MODULE TWO: ALIGNMENT

Transcription

1 DIAPHRAGM/PELVIC FLOOR PISTON FOR ADULT POPULATIONS ONLINE Julie W. Wiebe, PT, MPT, BSc Module One Concepts Evidence Core Function/Dysfunction Module Two Module Three Diaphragm Breathing Mechanics Module Four Pelvic Floor Transversus Abdominis Module Five Synergists: POS Module Six Synergists: LS/AOS Module Seven Synergists: RS Gait Plyometrics MODULE TWO: ALIGNMENT Julie W. Wiebe, PT, MPT, BSc material is prohibited. 1

2 Module Two Preparation Full length mirror Selfies: Your standing alignment (uncorrected or perfected, please) both a front and side view. 2 pictures of your low back (skin revealed) from pelvis to shoulders: one picture with you hands on top of pelvis with thumbs pointing to lumbar spine; one picture with your arms hanging at your side. Have a friend or colleague video you while performing a squat, a single leg squat (both LE), and single leg stance (both LE) Have a fried or colleague video you while taking a deep breath (from the front, and side). The Lynchpin Muscle Activation Characteristics of Stance Balance Control in Children with Spastic Cerebral Palsy Burtner et al (1998) Neurologically typical kids in crouch position characteristic of CP. Similar recruitment pattern in balance perturbation. Balance deficits due to neural and mechanical differences. (Noted similar impact in gait in previous studies). material is prohibited. 2

3 Impacts Muscular recruitment (midrange optimization) Vestibular input, cranial nerves (head position) Proprioceptive Visual Breathing patterns Joint centration All inputs for brain to evaluate threat for protective output Enhance or diminish components of the central stability system based intervention is critical Name that muscle! Accepted terminology: Hyperlordosis/Ant Tilt Hypolordosis/Post Tilt Neutral Pelvis/L-spine What about the position and forces imposed by upper quarter? material is prohibited. 3

4 Pop Quiz Name that alignment? Pop Quiz How about now? : Function follows Form Ribcage position dictates: Excursion and contribution of the diaphragm to physiologic priorities, postural control and movement support Impacts the capacity of the diaphragm to set up the IAP pressure system material is prohibited. 4

5 How Do Anterior/Posterior Translations of the Thoracic Cage Affect Lumbar Spine, Pelvic Tilt, and Thoracic Kyphosis Harrison et al (2002): Posterior Thoracic Cage Translation Decrease lumbar lordosis (7.4) S-curve L-S (T-12-L2 flex) *apex* Increase pelvic posterior tilt (15.9) Sacral base posterior tilt (13.1), closer to horizontal Posterior Ribcage Translation Position of the ribcage relative to the pelvis q Part 1: Military Posterior Ribcage Translation Position of the ribcage relative to the pelvis q Part 2: Slouch material is prohibited. 5

6 Rib Cage Tip: Bell Ringing Bell Rung Up Bell Rung Down Bell Rung Up Top of ribcage behind L-S Dixie Cup on a Stick Bell Rung Down Bottom of the ribcage behind LS Dixie Cup on a Stick material is prohibited. 6

7 Defining the New Neutral Neutral Ribcage/Pelvis Position of optimum recruitment of the Diaphragm/Pelvic Floor Piston Balance of flexors and extensors Sweet Spot within neutral range; balancing their structure, muscular forces, and pressure : Clinical Presentation Hyperlordosis/Anterior Tilt (AT) Sit in posterior tilt Stand in anterior tilt Reverse C s Hypolordosis/Posterior Tilt (PT) Sit and stand in posterior tilt C s material is prohibited. 7

8 Mixed Posture Type Former AT à PT Former PT à Kinked Somewhere in between MODULE TWO: ALIGNMENT SCREEN Julie W. Wiebe, PT, MPT, BSc Initial Assessment material is prohibited. 8

9 Initial Functional Screen How do we distinguish? Screen Apex of the lumbar curve Ribcage position Gluteal definition Pelvic tilt? How do we distinguish? Screen Apex of the lumbar curve Ribcage position Gluteal definition Pelvic tilt? material is prohibited. 9

