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Here is an article written by Talia King. This is a special article that highlights the many factors one need to consider when trying to find the root cause of an illness. Our habits and lifestyle are minor or major reasons, but when left unaddressed, it could be the things that are making you sick last longer than you would like.
Good health is something all of us want, so we eat a balanced diet, exercise regularly, and try to get enough hours of sleep. While these are good habits to have, there are also a lot of common practices that pose health risks. Read on to learn four things that actually make you sick. You might be unknowingly sabotaging your health.
An estimated 1 in every 3 people has tennis elbow at some time in their lives. This common yet painful condition can be treated though! We have done our research to provide you with the top 5 exercises for tennis elbow to help get you back into the swing of things in no time.
These exercises can bring tennis elbow pain relief and strengthen muscles. Let’s take a look into what tennis elbow is, the causes of tennis elbow, and the exercise treatment for tennis elbow!
What Is Tennis Elbow?
Tennis elbow is a form of tendonitis which is a swelling of the tendons. This swelling causes pain in the arm and elbow area. Although its name is tennis elbow you don’t have to swing a racket to suffer from this painful condition!
Repetitive gripping motions can cause a flare-up of the condition. Tennis elbow generally only affects one elbow, however, it can affect both depending on the activity. The condition can occur at any age, however, it is more common in people over the age of 40.
Welcome to another article written by intern Marvin Perkins during his mentorship at ReVITALize Rehab Club. The topic at hand is to determine which factor is important during your physical therapy rehabilitation or sports medicine performance enhancement experiences. This complex but crucial topic was meaningful for Marvin since he was dealt with a common but under-managed sports injury. As a collegiate sports athlete, we felt it was fitting for him to learn more on building movement from a foundation of mobility and stability.
Hope you enjoy his article. Share your thoughts about your injury.
Medicine is often viewed as a parts-based system. While that may be true to a certain extent, in reality, patterns often play as large, or a larger factor in medicine than most individuals realize. What does that mean? I will explain it. On the day to day, medical professionals see athletes or individuals come in with all sorts of complaints. It can be seen they are well versed in the anatomical parts that are creating the issue for them. However, when it pertains to function, they are less educated.
For example, a woman might come into the office and say, “Hey Doc, I am having pain in my knee, I think it is just deteriorating due to all my years as a powerlifter.” In my case, I once strained my quadricep during a track meet in the spring of 2019. I went to a Physical Therapist for rehabilitation, but I did not fully understand what he was doing concerning my therapy.
When we have pain, there is a tendency to point to the part as the main issue or focus. While in some instances that may have some merit, often it can be a misleading idea. Let’s go back to the powerlifter example, she is complaining of knee pain, but the imagery shows her knee is normal. The actual problem is that she suffers from poor hip stability, which is perpetuating that knee pain. In discussing my quad, when I was attending therapy, I expected that my PT would be focusing solely on that area, which was not the case. He had me performing rehab exercises that focused on my hips, ankles, and feet.
The point is that patterns of movements created from multiple areas largely contribute to the function of a part. Primarily people are uneducated about this aspect to misguide their thinking regarding what is wrong with them. Using a parts based perspective will not yield the desired results. On the other hand, investigating with a pattern-based perspective provides the most efficient method in seeking a part.
This article is designed to help you to learn the 4 power tests we use and other professional sports teams are using to assess for power. You can train hard but it may not be translating towards power. If you have to train one region of your body, which includes the upper body, spinal core, or lower body, would you know which one is holding you back? This article will help you identify this question without you guessing.
As a provider that specializes in producing rotational power, we thought it would be nice to have one of our interns write a special article for you. Marvin Perkins Jr is not new to the idea for power. He is a college student that is aspiring to become a Sports Physical Therapist or Athletic Trainer with an emphasis on performance training. He is a college football player and track-and-field athlete himself. We taught him principles of developing power and here is his summary write up on the assessment of power.
