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The Hips, Pelvis, Spine & Shoulder Girdles: Facilitating Optimal Movement & Regional Integration - Gordon Browne (USA)

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Duur 4 dagen Start 28/06/2017 Uiterste inschrijvingsdatum 28/06/2017
Prijs € 895 Artikelnummer IC_HPS17 start op 28 juni t/m 01 juli
Docenten Gordon Browne (USA)
Adres Campus UZ Gent, De Pintelaan 185, 9000 Gent (inrit via Corneel Heymanslaan), gebouw B3, 5e verdieping leslokaal 5.17

Course dates: 28/06/2017 tm 01/07/2017 from 9h till 17h.
Adress: Campus UZ Gent, De Pintelaan 185, 9000 Gent (inrit via Corneel Heymanslaan), building B3, leslokaal 5.17.

A course day has 2 coffeebreaks and one lunch break.

Course Description

In working with hip, pelvic and lumbar issues, you will develop a clearer understanding of relationships within this region (hips to pelvis to low back; left hip to right hip) as well as relationships to higher spinal regions. The initial two days of this course blends existing core stabilization principles with emerging regional interdependence realities to advance our understanding of and treatment of this critical region. Hip immobility and instability issues are addressed and movement sequences built around functional contexts (sit, stand, bend, turn, push/pull, lift, walk) help our patients with both skills acquisition (strength and flexibility) and with application of functional lumbo-pelvic stabilization and neutral back awareness to activities of daily life. In working with the neck, thorax and shoulder girdles over the subsequent two days, we will be continuing our themes of regional interdependence and patient proprioceptive awareness. Thoracic and rib cage mobility, motor control, AP and left/right balance and integration with movements of the head are critical to cervical health and musculoskeletal efficiency. The scapulae are the jumping off point for the arms and share the support system of pelvis, spine and rib cage with the head and neck; all are inexorably intertwined. We will be exploring experientially, observationally and intellectually how the slinky-like rib cage and thoracic spine constitute a mobile and flexible base from which the head, neck and arms can move. We will be moving beyond origin and insertion thinking and will utilize integrative movement principles that see the head and arms moving as an extension of the torso, rather than moving relative to an artificially stabilized torso or scapula. Facilitating proximal power, balance and mobility with distal control, nuance and delicacy, this course explores the various relationships of the spinal system; the mistakes people make that create repetitive strain injuries as well as the compensations made in response to injury. Informational movement sequences built around functional contexts of postural balance, orientation to a high horizon, breathing, orientation up/down and along the horizon and dynamic scapular stabilization again help our patients with skills acquisition, proprioceptive self-awareness training and ADL optimization.

Course Objectives:

  1. Define Regional Interdependence and Specific Motor Control Exercise.
  2. List the three primary differences between Static Integration- and Dynamic Integration-based exercise
  3. Define the difference between Global and Differentiated movement or postural patterns and list two examples of each in both low back/hip and neck/thorax regions.
  4. List three principles of Optimal Movement and give examples of common hip, lumbar, cervical and shoulder girdle injuries resulting from sub-optimal movement.
  5. Explain these important regional relationships and give two examples of each in common functional activity; hip flexors/lumbar flexion stresses, hip extensors/lumbar extension stresses; semi-predictable thoracic muscle antagonist imbalances and how they affect directional cervical instability.
  6. Demonstrate three variations of Pelvic Force Couple facilitations and list one benefit for each of the following; lumbar extension related LBP, lumbar rotation/lateral shear related LBP, labral issues, FAI, hip THR/fractures, trochanteric pain syndrome.
  7. Pinpoint long-term habitual movement and postural mistakes and correlate to specific cervical and shoulder girdle traumatic and repetitive stress injuries; cervical disc/joint degeneration, cervico-genic headaches, shoulder girdle myofascial syndromes, thoracic outlet syndrome, whiplash/MVA.
  8. Perform teaching techniques throughout the course that make exercise more “informational”; reciprocating movements, use of constraints, change of venue, goldilocks principle and link to functional context.

Course Outline: Lab sessions involve movement observation, participation and analysis as well as discussion of clinical relevance, modifications and manual/verbal cueing.

