I apologize for the delay in posting I was detoured by the Final Four. I had the opportunity to attend this year and it was an unreal experience. Not only did I attend but I had the opportunity to watch individuals that I worked with participate on the biggest stage in college basketball, the championship game. Their hard work all season paid off even though they ended up losing to the Cardinals.
Back to business! This weeks must reads are as follows
Sexy Shoulder Function - Robertson
It's Not What You Do But HOW You Do It - Luka Hocevar
Kelly Starrett on The Power Clean
Too Jacked to Olympic Lift - Wil Flemming
Character and Conditioning - Coach Taylor
Bulgarian Strongman - Chase Karnes (This one is awesome!)
Saturday, March 16, 2013
Spinal Influences in the Extremities
Mark Z. Jamantoc, PT
If you are a patient who is seeing a clinician (PT / Osteopath / Chiro), it is so important that you let these individuals know if you have any neck symptoms. Whenever I would see a shoulder patient, I almost always screen the cervical spine.
"Excited nervous system" is the term for this. It has also been proposed that Cervical Segmental Facilitation secondary to somatic dysfunction is a common cause of scapular dyskinesia. Oftentimes, we see a patient with a very hypertonic rotator cuff (C4-C5 areas perhaps). This, in turn, causes some imbalance in the synergistic ability of the shoulder girdle muscles, thus causing scapular dyskinesia
How do we define Somatic Dysfunction? According to The Educational Council on Osteopathic Principles, somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, or myofascial structures, and related vascular, lymphatic and neural elements.
Ever seen a hypertonic upper trapezius or even the biceps long head that just would not relax no matter how much you stretch it out or Massage it out? Ever palpated a tight piriformis or gluteus medius that no matter how much you"roll it out", it still stays tight? That may be caused by segmental facilitation.
To explain it in easier terms: segmental facilitation happens when there is increased sensory input from a specific part of the spinal cord AND it keeps that area in an "excited state."This, in turn, allows the motor nerves to produce a slightly weaker stimuli that results in increased motor output - and thus causes the skeletal muscles and visceral organs to sustain a state of incremental activity.
In relation to this, let's talk a little bit about hypermobility of the spine. If you have heard of selective tightening, this does mean that the muscles surrounding the vertebrae tighten up to support the spine. Think of a building whose foundation is not entirely 100% that it is needing external forces to enhance its stability. The spine is much like a building. Loosen it too much and it will need to "grab" on surrounding muscles to keep it stable. It has been hypothesized that spinal hypermobility may actually cause segmental facilitation.
SEGMENTAL FACILITATION - WHAT SHOULD YOU BE LOOKING FOR?
1. Hypertonic muscles - palpation of the muscles surrounding the area you are suspecting of being hypermobile. You may also need to check on the transverse processes.
2. Hyperactive reflexes - related to the segment you are checking
3. Non-Fatiguable weakness - inherent, if you test the muscle 3-4 times, you will get the same "weakness", not an increasing fatigability like those found in neuropathies
4. Increased sensitivity to touch - when you palpate the area supplied by the segment, there is increased tenderness.
5. Symptoms of Sympathetic responses (a little fight or flight response) - increased sweating, pupil dilation, blood pressure increase, blood vessels constriction, lungs dilation, and peristalsis of digestive tract among others.
I once had a patient referred to me by a family physician for evaluation and treatment of bilateral carpal tunnel syndrome AND bilateral tennis elbows. WOW. This immediately made me suspect of the cervical spine. This patient, apparently had been with two or three other physical therapy clinics and have been seen for at least 4-8 visits with massage, modalities and exercises for Tennis Elbow and Carpal Tunnel Syndrome but symptoms have stayed consistently the same. So, during the initial assessment, after taking down the history, I went straight to cervical assessment. Sure enough, the muscles surrounding the cervical spine were so spasmic that touching them produced a twitch in the upper trapezius on bilateral sides. Can you guess the occupation of the patient? He was a 36 year old builder and painter and looks upward (with the neck in full cervical extension) 5-7 hours a day. After about 3-4 visits of PT, he reported 80% improvement on the elbow and wrist symptoms.
Never forget the spine. It is so important to include it in the screening. If you're a patient, always inform your clinician about certain neck symptoms (if any).
ABOUT OUR GUEST WRITER:
MARK Z. JAMANTOC, PT
Mark is a Physical Therapist specializing in Orthopedics and Manual Therapy. He has been in active clinical practice since 2002. He graduated with a degree in Physical Therapy and was given the distinction of PT of the year from St. Paul University Iloilo, Philippines. In the past 6 years, Mark has been focusing his skills in upper quadrant rehabilitation and continues to take continuing education classes around the country to enhance his skills as a clinician. He is passionate about helping people achieve their goals and develop a solution for themselves. He may be reached at www.markjamantoc.com or www.facebook.com/findyourwellness.
Wednesday, March 13, 2013
Plyometrics; the key to enhancing your ability to improving your performance capacity. Plyometrics or sometimes referred to as reversible muscle action are movements in which a muscle group is stretched and immediately contracted. An example of a plyometric would be depth drop where an individual steps off a box or step and upon landing immediately jumps into the air. These types of movements train the muscular and nervous systems by enhancing the ability of tissues to deform (stretch) much like a rubber band. While this stretch or deformation is occurring energy is stored, if this deformation is directly followed by movement some of the stored energy is applied to the movement allowing the individual performing the movement to apply more force into the vector desired. Plyometrics are able to increase the deformation by inhibiting the reflex from the Golgi tendon organ which acts as a safety mechanism and causes the muscle to decrease force production. They also enhance the ability of force application by increasing intermuscular and intramuscular coordination which in turn increases excitation of agonists and synergists and inhibition of antagonists, increased motor unit recruitment, firing rates and synchronization.
Now that we know WHAT plyometrics are and what they do let’s look at practical ways to implement them into a training program. To effectively design and implement plyometrics you must implement them with care and caution. Plyometrics utilize extremely high loads on the joints and tissues of the body. The key factors for applying successful Plyometrics are vector or direction, rate of force production, and muscles performing work. Let’s dissect these concepts, a basketball player performs lateral, vertical and horizontal dynamic (vector or direction). Basketball is a game of rapid footwork and change of direction which requires a large amount of force be applied into the ground very quickly (rate of force production) and it utilizes core (shoulders-hips) and lower extremity muscles to produce these movements (muscles performing work). Now to develop a proper plyometric program for a basketball player it would be appropriate to perform Plyometrics vertically, horizontally and laterally with low ground contact time and without the aid of a machine to create a link between our lower appendages and upper.
Plyometric variations are only limited by the imagination of the creator. They can utilize single leg, double leg, and alternate leg variations. Weights and heights can also be added to increase the intensity of a plyometric. A single leg step from a box into a jump is much more intense than a counter movement jump. As long as the plyometric used is specific to the demands of the event being trained for it will be effective. Imagine a marathon runner (yes runners need adequate power output to be optimally efficient transitioning from leg to leg) performing lateral Plyometrics to help them transfer forces horizontally, not very effective use of Plyometrics and will have limited carry over.
In summary Plyometrics are a great way to increase your ability to generate power but need to be carefully planned and programmed for safety and effectiveness. Make sure that your Plyometrics are specific to what you’re trying to accomplish directionally, utilize a similar rate of force production and the same muscles required for the activity being trained for. If you follow these few steps you will be well on your way to successfully improving your performance capability.