NKT

Skin deep? The role of skin in motor control and dysfunction.

Many people are aware that dysfunction can occur from many different areas. Scar tissue, joint and ligament/tendon receptors, muscle fibres and many more factors contribute to pain and movement issues. The role of skin in providing feedback is not so prevalent in literature or discussed as a source of a client’s motor control, pain or dysfunction issues. Whilst muscle and joint receptors are well known as proprioceptors, the skin contains a large amount of feedback from exteroreceptors originally proposed by Sherrington. These include:

Meissner – vibrationskin copy

Pacinian- vibration

Ruffini - pressure response

Krause – pressure in mucosal tissues

Merkel - pressure/touch to skin

Free nerve endings – nociceptive/pain stimulation

The skin provides feedback from external stimulus, adjusting steps and movement. Damage to the skin can be one of the many areas that clients often forget and for that matter, surgeries such as appendectomies, c –sections and kidney removal are just a few of the ‘small’ procedures that have not been mentioned in an initial session.

Deep abrasions on young tissue, which heal and visually, present little to see on an adult body, are common. A recent finding with a client was a certain amount of dysfunction between a deep unseen scar from falling from a bike 20 years ago playing havoc with the scar tissue and stability of   the same knee from a later ACL reconstruction. Using techniques such as PDTR (proprioceptive deep tendon reflex) and NKT (neuro kinetic therapy) it is possible to assess the impact of scars, seen or unseen on stability and motor control of muscle and ligamentous tissue.

Another common issue is the role of deep coloured tattoos and their impact on surrounding muscle tissue via skin receptor dysfunction. Usually dysfunction between quick pin tracts (Neospinalthalmic tracts) and slower pain (Paleospinalthalamic tracts) are prevalent with tattoos but depending on depth and other factors, dysfunction can present via the receptors suggested above.

Tattoos can create dysfunction in underlying and other tissues

 

Addressing muscular dysfunction can be useful and effective as part of the treatment but in addition to assessment of joint, ligament, tendon and pain pathways; assessment of the skin and its associated receptors should be an integral part of the client’s treatment.

 

References:

Palomar, J. Proprioceptive Deep Tendon Reflex. Course manual.

Purves D, Augustine GJ, Fitzpatrick D, et al. Neuroscience 2nd edition.

Sinauer Associates 2001.

Bin the flip-flops for better performance

I have worked with thousands of clients over the years and one of the most consistent links that I can say with certainty exists, is the link between biomechanical dysfunction from flip flop wearing. You can also lump tight shoes, high heels and other rogue foot wear that simply do not allow the feet to function correctly in that description. What I am not saying is that you can never wear those shoes that you hold so dear to your heart again. What I am saying is; that if you are engaged in an exercise regime, be it professional or someone who wants to get the best from your training regime, without injury or decreases in performance. Ditching those pesky flip-flops and other gait restrictors are probably a good idea.

If you want to wear them, then doing some kind of releases that address your own personal restrictions is key. This flip-flop release is very useful but not complete.

https://youtu.be/y1a6W86Yp8I

With the twenty-six bones, thirty-three joints and over one hundred muscles and ligaments, each person demonstrates their personal movement and dysfunction in slightly different ways.

I can tell straight away, when a client walks in whether they wear flip-flops, tight work shoes or over used high heels. So what are the common issues that I see?

  • Inability to optimally recruit the hip and thigh (glutes/hip flexors/quads/hamstrings) muscles.
  • Restriction in mobility/stability to the neck.
  • Poor core function due to overuse of the back muscles.
  • Calf strain and usually a decrease in shin muscle contracture
  • Instability of the big toe-essential for push off in gait
  • Permanent contraction of the toes

There are others and many clients often look at me like a madman as I say that their problems are coming from their footwear. Usually the improvement in function and decrease in pain relatively quickly is enough to ensure their compliance to restricting problematic footwear and addressing their muscular problems with some foot TLC homework.

