“At what age should you start developing movement patterns for the purposes of injury prevention?”

In my opinion, this was a significant question in light of the fact that there as been ongoing discussion on several forums as to what minimum age would be most appropriate for the application of the Functional Movement Screen.

Since many of the athletes I work with fall within the 12 to 21 year old age range, it seems only appropriate that I address this question. Here are some tidbits of information that may assist in clarification:

Childhood ranges from 6 to 9 years of age and is marked by significant physical changes that in general, exhibit a linear growth. Development is typically somewhat predictable.

Adolescence, in contrast, ranges from 10 to 16 years of age and is marked by dramatic and rapid physical changes.

When considering the appropriate minimum age, it is also important to understand the differences between growth and maturation.

• Growth: actual changes in size occurring over a period of time
• Maturation: progress towards biological maturity (timing and rate of maturation generally varies between and within individuals).

Adolescent growth spurts generally occur between 13 and 15 years of age in males and between 11 and 13 years of age in females, while the age of maximal rate of growth (aka peak height velocity) generally occurs approximately 1 to 2 years following the commencement of sexual maturation. These variables may indeed influence motor learning and control.

In general, young children lack the motor skills required to adequately run, jump, and throw. With growth and maturation of the neurological and musculoskeletal systems, so do the development of these skills. The adult forms of these skills are generally acquired between 6 and 10 years of age and while the nervous system reaches 90% of its adult size by the age of 6 and full maturation by puberty, ultimate skill development depends highly on practice and training.

Gender differences do occur with motor performance with boys generally outperforming girls in run, jump, and throw performance. Further, males generally demonstrate continual improvement until early adulthood while improvement in females often slow by age 14…likely a result of proven decreases in levels of physical activity. It should be noted however, that in general, females tend to perform better than males on fine motor tasks.

Through an examination of the Long Term Athletic Development stages from the Canadian Sport for Life resource, it is apparent that the Learn to Train stage (Boys 9 – 12, Girls 8 – 11) is the stage at which adolescents should be developing and refining all movement skills, since the brain is capable of highly refined skill performance.

Interestingly, those who may be classified as “late developers” actually have an advantage since this learn to train stage is actually lengthened in this population.

During my graduate education experience, I had the privilege of working closely with Joe Baker, Phd of York University who’s primary focus and interests lie in optimal human development. When asking his opinion of this topic, his response was:

“…‘lack of consensus’ is a good way to describe most of the recommendations regarding training and rehab issues with youth and adolescent athletes. It’s clear that there are significant and persistent problems with this population but no real consistency in the recommended approach to deal with them. The immature motor system is part of the explanation but it also relates to the motor system’s interaction with the still developing cognitive and physiological systems. Adolescent athletes are at a stage of development that is almost constantly in flux making a ‘one size fits all’ approach very difficult…Unfortunately, I’m not sure of any rehab recommendations for this population.”

So in consideration of the above information, my recommendations would be as follows:

• Movement pattern development for the purpose of injury prevention may be implemented at the ages corresponding to early adolescence

• Functional Movement Screening for the purpose of identification of injury risk may be implemented at a similar age, HOWEVER, it is my opinion that the development and refinement of general movement skills take priority over the screen itself.

• Focus should be on the fundamental of motor development until mid to late adolescents – at least that’s what our research would suggest for most late maturation sports. (a recommendation from Dr. Baker)

.

The following information was derived primarily from the text, “Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation” by Magee et al as well as the Canadian Sport for Life website.

For more information on youth development please visit the International Youth Fitness Association and Canadian Sport for Life.

Photo source

Related posts:

1. Motor Learning and Neuroplasticity in Rehabiliation Summarizing the benefits of motor-skill training in musculoskeletal rehabilitation....
2. Common Movement Dysfunctions What to look for when screening and assessing the moving...
3. The glutes may not die but they sure can fall asleep! Picking our battles...

Related posts brought to you by Yet Another Related Posts Plugin.

Please be aware that the following information is based on my interpretation of each lecture and therefore, may be subject to “lost in translation”.

Please click here for Part 1

Please click here for Part 2

.

.

