This week we started assessment of the spine, in particular, the Thoracic spine. The Thoracic spine is an area of the body which can create problems in many other areas, such as the Low back, Cervical spine, Shoulders, Knees, Hips and Feet. The abdominal muscles require full 3D motion of the Thoracic spine if they are to be loaded to explode. The power transfer from the movements of the pelvis and hips are will maximised through full Thoracic spine motion.
The Thoracic spine can create pain in other areas of the body, but not have pain itself or have less pain. The Lumbar Spine acts as a force transmitter, passing forces between the upper and lower halves of the body. If there is low back pain, the Thoracic Spine must be assessed.
The Thoracic spine is a region of mobility in all three planes. Some planes will have more movement depending on the level of the Thoracic spine. The rib cage makes it a stable region and the rib articulations must be assessed.
I can see the Thoracic spine assessment and treatment will use top- down and bottom- up drivers and is best done in gravity influenced positions.
Week 18 also looked at the value of tweaking the environment on the Chain Reaction. It was interesting to see how increasing the pronation of a foot (not to end range) can create greater load to the lower limb muscles and therefore be a valuable tweak in exercise progression. We also looked at diagonal lunges and how the foot position can be altered to change the load through the chain reaction.
This week was an introduction to work on the Spine. It will be great to see how we connect the shoulders to the spine and use 3D motion to rehabilitate the shoulders.
This week had a large number of webcasts covering a multitude of topics. The key muscle introduced was the Popliteus muscle. This is an upside down muscle. It’s tendon runs up towards the head, whilst most run towards the toes. This orientation makes it an ideal controller of external rotation of the knee. It will also control adduction and extension.
Gary Gray introduced the Chain Reaction Biomechanics of the foot in forefoot running. In calcaneal inversion the forefoot will be able to invert. Inversion of the forefoot will allow pronation to occur and normal tibial internal rotation and back butt muscle activation. The foot is magnificent in its creation and ability to shock absorb when required, and be a rigid lever for propulsion at other times.
The course is slowly expanding into diagnosis and using small tweaks to lengthen or load muscles or make them work harder by reducing their loading. Tweaks are done in small increments. This is the real skill of a clinician. Use the right tweaks to find a clients threshold of function, find what is successful and build on that success.
If we were to test the entire body to come up with a cause and diagnosis for pain, it could be very time consuming. The Gray Institute highlighted the probable suspects for Achillies Tendinopathy to speed up this process. These were reduced ankle Dorsiflexion, Thoracic spine restriction, Cervical spine restriction, and reduced Load to Explode of the opposite leg. The primary aim is to make sure all leg muscles, especially the Glutes, are working to take load off the Achilles Tendon. This requires normal Chain Reaction Biomechanics of the Cervical spine down to the big toe.
Finally we looked at hip retroversion and antiversion. When we assess hip Range of Motion from anatomical neutral position we will see a reduction in ROM in one direction and an increase in ROM in the opposite direction of Rotation. In reality, if the hip joint is started from the mid position of the retroverted or anteverted hip, there is a normal amount of hip ROM. The start position of testing is key to seeing this in clinic. This is a structural issue and rehabilitation will need to work around this issue.
The content this week reinforced the movements of the pelvis on the same axis. The pelvis moves on the same axis and same plane. They create contribute to the load and explode in the Gluteal muscles in gait. These movements can be palpated and influenced using FMR. The use of translation and rotation in motion of the pelvis is important to assess in function.
A new series on Tweaking was introduced in the webcasts. This week teaching focussed on subtle, moderate and dramatic tweaks. This information accompanies the Process Flowchart. The degree of tweak can be altered in the TZ, Goal, movement variables, influence variables and complement drivers. This series runs for 10 weeks and leads in Gift Gathering 2 in July.\
Each week there are two webcasts by past GIFT graduates. The topic is the graduates own choice. Usually the topic is one which inspires the graduate. This week there was an incredible presentation on using GIFT to transform the health of children. In Canada 1 in 3 children has diabetes. The skills we are learning at GIFT can be used educate and teach young children to move again. To have fun and to experience the GIFT of movement. There is resistence to change in Society, but the need for movement based therapy, cannot be highlighted enough by the state of health in our children today. There is a calling to all GIFT graduates to contribute to community, and use the knowledge gained from the course, to reverse this downward spiral of health our children.
It has been a powerful message this week in the webcasts. I am excited about using the Process Flowchart and mastering Tweakology in the next 10 weeks.
This week was the week of the adductors. What do the adductors actually do? they are massively important in function. They will function commonly with the opposite abductors and will work bilaterally. If they become short and limit movement, they will inhibit adjacent muscle function.
