Cumpelik

JiriCumpelik-rehabchiropractorGroupI had the pleasure of hosting Jiri Cumpelik, PT, PhD from Prague.  His physiotherapy and yoga background create a unique blend and a wonderful course.  We had a great group assembled and here are a few of the points and reminders I took away.  [Disclaimer: All brilliance is the result of Jiri’s skills and the history of the Prague school.  Any inaccuracies are my own.]

Breathing:

  • Breathing is often coached into the abdomen.  What is more ideal is to coach lower rib (lateral) expansion.  This leaves the abdomen as a fixed point.
  • Breathing is disrupted if the 3 points of contact for the foot are not kept.  Supportive shoes or orthotics can do this. You will find lateral breathing diminished.
  • When the diaphragm has sternal support breathing is anterior upper abdominal; with costal support it is anterior mid abdominal; with lumbar (TL junction) support it is lower abdominal.  Ideally it should be all 3 simultaneously and lateral expansion of the ribs should occur effortlessly.

Foot contact:

  • The foot is dependent on 3 points of support. This afferent information feeds the system.  Yes, this creates arches.  However, supporting the arch creates the illusion of proper positioning, but it does so without creating any of the necessary afferent info.
  • If you were repairing an archway or a bridge… would you support the arch or would you support the pillars?
  • Arch support or back support without improving afferentation is analogous to putting your team in the right positions, but with little or no communication from the sideline about what play or defense they should be running.  It looks good, but the tendency will be towards chaos and compensation rather than organized, efficient force.
  • Foot contact is often more toward the heels than it should be.  In standing and walking we need to encourage forefoot weight bearing without loading/overloading the toes.  The same is true in squat and dead-lift. The pressure through the heel should feel like it is going into the ground with a 45 degree angle posteriorly.

Posture:

  • Proper sitting doesn’t require a cushioned, supportive,  high back executive chair.  It requires quality input.  Likely a firmer chair.   Think of the piano player, someone who sits for peak performance.  They gracefully sit on an unsupported stool/bench.  With all the practice hours required, why don’t they sit on something more resembling a desk chair?  Do they know something most of us don’t?
  • “It is easier to move a chair than a sack of sand.”  – Reference to firm posture rather than slouched, jello-like, amoebic positioning of some people.  Having structure and support makes movement and control of the body more effortless.  Postural control creates efficiency.
  • Posture can be driven from the foot as described above, it can also be facilitated through the hand.  “Stretch the pinky” (elongate and radially deviate) is a way to get support from the upper extremity.  This can be acheiecd open chain and during gait on the reach forward as well as during true supporting functions.
  • Sitting posture should not be on the “sit bones” as so many conveniently describe.  Looking at the shape of the pelvis is sitting on the ischial tuberosity realistic?  Would you design a system to balance on a roughened, round object?  It was suggested that sitting on the ischiopubic ramus was more ideal.  With a slight anterior lean, this provides a ‘flat spot’ to balance on.  Try it. See what your body tells you.  (remember to use a firm chair)
  • Forward head carriage is understood to be compensatory.  The chin tuck can improve this.  It can also improve posterior breathing.  However, too much chin tuck can impair lateral breathing.  (We do not want to sacrifice lateral breathing for the appearance of good head position.  You can pack the neck too far.  I am playing with finding the right degree of chin tuck based on breathing patterns.  If lateral diminishes, you’ve gone too far.)
  • It must be practiced, “All the time”.  While we discuss sets and reps, one of the main take homes was that the small, but important changes we were making needed to be integrated into all activities.  They should become part of your life.  This was likely the hardest, but most rewarding part.  It requires a lifestyle change, not simply doing some correctives periodically as prescribed.
  • Posture is synergy (or as McGill describes “the orchestra”).  To get synergy back, play a few leading notes (movements or positions that can stimulate quality positions):  abduct the toes, elongate the pinky, open your mouth, “Kaa” (depress the hyoid), tongue position/movement, eye movement, feeling ground contact, …. & many more.  Once the musicians know what tune they’re supposed to be playing others come on line, listen to your body and recognize the changes.

Random:

  • Hand positions (even open chain) can drive breathing.  See mudras and experience it for yourself.  Some beautiful demos during a course break.
  • Children will be able to control their sphincter when they can stand on one leg.  [As this often happens around 3.5 years and we see children potty trained earlier than this, we question what happens?  While uncertain, hyperactive pelvic floor seems very possible to me.]

