GIFT: week 34 Serratus Anterior, Breathing, the Throwers Elbow and Assessment strategies

This is an excellent week covering a variety of subjects from the loading phase of the Serratus Anterior to Respiratory function to assessing the Thoracic Spine.

To understand how to load the Serratus Anterior you must know the 3D function of the scapula, and what the SA will do to the scapula. To load the SA you then place the scapula in the position to lengthen the SA, and use the Thoracic Spine and Pelvis as Drivers to create the load. Sounds complex but the beauty of this strategy is it is backed by sound principles of biomechanics and muscle function. It is knowing the Chain Reaction Biomechanics of the body.

In throwing, the elbow can be overloaded in a valgus stress and injure soft tissues, bone and/ or neural tissue. What are the probable suspects of this type of injury. Consider the same side overpronation, reduced 3D motion in the same side hip and Thoracic Spine, and reduced proximal deceleration. Again, the Chain Reaction Biomechanics are key knowing what would increase the valgus extension stress to the elbow.

Breathing is more complex than we realize. Transdiaphragmatic breathing is understanding that the pressure of the diaphragm on the right will compress the liver, send transverse pressure across the viscera, and create and upwards force on the ribcage, thus assisting in expansion of the left lung. The right diaphragm is larger due to the size of the Liver. The Diaphragm is influenced by the fascial trains of the body, along with the position of the spine. Remember there is an appropriate amount of Diaphragmatic motion for each person. We want to avoid over or under inflating the lungs.

In training we can isolate the load on specific muscles by prepositioning joints to shorten or lengthen their friends. This is also called Integrated Isolation. This is a great strategy for training a muscle for sport specific function. Overload it to create a buffer of muscle function i.e the muscle can take extreme muscle loading.

Other topics covered this week included Mostability and taking away support in a subtle manner. Assessing the motion of the Thoracic Spine and Skun (Skip and run). These topics consolidated our knowledge, by drawing together several concepts into a full assessment strategy.

The weeks get better and better as we head towards GG3.


GIFT: week 33 Impingement of the hip, Quadratus Lumborum, breathing, nutrition, basketball and cricket

This week we were given fantastic techniques to help with Femoral Acetabular Impingement and how to moblise the hip joint. The techniques were based on the principles of rotation and translation of the hip joint. If the femur does not move smoothly under the pelvis and the pelvis does not move smoothly over the femur, in particular, in the planes of internal rotation, flexion and adduction, there is an increase risk of impingement. The techniques used bands to slow down motion of the distal segment to increase joint range of motion.

We also looked at the Quadratus Lumborum or the back abdominals. This muscle is enveloped by the thoracoumbar fascia and runs in an anterior to posterior direction, from the 12rib and T-processes of the lumbar spine to the iliac crest. This muscle is lengthened and shorted at the same time, with movement in different planes. This again is an example of econcentric contractions.

Breathing and nutrition has been introduced this week. The body is very asymmetrical but in the end balances itself out e.g. the liver under the right lung makes the diaphragm bigger on this side. The left side of the chest cavity has the heart. There are two lobes on the left lung and three on the right. We will look at how these asymmetries will influence breathing later in the series.

Nutrition is highly contentious and there is not one way which is right for everyone. There is a book called the Diabetes Diet and introduces the concept of controlled carbohydrate diets. It appears carbohydrates need to be controlled if we want to keep blood sugars level and maintain or lose weight. Interesting theories to test.

There were webcasts on basketball matrices and cricket biomechanics. It is getting interesting with a variety of sports now being discussed.

Another great week of information

GIFT: week 32 Hip, Running, Shoulder, FMR and Econcentrics

This week had a significant amount of new information mixed with relearning past information. The focus was on the Latissimus Dorsi accompanying webcasts on the hip, running, shoulder, FMR and econcentrics.

The Latissimus Dorsi is attached to the pelvis, trunk, scapula and humerus. The motion influencing all these areas has been termed peltrunkularus. Multiple attachments allows the Lat. to work econcentrically in the load and explode phases of motion. We assessed how foot, knee, pelvis and hand drivers can move or preposition the Lat to work econcetrically and where this was felt in the body. Remember the stretch can be felt in different places for everyone.

We were shown how to increase motion in the hip using SFT prepositions and functional motion with SFT. The assessment becomes the treatment so focusing on the Transformational Zone helps direct these strategies. Sometimes we need to move away from authentic motion to allow us to get muscle activation or motion at a joint before going authentic. Remember, proprioceptors need authentic motion for correct function.

This week we were shown running, runuffle and runeoka. These are forms or running we can use to assess in all three planes of motion. They can show up faults in the Chain reaction biomechanics. The runeoka is quite a challenge.

Secondary shoulder instability can come about because of hypomoblity in other parts of the chain reaction or a lack or mostability creating hypomobility. Remember to test mostability of joints in the chain reaction. If there is normal joint ROM but poor mostability in parts of the chain, this can create shoulder instability.

