PDTR

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.