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.

I have noticed an interesting evolution in my practice. When I was in my 20′s the vast majority of my patients were similar in age, and therefore had questions commonly found in the 25-38 year old crowd. Questions like, “How do I get a six-pack?” used to dominate the discussion.

Now in my 40′s, the tones of vanity have given way to cries for survival!

“Why is this happening to my body?”
“Will I ever be able to do that again?”
“Why is it taking me so long to heal?”

And my personal favorite, “Do you have any secrets for living longer?”

Well luckily, I do advice in the area of longevity, but I have to warn you, be careful for what you wish for, because when pressed on the subject, most honest people are able to admit, its not living longer that we most desire, its living more quality years.

So before I dive into the first lesson for longevity a few Rules We Must All Agree On:

1. Anti Aging is QUACKERY! I will tell you that real scientists agree that they cannot do such a thing, so anyone making those claims is a con artist and a charlatan.
2. Our Goal is more quality years NOT more total years.
3. Longevity is more than just your physical being, it is the health of your mind and spirit.
4. I am not sharing any Rules or hidden secrets, I am sharing lessons learned from the most successful cultures on this planet. Cultures that seem to have fooled the clock, or the science books, about the concept of living a long and happy life. Many of these lessons were taken from studies done in the book “The Blue Zones.”

Without further delay:

RULE NUMBER ONE: Move Naturally

Considering I just completed a marathon, this first rule may surprise you. The research suggests that longevity isn’t about running marathons and triathlons, and it isn’t about being the weekend warrior. Worse still, it isn’t about the 90 day P90x or Insanity workouts, its about making regular, low-itensity physical activity, part of a daily routine. Cultures that spent their lives gardening, or working as shepherds; doing daily yoga or taking regular nature walks, did the best.

Remembering that “LIFE” is the marathon, so don’t approach it as a sprint. All of the longevity cultures studied incorporated some form of regular, low-intensity activity that satisfies each of the following:

-A large emphasis on core strength at least twice a week,
-Daily balance exercises
-Aerobic exercise 5 times a week.

STRATEGIES TO INCORPORATING LESSON ONE

1. Inconvenience Yourself-Use the stairs not the elevator, get up to change the channel, get rid of the electric can opener/snow blower/garage opener.
2. Have Fun. Keep Moving.-Rather than exercising for exercise sake, make your lifestyle active. Take walk breaks instead of coffee breaks, don’t join a gym if you hate it, do things that keep you active that you enjoy.
3. Walk.- Its easier on the joints, always accessible and invites company.
4. Make a Date.-Getting out and about can be more fun with other people. Knowing someone else is counting on you will motivate you to keep at it.
5. Plant a Garden.-Working a garden requires frequent, low-intensity, full Range of Motion activity, and you have the benefit of fresh vegetables!
6. Enroll in a yoga class.-Just be sure to practice it 2 times a week.

Here are 5 simple ways to cut 250 calories:

1. Drink plain coffee instead of a sweetened coffee drink. Flavored coffee drinks are delicious but filled with way too much sugar. Drop 250 calories (or more) when you stick with plain coffee or tea instead of sugar-filled coffee drinks.
2. Jog for 30 minutes. Want in on a little secret? The hardest part about a simple 30 minute jog is the act of getting your shoes on and walking out the door. It’s true.
3. Exchange 20 oz of regular soda for water. You know that soda is filled with tons of sugar, so why are you still drinking it? Every time you crave an ice cold cola picture swallowing spoonfuls of white sugar. That’s probably the easiest way to weight gain. Stick with water and kiss those extra calories goodbye.
4. Swim laps for 30 minutes. If your response to my jogging suggestion was ‘I have bad joints’, then you are in luck. Swimming is one of the best aerobic activities you can do, and it is impact-free. When you swim you recruit your entire body, a process which requires lots of energy—AKA calories.
5. Eat an apple instead of a cookie. Do you always go for something sweet after dinner? While your first instinct may be to reach for a cookie or a bowl of ice cream, why not consider what nature has to offer? Fruit is sweet, natural and lower in calories than traditional desserts.

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.

A good friend of mine, Dr. Lorraine Johnson of trackmom.com, told me about a really useful technique she like to incorporate. She begins her “New Year’s Resolution” immediately after Labor Day.  At first, I thought this to be an odd practice.  But after studying her concept more deeply, and actually attempting it on my own, I now see the genius.

For most of us, our year doesn’t actually begin in January, rather it begins in September.  I understand what our calendars say, but think about it.  September is when the randomness of summer once again gives way to the routine.  For many of us, September is when the summer camps and  vacations end and our kids school year begins.

In fact, it can be argued that January isn’t a change at all from December, but by comparison, September is a totally new world from the frolic and frenzy of the summer.

So as the world demands you to “get back into your routine”, I challenge you to “get back on the wagon” now!  Why wait 4 more months to do what is probably better suited now?

Think about this…if you started a 90 day fitness program now, say a Body For Life or P90X program, imagine where you would be come December?

BUT I HAVE EVEN A BETTER IDEA!!

Instead of stressing for 90 days, start today and take 10 days off the 9o day program and make it an 80 plan!! If you look at your calendar, that gets you looking and feeling great just in time for Thanksgiving.  Now you can can eat whatever you like over the holidays and not feel at all guilty about it!

If an 80 day commitment sounds too daunting, I have a simple 7 day Solution, that only requires 2 simple steps to jump start your New Resolution.

1.  For 1 week (7 Straight Days) Drink Only Water! This means no soda, no juice, no milk, no coffee/tea, no alcohol.  (If you need something warm, choose an herbal tea.)  I won’t bore you with a lecture about the benefits of clean water, but suffice it to say, this simple step may take a bit of getting used to, but after only 7 short days, you will have no idea how alive and awake you will feel. You can thank me then.

