Tag Archives: Movement

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

My Movement Philosophy…

I’ve been thinking for a long time now how I should write this post. This is kind of a play on one of Gray Cooks audio lectures on having a movement philosophy (www.movementlectures.com) I’ve thought about tailoring into specific categories… I’ve thought about taking it the direction of comparing philosophies… I’ve thought about how can I make this post different than other that have posted similar related blogs…

After thinking about all of that I decided to do what I do best… WING IT and just type away with what goes through my head when I am either looking at a patient move or I am teaching movement strategies to a class of clinicians. I get asked all the time to describe what’s going on in my head when I look at patients, so here it is. A glimpse into the mind of Rick Daigle- and fair warning that there is a lot of madness going on! I’m going to do my best to organize what goes on in my head, but those of you who know me, realize that this will be a TALL task. Can you say ADD? Oh my god, look there’s a squirrel!

For starters- there is no cookbook here and what I am going to tell you is how I do things. It does not mean it’s the best way or the only but rather it’s my way! How I treat patients is from a combination of all the people I have learned from. Here are a few (but not all)- Gray Cook, Tim Heckmann, Kai Aboulian, Gary Gray, Perry Nickelston, Mike Voight, Tom Myers and my mom. (Mom taught me how to listen- we’ll talk a lot about that in this blog).

When I first meet a patient I place them into one of three categories:
1- Post-op
2- Traumatic Injury
3- Overuse/Repetitive Stress Injury

For the purpose of this blog; we are going to focus on the third category. With regards to the first two; I won’t look at their movement until all restrictive phases are gone and I know I am clear. THOUGH- I will without a doubt be looking at and treating other parts of their body (IE working on hip mobility when I patient is still in the shoulder sling post-op). By focusing on the third category, my hope is that you can see where my head is going with treating patients.

Day 1- Initial Evaluation
This is where I do my standard evaluation and figure out why they think they are in PT. I’ll use methods to diagnose their pain and work at trying to calm their pain down with a multitude of strategies. If they are VERY acute, I won’t go further on day 1. If I think they can tolerate, I might go into looking at a few key movements. But to me, the most important part of Day 1 with a patient is the HISTORY! Listen (thanks Mom) to the patient and let them tell you their story as you would be surprised how much info you can get. I think most of us reading this know who James Cyriax, MD is and probably know that he formed one of my favorite quotes- “If you listen to a patient they will tell you what’s wrong with them. If you listen to a patient long enough they will tell you how to fix them.” Pretty strong and accurate words. I cannot tell you how many times a patient has told me something that I thought was irrelevant and then BOOM it showed in their movement.

Day 2- This is where the magic starts… Movement baby! When they first walk in on day 2, it’s right to my movement screens. The SFMA, Y-Balance Test, FMS (yes I know this is meant for people without pain, but I still like to look at it for information), gait analysis and of course (drum roll please) rolling and crawling assessments.

Now before I go any further, I’m going to focus on the SFMA (Selective Functional Movement Assessment) and Rolling patterns for this post. I’m going to talk about how I use it, which might be different than some people, but again, this is my opinion and what works best for me. The best part of the SFMA is that it give you a systematic approach to looking at movement and while it is not the end all be all, it sure is damn close and pretty spot on for finding dysfunction that’s hiding from you.

For those of you who have never used the SFMA, well, you need to. Take a look at http://www.sfma.com or http://www.rehabeducation.com to find out about courses coming to a city near you! By far the biggest game changer in my career yet. BOOM!

Ok- the basis of the SFMA is to find where stuff is not working properly and use it to help optimize their function and help create a better system of movement and fix compensation. We place each movement into 1 of 4 categories:

1- Functional and Non-Painful (FN)
2- Functional and Painful (FP)
3- Dysfunctional and Painful (DP)
4- Dysfunctional and Non-Painful (DN)

Where do you think we are going to target? If you said DN, winner winner chicken dinner! That is the movement the person has NO pain with but can’t do it properly. Also, don’t forget- Not bad is not good! Be picky. Just because EVERY movement might be dysfunctional, does not mean the person is a train wreck. They might have 1 or 2 BIG dysfunctions that when fixed will allow the little dysfunctions to go away. In other words a horrible looking multi-segmental rotation might be graded as more important in my head when compared to a mildly dysfunctional cervical extension… Just a little side note- EVERY patient is different and I might think dysfunction A is more important for one patient but dysfunction B is more important for another patient.

So where do we go from here??? We know patient A has 4 DN’s but do we know why yet? Nope… We have to look at specifics and determine if the problem is related to mobility, stability or motor control. That’s where we will get into figuring out what needs to get fixed. Ok, in my OPINION- Mobility has to get fixed first. If you put load on to a mobility issue, well, you’re screwed. If you put load onto someone who has a motor control issue, well, you’re still screwed. Mobility first then motor control and then load it and gain stability.

Remember not to get punked and automatically think it’s a mobility problem until your full assessment is done. Why? Well if there is an inconsistency, it cannot be mobility. Mobility issues (think of a bony block in the hip) is and always will be consistent until you fix it. A lot of times it’s a persons inability to fire the deep stabilizers and sequence that makes them look like they have a mobility issue. Loaded vs unloaded, active vs passive and unilateral vs bilateral need to be assessed before you can determine the true cause. Take that to the bank.

Now- You clear out mobility through each joint (we’ll talk joints shortly) and the soft tissue is clear but the person still cannot move. Get them on the ground and start rolling. To segmentally roll from supine to prone (or vice versa) the inner core (diaphragm, pelvic floor, multifidus and transverse abdominals) need to fire and stabilize. Rolling is my way to assess and then train the brain to fire the inner core. Oh yeah, don’t forget breathing… That’s kind of important don’t you think? Not on the docket for today, but just take a moment and review all of the attachments of the diaphragm- important maybe? Yeah, I think so.

Ok, so what did I just say? The basic jist is find the issue causing the body to compensate. The human body will always sacrifice quality over quantity so you have to fix what it is compensating for. Treat the patients pain with your methods, absolutely, but if you do not find the root cause I promise you the patient will be back to see you again in the very near future. Remember this simple fact and you’ll be fine- Everything is attached to everything and anything can cause anything. Again, take that to the bank. Something else you can take to the bank is the Joint By Joint approach from Gray and Mike Boyle. The body has to alternate joints mobility vs stability. You cannot have 2 stable or 2 mobile joints stacked on top of each other… Unless you are looking for that person to fail miserably at their task.

Have a system… Have an open mind… Have a global view…

Don’t just focus on pain… Don’t cut the patient off… Don’t overthink it…

Do look at patterns… Do listen to everything… Do right by your patient and promote proper movement…

So that’s a brief glimpse into my mind… That only scratches the surface of what goes on in my head when treating patients. One thing I can promise you is that I function different from patient to patient and day to day. There is no cookbook and there is no standard way of doing anything in my opinion. I do what works for me and I get results- that’s what matters. Keep putting more tools in your tool box and be the best clinician you can be by pulling the right tools out at the right time.

Oh yeah, DON’T OVERTHINK IT! If you aren’t sure- it’s dysfunctional.

And a little side note- If there is a T-Spine mobility issue, I’ll usually start there. The t-spine is somewhat important to human movement.

I hope you all enjoyed this little tidbit of info and trip through my crazy head. Remember that these are my opinions and they might not work for you. Find your own Movement Philosophy and stick to it, keep learning and have some fun!

– Rick