Jiri Cumpelik, PT

Prague RehabBringing the Prague School to you.

Prague School in Newark, NJ!

I had the pleasure of meeting PhDr Jiri Cumpelik during a recent trip to Prague. Jiri Cumpelik & Jason BrownHe was kind enough to allow me to visit him while he was treating performers at the National Theater in Prague.  While we were only able to spend a few hours together it became very clear to me that he has a deep appreciation for movement, body position, breathing, and training mindful movement and that I had a lot to learn.  I’ve remained in contact with Jiri and he’s graciously accepted an invitation to return to the U.S. to instruct.  While he continues to teach in Europe, Jiri has been absent from the US for some time.  Some may remember his last visit to the Rehab Institute of Chicago.  This is a course, I’m honored and excited to host.  Details are below for those who wish to join us.

Jiri Cumpelik with Prof. Frantisek Vele

Cumpelik Course details:

Date: April 12-13, 2014
Times: 9-5:30 Saturday. 9-2:30 Sunday.
Location: Newark, NJ @ the Marriott Newark Liberty International Airport. (Group hotel rate by clicking link.)

This location is at the Newark Airport and there is shuttle service for anyone flying in.

For those driving:
Newark Liberty International Airport Marriott
1 Hotel Road
Newark, New Jersey 07114 USA

Please com dressed to participate.

Jiří is the resident physiotherapist for the National Theatre Ballet. He also lectures to students of the Physiotherapy department of the 2nd Faculty of Medicine of the Charles University in Prague and students of the Physical Education and Sport Faculty of the Charles University in Prague, as well as other distinguished institutions throughout Europe.   Jiří’s unique approach combines Yoga with principles of kinesiology (body motion and correct posture).

PhDr. Jiří Čumpelík, PhD is part of the early Prague school learning from the greats of Lewit, Janda, and their contemporaries.  He frequently co-taught with Prof. Vele (seen above) and from his intimate early studies he possesses a deep understanding of the foundation concepts the Prague School of Rehab is known for.  He began studying Yoga in the 1970s in India where he gained an insight into the physiology of breathing and its influence on posture and inner stability. He further researched spinal and breathing exercises as preventive and therapeutic techniques for functional disorders. He is published in several texts including: Yoga-Based Training for Spinal Stability in Dr. Liebenson’s Rehabilitation of the Spine (2nd ed) and Clinical Rehabilitation, edited by Dr. Pavel Kolar.

 

“The goal of our yoga-based exercises is to repair the altered CNS postural and respiratory programs and to restore spinal stability.”

 

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“In a functional and mobile spine, the physiological movement of the cervical spine starts from T4 and progresses upward, and the movements of the lumbar spine from T6 and go downward.”

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“In chronic cases, local mobilization can relieve local problems temporarily, but resolution of the condition is only possible by repairing the faulty respiratory program controlled by the CNS.”

Course outline:

The relationship of breathing with posture stabilization

The concept is based on personal experiences, own research, child development and yoga

The course emphasis will be on the relationship between breathing, posture and its stabilization

  • Theory, evaluation, therapy, prevention exercises
  • Pelvic floor, diaphragm and upper aperture of the thorax its interaction and correlation with breathing and postural function
  • Stereognosis function and posture
  • Importance of starting position for effective exercise
  • Positioning of the foot and its influence on the breathing and posture (effective treatment of the flat foot)
  • Evaluation of walking movement and treatment

Practical

  • Spinal exercises
  • Breathing
  • Perception of the body and mind
  • Stability of posture

Preparatory sequence of spinal exercise

Concept of breathing

  •  The breathing movement is continual process and therefore if we have right concept about the natural form of breathing movement we can come to conclusion if  posture is stable or needs to be changed. Practical demonstration for diagnosis.

Concept of posture

  • Posture is any position which is holding the body against gravity. Hence posture must be stable otherwise certain parts of the body will be overstraining, which leads to pain and if not treated to structural changes. The longer we ignore the proper concept of the posture, the more difficulty we meet later on in the therapeutics.

Concept of perception

  • Before we are able to move our body we must have the inner picture about the movement. This inner picture is formed in the mind on the base of sensory information. We are getting information about the outside world as well the inner body to be able to control the movement. The mind is able to decide what kind of proprioception setup is good for our stable posture (motoric intelligence).  Perception of the body must be a part of the postural training.

Concept of posture stability

  • There is not general agreement about posture – different authors trying to define their own aspects of vision and there is not any reliable method to prove these individual concepts.
  • Up to now there does not exist a method, which can objectively measure the stability of the posture. Posturography, plantography methods are informing us about how the weight of the body is distributed on to the foot, but not how its influencing other parts of the body. We are trying to develop a photorespirography method, which will tell us much more about it.
  • Body stability is a concept, how all moving segments are aligned with the help of stabilization process initiated by intention to move. All these processes are part of the course training.

