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Independent Function


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The World Health Organization has recommended the goal of promotion of Independent Function for programs addressing musculoskeletal pain. Pain sources, functional goals, biomechanical obstacles to recovery and the LASS strategic approach is described.

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Independent Function

  1. 1. The L.A. Sports & Spine Philosophy Craig Liebenson, D.C. (310) 470-2909 [email_address]
  2. 3. OUR PHILOSOPHY <ul><li>Finding the Source of Your Pain </li></ul><ul><li>Functional Goals of Care </li></ul><ul><li>Modern Approach to Fitness </li></ul><ul><li>Functional Approach - Biomechanics </li></ul><ul><li>What You Can Expect at L.A.S.S. </li></ul>
  3. 4. FINDING THE SOURCE OF YOUR PAIN Injury Repetitive Strain
  4. 5. What leads to pain? Genetics/Anatomy Injuries/Trauma Repetitive Strain/ Overuse
  5. 6. Repetitive Strain/ Overuse <ul><li>If your ACTIVITY DEMANDS exceed your FUNCTIONAL CAPACITY this will cause repetitive strain </li></ul><ul><li>Any GAP between your DEMANDS & CAPACITY must be erased by postural advice & core-stability training in order to address your “weak link” </li></ul>
  6. 7. Site vs Source of Pain <ul><li>Site </li></ul><ul><li>Pain Generator </li></ul><ul><li>Structure </li></ul><ul><li>Source </li></ul><ul><li>Factors responsible for pain </li></ul><ul><li>Overactivity </li></ul><ul><li>Poor posture </li></ul><ul><li>“ Weak link” </li></ul>
  7. 8. Guarding after an injury is normal <ul><li>“ after an injury tissues heal, but muscles learn, they readily develop habits of guarding that outlast the injury” </li></ul><ul><li>Janet Travell, MD </li></ul><ul><li>White House Physician, </li></ul><ul><li>President John F Kennedy </li></ul>
  8. 10. Hardware vs Software <ul><li>Hardware </li></ul><ul><li>Orthopedic problem </li></ul><ul><li>Structural problem </li></ul><ul><li>Injury or Degeneration </li></ul><ul><li>Inflammatory </li></ul><ul><li>Software </li></ul><ul><li>Rehabilitation problem </li></ul><ul><li>Functional problem </li></ul><ul><li>Postural </li></ul><ul><li>Mechanical </li></ul>
  9. 11. Corrupted Motor Program <ul><li>The Corrupted Program: </li></ul><ul><li>Faulty movement patterns </li></ul><ul><li>Poor biomechanics </li></ul><ul><li>Is a protective reaction to pain or injury </li></ul><ul><li>Is memorized as a new motor program & becomes a habit! </li></ul>Pain/Injury or Repetitive Strain Corrupted Program “ emergency brake” <ul><li>Disability - </li></ul><ul><li>Activity </li></ul><ul><li>Tolerance </li></ul>
  10. 12. Corrupted Motor Program - altered biomechanics <ul><li>Poor posture </li></ul><ul><li>Faulty movement patterns </li></ul>
  11. 13. GOALS OF CARE <ul><li>Improve your biomechanics! </li></ul><ul><li>Postural Correction </li></ul><ul><li>Core Activation </li></ul><ul><li>Breathing Re-education & Flexibility Training </li></ul><ul><li>Independent Functioning </li></ul>
  12. 14. Goal: Correct your Posture <ul><li>Poor posture strains your joints and overloads your muscles </li></ul><ul><li>Correcting your posture re-aligns you </li></ul><ul><li>Correcting your posture is the first step in injury prevention, recovery & performance enhancement </li></ul>
  13. 15. Goal: Correct your Posture <ul><li>A Posture Test </li></ul><ul><li>Can you reach your arms overhead so that the back of your hands touch the wall? </li></ul><ul><li>Can you do this without your back arching away from the wall? </li></ul><ul><li>Can you flatten your back? </li></ul><ul><li>Is it painful? </li></ul>
