Great Info from the Gray Institute Newsletter
TWEAKOLOGY is the transformation of the notion (what we know about function) into the motion (what function looks like). Knowing that every “tweak” will create a different reaction, mindfully chosen “tweaks” provide the foundation of the exercise strategies that are specific for each individual.
This month we highlight the BALANCE REACH as our exercise and use SPEED as our “tweak”. Before we further describe the exercise, let’s discuss balance in general. Balance is a state of equilibrium, it is dynamic in nature, it requires a combination of stability and mobility or “Mostability”. Balance does NOT require stillness and is hampered by rigidity.
Back to the task at hand…SINGLE LEG BALANCE REACH. Two things to look for when observing this exercise are: 1) how far the individual can reach their and 2) the ability to transform the direction of the movement. Let’s perform three different foot reaches at ground level using the three cardinal planes 1) Sagittal Plane (click HERE to view) 2) Frontal Plane (click HERE to view) 3) Transverse Plane (click HERE to view). Perform 3-5 repetitions with each foot at a self-selected speed. Observe not only the reaching foot and leg, but observe the “balance” leg. Also observe the reaction of the trunk, the shoulders and even the head and hands. Does each side react the same? Is there similar control demonstrated? Similar ranges of motion throughout the body? Similar quality of movement through the Chain Reaction™? Now let’s tweak it. Repeat the balance reaches with decreased speed. How does decreasing the speed affect control, range of motion, and quality of movement? If the body senses a loss of stability and control, with the simple tweak of increased or decreased speed it will react with an immediate neurological stiffening to add control back into our system – to prevent one from falling. Remember, it is always about preserving ourselves within our environment. As you experience a stiffening effect, do not worry – but note the difference between fluidity in motion versus rigidity.
Find the speed of your success. Also find the speed of success for those that you are assessing, training and rehabilitating. Depending upon the function that they are looking to improve, condition the movement with slightly decreased speeds and slightly increased speeds, over time without sacrificing fluid efficient movement.
As always, safety is the number one concern. Any time you believe you are not able to complete the movement without the need for additional stability, make sure that you are performing the balance foot reaches in a doorway, next to a wall, or next to a chair or even having someone else control you through hand stability. Remember to provide the same safety net and opportunities for your patients and clients.
Posts Tagged ‘gary gray’
Tags: Balance, core exercise, equilibrium, exercise, functional exercise, gary gray, leg exercise, physical therapy, rehabilitation, single leg exercise, Sports Medicine, sports training
Tags: chain reaction, functional exercise, gary gray, hopping, jumping, physical therapy, Sports Medicine
By Doug Gray
Jumping is an action that has implications to everything we do. Squatting, walking, running, lunging, etc. has components of jumping involved. Therefore, jumping better will pave the way to functioning better. A common element of plyometrics and calisthenics is jumping. Jump training is a point of focus in sport, yet has extreme implications to life in general. The topic of jumping initiates many questions to consider, such as the following:
• Is your jump training directly carrying over to that which you are training for?
• Is your jump training better preparing you to execute activities more efficiently, whether in sport or active daily living?
• Is your jump training incorporating all three planes of motion (as the body is intended to function)?
• Is your jump training properly sequenced to be safe and guarantee progress / improvement?
• Is your jump training properly preventing future injury?
• Is your jump training dynamic and variable (i.e. – incorporating two feet to two feet, two feet to one foot, one foot to two feet, and one foot to the same foot)?
As the above questions trigger contemplation to the purpose, logic, and sequencing of one’s training regime, it sets the table for exploration on how to better train the body. A great starting point is identifying and discussing a functional threshold. A functional threshold … the body’s ability to successfully perform the multiple tasks required for what one needs to do and what one wants to do in life. In essence, it leads to productively owning ones three‐dimensional space in completing the desired task at hand. The spectrum of “needs” and “wants” is long and variable, yet lends itself to the following point: it is in ones best interest to expand his / her functional threshold in order to enhance overall performance.
