The Athlete Movement System: Spine...– Orthopedic residency mentor – Three books on athlete injury prevention – Numerous publications on injury prevention – Editorial board

Not for reproduction or redistribution

The Athlete Movement System: Spine

Jared Vagy, PT, DPT, OCS, CSCS


• Financial– None

• Nonfinancial– TheraBand Academy Speaker

Disclosure


About the InstructorJared Vagy, PT, DPT, OCS, CSCS

– Doctor of physical therapy– Orthopedic clinical specialist– Residency training: orthopedics– Fellowship training: movement science– DPT teaching faculty at USC– Orthopedic residency mentor– Three books on athlete injury prevention– Numerous publications on injury prevention– Editorial board of Advance Rehab Magazine– Elite athlete physical therapist

• Chinese national track and field team• US Olympic Training Center rotation• USA Track & Field Olympic team trials• World Championships of Weightlifting


• Clare Frank• Shirley Sahrmann

• Joe Godges• Beth Fisher• Chris Powers

Special Thanks


• USC Division of Biokinesiology and Physical Therapy• TheraBand: Systems of Progressive Exercise• Aaron Atkins, PT, DPT• Tatiana Brovko, PT, DPT, OCS• Lyssa Cleary, PT, DPT, OCS• Joe Derian, PT, DPT, OCS• Sam Franklin, PT, DPT, OCS• Connie Hutchins, PT, DPT, OCS• Amir Khastoo, PT, DPT, OCS• Tyson Matsumoto, PT, DPT, OCS

Special Thanks (cont.)


Shirley Sahrmann, PT, PhD– Books

• Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines

• Diagnosis and Treatment of Movement Impairment Syndromes

Background


Clare Frank, DPT, MS, OCS, FAAOMPT– Book

• Assessment and Treatment of Muscle Imbalance: The Janda Approach

– MedBridge courses• Movement Links: Neuromuscular Rehabilitation of the

Upper Quarter

• Movement Links: Systematic Evaluation of the Lower Quarter

Background (cont.)


• Chapter 1: The Movement System– Posture– Movement– Mobility– Muscle performance– Symptom modification procedures (SMPs)

• Chapter 2: Posture and Movement– Lumbar, thoracic, and cervical spine– Posture and movement analysis examples

• Chapter 3: Classification– Using the movement systems impairment (MSI) classifications– Movement analysis examples

• Chapter 4: The Treatment Pyramid– Lumbar, thoracic, and cervical spine– Patient cases from 15 sports

Course Outline


• Learn the framework of the movement system and use the system to sequence and organize your assessments

• Understand how symptom modification procedures (both active and passive), mobility, and muscle performance assessments can be used on patients with neck and low back pain

• Utilize movement system impairment (MSI) syndromes developed by Shirley Sahrmann and colleagues to classify cervical and lumbar movement dysfunction

Learning Goals: Chapters 1–3


• Learn the framework of a rehabilitation pyramid• Understand how mobility deficits, muscle performance

deficits, and movement coordination impairments fit within the rehabilitation pyramid

• Utilize the pyramid to sequence interventions• Progress an athlete through the pyramid while

addressing sport-specific movement mechanics

Learning Goals: Chapter 4


Chapter 1The Movement System


Introduction to Spine Injury

• Pain that interferes with activities of daily living in lifetime– Back pain: 60% to 80% – Neck pain: 20% to 70%

• Pain at any given time– Back pain: 15% to 20% – Neck pain: 10% to 20%

• High frequency of recurrence• Low back pain first episode

duration linked to recurrence

Sinnott, P. L., Dally, S. K., Trafton, J., Goulet, J. L., & Wagner, T. H. (2017). Trends in diagnosis of painful neck and back conditions, 2002 to 2011. Medicine, 96(20).


