How movement analysis helps us help you

Once upon a time..
Like most doctors/P.T.'s, I used to use a standard process of finding what was wrong with my patients. It usually consisted of testing the affected area with orthopedic tests.  As I pursued my rehab specialty I found that there is more to consider, that the hip bone is indeed connected to the thigh bone. I was taught to look at the whole, as opposed to the sum of it's parts.  In previous posts I mentioned how the hip can be a major contributing factor in lower back and knee issues(see "The bad neighbor"), today I want to share how we find just that.
Our body is a moving chain?

At least that's what I used to tell everyone, but really it's alternating series of mobile and stable links. Life is dynamic, and we ask our bodies to move and conform to every imaginable task we set out to perform (sit, stand, crouch, squat or crawl).  There is a  new approach in manual medicine(Chiropractic and Physical Therapy) called Functional Movement Analysis is a new approach that we use to figure out why certain movements, or lack thereof, are causing the body to overuse and break down. It tells us if the areas that should be moving are moving & if the areas that are supposed to be stabilizing are stabilizing.  These patterns are universal to all of us and when disrupted or absent create undo stress to certain critical body parts.

What's in a test?

Any movement can be a functional test, something as simple as watching someone rise  from a chair, squat down or jump down off of a box.  Lets consider the squat. By analyzing figure 1 the squatter on the right needs to work on the amount her upper back can bend backward (extend). She could also use some lower back stability training and ankle mobility as well. Hopefully it's easy to imagine the squatter on the left being able to endure more squatting without injury over the squatter on the right, because that is the case.

Figure 1 courtesy of NASM

These female athletes were asked to drop off the box and then jump as high as they could, you can see that the athlete in figure A maintains the space between her knees while the athlete in figure B collapses. The second athlete has a much higher rate of ACL tears because of the hip weakness, she shows in this movement test. Finding and correcting that flaw may save her athletic career.

figure 2

figure 2

The news is getting out.
Several recent studies performed by orthopedist are being published supporting this theory of "the bad neighbor". That shoulder problems and knee problems are greatly affected by related body parts, and that just treating the affected area is just sweeping the dirt under the rug. Study on how shoulder pain is connected to hip issues. As well as a great post on the influence of hip and ankle on knee pain.

Good enough for world champs?

These "functional" testing procedures not only allow for detection of impending injuries but we also use them as a baseline to measure future progress.  After finding these underlying problems, specific corrective exercises are prescribed to correct it. (mentioned in this post). In fact we usually see improvements in the first treatment. There are many systems of testing out there, all of them have merit and while we favor a select few, we use most of them in some form or another.  The Super Bowl winning Seattle Seahawks use this as a guide for off season training and injury prevention, and if it's good enough for them, well you know how that goes...

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

Strength from the ground up

Functional exercise
Today we are going to dive right into the  new phenomenon of "Functional Exercise" seen in many of the gyms & exercise magazines. If you look back at my previous posts your aware of the reasons we stiffen. As adults we quickly lose mobility which robs us of moving correctly, or what we in the rehab world call "Functionally". One of the primary purposes I began writing this blog was to explain the importance of movement. A big part of getting you moving again, without compensations that  harm you, is getting you back to your developmental roots.
Developing our motor skills  occurs when we are infants. We first learn to roll over, then crawl, eventually we get up on one knee and ultimately we stand. As infants we have all the mobility in the world, it's the stability that needs to be learned. In rehab we use these positions as "resets" to reestablish movement patterns that are essential to correct functional movement, and functional exercise(more on this in future posts).

Why are we doing this again? 

Many trainers are adding functional exercise, not understanding the reasoning  & it's became a novelty.  Functional exercise is most effective when used to improve a deficiency.  As a Functional Movement Screen practitioner, I use the findings of the screen as the basis for prescribing the exercise. 

This will end badly...

When we look at one of the most fundamental movement not only in exercise but in life; the squat, this concept can be better understood..