From a muscular and myofascial line Myers proposition of the structural connectivity via superficial  back line the superficial back line can show us how muscular and ligamentous issues in the feet might affect the whole line where the muscles are continuous with the cranial fascia. Addressing the foot has often decreased pain and increased mobility in the neck in many clients.

A long-standing client of mine who is a competitive swimmer was reminded of the implications of flip-flop wearing and performance. Originally a back pain client that was cleared, he was complaining of a lack of ability to complete a six beat stroke with his feet. After clearing the distortion of the peripheral and central nervous system and restoring optimal muscle function (Using NKT or Neuro Kinetic Therapy and Proprioceptive Deep Tendon Reflex/PDTR), he reported a return of the function that night.

Whether exercising or just for moving efficiently you can still wear these shoes but just be aware that there is a cost. To remove the dysfunction you will need to do corrective work and more homework and lets be honest for those that do exercise, correctives are adistraction from the main event. More mobility and stability work? Come on!

Well if you just treated those feet with more respect you wouldn’t need too.

 

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.

 

 

 

 

 

Working with Amna

In the past few months I have had the pleasure of working with Amna Al Haddad. She is a motivated, strong woman with a goal of training for the 2016 Olympics in Rio. When I first met Amna she was a little disappointed with her progress and felt like she had hit a wall with her training. Initially the goal was to tweak her energy levels by analysing her metabolic rate and modifying diet to get the optimal amount of energy, to improve performance. When people participate at high level sports they can often become very strong through compensatory mechanisms. Using bio-mechanical assessments and motor control evaluations such as SFMA and Neuro Kinetic Therapy, we were able to change the way that Amna's nervous system communicated with the appropriate muscles and present some strategies that kept them optimal.

Understanding the difference between mobility versus stability issues is key.This ensures that movement remains great and injuries are reduced.

It's been great to see Amna hit some new PB's and stay motivated for her goals ahead. Really looking forward to see her excel over the next few years as it has been a pleasure working with someone so motivated to achieve their targets.

Amna's face book page 

"Working with Keith in the past few months have been absolutely great. My performance, energy levels, and stability definitely increased after our treatment sessions. My muscles have been compensating a lot, often causing a lot of dysfunction and irritation that has affected my weightlifting and strength levels.Keith understands the human body in a different way than what I have seen before from a performance consultant; he can immediately show you how to activate a muscle and restore its strength, reduce pain, and more in just a few seconds! BUT..you have to do your homework to reinforce the new movement patterns."  Amna Al Haddad, UAE national Olympic Weightlifter

 

51

The difference between mobility and stability issues

Do you have an injury that keeps reoccurring? Finding the difference between mobility and stability issues can be the key to eradicating pain for good If you have ever suffered from an injury and there was no difference made between a mobility or a stability issue. Chances are you may still have the injury.

You often see many trainers and therapists focusing on mobility, mobility and more mobility. Release this muscle with that foam roller release the fascia with this ball but unless the distinction is made between whether a mobility drill or stability training or re-programming of the nervous system needs to occur, All you will end up with is one mobile injured body. It’s a simple thing to do. Just determine whether the movement can be conducted through the desired range. If it can’t, the question should be asked can this be done passively, with someone else guiding you through the movement. If the answer is yes. You have a stability or motor control dysfunction.

If you are the one of many going through the insurance/treatment mill or simply not getting any resolve from massage, exercise or whatever therapy that you are undertaking. Don’t be scared to ask the person treating you…Do I have a mobility or stability issue? It will help to cut through all the fluff. .

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.

Old injuries and new pain?

Image-1 (2) Most people don't associate long term injuries that are often asymptomatic with current levels of pain. This single case study is a great way of demonstrating just how this can occur.

