Single Leg Balance and Reach Exercise

Great Info from the Gray Institute Newsletter TWEAKOLOGY is the transformation of the notion (what we know about function) into the motion (what function looks like).  Knowing that every “tweak” will create a different reaction, mindfully chosen “tweaks” provide the foundation of the exercise strategies that are specific for each individual. This month we highlight the BALANCE REACH as our exercise and use SPEED as our “tweak”.  Before we further describe the exercise, let’s discuss balance in general.  Balance is a state of equilibrium, it is dynamic in nature, it requires a combination of stability and mobility or “Mostability”.  Balance does NOT require stillness and is hampered by rigidity. Back to the task at hand…SINGLE LEG BALANCE REACH.  Two things to look for when observing this exercise are: 1) how far the individual can reach their and 2) the ability to transform the direction of the movement.  Let’s perform three different foot reaches at ground level using the three cardinal planes 1) Sagittal Plane (click HERE to view) 2) Frontal Plane (click HERE to view) 3) Transverse Plane (click HERE to view).  Perform 3-5 repetitions with each foot at a self-selected speed.  Observe not only the reaching foot and leg, but observe the “balance” leg.  Also observe the reaction of the trunk, the shoulders and even the head and hands.  Does each side react the same?  Is there similar control demonstrated?  Similar ranges of motion throughout the body?   Similar quality of movement through the Chain Reaction™?  Now let’s tweak it.  Repeat the balance reaches with decreased speed.  How does decreasing the speed affect control, range of motion, and quality of movement?  If the body senses a loss of stability and control, with the simple tweak of increased or decreased speed it will react with an immediate neurological stiffening to add control back into our system – to prevent one from falling.  Remember, it is always about preserving ourselves within our environment.  As you experience a stiffening effect, do not worry – but note the difference between fluidity in motion versus rigidity. Find the speed of your success.  Also find the speed of success for those that you are assessing, training and rehabilitating.   Depending upon the function that they are looking to improve, condition the movement with slightly decreased speeds and slightly increased speeds, over time without sacrificing fluid efficient movement. As always, safety is the number one concern.  Any time you believe you are not able to complete the movement without the need for additional stability, make sure that you are performing the balance foot reaches in a doorway, next to a wall, or next to a chair or even having someone else control you through hand stability.  Remember to provide the same safety net and opportunities for your patients and clients.

Jump-Hop-Hop; Load Better to Explode Better

By Doug Gray

Jumping is an action that has implications to everything we do. Squatting, walking, running, lunging, etc. has components of jumping involved. Therefore, jumping better will pave the way to functioning better. A common element of plyometrics and calisthenics is jumping. Jump training is a point of focus in sport, yet has extreme implications to life in general. The topic of jumping initiates many questions to consider, such as the following:

• Is your jump training directly carrying over to that which you are training for?

• Is your jump training better preparing you to execute activities more efficiently, whether in sport or active daily living?

• Is your jump training incorporating all three planes of motion (as the body is intended to function)?

• Is your jump training properly sequenced to be safe and guarantee progress / improvement?

• Is your jump training properly preventing future injury?

• Is your jump training dynamic and variable (i.e. – incorporating two feet to two feet, two feet to one foot, one foot to two feet, and one foot to the same foot)?

As the above questions trigger contemplation to the purpose, logic, and sequencing of one’s training regime, it sets the table for exploration on how to better train the body. A great starting point is identifying and discussing a functional threshold.  A functional threshold … the body’s ability to successfully perform the multiple tasks required for what one needs to do and what one wants to do in life. In essence, it leads to productively owning ones three‐dimensional space in completing the desired task at hand. The spectrum of “needs” and “wants” is long and variable, yet lends itself to the following point: it is in ones best interest to expand his / her functional threshold in order to enhance overall performance.

Jump‐Jop‐Hop Explosion, which is part of the Gray Institute’s 3D Matrix Performance Series, is a workout intended to increase one’s vertical, to protect one from injury, as well as to improve one’s strength, flexibility, cardiovascular endurance, coordination, agility, power, speed, reaction, etc. More importantly, it is designed to enhance one’s overall health, wellbeing, and longevity by creating an environment where one can expand his / her functional threshold. Jump‐Jop‐Hop Explosion, as all DVDs in the 3D Matrix Performance Series, consists of both instructional and follow‐along segments.

