By Dr Matt Fontaine, ART

A.  Summary of complete team approach

A comprehensive sports medicine approach should include  1.) A team coach for the sport   2.)  A strength coach and/or Athletic Trainer
3.) A medical doctor who specializes in sports medicine and    4.) A Chiropractor/ Physical Therapist who is a certified ART® provider.   5.)
Proper Nutrition Counseling.  Get the best care you can by incorporating all these people into your team of Human Performance specialists.

It is important to note that the human frame and human performance physiology is far too complex for any one healthcare professional to be able to thoroughly detect, address, and resolve all issues that need attention.

The Need for a Tri-Prong Approach

Dynamic Neuromuscular Stabilization/Postural Restoration

-The need for soft tissue work such as Active Release Techniques to release overactive muscles.

-The need for joint manipulation to reduce joint compression and correct misalignment to restore proper  joint mobility.

-The need for rehab to restore mobility and stability to the muscles and joints of the body in order to ensure optimal body movement patterns.

A Tri-Pronged Approach

A. Manipulation and the Arthrokinetic Reflex

The most common question patients ask in clinic is “is my problem muscle related or joint related?”  Another common statement is “I think I have a pinched nerve”.  The simplest way to answer a very complex set of occurrences that surround muscle and joint pain syndromes is that most patients are dealing with a tri-factoral problem.   Barring acute trauma whereby fracture or dislocation is involved, it is important to give note that nerve involvement should take priority in a muscle and joint pain syndrome.  Let’s look at the nerve issue first.

Hilton’s Law states:

The principle that the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles.

Understanding the Arthrokinetic Reflex

Arthrokinetic reflex refers to the neurology of joints in which joint movement can  reflexively cause muscle activation or inhibition.^[1]

Arthrokinetic Reflex of the Knee

Leonard A. Cohen ¹ and Manfred L. Cohen ¹ From the Department of Physiology and Pharmacology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

The prefix “Arthro-” means joint and  ”kinetic” signifies motion, and a reflex in humans refers to an involuntary movement in response to a given stimulus. Thus, the arthrokinetic reflex refers to the involuntary response that happens when a joint is moved, namely that relevant muscles fire reflexively.

The joints have nerve receptors called mechanoreceptors.  These mechanoreceptors are responsible for  transmitting movement impulses from the joint to the brain for interpretation.  Depending on the stimulus or lack thereof, these  Type I and II articular mechanoreceptors inhibit or facilitate muscle tone.  The neurology and physiology behind the arthrokinetic reflex is a main reason why manipulation is so effective at
treating chronic lower back and neck pain and also why it helps to improve sports and human performance.
A simple way to think about this is that “jammed joints” result in weaker muscles and mobile joints = strong muscles. Joints that are closed or compressed shut down muscles. They have joint dysfunction, either a joint has been strained or is locked up and fixed from  it’s normal motion.   Therefore, you must clear the joint motion in order to fully reflexively turn the muscle back on.

B.  Soft Tissue/ Fascia Release

They have a muscle problem, either the muscle has been “strained” or torn, or repetitively overloaded and has tightened and developed scar tissue over time.

The following link is an article by Dr. William Brady, an ART physician.  In it he discusses the importance of releasing scar tissue.  Hypoxic Fibrous Adhesion Pathway .

C. Functional Corrective Rehab

The need to retrain proper movement patterns.  3000-5000 repetitions to reprogram a movement so it becomes involuntary.
Only then can we “SAFELY” progress to strength training with proper movement and ensure optimal human performance.

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.

Now that you’ve heard about all the benefits of exercise as you age, you’re ready to hit the gym or at least go for a daily walk. There’s only one problem: Your joints don’t seem to want to cooperate. Is it too late to limber up? For most people, the answer is NO!  Flexibility decreases with age and physical inactivity, and this can cause your muscles, tendons and ligaments to grow shorter over time. But regardless of your age, you can increase your flexibility by incorporating stretching into your daily routine. Remember, though, that aerobic fitness and strengthening are also very important for older adults. And exercise can improve your well-being and reduce your risk of falling.

Note: Always consult your doctor before starting a new exercise or stretching routine.

A daily stretching routine can improve the following:

Physical performance. Increased flexibility makes it easier and less tiring to perform daily tasks such as lifting, bending, turning and engaging in other repetitive movements.

Circulation. Stretching raises the temperature of your muscles, increasing the circulation in that area – which helps keep your tissues healthy.

Posture. Short, frequent stretches throughout the day can keep your muscles from getting tight. This helps you maintain proper posture and reduces aches and pains.

• Stretch lightly before engaging in strength and endurance activities, then stretch more thoroughly after your workout.
• If you’re unable to perform strength or endurance exercises but able to do stretching exercises, do them at least three times per week for at least 20 minutes per session.
• Do each stretching exercise three to four times during each session.
• Stretch slowly and as far as possible without pain. Hold the stretch for 10 to 30 seconds. Relax, and then try to stretch further with each repetition.

