Mapping Movement MedicalMarketingpast.life.edu/.../uploads/2015/09/Nickelston_Perry.pdf ·...
Transcript of Mapping Movement MedicalMarketingpast.life.edu/.../uploads/2015/09/Nickelston_Perry.pdf ·...
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Medical MarketingMapping Movement
Danny porcelli, dc
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somewhere, something went terribly wrong
Brazilian researchers discovered an interesting link between a person’s ability to sit and rise from the floor and the risk of being 6.5 times more likely to die in the next six years.Brito LBB, Ricardo DR, Araujo DSMS, et al. Ability to sit and rise from the floor as a predictor of all-‐cause mortality. European Journal of Cardiovascular Prevention, 2012;
SIX YEAR STUDY2,000 PEOPLE AGES 51 TO 80.
A SCORE OUT OF 10.
Instructions: "Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed.”
Each of the two basic movements were assessed and scored out of 5, with one point being subtracted from 5 for each support used (hand, forearm, knee, for example).
159 people died Each point increase in a person's test score was linked with a 21 percent reduction in their risk of death.
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Movement is our Business
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Movement never lies
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corrective exercise -‐ Used to normalize human movement before increasing training or exercise demands
rock tape -‐ A special kinesiology/sports tape that provides support while allowing full range of motion. Tape is used to decrease pain, unload tissue via decompression, and provide a novel stimulus that improves body awareness.
iastm -‐ Instrument -‐ Assisted Soft Tissue Massage -‐ A manual therapy technique designed to provide direct, mechanical manipulation of irregular tissue.
rolling/balls/bands -‐ A collection of tools used by athletes for manipulation of the myofascial system to normalize muscle tone.
assessment-‐ The act of making a judgment about the quality of human movement
screening-‐ The act of examining people to decide if they are suitable for a particular movement or exercise
RockTape movement pyramid
MOVE Well FIRSTthen MOVE Often
then LOAD Regularly
Movement as MEDICINE
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Evaluate Movement Prior to Load/Stress
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soft tissue
neurological joint
What is causing abnormal movement?
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Absent trauma, all stiffness is
compensatory for instability elsewhere
“Movement never lies.”Martha Graham
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stiffness compliance
Criteria for Optimal Efficiency
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ELASTIC SPRINGY
Rapid deliver of muscular energy is the key
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pre-‐push
Adjo Zorn – Fascial Elasticity
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fascia as our roadmap
IT’S ALL CONNECTED
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mesoderm – old model ectoderm – new model
connected both mechanically and neurologically
nervous system
Pain/Performance
Movement articular
muscularFascia
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past
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future
Future
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It’s Alive
Fascia Senses Richest Sensory Organ
Fascia Transmits Force Globally Common myofascial pathways for transmitting stability, strain, and response Distributes strain
Continuous interconnected web A GPS system of strain distribution
what is fascia
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Muscular strain is applied along traceable “Myofascial Lines”
Thomas Myers – Anatomy Trains
toe touch test
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regional interdependenceAKA -‐ Joint by Joint Approach
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Wainner, RS, et al. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-‐660
“When the assessment is initiated from the perspective of a movement pattern,
the clinician is able to identify meaningful impairments that may seem
unrelated to the main complaint”
Regional Interdependence
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MOBILITY vs. Stability
Joint by Joint ApproachGrey Cook & Michael Boyle
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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex Mobile Elbow Stable Wrist Mobile
** key mobility centers 34
mo·∙bil·∙i·∙ty mōˈbilədē/
the ability to move or be moved freely and easily.
sta·∙bil·∙i·∙ty stəˈbilədē/
the state of being stable.
motor control the systematic transmission of nerve impulses from the motor cortex to motor units, resulting in coordinated contractions of muscles.
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Motor%Control%Pa+erns%%Mobility%Pa+erns%%
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movement screening methods
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corrective exercise -‐ Used to normalize human movement before increasing training or exercise demands
rock tape -‐ A special kinesiology/sports tape that provides support while allowing full range of motion. Tape is used to decrease pain, unload tissue via decompression, and provide a novel stimulus that improves body awareness.
iastm -‐ Instrument -‐ Assisted Soft Tissue Massage -‐ A manual therapy technique designed to provide direct, mechanical manipulation of irregular tissue.
rolling/balls/bands -‐ A collection of tools used by athletes for manipulation of the myofascial system to normalize muscle tone.
assessment-‐ The act of making a judgment about the quality of human movement
screening-‐ The act of examining people to decide if they are suitable for a particular movement or exercise
RockTape movement pyramid How do we evaluate movement?