The adductors are will work ecconcentrically in TZ1 and TZ2. They will be influenced in all three planes of motion of the hip. They will require adequte length to create normal Chain Reaction Biomechanics (CRB) for gait.
The adductors can be the forgotten area of the legs, but they have a significant role in all planes of motion and hence function.
Week 15 introduced the translation and rotation of the pelvis with gait. We looked at what happens in all three planes. There was a difference with translation and rotation when in the same plane or along the same axis. These motions are contributing to the ability of the body to load and then explode in gait. Next week these concepts will be explained further.
GIFT is about creating empowering environments for transformation, through the use of drivers, to create desired CRB. Lets change pain into comfort, fear into confidence and guilt into compassion.
Week 16 next week and looking forward to it.
Week 14 was a great week to look at all the Functional muscle function (FMF) techniques of the ankle, subtalar and midtarsal joints. We then identified the probable suspects causing Plantarfasciitis.
Some of the probable suspects causing Plantarfasciitis would be reduced Dorsiflexion of the ankle (ankle equinis) caused by reduced calf length and/or hip extension, poor motor control of the glutes and associated muscles decelerating Transformational Zone, poor load and explode of the opposite leg to create the Chain reaction of supination in the foot and finally the control of the abdominals on the pelvis, and this requires adequte Thoracic spine motion.
There was a hands on appropach this week, with a review of the FMF techniques for hip and foot and knee in TZ1 and TZ2. All useful techniques for assessment and treatment. Understanding what should happen in each of these transformation zones helps to assess movement in the entire body with assessment.
The foot has a significant influence on the rest of the chain reaction. We reviewed a standing assessment to decide if orthotics are required. The main advantage of orthotics is to make the glutes work better. Once orthotics are in place do they allow a better load to explode of the glutes for function?
Each week we are learning more and more. It is a little bitsy at the moment. I think when we start pulling all the information together in assessment the clinical reasoning will improve significantly.
This week was an introduction to more incredible new information. We had Gary Gray do a very realistic impersonation of a baby, to educate us on the Iliotibial band or Itty Titty Baby, as he calls it. This is a special band which is influenced by motion at the hip, knee and foot. The Tensor Fascia Lata, attached to the ITB, is eccentrically loaded in the front leg of gait. It is then stretched with hip extension in the back leg of gait, to assist with knee extension and tibial external rotation. There are many ways to stretch the TFL, Glute Max, and ITB complex. It is best to simulate the stretch required in your clients function.
In the webcasts there were Functional Manual Reaction techniques for the front and back knee of gait, Translation and rotation of the pelvis, and using hand drivers to influence Chain Reaction Biomechanics (CRB). We are starting to integrate the upper body motion and pelvis with lower limb CRB.
There was a recap of GG1 lectures on proprioceptors. It is key to know about proprioceptors, to choose exercises which enhance proprioceptor stimulation, to improve movement throughout the body and allow the body to become a more robust system. The proprioceptors discussed were the Pacinian Corpuscles, Golgi- Mazzoni, Ruffini, Golgi Tendon Organs, Free nerve endings, Muscle spindle, Fascia, Golgi ligaments.
Doug Gray introduced 3D hopping matrices. The choice of movement is limitless.
Finally, the learning opportunity looked at the stress on the Medical Collateral Ligament when the buttock was tweaked out (reduce support) during different lunge patterns. By learning what happened in this LOP, the clinician is able to choose which lunge is safe for the MCL.
It is great to work up the body and start looking at how the pelvis and spine move. Week 14 starts tomorrow.
It is nice to arrive into a different country and experience a different culture again. Detroit airport was quite and there were no problems getting through customs. In fact I heard others going to GG1 telling custom officers they were going to a Physical Therapy conference too.
I could not find my way to the pick up point but when I asked an American at the taxi stand, I received Royal treatment. He was going to walk with me, up one flight is stairs, and take me to the pick up point. I had a trolley so asked him to give me directions and got there by myself.
The GIFT white van arrived at the pick up point and, whilst waiting for everyone to arrive, I got to know the Brits who came over on the same flight and a few Americans. The Americans were from Iowa, Miami and California. Great chat on the way to the hotel. Photo: Gary Gray and Rhys Chong
The Carlton Hotel was a good hour from the airport. Within 30 mins of arriving at the Hotel we had a business conference followed by pizza party. The GIFT leaders were all there to meet and greet us. It was a great way to meet other GIFT fellows and hear about success businesses using GIFT strategies.