Day 1

8:00-9:30-Introduction to Integrated Movement Principles

9:40-12:00-Lab #1: Lumbo-Pelvic AP Relationships (1st Approximation)

  • Determining Habitual & Non-Habitual Differentiation Patterns
  • Hip Extensor/Abdominal & Hip Flexor/Back Extensor Synergies
  • Facilitating Patient Perception: Find & Maintain AP Neutral Spine

1:00-3:20- Lab #2: Lumbo-Pelvic Rotational Relationships (1st Approximation)

  • Mobilizing Hip IR/ER: Stabilizing Pelvis & Low Back Rotationally
  • Functional Training of Hip Rotators, Adductors & Gluteus Medius
  • Reciprocating Movements: Balancing Antagonists & Re-Calibrating Neutral

3:30-5:30- Lab #3: Lumbo-Pelvic AP Relationships (2nd Approximation)

  • Mobilize Thoracic/Stabilize Lumbar: Funneling Movement Where We Want It
  • Applying Constraints & Changing Venues: Targeted Thoracic Activation
  • Facilitating Even Distribution of Movement & Proportional Use of Synergists

Day 2

8:00-9:30-Lab #4: Lumbo-Pelvic Rotational Relationships (Second Approximation)

  • Adding Resistance: Facilitating Core Awareness & Control
  • Coordinating 3 Layers of Stability: Intersegmental, Waist & Pelvis
  • Patient Pattern Recognition & Problem Solving: Creating Progressions

9:40-12:00-Lab #5: Lumbo-Pelvic AP Relationships (3rd Approximation)

  • Functionalizing Exercise: Sit, Stand, Bend, WIFS
  • Making Better Movement Choices: Introducing Deliberate Mistakes

1:00-3:20-Lab #6: Multi-Planar Hips (Diagonals, Force Couples & 3D Hips)

  • Defining & Training Pelvic Force Couples
  • Unilateral Hip Flexor & Hip Extensor Use: Balancing L/R
  • Stabilizing the Hips: Trochanteric Pain, FAI, Labral Issues & Piriformis

3:30-5:30-Lab #7: Gait Considerations

  • Common Gait Types: Rotational, Lateral Shear & Heavy-Footed
  • Pelvic Force Couple Gait Pattern: Advantages & Drills
  • Review & Questions

Day 3

8:00-9:30-Overview of Cervical & Shoulder Girdle Function/Development

9:40-12:00-Lab #8: Simple Head-to-Tail Relationships (Global & Cardinal Plane)

  • Recognizing Hypermobility/Hypomobility Pairs
  • Balancing Antagonists Locally, Regionally & Globally: Neck Starts at Hips
  • Facilitating Even Distribution of Movement & Proportional Use of Synergists

1:00-3:20-Lab #9: Complex Head-to-Tail Relationships (Differentiated & Multi-Planar)

  • Mobilize Thoracic/Stabilize Cervical: Funneling Movement Where We Want It
  • Applying Constraints & Changing Venues: Targeted Thoracic Activation
  • Facilitating High Horizon & Level Horizon: Fascio-Skeletal Weight Bearing

3:30-5:30-Lab #10: Challenging Head-to-Tail Relationships (Increasing Demand)

  • Intention to Move Distally Eliciting a Proximal Response
  • Functionalizing Exercise: Orientation, Balance, Transitions
  • Reciprocating Movements: Balancing Antagonists and Re-Calibrating to Truer Middle

Day 4

8:00-9:30-Lab #11: Dynamic Scapular Stabilization & Scapulo-Thoracic Relationships I

  • Scapulo-Thoracic Global & Differentiated Relationships
  • Closed Kinetic Chain Facilitations
  • L/R Thoracic Extension Diagonals: Key to Cervical & Shoulder Girdle Health

9:40-12:00-Lab #12: Dynamic Scapular Stabilization & Scapulo-Thoracic Relationships II

  • Anchoring the Arm to the Back vs. the Neck
  • Dynamic vs Static Scapular Stabilization
  • Grand Coalition of the Arm: Serratus, Lower Trap & Thoracic Extensors

1:00-3:20-Lab #13: Combined Themes & Loose Ends

  • Differentiating Thoracic Extensors From Scapular Retractors
  • “Setting” the Shoulders: Lifting, Holding, Carrying
  • Functionalizing Exercise: Bending, Pushing, Reaching

3:30-5:30-Lab #14: Sympathetic/Parasympathetic Balancing

  • Minimization of Unnecessary Effort
  • Detailed Eye Movements & Upper Cervical Bobble-Head
  • Directed Breathing: The 360° Slinky & The Relaxation Response

