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Author Topic: Alignment  (Read 15741 times)
Crafty_Dog
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« on: February 13, 2009, 04:16:19 PM »

The following is from a recent DBMA Newsletter.  Have YOU signed up?

============
Alignment

DBMA has as its mission statement "Walk as a Warrior for all your days". To this
 end, we have "The Three Fs": Fun, Fit, and Functional.  By this we mean that a)
 the Art should be fun to train b) it should promote Fitness, and Health c) It should
be Functional-- it should work.

This point about Fitness and Health is also made by one of my teachers, GM Myung
 Gyi, who speaks of The Three Hs":  Hurting, Healing, and Harmonizing". By this
he means that we come to the Art seeking to learn how to Hurt.  By so doing, we
accumulate injuries, and must learn to Heal them lest we and our comrades be reduced
in our capabilities, and by learning to Heal we learn Empathy and thus learn to
live a more harmonious life.

In DBMA we integrate the concept of The Three Hs into our curriculum.  In other
words, there are portions of our curriculum which are not directly about Fighting,
but are about Fitness, Health and Healing-- as well as Harmonizing.

As some of you may know, in 1992 I had a terrible knee injury wherein my ACL, PCL
and Lateral Collateral Ligaments were all snapped in half due to a horribly misapplied
throw by a training partner.  It took three surgeries over the course of many months
to replace these ligaments and during this time many muscles atrophied dramatically
which resulted in tremendous misalignment of my posture.  Thus, as I returned to
 training and fighting, many other injuries both small and large occurred.

Of necessity, I became extremely interested in matters having to due with postural
alignment and over time through research, investigation and experimentation, I developed
a body of principles which I call "The Self Help Principles".  Although in their
development I ran them by experts in many fields to favorable reviews, please understand
that I have absolutely no credentials in these matters and offer them only as what
works for me. As always in anything having to do with my teaching, for reasons of
legal liability I am Dog Brothers Inc and only you are responsible for you-- no
suing no one for no reason for nothing no how no way.

The first principle is the importance of postural alignment. When our posture is
 bad, certain parts of our body become overloaded.  As such they wear out more quickly
and are more susceptible to injury.

So the first question becomes "How can we tell if we are in alignment?"

It will be helpful if you have a training partner to observe you from the side.

Stand in front of a full length mirror with your eyes closed.  Open them and move
nothing.

The first thing to notice is your feet.  They should be directly under your hip
socket and evenly weighted.  They should be parallel.  Many/most people will have
one or both feet pointed outwards to some degree.  This is a sign of imbalance between
the external rotators (e.g. the piriformis) and the internal rotators (e.g. the
adductor complex) of the femur.   Typically this correlates with pressure at the
 sacrum (where the spine and the pelvis meet)

The second thing is to notice whether your hips are level or tilt forward. If your
training partner lacks the eye to discern this, a simple indicator is whether your
belly has a tendency to protrude (no matter how much ab work you may do)  This is
a sign of tight hip flexors (psoas, ilio, and quads) and typically it correlates
with a tight/achy lower back

The third thing to notice is whether your thumbs point straight forward (parallel)
or inwards.  They should be parallel.  If they are inwards, there is an issue with
the shoulder being internally rotated/collapsed.  This correlates with shortened
 pec minor and overextended external rotators of shoulder (e.g. teres minor).  This
often correlates with an irritated bicep tendon under the front deltoid muscle of
the shoulder.

The fourth thing to notice is the position of the ears in relation to the shoulders.
 Your partner should see that your ears are directly above your shoulders-- the
seam of your t-shirt is a good indicator of exactly where. With many people the
ears are forward of the shoulders.  This correlates with a tight neck and trapezius
muscles-- and the solution is not to be found in the neck.

To put things right requires a synergistic series of exercises.  The muscular skeletal
system is a magnificent creation in tensegrity and to put things right requires
an understanding of how to restore function to a state of complementary opposites.

But that is another subject for another time and place.

The Adventure continues!
Guro Crafty
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Crafty_Dog
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« Reply #1 on: February 13, 2009, 04:21:29 PM »

The following is one of the responses to the newsletter.  With permission it is used here: 
========

Thank you my friend, I would be Honored if you would use this material. I just want to give credit where credit is due. the material from which I studied to get this knowledge comes from the Postural Restoration Institute in Lincoln NE. I am in the process of getting certified in their method. 

Richard Artichoker



==========
 Let me begin by saying that I am a Physical therapist and my primary area of interest is in postural rehabilitation.  I work with people from all walks of life  and the most common problems I see are Back and Neck and shoulder pain, followed closely by knee and foot pain, all of which can be traced Back to faulty postural habits and/or poor conditioning

      Your breakdown of desirable postural landmarks and positioning was very accurate and insightful, what i find The most interesting however was the fact that you were even aware that the nagging pains and injuries you were suffering from Status Post surgical repair of your knee was directly related to postural imbalances and dysfunction.  In my experience, even a lot of MD's  can't seem to make that connection and Orthopedists are the worst.

    here are some principles I espouse in the clinical setting that seem to help a majority of my patients.

          1) The Lumbo-pelvic-Femoral complex is THE keystone to correct alignment of the whole spine. without neutrality and stability of this complex  you CANNOT  correct dysfunctional anomalies further up the chain.   Now again, i repeat, you CANNOT correct up the chain without establishing a neutral and stable pelvis. This is a key concept in postural reeducation. There are many therapists and Chiropractors alike out there who will probably disagree with my last statement referring back to their succeses with resolving neck and or thoracic symptoms utilizing the standard therapeutic method of their given vocation and without addressing pelvic stability.  i contend however that utilization of  muscle, tendon and ligamentous stretching and joint mobilization with creating a neutral and stable framework and without balancing the Net forces across the joint is doing nothing but creating an Asymptomatic/pathological patient.  I use Newton's third law as my guiding principle. "for every force, there is an equal and Opposite reactive Force"  In order for a system to work in balance this statement must be true, lets look at a joint, a knee for example: a simple problem i encounter in the clinic is Patela/femoral instability. this syndrome is a result of unequal forces across the joint made up of the patella and femoral condyle  resulting in the patella tracking laterally in the condylar groove leading to rubbing of the lateral patela on the lateral femoral condyl. the standard  approach to treating this is to strengthen the VMO(Vastus Mediallis Oblique), reduce tension in the Illio-tibial band with heat and stretching and some progressive thinking therapists will also try and address misalignment issues between the femur and tibia usually with orthotics.  Ron Hruska of the Postural Restoration institute would probably say that this problem is more likely the result of Femoral pelvic misalignment especially during functional activities do to Glute max and hamstring weakness especially when encountered on the right side of the Body.

     The key to lumbo pelvic stabilization lies with these three muscle groups: Glute max, Hamstrings and Adductors. the patient must be assessed  for the following:can they Adduct? and can they extend their right hip without pelvic rotation. if not the three muscle groups mentioned previously must be strengthened while at the same time working to inhibit the Oppositional muscles such as The lateral quads and the hip flexors.



    2) Correct breathing is essential to correct thoracic and cervical spine alignment and function! I won't go too much into the details of this as I have taken up quite a bit of your Time as it is, but just keep in mind that your diaphragm is not one symmetrical muscle as i think many people would believe and we have a nice big liver positioned perfectly underneath our right diaphragmatic hemisphere.  so what?  well the amount of excursion that that right diaphragm has is essentially less that that of the left leading to asymmetry of the diaphragm as well as hyper-inflation of the left chest wall. Try this experiment. take a few of your students or any of the staff there and ask them to lie supine on a flat surface and observe how the lower ribs look in this position. Does the left rib cage look a little more expanded? do you notice flaring of the lower left rib cage?  can the person flex their left shoulder overhead in supine to 180 degrees? can the person Internal rotate their Right arm to full range with the right shoulder  at 90 degrees of abduction?  If the answer to the  first two questions is yes and the second two is NO then that person is experiencing thoracic rotation due to respiratory dysfunction.