‘Clinical Update: Emerging trends in exercise management of spinal pain’

~ Paul Hodges & Stuart McGill

This lecture was the meat and potatoes of the symposium. Dr. Hodges was the main presenter and often asked Dr. McGill to provide some practical insight into some of his interventions for low back pain. While they both stressed that they were likely very similar in their approach to spinal care, it was evident from this talk that the divergence is still glaring. In fact, even the miracle blade could not cut the tension in the air although both were very professional in their “debate”.

Here are my notes:

Basic principles:

• Dynamic control far exceeds static control
• The system as a whole is what’s important, not a single muscle
• The biopsychosocial framework must be considered during intervention
• The assessment is highly important
• The principles are drawn from multiple approaches in training

5 basic but key components to DYNAMIC CONTROL:

• Posture
• Movement
• Underactivity (tends to involve local structures)
• Overactivity (tends to be global structures)
• Evaluation of both provocative and relieving factors

Treatment Goals:

• Postural correction
• Movement correction
• Muscle Activation Optimization

Posture:

Dr. McGill gave an example of the importance of posture and its relationship with our breathing. Feel free to perform a self-assessment in the various positions

• Regular sitting – normal breath
• Slouched – breath goes directly to mid-chest level
• Military position (shoulder retraction, thoracic extension) – breath goes down to base of lungs
• Rotate and list to one side – one lung becomes compromised and breath is taken up by contralateral lung

Movement:

Dr. McGill also provided us with a movement correction example

• Upright stance and muscle activity
• A forward posture (slouched or neck protraction) vs neutral spine
• Bottom line: change posture during movement may change activity of lumbar musculature (i.e. extensors)
• For those of you who have his newest DVD, he also demonstrates this example there.

*All three (posture, movement, muscle activation optimization) are important but we as clinicians have to figure out which of these is our priority in treatment.

“STATIC STABILITY DOES NOT EQUAL FUNCTION”

Interplay between dynamic and stiffness:

• This is a continuum
• Depends on the load (high load requires high stiffness)
• Depends on the movement (greater movement requires greater dynamic control)
• Depends on the predictability (low predictability requires high stiffness)
• We need to find the right balance!

“Change in motor control is about looking at the whole system not the parts.”

Common features of motor control strategies:

Dr. McGill on posture correction:

• First try to achieve elastic equilibrium
  • First start with a position of least load / stress concentration
• Then try to modulate that with pain
  • Can be standing
  • Can be seated
  • This seated example touched upon correct posture. Rather than actively extending the thoracic spine (which increases extensor muscle activity), tilting the pelvis anteriorly is preferred

Preservation of feedback control may be via taping:

• I found this to be quite interesting in light of the various taping techniques currently on utilized in the rehabilitation and sport medicine settings
• Taping may also be used for modifying muscle activation strategies

“NEUTRAL SPINE IS NOT STATIC!”

• It needs to be variable…and within the functional range

“The gluteus maximus is a (free) knee extensor!”

• When standing, active contraction of this muscle passively extends the knee
• “Spread the floor and use the hips”
• This is advantageous as it unloads the quadriceps muscle

Activating the HIGH glutes & glute med:

• Needs core stiffness
• Externally rotate hips
• This may be done actively and reactively (minibands around the knees and around the feet)

Activating LOW glutes:

• Only achieved in a deep squat position

Posture and Movement is about load:

• How does pain change with the addition and removal of load?
• McGill  – “tolerance is a function of posture and movement”

McGill on Bracing:

• Become a dimmer switch not a light bulb
• Its all about tuning!

Hodges: There’s a difference between just making a muscle active (Transversus Abdominis) vs an optimal way of using the muscle:

• It’s not enough just to activate the muscle…you have to learn how to use it!

Hodges:

“There is no doubt that Stu and I have differing positions on the role of the deep muscles in the clinical approach but I think it is good that we have different ideas because all individuals patients are different.”

“The Transversus Abdominis is not the most important thing in low back pain but our data show that it is the most consistent deficit in low back pain presentation. Therefore it is important to address this muscle as part of the comprehensive package of treating low back pain.”