Jump‐Jop‐Hop Explosion, which is part of the Gray Institute’s 3D Matrix Performance Series, is a workout intended to increase one’s vertical, to protect one from injury, as well as to improve one’s strength, flexibility, cardiovascular endurance, coordination, agility, power, speed, reaction, etc. More importantly, it is designed to enhance one’s overall health, wellbeing, and longevity by creating an environment where one can expand his / her functional threshold. Jump‐Jop‐Hop Explosion, as all DVDs in the 3D Matrix Performance Series, consists of both instructional and follow‐along segments.
The terms jumping, jopping, and hopping all refer to the act of loading the lower body and trunk to efficiently and effectively (as well as explosively) unload the body to become airborne in defying gravity. Pure jumping is defined as leaving the surface (or ground) on one foot or both feet and landing on both feet. Pure jopping is defined as leaving the surface on both feet and landing on one foot. Pure hopping is defined as leaving the surface on one foot and landing on the same one foot.
The Chain Reaction™ biomechanics involved with jumping are very similar to that of the lead (or front) leg in gait (or walking). In understanding this better, it is valuable to identify what is known as a Transformational Zone (TZ). A TZ is defined as the period of time when motion changes direction. Moreover, a TZ is the point where eccentric lengthening (loading) of a muscle transforms into a concentric shortening (unloading). The TZ of jumping (when the body compresses before exploding upward or outward) calls for a three‐dimensional Chain Reaction™ throughout the entire body (feet / ankles, knees, hips, trunk, etc.). This load and explode sequencing is a common denominator for all forms of movement. For that reason, Jump‐Jop‐Hop Explosion is not strictly for jumping population, but for all walks of life.Jump‐Jop‐Hop Explosion is a workout that trains the body’s muscles and joints to load and explode in a variety of ways in performing jumps, jops, and hops. Embedded into the workout is a progression that gradually intensifies the workout from round to round (consist of three rounds) by beginning with jumps (two feet to two feet), then shifting to jops (two feet to one foot) and hops (one foot to same one foot). Also, very important to the topic of the DVD, a strategy of safety and progression is performing the workout in initial ranges of motion until the body is comfortable and strong enough to be challenged more (which would involve moving then into mid ranges of motion, and then moving into end ranges of motion).
Additionally, Jump‐Jop‐Hop Explosion positions the body from the top‐down to facilitate and different Chain Reaction™ to add variety and functionality to the workout. For example, both hands are positioned differently in certain portions of the workout to put parts of the body at a biomechanical advantage, while putting other parts of the body at a biomechanical disadvantage, in order to mimic sport and daily activities that the body needs to perform. Of course, these positions are logically organized into all three planes of motion (in front of, above and behind, to the right of, to the left of, rotationally to the right of, and rotationally to the left of the body). Placing the hands in front of the body (anterior at hip) recruits more of the back hip (glute muscles) to execute the task, whereas placing the hands above and behind the body (posterior at overhead) recruits more of the front hip to execute the task. Different positions of the body allow gravity to compress the body differently, as gravity is the competitor of jumping, yet also the best friend when it comes to loading the body to jump.
According to the Gray Institute’s Functional Video Digest Series v2.4, “Jumping: Unleashing the Load” CLICK HERE, jumping is a tri‐plane phenomenon. Also, to enhance jumping, it is imperative that new pathways of loading the body are established and existing pathways are deepened and enhanced. Jumping is not only vertical, but also horizontal and rotational. All these dimensions need to be exploited in any jumping program to better prepare and protect the body in all areas of performance, in which Jump‐Jop‐Hop Explosion successfully exhibits. This needs to be the goal for any athlete: to develop and enhance the gifts and talents that he / she has been given. Therefore, all dimensions need to be attended to in expanding one’s functional threshold. Jump‐Jop‐Hop Explosion is an integral step to this process.
Tags: functional anatomy, functional training, gary gray, golf swing, low back, physical therapy, Sports Medicine
By Michael Rizk, CPT, ART
Have you ever witnessed a relationship gone sour? The telltale signs are significant, but many
times the root cause stems from poor communication. There is one particular area of the body
that seems to get more press than a short‐lived Hollywood hook‐up. You’ve got it – the lumbar
spine (LS) is likely the most injured, dysfunctional, and (supposedly) weakest link of the body.