I will simply leave you with that for Now Guru Denny, if you have any further questions I would  be happy to answer them Smiley  Take care and Hoka Hey Kola!
======
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maija
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« Reply #2 on: February 13, 2009, 08:14:21 PM »

Great Topic.
From my experience, of myself and others, peoples' proprioception is generally pretty poor. You have to practice looking at what you do and how you are very objectively, definitely with the aid of a training partner (as we have a tendency to lie to ourselves if left to our own devices) and preferably with someone who can point out what to look for.
You can't fix what you don't know, so I heartily agree with Guro Crafty that awareness and good alignment, i.e. using your body as it was designed to work in a gravitational environment, are key for a HEALTHY long life.

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jkrenz
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« Reply #3 on: February 18, 2009, 02:36:05 AM »

Guro Crafty,

About how long did it take before you recovered from your injury?
I tore my PCL during a Combatives session during PT almost a year ago and I still don't feel like the recovery process is anywhere near complete.  I started running again about 4 months ago and have worked up to the point where I can sprint.  I think I'm just afraid of re injuring my knee and I don't want push my luck... cry   
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Crafty_Dog
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« Reply #4 on: February 18, 2009, 08:36:30 AM »

You may be sorry you asked , , ,  cheesy

After the failure of the second surgery (which was emotionally very discouraging to me because the docs could not understand why it had not worked) at my request the doctors put a cast on my leg from foot to hip to ensure success in the third surgery.   The transplanted tendon did "take", but the attendant atrophy on my already substantially diminished leg made created HUGE alignment and body mechanic issues.

 I strongly draw your attention to the imporatance of walking and moving evenly.  It can be very easy to carry the "gimpiness" provoked by the injury far, far longer than you realize and the bad movement then creates additional problems.

In my case while the cast was on my leg, unbeknownst to all, my hamstring partially adhered to my femur and this subtly and continuously caused my right pelvis to dislocate at the sacrum for several (6?) years.  Typically I was at the chiropractor 8-10 times a month.  Often pain would wake me up in the wee hours of the morning and I would have to stretch for an hour or two and self-medicate to get to where I could go back to sleep.  This was a very discouraging time, but in a sense it was my good fortunate that both Top Dog and Salty Dog were on sabbatical from fighting for various reasons (e.g. Salty's wife's brother had been murdered and there was a trial of the killer) and I felt that it was up to me as the remaining "name" fighter for the DBs to show up and represent for the Tribe , , , I did not think that the second wave was quite ready to stand on its own yet.

Having a cause, a mission to accomplish greatly helped me focus on doing what was necessary to get ready to fight.   For all I know without this I would have figured that bummer, I was done for.

It was only after Guro Inosanto introduced me to Barrance Baytoss, an extraordinary body worker (Kobe Bryant takes him on the road with him to keep him functioning high level, he works on world class sprinters, etc) that Barrance discovered the partially adhered hamstring and lifted it off the femur.   Then about 18 months of work in Pilates Gyrotonics with Ann Barber (another introduction by Guro Inosanto) got my hips to level out and stabilize.

Now I do have to do a lot of work to compensate for the continued susceptibility of the right hip to dislocate, rarely do I have to go to the chiropractor.

My caution to you is to think not in terms of the knee, but to think in terms of alignment.  As Sarah Pettit, yoga instructor to Guro Inosanto says (and here I am proud to say I introduced her to him) "Knees are escape valves for hips."  If your hips are tight or distorted in their alignment, then unfriendly pressures and forces will be sent to the knee.  Also make sure that your foot/ankle is lined up correctly with Mother Earth, lest once again, unfriendly pressures and forces flow through the knee.

HTH,
CD
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maija
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« Reply #5 on: February 18, 2009, 09:55:23 AM »

A teacher of mine once said that 'the knees are weight transferal joints, not weight bearing joints' carrying the weight coming through the hips, to the ankles and feet. If the knees are not over the feet, in a forward/back and a side to side plane, then weight is being carried by the knees and can cause problems.

Also, on the symmetry issue, a friend of mine who was a marathon runner started getting very bad sciatica in one leg. Long story short, she finally found someone who watched her as she walked and ran, discovering that her right side stride length was shorter than her left, and that she clenched her right fist as she ran and swang her right arm less than her left.
This was all traced back to a childhood fall onto her coccyx which had led to her holding one side of her body tighter as she limped during her recovery. Years and years of running with this asymmetry was causing the problem.
My friend spent many months re-learning how to walk and subsequently run, with even strides on both sides. This involved everything from learning to keep her head pointed forward instead of twisted, relaxing her shoulders and hands, to carefully watching the precise length of each stride and how her feet contacted the ground.
Everything is connected to everything else, right .... how does that song go? cheesy
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Tony Torre
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« Reply #6 on: February 19, 2009, 08:50:38 PM »

Crafty,

You mentioned you did pilates as part of your rehab.  Was it specific exercises or just a regular class?

Tony Torre
Miami Arnis Group
www.miamiarnisgroup.com
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Crafty_Dog
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« Reply #7 on: February 20, 2009, 01:10:35 AM »

Ann Barber.  Guro Inosanto introduced us and trains with her himself.  My work with her was a mixture of Pilates and Gyrotonics (a weird, hard to describe contraption.    Given that Guro I trains with her, I was not at all surprised to find her having deep insight.  I worked under her guidance for about 18 months and as a result my years of tremendous instability in my right pelvis improved to where I now have to go to the chiro only once of twice a year.
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Tony Torre
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« Reply #8 on: February 20, 2009, 09:16:34 PM »

Thank you Crafty.

Tony Torre
Miami Arnis Group
www.miamiarnisgroup.com
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peregrine
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« Reply #9 on: February 21, 2009, 02:30:57 AM »

The foam roller has been a large part of my longevity program. I use it atleast 5 times a week to work out adhesions, scar tissue and subluxations.

Bands are another benefical piece of equipment. Band walks are great for knee and hip stability. They also provide great work on the various structures in the shoulders.

A few of my favorite prehab work are
1. planks
2. foam rolling(all over)
3. band walks
4. inlocate dislocates with a broom stick or band for the shoulders
5. rotator cuff work
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Crafty_Dog
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« Reply #10 on: February 21, 2009, 07:11:01 AM »


"The foam roller has been a large part of my longevity program. I use it atleast 5 times a week to work out adhesions, scar tissue and subluxations."

Yes!  Very good!  Chris Gizzi showed me using the medicine ball in the manner.  Stupidly I regularly forget to do this regularly. tongue
 
"4. inlocate dislocates with a broom stick or band for the shoulders"

What's this?
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peregrine
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« Reply #11 on: February 22, 2009, 04:24:46 PM »


"4. inlocate dislocates with a broom stick or band for the shoulders"

What's this?


Taking a broomstick behind the back and moving it from the ack to front with shoulder rotation only.
http://www.youtube.com/watch?v=xlO-Kv-QeRY&feature=channel_page
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Crafty_Dog
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« Reply #12 on: February 22, 2009, 07:58:38 PM »

Thank you.  Next time we get together, remind me to show you the thoracic mobilization that I learned from Chris Gizzi.
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Kaju Dog
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« Reply #13 on: February 23, 2009, 07:24:59 AM »

Im closely watching this thread.  As a victim of my active youth, I have had a fracture to my S1 (since healed), buldged discs at L5 & T11, full ACL and bilat meniscus reconstructions at both knees (right was bone tendon bone graft) (left was hamstring graft).  My left knee is not recovering well and my Therapist feels that there may be some internal derrrangement (suspecting another surgery in my future).  Both my legs are poorly developed and this in addition to my back are bothersome. 

