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.

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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.

 

Week 16: Pelvis and Beginning to tweak

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.

Week 13: ITB, hand drivers and proprioceptors

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.

Gray Institute: GIFT Gathering 1

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.Image  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.

GIFT week 5: Looking at AFS and the Calf complex

GIFT week 5 was a week of further development of what AFS represents and the progression of bone and joint motion to the function of the calf complex. 
 
This week there was a strong emphasis on what makes an AFS exercise an AFS exercise. Specific points were made on drivers,3D motion, unconscious chain reaction, path of least resistance, Authentic movement and uniqueness of environment. I can see each week these concepts are continually emphasised, in various ways, to embed them firmly in our minds. I can see these will create the framework from which we will diagnose, prescribe exercises and tweak exercises. The Litmus test has been described in the DVD series called Chain Reaction. These tests are those points described above.
 
In the webcasts this week the focus was on the calf complex. What it does and how it works econcentrically. The joint motion was described for the transformation zones of gait. The function of the calf muscles were described at the foot, ankle, and knee levels. It was refreshing to get a true functional understanding of the calf complex. It makes sense that muscle does not work in one plane of motion or is purely a concentric or eccentric muscle contraction. 
 
The webcasts further expanded on lunge matrices. This week it was description of how Lunge matrices can be used to enhance balance. The key point is balance needs to be trained dynamically and not statically. It can also be trained in 3 planes of motion. I think clients will enjoy how balance training can be so variable. 
 
Gift is about communication and this week we expanded our sign language learning to include letters  M to R. It is empowering to learn sign language and I hope by week 40 I will be able to sign simple expressions.
 
The learning this week has taken a step up, and is testing our knowledge, to make decisions on what is happening to joint motion with different tweaks and drivers. The knowledge builds.