Whoa, slow down there tiger

As you can see our young friend can easily sit in a deep squat while playing, while our weight lifting friend is about to get a chance to meet yours truly (after he sees every other provider without relief). The weight lifter is trying to build strength on poor movement. While he may get away with it for a short time, this strategy is sure to fail, this is the scenario I'm attempting to save you from. The functional movement that I referred to applies not only to the squat but many other exercises & activities that will be spoken about frequently in my posts.
Baby steps
Nobody wants to have to take a step back, but in order to "Live to Move", we will need to go through prescribed corrective exercises to get the movement right, before we start adding resistance and accentuating our faults. The more the individual strengthens their faults, the more work there will be in reversing that process.  An example of stepping back to master the squat would be for someone to learn to hinge at the hips, build mobility in the hips ankle and upper back, followed by learning to master the glute bridge,  and  finally progress to face the wall squats.

 Putting it all together

By taking a step back and making sure the way you move isn't hurting you, you will create and maintain an amazing foundation to move better, feel better, work better and train better. The squat is a tremendous and fundamental movement most of us have difficulty performing.  It's also one of the best exercises for loosing fat and adding muscle when performed correctly, and when we add functional movement it's also one of the safest. 

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

A Body in Motion Tends to Stay in Motion

How to save your back and knees! The Bad Neighbor; continued..

PART III of "It's all in the hips" 
A Body in Motion Tends to Stay in Motion

In the last post we discussed what can be done to lessen the effects of postural strain and the resultant muscle imbalance that is silently causing or contributing to the back and knee syndromes.  We also need ACTIVE strategies to move well.  
The active strategies are called corrective exercises, they can be performed for just a minute (micro-break), as part of your "dynamic" warm-up, or in the cool down phase of your workout. The moment and duration you would perform these depends on individual needs, but it's hard to overdo these. Ask your qualified health/fitness pro for clarification or call upon us for specifics. These may look familiar for those of you with a regular work out routine, however why you're doing them may have been a mystery.

The Leg Lowering Progression

Here's a great exercise from Gray Cook, found in his book "Movement" (1), it promotes the amount one hip can move in relation to another. One may wonder why that's important, until we consider some sporting activities. Start with a supported (wall or partner) straight leg raise. The athlete should be pressing hard into the floor with the hands to lock in the trunk throughout the movement. Knees should remain straight, ankles dorsiflexed, hips neutral (watch for external rotation), and trunk is rigid.

The tall half kneel

This position is an essential step in our rehab progressions, and it's also a great way to strengthen with core integration, but it's use in this discussion is to promote hip extension. Hip extension is so critical to us all, it's especially absent in so many of my runner patients, so here's the fix. In performing the tall half kneel, form is everything, the upside knee and the downside knee are both at 90 degrees and the posture is lengthened (thus the tall). While maintaining the tall posture lean in to the front knee. 5 second pulses with a second break will restore some much needed movement.  This courtesy of functionalmovement.com , an excellent resourse for anyone that wants to perform better.

Tim Lincecum, a pitcher for the San Francisco Giants displays incredible hip "dissociation" which allows him to generate speed from his core, not his shoulder.

While we're not all MLB pitchers, the same principles that make these guys great in their movements,  help us be proficient at the activities we love also.  The opposite is also true, if we lack this movement, it's part of the problem. Hiking, surfing, soccer, racket/club sports and many other activities rely on this essential movement to generate power from the core. 

The Dynamic Warm up

The latest research on warming up before your work out supports moving stretches done briskly and briefly. These new stretches are called dynamic warm ups. The general rule is 10 to 20 paces, moving in a range that is only slightly challenging. We're not looking for the deep burn you may experience in Yoga, this gets the ligaments, tendons and joints ready for activity. The warm up you choose should mimic the target activity.

These two activities are literally the tip of the corrective exercise iceberg, I don't want to overwhelm you, just provide a deeper understanding of the many options that are becoming popular in the world of rehab and sports science. Contact us with any questions and consider getting some instruction on activities such as these.

1-Cook, Gray. Movement: Functional Movement Systems ; Screening, Assessment and Corrective Strategies. Santa Cruz, Calif: On Target Publications, 2010. Print.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

The bad neighbor..