HOPE YOU ENJOY! Here it is below.
People have many ideas of what power is. Some will tell you it is the abilities that superheroes have. Others will say power is another way to discuss electricity. Athletes or the avid weight lifter will likely tell you power is one’s strength. Of course, these various connotations of power are valid, but what if I were to say you have the power within you at this moment? Would you believe me if I said it is possible to test for this as well? No, the test will not uncover a superpower you never knew you had. However, the results will show whether one has low or high power. Before I further discuss the screening process for power, it is essential to understand what power is.
To comprehend the functionality of power, we must make a quick shift to physics. I know many dread the “p-word,” so I will express my apologies in advance; however, I would not mention it. Power can be defined as the amount of work done over some time. Work can be represented by force multiplied by displacement (W= F x D). As a result, we can re-write the formula for power as P = F x D/T. The formula for velocity is displacement over time (V= D/T). Therefore, we can simplify the formula for power as P= F x V. What this tells us is that a high amount of power equates to a large force and a large velocity. Now that we have a fundamental understanding of power we can transition to testing for power.
Eye-hand coordination is more than the idea of see and catch. What matters to most people is to move and to perform at a comfortable level. If you look at the brain, almost a third of your mind is dedicated to using your eyes! That should give you an idea of how vital your vision systems are. As a duel Sports Medicine and Orthopedic Specialist, we have been amazed at how much lasting changes happen when we address the software (brain + mind) with the machine (human body).
Your spinal muscles are taken for granted when you feel great. When you have tension or discomfort, we push through it, and then the discomfort goes away. When you take the body signals seriously or have a convenient time to help, the typical path is to target the neck or spinal muscles as the first-line treatment. We are here to help you understand that it may be wise to manage the body holistically, so you are not in the quick-fix trap.
Types of movement
There are two types of movement: power and strength versus balanced and finesse. We chose different words because we are implying movement necessary for daily and reflexive tasks. Tasks that need less cognitive thinking to execute. Then some jobs require training and different sets of skills to acquire. You might be wondering how strength is an acquired skill? You have been working on building strength your whole life. However, if you are sedentary as a child, you can still move, but lack strength. There is a lack of cognitive training to allow you to access more of the nerve to muscle connection called the motor unit.
Yes, this is a very simplistic explanation. We can break it down into reflexive and non-reflexive. Vision helps us bring a more transparent connection and intuitive control to your spinal muscles: neck, torso, rib cage, lower back, and pelvis. You can add your hips and shoulders to this.
Research has shown that when you need to react or quickly decide to reach or lift for something, your body reacts before moving your arms and legs!
You have seen the athlete that moves with finesse. Think Kobe Bryant. He makes everything look easy, but when we try, we find it harder to dribble, sneak through two defenders, and know where everyone is. Your spinal muscles need to have this Goldilock phenomenon. Your lower back and hips need to contract just enough: not too strong and not too relaxed. Your next quick step forward or decision to pounce backward is executed efficiently like you have been doing this for the 1000’s of time, or clunky. His peripheral vision is clear and his ability to manipulate his body based on his sight of the vision and vice-versa is what he has mastered.
This article is a treat for someone who wants to learn about the evolution and philosophy of Physical Therapy. As you desire to learn more about the management of your lower back pain, Dr. James Taylor summarized this podcast. He is a Doctor of Physical Therapy intern.
This article’s objective is to help people understand that there is no medical field that is perfect and knows precisely everything. What I am proud of my profession is the desire to bridge the gap of research and clinical relevance for the benefit of the consumer.
When management of back pain is not getting any better, self-reflection is vital to improve outcomes. There is no self-destruction or allowing the ego to impact the pureness in the act of helping people. Consumers are lost when seeking medical help when every profession brings a perception that they can help. We hope you find this article helpful as it is essential to understand the evolution of a professional trade.