  14. 16. Goal: Activate your core <ul><li>Your core muscles give you support & stability </li></ul><ul><li>They help you prevent injury </li></ul><ul><li>They aid your recovery & rehab </li></ul><ul><li>And, they enhance your performance </li></ul>Your core provides you with a 360º ring of support
  15. 17. Goal: Activate your core <ul><li>A Core Test </li></ul><ul><li>Perform a plank </li></ul><ul><li>With only your toes & forearms on the floor </li></ul><ul><li>Can you hold this position for 60 seconds? </li></ul><ul><li>Try a front plank </li></ul><ul><li>Try side planks </li></ul><ul><li>Is it painful? </li></ul>
  16. 18. Husk vs Core <ul><li>Husk/Shell </li></ul><ul><li>Outer Superficial Muscles (e.g. shoulder shruggers, chin pokers, jaw clenchers) </li></ul><ul><li>Compensate </li></ul><ul><li>Guard/Protect </li></ul><ul><li>Emergency Brake </li></ul><ul><li>Limit Mobility </li></ul><ul><li>Increase Stress/Tension/Pain </li></ul><ul><li>Deep Core </li></ul><ul><li>Inner Muscles (e.g. shoulder depressors, pelvic floor, gluteals) </li></ul><ul><li>Stabilize you </li></ul><ul><li>Guide movement </li></ul>
  17. 19. Goal: Re-educate Breathing <ul><li>Breathing with your chest & shoulders in a vertical direction is a common error </li></ul><ul><ul><li> ’ es shoulder/neck tension </li></ul></ul><ul><ul><li>Disables the core </li></ul></ul><ul><li>Standing or Sitting </li></ul><ul><li>Breathing Test </li></ul><ul><li>When you breathe in do your shoulders rise up </li></ul><ul><li>Ideally you would breathe horizontally not vertically </li></ul>
  18. 20. Goal: Re-educate Breathing <ul><li>A Breathing Test: </li></ul><ul><li>Lie on your back & see if when you breathe in your abdomen or chest rises more </li></ul><ul><li>Ideally, your abdomen would rise more </li></ul>
  19. 21. Goal: Flexibility training <ul><li>Tight muscles lead to muscle imbalances & poorly compensated movement patterns </li></ul><ul><li>If you have good flexibility then you can maintain an upright posture during normal activities such as: </li></ul><ul><ul><li>Standing </li></ul></ul><ul><ul><li>Squats </li></ul></ul><ul><ul><li>Lunges </li></ul></ul>
  20. 22. Goal: Flexibility training <ul><li>A Flexibility Test: </li></ul><ul><li>Perform a squat </li></ul><ul><li>Can you keep your chest arched up in front? </li></ul><ul><li>Can you keep your head over your knees? </li></ul><ul><li>Can you prevent your knees from passing in front of your toes? </li></ul>
  21. 23. Goal: Flexibility training <ul><li>A Flexibility Test (cont’d): </li></ul><ul><li>Can you prevent your knees from collapsing inwards? </li></ul>
  22. 24. Goal: Flexibility training <ul><li>A Flexibility Test: </li></ul><ul><li>Perform a kneeling lunge </li></ul><ul><li>Can you reach overhead with your arms so they are vertical? </li></ul><ul><li>Can you lean forward in your hip without your knee pressing forward of your knee? </li></ul><ul><li>Can you feel the stretch in the front of your hip on the back leg? </li></ul>
  23. 25. Goal: Independent Functioning <ul><li>Our goal is to help you return to your activities as soon as possible </li></ul><ul><li>We will guide you through this process </li></ul>INDEPENDENT SEMI-SUPERVISED SUPERVISED
  24. 26. FITNESS FACTORS <ul><li>Traditional </li></ul><ul><li>Strength </li></ul><ul><li>Flexibility </li></ul><ul><li>Cardio-vascular </li></ul><ul><li>Functional </li></ul><ul><li>Agility </li></ul><ul><li>Balance </li></ul><ul><li>Coordination </li></ul><ul><li>Speed </li></ul><ul><li>Endurance </li></ul><ul><li>Relaxation </li></ul>
  25. 27. Which is the athlete? <ul><li>Bodybuilding (cosmetics) vs. Athletics </li></ul>Big & Strong Quick & Powerful
  26. 28. FUNdamental ABC’s of Fitness COORDINATION BALANCE AGILITY
