The Joint by Joint Approach
Marc Heller, DC


With thanks to Mike Boyle, who
coined the term
http://www.strengthcoach.com/public/128
2.cfm

Stability- for LB and Pelvis

Mobility- for Thoracics and Hip
1
More on the joint by joint




The thoracics are built for stability
Connections to rib cage
Tendency to get stiff
Neither chest breathers or belly
breathers move the lower thoracics
2
Lumbar and Pelvis
Tendencies toward excess mobility




Designed as a hinge, between trunk
and legs
In females, designed to open for
childbirth
In hypermobile people
After injury, structures that do not
heal
3
The brilliance of
the joint by joint approach




See the big picture
Recognize what areas, in general
Need more flexibility
Which need more stability
4
Does this mean I
should not mobilize the lower back,
should not release low back muscles




NO, this is not a rule
It is a guide
Be more selective
Be aware of the general tendencies
5
Why Low Force?
What is Low Force?





An attitude, just enough pressure
Getting more information
from a lighter touch
A Safer way to mobilize
Don’t upregulate the pain receptors
Don’t startle
6
Pain creates Inhibition





Pain (any pain) causes
profound inhibition of stabilizers
transverse abs, multif, psoas, pelvic
floor
And Gluteus medius and Gluteus
Maximus
Weakness and timing delay
7
What do the stabilizers do?






The stabilizers are small muscles,
Connecting individual joints
Centrally located in the trunk
(primarily)
They control small motions
They have precise innervation
They are designed to be able to
activate for longer periods.
8
The vicious cycle of pain
Pain
Inhibition
Instability
9
Vicious cycle





Pain- creates inhibition of stabilizers
Inhibition allows excessive
movement
(Especially at weak links, pain sites)
Excessive movement stresses weak
links
And creates pain
10
Muscular Patterns- hypo



Multifidi, psoas,
(plus transverse abs, pelvic floor,
deep sacral gluts)
Loss of stabilizer function
11
Muscular Patterns- hypo- hip




Hip stabilizers that get inhibited
In frontal plane, gluteus medius
In saggital plane, gluteus maximus
And psoas- as both a stabilizer and
as a hip flexor
12
Muscular patterns- Hyper

What happens in dysfunction and
pain
Hypertonic, erector spinae
Bulk at T-L junction

Hypertonic- rectus femoris and TFL


13
Mobility vs Stability theme






Thoracics and TL need more mobility
Lumbars and Pelvis need more
stability
In LB pain, vicious cycle
Of rigidity in wrong places
Loss of stability, excessive movement
at the weak links
(but the patient experiences
stiffness)
14
And on we go






The rest of the class goes into the details,
Where and how to mobilize
How to train for basic stabilization
Management of discogenic and SI pain
How to mobilize SI and the facet joints,
and decompress the disc
How to assess and mobilize the hip joint