Hans Lindgren

Postural Tai-Chi

Mon, 28 Jan 2013 16:21:59 +1000

I recently received a website inquiry for more information on “Postural Tai-Chi” which I mentioned in one of my DNS blogs. I doubt there is much material available, so I thought it was a concept worthwhile expanding upon.

I would explain the method as follows:

Postural Tai-Chi – As described by Pavel Kolar is a method of restoring ideal movement patterns in an individual. It can be further explained as: the process of an individual moving from one position to another with perfect form (joint centration with proper stabilization) to re-establish the ideal program in the brain. Moving back and forth from one position to another creates a proprioceptive driven map of the movement in the brain. The muscles ability to stabilize a joint in a centrated position while performing both concentric and eccentric contractions is important for ideal movement patterns to occur.

A functional movement pattern depends upon joint centration, sufficient mobility, and good stability. To evaluate the quality of an individual’s movement patterns a series of tests can performed. Describing all the tests in detail is a too big a topic for this blog, but I will give you a few examples: Breathing pattern, squat, bear position, as well as quadruped position (on hands and knees) to evaluate scapular stability.

Observing an individual performing a sport or other activity is a great way to identify dysfunctional patterns. The ideal movement patterns are the same in all sports and activities. Sometimes we see top-athletes performing well even though they have dysfunctional movement patterns. These athletes are not doing well because of the faulty movement patterns, they are doing well despite their poor patterns. Faulty patterns will dramatically increase the risk of injury.

Pavel Kolar described a method of identifying the faulty patterns by filming an athlete performing, and then going over the movements screen by screen to evaluate the quality of the stabilization in the different transitions from one position to another.

When dysfunctional movement patterns have been identified a strategy to restore the ideal mobility and stability patterns can be designed. There is no simple “cook-book” with a generic recipe that fits all. Every person has to be individually assessed and depending upon each person’s ability to correct the patterns, or not, a decision made on what strategy to use.

When the individual can correct the pattern themselves they can go directly to specific exercises including “Postural Tai-Chi”.

If the individual cannot correct the faulty pattern, DNS practitioners have the options of using “Reflex Locomotion” or specific Therapist controlled exercises to “trigger off” the correct patterns. Once the ideal patterns have been “triggered off” the number of times required for that individual’s proprioceptive system to recognize the ideal pattern and thereby be able to reproduce it, the person is ready to perform exercises. Initially exercises are to be supervised by the Therapist to ensure that the form does not deteriorate. Perfect form is absolutely crucial to rebuild functional movement patterns. It should be viewed as a process of rebuilding the ideal movement pattern in the Central Nervous System. Once the ideal pattern has been performed over and over again it will become automatic, and so this is where “Postural Tai-Chi” is very effective.

Summary: Every person should be individually assessed for functional movement patterns, and any dysfunctional movement patterns should be identified and corrected. Once the individual can perform the movement pattern correctly exercises can be introduced. Performing postural Tai-Chi back and forth across the joint in a functional way will rebuild the proper pattern in the CNS. Therefore every person would have their own individual “Postural Tai-Chi” program involving a series of moves aimed at correcting their weak patterns. The concept can also be used for a more generic combination of movements necessary for each specific sport and activity.

An example would be:

A small portion of a lunge or squat pattern which showed dysfunctional stabilization has the proper pattern activated and then the individual moves back and forth across that joint position to eradicate the faulty pattern and replace it with a functional one.

Postural Tai-Chi can be used across every joint in the body as soon as a functional movement pattern has been established. Performing exercises with poor form will never improve the function, but only further strengthen the faulty pattern in the nervous system.

Exercises will strengthen all movement patterns-both the good and the bad ones.

Unilateral Gluteus inhibition from Sacro-iliac joint dysfunction-Janda

Fri, 04 Jan 2013 20:00:00 +1000

The importance of muscle dysfunction in various pain conditions of the locomotor system is widely accepted. The quality of muscle function depends directly upon the Central Nervous System activity. The tendency for some muscles to develop tightness and others to be inhibited and weak is known and plays a large part in the evaluation and treatment of various pain syndromes.

The decrease of activity of some muscles is often considered to simply be muscle weakness without recognition that this decreased activity and resulting weakness may be due to altered movement patterns, and specifically due to an inhibitory phenomenon related to joint dysfunction and the resulting altered sensory afferent signalling.

In the nervous system there are constantly occurring processes of excitation and inhibition which substantially affect the function of any part of the body. There might be an inhibition based on altered reciprocal interaction due to the activation of an antagonist muscle in spasm or directly from the pain of the muscle spasm. Pain leads to alterations of movement patterns and can thereby affect the activation of individual muscle groups. Change of movement patterns is the result of long lasting dysfunctional proprioceptive signalling.

There is strong evidence that impaired function of muscles occur in close relationship with the development of joint dysfunction. It has been shown that certain muscles tend to deteriorate in their function, which can clinically be demonstrated by three main syndromes:

Hypotonia, which can be determined by observation and palpation.
Decrease of strength. The problem is that Strength testing is difficult and often quite inaccurate as it is hard to isolate individual muscles.
Change in timing is the most important feature of inhibition and results in a delayed activation in movement patterns. It is usually the start of the muscle activation that is delayed so that the order in which the individual muscles are activated changes. The non-inhibited synergists and stabilizers usually become activated earlier. The decrease of activity of a particular muscle can be of such a degree that it remains almost silent on EMG testing, which may lead to the wrong conclusion that the muscle strength is zero. Such muscle may however be activated after proper facilitation. Often these inhibitory changes appear clinically as a slight paresis and as such Professor Janda often called it “Pseudo-paresis.

An important fact that has to be considered is that input that normally would be considered can instead have an inhibitory effect on Pseudo-paretic muscles. This can be demonstrated where the muscle is forced to work against resistance, which generally is considered as one of the most facilitatory techniques, as the number of activated motor-units increase in proportion to the magnitude of resistance. Pseudo-paretic muscles can however react completely differently by showing a decrease in activity with increased loading. This has been explained to be due to a direct inhibition of some motor-units due to over-load or simply by elimination of the pseudo-paretic muscle from a certain movement pattern and its replacement by non-inhibited and sufficiently strong muscles.

The decrease of tone, strength and elimination from movement patterns do not affect all muscles, but predictably only some groups. The following muscles have a tendency to develop Pseudo-paresis: Tibialis anterior, Peronei, Vastus Medialis, Long thigh adductors, The gluteus muscles (maximus, medius and minimus), abdominals, the lower stabilizers of the scapula (Rhomboids, Serratus anterior, lower and middle trapezius), and the deep neck flexors.

Altered joint function (movement restriction or decrease of joint play) is one factor which dramatically changes the quality of the muscles which cross the particular joint. Even though it seems that joint pain quickens the development of inhibition, pain does not necessary precede inhibition. The altered proprioception from the joint plays a more important role, influencing the muscles either by inhibition or facilitation.

A study by Professor Janda showed that in subjects without any painful conditions of the locomotor system, those who had Sacro-iliac dysfunction there appeared to be a striking hypo-activity of the Gluteus maximus and medius during hip extension and hip abduction.

The effect of antagonistic muscles should not be neglected as it has been shown that tight muscles evidently have an inhibiting effect on their antagonist (Sherrington’s law on reciprocal inhibition). Stretching and restoration of normal length of tight muscles reduces the inhibition to the pseudo-paretic muscle to improve their activity.

Proprioceptive input from blocked joints give altered information to the CNS, which changes the program on the cerebral cortex level. If the proprioceptive alteration persists for an extended period of time it leads to a centralisation (reprogramming) of the dysfunction, which makes it harder to restore the ideal function. Any joint dysfunction should therefore be treated to avoid centralisation of the problem. Joint blockages are usually painless unless there is a muscle reaction (spasm).

Sacro-iliac (S/I) joint Dysfunction

A blocked S/I joint inhibits Gluteus Maximus and facilitates activity of the Psoas and Piriformis muscles on the side of dysfunction. On the opposite side the Gluteus medius and minimus are inhibited which leads to a pelvic shift towards the non-blocked side. A dysfunctional S/I joint often causes a spasm in lower quadriceps and Rectus Abdominis. The gait mechanism alters due to the limitation of end range of hip extension, and the reduced hip movement gets compensated for by an increased anterior pelvic tilt which increases movement and stress of the lumbar spine. The Gluteal inhibition is also often compensated for by increased activity of the ipsi-lateral hamstrings and the contra-lateral back extensors. No muscles cross the sacro-iliac joint, but the Piriformis attach to the sacro-tuberous ligament and so does the long head of the biceps Femoris. It has been shown that patients with S/I joint dysfunction had delayed activity of the Gluteus max, multifidus and internal obliques on the affected side when tested in a one-leg stance position.

The close relationship between a S/I joint dysfunction and inhibition of the Gluteus Maximus indicates that everybody with Gluteal inhibitions should be tested for S/I joint function, but also that everybody that is being treated for a S/I joint problem should have the Gluteal muscle function tested and facilitated when needed. Inhibition of the Gluteal muscles is a possible cause for recurring S/I joint problems.

