Presentatie-MScappaticci-FMsummit2013

2013-10-15

1

Functional Integrated Therapy Your Blueprint for Optimizing Performance

Functional Integrated Therapy™ An Advanced Treatment System For

Performance Enhancement

2013-10-15

2



A Contemporary System

“Systems theory looks at the world in terms of the interrelatedness of all phenomena, and in this framework an integrated whole whose properties cannot be reduced to those of its parts is called a system.”

Fritjof Capra


Performance Enhancement Functional Integrated Therapy System

The Functional Integrated Therapy™ approach is an assessment and treatment system based on a functional understanding of the body, where dysfunction of the neuro- musculoskeletal system are considered, taking into account all structural and functional components together as a whole.

2013-10-15

3



�  Optimal Biomechanics

Sphere of Optimal Performance “Address the ‘factors within the sphere of optimal performance’ to prevent injury regression and reoccurrence. ”

Ø  Optimal Nutrition Ø  Optimal Rest Ø  Optimal Program Design Ø  Optimal Technical Skill Ø  Optimal Mental Focus Ø  Optimal Adaptation To Stress Ø  Optimal Restoration


Performance Enhancement Functional Integrated Biomechanical Model

Optimal performance and accelerated recovery of injuries are dependent upon Optimal function of:

Ø  Nervous System Activity

Ø  Soft Tissue Mechanics

Ø  Joint Mechanics

2013-10-15

4

Optimizing Performance Performance Optimization defined: The ability to identify areas of increased stress to the system that cause abnormal tissue tension and changes in the functional kinetic chain that result in abnormal sensorimotor integration.

General Considerations

� Lower extremity design � Support for trunk � ★★ Dispersion of reactive

ground forces

2013-10-15

5

General Considerations � The Nervous System is responsible for

the complex structural-functional interplay between the joints and Soft Tissues of the entire body. Any abnormal stress to the body results in modification of the nervous system and changes in sensorimotor integration.

General Considerations � Training with poor technique or affect of

repetitive stress �  Increases stress to structures of joints and soft

tissues of lower extremity and trunk

� Adaptation mediated by the Nervous System � Faulty patterns seen in Lower Extremity / Trunk � Goal: to improve performance is to identify

and correct these forced adaptive patterns before any symptoms appear.

2013-10-15

6

General Considerations � Adhesions � Abnormal tissue Tension � Abnormal tissue Texture � Abnormal movement patterns

General Considerations

� Functional Integrated Treatment � FIN and PT: neuro-modulation � FAT, TTR and SMT: normalize

mechanics

2013-10-15

7

General Considerations Range of Motion § Active vs Passive § Passive: gives the most information

regarding muscle and joint restriction § Active: gives more information regarding

sensory motor integration

General Considerations � Range of motion limitations � Joint restrictions –hard end feel � Soft tissue mechanics—elastic end feel with

more give at end range for muscle tissue, less elastic end feel for contractile fascia.

� Observe abnormal recruitment of functional synergistic muscle groups during active movement

2013-10-15

8

General Considerations � Gait assessment is essential yet

complicated

� Gracovetsky, Bogduk and Vlemmings work illustrates the link between the coupled motions of the Lats, Gluts, DSL, STL and hamstrings and back force transmissions with abnormalities in gait.

General Considerations The Lower extremity kinetic Chain:

•  First Ray Complex •  Calcaneocuboid •  Transverse tarsal •  Subtalar •  Talocrural •  Superior and inferior Tib/Fib •  The Knee •  The Hip •  Pelvic joints •  Lumbar spine •  Aponeurosis of the erector spinae •  Thoraco lumbar fascia •  (Lateral Raphe and ventral connections}

Ø THE TONIC, PHASIC MUSCLES AND THE SOFT TISSUE CONNECTIONS OF THE ENTIRE KINETIC CHAIN ARE INCLUDED

2013-10-15

9

Mechanism of Soft Tissue Injury

Reprinted with permission from author: Assessment and Treatment of Muscle Imbalance

PO₂

chemotaxis

proliferation of fibroblasts Dawes, American Journal of

Respiratory Cell & Molecular Biology

2013-10-15

10

PO₂ mRNA

alpha 1 procollagen

scar tissue Falanga, Journal of Cellular Physiology, 1993

Role of Muscle and Fascia

2013-10-15

11

Role of Muscle and Fascia �  “Fascia is a tough connective tissue that spreads

throughout the body in a three dimensional web from head to foot functionally without interruption” (Barnes).