Management of low back pain was very detailed and forgot the person as a part of the healing equation. That did not work as more people nowadays have lower back pain — the same time and era of modern science and stem cells. The profession and ourselves looked within are evolving. Like many evolutions, we tend to swing towards the extremes due to the logic of “if one does not work, then it must be only option B that works.” The answer lies in the gray middle, and the article and podcast explain why we need both perspectives in your care.
I hope you enjoy reading and listening to this content. This article is written to educate Physical Therapist and other rehabilitation professionals.
Dr. Ngo’s Personal History of Physical Therapy
In this episode, Dr. Ngo makes the argument that biomechanics holds an essential place within the context of the biopsychosocial model. Dr. Ngo graduated in 2004 from CSULB when the concept of the clinical prediction rule (CPR) was considered sexy and essential. This is the time when researchers such as Cleland were trying to standardize PT. This came for an excellent reason. Our profession wanted to ensure that ortho PT comes from the same playing field, and through the process, make it less daunting (by 5%) for students coming out of PT school. The trouble with CPRs is that a lot of people don’t fit within them. The osteopathic model influenced Dr. Ngo’s graduate school teachings. His professor came out from Michigan, which had a robust biomechanical emphasis on movement system impairments. An example was classifying spinal patients based on FRS (flexion-rotation syndrome) and ERS (extension-rotation) to target a specific region where the use of muscle energy techniques (METs) could be helpful.
Adapting to Changing Times
By the time that Dr. Ngo sat for his OCS, the field was shifting from a pathoanatomical model to a more generalized model where you can’t isolate dysfunction or treatment to a specific segment. In light of this new information trend, Dr. Ngo attempted to swing both ways as it is important to understand both worlds to provide the best treatment for each patient. A lot of people gravitated towards explaining pain, and the pain science world helped to explain this. People use the pain science model too much to explain the inadequacy of why things they are the way they are….it’s not bad explaining this, however it is hard when you only have 40 minutes for an eval and/or are seeing 25 people and immersing yourself in that world through the biopsychosocial model. As PTs, our bread and butter are to address the mechanical system, something we do better than personal trainers or kinesiologists because that’s what we do. If we can’t explain, we have to keep asking why. Today, there is the discussion that we have to stop asking why specific dysfunction exists. However, we need to craft the art while laying on science for the foundation (80%) of our biomechanically-based treatment.
Evolution
What initiated the call for uniformity in PT’s approach to care? We can’t be too sure, but word came around that a writer, or editor, went to a PT clinic and experienced many different inconsistencies in the course of his treatment. His documentation of his experience put the PT world under pressure, so we developed the CPR rule to standardize PT and make it uniform. Coming in as a new grad, Dr. Ngo found the treatment of the spine to be very daunting and nerve-wracking. As he struggled with the inadequacy that he felt, Dr. Ngo went the Norwegian route with the work of Freddy Kaltenborn who utilized a lot of traction and decompression with subsequent localization of symptoms with fine movement and loading/unloading the joint followed by exercise, traction, and stabilization to facilitate the transfer from unloaded to loaded positions. After a few years in the field, Dr. Ngo wanted to do residency and fellowship, however, he couldn’t afford to take the pay cut, so he became obsessed with this material and attempted to teach himself by taking several courses through NAIOMT (North American Institute of Orthopedic Manual Therapy). Dr. Ngo chose NAIOMT because their curriculum required twice the number of didactics compared to other manual therapy programs. NAIOMT utilizes an evidence-based, eclectic amalgamation pulling from many different systems, though strongly baked on the Cyriax model.
Applications of the NAIOMT model
Part of the foundation of Dr. Ngo’s biomechanical argument comes from the Level 1-3 coursework of the North American Institute Orthopaedic Manual Therapy (NAIOMT). Erl Pettman, being a practitioner in the Canadian medical system with direct access, taught him to understand the importance of medical screening so they trained Dr. Ngo to have a mindset of safety. Along with this, they taught the difference between normal spinal mobility, hypermobility, hypomobility, and a novel concept of an unsound joint. Dr. Ngo focuses on not the pain associated with mobility but the applied function that comes as a consequence of hypomobility, hypermobility, or an unsound joint. Hypermobility usually involves one plane of motion.
