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Do Biomechanics Matter?

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  • #31
    Originally posted by FrustratedNewGrad View Post
    One thing I always struggle with is the concept of motor control.
    You're not the only one!

    Matthew Low did a poster presentation at IFOMPT earlier this year titled "Motor Control in Musculoskeletal Physiotherapy: A Concept Analysis". Might be of interest
    Morten

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    • #32
      Originally posted by FrustratedNewGrad View Post
      I had a patient who was a post op shoulder and he had to get on another therapists' schedule for a visit.

      I had him doing prone horizontal abduction off of a plinth with with some weight. The therapist responded with why are you having him do it with that weight, he's clearly compensating with his upper traps, you should drop down in weight and cue him to keep his shoulder down. In my head I'm like "who cares, why does it even matter? What's wrong with using your upper traps? It doesn't hurt him". Instead I said "yeah you're right".

      Will having him learn to isolate his mid traps (if you can even do that) help him in any way? Who cares what his movement is if it doesn't hurt? Is it truly a bad movement pattern? How can you predict that him "compensating with his upper trap" will lead to anything negative? I don't think you can and I don't think it even matters.

      I think form somewhat matters but not really as much as most people think. Especially when it's not a high load.
      To play devil's advocate, isn't the first question to answer why have you prescribed this particular exercise, and in prone and with a weight?

      What tissues were you hoping to load and why or was this primarily for a movement experience? I could see if a therapist thinks 'I prescribe weighted horizontal abduction in prone position to load mid traps and train scapular retraction with GH horizontal abduction' then they would emphasize form or the movement pattern that targets that goal.

      Is there ever a reason to do that? I would think it depends.
      Christine

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      • #33
        I was wondering about this also. Is there weakness?
        Barrett L. Dorko

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        • #34
          Originally posted by nykinvic View Post
          To play devil's advocate, isn't the first question to answer why have you prescribed this particular exercise, and in prone and with a weight?

          What tissues were you hoping to load and why or was this primarily for a movement experience? I could see if a therapist thinks 'I prescribe weighted horizontal abduction in prone position to load mid traps and train scapular retraction with GH horizontal abduction' then they would emphasize form or the movement pattern that targets that goal.

          Is there ever a reason to do that? I would think it depends.
          Yeah that's a good point and it's something I've thought about. Really when it comes down to it I'm just finding different and novel ways to load the joint and not really caring about how it's done. I don't always know if strength in a particular muscle is always useful for pain. I have no idea if this is valid or not but I tend less to think about strengthening particular muscles and more so particular movements. So instead of focusing on strengthening the mid traps I'm focusing on strengthening horizontal abduction and not caring so much how it's done because it probably doesn't matter.

          Not to say I don't attempt choose exercises which target more or less a particular muscle. If you want to load a particular tendon I think you need to.

          I don't know though my views are constantly changing.

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          • #35
            Originally posted by Jamie R View Post
            So, as an example, everyone thinks that knee valgus during loaded movements such as squatting, or changing directions, etc, is the root of all knee evils.

            He would say that he isn't too concerned when this happens during a resistance training exercise. It might matter more if you jumped off a building, and landed on one leg in valgus collapse. Obviously an intentionally extreme example. I think the relevant slide in his presentation said "Is there a better way to jump off a roof?"

            His big thing is whether the region is adapted to whatever load you place on it.

            So, I think he say would say that biomechanics matter under certain conditions, and biomechanics can influence capacity. Ultimately, the load cannot exceed the capacity, but with exercises/activity the body will adapt to stress/load.
            Thanks for this Jamie. What you've written here is exactly what I've read and heard in his work!


            I think one of the assumptions that seems to be made and that I'm struggling with is that it is high loads that exceed our capacity to adapt? Do you see how that's an assumption being made? I'm guessing we exceed our capacity to adapt when we chronically under load too.

            Also, if we can't 'know' what optimal form is for any one person due to anatomical variation of our tissues (including the nervous system) - one of the arguments made against trying to teach any sort of optimal strategy at low loads - how do we know what optimal is for each person just because the load is more intense?...seems like a double standard because no one (as far as I know) is saying well, were still guessing on optimal biomechanics but because the risks of exceeding capacity is greater, we think it's worth guessing.

            The other thing I wonder about is at such a high load as jumping off a roof, does it really matter how you do it? Don't most people end up with bilateral crushed calcanei? I suspect those that don't, have specifically practised that activity (with whatever form allows them to continue to do it) and/or they've been lucky.


            ps

            So, as an example, everyone thinks that knee valgus during loaded movements such as squatting, or changing directions, etc, is the root of all knee evils.
            Not everyone! Some of us wonder if it isn't the lack of squatting in our everyday lives thanks to a built environment and culture that does not require it that may be one of the roots of knee evil...I think the obsession of the relative knee valgus and varus positions with respect to the squat is born out of our professions perspective being largely dominated by sport and performance related questions being the interest of clinican/researchers. How many varsity athletes were in your PT graduating class?!!
            Last edited by nykinvic; 21-09-2016, 10:27 PM.
            Christine

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            • #36
              Frustrated says:

              I have no idea if this is valid or not...
              It isn't.

              If it moves people correctively, that's luck. We can do better.
              Barrett L. Dorko

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              • #37
                Originally posted by Barrett Dorko View Post
                Frustrated says:



                It isn't.

                If it moves people correctively, that's luck. We can do better.
                Could you elaborate?

                What would be your definition of corrective movement?

