Back Pain - A Movement Problem: A clinical approach incorporating relevant research and practice

Cover Page
......Page 1
Front matter......Page 2
Dedication......Page 5
Copyright......Page 6
Foreword......Page 7
Preface......Page 9
Acknowledgements......Page 10
Introduction......Page 12
References......Page 13
The diagnosis dilemma......Page 14
Classification systems for chronic low back pain......Page 15
The need for clinical classification of chronic LBP for diagnosis and directing appropriate physical therapy......Page 16
The biopsychosocial model......Page 17
Evidence based practice......Page 18
References......Page 19
Motor development theories......Page 22
Neonatal period and change birth - 9 months......Page 23
Galant's reaction:precursor to lateral movements......Page 24
Early protective responses......Page 25
Positive supporting reactions underpin antigravity control......Page 26
Tonic attitudinal postural reflexes: produce changes in postural tone and body posture as a result of head position
......Page 27
Integration and contribution of postural reflexes in the development of movement......Page 28
Three righting reactions: orient the head in space......Page 29
Development overview: first 12 months......Page 30
Important patterns of spinal stabilization: established 0-6 months......Page 31
Spatial-reaching equilibrium reactions......Page 33
The next 5 years......Page 34
Normal motor development: significant basic components overview......Page 35
Integration of early flexor and extensor response......Page 36
Development of extension......Page 37
Development of rotation......Page 39
Inhibition and the control of movement......Page 40
Stability and mobility: constant relationship in movement......Page 41
Vertebrate patterns......Page 42
Reach and pull patterns......Page 43
Development of spinal support and control: overview......Page 44
Spinal loading progressively occurs: neuromusculoskeletal system in the process of development......Page 45
References......Page 216
Therapeutic algorithm......Page 47
A) Observation......Page 303
Planes of motion......Page 48
Sagittal view......Page 49
Coronal view......Page 50
SXS: characterized by altered sagittal alignment of upper pole of body......Page 51
Limb load tests e.g. the active straight leg raise test......Page 52
Strength versus control......Page 53
Weakness vs inhibition......Page 54
Strength vs endurance......Page 55
Concentric, isometric and eccentric muscle interplay......Page 56
Co-activation or co-contraction of muscles......Page 57
Open and closed kinetic chain movements......Page 58
Mobilizing and stabilizing elements interact (see Ch.13)......Page 59
The construct of the `body cylinder´......Page 102
Motivation and motor performance......Page 60
Continuum concept of dysfunction......Page 61
References......Page 62
Poor pelvic base of support......Page 65
Tonic and phasic muscles......Page 66
Muscle classification according to Vladimir Janda......Page 67
Local and global muscles acting on the lumbar spine......Page 68
The influence of Bergmark:stabilizers and mobilizers......Page 69
Normal postural reflex mechanism (NPRM)......Page 70
Functions ascribed to the postural reflex mechanism......Page 71
Importance of breathing in manual therapy......Page 330
Sport and recreation: `stretching´, `Pilates´ and yoga......Page 72
Predominant patterns of shoulder girdle use create predictable patterns of muscle dysfunction......Page 257
Abdominal muscle group......Page 76
Overview......Page 77
References......Page 79
The axial spine functions as a system......Page 82
`Acquired´ aspects contributing to posturomovement dysfunction......Page 162
The spine comprises multiple functional spinal units (FSU)......Page 83
Movements of the axial spine......Page 84
Pelvic (sacral) spatial position affects spinal alignment......Page 85
The junctional regions......Page 86
Spinal loading and the control of forces in movement......Page 87
Importance of shoulder girdle muscles in generating upper torso pain syndromes......Page 88
Fascial system......Page 89
Muscle coactivation or cocontraction (see Ch. 4)......Page 90
Forward bend pattern......Page 91
Effort response......Page 92
Postural equilibrium......Page 93
Anteroposterior stability......Page 94
The intra-abdominal pressure mechanism (IAP)......Page 95
The low load postural response model of IAP: a function of the SLMS......Page 96
The inspiratory muscles......Page 97
Diaphragm......Page 98
