r-phase certification - z-health university

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R-Phase Certification

“Everything should be made as simple

as possible, but not simpler."

- Albert Einstein

You ARE Your Brain!

“Everything you have ever felt or

done in your life was due to brain

function. At the most basic level, the

intricate firing rates and patterns of

your brain both determine who you

have been and, more importantly,

who you will become. All human

change represents changes in that

individual’s nervous system.

All that we are is brain-derived.”

So What Is Z-Health?

Z-Health is a scientifically designed

system of exercise crafted to

specifically target what matters most

in human performance –

The Human Brain.

It developed out of the simple

premise that all forms of training and

rehabilitation specifically target the

brain – whether we know it or not!

The Three R’s of R-Phase

1. Injury Rehabilitation

2. Neural Re-Education

3. Mobility Restoration

1. What are yours?

2. Here are ours:

• Learn R-Phase Exercises (How

To Teach, How To Do)

• Learn 3 Assessment Processes

• Learn Monday Morning Protocol

Expectations

Z Performance Principles

1. Everyone is an athlete.

2. Everything is a skill.

3. The nervous system controls

everything in the body.

4. Change occurs at the speed of the

nervous system.

Three Reasons To Focus On The Nervous System

1. The Governing System

2. The Fastest System

3. The Most (Anatomically) Stable

and (Functionally) Plastic System

Let’s Begin With Neurology Simplified

The

Nervous

System Is

Orderly

Basic Brain “Functional” Divisions

The Old 1st Brain

• Old Brain

• Non-Reasoning, Non-Rational

• Seat of Emotion

• Reviews and Judges All Incoming

Stimulus

• Acts as GATEKEEPER to 2nd Brain

• Brainstem, Superior Colliculus,

Inferior Colliculus, Limbic Lobe

• Only Interested in Answering 1

Question:

IS IT SAFE?

The New 2nd Brain

The New 2nd Brain

• New Brain – NeoCortex

• Conscious Thought

• Memory

• Language

• Creativity

• Decision Making

• Movement

• Conscious Sensation

• Vision

• Enacts Decisions

1. Fuel (Oxygen, Glucose)

2. Activation (Use It or Lose It)

The Two Things Your Brain

Needs To Stay Alive:

Foundational Brain Concepts

Your Brain’s Basic Feeding Pattern

1. Bottom To Top

2. Back to Front


Is The Body More Oriented

Toward Survival or

Performance?

Job #1 – Survival!

How Does The Brain Keep Us Alive?

Survival processing in the

human brain can be summed

up in two words:

PATTERN RECOGNITION(or more simply: PREDICTION)

Let’s Begin With Neurology Simplified

The Nervous System Does 3 Things

1. Receives Input (Afferent)

2. Decides What the Input Means

and What to Do About It

(Interpretation & Decision)

3. Creates Motor Output (Efferent)

Neurology Simplified: Inputs

Exteroception:

- Monitoring the external

environment

1. Sight

2. Smell

3. Hearing

4. Taste

5. Touch


Interoception:

- Awareness of bodily

sensations & feelings

1. Heart Rate

2. Respiration

3. Visceral Organs

4. Thermoregulation

5. Sense of Ownership


Proprioception:

- Awareness of limb & body

position in space

1. Mechanoreceptors

2. Baroreceptors

3. Thermoreceptors

4. Chemoreceptors

5. Electromagnetic Receptors

6. Nociceptors

Everything CAN Matter!

How Many of These

Inputs Do We Typically

Assess?

Neurology Simplified: Interpretation & Decision

Interpretation:

- Integration with other

senses, memories, and

predictive processes.

1. Old Brain First

2. THEN New Brain

Decision:

- Can be made at

either level.


• Vision Processing

• Integration

• ABC’s

• Auditory & Vestibular Processing

• Language Recognition

• Sensory Mapping

Frontal Lobe

• Executive Function

• Decision Making

• Cognitive Thinking

• Inhibition• Autonomics

Neurology Simplified: Outputs

PAIN

Fatigue

Inflexibility

Immobility

Dizziness

Poor Movement

Poor Balance

Migraines

Coordination

Strength

Speed

Pain Free Movement

Immune Health

Endocrine Health

Great Balance

Movement Neurology for

Strength Training

1. Increased Neural Drive

2. Improved Reflexive Tone

Movement Neuroanatomy 101

In terms of movement training in this

course, we are primarily interested in

3 different brain regions:

1. Cerebellum – Coordinates and

“Fixes” Movement Errors

2. Frontal Lobe (Cortex) –

Initiates Movement

3. Pontomedullary Reticular

Formation (PMRF) – Posture,

Global Muscle Tone, and

Autonomic Control

The Cerebellum

Cerebellum – Integrates (and simplifies) the

complex data generated from all of our body

systems and cognition. The cerebellum

performs these tasks in movement:

1. Coordinates complex movements ipsilaterally.

2. Eliminates all unwanted movement by ensuring Accuracy, Balance,

and Coordination

3. Directly stimulates the contralateral cerebral cortex (frontal lobe)

4. Is in direct communication with the ipsilateral vestibular system.

R-Phase Cortex Rules

1. All sensory input eventually

goes to the contralateral

cortex, except smell.

