Content

• Assessment and Training of Faulty Movement Patterns bridges the gap from acute care to injury prevention to skills training. This program is ideal for any musculoskeletal practitioner who works with patients or clients that want to enhance their results. Learn the art of functional assessment of the kinetic chain and how this relates to sports function as well as injury rehab. Particular emphasis will be on the groundbreaking work of Pr’s Janda & McGill, Gray Cook, Michael Boyle and other leaders in athletic development.

Several of the Topics to be Covered

• Subcortical Reprogramming of Movement Patterns
• The Frontal Plane and Knee Instability
• The Transverse Plane and Upper Quarter Syndromes
• Kolar-McGill: Biomechanics and Neuro-Development
• Cortical Plasticity and the Neuro Matrix

Workshops Covered

• Deadlifts vs Squats: How to stabilize the SI Joint and Knee
• Acetabulo-Femoral Sensory-Motor Amnesia: Identification and treatment of this underdiagnosed proglem
• Anterior rib cage dysfunction and shoulder impingement syndrome: the key role of the diaphragm
• Scapulo-thoracic stabilization, faulty respiration and neck pain
• Integrating the Core with lower quarter training to address Janda’s Lower Crossed

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For more information and registration, click here

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2. Craig Liebenson’s DVDs Core Stability Training. Flexibility, Yoga Training, and Ergonomic Advice. Functional...
3. Edmonton Strength & Conditioning Seminar January 14, 2012 - Foote Field, University of Alberta...

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For detailed information on this course, please click here -> Musculoskeletal Pain Syndromes

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1. Understanding Pain and Clinical Applications with Lorimer Moseley Recap of this workshop, hosted by Cynergy Education on May...
2. Manipulative Therapy: Musculoskeletal Medicine (Karel Lewit) A different kind of review...

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As always, these interviews will be held on a weekly basis and will profile the following world-renowned experts in our field.

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…and the best part about it is the cost.

It’s FREE!

The teleseminars will start on Jan. 17 so make sure you head on over to the sign up page to register!

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Functional Movement Systems Internship

Dynamic Neuromuscular Stabilization “A”

Dynamic Neuromuscular Stabilization “B”

Dynamic Neuromuscular Stabilization “C”

TEDx Vancouver – Ideas Worth Spreading

FMS Symposium – “Movement” Comes to Life

Dynamic Neuromuscular Stabilization Review

Functional Capacity Evaluation and Treatment

Diagnosis and Management of Tendinopathies

Understanding McKenzie MDT – “A”: The Lumbar Spine

Understanding Pain and Clinical Applications with Lorimer Moseley

The Integrated Core: Harnessing the Diaphragm / Pelvic Floor Piston

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*Don’t forget to check out last year’s 12 posts of Christmas*

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Ken Crenshaw, Pavel Kolar, Lucie Oplova, Alena Kobesova, Sue Falsone, Rob Lardner, Clare Frank, Kathy Kumagai and Craig Liebenson

Along with the medical staff members of several major league baseball teams, prominent and budding physical therapists and chiropractors, I was fortunate to attend the “C” course, where our knowledge of the system was tested, advanced and enhanced throughout this 4-day learning weekend.

Because the “A” and “B” courses in this program form its foundation, this “C” course not only packages all the DNS principles together seamlessly, but also takes its principles to specific conditions whereby troubleshooting becomes much, much easier.

Now because I am a big fan of learning principles over specific tools and methods, the following information will be based on some of the key points that resonated best with me. My apologies for those that are new to the DNS system and may not be familiar with some of the concepts below. Should this be the case, please check out my review of the “A” course here prior to moving forward.

• One of the key tenets stressed in this course was the thorough understanding of the anticipated movements. Knowing what should “come next” and what you should expect, essentially will help guide and gauge whether you are right or wrong in your approach and treatment.
• When encountering troublesome hip problems, it may be wise to check the muscle activity and pressurization ability low down in the abdomen (near the groin) to assess for compensation. The body may be robbing Peter to pay Paul. Most, if not always, the goal should be balanced intraabdominal pressure throughout the entire cavity.

This is not a muffin top.

• Unilateral hip flexion is dependent on Thoracolumbar junction stability and contralateral hip stability, among other regions.This is based on the concept of the punctum fixum.
• Quite often, dysfunctions in neck stability/motor control stem from lower down the body. Just like the glenohumeral joint needs a stable scapulothoracic girdle, so too does the cervical spine. The “cannon from a canoe” concept applies here as well. Again, the importance of IAP cannot be stressed enough here.
• In chronic posterior chain dysfunction patients such as achilles tendinopathies, plantar sided foot pain, etc, again it would be more than wise to assess intraabdominal pressure. Trust me.