Low Back & Hips Bibliography

Specific Motor Control Exercise (SMCE) and Regional Interdependence

  1. Efficacy of movement control exercises versus general exercises on recurrent sub-acute nonspecific low back pain in a sub-group of patients with movement control dysfunction. protocol of a randomized controlled trial. V Lehtola, H Luomajoki, V Leinonen, S Gibbons, O Airaksinen. BMC Musculoskelet Disord. 2013; 13: 55
  2. Modiying patterns of movement in people with low back pain-does it help? A systematic review. R Laird, P Kent, J Keating. BMC Muculoskelt Disor. 2012; 13: 169.
  3. Does it matter which exercise? A randomized control trail of exercise for low back pain. Long A, Donelson R, Fung T. Spine. 2004 Dec 1;29(23):2593-602.
  4. Evaluation of a specific home exercise program for low back pain. Descareaux M, Normand MC, Laurencelle L, Dugas C.Journal of Manipulative and Physiological Therapeutics. 2002 Oct;25(8):497-503.
  5. Regional interdependence: a musculoskeletal examination model whose time has come. Bialosky JE, Bishop MD, George SZ. J Orthop Sports Phys Ther. 2008 Mar;38(3):159-60
  6. Activation of back muscles during voluntary abduction of the contralateral arm in humans. Davey, NJ, Lisle, B, Loxton-Edwardss, AV, Nowicky AH. 2002 Spine 27(12): 1355-60
  7. The hips influence on low back pain: a distal link to a proximal problem. Reiman MP, Weisbach PC, Glynn PE. J Sport Rehabil. 2009 Feb;18(1):24-32.
  8. Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. Nadler SF, Malanga GA, Feinberg JH, Prybicien M, Stitik TP, DePrince M. Am J Phys Med Rehabil. 2001 Aug;80(8):572-7.
  9. The influence of ankle sprain injury on muscle activation during hip extension. Bullock-Saxton JE, Janda V, Bullock MI. Int J Sports Med. 1994 Aug;15(6):330-4.
  10. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Sueki DG, Cleland JA, Wainner RS. J Man Manip Ther. 2013 May;21(2):90-102.
  11. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Lejkowski PM1, Poulsen E. J Bodyw Mov Ther. 2013 Oct;17(4):448-52.
  12. Gender Differences in Modifying Lumbopelvic Motion during Hip Medial Rotation in People with Low Back Pain. Hoffman SL1, Johnson MB, Zou D, Van Dillen LR. Rehabil Res Pract. 2012;2012:635312. Epub 2012 Jan 23.
  13. Factors related to low back pain in patients with hip osteoarthritis. Tanaka S1, Matsumoto S2, Fujii K3, Tamari K4, Mitani S5, Tsubahara A6. J Back Musculoskelet Rehabil. 2014 Oct 15. [Epub ahead of print]
  14. The Role of Decreased Hip IR as a Cause of Low Back Pain in a Golfer: a Case Report. Reinhardt G. HSS J. 2013 Oct;9(3):278-83.
  15. Hip Stiffness Patterns in Lumbar Flexion or Extension-Based Movement Syndromes. Zafereo J1, Devanna R2, Mulligan E2, Wang-Price S3. Arch Phys Med Rehabil. 2014 Oct 10.
  16. Relationship Between the Hip and Low Back Pain in Athletes Who Participate in Rotation-Related Sports Marcie Harris-Hayes, Shirley A. Sahrmann, Linda R. Van DillenJ Sport Rehabil. 2009 February; 18(1): 60–75.
  17. Hip Rotation Range of Motion in People With and Without Low Back Pain Who Participate in Rotation-Related Sports Linda R. Van Dillen, Nancy J. Bloom, Sara P. Gombatto, Thomas M. Susco Phys Ther Sport. Author manuscript; available in PMC 2008 December 9. Published in final edited form as: Phys Ther Sport. 2008 May; 9(2): 72–81.
  18. Greater trochanteric pain syndrome: frequency and associated factors in patients with stroke. Köseoğlu BF, Kesikburun B, Oken O. Top Stroke Rehabil. 2014 Sep-Oct;21(5):383-90.
  19. Trochanteric bursitis: the last great misnomer. Board TN1, Hughes SJ, Freemont AJ. Hip Int. 2014 Aug 29:0. doi: 10.5301/hipint.5000154. [Epub ahead of print]
  20. Greater trochanteric pain syndrome diagnosis and treatment. Mallow M1, Nazarian LN2. Phys Med Rehabil Clin N Am. 2014 May;25(2):279-89.
  21. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction. Ho GW1, Howard TM. Curr Sports Med Rep. 2012 Sep-Oct;11(5):232-8.
  22. Nonoperative Management of Acetabular Labral Tear in a Skeletally Immature Figure Skater. Liem BC, Loveless MS, Apple EL, Krabak BJ. PMR. 2014 Apr 5. pii: S1934-1482(14)00152-X. doi: 10.1016/j.pmrj.2014.04.001. [Epub ahead of print]
  23. Persons with chronic hip joint pain exhibit reduced hip muscle strength. Harris-Hayes M1, Mueller MJ, Sahrmann SA, Bloom NJ, Steger-May K, Clohisy JC, Salsich GB. J Orthop Sports Phys Ther. 2014 Nov;44(11):890-8.
  24. Gait considerations in patients with femoroacetabular impingement. Kokmeyer D, Strzelinski M, Lehecka BJ. Int J Sports Phys Ther. 2014 Nov;9(6):827-38.

