Deconstruction of "Z-Health Performance Solutions"

[Jason Silvernail]

Geoff-
I've shown neither bias nor ignorance here. Unless you consider my (along with other posters here) devotion to science and scientific principles in medicine and therapy to be bias, in which case, guilty as charged.

Your comparison of people with painful problems to operating an automobile is inaccurate. As I said before you don't know what you don't know. Hopefully if you (or any other fitness trainer) pretends to treat medical problems, you at least get a referral from a medical provider such as a physician or a physical therapist so you don't hurt anyone.
This is probably not the thread to go further into this issue, though I lay the blame in no small measure on Mike Clark's program for encouraging this sort of thing. Back to Z-Health, I suppose.

If I came on to a science-based training and conditioning board (such as NSCAs) claiming I got all sorts of people to deadlift PRs with a new system when no other trainer or coach could help, and I talked about this kind of stuff, they would tear me apart. And rightly so. They're scientists, too.

Courtney-
Regarding hostility, cynicism, and sarcasm - isn't that what the claims and explanations being made for this system require? People promoting this system had (and continue to have) plenty of opportunity to provide any sensible explanation for the results (which by the way have not been disputed)that they see. Before your post, there was nothing but a regurgitation of marketing material. What do you expect from your fellow scientists?

Yes, we prefer journal articles to anecdotes - if you've earned a doctorate in your field, don't you, too? Journal articles aren't even required - just a sensible scientific explanation for what's being claimed. As of now, this thread is 2 full pages long, and your post (such as it is) is the first serious attempt to explain anything.
It has been my experience that when people lament of cynicism and complain of hostility and personal attacks in the clear absence of such things, they really are just disappointed that others aren't as credulous as they are.

[cneupert]

Diane - What is the question here then? It seemed as if Keats was originally asking what Z was based on some experiences posted on a blog. There is no heavy marketing going on here. The only marketing is on the Z health website - which is for their business - I should hope there is some marketing on a business website! Some of the trainers have attempted to answer your questions based on their enthusiasm and real world experience with the system. Anecdotal evidence is still evidence - it is just not written up yet.

As for neural glides - it is possible. As you mobilize a joint actively you are also stretching the skin and tissue around the joint which contain mechanoreceptors among other things. You are also initiating some muscular contraction to perform the movement, and the movement would also affect circulation and lymphatic drainage. Through myofascial connections, you are probably getting some neural gliding. Is this the sole reason for the results? Maybe, maybe not. It could also be pointed out that when you are performing a nerve glide, you are also stretching fascia and moblizing joints, so again, is the nerve glide the sole reason for the results? Maybe, maybe not. Does cognitive intention play a role? Probably. Intentional nerve glides are also in the toolbox within the Z health system - much of it based on the works by David Butler, the NOI group, etc. With the basic joint mobility exercises however - I doubt you are truly getting enough of a glide to effect the kind of change you are talking about. The movements are very subtle, and most of them are begun in positions of neural slack. You can also modify movements to decrease neural tension even further and still get the same result. Whether you are performing a nerve glide or stimulating mechanoreceptors through joint motion or other tools, you are always affecting the CNS. The question is whether the change you are getting is good in the long term. Z provides a framework where you can quickly ask and answer this question within a treatment session. The take home point is - there are a lot of really good treatment modalities including nerve glides, joint motion, myofascial release, cognitive therapy, strength and conditioning, nutrition etc etc, but it is imperative to determine which modality is needed when, and be able to reassess to see if what happened was what you actually intended.

Hope that helps.

[Barrett Dorko]

According to Dr. Cobb, what are the origins of the patient's/client's complaint when his method is appropriate?

I assume the answer will be short and to the point but probably shouldn't ask for that much. (I will admit that's mildly sarcastic but not hostile at all. It just expresses my desire for answers that don't include every possible mechanism)

When do you suppose Dr. Cobb himself will join this discussion? Why wouldn't he?

Thank you Courtney for not including another testimonial with your last post. That stuff can wear on you.

[Jason Silvernail]

Courtney-

What is the question here then?

Are you kidding?

The question continues to be - what is the explanation for the supposed results seen by using this system? Also, how is this system better than the million other treatment and movement therapies out there?

Answers about it being "applied neurophysiology" and giving responses based on mechanoreceptor activity and joint mobilization is well and good, but this doesn't make it any different than any other exercise or movement program. My walking to the refrigerator for a beer does all those things, too.

Perhaps making the question more specific would help. Regarding your story of your hammer toes straightening or your sudden deadlift success - how did/does "Z" achieve this, do you think? Can you explain how this system accomplished these feats?