Over the next 3 days we were lectured on concepts we had learnt over the past 10 weeks, new information on Functional Manual Reaction Techniques and proprioceptors of the body. We were introduced to Free 2 play (www.F2Pacademy.com), with a 1 hour torture sesion of intense training in a basketball gymnasium. This taught us how to use 3D matrices to create a full body workout. Free 2 play is the Gray Institute’s free programme in schools which helps children learn to move again. The children take what they learn about the body to further stimulate their minds and spirits. It is a powerful tool in schools and the Gray Institute hopes to spread this throughout the USA and the World.
On the course we supported the success of a disabled basketball team reach the finals of their regional competition. We learnt more sign language and watched the power of sign language when matched to music. We were asked to create our own 3D dance to a song of our choice. The teams were very creative and it was a laugh to see how we all moved. It was run like talent show, with inteviews and judging. A fun way to learn.
GG1 was important in the learning process, as it locked home what we had learnt on the webcasts, and eanbled us to interact and ask questions directly to the Gray Institute team. This is first of three Gift Gatherings. I look forward to next one already.
This week has been a further progression on understanding the foot, and its important role in helping the rest of the body move. The three key areas of body which must funciton correctly are the Big toe, Bog Butt and Big Belly.
The big toe must Dorsiflex in the push off phase of gait to optimise the chain reaction up the rest of the body, and proper Butt and Abdominal activation. To Dorsiflex well the Ist Ray must position itself in Plantarflexion. This requires the subtler joint, ankle, hip and the opposite leg all to move load and explode correctly. The upper body is also involved.
The treatment approach could start with therapist mobilisation of the foot to improve DF of the 1st ray. It could then progress to client mobilisation, and weight bearing mobilistaion.
Included in this weeks Chain Reaction Biomechanics is the knee. What happens to the knee in when the foot hits the ground and when the foot is about to leave the ground. The knee is wedged between the foot and the hip. To understand how the knee moves is to understand how the hip and knee influence the femur and the tibia.
Functional exercises reviewed this week was the JOP (Jump-Hop). This means jump off two feet and land on one foot. There was progression to JOPing along a 3D plane and then Joping along a plane whilst maintaining the JOP in a different plane. There are amazing progressions for movements and all challenge the body to load and explode in different planes. The skill is to choose which one is the best for the client in front of you.
Finally, we were asked to identify which lunges would load the Medial collateral ligament of the knee the most and least. We placed the lunge matrices in order of least load to most load. It was a great exercise to understand how to choose the most approprate lunge for a pathology of the knee. This skill does require and understanding of Chain Reaction Biomechanics of the knee.
I look forward to improving my skill in assessment and exercise selection next week.
This week we have learnt assessment and treatment techniques for joint restrictions. A valuable assessment tool is to place the limb in a one plane position, Drive in another plane and tweak in another plane. By Tweaking in another plane, I can find which plane position is successful, drive the relative joint motion, and as motion is gained in the joint, slowly tweak out to the unsuccessful plane position. I can then convert the assessment to a treatment technique.
The learning opportunity highlighted the difference between driving the body to achieve a specific motion at a joint as opposed to driving for authenticity of gait. If the goal is to drive the body to get a specific joint to move, it is not necessary to drive in an authentic gait motion.
The learning opportunity also highlighted assessing the knee. If driving with bilateral hands, look at the effect on the knee in each plane to determine its compression with in the knee joint. Consider the gravity, centre of gravity and mass and momentum.
The hamstrings will be influenced by the motion of the tibia. If there is relative internal rotation of the knee, the lateral hamstrings are recruited. It is vice versa for external rotation of the tibia.
The course is creating a clinical reasoning process for assessment and treatment. Everything we have learnt is now coming together. We have looked at the role of proprioceptors. What types of proprioceptors exist in the body, and how we want to stimulate them in our treatment exercises.
It appears the Saggital, Frontal and Transverse tweaks must be understood to progress further in this course.
This week we covered the techniques to mobilise the subtalar joint and mid tarsal joint on the treatment table. These joints were mobilised by understanding how these joints connect and influence each other in weight bearing. These techniques were easy to use, and performed in as close to the normal hip and knee position as possible.
Using techniques on the treatment table fail to include the forces of gravity, ground reaction forces, mass and momentum when in weight bearing positions. We can use environmental aids and in standing positons to best replicate normal funciton, and then mobilise the joints of the foot.
To be able to select the best position to place the body and then drive the body to get the desired chain reaction we can use TRAZMA analysis. In this analysis we look at what the bones are doing and what the relative joint motion will be. This is a key analysis to help confirm the correct drivers and body positions are used to get the desired chain reaction.
This week we covered balance and how we can mobilise the joints to get better stability with motion. There are many positions to use to test balance and they all involve movement, instead of standing still on one leg.
We are one week away from Gift Gathering 1. There is a good build up of skill before the gathering. Time to test it out.