Final Thought:

Contemporary clinicians and trainers (and just about everyone who reads this blog) are aware that we think in terms of the CNS rather than specific muscles or joints.  We reference muscles or joints for the ease of communication, but we appreciate the fact that we are trying to create neurologic change and are evaluating neurologic dysfunctions in movement.  Here’s where I think many of us fall short.

I’ve seen the Gray Cook, PT quote, ““The brain does not think in terms of individual muscles it thinks in terms of movement”  referenced hundreds of times.  The problem I see is while we think we’re training the CNS, many take from this quote “movement not muscles”.  I think too many omit the word “thinks”.  (You’ll notice Gray put it in there.)  Doing correctives to improve movement isn’t enough (but it is a good start).  The brain is familiar with half kneeling, bear position, etc, ….   however it also doesn’t think in these terms.  The brain knows goals.  I want, I need.  As we use positions and movement to improve dysfunction we must engage the brain in thinking.  Run the mental program of reaching for a desired object, operate the software to open the mouth and eat a sandwich, and focus on ground contact & pushing away.  These external cues feed the CNS what it truly wants and knows.  (Ex.  grab the car keys, reach for the doorknob, give me a high-five.)  Give targets and goals during exercise.  They can be physical or based on mental imagery.  You’ll be surprised how much changes even with a different image of what we’re doing.   Follow the same principles of movement, but get the brain running the software it needs to.

Finally, a public thank you to Jiri Cumpelik for sharing his thoughts, ideas, and views.

Link of interest: A blog post from Geoff Girwitz who attended Jiri’s workshop in Newark.

Quantity vs Quality – Past & Present

The age of electricity began in 1882 and fueled the second Industrial Revolution.  The ability to produce more goods faster, shaped the outcomes of major world events such as World War I & II.  Consider that only England, Germany, France and the U.S. has completed the industrial revolution at this time. Our ability to produce mass quantities of weapons, uniforms, supplies, and food was significant in this era.  History buffs know there are many examples of how German technology was superior to US/British technology at this time, however we all know the outcome. In short, during this period quantity trumped quality.

As this has carried forward we see widespread  examples of how this concept of quantity over quality has gone wrong.  Quantity over quality  has corrupted society.  We are saturated in low quality abundance.

  • Calories over nutritional content.
  • White bread everywhere vs. whole grains.
  • American cheese food vs. actual cheese.
  • Processed, packaged foods full of preservatives.
  • ALL LEAD TO: Obesity & disease

 

  • Exercise fads, the quick easy, this is for everyone approach.
  • 3 sets of 10 mentality.dysfunctional hypertrophy in bodybuilding
  • Lift more weight.
  • Add balance challenges to anything.
  • No pain, no gain mantra.
  • LEADS TO:  hypertrophy, compensatory pattern, accumulation of stress/strain, failure to meet goals, frustration, injury,…… inactivity.  (Stronger, but no healthier.)

 

We now know that quality of exercise is more important than quantity.  The same holds true in nutrition, quality foods (whole foods, organic foods) are more valuable than quantity.
Systems have been developed to access quality of movement.  Functional assessment or evaluation of movement quality have been around for some time and were championed by Vladamir Janda.

  • Janda & Prague School teachings including Dynamic Neuromuscular Stability.
  • FMS /SFMA
  • Liebenson’s Mag 7

These methods are not always used as we rely on traditional orthopedic testing (which has it’s place in examination, but also has it’s limitations) and diagnostic imaging.  Imaging such as x-ray, MRI, CT also has it’s utility, but is frequently over utilized and often muddles the clinical picture as it does not show function or pain.  Evaluation of structural change has poor correlation to pain and function, it can be misleading.  To combine the concepts, below are some examples of imaging (flouroscopy) during poor quality and then high quality movement patterns.  After watching them which is more important, the # of repetitions you do, or the quality of the repetitions?  Would you prefer 3 sets of 10 with bad form? Or one set of 4 with good form?

Abduction of the shoulder, first with a shrugged, decentrated, elevated scapula; then repeated with proper packing/stabilization.

original posting @ http://irontamerblog.com/packing-the-shoulder/

Which shoulder exercise would you like to see in your patients?  In your own exercise?

The days of quantity have passed.  The emphasis needs to return to QUALITY.   Once we achieve quality, quantities of quality exercise can be used to increase capacity.