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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GIFT: Week 35 breathing, looked at lateral epicondylitis, motions of the lumbar spine and the Pecs

Breathing is an integral motion of the body, which can be influenced by stress. When we are stressed we have an increase in our rate of breathing (normal 10-12 breaths per minute) and CO2 production. The pH levels in our bodies will lower because there is more Co2 in the bloodstream. As a consequence our mediastinum pressure increases.

There are three chambers we want to balance when our breathing patterns are correct. These are the cranium, mediastinum, and abdominal. If we lose pressure in these our exoskeleton (muscle and bone) would collapse. We want to have appropriate pressure in each chamber. Too much or too little in one or more chambers will influence the body negatively.

There are three bones related to each of these chambers; the Sphenoid, Sternum and Sacrum. Each bone must be balanced in all three planes.

It was interesting to learn mouth breathing alters the length tension relationships around the neck and will create more upper chest breathing. Nose breathing is best.

The movement of the rib cage and the position of the scapula, with associated muscle attachments, will influence the body’s ability to breathe. There will be other friends of rib cage motion and we want to be sure they are all supporting good breathing patterns.

Epicondylitis of the elbow is a common injury in raquet sports, golf and repetitive overload. In the Thrower there can be a restriction through the Chain Reaction Biomechanics which leads to an overload of the elbow structures. If the medial ligament is repetitively injured, this could lead to an increase in laxity of the joint and early joint damage. A key to treating Epcondylitis is to look at the offending Transformational Zone and determine what drivers you can use to create successful Chain Reaction Biomechanics.

The Lumbar Spine will be influenced by motion of joints above and below. When there are areas of the body not contributing to normal Chain Reaction Biomechanics there is an overload to the Lumbar Spine and pain. When we just treat the Lumbar Spine we are missing a huge piece of the puzzle, to prevent long-term pain and fast recovery.

The Pectorals are a powerful muscle group which can be loaded in three planes of motion to function optimally. They can be loaded with extension, flexion, horizontal abduction, and external rotation. They will explode in the opposite direction. Remember the effect of proximal acceleration in increasing this loading mechanism. The Pecs will need it’s friends the feet, hips, thoracic spine, rib cage , scapula and neck working to fully load it.

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.

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.

 

 

WEEK 21 & 22 Quadriceps, lumbar spine and thoracic spine

These last two weeks have been building up to Chain Reaction Biomechanics of the Lumbar and Thoracic spine. The Lumbar spine is the cross roads of the body. It reacts to what is happening in other joints of the body. The two key joints to assess with Lumbar spine pain are the hips and Thoracic spine. If the hips and Thoracic spine have good motion then the feet and the Cervical spine might be influencing their motion respectively.

When considering Chain Reaction Biomechanics of the Lumbar and Thoracic spine, look at the top down and bottom up drivers. When I am tring to influence these spinal areas, I can choose a multitutde of ways to create top down and bottom up triplane driver motion.

In the Thoracic spine we can look at in sync and out of sync motion. In sync motion means the pelvis and the shoulder move in the same direction e.g. a tennis forehand, a golf swing, a baseball batter. Out of sync means the pelvis and shoulders moving in opposite directions. When I am testing and treating the Tx, I want to choose the appropriate insyn or out of sync motion, based on the TZ I am assessing. If the TZ is insync then I can use foot and hand drivers to replicate this motion.

The Quadriceps is a a group of muscles designed to lengthen with triplane decelerating motion at the knee. This requires the physioological motion of flexion, internal rotation and abduction at the knee. It does little to help with extension of the knee in gait. This is done mainly by the soleus, Tib. Post. and P.  Longus slowing down the Tibia and the mass and momentum of the body coming over the tibia to extend the knee. Remember the factors creating the forward momentum will be the Glutes and hamstrings and the swing of the opposite leg. In fact remember all the muscles work together and we cannot fully seperate their function.

We also looked at tweaking using Triagulation variables. This means changing the Angle, Verticality or Horizontal components of triangulation together or seperately. I noticed I could get different responses in the body when I changed these components in different orders e.g. A,V,H or V,H,A or H,V,A This is a useful tool to find what is most successful for a client and where to start my rehabilitation.\

We are now building to GG2. I am looking forward putting all this information into use and learning more from the Gray Institute

 

 

WEEK 19 Iliopsoas, on the ground training and tweaking for success

This week was full of new information and concepts. We had been trained as therapists to “train the way you play” i.e. if you perform in an upright position, you should train in an upright position. The Gray Institute has looked closer at on the ground training, and thinks we are missing a key to using  the bodies natural developmental stages, in the first year of life, to assist in upright function.

We can look at the Transformation Zone of  upright function and decide what would assist with on the ground function. We can use  a variety of start positions such as prone, supine, side ly, and kneeling, with manipulations of these positions. Then use drivers of the head, trunk, hands, pelvis, and feet to move the body for greater mostablity.

The muscle discussed this week was the Iliopsoas. It is the muscle called on in emergencies and is responsible for swinging the leg and body through from toe off to heel strike in gait. It has connection to the transverse processes of L1-L5 and vetebral bodies of T12-L4. This muscle is loaded significanlty with transverse plane motion (internal hip rotation), but also extension, Abduction (Psoas muscle) and Adduction (Iliacus muscle) of the hip. Even if the hip is flexed it’s transverse and fontal plane loading has an important part to play in function.

At the spinal level, rotation of the spine can load the Iliopsoas, depending where the spine is relative to neutral. In the front leg of gait it is unclear of the Iliopsoas decelerates lumbar rotation or rotates it in the same direction as the pelvis. The iliopsoas will decelerate contralateral Lumbar lateral flexion.

Remember AFS is.. encourage transformation in others through the creation of personalised environments, using drivers, to create normal chain reaction through the body. If we can choose the correct drivers to load the Iliopsoas, we can create the explosive power we need it to produce for function.

Finally we looked more at tweaking the body for success. If we can choose the degree of tweaks (subtle to dramatic) which encourage the desired change reaction in the body, we can become more effective at attaining success. We looked at using bilateral symmetrical and assymetrical hand drivers, and then whether to use them in an alternating fashion. We looked at the power of the pelvis as a driver and how this is often the key driver in function.

We are starting to learn more about the spine and the muscles influencing the spine. I look forward to enhancing my knowledge of chain reaction biomechanics through spine and then the shoulder girdle.

Week 17 Popliteus, forefoot running and tweakables, hip retroversion and anteversion and Achilles Tendonopathy

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.