Presented by Activating The Core Slings Learning Objectives
Transcription
Presented by Activating The Core Slings Learning Objectives
1/7/2013 Learning Objectives Restoring the Core Slings: How to identify and activate. EATA 2013 Annual Conference Buffalo, NY Presented by Brian Catania, MPT, SCS, ATC (Lead Presenter) Site Manager with Christiana Care PT PLUS Adjunct faculty member of the University of Delaware’s Athletic Training Program [email protected] Review anatomy of the core. the major core slings. Learn common injuries associated with each sling. Learn how to test the core slings. Learn manual and neuromuscular techniques to improve specific core sling activation. Learn Numerous studies point out: The Core Matters Travis Ross, DPT (Lead Lab Instructor) Staff PT for Christiana Care PT PLUS [email protected] Activating The Core Slings journal of orthopaedic & sports physical therapy | volume 41 | number 10 | october 2011 | 767 JULIE A. HIDES, PhD1 • CASSANDRA T. BROWN, BPhty (Hons)2 • LACHLAN PENFOLD, BHMS3 • WARREN R. STANTON, PhD4 “Screening the Lumbopelvic Muscles for a Relationship to Injury of the Quadriceps, Hamstrings, and Adductor Muscles Among Elite Australian Football League Players Sampling of Conclusions “An association between multifidus muscle size (relative to age, height, and weight) and preseason injury suggests a way to identify players at risk of severe HGT injuries. “Small multifidus muscle size at L5 through MRI predicted 5 of 6 players who incurred a more severe HGT injury, but No relationship was found the ability to contract the transverse abdominis muscle through the drawing in of the abdominal wall.” “People with LBP have delayed recruitment of the Transversus Abdominis with upper and lower extremity movement.” “Hides et al does note that a previous report showed AFL players with groin pain also had delayed activation of Transversus Abdominis.” 1 1/7/2013 Identifying the true core weakness Diaphragm – Top of cylinder The core slings are our window into where the core is actually weak, typically it is not the entire cylinder, especially if you catch the injury in its early stages. Muscle Slings according to “The Janda Approach” text Diaphragm Noted in European Medicine since 1930s movement and stabilization across multiple joints!” Facilitate rotation Transfer forces through the trunk Interconnected – one muscle insertion is connected to the next muscle’s origin via a common keystone structure. Fixation points = stability for the chain Sternal: Review: Anatomy of the core cylinder Pelvic Floor – Bottom of cylinder “Provide Top = Diaphragm Lateral slings Anterior oblique slings Posterior oblique slings Deep longitudinal subsystem Bottom = Pelvic Floor two muscular slips from the back of the xiphoid process. Costal: the inner surfaces of the cartilages and adjacent portions of the lower six ribs on either side, interdigitating with the Transversus abdominis. Lumbar: aponeurotic arches, named the lumbocostal arches, and from the lumbar vertebrae by two pillars or crura Female Pelvic Floor Male Pelvic Floor 2 1/7/2013 Lateral slings Common Injuries associated with disconnected lateral slings Ipsilateral Patella internal oblique and Gluteus Medius Keystone attachment = pelvis Femoral Syndrome Anterior hip impingement more lateral Low Back Pain Common Lab: Anat. of the Lateral Slings Internal Oblique Proximal Attachment: lumbar fascia, iliac crest, and inguinal ligament Distal Attachment: linea alba, pubis crest, 9th-12th ribs and costal margin Gluteus Medius: Proximal Attachment: gluteal surface of ilium Distal attachment: Greater trochanter Lab: Test for Lateral Slings: Manual Muscle Test Hip Abduction in correct alignment Reasons: Tight TFL Excessive hip IR Overactive Quadratus Lumborum Inhibited glut med and internal oblique Treatment strategies Most techniques mentioned and shown in lab can be found at: