GIFT: week 36 Measurement of the foot, Rhomboids, Improving breathing, Pelvic translation and rotation, assessing and treating the shoulder  

This week we looked at measurement of the foot. If we want to be objective we can assess the angulation, verticality and horizontal measurements of various joints to assess the motion at the foot e.g. measuring the knee position with a single knee bend. The GIFT institute using a 3D testing system but it is no longer on sale. Making your own and using goniometers etc will be required.

The Rhomboids are a muscle we don’ t often think about as we cannot separate its function from other scapulothoracic and humeral muscles. We want to know what will load these muscles and we can consider translations and rotations e.g. lateral and inferior translation and rotations of superior, internal rotation will lengthen them. It is ideal to look at the TZ and see what ecconcentric activity is happening with the Rhomboids.

Here are some secret strategies when improving breathing……….

  1. Load with breathing in to explode or exhale
  2. Improve mostablity of the Thoracic Spine, rib cage, pelvis, hips and rest of CRB
  3. Do the CRB allow normal relative motion between the Thorax and pelvis. Can the rib cage and diaphragm move normally with the Thoracic spine insync when inhaling and out of sync when inhaling
  4. Look at bottom up and top down strategies
  5. Assess ecconcentric and integrated isolation techniques

Gary highlighted pelvic translation and rotation this week. It is important to remember that roation and translation will occur on different planes. I can use these in rehabilitation strategies with FMR.

The shoulder can be a difficult joint to assess. DT discussed important assessment strategies. Here is my summary…..

  1. Remember to look at full body motion with assessment and you can get the shoulder to move in one plane or more than one plane
  2. To assess the influence of the legs on the shoulder you can use a sinle leg stand and toe touch. This will also look at mostability
  3. Use your hands on the body to feel Scapulothoracic and scapulohumeral motion. Use FMR to influence this motion
  4. You can assess humerus on scapula and scapula on thorax motion if you place the hand on a wall and move the pelvis or thorax. This is, in theory, proximal acceleration. If this is easier for the client to perform, compared to open chain hand motion, then this could indicate GHJ instability
  5. If there is winging and, when I hold it down with my hand, the winging stops, this could inidicate a weakness issue. If the winging persists, this could indicate GHJ stiffness
  6. Assess good arm before bad arm
  7. You can take the feet out by kneeling and hips out by sitting
  8. Add load and reps to see more dysfunction

DT highlighted that impingement is often a result of poor CRB. In other words increased GHJ excursion due to poor load to explode of friends of motion. Quick tips to treating impingement are…

  1. Correct the feet, hips and Thoracic Spine. Preposition these joints out of restriction to get quick successful shoulder motion. Then use FMR to get the restricted motion back in these areas.
  2. First goal is to get some painfree motion rather than increase in motion, therefore, reduce gravity by placing hand on the wall or moving the shoulder in supine.
  3. When fixing the hand on a wall there can still be pain as the scapula is not moving correctly and allowing impingement. you can use FMR to help control normal CRB at the scapulo-thoracic and scapulo- humeral joints. If the GHJ is stiff then you can move the scapula with the trunk and pelvis and slow down the humeral motion
  4. Look for successful strategy first and then build on that success
  5. Use Load to explode to regain motion. If I want to increase external rotation I could load into internal rotation first and then as speed increases explode into external rotation. Remember be subtle.
  6. Work above or below 90degrees of shoulder flexion to reduce the effects of gravity

Finally being able to measure knee motion using the 3D analysis tenchnique and using a tape measure to measure chest Ap and lateral will enable clear objective indication of changes post treatment.

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