Foundations Of The ProSport Academy Therapist System Dave - - PowerPoint PPT Presentation

Foundations Of The ProSport Academy Therapist System

Dave O’Sullivan

Updated June 2016

• Meirion Jones / Martin Higgins

(ProSport Physiotherapy)

• Mulligan MWM’s
• Butler’s NOI
• Shacklock’s Neurodynamics
• Shirley Sahrmann - Movement

Impairment Syndromes

• Functional Movement Screen /

SFMA

• VOILA - Structural Joint

Balancing

• Club Physio - Dry Needling

Gray Institute - Certificate in Applied Functional Science Anatomy In Motion Neurokinetic Therapy / Applied Kinesiology Online Courses Proprioceptive Deep Tendon Reflex Integrative Diagnosis Postural Restoration Institute Active Release Techniques Active Isolated Stretching / Fascial Stretch Therapy Frans Bosch | Louis Gifford

My Main Past Experiences/Influences

Your Journey Over The Next 12 Months...

The Bigger Picture

• MY Current Thought Process
• A PB Run Free Athlete is a durable, sustainable,

robust athlete

• BUT FIRST

The BIG ProSport Academy Secret

• PAIN IS AN OUTPUT OF THE BRAIN

It’s all About The Brain! (Kind Of)

• Your client’s movement strategies are a result of the output of their
• brain. Change how their brain interprets information and we change

their symptoms, and how they move.

Autonomic Nervous System

• 2 Main Divisions:

Parasympathetic & Sympathetic Nervous System ‘Fight or Flight’ & ‘Rest and Digest’

• Shift between the two daily

depending on the perceived stressors

• Can be analysed using Heart Rate

Variability

• Can be influenced with conscious

command via the respiratory system

Chronic Pain Patient...

Chronic Pain Patient...

Our body loves variability...

• Heart Rate - Diaphragm - Movement

• We don’t provide interventions/rehab to

pass specific tests, we provide interventions/rehab programs primarily to decrease the ‘perceived threat’ SPECIFIC to the PERSON in front of us.

• => Only this will lead to LONG LASTING

changes IMPORTANT

How Your Athletes Nervous System Interprets Information?

• Visual *(Eyes Down Or Out?)
• Vestibular
• Kinesthetic
• Attention / Meaning
• Past Experiences / Pain?

Performing Movement

• Initial Intent To Move
• Receiving And Analysing Neural Input From Sensory Inputs

From Within The Body & Externally From Environment

• Decision To Move -> Process Of Planning
• Plan Influenced By Previous Experiences With

The Movements, Movement Situation, Initial Evaluation, Choices Of Movements And Task Involved

• Once General Plan Executed, Add

Various Movement Parameters (Force, Velocity) To Achieve Movement Within The Environment (On Grass or 3G or Gym)

Movement

Brain Controls The Intention Cerebellum Makes It Fluent Spinal Relays Make It Rhythmical Synergies Absorb Errors Co-Contractions Influence ROM

Adapted From Frans Bosch, 2011

What Do We Already Know?

• Previous

Recurrent Injury

• Previous Surgery
• Asymmetrical

Dorsiflexion

• Pain On FMS

Clearing Tests

Where Can The Threats Come From?

• Movement Technique
• Training Loads Spike
• Not Strong Enough To

Handle The Load

• Anxiety
• Fear of Failure
• Home Issues / Contract

Issues / Self Perception

• Perceived threat -> Altered Movement Strategy

short term -> Altered force DIRECTION and motor output

• Ok initially but long term whats the

consequences?

Key points...

• BUT SECOND

Self Limiting Beliefs...

• If your beginning to doubt your ability

to help a patient, then you’re probably focusing on the pathological tissue and not the person and their nervous system...

• It’s not your job to tell the patient

there’s no hope for them and their nervous system...

• Believe 100% you can help them, the

answer is right there, between the two of you...

Ask Yourself Questions

• ALL THE TIME WHEN

ASSESSING, WHEN TREATING

• Focus

Your Mind And Get Answers From Your Subconscious...

Ask yourself better questions, get better answers...

• The quality of our lives will be determined

by the quality of questions we ask

• urselves...
• Karl Morris 2015, Mind Coach.

