DNS

If you can’t rotate, just wait…for the injury.

Rotation is one of the most important motions that humans have in their repertoire of locomotion. After stabilisation of the neck, chest and pelvis is achieved at the age of 4-5 months, a baby develops the ability to rotate from supine to prone and back and then progress to four-point, quadrapedal and then verticalisation before the monumental task of gait is achieved. So if rotation is one of the first components of movement and locomotion that we establish, it would also appear to be one of the first movements that we tend to lose as we develop dysfunctional or habitual movement.

Why does this happen? Or A question that I am often posed by my clients. How did I get to be like this? I would offer the following scenarios:

  • Too much exercise- focus on sagittal plane or backwards and forwards motion.
  • Too little exercise – stuck at a desk-sofa, inability to breathe, lack of movement.

For the committed exerciser a lack of rotation or the lack of reprogramming of rotation is often key. The neck and thoracic spine were built for rotation. Squats, deadlifts, pull ups, benching, Olympic lifting and other exercises do little to improve rotation. Even if a good trainer implements some great rotational exercisers such as wood-chops, cable push or pulls with rotation, med-ball tosses and the like, the action of creating an optimal rotation pattern is hard to achieve without some form of neuro-biomechanical re-programming. In short:

MORE DOES NOT MEAN BETTER

Understanding how good rotation (and frontal plane or side to side mechanics) looks like and how to reprogram it, should be considered by those wanting to improve mechanics or to move away from sources out of pain but of course a lack of rotation is not the only cause of pain and or altered mechanics. Regional interdependence is a concept that suggests that poor movement and pain in one area may be the product of another seemingly unrelated area.

So what’s good?

As always depending on your slant opinions can vary. I tend to use mechanical analysis such as SFMA (Selective Functional Movement Analysis), combined with some other biomechanical considerations such as, DNS, gait and to change the clients patterns I use techniques such as Neuro Kinetic Therapy and Proprioceptive Deep Tendon Release or PDTR for efficient results.

Here’s a quick way to analyse rotation.

Standing

OLYMPUS DIGITAL CAMERAThe standing position observes a ground up view of rotation. In short it helps to breakdown issues related to mobility or stability. What you are looking for is approximately 45-50 degrees of rotation at the hip and pelvis and 90 degrees of rotation of the upper body. It should be compared with the other side

 

 

 

 

Seated

ComplOLYMPUS DIGITAL CAMERAeting  the test seated with the feet on the ground allows for an assessment of rotation of the upper body minus involvement of the lower body to determine interactions. In short an approximate rotation of 50 degrees either side is ideal. Unilateral differences should be compared as part of the treatment strategy.

Is it a mobility or stability issue? An old vid blog can you up to date on this concept. 

Rolling.

OLYMPUS DIGITAL CAMERAThe rolling pattern is a great leveller for the athlete and non athlete alike. The concept is to assess the ability to roll using only upper body or lower body, analysing segmental movement and in most cases many people cannot adequately roll.

In fact the compensation strategies can reveal much about how an individuals brain has elected to move with compensatory mechanisms. Correcting these can be achieved with NKT and PDTR in the space of a few minutes in some cases.

Rolling patterns represent one of the first forms of locomotion in the neonate and initial rolling patterns starts at the age of 4-5 months.

Rolling assessment allows for the identification of muscles/structures that may contribute to poor rotation in gait, day - day and sporting activities.

Comparing upper to lower body and prone to supine can determine deficits that can be rectified in both pain and optimisation of movement.

  • Upper body prone to supine left to right
  • Upper body supine to prone left to right
  • Lower body prone to supine left to right
  • Lower body supine to prone left to right

 When we lose efficient rotation in everyday activities such as walking and running, structures that may not be able to rotate efficiently may be forced into compensatory movement. For instance, the lumbar spine which has minimal degrees of rotation when compared to the thoracic spine can often be the source of pain

Integrating rotation into your exercise and injury prevention routine should be as important as your warm up itself. If you feel that you can’t rotate that well then get in contact with someone who can assess and change your rotation.

You can find out more in my breathing pattern and core workshop coming up soon called The Foundational Five about how to change core function.

 References:

  • Cook, G. et al. Selective Functional Movement Assessment. Course Manual
  • Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system, Journal of Bodywork & Movement Therapies (2013),
  • Weinstock, D. Neuro Kinetic Therapy.
  • Cook, G. Gill, L. Hoogenbam, Voight M. Using Rolling to Develop Neuromuscular Control and Coordination of the Core and Extremities of Athletes. N Am J Sports Phys Ther. May 2009; 4(2): 70–82.