An example is detectable excessive movement of a spinal segment unstable in the sagittal plane testing like Anterior shear with PAIVM or PPIVM testing, but the rotational plane is stable. An unsound joint involves multiple planes. You detect hypermobility, as pain could be associated, with 2 or more PAIVMs and PPIVMs movements of the spine. The interpretation is that the spinal segments cannot maintain movement integrity as it moves. This leads to excessive joint shearing and alters the axis of rotation.
Based on this assessment, you have an understanding of the natural course of what your patient’s spine has gone through. To understand the joint at this level allows the clinician to use this knowledge depth to make a treatment choice. An example is that if you find an unsound joint, you don’t manipulate through it. You protect it and alter your thrust technique vector to protect that zone. There is no business leverage through an unsound joint. You cannot use the passive restraint so you choose a manipulation vector that will restore motion, without going through the unsound joint segment.
This mechanical approach is clustered along with medical histories such as consideration of blunt trauma or overuse / repetitive trauma. For example, when someone says “my back pops”, the evidence says there is no mechanical damage. However, he believes and assumes the “popping” indicates joint instability until proven otherwise.
The next distinction to make within this system is the difference between the noisy victim (pain and impairment) and the silent culprit (no pain but impairment that is driving the root cause of the symptoms). A common sign of the noisy victim is hypomobility…which usually indicates an underlying unsound joint which trips up scenarios because, with an unsound joint, the body will adapt through osteophytes, ligamentous hypertrophy. If a joint were truly unsound, initially, the person may feel good, however later they are more in pain. In the typical subjective report for these patients, the cardinal report is intermittent, recurring low back pain that transitions from low back pain periodically to no pain after 40 years old. This represents the transition from unsound to hypermobility (utilizing the passive system for core stabilization).
If you only have 15-20 minutes with the patient, it would be easier to fall back on just saying they have to cope with the pain, we have to also realize the impact that exercise and manual therapy can have on treating the dysfunction and avoiding the patient from simply coping with the pain.
Application of Biomechanics to LBP Treatment
Two points that drive Dr. Ngo’s practice is the sentiment that the question you ask determines the decision you make, and the decision you make leads to your destiny. This is because Dr. Ngo wanted to be the safest and was on a mission to avoid flaring up any of his patients. The other point he would ask himself would be “how can I be aggressive at the same time while being safe?†Dr. Ngo came from a camp in his schooling / early years where clinicians tended to underload people, so from exercise science, he chased after this question. One of the answers to this he found in the joint-by-joint-alternating-system theory by Gray Cook.
A key example from this system within the context of LBP is that the lumbar spine craves stability because it tends to be hypermobile. So by design, the lumbar spine is designed to facilitate sagittal plane motion and reduce rotation (only 30 degrees rotation), while the purpose of the facet is to distribute the WB (typically this ranges around 10-25% but as you get arthritic changes, it increases to 50-60%).
Returning to Dr. Ngo’s previous points about degenerative changes in MRI, you also have to look at facet orientation, as this can aid or limit more rotation. Because the lumbar spine tends to crave more stability, lumbar facets tend to be oriented sagittally. Anatomically, there aren’t many restraints moving into rotation however, so the flow of force goes to the annulus and the oblique. Remember, the annulus’s role is to restrict motion, and the orientation is like a rope with a 45 deg lattice to limit rotation. If you get disruption in this, you get disruption of the nucleus. With further sustained trauma, you get degeneration in the endplate.
