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Lumbar Spine: Movement & Loading Analysis for Motor Behavior Therapy: Laval, Quebec, Canada: Part 2

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Note: This course is being taught over two weekends (October 18-20 & November 1-3). The hours for each course will be: Friday: (1:00 to 5:00), Saturday (8:30 to 4:30) and Sunday AM (8:00 to 11:30).

Course Description

Note: This course is being taught over two weekends.

Lumbo-pelvic pain can be related to a variety of factors including trauma or overuse, but frequently it is an insidious, recurrent and an ongoing problem for many people. This is often related to sub-optimal loading on around the lumbo-pelvic region.

The mechanism driving the sub-optimal loading on the tissues may related to:

  • Movement Pattern Control
  • Translation Control of the joint
  • Biomechanical Exposures to Loading

There is considerable individual variation in how these present. These loading mechanisms may occur in combinations or alone. Presentations include a spectrum from “too little control” to “too much control”. Each tissue loading mechanisms has causation creating the need for highly individualized management.

The underlying hypothesis of movement as a link to musculoskeletal symptoms is that the way the central nervous system coordinates movement can influence tissue loading. For example, people with lumbar low back pain can move the lumbar spine more than their hips into flexion and extension.

In normal function we need the ability to vary postures and movement patterns, or kinetic chain sequence, in order to avoid tissue overload. It is normal and necessary to use our end range movements, however it is abnormal to continuously use the same movement pattern or end range movement. If the ability to vary the kinetic chain and control movement is lost, tissue load can be exceeded, tissue repair can become compromised and pathology may result.

Altered translation control can manifest as too much little control (e.g., shear) or too much control (e.g., compression).  Too much shear can place stress on articular structures that limit movement. Compression with shear places more stress on articular structures (e.g., disc). Altered translation control can present with altered movement patterns and can contribute to ongoing symptoms. For example, lumbar instability is not rare.

 

Biomechanical exposures to loading are the physical stresses experienced by the body. Biomechanical factors include gross body position, exertion, forces and motions. This loading causes mechanical tension within the tissues which can lead to microdamage if the load tolerance is exceeded.  This can occur on its own, but is often combined with movement or translation control mechanisms.

Why is the central nervous system moving the body in a way that is potentially harmful?

This question should be answered or many people will not progress or quickly plateau. We review the functional causes of altered movement and motor behavior.

How does it fit in? – Movement as a Clinical Reasoning Tool

Targeting movement and motor behavior will allow you to be much more effective with whatever skills you already have! Treatment and progression will also be faster. These are discussed and numerous examples demonstrated during the practical sessions.

Why not just let it heal and load it?

 Load management and progressive loading principles are appropriate for some people. However, everyone does not respond the same and multiple loading mechanisms can occur together. The Movement Exposures & Loading Tool© is a simple questionnaire which will facilitate the need for load management.

Is this for everyone? – Of course not!

This is what a Sub-classification is for. Motor behavior issues represent a subgroup of patients and are not the priority for everyone. The purpose of the sub-classification model is to show you how to identify who will respond to this type of therapy. Some people do not have the ability to learn motor control based exercises. Others can learn, but won’t respond. Some do not have a nociceptive pain mechanism. While others have neuro-immune-sympathetic dysregulation or nociplastic pain).

This course will provide participants with skills in assessing movement and sub-classifying movement pattern and motor control deficits that will relate to the functional movements that provoke the patient’s symptoms.  Rehabilitation strategies will provide a logical and functional based starting point with directions for progression. A universal clinical problem-solving model is given to iron out real-life difficulties.

Course Objectives:

  • Make a movement pattern control sub-classification and relate this to the client’s presentation
  • Utilize strategies to diagnose lumbar instability
  • Use movement patterns as a clinical reasoning tool to help guide manual therapy and other techniques
  • Integrate the treatment of movement patterns and translation control into clinical practice

WHAT WILL YOU GET FROM THIS COURSE THAT YOU MAY NOT ALREADY HAVE?

Predict who will Respond to Therapy

Don’t waste time. Learn the factors that predict a very favorable respond to Motor Behavior Therapy for movement pattern control and segmental stabilization exercise (for translation control)

Diagnostic Accuracy of the Articular Related Pain: Lumbar Spine
We’ll review the best tests for you to use clinically

 Psoas Major

Psoas major barely flexes the hip! – it’s main function is to stabilize the lumbar spine, sacro-iliac joint and hip. Research shows that it has segmental atrophy similar to multifidus. It likely needs specific rehab. We also have new facilitation strategies.

Transversus Abdominis Asymmetry
We’ll show you how to test for and rehabilitate asymmetry

Multifidus Cuing – Beyond “Swelling”

Newer cues help people who can learn much better than these older cues!

Breathing
Do you know what normal breathing is?  Do you know how to retrain it? The diaphragm is a muscle and changes with posture and pain and can affect all aspects of our function.  Breathing is an essential part of rehabilitation and needs to be addressed.

Gluteus maximus is a multitasking muscle!
It has three functional subdivisions. The Deep Sacral Gluteus Maximus only crosses the sacroiliac joint and is ideally suited for SIJ stability.  Why don’t some people progress with glut max training and what can we do about it?

Neurodevelopmental Disorders and Postural Reflexes
We`ll show you how postural reflexes can be the cause of increased lumbar spine flexion compared to hip.

Primitive Reflexes

Over 90% of people with musculoskeletal pain have primitive reflexes. They contribute to altered motor control and tone. Learn how they will influence the lumbar spine.

Core Cylinder
The translation control mechanism of lumbo-pelvic stability partially depends on integration of the whole cylinder. We’ll show you how to assess and rehabilitate this.

Myofascial Trigger Point (MTP) Release
MTP release is a useful way in many people to improve aspects of motor behavior (e.g., range of movement). In some people it can be a source of pain. Motor Behavior Therapy can be used to help desensitize MTP’s.

Clinical Reasoning in Motor Behavior Therapy

Providing the right therapy for the right person at that time in their rehab – the essence of sub-classification. To do this you need to logically match the history to the patho-anatomical diagnosis to the mechanisms involved.

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