IAP: It's important, trust me.

• Too much concentric activity of the abdominals, pectorals, trapezius, etc may negatively affect the diaphragm’s ability to induce pressurization. The diaphragm and pelvic floor largely play a concentric role. All other muscles (i.e. above), are more important eccentrically.
• This is a no brainer, but a muscle’s ability to relax is very important.
• Gluteal filling (volume expansion) is important for lumbosacral and sacroiliac stabilization.
• Very often a lack of coordination of muscle activity is more important that a lack of strength. Proportion of muscle forces is important.
• Hips often do not need surgery, they need to improve their movement patterns.
• For stabilization, it is likely more important to simply hold the position (i.e. isometric holds) than dynamic repetitions.
• We can learn a lot from sumo wrestlers. They are very strong but rarely bench. They simply do thousands of centrated movements in a slow and controlled manner. Therefore, when working with young athletes, training a high number of centrated movement patterns is likely more important than loading.

DNS and Sumo Wrestling have more in common than you think

• It is always important to assess whether the problem is a contralateral pattern dysfunction or that of an ipsilateral pattern.
• In high tone/stress individuals, it may be wise to first start with mobilization and/or release. In persons possessing a parasympathetic state, load them up with stabilization.
• You can use which ever exercise progression you want, just respect the principles of a) centration and b) support and stepping functions.
• “Train the same pattern, only in different positions”
• The body’s ability to relax is related to body awareness. A lack of body awareness can be called “Body Blindness” – the inability to know the body, especially with the eyes closed.
• Low back (i.e. discogenic) patients with good quality of stereognosis (body awareness) will have a better likelihood of surgical success. Those who lack stereognosis would be wise to improve body awareness prior to surgical referral.

A different type of body awareness

• The principles of stereognotic training (which is based on Feldenkrais and Ayres) is slow, precise, repeated and simple movement with high central nervous system control. To me, it is the “recognise” of movement based rehabilitation. The objective is to learn to differentiate movement, controlled relaxation of the body with movement, and progression to higher level positions. Essentially, this may be an excellent intervention for motor morons.
• The goal of DNS rehabilitation is not only to improve the integrated spinal stabilizing system, but also to restore stereognosis. Therefore, Tai Chi may be an excellent method of physical activity for patients of all ages. As a side note, I’m really looking forward to Tai Cheng.
• DNS is not about the baby, it’s about optimal movement.

With Craig Liebenson, Ken Crenshaw, Pavel Kolar

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2. Dynamic Neuromuscular Stabilization “B” September 29 - October 2, 2011 - Montreal, Quebec...
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As such, and to gain a better understanding of this system, I decided to host McKenzie “A” – The Lumbar Spine at my clinic.

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It truly is more than centralization

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Apparently, this was the first course held in Canada that combined physical therapists and chiropractors as delegates. To me this was significant as I have always held the belief that who you are is more important than what you are.

Now the key take away from this course was perhaps the first statement made by our instructor, Audrey Long.

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“It’s about applying the right thing to the right patient”

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To me, the above statement means conducting a thorough and accurate assessment, applying the appropriate management strategy, and reassessing to confirm the effectiveness of that strategy. So it was clear to me that McKenzie MDT was more of an assessment method than a treatment method.

The second principle learned from this course was another “Craig-ism”…the importance of self-care. That it is very important that we first utilize an active, hands off, approach in order to allow the patient to learn about the treatment experience. Taking this approach promotes independence and a better understanding (by the patient) that they have the power to “make themselves feel better”.

Now it is still considered manual therapy, better decision making is just employed to determine when and when not to put one’s hands on the patient.

One important key to a thorough assessment is the patient history, and understanding why they got there in the first place. Quite often it is what they didn’t do, rather than what they did, but it is also likely related to their tendencies. Do they sit all day? Do they stand all day? Are they constantly bending? Are they constantly twisting? Or…do they have faulty movement patterns?

Maybe it is simply a matter of facebooking and skinny jeans?

In all seriousness, while the philosophy that surrounds this method of treatment lies in the clinical audit process, there is no question that most therapists equate McKenzie MDT to discogenic pathologies. And for good reason.

However, quite often such pathologies, especially of the acute variety, present with pain induced sympathetic overload and/or faulty core function secondary to high threshold strategies.

For the latter, often the patient presents with antalgia and obvious signs including, but not limited to, guarding, sweating, fear of movement, etc. In such cases, for me to put them through repeated movement testing from the get go, may not be the best approach. Some therapists will often use ice, IFC and e-stim, but for me, I would rather unwind the system that’s on lockdown. And by that I mean, decreasing the threat.

