3/15/19 FMT Blades IASTM Practitioner Certification Instructor Name…. Who am I? 1 Name Alphabet Soup 2 Paperwork This is a footer, so use it when you need it. 3 1 3/15/19 Provider/Financial Disclaimer RockTape and the presenter for this seminar have financial associations with the manufacturer of commercial products used in this seminar. You are not required to purchase the supplies or products used in this course. 4 “ We are a Movement Company - Someone important 5 Movement Matters 6 2 3/15/19 “ We are going to challenge your current understanding 7 Our Stance Is it not time to reinvent manual therapy and exercise? Could we simply stop trying to study or “fix” structural or purely imaginary “things”? Could we not just reframe them as a way we can interact more with the actual patient/client. Øberg et al. 2015, Olesen 2015 This is a footer, so use it when you need it. New model in soft tissue manipulation Neurological effects 8 RockBlades Outline Mechanical effects Treatment vectors/rate/time/depth Fascial Chains (Tracing) Case Study 9 3 3/15/19 Content FREE zone. When you understand a technique, you know a technique. When you understand a concept, you know a thousand techniques. 10 “Understand the Rules Before you can Break Them” Mitch Hauschildt - ATC 11 The “Recipe” Paradox 12 4 3/15/19 Movement Pyramid 13 “ Never be sure of what you think You think, but are you sure of what you think? Dr. Jean-Claude Guimberteau 14 Personal & Professional Reflection 15 5 3/15/19 Paradigm Shift in Rehabilitation 16 “ Simple Solutions to Complex Problems is NOT working NOI - Neuro Orthopedic Institute 17 “ We are fearfully and wonderfully complex Lorimer Moseley 18 6 3/15/19 What We Think We Are Doing • Feeding the Sensory System to Change Motor Output • A form of Sensori-Motor Re-Training • Influencing the Predictive Capacity of the Brain • Decreasing Threat Response 19 Limits Exist Only in the Mind 20 Multiple Considerations soft tissue neurological joint 21 7 3/15/19 Tissue Requirements + ELASTIC SPRINGY COMPLIANT STIFF MOBILITY STABILITY 22 How to Attain Chronic Change COMPLIANT + REACTIVE + STIFF MOBILITY MOTOR CONTROL STABILITY (IASTM) (TAPE) (IASTM) = EFFICIENCY 23 Mechanical Effects Mechanical Effects 24 8 3/15/19 Content FREE zone. This is a footer, so use it when you need it. 25 Dr. Robert Schleip • Debunked idea of fascial “release” (mechanical deformation of fascia) • Dismisses traditional explanations of thixotropy and piezoelectric-effect-mediated adaptation • Concludes plastic fascial changes in response to moderate loading is “impossible to conceive” 26 2000lbs/sq” The amount of pressure necessary to distort mechanically fascial tissue Three-dimensional mathematical model for deformation of human fasciae in manual therapy. Chaudry H, et al. J Am Osteopath Assoc. 2008 Aug; 108(8): 379-390. 27 9 3/15/19 Cross-Sectional Anatomy Lesson Epidermis/Dermis Skin ligaments Superficial fascia Deep fascia Muscle 28 MSK Ultrasound Tutorial Skin Superficial Fascia Deep Fascia Muscle 29 Fibrosis or Densification? (Lateral Rib Cage) Pre Treatment This is a footer, so use it when you need it. Post Treatment 30 10 3/15/19 Densification vs. Fibrosis Densification Fibrosis • Indicates an increase in the density of fascia. This is able to modify the mechanical proprieties of fascia, without altering its general structure. • A. Stecco A. Birbrair Similar to the process of scarring, with the deposition of excessive amounts of fibrous connective tissue, reflective of a reparative or reactive process. 