Bernstein’s Problem and Habit Formation

  1. Solving Bernstein's problem: a proposal for the development of coordinated movement by selection. Sporns O, Edelman GM. Child Dev. 1993 Aug;64(4):960-81.
  2. The importance of postural habits in perpetuating myofascial trigger point pain. Edwards J. Acupunct Med. 2005 Jun;23(2):77-82.
  3. Postural hygiene program to prevent low back pain. Méndez FJ, Gómez-Conesa A. Spine (Phila Pa 1976). 2001 Jun 1;26(11):1280-6.
  4. Muscle coordination  habitual rather than optimal. de Rugy A, Loeb GE, Carroll TJ. J Neurosci. 2012 May 23;32(21):7384-91
  5. Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance. Noakes TD. Appl Physiol Nutr Metab. 2011 Feb;36(1):23-35. doi: 10.1139/H10-082.
  6. Learner-Controlled Self-Observation is Advantageous for Motor Skill Acquisition. Ste-Marie DM, Vertes KA, Law B, Rymal AM. Front Psychol. 2012;3:556
  7. Awareness affects motor planning for goal-oriented actions.  Bozzacchi C, Giusti MA, Pitzalis S, Spinelli D, Di Russo F. Biol Psychol. 2012 Feb;89(2):503-14. doi: 10.1016/j.biopsycho.2011.12.020. Epub 2012 Jan 9.
  8. Can proprioceptive training improve motor learning? Wong JD, Kistemaker DA, Chin A, Gribble PL. J Neurophysiol. 2012 Dec;108(12):3313-21
  9. Can proprioception really be improved by exercises? Ashton-Miller JA, Wojtys EM, Huston LJ, Fry-Welch D. Knee Surg Sports Traumatol Arthrosc. 2001 May;9(3):128-36
  10. Slow Movement with Awareness: Better than Exercise? Restorative embodied self-awareness as a pathway to well-being. Alan Fogel  Body Sense. July 6, 2010.
  11. Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study.  Maddali Bongi S, Di Felice C, Del Rosso A, Landi G, Maresca MGiambalvo Dal Ben G, Matucci-Cerinic M. Clin Exp Rheumatol. 2011 Nov-Dec;29(6 Suppl 69):S12-8. Epub 2012 Jan 3.
  12. Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies. Mehling WE, Wrubel J, Daubenmier JJ, Price CJ, Kerr CE, Silow T, Gopisetty V, Stewart AL. Philos Ethics Humanit Med. 2011 Apr 7;6:6. doi: 10.1186/1747-5341-6-6.