In relation to the rest of the body, the LS is active in nearly every functional task performed … it
resides at the crossroads of the body. For that reason, it is important for the rest of the body to
communicate with the low back to let it know how important it is, how much it is needed, and
how much it is appreciated for all it does.
What is meant by communication with the LS? Great question! Communication refers to the
ability of all our joints to feed triplane motion to the LS creating triplane stability. A lack of
triplane mostability (mobility plus stability) can shut down the phone lines feeding
proprioceptively rich information to the LS, thus creating undesirable chain reactions.
By design, the LS facilitates flexion and extension, allows lateral flexion, and almost inhibits
transverse plane motion. The small amount of transverse plane motion may in fact be the most
important motion allowing the LS to be the transverse plane transmitter of forces between the
upper and lower extremities.
To simplify motion, we consider two phases: loading and unloading. Loading is the preparation
of the task and unloading is the performance of the task. Using the golf swing as an example,
the backswing is the load and the downswing / follow through is the unload. The moment of
time between the load and unload is what we call the transformational zone (TZ). The TZ is
where motion is decelerated and transformed into a concentric production of force.
Understanding what happens just as we enter and exit the TZ will allow us to effectively assess
our patients and clients.
I recently assessed a 57‐year‐young right‐handed golfer with right low back pain, which
occurred during the end range of his back swing just prior to transition. His approach to me was
simple, “So I heard you can fix my back.” With a humble smile, I explained how the body works
relative to the intended task. I shared with him how a lack of three‐dimensional motion
(communication) at any segment will become excessive compensatory motion elsewhere.
While his assessment started with a gait evaluation, I kept in mind that gait and golf create very
different chain reactions in the TZ. During gait, the pelvis and trunk move opposite each other,
and in golf, they move in the same direction. However, I immediately noticed an inability to
load the left side of his body during gait, which was evident by a rough transition from his right
to left foot, as well as an early heel rise on the left foot. After viewing this global glitch, I had to
become a biomechanical detective and get more specific.
To further assess his left ankle and left hip, I had him perform a three‐dimensional balance
reach matrix. He lacked balance when I asked him to reach in the frontal and transverse planes
from his left foot. To create stability, I placed him in the TRUEStretch™ in a backswing posture
and had him perform his balance reaches from this golf‐specific position. Lo and behold, he said
“Wow, it feels like my ankle doesn’t want to turn that way!” He continued to say, “I wonder if
the left ankle sprain I had playing college basketball has anything to do with this?”
Next, I positioned him in his backswing posture to his threshold of success (meaning prior to
experiencing any pain or compensation) and used my hands as a driver to facilitate frontal and
transverse plane subtalar joint (STJ) motions. To balance his new mobility with stability, we
performed lateral and rotational lunges with three‐dimensional arm drivers specific to the golf
TZ. This strategy facilitates proprioceptive communication between his left STJ and right LS.
Within one week, my client was enjoying a pain free backswing with added yardage and accuracy. Needless‐to
say, we were both happy. Even though my client came to me with low back pain, I am led to believe his lack of frontal and
transverse plane motions at his left STJ was, at least, in part the CAUSE of his LS dysfunction. If
we take a snapshot of the backswing, we can see the following: right trunk rotation, right hip
internal rotation, left hip external rotation, right ankle inversion, and left ankle eversion. Frontal
plane eversion of the left STJ transforms into rotation of the left limb; therefore, a lack of that
motion must be made up somewhere else in the kinetic chain. With the nominal amount of LS
rotation available there, is not much room to compensate at the LS before dysfunction and pain are experienced.
With an understanding of Applied Functional Science (AFS) and chain reaction biomechanics we
can effectively and efficiently keep the LS healthy and functional with improved communication.
Oh how I love function!
Get Strong! Stay Strong!