Classification Model


The Movement System


Diagnosis

Symptom Modification Procedure (SMP)

• An alternative method of treatment-based clinical examination

• Mechanical symptom alleviating techniques that are applied during symptomatic postures or movements

Lewis, J. S., McCreesh, K., Barratt, E., Hegedus, E. J., & Sim, J. (2016). Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain. BMJ Open Sport & Exercise Medicine, 2(1), e000181.


SMP

Passive SMPActive SMPMovement fault


• Utilize the movement system model to organize your objective exam tests and measures

• Start with movement, and further use mobility and muscle performance to achieve a patient diagnosis or classification

• Integrate symptom modification procedures to inform clinical decision-making

Chapter 1 Summary


Chapter 2Posture and Movement


Posture


Lumbar Oblique concavity, horizontal crease, rib angle

Pelvis Pelvic rotation clockwise or counterclockwise

Hips Abducted, adducted, or neutral

Knees Patella alta/medial/lateral

Foot/ankle Pronation/supination, forefoot varum

Toes Hallux valgus, hammer/claw/mallet toe

Posture: Anterior Alignment


Posture: Anterior Alignment (cont.)


Lumbar Asymmetric creasing, excessive paraspinal tone, scoliosis

Pelvis Iliac crest height (half inch)

Hips Lower gluteal fold, hypertrophy of distal two-thirds of hamstring

Knees Genu valgus or varum, popliteal angle medial or lateral rotation

Foot/ankle Calcaneal valgus or varus

Toes Too many toes sign (may be from hip)

Posture: Posterior Alignment


Posture: Posterior Alignment (cont.)


Lumbar Swayback, excessive lordosis, insufficient lordosis

Pelvis Neutral, anterior, or posterior tilt (within 15 degrees of horizontal)

Hips Neutral, flexed, or extended Lateral gluteal concavity

Knees Neutral, hyperextended, or flexed

Foot/ankle Neutral, plantar flexed, or dorsiflexed

Posture: Lateral Alignment


Posture: Lateral Alignment (cont.)


Movement


Movement and SMP


VideoCervical Rotation


Cervical Rotation


? ?


What did you see?A. Inadequate cervical sidebendB. Excessive thoracic motionC. Excessive cervical sidebendD. Inadequate thoracic motion

Poll Question


Cervical Rotation SMP

Jared Vagy PT, DPT, OCS, CSCSThe Athlete Movement System: Lower Quarter


?


VideosCervical Rotation Movement Fault

Cervical Rotation SMP Active


Apply the Movement System


VideoCervical Extension


Cervical Extension


? ?


What did you see?A. Excessive thoracic extension B. Excessive thoracic flexionC. Excessive midcervical motionD. Excessive lower cervical motion

Poll Question


VideosCervical Extension Movement Fault

Cervical Extension SMP Active


Cervical Extension SMP


?




VideoLumbar Sidebend


Lumbar Sidebend


? ?


What did you see?A. Inadequate upper lumbar motionB. Excessive upper lumbar motionC. Excessive lower lumbar motionD. Inadequate femoral adduction

Poll Question


VideosLumbar Sidebend Movement Fault

Lumbar Sidebend SMP ActiveLumbar Sidebend SMP Passive


Lumbar Sidebend SMP





VideoLumbar Flexion


Lumbar Flexion


? ?


What did you see?A. Inadequate thoracic flexionB. Excessive hip flexionC. Excessive cervical extensionD. Inadequate hip flexion

Poll Question


VideosLumbar Flexion Movement Fault

Lumbar Flexion SMP ActiveLumbar Flexion SMP Passive


Lumbar Flexion SMP





• Posture tells a story but does not always determine how a patient moves

• Inefficient lumbar and cervical movements repeated over time can lead to patient pain and dysfunction

• Analyze patient movement and determine active and passive symptom modification procures that can improve movement efficiency and decrease symptoms

Chapter 2 Summary


Chapter 3Movement Classification


MSI Syndromes

• The human movement system

• Determinants of motion path – Relative flexibility– Relative stiffness– Motor learning

• Inducers and modifiers• Sustained alignment in a non-

ideal position and repeated movements in a specific direction are associated with several musculoskeletal conditions

Sahrmann, S., Azevedo, D. C., & Van Dillen, L. (2017). Diagnosis and treatment of movement system impairment syndromes. Brazilian Journal of Physical Therapy, 21(6), 391-399.