31 Mechanical/Neuro Barriers Densification Lack of Glide Normal Tissue Neurological Barriers (Think “Ant”) 32 Neurological Effects 33 11 3/15/19 Old School • Aggressive and intense manual therapy with no regard for the state of the patient’s nervous system is problematic • No Pain, No Gain www.noigroup.org 34 Diane Jacobs - Dermoneuromodulation Hilton’s Law (1863) “The same trunks of nerves whose branches supply the groups of muscles moving a joint furnish also a distribution of nerves to the skin over the insertions of the same muscles; and what at this moment more especially merits our attention - the interior of the joint receives its nerves from the same source.” 36 12 3/15/19 Talk to the Brain 37 Precision Training Improve Sensory Map Change Body Awareness Decrease Pain Improve Motor Control 38 Body Maps 39 13 3/15/19 Smudging Concept Smudged 40 Movement & Faulty Maps Body mapping is the conscious correcting and refining of one’s schema to produce efficient, graceful and coordinated movement • Body map is one’s self-representation in one’s own brain… if representation is accurate, movement is good • If our representation is faulty, movement suffers. When our map is corrected, movement improves • David Nesmith - Alexander Technique 41 Precision Training Improving the Cortical Map 42 14 3/15/19 Connect the Dots • Redefining body maps rehabilitation will be via normalization of sensation, motor control and congruence of these factors • Modern NOI Group (Moseley, Butler) 43 Connect the Dots 2 Point Discrimination (Tactile Acuity) 44 Tactile Acuity - OA Knee 45 15 3/15/19 Tactile Acuity - Chronic LBP This is a footer, so use it when you need it. 46 Tactile Acuity and Pain 47 16 3/15/19 Making the Invisible, Visible Layman Explanation to Clients/Patients 49 Touch/Brain Map Connection Cleaning up Maps 50 The nervous system is the gate keeper to change. Sta cey Tho m a s, LM T 51 17 3/15/19 Sensory Stimulation Theoretical Basis of IASTM Mode of Action 52 What Are We Treating? • “The nervous system is the most important target for influencing posture and movement.” Feldenkrais • “Fascia is the most important tissue for posture and movement.” - Rolf BOTH! 53 Satellite Systems Visual Exteroceptive Vestibular Interoceptive Proprioception 54 18 3/15/19 Sensory Receptor Classification Proprioception: – is the kinesthetic sense that enables us to sense the relative position of the parts of the body, posture, balance, and motion. – Located in Muscles, tendons, joints, internal ear Exteroception: – pertains to the stimuli that originates from outside the body – Located at or near the body surface Interoception: – is defined as sensitivity to stimuli originating inside of the body. –Interoceptors: Free nerve endings –Located in blood vessels, organs, and connective tissue (skin/Fascia) 55 Mechanoreception Connective tissue and fascia are highly innervated Often reported only to occur in muscles and joints The fascial network possesses approximately 10 times the sensory receptors as compared to its muscular counterpart ( van der wall 2009) Includes many types of receptors: – Golgi, Ruffini, Pacinian, Free nerve endings (Interoceptors) Fascia considered more of a perceptual organ than a mechanical organ. 56 Instrument Assisted Neurosensory Modulation IANSM 57 19 3/15/19 Whats the Process? Graded Exposure Concept 58 Graded Exposure Remember, you are working on a person attached the tissues 59 Graded Exposure Therapy • Systematic desensitization (aka graduated exposure therapy) • Used in psychology • Recently adopted to address musculoskeletal conditions 60 20 3/15/19 The Method Bio-psycho-social Model 61 To Start: Have a Plan • What do you want? your baseline • Plan your progression • Be persistent • Educate • Find www.noigroup.org 62 Graded Myofascial Release • Slow progressions • Avoid flare-ups • Improve tissue tolerance • Distraction therapy Decrease the Threat 63 21 3/15/19 Distraction Methods This is a footer, so use it when you need it. 64 22 3/15/19 Chemical Distraction = Chemical Stimuli Laing RJ, Dhaka A. ThermoTRPs and Pain. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry. 2016;22(2):171-187. 67 Tissue Tolerance TT TT Explain Pain - Moseley/Butler 68 Driver’s Education 23 3/15/19 Benefits of using an Instrument • Preserve your hands • Augmented palpation • Therapeutic alliance with patient 70 Treatment Variables Grip: Treatment Rate: • • • • • Standard • Thumb • Edge Fast / Feathering Slow Fluid Capture Shearing – Tangential Treatment Vector: Skin Prep: • Wet – Emollient • Dry – No lubricant • Myofascial Chains • Linear • Non - linear Treatment Depth: • Angle of Approach • Pressure (Grading of Touch) 71 Tool Navigation Fine Tuning Edge Groovy Rock Soft Rock Finger Pads Bottle Opener Hard Rock Grip Grip Narrow Edge Blunt Edge Alternative Rock 72 24 3/15/19 Accessories Disenffectant Wipes Emollient 73 Content FREE zone. 75 25 3/15/19 Content FREE zone. 76 Dosage Matters H a ve Intent w hen yo u trea t 77 Variables Matter Rate/Speed Depth Time 78 26 3/15/19 Depth Gauge Grades Skin SubQ Sup Fascia Deep Fascia Muscle Trauma 79 Depth Gauge Scale 1-3: Very light (eyelid analogy) 4-6: Moderate 7-8: Firm 9-10: Deep 80 Depth = Angle of Approach Depth of penetration does NOT require overpressure. 81 27 3/15/19 Content FREE zone. This is a footer, so use it when you need it. 82 Content FREE zone. This is a footer, so use it when you need it. 83 Content FREE zone. This is a footer, so use it when you need it. 84 28 3/15/19 Dose Dependent • Dosing of 90 seconds to 5 mins of additional strain treatment to human fibroblasts decreases apoptosis (cell death) patterns of cell • Modeled MFR (Myofascial Release) – reverse phosphorylation of the protein (peptides) the mediates the apoptosis of the cells. • Less is more Standley 2015 85 Time Rx Dosage: • Target tissue tx - 10-30 sec • Ripple above and below = 10-30sec • Total = 90 seconds Sweet spot: • 90 seconds to a max of 5 minutes Standley 2015 86 Human GPS A lterna te N a viga tio n System 87 29 3/15/19 Ripple Effect Concept Where you think it is, it ain’t. Ida Rolf 88 Ankle Restriction Ripple: calf/shin/hamstrings Target tissue: ankle Ripple: foot 89 Shoulder Restriction Ripple: midback/lats/pectorals Target tissue: shoulder Ripple: arm/forearm/hand 90 30 3/15/19 Wrist Restriction Ripple: forearm/shoulder/midback Target tissue: wrist Ripple: hand 91 Treatment Strokes Up-Regulation Pacinian Pain Modulation Tissue Glide Fluid Capture Interoception Mechanical Mechanical Down-Regulation Ruffini 92 Indications • Limited motion motion • Motor dysfunction • Lack of tissue glide • Poor body representation • Painful 93 31 3/15/19 Contraindications • Comprised tissue (open wound, infection, tumor) • Active implants (pacemaker, internal defibr., PICC/pump lines) • Deep vein thrombosis • Over cervical carotid sinuses • Patient unable to communicate 94 1 Pain Modulation Feathering Stroke 95 Pain is a request for change. Perry N ickelsto n, Sto p C ha sing Pa in. 96 32 3/15/19 “ It’s easy to be heavy; hard to be light. G.K. Chesterton 97 Not “always” Necessary Graded Exposure Consideration 98 Less is More. Graded Exposure Consideration 99 33 3/15/19 Interoception/Pain Relief Feather Stroke Method 100 Fascia as Interoceptive Organ • 7 x more interoceptors than other mechanoreceptors • Higher concentration in hairy skin • Stimulation of