Monday Memo 8/28/17

The Monday Memo

August 28, 2017                                                                           PITT DPT STUDENTS

MOVEMENT IS MEDICINE

Charles Badawy SPT, CSCS, USAW

Intentionally or not, our society is CONDITIONED to be afraid of moving. As we age, gathering our bumps and bruises along the way, we’re told we’re broken:

  • Ruptured discs.
  • Rotator cuff tears.
  • Knee arthritis.

We’re often told these things just happen:

  • They’re a product of age.
  • We’re told to stop:
  • Stop bending over.
  • Stop picking things up.
  • Stop using your arms.
  • Stop running.

These people are right, but they’re also very, very wrong. Injuries and tissue pathology are in fact a consequence of being a human. If you’re doing it right, you’re going to get hurt sometimes. Impersonate your favorite Peter Griffin GIF, rub some dirt in it, and get back to work. More often than not, injuries are temporary. They knock ya down, but not out. Much like a good relationship, it’s important that you respect the injury, give it time to calm down, and then approach it from a different angle.

However, that different “angle” is, and will always be, movement. Blown disc so you can’t bend forward? Bend backward for a little while instead! Move your shoulders, hips, knee, and elbows! Move your neck! Torn labrum? Pull. A lot. Strengthen your back and posterior deltoids until the pain goes away. Knee Pain? Bike instead of run, then get to work on those glutes and hamstrings, because I can almost guarantee you they’re weak. The end goal after an injury is obviously to regain function. This in itself demands that we perform the movement that is painful or the movement that isn’t working properly. We want to regain that ability. And we can.

Let’s cover this very briefly to avoid a novel:

1. First, you need to stop hurting. Nothing will work if you’re in pain.

2. Then, and really at the same time, you need to keep moving. Find movements you can tolerate and keep the tissue active.

3. Slowly, and methodically, load the tissue. Teach it to be resilient again. This is how you heal. This is how you stay young. This is how you retain the basic functions that make us human.

Movement is medicine folks, so get moving.

 

August 28, 2017 |

Monday Memo 8/14/17

The Monday Memo

August 14, 2017                                                                           PITT DPT STUDENTS

What is Functional Training?
Charlie Badawy, SPT, CSCS, USAW

 

There are so any answers to this question. Some people say kettlebell movements. Some say emphasize rotation and diagonals. Others are convinced you simply need to get stronger and “function” will improve. In reality, everyone is right and every is wrong.

 

Functional training is not a garbage term. It’s very real, but also very ambiguous. Functional training for a Strongman or Nordic Games competitor will look nothing like that of a ballerina or gymnast. The functional demands of one individual are wildly different than that of another, which is what should drive variation in our training and rehab approach.

 

I propose that this isn’t necessarily true for the general population. The average joe. Yes, we are all special snowflakes, but we operate very similarly when it really comes down to it. Sure, some of us may have some occupation-specific requirements that should guide the rehab and training approach. However, when it really comes down to it, there are three tasks we most of us must be able to do:
1. Get up off the ground
2. Walk
3. Pick up & manipulate objects

 

We need to be able to change position and rise from the floor in case we fall. Whether we’re teaching proper transfer mechanics or Turkish Get-ups, we’re accomplishing this goal. 

We already know the importance of restoring proper gait mechanics, but what about using loaded carries to strengthen those mechanics once in place or target individual weaknesses?

 

Lastly, life simply wouldn’t be any fun if you didn’t have the ability to manipulate and interact with your environment.

 

These are foundational abilities that humans should possess and there are so many different ways of training them! We should scale to the individual in front of us – Utilize progressions or regressions appropriate for their level of physical preparedness. At the end of the day, when we stop doing these things, we really stop living.

 

 

August 14, 2017 |

Monday Memo 8/7/17

The Monday Memo

August 7, 2017                                                                           PITT DPT STUDENTS

 

WHAT IS MOBILITY?

Charles R. Badawy SPT, CSCS, USAW

 

 

MOBILITY

This term is thrown around constantly, but do we really know what it means? Some see it as a measure of the amount of range-of-motion (ROM) available at a joint, others imply a stability component. This indecision is an issue and the term must be clearly defined if it’s to be used properly.