Professor Janda showed a quick and simple screen for Gluteal inhibition related to S/I joint dysfunction. With the patient prone the examiner stands at the head end of the table and observes the contour of the buttock muscles. The side with the S/I joint dysfunction appears flatter and much smaller.

Summary:

The Gluteal muscles should have a round full appearance. Flattening of the gluteal muscles in the upper quadrant or buttocks with a loose hanging appearance indicates inhibition.
There should be symmetry of the gluteal muscles where both side should look the same
Asymmetrical appearance of the Gluteal muscles is often due to an S/I joint dysfunction, leg length difference or hip-pathology. There is always tightness of the Piriformis muscle when the S/I joint is dysfunctional.
Tightness of the hip flexors may inhibit the Gluteal muscles
Gluteal muscle inhibition affect hip extension, so the hip extension test is a useful examination tool.
Hamstrings often compensate for Gluteal muscle inhibition

Self-assessment and treatment of the Pelvic Cross Syndrome

Mon, 17 Dec 2012 21:13:21 +1000

The Pelvic Cross Syndrome according to Professor Janda is one of the most commonly seen muscle imbalances causing lower back pain.

The Pelvic Cross Syndrome is characterised by a tightness of the hip flexors and back muscles and a weakness (inhibition) of the Gluteal muscles, abdominals and the hamstrings.

Signs of a Pelvic Cross Syndrome are:

Symptoms are often pain and tightness of the bottom of the lower back.
A forward tilt of the Pelvis (duck bum) with a sharp lumbar lordosis. (Check the belt line)

Flat or hanging gluteal muscles (the buttocks should be firm and round) Professor Janda described the faulty look as “bags of water”.
Over-developed hamstrings in relation to Gluteal muscles. Hamstrings are often perceived as tight because they are over-loaded attempting to compensate for the inhibited gluteals.
The syndrome is often accompanied by a tight kyphosis at the Thoraco/lumbar junction
Often the neck is involved with a forward head posture and an increased curve.

Test yourself for a Pelvic Cross Syndrome:

Stand with the back against a wall with the heels touching the wall. Try to flatten the lumbar spine out to touch the wall without letting the pelvis or thoracic spine lose contact with the wall.

In the same position try to lift the arms all the way to touch the wall above your head without increasing the lumbar curve or letting the pelvis or the thoracic spine lose contact with the wall.
Sit at the end of a table or a bed. Lift one leg up against the chest and hold on tight with the arms. In a slow controlled movement roll back onto the back without losing the grip of the knee as it would affect the result of the tests. Laying on the back the other leg should be hanging in a horizontal position, and it should be possible to push it down below horizontal without too much discomfort. If the leg is elevated above horizontal the hip flexors are too tight. Extend the knee to see if the leg can be lowered further, if that occurs the main tightness is probably in the Rectus Femoris (thigh muscle). If the knee position does not affect the thigh position the Ilio-psoas is probably too tight. With the leg hanging in horizontal the knee should be vertical (80-90 degrees of knee flexion) and you should be able to bend it further in without the thigh moving up or feeling any excessive resistance at the front of the thigh.

Repeat with the other side.
If the Iliopsoas or the Rectus Femoris are too tight the testing positions can be used as the initial stretching positions. Simply lie on the back with one leg pulled tight towards the chest and use muscle force to slowly push the leg down past horizontal and maintain that position for 30 seconds whilst breathing calmly and slowly. Repeat 2-3 times. To stretch the Rectus Femoris keep the thigh in a horizontal position and slowly bend the knee. Hold the stretched position for 30 seconds and repeat the procedure 2-3 times. Stretching of the short muscles should always precede attempts to strengthen the weak muscles involved. Progression of stretches may include:

After 2-3 weeks of daily stretching of the Rectus Femoris and Iliopsoas you are ready to start activating the inhibited Gluteal muscles. Lying on the stomach with the knee bent slowly lift the leg up without excessive movement of the pelvis and the lower back. Maintain that position for 10 seconds and repeat 10 times, before switching to the opposite leg.

Once the muscles are activated (1-2 weeks) the muscle is ready to be further challenged. Bridge exercises are a viable next step. Lay on the back and bend the knees so that the feet have a flat contact with the ground. Slowly lift the buttock area off the floor with the trunk braced as one solid unit. The hip joint should be the only joint moving in this exercise.
When the gluteal muscles have started to perform their normal duties they can slowly be introduced into more advanced exercises.
Keep in mind what the imbalance is and focus on stretching of the Rectus Femoris and Iliopsoas whilst concentrating on strengthening the gluteal , hamstrings and abdominal muscles.

Slight limitation of hip movement (mainly extension) is a common examination finding caused by the Pelvic Cross Syndrome and significantly the main symptomatic complaint is back pain not hip pain

Most people I examine have varying degrees of the Pelvic Cross syndrome, and I have still today never come across an individual where the Gluteal, hamstrings and Abdominal muscles are too strong.

Video

Janda’s Pelvic Cross Syndrome

Thu, 29 Nov 2012 20:00:00 +1000

Janda’s Pelvic Cross Syndrome, also known as the “Lower Cross Syndrome”, has been widely used in rehabilitation and corrective exercise strategies. The purpose of this post is to share some of the wisdom taught by Professor Janda, and to describe how I incorporate the Pelvic Cross methods in my work.

The pelvic cross syndrome is characterised by the imbalance of tight and short hip flexors and inhibited and weakened gluteal and abdominal muscles. The syndrome promotes a forward tilt of the pelvis with an increased lumbar lordosis, and a slightly flexed position of the hips. The hamstrings are often found to be tight in this syndrome, which may be a compensatory mechanism to lessen the anterior pelvic tilt, or the over-activity and perceived tightness could be a functional compensation for the inhibited gluteal muscles. Over-activity and tightness of the Erector Spinae muscle in the presence of inhibited and weakened Gluteal muscles will alter the pattern of hip extension, which is a fundamental part of the gait-pattern.

The postures resulting from the imbalances in this syndrome change the distribution of forces in both the lumbar segments and the hip joints. If the hips lose their ability to extend to the range required in the gait cycle, there will be compensatory patterns of further increased anterior pelvic tilt and hyper extension of the lumbar spine (L5-S1 and L4-5 hyper mobile). The result of the excessive loading of the lumbar spine and hip joints may lead to stiffness, irritation and inflammation of the joints and surrounding soft tissues. The lumbar spine gets over-loaded at the posterior aspect of the disc spaces and the intervertebral joints, which normally do not carry load but only control movement.

The instability of the lower lumbar spine is often compensated by a stiff kyphosis of the Thoraco-Lumbar junction, and an increase of the cervical lordosis develops in efforts to balance the body against gravity and to keep the head and eyes in an upright position. The compensatory changes of posture may lead to symptoms of pain and stiffness in these areas.

An imbalance can also exist in the lateral Lumbo-pelvic musculature, where inhibition of the Gluteus Medius is compensated for with a hyper-activity and tightness of the ipsi-lateral (same side) Quadratus Lumborum (QL) and Tensor Fascia Latae (TFL)

The Assessment of the Pelvic Cross Syndrome can be divided into three stages:

1. Evaluation of standing
2. Examination for muscle tightness
3. Examination of movement patterns

The Assessments should not be performed on patients in acute pain, since the pain might distort the posture and muscle function to such a degree that tests yield invalid information. In such patients the emphasis should be placed on acute care and the assessment should only be conducted when the acute episode has subsided and the patient has regained the habitual posture and movement patterns.

1- Evaluation of standing

Many abnormalities of posture can occur in the lower back patient and the therapist has to differentiate between possible causes, as many factors including structural variations, age, altered joint mechanics, muscle imbalances and residual effects of pathology can all causes postural deviations. Certain signs can be observed that reveal whether or not muscle impairment is causing or contributing to the altered posture. Change in size and/or shape of muscles known to react either by over-activity and tightness or inhibition and weakness.

Muscles prone to develop tightness: Triceps Surae (calf – Gastroc and Soleus), Hamstrings, short thigh adductors, hip flexors (Ilio-psoas, Rectus Femoris and TFL), Piriformis, QL, Spinal Erectors, Pectoralis, Upper Trapezius, Levator Scapulae, Sterno-Cleido Mastoideus, and the short deep neck extensors.

Muscles prone to inhibition: Tibialis Anterior, Vastus Medialis, Rectus Abdominis, Lower Stabilizer of scapula (Serratus Anterior, Rhomboids and lower & Middle Trapezius) and the deep neck flexors (DNF)

To evaluate the patient:

Observe the position of the pelvis- Imagine the belt line – Is the belt line horizontal or is there an anterior pelvic tilt?

Gluteal Muscles- Ideally the Gluteal muscles should be symmetrical and well rounded. If they are inhibited and weak the muscles tend to hang loosely (“Bags of water”- Janda). Asymmetry of the gluteal muscles where only one side is affected may indicate hip pathology, a leg length discrepancy or most commonly an S/I joint dysfunction ( see separate blog about S/I joint and Gluteal inhibition)

The hamstrings are usually well developed, but it is important to look at their bulk relative to that of the Gluteal muscles, for when the latter are inhibited the hamstrings become dominant. This is very evident when there is unilateral (one-sided) inhibition of the gluteus Maximus.