these receptors result in activation of an area of the brain (Insula) associated with pain perception and sense of well being • 40% of these receptors are low threshold receptors which are responsive to light touch – Painter’s Brush – Cotton Ball – Feather stroke 101 Insula Sense of wellbeing Anticipation of pain Perception of pain Empathy Affective touch More! 102 34 3/15/19 Interoceptive Pathway Insula Wellbeing Center of Brain Thalamus Prebrachial Nucleus Lamina I of Spinal Cord Interoceptive C-Fiber Endings Free Nerve Endings Fascia Hairy Skin 103 Manual Therapy • Manual therapists usually concerned with biomechanical effects on non-neural tissues • We advise consideration of interoreceptive receptors when addressing those experiencing pain as the issue may NOT be biomechanical in nature 104 Feathering Interoception Stimulation (Free nerve endings, C-Tactile Fibers) Clinical Relevance - Pain, Hypersensitivity (scars), Hyperalgesia, Threat Movement Relevance - Pain Avoidance Behavior 105 35 3/15/19 Scanning Tissue (Mini-Screen) • Irregularity of Tissue • Petechiae Rate • Neurological Cues 106 Alternative Scanning Process Useful to pay attention to the autonomic responses of each treatment Variable: Neurological cues: – Warmth – lightheadedness – nausea – pulsation – sense of wellbeing – facial expression – breathing – pupil dilation/constriction – skin color changes – temperature changes 107 Autonomic Heisman Pay attention to Patient/Client Response Jessica Hill - PT 108 36 3/15/19 Pain - Feathering 1. SCAN tissues targeted within workout. 2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE 3. SUPERFICIALLY FEATHER pressure on target tissue for 30 seconds to tolerance 4. ADDRESS tissues up/down stream to target tissue = RIPPLE SCAN + IDENTIFY + FEATHER STROKES + RIPPLE This is a footer, so use it when you need it. 109 Depth Gauge 1…..3 Rate might matter CT preferred velocity 3cm/second Liljencrantz et al 2014 111 37 3/15/19 Feather Stroke 112 IASTM Light Touch Research Abstract Background: Instrument assisted soft-tissue mobilization (IASTM) is a popular myofascial intervention. Despite the popularity, the current evidence is variable and has shown favorable outcomes in a small number of musculoskeletal conditions. Currently, there is little consensus on the optimal treatment parameters. Of interest, are the effects of IASTM on delayed onset muscle soreness (DOMS) after strenuous exercise. To date, no studies have reported these effects. Purpose: The purpose of the investigation was to measure the therapeutic effects of a light pressure IASTM technique to the quadriceps muscle group on tactile discrimination and pain perception in healthy individuals after strenuous exercise. Study Design: Pretest, posttest randomized controlled trial Methods: Twenty-three recreationally active adults underwent three different testing sessions: baseline measures and exercise, 24-hours (post) IASTM treatment and measures, and 48-hours (post) IASTM treatment and measures. Outcome measures included two-point discrimination (TPD) and pressure pain threshold (PPT) using algometry. Statistical analysis included parametric and non-parametric tests to measure changes among groups. Results: Twenty-four and 48 hours post exercise, a statistically significant post intervention change was observed for TPD (p = <.001) and PPT (p = <.001). When comparing 24 and 48-hour post intervention measures, there was no significant difference found with TPD (p=.595) and PPT (p=.016). Conclusion: The results of this investigation suggest that a light IASTM stroke using specific parameters may produce a neuromodulation