2. Voluntary movement is

created by the contralateral

cortex, and controlled by

the ipsilateral cerebellum

(remember Accuracy,

Balance, Coordination).

The PMRF

PMRF - Part of the brainstem

that is of great importance in

pain relief, postural control,

and movement.

All functions are ipsilateral:

1. Inhibits pain

2. Inhibits sympathetics

3. Creates good, upright

posture by affecting muscles

above/below T6

4. Creates good muscle

resting tone.

1.

2.

3.

4.

Understanding the Neurology of Movement

• Healthy, strong

movement requires

healthy, active

neurologic signaling

• If deficits exist in the

Cerebellum, Cortex,

or PMRF then

movement and

strength suffers!

Inputs to the PMRF

Increase activation of

the PMRF by

stimulating:

1. Ipsilateral

Cerebellum

2. Ipsilateral Cortex

3. Ipsilateral

Vestibular System

8 Levels of

Assessment

Model

Pain & Performance

Receptors

Peripheral Nerve

Spinal Cord

Cerebellum Brainstem

Thalamus

Insula

Cortex

Receptor Type Sensation Signals Adaptation Speed

Muscle Spindle Encapsulated Muscle Stretch Muscle Length &

Velocity

Rapid Initial Transient

& Slow Sustained

Muscle: Golgi Tendon

Organ

Encapsulated Collagen Muscle Tension Muscle Contraction Slow

Joint: Pacinian Encapsulated &

Layered

Joint Movement Direction & Velocity Rapid

Joint: Ruffini Encapsulated Collagen Joint Pressure Pressure & Angle Slow

Joint: Golgi Organ Encapsulated Collagen Joint Torque Twisting Force Slow

Muscle/Joint Receptors

Receptor Type Sensation Signals Adaptation Speed

Meissner Corpuscle Encapsulated &

Layered

Touch: Vibration &

Movement

Frequency, Velocity &

Direction. 30HZ

Vibration

Rapid

Pacinian Corpuscle Encapsulated &

Layered

Touch: Vibration Frequency: 100-300

HZ

Rapid

Ruffini Corpuscle Encapsulated

Collagen

Touch: Skin Stretch Direction & Force Slow

Hair Follicle Unencapsulated Touch: Movement Direction & Velocity Rapid

Merkel Complex Encapsulated

Collagen

Touch, Pressure,

From

Location & Magnitude Slow

Free Nerve Endings Unencapsulated Pain, Touch,

Temperature

Tissue Damage,

Contact, Temperature

Change

Depends on

Information Carried

Cutaneous Receptors

Tract Origin Function

Dorsal Column Ipsilateral Dorsal Root Ganglion Fine Touch, Vibration, 2 PT

Discrimination, Pressure, Proprioception

- Contralateral

Dorsal Spinocerebellar Ipsilateral Nucleus Dorsalis of Clarke Unconscious Proprioception, Online

Corrections of Evolving Actions -

Ipsilateral

Ventral Spinocerebellar Contralateral Dorsal Horn Unconscious Proprioception, Online

Corrections of Evolving Actions -

Ipsilateral

Lateral Spinothalamic Contralateral Dorsal Horn Pain and Thermal Sensations -

Contralateral

Anterior Spinothalamic Contralateral Dorsal Horn Crude Touch, Pressure, Itch, Tickle -

Contralateral

CNS Overview – Spinal Cord Ascending Tracts

Tract Name Origin Function

Lateral Corticospinal Contralateral Cerebral Cortex Control of Skilled Movements - Contralateral

Anterior Corticospinal Ipsilateral Cerebral Cortex Control of Skilled Movements - Contralateral

Rubrospinal Contralateral Red Nucleus (Midbrain) Contributes to Arm, Hand and Finger

Movements, Arm Swing, Facilitation of Flexor Muscles

Lateral Vestibulospinal Ipsilateral Lateral Vestibular Nucleus Controls Posture and Spatial Orientation. Facilitates Extensor Muscles.

Medial Vestibulospinal Ipsi and Contralateral Medial Vestibular Nucleus

Controls Neck Posture

Reticulospinal (RST) Medullary and Pontine Reticular Formation BI

Postural Functions

Lateral RST: Facilitates Proximal and Flexor

Muscles

Medial RST: Facilitates Proximal and Extensor Muscles

Tectospinal Contralateral Superior Colliculus (Midbrain) Generates Reflexive Changes in Head

Position in Response to Bright Lights, Sudden Movements and Noises

Spinal Cord Descending Tracts

“Movement is the basic currency of

health, fitness and performance. Great

movement produces healthy, pain-free,

high-level performance. Bad movement

promotes pain, dysfunction, and

progressive decreases in movement,

which themselves lead to progressive

decreases in brain function and health.”