The terms jumping, jopping, and hopping all refer to the act of loading the lower body and trunk to efficiently and effectively (as well as explosively) unload the body to become airborne in defying gravity. Pure jumping is defined as leaving the surface (or ground) on one foot or both feet and landing on both feet. Pure jopping is defined as leaving the surface on both feet and landing on one foot. Pure hopping is defined as leaving the surface on one foot and landing on the same one foot.

The Chain Reaction™ biomechanics involved with jumping are very similar to that of the lead (or front) leg in gait (or walking). In understanding this better, it is valuable to identify what is known as a Transformational Zone (TZ). A TZ is defined as the period of time when motion changes direction. Moreover, a TZ is the point where eccentric lengthening (loading) of a muscle transforms into a concentric shortening (unloading). The TZ of jumping (when the body compresses before exploding upward or outward) calls for a three‐dimensional Chain Reaction™ throughout the entire body (feet / ankles, knees, hips, trunk, etc.). This load and explode sequencing is a common denominator for all forms of movement. For that reason, Jump‐Jop‐Hop Explosion is not strictly for jumping population, but for all walks of life.Jump‐Jop‐Hop Explosion is a workout that trains the body’s muscles and joints to load and explode in a variety of ways in performing jumps, jops, and hops. Embedded into the workout is a progression that gradually intensifies the workout from round to round (consist of three rounds) by beginning with jumps (two feet to two feet), then shifting to jops (two feet to one foot) and hops (one foot to same one foot). Also, very important to the topic of the DVD, a strategy of safety and progression is performing the workout in initial ranges of motion until the body is comfortable and strong enough to be challenged more (which would involve moving then into mid ranges of motion, and then moving into end ranges of motion).

Additionally, Jump‐Jop‐Hop Explosion positions the body from the top‐down to facilitate and different Chain Reaction™ to add variety and functionality to the workout. For example, both hands are positioned differently in certain portions of the workout to put parts of the body at a biomechanical advantage, while putting other parts of the body at a biomechanical disadvantage, in order to mimic sport and daily activities that the body needs to perform. Of course, these positions are logically organized into all three planes of motion (in front of, above and behind, to the right of, to the left of, rotationally to the right of, and rotationally to the left of the body). Placing the hands in front of the body (anterior at hip) recruits more of the back hip (glute muscles) to execute the task, whereas placing the hands above and behind the body (posterior at overhead) recruits more of the front hip to execute the task. Different positions of the body allow gravity to compress the body differently, as gravity is the competitor of jumping, yet also the best friend when it comes to loading the body to jump.

According to the Gray Institute’s Functional Video Digest Series v2.4, “Jumping: Unleashing the Load” CLICK HERE, jumping is a tri‐plane phenomenon. Also, to enhance jumping, it is imperative that new pathways of loading the body are established and existing pathways are deepened and enhanced. Jumping is not only vertical, but also horizontal and rotational. All these dimensions need to be exploited in any jumping program to better prepare and protect the body in all areas of performance, in which Jump‐Jop‐Hop Explosion successfully exhibits. This needs to be the goal for any athlete: to develop and enhance the gifts and talents that he / she has been given. Therefore, all dimensions need to be attended to in expanding one’s functional threshold. Jump‐Jop‐Hop Explosion is an integral step to this process.

A Great 1 1/2 Minute Whole Body, Multi Directional Exercise

This is a great little exercise routine (inspired by Gary Gray)that involves multiple planes of motion, multi level lifts and doesnt take a lot of time.  So, if someone tells me they dont have time to exercise, I say Bull@#$&!  I have an answer!  The Matrix.  It only takes about a minute and a half!  And if they still say they dont have time, I tell them to just do it faster!  Or I know they really dont want to exercise.

THE MATRIX       Alternate reps for 6 for each movement in each plane.  Move as quickly as you can with full range, good form and control. Try doing multiple sets with 1-3 min rest between.

Shoulder to Overhead Series

               

Waist to Shoulder Series

         

Lunge and Reach Series –  Chest to Knee or Floor (if able)  Do sagittal then frontal then rotation   

          

Lunge and Reach Series 2 – Chest to Knee/Floor and Return to Overhead Position

Do sagittal then frontal then rotation

           

Some variations are to use 2 diff size weights and/or do with one or both eyes closed

Have fun and enjoy!!!!

Get Strong! Stay Strong!

Chris

The Lumbar Spine: Poor Communication Equals Poor Spine

 

 

By Michael Rizk, CPT, ART  

 

Have you ever witnessed a relationship gone sour? The telltale signs are significant, but many  

times the root cause stems from poor communication. There is one particular area of the body  

that seems to get more press than a short‐lived Hollywood hook‐up. You’ve got it – the lumbar  

spine (LS) is likely the most injured, dysfunctional, and (supposedly) weakest link of the body.    