Role of Muscle and Fascia �  “It is my proposal that the fascia is the integral part of

the soft tissue system responsible for transmitting forces and tying up tissue, creating 3D tissue tension lines. The muscular system is the functional component within the fascial Matrix that is responsible for movement and is used to landmark functional barriers” (Scappaticci-2005).

2013-10-15

12

Role of Muscle and Fascia �  It is now known that this vast connective tissue

has contractile properties resulting in shortening of fascia. Its response to therapy is very unique and different from muscle and loose connective tissue. It responds to sustained tension and pressure from 10 seconds to several minutes. The myofibroblasts will lengthen restoring normal sensorimotor integration.

Role of Muscle and Fascia �  There are numerous mechano-nociceptors dispersed

throughout the fascia that are sensitive to changes in tension and can mediate pain when over stimulated. There are specialized nerve endings within the dermis and overlying fascia that respond to various types of stresses and can modify nervous system activity.

2013-10-15

13


Reprinted with permission from author: Assessment and Treatment of Muscle Imbalance


2013-10-15

14



2013-10-15

15

Role of Muscle and Fascia � Abnormal tension within this system from

repetitive micro-trauma, abnormal joint mechanics or nervous tissue irritation, results in a decrease in efficiency as a result of the body’s physiological adaptive capacity. Physiological changes can be seen in the anatomy.

POWER OF INTENTION

TREATMENT STRATEGIES

2013-10-15

16

IDENTIFYING BARRIERS: POSTURE AND GAIT

HEAD:&'(lt'''''''''''''&'rota(on'SHOULDER:'&'level'

'''''''&rota(on'SCAPULA:&'level'''''''''''''''''''&protracted'ARM:&internal'rota(on''''''''''''&external'rota(on''''''''''''&'distance'to'body'RIB'CAGE:'symmetry'ILIAC'CREST'TO'LOWER'RIB'DISTANCE'BELLY'BUTTON'POSTION'SPINAL'ALIGNMENT'PELVIC'POSITION:&level''''''''''''''''''''''''''''''''''&Anterior'(lt'''''''''''''''''''''''''''''''''&Posterior'(lt'''''''''''''''''''''''''''''''''&Torque'ASIS/PSIS'LEVEL'TROCHANTERIC'LEVEL'GLUTEAL'SHAPE'GLUTEAL'FOLDS'LEG'ROTATION'PATELLAR'POSITION'&:alta'''''''''''''''''''''''''''''''''''''''&Squin(ng'POPLITEAL'CREASE'GASTROC'SHAPE'ACHILLES'ANGLE'KNEE'ALIGNMENT'OVER'2nd'TOE'FOOT'POSITION'HEEL'SHAPE.'

POSTURAL'ASSESSMENT'CHECKLIST'

2013-10-15

17

Postural Syndromes LOWER CROSSED SYNDROME, UPPER CROSSED

SYNDROME and PRONATION DISTORTION SYNDROME are common postural dysfunctions affecting the upper and lower back, lower limbs and optimal gait mechanics.