Movement Is Life.

Job #2 – Movement!

Movement Creates Structure

The body you have is the

body you’ve earned by

the way that you move.

Wolff’s Law and Davis‘ Law

Bones and soft tissues remodel along lines of chronic stress.

Form Follows Function!

In most cases, WALKING is the single strongest, most chronic, full-body loading event our bodies undergo. So, if you want to fix both short and long-term problems, as well as increase performance and efficiency – fix their gait.

Ground Forces Math – Load in Kg

How Hard Do We Strike the Ground?

During Walking: 1.07-1.2x Bodyweight

During Running: 2.0-2.9x Bodyweight

During Sprinting: 4.6-5.5x Bodyweight

The Math

Average Male: 80kg

Danish Study 2011-2012 = 8,341 Steps/Day

80kg x 1.2= 96kg/Step

96kg x 8,400 = 806,400kg per day

806,400 x 7 = 5,644,800kg per week

5,644,800 x 52 = 293,529,600 per year

Do you think a small joint issue could become a major problem?

Ground Forces Math – Load in lbs

How Hard Do We Strike the Ground?

During Walking: 1.07-1.2x Bodyweight

During Running: 2.0-2.9x Bodyweight

During Sprinting: 4.60-5.5x Bodyweight

The Math

Average Male: 200lbs

Average Steps Per Day (In Europe) = 8,341

200lb x 1.2= 240 lbs/Step

240lb x 8,400 = 2,016,000 lbs per day

2,016,000 x 7 = 14,112,000 lbs per week

14,112,000 x 52 = 733,824,000 lbs per year

Do you think a small joint issue could become a major problem?

What is Proprioception?

The body’s 3-D map of

itself in space and time.

AKA our movement &

awareness map.

Body Maps & Neurosignatures

The nervous system carries many

maps. In R-Phase, we are primarily

concerned with the proprioceptive

map. In subsequent certifications we

will cover the visual and vestibular

maps in great depth.

The Proprioceptive System

1. The Brain Maps (Parietal &

Frontal Lobe)

2. The Spinal Cord

3. Peripheral Nerves

4. Many Different Types of

Nerve Endings

5. Remember That

Proprioception LIVES In

The Brain, not the Joints!

Proprioceptive Nerve Endings

Nerve endings that provide

many different types of

information to the nervous

system such as:

• Mechanoreceptors

• Chemoreceptors

• Thermoreceptors

• Baroreceptors

• Electromagnetic Receptors

• Nociceptors

Proprioception = All The Body, All The Time

When you change one piece of the map, you change the whole map.

Two Most Critical Components of Proprioception

Type A Fibers: Mechano/Baro (Fast)

Type C Fibers: Nociceptors (Slow)


The Sensory-Motor Cortex


The Sensory Homunculus


The Motor Homunculus

Side By Side

Map Blurring

What are the

ramifications of

map blurring?

The Four Reasons Clients See You

1. Body Composition

2. Pain Relief

3. Performance Enhancement

4. Injury Prevention

What ONE Factor Is Required

To Achieve All Four Goals?

Better Movement!

The Z Paradigm Shift

This means that

EVERY problem is

a MOVEMENT

problem.

The Z Paradigm Shift

The Human Nervous SystemLatest estimates state that there are up to 120

billion neurons in the human brain. Each of those

neurons connects to and works with between

10,000 and 80,000 other neurons. So, multiply

120 billion x 80,000 and you end up with

9,600,000,000,000,000 (9.6 quadrillion) potential

connections. To put this in perspective, the milky

way galaxy has about 200 million stars.

What One System Controls Movement?

Neuroplasticity – A Key Component of Z-Health

Neuroplasticity (also referred to as

brain plasticity, cortical plasticity or

cortical re-mapping) is the changing

of neurons, the organization of their

networks, and their function via new

experiences.

Neural Plasticity – Metaplasticity

Metaplasticity

The Plasticity of

Plasticity

“The concept of metaplasticity may have

significant implications for neurorehabilitation

for two reasons. The first is that the history of

experience-dependent plasticity of a patient

prior to injury may contribute to the capacity

for rehabilitation-dependent plasticity and

functional improvement. Indeed, there is

evidence showing how increased cognitive

and motor activity significantly reduces the

onset or incidence of Alzheimer’s Disease

(Wilson et al., 2002; Laurin et al., 2001).

Similarly, lifestyle differences may also affect

recovery from less insidious disorders such as

stroke (Kulzer et al., 2008).”

- Jeffrey Kleim, PhD

Specific Adaptation To Imposed Demand (SAID)

• This is the FUNDAMENTAL LAW of

human physiology.

• The classic definition: “The body

adapts to whatever it does.”

• The Z-Health definition: “The body

ALWAYS adapts to EXACTLY what it

does.”

• The take home message here is that if

you want a certain result, you must

train with PRECISION.

The Fastest Route To Proprioceptive Enhancement

1. Increase mechanoreceptive

activity

2. How do you stimulate the

maximum number of

mechanoreceptors?

