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LUMBAR STABILITY THROUGH REGIONAL MOBILITY

• Craig Faeth, PT, ATC, CSCS, FAFS(FMR), NG 360 GPS

• Fellow of Applied Functional Science

Identify tri-plane mobility restrictions of the lower extremities and spine. Understand the direct and indirect relationships between regional movement dysfunction and lumbar spine dysfunction. Increase understanding of the lumbar spine biomechanics during gait, running, lunging, squatting, and other primary physical skills related to athletic participation and competition.

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Apply functional mobility exercise that is at the same time isolated from and integrated with the low back.

Understand application of resistance to support functional improvement without isolation to the lumbar spine.

The Gray Institute for Functional Transformation

“AFS is the convergence of sciences that allows for purposeful movement. The convergence of Physical

Sciences (the world we live in), Biological Sciences (the miracle of the human body), and Behavioral Sciences (the

power of the mind and spirit) is the DNA of AFS…”

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The Gray Institute for Functional Transformation

“…For the Physical Sciences, the truths of Environment, Gravity, Ground Reaction Force, Mass, and Momentum are considered and

leveraged. For the Biological Sciences, the truths of Motion, Reaction, Proprioceptors, Muscles, Joints, Task, Specificity, and

Mobility / Stability are considered and leveraged…”

The Gray Institute for Functional Transformation

“…For the Behavioral Sciences, the truths of Success, Encouragement, Locus of Control, Empowerment, Relevance, and

Significance are considered and leveraged…”

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Principles are the why of movement. Strategies are the how of movement.

Techniques are the what of movement.

Three dimensional -sagittal, frontal, transverse.

Chain Reaction – proximal and distal joint linkage.

Driven – task, external, internal.

Subconscious – complex stabilization and muscle synergies happen

subconsciously.

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Three dimensional – matrix training or

deliberately isolating, while integrating, a

particular plane of motion

Chain Reaction – direct versus indirect

mobilization, manipulating the triangulation

(angulation, verticality, horizontal), to achieve a

desired chain reaction.

Driven – use of external drivers consistent with the task can help change restrictive internal drivers, as well as create an

environment for proprioceptively consistent functional strengthening.

Subconscious – core activation (anterior and posterior) as a result of reflexive proprioceptive activity; lumbar deceleration

of GRF proportionate with hips, thoracic spine and feet.

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Utilizing the principles, which have lead you to your

strategies, the techniques are virtually endless,

highly individualized and customizable.

The possible techniques are only limited by your

imagination.

Manual therapy and exercise intervention often

become seamless applications.

Gravity and GRF - used or

confused

Mass and Momentum - leveraged

or neglected

Motion - 3D or 1D

Reaction - chain or link

Muscles - reactor or actor

Joints - integrated or isolated

Mobility/Stability - combined or

segregated

The Gray Institute

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What body positions do we use for exercise?

What drivers do we use to facilitate the

performance we are looking for?

Do we leverage proximal and distal segments to

achieve our desired chain reaction?

Do we try to achieve stability through mobility?

Assessment Strategies Traditional - Local

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Myotomes - manual muscle testing

ROM - challenging to measure with accuracy

Segmental instability testing - unreliable, and difficult to

localize

Positional deformities - easy to palpate, but leave no

reasons for why they are there

Nerve root compression tests - valuable in defining tissue

of lesion, not in explaining the “reason” for the lesion

Traditionally soft tissue mobility has been thought of and evaluated as muscular restriction, spasm, tenderness or nodule identification.

Powerful information coming from the Fascial Research Congress

(http://www.fasciacongress.org) is beginning to reshape what we think about the role of connective tissue in human function.

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Assessment Strategies Functional - Global - Integrated - Putting It All Together

The Gray Institute - 3D MAPS

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Transformational Zone

Deceleration to

acceleration

Notice the rotation and

counter rotation

Stand up.

Put your hands on your waist.

Step forward with your right foot.

Notice the your pelvis rotates in this case to the left.

With normal and natural arm swing, your shoulders

would rotate to the right.

You are in the TZ of gait.

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Right foot pronation (STJ) at heel

strike, with calcaneal eversion.

Tibiofibular (ankle) internal

rotation.

Knee flexion, IR, abduction.

Femoral (hip) internal rotation.

Pelvis - anterior rotation, left

lateral flexion, left rotation.

Absorbing GRF

flexion - femur and pelvis both moving

internal rotation - from the ground up; femur moving faster than the pelvis.

adduction - midstance

All necessary for proprioceptive stimulation of the supporting musculature.

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Transverse plane - left rotation

Frontal plane left lateral flexion

Sagittal plane - anterior rotation

SI joint motion is present

(counternutation, R SB, R rot),

but globally moving in the

same direction as the pelvis.

L5-S1 relative motions -

extension, right side bending,

right rotation (real bone motion

in space left rotation).

Biomechanics naming of motion in the spine is for the proximal segment on distal segment motion.

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The same relative motions would occur

between each lumbar vertebrae, up to

the thoracolumbar junction or lower

thoracic spine, depending on your

information source.

At some point, due to the opposite

rotation of the shoulders relative to the

pelvis, there would be a segment or two

with no relative motion.

With shoulder rotation opposite of pelvic

rotation, the thoracic spine can drive

dysfunction from the top down.

Thoracic spine immobility is a major factor in

limiting good proprioceptive abdominal

activation.

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SO HOW DO YOU ASSESS ALL THAT?

In-sync Spherical Matrix

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Driving the trunk into side

bending with the hands or

shoulders.

Feet positioned in wide and

narrow stance.

Looking for restricted segmental

motion, pelvic reaction.

Driving the trunk into right and

left rotation with the hands or

shoulders.

Feet positioned in neutral width,

toe-out and toe-in.

Looking for restricted segmental

motion, pelvic reaction.

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Driving the trunk into flexion and

extension with the hands.

Feet positioned in neutral width,

R foot forward and L foot forward.

Looking for restricted segmental

mobility, pelvic reaction.

Functional Movement Screen (FMS) Deep squat (hands over head)

Hurdle step (proper stride mechanics?) In-line lunge (resist rotation?)

Shoulder mobility (towel stretch? Thoracic spine side bending?)

Active SLR??? (where is the function?) Trunk stability push-up

Rotary stability Good performance usually is rated as extremity

mobility with pelvic or core rigidity?

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A Functional Approach to Treatment

Regional Mobility for

Lumbar Stability

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To keep the lumbar

spine from taking the hit,

you would need:

left hip extension and

external rotation

thoracic spine extension,

left side bending and right

rotation

To keep the lumbar spine from

taking the hit, you would need:

Right hip IR, abduction in

flexion.

Left hip ER, adduction,

moving into extension.

Thoracic spine right rotation

and left side bending, while

flexed.

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To keep the lumbar spine from

taking the hit, you would need:

Right hip flexion, IR,

adduction.

Left hip ER, extension,

adduction

Thoracic spine flexion, right

rotation and side bending.

Lumbar soft tissue must be able to handle large eccentric load to explode.

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Craig Faeth, PT, ATC, CSCS, FAFS(FMR), NG 360 GPS, CAFS, 3D MAPS

cfaeth@comcast.net

253-970-1427

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