• A structured exam • Patient performs motion (test) in preferred pattern (primary

test) – Symptoms are noted – Movement pattern is assessed

• Patient performance is corrected (secondary test) – Effect on symptoms is noted

• Classification is determined by the motion direction or alignment that most consistently elicits symptoms and, when corrected, decreases symptoms

• Greater weight is given to symptom behavior with tests than signs

The MSI Model


• Cervical flexion • Cervical extension • Cervical rotation• Cervical flexion-rotation • Cervical extension-rotation

Adapted from Shirley Sahrmann

MSI Cervical Syndromes


Classification

• Six movement videos• Analyze the movement

• Classify the movement– Flexion– Extension– Rotation

• Determine the deficit– Mobility– Muscle performance


VideosOptimal and Suboptimal

Smartphone HoldShoulder Abduction and Scaption

Quadruped Rockback


• Cervical flexion syndrome– Increased motion or painful cervical flexion

• Example: smartphone hold

• Cervical extension syndrome– Increased motion or painful cervical extension

• Example: quadruped rockback

• Cervical rotation syndrome– Increased motion or painful cervical rotation

• Example: standing shoulder abduction

Cervical Syndromes: Clinical Examples


• Lumbar flexion syndrome• Lumbar extension syndrome• Lumbar rotation syndrome• Lumbar flexion-rotation syndrome• Lumbar extension-rotation syndrome

Adapted from Shirley Sahrmann

MSI Lumbar Syndromes


Classification

• Six movement videos• Analyze the movement

• Classify the movement– Flexion– Extension– Rotation

• Determine the deficit– Mobility– Muscle performance


VideosOptimal and Suboptimal Seated Knee ExtensionQuadruped RockbackProne Hip ExtensionProne Knee FlexionSeated Hip FlexionProne Hip Rotation


• Lumbar flexion syndrome– Increased motion or painful lumbar flexion

• Seated knee extension• Quadruped rockback

• Lumbar extension syndrome– Increased motion or painful lumbar extension

• Prone knee flexion• Prone hip extension

• Lumbar rotation syndrome– Increased motion or painful lumbar rotation

• Prone hip rotation• Bent knee fallout

Lumbar Syndromes: Clinical Example


• There are five categories within the movement system impairment (MSI) model that can be used to classify cervical movement dysfunction

• There are five categories within the movement system impairment (MSI) model that can be used to classify lumbar movement dysfunction

• By analyzing specific repeated motions in a variety of patient positions, a therapist can classify a patient based on how the patient moves

Chapter 3 Summary


• Chapter 1: The Movement System– Posture– Movement– Mobility– Muscle performance– Symptom modification procedures (SMPs)

• Chapter 2: Posture and Movement– Lumbar, thoracic, and cervical spine– Posture and movement analysis examples

• Chapter 3: Classification– Using the movement systems impairment (MSI) classifications– Movement analysis examples

Chapters 1–3 Summary


Chapter 4The Treatment Pyramid


Educate the client

Train function and skill

Developed by Jared Vagy. Adapted from FMP by Clare Frank and Phil Page

The Treatment Pyramid




Educate the Client


• Learning modalities are the sensory channels or pathways through which individuals give, receive, and store information

• The modalities or senses include visual, auditory, tactile/kinesthetic, smell, and taste

Learning Modalities: The VAK

Images and graphics

Verbal presentations

Physical or hands-on

Visual Kinesthetic Auditory


Research: VAK and Learning• 146 medical students divided into one of four

groups based on VAK learning styles self-assessment questionnaire

– Visual – Auditory – Kinesthetic – Traditional

• Each group was instructed on respiratory physiology based on their grouping; pre- and posttest exams were taken