effect on local TPD and pain perception in individuals with DOMS. Clinicians must consider these results as exploratory before integrating such strategies into their clinical practice 113 Hand 114 38 3/15/19 Medial Elbow 115 Shoulder 116 Up/Down Regulation Changing Fascial Tone 117 39 3/15/19 Variables Matter Rate/Speed Depth 118 Fascial Tone - Chemical Mediators This is a footer, so use it when you need it. 119 Fascial Tone Schleip et al 2007 120 40 3/15/19 Fascia Contracts 121 Tone Modulation Fascial Tone 122 2 Up-Regulation Pacinian Corpuscles Stimulation Clinical Relevance - Hypotonicity Movement Relevance - Hypotonicity, Under-Activity (Decreased Tone) 123 41 3/15/19 Up-Regulation = Fast Pacinian corpuscles: • respond to rapid/oscillating mechanical pressure • This improves tactile acuity and motor control 124 Satellite Systems Visual Exteroceptive Vestibular Interoceptive Proprioception 125 GPS Losing Signal • Like losing signal in a big city it’s most needed, the GPS system can become faulty • The brain, which functions on prediction, loses its signaling capacity • When 126 42 3/15/19 Cortical Smudging Normal Smudged Explain Pain - Moseley/Butler 127 Touch/Brain Map Connection Cleaning up Maps 128 Body Map Receptors & Tactile Acuity • Pacinian mechanorecptors • Primarily respond to rapid pressure changes • Stimulating these receptors can result in improved proprioceptive feedback and controlled movement 129 43 3/15/19 Up Regulation - Fast/Oscillating 1. SCAN tissues that will be targeted in specific workout out. 2. IDENTIFY areas of tightness/tenderness = TARGET TISSUE 3. QUICKLY oscillate over the area for 10 seconds = RAPID STROKES 4. ADDRESS tissue up/down stream to target tissue = RIPPLE SCAN + IDENTIFY + RAPID STROKES + RIPPLE This is a footer, so use it when you need it. 131 Depth Gauge 2…..4 44 3/15/19 Content FREE zone. Rate of Oscillation: 2-6 Hz Level - 200-300 BPM This is a footer, so use it when you need it. 133 To the beat… Metronome Apps Available Rate Rx: 120-300 BPM (Approx 2-6Hz) 134 Foot 135 45 3/15/19 Ankle 136 Lower Leg 137 Knee 138 46 3/15/19 3 Down Regulation Ruffini End Organ Stimulation Clinical Relevance - Hypertonicity, Contractures Movement Relevance - Hypertonicity, Over-Activity (Increased Tone) 139 Inhibitory Receptors Ruffini mechanoreceptors: • • • Stimulation of Ruffini corpuscles is assumed to result in lowering of sympathetic nervous system activity (Van den Berg & Capri, 1999) Slow, deep tissue techniques tend to have relaxing effect on local tissues as well as whole organism Appears that deep manual pressure, specifically slow or steady, stimulates interstitial and Ruffini resulting in global muscle relaxation as well as more peaceful mind and less emotional arousal 140 Fascia Can Contract • Fascia has the ability to change its tonus autonomously, independent of outside muscular forces. • Dr. Jochen Staubesand found, using electron photomicroscopy, smooth muscle-like cells embedded within this fascia’s collagen fibers. • Staubesand also found a rich intrafascial supply of sympathetic nerve tissue and sensory nerve endings. • Based on these findings he concluded that it is likely that these fascial smooth muscle cells enable the sympathetic NS to regulate a fascial pre-tension independent of the muscular tonus. Staubesand, J., & Li, Y. (1996). Zum Feinbau der fascia cruris mit besonder Berucksichtigung epi – und intrafaszialer nerven. Manuelle Medizin, 34, 196-200. 