The importance of expiration is frequently overlooked......Page 101
Bracing the pelvic arches: re-examining the paradigm of sacroiliac stability......Page 105
The sacrum......Page 107
Innominate......Page 108
Movements of the innominate in closed chain movements of the hip......Page 109
First fundamental pelvic pattern (FPP1)......Page 110
Third fundamental pelvic pattern (FPP3)......Page 111
`Distorsion´......Page 112
Movements of the innominate in open chain movements of the hip......Page 113
Standing spatial control......Page 114
Sitting spatial control......Page 115
The pelvic floor or diaphragm......Page 117
`Lower pelvic unit´: support comes from within and below......Page 119
Sacroiliac joint `self-locking´ when upright......Page 121
Dynamic control of Sagittal pelvic tilt: the important primary role of the deep intrinsic force couple - iliopsoas and obturator group (with the hamstrings)
......Page 122
Influence of the thorax on sagittal pelvic tilt......Page 125
The further functional roles of iliacus and psoas......Page 126
Frontal plane control......Page 127
Hip rotator balance: important for both hip and pelvic myomechanics......Page 128
What is core control?......Page 130
Functional role of the abdominal group of muscles......Page 131
Pattern of forward bending - lumbopelvic rhythm or pelvi-femoral rhythm?......Page 135
Functional forward bend pattern: semi-squat involving `pelvic swing and shift patterns´......Page 136
Lifting......Page 137
The importance of the feet......Page 139
Thorax......Page 140
Regions......Page 141
Scaffolding of the upper pole of the body cylinder supported by the SLMS......Page 142
Myofascial geometry helps `shore up´ the thoracolumbar junction at a potential cost......Page 143
Sagittal alignment of the thorax......Page 144
Myofascial control of sagittal thorax alignment......Page 145
Shoulder girdle......Page 146
Myofascial balance in the shoulder girdle ensures optimal shoulder and thorax function......Page 147
Sagittal plane view......Page 148
Transverse plane......Page 149
Cervical spine and head......Page 150
The extensor mechanism of the body......Page 151
The main functional roles of the upper and lower body......Page 152
Walking......Page 153
References......Page 154
Functional pathology of the motor system
......Page 161
Passive strategy......Page 176
Muscle imbalance......Page 163
Imbalanced activity between the two muscle systems: direct ramifications for underlying control of NPRM......Page 164
Muscle fatigue......Page 165
Effect of pain on altered motor control......Page 166
Altered muscle tonus and flexor/extensor proclivity......Page 167
Is altered motor behavior observed in people with back pain functional or dysfunctional - adaptive or maladaptive?
......Page 168
Movement behavior quality: characteristic of more primitive and coarse motor control......Page 169
Changed alignment changes function through the junctions......Page 181
Cervicothoracic junction......Page 171
A general or regional lack of axial extension control......Page 175
Overactive strategy......Page 177
Defective intrapelvic control (refer to Ch. 6 Part B)......Page 178
Defective spatial control of the pelvis......Page 179
Coronal plane......Page 180
Sagittal plane......Page 182
Coronal plane......Page 183
The close functional relationship between hip-pelvis myomechanics......Page 184
Sacroiliac Instability?......Page 185
Neuromyo-articular dysfunction of the spinopelvic-hip complex underlies most pelvic girdle pain and related disor
......Page 187
Pelvic floor and continence......Page 188
Movement control becomes coarser resembling more primitive and total flexion/extension movement patterns......Page 189
Flexor pattern influence......Page 190
Extensor pattern influence......Page 191
Further changed muscle activation patterns within the dominant flexor/extensor patterns reduce selective movement control in torso and affect alignment
......Page 194
Imbalanced activity between the two systemic muscle systems occurs in differing proportions......Page 195
Are movement impairments and control impairments co-related?......Page 196
Bridging sequences......Page 361
Shoulder girdle......Page 197
Thoracic spine......Page 198
Reduced weight shifts over the base of support and through the spine affect equilibrium control......Page 199
Poor proprioceptive, spatial, kinesthetic awareness......Page 202
Movement quality reflects excess effort and stress/tension patterns (see Ch. 6, Part A)......Page 203
Dysfunctional breathing patterns (DBP) emerge (see Ch. 6, Part A)......Page 204