• Posttest scores were significantly higher in all three learning-style-based groups compared to traditional

• Utilizing patient’s preferred learning style may improve a therapist's effectiveness in patient education and patient’s understanding of injury/treatment

Anabarasi, M., Rajkumar, G., Krishnakumar, S., Rajendran, P., Venkatsan, R., Dinesh, T., Mohan, J. & Venkidusamy, S. (2015). Learning style-based teaching harvests a superior comprehension of respiratory physiology. Advances in Physiology Education, 39(3), 214–217.


Movement

Diagnosis

CorrectionMuscle Performance Mobility

Correction

Posture

Correction

Direct access Physician referred

Identify source tissue

Minimize fear with normative data

Reeducate with diagnosis and prognosis

Correction

Empower change

Identify learning style

Muscle Performance Mobility

VAK Model and Patient Education


The VAK Model

KinestheticAuditoryVisual


Apply to Athletes


Educate the client


Unload the Affected Tissue


Ballet Dancer

• Report– Neck pain after dance

practice• Movement fault

– Excessive scapular depression with shoulder flexion and cervical rotation

• Intervention– Scapular depression

unloading


Research: Scapular Unloading• Participants

– Fifty-two participants with a normal or depressed scapula• Hypothesis

– A position of scapula depression will maintain the upper trapezius muscle region in a lengthened position, causing excessive strain

• Goal– Assess pain pressure threshold (PPS) of the upper

trapezius region in a young healthy population• Results

– Lower mean PPT values when compared to NS – Depressed scapula group [19.0+/−9.0 N/cm(2)] – Normal scapula group [26.1+/−9.6 N/cm(2)] (p < .01)

• Healthy young subjects with depressed scapula position had significant lower upper trapezius PPT values when compared to subjects with normal scapula position

Azevedo, D. C., de Lima Pires, T., de Souza Andrade, F., & McDonnell, M. K. (2008). Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. European Journal of Pain, 12(2), 226-232.


How do you progress this intervention to include shoulder flexion?

Scapular Depression Unloading

Image


Cyclist

• Report– Thoracic pain after long

rides

• Movement fault– What do you see?

• Intervention– What would you do?


VideoCyclist


What do you see/what would you do?A. Excessive thoracic flexion/raise the seatB. Excessive thoracic flexion/extend the handlebar stemC. Excessive cervical flexion/add handlebar spacersD. Excessive lumbar flexion/lower the seat

Poll Question


VideoUnloading Spinal Dura


Unloading Spinal Dura

Extend the stem Insert spacers


Educate the client

Unload the affected tissue

Improve alignment and joint centration

Restore mobility and relative motion

Utilize newly acquired motion

Increase selective motor function


Use the entirekinetic chain


Improve Alignment and Joint Centration


Football Quarterback

• Report– Neck pain

• Movement fault– Excessive cervical

sidebend with rotation

• Intervention– Joint position error

training


Research: Joint Position Error• Participants

– Twenty elite rugby players (10 forwards and 10 backs) and 10 young nonrugby elite sports players

• Results– Cervical joint position sense

differs between rugby players and non-rugby-players

– The two groups of forwards and backs exhibited higher absolute and variable errors than the group of non-rugby-players

• The cervical joint position sense of young elite rugby players is altered compared to that of non-rugby-players

Pinsault, N., Anxionnaz, M., & Vuillerme, N. (2010). Cervical joint position sense in rugby players versus non-rugby players. Physical Therapy in Sport, 11(2), 66-70.


Joint Position Error Training

Vagy, J. (2015). A laser focused method to retrain neck movement. Advance, 23–24.