“Improving the activation of the deep muscles may decrease the over activity of the global/superficial muscles.”

Dr. McGill on the Transversus Abdominis:

• He understands that the TrA is important. His problem is that there are so many other important aspects to low back pain patients.
• …and far too often the patients that he sees are “paralyzed” by the concept of a dysfunctional TrA. They are always asking, “is my TrA working?”, “why isn’t my TrA working?”
• This is why he subscribes to the method of external focus for motor learning by Gabrielle Wulf.

Dr. Hodges:

• Counters that there is data to show that simply an internal focus to “wake the muscle up” is ok. As long as there are subsequently more functional goals to focus on

*In my opinion, It’s an apples vs oranges debate!

“Train movement control, posture and muscle activity during rehabilitation”

• If they flex the spine while bending forward then train them not to flex the spine while bending forward.
• Its that simple!

Dr. McGill:

“Fix the biggest things first to get them out of pain…THEN fine tune!

• This was his rebuttal to the TrA and MF controversy. He states that he has never encountered a patient where the TrA deficit was the most significant dysfunction

Dr. Hodges’ strategy of multifidus activation:

• Can you turn it on?
• What else happens when you turn it on?
• Do you have control over the strategies?
• Most important and effective strategy is to use imagery.

“There’s something about attention to detail that’s driving changes in neuroplasticity”

Dr. McGill:

• States that his athletes cannot individually activate muscles medial to lateral but they can superiorly and inferiorly
• BUT THE MENTAL FOCUS WAS IDEAL!!!

Dr. Hodges:

“Delays are significant in a motor system.”

• This deficit is NOT the dysfunction but only a window of opportunity to look into the system.

.

As mentioned earlier, this turned out to be an interesting and enlightening high tension academic debate but both experts argue that it would be most valuable to have a patient on hand to both assess to really truly get an idea of how each think. They agreed that this would truly provide valuable insight into the magnitude of their agreement/disagreement.  Out of all of this, they state that there is mostly convergence between the two and that it may be the last (5%)…i.e. their specific methods…that may be different.

“Divergence is healthy. Because if not, what would drive research?”

*The purpose of everything is the individualized goals of each patient. That’s it!

Related posts:

1. 2010 Spine Control Symposium Recap: Part 2 A recap of the presentations put forth by Paul Hodges...
2. 2010 Spine Control Symposium Recap: Part 1 A recap of the presentations put forth by Peter Reeves...
3. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...

Related posts brought to you by Yet Another Related Posts Plugin.

August 28, 2010

8:00am – 8:30am Check-in and registration

8:30am – 8:45am Welcome and Introduction – Professor Paul Hodges

8:45am – 9:35am Professor Stu McGill

• Opinions on the links between back pain and motor control: The disconnect between clinical practice and research

9:35am– 10:25am Dr. Lorimer Moseley

• Talk title TBC

10:25am – 10:40am Morning Coffee Break

10:40am – 11:30am Professor Paul Hodges

• Motor control changes in spinal pain: effects mechanisms and efficacy of interventions.

11:30am – 12:20pm Associate Professor Peter N. Reeves

• Spine Stability: the six blind men and the elephant

12:20pm – 1:00pm Lunch

1:00pm – 2:00pm Clinical Update – Professor Paul Hodges

• Emerging trends in exercise management of spinal pain

2:00pm – 2:30pm Symposium Update

• Panel discussion on areas of convergence and divergence

2:30pm – 3:00pm Question and answer session.

3:00pm Symposium Close

Register here

Related posts:

1. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...
2. Thinking About Thoughts Cognitive aspects of treatment of lumbopelvic pain. From the upcoming...
3. Dr. Richards on Biomechanics & Stretching A lecture by one of my university professors and mentors...

Related posts brought to you by Yet Another Related Posts Plugin.

Here’s a brief summary of the study:

Study Purpose:

• To determine the presence of a relationship between hamstring length and PFJ stress at 3 specific knee joint angles of flexion.

Study Population:

• 16 recreationally active males divided into two groups based on knee joint angle-measured hamstring length.

