Lumbo-Pelvic Region

Movement Analysis, Sub-classification & Neuromuscular Retraining for Functional Movement Control of the Lumbar Spine & Pelvis

Course description

Back pain can be caused by trauma but frequently it is insidious, recurrent and an ongoing problem for many people.  Research has identified a sub-group of people with low back pain that have poor control of movement in the lumbar spine and have deficits in the awareness of their lumbo-pelvic positioning. These people move more at the lumbar spine that at the hips and it is commonly the uncontrolled movements of the spine and pelvis that provoke their pathology and pain.

This course will provide participants with skills in analysing movement and diagnosing movement pattern control deficits in the lumbopelvic region that will relate to functional movements that provoke the patient’s symptoms.  Retraining proprioceptive awareness of lumbo-pelvic positions and control of movement patterns is the key.  Movement pattern control starts with specific non functional movements and progresses through kinetic chain sequencing into function. Specific functional requirements are analysed with the Functional Performance Evaluation© tool.

Treatment is enhanced by understanding the mechanism behind the altered movement pattern. These are discussed and examples demonstrated during the practical sessions. A universal clinical problem solving model is given to iron out real-life difficulties.  Normal movement develops during infancy with primitive and postural reflexes.  This process will be discussed and examples provided to show how movement patterns can quickly change with primitive reflex inhibition.   We will provide participants with easy to use clinical prediction rules to diagnose and rehabilitate low back pain.

This is an evidence based course.  Four randomized controlled trials support the use of controlling movement of the lumbar spine.

Course objectives

The participant will be able to:

  • Be able to assess for movement pattern control deficits in the lumbar spine and pelvis relating to functional movements that provoke the patient’s symptoms
  • Understand the different mechanisms behind movement pattern control deficits
  • Appreciate the different causes of restrictions and increased muscle tone
  • Apply Clinical prediction rules for:
    • sub-classification to diagnose a movement pattern control deficit
    • prescription of appropriate rehab strategies.
  • Show an understanding of the progression of movement pattern control into movement and function using
    • Kinetic chain sequencing and
    • The Functional Performance Evaluation©

WHAT WILL YOU GET FROM THIS COURSE THAT YOU MAY NOT ALREADY HAVE?

Mechanisms of Movement Pattern Control Deficits
Treatment is enhanced by understanding the mechanism behind the altered movement pattern. We will provide you with our research and show you how to identify this clinically.

Primitive Reflexes
Primitive reflexes can influence the ability of people to perform these exercises.  We will show you how to identify some of these and give you options of how to deal with them.

Postural Reflexes
You can quickly change movement patterns by facilitating normal postural responses.

Psoas Major as a Stabilizer
Psoas major barely flexes the hip! – its main function is to stabilize the lumbar spine, SIJ and hip. Research shows that it has segmental atrophy similar to multifidus and needs specific rehab.  We can also use psoas major for pelvic floor rehab!

Gluteus maximus is a multitasking muscle!
It has three functional subdivisions. The Deep Sacral Gluteus Maximus only crosses the sacroiliac joint and is ideally suited for SIJ stability.  Why don’t some people progress with glut max training and what can we do about it?

Vertical loading is a direction of load that can cause a control deficit!
During vertical loading, the lumbar spine can move into uncontrolled flexion, extension and /or rotation. We have two validated tests you have not seen before.

Other Rehab Options
Some people do well by going to the gym or doing things like pilates, or going to the gym, but some don’t.  We’ll show you how to give people accurate advice and what they can and can’t do.

What about the people who don’t get it?
Some people cannot or have significant difficulty learning specific exercises.  We’ll help you screen them and give you alternative rehab options.

Core Stability Explained
There are many interpretations of core stability.  Some people do better with strengthening and some do better with gentle and specific exercises.  We will explain all the interpretations and show you how it all fits into rehabilitation.

 

Program & Pre-course Reading

Suggested pre-course reading

Revision of the Clinical Reasoning or Key Concepts course

Gibbons SGT, Comerford M J 2001 Strength versus stability Part I; Concepts and terms. Orthopaedic Division Review, March/April: 21-7 (see www.smarterehab.com/resources/publications)
Gibbons SGT, Comerford M J 2001 Strength versus stability Part II; Limitations and benefits.  Orthopaedic Division Review. March/April:28-33 (see www.smarterehab.com/resources/publications)

Free articles available at:  http://www.ncbi.nlm.nih.gov/sites/gquery

Reliability of movement control tests in the lumbar spine. Hannu Luomajoki, Jan Kool, Eling D de Bruin, and Olavi Airaksinen. BMC Musculoskelet Disord. 2007; 8: 90. Published online 2007 September 12. doi: 10.1186/1471-2474-8-90. PMCID: PMC2164955

Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. Hannu Luomajoki, Jan Kool, Eling D de Bruin, and Olavi Airaksinen. BMC Musculoskelet Disord. 2008; 9: 170. Published online 2008 December 24. doi: 10.1186/1471-2474-9-170. PMCID: PMC2635372

Regional differences in lumbar spinal posture and the influence of low back pain
Tim Mitchell, Peter B O'Sullivan, Angus F Burnett, Leon Straker, and Anne Smith
BMC Musculoskelet Disord. 2008; 9: 152. Published online 2008 November 18. doi: 10.1186/1471-2474-9-152. PMCID: PMC2605454

The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. James S. Thomas and Christopher R. France. Eur Spine J. 2008 January; 17(1): 97–103. Published online 2007 October 31. doi: 10.1007/s00586-007-0532-6. PMCID: PMC2365523

Program
Day 1
8:30 – 9:00 SMARTERehab System & Clinical Reasoning Review
9:00 – 9:30 Clinical prediction rules for Motor Function
9:30 – 10:30 Neutral positioning
10:30 – 10:45 Break
10:45 – 12:00 Lumbar flexion load testing & rehabilitation
12:00 – 1:00 Lunch
1:00 – 2:30 Lumbar flexion load testing & rehabilitation (continued)
2:30 – 2:45 Break
2:45 – 4:30 Lumbar extension load testing & rehabilitation
Day 2
8:30 – 9:00 Lumbar extension load testing & rehabilitation (continued)
9:00 – 10:30 Rotation load testing & rehabilitation
10:30 – 10:45 Break
10:45 – 12:00 Muscle imbalance rehabilitation
12:00 – 1:00 Lunch
1:00 – 2:30 Restrictions and mechanisms of altered movement control
2:30 – 3:00 Functional Performance Evaluation & functional exercise
3:00– 3:15 Break
3:15 – 4:00 Case Studies
4:00 – 4:30 Questions & Summary

 


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