  In relation to the rest of the body, the LS is active in nearly every functional task performed … it  

resides at the crossroads of the body. For that reason, it is important for the rest of the body to  

communicate with the low back to let it know how important it is, how much it is needed, and  

how much it is appreciated for all it does.    

  What is meant by communication with the LS? Great question! Communication refers to the  

ability of all our joints to feed triplane motion to the LS creating triplane stability. A lack of  

triplane  mostability  (mobility  plus  stability)  can  shut  down  the  phone  lines  feeding  

proprioceptively rich information to the LS, thus creating undesirable chain reactions.  

  By design, the LS facilitates flexion and extension, allows lateral flexion, and almost inhibits  

transverse plane motion. The small amount of transverse plane motion may in fact be the most  

important motion allowing the LS to be the transverse plane transmitter of forces between the  

upper and lower extremities.   

  To simplify motion, we consider two phases: loading and unloading. Loading is the preparation  

of the task and unloading is the performance of the task. Using the golf swing as an example,  

the backswing is the load and the downswing / follow through is the unload. The moment of  

time between the load and unload is what we call the transformational zone (TZ). The TZ is  

where  motion  is  decelerated  and  transformed  into  a  concentric  production  of  force.  

Understanding what happens just as we enter and exit the TZ will allow us to effectively assess  

our patients and clients.  

  I  recently  assessed  a  57‐year‐young  right‐handed  golfer  with  right  low  back  pain,  which  

occurred during the end range of his back swing just prior to transition. His approach to me was  

simple, “So I heard you can fix my back.” With a humble smile, I explained how the body works  

relative  to  the  intended  task.  I  shared  with  him  how  a  lack  of  three‐dimensional  motion  

(communication) at any segment will become excessive compensatory motion elsewhere.    

 While his assessment started with a gait evaluation, I kept in mind that gait and golf create very  

different chain reactions in the TZ.  During gait, the pelvis and trunk move opposite each other,  

and in golf, they move in the same direction. However, I immediately noticed an inability to  

load the left side of his body during gait, which was evident by a rough transition from his right  

to left foot, as well as an early heel rise on the left foot. After viewing this global glitch, I had to  

become a biomechanical detective and get more specific.  

 To  further  assess  his  left  ankle  and  left  hip,  I  had  him  perform  a  three‐dimensional  balance  

reach  matrix.  He  lacked  balance  when  I  asked  him  to  reach  in  the  frontal  and  transverse  planes  

from  his  left  foot.  To  create  stability,  I  placed  him  in  the  TRUEStretch™  in  a  backswing  posture  

and had him perform his balance reaches from this golf‐specific position. Lo and behold, he said  

“Wow,  it  feels  like  my  ankle  doesn’t  want  to  turn  that  way!”  He  continued  to  say,  “I  wonder  if  

the left ankle sprain I had playing college basketball has anything to do with this?”    

Next,  I  positioned  him  in  his  backswing  posture  to  his  threshold  of  success  (meaning  prior  to  

experiencing  any  pain  or  compensation)  and  used  my  hands  as  a  driver  to  facilitate  frontal  and  

transverse  plane  subtalar  joint  (STJ)  motions.  To  balance  his  new  mobility  with  stability,  we  

performed  lateral  and  rotational  lunges  with  three‐dimensional  arm  drivers  specific  to  the  golf  

TZ.  This  strategy  facilitates  proprioceptive  communication  between  his  left  STJ  and  right  LS.  

Within  one  week,  my  client  was  enjoying  a  pain  free  backswing  with  added  yardage  and  accuracy.  Needless‐to

say, we were both happy. Even though my client came to me with low back pain, I am led to believe his lack of frontal and  

transverse  plane  motions  at  his  left  STJ  was,  at  least,  in  part  the  CAUSE  of  his  LS  dysfunction.  If  

we  take  a  snapshot  of  the  backswing,  we  can  see  the  following:  right  trunk  rotation,  right  hip  

internal rotation, left hip external rotation, right ankle inversion, and left ankle eversion. Frontal  

plane  eversion  of  the  left  STJ  transforms  into  rotation  of  the  left  limb;  therefore,  a  lack  of  that  

motion  must  be  made  up  somewhere  else  in  the  kinetic  chain.  With  the  nominal  amount  of  LS 

rotation available there, is not much room to compensate at the LS before dysfunction and pain are experienced.  

