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 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.

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.