breathing pattern dysfunction

Why baby walkers are a disaster for the growing child.

Why baby walkers are a disaster for the growing child. It was the fourth client in the space of two weeks that prompted me to write this quick blog. Four teenagers all aged 14 with pain and compromised movement. Where did it all start? How does this happen? The parents enquire, looking for a definitive reason.  walker-clipart-baby_in_walker

As with all aetiologies of pain and movement dysfunction it can be hard to determine exactly what drives an individual’s problems. But when you can observe the way that a young person breathes you can, in most cases determine whether they have been placed in a baby walker, without any other form of assessment.

A rough overview would reveal that, within the first 9 months of movement and prior to the process of standing (verticalisation) there are many key stages of development that need to occur.

These include.

  • Lifting the head
  • Stabilising the back line between neck, chest and pelvis
  • Rotation via rolling
  • Quadra pedal or four point stance
  • Crawling and cross patterning of shoulder to hip.

So why is it that the baby walker is such a problem?

Consider the actions that a baby needs to achieve before it stands, let alone walks. Crawling develops hip, trunk and shoulder musculature. Due to the reciprocal relationship between the neck and the lower back, which counter rotates to the direction of the thoracic spine, optimal conditioning of reflexes, muscles, tendons and ligaments should occur. If a child is placed into a walker, the challenge is then geared towards locomotion and gait, rather than rolling and crawling. This is where the problems start and it presents several issues to consider.

  1. The ability to stabilise using the diaphragm is decreased due to in an early standing position, that is not conditioned enough from crawling. (observation can be made by the upper breathing pattern, using chest and neck muscles)
  2. The lower leg muscles are stressed to create movement and in particular the calve muscles are strengthened and may contribute to excessively to actions such as hip and knee flexion and extension (as well as many other movements. (look for those over developed calve muscles)
  3. The lack of rotation created by a lack of motion in the spine, decreases essential loading of the spinal ligaments, which will decrease recruitment of the muscles needed for optimal gait. (you can see poor movement and stability from the most basic movements)

Another insult added into the equation is the constant use of flip-flops. This previous blog breaks down why flip-flops are disastrous for athletic and day-to-day performance.

To develop optimal movement that progresses throughout childhood into adult life, rolling, crawling and walking patterns should not be supported with baby walkers or bouncers. It might be hard to believe but the walker does play a significant part to why younger clients present with pain and movement issues. There's no doubt that technology has significant benefits it many aspects of life. But when it comes to human movement, the brain already has it optimised, you just need to let it of its own thing.

Thankfully with a little work, the problems can be unravelled but don’t get me started on the use of iPads and mobile phones!!

References:

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),

Kolar, P. et al. Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. J Orthop Sports Phys Ther 2012;42(4):352-

 

Latest Dubai Eye Interview: Longevity, pain relief, movement and well being

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.