Stress precedes pain…

• Replace the Word STRESS with PAIN…

Stress…

Physical Stressors (Including Previous Injuries) Emotional

We have all been lied to! Textbook healing times are obsolete and old school thinking

Welcome to the

So how Do We Do It?

• What Does The Brain really Want?

Homeostasis

• On A Cellular Level

But I’m a Therapist Not a Microbiologist

What Do We Require For This First And Foremost?

• “All chronic pain, suffering and diseases are caused from a lack
• f oxygen at the cell level”

– Prof. A.C Guyton, MC, The Textbook Of Medical Physiology

What Else Can We Help The Brain With To Achieve Homeostasis?

• Achieve A Neutrality That The Nervous System

Is Content With And Keep It

But what is neutrality?

• - A mid point between one extreme to another

sethoberst.com

Look at the relationship between the lungs and diaphragms ability to lengthen…

The most important thing to your brain is the very next breath...

If you can’t control your inhalation, you can’t control your anterior tilt

If we lose the lengthening ability of the diaphragm, we lose movement variability...

sethoberst.com

Practically...

• Our Brain Wants Homeostasis
• I.e Our Nervous System Wants Full Range

Of Motion Within Every Joint In The Body To Access If Required

• Our Nervous System Will Be Able To

Access Both ‘Parasympathetic’ and ‘Sympathetic’ Nervous Systems

• => Full Range Of Motion Requires All The

Soft Tissues To Lengthen And Shorten Around An Instantaneous Axis Of Rotation Of One Or More Joints

How Do We Assess Homeostasis of the body?

• Subjective: Sensory

Feedback From Client

• Behaviour of the

client

• *Pain / Stiffness
• *Ease of Movement
• *Others?
• Sleep/Breathing?

Objective Range of Motion

* Joints *Joint Capsule * Muscle * Ligaments * Nerves * Vascular/Arterial * Skin * Fascial *Other Mobile Connective Tissue

How does the brain keep homeostasis?

• Feedback controls - corrective response

after sensory detection

• Feedforward controls - Anticipatory actions
• ccurring before sensory detection

Somatosensory, Visual and Vestibular input provides the information necessary for both forms of control during motor activities

Movement Control Central Control Preflexes

We Can Effect Somatosensory Input With Manual Therapy

(Pay Attention Here)

Superficial and Deep Adipose Tissue & Retinacula Cutis

Sensory Input To The Brain

• Superficial and Deep Fascia + Joint Capsule

Fascia have 9 times more sensory innervation than muscles

• When you FEEL a stretch, you are FEELING 9

times more fascial receptors than muscle receptors...

• Your client is feeding back 9 times more fascial

receptors than muscle receptors, REMEMBER THIS

Motor Perception

• determined by neuro-receptors such as ruffini

corpuscles, pacini corpuscles, golgi corpuscles and free nerve endings

• these neuroreceptors are activated by stretch

and can only function correctly if they are embedded in a tissue that is capable of lengthening

• when we side-bend we feel the stretch in the

trunk wall rather than the vertebrae

• 90% more receptors in fascia than muscle

Motor Coordination

• Muscle spindles and golgi tendon organs are nerve terminations that regulate muscular

contraction

• Muscle Spindles embedded in the deep fascia parallel with the muscle fibres
• Golgi tendon organs embedded in the myotendinous junctions in series with the muscle

fibres

• Continuity of the endomysium with the connective tissue skeleton ensures transmission
• f spindle contraction of the entire facscia
• These mechanisms can only be activated correctly if the fascia

maintains its physiological elasticity.

• If fascia is too rigid it cannot adapt to the stretch of a single muscle spindle and the

enlargement of the of the central part of the annulospiral fibres does not take place.

• Golgi tendon organs also have a web of collagen fibres surrounding their axons; these

fibres wind up or unwind according to the DIRECTION of stretch to which they are subjected to, such that the inhibitory nerve impulse may or may not be activated.

Deep Fascia Unable To Slide

We are constantly moving...

Practically What Does This Mean?

