Archives for posts with tag: functional movements

Patient Instructions:

Place the tips of your thumbs together and raise your hands above your head

Typical Dysfunctions:
Tight latissimus dorsi = decreased shoulder flexion / lumbar lordosis
Tight pectorals = decreased shoulder abduction (Y’ing)
Weak rectus abdominis = cervical flexion to tension anterior line

Atypical Dysfunction (from seminar in Houston TX):
Picture 1 demonstrates limited right shoulder abduction with hyperabduction on the left. Her torso also laterally flexed to the right.

History:
Patient had “bone scrapping” performed on her right femur when she was 5 years old. A total of 4 vertical scars averaging 3 inches each were placed around her right patellofemoral joint. As she continued age and grow, the scar tissue did not resulting in her movement patterns being pulled to the scar due to the limitation.

Treatment:
Treatment initiated consisted of r 3-4 minutes of scar tissue mobilization via gua sha followed by scar tissue mobilization taping with Rocktape kinesiology tape resulted in substantial changes to her bilateral shoulder mobility.

Discussion:
Scar tissue creates binding of the superficial skin to the superficial layer of fascia to the deep fascia to the muscle. When these adhesions form, it prevents the gliding ability necessary between these tissue for movement to occur. The adhesion can also encapsulate the nociceptors creating chronic pain.
Her right shoulder and trunk were limited due to her right lateral and anterior spiral lines (Anatomy Trains) whereas her left shoulder was affected by both her anterior spiral and anterior functional lines.

Typically, when discussing fascial compensations, we discuss hypomobility in one area leading to compensatory hypermobility in another region that typically becomes symptomatic/painful. However, there are times when weakness in a portion of the line will lead to compensations elsewhere.

Superficial Anterior Fascial Line
A fascial line spans the human form from the feet to the cranium. While it is looking at fascia specifically, the overlay tends to encompass common postural muscles. The SAFL is comprised of :
Extensor digitorum/hallucis longus
Anterior tibialis
Rectus femoris
(connection via the inguinal ligament)
Rectus abdominis
Sternalis/sternal fascia
Sternocleidomastoid
Cranial aponeurosis

When weakness occurs in one of the sub-units/muscles, another area will increase in tone to tension the entire line for either stability or strength. This may be automatic in some individuals but a trained response in others.

SAFL Strength and Stability
Any anterior core exercise can be utilized to assess the strength and stability of the SAFL. Common examples include:

The Crunch
Due to weakness in the rectus abdominis, the individual initiates the movement in the cervical spine by moving into lower cervical flexion and upper cervical extension via contraction of the sternocleidomastoid. This will tension the sternalis/sternal fascia which then tensions the rectus abdominis to pull the thoracolumbar junction into flexion. In cases of extreme rectus abdominis weakness, the clinician can see a whipping action of the head as the individual attempts to create momentum to bring their upper torso off the floor.
Cuing should consist of keeping the scapula retracted and the cervical spine in neutral while activating the rectus abdominis. Range of motion may initially be limited to ensure proper form before progressing through a larger range or performing an isometric hold.

The Plank
Again, weakness in the rectus abdominis tends to be the limiting factor in completing this movement. The individual tensions the rectus femoris which creates slight knee hyperextension but definite hip flexion. The pull of the rectus femoris on the AIIS of the pelvis creates an anterior rotation that pulls the distal insertion of the rectus abdominis inferiorly to tension the muscle. In cases of extreme rectus abdominis weakness, you may also see cervical flexion as the sternocleidomastoid also attempts to tension the rectus abdominis via a superior pull as well.
Cuing should emphasize performing an isometric contraction of the gluteus maximus (i.e. glute set, glute squeeze) to provide lumbo-pelvic stabilization. Modifications should consist of proper initiation of the rectus abdominis by having the thighs fully supported on a Swiss ball or mat table where the patient only has to manipulate half of their body weight initially; progression would involve moving the ball distally towards the feet to increase weight bearing status while also increasing the number of anterior core muscle recruited.

REFERENCE
Myers T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists.

CLINICIAN EDUCATION:  Functional Movements

The National Academy of Sports Medicine (NASM) defines functional movement as:
“All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all three planes of motion.”

While this makes a good textbook definition, what does it actually mean? The NASM offers the overhead squat assessment (left image) as their assessment means.

Gray Cook and the Functional Movement Screen offer 7 specific movements that comprise their philosophy: overhead squat, step over, quadruped stability, lunge, pushup, straight leg raise and shoulder mobility (i.e. Apley’s scratch or “zipper” test).

Our philosophy is that a functional movement should encompass a movement out patient makes on a daily basis. Simple activities of daily living require: acture, hip hinge, overhead reach, high step march and axial rotation. We then break this down to assess the dysfunctional joint(s):
1) Is there sufficient length to the myofascia of the movements antagonist’s to allow the movement to occur?
2) Is there sufficient mobility of the capsule to allow the movement to occur?
3) Is there sufficient strength to the movement’s agonist to allow the movement to occur?

What is your definition/example of a functional movement?

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