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Medical  MarketingMapping Movement

Danny porcelli, dc

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somewhere, something went terribly wrong

Brazilian  researchers  discovered  an  interesting  link  between  a  person’s  ability  to  sit  and  rise  from  the  floor  and  the  risk  of  being  6.5  times  more  likely  to  die  in  the  next  six  years.Brito  LBB,  Ricardo  DR,  Araujo  DSMS,  et  al.  Ability  to  sit  and  rise  from  the  floor  as  a  predictor  of  all-­‐cause  mortality.  European  Journal  of  Cardiovascular  Prevention,  2012;  

SIX  YEAR  STUDY2,000  PEOPLE  AGES  51  TO  80.  

A  SCORE  OUT    OF  10.  

Instructions:    "Without  worrying  about  the  speed  of  movement,  try  to  sit  and  then  to  rise  from  the  floor,  using  the  minimum  support  that  you  believe  is  needed.”  

Each  of  the  two  basic  movements  were  assessed  and  scored  out  of  5,  with  one  point  being  subtracted  from  5  for  each  support  used  (hand,  forearm,  knee,  for  example).  

159 people died Each  point  increase  in  a  person's  test  score  was  linked  with  a  21  percent  reduction  in  their  risk  of  death.  

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Movement is our Business

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Movement never lies

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corrective exercise -­‐  Used  to  normalize  human  movement  before  increasing  training  or  exercise  demands

rock tape -­‐  A  special  kinesiology/sports  tape  that  provides  support  while  allowing  full  range  of  motion.  Tape  is  used  to  decrease  pain,  unload  tissue  via  decompression,  and  provide  a  novel  stimulus  that  improves  body  awareness.

iastm -­‐  Instrument  -­‐  Assisted  Soft  Tissue  Massage  -­‐  A  manual  therapy  technique  designed  to  provide  direct,  mechanical  manipulation  of  irregular  tissue.

rolling/balls/bands -­‐  A  collection  of  tools  used  by  athletes  for  manipulation  of  the  myofascial  system  to  normalize  muscle  tone.

assessment-­‐  The  act  of  making  a  judgment  about  the  quality  of  human  movement

screening-­‐  The  act  of  examining  people  to  decide  if  they  are  suitable  for  a  particular  movement  or  exercise

RockTape movement pyramid

MOVE Well FIRSTthen MOVE Often

then LOAD Regularly

Movement as MEDICINE

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Evaluate Movement Prior to Load/Stress

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soft tissue

neurological joint

What is causing abnormal movement?

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Absent trauma, all stiffness is

compensatory for instability elsewhere

“Movement never lies.”Martha Graham

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stiffness compliance

Criteria for Optimal Efficiency

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ELASTIC SPRINGY

Rapid deliver of muscular energy is the key

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pre-­‐push

Adjo Zorn – Fascial Elasticity

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fascia as our roadmap

IT’S ALL CONNECTED

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mesoderm – old model ectoderm – new model

connected both mechanically and neurologically

nervous system

Pain/Performance

Movement articular

muscularFascia

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past

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future

Future

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It’s Alive

Fascia Senses Richest Sensory Organ

Fascia Transmits Force Globally Common myofascial pathways for transmitting stability, strain, and response Distributes strain

Continuous interconnected web A GPS system of strain distribution

what is fascia

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Muscular strain is applied along traceable “Myofascial Lines”

Thomas Myers – Anatomy Trains

toe touch test

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regional interdependenceAKA  -­‐  Joint  by  Joint  Approach

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Wainner,  RS,  et  al.  Regional  Interdependence:  A  Musculoskeletal  Examination  Model  Whose  Time  Has  Come.  J  Orthop  Sports  Phys  Ther  2007;37(11):658-­‐660

“When the assessment is initiated from the perspective of a movement pattern,

the clinician is able to identify meaningful impairments that may seem

unrelated to the main complaint”

Regional Interdependence

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MOBILITY vs. Stability

Joint by Joint ApproachGrey Cook & Michael Boyle

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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex Mobile Elbow Stable Wrist Mobile

** key mobility centers 34

mo·∙bil·∙i·∙ty  mōˈbilədē/  

the  ability  to  move  or  be  moved  freely  and  easily.

sta·∙bil·∙i·∙ty  stəˈbilədē/  

the  state  of  being  stable.

motor  control  the  systematic  transmission  of  nerve  impulses  from  the  motor  cortex  to  motor  units,  resulting  in  coordinated  contractions  of  muscles.

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Motor%Control%Pa+erns%%Mobility%Pa+erns%%

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movement screening methods

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corrective exercise -­‐  Used  to  normalize  human  movement  before  increasing  training  or  exercise  demands

rock tape -­‐  A  special  kinesiology/sports  tape  that  provides  support  while  allowing  full  range  of  motion.  Tape  is  used  to  decrease  pain,  unload  tissue  via  decompression,  and  provide  a  novel  stimulus  that  improves  body  awareness.

iastm -­‐  Instrument  -­‐  Assisted  Soft  Tissue  Massage  -­‐  A  manual  therapy  technique  designed  to  provide  direct,  mechanical  manipulation  of  irregular  tissue.

rolling/balls/bands -­‐  A  collection  of  tools  used  by  athletes  for  manipulation  of  the  myofascial  system  to  normalize  muscle  tone.

assessment-­‐  The  act  of  making  a  judgment  about  the  quality  of  human  movement

screening-­‐  The  act  of  examining  people  to  decide  if  they  are  suitable  for  a  particular  movement  or  exercise

RockTape movement pyramid How do we evaluate movement?

1. Screen  –  A  simple  test  performed  on  a  large  number  of  people  to  identify  those  who  have  or  are  likely  to  develop  a  specified  disease  (Higher  Level  Function)  A. Static  B. Dynamic  

2.    Assessment  –  In  depth  evaluation  of  a  clinical  condition.      Usually  in  presence  of  pain    3.    Testing  –  Isolated  evaluation  

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Movement screening

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all movement is a screen

Posture Analysis - STATIC

Bio-­‐Checkpoints:  

1. Feet  2. Ankle  3. Knees  4. LPHC  5. Scapula/Thoracic  6. Cervical  7. Upper  Extremity

Movement Analysis - Dynamic

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multi-planar approach

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OHS - Normal

trunk  &  tibia  parallel

elbow  straight

no  shifting  of  weight

hips  past  90  degrees

arms  in  line  with  ears

feet  parallel

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planar dysfunction

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We are looking at skin, not muscles.

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mobility or stability?

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mobility principles

Pain Affects Movement

“Patterns  involving  pain  should  be  treated  with  manual  therapy  

techniques.    Exercises  in  that  pattern  should  not  be  used  until  the  movement  is  pain  free.”  

-­‐Grey  Cook,  PT

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1joint restriction:

• CMT  -­‐  you  • Banded  Distractions  -­‐  learn  today     2

soft tissue shortening:• Foam  Rolling  • Ball  Release  

principles of mobility 2 levels of restriction

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normal tissue adhesions

villain’s accomplice

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• What can the joint accomplish without external influence

• “Hinges on the door” concept • Mobility are the hinges

mobility

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• Increases tactile acuity (kinesthetic sense) • Inexpensive massage that your patients can do on their own • Alleviate tightness • Increase ROM at joints • Decrease muscle soreness • Maximizing optimal length/tension relationship • Relieve joint stress

Self Myofascial Release (SMR)

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When you treat a patient or foam roll yourself and feel better it is the nervous system that you have influenced. It is unlikely that any changes in the mechanical properties of tissues have occurred.

You have convinced the nervous system to let you move farther, with greater ease or with greater strength.

