By Dr. Matt Fontaine

This is the first in a series of articles that will detail a new paradigm in dealing with musculoskeletal injuries.  The first of which will deal with assessing human movement, and highlight the Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA), developed by Gray Cook and Lee Burton.  The Functional Movement Screen™ is an innovative system used to evaluate movement pattern quality for clients or athletes.

“It has also been recognized that the dysfunctions of muscles and joints are so closely related, the two should be considered a single, inseparable functional unit” Dr. Vladimir Janda

Our nervous system generates normal movement by integrating and orchestrating groups of muscles to produce fundamental movement patterns with an adequate balance of mobility and stability to meet the demands of the task at hand.

The human system will compensate normal patterns of movement in response to pain or in the presence of weakness, tightness, or structural abnormality. Over time, pain alters normal movement patterns, often causing compensation such as limping or guarding to protective injured joints or muscles.   The pain associated with movement often results in as decreased ROM, muscle length changes, and decreased strength.

Gray Cook has said that a limp is visual representation of the body giving up it’s core stability in order to prevent the loading of a painful joint.  Sometimes the body compensates in a less dramatic fashion and the altered movement patterns are more subtle.

The traditional sports medicine model is to look to the pain.  Typical RICE(rest, ice, compression, and elevation) is helpful to control inflammation.  However, using an isolated or regional approach to either evaluation or treatment will not accurately detect the issues that caused the pain, nor restore function. Gray Cook has said repeatedly that functional restoration requires a map of dysfunctional patterns and a working knowledge of functional patterns to gain clinical perspective and design an effective treatment strategy.

Pain-free functional movement for participation in occupation and lifestyle activities is desirable. In order for our body to create proper pain-free functional movements during sport or activities requires adequate posture, full unimpeded range of motion, proper muscle and fascial gliding between soft tissue structures, motor control, and balance reactions.  Impairments in  any of these areas can alter functional movement resulting in or as a consequence of pain.

Utilising the Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA) allows healthcare professionals to assess key functional movement patterns the body performs and allows the detection of faulty movement, muscle imbalances, and lack of joint mobility and stability.  This information is essential to identify dysfunctional movement. Traditional muscle length, strength, and special tests can be used to help the clinician identify the impairments, which are associated with dysfunctional movement.

By using the Selective Functional Movement Assessment (SFMA) as an approach designed to complement existing exam the practitioner can better detect faulty movement patterns and be much more specific in devising a program therapeutic exercise to help correct the problem or issues. The Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA) serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of the movement system into musculoskeletal practice. It should also serve as a feedback system for the effectiveness of the therapeutic exercise program, which should target the dysfunctional movement pattern as well as the impairments that have been identified.

Part two will address the approach that should be utilized to properly evaluate and manage muscle and joint pain syndromes.

Have you ever been frustrated over a lack of results from your workout routine?

If so, you are in good company. Even the most seasoned athletes experience times when their results plateau.
When you continue to put in the same effort day after day with little or no results it is safe to say that you’ve hit your own fitness plateau.
Your body adapts quickly to any repetitive routine. The definition of ‘insanity’ is to do the same thing over and over while expecting different results. This holds true for your workouts. When your results stop then it’s time to do something new.

There is good news – the following 4 tactics are guaranteed to crank your workouts up to the next level and to deliver the fast results you want.

1: Focus on Negatives
Each time that you do a weight lifting repetition you are utilizing three types of strength. These are:

1. Positive strength: the motion of lifting the weight.
2. Static strength: holding weight in a contracted position.
3. Negative strength: the motion of lowering the weight.

Most people completely miss the benefit of the negative in each repetition by allowing the weight to drop quickly with little control. It is understood that the negative portion of a repetition is just as important as the positive portion, and possibly more important.
Focus on the negative portion of each repetition by lowering the weight very slowly. Concentrate on the negative contraction, and make each repetition count.
If you are advanced, then use a training partner to assist you in moving heavier-than-normal weight into a contracted position, then lower it very slowly.
Another way to utilize negative repetitions on a machine is to lift the weight using two limbs but then lower it with just one. For example, use both legs to lift the weight on a leg extension machine, but then lower it back down slowly using only one leg.