Tightness of the short hip adductors can be seen as a distinct bulk of muscles at the upper third of the inside of the thigh.

Careful attention should be paid to the back muscles. The bulk of the Erector Spinae should be compared from side to side as well as from the lumbar and Thoraco-lumbar regions. There should be no difference in bulk between the sides and regions. Prevalence of the Thoraco-lumbar portion indicates that there is poor muscle stabilization in the lower lumbar region.

The Abdominal muscles should flat and not sagging and protruding.

From the initial observation of standing the therapist should have gained an overall impression of the patient’s muscle status, and important syndromes such as the Pelvic Cross been identified. The standing assessment should lead the therapist to specific tests of both muscle length and movement patterns.

2- Examination of muscle length

Thomas Test

Place the patient end of the table and get them to flex the opposite hip and knee up to the chest, thus eliminating the lumbar lordosis. The patient then rolls backwards maintaining a flattened lumbar spine until laying supine. This position is very important, if there is not adequate stabilization of the pelvis and lumbar spine there will be false results in the length tests. The tested leg hangs freely over the edge of the table.

Note the following:

Ilio-Psoas- the femur rests at horizontal and the thigh may be depressed a further 10-15 degrees without excessive soft-tissue resistance

Rectus Femoris- with the femur horizontal the lower leg should hang vertically (knee 80-90 degrees flexion) and the knee should be able to be passively flexed to approximately 105 degrees of flexion without excessive resistance.

Hip Adductors- with the thigh horizontal, the hip should be able to be abducted 15-20 degrees without either movement of the pelvis or soft-tissue resistance. Tightness of the short adductors is indicative of a possible hip-joint lesion. A Flexed knee position tests the length of the short while a straight leg will test the length of the long adductor muscles.
TFL-adduct the horizontal thigh until the pelvis moves. There should be 15-20 degrees of adduction.
Ilio-Tibial-Band (ITB)- A groove visible on the lateral aspect of the thigh indicates a tightness of the ITB. This is confirmed by restricted passive extension/adduction of the thigh with the knee flexed at 90 degrees.

Further information from the same position:

When the thigh does not rest horizontally when held in the midline (adduction/abduction), extend the knee and observe what additional range of hip extension is available when the Rectus Femoris has been taken off-stretch position.
Abduct the thigh and observe what additional hip extension is possible when the TFL is off its stretch position. In this position any residual lack of extension from the horizontal position is likely to be from the Iliopsoas muscle.

Note: it is not possible to eliminate the influence of any shortening of the joint-capsule in this position.

When testing the hamstrings have the patient in a supine position with the other leg flexed, as a tight Iliopsoas will cause an anterior tilt the pelvis. It makes more sense to regard the hamstrings as feeling tight due to the anterior pelvic position than being shortened. I personally prescribe more strengthening exercises than stretches for the hamstrings in this syndrome.

3- Movement patterns to evaluate: Janda recommended 6 patterns, out of which two play a major role in the pelvic cross syndrome. The relevance of inhibited or weak muscles is not in their lack of maximum strength capacity, but mainly in the onset of activation during movement.

Hip Extension Test: Hip extension is the most important and affected part of the gait cycle. The patent lays supine with the feet off the end of the table, and is instructed to slowly lift the leg off the table. The practitioner observes the different muscles regarding timing and quality of activation. Hamstrings can initiate the movement, but Gluteus Maximus closely follows. The Order of activation should be 1-Hamstrings, 2-Gluteus, 3-contra-lateral lumbar extensors, 4-ipsi-lateral lumbar extensors, 5-contra-lateral Thoraco-lumbar extensors, 6- ipsi-lateral Thoraco-lumbar extensors. The activation does not have to follow the entire chain, but it is important that it follows the correct sequence. Activation of the lumbar extensors prior to Gluteus, activation of the ipsi-lateral lumbar extensors before the contra-lateral part, or a too early activation of the Thoraco-lumbar region indicates muscle inhibitions and stabilization issues. In severe cases the Thoraco-lumbar extensors as well as neck muscles are recruited to initiate the movement. Faulty patterns most often create an anterior pelvic tilt and a hyper-lordosis of the lower lumbar spine.

Hip Abduction Test- Testing for inhibition of the Gluteus Medius and Minimus. Approximately 85% of the gait cycle is spent in a one leg stance. Inhibition of the Gluteal muscles creates poor lateral stabilization which results in a walk with increased pelvic sway with the use of ligaments and TFL for lateral stabilization. Place the patient on the side with the bottom leg flexed. The patient is instructed to slowly lift the top leg off the table. There should be approximately 20 degrees of straight hip abduction without any flexion, hip elevation or trunk rotation. Flexion of the hip indicates TFL tightness. A hip elevation (hike) indicates that QL has been recruited as a prime mover instead of its normal stabilization function.

The treatment protocol for a Pelvic Cross Syndrome:

Normalize joint function – Dysfunction of the S/I joint will inhibit Gluteal function.
Lengthen tight muscles (Rectus Femoris, iliopsoas, TFL, back extensors).
Activate/facilitate inhibited and weakened muscles- using small contractions (30%). Patient is instructed to maintain a controlled position while light load is added. Additional facilitation can be added by stroking or tapping the targeted muscle.
Gradually integrate the facilitated muscle back into basic movement patterns
Progress the movement patterns- Pay close attention to ideal muscle recruitment and do not exceed what can be performed using correct muscle activation.
Progress patterns using parameters of speed and load.

Point 6 is often introduced too early since a common belief is that the muscles are weak and just need strengthening. Proper activation has to be achieved before strength training can occur and no training should exceed what can be achieved with ideal movement patterns.

Mobilization of a tight Thoraco-lumbar region when a Pelvic cross syndrome is present often takes compensatory stabilization away and the patient may get worse. Mobilizing the compensatory stabilization segments is not recommended until the muscles are balanced.

Hip Flexor Stretch

Rectus Femoris Stretch

Gluteus Activation

Glute-bridge

Glute Excercise!

Glute-excercise: with the hands supported, stand on one leg with the oposite leg elevated behind the body. Sit back and stretch the elevated leg backwards. Make sure that the knee on the supporting leg does not move inwards (valgus collapse) or in front of the foot. Slowly move back and forth over the supporting hip.

What if cars were like us?

Fri, 26 Oct 2012 22:36:12 +1000

Often we see health care and fitness professionals use the car reference to illustrate how well most people look after their cars, while completely neglecting the care and maintenance of themselves.

The comparison between us and cars could be further expanded to illustrate what it would be like if cars were like us.

First of all there would be some very firm basic rules:

Every car would almost be the same, as in a low-budget standard sedan with a small engine and without any frills.
The initial car would have to be kept for life. There would be no possibilities of selling the car and buying another.
Cars would to a large extent be self-repairing. No need for mechanics, the cars would try to fix themselves.

Having the knowledge that the initial car would have to last for the rest of our lives would probably guarantee that most people would look after their cars meticulously.

Cars working like humans would not be all bad if people were prepared to put in some hard work into their cars. An exciting and positive fact is that cars would have the human capacity of Super compensation and SAID.

Super compensation is the ability to adapt and improve to withstand increased demand. This is the fundamental principle behind all training, where there will be a period during which the trained function would have a higher performance than it did prior to the training. In brief terms this means that the more challenge you expose yourself to, the better you will get.

The general idea of training is to challenge the body and then allow it sufficient rest to repair and come back stronger. Regular training can thereby make the body better and better. If not enough rest is allowed or the challenge is too demanding, the body will not be able to repair properly and thereby not improve, and instead show signs of injury (over-training). When the training does not challenge the body or if the rest is far too long, there are no improvements (under-training).

SAID stands for Specific Adaptation to Imposed Demand and describes the specificity of the compensation phenomenon. The SAID principle explains how we only improve in what we specifically expose our bodies to. That is why we don’t get better at running from lifting weights and why running long distance will not improve our sprinting capacity.

How would these two fundamental principles affect the cars?