I am up early this morning and heading to see a Neuro surgeon in Bakersfield to get his input on whether I am a surgical candidate. 

I have spoken with the Veterans Affairs office and I am looking at all options.  Military life is like dog years...  Its a job for young bucks and my body has let me know that.

The last thing I want is another Dr cutting into my back and/or knee(s).

I'll follow up with news from the Dr. 

I may be looking at Medical Seperation...   undecided

As a Physical Therapy assistant for the last 1.5 yrs I have been learning as much as I can about the recovery/rehab life changes.

C-KD
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Blackwolf_101
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« Reply #14 on: February 23, 2009, 07:52:56 AM »

Woof Everyone,

I am happy to see this subject has been posted and has gotten some interest. you have all made some good points and asked some good questions regarding this information.  One of the things I am going to be doing soon ( I hope) is writing an article on the postural benefits of sitting breathing practice. as I stated in my response to Guru crafty's newsletter breathing correctly is one of the key elements to achieving correct postural alignment of the spine as a whole. I use a technique known as diaphragmatic breathing which, if any of you have had singing lessons you most likely taught diaphragmatic breathing. unfortunately I still see people breathing incorrectly even when they have received this instruction previously.

The key to correct breathing is inhalation through the nose, exhalation through the mouth. do not purse the lips as if blowing through a straw. sigh the air back out. i remember reading an interveiw with Lance Armstrong a few years ago and he happened to be talking about breathing when riding in a race or time trial. He reported that it is important to: "make a Big Hole in  your Face" in order move enough air to breath efficiently enough to perform at that level.

It is also important to keep your breathing relaxed and natural in order to avoid kicking in the "accessory muscles of respiration". watch a baby breath as it sleeps. it is not forced, it is relaxed and natural. it is also helpful to breath to a rhythm such as in some meditative practices. I  tell many of my patients to inhale for 4 counts exhale for 6 or 8 counts and then PAUSE before restarting the cycle. This helps to reset the system and help our diaphragm come to it's "Zone of Apposition" which is essential for natural breathing.  Unfortunately I have to get going to work so that is all for now. thanks again guru Crafty for posting my response and I hope this has helped. i will talk more about this (it's one of my favorite subjects  grin. ) Later. 

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Crafty_Dog
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« Reply #15 on: February 23, 2009, 09:14:40 AM »

C-Kaju:

Would love to see you and share what I think is a pretty slick and rather safe little program.   Please feel free to call me at your convenience.
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Kaju Dog
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« Reply #16 on: February 23, 2009, 02:23:57 PM »

C-Kaju:

Would love to see you and share what I think is a pretty slick and rather safe little program.   Please feel free to call me at your convenience.

Sir/Crafty,

That sounds like a great learning experience for me.  I would love a chance to have you share your program with me.  I will be seeing you in April and look forward to our discussions and sharing. 

PS
I just got back from seeing Dr. Wrobel and he confirmed my fracture at S1, and L5 disc problem.  He advised that he could fuse S1 & L5 and attempt to give me some relief of the disc / Nerve pain at the same time. 

Not sure how the Navy is going to react but I have an idea. sad

More to think about and discuss with my elders.   huh

Talk to you soon,
C-Kaju

Blackwolf,

Thank you for sharing you knowledge with us so freely.  I practice some Qi Gong and find when used with proper alignment both stationary and gentle movement that it does aid with my pain management.  It is a discipline that takes consistency and I must admit that I need to practice more of what I preach. 

With all the pressures of Western life, it is often the hardest thing to find/make time to take care of ourselves the way we know we should. 

 smiley  Yip
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foxmarten
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« Reply #17 on: February 23, 2009, 10:42:45 PM »

Hey Crafty

Sorry to hear about you ongoing knee problems.  That is a nasty, aptly named, “terrible” injury…
http://www.sandersclinic.net/terrible-triad.html
An orthopaedic buddy of mine got that injury from skiing and even though he lived in San Diego and could have used the Charger’s doc he flew to Vail and paid cash to get a repair from a guy that does several of those procedures a day.  He says he is lucky to be walking.

Hey Dean
Sounds like you have a surgeon interested in you.  There is an old saying…
“Be careful when you talk to someone who carries a knife...”

Spinal decompression is showing some promise for radiculitis, especially if you don’t have a free fragment and aren't showing a neurological deficit.

http://pt.wkhealth.com/pt/re/pain/abstract.00134456-200801000-00003.htm;jsessionid=Jj2djH8LGJgMz1tpTRthmcgnLl1lWcqgG6D1FsTVhgWvHVxF0bM7!-858031623!181195628!8091!-1.

I can empathize with alignment issues as I have recurrent pain with overuse attributable to sacroiliac dysfunction as well as lumbar disc disease.  I can still claw my way up into an inverted hanging position with my anti-gravity boots, which has helped my sacroiliac and lumbar pain/alignment issues. I still see a chiropractor every so often, which is a little embarrassing since I’m an osteopath.  But all my colleagues around here don’t do manipulation and the students I teach are a bit timid.  But given your knee problems the antigravity boots might bee out of the question and you might want to consider the Back Bubble.  The back bubble is similar to a rescue sling used by the Coast Guard, and uses the weight of your pelvis to effect lumbosacral decompression.  In the upright position you can tolerate this for extended periods of time as opposed to the old school antigravity boots which I can only tolerate for 5 minutes at a time.  It worked well for me and isn’t that expensive when you consider the benefits.

http://www.backpainrelief.com/images/backbubbletherapy.pdf

http://www.amazon.com/dp/B0017G1NWA/?tag=yahhyd-20&hvadid=39587024511&ref=pd_sl_81ffiw9i7b_b

Paul
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Blackwolf_101
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« Reply #18 on: February 24, 2009, 07:22:42 AM »

woof,

it's good to have another medical opinion weighing in on this thread. thanks foxmarten. I feel i have to say however, that in my experience, most mild to moderate cases of spinal stenosis  and disk disease can be effectively managed with non- invasive means. surgery should be a last resort and as a clinical therapist i see people all the time who have had some form of back surgery and continue to have back pain, sometimes worse than before the surgery.  Imho postural re-education programs are very effective if the patient is willing to comply with them and be patient enough to wait for the results which sometimes can take weeks.  I have had a few cases where i was able to relieve a patients symptoms in one or two sessions by simply teaching postural principles and giving them some pelvic repositioning exercises but they are the exception not the rule. unfortunately, some of the  people who come to see me in the clinic have been suffering, sometimes for years and often times have had a previous course of therapy that failed and therefore are expecting failure again so do not stick with the program long enough to see the results.

I feel like modern medicine has done a dis-service to the public in creating a culture that feels like they can go in to see a doctor and get a pill or surgery that will fix em right up, no hassles, no worries. unfortunately, this is not true for many. as guru crafty has pointed out that one of the universal truths is "only you are responsible for you" this is and has been one of my guiding principles for years. i see the best results in the clinical setting and with martial arts when the people i work with take  responsibility for their own experience and their own outcome and work hard to achieve their goals.


Mitkuye  Oyasin (lakota for: "we are all related")
Blackwolf_101
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foxmarten
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« Reply #19 on: February 24, 2009, 10:57:13 AM »

... I feel i have to say however, that in my experience, most mild to moderate cases of spinal stenosis  and disk disease can be effectively managed with non- invasive means. surgery should be a last resort and as a clinical therapist i see people all the time who have had some form of back surgery and continue to have back pain, sometimes worse than before the surgery. 