The FMR technique we learnt this week, allowed us to increase motion at a desired joint, whilst restricting motion at another. If the body has a habitual way of moving, we sometimes need to control the hypermobile segment, and promote motion where it should occur. We can do this my correcting the position of the hypomobile segment or limiting motion in the hypermobile segment or both.

This week has the most intensive LOP to date. It tested our knowledge of nomenclature and econcentric activation of the Latissimus Dosi. The knowledge is coming together but there is still a lot to learn.

Looking forward to another big week next week.

GIFT week 30 Runners, Proximal acceleration, PST

This week takes everything we have learnt in the past, and reinforces how we can take Principles and apply them in assessment and treatment.

There were very practical webcasts using FMR to locate and mobilise dysfunctional ares of the body during movement testing. We were shown how to sequence exercises to ease low back in gait. We were given the principles of load to explode and how to apply it to the total hip joint replacement.

The relative joint motion and real bone motion in runners was illustrated by Gary Gray. It is so important to remember joint and bone motion, and the concepts of authentic triplane motion with all movement analysis.

We were show triplane motion with walking, walkuffle and walkeoka. These are types of walking we can use in assessment and treatment.

There is so much to digest and integrate. We are in a phase of applying the principles. This is where the analysis skills will be honed.

GIFT Weeks 28 & 29 Looking at the upper quadrant, mass & momentum, throwing

The last two weeks have been jammed packed. We have shifted to the neck and scapula and now the action of throwing.

We have discussed how the scapula can lock down the thoracic spine and by using an assist assist approach, to loading and unloading the scapula, we can reduce the tension around the neck and upper back and improve the chain reaction throughout the body.

In GG2 we systematically analysed Transverse, Frontal and Saggital plane motion from head to toe. This approach looks is a strategy to release stiffness as opposed to using successful motion to gain more successful motion. The scapula release had a profound improvement on hip motion and improved neck rotation.

The neck series has started and we have started with increasing saggital plane motion using bilateral hand drivers and eye drivers. Very simple techniques and I look forward to using them in the clinic.

Gary described the influence of mass and momentum on CRB. In clinic we want to visualise where the centre of mass of the body will be with movement. I can then use FMR to control that mass and momentum and use it tweak more successful motion. Using mass and momentum around the pelvis as a driver led us onto the concept of “rotation”. This is knowing how the pelvis rotates and translates along the three cardinal planes of the body.

Understanding rolation allows us to control the 6 degrees of freedom of the body via the pelvis. By doing a TRAZMA analysis we can complete the picture with Rolation.

This week we really focussed on throwing. We learnt what the transformational zones of throwing are and what the deceleration – acceleration whip means. In a left handed thrower, the right foot plants into the ground to allow the hand to whip around and throw the ball. The right leg planting allows the pelvis to rotate, followed by the trunk, and finally the hand. Without planting of the right foot a throw is not possible. The is called the deceleration – acceleration whip.

The probable suspects for shoulder injuries are the ankles, hips and Thoracic spine. Remember where the pain is felt is often now where the problem lies. Find the cause of the pain through analysing CRB.

I look forward to next week, where we build our knowledge of running biomechanics and using progressions in rehab to running, skipping, hopping and variations of these for triplane rehabilitation.

Week 25 and Gift Gathering 2: Peltrunkularus

At Gift Gathering now and reviewing all that has happened over the past 3 days. The information from week 25 was the focus for GG2.

The focus was on movement of the pelvis, trunk, scapula and humerus. The Gray Institute calls the combined movements of these regions as Peltrunkularus.

On the first day we assessed the following movement, XXX, Right foot same side rotation lunge with bilateral hand right rotation @ shoulder reach and head rotated to the same side. We assessed the restriction in the motion of the hands and then “chunked” what was happening between “blocks” within the body e.g. head on Thorax, scapula, Thoracic spine, Thoracic and Lumbar Spine, Lumbar spine and Pelvis and Pelvis on Hips.

We were looking for areas in the body, which were influencing the bilateral hand reach to the right. When we used FMR techniques we could identify the influence of each area on the bilateral hand reach. We actually found the scapula and thoracic spine were the pain restrictions to the bilateral hand reach. The foot was also blocked at the subtalar joint.

On the same day we practiced FMR techniques to load the scapula in all three planes. These techniques felt great and were very effective in increasing GHJ motion. It was important to tweak the techniques to avoid impingement in the shoulder. The focus was always painfree motion. These techniques were later tweaked to include the GHJ. The ratio of scapula to GHJ loading should be 75%: 25% respectively.

Often the postures we assume will influence the position and movement of the scapula. The FMR techniques, which can counteract these gravity created scapula postures, were horizontal abduction, flexion and abduction. To assist the muscle loading to improve elevation motions we can use FMR techniques for extension to assist flexion and adduction to assist abduction.

