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……….
- Load with breathing in to explode or exhale
- Improve mostablity of the Thoracic Spine, rib cage, pelvis, hips and rest of CRB
- 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
- Look at bottom up and top down strategies
- 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…..
- 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
- 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
- Use your hands on the body to feel Scapulothoracic and scapulohumeral motion. Use FMR to influence this motion
- 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
- 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
- Assess good arm before bad arm
- You can take the feet out by kneeling and hips out by sitting
- 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…
- 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.
- 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.
- 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
- Look for successful strategy first and then build on that success
- 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.
- 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.
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 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.
The foot is often overlooked by medical professionals and trainers. The foot can be a common cause of problems in other areas of the body. Biomechanics of the foot can be complex; however if assessed with video analysis, looking at joint play within the foot and how the muscles are coordinated to control the foot, then often the problem can be identified.
I have treated a runner who developed groin pain because he developed a stiff first toe (big toe). He was a 100m sprinter which involved rapid bursts out of the blocks and ten seconds of very intense running. Over time the big toe created abnormal ankle movement which led to knee, hip, pelvic and lower back pain. The weakest link among all these joints was his groin. The groin pain affected him so badly he could no longer compete for that season.
Another illustration is someone who has had a previous ankle injury and the ankle joint is stiff. When comparing the right and left sides they can see that one side of their body has less ankle movement when they squat. The restriction in the ankle will create abnormal knee and hip motion and have consequences on the pelvis and lumbar spine. The ankle joint can be a difficult joint to increase mobility. To keep the improved range of motion often requires regular home stretching. Sometimes a Physiotherapist is required to help return normal joint play to the smaller joints within the foot.
The foot and ankle are made up of an array of small and long bones; these bones all have to work in a coordinated fashion to enable the ankle joint to move correctly. It is the job of the physiotherapist and trainer to identify where these smaller restrictions may be – where they affect or present as generalised pain in other parts of the body.
Clinically, if the ankle has been fractured or sprained there can be restrictions due to a poor healing process. If the restriction has come on with no trauma then maybe the ankle has been restricted over time due to myofascial restrictions throughout the foot and ankle. The latter can be corrected much more quickly. When a client has on-going assessment by their personal trainer and Physiotherapist myofascial restrictions like this can be easily identified, especially in the foot but also throughout the rest of the body.
The foot and ankle are the first parts of the body to connect with the ground when walking, standing, running. Before training, it is important that the foot and ankle have normal range of motion to prevent injury.
I believe being healthy is important, as it affects every area of life – if you are healthy you can do more and feel better doing it. Often people find it difficult to motivate themselves to go to the gym or to do sport; they need someone to direct them in their training, give them focussed goals, and keep them motivated along the way. Personal trainers play a significant role in this regard – helping people achieve their physical goals. Today personal trainers often work in one-on-one training facilities, to offer functional gym training in a smaller more intimate environment;the gym generally has better equipment, is cleaner and the trainers can offer state of the art functional training.
Having spoken with several high profile trainers in London, we have identified the need for physiotherapists to work with trainers.People find it frustrating when they get injuries and the trainer sends them to a physiotherapist they do not know; the physiotherapist may not clearly communicate back to the trainer what the client’s injury is, and how to help heal that injury during training. Sometimes training is stopped for no reason and the client is taken away from his / her training goals.
The way to improve the training process is to have a physiotherapist work with the trainer from the very start. By getting assessed by a physiotherapist before training starts, a person can discuss their injuries and how their body operates with a medical professional. The physiotherapist will identify the injuries, past and present, which may present during training sessions; even if there are no current injuries, the physiotherapist can identify potential pitfalls a person may encounter as they go through their training regime towards their goals. Once the person is assessed by the physiotherapist the physio can feed back to the personal trainer what to look out for during the training process, what limitations there are for that person in training, and whether the training goal is appropriate. The trainer can then confidently train a client knowing that he/she is supported by a medical professional who understands injuries and how the body functions in response to them.
The personal trainer will continue to communicate closely with the physiotherapist during the training process; the physiotherapist will continue in their assessment of a client throughout their training regime in order to maintain correct movement of the body and further direct the trainer towards more advanced training goals. By working well together in this way the physiotherapist and trainer help to provide a better service to their clients. If an injury does occur during training the physiotherapist will already know the client, and the trainer will be able to communicate immediately with the physio on how to proceed. The synergy of this relationship far exceeds any personal training system by itself.
The benefits to the client are:
- Prevention of injuries during training
- Faster goal attainment
- Faster return to training if an injury does occur.
If you are interested in working with a physiotherapist and personal trainer contact us at http://www.physical –edge.com
Today we had Sarah from New Zealand give us the latest updates on treating the temporomandibular joint.
She described how the joint contains a fibrocartilaginous disc and if has no nerve supply in its intermediate section. It is this section that is compressed in the joint normally. When the joint is pulled out of alignment the anterior or posterior sections of the disc can be compressed and there structures have nerve supplies and create pain.
The TMJ can be effected by Bruxism (clenching jaw), trauma, postural issues, and structural changes. The cause of the pain can involve the upper cervical spine as these three segments communicate with Trigeminocervical nucleus and can produce pain anywhere innervated by the trigeninal nerve (Supplies skin sensation to the face and head).
In the above conditions is important to address the muscle imbalances around the TMJ and his can be treated with trigger point release and muslce releasing inside the mouth. The neck posure can be improved with rehabilitation. Acupuncture will be effective in treating sinus pain and headaches.
In trauma mobilisaiton of the TMJ will include traction and Mobilisation with movement.
The results have been great and symptoms can be changed in 2 weeks. In New Zealand botox is used to release muscles in acute pain before treatment starts. I am going to meet a chiropractor on the weekend to find out what chiropractors do in treating TMJ pain.
I sam for the first time in my Orca wetsuit and it felt amazing. The suit is so light and flexible and it keeps me really boyant. I swam in the suit for 300 metres and I felt pain develop in my left shoulder as I was finishing the recovery phase of the stroke. I took the suit off and I could change the pain by turning my body more towards the pain shoulder (left) at the time I felt the pain. It knocked my confidence in the suit so I spoke to my swim coach Emile and these were his words of wisdom.
Swim Coach (Emile) writes…
Re the left shoulder issue, assuming there are no pre-existing skeletal issues then it’s likely to be one of the following:
1. Levering off the left hand particularly when breathing to the right.
You may be putting unnecessary pressure in a downwards direction to support breathing to your right. Ideally when breathing on either side the leading arm will remain high and stretch forward. Occasionally through lack of rotation to the right, lack of confidence breathing to the right or simply an urgency to begin the propulsive phase of the leading arm (as when sprinting) the leading arm presses down and when coupled with the added weight of the head turning to breathe you can apply unnecessary pressure to the shoulder area. Because of the repeated nature of swimming the slightest pressure although not an issue for a short distance swimmer will start to cause problems for the endurance swimmer. As is the case with many aborted channel crossings.
Remedy – ensure you fully rotate, keep the head position low in the water when breathing and project the leading arm comfortably forwards rather than downwards
2. High elbow recovery on the left side without adequate rotation.
You may well be recovering the elbow too high for the rotation on that side. If the rotation is limited and the elbow recovers high the result is an impingement in the rotator cuff area. Again a common injury for channel crossers which is why to avoid the issue they tend to under rotate and recover with very low wide arms.
Remedy – you could take the channel crosser approach but I would suggest for anyone with good core strength able to support full rotation you simply rotate more on the left side and experiment with a slightly lower elbow recovery.