Movement. Mapping. somewhere, something went terribly wrong. Medical Marketing

Mapping Medical  Marketing Movement Danny porcelli, dc 1 somewhere, something went terribly wrong 2 Brazilian  researchers  discovered  an   inte...
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Mapping

Medical  Marketing Movement Danny porcelli, dc

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somewhere, something went terribly wrong

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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  STUDY
 2,000  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.  


Movement is our Business Movement never lies

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RockTape movement pyramid 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  

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MOVE Well FIRST
 then MOVE Often
 then LOAD Regularly

athletes  for  manipulation  of  the  myofascial  system  to   normalize  muscle  tone.

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

Movement as MEDICINE

screening-­‐  The  act  of  examining  people  to  decide  if  they  

are  suitable  for  a  particular  movement  or  exercise

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Evaluate Movement Prior to Load/Stress

What is causing abnormal movement?

soft tissue

neurological

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“Movement never lies.”

Absent trauma, all stiffness is compensatory for instability elsewhere

Martha Graham

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joint

Criteria for Optimal Efficiency

Rapid deliver of muscular energy is the key

compliance

stiffness

ELASTIC 17

SPRINGY 18

Adjo Zorn – Fascial Elasticity

fascia as our roadmap

pre-­‐push 19

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IT’S ALL CONNECTED

connected both mechanically and neurologically mesoderm – old model ectoderm – new model

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nervous system

past Fascia

muscular Pain/ Performance

Movement

articular

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future 


what is fascia It’s Alive Fascia Senses Richest Sensory Organ

Future

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

Continuous interconnected web 25

A GPS system of strain distribution

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toe touch test Muscular strain is applied along traceable “Myofascial Lines” Thomas Myers – Anatomy Trains

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regional interdependence AKA  -­‐  Joint  by  Joint  Approach

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MOBILITY vs. Stability

Regional Interdependence “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”

Joint by Joint Approach
 Grey Cook & Michael Boyle Wainner,  RS,  et  al.  Regional  Interdependence:  A  Musculoskeletal  Examination  Model  Whose  Time  Has  Come.  J  Orthop   Sports  Phys  Ther  2007;37(11):658-­‐660 31

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

Stable Mobile Stable Mobile Stable Mobile Stable Mobile Stable Mobile

sta·∙bil·∙i·∙ty  

mōˈbilədē/  

stəˈbilədē/  

the  ability  to  move  or  be  moved  freely   and  easily.

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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** key mobility centers

Mobility%Pa+erns%%

mo·∙bil·∙i·∙ty  

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Motor%Control%Pa+erns%%

movement screening methods

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RockTape movement pyramid

How do we evaluate movement?

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.

A. Static   B. Dynamic  

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

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)  

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

Movement screening

all movement is a screen no reliable methods

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Posture Analysis - STATIC

Movement Analysis - Dynamic

Bio-­‐Checkpoints:   1. 2. 3. 4. 5. 6. 7.

Feet   Ankle   Knees   LPHC   Scapula/Thoracic   Cervical   Upper  Extremity

multi-planar approach

OHS - Normal no  shifting  of  weight

arms  in  line  with  ears

trunk  &  tibia  parallel

elbow  straight

hips  past  90  degrees

feet  parallel

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We are looking at skin, not muscles.

planar dysfunction

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mobility or stability?

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mobility principles

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principles of mobility 2 levels of restriction

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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joint restriction: • CMT  -­‐  you   • Banded  Distractions  -­‐   learn  today    

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soft tissue shortening: • Foam  Rolling   • Ball  Release  

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villain’s accomplice normal tissue

mobility • What can the joint accomplish without external influence • “Hinges on the door” concept • Mobility are the hinges

adhesions

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Self Myofascial Release (SMR) • • • • • • •

rolling the brain

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

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.

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RECOVERY/PAIN mobility techniques !

!

!

!

tissue manipulation

stimulation of mechanoreceptors

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

Autonomic Nervous

Hypothalamic tuning System - Brain Global muscle tone

palpable tissue response

!

!

!

!

