advanced cpd in modern, functional, pregnancy ......(the link to this page in below). these videos...

© Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).

ADVANCED CPD in Modern, Functional, Pregnancy Exercise Programming

ON-LINE, Global Certification

Module 1Foundation Natal Anatomy/Physiology and Assessment

Tutor: Jenny Burrell BSc (Hons), Dip SMRT, Head of Burrell Education, London, UK.


Goals and Aims of this Education

1. To make you an amazing practit ioner, with a deep understanding of the physical and mental challenges associated with Pregnancy throughout the Trimesters.

2. To give you great strategies for assessing and prescribing ‘bespoke’ restorative and functional exercise that truly serves the client.

3. To demonstrate the huge value in looking outside of the ‘fitness’ environment when seeking to serve this client population.

4. To provide an ever-green resource and community that will assist you in your work with these wonderful women that will help you to create a business that both you and your clients LOVE!

5. To help you create a business that your clients RAVE about and become living referral machines for.

6. To help you REALLY solve the problems of Pregnant women…..REAL SOLUTIONS for REAL WOMEN!


Goals of Module 1 - Foundation Natal Anatomy/Physiology and Assessment• Pregnancy Through the Tr imesters – Review of Foundat ion Anatomy &

Physio logy of Pregnancy and Bir th ing.

• Whole-Cl ient Pre-Screening (general heal th and Pelvic Heal th) of the Pregnant c l ient – caut ions, considerat ions and contraindicat ions to exerc ise programming & g lobal guidel ines.

• Common and Key Pregnancy Al ignments Throughout the Tr imesters inc luding a demonstrat ion of how to f i t Diane Lee’s Baby Bel ly Bel t™ for SPD and Sacroi l l iac Support .

• The Pregnant Core & Pelvic Floor Throughout the Tr imesters.

• Changes to the Myofascial /Musculoskeletal Systems and Postural Al ignment Dur ing Pregnancy.

• The Pregnant Cl ient ’s In i t ia l Consul tat ion – Key Elements, ‘MUST DO’S' , and how to present your s ignature offer ing wi th empathy and professionals to win c l ient – EVERYTIME.

• End Module 1 Webinar – What’s ‘Normal ’ Dur ing Pregnancy and When To Seek Referral For Your Cl ients wi th Michel le Lyons – Women’s Heal th Physiotherapist .


Your Territory Ante/Post Natal Obs & Gynae Guidelines

1. UK: Royal College of Obstetricians & Gynaecologists – RCOG - http://www.rcog.org.uk/

2. US: American College/Congress of Obstetricians & Gynaecologists – ACOG -http://www.acog.org/

3. Canada: Society of Obstetricians & Gynaecologists -http://sogc.org/

4. Australia and New Zealand: RANZCOG -http://www.ranzcog.edu.au/

These links are listed in your Module 1 Resources


Pregnancy Through The Trimesters

• You have two videos to view within your ‘Video Resources’ (the link to this page in below). These videos are simple and easy to watch explanations of the development of the foetus, week by week through the 3 Trimesters. Please v iew them and take no tes as the re w i l l be quest ions in the End o f Modu le Exam about these v ideos .


Key Components of Programming for the Pregnant Client

Pre-Screening & Hands-On Initial Consultation

Education Support and Direction

Soft Tissue Work/Release & Re-Alignment Strategies

Establish Intrinsic Core Synergy ® &

Lumbopelvic WellnessTrain Integrated Motherhood

Movement Patterns®

Nutrient Density/Optimal Nutrition For Maternal,

Foetal and Infant Development & Health

Restorative Activity


Creating A REAL BUSINESS Serving The Pregnant Client

Diagram Courtesy of Seth Godin

Marketing 101:

People pay money to solve problems……identify the

problem, create the solution, promote to target audience. The more challenging the

problem, the higher value the solution. Charge according to

the lifetime value of the problem solved!

Add value, thrill your customer to ensure they rave about your amazing service!

Be a PURPLE COW!


Current UK, US, Canadian, Australian & NZ Birthing Stats

• Just under 800,000 l ive births in the UK last year – 26% C-Section Rate• 3,952,841 l ive births in the US – Average of 32.8% C-Section Rate• 309, 582 l ive births in Austral ia – Average 20-35% C-Section Rate• 377,636 l ive Births in Canada 2014 – Average 30% C-Section Rate

• Front-Line Staff are t ime-poor and resources are stretched.• Workman-l ike approach to Pregnancy.

