For those of you that have attended the Impingement and Instability course, you understand the concept of right compensatory femoral acetabular internat rotation (FA IR) and right compensatory tibial femoral external rotation (TF ER).  Here is a fabulous video that shows this pattern!

Today brings an end to the discussion of System Integrational Dilemmas.  If you have been tuning in the last few days, we have been presenting common issues that arise with PRI programs and some things to think about when attempting to overcome these dilemmas.  Today we will feature common dilemmas that arise with a Cervial Cranio-Mandibular Restoration program:

1.  Can’t open mouth past 45mm - no click

More than likely will need an appliance or see an orthopedic gnathologist oriented dentist.

2.  Can’t open mouth without a click

Treat TMCC issues, free up cervical axial limitations, restore C3-C5 lordosis and if PRI stabilization effort maintains cervical neutrality a splint or TMD treatment may not be necessary, especially if there is no associated joint pain.  If joint pain,  then refer to a dentist for an appropriate splint.

3.  Can’t passively rotate cervical spine to the left – axially with neutral brachial chains

Treat left SCM, scalenes, upper trap, anterior and posterior capitus muscles to achieve right sidebending at OA and AA.
Restore cranial flexion on the right manually.
Re-check after placing tongue depressor between left molars; if cervical spine resumes neutrality – refer for intra-oral appliance.
If all the above fail, consider neuro-optometric treatment.

4.  Can’t protrude without lateral trusion

Treat left SCM, scalenes, upper trap, anterior and posterior capitus muscles to achieve right sidebending at OA and AA.
Restore cranial flexion on the right manually.
Re-check after placing tongue depressor between left molars; if cervical spine resumes neutrality – refer for intra-oral appliance.
If all the above fail, consider neuro-optometric treatment.

5.  Can’t decrease a cant (bipupilar plane, otic plane, transverse occlusal plane)

Will more than likely require palate expansion for system unlocking and possibly orthodontistry to ‘stabilize’ neutral cranium with proper occlusion.

For those of you tuning in the last few days, we have been discussing common dilemmas that occur with a PRI program.  Today we will highlight dilemmas that occur when instructing a Myokinematic Restoration program and offer suggestions on how to correct the dilemma:

1.  Can’t find and feel left hamstring

In a 90-90 position use the isotrainer ledge or similar set up to disengage paravertebrals
Blow up a balloon in a 90-90 position with right arm reach and toes off the wall
Protonics

2.  Can’t find and feel left adductor

Allow the patient to ‘roll’ entire torso and hip back upon Right Sidelying Left Adductor Pull Back during inhalation.  Upon exhalation, contract the left abdominals - left knee into right thigh or ball
Right Sidelying Knee to Knee – we often forget about this co-contraction adductor technique
Left Sidelying Knee Toward Knee with Left Trunk Rotation – move knee with left abs on and during state of inhalation

3.  Can’t find and feel right glute max

Single Leg Wall Left AF IR with Right Glute Max
Standing Supported Right AF ER with Right Glute Max
Left Retro Stairs with left AF IR Stance, left foot one step higher than the right.  Focus on right AF ER / glute max facilitation

4.  Can’t abduct right leg without right low back activity

Un-Resisted Single Leg Lateral Dip - emphasis on simultaneous right cervical and left thoracic abduction
Sidelying Swiss Ball with Passive Apical Expansion - focus on contracting left IO/TA’s upon inhalation, hold and then attempt to raise right leg with hip abductors
Standing Resisted Adductor Pull in -left leg in left thoracic abduction

5.  Can’t inhibit left TFL or left hip flexors

Single Left Leg Kneeling with right hip flexion
Right Sidelying Left Glute Med in Hip Extension - push left knee into the wall above
Right Sidelying Left Anterior Glute Med with TFL Inhibition - push left thigh into post

Tommorrow we will highlight common dilemmas that take place with a Postural Respiration program!

If you caught yesterday’s blog…here are the other five reasons PRI dilemmas are reduced or resolved:

6.  Leading with left hand and right leg to encourage right arm extension (right thoracic rotation).

7.  Achieving a reverse squat from a PRI level 4 Squat Test.

8. Occasionally focusing on a target with left eye during upright (standing or seated) diaphragmatic breathing.
9.  Keeping tongue up with right upper extremity demands.
10. Walking counterclockwise periodically throughout the day with calcaneal stabilization footwear and mid arch contact.

Next week we will discuss common Myokinematic Restoration, Postural Respiration, and Cervical-Cranio-Mandibular Restoration dilemmas.