http://www.youtube.com/cataniahesc406 Treatment strategies for Lateral Slings Tight TFL/QL internal oblique and glut medius Inhibited STM to TFL/QL/rectus femoris Correct innominate dysfunctions of inflare and anterior rotation NMR for glut medius and internal oblique 3 1/7/2013 Lab: Test for Anterior Slings - Manual Muscle Test Hip Adduction in correct alignment Lab: Lateral Slings Treatment/NMR STM: to internal oblique with rotation and clear TFL/QL NMR/Therex: Side triceps push-up Side lying hip abduction with cross isometric extension Anterior Oblique Slings External Oblique and contralateral adductors Keystone attachment = Pelvis Common Injuries associated with disconnected anterior oblique slings Groin strain Oblique strain Sports hernia Pubic Ramus stress fracture Anterior hip impingement along inguinal line Lab: Anatomy of the Anterior Oblique Slings Adductor Group: External Oblique: Proximal Attachment: 5th12th ribs Distal Attachment: meets the rectus abdominis via tendon, anterior half of iliac crest, inguinal ligament Proximal Attachment: Pubic Ramus and pubic symphysis Distal Attachment: broad attachment on linea aspera of femur Common Hip labral pathologies Reasons: Tight adductors Weak external oblique Rib 5-12 dysfunction Restricted diaphragm Limited thoracic rotation Treatment strategies for Anterior Oblique Sling dysfunction Inhibited external oblique (EO) Tight adductors Anterior hip impingement Correct key rib dysfunction from 5-12 and STM with NMR STM to adductors along with NMR for EO STM along inguinal line with posterior glide of femoral head with single knee to chest 4 1/7/2013 Lab: Anterior Oblique Slings Treatment/NMR Lab: Test for Posterior Oblique Slings: Manual Muscle Test Hip Extension in correct alignment STM: to external oblique with rotation. NMR/Therex: Side triceps pushup with rotation toward ground with hip adduction Posterior Oblique Slings Common Injuries associated with disconnected Posterior Oblique Slings Latissimus Dorsi with contralateral Gluteus Maximus Keystone attachment = Pelvis and thoracolumbar fascia Hamstring Lab: Anat. of the Posterior Oblique Slings Treatment strategies for Posterior Oblique Slings Latissimus Dorsi Prox. Attach.: SPs of T7-L5, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula Dist. Attach.: floor of intertubercular groove of the humerus strain back pain Shoulder pain/impingement Low Gluteus Maximus Prox. Attach.: Gluteal surface of ilium, sacrum, sacrotuberous ligament, lumbar fascia Dist. Attach.: Gluteal tuberosity of the femur Weak/Inhibited gluteus maximus Tight contralateral latissimus dorsi Weak/inhibited gluteus maximus hamstring and thoracolumbar fascia Tight latissimus dorsi Tight STM to opposite lat/thoracolumbar fascia and ipsilateral hamstring STM to contralateral lat and correct any rib dysfunctions from 6-12 NMR for glut max activation and decrease overactive hamstring 5 1/7/2013 Lab: Posterior Oblique Slings Treatment/NMR STM: to latissimus dorsi and thoracolumbar fascia with arm reach NMR/Therex: Prone or Q-Ped Hip Extension with opp. UE distraction Child pose with rotation and reach Treatment strategies for overactive DLS STM to overactive structure (i.e. biceps femoris, sacrotuberus ligament, erector spinae) Manipulate or mobilize Lumbar dysfunction Restore normal gluteus maximus recruitment Deep Longitudinal SubSystem (DLS) How to identify and activate a dysfunctional sling? Erector Hip Spinae Sacrotuberous ligament Femoris Peroneus longus/anterior tibialis Biceps Common Injuries associated with overactive DLS Ipsilateral Injuries Low back pain Hamstring strain Ankle sprain Knee pain/PFS abduction weakness = ipsilateral internal oblique Hip adduction weakness = opposite external oblique Hip extension weakness = opposite latissimus dorsi or overactive ipsilateral DLS Therex: Taking it to function Sitting thoracic rotation with ball squeeze