Methodology:

• A biomechanical model incorporating knee joint angle, knee extensor moment, and PFJ contact area was used to quantify PFJ stress.
• MRI and 3D motion analyses were also utilized in this study.
• A one-way ANOVA to determine the variations in PFJ stress between the 2 groups (with and without reduced hamstring length) was used.

Main Findings:

• Patellofemoral Joint stresses differed significantly between the two groups at specific angles of knee flexion.
• No significant differences in hip angles between the two groups.

Clinical Application:

• This study demonstrated that subjects with reduced hamstring lengths have increased PFJ stress during various positions of the squatting movement.  As a result, such a decrease in length MAY contribute to the pathogenesis of various conditions relating to the knee.
• These results enable us to consider another factor when managing those with knee pathology.

For a complete and “evidence-informed” understanding of the study, look out for my review. I have obviously left out specifics from this study in this post as Research Review Service is a paid membership site. However, if you would like more information, please do not hesitate to ask.

Photo source

Related posts:

1. Zygapophyseal Joint Pain Patterns: Part 1A (Cervical Spine) This one's for the manual therapists out there. A brief...
2. Jump-Landing Biomechanics Knee pain. Knee Injury. “Certain athletes are at higher risk...
3. Research Review Service for Fitness Professionals A continuing education resource for those of you looking to...

Related posts brought to you by Yet Another Related Posts Plugin.

The Deep Line as Patrick states, consists of the following:

Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes

Patrick goes on to explain how breathing plays a very important role in the function of this line and provides some excellent strategies for correction and progression.

This got me thinking…

Often times I will use the Bunkie Testing method to assess the various lines throughout the body. I wrote a piece about the Bunkie Test late last year and it can be viewed here. Kevin Neeled also wrote a piece and shot some video on how and why this testing method may play an important role in kinetic linking for hockey players. You can read that here.

As mentioned last fall, the Bunkie Test consists of tests for the following

• Anterior power line
• Medial stabilizing line
• Lateral stabilizing line
• Posterior stabilizing line
• Posterior power line

Do we truly know that we’re testing each of the above? Who knows, but based on Patrick’s article, I think we need to revisit the test and see how we can start testing the DEEP FRONT LINE. That is, the Deep Stabilizing Line. Maybe we can’t. But perhaps we can. I am not trying to reinvent the testing method here. I am simply seeing a flaw in the testing procedure and am now looking for a way to improve it. Joe Heiler of Sports Rehab Expert recently invited me to do an interview and discuss the Bunkie Method of Testing. I hope to do this interview in July so maybe I’ll have some answers by then.

Perhaps there are other ways to test this. I can’t remember off the top of my head right now so if you can think of one, make sure you let me know.

When a patient does present with “dysfunction” of this Deep Front Line, aside from attacking their breathing patterns, I progress to improving their rolling patterns as well. Generally, I will work the supine to prone rolling pattern to improve this line and specifically target the right arm / left leg or left arm / right leg combinations as needed. Carson Boddicker has written several pieces on these topics, one of which is a must read.  For an introduction, make sure you read Core Competencies. Mark Young makes a good argument about testing the roll, but personally, I think quality is more important than quantity in this case…but that’s just my opinion!

Progression from here would be to the Dead Bug tract (not dissimilar to Patrick’s videos) and onward to chops and lifts (thanks Mike) and beyond to really attack their stabilizing function. Check out Nick Tumminello’s video of the Vertical Pallof Press for anterior stabilization (to combat lumbar extension).

Lots of info to digest here and certainly plenty of hot links to click on. So thanks to Patrick, Mike, Kevin, Mark, Carson, Nick, and Perry for unknowingly being participants in this post!

Related posts:

1. The Bunkie Test Although the assessment and treatment of myofascial and kinetic chain...
2. Minimizing Hip & Groin Injuries Considerations for minimizing hip and groin injuries in activity and...
3. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...

Related posts brought to you by Yet Another Related Posts Plugin.

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!

Related posts:

1. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
2. Optimum Body Mechanics A brief summary of maximizing Optimum Body Mechanics in activity...
3. Core Values (NY Times) Dr. Stu McGill demonstrates some "early" phase low back and...