• Talk to your doctor before engaging in a new exercise program.
• Warm up before you stretch. A little bit of easy walking or arm pumping should be sufficient.
• Mild discomfort or a mild pulling sensation is normal during stretching, but you should never stretch until you feel pain, especially joint pain. If you feel pain, reduce the stretch so that it doesn’t hurt.
• Ease slowly into a stretch – don’t bounce. Jerking into a stretch can cause muscle tightening and increase your risk of injury.
• Don’t lock your joints into place when you straighten them during a stretch. Your arms and legs should be straight when you stretch them, but not tightly so. You should maintain a very small amount of bending in your joints.
• If you’ve had a hip replacement, talk to your surgeon before doing lower-body exercises. When stretching, you shouldn’t cross your legs or bend your hips past a 90-degree angle.

If you have a hard time getting motivated to exercise, enlisting a fitness partner can help. A partner can encourage, challenge and pace you and make working out more fun.

A recent study found that new mothers who had fitness partners got more exercise than mothers with no partner support. Another study found that just a phone call can help motivate people to exercise more. After three months, those who had received motivating phone calls were more likely to have increased their level of physical activity than those who hadn’t.  A fitness partner can motivate you to work out even when you don’t want to, simply because you know someone is counting on you. Exercising with a partner is also a great way to socialize. Instead of dreading your daily workout, you’ll find yourself looking forward to catching up with a friend.  In addition, a fitness partner can make it less intimidating to join a gym, try a new class or learn a new sport. Your friend can give you the courage to take that kickboxing class you’ve had your eye on or head to that hiking trail you’ve always wanted to try.  Finally, it’s safer to work out with someone. If you injure yourself on a run, for instance, your partner can find the help you need.

Choosing a Fitness Partner

While the right partner can motivate you to accomplish your fitness goals, the wrong one could squelch your efforts. When deciding on a fitness partner, keep these things in mind:

• Choose a partner with a fitness level similar to yours. If you haven’t exercised for years, don’t choose a partner who runs four miles a day. If you and your partner have similar fitness levels, you can progress at a similar pace and encourage each other as you improve.
• Find someone who shares your fitness goals. By working with someone with similar goals, you can help motivate each other and share your triumphs. If, on the other hand, you want to gain muscle and your partner is looking to slim down, you and your partner may quickly become frustrated.
• Make sure you have things in common other than exercise. If all you have in common with your fitness partner is working out, you may not find yourself looking forward to your next workout. Choose someone whose company you genuinely enjoy, so that your workouts are as socially fulfilling as they are physically challenging.

Working Out with a Fitness Partner

Once you’ve found the right fitness partner, it’s time to get moving. Get together with your partner – calendars in hand – and schedule when and where you’ll meet to regularly exercise. Then, set some ground rules and stick to them.  Agree upon a cancellation policy, just as you would for a doctor’s appointment or hotel reservation. If one of you can’t make it to a scheduled workout, select a time period (24 hours, for example) in which you must cancel in advance. Also, figure out how you’ll decide on your activities. For example, you could design this week’s exercise schedule, your partner could design next week’s, and so on.

Now it’s time to enjoy the benefits your partner brings. Besides being someone to chat with, a partner can encourage you to participate in workouts that you wouldn’t consider otherwise. You can also mix up your workout schedule by adding partner-focused activities such as tennis or basketball.  Ask your partner to teach you activities that he or she has mastered, and share your skills as well. With a fitness partner, you can quickly add variety to your fitness routine, which will go a long way toward keeping you motivated to become fit and stay that way.

I’m willing to bet that some of you are still having nightmares of all of the snow from this winter! Didn’t it seem like the snow might not ever go away?With all of that snow, what’s a runner to do? Head to the gym of course. Local gyms certainly had their work cut out for them, as suddenly tread mills and other exercise equipment were in high demand! But finally, SPRING HAS SPRUNG! And although we love the benefits of an indoor workout, there’s nothing like the great outdoors! So before we enter the ‘dog days of summer,’ trade in some of your regular gym sessions and go for some outdoor fun!

Recent studies suggest that even just a few minutes outdoors can have a positive impact on your mind, body, and soul. Build your self-esteem, give your mood a boost, and increase your overall lifespan just by spending a few minutes a day outside. Not to mention, you are doing everything you can to “go green” right?? Help out the environment by limiting your use of machines and head outside for your next run…feel the breeze, smell the fresh air, check out the trees…all along the way. Don’t worry; outdoor activities are not limited to runners! Need some outdoor activity ideas?? Try working on a garden, take a stroll through your area zoo, walk to the grocery store, or even play hide and seek with the kids. No matter what your activity, take advantage of the GREAT OUTDOORS!

http://www.thatsfit.com/2010/05/04/outdoor-workouts-how-a-little-green-time-could-save-your-life/

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.

Our very own physical therapist — Barbara Fallon Wallace, MSPT, DPT and Dr. William Booker, DC as well— were each highlighted in this month’s edition of Washingtonian Magazine!

Kudos to Barb, Bill and the rest of our Capitol Rehab of Arlington family!