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Functional Fitness and Chiropractic- Body weight
Jeffrey Sergent DC
Jeffrey Sergent DC
2004 Michigan State University- Environmental Science
2008 - National University of Health Science
Post graduate training
300 plus hours Diplomat, Rehab American chiropractic Council
McKenzie Mechanical Diagnosis and therapy, A-C
Dynamic Neuromuscular Stabilization, DNS, Clinical A-C, Certified Exercise Trainer
Functional Movement Systems I and II
Movnat certified trainer
Selective Functional Movement Assessment
Primary Spine Practitioner - University of Pittsburgh -Current
Functional exercise and ChiropracticPurpose of today's lecture is to give focus on what ailments enter our office, giving clinicians a background of the current training methods and theories and how it impacts our patients
This will not make you an expert in crossfit, oly lifting, powerlifting
This will give you a lens into evaluating, treating and mindset of our training and fitness patients.
We will take time to go through the exercises on form in preparation to helping our patients take away the “hammer” and keep them active.
Agenda Definitions - Work out terms, rehab terms
Exercises - Fitness/Rehab, both? Body weight exercises
Common faults
Clinical evaluation
Rehab and treatment of common conditions
Ice breaker Think of your schedule for monday.
Patient vs Doctor view Psychologically informed practicePerceptions of athletes can be skewed. They are not super humans
The thoughts that athletes have about experiencing pain:
Game ending, Fitness ending,
The words we use matter.
Patient one30 year old, female, US Triathlon team
Presented with Severe neck pain
Thoughts: can not work out and train, has to cancel her training center visit and appointments can not make it to nationals, can not make it to worlds, get kicked off team
Intervention: discussed how much she had been training (she’s resilient), showed her what she could do, create an rehab program that went through the changes and put her injury as a gift
Patient 2 52 year old male, self proclaimed “Crossfitter”, started on weight loss journey 3 months ago. Started because he was overweight, hypertension and close to being diabetic.
Presented with Lower back pain
Thoughts: all his hard work is for nothing, he is going to gain all the weight back, getting back to workout is never going to happen.
Intervention:
The Lancet – Low back series 2018
● MSK disorders are number 2 leading cause of disability world wide
● Guidelines recommend self-management, physical and psychological
therapies, and some forms of complementary medicine, and place less emphasis on pharmacological and surgical treatments; routine use of imaging and investigations is not recommended
The Lancet – Low back series
● The evidence:
● Little prevention evidence exist
● Exercise and education best evidence
● Ergonomic alone – ineffective
● “Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery “
The Lancet – Low back series
Exercise Therapy
Spinal Manipulation
Behavioral Therapy
The Lancet – Low back Serie
● Overall:
● Spend more = worse outcomes
● Patient Centered Care for best outcomes
The Lancet ● Low back pain● Published: March 22, 2018● What low back pain is and why we need to pay attention● Jan Hartvigsen, Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane
Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob J Smeets, Martin Underwood on behalf of the Lancet Low Back Pain Series Working Group
● The Lancet, Vol. 391, No. 10137
● Prevention and treatment of low back pain: evidence, challenges, and promising directions
● Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, Judith A Turner, Chris G Maher on behalf of the Lancet Low Back Pain Series Working Group
● The Lancet, Vol. 391, No. 10137● Low back pain: a call for action● Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa,
Anthony Woolf, Mark Schoene, Peter Croft on behalf of the Lancet Low Back Pain Series Working Group
● The Lancet, Vol. 391, No. 10137
JAMA 2018 Physical activity guidelines for Americans
Guidelines for kids
● 3- 5 year: Active through out the day
● 6-17: 60 minutes or more per day○ Moderate to vigourous
Adults ● 150 -300 minutes per week
moderate intensity● Or● 75-150 vigorous or equivalent
combination of moderate and vigorous
● AND● 2 or more strength days per week● Older adults need to focus on
balance as week
Current state of careMusculoskeletal conditions are on the rise. Low back pain being the highest increase in visits.
They are taking up more visits to the ER and PCP than ever before. From 8/100 visits to 13/100 over the last 10 years.
MSK super market: PCP, PMR, Surgeon, ER, Pain management, PT, DC, LMT, LAC, ATC, ND, Rolfing, Personal trainer, Google, devices, Reiki…. The list goes on
Who do they chose and why?
Exercise and Chiropractic SMT: Best short term outcomes (better than exercise alone)
Exercise: Best long term outcomes
SMT + exercise = “perfect marriage”
LBP guidelines,Joint pathology, Tendonipathy guidelines around the world require “Promoting functional Restoration”
Having an understanding of what our patient are doing outside and how we can promote a life of exercise is key and the “golden ticket” to long term success for our patients.
Healthcare 3.0Patient centered care
Doctor treats with the best evidence
Patients and Doctor form a team
Chiropractors can lead this!
