• 12
    Mar

Manual Therapy Techniques For Fitness Professionals

By jkellyie

I am going to post a series of articles on simple but effective manual therapy techniques to show all fitness professionals how to perform some important elements of a postural assessment that will help them identify postural issues which may inhibit their clients development, or worse, cause an injury during a training session.

I WILL RUN A WORKSHOP DETAILING HOW TO FIX THIS ALONG WITH ALL OTHER MANUAL THERAPY TECHNIQUES I DISCUSS.

 

If you are interested in attending this Work Shop please email me at jkellyie@gmail.com for details.

 

 

We have all heard horror stories where people have been badly injured (usually low back) doing a compound lift such as a squat or dead lift. What if this was preventable or if you had the tools as a trainer to assess this person’s pelvis and make an informed decision about whether to proceed or not?

 

Could your client screening system do with an upgrade? If you are interested in increasing the effectiveness of your client screening systems and adding to your already bulging arsenal of assessment tools then read on :)

 

As we all know assessment is the rock on which any good Therapist or Personal  trainer is built. I read this somewhere last week and thought it would be a good starting point for this post.

 

Most personal trainers can adequately assess a client from a functional perspective if they have a decent qualification but can they assess whether or not to proceed with a training session if a client presents with some lower back pain? Would you like to be able to assess this in a matter of minutes and fix the most likely causes too?

 

WHAT’S A DECENT QUALIFICATION?

This means obtaining a Level 2 or higher P.I.C.P. or equivalent certification. This is just the minimum requirement. At this level you have only been exposed to the basics of functional screening and client assessment. Basically, you have a scissors but you’re not a barber yet!

 

However, this is not enough. A thorough knowledge of other screening tests such as the over head squat test (OHS) are also required if you want to be closer to adequately assessing a client.

 

Now you need to master everything that you have learned. This is the key to becoming good at anything - practice.

 

Personally speaking, I have attended many courses with other fitness professionals and have watched them forget almost everything that they have learned on course X due to a failure to simply practice what they have learned before moving onto the next latest and greatest training system detailed in course Y.

 

When you learn something new incorporate it into your work practices immediately, if you feel it is of benefit. Practice your new techniques on your friends and all your current clients.

 

Before you know it you will have mastered what you have just learned. Now you will be able to utilise this and adapt it when required. The alternative is to forget it and do another course at more expense to re-learn it!

 

Now you can properly functionally screen a client.

 

BUT CAN YOU REALLY?

 

Many people would happily think so at this stage and head off into the personal training abyss ready to screen clients to within an inch of their lives but a thorough functional screening system must also contain many postural screening elements too.

 

This is where most Personal Training courses fail. They address certain elements of a complex puzzle while completely disregarding others. Possibly due to time constraints, money or lack of knowledge. Who knows.

 

Yes the OHS test is an amazing functional screening tool and gives you a great deal of information about the client standing in front of you (usually trying to balance a bar over their head while avoiding somersaulting forwards or backwards) but how accurate are your results from this test if your client has a dysfunctional pelvis which is actually causing many of your accurately assessed negatives to be false negatives.

Yes they are accurate based on what you have been taught but may be incorrect due to the fact that you can’t assess the entire picture in front of you. After today you should have a better idea of how to…

What if an anteriorly tilted hemi-pelvis (half pelvis – on one side) was complicit in your recording of a forward tilting torso? This anterior pelvic rotation could also throw all your upper body results into disarray too. Was the weakness or protracted movement noted in the right shoulder complex really caused by true weakness or tightness or was the pelvic tilt on that side guilty to a degree throwing the entire upper torso out of symmetry and balance?

 

The purpose of this post and subsequent posts on this subject will be to highlight the possible limitations of our existing functional screening systems for fitness professionals and to offer some easily mastered manual therapy techniques to complement what we already know.

 

Now, some of our more learned colleagues will jump in here at this stage and say that the techniques I am going to divulge here take years of training and years of practice to master and that this should be left to Neuromuscular Physical Physiotherapist Osteopathic types!

Not so! I am going to detail the basics. I have been able to teach complete novices to perform the following with little or no intervention. If most of my athletes can realign their own bodies then anyone can.

 

I was shown these simple techniques by the esteemed Leon Chaitow ONCE 12 years ago in Dublin and practiced them on a few clients and have used them successfully ever since.

 

Should a proper client assessment not start with a simplified postural analysis even for a Personal Trainer?

As a fitness professional screening a client we are only interested in certain elements of a postural analysis.

 

Imagine a client standing in front of you or better still do this with a client standing in from of you.

 

WHAT ARE WE LOOKING FOR?

 

STAGE 1

Stand behind Subject:

1. Check both shoulder heights – acromial process heights.

Note Result:

Level/Not Level/Which side is higher?

 

2. Check iliac crest heights – slide hands to top of each ilium until you reach the top and both thumbs are pointing towards each other.

Note Result:

Level/Not Level/Which side is higher?