Common clinically observed features of thoracic dysfunction help provide a functional working model......Page 207
Alterations in the spatial and movement properties of each region......Page 209
Biomechanical and articular changes become predictable over time......Page 212
Clinically observed and found regions of stiffness......Page 213
The junctional regions......Page 214
The lower kinetic chain......Page 215
The case for a clinical classification based upon underlying motor control impairments......Page 224
The two primary pictures of torso dysfunction......Page 226
Sagittal alignment characterized by:......Page 228
As a consequence we can expect or predict that in movement:......Page 231
Sagittal alignment is characterized by:......Page 233
`The hamstrings/posterior hip muscle conundrum´......Page 235
The hamstrings are not the only supercharged posterior hip muscles......Page 294
If some show flexor dominance why work their abdominals so?......Page 242
References......Page 243
Mixed Syndrome (MS)......Page 245
Central posterior cinch (CPC)......Page 246
Central anterior cinch (CAC)......Page 248
Central conical cinch (CCC)......Page 249
Overall effect of CCPs......Page 250
`Butt-gripping´ further affects function in ischial swing and pelvic floor myomechanics......Page 251
Lateral shift or `list´ patterns of the trunk......Page 253
Shoulder Crossed Syndrome (SXS) (refer to Ch. 6, Part C)......Page 254
Head control suffers......Page 258
Mutual dysfunction between the thorax and shoulder girdle......Page 259
Further contributing factors......Page 260
Stratification or Layer Syndrome (also see Ch. 8)......Page 261
Belted Torso Syndrome (BTS)......Page 262
Disturbed central internal control......Page 263
The `inferior tethers´......Page 264
References......Page 267
Altered postural responses within the column......Page 270
Lifestyle......Page 271
Patterns of active movement......Page 307
Sitting......Page 272
Fashion......Page 273
Psychosocial and emotional factors......Page 274
Misinformed beliefs......Page 275
`Training´ and the fitness industry......Page 278
Therapeutic misadventure......Page 279
Post script: epidemiological surveys among children and adolescents for low back pain......Page 280
References......Page 281
Altered loading stresses through the functional spinal unit (FSU) affects local, regional and general neuromuscular responses
......Page 284
Altered segmental muscle function......Page 285
Altered loading stress through the FSU creates the conditions for neural irritation creating local and referred pain and other epiphenomena
......Page 286
Local and referred pain......Page 290
Why are the posterior hip and thigh muscles so commonly overactive and tight?......Page 295
References......Page 297
Therapeutic approach......Page 301
C) Passive testing of the joints and myofascial tissues......Page 326
The competent manual therapist is an artist......Page 328
Check the function in the junctions......Page 331
Lumbosacral junction......Page 332
Thoracolumbar junction......Page 337
Is it possible that there is a `basic lumbar pattern´ of joint findings?......Page 340
The `dome´ (Ch. 8)......Page 341
Cervicocranial junction......Page 344
Active......Page 347
Passive......Page 348
Simple adjustments to common daily activities......Page 349
Home exercise programs......Page 350
Strength and conditioning/functional restoration rehabilitation model......Page 351
The functional motor control model......Page 352
Negative outcomes......Page 353
The case for therapeutic exercise and movement classes for more optimal relearning of motor control targeting the SLMS
......Page 354
General guiding principles for facilitating improved activity in the SLMS while addressing key aspects of control necessary for functional restoration
......Page 355
Effective `grounding´ through the base of support provides the stability for control......Page 359
Kneeling patterns can reveal a lot......Page 362
Some apparent general faults when stretching......Page 364
The therapeutic use of rotation......Page 365
Stability and mobility are in constant relationship in movement......Page 366
References......Page 367
`Owning your problem´ of back pain......Page 373
The wider implications of the model......Page 374
Glossary......Page 375
B......Page 376
C......Page 377
F......Page 378
H......Page 379
L......Page 380
M......Page 381
O......Page 382
P......Page 383
S......Page 385
T......Page 387
Z......Page 388