This is really what initiates the cascade because it is where hydration/nutrition exchanges take place (fat infiltration, nerve ending growth takes place). If we’re not paying attention to progression, we want to go too fast and then this shearing happens which flares people up. This doesn’t pain science, it’s exercise science. In the course of Dr. Ngo’s development as a clinician, he had the duel of being the safest and then being aggressive utilizing the joint-by-joint model to determine how he could treat…who does he have to nurture with movement science ( joint by joint, Sahrmann, breathing tactics) and who he needs to be more aggressive with.
Final Recommendations
A strong recommendation of Dr. Ngo’s is the 1st edition of the OCS Current Concepts. The material in this edition had very dry material but also key info and insight into how the spine works so you can apply anatomy and physiology. Other recommendations include looking into the movement and exercise science worlds to provide your in-depth knowledge on how to prevent rotational stress and shearing to minimize flare-ups, such as the work and teachings of Stuart McGill. Ultimately, you have to understand the patient’s whole history, look at the MRI, and test different movement systems…very rarely does it become pain science, it’s more functional medicine. If you have questions, ask them, because discussion promotes learning.
Please comment and let us know what your thoughts on this subject.
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Swaying is one of the big 12 pitching technical characteristics that OnBASE University have identified. This article will dive into what swaying looks like and what can lead to swaying. All of the identified big 12 does not necessarily equate to poor performance. But when a pitcher has trouble with consistent delivery, understanding how your physical body make-up can give you clues on why you might be swaying during the early part of your pitching sequence. Improve your pitching rotational power by knowing if you have sway or not with this article.
The good news is that this step-by-step article will help you tease out if you have physical mobility, stability, or pitching technique problems.
What is the “sway” pitching posture?
Swaying can be seen when you look at the pitcher face-on. As the pitcher raises his front leg (“pivot” to “top of leg lift”), an energy-efficient strategy will have the pitcher’s torso be vertical or leaning forward to the inner knee of his stance leg. A pitcher will sway if they shift behind this imaginary vertical line drawn from their inner stance knee towards their head.
What does this mean from a physical standpoint?
The goal of the pitching sequence from “pivot” to “top of leg lift” is to prepare and load the body to produce explosive rotational power. The power that needs to be displayed as precise pitching accuracy towards the home plate. The back stance leg sets the tone as two factors: setting up the stability of delivery and transfer the ground reaction force up to the pitching arm. The muscular or dynamic coordination of the entire stance leg, from hip to ankle muscles, will titer the torso to stand erect, swayback, or direct forward towards home plate. Two important muscles that will impact stance leg control are the Gluteus medius and Posterior Tibialis muscle. More to come on this.
You do not want any movement “leaks” during the pitching sequence, as that will result in higher energy use. A pitcher will later be fatigue and this can cost him pitching control in later innings. They will force the throw to make up for this movement leak during the wind-up.
Preface. This article is a summary of one of the podcasts that we host called “Awakening the Physio”, where Dr. Ngo elaborates on how he brings a holistic approach to a singular field of Orthopedics and Sports Medicine. You can listen to the podcast as linked below. As part of Dr. James Taylor’s mentorship, he graciously took on this task as part of his mentorship experiences at ReVITALize Rehab Club.
Before we start with Dr. Taylor’s summary, we would like to emphasize that there is ONE focus when it comes to how we bring care to you. Your goal is our goal. Many come to us with the desire to move better and enhance their mobility, strength, alignment, and/or posture. The holistic perspective is good and dandy, but unfortunately, the consumer gets the short end of the stick when a holistic practitioner is not focused on one particular path during your plan of care. Holistic is broad and the experience can be all over the place. This is the reason why we decided this is an important article to help you to know how we blend many systems with the FOCUS on better movement.
Everything trickles down to movement. We evaluate holistically to learn how we can help you to move better. Every question we ask is targeted in the direction of learning why you have trouble moving. The targeted treatment and therapeutic exercises are geared towards getting you to be closer to enhanced movement. More energy. More confidence. As you read this whole article, you will understand why 90 minutes is the right amount of time for a practitioner to understand your problem at another and deeper level. This is how you will get better.