Tags: Abdominal training, exercise, functional exercise, functional training, gary gray, human movement, physical therapy, Sports Medicine, training
By David Westerman LMT, FAFS
Are we utilizing “authentic” principles of Function when designing our strength and
Is there a special population that might be missing two of the most important bio‐
motor abilities in their training and rehabilitation programs?
As a former collegiate and professional strength and conditioning coach, strength
and power were (and are) the two most emphasized bio‐motor abilities.
Take, for example, the “power clean” in an athletic weight room. This is one of the
most utilized exercises in “power” training. The typical strategy is to put as much
weight on the bar and successfully lift it one to four times. Let’s see if we can use
part of our litmus test of “authentic” strength and power principles to better
understand its carryover to three‐dimensional Function.
Is it threedimensional?
The power clean is a sagittal plane‐dominate
movement. Most activities require three‐dimensional movement in all
muscles and joints.
Is it specific to activity?
Considering most sports and activities have a
horizontal component to load, the power clean is mostly a vertical load.
What is the neural input and range involved?
If the weight is too heavy
and we go through long ranges, we may actually slow down the neural input
which will inhibit our power and strength transfer to activity.
Are we taking advantage of the Transformation Zone?
The fact that
most of our power is utilized at the zone in which a direction is reversed in a
motion needs to be considered (i.e. – plyometrics).
Above are a few key questions that we can use for any population or exercise we
choose to work with.
Typically we associate strength and power with athletes. However, the population
that may need it the most is our senior population. With the baby‐boom explosion,
more and more of this growing population are getting injured and becoming more
sedentary. Consider the following scenario and proposed training / treatment
A 75‐year‐old woman has balance problems when walking.
Through functional assessments, the practitioner finds abdominal muscles
are weak and significantly lack the ability to move in all three planes of
: Position client in a small stride position with the left leg
forward in front of a wall for support and as a target. To create a load in the
abdominals we want to reach with the left shoulder posterior (backward) at
shoulder (height) towards the wall in a short range of motion at a moderate
to fast speed.
This facilitates tri‐plane loading of the abdominals in the
Transformational Zone of walking with an exercise that replicates the
activity, while creating more power that will transform into better strength
of the entire kinetic chain by using a short (safe) range and increased speed.
Whether you seek strength or power, our strategies and exercises need to be based
on “authentic” principles of Function.
Get Strong! Stay Strong! (and be functional)
Tags: applied functional science, function, functional anatomy, functional biomechanics, gary gray, hip, hip function, lumbopelvic, physical therapy, Sports Medicine
By Barbara Fuller PT, FAFS
The late-seventyish woman looked at me with a bit of skepticism mixed with a little fear. After I introduced myself to her she said, “Before we start, I want you to know that I would like for you to address my low back pain, but I don’t want you to mess with my hip.” When I urged her, she further explained that she’d had problems with her right hip for a long time, with x-rays revealing severe arthritis and necrosis of the femoral head. She had been to an orthopedist who told her to come back for a total hip replacement when she could not stand the pain anymore. She was not ready for that. Her back pain was relatively new, but it was making her even more miserable, as well as making her unable to do the yard work she loved doing or taking a walk. Most telling was the account of her last experience in physical therapy when her hip was forced passively beyond what she could tolerate, thus resulting in increased pain. Needless-to-say, she never went back. Before I even touched this patient, or put her through any functional movement assessments, I felt a strong need to educate her about the hip – especially its relationship to the lumbar spine. I told her that the hip is the low back’s best friend. I explained how a normally functioning hip, one that moves well and is strong in all three planes of motion, allows the low back to function normally by protecting it from excessive motion and wear and tear. I demonstrated how a hip, with a decent amount of extension, propels the body forward, but without that extension, the task falls to the low back causing all sorts of problems. I told her that her hip had let her low back down and was probably the cause of her low back pain. All that being said, I then told her that I really felt that I needed to at least take a look at the hip or I would be doing her a disservice. I also promised her that I would not do anything she did not agree to me doing and that I would be very gentle. She agreed. In addition to the hip being quite friendly, the hip is BIGGEST of the BIG rocks in our body! Big rocks are the areas of the human body that provide