• ‘Li fe-Preservers’ .• Huge scope to nurture, support , educate & ‘ tend & befriend’ the Pregnant

woman.• Offer a bespoke, heart - fel t and empathetic service that’s f i t for the modern

woman and support the woman as a ‘sister ’ .


What are the Key Pregnancy NEEDS & POTENTIAL PROBLEMS?

Empathy

Health & Nutrition

Education

Safe Activity

Soft Tissue/Pain Management

Reassurance

Pelvic Floor

Restorative Activity

Post Natal Information

Creating a service that really speaks to the

needs of your clients. Are you solving as many of

their problems as possible?


Education Re: Modern Pelvic Floor Theory and Practical Application For the Pre/Post Natal Client

For many women, this will all be brand new information so don’t assume ANYTHING.

Really important to use props, diagrams and physical activity

to account for the learning style of client.


Pelvic Floor ‘Turn Offs’ / Weakeners

1. Immob i l i t y, sedenta ry l i f es t y le

2 . Combat ive spo r t s o r t hose tha t i nvo lve body b lows (cons ider a pa ra l le l ba r gymnast ) .

3 . An te r io r t i l t ed pe lv i s ( t he usua l pe lv i c pos i t ion o f t he P re & Pos t Na ta l c l i en t ) .

4 . Ove r -ac t i ve P i r i f o rm is – seen by some as ‘SYNERGYIST ’ o f t he Pos te r io r PF.

5. P regnancy (s t re t ch ing o f t he PF musc les by the we igh t o f a g rowing baby) .

6 . Vag ina l b i r t h ing espec ia l l y when ass is ted – produces va ry ing degrees o f so f t t i ssue t rauma tha t can have a d i rec t impac t on the f unc t ion and connect ion to the PF musc les pos t b i r t h .

7 . C-Sec t ion –c ruc ia l syne rg is t i c co re l i gaments , ne rves , sk in , b lood vesse ls and f asc ia a re seve red and take many months to repa i r / reconnect

8 . Cogn i t i ve impa i rment

9 . Pe rs i s ten t cough ing wi thou t m ind fu l con t ro l o f t he inc reased in t ra -abdomina l p ressure .

10 . Obes i t y - causes ch ron ic i nc rease in t ra -abdomina l p ressure .

11 . Menopause – causes a f a l l i n Oes t rogen p roduct ion wh ich a f fec ts connect ive t i ssue f o rmat ion and s t reng th .

12 . Age ing – an ongo ing dec rease in Co l lagen and E las t in f o rmat ion a f fec ts connect ive t i ssue tens ion and less res is tance to g rav i t y and p ressure .


Pelvic Floor ‘Turn On’s’/Strengtheners

1. Movement! Think of the effect of immobi l i ty on the cont inence of sedentary e lders.

2. Vibrat ion – whole body vibrat ion a lso involves Pelvic Floor muscles too!3. Instabi l i ty – the whole core is act ivated inc luded TVA which is a synergist

of PF.4. Adduct ion – due muscular & fascia l l inks between adductors of the Femur

and PF.5. Abduct ion – due muscular & fascia l l inks between the deep latera l rotators

of the Femur and the PF.6. Mul t i -Planar Movement –a combinat ion of s t imulat ion of adductors and the

stretch ref lex occurr ing in the PF muscles.7. Flexion & Extension8. Working against gravi ty, especia l ly wi th speed and power.9. TVA Act ivat ion & Diaphragmatic Breath ing – TVA, Diaphragm and PF

muscles are synergists.10. Integrated Co-Act ivat ion of PF through act ivat ion of the Muscular

Sl ing and fascial systems ie. , fu l l body in tegrated/compound movements.


Intrinsic Core Synergy®

Please view the teaching video on

Intrinsic Core Synergy® in your Module 1

Resources


Do Kegels Matter? The Kegel Continuum

Traditional Kegels

Revised Kegels, the breath & visualizations

As before + light resistance + pre-

tension

As before + light resistance + pre-

tensions + functional movement

As before + increased

dynamic/loadedmovement

There is a full 30 minute video on this concept in your Module

1 Resources, please view.


Top Pelvic Floor Re-Connection/Visualization Strategies• 1. Mimic the smooth, integrated pulse and lift of a Jelly

Fish moving through water as you activate and lift your entire PF.