Therefore it is proposed to concentrate on the basic principle of child development and on biomechanical, neurophysiology aspects.

Core, Crunches, & Oversimplification

There is a wealth of information on the core, spinal loads and biomechanics, and appropriate exercise selection. Despite this, there are no perfect, uniform laws of core training. There are some great principles and guidelines, but there are no unbreakable laws. Perhaps in our desire to communicate the ills of repeated, loaded spine flexion some of us have oversimplified this concept.  Such as don’t flex the spine and don’t do crunches.  (I know I may be guilty of this, and in doing so failed to follow one of Einstein’s cautions.  I admit my bias is due to working with a large population of folks with back pain and a great number of athletes/weekend warriors who spend there days in seated flexion during desk work.)  Please note that I am not advocating for or against the crunch, sit up, leg lift, V-up, or any other particular exercise, just a reconsideration of what we know, how we train, and what we say to people about their movements. Perhaps a more complete, reasoned approach is warranted.

Make things as simple as possible, but no simpler.  – Albert Einstein

 

Paraphrasing Stuart McGill, ‘there are no good or bad exercises‘.  We need to find the right exercise for the right person at the right time.  In my opinion this is best done with a constant monitoring: assess, implement training strategy, reassess (within visit and over time).

What does your core training produce? Quality? Capacity? or Both?

I would argue for the novice trainers and clinicians to avoid spine flexion with their patients/clients (particularly loaded or repeated) may be advisable as the yearly and lifetime prevalence of back pain is quite high, 40% and 85% respectively.  However, the more seasoned should take a careful look at the individual, their activities and demands, and then weigh the risks and benefits.  Below are links to an interesting discussion on this, it is 3 parts of a well reasoned, collegial blog conversation.

Side note: I’d like to applaud both authors for stating their points with their own clinical and scientific understanding, reasoned arguments, and interesting perspectives, rather than sinking to the level where some online disagreements tend to go all to quickly..

Side note #2:  The discussion above represent my thoughts and is not intended to summarize the posts below.

Use the links below for a great discussion about appropriate training of youth athletes, the limitations of certain approaches, and finally the multitude of factors that influence appropriate training (particularly in the female athlete). 
Take a moment… read it, think about it, challenge your current understanding…

Post #1: by Julie Wiebe, PT “dear coach”

http://www.juliewiebept.com/alignment/dear-coach/

 

Post #2:  by Greg Lehman BKin, MSc, DC, MScPT  “Dear Julie”

http://www.thebodymechanic.ca/2013/02/14/dear-julie-in-defense-of-the-crunch/

 

Post #3: Response to Lehman’s post by Wiebe “Dear Greg”

http://www.juliewiebept.com/fitness/dear-greg/

 

Things to consider:

  • What factors govern your exercise selection?  Age? Gender? Injury history?  Activity/sport?  Frame size?  Disc shape?  Related mobility (hips/ankles/thoracic)?
  • Are there patients/clients who should avoid spine flexion?
  • Are there folks who should be encouraged to flex?
  • When training flexion how much repetition or load is reasonable?
  • Should training recreate the demands of the sport/activity?
  • Should training prepare someone to resist the loads of their sport/activity?
  • Is core training the same for the male and female athlete?

A bullet list of quality reminders regarding core & pelvic floor.  Once again compliments of Dr. Cubos.

R2P in Daytona: Spine Rehab

Rehab 2 Performance seminar:

The Cutting Edge: Lumbar Spine Rehab

Principles, Fundamentals, and Putting it into practice.

with Jason Brown, DC
Rehab 2 Performance logo

Date: Sat/Sun April 6-7, 2013

Time: 10-6 Saturday   &  8:00-1:00 Sunday

Cutting Edge: From Occam’s razor to the sharp, crisp blows of Bruce Lee, we see the power of simplicity. Mastery of the basics is essential to exceptional performance.  We will draw from the a variety of contemporary rehab methods (Prague school of rehab [Janda, Lewit, DNS], SFMA, and the works of Liebenson, McGill, Cook, & Butler & Moseley) to help you master the basics of lumbar spine assessment and rehab.

In this mixed lecture, demo, and participation based seminar you will be introduced to the principles behind modern spine care.  During the weekend we expect you to gain an appreciation of contemporary functional assessment, solidify your selection of corrective strategies, and hone your instruction and cueing techniques.  By mastering the basics you will have something usable on Monday morning in the clinic and something that will help you change peoples lives.