141 47 3/15/19 TGF Beta1 + Up Regulation of Tone Sympathetic drive increases release of cytokine (chemical mediator) that causes fascial up regulation (increase tone) Bhowmick, S., Singh, A., Flavell, R.A., Clark, R.B., O’Rourke, J., & Cone, R.E. (2009). The Sympathetic nervous system modulates CD4(+) FoxP3(+) regulatory T cells via a TGF-betadependent mechanism. J Leukoc Biol, 86(6), 1275 – 1283. 142 Down Regulation - Slow/Deep Stroke 1. SCAN tissues targeted within workout. 2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE 3. Deep/Slow pressure on target tissue for 30 seconds to tolerance 4. ADDRESS tissues up/down stream to target tissue = RIPPLE (30STROKE seconds + each) SCAN + IDENTIFY + SLOW RIPPLE This is a footer, so use it when you need it. 144 48 3/15/19 Depth Gauge 4…..6 Down-Regulation Stroke 146 Content FREE zone. This is a footer, so use it when you need it. 147 49 3/15/19 High Tone Regions Pectoral Fascia Trapezius Fascia 148 Abdomen/Diaphragm 149 Calf 150 50 3/15/19 4 Tissue Glide Clinical Relevance - Joint/Tissue Mobility, Restricted ROM Movement Relevance - Mobility Loss, Restricted ROM, 151 Interlayer Gliding 152 Dr. Geoffrey Bove • “It’s all about the interfaces” • Interfaces are essentially the fascial planes between muscles, nerves, fascia, etc.. • Lack of gliding is the enemy • Positive treatment effects are at the loose connective tissue and not in the fascia • Early intervention is the key Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent post-surgical adhesions. Journal of Bodywork and Movement Therapies, 16, 76-82, 2012 doi: 10.1016/j.jbmt.2011.02.004 153 51 3/15/19 Tangential Angle Superficial Fascia Deep Fascia Content FREE zone. This is a footer, so use it when you need it. 156 Role Hyaluronic Acid (HA) Hyaluronan or hyaluronic acid (HA) is found throughout the extracellular space of higher animals, in human skeletal muscle of the lower extremities, and in loose connective tissue Increased concentration and size of HA chains entangle into complex groupings, changing the hydrodynamic properties and thereby altering normal viscoelastic qualities of adjacent tissues. 157 52 3/15/19 A Deeper Perspective Dynamic view of tissue manipulation via musculoskeletal ultrasound imaging 158 T/L Jxt Shear - Langevin et al. 159 Fascial Gliding - Control vs. LBP Langevin et al. 160 53 3/15/19 Wet vs. Dry Treatment Dry Treatment: Wet Treatment: – Improve skin drag – Allow for superficial to create tangential skin/fascial load to skin/fascia stimulation at a – Stimulating Ruffini faster rate (Pacinian Endings that Corpuscle) respond best to – Allow for feathering shear effect on interstitial – Improved gliding fibers effect (fascial (interoception) interface) 161 Rapid Stroke Dry Stroke Tissue Glide (aka “Dry Stroke”) 1. SCAN tissues targeted within workout. 2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE 3. TENSION TO END RANGE + CHOPPING strokes on target tissue for 30 seconds to tolerance 4. ADDRESS tissues up/down stream to target tissue = SCAN +RIPPLE IDENTIFY + CHOP STROKES + RIPPLE This is a footer, so use it when you need it. 163 54 3/15/19 Depth Gauge 5…..7 (Max) Altering HA Viscosity • Dysfunction or "densification" of fascia occurs in the loose connective tissue containing adipose cells, GAGs and HA • A recent paper on this subject by Stecco A, et al. (2013) explains how densified tissue (increased viscosity) can be responsible for Myofascial Pain Syndromes. • Abnormal HA fragmentation can be reversed by increased temperature, local alkalization, deep massage or physical therapies 165 55 3/15/19 Changes to Hyaluronic Acid (HA) Hydroplaning Analogy 168 Most Effective Treatment Modalities 1. Vibration (Perpendicular Load) 2. Tangential Oscillation (Lateral Shear) 169 56 3/15/19 Tissue Glide 170 Tissue Glide 171 