• Welcome
  • About
    • Travel in India
  • Consultations and Classes
    • Larkspur, CA
  • Contact Us
Warning: Empty Rotating Images Group! Upload images for this widget to function.
Warning: Empty Rotating Images Group! Upload images for this widget to function.
Warning: Empty Rotating Images Group! Upload images for this widget to function.
  • Himalayan Yoga
    • Meditation
      • Meditation
    • Yoga
    • Pranayama
    • Breathing
    • Philosophy
    • Travel in India
  • Physical Therapy
    • Posture
    • Exercise
    • Movement & Motor Control
    • Movement
    • Movement Evaluation
  • Etc
    • Humor
    • Inspiration
  • Blog

Archive for Movement Evaluation

Anterior Shoulder Pain!

By Peter Fabian · Comments (0)
Tuesday, December 28th, 2010

The following is an interesting sequence of events of a new granddad who had recently been carrying around his 20+ pound grandson.

Case Presentation

A young grandfather was in my office the other day and his main complaint was left anterior (front) shoulder joint pain.  He denied any neck symptoms and no complaint of radiating symptoms.

Observation

He sat with his left shoulder lower than right.  His trunk was side bent to the left.  His shoulder elevation was limited by 15 degrees but not painful.  Resisted flexion and rotation of his shoulder reproduced his anterior shoulder symptoms and were weakened (probably inhibited/interfered with by pain and malposition?).  Also his left shoulder was protracted and slightly subluxed anteriorly.

His neck was blocked in left side bending and rotation of the lower neck segments.  He was not aware of this difference until formal testing.  Passive range was also blocked in the lower cervical spine in this left direction.

Also when I tried to side bend him to his left from caudal (head to tail) pressure on top of his shoulder he was easily moved.  Side bending to the right was markedly restricted in the mid thoracic (rib) spine.

Immediate investigation

I started with the hypothesis that there was a strain to the shoulder, possible due to poor stabilization of the shoulder complex–that was brought out in a more pronounced way due to having to carry around his grandson for long periods.  He could have over recruited his neck and set up very poor neurmuscular motor and sensory flow to the upper quadrant area.   Since he had such a pronounced movement dysfunction in thoracic side bending, I thought it would be interesting to see what if anything this lack of side bending may have to contribute.  (Both to mal-position of the shoulder on the opposite side and poor transference of stabilizing forces through the trunk).

  1. Tried to initiate active assisted trunk side bending to his right (remember he was already in a left side bent position).   This did not occur readily so looked lower.
  2. His right hip was carried in external rotation in sitting, his right hip internal rotation was limited.
  3. In sitting:  immediately had him place his right hip in internal rotation (foot out to the right side)–until we could cause him to shift his weight onto his left IT (sit bone) and gently start encouraging his trunk to side bend to the right–slowly as this side bending became easier we facilitated left side bending also of his lower neck segments.
  4. Had him sit straight again and noticed:  His shoulder less protracted and less subluxed.  He gained 10 degrees in shoulder elevation.  His resisted movements were much less provocative but still weak in external rotation.
  5. Finished with some activating/strengthening/stabilizing exercises for the scapula and shoulder complex.  Included cervical and thoracic active mobility also.
  6. Upon completion of the exercises, there were no reported symptoms with the previous provocative movements.

Summary

OK, not everything that walks into my office has such an easy resolution.  I just thought this case at least demonstrates some of the interesting connections that I find in working with people.  Also it has been my experience over many years that once could have started in different places and shown success.  I think success does not necessarily always mean such a quick resolution to a person’s problem.

One of the most important points I find is to see the relationships that exist.  Possibly an isolated approach of the shoulder or neck may have proved helpful.  If the whole pattern that is involved is not understood/recognized, then in more protracted cases, important elements may be ignored.

Now

Let me know what you think.  If there is any way I can be of service, please contact me here, for a consultation.  Thank you.

Comments (0)
Categories : Movement Evaluation, Physical Therapy
Tags : Cervical spine dysfunction, exercise, movement awareness, movement learning, neck pain, neuromuscular dysfunction, neuromuscular training, Physical Therapy, posture, shoulder pain, subluxation

Physical Therapy

By Peter Fabian · Comments (0)
Tuesday, August 17th, 2010

Movement and Posture

Therapy is a method of helping to bring one to a place of balance.  This place is not always a singular location.  In therapy, one may just come to a better understanding.  This understanding allows one to hopefully function at a better level.  Much of “Physical Therapy” is helping one come to better movement and posture.  It is usually focused on the physical aspect of our being and it does fit well with the preparations that are taught in many other sciences like yoga.