Brief history of client-34 year old rugby player presenting with recurrent achilles pain despite long term physio. A great case of lifitis as somebody reminded me about my own injuries recently! Two ruptured biceps over the last decade and neck injuries to boot. Presented with inhibited bilateral hamstrings, right lat, neck extensors and left rectus femoris and quadricep (hip and thigh muscles) inhibited. Also poor dorsi flexion (raising the foot from the floor) inhibited by his calf muscles. His thoroca-lumbar fascia, the piece of tissue that connects the glutes and lats was holding a lot of tension and contributing to a poor link between these two powerful muscles.

Compensation can take many forms. For example with this case the client was usiing his diaphragm to help stabilise other joints in his body that was not balanced with the pelvic floor and TVA (transversus abdominis or hoop like muscle that is a key player in spinal and segmental stability)

After testing and re-activating the muscles that were inhibited using NKT (TM) the muscles, I taped the right to left posterior oblique sling as you can see in the picture, with great results. The tape acts as a conduit for proprioception or communication between this key sling. Client has been free of achilles pain despite training heavily during pre season rugby training.tape Posterior oblique sling

Analysis in the form of SFMA selective functional movement assessment and re-establishing neural pathways through the use of NKT, appropriate treatment and exercise have ensured that this client got out of pain most effectively and the interesting part...I didn't touch his heel to get rid of the pain! To find out how to get pain free, moving and grooving get in touch to find out more.

Cesarean section or Chaos section? Why you may have back pain after your baby.

Medical systems can often create a vicious cycle and the Cesarean section is one such cycle. The creation of specialist departments often creates a vacuum where, what some might think as minor issues go ignored, yet affect those who have to undertake specialist procedures. In any other system say finance or banking it would be called negligence or incompetence for failing to notice where the system broke down (something not often noticed until after the debacle has occurred) but because it often involves individuals who suffer from one of the most common medical issues in the world the cause and effect often go unnoticed. It's a simple statement Cesarean sections could be one of the leading causes of back pain in females. A statement that can be validated fairly easily when you observe this phenomenon on a regular basis . I have never met a female client who had a C-section who didn't suffer from either lumbar, cervical or sacroiliac joint dysfunction. Governments who want to save hundreds of millions of unnecessary cash spent on treating back pain may want to scrutinise this point. It often serves the medical insurance system to keep this cycle system in full flow.lumbar spine

Females who have suffered from back pain, most likely due to failure to rehabilitate the key stabilising mechanisms of the the lumbo-pelvic complex may have avoided back pain all together. Implementing a basic program would not only help to avoid back pain but may aid women back into exercise much sooner assisting any psychological issues such as post-natal depression.

A general rule for low level exercise post C-section to begin is 6-8 weeks. The healing process starts immediately post op and the nutritional status and individuals immune system plays a significant role in healing time, decrease of infections and energetic processes.

During the surgery process. The skin, abdominal fascia, Rectus Abdominus and Transversus Abdominus (TrA) are easily severed with many nerves also being affected by the surgeons scalpel. This is where the chaos begins. Whilst the global implications of movement dysfunction are readily observed with restrictions to simple tasks such as standing, sitting and even turning over in bed. The local intrinsic nature of lumbo-pelvic stabilisation dysfunction is not observed until the women attends a specialist to deal with a particular pain syndrome. More often than not light cardiovascular exercise is recommended which serves to deepen the dysfunction not only due to the lack of appropriate muscle activation but also due to its effects on respiration.

The TrA whilst important with its synergistic role with the multifidi, diaphragm, pelvic floor muscles also has an essential function with respiration. During inspiration the primary muscle of inspiration the diaphragm contracts displacing the abdominal viscera outwards and downwards placing both the muscles of the pelvic floor and TrA in a stretched position. The natural recoil of the TrA assists in exhalation,helping to force air from the lungs. Post C-section this action can diminish placing additional stress on the excessory muscles of respiration. Additionally the flexors of the trunk, primarily the Rectus abdominis often become inhibited and other muscles can facilitate in response to altered movement dysfunction. In one case a patient with multiple C-sections presented with chronic recurrent cervical and lumbar disc issues. In particular the MRI showed a flattened cervical spine and it is worth-speculating that the anterior cervical flexors facilitated in response to a lack of trunk flexion. The patient was literally trying to flex her whole spine with her neck flexors. Use of Neuro Kinetic Therapy (TM) helped to re-establish synergistic neck and trunk flexion by restoring equilibrium.conceptual model