Hockey Player

• Report– Low back pain when

cutting• Movement fault

– Excessive lumbar rotation with bent knee fallout

• Intervention– Brace with limb

movement progression


Brace With Limb Movement Progression

Initial exercise Exercise progression


VideoBrace With Limb Movement Initial Exercise Brace With Limb Movement Progression


Volleyball Player

• Report– Neck pain during blocking

and spiking the volleyball


extension and rotation with arm raise

• Intervention– Neck centration

progression


Initial Exercise

Initial exercise Exercise progression


If a patient raises the right arm into flexion and the spinous process moves to the right, which muscle is causing this action?

A. Upper trapeziusB. Levator scapulaC. Middle trapeziusD. Longus capitus

Poll Question


Educate the client

Unload the affected tissue

Improve alignment and joint centration

Restore mobility and relative motion

Utilize newly acquired motion

Increase selective motor function


Use the entirekinetic chain


Restore Mobility and Relative Motion


Swimmer

• Report– Neck pain during

butterfly stroke

• Movement fault– Inadequate segmental

thoracic extension

• Intervention– Thoracic mobility

progression


Research: Mobilization and Exercise• Investigate whether a craniocervical flexor exercise and

thoracic mobilization are effective for muscular endurance, visual analog scale (VAS) pain, and neck disability index (NDI) of patients with chronic neck pain

• 53 patients who had chronic neck pain. The experimental group (n = 27) did both craniocervical flexor exercises and thoracic mobilizations; the control group (n = 26) did craniocervical flexor exercises

• The experimental group showed greater improvement in endurance (between-group difference of 14.26 seconds), VAS pain (between-group difference of 2.02 points), and NDI (between-group difference of 2.07 points)

• These results suggest that the combination of thoracic mobilization with craniocervical flexor exercise was more effective at increasing endurance and reducing VAS pain and NDI

Ko, T., Jeong, U., & Lee, K. (2010). Effects of the inclusion thoracic mobilization into cranio-cervical flexor exercise in patients with chronic neck pain. Journal of Physical Therapy Science, 22(1), 87-91.


Thoracic Mobilization 1

• Patient is seated with band wrapped in an X under the thigh and above the elbow

• Therapist places their thumb on the selected spinous process they intend to mobilize

• Therapist overpresses the patient into thoracic extension at a specific level of the thoracic spine


VideoThoracic Mobilization 1


Thoracic Mobilization 2

• Apply prone segmental PA at a rate of 3 hertz for 60 seconds (equals 180 cycles per minute)

• Apply prone segmental PA at a rate of 40 hertz at 60 seconds (approximately 2,400 cycles per minute)

• 13 times more treatment cycles with percussive tool– Do increased repetitions

translate to greater results in less time?




Thoracic Spine Mobilization 3

• Place UE and LE in sport-specific position

• Therapist’s thumb is placed at the desired segment on the thoracic spine as the patient lifts head





Utilize Newly Acquired Motion


Long-Distance Runner

• Report– Low back pain after

running

• Movement fault– What do you see?

• Intervention– What would you do?


VideoLong-Distance Runner


What do you see/what would you do?A. Excessive pelvic rotation/stretch hip flexorsB. Inadequate pelvic rotation/strengthen glut medC. Excessive lumbar flexion/strengthen trunkD. Inadequate ankle dorsiflexion/stretch soleus

Poll Question


VideoLong-Distance Runner Analysis


Improve Hip Extension Mobility

Mobility Assessment


Utilize the Acquired Range of Motion

Integrates motor coordination, muscle performance, and mobility

– Athlete stands with heel on wedge or towel and opposite leg on chair

– Maintains knee extension and posterior tilt while therapist applies manual resistance to prevent pelvic rotation and promote hip extension

Start

Finish


• Setup– Wrap belt around the shoulder of the side the pelvis is rotating toward

posteriorly. Spiral the belt around the trunk so it runs over the involved-side pelvis. Attach a resistance band to the mobilization belt.