 

AT THIS STAGE I GET THE CLIENT TO STEP AWAY FROM ME AND I SHOW THEM EXACTLY THE LEVEL OF THEIR PELVIS BY KEEPING MY HANDS WHERE THEY WERE.

 

This is a highly effective tool as they usually cannot believe that they are out of place and this is a great visual for them.

When I realign them later I repeat this to confirm that I did in fact do something positive :)

 

When I was originally studying this area I attended every physiotherapist, therapist and chiropractor that I could locate in my area as the best way to learn is to see other people in action. Insert your gag of choice here!

 

However, I did learn something.

I learned that most of these disciplines did not assess you correctly before and AFTER the treatment.

How many chiropractors just pop your hips without checking your hip level afterwards?

All the ones I attended.

The take away point here is check and check again. It only takes a few seconds to ensure you did a procedure the right way so do it.

 

3. Now run your first two fingers down the clients spine.

One finger on either side of the spinous processes (technically on the transverse processes but lightly touching the spine as you glide down).

Note any changes in skin colour.

Do certain spinal areas become a deeper shade of red than others?

 

This indicates the possibility of a subluxed vertebra in this location.

 

 

WHAT DO YOU NOW KNOW THAT YOU DIDN’T EARLIER?

Now you know whether the clients hips or spine are in place or not. You may not know how to fix what you have found but at least you now know if there is a problem or not.

 

A good rule of thumb is if the clients shoulders are level and their iliac crest heights are level there is a great chance that they are in alignment.

 

I hear someone thinking that even though the iliac crests can be level and the shoulders are level that they can have bi-lateral pelvic dysfunction!

Yes they can. Both hips can be anteriorly or posteriorly rotated to the same degree giving you a false positive result.

 

However, if your hips are level and your shoulders are not then you have one or more subluxed vertebrae. This will cause a slight curvature of the spine. This is not to be confused with a condition called scoliosis.

 

Therefore, let’s move onto the next stage. Stage 1 above requires very little knowledge of anatomy and just a couple of practice attempts and correction before you can use it in your practice.

 

Stage 2 requires a little more knowledge…

 

STAGE 2

1. Pick a side on the above client

2. Kneel at this side

3. Locate the ASIS (anterior superior iliac spine) with index finger of one hand

4. Locate the ipsi-lateral (same side) PSIS (posterior superior iliac spine) with index finger of other hand

5. Visually draw a line between these two points

6. Record your result

7. Repeat for the other side.

 

WHAT DID YOU NOTE?

1. Both points level?

2. A tilt to the front (anterior tilt)?

3. A tilt to the back (posterior tilt)?

 

COMPARE BOTH SIDES:

Are they the same?

Does one tilt forwards while the other tilts back?

 

Most people should have a slightly ANTERIORLY tilted pelvis. I say most people because I have come across certain anomalies where a completely flat or slightly posterior tilted pelvis was the body’s favoured working position for some clients.

 

However the norm is usually a slight anterior tilt. I won’t get into how many degrees (3 – 5) etc as I want you to get a feel for what you are doing and not get bogged down in technicalities…

 

Now you are able to determine whether a pelvis is level or not.

 

STAGE 3

Standing forward Flexion Test

This is a very simple test to administer and ties in much of what we have learned above.

 

1. Stand behind client

2. Locate the PSIS on both sides

3. Lock into these with your thumbs
ARE THEY LEVEL?
IS ONE HIGHER THAN THE OTHER?

4. Ask the client to slowly forward flex as far as comfortably possibly

5. Pay attention to how far both PSIS (thumbs) travel

6. Do they travel the same distance

7. Does one travel further than the other

 

Even if your hips test level from the above (stage 1 and stage 2) you may still have a dysfunctional pelvis.

This is usually indicated if one PSIS travels further than the other DURING THE ABOVE TEST.

 

WHAT TO DO  NEXT?

1. Unilaterally or bilaterally ANTERIORLY tilted pelvis?

Fix using a simple muscle energy technique (MET) (see next post)

 

Usually this will not halt a training session but it is advisable to learn how to fix this as it reduces pressure on the hamstrings and can cause the gluteus maximus to be inhibited (reciprocal inhibition caused by a tight psoas or a dysfunctional pelvis) and weak.

 

I will write a post on speed training in a few weeks which will cover this subject.

 

2. Unilaterally or bilaterally POSTERIORLY tilted pelvis?

 

DO NOT TRAIN. REFER TO A THERAPIST.

 

This is the most painful and damaging hip position. Learn to identify it. LEARN TO TREAT IT!

 

In the next post I will show you how to check for a Leg Length Discrepancy and how to fix an anteriorly rotated pelvis with some simple Muscle Energy Techniques after investigating and resolving a spastic iliopsoas (main hip flexor) muscle.

 

I WILL RUN A WORKSHOP DETAILING HOW TO FIX THIS ALONG WITH ALL OTHER MANUAL THERAPY TECHNIQUES I DISCUSS.

 

If you are interested in attending this Work Shop please email me at jkellyie@gmail.com for details.


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