• Full Range Of Motion In

EVERY Joint In The Body

• Ability To Access Full

Range Of Motion

• If The Tissues Can Slide In

EVERY DIRECTION and provide adequate TENSION then the motor output of the PARTICULAR muscle fibres will take care of themselves if no excessive nociceptive input is present

Why is range of motion of connective tissue important?

• Skin, Fascia and Muscles are viscoelastic and

all contain proprioceptive receptors that respond to various stimulus and force.

• A lack of range of motion = decreased

proprioceptive input to the brain as some receptors wont be utilised.

• ? Some receptors become dysfunctional,

hypo or hyper sensitive and portray aberrant feedback to the nervous system.

• Homeostasis = Full Proprioceptive Input

Ligaments As A Proprioceptive Player

• Respond To Tension
• Mechanoreceptors

consisting of Pancinian, Golgi, Ruffini and Bare Nerve Endings

• Feed forward mechanism

to muscles

Muscle Properties

Muscle Slack Muscle Fibres Eccentrically Lengthening Muscle Co-contraction / Stiffness

Screenshot From Frans Bosch - ProSport Academy Mentorship Lecture. For use in the mentorship only. Not for redistribution.

Muscle Elasticity

Muscle has elastic properties & contractile properties

• If we can control contractile activity & avoid eccentric

muscle contractions => all energy stored in elastic components => when external forces are gone, can utilise tendon to sprint. To store elastic energy you cannot have concentric and eccentric fibre shortening and lengthening to store elastic property High tension allows for optimal elastic component for more efficiency- redirect energy 


Preflexes

Screenshot From Frans Bosch - ProSport Academy Mentorship Lecture. For use in the mentorship only. Not for redistribution.

The Importance of Fascia and Skin Movement

• The tissues are required to slide and glide

for proper muscle coordination to occur.

• Inability to slide = muscle incoordination.
• Inability to slide; 1) Fascial Adhesions? or

just Nervous System Tension/Protection?

• Allow intrinsic muscle properties to

function (Preflexes)

Movement Control Central Control Preflexes Control

Isometrics

3D Lengthening Of Tissues

Mindfulness | Respiration

• Decreasing The ‘Perceived Threat’ |

Update The Belief System With Positive New Experiences

Dermomyofascial Testing Passive ROM

Rethinking Passive Range of Motion Assessments

• Looking for barriers to homeostasis
• Why has the brain put barriers in

restricted range of motion?

• = Threat, Interpretation or Adaptation To

Demands On The Nervous System?

• Looking for particular tissues that are

causing the barriers to homeostasis?

• = Rethink using ‘protection’ for the word

‘tight’ to help your brain think of reasons for this protective tension.

• Also a test of the patients ability to ‘relax’

when your hands are on their body, do they trust in you already?

INSTANTANEOUS Axis of Rotation

• Joints move in three planes of motion
• At any particular part of a range of motion, there is a point upon which

the joint pivots or rotates which is called the instantaneous axis of rotation

• There are tissues on one side of the axis that lengthens/decompress,

tissues on the other side that needs to shorten/compress

• Combination of a passive subsystem (osseous and connective tissue),

active subsystem (dynamic contractile tissues) and the neural subsystem (nervous system interpretation of proprioceptive input)

Path of Least Resistance

• Is essentially a reflection of a combined axis of rotation across multiple joints
• Nervous System Application To Axis of Rotation
• => Knee Dominant Squat: ? Reflection of the axis of rotation of the ankle joint,

lumbar spine, sacroiliac and hip joints.

• For example:
• Inability of the posterior hip joint tissues or pelvic floor to lengthen, means the hip

joint axis of rotation is altered, the nervous system received this information and finds an alternative solution, in the form of excessive knee flexion as the motor output. Solution: Return the hip joint or pelvic floor cells to homeostasis.

• Why did the posterior hip tissues or pelvic floor lose the ability to lengthen should be

your next question!

• This is individual to the PERSON you are treating. There are no cookbook recipes.

The persons injury history and previous experiences will be the reason. It is up to you to find out how to help them change their nervous system output.

Applying The Axis of Rotation

• Tips to help:
• Usually the tissues closest to the joint will influence the axis of rotation

greatest and will be reported as deep pinch of the osseous structures with abrupt instant increase in tension

• An inability of the deep tissues at the posterior hip will usually be

reported as a pinch in the opposite side of the joint. E.g pain deep in the groin with passive hip flexion.