 

 

 

 

 

Getting to the core and why you have back pain despite rock hard abs!

The concept of ‘core’ conditioning has evolved significantly since the millennium and there have often been some common misunderstandings of the mechanisms, which can increase the prevalence of back pain. I know because I taught them in an inappropriate way, that’s the way that I was taught. But times change and increased knowledge and application go a long way for someone to determine what works and what doesn’t. Many people still have back pain despite participation in core conditioning regimes, pilates and other types of 'core' workouts. Many lay peoples understanding of the core is that a strong set of abdominal and back muscles prevents back pain. This statement is false and I have seen hundreds of people with strong trunk muscles all still prevent with back pain. Overtraining of the core is responsible for increasing back pain in many individuals. Many focus on strength, skipping key elements such as flexibility and stability paving the way for muscular dysfunction. Neuromuscular retraining should often be the focus for optimal core function but for many throwing big weights around, worrying about weight loss or how many spin classes they can get to takes precedence over dysfunctional movement and pain .

Then there is the concept of the inner unit which was touted by Richardson, Jull and Hodges, a good book and one that was part of the curriculum at the CHEK Institute (where I learnt a lot about rehabilitation) and no doubt many other institutions and how, by isolation of the Transversus Abdominus or TrA created an increase in Intra-Abdominal Pressure (IAP) co contracted with the multifidus and worked intrinsically with the pelvic floor.

Training the TrA in isolation fails to offer the complete picture and treatment for segmental stability. The diaphragm working in co-contraction with the TrA, pelvic floor and lumbar multifidus present a more appropriate method for stabilising not only the lumbar spine but provide a foundation for a more efficient methodology of rehabilitation which covers stability.

The Rehabilitation School of Prague’s model of Dynamic Neuromuscular Stabilisation offers a compelling model of stabilisation via developmental kinesiology. How the developing child moves and integrates stability is an effective method for re-integration of the intrinsic stabilisation system which comprises of the diaphragm, pelvic floor, TrA and spine flexors and extensors. The image below of the open scissors position of the rib cage and pelvis details the oblique angle that can occur when poor stability is mediated by poor diaphragmatic action.

why you get back pain, DNS

With DNS technique the flare of the rib cage and optimal contraction of the diaphragm can be corrected in the space of minutes to provide an optimal pathway for diaphragmatic breathing.

This concept is an effective method for rehabilitation but in my opinion there remain questions when utilising the concept of stability from the trunk. The diaphragm has the capacity to work segmentally too much or too little based upon a client’s injury history. Here are just some of many scenarios where the intrinsic stabilising system could become dysfunctional.

• TMJ or jaw dysfunction • C section or other significant scars on the body • Pelvic floor dysfunction • Any other muscles has the capacity to affect any other muscle in the body. • Local inhibition of synergistic, functional opposites or stabilising muscles • Emotional distress • Broken bones • Functional slings such as the posterior oblique sling, lateral sling and others • Why you get neck pain

Use of a joint by joint approach to testing such as Neuro Kinetic Therapy ™ helps to establish a baseline for dysfunctional patterns of facilitation (overworked muscles) and inhibition (underworking muscles). Decisions should be made as whether a mobility or a motor control issue exist. Motor control or the ability of the muscles to be efficiently recruited by the nervous system can be rectified by understanding patterns of inhibition and rewiring the nervous system for optimal control. Integration between both NKT and DNS techniques allows for a progression from pain and dysfunction to integrated movement patterns that can be hard wired with practice of developmental kinesiology exercises.

Many traditional and rehabilitation conditioning exercises often serve to increase dysfunction. Extension and even neutral load training based exercises such as deadlifts, bird dogs and horse stances can increase activation of the thoracolumbar fascia which serves as a conduit for force transfer especially for the posterior oblique sling. index

A release of the thorocolumbar fascia and integration of the posterior oblique sling through proprioception via taping or exercises remains an efficient method of neuro muscular activation rather than just increasing motor activity via strength and conditioning exercises. tape Posterior oblique sling and reducing back pain

Integration of techniques allows for a much more efficient treatment for clients who suffer from pain and movement dysfunction and can truly get to the core of both acute and chronic conditions. Isolated approaches yield isolated results.

To find out more about how to get out of pain and improve movement and energy please get in touch.

