At Gray Institute®, a process serves as the foundation of Applied Functional Science® (AFS). Specifically, this is called the Principles-Strategies-Techniques (PST) Process. The Techniques (movements / exercises) that are used for examination and treatment are derived from a specific Strategy. The Strategies emanate from one or more Principles (or truths) of human movement. This blog will describe how the Techniques are designed based on a Strategy that emanates from the Principle that human movement is three-dimensional (3D).
The focus of this blog is to describe how the 3D Principle can provide practitioners with Strategies to deal with Mobility deficits that do not appear until the three planes of movement are combined. This blog will discuss how to take successful movement in each separate plane to create success with tri-plane movements. Let’s use the case of a right-handed golfer who complained of pain on the right side of the low back during the follow-through of the swing. There could be a lot of deficits above and below the lumbar spine that are causing this pain. 3DMAPS® (3D Movement Analysis & Performance System) will quickly allow us to analyze the joint contributions during the global movements. (For more information on 3DMAPS®, please click on https://www.grayinstitute.com/courses/maps.)
In this patient / client, the six Mobility and Stability Analysis Movements showed no obvious deficits. The next step was to take advantage of the Performance System Movements for further analysis by combining planes of movement. Using the Hybrid (Hands) and Hybrid (Feet) together, an analysis movement was created to approximate the golf swing. When the three left hip motions that are required for the follow-through were combined in a single movement, the deficit became obvious. Left hip extension, adduction, and especially internal rotation could not occur at the same time. The internal rotation could not occur when combined with adduction and extension. This created substantial Transverse Plane compression of the lumbar facet joints when swinging the club to the finish position. In fact, the golfer tried to keep the left hip flexed during the follow-through movement to allow more hip rotation. The Principle of 3D identified the problem, but could it help eliminate the pain?
The Strategy used for this patient / client was to use the success in each of the single planes of motion to improve the tri-plane Mobility and, subsequently, the tri-plane Stability movement of the golf swing follow-through. Since the left hip showed the tri-plane restriction, lunges of the right leg were used. The “Right Foot, Anterior, Lunge” creates extension of the left hip. The direction of anterior lunge was gradually tweaked to introduce adduction and internal rotation. The “Right Foot, Opposite Side Lateral, Lunge” creates left hip adduction. That lunge was tweaked to add hip extension and internal rotation. The “Right Foot, Opposite Side Rotational, Lunge” (which creates the all-important internal rotation of the left hip) was tweaked by increasing the horizontal distance. This combines extension and adduction with the internal rotation. In each of the three lunges, as soon as motion in the left hip improved, the program worked on the tri-plane Stability Movements as exercises to establish control of the new motion.
Initially, bilateral hand swings were not used in this golfer’s program. Driving hip motion using hand swing would have created stress in the lumbar spine. But, a tri-plane hand swing is authentic to, and essential for, the follow-through. Once the hip motion improved, the hand swings were gradually introduced to create a full golf swing movement. Fortunately, the thoracic spine motion in this patient / client was very good, but movement practitioners need to recognize that the low back symptoms occurring during the follow-through could easily have been caused by restricted tri-plane motion in the thoracic spine.
In a 3DMAPS® Analysis of a patient / client, you often find a motion deficit during the Mobility Movements. Sometimes though, no deficits are discovered until the Stability Movements, indicating the inability to control the available joint motions. In other patients / clients, you will find both limited movement and less than optimal ability to control the limited movement – both Mobility and Stability deficits. In the case for this blog, it was the combined tri-plane movement that was the problem. In these cases, Stability training must be an essential component. Dr. Gary Gray often reminds us that giving a patient / client a new movement resource without the ability to control that resource is creating instability. The motion is available, but the person will not utilize the motion during functional activities. In all cases, Strategies emanating from the 3D Principle provide movement practitioners with the tools to discover and resolve functional deficits.