With  an  understanding  of  Applied  Functional  Science  (AFS)  and  chain  reaction  biomechanics  we  

can  effectively  and  efficiently  keep  the  LS  healthy  and  functional  with  improved communication.  

Oh how I love function!

Get Strong! Stay Strong!

Chris

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Transformation of Strength and Power

By David Westerman LMT, FAFS  

Are  we  utilizing  “authentic”  principles  of  Function  when  designing  our  strength  and  

power programs?  

Is  there  a  special  population  that  might  be  missing  two  of  the  most  important  bio‐ 

motor abilities in their training and rehabilitation programs?  

As  a  former  collegiate  and  professional  strength  and  conditioning  coach,  strength  

and power were (and are) the two most emphasized bio‐motor abilities.   

Take,  for  example,  the  “power  clean”  in  an  athletic  weight  room.  This  is  one  of  the  

most  utilized  exercises  in  “power”  training.  The  typical  strategy  is  to  put  as  much  

weight  on  the  bar  and  successfully  lift  it  one  to  four  times.  Let’s  see  if  we  can  use  

part  of  our  litmus  test  of  “authentic”  strength  and  power  principles  to  better  

understand its carryover to three‐dimensional Function.  

  Is  it  three­dimensional? 

  The  power  clean  is  a  sagittal  plane‐dominate  

movement.  Most  activities  require  three‐dimensional  movement  in  all  

muscles and joints. 

  Is  it  specific  to  activity?  

Considering  most  sports  and  activities  have  a  

horizontal component to load, the power clean is mostly a vertical load.  

  What  is  the  neural  input  and  range  involved?  

If  the  weight  is  too  heavy  

and  we  go  through  long  ranges,  we  may  actually  slow  down  the  neural  input  

which will inhibit our power and strength transfer to activity.  

  Are  we  taking  advantage  of  the  Transformation  Zone?  

The  fact  that  

most  of  our  power  is  utilized  at  the  zone  in  which  a  direction  is  reversed  in  a  

motion needs to be considered (i.e. – plyometrics).  

Above  are  a  few  key  questions  that  we  can  use  for  any  population  or  exercise  we  

choose to work with.     

Typically  we  associate  strength  and  power  with  athletes.    However,  the  population  

that  may  need  it  the  most  is  our  senior  population.  With  the  baby‐boom  explosion,  

more  and  more  of  this  growing  population  are  getting  injured  and  becoming  more  

sedentary.  Consider  the  following  scenario  and  proposed  training  /  treatment  

approach:  

Scenario:  

A  75‐year‐old  woman  has  balance  problems  when  walking.  

Through  functional  assessments,  the  practitioner  finds  abdominal  muscles  

are  weak  and  significantly  lack  the  ability  to  move  in  all  three  planes  of  

motion.  

Potential  strategy 

:  Position  client  in  a  small  stride  position  with  the  left  leg  

forward  in  front  of  a  wall  for  support  and  as  a  target.  To  create  a  load  in  the 

abdominals  we  want  to  reach  with  the  left  shoulder  posterior  (backward)  at  

shoulder  (height)  towards  the  wall  in  a  short  range  of  motion  at  a  moderate  

to fast speed.  

Rationale: 

  This  facilitates  tri‐plane  loading  of  the  abdominals  in  the  

Transformational  Zone  of  walking  with  an  exercise  that  replicates  the  

activity,  while  creating  more  power  that  will  transform  into  better  strength       

of the entire kinetic chain by using a short (safe) range and increased speed.     

Whether  you  seek  strength  or  power,  our  strategies  and  exercises  need  to  be  based  

on “authentic” principles of Function. 

Get Strong! Stay Strong! (and be functional)

