Lecture 1-Introduction-Rationale for Corrective Exercises

KINE 4200-Week 1Introduction and Rationale for functional

movement screening and corrective exercises

Sergiu Fediuc, PhD

Case Study

Subject: FemaleAge: 22 Sport: BasketballIt’s the end of the 1st half. She jumps up for a

header, lands, and quickly pushes of the landing foot to change direction (side cut). She hears a pop.

What happened?

Alentorn-Geli E., et al. (2009). Prevention of non-contact anterior cruciate ligament injuriesin soccer players. Part 1: Mechanisms of injury

and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 17:705–729

Q-angle

• The forces that act on the female knee are different than those that act on the male knee

• Predisposes females to certain injuries

Fig 3.9

Hyperpronation (Valgus Collapse)

ACL injuries in women (Fig 13.7)

• Risk of woman sustaining ACL injury is 5-7x greater than that of a man

• May be related to a greater Q-angle in females compared to males• Adds more strain on the knee joint• Additionally, muscle activation differs between males and females

http://www.youtube.com/watch?v=2X5BE3oAt1k&feature=related

Anterior Forces Lateral Forces Rotational Forces

Possible problem

A) Hip complex:• Adductor tightness, or weakness of hip

external rotatorsB) Knee complex:• Weakness of anterior and posterior tibialis

and calf (gastrocnemius or soleus).

What would you do to help correct this problem?

Corrective Exercise Training

• Athletic performance• Efficiency of movement• Overuse injuries• Correcting posture problems• Muscle imbalances• Chronic problems (lower back pain)

Contact information and office hours

Instructor: Sergiu Fediuc, PhD

Email: sergiu.fediuc@guelphhumber.ca

Office: C105

Office hours: Wednesday 9:55am-11:40am, or by appointment

LecturesLectures:• Wednesday, 11:45am-1:30pm, Room• Thursday, 8:05am-8:55am, Room• Lecture notes will be posted on course

website on a week-by-week basis• It is expected that you supplement the

provided lecture notes with your own in-class notes

Important Dates1) Midterm (Wednesday, February 8th), 30%2) Lab Assignment/s (Due at the end of the semester

to your lab instructors), 20%• The specific due date will be set by your lab instructors.

3) In-class presentations, 20% (In the last 3 weeks of the semester): • Week 10 - March 21, 22, Week 11 - March 28, 29, Week 12 -

April 4, 5.

4) Final Exam (date TBD), 30%

ExamsFormat:A) Multiple choiceB) DiagramsC) T/FD) Fill in the blanksE) May have some short answer questions• Based on lecture notes and material taught during the lecture

and labs• Not all the content will be provided on the lecture slides.• Some questions can be based on discussions that may arise in

class. • Will follow textbook but will also use supplementary resources

(articles). NOTE: It is your responsibility to use GH library to obtain the article.

• Due to copyright issues articles can not be provided. The reference to the articles will be provided.

• Rather than search article title, it is recommended that you search for the journal

Labs • Attendance is NOT mandatory• Major Component:

– You will work with the same partner throughout the semester and will learn how to: 1) Assess movement dysfunctions, 2) Prescribe and implement corrective exercise strategies.

• Final lab report submission, will be a collection of the results you have obtained on a week-by-week basis in the lab

• Lab assignments may be lab submissions – hand-ins based on lab topics– Cannot submit lab write up if you did not attend lab

• No lab manual: Labs will be posted online on a week-by-week basis

Presentations

Week 10 - March 21, 22, Week 11 - March 28, 29, Week 12 -April 4, 5.

• 7 minutes each

• Student presentation will be an evaluation and corrective prescription of your lab partner based on lab experiences throughout semester.

• Presentation content will be graded by lab instructor.

• Presentation style will be graded by me in class.

• Presentation schedule will be made by me and will be posted on the course website.

• A detailed grading rubric will be provided.