When assessing CRB we must look at both sides of the body, as one will influence the other. Commonly the hips need to be assessed bilaterally e.g in right sided same lunge, the right hip is loaded in the glutes and the opposite is loaded in the adductors.

We went on to assess the motion in the Thoracic spine from a global perspective. There were 6 motions to assess. We looked at FMR techniques to facilitate or slow motion down at any area within the Chain. These handling techniques were useful for increasing or decreasing motion where I thought it was needed. Remember to get good thoracic motion to keep the arcs of motion large with the hands. Some people like a target to aim for and this could be done with a mark on the wall

Tips in assessing are to first go Global, then local, and back to Global. Try to keep the motion as authentic as possible.

With FMR techniques I want to keep the facilitation to the bare minimum and aim to be authentic. I want to take my hands off as fast as I can.

If there are problems it always helps to get back to the pelvis, as all other drivers are trying to influence it. In other words, all the drivers will focus on loading the pelvis, as the first bone to explode is the pelvis-hip. The pelvis must be loaded first. If we aim treatment and assessment at the pelvis first we can see what the rest of the body is doing to it and we can start treating it. Gary calls this “Going home”. An example of load and explode in the pelvis is TZ1. When the glutes explode they help to swing the contralateral leg forward.

Rolation is combining the rotation of the pelvis with translation along its axis e.g anterior pelvis tilt will be combined with translation on the left and right lateral axis, Transverse plane rotation will be combined with translation up or down the superior to inferior axis.

These combined motions can be assessed and facilitated with FMR. Remember the order they may occur in loading e.g. rotation before translation or translation before rotation. Remember the order they occur in the explode e.g. translation inferiorly with rotation to the right of the pelvis when it is loaded. In the explode rotation to the left can start before the translation superiorly begins.

Walkuffle is the combination of walk in all three planes with a shuffle i.e. side to side walking with feet coming together with each step. This can be used as an assessment tool and treatment.

Sitting Pain
We discussed pain with sitting and it is not a matter of the right chair and ergonomics. It is about the body being compressed and the need for the body to be decompressed with movement. Maybe actions at the desk need to greater e.g. placing the phone and papers further away from the body. What is happening at the Thoracic spine with repetitive motion e.g. is there a type 1 or type 2 restriction in movement.

A strategy could be, every 45 minutes, doing some motion. The key is to go deeper in the range e.g. more flexed position, then opposite e.g. to expode and then unload e.g. traction motion. The goal is to create a buffer for the body to manage the next period of compression. It is like brushing your teeth. Keep regular motion in the body to keep pain away.

To manage hypermobile joints I want to first know what is causing the hypermobility. What parts of the body are pissing off the joint? I can assess from bottom up and find the major rocks. If the shoulder is hypermobile I might find the hip is not loading correctly and I must get a better load on the buttock to take the need for increased load off the GHJ. I should not treat at the GHJ. I should treat other areas in the chain, get these areas strengthened to take load off the GHJ. Remember the body is chain reaction and the body can heal itself. It is not the therapists job to heal, but to create the environment to heal.

Tip: Spodylolithesis is often created by a lack of motion in the TX and hips in the transverse plane, form the bottom up.

If the neck painful look at the Thoracic spine and the scapula. If the low back is painful, look at the Thoracic spine and the hips.

The main rocks on the body are the feet and ankles, hips, Thoracic spine and the head/ eyes moving the head.

Week 24 The spine and finding success

This week we looked at the Cervical, Thoracic and Lumbar spine and how we can assess each area to find successful motion. Remember successful motion begets successful motion. 

The lumbar spine is often the “victim” as it sits between the hips and the Thoracic spine, and everything else above and below them. The hips and the Thoracic spine are common areas of the body with restriction, and will create overload to the Lumbar spine. The Thoracic spine is as much, if not more, a probable suspect in causing problems to any area on the body. It has good triplane motion, but is prone to restriction, and therefore creating problems elsewhere. The Cervical spine sits between the head, Thoracic spine and shoulder girdle. It has an upper Cervical spine with type 1 motion and Lower Cervical spine with type 2 motion. If the Upper Cervical spine cannot dissipate type 1 motion, then the lower cervical spine will run into trouble when asked to perform more type 1 motion from the bottom up.

Assessing each area requires a preposition from the top down or bottom up and then driving from the opposite i.e. bottom up or top down respectively. I could find success in mid or end or range prepositions. The principle is to choose the preposition which creates success. 

We can use load as a tweak in our testing and treatment. We would use load to increase proprioception excitation or to work on power and strength. It is important to identify the Transformational Zone and look to create the correct load to load and explode correctly.

GG2 next week. Getting excited. We will consolidate all we have learnt so far and we will be working with groups of children, to help them move more in their lives, and it is totally free for anyone to do.