Neck, Thorax & Shoulder Girdle Bibliography

Regional Interdependence & Specific Motor Control Exercise

  1. Regional interdependence: a musculoskeletal examination model whose time has come. Bialosky JE, Bishop MD, George SZ. J Orthop Sports Phys Ther. 2008 Mar;38(3):159-60
  2. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. Strunce JB, Walker MJ, Boyles RE, Young BA. J Man Manip Ther. 2009
  3. Physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm. Wang WT, Olson SL, Campbell AH, Hanten WP, Gleeson PB. Effectiveness American Journal of Physical Medicine and Rehabilitation. 2003 Mar;82(3):203-18.
  4. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Sueki DG, Cleland JA, Wainner RS. J Man Manip Ther. 2013 May;21(2):90-102.
  5. Facilitating Cervical Flexion Using a Feldenkrais Method: Awareness through Movement. Ruth S, Kegerreis S. J Orthop Sports Phys Ther. 1992;16(1):25-9.
  6. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. Strunce JB, Walker MJ, Boyles RE, Young BA. J Man Manip Ther. 2009;17(4):230-6.
  7. Influence of posture on swallowing. Lumbau A, Schinocca L, Chessa G. Eur J Paediatr Dent. 2011 Sep;12(3):171-4.
  8. The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review. Huisman PA, Speksnijder CM, de Wijer A. Disabil Rehabil. 2013 Jan 23.
  9. The influence of the mobility in the cervicothoracic spine and the upper ribs (shoulder girdle) on the mobility of the scapulohumeral joint. Sobel JS, Kremer I, Winters JC, Arendzen JH, de Jong BM. J Manipulative Physiol Ther. 1996 Sep;19(7):469-74.
  10. Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia. Edmondston SJ, Chan HY, Ngai GC, Warren ML, Williams JM, Glennon S, Netto K. Man Ther. 2007 Nov;12(4):363-71.
  11. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. Br J Sports Med. 2010 Apr;44(5):376-81.
  12. Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash-associated disorder. Helgadottir H, Kristjansson E, Mottram S, Karduna A, Jonsson H Jr. J Appl Biomech. 2011 Aug;27(3):181-91.
  13. Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. Zakharova-Luneva E, Jull G, Johnston V, O'Leary S. J Manipulative Physiol Ther. 2012 Jun;35(5):346-53. Epub 2012 May 17.

Bernstein’s Problem and Habit Formation

  1. Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance. Noakes TD. Appl Physiol Nutr Metab. 2011 Feb;36(1):23-35
  2. Solving Bernstein's problem: a proposal for the development of coordinated movement by selection. Sporns O, Edelman GM. Child Dev. 1993 Aug;64(4):960-81.
  3. The importance of postural habits in perpetuating myofascial trigger point pain. Edwards J. Acupunct Med. 2005 Jun;23(2):77-82.
  4. Muscle coordination habitual rather than optimal. de Rugy A, Loeb GE, Carroll TJ. J Neurosci. 2012 May 23;32(21):7384-91
  5. Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance. Noakes TD. Appl Physiol Nutr Metab. 2011 Feb;36(1):23-35. doi: 10.1139/H10-082.
  6. Learner-Controlled Self-Observation is Advantageous for Motor Skill Acquisition. Ste-Marie DM, Vertes KA, Law B, Rymal AM. Front Psychol. 2012;3:556
  7. Awareness affects motor planning for goal-oriented actions.  Bozzacchi C, Giusti MA, Pitzalis S, Spinelli D, Di Russo F. Biol Psychol. 2012 Feb;89(2):503-14. doi: 10.1016/j.biopsycho.2011.12.020. Epub 2012 Jan 9.
  8. Can proprioceptive training improve motor learning? Wong JD, Kistemaker DA, Chin A, Gribble PL. J Neurophysiol. 2012 Dec;108(12):3313-21
  9. Can proprioception really be improved by exercises? Ashton-Miller JA, Wojtys EM, Huston LJ, Fry-Welch D. Knee Surg Sports Traumatol Arthrosc. 2001 May;9(3):128-36
  10. Slow Movement with Awareness: Better than Exercise? Restorative embodied self-awareness as a pathway to well-being. Alan Fogel  Body Sense. July 6, 2010.
  11.  Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study.  Maddali Bongi S, Di Felice C, Del Rosso A, Landi G, Maresca M, Giambalvo Dal Ben G, Matucci-Cerinic M. Clin Exp Rheumatol. 2011 Nov-Dec;29(6 Suppl 69):S12-8. Epub 2012 Jan 3.
  12. Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies. Mehling WE, Wrubel J, Daubenmier JJ, Price CJ, Kerr CE, Silow T, Gopisetty V, Stewart AL. Philos Ethics Humanit Med. 2011 Apr 7;6:6.

Lecturer:

Gordon Browne, PTGordon Browne, PT, GCFP

Physical Therapist, Guild Certified Feldenkrais Practitioner

Gordon has been a physical therapist for 30+ years, with a particular interest in musculo-skeletal pain and injury. He uses movement education extensively in his practice, drawing from his first-hand knowledge of Feldenkrais, Yoga, Tai Chi and Qi Gong. He teaches continuing education courses to physical therapists nationally and internationally through Therapeutic Movement Seminars and has written two books on the subject of movement and physical therapy. His approach is gentle and mindful, emphasizing patient self-awareness and flowing, integrated movement patterns. A nature buff, Gordon enjoys hiking, white-water canoeing, backpacking and sea kayaking.

Education

  • Physical Therapist Degree from University of Washington, 1983
  • Guild Certified Feldenkrais Practitioner through Anat Baniel, 1994