1. Screen – A simple test performed on a large number of people to identify those who have or are likely to develop a specified disease (Higher Level Function) A. Static B. Dynamic
2. Assessment – In depth evaluation of a clinical condition. Usually in presence of pain 3. Testing – Isolated evaluation
39no reliable methods
Movement screening
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all movement is a screen
Posture Analysis - STATIC
Bio-‐Checkpoints:
1. Feet 2. Ankle 3. Knees 4. LPHC 5. Scapula/Thoracic 6. Cervical 7. Upper Extremity
Movement Analysis - Dynamic
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multi-planar approach
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OHS - Normal
trunk & tibia parallel
elbow straight
no shifting of weight
hips past 90 degrees
arms in line with ears
feet parallel
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planar dysfunction
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We are looking at skin, not muscles.
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mobility or stability?
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mobility principles
Pain Affects Movement
“Patterns involving pain should be treated with manual therapy
techniques. Exercises in that pattern should not be used until the movement is pain free.”
-‐Grey Cook, PT
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1joint restriction:
• CMT -‐ you • Banded Distractions -‐ learn today 2
soft tissue shortening:• Foam Rolling • Ball Release
principles of mobility 2 levels of restriction
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normal tissue adhesions
villain’s accomplice
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• What can the joint accomplish without external influence
• “Hinges on the door” concept • Mobility are the hinges
mobility
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• Increases tactile acuity (kinesthetic sense) • Inexpensive massage that your patients can do on their own • Alleviate tightness • Increase ROM at joints • Decrease muscle soreness • Maximizing optimal length/tension relationship • Relieve joint stress
Self Myofascial Release (SMR)
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When you treat a patient or foam roll yourself and feel better it is the nervous system that you have influenced. It is unlikely that any changes in the mechanical properties of tissues have occurred.
You have convinced the nervous system to let you move farther, with greater ease or with greater strength.
Thought to stimulate intra-fascial mechanoreceptors which cause alterations in the afferent input to the CNS, leading to a reduction in the activation of specific groups of motor units
More widely accepted than the older mechanical models.
rolling the brain
!!
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!
!!
!!
Autonomic Nervous System - Brain
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Hypothalamic tuning Global muscle tone
intra-fascial smooth muscles
palpable tissue response
tissue manipulation
stimulation of mechanoreceptors
56SCAN + IDENTIFY + RECOVERY RELEASE + NAVIGATE
1. SCAN tissues targeted within workout.
2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE
3. HOLD pressure on target tissue for 30 seconds to tolerance = RECOVERY RELEASE
4. Address tissues up/down stream to target tissue = NAVIGATE
RECOVERY/PAIN mobility techniques
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Untreated Knee
Rock Tape Knee
Foam Roll 1 Knee
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mobility - ripple effect
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where you think it is, it ain’t.
Ida Rolf
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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable ** key mobility centers
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ankle restriction
• ripple: • calf/shin/hamstrings
• target tissue – ankle • ripple:
• foot
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hip restriction
• ripple: • Q/L, mid-back, lats
• target tissue – hip • ripple:
• hamstrings, quads, calves, foot, shins
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shoulder restriction
• ripple: • mid-back, lats,
pectorals • target tissue –
shoulder • ripple:
• arm, forearm, hand
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banded mobilizations
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1. Grade I: Small amplitude at the beginning of the range of motion (ROM)
2. Grade II: Large amplitude not reaching the end of the ROM
3. Grade III: Large amplitude reaching the limited ROM 4. Grade IV: Small amplitude at the end of the limited ROM 5. Grade V: Small amplitude and high velocity at the end of
limited ROM (manipulation or thrust)
Maitland mobilization categories
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• Malignancy in area of treatment
• Infectious Arthritis
• Metabolic Bone Disease
• Neoplastic Disease
• Fusion or Ankylosis
• Osteomyelitis
• Fracture or Ligament Rupture
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• Excessive pain or swelling
• Arthroplasty
• Pregnancy
• Hypermobility
• Spondylolisthesis
• Rheumatoid arthritis
• Vertebrobasilar insufficiency
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+ Torque
mobilization vectors
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2. traction - parallel to joint
1. glides - perpendicular to joint plane
3. torque - tissue torque applied with mob band
3 mobilization vectors
Compliments CMT, send them home with
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proximal stability allows for distal mobility
3 points of
contact
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anchor
3 points of contact
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Clock Method
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30-60 seconds
Glide - posterior vector (hip)
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glide - anterior vector (hip)
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glide - lateral vector (hip)
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glide - multi-vector mobilization (hip)
6 o’clock
7 o’clock
9 o’clock
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traction (hip)
long axis
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torque
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Torque (hip)
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motor control principlesRewiring the Brain
Pain and Motor Control
“Motor Control will be distorted and outcomes will be inconsistent when
exercise is performed in the presence of pain.”
