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A new released article from Dr McGill :

click here

See Below for details on his upcoming course:

Building the Ultimate back: from Rehabilitation to Performance

November 20 and 21, 2010 in Toronto

• 4 hours – Building the foundation
• 2 hours – Interpreting patient presentation
• 1 Hour – Preventing Back Disorders
• 4.5 hours – Rehabilitation Exercise
• 4.5 hours – Training for performance

This 16 hour lecture / workshop weekend with Dr. McGill will be located at  the Westin Harbour Castle, 1 Harbour Square, Toronto. I am also thinking of hosting a social this weekend so if you are attending please let me know.

For more information on Dr. McGill visit www.backfitpro.com

Visit  www.msk-plus.ca/Courses.htm for more information and online registration, or email info@msk-plus.ca for more details.

See you there!

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The above question is just one reason why I am looking forward to the 7th Interdisciplinary World Congress on Low Back and Pelvic Pain. Among other “questions”, answers (or at least directions) to the above will be addressed throughout this congress. Here’s a look at the preliminary program.

What are your thoughts on the above question?

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Suboccipitals: Small but important!

The Clinical Importance of the Anterior Strap Muscles

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The Functional Movement Screen (FMS) is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.

The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

Exercise professionals monitor the FMS score to track progress and to identify those exercises that will be most effective to restore proper movement and build strength in each individual. (…cont’d)

The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain. When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contribute to the associated disability. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides the clinician to the most dysfunctional non-painful movement pattern, which is then assessed in detail. This approach is designed to complement the existing exam and serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain. (…cont’d)

To describe the above in layman’s terms, the FMS is a screen to identify who may be at risk based on their presenting movement patterns. Why they are at risk is not the objective here, it is simply a filter. On the other hand, the SFMA is an assessment tool aimed at determining one’s cause of pain.

If you are interested in learning more about these systems and especially how to apply them in a clinical / rehabilitation setting, I urge you to join Sports Rehabilitation Expert.

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Here are some links to help you do so:

Rest, Recover, Regenerate from Patrick Ward, MS CSCS LMT

Recovery & Regeneration from Greg Wells, PhD

Photo source

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I am really looking forward to what Mike Reinold and Eric Cressey have to offer since I visit their websites on multiple occasions each week. In my opinion, they bring together what drives my passion in everyday practice: a blend of evidence-based sport medicine and athletic performance.

Mike Reinold

Eric Cressey

Unfortunately, I have come to a realization that my continuing education budget is much higher than what my entire tuition was.

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But is this the most effective way to apply strain to the posterior capsule?

Using a cadaver-based study, Izumi et al examined and measured posterior capsule strain of 8 different shoulder positions.

What you need to know:

• 3 male and 5 female fresh cadavers were included (74 – 96 years of age)
• Bodies were disected and prepared so that only the posterior capsule was preserved and exposed.
• A displacement sensor (Pulse Coder, Levex, Kyoto, Japan) was used to measure posterior capsule strain
• For specific strain measurements, the posterior capsule was sectioned into 3 parts (upper, middle, and lower)
• Passive internal rotation was used as the primary motion for strain measurement.

Measurement positions:

• Internal rotation + 0 deg. elevation in scapular plane
• Internal rotation + 30 deg. elevation in scapular plane
• Internal rotation + 60 deg. elevation in scapular plane
• Internal rotation + 90 deg. elevation in scapular plane

• Internal rotation + 60 deg. flexion (IR in 60 deg. elevation + 60 deg. horizontal ADDuction)
• Internal rotation + 60 deg. ABDuction (IR in 60 deg. elevation + 30 deg. horizontal ABDuction)
• Internal rotation + 30 deg. extension (IR in 30 deg. elevation + 120 deg. horizontal ABDuction)
• Internal rotation + 60 deg. flexion + horizontal adduction (IR at 60 deg. flexion + 30 deg. horizontal adduction)

More information pertaining to this study’s methodology:

• A reference length (R0) was first established and indicated the point at which the stress-strain curve first indicated a sudden decrease in strain
• Strain of the capsule was measured at the terminal range of passive IR. This was determined by grade III mobilization after Kaltenborn procedure.
• Beyond this point, a stretch was applied to the joint for 10+ seconds until no further strain was observed
• To determine the Glenohumeral joint positions that demonstrated significant increases in strain from R0, a one-way repeated measures ANOVA was used.
• The differences in strain among the positions were assessed via paired t-test.

Glenohumeral positions that significantly stretched the posterior capsule:

• Internal rotation + 30 deg. elevation in scapular plane: significantly stretched the UPPER and MIDDLE sections of the posterior capsule

Self stretch

Rotater – assisted

• Internal rotation + 30 deg. extension: significantly stretched the UPPER and LOWER sections of the posterior capsule

Rotater – assisted

Caution:

It should be noted that joint capsule strain seen in aged cadavers may not be similar to that seen in younger adults. In fact, strain rates in younger populations may indeed by larger.

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CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS II: A clinical evaluation (Aprill et. al., Spine, 1990)

A study testing the reliability of their pain charts by a clinical trial

Guiding principle: if the pain patterns could correctly identify the source of neck pain, they could then be used as diagnostic aids in the clinical assessment of neck pain.

10 subjects used and were administered diagnostic blocks according to the above pain patterns. A positive response was recorded if within 10 minutes, the blocks provided complete relief of pain lasting for the duration of action of the local anesthetic agent used

The diagnostic blocks used were cervical medial branch blocks performed under image intensifier using a lateral approach

In eight cases, there was complete concordance in the predicted levels between the first and second observers

In nine of ten patients, there was complete concordance between the predicted level and the positive response to blocks

Most patients reported areas that were more extensive than those seen in normal volunteers. Therefore, it appears that with stronger stimuli, the pain can spread beyond the core area, overlapping into adjacent zones

Results demonstrated that the segmental pain charts could be used with good accuracy to predict the segmental location of the symptomatic joint

Click here for Part 1A

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