• Procedure– Athlete walks, runs or performs the pain generating task while maintaining

pressure into the strap at the level of the ASIS

Further Utilize With Function


VideoUtilize the Acquired Range of Motion

Further Utilize With Function


Golfer

• Report– Low back pain playing

golf• Movement fault

– Inadequate hip internal rotation range of motion and control during follow-through

• Intervention– Utilize newly acquired hip

on femur internal rotation motion


Utilize Functional Motion

FMR CLX femur block Vaso strap SLB rotation


VideoUtilize Functional Motion FMRUtilize Functional Motion CLXUtilize Functional Motion Vaso


Tennis Player

• Report– Low back pain during

forehand stroke• Movement fault

– Inadequate hip internal rotation range of motion and control during follow-through

• Intervention– Utilize newly acquired

femur on hip internal rotation motion


Improve Hip Rotation Mobility


Low back pain during forehand stroke while playing tennisThe patient engages their abdominal muscles and stabilizes their

pelvis as they control their hip into internal rotation

Functional Intervention


VideoFunctional Intervention


Educate the clientUnload the affected tissue



Increase Selective Motor Function


Baseball Player

• Report– Low back pain while

throwing the ball

• Movement fault– Excessive rib flair

during later cocking

• Intervention– Selective activation of

the abdominals


Research: Enhancing Core Stiffness• 24 healthy males • Determine if passive torso stiffness can be

increased, and if so, is isometric or dynamic core training better?

• Three training groups– Isometric exercise – Dynamic exercise – Control

• Significantly greater increases in torso stiffness in the isometric exercise group compared to dynamic exercise after six-week intervention period.

• The application of isometric core exercises appears to increase torso stiffness more than dynamic core exercises, which may enhance relative stability distally

Lee, B. C. Y., & McGill, S. M. (2015). Effect of long-term isometric training on core/torso stiffness. Journal of Strength and Conditioning Research, 29(6), 1515–1526.


Increase Abdominal Motor Function

• Setup– Patient is placed in hip

and shoulder flexion• Procedure

– Place arms against distal humerus and distal femur

– Provide a femoral extension and humeral flexion force for sagittal plane bias

– Sustain position and roll body as a unit to one side


Throwing-Specific Progression

• Setup– Patient is placed in

throwing position with arm abducted and externally rotated and contralateral hip flexed

• Procedure– Place arms against distal

humerus and distal femur– Provide a femoral

extension and humeral flexion force for sagittal plane bias

– Sustain position and roll body as a unit to one side


VideoIncrease Abdominal Motor Function


Which muscle has the greatest influence on depressing the ribs?

A. External obliqueB. DiaphragmC. Internal obliqueD. Rectus femoris

Poll Question


Boxer

• Report– Neck pain after knockout

about three months ago

• Movement fault– Inability to maintain

cervical cranial flexion with head lift

• Intervention– Selective activation of

cervical cranial flexors


Boxing-Specific Progression



Use the Entire Kinetic Chain


Research: Directional Carryover • Purpose

– To compare unilateral-horizontal-direction plyometric exercise to bilateral-vertical-direction plyometric exercise and the effects of both on sprinting, jumping, and change of direction in basketball players

• Participants– 20 youth basketball players– Average age: 13 years old

• Results– Unilateral-horizontal-direction plyometric

exercises group significantly improved on 10-meter sprint and V-Cut Test compared to bilateral-vertical exercise group

• Direction-specific plyometric training effects can carry over into sport and performance tasks with similar force vector demands

Gonzalo-Skok, O., Sánchez-Sabaté, J., Izquierdo-Lupón, L., & Sáez de Villarreal, E. (2018). Influence of force-vector and force application plyometric training in young elite basketball players. European Journal of Sport Science, 19(3), 305–314.