Sports cars and other high performance vehicles could not be bought but would have to be made through regular hard work. The standard sedan would improve with imposed demand, which means that the more vigorous we drove it the better it would get. Regularly accelerating would make the car faster to take off, and constantly sitting at maximum speed would gradually increase the top speed of the car. Regular firm braking would not wear the brake pads out but instead make them better, and if we wanted to improve the suspension we would just drive on rough roads. Steering, transmission - well actually all other functions of the car- could be improved with regular use. Not all cars could be turned into Ferraris, but all the individual specifications would greatly improve and the looks of the car would be positively affected as well. Once the car had transformed into a high performance vehicle it would have to be continuously exposed to the increased demand otherwise it would slowly start to revert back into a standard low performance car again. Through lack of effort the sports car would disappear again.
Depending upon what car we preferred, the driving strategy would be designed to suit. Some people strive for a sports car while others are more interested in creating a strong and durable vehicle. The more load the car carried or towed, the larger the loading capacity would get. Fuel economy would also be improved with regular use.
If the car was never pushed towards new limits, but just casually driven around aimlessly it would never fulfil it true potential. Without challenges it would remain a standard, low performing vehicle for ever.
The car would also be self-repairing provided it received good nutritious fuel, quality oil and had sufficient, but not too much rest between the work-outs.
Not using the car and having it standing still would make it deteriorate and lose its performance very quickly. The small engine would steadily become weaker until it one day was not even able to propel the car around properly anymore. Apart from the reduced performance, the safety and appearance of the car would also dramatically decline.
Tyres would not wear out from heavy use but only from faulty alignment. Hard use of the tyres, provided they were properly aligned, would only improve the performance.
Most of the car parts could not be replaced, and if deteriorated or broken through neglect or abuse it would still have to keep performing with its reduced capacity. Some parts like tyres and exhaust systems could occasionally be repaired or replaced by a car-surgeon, but would doubtfully ever perform to the original capacity again, and if replaced the new part would not be self-repairing.
The cars computer (brain) could become stressed and tensed, leading to a tendency to idle at too high revs and being jerky and unreliable when driving, as well as frequently blowing fuses.
Bad fuel would clog up the engine and could cause clots to develop in the fuel lines blocking the passage of fuel to the engine. The unhealthy fuel would also turn the car into a heavier vehicle, but with the same low performing engine. A heavy low performance car would struggle driving up-hills and would also be very slow and uncomfortable. Bad fuel would not only make the car heavier, it would also make it bigger and bulkier on the outside without any extra space for the passengers on the inside. The big cars could even get too big for garages and parking spaces.

Summary: How you treat the car would determine whether you are going to end up with a vintage sports car or an old rust bucket.

It is very surprising that so many people allow themselves to be a low performing or sometimes even non-performing “rust bucket”, when we all have the ability of being so much better with regular exercise and good quality food.

Finishing this post off with an interesting MRI study, showing the effect of regular exercise in preserving muscle mass in masters Athletes.

Seeing the muscles of the 70 year old athlete makes me even more determined to never give the training up.

The whole study can be found here > .

GORD Treatment without drugs

Sun, 23 Sep 2012 17:30:00 +1000

During the recent DNS-Advanced course in Prague I was fortunate to once again participate in a lecture about Viscero-Vertebral patterns held by Petr Bitnar. Petr is not only a great and very entertaining lecturer he is also a renowned researcher. Petr Bitnar together with Pavel Kolar et al (1) has studied the effect of proper diaphragm activation in treatment of GORD/GERD. (Depending upon the spelling of the Structure-oesophagus or esophagus- the condition is called GORD or GERD).

GORD Gastro-Oesophageal-Reflux-Disease (GERD- Esophageal)

The oesophagus is the tube that connects the throat to the stomach. Food is pushed down the oesophagus by a series of muscle contractions. Gastro-Oesophageal reflux means the return, or reflux, of the stomach’s content back up into the oesophagus, which can eventually damage the oesophagus as it ends up being regularly bathed in stomach acid. This is a very common condition, as it is now estimated that 15-20% of the adult population regularly experience symptoms of gastro-oesophageal reflux. When the condition takes on a chronic prevalence it is referred to as GORD. The severity of symptoms can vary from person to person and may include bleeding of the oesophagus, vomiting of blood, respiratory symptoms of wheezing and coughs, and Barrett’s oesophagus where there is an increased risk of cancer due to a change in the cells lining the oesophagus.

Traditional treatment of GORD includes life-style changes like weight-loss, reducing food serving sizes, avoidance of certain foods and alcohol, and the use of antacid medication. In some cases surgery is performed that is aimed at tightening the junction between the oesophagus and the stomach to reduce the amount of acid that enters the oesophagus.

And now for a completely drug-free solution-

An alternative method for the treatment of GORD

The diaphragm is not only the main respiratory muscle and a crucial part of the stabilizing system of the spine, it also fulfils a lesser known function as an external lower oesophageal sphincter.

Dysfunctional diaphragm activation opens the lower oesophageal sphincter during inspiration. Petr Bitnar showed a video taken during gastroscopy that clearly demonstrated the difference in sphincter activity between proper abdominal breathing compared to dysfunctional chest breathing. The video showed that during ideal diaphragm activity the sphincter remained closed, preventing the stomach contents from re-entering the oesophagus. However, during dysfunctional breathing, the oesophageal sphincter was clearly shown to open up widely, thereby allowing the stomach contents a passage back up into the oesophagus.

Dysfunctional breathing-open LES

In the study by Bitnar and Kolar(1) it was indicated that there was a significant impairment of respiratory muscle strength (especially of the diaphragm) in GORD patients. A decrease in pressure at the oesophageal sphincter during maximal inspiratory pressure was observed in patients with dysfunctional breathing patterns. There was also recorded an impaired diaphragm activity and defective breathing pattern during normal respiration by Manometric examination. Conversely, the majority of the dysfunctional findings were normalized during the facilitation of correct abdominal breathing. Additionally, the activation of proper diaphragm contraction was also shown to stimulate an increased contraction of the smooth muscles around the lower oesophagus. The conclusion of this study was that diaphragm dysfunction is evident in GORD patients.

Links to DNS study:

http://www.rehabps.com/REHABILITATION/Literature_Research_files/Bittnar%20GER_2_1.pdf

http://www.rehabps.com/REHABILITATION/Poster_GR.html

http://www.rehabps.com/REHABILITATION/Literature_Research_files/Bitnar%20LES_GER.jpg

Petr Bitnar further described some postural situations which limit the diaphragm’s ability to contract properly, thereby reducing the sphincter function. There are a group of people with the tendency to tighten the abdominal wall in an attempt to appear slimmer (the hour-glass posture), as well as another group with a large stomach which causes elevation of the chest and anterior tilting of the pelvis, thereby forcing the diaphragm into an oblique dysfunctional angle (the open scissors syndrome). Too tight clothing or belts may also restrict the diaphragm’s ability to contract properly.

A study performed by Austrian researchers (2) showed that practising proper diaphragm breathing for 30 minutes a day for four weeks reduced the acid exposure in the oesophagus and thereby relieved the symptoms of GORD. A follow up after 9 months revealed that those who continued with the exercises had a significant reduction of the symptoms of GORD.

Other studies have shown that:

The increase of pressure in the sphincter area during inspiration in cats was caused primarily by diaphragm contraction (3).
Mittal and colleagues (4) demonstrated on humans that the increased pressure round the LES (lower esophageal sphincter) is directly proportional to the force of diaphragmatic contractions.
Contraction of the diaphragm in maneuvers to create an increased Intra-Abdominal Pressure was demonstrated to activate the pressure in the lower esophageal sphincter (5).

Summary: The cause of GORD (or acid reflux) is primarily a mechanical imbalance, not a chemical one. The symptoms are not from an excess of stomach acid but from the fact that acid is able to pass back up through the lower Oesophageal sphincter - which is controlled by the diaphragm. A properly functioning diaphragm keeps the acid in the stomach.

Instead of regularly taking antacids, correct the breathing pattern and the acid-reflux will doubtless improve, and may well disappear.

To briefly recap previous posts regarding diaphragm function and testing

Assessment of Diaphragm function: (chest breathing is dysfunctional)

Is there a sideways expansion of the lower ribcage (or is it moving up) when breathing in?
Is there an expansion of the entire abdominal wall when breathing in?

Breathing exercises:

Practise expanding the lower ribcage when breathing in
Try to fill the entire abdomen when breathing in- front, sides, back and all the way down to the lower abdominal cavity.
Correct the position of the ribcage which has been shown to aid proper diaphragm activation (see previous posts about Zone of Apposition).
Practise every day- many times a day

References:

Bitnar P, Smejkal M, Dolina J, Kriz J, Kolar P, Soska J, Sulc J. Diaphragm function in GERD patients: PET assessment with extended esophageal manometry.
Eherer AJ, et al. Positive effect of abdominal breathing exercises on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroentereol. 2011 Dec 6 (Epub ahead of print)
Boyle JT, Altschuler SM, Nixon TE, Tuchman DN, Pack Al, Cohen S. Role of the diaphragm in the genesis of lower esophageal sphincter pressure in the cat. Gastroenterology 1985;88:723-730
Mittal RK, Rochester DF, McCallum RW. Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction. J Clin Invest 1988:81:1182-1189
Mittal RK, Rochester DF, McCallum RW. Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans. Am J Physiol 1989;256: 139-144

DNS - Advanced Course-Prague 2012

Wed, 12 Sep 2012 13:00:00 +1000

In the beginning of this month I had the pleasure of once again travelling to beautiful Prague in the Czech Republic for an Advanced DNS Course called “Latest concepts in DNS and Skills Review”.

Topics covered in the course were:

Functional assessment and treatment of vertigo and balance disturbances.
Viscero-Vertebral patterns (separate blog about GORD treatment to follow)
The importance of eccentric contraction for stabilization
Orthopaedic evaluations of hip and spinal conditions
DNS assessment and treatment of babies with central coordination disturbance
Functional assessment and treatment of neurological conditions like stroke, myopathy & Parkinson’s

The group also got to spend a full day at Pavel Kolar’s new amazing Rehabilitation Centre, where the program concentrated on DNS strategies for Performance enhancement of athletes, and DNS principles for resistance exercises. The Centre is equipped with “David” machines which offer great possibilities for adjusting vectors, range of movement and resistance to specifically suit each person. An individual’s range of movement and strength can also be accurately measured and displayed for immediate feed-back and evaluation.