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Tap into their PNS and the guards will go away.

Patrick Ward recently wrote about the Parasympathetic Nervous System. For me, the methods I often use are crocodile breathing, gentle perturbations rib cage and hip mobilizations, soft bracing as per Stu McGill, reactive neuromuscular training and reflex stimulation…all dependent on patient presentation. And ALL with appropriate (read reassuring) communication.

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I will also groove proper hip hinging and thoracic uprighting. But following that, and when appropriate, I would then implement centralization methods. Likely on the first visit but always with respiratory control.

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Ultimately though, my goal aside from the above history, would be to understand why the individual mechanically sustained the injury to begin with. And this is where the SFMA fits in…to respect the high threshold strategy. This is also where Stuart McGill’s strategies come in. Sometimes prior to calling off security, and sometimes after. But definitely always.

I admit that I am still having difficulties with my understanding of McKenzie methods. Not only because this method “tissue-fies” many pain presentations, but also because I believe there may be more appropriate ways to assess and “treat” with repeated movement in very acute conditions. Our instructor suggested that,  ”we should stick with McKenzie and not mix systems (i.e. stability and muscle imbalances)” and to me, this may not be the best approach. I truly believe that the patient should take priority over the method and therefore, I will continue to do what I feel is most appropriate.

That said, I still have a lot of learning to do but thankfully the manual is close to 200 pages, so I’ll certainly be busy studying over the holidays.

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Related posts:

1. McKenzie Method in Mechanical Diagnosis and Therapy – Part A Spruce Grove, Alberta - December 2-4, 2011...
2. Movement Patterns of the Lumbar Spine and Sacrum During the Back Squat McKean MR et al. (2010). The lumbar and sacrum movement...
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I sincerely do my best to find the right match but I will admit that it really takes a lot for me to trust a fitness professional with my patients.

The main reason for this? Continuing education and regard for movement quality.

So how, you ask, might you get on my referral list?

Well first and foremost, you need to have great communication skills and excellent client rapport. Most trainers have this and I commend you for it.

Secondly, you have to be good. Certifications mean little if a sound method to your system is lacking.

Finally, it is very important to be up to date with contemporary corrective exercise and post-rehabilitation principles. So for those of you in Alberta, let alone the Greater Edmonton area, here are a few must attend continuing education workshops.

• Ultimate Back Fitness and Performance with Dr. Stu McGill
• Functional Movement Screen Home Study Course
• Training = Rehab, Rehab = Training with Dr. Charlie Weingroff

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Check out his interviews with Drs. Craig Liebenson, Clare Frank and Alena Kobesova (Rehab Prague School), Sue Falsone (L.A. Dodgers and AP), Ken Crenshaw (Arizona Diamondbacks), and others.

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• DNS Course in Phoenix, AZ

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• Dynamic Neuromuscular Stabilization (DNS)–Personal Musings and Clinical Perspectives

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Related posts:

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2. Dynamic Neuromuscular Stabilization “B” September 29 - October 2, 2011 - Montreal, Quebec...
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For those of you who have yet to read my posts on the previous courses, please take the time to read them below prior to moving forward.

• Dynamic Neuromuscular Stabilization “A”
• Dynamic Neuromuscular Stabilization “B”
• Dynamic Neuromuscular Stabilization “C”

So here are my thoughts.

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www.rehabps.com

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Assessment

Similar to the Selective Functional Movement Assessment, DNS has a series of tests within their system. And over the last several months but also this weekend, I have realized the importance of performing all the tests especially for those who are just starting out.  To me, getting into this habit ensures that clinical intervention is based on reasoning rather than assumption and provides the clinician with a global picture of the patient or athlete’s presentation. Regardless of whether they are performed at the beginning of the initial examination or in conjunction with other testing procedures, doing so may not only act as a filter for one’s current examination protocol, but may also lead to more effective stabilization strategies in rehabilitation.

Ultimately, the key link to the individual’s functional pathology must be found and finding this link will likely guide the practitioner to the most appropriate exercise intervention and, if necessary, the ideal reflex stimulation technique.

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Treatment

One of the most important recommendations I can give is to know the anticipated movements and understand the supporting and stepping pattern framework. Ultimately, the clinician can utilize whichever exercise progressions he or she wants but I cannot stress enough that when doing so, the principles discussed over during the courses must be respected. For those that are curious, I myself largely utilize progressions based on the neurodevelopmental perspective, principles that are common between the Functional Movement System and DNS.