Hodges PW Pain and Motor Control: From the laboratory to rehabilitation. Journal of Electromyography and Kinesiology 21 (2011) 220-‐228
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On the Fence?
Stability typically precedes mobility
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ability of a joint system to control movement in the presence of change
Stability
RockTape Arsenal
Todays TOOLS
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MOBILITy vs Stability
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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable
** key mobility centers 92
corrective exercise -‐ Used to normalize human movement before increasing training or exercise demands
rock tape -‐ A special kinesiology/sports tape that provides support while allowing full range of motion. Tape is used to decrease pain, unload tissue via decompression, and provide a novel stimulus that improves body awareness.
iastm -‐ Instrument -‐ Assisted Soft Tissue Massage -‐ A manual therapy technique designed to provide direct, mechanical manipulation of irregular tissue.
rolling/balls/bands -‐ A collection of tools used by athletes for manipulation of the myofascial system to normalize muscle tone.
assessment-‐ The act of making a judgment about the quality of human movement
screening-‐ The act of examining people to decide if they are suitable for a particular movement or exercise
RockTape movement pyramid
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2 ways to affect motor control 1. tape on skin 2. corrective exercise
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tape - mechanical effect
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tape - neurological effect
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“much of what we know about pain is based on the skin. In this sense, it mirrors the state of the nervous system. “Excerpt From: Dr David S. Butler & Prof. Lorimer Moseley. “Explain Pain.” Noigroup Publications. iBooks.
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modern rehabilitation/training will be via normalization of sensation, motor control.
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when you are defending, you can’t be performing Douglas Heel (Mind and Muscle)
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Stretch the area
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lay down 1-‐2 pieces of tape, no stretch Rub in the adhesive
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what about direction of
tape?
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what about the amount of stretch?
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Research shows that kinesthetic guidance can be translated into
behavior 30 times faster than visual guidance can and many thousands of times faster than audio guidance.
(Birdwhistell, 1971).
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2 ways to affect motor control
1. tape on skin 2. corrective exercise
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+ =low threshold repetition
plastic change
neuroplasticity
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less is more- mies van der rohe
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2 steps
+isolation integration
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isolation exercises
reactive neuromuscular training (RNT)
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integration exercises - PMT Training
Brugger’sPallof
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the blueprint
1. screen 2. moblilize / ripple 3. stabilize / Motor Control
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classic relationships along kinetic chain
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Foot Stable Ankle** Mobile Knee Stable Hip** Mobile Pelvis/Sacrum/L-Spine Stable Thoracic Spine** Mobile Cervical Spine Stable Shoulder complex MOBILE Elbow Stable Wrist stable
** key mobility centers
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1. screen 2. mobilize/ripple:
• toe, calf + ripple mobilizations 3. stabilize:
• foot TapinG • Motor Control: short Foot
foot - classic area of stability loss
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screen
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mobilize
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stabilize
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motor control
short foot
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1. screen 2. mobilize:
• banded mobilization (multi-planar) 3. Stabilize - Ripple foot and knee
ankle - Classic area of Mobility loss
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screen
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mobilize
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1. screen 2. mobilize/ripple:
• foam roll + ripple
3. stabilize: • Tape -knee • motor control - lateral band walks, RNT
(variations)
knee - classic area of stability loss
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screen
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mobilize ripple
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mobilize
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stabilize
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motor control
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1. screen 2. mobilize:
• trunk, t-spine, shoulder girdle, upper c-spine mobilizations + ripple
3. stabilize: • Tape - low back • motor control: lateral band exercises (progressions)
hip - classic area of mobility loss
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screen
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mobilize
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band mobilization
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stabilize
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motor control
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1. screen 2. mobilize:
• diaphragm, t-spine, hip mobilizations 3. stabilize:
• lumbar, diaphragm + ripple 4. movement:
• isolation: RNT (quadraped) • integration: brugger’s, pallof
trunk - classic area of stability loss
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screen
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stabilize 156
motor control
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1. screen 2. mobilize:
• t-spine, upper c-spine, shoulder girdle
3. stabilize/Ripple option: • Tape - lower back, shoulder girdle, lower c-spine • motor control -open book exercise
thoracic spine - classic area of mobility loss
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screen
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isolation
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1. screen 2. mobilize/ripple:
• t-spine, upper c-spine, elbow 3. stabilize:
• tape - elbow, cspine - shoulder? • Motor COntrol - chops
shoulder complex - classic area of mobility loss
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screen
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motor control
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• skin is an extension of the brain • tape augments our body awareness • screen movement, not muscles • tape movement, not muscles • use fascia as a map • retrain the brain
in summary