Tissue Glide Relaxed Lengthened Semi-Loaded 172 57 3/15/19 5 Fluid Capture Clinical Relevance - Acute/Chronic Edema (Congestion) Movement Relevance - Post Training Recovery 173 Fluid Capture 174 Stroke Recap Pain Mitigation Increase Tone Decrease Tone Tissue Glide C-Fibers Interoceptors Pacinian Ruffini Fascia Interface Slow Moderate Fast Slow Chops Fluid Management Sub Dermal Fluid Slow 175 58 3/15/19 Down Regulate Up Regulate Tissue Response Pain Mitigation Shear A.M. Take Home: Sensory - Motor Precision Training Dosage Matters Graded Exposure Alternate Method of Navigating the Human Body 178 59 3/15/19 Content FREE zone. Fascia Joint by Joint This is a footer, so use it when you need it. 179 Fascia as a Roadmap 180 IT’S ALL CONNECTED 60 3/15/19 Morphological Definition • Fascia is a sheath, a sheet, or any number of other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and internal organs. Dr. Carla Stecco, et al. 182 Functional Definition • The fascial system interpenetrates and surrounds all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner. Fascial Research Congress 183 Content FREE zone. Past This is a footer, so use it when you need it. 184 61 3/15/19 500 Years - Parts Model 185 Content FREE zone. Future This is a footer, so use it when you need it. 186 What is Fascia? it’s alive fascia senses richest sensory organ fascia transmits force globally common myofascial pathways for transmitting stability, strain, and response distributes strain continuous interconnected web a GPS system of strain distribution 187 62 3/15/19 Muscular strain is applied along traceable “myofascial lines” C redit: Thom as M yers - A natom y Trains 188 Content FREE zone. This is a footer, so use it when you need it. 189 Who’s Got Tight Hamstrings? 63 3/15/19 Screen/Re-Screen Joint by Joint Concept 192 Foot Stable (control) Ankle** Mobile Knee Stable (control) Hip** Mobile Pelvis/Sacrum/L-Spine Stable (control) Thoracic Spine** Mobile Cervical Spine Stable (control) Shoulder Complex Mobile Elbow Stable (control) Wrist Mobile ** Key mobility centers 64 3/15/19 The BluePrint 1. 2. 3. 4. Screen Mobilize - IASTM (IANSM) Stabilize - IASTM (IANSM) Re-screen 194 Movement Screening 195 Movement Pyramid 196 65 3/15/19 Screening This is a footer, so use it when you need it. 197 All Movement is a Screen 198 Planar Focus 3 Planes of Movement 199 66 3/15/19 Planar Dysfunction Screen Sagittal Frontal Transverse 200 Standardize - Be Consistent Screening Tech 202 67 3/15/19 Decision Time Mobility problem = consistent • eg: something is restricted in both a loaded and unloaded position Stability problem = inconsistent • eg: something is restricted in a loaded position but not in an unloaded position 203 Regression Strategies Loaded Unloaded Mobility problem = consistent Stability problem = inconsistent 204 3 Planes (Vectors of Movement) Movement Vector Skin/Fascial Vector 205 68 3/15/19 Sagittal Plane Movement Movement Vector Skin/Fascial Vector 206 Performance Front/Back Chains Sagittal Extension Anatomy Trains Sagittal Flexion 207 Sagittal Plane Screen 208 69 3/15/19 Frontal Plane Movement 209 Performance Lateral Chain Frontal- Lateral Flexion 210 Frontal Plane Screen 211 70 3/15/19 Transverse Plane Movement Movement Vector Skin/Fascial Vector 212 Performance Functional Chains 213 Transverse Plane Screen 214 71 3/15/19 Fascial Chains 1.Performance Front Chain 2.Performance Back Chain 3.Performance Lateral Chain 4.Performance Functional Chain 5.Performance Arm Chains 215 Performance Front Chain 216 Performance Front Chain Dorsal Toe Extensors Short/Long Toe Extensors Anterior Tibialis Anterior Compartment Sub