No argument here, and I suspect that Dean has seen some failed back surgeries in his work at the rehab center. 

http://www.painphysicianjournal.com/2008/may/2008;11;333-338.pdf?PHPSESSID=7ee05aef2de968a9fbcf6c0d0cf8f83f

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2006000500011&lng=en&nrm=iso&tlng=en

http://www.jabfm.org/cgi/content/full/22/1/69

And unless Dean got blown up over there I am wondering if his S1 fracture might actually be a congenital abnormanity...


http://www.uiowa.edu/~anthro/paleopathology/crowcreek/congenital/cxcv.jpg
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Kaju Dog
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« Reply #20 on: February 24, 2009, 01:11:24 PM »

unless Dean got blown up over there I am wondering if his S1 fracture might actually be a congenital abnormanity...


Yip,

My S1 fracture was actually from "fireman carrying" a 6ft 300+lb Marine (including full combat load on both of us) and then lifting him into the back of a 5 ton truck.  He was #5 out of 5 from the Humvee when I felt my back give and shift.  I couldn't move for some time immediately after and was in the field for another night before getting help back to the BAS.  I continued to do my job and self medicate for about a year before finally getting sent for an MRI after both legs went numb.  Initial diagnosis (pre-MRI) was muscle strain.  LOL  "Corpsman don't go to sick call" is what I was told back then. 

In respect for the Neuro Dr. he advised that even though he could do the surgery, that he would rather me get it done down the road.  Partially due to the high risk involved and that he is moving in April and does not want to do it at this time.

Big Navy will be looking to put me out between now and July.  Then I am at the mercy of the VA system.

TAC undecided
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maija
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« Reply #21 on: February 28, 2009, 10:17:47 AM »

C-Kaju Dog
Sorry to hear you are dealing with this .... but great to hear that you are practicing Qi Gung.  grin
Though, as you point out, it is something that you have to do (ideally) every day, it really is worthwhile, so I'm sending you a message of encouragement to keep at it! I've found it very helpful for spine, and in fact any joint issues.
It's also helped me very much with keeping an old ankle injury at bay - I pulled the ligaments around my ankle almost 20 years ago whilst fell running in the mountains. Of course I was young and so never went to see a doctor. undecided For a couple years, I limped pretty badly every morning when I got out of bed, though through the day it would get better. I was finally recommended taking Arnica (worked great) and now I spend a couple minutes every morning doing some foot and ankle Nei Gung. This along with the Tai Ji and Bagua I practice keep it healthy. OTOH, If I DON'T do the exercises for a while, the ankle starts to hurt again ...... They say that each time you practice is like putting one sheet of paper ontop of another ... at first it doesn't look like much, but after a while you have a big pile. cool
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Crafty_Dog
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« Reply #22 on: February 28, 2009, 10:37:06 AM »

C-Kaju:

Until I see you in a few weeks, I would orient you towards peak contraction of the glute hamstring nexus as a foundation for hip flexor (psoas, ilio, quads) release.

CD
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Blackwolf_101
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« Reply #23 on: March 01, 2009, 06:29:06 AM »

Woof

I agree with with what Crafty said and would like to add peak hip adductor contraction as well.  The IC (Ischio-Condylar) or Adductor magnus is the third Piton in the pelvic stabilizer triad.  the triad includes: Glutes, Hamstrings and adductors.  work on your lateral movement also you'll be amazed at how much that can get the medial quads and adductors firing.  grin
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« Reply #24 on: March 01, 2009, 08:11:07 AM »

"The IC (Ischio-Condylar) or Adductor magnus is the third Piton in the pelvic stabilizer triad."

Please expand upon this!!!

Do you have a URL of a picture of it?
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foxmarten
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« Reply #25 on: March 02, 2009, 07:46:48 PM »

Hi Crafty
C-Kaju:

Until I see you in a few weeks, I would orient you towards peak contraction of the glute hamstring nexus as a foundation for hip flexor (psoas, ilio, quads) release.

CD

The approach you describe is similar to what some osteopaths use to achieve normalization of the lumbosacral mechanics in chronic lumbago.
http://en.wikipedia.org/wiki/Muscle_Energy_Technique
With Dean I am a bit worried that lengthening his psoas muscles might lead to increased symptoms as a result of an increase in his lumbar lordosis.  Many patients with disc disease essentially flatten their spines in order to take the pressure off the inflamed nerves...especially if they have a free fragment.  Axial decompression might be the best initial approach.

Hey Dean

The above is from me with my "family doc hat" on.  But when I reflect on what I witnessed during my psychiatry residency at the VA hospital in San Diego I feel obligated to encourage you to actively pursue as much service connected disability as possible during your separation from the Navy.  The access of a service connected vet to prompt care can be far superior to that of a 0% service connected vet.

Paul

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« Reply #26 on: March 02, 2009, 10:03:39 PM »

removed details for CYA resons.  (I was thinking next time to just PM you with specifics but I feel you have had time to digest)
I will be writting my story soon and documenting all for the VA to have on file.  I only pray that they do me and my family fairly.

PPS
If not for Crafty, my Kaju Dad and all my Warrior Brothers...  I dont know how I would cope.  My fights with you at the gatherings have a very therapudic affect on me and give me something to look forward to "For all my days".


The PAIN lets me know that I am still alive.  My Ohana and the Tribe give me comfort.
..... 
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« Reply #27 on: March 02, 2009, 10:19:48 PM »

Paul:

I am a layman and you are a doctor.  

That said, I truly am not sure we are not yet fully communicating.  Is your URL's point PNF?  If so that is not what I am describing at all.  

I think I fully understand your point about the patient flattening out his lordisis to diminish pain.  I saw this up close with Guro Inosanto in the mid-late '90s.  He had lost his lordosis entirely and was in great pain.  Guro I. has flattered me by thanking me for telling him that BJJ would be good for his back (I introduced him and the Machado brothers and drove him to his first lesson as well as often served as a body upon which he would practice as well as introduced him to his yoga teacher Sara Petit)

I do not understand your concern that releasing the psoas et al will increase lordosis- quite the contrary!  Please help me understand.

BEGIN:

"Reciprocal inhibition
Reciprocal inhibition uses the body's antagonist-inhibition reflex to induce relaxation of a "tight" muscle. For example, when the biceps (in this case the agonist) is flexed, a reflexive inhibition of the triceps (here the antagonist) is induced. Thus loss of range of motion in the triceps can be incrementally restored by flexion of the biceps."

"[edit] Post-isometric relaxation
Immediately after isometric contraction, the neuro-muscular apparatus becomes briefly refractory, or unable to respond to further excitation. Thus, stretching a muscle immediately following its isometric contraction may incrementally restore range of motion."

This sounds like basic PNF if I understand correctly.  If so, I perceive what I have in mind as a bit different.

My thought process includes the idea that tight psoas and other hip flexors (and weak activation of the hip extensors in the peak range of motion!) lead to compression of the lumbar region with attendant pain.  As I understand it, the flattening of the lordosis that Guro I. was a palliative, but not a solution.  

C-Kaju, quick question.   Stand without thinking.  Look down at your feet.   What do you see?  Are they parallel or does one or both of them point outwards?  Additionally, stand in front of a mirror without thinking-- are your thumbs parallel or do they point inwards?

Edited to add that this was posted before seeing C-Kaju's post immediately prior to this one.
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« Reply #28 on: March 02, 2009, 10:38:31 PM »

C-Kaju, quick question.   Stand without thinking.  Look down at your feet.   What do you see?  (my big belly - LOL) Are they parallel or does one or both of them point outwards?  

A:  Both point outwards, left leg is slightly forward.  L big tow sits at roughly 45 degrees and right 65  degrees.


Additionally, stand in front of a mirror without thinking-- are your thumbs parallel or do they point inwards?

A:  Both inwards aprox 80 degrees with the right arm slightly forward about an inch. 

Edited to add that this was posted before seeing C-Kaju's post immediately prior to this one.