Thought to stimulate intra-fascial mechanoreceptors which cause alterations in the afferent input to the CNS, leading to a reduction in the activation of specific groups of motor units

More widely accepted than the older mechanical models.

rolling the brain

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Autonomic Nervous System - Brain

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Hypothalamic tuning Global muscle tone

intra-fascial smooth muscles

palpable tissue response

tissue manipulation

stimulation of mechanoreceptors

56SCAN + IDENTIFY + RECOVERY RELEASE + NAVIGATE

1. SCAN tissues targeted within workout.

2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE

3. HOLD pressure on target tissue for 30 seconds to tolerance = RECOVERY RELEASE

4. Address tissues up/down stream to target tissue = NAVIGATE

RECOVERY/PAIN mobility techniques

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Untreated  Knee

Rock  Tape  Knee

Foam  Roll  1  Knee

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mobility - ripple effect

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where you think it is, it ain’t.

Ida Rolf

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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable ** key mobility centers

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ankle restriction

• ripple: • calf/shin/hamstrings

• target tissue – ankle • ripple:

• foot

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hip restriction

• ripple: • Q/L, mid-back, lats

• target tissue – hip • ripple:

• hamstrings, quads, calves, foot, shins

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shoulder restriction

• ripple: • mid-back, lats,

pectorals • target tissue –

shoulder • ripple:

• arm, forearm, hand

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banded mobilizations

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1. Grade I: Small amplitude at the beginning of the range of motion (ROM)

2. Grade II: Large amplitude not reaching the end of the ROM

3. Grade III: Large amplitude reaching the limited ROM 4. Grade IV: Small amplitude at the end of the limited ROM 5. Grade V: Small amplitude and high velocity at the end of

limited ROM (manipulation or thrust)

Maitland mobilization categories

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• Malignancy in area of treatment

• Infectious Arthritis

• Metabolic Bone Disease

• Neoplastic Disease

• Fusion or Ankylosis

• Osteomyelitis

• Fracture or Ligament Rupture

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• Excessive pain or swelling

• Arthroplasty

• Pregnancy

• Hypermobility

• Spondylolisthesis

• Rheumatoid arthritis

• Vertebrobasilar insufficiency

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 +  Torque

mobilization vectors

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2. traction - parallel to joint

1. glides - perpendicular to joint plane

3. torque - tissue torque applied with mob band

3 mobilization vectors

Compliments  CMT,  send  them  home  with  

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proximal stability allows for distal mobility

3 points of

contact

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anchor

3  points  of  contact

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Clock Method

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30-60 seconds

Glide - posterior vector (hip)

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glide - anterior vector (hip)

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glide - lateral vector (hip)

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glide - multi-vector mobilization (hip)

6  o’clock

7  o’clock

9  o’clock

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traction (hip)

long  axis

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torque

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Torque (hip)

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motor control principlesRewiring  the  Brain

Pain and Motor Control

“Motor  Control  will  be  distorted  and  outcomes  will  be  inconsistent  when  

exercise  is  performed  in  the  presence  of  pain.”  

Hodges  PW  Pain  and  Motor  Control:  From  the  laboratory  to  rehabilitation.  Journal  of  Electromyography  and  Kinesiology  21  (2011)  220-­‐228

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On the Fence?

Stability typically precedes mobility

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ability of a joint system to control movement in the presence of change

Stability

RockTape Arsenal

Todays TOOLS

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MOBILITy vs Stability

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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable

** key mobility centers 92

corrective exercise -­‐  Used  to  normalize  human  movement  before  increasing  training  or  exercise  demands

rock tape -­‐  A  special  kinesiology/sports  tape  that  provides  support  while  allowing  full  range  of  motion.  Tape  is  used  to  decrease  pain,  unload  tissue  via  decompression,  and  provide  a  novel  stimulus  that  improves  body  awareness.

iastm -­‐  Instrument  -­‐  Assisted  Soft  Tissue  Massage  -­‐  A  manual  therapy  technique  designed  to  provide  direct,  mechanical  manipulation  of  irregular  tissue.