Movement primary care
Focused on conservative management- chiropractic adjusting, nutrition and exercise.
Closed Chain/open chainOpen chain: O-I
One primary joint
On stationary other mobile
Isolated joint motion
One plane of mov’t
Non - functional
Closed Chain: I-O
Multiple joints axes
Both segments move simaneoulsy
Multiple joint movements
Multiple planes of movement
Significant functional oriented
In respect to joints:
Closed chain- Distal aspect of extremity is fixed
Open chain - proximal aspect of the extremity is fixed
Karel LewitIf breathing is not normalised – no other movement pattern can be” Karel Lewit, MD
Cylinder
Inferior drawParachute effect
Definitions Exercise programming
1. EMOM- Every minute on the minute: scrutinies the power of recovery
5 push ups, 10 squats every minute for 10 minutes
2. AMRAP- As Many Reps/Rounds as Possible. Pushes endurance, power and mental strength
12 minutes of 8 back squats and and push press
Definitions...3. RFT : Round for Time. Completing a given number of rounds of a circuit as fast as possible. Short rest helps develop timing and muscle endurance
Eight rounds of 15 KB swings, 10 KB clean ans press and 5 KB Snatches
4. Chipper: One round series of exercises, usually with high reps, to be completed in the fastest time possible. A high volume, muscle building grind
100 wall balls, 75 body weight squats, 50 push ups, 25 pull ups
Definitions Workout5. Ladder: One or more movements, increasing or decreasing with workload overtime
1-10 reps of goblet squats super set(no to minimal rest) with 10-1 reps of pull ups
6. Tabata: Do eight rounds of high intensity intervals, alternating 20seconds effort with 10seconds rest. Fast eviscerating finisher
20 seconds of assault bike for max calorie
Workout definitionsMetCon - Metabolic conditioning-
Dynamic training of challenging and cardio sessions
As opposed to traditional trunning of cardio training, long runs on the treadmill or elliptical
Body weight exercisesCommon ones
Push up
Pull up
Air squat
Burpee
Core
Push up“Ideal push up”
Armpit line/nipple line - can do a T test - arms to T, bring them in front,then retract back
Toes “dug in”
Push through full hand and torque through elbows on raise
Neck retracted or neutral
IAP through out movement
Push up Common mistakes
-Can not retract scapula and protract/elevate to push up
Rx: Scap stabilizer strength/motor control/T spine mobility
-Shear of the lower back
Rx: Anti shear exercises/core endurance/T spine mobility
- Distribution of weight through the hands transfer to outside of hand
Rx: Scap stabilizer strength/motor control
-Neck is a “noodle” or looking at abs
Neck endurance and Core endurance exercise, Scap stabilizers
Pull up
Ideal pull up
Grip - shoulder width apart
Shoulders pact
Elbows in front of body
Try to pull hands “in and down”
Hollow position- seals up energy leaks- feet pointed, glutes/core tight
Attack bar with chest
Pull ups common mistakes -Grip
Too close lots of elbow/brachioradilius primary mover (important but not driver)
Too wide allows for elbows to flare, causing protraction/elbow
Caved position of the chest- thoracic flexion and protracted shoulders
Neck extension
Feet crossed
Pull up- rehab treatment Scap stabilizers strength
Grip strength- can you hang the amount of pull ups you want to do?
Core endurance
Full external rotation/supination of the UE, supination
Air Squat -not loaded Foot placement - slightly greater than shoulder with apart, slight external rotation
Foot tripod- 3 triangle of the foot
Elongate through spine, keeping neck retracted
Knees travel to the mid foot, over foot
Arms stabilize the body as counterweights
Hip travels to 110 ish degrees with no butt wink, below that is okay
Tibia is parallel to spine angle at the bottom
Triangle position of the foot
1st metatarsal
5th metatarsal
Calcaneous
Increase surface areaIncrease ground reactive forcesBetter position
Air Squat - common mistakes
Toes flaring up- Stiffness in foot joints and muscles
Knee valgusity - Hip strength vs. ankle mobility
Quad dominance - Hip strength vs. ankle mobility
Forward flexion - Hip strength vs. ankle mobility
IAP loss
BurpeeSquat down to 100 degrees
Place hands on the ground shoulder width apart
Lower chest and thighs to the ground
Jump feet up to hands
Jump vertically with full hip and knee extension
Combining the rules of push up and squat
Common faults of the burpeeShearing of the spine
Core endurance and anti shear training
Hip impingement- feet too close together
Cue different or hip strengthening
Hands too far apart leads to protraction of the shoulders
Shoulder stabilization, thoracic spine mobility
CoreSit up
A traditional sit-up generates at least 3,350 newtons (the equivalent of 340 kg) of compressive force on the spine. The U.S. National Institute for Occupational Safety and Health states that anything above 3,300 newtons is unsafe.