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foxmarten
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« Reply #29 on: March 03, 2009, 12:50:03 AM »

Hey Crafty
The flattening of the spinal curve is indeed palliative, decreasing range of motion and opening the foramen to take the pressure off the spinal nerves. Good stuff in an acute injury...or chronic injuries associated with athletics.  Dean's post also lists spinal stenosis.  In lumbar spinal stenosis confort and exercise tolerance is increased by forward bending/flexion. 

I think that we are slicing the same pie, just in different dimensions.  Osteopaths, kinesiologists, chiropractors and PM&R docs all use different nomenclature. The glute maneuver you described in most situations will also be accompanied by a stabilizing contraction of the lumbar paraspinal muscles and a reflex inhibition of the psoas complex, unless an assistant isolates that area via positioning and bracing.  Very effective in restoring muscle balance and normalizing pelvic tilt.  In my experience this is best instituted after relaxing the lumbar paravertebrals and decompressing via axial traction.  Increased psoas tenson may indeed contribute to disc induced symptoms, its just addressing that is usually third in my approach.

Hey Dean

I'm glad you are documenting everything.  Too many of my patients at the VA kept their symptoms to themselves, self medicated and then faced an almost insurmountable task of appeals and legal challenges in getting the benefits due to them as a result of their service to our nation. 

Best wishes,

Paul
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« Reply #30 on: March 03, 2009, 01:14:09 AM »

Paul:

Thank you.  I agree with your comments.   Please continue my education if you would by expounding a bit on spinal stenosis.

Comment:  In the progression that I favor, I seek to align with Mother Earth first-- i.e. work from the feet up.  There is a series of exercises that I have evolved using a medicine ball towards that end that I have not seen put together in similar fashion elsewhere but I have run it by qualified people whom I respect to very positive reviews.

Dean's comments on his feet and thumbs were EXACTLY what I expected.  MOST people have imbalance between external and internal rotation of the femur and this imbalance creates pressure discomfort at the sacrum-- and is part of the chain that creates internal rotation of the shoulders, as flagged by the thumbs.  By the criteria which I believe to be true, the feet should naturally come to rest at parallel, as should the thumbs. 

As the progression I use works its way from the ground up and arrives at the femur-hip joint I use two exercises to release the piriformis and the IT band, and one to activate the adductors.  It is then that I go into the glute-hamstring peak contraction as foundation for releasing the hip flexors.   For cases requiring lots of attention, there is also a particular quad stretch that hits it in its funtion as secondary hip flexor too.

THEN the progression activates the lumbar and continues up the spine with a unique thoracic activation exercise that I learned from Chris Gizzi.  Then it is time for classic rotator cuff stuff.  By the time we get to here, both the feet and the thumbs should be parallel when standing without thought.

There are some additional points concerning the positioning of the neck, head/ears, but with the foundation properly set, they come easily enough.

First and final point.  I ALWAYS let people know that I am self-educated, tell them my intention, and receive agreement that only they are responsible for them and to do only what they are comfortable doing. 

In the case of acute injury-- e.g. as here with C-Kaju, there will be extensive conversation first.  In his case, the conversation will be greatly enabled by his substantial medical knowledge.
================
PS: Reminder!!!

""The IC (Ischio-Condylar) or Adductor magnus is the third Piton in the pelvic stabilizer triad."

Please expand upon this!!!

Do you have a URL of a picture of it?"
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foxmarten
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« Reply #31 on: March 03, 2009, 11:17:28 PM »

I am assuming that Dean's issues relate to the lumbar region...
http://www.niams.nih.gov/Health_Info/Spinal_Stenosis/default.asp
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Blackwolf_101
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« Reply #32 on: March 04, 2009, 06:52:24 AM »

Hey there  Crafty, I haven't forgotten  smiley, In fatc look for an article I am writing on pelvic stability. my intention is to get it posted this weekend. i am tied up at work getting caught up on paperwork and so am spending extra hours there. but look forward to getting back to this subject.
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« Reply #33 on: March 04, 2009, 08:55:53 AM »

Thank you, looking forward to it! cool
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« Reply #34 on: March 04, 2009, 08:18:36 PM »

I gave a workshop this past weekend on Russian and Indonesian Joint Mobility. It was done in tandem with Guru Santiago Dobles doing his Kundalini Awakening Process. I had some hard players there including many veteran martial artists, and Coast Guard Rescue Diver/Crossfitter, Yoga instructors, etc. Everyone seemed to be shocked about how adaptable the material was.
I'm constantly trying new methods of Yoga, mobility, and training and beginning to understand how powerful pure alignment is.

This past fall I gave a workshop in Vegas with a cast of incredible teachers. Jon Hinds of Monkey Bar gym told a story of alignment and training that HUGELY changed my game. His Eischen's Yoga is a cool view of healing and I am a fan.
My description of the workshop is here, www.tom-furman.blogspot.com , and I avoided talking about myself, since that gets boring fast wink

I'm interested in more of the Burmese Yoga from Dr. Gyi. It looks to be very powerful. I'd highly recommend Andrey Lappa (check youtube and Amazon for his dvd) as a very, very, very, adept teacher.

This is a great thread.
------Tom Furman
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foxmarten
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« Reply #35 on: March 05, 2009, 12:46:46 AM »

Dean
I understand the CYA deletion all too well.  You are essentially going through a divorce.  You should talk to a VA advocate and consider legal counsel.  Otherwise it's like trusting your ex's lawyer to hand you a fair deal.  My hope is that you will get a great result from surgery, get an RN degree, and hire on to Corrections or DMH and make the 100K a year that nurses are making these days.  Talk to Dog Pound about this.  Feel free to PM me if you want more on this topic.
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« Reply #36 on: March 05, 2009, 01:08:52 AM »

Foxmarten:

Thank you for the piece on spinal stenosis.  My sense of it is that is exactly why it is important that the femurs be balanced between internal and external, the hip flexors be released, and the hips be balanced.   I suspect in a large % of cases that sustained tension from the flexors contribute mightily to the stenosis.

Am I missing something here?
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« Reply #37 on: March 05, 2009, 04:04:01 PM »

Professor Ron Chapel,, the Kenpo Master had this spine issue (stenosis). He was very articulate on it as he spoke late one night in Cliff Stewart's house.
I'd suggest you look him up. His knowledge of Physiology is really good. He is quite a martial artist too.

---Tom Furman
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Howling Dog
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« Reply #38 on: March 05, 2009, 05:57:00 PM »

Woof C-Kaju, I know your a patriot and a honest hard working man.....and I must admit that I'am concerned that you won't pursue all that you are entitled to for your service.
Foxmarten is giving you some good advice.....and now is the time to think of your family and yourself.
Please pursue aggresevliy all that you can get from the U.S. Navy.
You have earned it and as a tax payer I owe it to you.
Hope to see you again soon! Take care and God bless!
                                                                 C-HD
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« Reply #39 on: March 05, 2009, 06:43:10 PM »

Woof C-Kaju, I know your a patriot and a honest hard working man.....and I must admit that I'am concerned that you won't pursue all that you are entitled to for your service.
Foxmarten is giving you some good advice.....and now is the time to think of your family and yourself.
Please pursue aggresevliy all that you can get from the U.S. Navy.
You have earned it and as a tax payer I owe it to you.
Hope to see you again soon! Take care and God bless!
                                                                 C-HD


Spoken like a TRUE Dog Brother.  Thank you and believe me, I am taking the bull by the horns and turning all my energy toward a possitive outcome for my family and I. 

I am a FIGHTER, this is just another mission and "I shall not fail".   BOHICA
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foxmarten
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« Reply #40 on: March 06, 2009, 11:18:35 AM »

Comment:  In the progression that I favor, I seek to align with Mother Earth first-- i.e. work from the feet up.