Enjoy! The article starts below and is geared to teach other Physical Therapist aspiring to adopt the Holistic and Functional Medicine model.
One of the biggest keys is to build good habits and make it a system. Part of these good habits is to keep the system always adapting, as this is what drives good outcomes. There are many systems in movement science (Maitland, Frank, Sahrmann, Greg Johnson, Mulligan), and these systems produce good results. However, one issue that arises is that clinicians have to immerse themselves in these systems, and many tend to become rigid and don’t tend to deviate as much from these systems. The purpose of this discussion is to examine Dr. Ngo’s system.
One model that research is proposing is the biopsychosocial system as well as the work of Chad Cook and Yannick Tousignant-Laflamme, the developers of the “five domains of pain and disability driver’s model”, which blends an ortho-sports model with holistic and functional medicine.
In addition to the sensory system, we also must consider the socioeconomic status of the patient as well as their spiritual and/or religious beliefs as these will place a huge impact on whether they will follow through with the advice that you are giving them. Paul Chek developed a totem pole hierarchy which states that one’s sense of self is at the top. From the primal/ancestral perspective, the general thought is that your body will protect you at all costs, however in some cases, feeling important and having a sense of purpose is more important than having a sense of existence. This is why people who feel deficient in this area tend to commit suicide because they feel (rather, unfortunately) that they have stopped to matter.
All of this is why Dr. Ngo spends at least 5 minutes of every evaluation discussing what motivates the patient, what gets them going in the morning so that he can evaluate to what extent they have a sense of purpose. If this is not included or considered, it would mean more work and more time that needs to be dedicated to helping them feel better.
Dr. Danh Ngo will elaborate more about the biopsychosocial model later as there is a key concept that will help bridge the two systems of managing the person and managing the body’s ability to move. One of the key principles of this model is that the source of an individual’s dysfunction comes from one of the following three areas: input, processing, and output. Constantly, the body receives info through the peripheral sensory system that is delivered to and is processed by cortical/spinal structures. These then initiate an output based on how the brain interprets what it is receiving from the periphery. Any patient coming into a PT clinic typically complains of an output problem manifested by pain, tightness, or decreased ROM. This means that the body’s ability to produce output is dysfunctional. This output problem is what school generally teaches to focus on, but we must look at the inputs that are creating this output problem.
An important concept to keep in mind is the fact that the sensory drives motor, whether that be from the auditory system through the startle reflex exhibited when you hear a loud “boom”, the visual system that causes you to shorten your stride when in a dark room, and any of the olfactory, vestibular, or proprioceptive systems.
The end goal of treating any patient is to get them to move well and without compensation.
To reinforce that brain/body connection, we want the output to be very predictable so that the patient can predictably produce a good movement pattern or motor response. For example, if you have your client performing a knee extension, they may feel it more through the inner thigh or hamstring area. This level of unpredictability messes up the equation.
Anything that interferes with the input and the ability to bring better “ease of pain, better movement” output can be looked at as “white noise”. There is an error in processing, as demonstrated in the example above. Another way to think about processing errors is with the metaphor of mind-body connection. Healthy movement leads to a harmony of muscles working like an orchestra to work with the joints, ligaments, and other passive structures. Movements are dictated by the brain. You cannot move if you are brain dead. Right?
The mind-body connection can be looked at the same as a router-wireless connection. The number of blocks or walls that prevent the router (brain) from transmitting a clear signal to the body (WiFi) is what we need to determine and address it. We need to help the brain to process the sensory and motor input for healthier movements.
The end goal of functional medicine is to help eliminate this “white noise” by looking at the internal health of the patient, utilizing movement (external health) as a reference point. Movement, in and of itself, never “lies” as it is a product of the response of the CNS to an input. Any factor that impacts this internal health and well being of the individual, not just the musculoskeletal system, will be reflected in the quality of their movement.
