KINE 4200-Week 1 Introduction and Rationale for functional movement screening and corrective exercises

Sergiu Fediuc, PhD

Case Study
Subject: Female Age: 22 Sport: Basketball Its the end of the 1st half. She jumps up for a header, lands, and quickly pushes of the landing foot to change direction (side cut). She hears a pop. What happened?

Alentorn-Geli E., et al. (2009). Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 17:705729

Q-angle
The forces that act on the female knee are different than those that act on the male knee Predisposes females to certain injuries

Fig 3.9

Hyperpronation (Valgus Collapse)

ACL injuries in women (Fig 13.7)

Anterior Forces

Lateral Forces

Rotational Forces

Risk of woman sustaining ACL injury is 5-7x greater than that of a man May be related to a greater Q-angle in females compared to males Adds more strain on the knee joint Additionally, muscle activation differs between males and females
http://www.youtube.com/watch?v=2X5BE3oAt1k&feature=related

Possible problem
A) Hip complex: Adductor tightness, or weakness of hip external rotators B) Knee complex: Weakness of anterior and posterior tibialis and calf (gastrocnemius or soleus).

What would you do to help correct this problem?

Corrective Exercise Training

Athletic performance Efficiency of movement Overuse injuries Correcting posture problems Muscle imbalances Chronic problems (lower back pain)

Contact information and office hours

Instructor: Sergiu Fediuc, PhD Email: sergiu.fediuc@guelphhumber.ca Office: C105

Office hours: Wednesday 9:55am-11:40am, or by appointment

Lectures
Lectures: Wednesday, 11:45am-1:30pm, Room Thursday, 8:05am-8:55am, Room Lecture notes will be posted on course website on a week-by-week basis It is expected that you supplement the provided lecture notes with your own in-class notes

Important Dates
1) Midterm (Wednesday, February 8th), 30% 2) Lab Assignment/s (Due at the end of the semester to your lab instructors), 20%
The specific due date will be set by your lab instructors.

3) In-class presentations, 20% (In the last 3 weeks of the semester):

Week 10 - March 21, 22, Week 11 - March 28, 29, Week 12 April 4, 5.

4) Final Exam (date TBD), 30%

Format: A) Multiple choice B) Diagrams C) T/F D) Fill in the blanks E) May have some short answer questions Based on lecture notes and material taught during the lecture and labs Not all the content will be provided on the lecture slides. Some questions can be based on discussions that may arise in class. Will follow textbook but will also use supplementary resources (articles). NOTE: It is your responsibility to use GH library to obtain the article. Due to copyright issues articles can not be provided. The reference to the articles will be provided.

Exams

 Rather than search article title, it is recommended that you search for the journal

Labs
Attendance is NOT mandatory Major Component:
You will work with the same partner throughout the semester and will learn how to: 1) Assess movement dysfunctions, 2) Prescribe and implement corrective exercise strategies.

Final lab report submission, will be a collection of the results you have obtained on a week-by-week basis in the lab Lab assignments may be lab submissions hand-ins based on lab topics Cannot submit lab write up if you did not attend lab No lab manual: Labs will be posted online on a week-by-week basis

Presentations
Week 10 - March 21, 22, Week 11 - March 28, 29, Week 12 -April 4, 5.

7 minutes each Student presentation will be an evaluation and corrective prescription of your lab partner based on lab experiences throughout semester.

Presentation content will be graded by lab instructor.

Presentation style will be graded by me in class. Presentation schedule will be made by me and will be posted on the course website. A detailed grading rubric will be provided.

Textbook
NASM Essentials of Corrective Exercise Training (1st Ed.) Clark, M.A and Lucett, S.C. Lippincott Williams & Wilkins, Baltimore, MD, 2011

Course overview
This course will provide you with the skills required to indentify functional movement limitations and prescribe exercise from a therapeutic/corrective perspective. You will learn how to identify musculoskeletal limitations and analyse posture, gait and basic movement patterns. Building upon the assessment of functional limitations, students will learn appropriate corrective strategies and progressions. Great course because it combines: Biomechanics, Motor Learning, Anatomy, and Exercise Prescription

Rationale for corrective exercises

Chapter 1

Knee Injuries
An estimated 80,000 to 100,000 ACL injuries occur annually. Approximately 70-75% of these are non-contact injuries.

Foot and Ankle Injuries

Plantar fasciitis accounts for over one million doctor visits per year.

Ankle sprains are reported to be the most common sportsrelated injury.

Low Back Pain

Low back pain is one of the major forms of musculoskeletal degeneration, affecting nearly 80% of all adults.

More than one-third of all work-related injuries involve the trunk; over 60% involve the low back. It has been estimated that the annual costs attributable to low back pain in the United States are greater than $26 billion.

Shoulder Injuries
Shoulder pain: 21% of the general population 40% persisting for at least one year Estimated annual cost of $39 billion
Shoulder impingement is the most prevalent diagnosis accounting for 40-65% of reported shoulder pain.

The Future
People are less prepared to partake in recreational and exercise-related activities both inside and outside of the gym. Todays client is not ready to begin physical activity at the same level that a typical client could 20 years ago.

Todays training programs cannot stay the same as programs of the past. Training programs must consider: Each person Their environment Tasks that will be performed

Important to address any potential muscle imbalances and movement deficiencies that one may possess to improve function and decrease the risk of injury.

The Corrective Exercise Continuum

Inhibitory techniques are used to release tension, and decrease activity of overactive neuro-myofascial tissues in the body. Lengthening techniques are used to increase the extensibility, length, and range of motion of neuro-myofascial tissues in the body.

