Low back/ Pelvic girdel diagnostic and motorcontrol

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Gervais McDaniel
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1 Low back/ Pelvic girdel diagnostic and motorcontrol Peter Viklund/ Scandinavian college of naprapathic manual medicine 1

2 Second International Fascia Research Congress Motor control Conductor of muscle activation strategies Proprioception Coordination 2

3 Motor control Pain It s relation to acute/chronic phase of pain. Short-term effect VS. Longterm consequences. Compensatory muscle inhibit and/or activation develops in individual patterns. Is the chosen strategy the mechanism that causes the pain? Interaction around pain Pain emotions (fear, stress, anxiety, depression) Motor control (proprioception, coordination) Awareness (consciousness) functional anatomy (Endocrine system, the immune system) 3

4 Proprioception Proprioception- the secret sixth sense(sheringham 1906). Third system-visually-vestibularproprioceptive. Skin-unspecific. Joint-only in end movement. Disc- high threshold. Lig, fascia- muscle spiders. Muscle Spiders Most important- the only receptor that is under CNS control, reacts on the muscle s/fascias length. Practice proprioception: mind, vibration, different movements, positions. (Simon Brumagne) Dynamic stability Movement Stability Optimal area A rigid system can become unstable for the tasks it s supposed to execute. Not stability VS. movement- but stability during movement. Motorcontrol- Match the solution based upon the task. 4

5 Motor control For the spine to function optimally it requires a balance between stiffness and motion. The balance depends on the task. Wrong matching solution towards the task = not optimal motorcontrol strategy (this should be addressed through rehabilitation). Examine the patient in the position where the patient s problems appear (walk, sit, stand)= Functional integration. Motor control If the contribution from any muscle is affected the spinal control will not be optimal. Rather than thinking about what muscle is most important, observe the relationship between the different muscles When stiffness increases during LBP -decreased control of fast movement - increased biomechanical compression/(jaap van Dieen). The question to be answered: Is more stability what that patient really need? 5

6 Motor control Increased and/or decreased muscle-activity occurs in individual muscle patterns. Is activation required for reduced passive control? For example, due to injury. (adaptive-maladaptive). Or is the pattern the root of the problem? (for the therapist to decide). Perhaps the pattern of choice is the cause of the frequent recurring pain (Jaap van Dieen). to Test motor control and more 6

7 ASLR Pelvic Girdel/Low back diagnosis Form closure (joint surface,lig) Force closure (muscle,lig, fascia) Motorcontrol (proprioception,coordination ) Awareness Emotions 7

8 External Force Closure External Force Closure Reaction force (changed transmission of power). Nutation (optimal function). Motorcontrol (changes the motorcontrol). Individual muscle/system. Claes Ekström Leg. Naprapat 8

9 Myofascial chains Anterior oblique M. Obl. externus, contralateral m. Obl internus and the anterior abdominal fascia and mm. aductor. Claes Ekström Leg. Naprapat Myofascial transmission of power between and within muscles. Within a muscle fiber up to 50% of the total power generated will transfer to nearby CT instead of the fiber's origin and attachment synergist and antagonist /Huijing Claes Ekström Leg. Naprapat & Peter Viklund Leg. Naprapat 9

10 Rehabilitating motor control It s not about training a specific muscle but to change the function in the motorcontrol-system. Shifted from training one muscle to train a movement. (Peter O Sullivan). The therapists aim should not be to make the patient more or less stabile but to increase the patient's ability and control of movement. Address the whole system, not only one specific muscle or treatment method. There is scientific proof for that specific attention of muscle activation can restore the motorcontrol/ P. Hodges Practice motorcontrol before traditional training if both are needed. Poor motorcontrol of torso is a risk that predisposes injuries for athletes (Jacek Cholewicki). Craig Liebenson-the sacred cows of exercise Craig Liebenson is under the impression that we should treat a symptom as little as possible or as much as it takes. 10

11 Rehabilitation What to do, when and for who? What prevents the body from healing itself? Our faith as therapists manage our treatment rather than the patient in front of us. Change a acute pattern that because of belief of pain has been maintained and has become provocative. Less focus at separate muscles, tests and symptoms- more focus at challenges, performances and belief in the future. Away from passive treatment? The patient can be provocative or avoiding in their behavior (shall not always be activated). Pain- increased stiffness in back more postural sway(is really stabilizing training the answer then?). (Paul Hodges, Jaap van dieen, Britt Stuge, Craig Liebenson, Kjartan Fersum,Lieven Danneels, Peter O Sullivan,, Trish Wisbey). 11

New York State Workers' Comp Board. Mid and Lower Back Treatment Guidelines. Summary From 1st Edition, June 30, 2010. Effective December 1, 2010

New York State Workers' Comp Board Mid and Lower Back Treatment Guidelines Summary From 1st Edition, June 30, 2010 Effective December 1, 2010 General Principles Treatment should be focused on restoring