A previous Blog/Vlog in the Principled Strategies series discussed in detail how the Drivers of human movement are used in designing programs based on the concept of authenticity. Programs that are comprised of movements that resemble the actual activities that our clients need or want to do will provide a large degree of authenticity. Authenticity considers the position of the person relative to gravity, the position of the body segments relative to each other, and the parts of the body that Drive the movement.
There are times when using strategies similar to the activity to design rehab and training programs is not the best course of action. Asking clients to perform movements that are already unsuccessful will not be productive. This is when authenticity must “take a back seat” to success. Alternative strategies are needed. The alternatives cannot be randomly chosen. The movements must be part of a well-constructed plan that will ultimately lead to authentic movements that then lead to success in the desired activity. A specific example will help clarify the alternative strategies. But first, when would a movement specialist need to utilize alternative strategies based on the Principle that Movement is Driven?
When a motion restriction exists as part of a global movement, asking the client to replicate the movement will not always reduce the restriction. These restrictions may limit the successful execution of the desired task. But, “attacking” the deficit directly may not produce the desired result. During the functional movement certain regions of the body will try to supply additional motion, or the soft tissue of the region will experience excessive stress. Often it is both. At the Gray Institute, this is referred to as “the body following the path of least resistance. It is very common that our clients will experience pain as a result of our program if the movements are too “authentic” to the actual activity before the motion restriction is resolved.
An example of an alternative strategy comes from a client who experienced pain while golfing. She described very specific right low back pain during the follow-through of her golf swing. She was right-handed and stated that during a round that the pain was minor and might even disappear at the beginning of a round, but would worsen at the end. She also felt this pain when practicing on the range for more than 20 minutes. The 3DMAPS examination revealed motion restrictions with the Left Same Side Rotational Mobility Chain, and the Right Opposite Side Rotational Mobility Chain (when compared to the opposite movements). There was minor right-sided discomfort with the restricted Chains. She also demonstrated sub-optimal control of movement with the Right Opposite Side Rotational Stability Chain. Further movement assessments indicated restricted internal rotation of the left hip and left rotation of the thoracic spine.
Both of these local motion restrictions created stress in the lumbar facet joints during the global follow-through part of the swing. Both limited total body rotation to the left, forcing the lumbar spine to try to increase this transverse plane motion. However the lumbar spine does not have a lot of transverse plane joint motion and this results in increased stress to the facet joints on the right side. The strategy employed required that the hip restriction be addressed with motion Driven by the right foot through the pelvis, thereby reducing the lumbar stress. Likewise, to avoid lumbar stress the thoracic spine limitation needed to be worked on with the arms Driving the motion. Because the lumbar spine was acutely painful, the initial program focused on the hip. Lunges of the right foot were used to Drive the left hip motion while the trunk was kept synchronized with the pelvis to minimize lumbar joint motion. The strategy started with the successful left hip motion in the sagittal and frontal planes to feed success in the transverse plane. A Right Anterior lunge was used to create left hip extension. Then a Right Opposite Side Lateral lunge was used to produce left hip adduction. Then the Right Opposite Side Rotational lunge was introduced. Both Mobility and Stability were emphasized with the lunges.
As her motion increased after a couple days, the bilateral arm swings of the Chains were initiated. In order to protect the lumbar facets, the arm swings were always performed with the lunges. This reduced the relative lumbar joint motion. The Right Opposite Side Lateral Chain was performed before the Opposite Side Rotational Chain. As the thoracic rotation to the left improved, two tweaks were employed. The first was to use the right arm to Drive the rotation, but the left arm reached overhead in the right lateral direction to Drive combined left rotation and right lateral flexion (to be more authentic to the follow-through). The second tweak was to stop the lunges and require the right foot to stay on the ground in a “toe-touch” position, which was also more authentic. These tweaks, while definitely more authentic, also created more stress in the right lumbar facet joints. Fortunately the improved motion in the left hip and the thoracic spine allowed her to complete the full golf swing without lumbar pain.
The alternative strategies used for the golfer were intended to allow pain-free training before a return to the authentic movement of the golf swing could occur. The Gray Institute has focused educational content in functional golf training that builds on 3DMAPS ….. etc