Lumbar Spine: Following the principles of the International Society of Clinical Rehab Specialists, we will discuss pertinent biomechanics and load of the lumbar spine, the role of the hips, function of the core, and how breathing fits in.  While discussing one region of the body, the course will focus on global assessment with appreciation for regional interdependence.  Ultimately we will help you understand how it all ties in.

Quality movement is the bridge from rehab to performance.  Improve your eyes and learn to see it.  Enrich your brain and know how to prioritize what you see.  Smooth out your explanation so you can communicate complex concepts concisely to patients and colleagues.

Location:  Daytona Beach Resort
2700 N Atlantic Ave. Daytona Beach, Florida 32118
Phone: (877) 644-3239

Beachfront rehab course = worth the trip.

Cost:

SEATING FOR THIS SEMINAR IS LIMITED and is first come first served.
$249/$329.  Register by paypal below.  (Registration by check can be arranged email: jbrowndc @ gmail.com)


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This course is held with the support of the International Society of Clinical Rehab Specialists and Theraband Academy

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McGill

I had the pleasure of spending a weekend in Saco, ME listening to Stuart McGill.  As you may know, Dr. McGill is a wealth of knowledge, info, research, and clinical insights.  So I don’t become one more in the long line of people to misquote Stu on the web, I’ll let his work speak for itself, you can read his books, review his research, or watch his DVDs to get his opinions and I’ll simply offer a few things I took away from this weekend.  Here’s a few reminders, tips, tricks, concepts, or soundbites I took away from the seminar. 

  • Always look at both sides of an issue.  Make an argument for it and against it.  Almost all tools/methods/systems have strengths and weaknesses.  You need to know this!  I was surprised to see how many exercises, methods, experts Dr. McGill began with I love (Insert method/technique here) it’s great at (insert desirable outcome here), but we’ve also shown that (insert negative impact or side effect).  My translation:  Use all of these great tools, just understand when to use them and when to apply other strategies.
  • Smiling is wonderful, but you can’t lift hard, train hard, or be powerful while you do it.   Concentrate and maintain complete focus until you’ve nailed some quality reps.  Smile after you reach your goal.  
  • Train the nervous system.  The evidence is overwhelming, this is what makes the best athletes.
  • Know the physical demands of the person you’re working with.  Assess their current capacities and then design a program to fill this gap.  For athletes review tape of their competition and break down the movements.  From a fundamental standpoint, what movements are you seeing?  How often? How many times? What duration?  In what combinations?  Write it down and be specific.  Train these fundamental movements.
  • Dissociate.  Proximal stability gives distal mobility and power.  If you can’t separate ball and socket movement from spine movement, stop, peel back and try again.  This is an essential skill.  (Side note great, descriptions in Osar’s book. Osar’s Movement lecture here.)
  • While movement quality  is essential, the fact that speed and load change these unpredictably cannot be ignored.  McGill’s research demonstrated that individual’s patterns changed, in both directions (from ideal to compensated and from compensated to ideal), under load.  Make sure your assessment includes something that matches your patient/athlete’s demands.  Also realize that even though someone passes an initial screen this does not mean the get the ‘green light’ to do anything.  They may have a green light to train, but you need to constantly monitor and assess for quality movement.  Patterns change with speed and load.  (This leads us into the next point.)
  • Assess, assess, assess. Constant assessment and reassessment is performed to titrate the exercise to work at the edge of the patient’s abilities.  It is also necessary to evaluate progress or impact of the intervention.  Assess, reassess, repeat if desired.  (Feel like I’ve seen this pattern somewhere before.)
  • Small things make a huge difference.  As with so many things the difference of good and great, or great and world class are little things.  Don’t overlook the little things that can take your patient to the next level.
  • You need to respect someone’s congenital limitations.  Hip shape is not uniform.  Squat depth and peak abilities will be affected.  Also simple exercise like tolerance for the elliptical trainer, can be dependent on having enough hip motion to spare the spine.  Assess the movement of the ball and sockets. Scour (perhaps daily according to Dr. Cubos).
  • Exercise selection is a risk vs. reward decision.  Stated this way I doubt many will disagree, but when presented more scientifically such as EMG activation vs. joint load, my guess is many will choose to remain in their comfort zone and stick with the exercises ‘that have worked before’.  While EMG studies have their limitations, remember risk vs. reward and that any training capacity you can spare, can be used later.  In those who are injured or at risk, choose exercises judiciously.

Other McGill resources:
Cubos notes from similar course. 

McGill resources from Liebenson

Backfitpro resources

McGill Movement Lecture

Prior post with links to McGill NY times video and article.  Hate sit ups?