Hey Crafty

I too tend to use that approach in the nonacute person.  I usually start with measuring leg lengths.  If there is a true anatomic discrepancy as little as a 1/16" shim in one shoe can make a big difference in preserving alignment.  I then square up the pelvis.  Many folks have a chronic sacral shear or iliac flare resulting from a significant fall or more often repetitive trauma such as putting your right foot into your vehicle and then falling onto your right buttock in order to get behind the steering wheel.  This link to a two part article describes the approach most chiropractors and osteopaths learn:
http://www.chiroweb.com/mpacms/dc/article.php?id=8998
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Crafty_Dog
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« Reply #41 on: March 06, 2009, 12:51:17 PM »

ONce I had a chiro tell me one leg was longer than the other and put a shim-- and it gave me a bad knee.   I prefer to think of it as aligment issues with the hip-- as discussed in the URL you cite.  I will give it a good look.  Thank you.
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foxmarten
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« Reply #42 on: March 06, 2009, 09:04:35 PM »

Indeed! An aggressive or ill-advised shim can cause anything from knee pain to headaches.  These are best used for an anatomical short leg with ongoing correction of functional contributions to the short leg such as SI shears.

http://books.google.com/books?id=WbThUt45ZXgC&pg=RA1-PA671&lpg=RA1-PA671&dq=short+leg+shim&source=bl&ots=T7FxmtGDQt&sig=TbAm39IBR96IS3L3DsKIHvQMHMU&hl=en&ei=reKxSaKGNJGUsAO99oF4&sa=X&oi=book_result&resnum=2&ct=result

But anytime we interverene we risk iatrogenic damage...even the most minor surgical procedure (a haircut) can result in an adverse outcome.  We pay our money and take our chances!
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« Reply #43 on: March 11, 2009, 08:47:14 AM »

Perhaps of interest

http://www.sportsinjurybulletin.com/archive/1090-lower-back-spams.htm
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Blackwolf_101
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« Reply #44 on: March 15, 2009, 01:13:23 AM »

Ok Here it is Finally.... a variety of issues kept me off the computer last week but here is the article promised.


Let’s talk about the lumbo-pelvic-femoral system.

      Pelvic alignment is the keystone to correct alignment of the rest of the frame. Without pelvic alignment and even more important, stability, you simply cannot correct either up or down the chain. I have seen this demonstrated over and over in the clinic with patients having complaints as wide ranging as neck pain to plantar fasciitis. Patients will do ok with traditional therapy techniques but often times come back or never fully get back to 100% until we start looking at the pelvis and alignment/stability thereof.

     There are three key anatomical structures that we must look at when determining pelvic alignment and stability: the inominants or iliac bones and their influence on the SI Joint, the AF Joint (Acetabular-Femoral), and the lower lumbar spine itself.  There are a variety of common complaints associated with these structures that are directly related to misalignment. To name a few: SI joint Dysfunction with associated back pain, Sciatica, some forms of Spinal Stenosis, Degenerative Disk disease, degenerative joint disease, Snapping hip syndrome, piriformis syndrome, Patella/femoral syndrome... the list goes on. According to Ron Hruska of the Postural restoration institute, the most common misalignment problem encountered in the clinic stems from a functional patterned instability of what we call The Left AIC (the Left Anterior Interior Chain). The Anterior-interior chain consists of: Two tracts of Muscles, one on the left side of the interior thoraco-abdominal-pelvic cavity and one on the right, muscular structures include: the Diaphragm, psoas, iliacus, tensor fascia latae, biceps femoris and vastus lateralis. This group of muscles provide support and anchor for abdominal counterforce, trunk rotation and flexion1 This patterned misalignment results in the following anatomical misalignments: anterior tilted pelvis in either the hemi pelvis or bilaterally, a varying degree of habitual pelvic rotation, usually to the right (clockwise), excessive right AF joint internal rotation and left AF joint external rotation, rotation of the lower lumbar spine often in the opposing direction. This pattern is considered multidirectional do to its sagital and oblique influences. This pattern results in habitual compensatory movement strategies. These compensatory movement strategies may manifest in the following joint movement deficits: excessive lumbar lordosis locking the facet joints and limiting rotational movement of the lumbar spine and placing excess stress on the lumbar disks,
decreased right hip extension, poor adduction of both hips with the left hip being worse than the right, sacral torsion with associated Sacroiliac joint dysfunction, mal-alignment of the iliac bones resulting in an apparent ( false )leg length difference.

      There are a number of variations of this pattern that people can present with in the clinical setting, quite often I meet people who have let their pain go on for too long and have developed compensatory movement strategies that leave them bilaterally symptomatic.  With this in mind, we often have to try and put the fire out, so to speak,
Before we can do any real investigating into what the underlying problem is. Usually however, a weakness in one or more of the following areas is associated with most patients’ lumbo-sacral-femoral pain: glutes, both maximus and medius, hamstrings, abdominals and IC (Iscio-Condylar) adductors.  Let’s talk about each of these areas in order to better understand their job duties and purpose.


GLUTES- 

        Gluteus Maximus is primarily known as a hip extender and external rotator. The attachment points or insertion/origin of the glute-max is from, the lateral border of the sacrum, the lateral face of the PSIS (posterior superior iliac spine) and the femur directly below the anatomical neck of the femur as well as fibers running to the Illio-tibial band.  It has the following duties: creates extension of the femur within the Acetabulum. It also “compresses the femur into the acetabulum” creating AF joint stability.  It also approximates the Sacrum to the innominant i.e. iliac bone. It’s purposeful chain of cause and effect goes like this: Sacrum to innominant-sacrum to femur- femur to acetabulum.
     
        Gluteus Medius- Primarily known as a hip abductor and lateral pelvic stabilizer. The attachment points for it are at the lateral upper third of the iliac bone and the later surface of the Greater Trochanter.  It performs the following duties: In open chain- abduction of the femur on the acetabulum. In closed chain- approximates or pulls the acetabulum onto the femur again stabilizing the AF joint and providing joint stability. It is also responsible for elevation of the opposing pelvic crest during gait.  The anterior fibers of the glute-medius also internally rotate the femur on the acetabulum.

         Gluteus Minimus- An internal rotator of the femur on the acetabulum. Attachment of the glute-minimus is from the anterior third of the lateral and middle third of the innominant bone to the anterior Greater Trochanter of the femur

ABDOMINALS-

           An extremely important and complex area, the abdominals perform a variety of functions. I am going to restrain myself from attempting to list the numerous functional duties at this time for fear that I would forget something important.  Instead we are going to focus on the duties of the abdominals relevant to pelvic stability. The abdominal complex is made up of fibers running both sagitally (forward and back), frontally (side to side) and obliquely. These fibers are known as:  abdominus rectus, external and internal obliques and transverse abdominus. Collectively they provide stability to the trunk as well as stability to the lumbar spine and lower ribs creating counter force and opposition to the diaphragm. They also assist with support to the internal organs through maintaining intra-abdominal pressure assisting with peristalsis and elimination of waste.  They also provide support for the anterior pelvic rim and maintenance of neutral pelvic rotation in the sagital plane.  How many times have we all seen someone with a distended abdomen due to stretched out abdominals also demonstrating excessive lumbar curvature and complaining of back pain?  I have read studies in the past that have concluded that most patients seen in the therapy clinic with a diagnosis of “low back pain” DO NOT NECESSARILY HAVE A WEAK BACK! Their pain can instead be related to a dysfunctional transverse abdominus which no longer contracts to provide compression of the abdominal contents and stability to the lumbar spine but instead it functions only in an eccentric manner providing a rigid but distended wall which utilizes surface tension in the expanded and rigid muscle fibers to assist with lifting pushing and pulling activities. The next time you attempt to lift a heavy object or push or pull a similarly heavy object pay attention to how you breathe. Do you inhale sharply and then hold your breath in an attempt to “brace yourself” for the task?  Or do you “exhale with exertion” utilizing a much safer and preferred abdominal contraction to engage all the core muscles for support.


