5 Takeaways From the ACA Rehab Symposium

Last week I attended the 16th Annual American Chiropractic Association Rehab Symposium in Orlando, Florida. The conference featured many speakers including Dr. Greg Rose, DC from Titleist Performance Institute and Sue Falsone, PT who is the former head athletic trainer for the Los Angeles Dodgers. Here are five takeaways that I learned over the weekend. 

1. Establishing a functional movement diagnosis is essential.
A thorough assessment of how someone moves is vital in determining what to treat. Dr. Greg Rose of Titleist Performance Institute summed it up nicely with “anyone can do a treatment, but are you treating the right thing?” Muscles, tendons, fascia, and ligaments can all be painful, but that does not always mean it is the source of the pain. Performing a movement analysis can identify what the source of the pain is.

Injuries can be categorized into three buckets: trauma, pain, and altered motor control. Injuries caused by pain occur when things start to hurt for no reason. Most of us have experienced a time when a body part just hurts for no reason in particular. Other times there is trauma to the tissue that leads to pain, such as spraining your ankle. Both trauma and pain account for a minority of injuries. The majority of injuries are caused by altered motor control. These injuries occur because there is a lack of coordination between muscles.

Proper spine angle. Loading through the hips to transfer power to the upper body. 

Proper spine angle. Loading through the hips to transfer power to the upper body. 

Example of reverse spine angle. Notice how I am leaning towards the target. 

Example of reverse spine angle. Notice how I am leaning towards the target. 

2. There is no perfect golf swing, but there is an efficient swing for every player.
If you were to dissect the top golfer’s in the world, you would notice one thing about their golf swings… They are all different. An efficient swing for a golfer is one that repetitively produces power, which will depend on the golfer’s ability to move. If the golfer does not have the ability to move in a certain pattern, it does little good to try to make their golf swing in that pattern. Instead, the golf swing should be modified to fit the golfer’s abilities.

From an injury prospective, low back pain is one of the most common issues golfer’s experience. The most common reason for lower back pain with the golfer is an altered extension pattern called a reverse spine angle. Normally, the trunk should be positioned away from the target. With a reverse spine angle, the trunk leans toward the target placing the trunk in excessive side bending. As the golfer progresses through the swing, the trunk bends away from the target and into extension, which causes a significant amount of compression on the right lower back (over 85% of golfer’s complain of right lower back pain… coincidence?) The reverse spine angle is typically caused by a lack of mobility in the thoracic spine or a core stability issue in the low back.

To learn more about the reverse spine angle & corrective strategies, visit Titleist Performance Institute here.

3. Pronation is normal, it’s timing & control that is an issue.
During gait, the stance leg goes through several phases: heel strike, to foot flat, to heel lift, then to toe off. As the stance leg progresses from heel strike, the foot goes into pronation (inside arch collapsing) to increase the amount of surface area in contact with the ground to disperse the force over a greater area. As the stance leg moves over the foot, the foot goes into supination (raising of the inside arch), to create a rigid foot used for propulsion. So both pronation and supination are normal motions.

Dysfunctions in the foot occur when pronation or supination happen in the wrong sequences. If the foot stays in supination for too long during heel strike and foot flat, there is decreased force dampening in the body. This leads to increased forces on the ankle and knee. If the foot stays in pronation for too long during heel lift and toe off, there is decreased propulsion from the foot. This can lead to increased stress on the soft tissues of the foot because of a lack of support from the bony structures of the foot.

4. If mobility is added to the system, stability also needs to be given to the system.
The joints in the body were designed for certain functions. If we take a look at each joint, the primary function of the joints alternate as we progress up the kinetic chain. The ankle joint moves in multiple planes and therefore it’s primary need is mobility. The knee on the other hand only moves in one plane, therefore it’s primary need is stability. Following this pattern, here is the joint-by-joint approach to the body: 

Joint - Primary Need
Ankle - Mobility

Knee - Stability
Hip - Mobility 
Lumbar spine - Stability 
Thoracic spine - Mobility 
Scapulothoracic - Stability 
Glenohumeral joint - Mobility

When the demands on the joints are altered, it causes increased stress on the joints which can lead to pain and dysfunction. With a decrease in ankle mobility, the demands on the knee increase causing knee pain and dysfunction. To properly address this example, mobility is added to the ankle while stability is added to the knee. This results in balance in the system.

5. “Above all, learn to breathe.”
Breathing is a vital function to deliver oxygen to the body. So proper breathing patterns are essential. The main muscle responsible for breathing at rest is the diaphragm. The diaphragm muscle is like a parachute that attaches to just about everything (seriously, xiphoid process, bottom 6 ribs, transversus abdominis, and 2-3 lumbar vertebra).
During inspiration, the diaphragm contracts, pushing down into the stomach area, to increase the size of the lungs. This decreases the pressure in the lungs, drawing air into the lungs. When the diaphragm relaxes, the space in the lungs decreases, forcing the air out. This type of breathing pattern is known as “belly breathing.”

Two common dysfunctional breathing patterns are apical breathing during rest and paradoxical breathing. Apical breathing occurs when the muscles of the upper chest are used to lift the ribcage. This breathing pattern takes over for diaphragmatic breathing, which increases the stresses on the muscles of the upper chest such as the scalenes and upper trapezius. Apical breathing during heavy exertion is a normal response. Paradoxical breathing occurs when during inhalation the belly goes in and goes out during exhalation. This type of breathing means that the diaphragm is working in the opposite pattern as it should be.

The weekend was packed with a lot of great information that we are incorporating at the clinic. Can't wait until the conference next week, but until then... Come see how Velocity Sports Rehab can help you today!