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Adam Daveline MSE, ATC, CES Stony Brook Sports Medicine Symposium May 11, 2012

Adam Daveline MSE, ATC, CES Stony Brook Sports Medicine Symposium May 11, 2012. REGIONAL INTERDEPENDENCE IN MOVEMENT AND ITS IMPACT ON PAIN. OBJECTIVES. No Change to the Evaluation/Diagnosis Process Define Regional Interdependence Understand Altered Motor Control Post-Injury

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Adam Daveline MSE, ATC, CES Stony Brook Sports Medicine Symposium May 11, 2012

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  1. Adam Daveline MSE, ATC, CES Stony Brook Sports Medicine Symposium May 11, 2012 REGIONAL INTERDEPENDENCE IN MOVEMENT AND ITS IMPACT ON PAIN

  2. OBJECTIVES • No Change to the Evaluation/Diagnosis Process • Define Regional Interdependence • Understand Altered Motor Control Post-Injury • Treating Pain With Movement

  3. TRADITIONAL vs. MOTOR SYSTEM • Traditional Model • Primary Complaint • Isolation of Pain/Discomfort • Plan Based on Isolated Finding • Motor System • Whole Movement Pattern • Fundamental Movement Patterns • Isolation of Dysfunction • Plan Based on Movement Pattern

  4. REGIONAL INTERDEPENDENCE • Motor System Functions As An Entity • Impairments Cause Dysfunctional Movement • Pain Caused By Compensatory Movement • Unrelated Impairment = Primary Pain

  5. ALTERED MOTOR CONTROL • Previous Injury Increases Risk to Future Injury • Decreased Muscular Activation • Decreased Gluteus Maximus Activation Post-Ankle Sprain • Adaptation to Altered Strategy • Timing and Sequence of Contractions Impacted

  6. PAIN AND MOTOR CONTROL • Pain May Not Always Decrease Muscle Activation • Unpredictable • High Threshold Theory • Altered Core Muscle Function With History of Low Back Pain • Pain Driven Alterations in Movement

  7. SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT • Assessment of Movement Patterns • Cervical Flexion • Cervical Extension • Cervical Rotation and Lateral Bend • Shoulder Flexion, Abduction, External Rotation • Shoulder Extension, Adduction, Internal Rotation • Multi-Segmental Flexion • Multi-Segmental Extension • Multi-Segmental Rotation • Single Leg Stance • Overhead Deep Squat

  8. SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT • Graded Movements • Functional Non-Painful • Functional Painful • Dysfunctional Non-Painful • Dysfunctional Painful • Target Most Dysfunctional Non-Painful Pattern • Highest on the Movement Patterns List First • Breakout Patterns to Isolate Problem

  9. SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT • Treatment Based on Breakout Findings • Stability Problem • Specific Exercises • Mobility Problem • Tissue Extensibility • ART, Graston, etc. • Joint Mobility • Manipulation

  10. PROS • Gauge Movement • Whole Body to Regional to Isolated • Narrows Down Core Issue • Focuses Treatment Program • Additional Treatment Option

  11. CONS • Space • Compliance • TIME • Has to be Sold

  12. SUMMARY • Motor System Functions as a Whole • Movement Dysfunction Creates Pain • Pain Alters Neurological Firing Sequence • Breakdown Movement Patterns • Restore Functional Movement • Move Away From Pain • Pros Outweigh Cons in Right Setting

  13. QUESTIONS ?

  14. REFERENCES • Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain. Feb 1996; 64(2): 231-240. • Bullock-Saxton JE, Janda V, Bullock MI. The influence of ankle sprain injury on muscle activation during hip extension. International Journal of Sports Medicine. Aug. 1994;15(6):330-334. • Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. Dec. 1 2005;30(23):2614-2620. • Cook G, Burton L, Hogenboom B. The use of fundamental movements as an assessment of function – Part I. North American Journal of Sports Physical Therapy. 2006;1(2):62-72. • Cook G, Burton L, Hogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function – Part II. North American Journal of Sports Physical Therapy. 2006;1(3):132-139. • Kiesel K, Plisky PJ, Voight ML. Can serious injury in professional football be predicted by a preseason functional movement screen? North American Journal of Sports Physical Therapy. 2007;2(3):147-158. • Kiesel K, Uhl T, Underwood FB, Nitz AJ. Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain. Manual Therapy. May 2008;13(2):132-138. • Radebold A, Cholewicki J, Panjabi MM, Patel TC. Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine. Apr. 15 200;25(8):947-954. • Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. Journal of Orthopedic Sports Physical Therapy. Nov. 2007;37(11):658-660.

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