Textbook NASM Essentials of Corrective Exercise Training (1st Ed.)Clark, M.A and Lucett, S.C. Lippincott Williams & Wilkins, Baltimore, MD, 2011

Course overview • This course will provide you with the skills required to

indentify functional movement limitations and prescribe exercise from a therapeutic/corrective perspective.

• You will learn how to identify musculoskeletal limitations and analyse posture, gait and basic movement patterns.

• Building upon the assessment of functional limitations, students will learn appropriate corrective strategies and progressions.

• Great course because it combines: Biomechanics, Motor Learning, Anatomy, and Exercise Prescription

Rationale for corrective exercises

Chapter 1

Knee Injuries

• An estimated 80,000 to 100,000 ACL injuries occur annually.• Approximately 70-75% of these are non-contact injuries.

Foot and Ankle InjuriesPlantar fasciitis accounts for over one million doctor visits per year.

Ankle sprains are reported to be the most common sports-related injury.

Low Back Pain

• Low back pain is one of the major forms of musculoskeletal degeneration, affecting nearly 80% of all adults.

• More than one-third of all work-related injuries involve the trunk; over 60% involve the low back.

• It has been estimated that the annual costs attributable to low back pain in the United States are greater than $26 billion.

Shoulder Injuries

• Shoulder pain:– 21% of the general population– 40% persisting for at least one year– Estimated annual cost of $39 billion

• Shoulder impingement is the most prevalent diagnosis accounting for 40-65% of reported shoulder pain.

The Future

• People are less prepared to partake in recreational and exercise-related activities both inside and outside of the gym.

• Today’s client is not ready to begin physical activity at the same level that a typical client could 20 years ago.

• Today’s training programs cannot stay the same as programs of the past.• Training programs must consider:

– Each person– Their environment– Tasks that will be performed

Important to address any potential muscle imbalances and movement deficiencies that one may possess to improve function and decrease the risk of injury.

The Corrective Exercise Continuum

• Inhibitory techniques are used to release tension, and decrease activity of overactive neuro-myofascial tissues in the body.

• Lengthening techniques are used to increase the extensibility, length, and range of motion of neuro-myofascial tissues in the body.

Inhibit Activate Integrate

Inhibitory Techniques

Self-Myofascial

Release

Activation Techniques

Isolated Strengthening

Positional Isometrics

Integration Techniques

Integrated Dynamic

Movement

Lengthen

Lengthening Techniques

Static Stretching

Neuromuscular Stretching

Fig 1.1

The Corrective Exercise Continuum

• Activation techniques are used to re-educate and increase activation of underactive tissues.

• Integration techniques are used to re-train the collective synergistic function of all muscles through functionally progressive movements.

Inhibit Activate Integrate

Inhibitory Techniques

Self-Myofascial

Release

Activation Techniques

Isolated Strengthening

Positional Isometrics

Integration Techniques

Integrated Dynamic

Movement

Lengthen

Lengthening Techniques

Static Stretching

Neuromuscular Stretching

Fig 1.1

Integrated Assessment Process

• An integrated assessment process must be done to determine dysfunction and ultimately the design of the corrective exercise program.

Movement Assessments

Range of Motion Assessments

Muscle StrengthAssessments

• This integrated assessment process will help determine which tissues need to be inhibited and lengthened, and which tissues need to be activated and strengthened.

Athletes and corrective exercises

Functional Anatomy-Review

Chapter 2

Planes of Motion and Axes

Fig 2.2

Joint actionsBe familiar with the following joint actions for the shoulder, hip,

spine, elbow:

• Flexion• Extension• Adduction• Abduction• Internal and External Rotation

Additional actions referring to specific joints:

• Dorsi- and Plantarflexion (foot)• Eversion and Inversion (foot)• Palmar pronation and supination (hand) Fig 2.3-2.5

Concepts in functional anatomy1) Local Musculature vs. 2) Global musculature

Local Musculature System (Stabilization System)

Rotator Cuff TransverseAbdominus

Multifidus

Diaphragm Pelvic Floor Muscles

The local musculature system consists of muscles that are predominantly involved in joint support or stabilization.

