inhibition

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.

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