Related posts brought to you by Yet Another Related Posts Plugin.

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?

Related posts:

1. Deep Thoughts Some good reads that I have come across in the...
2. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
3. “What are the best core exercises in your opinion?” I was JUST asked this question on facebook, click to...

Related posts brought to you by Yet Another Related Posts Plugin.

Also make sure to check out the following posts as scapular dyskinesia may play a role in both:

• Neurovascular Problems in the Athlete’s Shoulder
• Rotator Cuff Tears: Predictive Factors for Management

Related posts:

1. Rotator Cuff Tears: Predictive Factors for Management This review was recently posted on ResearchReviewService.com and integrated the...
2. The Shoulder in Sport The Shoulder in Sport: Management, rehabilitation, and prevention Andrea Fusco,...
3. The Rotator What is it? A device that can be used in...

Related posts brought to you by Yet Another Related Posts Plugin.

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.

Related posts:

1. Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation is...
2. Assess and Correct: A Review On Friday, I finally received my DVD copy of Assess...
3. Zygapophyseal Joint Pain Patterns: Part 1B (Cervical Spine) A study testing the reliability of their pain charts by...

Related posts brought to you by Yet Another Related Posts Plugin.

• The data from this study came from two sources (firefighters and kinesiology students).

• The main objective of this study was to assess the relationship between the V-sit test and the plank test for torso flexion endurance.

• The pearson correlation was r=0.34 (low correlation) as well as the r-squared value. It almost seems obvious that these two wouldn’t correlate well as they are two totally different positions.

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).

• The moral of the story is to use the V-sit when doing your tests for flexion endurance.

• He also cautioned against “training the test” due to the high compressive loads.

I do not have an image of the V-Sit test but can send you a copy of the full article if you would like. Just reply below with your email and I’ll shoot it over.

Related posts:

1. Core Values (NY Times) Dr. Stu McGill demonstrates some "early" phase low back and...
2. Common Movement Dysfunctions What to look for when screening and assessing the moving...
3. Optimum Body Mechanics A brief summary of maximizing Optimum Body Mechanics in activity...

Related posts brought to you by Yet Another Related Posts Plugin.

FOOT AND ANKLE

Pes Planus

During the movement screen, we examine your foot to determine if the movement in your foot is optimal.  Specifically, the most common type of dysfunction in the foot that can lead to energy leaks is a pes planus.  Pes planus, or flat feet, is a very common finding among the general population.  When dynamically tested, individuals with pes planus will exhibit turning out of their feet and a collapse of the main arch of their feet (longitudinal arch).  This finding can also contribute to the other findings within the movement screen.

Limited Dorsiflexion

This finding represents a limitation ankle joint’s range of motion.  Specifically, it means that the top of the foot does not get as close to the shin as it should while being loaded such as while performing a squat.   What this means is that those who have limited dorsiflexion in their ankle are likely make up for this lack of range by compensating somewhere else to get to the same depth of a squat.  Often times, people will use their backs predisposing them to injury due to overuse/misuse, or they may simply not be able to achieve the same range of movement while performing the specific movement in question.

External Foot Flare

This finding represents turning out of the foot while under dynamic load.  This may be a result of poor foot posture stemming from over pronation or pes planus.

KNEE

Dynamic Valgus

This finding represents the knees inability to maintain its dynamic integrity (position during movement) while under load.  What we see is a collapsing medially (inward) of the involved knee representing poor control, weakness of the hip musculature, and/or poor foundational support from poorly controlled foot motion.

Sagittal Control

This concept represents the importance of muscular control of one’s knee while under dynamic load.  What we see at times is a “shimmy” in the knee while the patient attempts to control knee movements such as a single leg squat.  This can represent poor muscular control and coordination  of the knee, hip and foot musculature.

LUMBOPELVIS AND HIP

Where your spine and hip attaches to your pelvis

Hip Hinge

This finding represents the correct way to perform a squat and generally to “bend at the hips”.  A good “bend” is initiated at the hip and not the low back where, as the name implies, you literally hinge your movement at your hips.  Those who cannot perform this movement and tend to favour bending through their back are predisposed to developing low back pain and poor performance, because instead of using their legs they use their spines to lift. Correcting this movement yields tremendous improvements for patients or athletes in terms of low back pain and performance.