• 2. Think of the openings of the PF (vagina & anus) as an Elephant’s Trunk collecting and sucking up a visualized object.

• 3. Perform a 2 or 4 Point Visualization – where the command is ‘ imagine you are drawing the pubis towards the coccyx and/or the two sitting bones towards each other before lifting the entire PF’.


The Hypertonic Pelvic Floor – How To Recognize & What To Do?

Signs & Symptoms of Hypertonicity

1. Strengthening PF work, make incontinence worse.2. Trouble beginning a stream of urine.3. An ‘anxious anus’ – trouble letting anus go for bowel movements.4. Pelvic Pain5. Childbirth trauma6. Sexual trauma7. Inflammatory Pelvic & Bowel Conditions

A major task is to ‘down-train’ the overactivity to facilitate optimal function…..too tight is also deemed as dysfunctional.

IT’S ESSENTIAL THE PREGNANT CLIENT HAS THE CAPACITY TO ‘LET GO’ AND ALLOW BIRTHING!

Amy Stein & DustienneMiller in your Module 1

Resources


Incontinence & Prolapse

Please join the POPS Group on Facebook, info in your Module 1 Resources & View the PDF Handouts on PF/Incontinence and Prolapse.


The ‘Loading the Pregnant Core’ Continuum

• 1. Breath

• 2. Bodyweight

• 3. Low Resistance

• 4. Resistance/Load/Weight Progressed

• 5. Weighted Locomotion/Dynamic (as appropriate)


Loss & Increase of Form and/or Form Closure & BiotensegrityLeading to Pain/Discomfort Issues

Please view the video of me explaining Tensegrity/Biotensegrityand Force and Form Closure in your

Module 1 Resources.


The Key Integrated Core Strength Principles –Movement-Based Pelvic Floor Exercise

Buckminster Fuller provided a beautiful description to view the human structure as a tensegritous one. The muscles, skin, and especially the connective tissues are

the tensional elements separated by the body’s hard compressional elements,

the bones, which act as the spacers that sustain their tension. It distributes stress

(energy, force and tension) evenly throughout the entire structure rather than allowing it to accumulate at certain points,

and also allows more stability and flexibility, as opposed to a compressional structure. When misalignment in the body occurs,

a tensegrity structure can disintegrate into a compressional structure, in which we

commonly call the ‘aging process’ or dyfunction.


Kegels vs Movement Study, 2011


Overview of TheMyofascial System as Described by

Thomas Myers1. Fas c ia f o rms a c o n t i nuou s t e n s io na l n e t wo r k t h r ough t he hum an body , c ove r i ng and c onnec t i ng

eve r y s i ng le o r g an , eve r y m u s c le and even eve r y ne r ve and m us c le f i b re . Fas c ia l s hee ts he lp t r ansmi t f o rces t h r oughou t t he en t i r e sys t em and so have t he capac i t y t o no t on l y s t i f f en l oc a l j o i n t s a n d a f f ec t l o c a l m us c u la tu re bu t a l s o have t he po t en t i a l t o a f f ec t s t ruc tu res s eve r a l j o i n t s f u r the r away . So t he o f t en asked ques t i on o f ‘wh i ch s i ng le musc le i s i n vo l ved i n t h i s movement ’ i s t hen r end ere d m u te f o r m any p r ac t i t i one rs who bas e t he f ounda t i on o f t h e i r b o d ywo r k /moveme nt p r a c t i ce on t h e m yo f as c ia l p r i nc i p l es .

2 . FASCI A i s c o m p os ed o f c o l l ag en a n d e las t i n f i b res t ha t p r ov ide e l as t i c i t y and s uppo r t f o r t he en t i r e m u s c u losk e le ta l s ys t em. T h i s m u l t i - l e ve l m a t r i x o f s o r t s c onnec ts eve r y c e l l t o eve r y o t he r c e l l w i t h i n ou r e n t i r e body , bones , m u s c le s , o r g ans , s k i n e t c .