  27. 29. Aristotle <ul><li>“Practice doesn’t make perfect, it makes permanent” </li></ul><ul><li>Quality NOT Quantity is our goal </li></ul>
  28. 31. Core Fitness Philosophies YOGA TAI CHI PILATES
  29. 32. Functional Approach - Biomechanics <ul><li>Holistic approach </li></ul><ul><li>Patient-centered care </li></ul><ul><li>Return you to your recreational, home & work activities as soon & safely as possible </li></ul><ul><li>Identify & train your “weak link” </li></ul>
  30. 33. Functional Approach - Biomechanics Legs and Feet Scapula Arm and Shoulder Thoracic and Lumbar Spine Hips and Pelvis
  31. 34. Faulty Biomechanical Movement Pattern - Running
  32. 35. Faulty Biomechanical Movement Pattern - Stepping
  33. 36. Faulty Biomechanical Movement Pattern - Reaching <ul><li>Ideal arm raising w/ shoulder relaxed </li></ul><ul><li>Poor pattern due to shrugging the shoulder up </li></ul>
  34. 37. You will learn the ATHLETIC POSTURE <ul><li>Chin in </li></ul><ul><li>Chest up </li></ul><ul><li>Shoulders relaxed </li></ul><ul><li>Knees over toes </li></ul><ul><li>This posture protects you against injury & enhances athletic performance </li></ul>
  35. 38. WHAT YOU CAN EXPECT <ul><li>Orthopedic & Functional Evaluation </li></ul><ul><li>Individualized Self-Care Prescription </li></ul><ul><li>Collaberation with MDs, Trainers, etc. </li></ul>
  36. 39. Evaluation <ul><li>Orthopedic </li></ul><ul><li>Initial </li></ul><ul><li>Rule out Serious or Sinister problem requiring medical/surgical intervention </li></ul><ul><li>Functional </li></ul><ul><li>After Ortho assessment </li></ul><ul><li>Biomechanical Predisposing or Perpetuating factors </li></ul>
  37. 40. Roadmap of Care - Your 1st Visit <ul><li>Orthopedic Dx – site of pain </li></ul><ul><li>Functional Dx – source of pain </li></ul><ul><li>Map of Problem – What makes you hurt </li></ul><ul><li>Goal: find the Compass – C ustomize your program. </li></ul><ul><li>Simple, light exercise to nourish tissue </li></ul>
  38. 41. Phase One of Care <ul><li>PHASE 1 – Approx 1 month - 3X/week </li></ul><ul><li>GOAL: Increase Function/Reduce Pain/Increase Activities </li></ul><ul><li>SUCCESS: 80% of people are 50-80% improved </li></ul>
  39. 42. Phase Two of Care <ul><li>1:1 Preventive & Functional Training </li></ul><ul><li>Soft Tissue Work </li></ul><ul><li>Diminishing frequency </li></ul><ul><li>More self-care </li></ul><ul><li>Return to activities </li></ul>
  40. 43. Synergy <ul><li>MD – Medication/Tests </li></ul><ul><li>ORTHO – Medication/Tests/Injections/Surgery </li></ul><ul><li>ACUPUNCTURE </li></ul><ul><li>PSYCHOLOGICAL COUNSELING - Relaxation </li></ul><ul><li>OTHER – Massage/Personal Training </li></ul><ul><li>LASS – Physical therapy, manual therapy, fitness training, soft tissue work, nutrition-supplements </li></ul>
  41. 44. What You Will Learn on Day 1 <ul><li>Site of pain </li></ul><ul><ul><li>Where it is coming from </li></ul></ul><ul><li>Source or cause of your problem </li></ul><ul><ul><li>Why it happened </li></ul></ul><ul><li>What will we do </li></ul><ul><li>What you should avoid </li></ul><ul><li>What you can do </li></ul><ul><li>Prognosis/forecast </li></ul>
  42. 45. Dr Liebenson works with premier elite athletes <ul><li>Kobe Bryant, Sam Cassell, Corey Magette - NBA </li></ul><ul><li>Jayson Werth, Troy Glaus, Eric Byrnes - MLB </li></ul><ul><li>Christian van de Velde - Tour de France </li></ul><ul><li>Nathan Ramsey - Motocross </li></ul><ul><li>Julia Mancuso - Olympic Gold Medal Skier </li></ul><ul><li>Tara Dakidas - Snowboarder </li></ul><ul><li>Scott Walchek - Triathlete </li></ul><ul><li>Team Chiropractor - NBA, L.A. Clippers </li></ul><ul><li>Consultant - MLB, Arizona Diamondbacks </li></ul><ul><li>Chiropractor - Athlete’s Performance International </li></ul>