2: Do a Drop Set
Drop sets have long been used to fight off exercise plateaus. This technique is great for adding muscle strength, endurance and for increasing the cardiovascular benefit of your workout – resulting in more fat burn.
Here, in a nutshell, is how to do a drop set: When you perform an exercise to exhaustion, don’t stop there. Drop the weight by 80% and do another set.
You could take it a step further by dropping the weight twice, making it a double drop. Or drop the weight three times for a descending drop set.
Use this technique only once or twice per workout, on the final set of the exercise.

3: Modify the Exercise
There are certain exercises that are considered ‘staples’ in the gym.
The squat. The lunge. The chest press. The shoulder press. The bicep curl, etc.

While you shouldn’t throw these exercises out the window, find creative ways to modify the familiar motion in order to challenge your muscles. Try these exercise modifications:

• Squat on a Bosu ball or balance board.
• Place a weighted bar across your shoulders and do walking lunges.
• Use an exercise ball for chest presses instead of the bench.
• Do a full squat between each repetition of shoulder presses.
• Do a shoulder press between each repetition of bicep curls.

4: Use Active Rest to turn each workout into High Intensity Interval Training
Every minute of your workout is an opportunity to increase intensity and to burn more fat. Don’t waste precious minutes with long rest periods between exercises.
While it is important to catch your breath if you feel winded, most of the time you would benefit more from an active rest than a passive one. Perform one of the following activities for 30 seconds between exercises and turn your regular workout into High Intensity Interval Training.

• High Knees with Alternating Punches: Alternately bring each knee high to your chest in a quick jumping movement while alternating forward punches at shoulder level.
• Burpees: Start in a sanding position and bend at the waist. Once your hands hit the floor, push your entire body back, extending your legs until they’re straight and you’re in the push-up position. Go down for a push-up, and when you push yourself up, jump slightly to bring your feet back near your hands. Finally, jump in the air with your arms fully extended over your head.
• Side-to-Side Jumps on Bench: Stand on one side of an exercise bench. Place the foot closest up onto the bench, jump up and switch feet, then land on the opposite side of the bench.
• Mountain Climbers: Place your hands wider than shoulder-width apart on the ground in a push-up position. Bring one knee to your chest and then back to the starting position, alternate each leg quickly.
• Side-to-Side Ab Twists: With feet close together, jump and twist your legs left to right – holding your abs tight. Keep a bend in your knees and swing your upper arms with each twist.
• Medicine Ball Squat Jumps: With feet wider than shoulder-width apart hold a medicine ball at chest level. Squat down until your knees are at a 90 degree angle. Explosively jump up, raising the medicine ball straight over your head.

A simple trick we like to incorporate with our marathon runners in training, as well as our elite athletes, is to introduce the use of alternating ice and heat on the lower extremities following a long run, rigorous workout or even an acute soft tissue injury.  This modality  has been popular for years in treating acute injuries, in particular those of the lower extremity.  The theory behind alternating ice and heat, or contrast baths, is to create a “pumping” mechanism of opening up the vasculature (vasodilation) with heat and closing the vasculature (vasoconstriction) with the application of ice.  The protocol can be introduced by alternately submerging the extremity in hot and cold baths, or by simply applying alternating hot and cold packs.  I find both methods sufficiently effective. A standard protocol follows below ( but a modified version with fewer cycles is acceptable as long as we always start with, and end with ice):

-10 min ice followed 10 min heat

-8 min ice then 8 min heat

-6 min ice then 6 min heat

-4 min ice then 4 min heat

-2 min ice then 2 min heat

-End with 1-2 min of ice.

Although the research on this subject is limited and frankly, not very supportive of the efficacy of  alternating ice and heat, I remain a hugh fan of this approach! If heat brings healthy blood into an area, and ice helps to flush out lactic acid and other inflammatory agents, then incorporating both heat and ice will provide both therapeutic benefits.

Traditionally, this approach was thought to be most effective in the sub-acute phase of healing after the inflammation has mostly subsided, but I find the approach more beneficial than ice alone, especially in the acute or early phase of injury.  My only disclaimer is that you may experience some additional soreness initially, but the benefits will quickly follow.

If you are training for a a sport, in particular an endurance sport OR have recently suffered a soft tissue injury, try incorporating the use of alternating heat and ice to flush out lactic acid, speed up recovery and reduced post workout soreness.