Follow the link to Pavel’s Rehab centre - Centrum Pohybove’ Mediciny

Or read the PDF

In addition to the comprehensive “David” range of equipment, the centre harbours a 3D core-strengthening device called the “Space Curl”. The movement in the machine is controlled by the activity of the muscles of the participant’s midsection and provides a great core workout.

My session in the space-curl was filmed and can be found following this link:
Youtube - Hans on space curl

As always I enjoyed the course and am really looking forward to the next time I can join Pavel and his DNS team at these fabulous facilities.

Movement Fluency

Fri, 10 Aug 2012 21:59:59 +1000

A few years ago I read an article that so nicely described the concept of functional movements, I took it to heart and have often used it as my method of explaining functional movement when lecturing.

Last weekend I ran a course and again used this way of describing functional movement – I have therefore decided to write a short blog to give full credit to the original article. The article is called- Movement Fluency and was posted by Todd Hargrove:

http://www.bettermovement.org/2008/movement-fluency/

This is the version I often find myself using when describing movement fluency in the form of a new language:

Learning a new skill or participating in a sport is similar to learning a new language, with every function required representing a separate word. Hip, thoracic, and ankle mobility are all different words, and so are scapular stability, proper breathing and gluteal activation. Every functional movement represents a different word, and how well the individual will speak the language of the new movement depends upon how many different words are mastered. Insufficient stabilization or reduced mobility creates spelling mistakes of those known words. Sentences in the new language can be compared with “Functional Movement Patterns” like a squat, lunge or hip hinge, which are all built by the appropriate words (movements). For the language to be fluent allowing the individual to actively participate in more advanced situations there has to be a large number of words (movement vocabulary) that are all being spelt correctly.

Say we move to a new country. We would get away with a limited survival vocabulary as long as we don’t expect too much. Staying at home, reading books from our old-country, making our way to the shops for simpler things and maybe even holding up a simple job could be possible. Similarly people who do almost no physical activities can manage their lives with insufficient movement patterns.

On the other hand, if we intend to maximize our experience in the foreign country we’d better improve our language skills. Participation socially, more advanced work situations, reading and watching media in the new language all require a much greater vocabulary. In the same way, as soon as we intend to be more active and participate in new activities, we need to improve our movement repertoire. As soon as we get into situations which reach beyond the limitations of our language skills, the risk for injury or embarrassing misunderstanding becomes evident.

Practicing the same words over and over again is not going to improve our language vocabulary and equally to improve our movement fluency we need to work on new patterns and skills. A functional movement screen can be equalled with a simple language test which will give good indications of where the existing limitations are. What words are missing and how well are the others spelt? Practising what we are bad at will therefore give the most dramatic improvement. Every new word we learn to master can thereafter be used in many different sentences and greatly improve our overall language skills.

Most children have all the words in the movement language, but unfortunately as we age we tend to lose many of them. The words are often still stored deep within our brains and we just need to recover them again. Once we have recovered all the words we will be fluent again and can manage most situations without getting injured.

So called “Functional Training” systems often expect the participant to make sentences without having learnt the words. There is no point trying to improve language skills by repeating the same basic vocabulary with many spelling or grammatical mistakes over and over again, and expect any improvements. Pronunciation and spelling should be practised separately until mastered and become automatic.

First of all we have to establish that there are no “functional exercises”. There are functional people with functional movement patterns that can perform activities and exercises in a functional way, but there are also a lot of people with dysfunctional movement patterns who when performing the same exercises turn it into “DYSFUNCTIONAL TRAINING”.

There is no point starting the language of eg Cross-fit and Boot-Camp without first learning the words involved. They are effective but very advanced forms of training that require a greater vocabulary than most individuals possess. We cannot make the sentence of squatting without knowing the properly spelt words of ankle, knee, hip, pelvis, gluteal, lumbar, thoracic, core, scapula, and neck stability and mobility.

Get functional by practicing the words in the language of functional movement!

Wollongong Course

Tue, 31 Jul 2012 15:01:48 +1000

On the weekend of 28/29 July I travelled to the Fig Tree Physiotherapy Clinic in Wollongong NSW, and delivered a 2 day course entitled “Core Stabilization from the inside-out” to a participant group which comprised Physiotherapists, Osteopaths and Exercise Physiologists.

The Fig Tree Physiotherapy Clinic was an excellent location to hold the course – great equipment and set-up which made delivering the course and carrying out the practicals so much easier.

The course covered functional stabilisation for rehabilitation and sports performance, with the morning of Day 1 consisting of an explanation of the diaphragm’s role in core stabilization, followed by testing and activation procedures for functional diaphragm activity. The afternoon was then dedicated to functional core training progressions.

On the morning of Day 2 we began with neck and shoulder testing and then practiced their activation and training, with the afternoon session covering the lower back, hips and lower extremities.

The group members were very knowledgeable and great to work with, and they showed a real interest and aptitude in the practicals.

As an added bonus, they also provided some very interesting dysfunctional scapular and hip stabilization patterns for me to work on.

I really enjoyed delivering this course and would like to thank everyone involved in its organisation, particularly Andrew D'Ath-Weston - thanks very much Andrew!

The participants gave me great feedback - below are some comments received at the end of the course:

“I loved the course. It will change the way I think of movement and core-training”
“Great concept, I enjoyed how it challenged things learnt at Physio School”
“Thank you, it was a fantastic course, and I really enjoyed the weekend”
“The course was fantastic, with plenty of practical strategies for assessing and creating stabilisation for function and performance”
“Very interesting stuff! I couldn’t recommend the course highly enough. Great tools for movement change”
“I really enjoyed the course and I got tonnes out of it and would be willing to fly to Brisbane for further coaching”
“Wonderful interesting course with a lot of depth and an original approach”
“I really enjoyed the course and thought the info was beneficial. It is something we can practice and better ourselves with”
“I thoroughly enjoyed the course. It gave me knowledge and practical skills that I can incorporate into treating clients straight away. I would definitively recommend the course to other practitioners"

Diaphragm Control Switch

Tue, 24 Jul 2012 14:30:00 +1000

Adjustable levels of Core control

Core stabilization is generated by proper activation of the diaphragm, but it is not as simple as just breathing. Controlling the diaphragm’s dual functions and adjusting its activity levels accurately requires practice. Take charge of your “Diaphragm Control Switch”.

Let’s recap some information from Pavel Kolar’s diaphragm MRI studies:

The diaphragm is under voluntary control
The diaphragm has dual functions of respiration and stabilization
The diaphragm can perform its stabilization function independent of respiration
The diaphragm can simultaneously perform both the respiratory and stabilization tasks.
The diaphragm performs its respiratory function in a lowered position when increased stabilization is required.

The secret of core-stabilization is to activate and control the diaphragm’s dual functions and then adjust the level of activity depending upon the required task.

I’d like to illustrate this graded activity by the use of a “Diaphragm Control Switch”.

Level 0-2 Represents dysfunctional diaphragm activation where not only insufficient spinal stabilization is provided, but the respiration is also impaired. It has been shown that Paradoxical breathing (chest breathing) does not create a full expansion of the lower parts of the lungs, which greatly reduces oxygenation.

Level 3 – Marks maximal respiratory function of the diaphragm with only a small stabilization activity. This is the level where people should spend the majority of their time. Breathing is greatly improved compared to the dysfunctional levels , and the stabilizing function of the diaphragm is at their disposal. To instantly increase stabilization the only thing required is to voluntarily push the diaphragm downwards while still maintaining the breathing function. An athlete might play a sport at Diaphragm level 3 and push the diaphragm down to level 7 when extra stability (eg going in for a big tackle) is necessary. The breathing function is slightly impaired at this lowered position.

Level 10- Representing the maximum contraction of the diaphragm, at Level 10 the respiratory function is greatly sacrificed and the stabilization function is at maximum capacity. This where power-lifters take a deep breath in and push very hard against every section of the lifting belt when performing a maximum lift. When breathing out again the stabilizing function diminishes slightly.

Every activity has different breathing and stabilization demands and the diaphragm function has to be adjusted accordingly. Core stabilization from the inside out requires proper activation of the diaphragm’s dual functions and they should therefore be practised until it becomes automatic. Time is much better spent activating the diaphragm functions than performing core exercises without core control. Once the diaphragm functions are properly activated the individual can take charge of the “Diaphragm Control switch” and adjust it as required.

Craig Liebenson – Summer Training/ Boot Camp for Athletic Development

Tue, 19 Jun 2012 15:23:11 +1000

During my visit to Los Angeles last week I was able to catch up with Craig Liebenson and observe the start of his Summer Camp program.

Hans & Craig Liebenson

The Craig Liebenson Summer Boot Camp is a 7 week long program aimed at improving sports performance and preventing injuries in young baseball players.