a foundation for normal mobility and stability (mostability). But if they are not functioning well, then they become the culprits of pain and dysfunction in joints above and below. For the hip, that includes its closest neighbors – the lumbar spine and the knee – but it can also include more distant neighbors like the opposite shoulder or elbow. Also, the hip is our power source. We can understand this when we consider the powerful muscles of the back and front butts, and their core connections, including the pelvic floor (with connection through the hip adductors and rotators) and the thoracic diaphragm (with connection through the abdominals to the thoracic spine and rib cage). It is through hip extension that we can most effectively load our abdominals. As promised, I was gentle with my patient and started her functional assessment with neutral standing (XXX) while hanging on to a counter top with both hands. She was limited bilaterally in lateral pelvic glides and rotations. Most significant, though, was her lack of right hip extension in a left stride stance (LXX). She also demonstrated to me a successful short squat – something that applied to her goal of continuing with yard work. Her home-workable exercise program (remember the test becomes the exercise and the exercise becomes the test) became XXX with right and left lateral glides and rotations of the pelvis for a warm-up, which was then followed by LXX anterior and posterior glides. After these, I asked her to do some of her short squats (start with success). On her next visit she beamed and said, “I’ve had very little pain since my first visit!” She progressed beautifully through her physical therapy. Although she did not get full mostability back in her right hip, she gained just enough that on the day when she was able to complete a common lunge matrix (anterior lunge, same side lateral lunge, and same side rotational lunge) – no hands – she looked at me and said, “I feel so empowered!” Wow! I did not heal this patient, but provided an environment in which her body could improve. By giving her complete control, her fears were addressed. By educating her about the truth of the hip, her skepticism was addressed. And by giving her a home-workable program, she was empowered … and so was her hip! This is the beauty of Applied Functional Science.
Get Strong! Stay Strong! (and don’t forget to be functional!)
Tags: Balance, function, gary gray, physical therapy, Physical therapy billing, shoulder rehab, Sports Medicine, weight bearing balance
By Andrea Wasylow PT, FAFS
The billing coordinator at the small hospital‐based rehabilitation clinic where I work is
phenomenal. In addition to being one of those people who you just enjoy spending time with,
she is exceptionally skilled at finding those small discrepancies that could potentially delay, or
give reason for denial, of payment for services. Prior to joining our team, she worked at a well
meaning, yet very “conventional,” physical therapy practice. Since coming to work with us, we
have had many conversations discussing the principles, strategies, and techniques behind
treatment, based on an Applied Functional Science approach.
One such discussion occurred recently when she asked, “Can you help me understand why
‘balance / stability training’ was included as part of the treatment plan for this patient being
seen for a shoulder diagnosis?” The discussion that followed highlighted some of the
misconceptions surrounding balance rehabilitation and training, and hopefully helped provide a
better understanding of balance as an integral part of all function.
Our coordinator had become accustomed to seeing static testing on the ground, or on a less
stable surface, as a common way to determine whether or not an individual had “good
balance.” Unfortunately, someone who may do well standing on one foot with their eyes closed
for a predetermined period of time may stumble or fall when turning to look at who just called
his / her name while he / she was walking.
Though commonly used, these traditional, static tests provide limited information when the
fundamental truths about balance are understood. Balance is dynamic and three‐dimensional.
It is our body’s ability to integrate the information from all of our body systems during a
functional task and use that information to displace our center of gravity. The system must then
decelerate that motion and either bring the body back or, more likely, move in a completely
different direction. Three of the main systems that feed the body information are the vestibular
system, the visual system, and the proprioceptive system. Though there is a minimal amount of
information generated to those systems in a static position, it is motion that truly “turns on” and
feeds these systems the information required for function. Balance requires the ability of the
neurological system to successfully receive information, process that information, and then
convey an appropriate motor plan for task completion – all while controlling the center of mass
against gravity. Balance requires range of motion and strength. If a body segment lacks motion,
then not only do accommodations of additional motion in other areas need to be made to
complete a task, but proper muscular loading and exploding at the restricted joint can not occur.
