The Full Rehab Picture

Senario from a clinician helping out an individual with some screening and treatment……..

– No Hx of pain
– Table assessments and FMS revealed stiff (not short) pectoralis maj. and latissimus dorsi both in prone and standing.- Soft tissue work to pecs and lats followed by mobility drills.
– Reassessed after 60 seconds. Improvement was seen objectively.

Same day tested his 1RM for various lifts (1RM conventional Deadlift, 1RM Bench Press, 1RM Back Squat). Next day tested vertical jump and 3RM ChinUp. No symptoms.  Next day rest.

Next day trained, felt “tense and weird.”  Next morning worse pain in memory, unable to put on jacket, or hold FSq with cross grip.

Pain subsided, still feeling “tense and weird.”

Manual Therapy on jet fuel, and you can even share them with the people you work with.

Here’s what I think happened.

Keep in mind, he has stiffness to start with, so we should assume he had that stiffness for a reason.
And that reason was likely to protect his shoulder. So it’s very reasonable that this protection was from a painful “something” in the shoulder. Janda would call this fellow a coper in terms that he was able to compensate his system to relieve the nociception.
Keep in mind that nociception isn’t always a tangible pathology. If pain is anything, it’s not tangible and objective.

So when you released the neurological hold on the lat and pec major, perhaps the activity led this individual to be a non-coper and now reports the pain.  Maybe a mild bone spur that “fell” into the right spot to cause pain.
This situation is actually a really great example of some things that Gray is going to publish in the coming months. He allowed me to be the first to discuss it in public when I presented with Thomas Myers in October, and he recently presented it @ TItleist Medical Level 3 in Orlando in November.

The Gua Sha you used did a great job at Step 1: The Reset.
This is typically a passive technique like a soft tissue strategy, dry needling, manipulation, reflexive stimulation, something that the clinician does to the patient or client. This is the epitome of removing the negative as I see it. You are finding the typically non-painful dysfunction that is screwing up the whole system, and you are knocking it out.
Apparently you did a pretty good job at it if he felt good, and quite frankly, Gua Sha is kinda hard to screw up. I really don’t know why more people don’t use IASTM.

However, you let him go after Step 1, which is very poor form. You skipped Steps 2 and 3, and your fellow immediately engaged in conditioning choices. Sometimes you can get away with this, but not this time.

Step 2 is The Reinforcement. In this case, this would have been some kind of kinesiology taping or maybe a posture shirt. In other body parts, you can use corrective bracing or taping. This is something that is typically in contact with the skin that influences or directly places the new reset system into an environment where the brain has a chance to recognize the new types of proprioception. This should take 48-72 hours before asking this system to be prepared and ready for aggressive correction. The reinforcement is quite literal for the good work that you did with the Gua Sha.

Step 3 is The Reload. This is where most people are at in their skill set, and it is even a step before the 1RM testing your fellow. This step is the corrective exercise where you are now adding back in the stability that caused the system to go south. Too often clinicians go right to the Reload because of the plethora of corrective exercises that they know, the nobility in doing what they can do to help. But when you go to Reload first, it’s like putting the engine block in before the frame of the car is all set. Saving the world with a Gray Cook band isn’t going to work 95% of the time.

So you didn’t honor this corrective process and really “rebuild it” before some serious neurological and biomechanical load to the shoulder and rest of the body.
You need this full integration of all the systems and keyholes for neuromuscular integrity.

Reset, Reinforce, and Reload are Gray’s terms, and we can be on the lookout for this thought process in upcoming SFMA trainings.

It's more than just finding the Reset.

  • January 2, 2011

Leave a Reply 3 comments Reply

As usual, the “full perspective” is excellent. I wonder though would it be possible to ellaborate on Step 2. Specfically, are there other options besides Spidertech taping and postural shirts? Am quite interested in the “reinforcement department”. Thanks, Charlie.

All the best,
Sam Leahey

Charlie Reply

Reinforcement choices can be kinesiology or corrective taping, pressure or posture garments, functional bracing, regressive orthotics or footwear, perhaps some tactile PNF cues.
Everything in this category is technically PNF though.

Michael Reply

Look forward to more on this. Always good to theorize about the changes that occur with treatments.

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