The Global Muscular Systems (Movement Systems)

Rectus Abdominis

ExternalOblique

Adductors

Erector Spinae

Hamstrings

Gluteus Maximus

LatissimusDorsi

Quadriceps Gastrocnemius

Movement Subsystems• Involve predominantly large muscles.• Associated with movement of trunk and limbs that

equalize external loads placed on body. • These specific muscles are involved in transferring

and absorbing forces from upper and lower body to the pelvis.

1) Deep Longitudinal Subsystem2) Posterior Oblique Subsystem3) Anterior Oblique Subsystem4) Lateral Subsystem

How do these 4 movement systems work?• Muscular forces (indicated by red arrows) generated on opposite sides of the body (i.e. left upper body) are counterbalanced by muscular forces generated on the opposite side of the lower body (i.e. right lower body)

• These forces intersect at a common joint (the hip)

Deep Longitudinal Sub-System (DLS)

•Provides force transmission longitudinally from the ground to the trunk and back down.

•The dominant role of the deep longitudinal system is to control ground reaction forces during gait motions.

Deep Longitudinal Sub-System muscles/structures

• erector spinae• thoracolumbar fascia• sacrotuberous ligament• bicep femoris

Fig. 2.18

• Transfer of force of the DLS is apparent during walking.

• Important in stabilizing SI joint

Deep Longitudinal Sub-System (DLS)

Fig. 2.18

Posterior Oblique Sub-System (POS)

•The muscle fiber arrangements of the posterior oblique sub-system run perpendicular to the sacroiliac joint and provide transverse plane stabilization to the SI joint.

Posterior Oblique Sub-System muscles/structures

• gluteus maximus• latissimus dorsi • thoracolumbar fascia

Fig 2.19

•Dysfunction of any structure in the posterior oblique sub-system can lead to sacroiliac joint instability and low back pain.

•The weakening of the gluteus maximus and/or latissimus dorsi can lead to increased tension in the hamstring and, therefore, cause reoccurring hamstring strains.

Posterior Oblique Sub-System (cont.)

Anterior Oblique Sub-System (AOS)

•Functions in a transverse plane orientation, mostly in the anterior portion of the body.

•The obliques, in concert with the adductor complex, not only produce rotational and flexion movements, but are instrumental in stabilizing the lumbo-pelvic-hip complex.

Anterior Oblique Sub-System muscles/structures

• internal oblique• external oblique• adductor complex• external rotators

Fig 2.20

• Both the POS and AOS contribute to the rotation of the hips during leg swing motion.

• Just like the POS, the AOS is important for functional activities involving the trunk and upper/lower extremities.

Anterior Oblique Sub-System (AOS)

Lateral Sub-System (LS)

•Implicated in frontal plane stability, and is responsible for pelvo-femoral stability during single leg functional movements such as in gait, lunges, or stair climbing.

Lateral Sub-System muscles/structures

• gluteus medius• tensor fascia latae• adductor complex• contralateral quadratus lumborum

Fig 2.21

Lateral sub-system (LS)

Dysfunction• Evident as increased pronation

• Reduced stability in the frontal plane during movements (due to decreased strength and neuromuscular control)

Important Pelvic/Trunk Stabilizers (The abdominals)

External Oblique

Bilateral contraction:Flexion of VC Compress & support

abdominal viscera,Posterior pelvic rotation

Unilateral contraction:Lateral flexion of VC

ipsilaterally Rotation of VC contralaterally

How can this muscle move the VC?

Internal Oblique

Bilateral contraction:Flexion of VC Compress & support

abdominal viscera,Posterior pelvic rotation

Unilateral contraction:Lateral flexion of VCIpsilaterallyRotation of VC ipsilaterally

How can this muscle move the VC?

Most tendinosus fibers of external oblique at the linea alba become continuous with the tendinous fibers of the contralateral internal oblique

Thus, these contralateral muscles work together