Hip Mobility

This finding represents your hip range of motion in flexion, extension, internal and external rotation, and all combined movements of the aforementioned ranges. As a car needs lubricant to function properly you need hip mobility to keep your hips, low back and knees functioning properly. Tightness in the hips lead to stress and strain into joints that can create many musculoskeletal conditions that overtime can easily lead to arthritis in the previously mentioned sites. Sitting and our normal activities of daily living reduce our hip mobility. Therefore to be able to achieve your full athletic potential combined with staying injury proof requires you to constantly maintain proper hip mobility.

Hip Strength Quality

This finding examines the strength and ease of movement the athlete or patient displays during the various movements assessed. It is seen during low load testing as the depth the individual is able to achieve for example during the squat, lunge, and single leg squats. During high load conditions it is the individuals’ ability to absorb forces through the muscular system and to develop power (rate of force development)

Spine Buckling

This finding represents the spines inability to handle load.  What this means is that the spine is unable to support itself due to poor core musculature support.  Much like a mast on a ship, the spine requires guide wires to tightly hold the mast upright otherwise it will crack and the ship will lose its sails.  Similarly, without appropriate conditioning of the core muscles around the spine and pelvis, the body’s mast (your spine) will buckle causing you to lose the wind in your sails and the spring in your step.  Simple movement such as bending forward becomes painful.  This finding tends to become apparent while perform any bending movement.

Sandwich Movement

This finding represents when a person has does not display a hip hinge, has poor mobility through their hips, and favours using their back while perform a specific movement.  Essentially, what is seen is the torso and legs form the “bread” of the sandwich while the space in between becomes the filling.  A well conditioned pattern finds that the torso is in a neutral position with the chest up; while a “sandwich pattern” finds the chest bent into the legs and facing down – they look like a sandwich. In this position the low back is doing the lifting not the legs. Adopting this pattern negates the most powerful muscles in your body in favour of the back which predisposed the individual to developing chronic low back pain. Correcting this movement pattern and developing a proper hip hinge would be tremendously beneficial. In fact, most people with low back pain display this dysfunction that once corrected no longer have back pain.

Pelvic Control

Much like the above three findings, pelvic control reflects the patient’s ability to dynamically (through movement) maintain a stable pelvis (foundation) while performing various movements.  Dysfunctions are seen as aberrant movements of the pelvis; shifting, tilting, hiking and rotating. These dysfunctions occur largely because of an inability to maintain neutral spine control and are linked to the findings throughout the other anatomical sites, such as your ankle and foot. The impact of poor pelvic control relates to its’ central position in the body. Your pelvis is the transfer point for forces generated in your hips (the main power centre in the body) combined with force contributions from other areas of the body. Pelvic control is like the drive train of a car which functions to transfer power developed from the engine to the wheels. Many problems throughout the body will occur with poor pelvic control such as low back pain, hip problems, knee problems, and even shoulder problems.

Something to Think About:

Regardless of whether you are an athlete or not, pelvic control is essential. If you are an athlete the demands for pelvic control are much higher and are reflective of the demands of your sport. For example it well known that hip and leg contribution to pitching velocity and tennis serve velocity is over 50 percent. This is only possible through pelvic control, or “THE CORE”. Many athletes that fail to develop the core suffer injuries by trying to make up the power elsewhere, such as the elbow and shoulder for both pitchers and tennis players.

SCAPULO-THORACIC HUMERAL

Where your arms attach to your spine

Thoracic Collapse

This is a secondary finding often times associated with sandwich movement.  This finding indicates that the patient is not hinging from the hips resulting in a back dominant initiation of movement resulting in thoracic or mid back collapse.  Essentially, the mid-back often times follows the lead of the low back; if the low back is poorly supported, then the same will be seen in the mid-back.