References:

Frank, C Kobesova, A and Kolar, P.Dynamic Neuromuscular Stabilisation and Sports Therapy.Int J Sports Phys Ther. 2013 February; 8(1): 62–73. Myers, T. Anatomy Trains. Churchill Livingstone Elsevier. 2001. Richardson C, Hodges P and Hides, J. Therapeutic Lumbo Pelvic Stabilisation. Churchill Livingstone. 1999 Weinstock, D. Nuero Kinetic Therapy. An Innovative Approach to Muscle Testing. North Atlantic Books.

Is your functional training making you dysfunctional?

Buzz words of the last decade in the health and fitness industry were terms such as functional, core, ground reaction, Paleo, intermittent fasting etc etc. It is an easy approach for people to throw around these types of phrases, impressing clients without having a true understanding of what they really mean. Like many it took me some time to realise that to get people strong you need a combination of good therapy, improved movement patterns and ultimately lifting well.  The emphasis on functional training has contributed to increased facilitation patterns which contribute to musculo-skeletal issues, much in the same way that the circuit training phase of the 90’s did. Now there are increased loads and patterns of dysfunction by methodologies such as Boot Camps, Cross Fit, TRX classes, Endurance events and the like and more than ever, I (and my peers) am seeing the incidence of overuse injuries created by inhibition and facilitation from poorly constructed exercise programming.

Let’s take this guy below. His exercise using the TRX must be functional , it must be making him strong right? Well no and here’s why? This gym dude like millions of others makes the mistake of utilising balance with strength as an exercise. The net effect of this type of exercise is facilitation when there is instability without the ability to stabilise.

trxjpg

You can clearly note here a rounding of the upper back   and cranial extension caused by inability to stabilise using the cervical flexors, mid and lower trapezius.

Facilitated                                                                          Inhibited

Upper traps/Scalenes                                                     Cervical flexors

Levator Scapula                                                              Middle and lower trapezius

Pec minor and probably major in this case                    Latissimus dorsi

Sternocleidomastoid                                                      Subscapularis and other structures

The cervical extensors, upper traps and pec minor amongst other structures have the ability to disrupt breathing patterns, gait and decrease strength in patterns such as the squat and dead lift. Those who teach these type of exercises should be skilled in spotting movement dysfunction, inhibition and facilitation and understand strategies of how to correct these issues or at least understand that if you keep exercising in this way you will lead to breakdown of key stabilising structures.

Is it a ‘core’ problem?

The core is really the interaction of all the muscles in the body but specific attention has been paid areas such as the ‘inner unit’ which comprises of the Tranversus Abdominus (TrA), multifidus, diaphragm and pelvic floor and the outer unit which comprises of the abdominals and internal and external obliques which interlink with many larger muscles.  In reality these muscles work in tandem with other muscles to create structural balance.  Many people think that to train their core they have to blitz their abdominals, obliques and back muscles with intensity which creates dysfunction.

This is where common misconceptions occur. The core more often than not, needs to be recruited appropriately and that should occur with proper movement development and determining what other structures beyond the core (such as previous injuries) are prevalent. Many of these problems can occur as a result of many factors. Children who don’t develop crawling patterns, who are either rushed into walking or put into baby crawlers can be at risk in later life of poor breathing patterns and core dysfunction. The seated position is not great for the spine and muscles can develop inhibition as other muscles get overworked and the nervous system will always take the least path of resistance when it comes to movement and muscle activation. Additionally the seated position also helps to create inverted breathing patterns, which disrupts the stabilising capacity of core muscles.

Many people make the mistake of activating the TrA in all the time (or drawing the belly in), even when walking. This is a disaster as it creates facilitation of the accessory muscles of breathing, creating a forward head posture, rounded back and weak links in the chain from head to the toe. In fact in some schools of thought letting your belly out and pushing outwards  also increases abdominal pressure and stabilising mechanisms that are just as good if not better for ‘core’ recruitment. Sometimes we are so fixated about our weight that we constantly walk around with our belly drawn in…let it hang out I say.

References:

  1. DNS technique according to Kolar. Training Manual Rehabilitation School of Prague
  2. Hodges, P. W. Is there a role for Transversus Abdominis in Lumbo-Pelvic  Stability? Manual Therapy (1999) 4(2), 74±86
  3. Kolá, P. Importance of Developmental Kinesiology for Manual Medicine.1996
  4. Weinstock, D. Neuro Kinetic Therapy. North Atlantic Books 2010