motor control

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.

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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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.

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