!

intra-fascial smooth muscles

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SCAN + IDENTIFY + RECOVERY RELEASE + NAVIGATE

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mobility - ripple effect Untreated  Knee

Foam  Roll  1  Knee

Rock  Tape  Knee

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

where you think it is, it ain’t. Ida Rolf

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** key mobility centers

Stable Mobile Stable Mobile Stable Mobile Stable MOBILE Stable stable 62

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 67

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banded mobilizations

Maitland mobilization categories 1. Grade I: Small amplitude at the beginning of the range 2. 3. 4. 5.

of motion (ROM) Grade II: Large amplitude not reaching the end of the ROM Grade III: Large amplitude reaching the limited ROM Grade IV: Small amplitude at the end of the limited ROM Grade V: Small amplitude and high velocity at the end of limited ROM (manipulation or thrust)

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• Malignancy in area of treatment

• Excessive pain or swelling

• Infectious Arthritis

• Arthroplasty

• Metabolic Bone Disease

• Pregnancy

• Neoplastic Disease

• Hypermobility

• Fusion or Ankylosis

• Spondylolisthesis

• Osteomyelitis

• Rheumatoid arthritis

• Fracture or Ligament Rupture

• Vertebrobasilar insufficiency 71

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mobilization vectors

3 mobilization vectors

1. glides - perpendicular to joint plane

 +  Torque

2. traction - parallel to joint 3. torque - tissue torque applied with mob band

Compliments  CMT,  send  them  home  with  

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proximal stability allows for distal mobility

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3 points of contact

anchor

3  points  of  contact

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Glide posterior vector (hip)

Clock Method

30-60 seconds 77

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glide - lateral vector (hip)

glide anterior vector (hip)

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glide - multi-vector mobilization (hip)

traction (hip)

9  o’clock 6  o’clock

long  axis

7  o’clock

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torque

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Torque (hip)

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Pain and Motor Control “Motor  Control  will  be  distorted  and   outcomes  will  be  inconsistent  when   exercise  is  performed  in  the  presence  of   pain.”  

motor control principles Rewiring  the  Brain

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

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Stability

On the Fence?

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

Stability typically precedes mobility

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RockTape TOOLS Todays Arsenal

MOBILITy vs Stability

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

Stable Mobile Stable Mobile Stable Mobile Stable MOBILE Stable stable

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RockTape movement pyramid 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

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

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2 ways to affect motor control 1. tape on skin 2. corrective exercise 93

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tape - neurological effect

tape - mechanical 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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when you are defending, you can’t be performing

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

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? 107

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what about the amount of stretch? 109

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 112

neuroplasticity

less is more low threshold

+

repetition

=

- mies van der rohe

plastic change

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isolation

+

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integration

reactive  neuromuscular  training  (RNT)

2 steps

isolation exercises 115

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the blueprint 1. screen 2. moblilize / ripple 3. stabilize / Motor Control Pallof

Brugger’s

integration exercises - PMT Training 117

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

classic relationships along kinetic chain

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** key mobility centers

Stable Mobile Stable Mobile Stable Mobile Stable MOBILE Stable stable 120

foot - classic area of stability loss

screen

1. screen 2. mobilize/ripple: • toe, calf + ripple mobilizations 3. stabilize: • foot TapinG • Motor Control: short Foot

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mobilize

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motor control

stabilize

short  foot

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ankle - Classic area of Mobility loss

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screen

1. screen 2. mobilize: • banded mobilization (multi-planar) 3. Stabilize - Ripple foot and knee

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mobilize

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knee - classic area of stability loss

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screen

1. screen 2. mobilize/ripple: • foam roll + ripple

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

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mobilize ripple

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mobilize

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stabilize

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hip - classic area of mobility loss

motor control

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)

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screen

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mobilize

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band mobilization

stabilize 145

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motor control

trunk - classic area of stability loss

screen

1. screen 2. mobilize: • diaphragm, t-spine, hip mobilizations 3. stabilize: • lumbar, diaphragm + ripple 4. movement: • isolation: RNT (quadraped) • integration: brugger’s, pallof 149

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motor control

stabilize 155

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thoracic spine - classic area of mobility loss 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

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screen

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isolation

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shoulder complex - classic area of mobility loss

screen

1. screen 2. mobilize/ripple: • t-spine, upper c-spine, elbow 3. stabilize: • tape - elbow, cspine - shoulder? • Motor COntrol - chops

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shoulder  

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motor control

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in summary • • • • • •

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 173

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