I ran the Inaugural Woodrow Wilson Half Marathon this past weekend.  Having trained for a full marathon in the past, I took the challenge of 13 miles a bit lightly.  Although the race went fairly well, my various post race symptoms ranged from soreness through my lower body to an unyielding case of lightheadedness. I was reminded of the 6 Post Race Must Do’s For All Distance Runners:

1.  Re-hydrate: This is an obvious one.  What may not be as obvious is that your re-hydration must include mineral replenishment.  Most people think of Calcium and Sodium when we talk of minerals, and although these essential minerals are important, the replenishment of Potassium and Magnesium are more critical.  Look for sports drinks that list Potassium and Magnesium high on their list of replacement minerals.

2. Re-Load The Carbs: Most endurance athletes are familiar with the concept of “Carbo-Loading” prior to long distance races.  What often goes overlooked is the need to replenishing your body with carbohydrates after the race.   During exercise the body breaks down glycogen in the liver into glucose, your body then converts glucose into energy. When the liver stores of glycogen run dry, the athlete may experience the effects of “hitting the wall”. Following a race, your body continues to burn up whatever glycogen it can find.  Replenishing with carbs will replenish the glycogen stores.

3.  Ice Bath : I understand that the immediate desire following a race is to take a nice hot shower.  But remember, all of that running and wear and tear has put your body in a full- on state of inflammation.  Ice baths will help to close off the vasculature, and will help to pump the inflammation and lactic acid out of the soft tissue and into the blood stream. It’s not a whole lot of fun, but your body won’t be as sore and you will be thankful you did it.

4.  Foam Roll: Create a mechanical advantage by using a foam roller to gently roll out the knots, adhesions and scar tissue that may have formed in the hamstrings, IT band, quads and calves. Every runner I work with who owns a foam roller swears by it. You will too.

5.  Double Down on You Multivitamins: I recommend you take a another serving of your daily multivitamin and Omega 3 Fatty Acid (fish oils).  If you took them the morning of the race, take another dose, if you forgot to take them before the race, double down after the race. Your body is depleted of important vitamins, yet needs them more than ever immediately following a race or long run.

6.  Schedule your visit with your trusty Massage Therapist or Active Release Technique Specialist. Long periods of running will result in overactive muscles, and overactive muscles will result in injuries of the Joints as well as the other surrounding muscles.  Muscle work 24-48 hours Post Race is not just a special treat for a job well done, it is often the key to a speedier “Post race recovery.”

In a couple of weeks I am heading to Minneapolis to take my Spine certification in Active Release.  I am extremely excited about this particular credential because it will complete my full body training (Upper Extremity, Lower Extremity and Spine) in the Active Release Technique.

Although I have been treating soft tissue syndromes and injuries for quite some time, I continue to find that the more opportunities I have to be around talented practitioners, and practice side by side with them, the more sensitive and precise my diagnostic and treatment skills become.

Of all the populations we treat with ART, runners seem to be the group that are collectively the most sensitive to ART treatments and seem to respond the best. I recently came across a good article written in The Running Times by Tamara Rice Lave, Ph. D.  Dr. Lave represented the U.S. in the marathon at the 2003 IAAF World Track and Field Championships in Paris.

Later this year I will complete the Active Release Certification in Long Nerve Entrapments as well as a Masters Program with the founder of ART, Dr. Michael Leahy.

If you have never been suffering from chronic pain or a nagging injury, I highly recommend seeking the advice of someone certified in Active Release.

Active Release Technique: Athletic Injuries & Carpal Tunnel Syndrome

What should you do if you think you have carpal tunnel syndrome? It is recommended that you identify a provider who is trained in Active Release Technique, ideally one who incorporates a functional rehabilitation program. In order to achieve long-term results, the patient must be instructed on home care and self-care exercises that address how to strengthen weakened muscles as well as how to release the overactive muscles as well.

To read this complete article, please click here.