Chris

The Hip: Power Source, Biggest Rock, Best Friend

 By Barbara Fuller PT, FAFS

The late-seventyish woman looked at me with a bit of skepticism mixed with a little fear. After I introduced myself to her she said, “Before we start, I want you to know that I would like for you to address my low back pain, but I don’t want you to mess with my hip.” When I urged her, she further explained that she’d had problems with her right hip for a long time, with x-rays revealing severe arthritis and necrosis of the femoral head. She had been to an orthopedist who told her to come back for a total hip replacement when she could not stand the pain anymore. She was not ready for that. Her back pain was relatively new, but it was making her even more miserable, as well as making her unable to do the yard work she loved doing or taking a walk. Most telling was the account of her last experience in physical therapy when her hip was forced passively beyond what she could tolerate, thus resulting in increased pain. Needless-to-say, she never went back. Before I even touched this patient, or put her through any functional movement assessments, I felt a strong need to educate her about the hip – especially its relationship to the lumbar spine. I told her that the hip is the low back’s best friend. I explained how a normally functioning hip, one that moves well and is strong in all three planes of motion, allows the low back to function normally by protecting it from excessive motion and wear and tear. I demonstrated how a hip, with a decent amount of extension, propels the body forward, but without that extension, the task falls to the low back causing all sorts of problems. I told her that her hip had let her low back down and was probably the cause of her low back pain. All that being said, I then told her that I really felt that I needed to at least take a look at the hip or I would be doing her a disservice. I also promised her that I would not do anything she did not agree to me doing and that I would be very gentle. She agreed. In addition to the hip being quite friendly, the hip is BIGGEST of the BIG rocks in our body! Big rocks are the areas of the human body that provide a foundation for normal mobility and stability (mostability). But if they are not functioning well, then they become the culprits of pain and dysfunction in joints above and below. For the hip, that includes its closest neighbors – the lumbar spine and the knee – but it can also include more distant neighbors like the opposite shoulder or elbow. Also, the hip is our power source. We can understand this when we consider the powerful muscles of the back and front butts, and their core connections, including the pelvic floor (with connection through the hip adductors and rotators) and the thoracic diaphragm (with connection through the abdominals to the thoracic spine and rib cage). It is through hip extension that we can most effectively load our abdominals. As promised, I was gentle with my patient and started her functional assessment with neutral standing (XXX) while hanging on to a counter top with both hands. She was limited bilaterally in lateral pelvic glides and rotations. Most significant, though, was her lack of right hip extension in a left stride stance (LXX). She also demonstrated to me a successful short squat – something that applied to her goal of continuing with yard work. Her home-workable exercise program (remember the test becomes the exercise and the exercise becomes the test) became XXX with right and left lateral glides and rotations of the pelvis for a warm-up, which was then followed by LXX anterior and posterior glides. After these, I asked her to do some of her short squats (start with success). On her next visit she beamed and said, “I’ve had very little pain since my first visit!” She progressed beautifully through her physical therapy. Although she did not get full mostability back in her right hip, she gained just enough that on the day when she was able to complete a common lunge matrix (anterior lunge, same side lateral lunge, and same side rotational lunge) – no hands – she looked at me and said, “I feel so empowered!” Wow! I did not heal this patient, but provided an environment in which her body could improve. By giving her complete control, her fears were addressed. By educating her about the truth of the hip, her skepticism was addressed. And by giving her a home-workable program, she was empowered … and so was her hip! This is the beauty of Applied Functional Science.

Get Strong! Stay Strong! (and don’t forget to be functional!)

Chris

Balance in Motion

 

  

By Andrea Wasylow PT, FAFS  

  The  billing  coordinator  at  the  small  hospital‐based  rehabilitation  clinic  where  I  work  is  

phenomenal.  In  addition  to  being  one  of  those  people  who  you  just  enjoy  spending  time  with,  

she  is  exceptionally  skilled  at  finding  those  small  discrepancies  that  could  potentially  delay,  or  

give  reason  for  denial,  of  payment  for  services.  Prior  to  joining  our  team,  she  worked  at  a  well  

meaning,  yet  very  “conventional,”  physical  therapy  practice.  Since  coming  to  work  with  us,  we  

have  had  many  conversations  discussing  the  principles,  strategies,  and  techniques  behind  

treatment, based on an Applied Functional Science approach.  

  

One  such  discussion  occurred  recently  when  she  asked,  “Can  you  help  me  understand  why  

‘balance  /  stability  training’  was  included  as  part  of  the  treatment  plan  for  this  patient  being  

seen  for  a  shoulder  diagnosis?”  The  discussion  that  followed  highlighted  some  of  the  

misconceptions  surrounding  balance  rehabilitation  and  training,  and  hopefully  helped  provide  a  

better understanding of balance as an integral part of all function.  

  

Our  coordinator  had  become  accustomed  to  seeing  static  testing  on  the  ground,  or  on  a  less  

stable  surface,  as  a  common  way  to  determine  whether  or  not  an  individual  had  “good  

balance.”  Unfortunately,  someone  who  may  do  well  standing  on  one  foot  with  their  eyes  closed  

for  a  predetermined  period  of  time  may  stumble  or  fall  when  turning  to  look  at  who  just  called  

his / her name while he / she was walking.  

  

Though  commonly  used,  these  traditional,  static  tests  provide  limited  information  when  the  

fundamental  truths  about  balance  are  understood.  Balance  is  dynamic  and  three‐dimensional.   