2. Start a solid multivitamin program. Visit your local Whole Foods, health store or give me a call for good suggestions.  Your program should include a multivitamin and preferably an Omega 3 Supplement as well.

Start with these 2 baby steps and then consider introducing another wellness component into your lifestyle.

If you have questions, do not hesitate to contact Dr. William Booker at Dr.Bill.Booker@gmail.com, or visit our website www.CapitolRehabOfArlington.com.

FACT: Back pain is the second most common reason, after a sore throat, for a visit to the doctor.

FACT: Back pain is the leading cause of disability for people under the age of 45.

FACT: Most back pain is preventable.

I always love it when people smarter than me say things that I have been saying for years. Dr. Oz, of Oprah fame, was recently on Good Morning America talking about the most common causes of back pain.  To view the interview, click here.

Obviously, in a 5 minute interview, Dr. Oz doesn’t have the time to go into detail on a couple of the real life strategies for preventing or dealing with low back pain. But luckily, in this blog I do:

1.  If you sit for long periods of time, be certain to use a good, supportive low back, or lumbar pillow or support in your chair.  It is too expensive on your spine to attempt to sit in good posture for prolonged periods of time.

2.  It is important to have a stable core, but you must train your core in order for it to be stable.

3.  There are shoes for fashion and shoes for function, go for the shoes for function. One of the smartest things I see women do here in the Metropolitan DC area, is wear their sneakers on the metro, to and from work, and then switch out to the stylish shoes once they get to work.  Try to minimize your time in the stylish, yet, spine damaging shoes.

For more tips and suggestions on core stability and/or injury prevention, please do not hesitate to email me at DrBooker@CapitolRehab.com don’t forget to enter “Injury Prevention” in the subject line of the email.

I came across a good article on AOL addressing the ongoing movement to incorporate exercise with seniors as the preferred treatment for chronic pain.  People in the rehab industries have been preaching this for years. I like to remind my senior population that “exercise is not optional” and this goes for everyone over the age of 5!

Our bodies are living, breathing organisms that require movement and activity. In simple terms, Use It Or Lose It!

It is also important to remember that pain or chronic pain is not simply a function of age.  I have patients who complain of chronic pain at 30 years old, and I have marathon runners who are 80.  To a large extent, the level of chronic pain is determined b the person’s willingness to simply get up and move!

Here are the recommended exercises by Liz Neporent of AOL:

1.  Wall Ball Slides: An excellent, no-impact way to strengthen the thighs, hips and buttocks.  These crucial areas are susceptible to early atrophy and weakness due to prolonged sitting.

2.  Bridges: Another excellent movement to strengthen and lengthen the buttocks, hips and core. Especially good for people with knee problems who may have trouble getting into the squat position.

3.  Trunk Curl-Ups: ** This is the only exercise on this list that I highly recommend people avoid.  The research is overwhelmingly opposed to this exercise as it puts tremendous stress on the lower spine.  I have included a video of a more suitable exercise, one that can be easily modified based on ones ability. Click on side bridges to view the video.  **

4.  Water Aerobics: When it comes to cardiovascular exercise the common question I get is, “What is the best cardio exercise?” And my answer is always the same, “The best cardio exercise is the one that you are willing to do!” Water aerobics are fun and they reduce a tremendous amount of stress to the spine and knees.  So if you are a fan of water aerobics, then they are the perfect cardio exercise for you.

5.  Arm Curl: Can be done in the gym, or in a water aerobics class, but the use of resistance training for the upper arms is very important, especially in cases of arthritis and chronic pain of the upper body.

For more information regarding exercises for the senior population, feel free to email me at DrBooker@CapitolRehab.com and enter “Seniors” in the subject line.

To read the complete AOL article, click (Read Full Article Here)

I came across this info just yesterday about BeltLife, an “Innovative Product Designed to Relieve Low Back Pain Naturally, Safely and Comfortably” … here’s the blurb:

BeltLife is a premium low-back heat wrap designed for athletes, outdoor enthusiasts, and everyday back pain sufferers. It’s shaping the natural back pain relief revolution.

http://www.prweb.com/releases/2009/11/prweb3179234.htm

So I guess we are using heat again to treat low back pain.  In short, for people who suffer chronic low back soreness due to muscle tightness or fatigue, heat will provide temporary relief.  It certainly won’t make the low back pain any better for any sustained period of time, and if used for prolonged periods will lead to de-conditioning, increases spasms and swelling and long term chronicity…but at least it felt good for a little while.

Question: When was the last time you saw the Trainer for your favorite sports team run onto the field and throw a hot pack on an injured athlete?  Your answer is NEVER and the reason is simple…heat increases blood circulation which does provide some short term benefit, but inevitably it results in increased inflammation.  Always use ice in the case of an acute injury, because your first goal is treating any musculoskeletal pain is to control inflammation.

For low back sufferers the rules are simple:

1.  If the pain is sudden and acute, use ice as directed above.

2.  If the pain is chronic, you have to CHANGE the conditions that have caused your back to be chronically dysfunctional.  IE:  You have got to:

    a.  Strengthen the weakened muscles,
    b.  Relax the overactive muscles
    c.  And mobilize any joints that lack movement or have become fixated.

I will talk at great lengths about the role of proper rehab for chronic conditions in the future.  But for now, the moral of the story is improving chronic pain requires work, and those who put in the work, benefit tremendously.  Just like you can’t simply walk into a gym and suddenly be in great shape, you can’t simply wrap a hot pack around your back and think you cured chronic pain and dysfunction.