Tag Archives: Mobility

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

Mobility vs. Stability: A guest blog from Mitch Hauschildt

I’d like to introduce you all to Mitch Hauschildt, MA, ATC, CSC. Mitch is a great friend but also one of the best clinicians I have ever met. Hands down. Mitch is the Rehab Coordinator for Missouri State University and is the Founder of Maximum Training Solutions. You can reach him at mitch@maximumtrainingsolutions.com. Here is Mitch’s take on Mobility vs. Stability!

Mobility.

Stability.

Both are needed for proper movement and function. Without both, authentic movement will never be achieved and injury risk will rise as a result.

Let’s break it down a little bit further…

Mobility has been defined as “the ability to produce a desired motion” (via Bill Hartman). The key word in that basic definition is “ability.” If someone doesn’t have the ability to produce or reproduce a specific movement pattern (due to lack of range), then they are inherently immobile.

Stability has been defined as “the ability to resist movement.” Without the ability to resist poor movement, one will never be able to create truly authentic movement and will always have compensatory patterns.

Be careful with this, however, because it can be very easy to confuse joint stiffness with joint stability. They are 2 very different things according to the nervous system. If someone only has joint stiffness, at some point they will be stretched to the end of their limited range and they will collapse and sustain and injury because they don’t have true stability.

So, how do we train mobility and stability? Gray Cook makes it very clear that you ALWAYS train mobility before stability. That is to make sure that you avoid the joint stiffness scenario that we just discussed.

I agree with Gray on this point almost all of the time when we are talking about relatively healthy individuals with relatively “normal” mobility (whatever that is). I have found that there are some occasions where it make sense neurologically to challenge the body via stability training within an available range of motion as you continue to improve their mobility. There are also some instances where it works well to improve both mobility and stability simultaneously. As with all situations, the rules are the rules, but they can be broken from time to time.

There is one area where this rule cannot and should NEVER be broken. That is the post surgical rehab patient. Mobility and joint range of motion MUST always be the first priority immediately following a surgical intervention. Without full range of motion, performing simple ADLs becomes problematic for patients.

Neurologically, activation patterns are significantly altered with poor range of motion. Because the nervous system controls every aspect of the body, the ripple effect that poor range of motion has on the body is immeasurable.

First, joint stability will never be realized with a limited range of motion. When muscles only work in a shortened position, they lose their mechanical advantage and can’t create the appropriate torque needed to keep a joint stabile in an unstable environment.

This leads to larger issues elsewhere. When the local stabilizers can’t keep a joint centrated, prime movers take over because they are typically larger muscles that are in a position to greatly improve joint position, even though that is not their intended role. This leads to decreased performance, especially if they are an athlete, because the prime movers are tied up performing stabilizing duties instead of moving the body. For the same reasons, this will also lead to overuse injuries.

These same poor activation patterns also impact other joints in the body. For example, the rotator cuff is specifically tied to grip strength. It is a protective mechanism that is used by the brain to protect a damaged shoulder. Thus, if the rotator cuff can’t work correctly due to a limited range, that person’s grip will be compromised.

Going further, that same patient with a poor functioning shoulder will have problems in the lower extremity. It is rather obvious that the Lats play an important role with the shoulder joint. Many people forget that the Lats are directly tied to the Gluts in a crossing pattern in the low back. Thus, if one Lat isn’t working well (because of a compromised shoulder), the opposite glut won’t function properly. This can lead to knee pain because the Gluts are a powerful external rotator of the femur, keeping it in an advantageous position for the patellofemoral joint.

Continuing on down the chain, when that glut doesn’t work, it will likely be correlated with an anterior pelvic tilt. An anterior pelvic tilt is associated with a number of issues, including an ankle dorsiflexion restriction. This can lead to ankle and foot problems. And, I can keep going…

Moving away from activation patterns, we also have to keep in mind that a poor functioning joint will have other effects on the joints around them. Looking at the joint-by-joint approach (Cook and Boyle), we understand that the human body is simply a series of stacked joints which alternate between needing joint mobility and joint stability. So, if you lose joint mobility in one joint, you are going to be asking another joint to make up for it. The body will find the motion somewhere. Unfortunately, the motion will have to come from a joint that is intended to provide stability.

As an example, if an ankle patient doesn’t regain full range of motion, they will develop knee or back pain. This is because the knee and low back are intended to be stable joints, but when presented with a lack of mobility below them, these joints become unstable and painful. It is consistent and predictable.

Honestly, these examples are just the tip of the iceberg. As you read this, you may be thinking to yourself, “I know Mitch, this is common sense.” And you are right. Unfortunately, I can’t tell you how many young athletes come into my practice from other therapists who are cleared to return to play missing 10, 20, sometimes 30 degrees of motion. Then, I get to tell the kid and their parents that they can’t play because they aren’t ready and then I get to spend the next few months fixing what should have been done early in the rehab process.

It’s honestly not about me though. None of us got into this profession for us. We love our patients and want the best for them. So, lets start doing just that. Give them the best treatment available. Today. Tomorrow. Next week. Next year.

Mobility precedes stability in the post surgical patient. ALWAYS!!