3. Moving the parts of the body

where the highest number of

them are found.

4. Where is that? The joints!

1. Basic mobility training

MUST teach active mobility

drills for each body part and

joint complex in all available

ranges of motion.

2. Most mobility approaches

are TOO COMPLEX AND

TOO INTEGRATED in the

beginning stages of training.

The ABC’s of Movement

Minimal Effective Dose

Exercise is NOT

so easy

that you cannot

screw it up!

Genetic Non-Responders to Exercise?

Individual Responses to Combined

Endurance & Strength Training

175 People for 21 weeks (5 months)

VO2 Max & Maximum Isometric Strength

15% SUPER Responders (+42%)

65% NORMAL Responders (+20%)

20% NON Responders (-8%)

Pain Does NOT Work Like This!

Unfortunately most “body” professionals

STILL do not recognize this fact. This

concept (of a single, isolated pain

center in the brain) originated hundreds

of years ago and has been in “place”

since the mid-1600’s.

Illustration: Descartes Reflex 1664

Z-Health Pain Basics

• In 1965, the world began to

change. Melzack and Wall, to

whom we ALL owe an

enormous debt, introduced

the revolutionary Gate

Control Theory of Pain.

• While it was a step in the

right direction, it was still

incomplete and incorrect in

many of its assumptions.


Based on fMRI, this is the

basic neurophysiology of pain

perception. But, there is still

more to the story!

Image Taken From Scientific

American Mind


After much study and further research,

along with the advancements in MRI, fMRI

and PET scans, everything began to

change. In 1999, Melzack introduced the

Pain Neuromatrix and life has become

both simpler and far more complex as a

result!


Z-Health’s

Threat Bucket

Pain & Performance Neuroscience

1. Pain is 100% of the time an output of the brain. This does NOT mean that peripheral

receptors and tissues are uninvolved but it does mean that these tissues can only send

DANGER signals to the brain.

2. Pain is a decision or construct made by the brain based on the perception of threat.

3. Because of the above, the brain should be the primary target for training in people

experiencing pain and performance blocks.

4. Injury does not equal pain and pain does not equal injury.

5. Pain is an THREAT/ACTION signal – not an indicator of damage.

6. Objective evidence of tissue “damage” does NOT mean it is the cause of the pain.

7. There is no single pain center in the brain.

8. The pain neuromatrix is individual-specific which means that there is wide variability in

which cortical areas are activated to produce pain between individuals.

9. Pain is experienced in the body image or “virtual body” held in the brain.

10.Practice of pain can create a neuroplastic change leading to a pain neurosignature.

10 Important Concepts of the Threat Neuromatrix

The Best

Athletes Make

Everything

Look Easy –

That Should

Be Our Goal!

What We Want

Which is effective?

Which is ineffective?

Why?

The Two Types of Efficiency

Efficiency is:

Doing just the right thing at

just the right time with just

the right amount of energy.

There are two types:

1. Effective (Healthy)

2. Ineffective (Unhealthy)

The Goal of Z-Health = Increased Efficiency

1 – 1,000 Reps

1,000 – 10,000 Reps

100,000 – 300,000 Reps

Motor Learning Basics – Posner Model

Perfect Form

Dynamic Postural

Alignment

Synchronized Respiration

Balanced Tension and Relaxation

The Path Of

Efficiency

Breakdown of Perfect Form

Loss of Dynamic Postural

Alignment

Loss of Synchronized Respiration

Imbalanced Tension and Relaxation

The Path Of

Inefficiency

The Four Elements of Efficiency

If you want to be as efficient as

possible, you must have a plan. In

Z-Health, the plan is called the 4

Elements of Efficiency:

1. Perfect Form

2. Dynamic Postural Alignment

3. Synchronized Respiration

4. Balanced Tension/Relaxation

1. The Startle Reflex

2. Sensory-Motor

Amnesia

The Two Enemies of Efficiency

Our genetically hard-wired

response to threat. It is

characterized by TWO

primary muscular actions:

• Flexion

• Adduction

What is the Startle Reflex?

1. Head – The head moves forward and down to shield the front of the throat and uses the base of

the skull to cover the more fragile upper cervical spine.

2. Face –The startle reflex tenses all facial and jaw muscles and closes the eyes in an attempt to

protect vision and prevent an unprotected blow to the jaw.

3. Shoulders – The trapezius muscles contract bilaterally and raise shoulders up toward ears. This

creates a further shield for the cervical spine and throat.

4. Chest – Anterior chest muscles contract and pull the shoulders forward and down to protect the

throat and upper rib cage which contain the heart and lungs.

5. Ribs – The intercostals muscles tighten and lock down the ribs in an effort to protect the lungs.

6. Abdomen – All abdominal muscles, deep spinal muscles and pelvic floor muscles contract

cooperatively to flex the body forward. This is done in hopes of shielding the internal organs from

trauma as well as to develop a strong, stable base from which to move.