It  is  our  body’s  ability  to  integrate  the  information  from  all  of  our  body  systems  during  a  

functional task and  use that information to displace our center of  gravity. The system  must  then  

decelerate  that  motion  and  either  bring  the  body  back  or,  more  likely,  move  in  a  completely  

different  direction.  Three  of  the  main  systems  that  feed  the  body  information  are  the  vestibular  

system,  the  visual  system,  and  the  proprioceptive  system.  Though  there  is  a  minimal  amount  of  

information generated to those systems in a static position, it is motion that truly “turns on” and  

feeds  these  systems  the  information  required  for  function.  Balance  requires  the  ability  of  the  

neurological  system  to  successfully  receive  information,  process  that  information,  and  then  

convey  an  appropriate  motor  plan  for  task  completion  –  all  while  controlling  the  center  of  mass  

against  gravity.  Balance  requires  range  of  motion  and  strength.  If  a  body  segment  lacks  motion,  

then  not  only  do  accommodations  of  additional  motion  in  other  areas  need  to  be  made  to  

complete a task, but proper muscular loading and exploding at the restricted joint can not occur.   

Balance  can  be  impaired  if  the  surrounding  musculature  is  unable  to  control  movement  into  

that  motion,  even  when  full  passive  range  of  motion  is  available.  Most  importantly,  balance  

requirements are determined by the functional task the body is being asked to perform. In order  

to  insure  successful  task  completion,  the  individual  should  be  able  to  control  three‐dimensional  

motion  beyond  that  required  of  the  functional  task.  Balance  rehabilitation  and  training  

programs should reflect that goal.  

 The patient whose chart our billing coordinator was reviewing happened to be an avid gardener.  

She  loved  her  flowerbeds  and  spent  significant  amounts  of  time  on  her  hands  and  knees  

weeding.  Her  balance  deficits  showed  in  this  position  when  she  would  bear  weight  through  her  

involved  upper  extremity  and  reach  with  her  other  hand.  Frequently,  she  had  to  quickly  move 

the  reaching  hand  to  the  ground  in  order  to  avoid  face‐planting  into  her  flowers.  As  it  turns  out,  

she  had  thoracic  spine  and  scapulo‐thoracic  range  of  motion  restrictions,  as  well  as  an  inability  

to eccentrically control the motion that her involved shoulder needed in order to accomplish the  

reach  distances  required  by  the  other  arm  for  weeding.  Thankfully,  with  training,  this  individual  

was  back  doing  the  gardening  that  she  loved  without  difficulty.  Also,  “armed”  with  additional  

understanding  about  balance,  our  billing  coordinator  was  able  to  coerce  payment  for  services  

rendered. 

Get Strong! Stay Strong!

Chris

Ankle Sprains: The Good, The Bad and The Ugly

 Will H. Stewart II, FAFS, CMT Fellow of Applied Functional Science

The Scene: 1996 Summer Olympics in Atlanta, Georgia USA

The Event: Womens Gymnastics The Apparatus: The Vault

The Athlete: Kerri Strug

This should start ringing a few bells. The US team needed a score of 9.493 to win the gold medal for the US. Her first attempt received a score of 9.162. It was erroneously thought not to be enough. To make matters worse, she had under-rotated her first fault and injured her ankle, and because of the miscalculations, her coach told her she needed to do it again. On an injured ankle, Kerri Strug sprinted down the runway and nailed her vault receiving a 9.712. Gold! This was truly what Olympic moments are made of. Ms. Strug was later taken to the hospital and treated for a third-degree lateral ankle sprain. This was, of course, after she had stood on the podium to receive her gold medal with Team USA Gymnastics.

Most of our ankle sprains are not as dramatic as Kerri Strug’s; however, they can be just as bad and ugly. The foot/ankle complex is an amazingly beautiful and complicated system of many bones, muscles and connective tissue that give 3-D support. However, this complex system is prone to injury. Eighty-five percent of ankle injuries are sprains and out of those, 85% are lateral ankle sprains. Unfortunately, ankle sprains that are not rehabilitated functionally can cause dysfunction not only at the foot/ankle, but also up the kinetic chain. Functionally, as we look at the foot and ankle, we know that as the foot hits the ground, it causes a chain reaction that takes the calcaneus into eversion. There are numerous muscles, in particular the peroneus longus, which decelerates the eversion along with assistance from the medial deltoid ligaments of the ankle. However, as stated before, most of our ankle sprains are inversion sprains. While we have muscles that decelerate inversion of the foot, along with the three lateral ligaments, it unfortunately is, as in Kerri Strug’s case, not enough. After the ankle is evaluated and diagnosed by a qualified health care provider, functional rehabilitation can commence. Traditionally, depending on the grade of the sprain, the R.I.C.E. method was recommended to control inflammation and ensure no further damage. Guided by Applied Functional Science, we know that there are 12 multi-joint muscles that send their tendons across the ankle and subtalar joints of the foot. We also know that ice reduces swelling.