HAMSTRINGS-

   The hamstrings consist of the: Biceps Femoris, semitendinosis and semimembrinosus. The hamstrings are known primarily as flexors of the knee they also act as extensors of the hip in closed chain and stabilizers of the knee for gait activities. They can also play a role in external and internal rotation of the femur depending on position. It is in the closed chain (feet planted on a surface) that they also become stabilizers as well as primary posterior rotators of the pelvis.  With a large portion of low back pain complaints demonstrating excessive lumbar lordotic curvature and accompanying anterior pelvic tilt of either one or both of the iliac bones, positional strengthening of the hamstrings becomes a primary focus in achieving a neutrally rotated pelvis with respect to it’s sagital alignment.  Isometric contractions of the hamstrings in the 90/90 position re used to positionaly strengthen the hammy’s for pelvic stability.


ADDUCTORS-

   For our purposes here we are only concerned with that portion of the adductors, Adductor Magnus in particular, that we will refer to as the IC adductor the IC adductor is that portion of the Adductor Magnus that runs from the medial portion of the Ischial Tuberosity and run to the medial condyle at the adductor tubercle. This portion of the Adductor Magnus is part of what is sometimes known as the “hamstring portion of the Adductor Magnus2.  This portion of the adductor is primarily an internal rotator. An important part of the“pelvic repositioning” protocol is utilization of what is known as Left AFIR (Acetabular-Femoral Internal Rotation) positioning.  It is the last key in re-establishing normal closed chain functional movement in the pelvic-femoral part of the lumbo-pelvic-femoral complex. Why is this important!? The million dollar question!  Because Left AFIR is NECESSARY FOR NORMAL WALKING MECHNICS! And far too many of us (meaning all of humanity) spend way too much time bearing the majority of our weight on our right leg leading to an excessively tight left AF joint capsule and a stretched and unstable Right AF Joint Capsule. Think about this… How many Times a day do you stand on your Right leg and Reach into the fridge with your right hand or open your car door or your office door or the door to your home with your weight on your right leg and reaching with your right hand. How often do you stand around chatting with friends or co-workers with 70-80% of your weight shifted over your right side and your belly button over your right pinky toe?  Or how about this watch other people without letting them realize you  are paying attention to their movements see how often you  catch them standing for lengths of time with their weight shifted almost exclusively to one side or the other (usually the right side). You may be in for a shock once you start keeping track of all the single leg standing you are doing in a day.  Now keep in mind that shifting our weight back an forth from one side to the other is Not a pathological pattern and in fact is something I try to promote in the clinic, it is the habitual and excessive single leg standing that becomes a pattern early in life and results in adaptive shortening of the posterior joint capsule of the Left AF joint (usually) and the adaptive lengthening of the Right AF joint posterior capsule over time that lead to compensatory movement patterns. This in concert with adaptive shortening of the Hip Flexors including the Psoas, Iliacus and rectus Femoris as well as tensor fascia latae  result in the pelvic misalignment patterns which can become pathological postural dysfunctions


      If you have made it this far I would like to thank you for bearing with me and hopefully what I have put down here gives you some insight into how the glutes, hamstrings and adductors as well as the abdominal muscles influence Pelvis alignment as well as stability. I have not included any exercise information or pictures at this Time as I need to get permission from the Postural Restoration Institute to share some of their color images from the Pelvic repositioning protocol.  The Black and white images I have at my disposal in an instructional manual do not scan well and would be virtually unusable as jpegs.  In the meantime I will do my best to answer any questions regarding general pelvic stability issues.  I unfortunately must avoid answering anything that might be misinterpreted as diagnosing a specific problem or as delivering a treatment as it could be considered practicing without a license depending on the state you are asking from  
I will post specific exercise images when they become available to me. Thanks everyone


Blackwolf_101
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Rich Artichoker

     

       
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peregrine
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« Reply #45 on: March 16, 2009, 12:06:32 PM »

Blackwolf-

would a generic prevention to this be and for rehab some of these exercises are of benefit
*band walks
*glute bridges
*walking lunges
*plie lunges(step behind diagonally and down)
*a well rounded abdominal program(or focused ab program depending)
*leg circles(lying on your back independantly rotating each leg- small to big circles)
*single stiff legged deadlift with dumbells or single legged romanian dl
*rope skipping doing various movements- slalom, skip, single legged, backwards, butt kickers, high knees(plyometric, proprioception, agility, numerious benefits)
*Y, T, W shoulder stability(all that stick movement)
*instinct training- no when to skip or go light, no when to turn it on
*planks
*oh squat

as well as complementary stretches for each of those movements

along with foam rolling to break up the adhesions in the lumbar and thoracic cavity, itb, hamstrings and quads.



This article complements Blackwolfs one.
http://posturalrestoration.com/media/pdfs/Pelvic_Stability_Article.pdf
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DougMacG
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« Reply #46 on: March 19, 2009, 01:54:47 AM »

Thanks for all the contributions here - what a wealth of information. The alignment  topic has been central to my life for about 35 years.   When I was 17, I was hit hard as a pedestrian by a car going roughly 50. I was hit on the lower left leg.  There was swelling like a basketball and about 50% overlap on the tibia and fibula. They decided that the set was good enough to heal and fill in, and I was plastered from hip to toe. 

On the first follow up the swelling had gone down and the alignment was checked by x-ray and modified by cutting and shimming the cast at the break with a cork and re-plastered over it.  Still the inside of the cast was loose and the resulting alignment was better but still off. 

I had doctor reports about alignment.  If I recall, the lower half of the lower leg is angled forward and out by 11-14 degrees, the foot is angled a little inward and the knees are fairly loose and slightly knock-kneed on both sides.  Amazingly, only one doctor thought to measure length and discovered that I lost 7/8 of an inch.  If I didn't notice almost an inch, there are people out there unaware of a 1/16 that foxmarten says should be addressed.

When I exercised and trained and built muscles around the knee I felt pretty good.  When I didn't play sports I would also lose the strength to stand or walk much.  My senior year in college I went on a mission to decide what to do about the alignment .  At each stop the first orthopedic surgeon would call in a colleague and then the department head.  It was amazing to me that I could sway their recommendation by whether I complained or downplayed my symptoms.  It seemed like there was little science to it.  I saw the head of the orthopedic department at the Mayo Clinic.  He wouldn't say he recommended re-breaking to correct the alignment, but said he would do it if that is what I wanted and we set an appointment for an osteotomy.  They would re-break higher on the bone than the original break and take out a notch for alignment.  I would actually have lost even more length.

I saw another specialist who recommended against it, wouldn't take on the risks of non-union, non-healing etc.  I canceled the procedure, got on with my life and have rarely looked back.

I tried to find out about a lift for the shortened leg.  Heal lifts were no good because they change the ankle position which is instant pain for me. I walked into medical supply places, asked questions and finally got a referral to a custom orthopedic shoe provider.  They build a 7/8 inch full length lift on a leather shoe, high topped to prevent ankle rollover and I wear it for everything, even golf. I felt better instantly and could feel years of damage go from 'hurt to heal to harmonize'. 

Now I'm 52 and doing well.  It's hard to tell which aches and pains are from sports, which are from aging and which are from this battle.

Some comments and observations:  Kids often notice the unmatched shoe heights instantly while many adults I've known for decades have no idea.

As I think Richard wrote, the alignment and function at the hips is the key to the back and spine.  Sitting and standing too long are strangely harder for me that playing up to 10 sets a day of tennis. 

Maija: "Everything is connected to something or how does that go?" - Lol.  When I tell people that their knees are connected they think I'm crazy, but the knees are only separated by a couple of hips, and the alignment on one side directly affects the other.  Limping to favor one side hurts the other. 

Paul (Foxmarten): the joke about being careful when you talk to someone who carries a knife is prophetic for me.  I've already got more good years without surgery than they would have predicted with it.  They were not selling a fast, certain or complete recovery.