In this and 100% of all clients who have had a C-section the TrA can either be facilitated or inhibited. strategies to stabilise compromised structures and dysfunctional movement can be local or global. How Muscular dysfunction occurs

Strategies can include:

Breath holding via facilitation and compromised diaphragmatic action Facilitation of the pelvic floor Clenching of the masticatory muscles of the TMJ/Jaw Local compensation such as Quadratus Lumborum facilitation Cervical muscle facilitation and inhibition Altered lower limb mechanics including plantar fascia and disruption of dorsi flexion and toe mechanics.

Scar tissue formation can be problematic due to adhesions of healing tissue in particular to fascial continuation, function and adhesion of tissue to internal organs. Addressing these adhesions and restoring optimal function of the TrA and its dual facilitory or inhibitory effect on both local and global structures can be achieved with therapies such as NKT and appropriate corrective exercises. Even without a Cesarean section, you can apply the same rationale to tears or episiotomy procedures and the same fuzziness that the nervous system experiences when trying to provide stability to the body.

References: Chek, P. Posture and Craniofacial Pain. A Chiropractic Approach to Head Pain. Williams and Wilkins 1994

Weinstock, D. Neuro Kinetic Therapy. North Atlantic Books. Berkeley, California.

 

Big Moves..small muscles

Muscular pain is one of the most treated issues globally and there are hundreds of modalities for treating musculo-skeletal issues. In my practice I often see many injuries that have often  been dealt with in such a passive manner that there is never real hope of treating the issue.  Identification of structural issues is key to changing the pattern of facilitation and inhibition that often occurs with many so called pain syndromes. An example of this pattern would be the Pec Minor’s inhibitory effect on the opposite hip flexor when facilitated. Why is it that so many people often fail to have successful responses to treatment? Here are just a few reasons.

  • Incorrect biomechanical evaluation
  • Poor treatment modality
  • Patient compliance
  • Imposed working postures, seated position.
  • Over exercise and pattern overload

Much postural analysis fails to observe dynamic actions and test specific local to global muscle actions that could be responsible for the facilitation/inhibition cycle that is present when dysfunction and injury is present. Much soft tissue work that is used is often only used to treat facilitated tissue. For a treatment to be effective inhibited muscle tissue is required to be taken from an inhibited pathway to an activated functional muscle that executes the desired motor program and helps to reduce inhibition of facilitated muscle tissue.

Neuro Kinetic Therapy (NKT) is an effective form of analysis and treatment that allows a joint by joint and functional approach to assessing muscular dysfunction and addressing both facilitation and inhibition in an effective and efficient manner. Once dysfunctional tissue that is either inhibited or facilitated, has been located, a strategy to restore function can be achieved by observing functional links between muscles either synergistic or antagonistic.  NKT is a favourable approach as it compliments many other rehabilitation, corrective exercise and performance exercise modalities.

If you take a look at the adaptation of Schmidt and Wrisburgs conceptual model of performance which is below. You’ll note that the stimulus and response stays the same to the activity undertaken, on a continuum of walking to complex sporting actions.  However due to Sherrington’s law of reciprocal innervation the motor program can ultimately be changed to reflect the same outcome and other muscles can be recruited in compensatory mechanisms.  This can occur during motor program execution and following muscular recruitment, can be impeded by either over training or poor motor recruitment.

There can many reasons why injuries occur which can include a simply repetitive over/underworked relationship between two muscles or through an entire muscular sling or line. Analysis of these relationships using NKT can reduce the amount of guesswork and increase the quality of both treatment and pain eradication. The days of laying on a physiotherapy or massage couches being treated by interferential machines and inappropriate cookie cutter exercises are numbered.

conceptual model

 

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