An active exercise program is essential to maintain good health….FOR EVERYONE! Exercising should be a part of your daily routine whether you are 10, 20, 40, or 60. Regular exercise is proven to lead to better long-term health. For seniors, ages 60 and up, we want you to keep living, actively, for as long as you can, to increase your chances of longevity. But before starting any daily exercise routine, it is important for everyone, seniors in particular, to remember to Warm Up! Warm up exercises help to stimulate blood flow, to prepare your body for the elevated exercise that is to follow, and to help reduce the risk of injury while exercising. Check out the following examples of warm up exercises to help you start your daily routine off right:
1) Walking – Start by walking in place for 5 to 10 minutes. This helps to gently raise your heart rate and breathing before beginning more strenuous exercise.
2) Bicycle Riding – Hop on your stationary bicycle for 5 to 10 minutes if you are not into walking in place. Maintain your pace to ensure a proper warm up.
3) Rowing – Either stationary or actually on the water, use this warm up exercise to increase blood flow, while using your arm and leg muscles.
4) Stretching – Take care to do slow, thorough movements, to build flexibility and to avoid muscle injury.

http://www.livestrong.com/article/129030-warmup-exercises-seniors/

A young athlete never wants to hear the coach say, “sit out,” or “you’re done for today.” It’s easy for teens to think they are being punished when asked to sit out of a game because of a fall during the last play…a fall that really didn’t seem so bad. But sometimes, it is far from punishment! In fact, sitting out could save your child’s life…when you’re dealing with concussions.
A concussion is a temporary disturbance of brain function, resulting in confusion, amnesia, loss of consciousness, or loss of vision. Other symptoms include headache, dizziness, impaired orientation and difficulty concentrating.
Many coaches, parents, and young players minimize athletic brain injuries. But listen up: IT IS NOT jus t a part of the game! Young athletes should not be encouraged to “be tough” and keep pushing to remain in the game if they have experienced a potential brain trauma. You should always keep in mind that it is very easy for what appears to be a minor injury, to become a very serious injury if a player returns to the game too soon. After sustaining one brain injury, the risk for a second injury is 3 times greater, while the risk for a third injury is 8 times greater. Always, always, always, encourage young athletes to SPEAK UP! Don’t be afraid to tell a coach or another adult about an injury during play.
Keep these steps in mind about how to recognize a concussion:
1) If an athlete loses consciousness, the first step is to remove him/her from the game
2) The level of consciousness is the single most important indicator of the severity of a brain injury
a. A mild concussion may not result in any loss of consciousness
b. A moderate concussion may result in loss of consciousness that lasts 5 minutes or less
c. A severe concussion may result in loss of consciousness that lasts 5 minutes or more
3) Test the memory of the injured player. Loss of memory of events just before the injury and just after the injury is a common occurrence. A loss of memory of anything preceding the injury could be a sign of a more serious concussion.
4) Seek profession medical attention.

http://www.teengrowth.com/index.cfm?action=info_article&ID_article=1213

Let’s talk teens and sports injuries! There are two main types of sports injuries: an acute traumatic injury, and an overuse or chronic injury. An acute traumatic injury involves a trauma from a single blow to an area of the body. They can include any of the following: fractures, strains, sprains, lacerations/cuts, abrasions/scrapes, head/neck/spinal cord injuries, or bruises/contusions. Chronic injuries are the result of repetitive training or overusing an area of the body over time. These can include: stress fractures, tendonitis, growth plate overload, and repetitive motion injuries. Although acute injuries are serious, overuse injuries should not be ignored. Overtime, untreated chronic injuries are sure to get worse.
Now that we know what a sports injury is, let’s discuss prevention. Here are some tips to keep your child safe in any sports season:
1) Insist on a pre-season physical. Make sure your child is in good physical condition before playing any sport.
2) Buy appropriate equipment. Make sure any protective gear fits properly.
3) Warm up. Make sure your child has a thorough 10-15 minute warm-up before beginning any activity. Don’t forget cool down stretches at the end of any activity.
4) Drink lots of water!
5) Don’t allow sick and/or recovering children to play. Keep them at home until he/she is fully recuperated.
6) Most of all, HAVE FUN!

https://www.akronchildrens.org/cms/tips/7af13d5c04c9c9cd/index.html

Capitol Rehab is pleased to announce that Dr. Beck has recently completed his Upper Extremity certification of Active Release Technique. Dr. Beck is now certified in both Upper and Lower Extremity protocols, broadening his knowledge of a variety of soft tissue injuries.

Active Release Technique is described as “a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves.”

At Capitol Rehab-Arlington, Dr. Beck is able to integrate this very comprehensive soft tissue technique with functional rehabilitation and Chiropractic Care to provide very detailed treatment of such difficult conditions as Carpal Tunnel, Sciatica, Plantar Fasciitis, Shin Splints and Tennis Elbow.

Dr. Beck plans on completing ART certifications in Spine and Long Tract Nerve Entrapment later this year.