Skier

• Report– Low back pain landing

from ski jumps

• Movement fault– Inadequate hip and knee

flexion during drop jump

• Intervention– Kinetic chain LQ double-

limb plyometric progression


Treatment: Double-Limb Plyometrics

• Countermovement jump• Squat jump

• Tuck jump • Broad jump• Hurdle jump

• Drop jump


Figure Skater

• Report– Low back pain landing

jumps

• Movement fault– Inadequate hip and knee

flexion during single-leg hop

• Intervention– Kinetic chain LQ single-

limb plyometric progression


Treatment: Single-Limb Plyometrics

• Countermovement jump• Squat jump

• Tuck jump • Broad jump• Hurdle jump

• Drop jump


Research: LQ Plyometric Dosage• Frequency: two times per week • Recovery: 48 to 72 hours• Volume: (foot contacts)

– Beginner: 80–100 – Intermediate: 100–120– Advanced: 120–140

• Intensity: scalable and patient specific

• Specificity: includes motions, angular velocities, loads, metabolic demands, etc.

• Results: 6–15 weeks vertical jump sprint time and running economy

Davies, G., Riemann, B. L., & Manske, R. (2015). Current concepts of plyometric exercise. International Journal of Sports Physical Therapy, 10(6), 760–786.


Basketball Player

• Report– Neck pain and inability to

half-court pass


extension

• Intervention– Increase upper extremity

power while maintaining neutral cervical spine


Upper Extremity Plyometrics

• Ball pass• Weighted ball pass

• Wall plyo pushup • Ground plyo pushup• Ground plyo clap

pushup • Ground plyo double-clap

pushup


Research: UQ Plyometric Dosage• Determine the impact of upper body

plyometric training (UBPT) on physical performance parameters such as strength, ball throwing speed, ball throw distance, and power in healthy individuals

• Systematic review of 264 articles• Only 11 articles met the eligibility criteria and

were selected • Though large to very small effects observed

in improving ball throwing velocity, ball throwing distance, power, and strength of upper limb muscles after UBPT, the results should be implemented with caution

• Inconclusive results obtained preclude any strong conclusion regarding the efficacy of UBPT on physical performance in healthy individuals

Singla, D., Hussain, M. E., & Moiz, J. A. (2018). Effect of upper body plyometric training on physical performance in healthy individuals: A systematic review. Physical Therapy in Sport, 29, 51-60.


Educate the client


Train Function and Skill


Research: Motor Skill Acquisition• 60 participants divided into six groups based on

how they will be instructed and cued to accurately and properly kick a soccer ball

– Control (no instruction)– Verbal instruction video and visual cues– Video and verbal cues– Video and visual and verbal cues– Video only

• Visual and verbal cues and video increased kicking accuracy and consistency at a faster rate and sustained a higher proficiency over time compared to all other groups

• Visual and verbal cues and video appear to enhance motor skill acquisition and overall performance of sport-related tasks

Janelle, C. M., Champenoy, J. D., Coombes, S. A., & Mousseau, M. B. (2003). Mechanisms of attentional cueing during observational learning to facilitate motor skill acquisition. Journal of Sports Sciences, 21(10), 825–838.


Sprinter Player

• Report– Back pain during

acceleration of sprint

• Movement fault– Excessive lumbar flexion

with hip flexion

• Intervention– Increase upper extremity

power while maintaining neutral cervical spine


Function and Skill Initial Exercises


VideoFunction and Skill Initial Exercises


Function and Skill Progressions

Parachute sprints

Overspeed training

Sled pulls


VideoFunction and Skill Progression


• The treatment pyramid is an organized way to address interventions related to patient movement dysfunction

• There is adequate research to support each stage of the pyramid

• The eight stages of the pyramid build upon each other but do not need to be implemented sequentially

Chapter 4 Summary


• Utilize the framework of the movement system, and use the system to sequence and organize your assessments

• Understand how symptom modification procedures (both active and passive), mobility, and muscle performance assessments can be used on patients with neck and low back pain

• Utilize the framework of the Rehabilitation Pyramid, and use the system to sequence and organize your assessments

