Lumbar Stabilization: Improving Hip & Thoracic Mobility

  In my last two blogs, I suggested principles of Optimal Movement we could be teaching our patients: •     Fascio-Skeletal Weight Bearing 
 •     Appropriate Distribution of Movement 
 •     Proportional Use of Synergists 
 •     Minimization of Unnecessary Effort 
 I would now like get more specific by talking about the 800 pound gorilla of physical therapy; low back pain. According to that font of all medical wisdom, the internet, low back pain is the third most common reason for a doctor visit in the US. Coming out of PT school in 1983, lumbar stabilization wasn’t even on the radar screen. We stretched the back into flexion (William’s), extension (McKenzie’s), side-bending and rotation, then strengthened the back and belly muscles. The back hurt because it was stiff and weak; it would feel better if it were flexible and strong. A brief perusal of back pain books on Amazon will show that old ideas die hard; the stretch and strengthen paradigm is still alive an

Principles of Optimal Movement II: Appropriate Movement Distribution & Proportional Use of Synergists

The last blog, Principles of Optimal Movement I, introduced the rehabilitation goal of movement optimization. This was defined and its’ importance in rehabilitation was articulated. Four principles of optimal movement were proposed: ·    Fascio-Skeletal Weight-Bearing 
 ·    Minimization of Unnecessary Effort 
 ·    Appropriate Distribution of Movement 
 ·    Proportional Use of Synergists 
 Fascio-skeletal weight-bearing and minimization of unnecessary effort were covered previously; appropriate distribution of movement and proportional use of synergists are the topics of this blog. 
 The emerging rehabilitation principle of regional interdependence is defined as “seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient’s primary report of symptoms.” (See excellent article in J. of Man. & Manip Ther. May 2013; 21(2):90-102. A regional interdependence model of musculoskeletal dysfunction: re

Mechanic or Coach: The Role of the Rehab Professional

  My father-in-law, a retired auto mechanic and professional curmudgeon, drives an early 80’s Pontiac and whiles away his time with an ancient Model T. Why does he drive a 30 year old car? Because in the mid 80’s auto manufacturers began installing computers in cars and now he can’t work on anything but the older models. He can twiddle a wrench or drive a screw, tighten a belt or adjust a spark plug gap with the best of them, but doesn’t have the tools or knowledge to work with control systems.  Having come out of PT school in 1983, I was trained somewhat mechanistically. We mobilized joints to improve joint play and arthrokinematics. We utilized tissue release techniques to improve fascial mobility and range of motion. We prescribed exercises to stretch or strengthen individual muscles. We used muscle energy techniques, strain/counter-strain and other techniques to move or align vertebrae.  What we didn’t think of then, and are still in our infancy in terms of c

Principles of Optimal Movement I: Fascio-Skeletal Weight Bearing & Minimization of Effort

The concept of “movement optimization” and the assignment of this role to rehabilitation professionals were previously introduced. It was suggested that if we embrace the role of movement teacher or coach we are obliged to answer two questions; what do we want to teach and how do we want to teach it? How do we define optimal movement and what are the characteristics of exercises we use that make them informational, that facilitate patient recognition of sub-optimal movement as well as an organic selection of more optimal movement and postural choices?  What is the definition of optimal? Best, most favorable or most desirable. Notice that these are subjective/qualitative terms. We are not asked to transform society (as per 2013 APTA vision) by improving goniometric measurements or manual muscle testing scores, but by improving quality of movement. While quantitative movement characteristics (how many, how much, how far and how long) are an aspect of well-organized movement