Thoracic Rigidity/Hyperkyphosis

This finding is the opposite of the thoracic collapse.  It represents the inability of the patient to maintain a “chest up” position while under load and undergoing specific movements, irrespective of the stability of the low back.  In chronic situations, this finding can contribute to thoracic outlet syndrome, neck pain, and headaches.

Scapular Winging

This finding represents poor posture of your should blades (aka scapulae).  This finding indicates that you are chest dominant in your posture with likely tight, forward rolled shoulders and weak mid-back muscles.  This can predispose patients to developing chronic rotator cuff tendons, mid-back, shoulder, and neck pain.

Internal GH Rotation

Internal glenohumeral rotation represents a finding that is often associated with hyperkyphosis and scapular winging.  This can also predispose the patient to chronic rotator cuff injuries leading to pain and poor function while attempting to participate in their chosen activity or job.

CRANIO-CERVICAL JUNCTION

Where your neck meets your head

Anterior Head Carriage

This represents the general finding found in almost all people to some degree or another.  It’s what I call the modern cave man position in which our head juts forward in front of our bodies when we primarily sit in a poor position in front of the computer, read or slouch. This finding can represent poor muscular control of the deep muscles of your neck and may lead to chronic neck and jaw pain as well as headaches due to hyperactive posterior neck musculature.

Lateral Shift

Lateral shift of your head on your shoulders may represent a muscle imbalance present at your shoulder, neck, or upper back.  It may also represent a favoured motor pattern that if not corrected can lead to over stressing specific structures and tissue, resulting in breakdown and injury.

Rotation

Rotation is very similar to the finding of lateral shift and is often found in conjunction with it. Rotation may also represent a favoured motor pattern that can indicate the presence of weak and tight neck muscles.

Courtesy of Dr. Thomas Lam

Related posts:

1. Optimum Body Mechanics A brief summary of maximizing Optimum Body Mechanics in activity...
2. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
3. Zygapophyseal Joint Pain Patterns: Part 1A (Cervical Spine) This one's for the manual therapists out there. A brief...

Related posts brought to you by Yet Another Related Posts Plugin.

What we need:

• Dorsiflexion mobility

Why we need it:

• Minimize stress on knee

How we can get it:

KNEE:
What we need:

• We need to realize that the knee is often an innocent bystander

Why we need it:

• We need to realize this because the research says so

How we can get it

• We can achieve optimal knee mechanics by looking both above (the hip) and below (the ankle) this joint.

HIP:

What we need:

• Saggittal plane mobility
• Extension strength

Why we need it:

• Minimize stress on lumbar spine

How we can get it:

• Glute Bridge
• Glute Bridge – Marching
• Glute Bridge – 1 Leg

What we need:

• Frontal & Transverse plane dynamic stability

Why we need it:

• Minimize dynamic valgus at knee and dynamic internal rotation at knee

How we can get it

• Side Lying Abduction
• Clam Shells (Hip – External Rotation)
• Mini Band – External Rotation
• Airplane (I’ll get a video of this up soon)

LOW BACK / CORE:

What we need:

• Antirotation, Antiextension, Antilateral flexion STABILITY

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Antirotation: “Pig on a Spit” Roll
• Antiextension: Front Plank series including the Body Saw
• Antilateral flexion: Farmer walk / Suitcase carry

What we need:

• Lumbar intersegmental stability

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Effective “core activation” methods

THORACIC SPINE:

What we need:

• Rotation & Extension mobility

Why we need it:

• Lumbar relief & Shoulder mobility

How we can get it:

SHOULDER:

What we need:

• Scapular stability

Why we need it:

• Shoulder mobility

How we can get it:

For those of you who are unfamiliar with this approach of looking at the body, please have a look at Coach Boyle’s The Joint by Joint approach and FITS Toronto’s 5-site Integrity

Anatomical photos courtesy of Primal Pictures

Related posts:

1. Minimizing Hip & Groin Injuries Considerations for minimizing hip and groin injuries in activity and...
2. Jumping Rope: A triathlete’s off season secret weapon? As I was jumping rope in between workouts yesterday (thats...
3. “What are the best core exercises in your opinion?” I was JUST asked this question on facebook, click to...

Related posts brought to you by Yet Another Related Posts Plugin.