PART II of "It's all in the hips"
The body is a mobile object
The body needs to move in every direction to accommodate our daily living activities, as well as any other activities we put it through. Each portion of our body contributes to the overall movement , as each instrument plays it's part in an orchestra. The body will steal from adjacent joint to accommodate the movement. In rehab, we call this "substitution". It's a normal event that occurs all day every day with each of us, whether we are "in shape" or not so much. When substitution occurs, the hips refuse to move causing the lower back to move too much to accommodate it, the hips become what is essentially a "bad neighbor".

Everything in moderation is all right
We all need to sit, but altering the position needs to become a priority. Substitution in excess will lead to poor biomechanics, so it's important we do what we can to avoid letting the hips get stuck in that seated position. In my last entry we discussed hip mobility and the effects static positions have on the hips. Any body part left in the same position for too long will soon loose it's ability to move, because of neurologic motor control principles.  An extreme example is where a joint is cast/immobilized for weeks and the patient has little to no movement when it's finally removed.

Ergonomics; fitting the individual to the workstation
No two people are the same, each individual has unique needs and characteristics that must to be taken into consideration when dispensing ergonomic advice. In general terms, we can look at what ergonomic help we can get to lessen the effects of prolonged postures.

In a kneeling chair or in a perched position (sitting at the edge of your chair) we improve not only is the hip angle, but also restore the natural and beneficial low back curve. Another beneficial effect is the glutes will "turn on" in this position, as sitting typically turns the glutes off forcing other muscles to overwork in a majority of the lower back pain syndromes.  Other chair substitutes in the past have included sitting on a physioball, however a recent study showed no improvement in posture and an increase in discomfort.(1).  As we stated earlier, changing positions has been shown to decrease physical stress and improve pain patterns.  There are some wonderful apps you can use as a reminder to take a "micro break", 30 seconds to a minute to perform some yoga like restorative stretches. For those who are confined to a car; the seat back should be altered often to alleviate the stress being placed on the hips. 

Get up stand up

In a similar vein, standing work stations are now being offered for some when your doctor recommends them to your HR department. The newest of these stations are actually adjustable putting the user at an optimal position in either the standing, perched or seated position. OSHA provides these guidelines to standing work stations, in this example it's for food handlers but it applies to any type of work. (2).  

Next post we will be discussing active sparing strategies and corrective exercises of the hips and lower back. 

1.Stability ball versus office chair: comparison of muscle activation and lumbar spine posture during prolonged sitting.

Gregory DE1, Dunk NM, Callaghan JP.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

It's all in the Hips

Part 1 of the Hip
Today's installment is about the hips. We hear a lot about back & knee pain, but many times it's the hips that cause and contribute to pain in those areas.  Here's what the National Institute of Neurological Disorders has to say about back pain; "Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions." 
The Hips are the linchpin of the lower half of our bodies, they help us move, dance, perform sporting activities and allow us to do daily living activities like bend over and pick up items. If we view our bodies as a moving chain, you could see how lack of movement in one area is sure to cause a increase in movement in an area close by. Therein lies the conundrum of modern life, for thousands of years our ancestors moved all day, seeking food, preparing shelter and defending those close to them. Fast forward to where we are today; where many of us travel hours for work, then spend the day siting at a workstation-- many of those who exercise do so in a seated position on cable driven machines--and to top it off we go home and rest, once again in a seated position.

We Live in a flexion based society.
Many of the problems we see in the clinical setting today have a element of muscle imbalance caused or contributed to by the summation of our daily activities. Our bodies are learning machines, they quickly adapt to whatever we expose them to, and in the case of the hip, if we leave it in a flexed position long enough (i.e. sitting) they tend to stay that way. When the hips can't move the compensation typically is the low back moving too much. This quickly overwhelms the low back which is designed for stability.

Exercise can actually worsen the problem.
Faulty movement patterns(secondary to imbalances) can actually feed the postural imbalances. For those who strength train, there's a tendency to focus developing the muscles we see in the mirror. Those muscles are situated in the front of the body, the same bad influence we get from sitting is accentuated in many of our work out routines.  To add fuel to the fire, running-a constant state of falling forward-contributes to muscle imbalances of the hip. 
Ask me how many runners I treat for knee pain...