I'm not calling your results into question, just asking for an explanation that works in the established framework of human physiology and that shows this system to be better than all the others. I mean, either of those two things you described, if they were explainable and repeatable, would do nothing short of revolutionize training and therapy. Think of all the wasted hammertoe correction surgeries just for example.

Additionally, I like that the name has been shortened to just "Z". Is this kind of like when MC Hammer changed his name to just "Hammer"?

[cneupert]

[quote=Barrett Dorko;36008]According to Dr. Cobb, what are the origins of the patient's/client's complaint when his method is appropriate?

The client's complaints may include but are not limited to specific localized pain from musculoskeletal disorders, generalized pain, mechanical dysfuntion, functional limitations, neurologic disorders, or desire for enhanced performance. The "method" depends on the client's complaint - again, using the right tool to achieve the desired outcome. (short enough for you?)


When do you suppose Dr. Cobb himself will join this discussion? Why wouldn't he?

He has been out of town teaching, which means that he hasn't had time to join the discussion. He will join when and if he wants to - although personally, I rather hope he stays above the fray.

[Barrett Dorko]

Well, it was short enough, but it wasn’t even close to the point.

I didn’t ask you what the patient was complaining of or displaying, I asked you what the origin of these things were, according to Dr. Cobb. Perhaps you should take a look at the Five Questions thread for a definition and discussion of origin and its importance. Then you could try again, or not.

“Above the fray”? I would think that Dr. Cobb would want to lend his support to his students speaking up for his method here. It would take all of ten minutes to throw some words onto the computer and hit “send.” Sort of the way John Barnes and Ron Hruska did.

Oh wait, that never happened either.

[anoopbal]

He will join when and if he wants to - although personally, I rather hope he stays above the fray

And why should he not? This is the great oppurtunity for him to show that his treatment is rooted in fundamental physiology and also great oppurtunity to market his product and get more clients.

As you said personal anecodotes can be used as evidence, but what if all the treatment modalities out there are wholly based on personal succes stories? Are you goona spend 2000 dollars and try each one by one and see if you could fix your hammer toes?

What do you suggest is a better option for anybody wanting to learn more?

Anoop

[Keats Snideman]

Nice to see this thread continuing...I do hope Dr. Cobb can join in so we can hear explantions from the creator of the system.

Thanks again to those who are contributing; healthy debate and discussion can only help and deepen true understanding.

Back to some earlier posts, I don't think we ever got an explantion of "neuromyofascial winding." I'd really like to know what this is. One of the problems between between healthcare disciplines is the different verbage that is used to explain various processes and phenomenon. It would be easier if everyone used the same words (science-based). On-line discussions of this sort become a true test of one's communication skills!

Let's keep the communication going and see where we can get realizing that we're all probably more alike than different; and realize that there is NO personal attack on any individuals here, just their ideas and concepts.

[Diane]

Coutney, I'm glad you're here and seem willing to do some of the deeper neuro digging from your side, which is closer to this matter than from where I sit. Thank you.

Jason has asked everything I had in mind in his post #94 succinctly. I look forward to your answers, or those of Cobb. Especially re: the toes.

Keats, looks like you'll get a debate going after all - that is, if everyone reads Jason's post and answers the question as he posed it.

The question continues to be - what is the explanation for the supposed results seen by using this system? Also, how is this system better than the million other treatment and movement therapies out there?

Be sure to read his whole post carefully to avoid wasting time falling into answers that he has suggested do not in the least matter.

Also Barrett's question as he posed it.

I didn’t ask you what the patient was complaining of or displaying, I asked you what the origin of these things were, according to Dr. Cobb.

[Mike T Nelson]

Just a clarification, my above posts were from my perspective as a TRAINER not a grad student. My primary goal as a trainer is to get results in a safe manner, even if my understanding of those methods is not based on a consensus in the literature. I do base it on science, but that is only a guide. If I waited for that I would not be doing much as there is tons of conflicting research (hence the need for more research). I fully understand that as a grad student that does method does not fly and I am working to get a deeper understanding.

I do NOT provide any diagnosis or prescribe anything. I do however help athletes complete exercises in a safe and effective manner. Others (like Courtney) who are physical therapists, etc are able to provide insight that I can not.

Great that we have some trainers on here! I too did my CSCS cert. Yes, you are correct that the exercise field is chalk full of all sorts of interesting/scary things.