7. Gluteals – Along with the abdominal contraction, the gluteals also contract bilaterally to tip the

pelvis. This aids in flexing the body and abdomen forward.

8. Legs – The adductors lead the contractions in the legs to lower the center of gravity and pull the

legs in to protect the pelvic floor from trauma. Additionally, the gastroc/soleus group often co-

contracts to increase body stability and balance.

The Elements of Startle

• A term coined by Thomas Hanna,

founder of Somatics.

• It means that we cannot feel and

cannot consciously move an area

of the body. Much of R-Phase is

about finding and correcting

SMA.

What Is Sensory-Motor Amnesia?

Remember Your ABC’s!

1. To stimulate as many

mechanoreceptors as

possible!

2. How should you move

the joints? In all

available ranges of

motion, aka, the ABC’s

of Movement.

Why Move Joints First?

• A reflex based on joint

movement and position.

• One of the missing links in

performance enhancement.

• Remember this, “Jammed

or immobile joints create

weak muscles. Mobile

joints create strength!”

The Arthrokinetic Reflex

The Passive vs. Active Paradox

The goal of efficient

training is to stimulate

mechanoreceptors.

Active work is the best

way to make that

happen. Remember the

SAID Principle!

Practicing Z-Health and Pain

1. Rule #1 = Do not practice Z-Health in pain. Remember the SAID

Principle. You do not want to gain “skill” at being in pain.

2. For your clients, you must differentiate between pain and

discomfort.

3. Discomfort = Sensation that you can relax and breathe through.

4. Pain = Sensation that creates startle responses.

The Training Rules

1. Never move into pain

2. If you have pain, slow down.

3. If you still have pain decrease

the range of motion

4. Long Spine/Long Body Position

5. Concentrate

6. Relax as much as possible

Remember the SAID Principle – if you don’t

train multi-speed mobility, you don’t OWN

mobility!

1. Super-Slow – 30 Seconds to 2 Minutes

– Motor Control & Strength Endurance

2. Standard – 5-15 Seconds – Motor

Control & Coordination

3. Coordinated – 1-8 Seconds –

Coordination and End Range of Motion

Control

4. Sports – ½-2 Seconds – Explosive and

End Range of Motion Strength and

Control

The Training Speeds

Basic Rules

1. Do not touch the muscle

being tested or a joint that

might impact on its

function.

2. The client initiates the test.

1. Gluteus Medius

2. Hip Flexors

3. Hamstrings

4. Deltoid

R-Phase Muscle Tests

R-Phase Muscle Tests

Train Everywhere!

1. Standing

2. Seated

3. Lying

R-Phase Is A Template

1. Joint Hypermobility

2. Joint Effusion

3. Inflammation

4. Malignancy

5. Bone Disease

6. Fractures

7. Total Joint Replacements

8. Post-Surgical

Most of these are RELATIVE. If in doubt,

always obtain doctor’s approval prior to

working with a client.

Contraindications

Remember SMA – The don’t

even know they don’t know.

1. Skin Stim (Light

Rubbing, Tapping, Etc)

2. Light Touch (Move

Away)

3. Hard Touch

4. Muscle Activation

Cueing Your Athlete – The Vital Skill

1. High Payoffs – When you have NO IDEA what else to do.

2. Opposing Joints/Opposing Movements – To quickly deal with pain and movement dysfunction. More “accurate” than HPO’s.

3. The 7 Step Protocol – The “Gold Standard” of R-Phase

R-Phase Assessments

• What is an assessment?

(To sit beside and judge…)

• Both Art and Science

• These are diametrically

opposed concepts.

• We will give you the science

in R-Phase and practice the

art.

R-Phase Assessments

To Pick A Starting Point!

The One Goal of Every Assessment

There is a neurological &

biomechanical connection between

“Opposing Joints”

These can be used as a way to

choose a starting place for joint

rehabilitation

Wrists/Ankles

Elbows/Knees

Shoulders/HipsThoracic/Lumbar

Cervical/Pelvic (S.I.)

TMJ/Coccyx

Carpals/Tarsals

Opposing Joints

1. In the Limbs: Always use

“Opposing Joints & Opposing

Movements”

2. In the Spine:

• During any Bending:

Use “Opposing Joints &

SAME Movement”

(Make a “C” shape of the

spine)

• During any Rotation:

Use “Opposing Joints &

Opposing Movement”

Opposing Joints

“WHY” This Works…

It is based on:

• Back Force

Transmission

System

• Inter-limb Neural

Coupling

• PMRF

Opposing Joints

1. The body is integrated – not isolated.

2. Muscles do not function properly if the joints they attach to are immobile.

3. The right lower extremity works in conjunction with the left upper extremity and

vice versa.

4. A loss of mobility in any area will be compensated for by increased mobility further

along the kinetic chain.

5. For the smart slings of the body to work correctly, the joints must be mobile and

under active control.

6. The body’s natural movement systems are always working to conserve energy.

7. Problems usually begin at the ground and work their way up, but not always.

8. Areas of the body with the most joints have the highest potential for changing

chronically poor movement patterns.