What do we do now?
There's a renaissance occurring in rehabilitation, as clinicians we are looking for the weak link as opposed to to simply treating the source of pain. Marvelous movement screens have been developed to detect these postural disturbances.  I use this type of analysis more than orthopedic testing with miraculous results. None of my patients with low back or knee pain leave without corrective exercise strategies to address "the hidden problem".  What I try and get across to them, and hopefully you, is that these problems are a culmination of everything we do.  If lasting relief of an injury or pain is expected, modification of lifestyle AND activity need to be addressed on a semi regular basis. 
Tune in next time for some of my favorite strategies and corrective exercise moves, from the leaders of this renaissance movement. These activities have become a game changer in my personal and professional life.  

^^Now, don't be this guy. ^^

Consider what you can do to make a difference in how you move today-a simple idea such as replacing your office chair with a standing station or kneeling chair, but more of that in our next post. 

PART II of "It's all in the hips"
The body is a mobile object
The body needs to move in every direction to accommodate our daily living activities, as well as any other activities we put it through. Each portion of our body contributes to the overall movement , as each instrument plays it's part in an orchestra. The body will steal from adjacent joint to accommodate the movement. In rehab, we call this "substitution". It's a normal event that occurs all day every day with each of us, whether we are "in shape" or not so much. When substitution occurs, the hips refuse to move causing the lower back to move too much to accommodate it, the hips become what is essentially a "bad neighbor".

Everything in moderation is all right
We all need to sit, but altering the position needs to become a priority. Substitution in excess will lead to poor biomechanics, so it's important we do what we can to avoid letting the hips get stuck in that seated position. In my last entry we discussed hip mobility and the effects static positions have on the hips. Any body part left in the same position for too long will soon loose it's ability to move, because of neurologic motor control principles.  An extreme example is where a joint is cast/immobilized for weeks and the patient has little to no movement when it's finally removed.

Ergonomics; fitting the individual to the workstation
No two people are the same, each individual has unique needs and characteristics that must to be taken into consideration when dispensing ergonomic advice. In general terms, we can look at what ergonomic help we can get to lessen the effects of prolonged postures.

In a kneeling chair or in a perched position (sitting at the edge of your chair) we improve not only is the hip angle, but also restore the natural and beneficial low back curve. Another beneficial effect is the glutes will "turn on" in this position, as sitting typically turns the glutes off forcing other muscles to overwork in a majority of the lower back pain syndromes.  Other chair substitutes in the past have included sitting on a physioball, however a recent study showed no improvement in posture and an increase in discomfort.(1).  As we stated earlier, changing positions has been shown to decrease physical stress and improve pain patterns.  There are some wonderful apps you can use as a reminder to take a "micro break", 30 seconds to a minute to perform some yoga like restorative stretches. For those who are confined to a car; the seat back should be altered often to alleviate the stress being placed on the hips. 

Get up stand up

In a similar vein, standing work stations are now being offered for some when your doctor recommends them to your HR department. The newest of these stations are actually adjustable putting the user at an optimal position in either the standing, perched or seated position. OSHA provides these guidelines to standing work stations, in this example it's for food handlers but it applies to any type of work. (2).  

Next post we will be discussing active sparing strategies and corrective exercises of the hips and lower back. 

1.Stability ball versus office chair: comparison of muscle activation and lumbar spine posture during prolonged sitting.

Gregory DE1, Dunk NM, Callaghan JP.

PART III of "It's all in the hips" 
A Body in Motion Tends to Stay in Motion

In the last post we discussed what can be done to lessen the effects of postural strain and the resultant muscle imbalance that is silently causing or contributing to the back and knee syndromes.  We also need ACTIVE strategies to move well.  
The active strategies are called corrective exercises, they can be performed for just a minute (micro-break), as part of your "dynamic" warm-up, or in the cool down phase of your workout. The moment and duration you would perform these depends on individual needs, but it's hard to overdo these. Ask your qualified health/fitness pro for clarification or call upon us for specifics. These may look familiar for those of you with a regular work out routine, however why you're doing them may have been a mystery.

