isolated vs. whole body movement

[BB]

A recent post sparked my interest and I didn't want to throw that thread into a tangent, so I am starting a new one.

A treatment was described for a shoulder movement in which cervical, thoracic, and rib movement was also facilitated. I have seen a similar approach before utilized by someone trained in feldenkrais and have wondered about it ever since. I should say (incase this is not accurate for the person who posted this technique) that the therapist I saw facilitated shoulder elevation in sidelying with a manual thoracic rotation to the same side.

My question is: What are your thoughts on this type of movement, incorporating movement of the trunk during extremity motion, vs. trying to prevent trunk motion during extremity motion?

I tend to specifically look for (what I call) these compensatory motions and teach the patient to prevent them. For example, if a patient presents with neck pain, I look to see if thier head rotates or side bends as they elevate one or both arms, and if it does I teach them to stabilize against this cervical motion.

I know that the feldenkrais therapist raved about the decrease in pain they saw with thier technique, but I also can say that I have seen equally positive results using my method.

Are we treating two different situations or looking through two different perspectives at the same problem? And if we are treating the same problems, why do two seemingly opposite approaches have positive effects?

Cory

[BB]

Hi Bernard,
Thanks for your response.
When you talk of the entire movement are you speaking in context of the function, such as combing the hair, and the zooming in is the shoulder motion that is occurring?

In response to your statement regarding the importance of where the motion begins...I think that is at the heart of my question/confusion. My treatment method is based on the thought of proximal trunk stability allows for mechanically proper extremity movement. In the case of the arm movement, such as to comb the hair, I would like to see thoracic segmental stability vs. motion. I view this as the way the movement can normally be performed with the least abnormal stress on the tissues involved. However, I do realize that "Mechanically Correct" does not necessarily mean pain-free as pain does not always follow consistently with tissue stress.

This is where I hope to gain from this forum. As you can probably tell, I think very mechanically, but I am not closed minded. I realize there is a need in my patients for me to help with thier function, even when it doesn't follow my mechanical processes.

So, if a movement needs to be performed using trunk motion for extremity motion (using the example) in order to be pain-free, what would tell you to go there? WHat is your process for assessing this need?

Hope I'm making sense!
Cory

[Green Hornet]

I am responding after reading the first one posted by BB.
If I duplicate some resposnes, forgive me.

The trunk movement along with shoulder movement itself is not bad and should not be the target of blame. We as trained professionals have to be able to identify pathological movement patterns and organic movement patterns. Organic trunk movement pattern with a certain shoulder movement NEEDS to be facilitated. Pathologic trunk movements need to be disengaged. That is all!

A lack of organic core movement can isolate the shoulder too much and for too long period of time. This is leading to a shoulder pain. The restoration of organic core movement associated with shoulder movement usually improves shoulder function immediately.

And trunk stability is NOT equal to RIGiDFYING the trunk. In Eastern movement therapy and martial arts, all the movements begin in the Hara (belly/core). Depending on what you do with extremity, you need to be able to appropriately position and align your core and create appropriate chain reaction in trunk muscles to distal/extremity muscles. The proper chain reaction is not spported by rigidifying the trunk.

[emad]

Hi Cory ,Takao &bernard;

excellent post Takao

i was in my way ,and thinking of p[osting a new topic regarding movement patterns .
it will be excellent if anyone provide us with links to that issue .
plaes more knowledge regarding orgaic & pathologic movement patterns , the issue seems that with painful disorders ,there are certain movement patterns that , if we inhibit thus will help in pain decreasing ,
e.g.
with cervical and shoulder disorders , there is shoulder elevation .....

cheers
emad :lol:

[Green Hornet]

Emad,
Identifying obvious pathological movement patterns is not difficult, but identifying slight but significant ones is still challenging to me. I am going to take Servaas' course in May and will have a better idea of what exactly organic movements and typical pathologic movement patterns are like.

But, in my mind, movements that flow from the head to toes are organic. They have a beautiful sequence from the beginning of the movement to the end. If you are looking at shoulder flexion and you see the trunk initiate the movement, movement flows from there to thoracic spine and sternum, rib cage, scapula, then humerus, that seems organic too me. If you see obvious movement disruption like shoulder hike, you need to note (at least) that something is wrong. And you take a specific look at it.

I don't believe pure isolated movement (= pathological). If you are slight but significant contribution from the core segment, your eyes are not trained enough.

[BB]

Hello all,
I don't want to give the impression that I think trunk motion is bad and rigidity is the goal. I will say that I believe that when a person becomes limited in a motion, such as shoulder flexion, usually another area begins to move too much in compensation. Maybe a person compensates in a way that is not a problem for them, but many people, especially people that we see as PTs compensate in a way that becomes a problem. In my experience, when the spine compensates for an extremity it is a problem of moving too much, not a lack of motion. As you said Takoa rigidity is not the answer in the same way that mobility is not the answer. Both are necessary for proper function. But I feel that during the part of function in which the arm needs to be raised, stability of the core becomes more important. To have good control of the moving arm, the base or core needs to be stable. It is the same concept as when you see a person with rotator cuff weakness or strain who has poor control of their hand. Proximal stability and distal mobility...isn't that the whole idea of the core?

Cory

[emad]

Hi alL:

Cory
yes , hypomobility in one area is compensated by hypemobility of a related area , this is sure practically.

Takao
seems that every disability (problem) has same pattern movement in all patients this is what we call signs ,symptoms ,postive and negative spectial tests .
pathological movement patterns seems to be complex (more than one movement) which may take place to protect from more further pain , sometime i feel that pathological patterns are the opposite to the neurdynamic tests positions , of course i can not reason/evidence that conclusion :?

cheers
emad :lol:

[Green Hornet]

Cory,
I typically see the trunk (in the presence of shoulder pain) moves PATHOLOGICALLY too much, But Organically TOO LITTLE. The absolute amount of movement is not the point. The point is "Is there an adequate ORGANIC (appropriate) movement pattern present?" Happy observation!

Often it is very helpful to exaggerate the organic movement pattern in the core in the process of rehab.

[BB]

Takoa,
As your terminology is new to me, let me know if I am interpreting it correctly:

Too much pathologic movement= moving in a dysfunctional way too often

organic movement too little= moving in a correct or healthy manner not often enough

Is this what you are meaning?

Also, amount of absolute movement is not important I think is a bit broad of a statement to be always true. Does every person need 180 degrees of shoulder flexion to be healthy? Of course not. But do some people need to gain some scapular upward rotation to be able to comb their hair without pain.....yes.

Cory

[emad]

Hi all:

Takao & Bernard
Look i am not the only one who said those are new terminologies!!!

cheers
emad :lol:

[bernard]

Emad,

Me, but I do use different terminology but I use my french brain. That's not really the same but gives the same results!!! :wink: :oops: :wink: