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  • ??? Do Biomechanics Matter?

    Do they? Ever? What would be an example? How does correcting muscular "imbalances" help with someone in pain?

    Is there such thing as a faulty movement pattern?

    How much does form with exercises matter?

    We had another therapist and his student present on the proper mechanics of squatting today. The importance of maintaining a neutral spine from lumbar to cervical was stressed. The term "shear force" was used a lot. There was emphasis on avoiding flexion because it could lead to herniations.

    Thought?

  • #2
    http://www.greglehman.ca/blog/2016/0...pare-for-doubt

    Read greg lehman's stuff. He can address a lot of your questions.

    Short answer. Biomechanics matter. Just not the way its taught. Load a structure/tissues more than tolerance (velocity, volume, intensity, long moment arms, combinations of each), you may get symptoms. Unload irritated structures, you may get a decrease in symptoms. Altering biomechanics can change tissue stress and loads. This can make a big difference for someone with load intolerant tissues.
    Last edited by Johnny_Nada; 20-09-2016, 11:58 PM.
    I may not be as smart as most people, but I'm sure as hell not as dumb....
    "The views expressed here are my own and do not reflect the views of my employer."

    Comment


    • #3
      Originally posted by Johnny_Nada View Post
      http://www.greglehman.ca/blog/2016/0...pare-for-doubt

      Read greg lehman's stuff. He can address a lot of your questions.

      Short answer. Biomechanics matter. Just not the way its taught. Load a structure/tissues more than tolerance (velocity, volume, intensity, long moment arms, combinations of each), you may get symptoms. Unload irritated structures, you may get a decrease in symptoms. Altering biomechanics can change tissue stress and loads. This can make a big difference for someone with load intolerant tissues.
      Nice read, I like Greg Lehman a lot. I also know he's one that isn't too keen on "form" per say. I wish I had access to more of his stuff.

      One thing I always struggle with is the concept of motor control. I was talking to another therapist about the squat and he mentioned for those who hyper extend their lumbar spine during a squat you'll see high tone in the lumbar paraspinals and this is because they have poor motor control of their multifidi. So I guess we can retrain them to use their multifidi so they now can squat without hyperextension in the clinic. That's nice I guess but how does this help with a person's pain? Does poor motor control lead to stress on certain tissues and therefore to nocioception > pain. Can we actually correct it? Or should we JUST LOAD IT like Erik Meira always says?

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      • #4
        Of course the mechanics of biology are important.

        In life (as if there were something else to therapists) they just aren't predictable.
        Last edited by Barrett Dorko; 21-09-2016, 01:24 AM.
        Barrett L. Dorko

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        • #5
          Originally posted by FrustratedNewGrad View Post
          Or should we JUST LOAD IT like Erik Meira always says?
          One of the things Erik Meira says

          First, when I say “load it” I am generally referring to applying stress to the organism. As physical therapists, the tool that we have in order to apply that stress is load in the form of external weight.
          which is by my understanding a narrow perspective. My understanding is that tissue load changes without me adding external weight when I simply change the relationship of my 'parts' relative to each other and relative to gravity.
          Last edited by nykinvic; 21-09-2016, 02:23 AM.
          Christine

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          • #6
            Originally posted by Johnny_Nada View Post
            http://www.greglehman.ca/blog/2016/0...pare-for-doubt

            Read greg lehman's stuff. He can address a lot of your questions.
            I look forward to attending Greg's course here in Victoria in October. One of the questions I'm hoping to better understand is why he thinks biomechanics/alignment may matter in high load situations but not in low load situations?

            I think it's curious that Lehman and others support statements such as "just load it " and "we improve specifically at what we do and by doing it enough." but then only count some of the loads (the higher intensity ones) and only some (typically exercise) of the what we do. This strikes me as odd when in a sedentary culture like ours the 'what' most of us do (including children) in our waking hours is sit mostly still.

            Katy Bowman has likened this to counting only the input of a kale salad for dinner while eating candy bars all day when considering our nutritional health.
            Christine

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            • #7
              Originally posted by FrustratedNewGrad View Post
              I also know he's one that isn't too keen on "form" per say.
              Its hard to say what correct form is for any exercise. It differs based goal, individual build, pain, mobility limitations, etc.

              Weightlifting is a perfect example. You'll see short levered lifters pulling and squatting quite differently than taller, longer levered lifters. Some with heels together, toes out. Others with wide stances and toes straight ahead. You will see consistency amongst them all. Barbells close to body and similar bar paths, but the method for creating those similarities differ.

              Originally posted by FrustratedNewGrad View Post
              thing I always struggle with is the concept of motor control. I was talking to another therapist about the squat and he mentioned for those who hyper extend their lumbar spine during a squat you'll see high tone in the lumbar paraspinals and this is because they have poor motor control of their multifidi. So I guess we can retrain them to use their multifidi so they now can squat without hyperextension in the clinic. That's nice I guess but how does this help with a person's pain? Does poor motor control lead to stress on certain tissues and therefore to nocioception > pain. Can we actually correct it? Or should we JUST LOAD IT like Erik Meira always says?
              If their primary complaint is pain during the squat, you can alter the technique and likely have a big improvement in pain. From a motor control perspective, don't worry about the multifidus. Use external cues (big chest, butt back, tight, etc) to address technique. Remember, tissues have a load tolerance and the way we move can distribute the loads to different areas. If you feel like they need to improve their load tolerance, load it. If you feel they need to re-distribute the load or unload an irritated area, alter the technique.
              I may not be as smart as most people, but I'm sure as hell not as dumb....
              "The views expressed here are my own and do not reflect the views of my employer."

              Comment


              • #8
                Originally posted by nykinvic View Post
                One of the questions I'm hoping to better understand is why he thinks biomechanics/alignment may matter in high load situations but not in low load situations
                High loads to me consist of max effort lifting, plyometric based tasks. These tasks are capable of damaging tissues. In these situation, the most efficient technique can (hopefully) distribute these loads to enough areas to reduce overloading of individual areas. Watch enough or train enough in weightlifting and you see how much biomechanics and tissue loading matters.

                [YT]r9Gfy7KlutE[/YT]
                I may not be as smart as most people, but I'm sure as hell not as dumb....
                "The views expressed here are my own and do not reflect the views of my employer."

                Comment


                • #9
                  An overly simplified example: shoulder impingement

                  A patient comes in with rounded shoulders, tight pecs, weak scapular retractors, positive neers/hawkins kennedy etc.

                  Biomechanically the thought would be to stretch the pecs, strengthen the scapular retractors to "open up" the subacromial space to take load off of the tissue. It usually works but was it the preceding clinical judgement that which actually solved the pain issue? Or was it something else? Maybe it was natural history?

                  I mean this study http://www.ncbi.nlm.nih.gov/pubmed/26160149 compares a single exercise (progression of shoulder abduction) to skilled physical therapy evaluation and treatment with manual therapy and a bunch of exercises and there is more or less no significant difference in outcomes between the groups. But at the same time there is no group that controls for natural history.

                  Does it even matter what exercise we give?

                  Does any of this matter?!! Gah!
                  Last edited by FrustratedNewGrad; 21-09-2016, 03:20 AM.

                  Comment


                  • #10
                    Its unlikely you'll change someone "posture" as described (the same person everyone talks about by the way) so stop trying. It doesn't mean you can't have them lift their arm overhead their way and get a concordant sign. Then have them try with a more upright position. You may find the motion increases and doesn't hurt as much. Maybe you "assist" the arm or scapula and notice an improvement in concordant sign.

                    You didn't change their body, but have shown them a way to move with less pain.

                    My take home from the SELF study is this. If you're going to load it, it can be simple. No reason to make things more complex than they need. Look at patellar tendonopathy and anterior knee pain research. Loading with a knee extension. Keep it simple.
                    Last edited by Johnny_Nada; 21-09-2016, 03:53 AM.
                    I may not be as smart as most people, but I'm sure as hell not as dumb....
                    "The views expressed here are my own and do not reflect the views of my employer."

                    Comment


                    • #11
                      Originally posted by Johnny_Nada View Post
                      Its unlikely you'll change someone "posture" as described (the same person everyone talks about by the way) so stop trying. It doesn't mean you can't have them lift their arm overhead their way and get a concordant sign. Then have the try with a more upright position. You may find the motion increases and doesn't hurt as much. Maybe you "assist" the arm or scapula and notice an improvement in concordant sign.

                      You didn't change their body, but have shown them a way to move with less pain.

                      My take home from the SELF study is this. If you're going to load it, it can be simple. No reason to make things more complex than they need. Look at patellar tendonopathy and anterior knee pain research. Loading with a knee extension. Keep it simple.
                      The KISS (keep it simple stupid) method. That's pretty much what I got out of the study as well. I showed that study to my coworkers and they were convinced that the manual treatment that was done in the study isn't like what WE do at OUR clinic so that study doesn't apply to US.

                      As a young therapist it's very hard to work in clinic that is heavily based on these types of biomechanical principals when you read so many things that contradict them. Who do I believe and who do I follow? I can't really go against what is done in my clinic. After all, these therapists are much more experienced than me.

                      What's your thought on PNF patterns? It's done heavily by therapists at my clinic and while I think it is somewhat useful, I just roll my eyes at some of the complicated positions my coworkers put patients in for these patterns. Talk about a theatrical placebo, the therapists basically put on a giant show with their patients with all these elaborate manual therapies. I mean have you ever seen a manual PNF squat done?

                      Last edited by FrustratedNewGrad; 21-09-2016, 03:57 AM.