There are 8 categories of dysfunction that can create this “white noise.
gut dysfunction
Hypothalamus-Pituitary axis (HPA) dysfunction
chronic infection
cellular dysfunction
nutrient imbalances
immune dysregulation
hormone imbalance
toxic overload.
All of these categories can affect the threshold of a patient’s pain, so we must examine areas such as the cardiovascular system and the patient’s history of chronic disease or autoimmune disorders.
Anyone who has an emotional breakdown or who lacks sufficient self-confidence cannot be expected to perform at peak efficiency. The same holds of those who train endlessly to participate in high-level spots but who also neglect to get sufficient sleep as this significantly impacts the brain’s ability to provide clear and precise signals to the desiredmotor output. Unlike the zombies of the Walking Dead show, we do not move as coordinated and reflexively when we are sleep deprived zombies.
Another important area to screen for is that of the level of stress or “allostatic load” on the individual, a concept developed by Bruce S. McEwen.
According to Dr. McEwen, there are four types of stress.
Perceived (Anxiety/depression related to neurotransmitter imbalance)
Circadian disruption (sleep impacted by caffeine/sleep apnea and an irregular work shift),
An easier way to screen for stressors in the PT clinic would be to examine the pneumonic NUTS. By this device, we ask if the stressor is Novel (something new), Unpredictability (no way of knowing if/when that stressor can occur), Threat (any perceived threat), and Sense of Loss of Control (feeling you have no control in a situation).
Our current situation with the onset of COVID-19 reflects as it impacts all four of these areas, and hence creates white noise so that the brain has to work harder to connect to the musculoskeletal system.
From an osteopathic perspective, mechanical stress on any bodily tissue can also create white noise that affects the connection to the musculoskeletal system. Dr. Ngo’s training reflects this perspective, as he has been trained in visceral, cranial, and vascular manipulation that he utilizes in his clinical practice regularly.
In summary, it is important that, in addition to being pain-free, your patients can feel how they are supposed to move. For this, Dr. Ngo created a screen containing the common stabilizers for each joint and tests these to make sure that the patient is feeling the muscle work in the correct position (i.e. making sure the patient feels the longus colli and rectus capitis muscles work anteriorly in a deep neck flexor endurance test and not more laterally).
Healthy movement is a big subject of debate within PT as the pendulum is swinging from a strict biomechanical perspective to a model more accepting of movement variability. From Dr. Ngo’s perspective, 80-90% of the time, people go through a predictable sequence of activity in their day (get up, brush teeth, go to work, etc.), and our expectation of movement should reflect this. Novelty and variability within the movement are great, however, we need predictability for what the body region in question is supposed to deliver.
This can first involve tapping the sensory system through the vestibular and ocular systems and improving this area first so that the body-brain map is less smudged. Once we provide a predictable response that the CNS can react to positively, then we can add in layers to build upon this (for example, progressing from left/right discrimination to explicit motor imagery).
From there, we can start to focus on breaking down the components of complex motor tasks that are meaningful to the patient. Has the client acquired the skills of moving well with factors that we can influence include endurance, flexibility, power, and speed? This applies whether we are training a normally, sedentary individual or training a high-level athlete. If we do not take the time to instill a predictable pattern of what movement should feel like, the patient might feel better for 3 minutes before they revert to their older patterns (most likely utilizing common global movement patterns).
Treating patients requires looking at the rehabilitative process from a multi-faceted perspective. Yannick Tousignant-LaFlamme and Chad Cook are among the chief proponents of this model. Yannick and Cook’s theory describes a pentagon with each side of the pentagon representing a different driver that can increase the level of pain/disability that the individual is experiencing.
Yannick Tousignant-LaFlamme’s model and list below.
Nociceptive pain drivers
Nervous system dysfunction drivers
Comorbidity drivers
Cognitive-emotional drivers
Contextual drivers.
Looking from this perspective involves looking at that patient’s history for MVA’s (recent trauma), sports participation, and/or physical abuse. Other models integrated in Dr. Ngo’s practice include those models of understanding pain offered by Butler and Moseley. As PT’s help bring higher level of understanding of the brain and individual’s expression of pain, we forget that the nervous system can greatly be enhanced with direct mechanical interventions. Dr. Ngo utilizes the hands to address mechanical tension in the brain/spine/dura. He provides dietary considerations to get nutrients more in balance. As the brain and body have the fuel resources to comprehend the task at hand, it can help.
Ultimately, it is the responsibility of us as clinicians to listen with an open heart to the patient and be emphatic to the patient’s situation as if it were your own. Science/evidence has a purpose to protect our clients and to give us as clinicians a framework from which to do no harm and to allow us to see the client as a whole person.
For further questions with the topic discussed, feel free to email us at info@revitalizerehab.com.
We like to express gratitude for Dr. James Taylor for his contribution.
You have back pain that is tight, stiff, or sharp. Your morning pain could be something you are having a hard time shaking off. Or is it the idea of picking something off from the floor? With many people experiencing lower back pain, there are only a handful of lower back pain diagnosis that account for the majority of the lower back cases. We will be addressing three important structures in your lower back region that is playing a role in your spinal health, rehabilitation, and recovery.
Let us start out by establishing the 5 common diagnosis you may have been told.
Lumbar disc herniation, bulge, “slipped” disc, or other various disc related pathologies
Lumbar spine stenosis or spondylosis
Lumbar spondylolisthesis or instability
Sacroiliac joint dysfunction or pain
Muscle sprain or strain
These diagnosis are part of a sequence of spinal stress and loading patterns that the lumbar spine goes through but has trouble sustaining and recovering from these load patterns. Basically, you are not trained to do what you are doing or not recovering sufficiently, so the lumbar disc, vertebral body, facets, or neighboring muscles and joints fatigue and “fail”.
We quoted the word FAIL because failure of the anatomical structures has no connection to pain and mobility over the long term. You may feel pain for years, but research have demonstrated with high level of evidence that structures does not equate to severity of symptoms. The interpretation, process, and ability to execute certain movement skills WITH a combination of a comprehensive protocol of sleep hygiene, blood sugar regulation, and emotional health are factors that have been highlighted as being more important to spinal pain.
There is conclusive evidence that Blood Flow Restriction (BFR) training will help you tremendously. If you have any injuries that have not allowed you to do “real” sustainable strength training, this is a must read. As Long Beach’s most sought after Sports Medicine Physical Therapy professional, blood flow restriction training has been an important piece in helping triathletes, weightlifting enthusiasts, runners, football, baseball, soccer, and basketball players get back to the routines they desire.
BFR got popularized when ESPN showed key sports athletes like Dwight Howards and some Houston Texans football players using it to rehabilitate from their surgery and/or injuries. The speed of their recovery highlights the ability to strength train sooner. This prevents muscles from getting weaker, called atrophy.
What many do not know is that BFR started with the work of Dr. Owens ( https://www.owensrecoveryscience.com/ ) from Texas. The immediate need and the innovation of BFR came from the desire to help the people in the limb salvage unit. They were weak and could not do many activities, but if there was a possibility of helping them do just a bit of activity, they would have a better chance of recovering. This is where BFR’s story started, becoming the white knight and hero for the very weak people.
The general idea is when performing BFR training, blood flow going back to the heart (venous) is blocked and the arterial blood flow to a region is not impeded. This results in tremendous benefits including the list below.
Increased type 2 fiber recruitment which is the faster and strength production type.
Increased local growth hormone and IGF-1 by 200-3000%
Greater and more rapid accumulation of metabolic by-products such as lactate
Muscle hypertrophy with lighter exercise via enhanced stimulation of muscle protein synthesis by 45-55%.
The building of non-contractile units that are designed to provide structure to the muscle fibers.