 

Therefore, one of the many strategies for rehabilitating a lateral ankle sprain (right foot, in this case) would be to mobilize the affected region by performing a 3-D lunge progression in cold whirlpool (as well as out of the whirlpool) that will elicit the proper sequence of joint motion and stress the tissues from least to greatest. This will effectively provide an authentic swelling control to “pump out” inflammation, as well as proprioceptively stimulate the ankle/foot complex. A lunge matrix progression for a right stable lateral ankle sprain that goes from least amount of stress to greatest could look like this:

Right Foot Left Lateral Lunge (Least Stress)

Right Foot Anterior Lunge

Right Foot Posterior Lunge

Right Foot Left Rotation Lunge

Right Foot Right Lateral Lunge (Most Stress)

The Right Foot Right Lateral Lunge is the last lunge in the progression since it will stimulate lateral ankle ligaments more than the others listed above it. Discretion for the lunge progression is paramount so that motion is introduced at the right time and right direction without overstressing the damaged tissues. Gary Gray explains and demonstrates other powerful techniques in the “Ankle Sprains: Chain Reaction Rehab” edition of the Functional Video Digest Series that observe proper biomechanics to facilitate proper joint motion, soft tissue healing and proprioception. Some ankle sprains are bad, some even look pretty ugly; however, if we understand Chain Reaction Biomechanics, we are able to assist the body in healing and returning to GOOD function.

Get Strong! Stay Strong!

Chris

The Cervical Spine: Getting the Whole Story

Andrea Wasylow PT, FAFS

A few years ago I had the opportunity to play a round of golf with some people I greatly
admire. It was a fairly typical golf outing until one of my opponents took his tee shot on
the 7th. It was one of the most amazing shots I have ever seen.

The paragraph above, in and of itself, is a story. But, doesn’t it leave you wanting more?
Who are these golfers? And why was that shot so amazing? Basically some information
has been provided, but not enough to show exactly what was happening. The same can be
said for conventional techniques used for evaluation, treatment, and training of the
cervical spine.

More than a few clients and/or patients have crossed our paths with complaints of “a pain
in the neck.” The stack of seven vertebrae at the top of the spine is an amazing structure.
Yet, the truth behind how this region functions the majority of the time is often
overlooked.

Conventional evaluation may have an individual perform a big “yes” sagittal plane nod, a
big “no” transverse plane rotation of the head and a big “I don’t know” frontal plane
lateral flexion of the head. But, as in the paragraph above, only part of the story is being
told.

Function of the cervical spine is driven both from the top down and from the bottom up.
The demands on the cervical spine depend entirely on the functional task being
performed. To complete the task, does the individual need to look in a particular direction
by turning the head while the body stays still? Does the person need to keep their gaze
fixed while the body moves below? Or, most likely, is there some combination of head
movement with simultaneous body movement below needed for the task? (In FVD
“Cervical Spine: Both Ends of The Chain,” there is a great example of this given by Gary
Gray PT in his demonstration and explanation of cervical function while swimming.)

If a functional task drives the system, then it stands to reason that our cervical evaluation,
treatment, and training techniques must reflect that task. For example, when walking and
taking a step forward with the left foot, the right arm swings forward. In order for this to
happen and allow the gaze to remain straight forward, there must be adequate right
cervical rotation. But this right cervical rotation is created by the head staying still while
the thoracic spine below rotates to the left. Rather than asking the individual to turn and
look over their right shoulder, a better cervical ROM test for this task could be to have
them fix their gaze straight ahead while performing a right hand, anterior at shoulder
height reach. Another example of cervical motion driven from the bottom up is seen
when playing golf. A left handed golfer needs tremendous right cervical rotation during
his/her backswing. If that bottom-up driven rotation isn’t available it could create
tremendous problems with his/her shot.