�  POSTURE ASSESSMENT OF LCS:

�  Increased anterior pelvic tilt

�  Increased lumbar lordosis

Postural Syndromes

2013-10-15

18

PRONATION DISTORTION SYNDROME

POSTURE ASSESSMENT:

�  Weak and or Flat Longitudinal Arch

�  Frontal and transverse plane compensations at knee and ankle

GAIT CHECKLIST PELVIC TILT PELVIC ROTATION LUMBAR SIDE FLEXION THORACIC FLEXION-EXTENSION SCAPULAR POSTION ARM SWING AND CARRYING ANGLE BREATHING PATTERN RIBCAGE POSITION HEAD POSITION AND MOVEMENT VERTICLE MOVEMENT LATERAL MOVEMENT-SWAY ROTATION HIP EXTENSION-LUMBAR EXTENSION HIP FLEXION FEMORAL ROTATION HIP ABDUCTION-ADDUCTION KNEE ALIGNMENT KNEE FLEXION-EXTENSION-IC-MS-IS SWING LINE KNEE CONTROL AT IC-MS FOOT PIVOTING- TOE IN/OUT HEEL RISE SUBTALAR-CALCANEAL POSITION LONGITUDINAL ARCH- NAVICULAR DROP-MS FORE FOOT ABD-ADD- MS METATARSAL PHALANGEAL EXTENSION- TS

2013-10-15

19

IDENTIFYING BARRIERS: FUNCTIONAL MOVEMENT

PATTERNS

FUNCTIONAL ASSESSMENT �  Each test should be repeated three times. Explain and

demonstrate the test if necessary. Standardize the method for consistency

�  Arms start at sides, they can be placed outstretched to the side or front depending on the test. This can make it easier to identify imbalances

�  Observe the global movement pattern as well as motion at each joint from the bottom up. Ankle-Knee-Hip-Trunk-Shoulder.

�  Identify differences from side to side and front to back making notes

2013-10-15

20

TEST ANKLE KNEE Hip Trunk shoulder

1. Single leg balance

2. Lunge f-s-b

3. Single leg squat

4. Single leg drop

5. Shoulder abduction

6. Overhead squat

7. Seated hip flexion

8. Single leg bridge

9. Hip extension

10. Hip abduction

11. Pushup glide

12. Torsion test A + B

Total Positive tests

Addressing Performance Barriers

� Functional Integrated Needling, Dynamic Neuromuscular Stabilization (DNS), Tissue Tension Release Technique, Fascial Abrasion Technique (FAT), and Performance Taping are techniques that help normalize sensorimotor integration.

2013-10-15

21

� Local effects of Dry Needle Insertion � 1:axonal reflex – CGRG release-inc in

circulation � 2:NO release from capillaries-increase in

vasodilation � 3:pain afferents- muscle relaxation � 4:fibroblasts release ATP-ADP blocks

nociception � 5:denervation of local afferents

Functional Integrated Needling (www.dryneedling.ca)

� Central effects of Dry Needle Insertion �  1:LS- decreased sympathetic tone- improved sleep �  2:SSC- decreased sensitivity �  3:AC- decreased fear- decreased CCK �  4:HT- normalization of hormone levels �  5:HC+C- improved neural mapping �  6:PAG-RNM- inc. opiod mRNA- DPIP �  7- local effects are immediate �  8-CNS effects 2-18hrs for DPIP �  9-CNS effect 1-2 days after- genome effect.

Functional Integrated Needling (www.dryneedling.ca)

2013-10-15

22

Functional Integrated Therapy™ An Advanced Functional Treatment System For Performance

Enhancement

Dry needling “When an injury occurs in the body there is an interruption of the energetic flow of micro-electric current that travels through the area.”

�  The Functional Approach

Ø  The Neuroanatomical Approach

Ø  The CNS Approach

FIT™ System: goals

•  nervous system activity normalization: sensory, motor, autonomic neuro-modulation

•  systemic regulation: metabolic/endocrine normalization. •  Dec. anxiety, Inc. wellbeing

2013-10-15

23

•  local input for lower extremity problem

FIT™ System:

•  axial input

FIT™ System:

2013-10-15

24

•  local and axial inputs combined in lower extremity problem treatment

FIT™ System:

•  CNS input

FIT™ System: CNS Regulation

2013-10-15

25

Assoc. Prof. Pavel Kolar, Paed.Dr., Ph.D.