rolling/balls/bands -­‐  A  collection  of  tools  used  by  athletes  for  manipulation  of  the  myofascial  system  to  normalize  muscle  tone.

assessment-­‐  The  act  of  making  a  judgment  about  the  quality  of  human  movement

screening-­‐  The  act  of  examining  people  to  decide  if  they  are  suitable  for  a  particular  movement  or  exercise

RockTape movement pyramid

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2 ways to affect motor control 1. tape on skin 2. corrective exercise

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tape - mechanical effect

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tape - neurological effect

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“much of what we know about pain is based on the skin. In this sense, it mirrors the state of the nervous system. “Excerpt From: Dr David S. Butler & Prof. Lorimer Moseley. “Explain Pain.” Noigroup Publications. iBooks.

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modern rehabilitation/training will be via normalization of sensation, motor control.

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when you are defending, you can’t be performing Douglas Heel (Mind and Muscle)

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Stretch  the  area  

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lay  down  1-­‐2  pieces  of  tape,  no  stretch  Rub  in  the  adhesive

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what about direction of

tape?

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what about the amount of stretch?

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Research  shows  that  kinesthetic  guidance  can  be  translated  into  

behavior  30  times  faster  than  visual  guidance  can  and  many  thousands  of  times  faster  than  audio  guidance.    

(Birdwhistell,  1971).  

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2 ways to affect motor control

1. tape on skin 2. corrective exercise

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+ =low threshold repetition

plastic change

neuroplasticity

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less is more- mies van der rohe

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2 steps

+isolation integration

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isolation exercises

reactive  neuromuscular  training  (RNT)

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integration exercises - PMT Training

Brugger’sPallof

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the blueprint

1. screen 2. moblilize / ripple 3. stabilize / Motor Control

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classic relationships along kinetic chain

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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable

** key mobility centers

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1. screen 2. mobilize/ripple:

• toe, calf + ripple mobilizations 3. stabilize:

• foot TapinG • Motor Control: short Foot

foot - classic area of stability loss

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screen

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mobilize

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stabilize

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motor control

short  foot

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1. screen 2. mobilize:

• banded mobilization (multi-planar) 3. Stabilize - Ripple foot and knee

ankle - Classic area of Mobility loss

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screen

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mobilize

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1. screen 2. mobilize/ripple:

• foam roll + ripple

3. stabilize: • Tape -knee • motor control - lateral band walks, RNT

(variations)

knee - classic area of stability loss

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screen

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mobilize ripple

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mobilize

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stabilize

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motor control

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1. screen 2. mobilize:

• trunk, t-spine, shoulder girdle, upper c-spine mobilizations + ripple

3. stabilize: • Tape - low back • motor control: lateral band exercises (progressions)

hip - classic area of mobility loss

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screen

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mobilize

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band mobilization

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stabilize

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motor control

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1. screen 2. mobilize:

• diaphragm, t-spine, hip mobilizations 3. stabilize:

• lumbar, diaphragm + ripple 4. movement:

• isolation: RNT (quadraped) • integration: brugger’s, pallof

trunk - classic area of stability loss

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screen

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stabilize 156

motor control

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1. screen 2. mobilize:

• t-spine, upper c-spine, shoulder girdle

3. stabilize/Ripple option: • Tape - lower back, shoulder girdle, lower c-spine • motor control -open book exercise

thoracic spine - classic area of mobility loss

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screen

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isolation

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1. screen 2. mobilize/ripple:

• t-spine, upper c-spine, elbow 3. stabilize:

• tape - elbow, cspine - shoulder? • Motor COntrol - chops

shoulder complex - classic area of mobility loss

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screen

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169 170shoulder  

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motor control

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• skin is an extension of the brain • tape augments our body awareness • screen movement, not muscles • tape movement, not muscles • use fascia as a map • retrain the brain

in summary