The Eight Rules of Assessment

• Introduced by Gracovetsky

• Primary Goal = Conservation

of Energy

• Pre-Cognitive = Reflexively

Driven (Central Pattern

Generators and Gait Reflexes)

The Sling System

1. Through the striking heel

2. Up the lateral leg

3. Up the lateral hamstring

4. Into the sacrotuberous ligament

5. Across the sacrum to the opposite SI joint

6. Up the throco-lumbar fascia

7. Up the latissimus dorsi

8. Force splits and travels both up the trapezius, and down the arm via the triceps brachii

9. Up and around the cranium to the TMJ

Back Force Transmission System

4 Common Functional Neurologic Presentations In Gait

1. Bobblehead = Midline Movement (Spine & Eyes)

2. Loss of Arm Swing = Ipsilateral (to the arm) Movement Drills

3. PMRF Gait Patten = Contralateral Movement Drills

4. Cerebellar Gait Pattern = Ipsilateral Movement Drills

R-Phase Gait Assessment & Neurology

Bobblehead - When your

client is walking, the head

and neck should remain

relatively still and fixed. If

your client displays a

significant amount of head

and neck movement during

the gait cycle this is often

indicative of either visual or

vestibular issues

Possible Solutions:

• Cervical Mobility Drills

• TMJ Mobility Drills

• Gaze Stabilization

• Smooth Pursuits

• VOR

• VOR-C

• Otolith Drills


Loss of Arm Swing -

Arm swing in gait is

controlled (in part) by the

CONTRALATERAL

HEMISPHERE.

Possible Solutions:

• Complex mobility drills on

the side of decreased arm

swing.

• Use history findings and

opposing joint/movement

concepts as a guide.


PMRF Gait Pattern – In this

gait, you will see internal

rotation of the UPPER

EXTREMITY and external

rotation of the LOWER

EXTREMITY. This must be

correlated with history

findings.

Possible Solutions:

• Complex mobility drills on the

side of the body

CONTRALATERAL to the

PMRF side.

• Consider unilateral strength

training on the side of the body

CONTRALATERAL to the

PMRF side for 6-8 weeks.


Cerebellar Gait Pattern – In

this gait, you will see internal

rotation of both the UPPER

EXTREMITY and LOWER

EXTREMITY. This will be

ipsilateral to the side of the

deficit. So, a right cerebellar

issue will cause this pattern on

the right side of the body.

Possible Solutions:

• Complex mobility drills on the

IPSILATERAL side of the body.

• Remember, that the cerebellum

responds to complexity so

increase movement challenges

with alterations in mobility drills:

• Speed

• Perturbation

• External Loads

• Bands

• Eyes Closed


1. Choose A Dynamic, Autonomous Activity To Assess

2. Stop and Be Present

3. Orient Yourself Correctly To Your Athlete

4. Listen

5. Look

6. Teach

7. Re-Assess

Remember that is you are not Re-Assessing, you are just guessing.

Guessing is NOT corporate policy.

The 7-Step Assessment Protocol

1. You want to see what they really

do when they ARE NOT

THINKING ABOUT IT.

2. Dynamic Cognitive assessment

techniques assess something

different than how they move day

to day.

3. You need to get Real information

from Real people.

Why Dynamic, Autonomous?

1. This is a reminder that you must

practice your craft deliberately. Every

day. Every session. That is how you

will master it.

2. As a Z-Health practitioner, you need

to be looking for subtle nuances that

others will miss. If you are not

focused, you will miss it like everyone

else!

Stop and Be Present

Assessments must be

repeatable and reliable. If the

coach does not ALWAYS

use the same position, visual

parallax will distort findings.

In R-Phase, always assess

gait either from directly in

front, directly behind or at 90

degrees.

Assessment Drills - Orientation

To increase the efficiency of

your assessment skills, visual

training is paramount.

Use negative space analysis to

QUICKLY take in a tremendous

amount of side-to-side

comparative detail.

Assessment Drills – Negative Space

1. Heavy Heel Strike – This means that

the hamstrings are NOT

DECELERATING CORRECTLY. They

are not coordinating well with the rest of

the body. What drill? Lat/Med Ankle Tilts

(Most of the time Lateral Tilts)

2. Cadence and Rhythm – Use this to

confirm a HEAVY HEEL STRIKE.

Normal gait should be rhythmic and

symmetric. Heavy heel strike gives a

PEG LEG SOUND

Listen – 5 Sounds

3. Scuffs – We have TWO DIFFERENT SCUFFS TO LISTEN FOR:

– Heel Scuff – This occurs during swing phase because THERE IS DECREASED HIP FLEXION!

What drill could we use? Primarily middle toe pull because we look at this as a Rectus Femoris

issue.

– Ball of Foot Scuff – This occurs during swing phase, also. It is because of a LACK OF

DORSIFLEXION. Do we have a magic drill for this? No. But WE DO HAVE A MAGIC RULE!