• Progress an athlete through the pyramid while addressing sport-specific movement mechanics

Chapters 1–4 Summary


• The Athlete Movement System– The Athlete Movement System: Practical Swimming Biomechanics and Treatment– The Athlete Movement System: Throwing Biomechanics and Treatment– The Athlete Movement System: Tennis Biomechanics and Treatment– The Athlete Movement System: Advanced Running Assessment and Treatment– The Athlete Movement System: Advanced Performance Training– The Athlete Movement System: Upper Quarter (Webinar)– The Athlete Movement System: Lower Quarter (Webinar)

• The Movement System– The Movement System: Assessment and Treatment of Low Back Pain

• Coming soon– The Movement System: Assessment and Treatment of Shoulder Pain Part 1– The Movement System: Assessment and Treatment of Shoulder Pain Part 2– The Movement System: Assessment and Treatment of Knee Pain

• Learn more– Theathletemovementsystem.com @athletemovementsystem

Additional MedBridge Courses

The Athletic Movement System: Spine

1

Bibliography

MedBridge The Athletic Movement System: Spine

Jared Vagy, PT, DPT, OCS, CSCS

1. Anbarasi, M., Rajkumar, G., Krishnakumar, S., Rajendran, P., Venkatesan, R., Dinesh, T. & Venkidusamy, S. (2015). Learning style-based teaching harvests a superior comprehension of respiratory physiology. Advances in physiology education, 39(3), 214-217.

2. Davies, George, Bryan L. Riemann, and Robert Manske. “Current concepts of plyometric exercise.” International journal of sports physical therapy 10.6 (2015): 760.

3. Gonzalo-Skok et al. Influence of force-vector and force application plyometric training in young elite basketball players. European Journal of Sport Science. 2019(19)305-314

4. Janelle C, Champenoy J, Coombes S, Mousseau M. "Mechanisms of attentional cueing during observational learning to facilitate motor skill acquisition." Journ of Sport Science. 2003;21:825-838.

5. Lee B, McGill S. "Effect of long-term isometric training on core/torso stiffness." J of Streng and Condit Research.2015;29(6):1515-1526..Lee B, McGill S. "Effect of long-term isometric training on core/torso stiffness." J of Streng and Condit Research. 2015;29(6):1515-1526..

6. Lewis, J. S., McCreesh, K., Barratt, E., Hegedus, E. J., & Sim, J. (2016). Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain. BMJ open sport & exercise medicine, 2(1), e000181.

7. Rajkumar A, et al. "Learning style-based teaching harvests a superior comprehension of respiratory physiology." Adv Physiol Educ. 2015:39;214-217.

8. Sahrmann, S., Azevedo, D. C., & Van Dillen, L. (2017). Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy, 21(6), 391-399.

9. Sinnott, P. L., Dally, S. K., Trafton, J., Goulet, J. L., & Wagner, T. H. (2017). Trends in diagnosis of painful neck and back conditions, 2002 to 2011. Medicine, 96(20).

10. Unload: A study on using a. scapular unloading (passive elevation) to reduce neck pain (the associated case is

a dancer who had scapular unload to reduce neck pain with arms overhead. Doesn’t need to match but given for context)

b. or postural modification to reduce sciatic nerve symptoms (the associated case is a cyclist who had a bike fit to thoracic flexion and his symptoms in his thoracic spine went away)

11. Joint position error training: A study on how joint position error training on can decrease neck pain

12. Restore mobility and relative motion: A study on how thoracic mobilization decreases neck pain

13. Utilize newly acquired motion: A study on how hip stretching and spinal stability exercises can reduce low back

The Athletic Movement System: Spine

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14. UQ Plyometric Dosage: A study or editorial on recommendationsor guidelines for UQ plyometric dosage

The Athlete Movement System: Spine...– Orthopedic residency mentor – Three books on athlete injury prevention – Numerous publications on injury prevention – Editorial board

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