between knees Standing resisted thoracic rotation with tband. Diagonal Lifts/Chops from ½ kneeling to standing Lunges in different planes with twist Side plank with rotation TRX single leg squat w/ t-band on lateral knee 6 1/7/2013 Slings in action Pitching Lacrosse Golf Swing Baseball When your slings are connected-- http://link.brightcove.com/services/player /bcpid42757819001?bckey=AQ~~%2cAA AABvaL8JE~%2cufBHq_I6Fnyo5urAiDw0MJ y4NVIDJred&bclid=1438915275001&bctid= 1427667895001 7 1/7/2013 References Page, Phil. Frank, Clare. Lardner, Robert.Assessment and treatment of muscle imbalance: the Janda approach: 2010 Benchmark Physical Therapy Inc. Houglum, Peggy A. Therapeutic exercise for musculoskeletal injuries, 3rd ed. 2010 Human Kinetics. “Screening the Lumbopelvic Muscles for a Relationship to Injury of the Quadriceps, Hamstrings, and Adductor Muscles Among Elite Australian Football League Players.” Journal of Orthopaedic & Sports Physical Therapy. Volume 41. Number 10. October 2011;767-773. Hides, J., Hughes, B., and Stanton, W. “Magnetic resonance imaging assessment of regional abdominal muscle function in elite AFL players with and without low back pain.” Manual Therapy. 16(2011). Pg. 279-284. Kolar et al.“Postural Function of the Diaphragm in People with and without Low Back Pain.” Journal of Orthopaedic & Sports Physical Therapy. Volume 42. Number 2. April 2012; pg. 352362. Brumitt, Jason, and Dale, R.B.“Integrating Shoulder and Core Exercises When Rehabilitating Athletes Performing Overhead Activities.” North American Journal of Sports Physical Therapy. Volume 4, Number 3, August 2009 pg. 132-138/. Jackson, R. and Porter, K. “The Pelvis and Sacroiliac Joint: Physical Therapy Patient Management Utilizing Current Evidence.” Independent Study Course from Current Concepts of Orthopaedic Physical Therapy, 3rd Edition, Orthopaedic Section, APTA, inc. Cervical-Thoracic Integration course by Tim Crunk, PT, MS, OCS, CFMT March 18-21, 2004 Clark, Michael; Lucett, Scott C.; et al. NASM Essentials of Personal Fitness Training: Chapter 2 pages 24-28. 2011 Lipponcott Williams and Wilkens. Primal Pictures Ltd. 2008 http://b2cfitness.com/cpt_blog/wp-content/uploads/2012/02/DLS.png References http://en.wikipedia.org/wiki/Transversus_abdominis_muscle http://en.wikipedia.org/wiki/Latissimus_dorsi_muscle http://en.wikipedia.org/wiki/Diaphragm_(anatomy) http://fantasyknuckleheads.com/wp-content/uploads/2010/03/albert-pujols.jpg http://www.brooklandssportsclub.co.uk/tour/lacrosse.htm http://nokoatemaildotco.blogspot.com/p/lacrosse.html http://therapyprotocols.webs.com/Oblique%20muscle%20slings.jpg http://fantasyknuckleheads.com/wp-content/uploads/2010/03/albert-pujols.jpg http://www.brooklandssportsclub.co.uk/tour/lacrosse.htm http://nokoatemaildotco.blogspot.com/p/lacrosse.html http://therapyprotocols.webs.com/Oblique%20muscle%20slings.jpg ittcs.wordpress.com http://i.istockimg.com/file_thumbview_approve/1621841/2/stock-photo-1621841nice-swing-softball-player.jpg http://www.pgatour.com/2007/mygame/08/09/one/ http://www.anatomytrains.com/uploads/rich_media/locomotor_slings.pdf http://www.google.com/search?q=pitching+pictures&hl=en&rlz=1R2GPEA_en&prm d=imvns&tbm=isch&tbo=u&source=univ&sa=X&ei=CpEwT_vGOLq0QG0x4jSBw&sqi=2&ved=0CCoQsAQ&biw=1024&bih=545 http://phillysportscentral.com/wp-content/uploads/2010/10/roy-halladay-nlcsgame5-e1287768077736.jpg http://megliofitness.com/theimportance-of-pitching-mechanics/ http://www.beyondbasicsphysicaltherapy.com/anatomypelvicfloor.shtml http://upload.wikimedia.org/wikipedia/commons/e/e2/Anterior_Hip_Muscles_2.PNG References http://www.audreysmassage.com/images/medical/GluteusMedius.gif http://www.maxrelax.org/wp-content/uploads/2012/08/internaloblique.png http://en.wikipedia.org/wiki/Gluteus_maximus_muscle http://ittcs.wordpress.com/2010/12/10/notes-on-anatomy-andphysiology-slings-at-the-front-slings-at-the-back/ 8