Alena Kobesova, M.D., Ph.D.

www.rehabps.com

Dynamic Neuromuscular Stabiliza8on according to Kolar:

A Developmental Kinesiological Model

�  A new manual rehabilitative approach based on neurophysiological & developmental kinesiology principles

�  A new method of intrinsic locomotor system stabilization

�  Designed to activate the “Integrated Stabilizing System” (ISS) for the purpose of achieving optimal levels of improved function

2013-10-15

26

�  DNS is not merely a technique, but rather an overall strategy to better understand the neurophysiological principles of the locomotor (movement) system.

�  It includes both a knowledge and theoretical base, in addition to assessment, treatment, exercise and integrative functional (sports, ADL’s, etc.) strategies.

www.rehabps.com

Fascial Abrasion Technique (FAT-Tool™)

� Treatment directed to fascial tension � Multi-directional 3D therapy �  Fascial Abrasion Technique � Vs: Graston, Sound assisted soft tissue

mobilization and other gua sha techniques � Follow 3D- LINES OF TENSION � Treats fascial system in a different way (www.FAT-Tool.com)

2013-10-15

27

SYNERGY!Performance Taping!

!(www.performancetaping.com)

Concepts Basic Practical Application

of the

Benefits of Taping �  Neuro-modulation of Pain and sensitivity

�  Assists in the re-education of movement

�  Helps reduce muscle fatigue

2013-10-15

28

PERFORMANCE TAPING™ !FOR THE PERFORMANCE THERAPIST!The Gold Standard in Muscle Balance Taping!

PERFORMANCE TAPING™!How it Works

�  The compressive forces and shear forces of the tape stimulates neurological structures in the skin, muscles and fascia in such a way as to normalize and improve muscle function.

�  The tape exerts its effect on these tisues by stimulating these specialized nerve endings.

We are taping the nervous system and not the muscle!

2013-10-15

29

Muscle Spindle Cell-GTO Therapy

GTO Therapy is in the same direction as above except these are located at muscle tendon junction!

Direction of Tape “Pull” vs Direction of “Recoil Effect”

�  Applying the tape with at least 50% tension will cause the tape to “recoil” in the direction opposite of application. This recoil effect is responsible for the “neuro-stimulatory” benefits of Performance Tape.

Tape is pulled from a midline base past the attachment points...

This causes a recoil effect approximating the receptors (GTO’s & muscle spindles).

This results in an “inhibitory” message to the nervous system, which relaxes the muscle.

TO INHIBIT

2013-10-15

30

PERFORMANCE TAPING™!Putting it on

�  To inhibit a muscle; you start at the middle and pull ends over the attachments with at least 50 percent of available stretch

Direction of Tape “Pull” vs Direction of “Recoil Effect”

�  Applying the tape with at least 50% tension will cause the tape to “recoil” in the direction opposite of application. This recoil effect is responsible for the “neuro-stimulatory” benefits of Performance Tape.

Tape is pulled from the muscle

attachments

ending at the mid belly of the muscle

This causes a recoil effect, pulling away from the midline,

separating the GTO and muscle spindle cells

This results in a facilitating message to the brain,

stimulating muscle contraction

TO FACILITATE

2013-10-15

31

PERFORMANCE TAPING™!Putting it on

�  To facilitate a muscle; you start before the attachments of the muscle and you pull to the midline of the muscle.

Role of Muscle and Fascia � Changes within the system result in

adaptation via the nervous system, of the cooperative, harmonious relationship between muscles and fascia and joints, leading to in efficiency

2013-10-15

32

Soft Tissue Therapy Principals � Need understanding of functional Anatomy � Must be able to trace tension line to foci � Focus on tension moving to and away from

foci in 3D pattern � Determine the muscular and or fascial

component � Use constant tension to release fascial barrier

and repeated movements in direction of tension line for muscular tissues

� Maintain depth of contact with appropriate anatomy

Functional Mechanics

� There are two muscle types. � Tonic: maintain upright posture, prone to

tightness � Phasic: rapid motion, prone to inhibition and

weakness � Each muscle does not necessarily have

predominately one muscle fiber type in this model.