Inhibit

Lengthen

Activate

Integrate

Inhibitory Techniques Self-Myofascial Release

Lengthening Techniques Static Stretching Neuromuscular Stretching

Activation Techniques Isolated Strengthening Positional Isometrics

Integration Techniques Integrated Dynamic Movement

Fig 1.1

The Corrective Exercise Continuum

Activation techniques are used to re-educate and increase activation of underactive tissues. Integration techniques are used to re-train the collective synergistic function of all muscles through functionally progressive movements.

Inhibit

Lengthen

Activate

Integrate

Inhibitory Techniques Self-Myofascial Release

Lengthening Techniques Static Stretching Neuromuscular Stretching

Activation Techniques Isolated Strengthening Positional Isometrics

Integration Techniques Integrated Dynamic Movement

Fig 1.1

Integrated Assessment Process

An integrated assessment process must be done to determine dysfunction and ultimately the design of the corrective exercise program.
Movement Assessments Range of Motion Assessments Muscle Strength Assessments

This integrated assessment process will help determine which tissues need to be inhibited and lengthened, and which tissues need to be activated and strengthened.

Athletes and corrective exercises

Functional Anatomy-Review
Chapter 2

Planes of Motion and Axes

Fig 2.2

Joint actions
Be familiar with the following joint actions for the shoulder, hip, spine, elbow: Flexion Extension Adduction Abduction Internal and External Rotation

Additional actions referring to specific joints: Dorsi- and Plantarflexion (foot) Eversion and Inversion (foot) Palmar pronation and supination (hand)
Fig 2.3-2.5

Concepts in functional anatomy

1) Local Musculature vs. 2) Global musculature

Local Musculature System (Stabilization System)

Rotator Cuff

Transverse Abdominus

Multifidus

The local musculature system consists of muscles that are predominantly involved in joint support or stabilization.
Diaphragm Pelvic Floor Muscles

The Global Muscular Systems (Movement Systems)

Rectus Abdominis

External Oblique

Erector Spinae

Gluteus Maximus

Latissimus Dorsi

Adductors

Hamstrings

Quadriceps

Gastrocnemius

Movement Subsystems
Involve predominantly large muscles. Associated with movement of trunk and limbs that equalize external loads placed on body. These specific muscles are involved in transferring and absorbing forces from upper and lower body to the pelvis. 1) 2) 3) 4) Deep Longitudinal Subsystem Posterior Oblique Subsystem Anterior Oblique Subsystem Lateral Subsystem

How do these 4 movement systems work?

Muscular forces (indicated by red arrows) generated on opposite sides of the body (i.e. left upper body) are counterbalanced by muscular forces generated on the opposite side of the lower body (i.e. right lower body) These forces intersect at a common joint (the hip)

Fig. 2.18

Deep Longitudinal Sub-System (DLS)

Provides force transmission longitudinally from the ground to the trunk and back down. The dominant role of the deep longitudinal system is to control ground reaction forces during gait motions.

Deep Longitudinal Sub-System muscles/structures

erector spinae thoracolumbar fascia sacrotuberous ligament bicep femoris

Deep Longitudinal Sub-System (DLS)

Transfer of force of the DLS is apparent during walking. Important in stabilizing SI joint

Fig. 2.18

Fig 2.19

Posterior Oblique Sub-System (POS)

The muscle fiber arrangements of the posterior oblique sub-system run perpendicular to the sacroiliac joint and provide transverse plane stabilization to the SI joint.

Posterior Oblique Sub-System muscles/structures

gluteus maximus latissimus dorsi thoracolumbar fascia

Posterior Oblique Sub-System (cont.)

Dysfunction of any structure in the posterior oblique sub-system can lead to sacroiliac joint instability and low back pain. The weakening of the gluteus maximus and/or latissimus dorsi can lead to increased tension in the hamstring and, therefore, cause reoccurring hamstring strains.

Fig 2.20

Anterior Oblique Sub-System (AOS)

Functions in a transverse plane orientation, mostly in the anterior portion of the body.

Anterior Oblique Sub-System muscles/structures

internal oblique external oblique adductor complex external rotators

The obliques, in concert with the adductor complex, not only produce rotational and flexion movements, but are instrumental in stabilizing the lumbo-pelvic-hip complex.

Anterior Oblique Sub-System (AOS)

Both the POS and AOS contribute to the rotation of the hips during leg swing motion. Just like the POS, the AOS is important for functional activities involving the trunk and upper/lower extremities.

Fig 2.21

Lateral Sub-System (LS)

Implicated in frontal plane stability, and is responsible for pelvo-femoral stability during single leg functional movements such as in gait, lunges, or stair climbing.

Lateral Sub-System muscles/structures gluteus medius tensor fascia latae adductor complex contralateral quadratus lumborum

Lateral sub-system (LS)

Dysfunction Evident as increased pronation

Reduced stability in the frontal plane during movements (due to decreased strength and neuromuscular control)

Important Pelvic/Trunk Stabilizers (The abdominals)

External Oblique
How can this muscle move the VC?
Bilateral contraction: Flexion of VC Compress & support abdominal viscera, Posterior pelvic rotation

Unilateral contraction: Lateral flexion of VC ipsilaterally Rotation of VC contralaterally

Internal Oblique
How can this muscle move the VC?
Bilateral contraction: Flexion of VC Compress & support abdominal viscera, Posterior pelvic rotation

Unilateral contraction: Lateral flexion of VC Ipsilaterally Rotation of VC ipsilaterally

Most tendinosus fibers of external oblique at the linea alba become continuous with the tendinous fibers of the contralateral internal oblique

Thus, these contralateral muscles work together