The Leg Lowering Progression

Here's a great exercise from Gray Cook, found in his book "Movement" (1), it promotes the amount one hip can move in relation to another. One may wonder why that's important, until we consider some sporting activities. Start with a supported (wall or partner) straight leg raise. The athlete should be pressing hard into the floor with the hands to lock in the trunk throughout the movement. Knees should remain straight, ankles dorsiflexed, hips neutral (watch for external rotation), and trunk is rigid.

The tall half kneel

This position is an essential step in our rehab progressions, and it's also a great way to strengthen with core integration, but it's use in this discussion is to promote hip extension. Hip extension is so critical to us all, it's especially absent in so many of my runner patients, so here's the fix. In performing the tall half kneel, form is everything, the upside knee and the downside knee are both at 90 degrees and the posture is lengthened (thus the tall). While maintaining the tall posture lean in to the front knee. 5 second pulses with a second break will restore some much-needed movement.  This courtesy of functionalmovement.com , an excellent resource for anyone that wants to perform better.

Tim Lincecum, a pitcher for the San Francisco Giants displays incredible hip "dissociation" which allows him to generate speed from his core, not his shoulder.

While we're not all MLB pitchers, the same principles that make these guys great in their movements help us be proficient at the activities we love.  The opposite is also true, if we lack this movement, it's part of the overall problem that leads to dysfunction and injury. Hiking, surfing, soccer, racket/club sports and many other activities rely on this essential movement to generate power from the core, without it we develop energy leaks and other parts that are related but not always close break down. 

The Dynamic Warm up

The latest research on warming up before your work out supports moving stretches done briskly and briefly. These new stretches are called dynamic warm ups. The general rule is 10 to 20 paces, moving in a range that is only slightly challenging. We're not looking for the deep burn you may experience in Yoga, this gets the ligaments, tendons and joints ready for activity. The warm up you choose should mimic the target activity.

These two activities are literally the tip of the corrective exercise iceberg, I don't want to overwhelm you, just provide a deeper understanding of the many options that are becoming popular in the world of rehab and sports science. Contact us with any questions and consider getting some instruction on activities such as these.

1-Cook, Gray. Movement: Functional Movement Systems ; Screening, Assessment and Corrective Strategies. Santa Cruz, Calif: On Target Publications, 2010. Print.

 Thanks so much for reading and if you think someone you know can benefit from this post, please share!

Dr. Gene Serafim

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

Hello friends, patients, students and fellow exercise professionals, welcome to Move to Live, Live to Move.   Recently I was asked by a trainer friend if I could guest blog &  I figured why not start my own! I'll be bringing you my take on topics in the fitness, health & healing world. For those of you who don't already know, I am a certified Specialist in the areas of Rehabilitation,  Strength &  Conditioning. I currently teach continuing education classes to Chiropractors across the country &  love staying current with the latest and greatest fitness trends. Anyone who is interested we'll be sharing the most efficient ways to gain greater mobility, increase strength, become leaner & more functional.
This blog is dedicated to feeling great, looking great and moving great.
Please ask questions and feel free to start a dialogue!
The back bone (pardon the pun) of our conversations will be mobility and stability.
Exercise is movement related and without mobility and stability, you can't stand walk or even crawl properly. Integrating these concepts into your fitness regiment is the foundation needed to begin any exercise program & the first piece necessary in reaching your goals. Taking a step requires a stable hip to stand on and a mobile hip to step with.  Any disruption to either of these tenets, will result in movement patterns that, when accelerated or repeated will cause the human frame to suffer. Many times when people begin an exercise plan they start with a Nautilus circuit- locking yourself into a machine that does not use "natural" movements is not the optimal way to maintain or improve mobility or stability & can lead to serious injury.
For those of you who have not begun or are looking to prevent injury, we'll bring you brief strategies that will keep you from harm and motivate you towards your health & fitness goals. For those who do work out, we'll provide concepts, exercises and postings that will change the way you do things.
In my own personal experience, it took me years to achieve my "healthy ideal". The secret was to accept that what I was attempting was not effective & then changing the way I approached exercise.
 I have so much to share, and this is a great forum to do so.
The definition of insanity is doing the same thing and expecting a different result, so join me in ending the insanity, and LIVE TO MOVE!


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.