Any muscle that is not coordinating well can be affected by MOBILIZING ANY JOINT THAT

MUSCLE CROSSES BECAUSE THEY SHARE THE SAME NERVE INNERVATION. So, this is

typically a tibialis anterior problem. You could then do toe pulls or ankle circles.

4. Brush – This occurs with a specific set of conditions, again during swing phase:

– Hip external rotation

– Hip adduction

– Hip flexion

– This points very specifically at the PSOAS. We can re-coordinate it with INSIDE TOE PULLS.

5. Clicks and Pops – This is called CREPITUS. It means NOTHING. The rule is, “if it doesn’t hurt,

don’t worry about it.” There are a hundred+ tissues in the body that can cause clicks and pops

Listen – 5 Sounds

1. Remember that you ALREADY know

what most of this looks like. You don’t

need all the machines and intricate

measurement systems that many

believe are required!

2. The chart is divided into three sections:

• Common Findings

• Associated Joint Mobility Loss

• Corrective R-Phase Drill

3. You will see that it is QUITE repetitive.

Remember you are just picking a place

to start!

Look

1. What Is The Goal Of An Assessment?

2. Don’t Belabor The Process.

3. Remember The 10-year Old Rule.

4. Don’t Over Analyze.

5. Pick A Drill And Teach It Well!

Teach

1. How fast does change occur in the body?

2. We want to IMMEDIATELY re-assess the effects of the exercise to understand how the athlete’s nervous system has responded.

3. The nervous system response is quite binary – yes or no.

4. How are we going to re-assess? Use the BFTS.

5. Where does force cross? The SI Joint

Re-Assess – The Magic of Z-Health

1. Category I = No Motion

2. Category II = Shearing

3. Category III = Rotation

4. Category IV = A/P Glide

Re-Assess – Grading SI Function

1. PALPATE THE SI Joints Bilaterally

2. When they begin walking look at one side at a time.

3. Use the following progression:

4. First decision to make – IS THERE MOTION? DO YOU SEE MOVEMENT OR

CREASING? If there is movement, it IS NOT A CATEGORY 1.

5. Now, look at the ILIAC CRESTS. Are they MOVING UP AND DOWN 1-2

INCHES? If so, it is a CATEGORY 2.

6. Next, shift your focus to the butt muscles. Are they moving lateral to medial

when the leg is in extension? If so it is a CATEGORY 3.

7. Finally, if all of the above answers are NO, you probably have a CATEGORY 4.

You should see a SMOOTH, SYMMETRIC, QUIET, GRACEFUL GAIT.

Re-Assess – Grading SI Function Steps

Introducing the Sacroiliac Joint!

Your athletes need to understand

that their body is a big X – the

right arm works with the left leg

and vice versa with the forces

CROSSING AT THE SI JOINTS.

The Big X

• Is There Any Movement?

• No = Cat. I

Yes?

• Are iliac crests moving up and down more than 1.5-2"?

• Yes = Cat. II

No• Are gluteal

muscles rotating lateral to medial during hip extension?

• Yes = Cat. III

No = Cat. IV

SI Re-Assessment Protocol

• No Motion Seen In SI Area

During Gait.

• Lumbar And Thoracic

Vertebrae Over-Rotate In

Compensation

SI Category 1

• Iliac Crests Rise More Than 1.5”-

2”

• Creates a Shearing Force

Through The SI Joints

SI Category 2

• Gluteal Muscles Rotating Lateral

To Medial During Hip Extension

SI Category 3

• A/P Glide is the ideal, smooth, small motion that occurs during gait along the natural plane of the SI joint.

• It creates a characteristic “dimpling” during gait at the level of the upper SI Joint.

SI Category 4

Based on movement

dysfunction it is

entirely possible to

have different

categories of SI

function on the right

vs. the left.

SI Combinations

The SI Joint can also be

subdivided into an Upper and

Lower Division. It is possible to

have upper vs. lower joint

restrictions which create a mixed

category of movement on 1 SIDE!

The most typical presentation

here is a 1:1 – 3:3 – meaning an

upper joint 1 bilaterally and a

lower joint 3. This will present as

NO MOTION in the upper SI with

ROTATION in the lower gluteal

muscles.

Same Side Mixes

Remember that we are after a dynamic,

autonomous gait!

Your athletes do NOT want to look bad so they

will often “perform” their walk rather than just

walk. Signs of performance gait are:

1. Stiff

2. Slow

3. Breath Holding

4. Placement Gait

Assessment Drills – Performance Gait

• Arches vs. Angles is a simple concept

that can massively improve your ability

to QUICKLY find areas of immobility.

• As you can see, the immobile areas are

the flat upper thoracic region and the

flat lower back. These are considered

“angles” on either side of an arch.