patellar Tendon Patella Rectus Femoris (Quads) Pubic Tubercle/AIIS Rectus Abdominus 5th Rib Sternalis Sterno-chondral fascia Sternal Manubrium SCM + Mastoid Scalp Fascia 217 72 3/15/19 Sagittal Plane Screen Flexion Extension 218 Mobility vs Stability 219 Front Chain 220 73 3/15/19 Front Chain 221 Performance Back Chain 222 Performance Back Chain Plantar surface of toes Plantar fascia and short toe flexors Calcaneus Achilles Tendon Gastrocnemius/Soleus Femoral condyle Hamstrings Ischial tuberosity Sacrotuberous ligament Sacrum/sacrotuberous fascia Erector spinae Occipital ridge Galea aponeurotica Epicranial fascia 223 74 3/15/19 Sagittal Plane Screen Flexion Extension 224 Mobility vs Stability 225 Back Chain 226 75 3/15/19 Back Chain 227 Performance Lateral Chain 228 Performance Lateral Chain 1st and 5th Metatarsal Bases Peroneals (Fibularis group) Lateral Crural Compartment Lateral Tibial Condyle ITB Abductor Muscles TFL Gluteus Max Iliac Crest, ASIS, PSIS Lateral Abdominal Obliques Ribs Ext/Int Intercostals 1st/2nd Ribs Splenius Capitis SCMOccipital Ridge/ Mastoid Process 229 76 3/15/19 Frontal Plane Screen 230 Mobility vs Stability 231 Lateral Chain 232 77 3/15/19 Lateral Chain 233 Performance Functional Chains 234 Performance Functional Chain Tuberosity of Tibia Subpatellar Tendon Patella Vastus Lateralis Shaft of Femur Gluteus Maximus Sacrum Sacral Fascia LD Fascia, Lat Dorsi Shaft of Humerus Linea Aspera of Femur Adductor longus Pubic Tubercle and Symphysis Lateral Sheath of Rectus Abd 5th rib and 6th rib cartilage Lower edge of pec major 235 Shaft of humerus 78 3/15/19 Transverse Plane Dysfunction 236 Mobility vs Stability 237 Functional Chains - Anterior 238 79 3/15/19 Functional Chains - Posterior 239 Performance Front Arm Chain 240 Movement Screen Starting Point: • • • • • ROM Grip Strength Dexterity 2 Point Discrimination Algometry 241 80 3/15/19 Mobility vs Stability 242 Front Arm Chain 243 Performance Back Arm Chain 244 81 3/15/19 Back Arm Chain 245 Re-Screen Check your Work! 246 Making it Stick Tape - Motor Control Resistance Bands - Stability 247 82 3/15/19 Motor Control 248 Tape - Mechanical Effect This is a footer, so use it when you need it. 249 Tape - Mechanical Effect 250 83 3/15/19 Tape - Neurological Effect 251 Mobility vs Stability 253 84 3/15/19 Body Maps 254 Taping Basics Clean Skin 255 Taping Basics Measure & Cut Round Edges 256 85 3/15/19 1. Stretch the Skin Pre-stretch is applied to the skin to engage the receptors and preload the elastic quality of the organ 257 2. Stabilization Strips 258 3. Decompression Strip Increases biomechanical lifting effect on skin and superficial fascia (over focal point area) Adds to increased mechanical disruption of local receptors 259 86 3/15/19 Voila Let’s practice. 260 Menthol/Capsaicin Effects + Mechanical Stimuli = Chemical Stimuli Laing RJ, Dhaka A. ThermoTRPs and Pain. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry. 2016;22(2):171-187. 261 Locking in the Change Adding Stability to Motor Control 262 87 3/15/19 Isolated Approach 264 Global Approach Pallof Bruggers 265 88 3/15/19 Case Study Goals: • Pain relief • Inflammation • Up regulation • Down regulation • ROM (glide) • Chains (ripple) • Tape • Corrective Strategies 266 RockBlade Jeopardy Challenge 267 In Summary… 1. New perspective in manual therapy 2. Neurological focus (IANSM) 3. New methods of navigating the human body 4. Layering multiple therapies (scrape/tape/move) to maximize outcomes 268 89 3/15/19 Paperwork 269 270 Jeanine Noble jnoble@healcerionusa.com www.postureanalysis.com www.webexercises.com www.pesi.com Instructor Name Instructor email 90