 

Lateral Stabilizers and Transverse Plane Exercise

Quadratus Lumborum

Can you see the stabilizing, connecting architecture.

We know that no muscle works in isolation and the brain thinks in terms of movement, not muscles.  So I think the title of these videos (and articles) may be misleading for those who are not familiar with the paradigm and principles that support it.  Despite calling it QL training, you will notice very quickly that Dr. Liebenson & Chad Waterbury are training patterns and functional whole body exercises, not working to isolate an individual muscle.  Keep in mind our common movement patterns as you review this and realize how neglected that lateral direction or transverse plane can be.  So far today I’ve spent 95+% of my time moving forward on level surfaces.  My activation of the lateral stabilizers has been minimal.  Our modern society and common training exercises necessitate evaluation of this plane and likely incorporation of these exercises into most routines.

A great introduction, now see how it’s done.

Some addition reading: on Dr. Liebenson’s blog  & Chad Waterbury’s blog.
Also a previous post by Dr. Cubos on Gluteus Medius activation which includes the role of the QL.

We must assess all planes and all movements.  Treatment is the applied to the worst, pain-free pattern (treat the abnormal motor control that improves the mechanical sensitivity).

How do you lift your weights???

While attending a seminar hosted at Peak Performance in NYC, I was impressed by the high level of training offered by Joe Dowdell and his staff.  [visit Peak Performance on facebook] Even as Joe and his staff joined us in the Functional Assessment seminar, workouts continued in the gym with excellent instruction.  The hallmark of quality training is making an exercise ‘challenging’ while maintaining good form, simply making an exercise ‘hard’ (adding weight, doing it faster, performing more reps or sets) is easy to do, but doesn’t produce quality results.  The ‘hard’ way is the hallmark of lesser trainers.  I was impressed by high caliber and ‘challenging’ exercises I saw while at Peak, and I think the contrast with what I saw next is what made it so apparent.

After watching an exceptional set of plank rolls, the athlete stood up, his trainer went to prepare the next exercise, and I watched the athlete bend into complete lumbar flexion with no hip hinge to pick up his water bottle.  Great form and core control in exercise should translate to the same in everyday activities, it clearly did not here.

I saw a similar episode after watching some well done box jumps.  The exercise was performed with quickness, balance, control of a neutral spine, and stability at the hip evident by no medial collapse at the knee or trendelenburg’s sign at the hip.  Upon completing the set, the trainer began to put the box away and the athlete bent over to retie her shoes.  Something like this:

Note extreme lumbar flexion, failure to hinge at the hip. This is not a spine sparing or load sharing strategy.

I was surprised both times this happened. It was clear to me that the athlete understood proper form from the way they performed the exercise. It was clear the trainer understood quality ‘challenging’ exercise from the standard they set for the athlete.  However, there was no translation into activities of daily living.

After thinking about this, I realized that this happens in my office as well.  I spend time training patients in the hip-hinge, proper lunge mechanics, and other spine-sparing strategies so they can continue functioning without aggravating their condition.  In addition to teaching this I explain disc loading (see chart below) and try to follow the teachings of manual medicine pioneer Karl Lewit, MD, “The first treatment is to teach the patient to avoid what harms them.”  However, on occasion that same patient at the end of their visit reaches down to put on their shoes, pick up there purse, or collect their wallet and cell phone and performs the exact movement we just trained with improper form.  I take the opportunity to remind them, they often have a surprised expression, and together we work to repeat the activity with a more spine sparing strategy.

Are you loading your back unnecessarily?

The challenge for the clinicians and the trainers out there… first recognizing improper movement strategies and training good form; second getting good form incorporated into activities of daily living, work duties, and recreational activities through functional training and repetition.  We need our patients and athletes to understand this connection and then we need to work on repetition to myelinate these quality pathways. That which we wish to do with ease, we must first do with frequency.

  1. Teach correct movement patterns. (choose spine sparing, painless, dysfunctional patterns to correct)
  2. Repeat and groove these patterns.
  3. Make movement patterns more complex and add functional challenges.
  4. Add stability.
  5. Build endurance.
  6. Add speed, power, or stability training.

The common thread here is that it is not what we can do it’s what we actually do that determines injury risk.  Much like Professor Stuart McGill’s critique of FMS or similar screens. A simple but brilliant comment. A great analogy is diet and nutrition.  If someone can demonstrate that they can make a healthy, balance, nutritious meal, but they instead choose to eat fried fast food, what is their health risk?

To be truly effective, an athlete or patient’s ability to perform quality movement in the office and/or gym must translate into proper movements during daily activity.