3 . T he An a t omy T r a in s t heory ( Mye r s 2009 ) i s an a t t empt t o des c r i be c om mon pa t hways o f f unc t i ona l f o r ce t r ansmis s ion t h r ough t he o u t e r l a ye r o f t he m yo f asc ia . Mye r s de f i ned 12 s e t s o f c onnec t i ons – ‘Ana tomy T ra ins ’ as a map suppo r ted by c l i n i ca l obse rva t i on , eas t e rn ph i l o soph ies such as yoga , ac upun c tu re /acupres sure a n d c om mon s ens e . T he t heo ry s uppo r t s g l oba l t r ea tmen t p l ans and movement p r og ramming t ha t suppo r t t he r es to ra t i on l oca l i s sues v i a an ‘ i n t eg ra t i on ’ m ind s e t .


Properties of Fascia • Connective t issue made of

collagen, the most abundant protein in the body.

• Connects the skeletal and muscular systems together.

• Holds everything together and wil l give a l i t t le in every direction.

• The majority of the volume of FASCIAL TISSUES consist of water SO HYDRATION AND MOVEMENT IS ESSENTIAL!


Thomas Myers’12 Myofascial Meridians & The Pregnant Core

and Global System

1. The Lateral Lines (2)2. The Spiral Lines3. Arm Lines (4)4. Functional Lines

(2 – front and back)5. Deep Front Line6. Superficial Front Line7. Superficial Back Line


The Superficial Front Line

• Extensor Digitorum Longus and Brevis

• Tibialis Anterior

• Patellar Tendon

• Quadriceps (including the Rectus Femoris)

• Rectus Abdominis

• Sternalis

• Sternocleidomastoid


The Superficial Back Line

(c) Burrell Education 2014 www.burrelleducation.com

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• Flexor Digitorum Brevis

• Gastrocnemius

• Hamstrings

• Sacrotuberous Ligament

• Erector Spinae

• Scalp Fascia


The Lateral Lines


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• Peroneus Longus and Brevis

• Anterior Ligament of the Fibular Head

• It-Band, TFL, Glute Max.

• Lateral Abdominal

• External and Internal intercostals

• Splenius Capitis and SCM


Back Functional Line


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• Latissimus Dorsi

• Thoracolumbar Fascia

• Gluteus Maximus

• Vastus Lateralis

• Subpatellar Tendon


Front Functional Line


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• Lower Pectoralis Major

• Lateral Rectus Abdominis and Abdominal Aponeurosis

• Adductor Longus


Spiral Line


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Anterior View• Splenius capitus• Rhomboids • Serratus anterior• External oblique• Rectus sheath• Internal oblique• Tensor fascia latae• ITB• Tibialis anterior

Posterior View• Peroneus longus• Biceps femoris S/L head• Sacrotuberous ligament• Spinae erectors


Deep Front Line


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Lowest Common Tibialis posterior Long toe flexors Posterior inter-muscular septum Popliteus fascia

Lower Posterior Posterior intermuscular septum Adductor magnus and minimus Pelvic floor fascia, levator ani, obturator

internus fascia


Deep Front Line


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Lower Anterior Anterior inter-muscular septum Adductor longus, adductor brevis Pectineus Psoas, iliacus

Upper Posterior Anterior longitudinal ligament Longus colli Longus capitis


Deep Front Line


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Upper Middle Posterior diaphragm, central tendon Pericardium Scalene muscles

Upper Anterior Anterior diaphragm Infrahyoid muscles Suprahyoid muscles Jaw muscles


Deep Front Arm Line

• Clavipectoral fascia

• Pectoralis minor

• Coracobrachialis

• Brachialis

• Biceps brachii

• Radial periosteum

• Thenar muscles


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Superficial Front Arm Line

• Pectoralis major

• Latissimus dorsi

• Medial inter-muscular septum

• Flexor group

• Carpal tunnel


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Deep Back Arm Line

• Rhomboids and levator scapulae

• Rotator cuff muscles

• Triceps Brachii

• Ulnar Periosteum

• Ulnar collateral l igaments

• Hypothenar muscles


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Superficial Back Arm Line

• Trapezius• Deltoid• Lateral inter-muscular septum• Extensor group


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The Myofascial Lines, Loss of Force/Form Closure and Biotensegrityinto the Post Natal Period Presenting as Rectus Diastasis, Poor C-Section Recovery, SPD, Pelvic Floor Dysfunction and MSK Pain & Dysfunction


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‘Core’ Maternal Adaptations To Pregnancy by 36 Weeks


Janda’s Upper & Lower Crossed Syndromes & The Ante/Post Natal Client

Locked Long and Locked

Short Tissues Marked by

Crosses

Links to Vladimir

Janda’s Work in Resources


Why is the Pregnant client pain/discomfort/experiencing dysfunction?