This brings us back to the incomplete story above. The golfer being described was none
other than Dr. David Tiberio. And the tee-shot he made was so amazing because it
actually went backwards (really). As it turns out, he was experiencing some cervical
spine motion limitations. Though his motion appeared fine using head active ROM
testing, when he kept his head still and drove his arms in all three planes, it became
evident that his cervical spine was limiting his ability to move below. Thankfully, he
recognized what was going on and was able to improve the limitation fairly quickly;
allowing the rest of us to wait for our turn at the tee-box, safely, for the rest of the round. —-Andrea Wasylow PT FAFS

Get Strong! Stay Strong!

Chris

The Functional Knee: Caught in the Middle with No Where to Hide

Injuries to the knee are seen throughout virtually all sports and all age ranges. Have you ever wondered why the knee is the most common reason for a visit to an orthopedic surgeon? Moreover, have you ever wondered how rehabilitation and training programs could better alleviate the stresses placed on the knee? The answers lie in using Applied Functional Science to understand the chain reaction biomechanics of the two “bookend” joints of the knee – the hip and the ankle.

Although the distal femur and the proximal tibia form the primary knee joint, the other ends of these two longest bones in the body reveal the reactive nature of the knee. The knee is referred to as a reactor because it responds to drivers from above and below. These drivers can be ground reaction force, gravity, momentum, hands, feet, or often times the eyes. During initial foot contact in upright function, the ankle joint, comprised of the distal tibia and talus, create a chain reaction from the ground up that directly influences the knee via tibial and fibular motion. Similarly, the hip joint, comprised of the proximal femur and the illium, influences the knee from the top down via the femur. The three-dimensional motions of these two “bookend” joints play a significant role in determining the magnitude of stress placed on the knee. An appropriate chain reaction from these two bookend joints enables the knee to effectively dissipate significant forces. However, dysfunction at either joint can leave the knee caught in the middle with few places to go and nowhere to hide.

A practical example of the chain reaction relationship between the ankle and the knee can be illustrated using a female beach volleyball player. Based on its attachment sites, the ACL it is placed under stress during combined knee flexion, abduction (i.e. valgus), and internal rotation. In this example, as the volleyball player approaches the net and begins to load her lower extremity to prepare for jumping, she steps in an uneven sand hole which causes her heel to abruptly evert and her talus to plantarflex and adduct. This motion of the talus influences the tibia to internally rotate and abduct. This tibial motion, if not properly decelerated, will create excessive knee internal rotation, abduction, and flexion which can directly lead to a right ACL tear. However, this motion can be properly controlled and reduce the risk of injury by muscles properly decelerating the tibia and femur. The specific tri-plane action of muscles that influence the knee are too numerous to adequately describe in this article and, therefore, will be discussed in an upcoming newsletter.

A second practical example can illustrate a situation when dysfunction at the hip is the underlying cause of patella femoral pain. Recent research has confirmed Gary Gray’s long held belief that patella femoral pain is more a track problem (femur) than a train problem (patella). Dr. Chris Powers, et al, summarized that “patellofemoral joint kinematics during weight-bearing conditions could be characterized as the femur rotating underneath the patella.”1 In another study, Dr. Powers, et al, goes on to assert that “interventions aimed at controlling hip and ankle motions may be warranted and should be considered when treating persons with patellofemoral joint dysfunction.”2

A forty-year-old triathlete with excessive femoral internal rotation during the loading phase of gait presents lateral right knee pain while running. His knee pain can be explained by the inability of the hip external rotators, adductors, and hamstring muscles to decelerate the excessive femoral motion. The track crashing toward midline too rapidly, in effect, causes the train to derail laterally. The symptoms are present at the knee; however, through use of lower extremity chain reaction biomechanics, one can easily understand how the cause is at the hip.

These examples illustrate a few core principles of Applied Functional Science. First, joints in the body move in three planes of motion. Second, function is driven by, among other things, ground reaction force, the environment, and gravity. Third, movement at one joint will create chain reaction responses at other joints throughout the body. Lastly, function is individualized and task-specific.

Applied Functional Science requires us to understand the person, tasks, and goal(s). A thorough understanding of the chain reaction biomechanics of all three joints will assist in implementing rehabilitation and training programs that ensure that, although still caught in the middle, the knee now has two powerful friends by its side. ——-By Brett Bloom

Gray G: Functional Video Digest. Functional Manual Reaction. The Knee. v3.7

Gray G: Functional Video Digest. Patella Femoral. The Train & The Track. v2.5

1. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weightbearing and non-weightbearing knee extension in persons with patellar subluxation: A preliminary study. J Orthop Sports Phys Ther. 33:677-685, 2003.

2. Powers CM. The influence of altered lower extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective J Orthop Sports Phys Ther. 33:639-646, 2003

Get Strong! Stay Strong!

Chris