SFMA

What is regional interdependence?

What is regional interdependence and why do we need to know more about it? History is often the most prevalent factor for the exposure to future injuries. Many clients and surprisingly clinicians are often blissfully unaware of the impact of previous injuries on current and future injury scenarios. Here are five key examples of actual clients that I have worked with.

  1. Left sided lower back pain, not resolved with surgery, from 40 year-old scar, left by kidney removal at the age of 1.
  2. Ankle injury causing lower back pain.
  3. Appendectomy scar, decreasing core function, causing lower back pain.
  4. Ear piercing creating shoulder dysfunction on the opposite shoulder.
  5. Hyper –contracted toe muscles creating mobility issues in neck.

Of course there are more, hundreds, perhaps thousands more. For the evidence medicine biased people, I am not about to create theoretical models for you to shoot down with a lack of scientific literature. Although there are increasing studies that support the rationale for regional interdependence. There are also many methods of assessment that create adequate reasoning to show how restriction, lack of stability and dysfunction in one area of the body may have a significant impact on other areas of the body. SFMA (selective functional movement assessment), Gray institute, Anatomy in Motion and many other forms of assessment provide insights to how a lack of mobility and stability at the ankle has an impact on say mechanics of the knee, hip, spine, shoulder and head.

Many practitioners and clinicians have often been taught to view each issue in isolation, which to a degree can be helpful; As local problems can often be responsible for a global issue. Think a scar, such as a C-section, inhibiting core function, increasing dysfunction in the posterior chain not addressed by anterior chain function. But what about when symptoms persist? True, there are many factors that can contribute to pain and dysfunction that simply will not be addressed by massage/trigger points, needles and corrective exercise and I might suggest that some gains may serve as mask to the actual underlying dysfunction.

 

10264312_699027360144587_8762295179813694115_nYou may have observed the concept of regional interdependence after having a good calf massage. Ever noticed how good your neck feels after having your feet and calf massaged? There’s a clear fascial line between the feet and the neck as proposed by Myers in the superficial back line. There is also literature to support the concept of viscerosomatic pain referrals. This may include pre menstrual issues on back pain or gastro-intestinal dysfunction involved in headaches. To address these dysfunctions truly we need to get to the root cause of the issues. That neck often gets tight again after having those feet massaged as the compensatory muscles are overworking for an underworking area.

If perhaps the calf muscles are overworking due to a lack of function in their antagonistic muscles such as the dorsi-flexors or shin muscles. You may well see the neck tightness dissipate, when this relationship is addressed. Follow up mobility work may also be useful for the neck.

Determining mobility versus stability issues is paramount. A decrease in mobility may come from many sources such as:

  • A lack of stability -( how to determine video)
  • Breathing pattern dysfunction (a stability issue)
  • Biochemical – vitamin D/K2/A/calcium factors
  • Gluten –stiff person syndrome, A tentative link between the consumption of gluten and muscle stiffness.

Here we can see the futile task of mobilising joints via releasing and stretching muscles, when there exists factors that contribute to the lack of mobility, that will not resolve with mobilisations.

It’s important for the patient to bring a complete injury history to the table and for the clinician to assess the impact and hierarchy of all factors. Determining mobility against stability factors, improving motor control and treating via the suggestion of regional interdependence may be more beneficial than simply just treating overworked painful areas.

 

References:

 

  1. Cook, G et al. SFMA Course Manual. 2011
  2. Hadjivassiliou M1, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N. GAD antibody-associated neurological illness and its relationship to gluten sensitivity. Acta Neurol Scand. 2011 Mar;123(3):175-80. doi: 10.1111/j.1600-0404.2010.01356.x
  3. Myers. T. Anatomy Trains. Elsevier. 2014.
  4. Sueki D. G., Cleland J. A., Wainner R. S. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual and Manipulative Therapy. 2013;21(2):90–102. doi: 10.1179/2042618612y.0000000027

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

 

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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. .

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.