Assessment Drills – Arches vs. Angles

Take a Great History• Set Session Goal

• Injury & Surgery History

• Prior Surgeries

• Scars

• Medications

• Sports & Training History

Check S.I. Function• Category 1: No Motion

• Category 2: Shearing

• Category 3: Rotation

• Category 4: A/P Glide

Decide HOW To

Choose a Drill• Neuro Gait Patterns

• 7 Step Protocol

• Opposing Joints

• High Payoff Drills

Monday Morning Protocol

Cognitive

Assessment for the

Client• Active ROM

• Strength

• Balance

• Functional Activity

Teach A Drill• Only Teach ONE

• Don’t Belabor The

Process

• Teach it WELL

Pre-Cognitive

Assessment for the

Coach• Recheck S.I. Function

• Look for Speed Changes

• Look for Sound Changes


Did S.I. Function

Improve?

If YES

Cognitive Re-

Assessment for the

Client• Active ROM

• Strength

• Balance


If NOGo Back to Choose

a New Drill


Stop Adding Drills

When or Before S.I.

Function Degrades• Watch Re-Assessments

• Watch Threat Responses

• Remember M.E.D.

• Remember E. of E.

Assign Homework• Typically Up to 5 Drills

• 3-5 Repetitions, 3-5x/Day

• Endurance Athletes May

Need 30-50 Repetitions

Minimum

2 Week Re-

Assessment• Re-Assess ALL Drills

Every 2 Weeks

• Provide NEW Set of 3-5

Drills

• Adaptation Will Occur,

and the Athlete Will Need

More Load


There are MANY elements to taking a good history.

Here are the basics:

1. Why are they there? Session goal?

2. “Show me what you can’t do.”

3. Prior injuries, broken bones, fractures.

4. Prior surgeries, large scars.

5. Accidents, falls

6. Medications and Vitamins

7. Exercise program

The goal in all of this is to establish TEMPORAL

CONNECTIONS:

“What happened before what happened,

happened?”

Monday Morning Protocol - History

• Dynamic, Autonomous Movement

• Gait Assessment

• Autonomous Sports Movement

• This type of assessment allows us to see

how they move in the real world, based on

their unique movement patterns.

• Note: Picture is of the crossed extensor

reflex – an example of a well-know central

pattern generator.

Monday Morning Protocol – Pre-Cognitive Assessment

• Range of Motion

• Strength


Monday Morning Protocol – Cognitive Assessment

Improved SI Function =

1. Increased Category

2. Increased Speed

3. Decreased Sound

Monday Morning Protocol – Pre-Cognitive Re-Assessment

Intelligently-Timed “Buy-In” Cognitive

Assessment For the Athlete

If the SI is better – Re-Assess

If not – Do NOT Re-Assess

Monday Morning Protocol – Cognitive Re-Assessment

An Incredibly Simple Concept:

Move both ends of the bone at the SAME SPEED.

Bone Rhythm

• Eyes Up – Facilitates Extension

• Eyes Down – Facilitates Flexion

• Eyes Right – Facilitates Right

Rotation, Right Extension, Left

Flexion

• Eyes Left – Facilitates Left Rotation,

Left Extension, Right Flexion

Using Eye Position for Reflexive Strength

As coaches, it is INCREDIBLY

important to help our athletes learn to

avoid self-induced arthrokinetic reflex

weakness based on technique and

postural distortions. The most

common one we see is poor neck

position in squatting and deadlifting.

Remember:

“A bad idea embraced by millions

of people is still a bad idea.”

Neck Position & Arthrokinetic Reflex

The rationale behind

intelligent, startle-free training

The Stress Hormone Cascade

Sacred Cows of Fitness – Swiss Balls

• What were they originally used for?

• Vestibular Rehabilitation – Not Tighter Abs!

• Unstable surface training does NOT carry

many of the benefits that its adherents claim

as it violates the SAID Principle for most

athletes, most of the time.

• At this time, research supports the

occasional use of UPPER BODY unstable

surface work, but lower body US training is

not necessary for the majority of our

athletes.

• The number one question to ask yourself

and your athletes is:

“Are the feet composed of different tissues

than the rest of the body?”

• If the answer is no, then why would you treat

them any differently? Remember this

phrase:

“The more expensive the shoe, the dumber

the foot that lives inside it.”

Sacred Cows of Fitness – Shoes

Sacred Cows of Fitness – Shoes

The majority of shoes make normal

gait impossible for five vital reasons:

1. Heels

2. Toe Spring

3. (In)Flexibility

4. Reduced Tread

5. Proprioception

Treadmills and other devices that mimic

human gait create:

• Altered movement patterns – No real

variability in stride length.

• No requirements to change based on

environment

• Instability so people hang on

• Boredom – So people don’t ENGAGE in

the exercise

• Weakness – Just like a Swiss Ball

Sacred Cows of Fitness – Treadmills

Recommended members of your

referral network:

1.Z-Health® Trainer

2.General Physician

3.Chiropractic Physician

4.Orthopedic Surgeon

5.Neurologist

6.Pain Management Specialist

7.Behavioral Optometrist (FCOVD)

Referral – The Professional Approach

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