Pregnancy/Post Natal MSK and Myofasical Hotspots


“Release What’s Tight/Short – Strengthen What’s Weak/Long”

D e p e n d e n t o n i n f o r m a t i o n g a t h e r e d f r o m y o u r c l i e n t ’ s P A R Q , t h e S t a t i c ,

D y n a m i c , S e n t i e n t P o s t u r a l / B i o m e c h a n i c a l

A s s e s s m e n t s – y o u c a n p r o g r e s s t o t h e p r o g r a m m e p l a n n i n g s t a g e u s i n g

t h e f o l l o w i n g b l u e p r i n t :

Assess

Release

Reintegrate

Strengthen


Pre-Screening, Initial Consultation & Client Assessment – Tick List

• Remote Pre-Screening Genera l /PN & Pelv ic Heal th and ‘qua l i f i ca t ion ’ – can you help th is lady?

• View of medica l notes.

• L i festy le , medica l background, v iew of hospi ta l notes, ‘sent ien t ’ assessment . MAKE TIME TO TALK!

• Visual a l ignment in walk ing, s tand, mood and language

• Breath ing s t ra tegy

• Assessment for Global Pain/Posture/Movement issues v ia pa lpat ion and sel f - repor t ing

• Coach In t r ins ic Core Synergy and Modern Pelv ic F loor s t ra teg ies

• Creat ion of re lease and ‘core -connect ion ’ , funct iona l s t rength & restora t i ve, homework programme.

• Br ief on nut r i t ion/ l i festy le /ho l is t ic protocols & communicat ion/connect ion between sess ions & YOUR SYSTEM!

You have both a general Pregnancy Health and Pelvic Health Pre-Screening in your Module 1

Resources


UK Pregnancy Hand-Held Patient Notes


Functional Training & Integrated Motherhood Movement Patterns®

The term “Functional Exercise” has recently become a buzz word in the world of fitness training like “Core Stability” a few

years ago. Basically, in terms of your training of Pregnant clients, “Functional” means :

“Your exercise prescription useful and applicable to assist your client in performing the Activities of her Daily Life (ADL) as the Trimesters progress or as she is recovering from birth

and her abilit ies and biomechanic function altered?”

When these factors have been taken into account - the programme design is deemed ‘FUNCTIONAL’.


Mommy Activity in Daily Life Functional Exercise Choice Equivalent

Rising from kneeling and sitting as the Trimesters progress Squatting & Lunging

Maintaining transverse plane as opposed to non-optimal frontal plane gait as the Trimesters progress Lunging, Rotation, Single Leg Strengthening

Putting first toddler into his special car seat Bend-to-extend, Squat, Horizontal Pull and Rotate

Turning to shout at first toddler in backseat while driving Seated Rotation

Bending over a cot rail to get first toddler out then lifting him to sit on the hip Bend-to-extend & Rotation & Vertical Press

Walking & pram pushing Single leg work & Lunge and Horizontal Pushing

Lifting shopping bags out of the boot Weighted Diagonal/Vertical Pull

Picking up toys from the floor while hoovering Squat, Bend-to-extend, Push and Pull

Placing ironing on shelves in wardrobe Vertical Press

Playing games with kids, lifting them high in the air Multi-directional Lunging and Horizontal & Vertical Press

Checking the clock on the bedside table in the middle of the night after being woken up for the 3rd time by your need to pee!!

Supine Lying with Torso Rotation

Wiping small children’s noses Bend-to-extend

Wiping small children’s noses as they try to run away Bend-to-extend, lunge, horizontal pull and rotation

Speaking face-to-face with a toddler Squatting & Bend-to-extend

Some Key ‘Mommy ADL’s’


Integrated Motherhood Movement Patterns®

Squat

Lunge

Push

PullRotate

Bend-Extend

Balance


The Birthing Process

Types of Delivery

Please view the selected video’s within your Module 1 Resources on all of the above birthing styles and strategies.

1. Vaginal

2. Forceps Delivery

3. Ventouse Extraction

4. Breech Delivery

5. Lower Segment Caesarean Section (LSCS


Phew! The END!

advanced cpd in modern, functional, pregnancy ......(the link to this page in below). these videos...

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