The first week of the program consisted of two sessions of functional testing at Craig’s centre in Los Angeles- L.A. Sports and Spine, where each player’s core stabilization was assessed on the first day, and the following day they were evaluated for shoulder stabilization.

The third and final day of the week we spent at Santa Monica College Tracks testing and training for speed and agility.

For a complete description of the program click here.

Craig has been leading the way in functional rehabilitation for many years now and this concept is another step in a direction other practitioners interested in sports performance and functional rehabilitation would benefit from following. I am convinced that the young players participating in this program will perform better with a reduced risk of getting injured when next season commences.

Hans with Craig Liebenson and the coaching staff at the Santa Monica College Tracks

Guest Blog Mike Reinold

Sun, 18 Mar 2012 22:19:13 +1000

Last week I had a guest blog posted on one of my favourite Rehabilitation and sports performance websites, and the response has been very encouraging.

I am very thankful for Mike giving me this opportunity,

Read the post on:

http://www.mikereinold.com/2012/03/core-stability-from-the-inside-out.html

DNS- Advanced Course-Sydney 2012

Sun, 18 Mar 2012 22:12:32 +1000

DNS Advanced courses are held regularly to highlight updates to the DNS programme and further sharpen the skills of those who are certified Practitioners. I attended my third “Advanced Course” in Sydney in February 2012, and it was great as usual. It is very obvious to me that DNS just gets more and more interesting and enjoyable the more we learn.

Pavel Kolar, Hans Lindgren and Alena Kobesova

Here are some short high-lights from the course:

We assessed athlete’s movement patterns frame by frame from a video to clearly see the dysfunctional movement and stabilization patterns.
The group looked at the timing of movements - which is important, but often neglected. Lack of proper relaxation is often a main issue. Many individuals are using far too much muscle activity, and muscles meant for phasic activity are incorrectly involved in stabilization. There is too much concentric and not enough eccentric muscle activity in many of our movement patterns.
Many individuals are wrongly stabilizing the shoulder-blade using Latissimus Dorsi instead of Serratus Anterior.
We were introduced to the concept of “Postural Tai-Chi”, where each sport and also every individual can have their own Tai-Chi program specifically created. The program is designed according to the movement requirement of each sporting activity and to correct each individual’s impaired stabilization patterns. The programs are to be practised over and over again back and forth in a slow and controlled manner.
Pavel demonstrated some new exercises in higher positions for activation of proper stabilization of the girdle joints, where the proximal joint socket is moved on top of a stable distal bone.
One session covered the early orthopaedic and neurological signs and the treatment of scoliosis, spondylosis /spondylolisthesis, and the different conditions of the hip-joint.
We summarised the neurology involved in Gnostic functions, Somatognosis, Proprioception and looked at effects of sensory integration and motor-control.

The further I go into the DNS program the more convinced I am that this is the future of Rehabilitation and Sports-Performance. I would therefore recommend any Chiropractor and Physiotherapist who is seriously interested in functional rehabilitation to register for a DNS course.

I am already looking forward to Advanced Course number 4 in Prague on September 6-9, 2012.

Do you have to be fat to be strong?

Sat, 10 Mar 2012 22:09:21 +1000

I have competed in Natural Body-building for quite a few years now, but this year I have decided to see what I can achieve in Drug-free Power-lifting instead. My training has changed to some extent to be more strength based, and I’ve added some extra exercises that will help me in the lifts. I have been researching the lifting techniques and in doing so I have come across a lot of information basically saying that you have to eat big to lift big. One of the first questions I would like to answer for myself is why so many power-lifters carry extra useless weight (are fat), and if there is an actual advantage or is it just an excuse to indulge? Coming from a body-building background I know that I will lose strength at the end of competition preparation, when body-fat is unhealthily low. I feel really strong and healthy around 10% body fat, so why would you then have to look like a pregnant man to lift heavy?

I have decided to perform my own little experiment:

Back-ground information on my Powerlifting plan:

As I’m 53 years old I will compete in the M3 division (50-54)
I feel my best just over 90Kg (90-92) so I have decided to compete in the 100Kg class (90-99.9Kg) (In body-building I usually compete at around 85-86Kg). My weight at the Powerlifting Novice Qualifier (5th Feb 2012) was 99.5Kg, and I actually had to take my shoes off at the weigh-in to even make my class.
I intend to go on a slow diet to get rid of unnecessary fat (I don’t like being this fat!) until my strength gets affected. I personally think I can reach 90-92Kg without losing any strength. The Australian Championships are on July 19^th so there is plenty of time to get ready.

I cannot see the advantage of the extra fat. We cannot flex the fat and in both dead-lift and squat the legs have to lift the fat around the waist as well, and I would rather have an extra 10Kg on the bar instead.

In Power-lifting, the lifts (squat, bench and dead-lift) are added together to make a total figure. In my case I am aiming for 180+150+220Kg which will give a total of 550Kg. A formula is then used so that the total gets multiplied with a number according to your body weight. The heavier you are the smaller the number is. For example if I would weigh in at 99Kg my total gets multiplied by 0.5565 which gives a total of 306.1Kg, but if I weigh in at 90Kg it gets multiplied by 0.5853 which gives a total of 321.9Kg. This means that if I can lift the same amount at 90Kg as I would at 99Kg the total weight would automatically be 15.8Kg better. Lose 8-9Kg which makes me feel (and look) much better and I would be more competitive at the same time…. Hmmmm, let me think about that!

These extra 8-9Kg I have been walking around with for a little while now actually interfere with my mobility and I can feel that it is even changing my posture. There is no wonder that people with big stomachs have sore backs!

For me it seems so obvious that a Power-lifter who competes in weight-classes, where you get penalised for every extra kilo you carry, would benefit from coming in as light as possible without losing strength.

The question I will answer to myself over the next couple of months is how fat do I really have to be, to be as strong as I can. There must be an optimal power-lifting weight, and I intend to work mine out.

Proprioception- The sixth sense

Sun, 29 Jan 2012 19:03:08 +1000

We have for a long time been taught that humans have the five senses of vision, hearing, taste, smell and touch. Aristotle (384-322 BC) is credited with this traditional classification.

Researchers are now stating that there are many more senses and some claim that it might be as many as 20 different senses. At the moment I would like to just add one more…the sixth sense, which is not about seeing and talking to dead people as in the movie.

The sixth sense is the sense of proprioception!

Out of all our senses the sense of proprioception is probably the one that has the greatest influence on the approach we chose and the results we achieve when training and rehabilitating individuals.

Proprioception (Latin meaning “one’s own” “sense”): provides sensory information about joint angle, muscle length and tension which is integrated in the brain to give information about the position of our bodies. This sense makes it possible to scratch your nose, change gears in the car and touch-type without looking. In a completely dark room proprioception let us know the position of our joints without having to turn the light on. Proprioception is achieved via a system of sensory receptors including Golgi-Tendons (muscle tension) and Muscle-spindles (muscle length).

Proprioception allows us to learn new motor skills, it is a key component in muscle memory and hand-eye coordination and training can vastly improve this sense.

To ensure movements are fast, precise and co-ordinated the nervous system must constantly receive sensory information to be able to adjust and correct movements. The nervous system achieves this mainly through the cerebellum, which receives sensory information about positions of the joints and body from the proprioceptors.

It is a common mistake to assume that everybody has the same level of proprioceptive ability.

Disordered sensory integration and motor learning

There are many names describing dysfunctions of integration of the sensory and motor systems: Motor skills disorder, Movement Clumsiness, Developmental Dyspraxia, Poorly Coordinated, Minimal Brain Dysfunction, Physical Awkwardness, Sensory Integration Dysfunction, and Developmental Coordination Disorder. The World Health Organisation currently list Developmental Dyspraxia as “Specific Developmental Disorder of Motor Function”.

Epidemiology: In the USA 4-6% of children at school age struggle with motor difficulties to the degree that it causes concern to them and those around them. In 1998 Kadesjö and Gillberg found that motor coordination disorder frequently coexisted with poor attention span and concentration in about 6% of children. A study in Singapore showed that 4% of children in the ages 6-9yrs had motor coordination difficulties. Conservative estimates suggest that 5% of children have sensory-motor dysfunctions worldwide and an additional 10% may have a minor form of the problem.

In 1996 Fox and Lent found that in contrast to the common belief that children grow out of these difficulties, they tend to linger without intervention. Early intervention is beneficial while the brain is changing dramatically during the first year of life and new connections and abilities are acquired. Delayed milestones (crawling, sitting, and walking), asymmetrical development, and regression of motor skills are signs of possible dysfunctions developing.

Dysfunctions may affect:

Muscle tone- hypotonic ( floppy) or hypertonic (stiff robot like)
Gross motor skills- posture, walking, running and jumping
Fine motor skills- movement of small joints and muscles.
Muscle strength – either weak or too brusque in their movements
Motor planning- sequencing and speed of movement. Coordination of movements.

