6 Steps in the Evolution of Therapy (part 2) by Peter Roach

by Peter on May 17, 2012

This is the second article in a series looking at the 6 principles of Neuromuscular Therapy, and how they are applied in my treatment programs. Last week I talked about Posture, the first component that I look at when you come for treatment. The 6 principles I will be covering are:

  • Correcting postural distortions
  • Correcting dysfunctional biomechanics
  • Manually working on areas of ischemia
  • Releasing trigger points
  • Releasing nerve entrapment
  • Rehabilitating with exercise

So let’s talk about biomechanics.

 Biomechanics

The next stage that works in tandem with postural assessment is to look at your movement and motor patterns. This, with posture, help determine how I will treat your pain and determine the exercises that will be appropriate for you at this point in time.

Biomechanics is a huge field and many books and studies have been written on the subject. For example, examination of the foot and it’s components as you strike the ground have been studied in depth, and progression of the body from there up can all be examined. However what I’m looking for when you first come in with a complaint is to get a sense of how you move generally.

Often I will have a patient go into the hallway and walk for me. As people say, it’s kind of weird to try to walk your normal way when someone is watching you. But it’s from this observation combined with your static posture that I can determine the best way to approach your pain.

A general observation of your movement is what I’m looking for. Of coarse it is sometimes the chicken and the egg thing, are you moving in a particular dysfunctional way because of your pain, or does your movement pattern contribute to your pain.

 

[quicktime]http://www.bayswater.ca/pictures/painful_gait.mov[/quicktime]

 This gait pattern obviously will have some consequenses

I will usually try to mimic your gait for you, or show you using video of yourself walking. In this way I can keep a record of your progression. At this time I usually will give a corrective movement pattern here, in the hall, to help restore proper movement.

The biggest component for re-education of movement patterns is repetitiveness. Movement has got to become a conscious act, especially at the beginning when re- grooving a new pattern. For example the most common movement pattern I see is patients walking with no movement of their arms, or an arm that swings across their body. If these destructive movement patterns continue then all the therapy in the world will be for not the moment you walk out of the therapy office and down the road with the same old pattern. An arm that swings across the body several thousand times throughout the day will eventual produce a rotatory component to your gait, and the same problem and pain will crop up once again. So don’t be fooled. If your gait hasn’t been looked at, your not getting the most out of your therapy.

 

[quicktime]http://www.bayswater.ca/pictures/female.mov[/quicktime]

[quicktime]http://www.bayswater.ca/pictures/male.mov[/quicktime]

Proper gait patterns

 

Corrective movement patterns need to be preformed with a conscious mind, repeated for several minutes at least, and repeated several times a day. Think of it this way. There is a field (your body) that has a path running through it (the nerve pathways). The more that people use the path, the more the path gets trampled down and grooved. It becomes the path of least resistance. The path becomes more established and the more that this path is used, the more it will be to the exclusion of others. Movement patterns are a series of nerves that fire in a particular order to produce the movement. In order to create a different movement we have to create a different pathway. As in the field, the more other pathways are created and used, the more the original pathway will overgrow and be lost. Reintroducing a new movement pattern has got to repeated often and with conciseness to produce a different pattern.

First observation when looking at your gait will be looking at such patterns as arm swings and movement of the shoulders and spine. How does your pelvis move, side to side in a fixed pattern or does it not move at all? How does your leg move through the flexion and extension phase, and how does that relate to your knee and the way your foot strikes the ground. All of this will effect the way treatment to resolve your pain will progress.

Reintroducing new movement patterns is fairly easy but as mention, need to be repeated often. Personally when I workout in my garage gym and on the treadmill, I find it a perfect time to check into my gait, and re-groove a movement pattern. Mindfulness is important in rehab, particularly in movement.

Using gait as an example, a decrease in hip internal rotation will not allow the pelvis to rotate over the stance limb, thereby limiting the coupling mechanics (a whole other discussion!!) of the sacrum and lumbar spine. Due to the lack of hip movement the lumbar vertebrae make up for the movement, thus rotating way to much for its true function. The lumbar vertebrae true function is to stabilize the thorax and the pelvis ( this will be discussed much more in-depth when we look at the Functional stability component of NMT. Additionally, muscles in the low back, like the multifidus, will not achieve their normal length-tension relationships due to excessive movement. Potentially, this can be the source of low back pain, the lack of pelvic movement. The lack of motion in the sacrum/ilium and the excessive movement of the low back may lead to degenerative changes and excessive compression of the facets. You can appreciate how complicated this can all get! However re-grooving the proper movement will help for the present pain and for the future.

So up to this point I will have looked at your posture and how that posture translates into your movement. At this point I will have discussed what I see and how we proceed from here.  Usually I then can progress into the next three principles of NMT, that is

 

  • Correcting postural distortions
  • Correcting dysfunctional biomechanics
  • Manually working on areas of ischemia
  • Releasing trigger points
  • Releasing nerve entrapment
  • Rehabilitating with exercise

 

Next week I will discuss the next three components. Until then if you have any questions, comments or concerns please do not hesitate to contact me.

In Health,

Peter Roach, RMT, CNMT

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