Interesting point about the knee hurting with a shim.  In the ski boot business they do something called canting.  My racing boots have allen screws that allow you to set the sideways tilt of the boot to the footbed so that the ski will sit flat on the snow as you stand naturally. 

« Last Edit: March 22, 2009, 10:32:48 AM by DougMacG » Logged
maija
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« Reply #47 on: March 19, 2009, 08:33:11 AM »

Hi Doug!
Wow, quite a story .. glad you have overcome it so well!
Quote " Limping to favor one side hurts the other."
No sh*t! With horses, if there is lameness in one leg, you stabilize both, otherwise the other gets over strained.
Also, can't remember if I wrote this already, but I've been told that the knees are not designed to be weight bearing joints but weight transferral joints, taking the weight of the upper body from the hips to the ankles and feet, and so to the ground. It makes complete sense to me then, that if the ankles, knees and hips are not aligned correctly, some of this weight is going to get 'stuck' in your joints to cause trouble over time.
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Blackwolf_101
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« Reply #48 on: March 21, 2009, 08:38:21 AM »

Woof Guys,

In Response to Peregrine's question, i apologize I didn't get back to this sooner, the weekend is always just the best time for me to write.


   Yes, while those exercises are Good ones for core stability in general. i still feel it is important to start more simply, Even though Ron Hruska wrote the article you posted I think He was writing for other therapists who have had some experience with the Myokinematics system and have had some questions regarding how to progress  patient beyond the basics. IMHO, To start with some of the exercises you had mentioned would be  little like showing up for the first day of Kali class and the instructor saying, " ok, were going to start with a variety of sinawali activities today".  When i Took Ron's course he stated that the Girls he works with in his capacity as Strength and conditioning coach at the University of Nebraska women's Volleyball team, that his girls don't progress to "Closed Chain" (standing or any activity in weight bearing position), until they can demonstrate ability to perform certain strength tests.  Just Like any methodology there is a progression of activity to The PRI method requires that you spend some time strengthening these specific Muscles groups before attemting to integrate functional movement pasterns into your routine.

here is a list of Exercises  instruct people in to get started:


                   1)      Supine 90/90 Position (on your back with feet on wall) Hip Lift.  i think the name throws people off on this one, i see people in the clinic performing bridges constantly and it is actually meant to be a posterior pelvic tilt for the purpose of creating lower lumbar flexion and activation of The hamstrings, and only the hamstrings, in order to create lower lumbar flexion. once A patient has the hang of this one I will sometimes encourage them to, " pull your belly button toward your spine" in order to engage the transverse abdominals but i always make sure they start with just a simple PPT (posterior Pelvic tilt) I always encourage Diaphragmatic breathing during all exercises.

                   2) Either supine 90/90 or sidelying 90/90 right Hip shift with right Hip external rotation vs. theraband if the patients tolerance will allow. This is isolate and engage the Glute max the sidelying position is my preference for this exercise because you are adding the effects of gravity to increase the difficulty. In The Clinic we often start with only the Right glutes and this is only because in a pathological/symptomatic patient often displays the hallmark weaknesses of the Left AIC Pattern which are as follows: weak Right glute, weak Left hamstring and weak Left IC adductor.  for your average person i would recommend you start focusing on the right glute max utilizing a moderate resistance exercise band and progress to doing the exercise bilaterally upon progressing to the next level of exercise band  The reason we just start focusing on Right Glute max is that Ron has seen enough patients in his career and done enough research to feel it is safe to assume that most ,if not all of us, have some degree of the Left AIC Patterned alignment dysfunction at work.  The Hip shift part of this exercise is performed in the following manner, you Lay on your Left side with the knees together and hips and knees bent to somewhere between 60 and 90 degrees, its a comfort issue but you may have to adjust leg position in order to perform the exercise correctly. You may place a folded towel between your knees for comfort. you would then place an exercise band around your legs just above the knees. you will have your left foot pressing into the wall to anchor, the right foot less so because it must pivot. you begin by shifting your right thigh and hip forward until you feel the adductors in your left thigh  grab. You may also feel a stretch in the posterior part of your left Hip. You Then externally rotate your right hip or in other words raise the right knee toward the ceiling being very carefull to maintain the right pelvis in a forward rotated position and as well as maintain the sensation that the left adductors are biting you just a little bit. It is very important to keep the back flat and  right hip rotated forward during this exercise.  Hold This position and Breath five big breaths, inhaling through the nose and Sighing the air out through the mouth. you will perform 5 -7 reps of this exercise and believe me, if you are doing it right this will be enough. Patients in the clinic often ask me "How do I know if  am doing this exercise correctly?"   tell them if you feel any muscles other than the left adductors and the right glutes working then you are doing it incorrectly. Common mistakes include:  using the toes on the right foot to push into the wall engaging both the right calf muscles and the right hamstrings, allowing the right hip to roll back upon externally rotating due to glute weakness and habitual over usage of the lumbar paraspinals , pushing the hips back with the left hip engaging the left glutes and hamstrings. these substitutions are common and i end up correcting these three mistakes the most often.


         3) Supine 90/90 Hip Lift with Left hip shift (Down) For This exercise you start in the same position as you do for the initial exercise i listed above. The only difference here is that we will be using a small ball (4-6) inches between the knees.  once up in the exercise position with the pelvis posteriorly rotated, you then will drop the left hip down making sure to keep the right thigh pointed straight at the ceiling. this will look as if you left thigh suddenly became shorter. how far you can or will drop your lef hip will depend on how much play you have in your left hip joint capsule. Here the goal is again to engage the Left IC adductor so you will hopefully be able to drop the left hip down far enough to feel that muscle engage and Bite a little bit. Ok ,you should now be in supine 90/90 position with your feet on a wall and with your pelvis slight lifted and in a  posterior tilt. you should also have the left hip dropped down enough to feel the Left IC adductor biting at you right in the left groin area. You Now squeeze inward with the left knee and only the left knee to create a maximal Adductor contraction.  with this exercise you will also be engaging your hamstrings so you should be feeling a strong hamstring contraction as well as maximal adductor contraction. to progress this activity you can perform a hemi-bridge by simply lifting your Right foot off the wall, this will allow you to create a maximal hamstring contraction on the left as well as maximal IC adductor contraction.
 
 have progressed this exercise in my own routine to utilize bilateral hipshifts and hemi bridges in order to alternately strengthen right and left hamstrings/adductors  feel this has helped improve my BJJ Gaurd immensely. Just ordered a new video camera and it should be here next week  I will post video of me performing this exercise on you tube under My account "Totalkombatarts" sometime next week.

There are of course a variety of exercises that one can do that will strengthen all of the muscles i have outlined here. I recommend these particular activities because we are not only talking about strength we are talking about training a muscle to perform a specific task, the task of stabilizing the pelvis,  and in as such we must remember that specificity in the training task is also important. these are the exercise i teach in the clinic to anyone who comes to me with problems related to instability of the back or pelvis. i also perform these exercises in my home routine in order to maintain pelvic stability for other activities.  Good luck wth these activities i hope this helps Smiley  I will try and get video of each of these activities posted on my you tube account soon. if you can't find my you tube account then simply go to my website www.totalkombatarts.com ad follow the you tube link from there. i probably wont be able to get anything posted till later in the week so keep checking.

Thanks everyone have a Nice weekend!


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Blackwolf_101
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« Reply #49 on: March 21, 2009, 08:52:11 AM »

Woof

Sorry for the many Typos i had  in my last post, it was early  didn't have my tea yet yet  shocked lol.

If you guys get the chance, everyone should read the article That Peregrine posted a Link to Ron is the master of Pelvic stability i would recommend starting with the activities I have just outlined and progressing from their as yu become more aware o the muscles that stabilize your pelvis.
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