knees and lumbar spine 6

Mechanical Stress Points Effect on spine

lumbar spine, pelvis and knees Before and

7 Mechanical Stress Points Effect on spine with RUE flexion, abduction and ER Note lumbar spine, pelvis and knees Before and after six treatment sessions SOFT TISSUE OBSERVATION Symmetries Proportions OBSERVATION OF PROPORTION AND SYMMETRY Anterior compared to posterior Right compared to left Superior compared to inferior Symmetries and Proportions 7

8 Disproportionate Segment And Stress Points Disproportionate Segment And Stress Points EVALUATION OF SOFT TISSUE CONTOURS Bands Constrictions Bulges Protrusions Contours Bands Constrictions COMPENSATIONS Constrictions and Protrusions Often occur in zig-zag zag and spiral patterns 8

9 Note: Zig-zag and spiral compensations Note: Zig-zag and spiral compensations IDA ROLF STATED Function reveals structure, structure determines function MOSHE FELDENKRAIS STATED Function develops structure Each person has untapped existing potential -Maggie Knott Case Report Clarence Before & After Treatments Before After 9

Things may be different than they appear!

(Normal Play) Fascia (Full mobility) Neurovascular

(Coordination) Response to Inefficient Patterns of

degenerative, dysfunctional, and symptomatic

10 Don't let the situation confuse you... Keep your mind open. Things may be different than they appear! EFFICIENT FUNCTION Arthrodal (Full Motion) Muscular (Normal Play) Fascia (Full mobility) Neurovascular Mobility Visceral Mobility Neuromuscular Control (Coordination) Response to Inefficient Patterns of Movement and Motor Control Structures may become degenerative, dysfunctional, and symptomatic secondary to altered movement patterns and motor control Symptomatic structures cause system wide compensations 10

STRUCTURAL (MECHANICAL) ISSUES IN THE TISSUES ALTERATIONS IN MECHANICAL CONDITION: Postural Dysfunctions Soft Tissue Dysfunctions Joint Dysfunctions Neural System Mobility/

Stressful Postures and Movements Abnormal Habitual Movement Patterns Disproportionate Segment(s) Segments that appear to be mal-aligned aligned and out of proportion to the

11 STRUCTURAL (MECHANICAL) ISSUES IN THE TISSUES ALTERATIONS IN MECHANICAL CONDITION: Postural Dysfunctions Soft Tissue Dysfunctions Joint Dysfunctions Neural System Mobility/ Physiologic Dysfunctions Efficient Alignment FUNCTIONAL (Neuromuscular and Motor Control) Excessive Muscular Activity Emotional or Mental Reactions Functional Holding Patterns Stressful Postures and Movements Abnormal Habitual Movement Patterns Disproportionate Segment(s) Segments that appear to be mal-aligned aligned and out of proportion to the other segments, creating poor weight distribution and stress points PHYSIOLOGICAL MOVEMENT EVALUATION Arthrodial Hypomobility Hypermobility Soft Tissue Compliance Neuromuscular Control 11

TOWARDS PERFECT TURNOUT

TOWARDS PERFECT TURNOUT BY NOA SPECTOR FLOCK 1 Section I Imagery & Integration Create ease, inner-space, awareness, re patterning and readiness, 1. Contract / Relax 2. Sea Weed 3. Leg out of the Pelvis