                Comment


                • #38
                  Originally posted by FrustratedNewGrad View Post
                  Another problem I run into when another therapist has a patient of mine is I will sometimes lose that patient to that therapist. I imagine it has to do with the perception of skill. When that therapist is telling them to keep their shoulders down to isolate their middle trap or when they manip them or do all these wacky PNF patterns or soft tissue in crazy body positions, they perceive them as more skilled than I am and they think they're getting more out of therapy. Are they though?

                  One time I had a patient who I was pretty buddy buddy with tell me how she really liked the therapist she had when I was out. I asked why and she said "they really stretched me out good."
                  I rarely ever book my patients with another Physiotherapist when I'm out. I generally tell my patients they will be better off doing the things I advised them and I'll see them in a week (if I'm off that long).

                  I also hate seeing other therapists patients.

                  Comment


                  • #39
                    Changes, challenges and opportunities for the shoulder… Adam Meakins

                    https://thesportsphysio.wordpress.co...-the-shoulder/
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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                    • #40
                      Originally posted by proud View Post
                      I rarely ever book my patients with another Physiotherapist when I'm out. I generally tell my patients they will be better off doing the things I advised them and I'll see them in a week (if I'm off that long).

                      I also hate seeing other therapists patients.
                      Exactly why I disliked working in anything other than a solo practice, the pretence that all PTs are alike and interchangeable as though we were robots.
                      Diane
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                      • #41
                        I saw a new patient today and the assessment took almost 90 minutes. Thirty minutes of that time was the patient telling me about every biomechanical "fault" and asymmetry that they had experienced since birth. They booked with me because of my orthopaedic background. I went through a thorough neurological assessment to help rule out red flags.

                        We discussed some of the relevant physical examination findings. She reported that she felt that she needed L1 manipulated. I stated that I don't "do that" anymore. I've not come across anyone in quite a long time so fixated on miniscule biomechanical issues. In my mind, they were not significant in this particular situation and not likely to be relevant to her present complaints but seemed like a significant concern to her. Did my best to present her with a sensible treatment approach but don't look forward to the next visit. Just when I felt like a majority of my patients were truly getting the neuroscience approach, I get a heavy dose of reality.

                        Aaron
                        Last edited by AJ1; 22-09-2016, 12:18 AM.

                        Comment


                        • #42
                          Corrective movement reduces one of the four origins of pain. The origin I can defend is mechanical deformation.

                          I use the characteristics of correction to identify when this occurs with Simple Contact.

                          See my website for more on this, and many conversations here.
                          Barrett L. Dorko

                          Comment


                          • #43
                            Originally posted by FrustratedNewGrad View Post
                            I had a patient who was a post op shoulder and he had to get on another therapists' schedule for a visit.

                            I had him doing prone horizontal abduction off of a plinth with with some weight. The therapist responded with why are you having him do it with that weight, he's clearly compensating with his upper traps, you should drop down in weight and cue him to keep his shoulder down. In my head I'm like "who cares, why does it even matter? What's wrong with using your upper traps? It doesn't hurt him". Instead I said "yeah you're right".

                            Will having him learn to isolate his mid traps (if you can even do that) help him in any way? Who cares what his movement is if it doesn't hurt? Is it truly a bad movement pattern? How can you predict that him "compensating with his upper trap" will lead to anything negative? I don't think you can and I don't think it even matters.

                            I think form somewhat matters but not really as much as most people think. Especially when it's not a high load.
                            I've given "form" a great deal of thought as someone who used to primarily do personal training and will likely return to it at some point. I've written more extensively about form here: http://www.truemovement.net/defining-good-form/ if you want to take a peek, but I'll summarize my main thoughts:

                            1. Is it safe?
                            2. Is it doing the job that it was intended to do?

                            1. There are known injury mechanisms in certain movements. To my understanding, the reason a Lachman test is done at ~20 degrees is because that's where the ACL is most vulnerable. Consequently, early valgus under high load at low degrees of knee flexion will more closely mimic injury mechanisms. Some people argue if it's better to avoid these positions or to train for them and I'm not really going to get into that now because it's a different kettle of fish. However, it's worth considering in either circumstance that different tissues adapt at different speeds due to vascular supply, etc. I would argue that when dealing with high levels of force through the body, it makes sense to spread load across more areas with greater adaptive capacity.

                            2. As you've already mentioned above, if you need to load a tendon or specific area, there are better and worse ways to do that. If you want to condition someone's legs and they keep feeling squats in their low back, the form needs to be modified to accomplish the task. If the goal of the squat is more to achieve the ability to lower and ascend, it's not likely as important where someone feels it or how it's done so long as function is attained. As something of a caveat to that, it makes sense to me that the ability to perform the same task multiple ways has value. A musician can't improvise if they've only been taught one song. So in your example of "compensating" with the upper traps, I don't view that as a fault if the goal was to achieve horizontal abduction. I would however be interested if more options for movement could be expanded if cued differently. I wrote a very short piece on that idea here: http://www.truemovement.net/movement-and-nutrition/

                            Please keep in mind that I am not a physio and have never pretended to be, but this is a subject that I've dedicated a lot of head space to.

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                            • #44
                              Regarding squats:

                              Here's a slow mo clip of one of my runners doing goblets.
                              Attached Files

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                              • #45
                                I'm curious Ken whether she has been coached in form or is that video a great example of the emergent interaction between the environment, task and the individual mover?
                                Christine

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