Balance can be impaired if the surrounding musculature is unable to control movement into
that motion, even when full passive range of motion is available. Most importantly, balance
requirements are determined by the functional task the body is being asked to perform. In order
to insure successful task completion, the individual should be able to control three‐dimensional
motion beyond that required of the functional task. Balance rehabilitation and training
programs should reflect that goal.
The patient whose chart our billing coordinator was reviewing happened to be an avid gardener.
She loved her flowerbeds and spent significant amounts of time on her hands and knees
weeding. Her balance deficits showed in this position when she would bear weight through her
involved upper extremity and reach with her other hand. Frequently, she had to quickly move
the reaching hand to the ground in order to avoid face‐planting into her flowers. As it turns out,
she had thoracic spine and scapulo‐thoracic range of motion restrictions, as well as an inability
to eccentrically control the motion that her involved shoulder needed in order to accomplish the
reach distances required by the other arm for weeding. Thankfully, with training, this individual
was back doing the gardening that she loved without difficulty. Also, “armed” with additional
understanding about balance, our billing coordinator was able to coerce payment for services
Get Strong! Stay Strong!
Tags: ankle sprain, functional rehab, gary gray, health, lunges, physical therapy, Sports Medicine
Will H. Stewart II, FAFS, CMT Fellow of Applied Functional Science
The Scene: 1996 Summer Olympics in Atlanta, Georgia USA
The Event: Womens Gymnastics The Apparatus: The Vault
The Athlete: Kerri Strug
This should start ringing a few bells. The US team needed a score of 9.493 to win the gold medal for the US. Her first attempt received a score of 9.162. It was erroneously thought not to be enough. To make matters worse, she had under-rotated her first fault and injured her ankle, and because of the miscalculations, her coach told her she needed to do it again. On an injured ankle, Kerri Strug sprinted down the runway and nailed her vault receiving a 9.712. Gold! This was truly what Olympic moments are made of. Ms. Strug was later taken to the hospital and treated for a third-degree lateral ankle sprain. This was, of course, after she had stood on the podium to receive her gold medal with Team USA Gymnastics.
Most of our ankle sprains are not as dramatic as Kerri Strug’s; however, they can be just as bad and ugly. The foot/ankle complex is an amazingly beautiful and complicated system of many bones, muscles and connective tissue that give 3-D support. However, this complex system is prone to injury. Eighty-five percent of ankle injuries are sprains and out of those, 85% are lateral ankle sprains. Unfortunately, ankle sprains that are not rehabilitated functionally can cause dysfunction not only at the foot/ankle, but also up the kinetic chain. Functionally, as we look at the foot and ankle, we know that as the foot hits the ground, it causes a chain reaction that takes the calcaneus into eversion. There are numerous muscles, in particular the peroneus longus, which decelerates the eversion along with assistance from the medial deltoid ligaments of the ankle. However, as stated before, most of our ankle sprains are inversion sprains. While we have muscles that decelerate inversion of the foot, along with the three lateral ligaments, it unfortunately is, as in Kerri Strug’s case, not enough. After the ankle is evaluated and diagnosed by a qualified health care provider, functional rehabilitation can commence. Traditionally, depending on the grade of the sprain, the R.I.C.E. method was recommended to control inflammation and ensure no further damage. Guided by Applied Functional Science, we know that there are 12 multi-joint muscles that send their tendons across the ankle and subtalar joints of the foot. We also know that ice reduces swelling.
Therefore, one of the many strategies for rehabilitating a lateral ankle sprain (right foot, in this case) would be to mobilize the affected region by performing a 3-D lunge progression in cold whirlpool (as well as out of the whirlpool) that will elicit the proper sequence of joint motion and stress the tissues from least to greatest. This will effectively provide an authentic swelling control to “pump out” inflammation, as well as proprioceptively stimulate the ankle/foot complex. A lunge matrix progression for a right stable lateral ankle sprain that goes from least amount of stress to greatest could look like this:
Right Foot Left Lateral Lunge (Least Stress)
Right Foot Anterior Lunge
Right Foot Posterior Lunge
Right Foot Left Rotation Lunge
Right Foot Right Lateral Lunge (Most Stress)
The Right Foot Right Lateral Lunge is the last lunge in the progression since it will stimulate lateral ankle ligaments more than the others listed above it. Discretion for the lunge progression is paramount so that motion is introduced at the right time and right direction without overstressing the damaged tissues. Gary Gray explains and demonstrates other powerful techniques in the “Ankle Sprains: Chain Reaction Rehab” edition of the Functional Video Digest Series that observe proper biomechanics to facilitate proper joint motion, soft tissue healing and proprioception. Some ankle sprains are bad, some even look pretty ugly; however, if we understand Chain Reaction Biomechanics, we are able to assist the body in healing and returning to GOOD function.
Get Strong! Stay Strong!
Tags: cervical spine, functional movement, gary gray, golf, physical therapy, Sports Medicine
Andrea Wasylow PT, FAFS
A few years ago I had the opportunity to play a round of golf with some people I greatly
admire. It was a fairly typical golf outing until one of my opponents took his tee shot on
the 7th. It was one of the most amazing shots I have ever seen.
The paragraph above, in and of itself, is a story. But, doesn’t it leave you wanting more?
Who are these golfers? And why was that shot so amazing? Basically some information
has been provided, but not enough to show exactly what was happening. The same can be
said for conventional techniques used for evaluation, treatment, and training of the
More than a few clients and/or patients have crossed our paths with complaints of “a pain
in the neck.” The stack of seven vertebrae at the top of the spine is an amazing structure.
Yet, the truth behind how this region functions the majority of the time is often
Conventional evaluation may have an individual perform a big “yes” sagittal plane nod, a
big “no” transverse plane rotation of the head and a big “I don’t know” frontal plane
lateral flexion of the head. But, as in the paragraph above, only part of the story is being
Function of the cervical spine is driven both from the top down and from the bottom up.
The demands on the cervical spine depend entirely on the functional task being
performed. To complete the task, does the individual need to look in a particular direction
by turning the head while the body stays still? Does the person need to keep their gaze
fixed while the body moves below? Or, most likely, is there some combination of head
movement with simultaneous body movement below needed for the task? (In FVD
“Cervical Spine: Both Ends of The Chain,” there is a great example of this given by Gary
Gray PT in his demonstration and explanation of cervical function while swimming.)
If a functional task drives the system, then it stands to reason that our cervical evaluation,
treatment, and training techniques must reflect that task. For example, when walking and
taking a step forward with the left foot, the right arm swings forward. In order for this to
happen and allow the gaze to remain straight forward, there must be adequate right
cervical rotation. But this right cervical rotation is created by the head staying still while
the thoracic spine below rotates to the left. Rather than asking the individual to turn and
look over their right shoulder, a better cervical ROM test for this task could be to have
them fix their gaze straight ahead while performing a right hand, anterior at shoulder
height reach. Another example of cervical motion driven from the bottom up is seen
when playing golf. A left handed golfer needs tremendous right cervical rotation during
his/her backswing. If that bottom-up driven rotation isn’t available it could create
tremendous problems with his/her shot.
This brings us back to the incomplete story above. The golfer being described was none
other than Dr. David Tiberio. And the tee-shot he made was so amazing because it
actually went backwards (really). As it turns out, he was experiencing some cervical
spine motion limitations. Though his motion appeared fine using head active ROM
testing, when he kept his head still and drove his arms in all three planes, it became
evident that his cervical spine was limiting his ability to move below. Thankfully, he
recognized what was going on and was able to improve the limitation fairly quickly;
allowing the rest of us to wait for our turn at the tee-box, safely, for the rest of the round. —-Andrea Wasylow PT FAFS
Get Strong! Stay Strong!
