Tag Archives: Mobility vs Stability

Meet Brent Brookbush and Why Functional Anatomy Is Important

I’d love to take this opportunity to introduce the MMIM Community to Brent Brookbush, PT, DPT, MS, PES, CES, CSCS, ACSM H/FS.  Brent is a breath of fresh air in our industry and even though he is a new grad to the PT world, he brings a ton of knowledge into rehab from his strength/conditioning background.  Brent has a unique skill set of taking daunting Human Anatomy and making it simple, and most importantly, functional.  Enjoy this 1st of many guest blogs from Brent where he introduces himself and lays the framework of why Functional Anatomy is important and critical.  As usual, for more Info on MMIM visit Medical Minds In Motion, LLC

-Rick

“The Brookbush Institute of Human Movement Science was created to enhance the delivery of evidence-based, practical education in human movement science. Most of our content is concerned with exercise and technique selection, routine design, assessment, etc. – the very application of the science in our field. With that being said, the fastest growing section of our online education platform is the portion dedicated to “Functional Anatomy” (Introduction to Functional Anatomy & Integrated Muscular Anatomy). Despite the fact that I’m as drawn as you are to new and innovative techniques, I have come to realize that understanding when to apply those techniques, understanding the intent of those techniques, and comprehension of the concepts with which those techniques were developed, is dependent upon on a strong knowledge of anatomy. Just as anyone can swing around a scalpel, it takes a surgeon’s knowledge of anatomy to use that scalpel in a manner that is effective. It could be said that a repertoire of effective techniques and assessments lies just beyond a conceptual doorway, and that functional anatomy is the key to that door.

Why “Functional” anatomy over traditional “Anatomy & Physiology”: Functional Anatomy implies a bias toward the subcategories of anatomy that specifically apply to human motion. It’s one thing to know that the trapezius originates from the external occipital protuberance to T12 and inserts on the spine of the scapula, acromion and clavicle, but it is another to know that the upper and lower trapezius work synergistically with the serratus anterior to upwardly rotate the scapula and ensure optimal acromioclavicular joint arthrokinematics. Further, all 3 of these muscles have a propensity toward under-activity in those individuals who exhibit upper body dysfunction, and due to this propensity may be the target of activation, integration, neuromuscular re-education and taping techniques. Further, these muscles have an effect on other joints, nerves and fascial structures – knowing how these structures are affected by dysfunction that may have originated with a change in the length and behavior of the trapezius, may provide us with a list of additional techniques that improve carry-over, or may simply be necessary for the more “stubborn” patient complaint. And that’s just one long-winded example…

If I may say with the utmost humility and respect for what we do, most of the concepts we build our interventions upon are fairly simple. Reciprocal inhibition, synergistic dominance, movement impairment, altered activity, adaptive length change, relative flexibility, compensation patterns, recruitment, release, stretching, mobilization, activation, integration, neuromuscular re-education, taping, IASTM, dry-needling, etc… can all be explained in a paragraph or less and often can be summarized in a sentence or less. But again, the concepts are just the doors to learning a repertoire of effective techniques and assessments, and our knowledge of functional anatomy is the key.

Where does that leave us? Dedicating time to increasing our knowledge of functional anatomy should likely consume the same amount of time that we dedicate to reading and understanding research in the pursuit of evidence-based practice. In essence, research refines our practice of techniques, built upon a foundation of functional anatomy knowledge. As an educator, I am excited about the opportunities a partnership with MMIM will provide. I can continue to build upon our library of foundational material, providing Rick Daigle and his faculty with a resource they can refer workshops participants too – leaving more time for practical education and lab in live workshops. I also look forward to gaining insight from the ingenuity of his staff, as they provide the Brookbush Institute with more great techniques for our library of practical content.”

Sincerely,
Brent Brookbush, President and Founder
DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

Brookbush Institute of Human Movement Science

BrentBrookbush.com

Brent@BrookbushInsitute.com

When is a mobility issue not a mobility issue?

Say what?!?!  When is a mobility issue not a mobility issue?  You read that right.  A mobility issue is not a mobility issue when it’s a stability issue. There I said it.  Soak that statement in and think about it for a few seconds before making any judgments (in either direction).

We know the human body is a wonderful and powerful tool.  We also know that the human body is the great compensator.  When you cannot move properly, the body will get it from somewhere else.  The epitome of robbing Peter to pay Paul.  The human body will also sacrifice quality over quantity.  I bet you that right now, you have movement dysfunction that you have no clue exists and there is a good chance you don’t have any pain associated with it…  Yet…  Eventually you will.  You can take that to the bank.

When the body reacts with pain signals- basically it’s saying to you, “Hey Idiot, do something. There is a problem somewhere”.  The problem is that a lot of practitioners are tricked by the pain and they start to “chase it”, as my good friend Perry Nickelston likes to say.  Just because there is pain in one location with a potential tissue lesion, does not mean that is the root cause.  We have to look at everything in order to understand 1 think.

Janda was way ahead of his time.  He stated that you must understand the motor system as a whole in order to understand individual impairments.  Damn that dude was smart.

So back to mobility issues not being mobility issues.  Do NOT take this as an absolute.  The only absolute is that there are NO absolutes (I can thank one of my students for that line).  Mobility issues must be consistent.  We know that and we understand that.  So having a patient/client fail a toe touch and then assuming they have tight hamstrings is putting the cart before the horse.  That’s only one way to look at movement.

1- Check toe touch in standing

2- Check toe touch in long sitting

3- Check active straight leg raise (needs to be greater than 70 degrees)

4- Check passive straight leg raise (needs to be greater that 80 degrees)

If you FAIL all 4 of those, guess what, there is a good likely hood you have a mobility issue or issues limiting you.  If you pass even just one of those, it most likely cannot be a mobility issue.

So what could it be?  It could be a lot of things but lets use this example.  A patient presents with a limited toe touch in standing and then a perfect toe touch in sitting.  One of the likely scenarios here is that this person has some fundamental core stability issues such as a lack of pelvic stability or diaphragmatic issues which is causing their hamstrings to contract in standing and stabilize the pelvis, thus causing a compensation.  You then have the person long sit- and BOOM they touch their toes.  What’s stabilizing the pelvis in this position- the FLOOR.  Hamstrings shut down, stop overworking and bingo, the person touches their toes.

Now- how do we go about fixing their toe touch in standing?  Stretch their hamstrings?  Mobilize their l-spine?  Nope. Not going to work.  Go to your days of Pediatric development and focus on rolling, crawling, half kneeling balance.  Maybe even before that you need to assess their breathing and teach proper diaphragmatic strategies.

One of the most powerful options to fix this issue is segmental rolling.  The next blog coming out soon is titled “This is How I roll” and will go in depth into segmental rolling.  Think about how we develop and think about what needs to stabilize properly in order to roll from your back to your stomach.  I have a few good videos that will accompany that blog which will demonstrate this.

The point is- develop proper fundamental core stability and you will clear up a lot of “mobility” issues.  Just remember this:  Mobility issues will be consistent.  If it’s inconsistent, you need to look at what stability problems are present.