Back to science now
Related to the post above, the hypothesis is that the Z Health system takes advantage of the joints and their effect on the body. One is the Arthrokinetic Reflex-if a joint is not have a full active ROM, the muscle function around that joint will be compromised. One abstract is below and yes I know it was done on decerebrate cats in 1955. Further data is Hilton's law that is the observation in the study of anatomy, one often finds that a nerve that supplies a joint also tends to supply the muscles that move the joint, or the skin that covers the attachments of those muscles. Is there a consensus that working on a joint can have an effect on the body?
Arthrokinetic Reflex of the Knee

Leonard A. Cohen 1 and Manfred L. Cohen 1

1 From the Department of Physiology and Pharmacology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania


The knee joint of decerebrate cats was rotated through a full range of flexion-extension movements. The tensions of quadriceps femoris muscle and semitendinosus muscle were recorded and the responses of these muscles to joint movement were studied. The medial and posterior articular nerves were later sectioned and control records were taken. Flexion of the knee decreased the tension of quadriceps femoris but increased that of semitendinosus. Re-extension of the knee restored both tensions to their resting values. Data were obtained which showed that these responses were reflex in nature. Since the knee joint reflex is basically a slow adapting movement reflex, the name ‘arthrokinetic reflex’ seems appropriate. The activity of the arthrokinetic reflex indicates that its general function is to coordinate knee movement with other nervous activity in thigh muscles. In addition to this, the arthrokinetic reflex of the knee appears to have specific orientation toward dealing with the powerful stretch reflex of the quadriceps femoris muscle.
Submitted on June 23, 1955

Maybe I should back up even further and see if there agreement that joints are an integrated part of the sensorimotor system? 2 reviews on that attached. I am not trying to be a wise a$$ or anything, I am just trying to find some common ground based on science as we know it. Again, I am still learning as much about this area as I can so any help is much appreciated.

Please discuss.
Mike N

[Jason Silvernail]

Yes, Mike, the nerve innervation of joints are part of the sensorimotor system.
What does this have to do with differentiating "Z" from other movement therapies again?

Further posts should, I think, attempt to address the questions posed above.

[BB]

I keep reading that just because the science is not there yet doesn't mean that we shouldn't proceed. Lack of RCTs is not what is being discussed here, really. Sure they would be a nice addition. The problem is the science that is already available does not support some of these claims.

For example, there is plenty of scientific research showing muscle function, motor control, and presence of degeneration are not predictive of pain. When this is the case, using these things as an explanation as to why this system helps is not supported.

And yes the nervous system is involved. You'll not need to spend any time convincing anybody here that. But when you speak in terms of relfex dysfunction, again this is not supported. As Jason and Luke have said, if this is the case why are there so many people out there with abnormal reflexes who have no pain?

There is a song on the newer White Stripes album that says "You can't take the effect and make it the cause." I think that applies here.

[Luke Rickards]

if a joint is not have a full active ROM, the muscle function around that joint will be compromised.

Hmmm, fine. But is it the chicken or the egg?

To stress some of the points raised above;
What is the origin of this compromised joint function?
How do you reliably test this?
When you treat this compromised joint, what is the therapeutic mechanism (in terms of physiology) that restores the function, and how has it addressed the origin?

Questions don't come clearer than that.

[Mike T Nelson]

Hmmm, fine. But is it the chicken or the egg?

To stress some of the points raised above;
What is the origin of this compromised joint function?
How do you reliably test this?
When you treat this compromised joint, what is the therapeutic mechanism (in terms of physiology) that restores the function, and how has it addressed the origin?

Questions don't come clearer than that.

The origin can be from repetitive impact on the joints or an old injury (sprain/strain/break). It could be from anything that causes the joint to see a high force and/or compresses the joint. I don't diagnose,as I am a trainer, so I am not overly concerned how it happened to be honest (as a researcher, yes I would be interested in how it happened but that is a difficult question to answer in a short period of time).

Since it is not a research setting, your options are more limited. You can do a gait assessment or a manual muscle test (ROM can be done also, usually active ROM). I am not looking for a fine gradient of responses--just simply does it test weak of strong for a muscle test. A gait assessment can be done also and is graded on a 1-4 scale.

A Z Health drill is done that is designed to "open up" the joint (mechanoreceptor stimulation being the primary intent) and gait/ROM/muscle test is done again. Any change is noted.

One demo I do is to do some muscle tests while the athlete is laying on their back until I find one that tests weak (let's say it is glute med). I then passively open the cuboid joint on the same side ankle, then retest the glute med (manual muscle test). Most of the time (not all) it will test strong. The premise is that "jammed" joints (joints not functioning 100%) are providing noxious stimuli (may or may not be painful as pain lives in the brain) to the nervous system, and thus comprising muscle function as a protective mechanism.

From what I can find, there is not much research done "opening a joint" and measuring muscle activity. Anecdotally, I have done this on about 50 athletes and in a vast majority muscle function can be enhanced or weakend by opening and closing a joint space.

Mike N

[Barrett Dorko]

Mike,

You're confusing origin with cause. My first lecture, page 3 in the course manual.