PlankPlanks
Common faults
Neck looking at abs
Shoulders not centrated
2 minutes max
UE Pathology - Examination
Rule out cervical spine
Elbow 44%
Wrist 38.5%
Shoulder 47.5%
Neuro exam and MDT exam key
Cervical spine : physical examArm Squeeze
“..squeezing with the hand [simultaneous thumb and fingers compression, thumb from posterior (triceps muscle) and fingers from anterior (biceps muscle)] of the examiner, the middle third of the upper arm, elicited local pain”-Eur Spine J (2013) 22:1558–1563
The test was considered as positive when the score was 3 points or higher on pressure on the middle third of the upper arm compared with the other two areas (difference between results in middle third of the upper arm area and in the acromioclavicular joint and subacromial area).
Shoulder exam 180 deg of passive range of motion
Active Shoulder Abduction
180 degrees of shoulder abduction
Pass shoulder moves through range of motion with no pain
Fail: elbow flexion, shoulder hike, “ concaving” of teres and infra
SCAP STABILIZERS● Serratus anterior● Lower trap ● Rhomboid● Levatorscap● Latissumus dorsi
OTHER MUSCLES THAT CROSS THE SHOULDER JOINT● 2 heads of the bicep● 3 heads of the tricep● Pect major● Pect minor● Coracobrachialis● Deltoid ● Teres major
SUPRA SPINATOUS INFRASPINATOUS
TERES MINOR SUBSCAPULARIS
Generalities of TendinopathyPresentation:
History of overuse or load recently
Pain is point variable 1-2 fingers width
Hurts to weight bear
Change direction painful
Moderate to severe pain
Swelling
Tendon pathologyContinuum model of tendinopathy
1. Reactive a. Young 15-25yrs oldb. Uncommon painful
2. Degenerativea. Older than 30-60 yrs oldb. Rarely present clinically
3. Reactive on degenerativea. Older 30 plus yrs oldb. Common in practice-painful
Tendinopathy- Cook et. al. Tendinopathy
Tendinopathy TreatmentDuring the reactive-degenerative stage: Tape, Adjust, biofreeze, Nutrition
These are not very resilient, can be aggravated by exercise
Isometric exercises 45sec hold x5 with 2 minutes in between, 2-3 x daily
Start affecting other parts of the chain
Take away painful events and movements.
Rest is NOT best.
Tendinopathy treatmentOnce the pain has reduced add in isotonic movements: eccentric and concentric
Evaluation: as load increases pain should decrease
If you load to early, the patient will let you know
Rule of thumb is 3-4/10VAS during exercise and no worse the next day
Last, Get patient ready for sport or athletic endeavor
Fix Mechanics, this can be through Manual muscle testing, functional movement screen, or other pertinent movement assessment
Shoulder exam Shoulder flexion: 180 degrees of movement
Pass: able to move through pain free with no elbow flexion
Fail: elbows bend, shoulder hikes, pain
Serratus anterior: Manual muscle test
Test through range of motions
Empty can test:
Standing at same time
WALL ANGEL ● This is a gross motor and range of motion test● Use goniometer for more exact quantification
Standing UE multi segment testPatient hands out in front :
Test Wrist extension - shoulders at 90, elbows at 0.
Patient then takes wrist through flexion and extension
Clinician is looking for compensation through chain and obvious difference
Test supination and pronation - Shoulders at 90, elbow at 0, wrist at 0
Patient takes forearm through supination and pronation,
Clinician is looking for compensation through chain and obvious difference
UE -rehab and correctionsManual therapy -
Subscap - compression through range of motion
Flexor group - stripping into wrist
Latissimus Dorsi - End range motion
Thoracic spine manipulation
UE Rehab Breathing
Serratus anterior activation drill
Hitchhiker rows
Serratus wall walks
Eccentric closed chain rotator cuff movement
Planes of motion Sagittal plane
Frontal plane Transverse plane
Breathing Hook lying
Triple flexion
Seated
standing
Cervical retractions Open Chain Variation
McGill Sit up with retraction
Patient supine with hands under back
Raise head and torso off ground
Serratus anterior Elbows and knees
Dolphin position
Wall position
Contralateral positioning
Hip rehabManual therapy
Abdominal trigger point therapy
Psoas
Hip strength exercisesLow oblique sit half kneeling sit back
Banded - Lateral walks, monster walks, air squats
Counter weights
rehab quadrupedQuadruped advancements
Bird dog - contralateral movement of the
Arms and legs
Bear stance- lift the knees slightly off the
ground
Rehab to performanceDeadlift
Barbell, Kettlebell, dumbbell
-Neck retracted
-shoulders retracted
So much more and not enough time...Thank you! For your participation
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