                      Comment


                      • #12
                        As a young therapist it's very hard to work in clinic that is heavily based on these types of biomechanical principals when you read so many things that contradict them. Who do I believe and who do I follow? I can't really go against what is done in my clinic. After all, these therapists are much more experienced than me.
                        I am decades away from your current milieu, it's well over twenty years since I have been a head of department/clinical lead, but I still have very vivid dreams that I'm back where you are now. My advice would be to watch what is happening with the patient rather than the operator and to read as much as you can. There is a great deal more to be learned from looking at what is going wrong than by watching a slick demonstration from whoever is flavour of the month.

                        I still take every opportunity to watch people move while they go about their activities of daily living, I also watch footage of the way they they used to move and deal with loads in the days of heavy industry, unmechanised farming and house work done with soap, water and scrubbing brushes.
                        Last edited by Jo Bowyer; 21-09-2016, 05:09 AM.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #13
                          Originally posted by Johnny_Nada View Post
                          High loads to me consist of max effort lifting, plyometric based tasks. These tasks are capable of damaging tissues. In these situation, the most efficient technique can (hopefully) distribute these loads to enough areas to reduce overloading of individual areas. Watch enough or train enough in weightlifting and you see how much biomechanics and tissue loading matters.
                          Interesting perspective.

                          To be clear, I don't need to watch weightlifting or lift in a gym to see that biomechanics and tissue loading matters.

                          Having been a PT for nearly 20 years, I've worked in a few cities in Canada (in pediatrics and adult neuro, cardioresp, medicine, ICU and geriatrics - never sports rehab) and a rural community in Kenya. I grew up on a farm, married a carpenter and birthed a couple of kids. I have plenty of both personal and professional experience to understand well that biomechanics and tissue loading matter without either spending a disproportionate time in the gym or thinking that gym/exercise time is the significant factor in most humans' tissue load profile.

                          Just because I wonder if the biomechanics of frequent, no and low loads matter does not mean I'm making the converse error of suggesting high, infrequent or unexpected loads don't matter.

                          I'm wondering if others are making that error.
                          Christine

                          Comment


                          • #14
                            Do they? Ever? What would be an example? How does correcting muscular "imbalances" help with someone in pain?
                            Sure. If your knees hurt when you squat, one thing to try is change how you squat. Shift more of the load to your posterior muscles and see if your sense of knee pain changes.

                            Is there such thing as a faulty movement pattern?
                            Good question. If you're squatting and generating so much downward force that you're pelvic organs are prolapsing, there may be a better pattern of movement for you.

                            How much does form with exercises matter?
                            I'm guessing less than the volume of research on the minutiae of exercise variables would indicate considering how few people exercise regularly or at all.

                            Originally posted by FrustratedNewGrad View Post

                            We had another therapist and his student present on the proper mechanics of squatting today. The importance of maintaining a neutral spine from lumbar to cervical was stressed. The term "shear force" was used a lot. There was emphasis on avoiding flexion because it could lead to herniations.

                            Thought?
                            Well, here are some thoughts on the biomechanics of squatting from Katy Bowman that may be informative and broaden the student's perspective on squatting.

                            It is most helpful to think of a squat as a journey and not a destination, both in the grand sense (ie you're probably going to be doing a modified squat for some time) and in the literal interpretation of the squat. You could define a squat as a position in which one's knees and hips are fully flexed. But if we say a squat is an essential human motion and define it as a fixed position, we again reinforce that there is an inherent benefit to a position. It's like reducing a human food (like an apple), to a single nutrient (like fructose). How does fructose behave outside the context of an apple? Reducing, in our minds, the squat to a single joint configuration takes the squat out of the movement context and makes it more challenging to see the full spectrum of its benefits

                            If we expand our definition of a squat to include the 'getting down' and 'getting back up' phase, we can see that the body is used differently for controlling our downward motion, hanging out in knee and hip flexion, and coming back up again. Each of these phases creates a different and essential load. A squat is nuch more than a position; a squat is an experience
                            from Move Your DNA pg 197

                            Single leg squats (and how to change the load).

                            What to expect when You're Squatting

                            Choosing to squat.

                            and finally

                            Competent movement is not about the movements themselves but about the non-movement experiences they can afford. Squatting reveals more of the world--stuff you can't see and interact with otherwise. Likewise, a stable gait and quick reflexes gift you the ability to move with enough confidence to look up at the world that surrounds you. If your balance requires that you stare at the ground ahead of your feet to make sure there's nothing that surprises you then I suggest you start by training your feet back into the "ground ears" they once were. Do some neck stretches outside (look all the ways!) so they stimulate parts of you beyond the borders of your neck. Movement can facilitate wonder and joy and awareness. Think outside the exercise box and watch your passion and capability for movement snowball.
                            Christine

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                            • #15
                              Originally posted by Johnny_Nada View Post
                              Its unlikely you'll change someone "posture" as described (the same person everyone talks about by the way) so stop trying.
                              Maybe I don't understand the accepted definition of posture, but why do you (and I've heard it form others here) say it's unlikely for someone's posture to change?
                              Christine

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