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 !
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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
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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