For those of you who viewed my presentation on SCWebinars, you’ll know that I hold a high regard for variability. I was glad to see that Pavel held similar beliefs as well. And using a case example with an elite track and field athlete over the weekend, Pavel spent a great deal of time training a specific pattern (the key link) in a variety of positions. In so doing, variability was achieved and progress was made. The take home message, train the key pattern…in varied positions.

Whether you choose to utilize DNS-based exercises or your own, it is always important to pay close attention to joint centration. Shirley Sahrmann calls this the path of instantaneous center of rotation. The DNS goal however, is global centration. While DNS will utilize partial patterns to improve the global pattern, the true objective is to respect the power of each joint’s proprioceptive capabilities.

Also respect the punctum fixum. It is never a bad idea to go after the supporting structures prior to the phasic structures. In fact, it’s a great idea. Doing so will establish a better base of support and will give you a better chance to achieve optimal movement patterning. But be picky. As best as possible, try to refrain from cutting the patient some slack. Think about the 3 month supine position (similar to the dead bug) for example. When going after optimal intraabdominal pressure, one common mistake is to let the patient’s feet touch each other. The punctum fixum is the TL junction. Allowing them to touch their feet together will create a false punctum fixum. The direction of muscle pull is important.

I have mentioned this several times before but (borrowing from Gray Cook), you can’t train stabilizing structures with strengthening exercises. So when considering scapular stability and DNS, it will no longer be difficult to understand that the punctum fixum and centration concepts play huge roles in intervention strategies.  All 4’s positions (low kneeling) and side lying positions (RT 2 & 4) are excellent starts.

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Integration

It is important to realize that taking DNS courses doesn’t mean clinicians have to drop everything they have learned in and outside of school. DNS is about the principles not the methods. Use the tools you have, just respect the integrated spinal stabilizing system.

For example, I have found that DNS goes hand in hand with the Selective Functional Movement Assessment. If you’re familiar with the SFMA, you’ll know that its breakouts contain similar assessments to the DNS assessment. The supine neck flexion pattern test and the arm elevation pattern test are two that immediately come to mind. Now if you look at these to tests from the DNS perspective, you’ll know that they are both dependent on optimal intraabdominal pressure. Certainly joint mobility and tissue extensibility dysfunctions may be present, however, often dysfunctional presentations are secondary to faulty stabilization as well. As long as mobility restrictions are cleared, there’s no question DNS principles can easily be integrated into treatment. Just go after the pattern and if the patient can’t get it, that’s where the “magic” comes in.

Just don’t forget to reassess.

Another example can be found with thoracic extension and/or rotation restrictions. If this is your patient’s key link, you now have more tools in your toolbox to build better movement patterns. Remember, every exercise is a test so among others, you have the prone extension test and the bear to work with. And, if they cannot get it on their own or with guidance, (i.e. manual, resisted or verbal-assisted centration) then reflexive locomotion and stimulation may likely be your next tool in line.  Try the 1^st position. Try RT 3.

Those who attended the “A” course need not worry, the Reflex Creep position may serve you just well.

Recently, I’ve been asked for my clinical opinion on ideas for troublesome achlilles tendinopathy and chronic exertional compartment syndrome.  If you know me, you’ll know that my first response would be to look everywhere but the lower leg (save for the foot). You can do so via the SFMA and you can do so via Dr. Liebenson’s Mag 7. But you can also do so via DNS. A simple example? Again, the prone extension test. Faulty uprighting may just be the key link to lower limb posterior chain overload.

Rolling patterns have been quite the buzz for several years though unfortunately, mastering the art often isn’t easy. We’ll know that our patients need to be here in the algorithm but often performance difficulties will lead to frustration. One revelation for me this weekend was that the oblique trunk flexion test may be an excellent breakout for the flexion rolling pattern to shed light on the ability of the chest to stabilize against the oblique muscle chains. One solution for improving rolling patterns then? RT 2.

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I hope this sheds some light to the utility of DNS in practice. For those of you looking for some insight into my thoughts on DNS C, I’ll make sure to provide a little summary sometime later this week.