10 Screen Apex of the lumbar curve Landmark: L4 at Iliac Crest Screen Apex of the lumbar curve AT: Deep apex at L4/L5 PT: Flat at L4/5; Kink/Apex at T12/L1 Mixed: Shallow at L4/5 (apex shifted superiorly) Elbow Sign! Apex of the Lumbar Curve material is prohibited. 10

11 How do we distinguish? Screen Apex of the lumbar curve Ribcage position Gluteal definition Pelvic Tilt? Ribcage Position Visual: Translation, bell, take a breath Palpation: Landmarks: ribcage and L5/sacral base Ribcage Position Visual Inspection AT: Posterior translation; Top of ribcage posterior to L5 (rung up) PT: Flat/stacked or minimal ribcage translation posterior to L5 (kink at T12/L1); Bottom of ribcage posterior L5 (rung down) Mixed: Ribcage max posterior translation behind L5 (Can ring up or down) material is prohibited. 11

12 Ribcage Translation/Tip Screen Bells and Breathing How do we distinguish? Screen Apex of the lumbar curve Ribcage position Gluteal definition Pelvic Tilt? material is prohibited. 12

13 Gluteal Definition Visual Scan! Gluteal Definition AT: Present PT: Flat Bum Mixed: Upper glute flat Glute Definition Screen material is prohibited. 13

14 AT PT Mixed How do we distinguish? Screen Apex of the lumbar curve Ribcage position Gluteal definition Pelvic tilt? Pelvic Tilt? Landmarks: Bilateral Ilium Can you tilt the pelvis? Move pelvis to see impact on lordosis Pull on your bum string Lift your tailbone on inhalation material is prohibited. 14

15 Pelvic Tilt? AT: Very limited anterior, if at all PT: Posterior or limited toward neutral Mixed: Very tilt-able anteriorly Pelvic Tilt Screen Let s Review Anterior Tilt Deep apex at L4/L5 Ribcage post shift to pelvis, rung up Glutes present Pelvis will not tilt anteriorly any further material is prohibited. 15

16 Let s Review Posterior Tilt Flat L4/5; Kink at T12/L1 Ribcage flat or min post shift, often rung down Glutes flat Pelvis will posteriorly tilt more, or can move minimally toward neutral Let s Review Mixed Posture Type Shallow apex at L4/L5 Ribcage max post shift, rung up or down Glutes flattening (upper glute) Pelvis can be tilted anteriorly easily and farther than you expect (try pulling on the bum string) Independent Lab Self-evaluate in Mirror or with smartphone selfie Where is the apex of your lumbar curve? Do you have an elbow sign? Are you: Bell rung up? Bell rung down? Is your ribcage translated posteriorly or stacked? Do you have glute bulk? Flat bum? Upper glute atrophy? Can you tilt your pelvis? Pull on your bum string and/or lift your tailbone? Where is your weight in your feet? material is prohibited. 16

17 Finding the Sweet Spot Re-Defining Neutral Neutral Ribcage/Pelvis Position of optimum recruitment of the Diaphragm/Pelvic Floor Piston Balance of flexors and extensors Sweet Spot within neutral range; balancing their structure, muscular forces, and pressure Achieving Your Sweet Spot material is prohibited. 17

18 Ski Jump Good Bad (forgot the ribcage) Achieving Neutral Ski Jump Bum String Tailbone Where s your weight? Find your breath Ease of breath Bell Rung Down cues Self-Corrections Lab Ski Jump Let ribcage glide over pelvis (avoid using abs to pull ribcage over pelvis) Observe passive change in pelvic position Shift back to middle and maintain relative position (relax) Feel weight distribution change in feet (goal: even) Pull on bum string Observe rib cage shift Avoid overcorrection, and/or rib thrust Lift your tailbone (couple with inhale) material is prohibited. 18

19 Concept Synthesis Pop Quiz Pop Quiz material is prohibited. 19

20 Name That Compare Double Unders Module Summary material is prohibited. 20

21 Optimizes availability of system components (both deep and superficial) Impacts recruitment patterns Impacts the pressure system Changes multiple inputs for the brain to assess to change output (motor, sensory or pain) Using passive strategies optimizes appropriate brain activated patterns (neuromuscular model) vs imposed conscious strategies (strength model) Ease of breath, where s your weight What s Next Module Three Diaphragm: Gateway Breathing mechanics assessment tools Link with Intervention strategies for different breathing types material is prohibited. 21