• Outer layers will be softer end feel, a sensation felt in the posterior of

the joint will be usually a derma/fascial elasticity issue or anterior to the joint will usually be a hypertonic muscle issue.

• Myofascial tissues can effect the ability to compress/shorten the joint

axis of rotation efficiently when hypertonic (incoordination - think skin/ fascia inability to slide) and will be reported superficial in the joint NOT DEEP .

Roughly Estimate The Axis Of Rotation At Each Joint

Applying The Axis of Rotation

• For any given movement, once we know the movement of the joint

(direction of the bones movement), then we should be able to logically reason which structures would be worthy of PRIORITISING assessment and treatment and not just throwing shit at the wall and hoping something sticks...

• Improve the axis of rotation to as close to homeostasis as possible and

in theory then the threat will be reduced from the nervous system

• Help the tissue mobilise to improve communication with the nervous

system, give a different input to the brain from these tissues, restore movement variability

• => Understanding the tissues responsible for each axis of rotation of the

joints in the body will allow you to reduce pain quickly on a local level and allow you time to figure out the bigger picture.

Applying This Tomorrow Recap

• PAIN is an output of the brain
• It is a response to perceived threat to the tissue
• rganism
• The movement ‘dysfunction’ or compensation

strategy in our traditional tests are REACTIONS to the perceived threat

• Our job is to convince our clients brain the threat

is no longer present by regaining homeostasis (of the respiratory system, joint movement, skin, fascia, muscle + other connective tissues)

• We can find the tissues that may be disrupting

homeostasis easily using the axis of rotation concept thinking skin, superficial and deep fascia

• Where is the primary threat coming from?

=> Subjective Assessment

• LISTEN TO THE CLIENT
• They will tell you the answer during the

subjective (AND treatment)

• History matters

Tomorrow...

Application; Finding The Perceived Threat (Drivers Of Pain/Movement Dysfunction)...

My Own Assessment System...

• Everything

You See And Feel SHOULD MAKE SENSE to the patients history

• If you go slightly
• ff, there will be

a safety net so don’t worry...

Subjective Gait/Walking General Movement Specific Objective Passive Joint Assessment Dermomyofascial Testing Accept Or Reject

What is the I.A.R for this movement or test you are looking at now and does this compensation make sense to the history??

ASSESSMENT...

Think 3 R’s...

• With Every Client, Start Thinking Threat

Response, Reassure, And Restore All Tissues Mobility Involved In EVERY Axis of Rotation They Have Symptoms or Reduced Motion

• Are There Common Denominator Tissues

Across Multiple Axis Of Rotation, that make sense to the person’s history?

• This will make biggest change in symptoms

quickly...

Finding These Tissues With Your Objective Assessment

• Use your passive joint assessments to

assess the protective tension of the client’s nervous system

• Assess both superficial fascia and deep

fascia viscoelasticity

• LISTEN to your client, they will say the

most random YET VITAL things during assessment and treatment => Subconsciously they are giving you clues

Coming Up In The Next Month...

My Overall Approach...

• A Detailed Subjective Assessment (IAR for the RESPONSE)
• Objective (General, Specific, Passive Assessment, Dermomyofascial Testing to

examine the RESPONSE of the nervous system)

• REASSURE Mentally and Physically (Pain Education And Breathing

Restoration straight away to help towards ‘rest and digest’)

• RESTORE with Manual Therapy (Dermomyofascial Restoration -

integrating the respiratory system to the common dominators for the IAR that match with the patients story)

• RESTORE with Low Load Rehab (Isometrics to reassure in a particular

movement at a specific length, tension of the tissues to influence the DIRECTION of the forces and coordination of motor units)

• RESTORE with Integrated 3 dimensional movements to give back

movement variability for the pattern above

• RESTORE the fundamentals: Squatting, Lunging, Reaching, Lifting, Pulling,

Twisting, Turning for daily living

• RESTORE the movement capabilities in the gym under heavier loads for

high level athletes; MOVE WELL IN THE GYM, MOVE WELL ON THE FIELD...

Practical Example

• Hip Joint Flexion
• But first any Questions?