Premise

A basic concept we deal with in the science of physical therapy (and even in yoga), is that there is:

  • A complaint or problem which one wishes to change
  • There is a reason for this complaint or problem
  • There is a solution/therapy/or way to manage these problems
  • The solution or management is based on a proper method and practice

Movement Case Study

Take a generic example of someone complaining of knee pain when walking up stairs.  The medical evaluation to look for any disease, in this case, shows some degenerative changes in the left knee joint.  Typical explanation for the symptoms becomes defined by the associated disease state.  This assessment is incomplete for a problem noted with movement.  The medical definition is correctly defining the parameters of the disease.  One cannot jump to saying it is the cause of the pain and movement problem when going up stairs.

Evaluation

Since there is a complaint of knee pain that is aggravated by movement, one needs to do some type of movement evaluation. Physical Therapist properly trained are experts in movement dysfunction.  That means they can assess what is not working and suggest how to correct the dysfunction.  Once again they are not focused on the disease.  It is only noted as appropriate.  Too many people only look for the problem and the solution from a medical/disease model.

Local vs Regional relationships

We need to look at how the knee bone is connected with the hip bone, etc.  Actually movement observation of a person doing a functional task like the stairs is following the flow of forces throughout the whole body.  Really this is a wholistic viewpoint (though an over-worn phrase).  Sometimes we look only at the place causing the pain.  This is a local approach.  It can be “successful” in a limited way, ie reduction of the symptoms.  The cause of the symptoms are not necessarily treated.

Location of symptoms and cause of the complaint are not the same often.  Anytime you have a reoccurring or chronic complaint you definitely need to look elsewhere for what may be contributing.  The knee sits between the hip and ankle joint.  The leg and pelvis are force producers and transducers between the ground and the trunk.  Of course this model just continues through the whole body.  We are functioning system.

System Relationships

As a system, everything is related to everything.  Whew–that’s a lot of things!  But as everything is related, not all relationships are significant.  (hmmm reminds me of a few).   So now we need to skillfully work with all these relationships to quickly find which ones are having a difficult time maintain cordial connections.  This is where a skillful therapist can quickly screen a variety of key movements and determine where they need to look further.

Treatment

What is the best exercise for knee pain?  I have no idea.  So if one approaches a problem with an answer, you have to be a good guesser.  The best approach to a problem is to ask another question.  Once you have arrived at the most significant movement problems, that aren’t acutely painful, you can start helping to restore proper movement. Select  the movements that organize the system to correct itself and restore normalcy.  There should be no elevation of the pain.  In fact it should become less.

Let’s say you’ve evaluated some hip abductor weakness and stiffness in extension and rotation of the lower to middle thoracic spine.  You exercise and other treatments should immediately show some positive change in the systems movement patterns.  They may move farther, easier, faster, smoother, stronger with less symptoms now–something positively must change immediately upon proper/skillful treatment or you have not found the right movement dysfunction or you have not found a proper comparable retest.

Follow up

So evaluation and treatment are linked from a movement perspective.  We are looking not at the medical problem but how is that a person is functioning and yet maintaining their symptoms.  Changes for chronic problems often take time.  Doing something to a person is not the answer.  It is only part of the process.  Learning must be big part of the equation.

Awareness

In learning, one needs to not just do a corrective exercise.  One must develop an ability to sense and feel what needs to be done.  This body awareness needs coaching, both internally and externally.  I don’t know how many times in the past that I’ve shown someone “what to do”.  When they return to the office, I ask them to once again show me their home program.  After that, I wonder who was the idiot who taught them “that”.  Doing without understanding and feeling (proprioceptively and kinesthetically), gets the above result.  So take the time to work on ensuring what  and how they are feeling these movement changes.  This sensory feedback only enhances the motor pathways of changed movement patterns.

Comments (0)
Categories : Movement Evaluation
Tags : degenerative changes, dysfunction, functional movement, hip abductior weakness, kinesthetics, knee pain, Movement, movement awareness, Movement evaluation, Physical Therapy, proprioception, thoracic stiffness, wholistic treatment

Feeling balanced today?

By Peter Fabian · Comments (2)
Monday, May 24th, 2010

Observations

Have you noticed that your balance may not be as good as it use to?  Is your assessment based on one leg, with or without eyes closed?