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Related posts:

1. Looking at the Literature: Vojta/Dynamic Neuromuscular Stabilization in a Migraine Sufferer Juehring DD & Barber MR. (2011). A case study utilizing...
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Muscle Imbalances Revealed – Upper Body

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Last year, you may have read several of my reviews on Muscle Imbalances Revealed – Lower Body, a dvd package put together by some of the top experts in the fitness industry. Well this year, I’ve had the privilege to contribute to the newest version of this product, Muscle Imbalances Revealed – Upper Body. Together with Rick Kaselj, Tony Gentilcore and Dean Somerset, we have essentially put together everything – well not everything but a whole whack-load of information – you need to know about the core, thoracic spine, shoulder, neck and arm. But for those of you really interested in what I had to say, well you probably won’t be surprised. So let me give you a quick run down:

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“Respiratory Control: Linking breathing with rehabilitation & training” 

This was my main presentation where I talked about the following:

• Nailing down your mobility and stability exercises with breathing
• “Money moves” for improved breathing
• The Stability-Motor Control Continuum
• Assessment techniques
• How to integrate breathing into movement

“Understanding Soft Tissue Management: Choosing the right tool”

This shorter presentation essentially discusses:

• The mechanism behind soft tissue injuries
• The 3 Phases of Healing
• Who’s who soft tissue world
• The “integr8r”
• The role of the Instrument Assisted Soft Tissue Mobilization in tissue recovery
• The most effective ways to foam roll the upper body

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But enough about me, what you really need to see is what the other guys had to say in Muscle Imbalances Revealed – Upper Body! Here are short clips from each of “the other guys’” presentations.

“Corrective Exercise Strategies for Athletes (and Meatheads, too)” with Tony Gentilcore

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“Myofascial Training for the Upper Body” with Dean Somerset

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“Unraveling Muscle Imbalances in the Shoulder” with Rick Kaselj

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Now I’m really excited about what we’ve put together. I truly think that regardless of whether you’re a manual & rehabilitation therapist, fitness professional, or just someone who loves to train, that you’ll benefit greatly from this package. In fact, I actually think that your friends and colleagues will benefit as well (so please spread the word)!  And the best part about it? You don’t have to spend your spouse’s hard earned money like I do and fly all over to get your con ed on. In fact, the cost is only $77.

Anyway…

-> -> HERE’S THE LINK <- <-

…and thank you in advance for your continued support!

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John D’Amico provided us with his summary on strengthcoach.com:

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I would like to take this opportunity to personally thank Chris Poirier and his staff at Perform Better for putting on one of the best conferences I have been to in years.

The team format of the conference allowed for great interaction between speakers and participants alike.

The conference topic “The Future” was terrific. Each speaker from Coach Boyle to John Berardi to Alwyn Cosgrove brought their A game to give us an idea where Strength and Conditioning, Fitness and Nutrition are heading in the next 10 years.

Some big picture take aways:

1. From programming to marketing, technology is and will grow as an integral part of your business.

2. Under no circumstance does the use of technology or electronic media come close to the importance of the 10 year, 10,000 hour rule. In other words you have to pay all the tolls on the turnpike to greatness.

3. Smaller is the wave in fitness. The day of the big box gym is over.

4. When opposing points of view are publically addressed the ensuing dialogue helps us assess the best path to take.

5. We work in an unusual business. What I mean is that by sharing ideas and information instead of hoarding make us all that much richer. Strength and Conditioning is not Apple vs Microsoft.

6. Succesful businesses will develop not just a destination for their clients but a culture that sustains the client.

7. Kids and Seniors are the wave of the future in fitness.

8. Plan to attend the next Meeting Of The Minds.

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And Jason Glass provided a nice write up on his site as well.

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Click on this image to read his summary

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If you were there and are willing to share your thoughts, make sure you let me know in the comments section below.

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No related posts.

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December 2-4, 2011

Spruce Grove, Alberta

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Part A: The Lumbar Spine

Course Description
This four day (28 hrs) course presents the theorectical aspects and concepts of the McKenzie Method in Mechanical Diagnosis and Therapy, as applied in the examination and treatment of patients with complaints of low back and related referred pain. Through lectures and patient demonstrations, the derangement, dysfunction and postural syndromes are described in detail and appropriate treatment plans are outlined with emphasis on the use of patient self-treatment procedures. The clinical efficacy and limitations of the McKenzie approach as applied to the lumbar spine, are illustrated by follow-up patient demonstrations.

Course Goals
Following attentive participation and completion, this course will provide participants with the introductory knowledge, basic skills and abilities to begin to:

1. Appropriately apply the McKenzie Method of Mechanical Diagnosis and Therapy to patients with lumbar spine problems.
2. Distinguish between the McKenzie syndromes (derangement, dysfunction, postural) and other spinal conditions and provide appropriate management regimens for each of the McKenzie syndromes.
3. Identify when the application of external forces is required for the resolution of symptoms using McKenzie’s concept of progression of forces.
4. Assist patients to design and apply the therapeutic processes on their own to achieve management goals.

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