Purpose: To prop up for target practice 17 assumed dysfunctions in human movement. Ideally, each “dysfunction” can be thoroughly critiqued to determine its relevance to ideal or painfree movement.
Why am I so critical?
I am critical of the strong. There is no point in slamming ridiculous fitness guru’s or fish in the barrel weak-ass chiropractic/rehabilitation theories. I want to critically evaluate the things that are closest to how I practice and those things that actually seem to dominate big swathes of evidence based practice. I challenge the strong because the ideas should be able to take it. If the “dysfunctions” in the post don’t hold up to scrutiny (and some don’t) then we are all the better for it.
In part one of this post I very simple reviewed some of the ideas behind core stability and how I questioned their relevance to a patient’s pain presentation. In this follow up post I will briefly review how people with pain have different function than those without pain and give an opinion on how core ‘stability” exercises may help with patients in pain in a manner that has nothing to do with stabilizing the spine.
Purpose: To cherry pick a few research articles to suggest that even though our knowledge of core stability is very impressive its link to pain is poor.
Nutshell summary: People in pain have spines that function differently than those not in pain. Many treatments can influence pain. The spine stability model of low back pain does not explain how people have pain and takes an overly mechanical view of the pain experience. No test has ever shown that a spine is unstable or how “increasing stability” would lead to a decrease in pain. Thinking that our spines need more stability or control may be the completely wrong path in explaining how people have pain or how our exercises help them. Our treatment “corrections” occur not via one specific “corrective” mechanism (e.g. improving stability) but rather through global non-specific mechanisms that our better explained by our understanding of pain neuroscience. Making the shift from believing that “stability” is the issue with pain can thus free up to choose completely different exercise programs. Exercise and treatment prescription thus become simpler. We have preliminary evidence to support this view with the clinical studies that show benefits with the various exercise conditioning programs that train different schools of thought on stability or the just as effective programs that completely ignore any concepts of stability.
This post is a link to a pdf ebook on the presentation I gave for the MSK-Plus course November 25, 2012. Below I give a brief intro into the confusion that surrounds these topics. If you note a huge amount of uncertainty, a whiff of grey and lack of simple answers than your interpretation is correct.
The pdf file is form footwear and footstrike running mechanics ebook nov20 2 2012.
1. Barefoot running and footstrike style overview
2. Gait modifications to influence impact loading
3. Barefoot running and running economy
4. Running in the backseat: lack of hip extension and its possible relationship to injury
5. What we know and don’t know about running injury prevention
A recent discussion was sparked by Mike Reinold’s thoughts on the Clamshell exercise. I found myself defending the lowly clamshell exercise for runners. I was discussing with other physios whether the clamshell exercise was less “functional” than a band walk exercise (where you put elastic bands around your knees/ankles and walk forwards, sideways or backwards). I suggested that both were NOT (or equally) functional but agreed that both had their uses. I can tell you, I convinced no one (more…)
Purpose: I recommend a lot of hip exercises and consider variety and novelty important for people in pain and for athletic injury rehabilitation. This is just a catalog of pictures. Please don’t do them and don’t consider these to be the be and end all for exercises. Many other exercises can also be chosen to achieve your goals. Below is a catalog of a number of exercises that you can use to train/stress your hips. (more…)
Purpose: To provide a very selective review of Charlie Weingroff’s course and how it actually fits with a neurocentric view of pain and function.
Audience: Therapists and strength coaches. Patients who have trouble sleeping.
1. Jeff Cubos discusses SFMA, DNS and Lorimer Moseley and they inform his practice style
2. My and Bret Contreras’ minor critical analysis of the Joint by Joint Approach
I took 2 days out of Charlie Weingroff’s course, Training = Rehab, Rehab = Training course here in Toronto from MSK-Plus. MSK-Plus is a continuing education company run by Dr. Glen Harris. Dr. Harris has brought in a lot of great educators over the years and this course was not an exception. (more…)
Audience: Patients and other health care providers
Purpose: To explain my treatment approach to Persistent Pain Problems.
Overview of the Treatment Program:
- Pain Physiology Education
- Movement (Graded exercise/activity exposure)
- Manual Therapy (more…)
Below is a guest post from Chris Beardsley in response to a recent post of mine that questioned the possibility of any manual intervention (this includes foam rolling) influencing the physical properties of fascia. It is also questioned how relevant is to pain and dysfunction.
Research Review: An analysis of Robert Scheip’s paper on Fascial Plasticity
By: Chris Beardsley
more from Chris at his website: http://www.strengthandconditioningresearch.com/ (more…)
Its not just fascia that is everywhere
Purpose: Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles. But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.
The fascial treatment fallacy. (more…)