Signs of sensory/motor dysfunctions vary from person to person and can include:

Poor balance
Poor timing of movements
Difficulty combining movements into a controlled sequence
Difficulty remembering the next movement in a sequence
Problem with proprioception – spatial body awareness
Problems picking up or holding objects due to poor muscle tone and/or proprioception
Clumsy- knocking things over or bumping in to people accidentally.
Difficulty determining left from right
Trouble determining distances between themselves and other objects
Inability to relax
Inability to isolate movements
Difficulty repeating movements
Low muscle strength and endurance
Over sensitive to touch, light, sound and other sensory inputs.
Difficulties with postural stability
Difficulty grading movement and knowing how much pressure is needed.

Training and Proprioception -

Training can improve the proprioceptive system. It is important to assess the individual’s proprioceptive ability and motor control skills prior to structuring an exercise plan. Their ability will affect how quickly the individual will be able to change faulty patterns and improve the control of the different exercises. Good control will allow the person to follow your instructions better, and they will be able to feel the difference between right and wrong. Individuals with poor control will be very slow in adapting and they require a lot more instructions and supervision. Some people cannot feel what position they are in and have very little ability to perform isolated movements of specific joints.

Testing of proprioceptive system (and overlapping senses):

Observation of muscle tone in sitting and standing gives clues of the ability to sustain a position against gravity
Motor sequencing- touching the thumb against the other fingers of the hand in sequence one after the other at a certain speed. Observe the errors in sequence and examine both hands. When attempting fine motor skills, affected individuals often show signs like grimacing or sticking the tongue out.
Nose-finger test to evaluate proprioception and fine motor coordination.
Moving a limb against resistance to evaluate strength. Also look for additional movement to evaluate the ability to isolate (stabilize) a joint.
Sustained testing- evaluate energy consumption in a movement. Some individuals will quickly fatigue and are unable to maintain energy wasting activities. Fatigue often affects proprioception.
Isolated movement- single joint and eye movement can easily be evaluated.
The ability to relax- examiner holds the individuals arm, instructs them to fully relax and lets go of the arm. If able to relax the arm should drop down.
Ability to detect an externally imposed passive movement. Assess whether the individual can detect passive movements of a joint with their eyes closed.
Ability to re-position a joint to a predetermined position.

Once the proprioceptive ability has been evaluated a program can be designed. Proprioceptive difficulties should be addressed immediately. Perfect form, good range of movement and adequate stabilization are all dependent upon proprioception. Working on specific stabilization patterns and isolated joint movements are good home exercises for patient and trainees. Proprioceptive awareness has to be trained very frequently to vastly improve.

When instructing an exercise program it is important to:

Aim for perfect quality of movements- poor form will not improve automatically instead we develop a fixed dysfunctional pattern.
Start with slow precise movements without loading
Focus on the movement
Use mirrors to demonstrate and monitor correct movements
Perform the movements with closed eyes – feel the movement
Be able to distinguish right from wrong in movements- “Show me right, show me wrong”
Remember that the sensory and muscular systems are trained simultaneously- brain training
Never exceed the loading the stabilization system can manage.
Train the same movement in different postural positions

When first learning an exercise the movement is often slow, stiff and easily disrupted. With practice the execution becomes smoother and almost automatic. This process is often referred to as muscle memory and motor-learning. Evidence has shown that increases in strength occur well before muscle hypertrophy does. Strength training enhances proprioception and motor-neuron excitability which improves communication between the nervous system and the muscles themselves. This confirms that muscle strength is initially influenced by the inner neural circuitry, rather than by physiological changes in the muscle size.

The Core should be firm...but flexible

Wed, 18 Jan 2012 18:57:29 +1000

Bracing of the abdominals is being promoted as the optimal core concept. Bracing involves tensing the abdominal muscles as if preparing for being punched in the stomach. The idea is to learn to tense all the muscles around the abdominal cavity to prevent movement of the lumbar spine. Apart from the abdominals the back and Gluteal muscles are also recruited to create a state of “Super-stiffness”.

Abdominal bracing and Super-stiffness and are not functional patterns because:

A too early or too forceful contraction of the abdominal wall prevents the diaphragm from descending into the abdominal cavity when contracting and is therefore counterproductive to proper core stabilization.
Most athletes have to be very mobile and flexible yet be able to support their spine. Looking at these different examples it is hard to imagine them performing their sport well with a stiff braced midsection.

Functional core stabilization has to allow for fast and smooth movements when required and yet provide increased stability when necessary.

Proper functional core stabilization is provided by a functional diaphragm contraction. Learning to control the breathing pattern is crucial for core stabilization from the inside out.

Facts about the diaphragm:

The diaphragm is under voluntary control.
The diaphragm can perform its stabilization task independent of breathing
The diaphragm can perform its breathing function at a lowered position to be able to provide spinal support while still breathing
The diaphragm does not work as one homogenous muscle, but has in reality four different parts that can contract independently of each other.
The position of the diaphragm determines the quality of its contraction.

Proper core stabilization is achieved by a functional diaphragm contraction working against an eccentric contraction of the abdominal wall and the pelvic floor. This creates an increased intra-abdominal pressure which supports the lumbar spine from the front.

The core stabilization created by an increased intra-abdominal pressure can be described like a firm plasticine ball, which is firm but flexible to allow for movements.

Pavel Kolar’s DNS program uses a flexible ball description which well illustrates a flexible core.

Core stabilization is not a maximal muscle contraction of the abdominal wall but an increased pressure created from the inside through the diaphragm.

Imagine a dial where 0 represents no core stabilization and 3 would be the level of small yet sufficient stabilization provided by proper diaphragm function. At level 3 movements would be un-restricted, but the system is fully activated so whenever required, like in the second before taking a big tackle, an increased contraction of the diaphragm would allow the core-stabilization to increase in a snap. Maximum contraction would minimize the mobility but is necessary when optimal stabilization is called for example during a heavy lift.

Intra-Abdominal Pressure

Fri, 06 Jan 2012 18:53:41 +1000

The Air Bag versus Guy Wires

Most people are not aware that sufficient intra-abdominal pressure is crucial for good core-stabilization. Core-stabilization from the inside out is driven by proper activation of the diaphragm.

Many core stabilization methods are based on the theory of bracing the muscles around the lower part of the trunk to minimize movement of the lumbar spine. Bracing the core involves tensing the abdominal muscles as if to prepare for being punched in the stomach.

The bracing method has been explained in a way that the muscles act as guy-wires on a mast stabilizing the spine.

The bracing method has some obvious limitations. First of all it has been found to increase the compressive loading on the spine. The harder the muscles are braced, the higher the compression on the spine. The mast of the sailing boat would be exposed to the same forces. The tighter the guywires are the more stable the mast would be, but at a price of increased compressive loading.

The diaphragm-driven core stability from the inside out produces an increased intra-abdominal pressure, which works in a similar fashion to an air-bag in a car.

An increased intra-abdominal pressure has been shown to decrease the compressive loading of the spine. Hodges et al showed that by facilitating a diaphragm contraction an extension force was produced in a flexed spine.

It has been shown that it is not flexion, but full flexion of a vertebral unit that causes disc-injuries, and an increased intra-abdominal pressure would stop the spine from being flexed to the end range.

To illustrate this let us look at the simple act of bending a chain. A sharp bend would define the position where a disc injury potentially could occur.

What about if we bend that chain over a fit-ball? The fit-ball represents the ball of support developed by the abdominal content being pushed together by the diaphragm, pelvic floor and an eccentric contraction of the entire abdominal wall. The firmer the pressure of the ball, the less likely it would be that the chain would be subject to a sharp bend at any point.

Another argument against the bracing method is that when performing bird-dog and plank exercises while bracing, it was noticed that a deep breath in actually decreased the stabilization instead of increased as assumed. A deep breath in with proper diaphragm activation will improve stabilization.

The most obvious sign of proper stabilization with a sufficient intra-abdominal pressure is the filling out of the concavities at the lateral lower abdominal wall.

If there are hollows (concavities) present, the pressure is not enough to stabilize the lower section of the spine.

The ability to create sufficient intra-abdominal pressure determines the ability to perform many exercises and other activities. Insufficient intra-abdominal pressure is the reason why the lower back gets rounded at the bottom of a deep squat in some individuals. The protecting intra-abdominal pressure will dictate how deep you can go in a leg-press, and how stable the lumbo-pelvic area would be in a dead-lift.

When it comes to protecting the spine the air-bag beats the guy-wires.

Janda first notes

Wed, 28 Dec 2011 22:12:44 +1000

Role of muscles in musculoskeletal syndromes

Vladimir Janda MD , Dr SC

Functional pathology of the motor system is a term used to describe, in various musculoskeletal syndromes, the pathogenitical importance of the impaired function rather than the structural lesions. An impaired function is often associated with pain, both acute as well as chronic. However, the development may be latent for a long period of time (even years). On the other hand, pain always causes an impaired function. This concept helps to bridge the discrepancy in correlation between symptoms and structural lesions.

To understand the musculoskeletal syndromes, from the functional point of view, three stages of understanding can be differentiated:

Joints and their dysfunction as a cause of pain,
Muscles and muscle-joint correlations as a main cause of the syndrome
Central nervous motor regulation, changes of movement patterns and quality of motor behaviour as a cause of (in particular) chronic pain.

