Here's a brief summary of an excellent paper by Boudreau et al from Manual Therapy.
The purpose of this paper was to summarize several important aspects of motor-skill training for enhancing musculoskeletal rehabilitation. Cortical Neuroplasticity: a dynamic feature of life that encompasses functional or morphological change in properties of neurons (connection strength, represenational patterns, neuron reorganization.
It is hypothesized that motor-skill training can influence the direction of change in cortical neuroplasticity.
Potential effects of motor-skill training:
Methods of Optimizing Rehabilitation:
The above information was derived from a multitude of studies and demonstrates that motor-skill training may positively influence cortical neuroplasticity in musculoskeletal rehabilitation
0 Comments
An article by Dr. S McGill compared the V-sit flexion endurance test vs the front plank test for endurance.
I think the main reason McGill did this study was because people were using the PLANK test in place of the V-SIT to test flexion endurance (which has plenty of data correlating poor endurance times with low back disorders).
DESTRUCTION PHASE:
Initial rupture and necrosis of myofibers
Hematoma formation occurs between the ruptured stumps of the myofibers Blood vessels tear and release inflammatory cells
*Note: Repair and Remodeling Phases Are Concomitant – simultaneously supportive and competitive REPAIR PHASE: Phagocytosis of necrotized tissue
Regeneration of myofibers
Production of a connective tissue scar
Capillary in-growth into injured area
REMODELING PHASE: Maturation of the regenerated myofibers Contraction and reorganization of the scar tissue
Recovery of the functional capacity of the muscle
.This week my review on Predictive Factors for Management of Rotator Cuff Tears was posted on Research Review Service.
This review integrated the results of two studies that investigated the effect of pain, tear size, location and humeral head migration on the clinical outcomes and risk of progression in patients with rotator cuff tears. As always, for a complete understanding of the study, please read the articles below. To access my review, please visit Research Review Service The two studies reviewed:
Main findings:
Clinical application: Conservative management alone may not be sufficient in those individuals presenting with the specific characteristics described above. Therefore, simultaneous referral for orthopaedic consultation would be warranted in prudent case management. The Sleeper Stretch has been one of the most commonly prescribed interventions for athletes presenting with Glenohumeral Internal Rotation Deficit (GIRD) of the shoulder.
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:
Measurement positions:
More information pertaining to this study's methodology:
Glenohumeral positions that significantly stretched the posterior capsule:
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 be larger. 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 This one's for the manual therapists out there. A brief little review of 2 landmark papers pertaining to fact joint pain and referral patterns.
Part 1A: CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS I: A study in normal volunteers (Dwyer et. al., Spine, 1990) A study determining whether or not pain from a given joint assumed a characteristic distribution…where the pain pattern in a given patient might be used as an accurate indicator for clinically diagnosing the symptomatic joint 4 asymptomatic subjects were used A contrast medium was injected into the joints, acting in a prevocational matter (experimental stimulus). Subjects were then examined for tenderness in both the cervical and shoulder regions The distributions of evoked pain were recorded and a visual analog scale was completed The medial branches of the dorsal primary rami were also blocked The pain felt was deep and achy in quality Pain patterns:
Following the analgesic blocks, the subjects unexpectedly demonstrated a slight hypesthesia over the area coinciding with the previous recorded area of invoked pain and tenderness Concluded that the cervical z-joints can be sources of pain, including referred pain and that a physiological mechanism must exist whereby pain stemming from a z-joint can be referred into the related limb or limb girdle Further, cervical z-joint pain is distributed in a pattern characteristic of its segmental origin The Journal of Bodywork & Movement Therapies published an article by Eyal Lederman: The Myth of Core Stability. The following information is a summary of Lederman's conclusions.
ASSUMPTIONS ABOUT STABILITY AND THE ROLE OF CORE MUSCULATURE Despite the role of the core musculature in creating spinal stability...
Despite the exponential number research studies conducted in the last decade...
TIMING While the control of specific core musculature has been highly regarded in its "relationship" to low back pain...
STRENGTH While it is known that trunk muscle strength may decrease as a result of low back pain and injury...
CORE MUSCLE ACTIVATION There are still many practitioners that still follow the single core muscle activation concept (TrA), unfortunately...
THE RELATIONSHIP BETWEEN CORE STABILITY TRAINING AND MOTOR LEARNING While training for an activity often leads to skill development in that activity (i.e. piano)...
Although many novel core exercises are now performed in more "functional" positions (i.e. standing, moving)...
Furthermore, while individuals are constantly reminded to continuously tighten their core musculature...
CORE STABILITY FOR INJURY PREVENTION AND THERAPY While an asymptomatic individual may present with weak abdominals...
CORE STABILITY AND ITS RELATIONSHIP TO THE CAUSE OF LOW BACK PAIN While our understanding of the aetiology of back pain has increased tremendously over the last decade...
POTENTIAL DAMAGING EFFECTS OF CORE STABILITY Although compressive forces on the lumbar spine may contribute to low back pain...
While core training may be aimed at biomechanical dysfunction...
TAKE HOME POINTS
If accessible, I strongly encourage you to read the paper in full. While Lederman makes some valid points, it was quite interesting that of the 200+ references cited, only one was primarily authored by Stu McGill, a 2003 study at best. Further, much of the points Lederman alludes to have already been elaborated upon by McGill in his book, Ultimate Back Fitness and Performance (also available in my "Educational Resources" above). Again, the above information are merely a summary of Lederman's conclusions. Make sure you leave a comment and let me know what you think! Photo source For those of you who are still using the Smith Machine to Squat, here is another reason why you should set yourself "free".
A recent study published in the Journal of Strength and Conditioning Research, examined the electromyographic activity (EMG) of various muscles during the squat exercise when performed using the Smith machine as well as using free weights. This was performed as a follow up to a 2005 study by Anderson and Behm that demonstrated higher EMG activity of the quadriceps muscles during the Smith Machine squat. The major difference between this and that of its predecessor was that a weight equal to an 8RM for EACH exercise (to facilitate relative intensity) was utilized in comparison to a fixed, absolute weight for both exercises used by Anderson and Behm. EMG activity was collected for the following musculature:
A relatively low "N" was used: 3 men, 3 women. All were active in sports and familiar with the use of both free weights and the Smith machine. The average absolute EMG activity for the free weight squat was:
Interestingly, no significant differences in EMG activity of the trunk musculature were found between the two exercises. I will keep my opinions to myself on this, especially when only 6 subjects were used. Additionally, I was both surprised and disappointed the authors failed to include the gluteal musculature within this study since hip extension is one major component of the squat exercise. My Thoughts: These findings likely represent a increased stabilizing role of the above musculature for the hip, knee and ankle during free weight squats.
If you are a strength coach or manual therapist, I can say with 99.9% certainty that you have at one point or another recommended a Standing Wall Stretch to a client or patient. You may have done so for various reasons, including improved triceps surae length, but have you recommended this stretch with external assistance?
The external assistance that I speak of actually comes from a medial arch support. A recent study published in JOSPT, examined the effect of Standing Wall Stretching on a number of variables in subjects with "neutral" foot alignment and in those with "flat" feet. The variables examined were:
The main finding of this study was that following the stretching protocol, the difference in DMTJ was significantly greater in those with flat feet (pes planus). Therefore, for those of you who recommend the Standing Wall Stretch to improve gastrocnemius length, it may be wise to use a medial arch support in those athletes presenting with Pes Planus. |