MUSCULAR IMBALANCE (CNS MODEL)

2013-10-15

33


� The muscular system is like a window into the CNS and allows you to see how the sensorimotor system is working

� There is a stimulus from the PNS to the CNS and there is a resulting reaction in the muscular tissue



� Muscular imbalance results from poor motor learning

� This prevents the motor system from reacting and adapting to changes in the body

� The result is poor mechanics and decrease in performance.


2013-10-15

34


� This is all mediated through the CNS from a number of stresses.

� Abnormal joint position or motion leads to changes in motor patterns

� Muscular imbalance is expressed will have a global response.


PERFORMANCE BARRIER PARADIGM

�  REPETATIVE STRESS

�  LEADS TO MICROTRAUMA ( SUB PAINFUL STIMULI)

�  CHANGES IN JOINT MOTION OR POSITION (ALTERED PROPRIOCEPTION)

�  ALTERED SENSORIMOTOR INTEGRATION

�  MUSCLE IMBALANCE PATTERN

�  ALTERED MOVEMENT PATTERNS AND ADAPTIVE CHANGES

�  DECREASE IN PERFORMANCE


BASED ON JANDA’S NEUROLOGIC PARADIGM OF MUSCULAR IMBALANCE

2013-10-15

35

During assessment identify:

�  Texture �  Tension �  Movement �  Function

Functional Integrated Therapy™ An Advanced System For Performance

Enhancement WHAT IS A TISSUE TENSION LINE ?

Continuous fascial tension lines that are directly connected to the tissue that is injured. It is this TISSUE TENSION LINE that is essential in evaluating. The tissue tension can follow a path from deep to superficial encompassing a number of soft tissue structures as it courses through a given region. The key is to follow this tension line from the foci, and treat it accordingly.

2013-10-15

36

Functional Integrated Therapy™ An Advanced System For


§  Local area of dysfunction

§  Local muscle involvement. The individual muscle belly it’s associated myo-tendon junctions and the tendo-periosteal attachment sites are considered.

Identify the Tissue Tension Line


Enhancement

§  Regional area of dysfunction

§  Regional muscles that are directly associated with the muscle tissue of complaint and the synergistic muscles involved in the functional movement that may be impaired. Also the fascial component at this level is evaluated.


2013-10-15

37


Performance Enhancement § Antagonist muscles

§ Antagonist muscles and groups of muscles are evaluated. Identifying antagonistic muscles that may inhibit or impair the normal functional mechanics of the area in question.


Enhancement

§ Global area related to dysfunction


2013-10-15

38


Enhancement

Complex Matrix Network

The nonspecific connective tissue network that creates increased tension on the tissue of complaint from a site that is not related to the function of the injured area. This is usually the result of trauma or surgery. There is an increase in scar tissue formation and a winding of associated connective tissue resulting in potential increased tension on the structures involved in the function of the injured area.

Identify Other Tissue Tension Lines



The goals are accomplished by: •  Decreasing tissue tension

along the tissue-tension lines. •  Improving movement between

muscles and fascia that are impaired.

•  Improving fluid dynamics by decreasing fascial tension.

•  Normalize sensorimotor Integration.

Functional Integrated Treatment

2013-10-15

39

Functional Integrated Therapy Approach

• Visual assessment of posture and gait. • Evaluation of functional movement patterns • Evaluation of ranges of motion and joint mechanics • Evaluation of muscle length and strength • Evaluation of soft tissue texture, tension and mechanics • Functional Integrated Treatment design • Functional exercise program

Performance Optimization

Thank You

Any Questions?

Dr. Mark J Scappaticci

Niagara Falls

[email protected]

2013-10-15

40

Optimizing Performance Functional Integrated Therapy

Any Volunteers ?

Presentatie-MScappaticci-FMsummit2013

Documents

advanced treatment system

functional understanding

functional components

optimal function

neuro musculoskeletal

nervous system faulty

abnormal stress

functional kinetic chain