Evaluation of the musculoskeletal system can be divided into two parts:

The actual diagnosis or estimation of a direct pathology/dysfunction which caused the acute pain syndrome. Treatment has often a character of the first aid.
Analysis of factors which may be considered as a presumption for acute decompensation. This analysis is important in particular from the point of view of prevention of recurrences of acute pain episodes or development of chronic pain.

In principle, three types of “pathology” of the motor system can be recognised:

Structural
Functional (hysterical)
Organic, however expressed by impaired function of any part of the motor system. Morphological changes in such a case are negligible or almost negligible and certainly irrelevant.

In motor disturbances, two types of functional impairment are to be considered:

Associated with a structural neurological lesion (alienation of Kenny in acute poliomyelitis, dormant motoneurons of Kabat in upper motor neuron lesions, such as in hemiplegia)
Occurring in morphologically intact nervous part of the system, as it occurs in various musculoskeletal disorders. Most pain syndromes belong to this category and may constitute a special clinical entity. This category includes some injuries, such as unstable ankle joint after a sprain (foot way, Freeman).

Motor system functions as one entity. One of the basic presumptions of our concept is that the motor system functions always as one entity. Any lesion located anywhere is immediately reflected by adaptative responses in the whole motor system. Therefore, a strictly localised lesion of dysfunction does not exist. One of the presumptions of a successful rehabilitation is to slow down the fixation of these adaptive reactions and fixation of impaired movement patterns and pain patterns. The process of development of adaptive responses occurs at all levels of the motor system and is called centralization. These adaptive responses may even prevail and be the source of further decompensation, creating a vicious circle. This is a frequent situation in chronic pain syndromes, in which the original cause of pain can be recognised only with greatest difficulties, if at all.

There are four levels of the motor system at which the adaptive reactions seem to be the most evident:

Cortical/subcortical regulatory centres,
Segmental spinal cord regulation,
Muscles
Joints and adjacent structures.

Regardless at which level the problem starts, the final result is a generalised dysfunction and we speak about the rule of vertical and horizontal generalization.

The muscular level represents perhaps the most exposed and labile part of the motor system. As the main effectors, they must respond quickly to all changes or stimuli coming from the neural structures as well as to changes in the peripheral part, i.e. from the osteoacticular systems and skin and of course from the viscera.

Muscles should not be considered as a homogenous “flash” because all striated muscles are composed from fast and slow twitch fibres. It has to be accepted that in man, different muscles behave in different ways. Although it does not seem to be a histological correlation, clinically two types have to be differentiated: those prone to develop tightness and those prone to develop inhibition and weakness. The changed relationship between these two systems results in a muscle imbalance with typical clinical consequences. Muscles imbalance is therefore considered as a systemic reaction of the muscle system.

The most important signs of impaired muscle function which should be considered in relation to the musculoskeletal disorders are: the increased muscle tone (muscle spasm), muscle imbalance, muscle patterns associated with the joint dysfunction, motor units firing pattern associated with the muscle contraction speed as an important factor to prevent injuries of the joint system.

Increased muscle tone is considered as an important factor in the genesis of pain in the locomotor system. It is believed that a joint dysfunction results into a painful condition only in presence of increased tone in a muscle which is related (anatomically or functionally) to that particular joint. Terminology, pathophysiology and treatment of muscle hypertonicity are vague. From the clinical point of view, however, at least five types of increased muscle tone would be differentiated and this should be taken into consideration in treatment. These different types are: limbic, segmental (spinal cord), uncoordinated contraction resulting in trigger points, pain irritation and muscle tightness, which is associated with altered elasticity and changes of the connective tissue and results into muscle imbalance.

Muscle imbalance is a systemic change of quality of muscle which results into altered biomechanics and is associated with a gradual alteration of movement patterns. Muscle imbalance has to be considered as one of the important factors which perpetuate recurrences and chronic pain syndromes. In short, muscle imbalance can be described as an altered relationship and balance between muscles which are prone to tightness or inhibition.

Muscles with tendency to develop into tightness are: triceps surae, hamstrings, short thigh adductors, hip flexors (iliopsoas, rectus femoris, TFL), piriformis, quadratus lumborum, spinal erectors, pectorals, upper trapezius, levator scapulae, STM, short deep neck extensors.

Muscles with tendency to inhibition: tibialis anterior, vastus medialis, abdominal rectis, lower stabilisers of the scapula (serratus anterior, rhomboids, middle and lower trapezius, deep neck flexors (scalenes)).

The main consequences of imbalance between the two systems are: uneven distribution of pressures on weight-bearing joints as a presumption for dysfunction, pain and later on probably degeneration, decreased ROM and compensatory hypermobility, altered proprioceptive information followed by adaptive regulatory central nervous regulation (reprogramming).

Although muscle imbalance after all involves the whole muscle system, it usually does not involve all muscles to the same extent at the same time but develops gradually. There are two predilection areas where the imbalance starts to develop: the pelvic region resulting into a “pelvis (distal) crossed syndrome” and the shoulder neck region, resulting into a “proximal crossed syndrome”. The pelvic crossed syndrome results into overstress of the L/S junction. The proximal crossed syndrome results into typical changes of posture with overstress of the cervicocranial junction, the C45 and T4. Due to the altered axis of the glenohumeral fossa to the overstress of the shoulder joint.

In addition to these two syndromes there is the later (stratification) syndrome which in principle is a combination of both crossed syndromes. It is a sign of an altered shape of the muscular system due to a long lasting dysfunction and is a sign of a bad prognosis.

Movement patterns and their evaluation is more important than estimation of muscle strength of individual muscles. The importance of inhibited and weakened muscles is not in their individual strength but rather that their activation is less and delayed.

In evaluation of movement patterns, the main concern is paid to timing (sequencing) of firing of muscles and degree of their activity. Muscles which are activated during a particular movement should be considered as synergists for the particular movement as they get activated in a mutual interplay.

There are six basic movement patterns which give quality information about the function of the motor system of the particular subject. These movements are: hip (hyper) extension, hip abduction, curl up from supine, head flexion, push up and shoulder abduction.

Treatment Proposal

The final goal of the therapeutic plan is to achieve the best possible movement patterns as a best possible prevention of recurrences of acute pain episodes.

The treatment proposal can be split into 3 basic steps:

Improvement of function of possibly all peripheral structures which show any kind of dysfunction, regardless whether painful or painless, as any dysfunction has to be considered as a source of impaired proprioceptive information. Based on the concept of motor learning, adequate information is essential to normalize the whole motor regulation.

Improvement of muscle imbalance as a presumption for improvement of the biomechanics. Treatment of tight muscles (stretching) should precede strengthening as tight muscles are not only readily activated but activated even during movements in which they should be silent. Therefore in presence of tight muscles it is impossible to strengthen specifically weakened muscles. This is one of the explanations why – if this rule is ignored – an exercise program fails.

Improvement of central nervous motor control, programming and improvement of motor units firing pattern in an attempt to speed up the muscle contraction and thus to improve the muscular protection of joints to prevent their injury. This in principle can be achieved in three ways, namely by

Increasing of the proprioceptive flow from the periphery to facilitate the efferent motor system
Activating systems which regulate co-ordination, posture and equilibrium (spino-cerebello-vestibular pathways)
Using primitive reflex locomotion (reflex creeping and reflex crawling) and irritation of reflex zones to facilitate in particular deep intrinsic muscles of the spine and thus to improve the stabilization of the spine.

Janda's Approach

Fri, 16 Dec 2011 21:58:14 +1000

This Blog heading is dedicated to Professor Vladimir Janda, who with his functional approach of Rehabilitation has greatly influenced the way I practice as a Chiropractor.

I was fortunate to be trained in these unique methods by Professor Janda himself on three occasions before he passed away in 2002.

I have further received training in the Janda Approach by:

Craig Liebenson
Clayton Skaggs & Susan Green
Joanne Bullock-Saxton
Michaela Veverkova

The first book I bought by Professor Janda, was in 1986 – it was translated from Czech to Swedish and was called “Muskelfunktions diagnostik”

Many practitioners unfortunately missed the opportunity to be taught by professor Janda, and I therefore intend to post small summaries of my lecture notes from the courses by Professor Janda that I attended.

For more information regarding Professor Janda’s approach and opportunities to receive training in these unique and very effective methods click the button below:

I would also strongly recommend anyone interested in the Janda Approach to read a very good book called “Assessment and Treatment of Muscle Imbalance” by Phil Page, Clare C Frank and Robert Lardner. The Book is very well written and explains the Janda Approach nicely.

Rehabilitation of the spine- By Craig Liebenson, is another excellent book that covers a lot of Professor Janda's material.

My boys

Sun, 27 Nov 2011 20:00:11 +1000

I just want to take the opportunity and introduce my boys, who make it possible for me to run this site.

First we have got Mattias:

Mattias Lindgren, Web-developer

Mattias runs a web-design and development study called “Left Right and Centre” here in Brisbane, Australia with his two business partners Matt James and Marc Colette.

Website : http://leftrightandcentre.com.au/

Mattias can be contacted on: 07 3831 8252

We have also got Felix.

Felix Lindgren, graphic design, video and modelling on photos and videos.

Felix is Mattias younger brother and he is responsible for design of the videos and all graphic material.