Tags: biomechanics, function, gary gray, human performance, Knee function, physical therapy, sport, Sports Medicine
Injuries to the knee are seen throughout virtually all sports and all age ranges. Have you ever wondered why the knee is the most common reason for a visit to an orthopedic surgeon? Moreover, have you ever wondered how rehabilitation and training programs could better alleviate the stresses placed on the knee? The answers lie in using Applied Functional Science to understand the chain reaction biomechanics of the two “bookend” joints of the knee – the hip and the ankle.
Although the distal femur and the proximal tibia form the primary knee joint, the other ends of these two longest bones in the body reveal the reactive nature of the knee. The knee is referred to as a reactor because it responds to drivers from above and below. These drivers can be ground reaction force, gravity, momentum, hands, feet, or often times the eyes. During initial foot contact in upright function, the ankle joint, comprised of the distal tibia and talus, create a chain reaction from the ground up that directly influences the knee via tibial and fibular motion. Similarly, the hip joint, comprised of the proximal femur and the illium, influences the knee from the top down via the femur. The three-dimensional motions of these two “bookend” joints play a significant role in determining the magnitude of stress placed on the knee. An appropriate chain reaction from these two bookend joints enables the knee to effectively dissipate significant forces. However, dysfunction at either joint can leave the knee caught in the middle with few places to go and nowhere to hide.
A practical example of the chain reaction relationship between the ankle and the knee can be illustrated using a female beach volleyball player. Based on its attachment sites, the ACL it is placed under stress during combined knee flexion, abduction (i.e. valgus), and internal rotation. In this example, as the volleyball player approaches the net and begins to load her lower extremity to prepare for jumping, she steps in an uneven sand hole which causes her heel to abruptly evert and her talus to plantarflex and adduct. This motion of the talus influences the tibia to internally rotate and abduct. This tibial motion, if not properly decelerated, will create excessive knee internal rotation, abduction, and flexion which can directly lead to a right ACL tear. However, this motion can be properly controlled and reduce the risk of injury by muscles properly decelerating the tibia and femur. The specific tri-plane action of muscles that influence the knee are too numerous to adequately describe in this article and, therefore, will be discussed in an upcoming newsletter.
A second practical example can illustrate a situation when dysfunction at the hip is the underlying cause of patella femoral pain. Recent research has confirmed Gary Gray’s long held belief that patella femoral pain is more a track problem (femur) than a train problem (patella). Dr. Chris Powers, et al, summarized that “patellofemoral joint kinematics during weight-bearing conditions could be characterized as the femur rotating underneath the patella.”1 In another study, Dr. Powers, et al, goes on to assert that “interventions aimed at controlling hip and ankle motions may be warranted and should be considered when treating persons with patellofemoral joint dysfunction.”2
A forty-year-old triathlete with excessive femoral internal rotation during the loading phase of gait presents lateral right knee pain while running. His knee pain can be explained by the inability of the hip external rotators, adductors, and hamstring muscles to decelerate the excessive femoral motion. The track crashing toward midline too rapidly, in effect, causes the train to derail laterally. The symptoms are present at the knee; however, through use of lower extremity chain reaction biomechanics, one can easily understand how the cause is at the hip.
These examples illustrate a few core principles of Applied Functional Science. First, joints in the body move in three planes of motion. Second, function is driven by, among other things, ground reaction force, the environment, and gravity. Third, movement at one joint will create chain reaction responses at other joints throughout the body. Lastly, function is individualized and task-specific.
Applied Functional Science requires us to understand the person, tasks, and goal(s). A thorough understanding of the chain reaction biomechanics of all three joints will assist in implementing rehabilitation and training programs that ensure that, although still caught in the middle, the knee now has two powerful friends by its side. ——-By Brett Bloom
Gray G: Functional Video Digest. Functional Manual Reaction. The Knee. v3.7
Gray G: Functional Video Digest. Patella Femoral. The Train & The Track. v2.5
1. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weightbearing and non-weightbearing knee extension in persons with patellar subluxation: A preliminary study. J Orthop Sports Phys Ther. 33:677-685, 2003.
2. Powers CM. The influence of altered lower extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective J Orthop Sports Phys Ther. 33:639-646, 2003
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