Testing one leg balance is quite popular in therapy, fitness and yoga–the repertoire in function and activities of exercise and asana often demand it.  What is surprising is to try it with the eyes closed.  Later in the post you can see a test the two physical therapist came up with.  I’m sure we have used these tests in the past, but take a look at the comparative performance scale–quite humbling for some of us.

I have been testing it more frequently in the clinic to see the range of different populations response–it is a definite eye opener (pun intended) for many.  Without that visual orientation our performance for balanced is generally and markedly affected.  Try it out!

Testing for Equilibrium

Marilyn Moffat and Carole B. Lewis, physical therapists in New York and Washington, respectively, agree with Mr. McCredie that “balance is an area of physical fitness that is often overlooked,” but they seek to correct that in their recent book “Age-Defying Fitness” (Peachtree Publishers). They define balance as “the ability of your body to maintain equilibrium when you stand, walk or perform any other daily activity” like putting on pants, walking on uneven ground or reaching for something on a shelf.

Dr. Moffat and Dr. Lewis suggest starting with a simple assessment of your current ability to maintain good balance. With a counter or sturdy furniture near enough to steady you if needed, perform this test:

1. Stand straight, wearing flat, closed shoes, with your arms folded across your chest. Raise one leg, bending the knee about 45 degrees, start a stopwatch and close your eyes.

2. Remain on one leg, stopping the watch immediately if you uncross your arms, tilt sideways more than 45 degrees, move the leg you are standing on or touch the raised leg to the floor.

3. Repeat this test with the other leg.

Now, compare your performance to the norms for various ages:

¶ 20 to 49 years old: 24 to 28 seconds.

¶ 50 to 59 years: 21 seconds.

¶ 60 to 69 years: 10 seconds.

¶ 70 to 79 years: 4 seconds.

¶ 80 and older: most cannot do it at all.

Comments (2)
Categories : Movement Evaluation
Tags : age defying fitness, balance, balance test, equilibrium, one leg balance, yoga

Stiff neck

By Peter Fabian · Comments (0)
Tuesday, May 11th, 2010

It’s not uncommon for someone to wake up and say–“oh, oh–I can’t look to the right”,  then as they get ready to drive to work backing up the car, they say “I just can’t see behind me”.

When they get into the office to get checked out, they are really limited in cervical right rotation.  What is interesting is what they sometimes say, “I was unable to see behind in backing up my car, because my neck was so stiff.”  When I ask them to show me.  They only move their head to look behind.  Realize I’m just asking them to do whatever they have trouble in doing.  Then if I see that they are holding their chest from turning–yes they are only using the neck to look behind.

So now when they turn like they always have (maybe), they feel a new limit and often complain of discomfort/pain.  Usually you can also appreciate increased tension in the whole upper quadrant and even their mid to low back becomes tense.  Often their breath is held near and at the end range.

If you start with having them become aware in what is turning–in this case only the head from the neck (mid to upper neck only, no lower neck), you teach them how they are doing their task of looking behind.  Read More→

Comments (0)
Categories : Movement Evaluation
Tags : awareness, Cervical spine dysfunction, movement learning
join our mailing list
* indicates required
Close

Tags

ageing and exercise alignment alternate nostril breathing asana attention awareness balance body breath breathing Cervical spine dysfunction diaphragmatic breathing dysfunction exercise exercise compliance fitness Full Moon Meditation hatha Himalayn Tradition humor inspiration kinesthetics learning meditation mind mobility and stability movement awareness movement learning neck pain Physical Therapy pleasant mind posture practice pranayama proprioception shoulder pain Sitting stability strength Swami Rama Swami Veda training yoga yoga philosophy Yoga Sutras

Archives

  • May 2015
  • April 2015
  • December 2014
  • August 2014
  • April 2014
  • March 2014
  • November 2013
  • September 2013
  • August 2013
  • April 2013
  • January 2013
  • September 2012
  • May 2012
  • April 2012
  • March 2012
  • February 2012
  • December 2011
  • October 2011
  • August 2011
  • June 2011
  • May 2011
  • April 2011
  • February 2011
  • January 2011
  • December 2010
  • November 2010
  • October 2010
  • September 2010
  • August 2010
  • July 2010
  • June 2010
  • May 2010

Resources

  • Ahymsin Himalayan Web Site
  • Swami Veda Swami Veda Web Site
  • Swami Veda's Blog Swami Veda’s Blog Site

Exercise Equipment

  • Monkey Bar Gymnasium
  • Perform Better.com
Strong Mind and Body™
Copyright © 2021 All Rights Reserved
iThemes Builder by iThemes
Powered by WordPress