 

To start, we need to address a few things. You see, there are principles at play concerning how “Mobility” is typically used. I think it’s important to bring them to attention in order to enhance our understanding of the term.

 

I think we can clearly understand that the term mobility at a basic level has to do with joint function. I like to believe people are well intentioned and genuinely use this term to help patients. They’re using it as an attribute. As a way to describe joint movement. Are there other well defined terms that would help us?

 

  • Range of Motion: Refers to the distance and direction a joint can move, measured in degrees in the field of physical therapy. There are two types to concern us with, although a third exists
    • Passive ROM (PROM)
    • Active ROM (AROM)

 

  • Flexibility: Refers to the ability to move a joint or series of joints through a full, non-restricted, injury, and pain-free ROM.

Flexibility helps us further break down PROM. Flexibility applies to any human joint, where PROM can refer to any mechanical system. Flexibility depends on the following factors: Joint ROM, Muscle Extensibility, & Neuromuscular control.

 

JOINT ROM, MUSCLE EXTENSIBILITY (ME) & NEUROMUSCULAR (NM) CONTROL

 

  • Joint ROM: In essence, PROM describes Joint ROM, the degrees of rotation allowed by the bony articulations, so what do the other two terms mean?

 

  • ME: A measure of the effect of muscles that cross the joint on the ROM available at the bony articulations. Is it highly extensible, giving it the ability to lengthen and allow for great joint movement? Or not? This applies a muscular layer to our current description of PROM or Joint ROM.

    Muscle extensibility has a passive effect, which is where the nervous system comes into play.

 

  • NM Control: The nervous system gives us our greatest gift, the ability to move. The nervous system has an affect on the muscular components of a joint, and applies an active component to the bony articulations. It is a measure of our AROM.

The nervous system processes information taken in through various receptors throughout the body and provides instructions to the muscles to contract a certain way. The end goal being: stability. A system can be referred to as being inherently stable when homeostasis, or the ability to maintain neutral position, is adequate to restore previous function. This poses the question, “What is stable?”
 

“WHAT IS STABLE?”

 

When it comes strictly to bony articulations, stable is a position where the bony structures are balanced against the effects of gravity. As the bones change positions and the forces applied to them change, our bodies depend on two factors to help us maintain stability, or this position of balance.

  • Active Restraints: Structures that produce and apply force to a joint.
  • Passive Restraints: Structures that don’t inherently produce force, but limit joint ROM due to their structure. Things like ligaments, bony architecture, etc.

 

You see, neuromuscular control affects these active restraints. When we run, forces are applied to the system that must be counteracted. The active restraints perform the bulk of the work here and the nervous system must be effective enough to accomplish a given task

 

The term neuromuscular control has huge implications on our understanding of mobility, in that it demands further information from those who utter it. Are we talking about the active mobility or passive mobility of a joint?

  • If we’re discussing the passive mobility of a joint, we’ve truly only discussing the extensibility of the soft tissue and bony architecture. We’re discussing the passive restraints.
  • If we’re talking about the active mobility of a joint, we are discussing nervous system function. How effective it is in processing information and modulating muscular force application. We’re discussing neuromuscular control.

 

SO WHAT’S OUR TAKEAWAY HERE?
Does the term even have a purpose? I’d argue that we already have defined attributes of joint function. If the definitions laid out in this article are to be accepted, the following statements can be made:

  1. Active mobility and neuromuscular control are synonymous.

  2. Passive mobility is simply a measure of tissue extensibility and bony architecture.

 

I’ve thrown around the term “mobility” countless times, but I’m trying to be more judicious in the way I communicate. These reflections show me that there may be more appropriate ways to describe joint function when talking to clients/patients.

 

At the end of the day, when attempting to create a therapeutic effect or change in performance, it’s important to understand the limiting factor: Should we be focusing on improving neuromuscular control, tissue extensibility, or bony architecture? The answer should greatly influence our method of intervention.

 

 

August 7, 2017 |