Rowing and OMT - PowerPoint Presentation

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Rowing and OMT

American College of Osteopathic PediatriciansShannon Moore, DORobert Hostoffer, DOSlide2
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The basic rowing action is a coordinated muscle action that requires application of force in a repetitive, maximal and smooth manner. Every large muscle group will contribute to this action. The rowing action has been divided into the following sequence:

The CatchThe Drive

Leg emphasisBody swing emphasisArm pull through emphasisThe Finish

The RecoverySlide8
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Catch

The erector spinae muscles of the back are relaxed to allow for trunk flexion, which is provided by the abdominals. The

psoas major and minor and the iliacus flex the pelvis and hips. The

sartorius

muscle rotates the thighs.

The hamstrings and

gastrocnemius

are contracting while the knees are in flexion.

The quadriceps are elongated and stretched, yet the rectus

femoris

is contributing to hip flexion.

The ankles are

dorsiflexed

by the

tibialis

anterior.

The elbows are extended by the triceps

brachii

.

The grip on the handle is accomplished by the flexor muscles of the fingers and thumb. Slide10

The Drive

Legs EmphasisThe quadriceps extend the knee.The feet are plantar flexed by the

soleus and gastrocnemius muscles. A number of stabilizing muscles aid in supporting the lower back.

All the muscles of the shoulder are contracting. These include the supra and

infraspinatus

,

subscapularis

,

teres

major and minor, and the biceps

brachii

.

The scapula is stabilized by the

serratus

anterior and

trapezius

muscles. Slide11

Body Swing

As the knees are finishing their extension, the hip is also extending by the contraction of the gluteus and hamstring muscles. Back extension is occurring by contraction of the erector spinae.

In the upper body, elbow flexion is occurring via the biceps, brachialis, and the brachioradialis muscles. Slide12

Arm pull through emphasis

The knees are maximally extended, and the ankles are plantar flexed. In addition, hip and back extension are being completed.

The upper body musculature is contracting with high force to finish the drive. The elbow flexors are dominant. The flexor and extensor carpi

ulnaris

muscles of the forearm contract to stabilize and adduct the wrist.

The shoulder is extended and adducted.

The upper arm is internally rotated by the

latissimus

dorsi

and

pectoralis

major.

The

teres

minor, posterior deltoid, and long head of the biceps are acting on the shoulder joint.

The scapula is rotated downward by the

pectoralis

minor and then drawn backward by the

trapezius

and rhomboid muscles.Slide13

The finish

The knees and ankles remain constant as the hips complete a full extension. The back extensors are continually contracting, and the upper arms are internally rotated by the contracting latissimus

dorsi. The triceps are extending the elbows slightly.Slide14

The Recovery

The arms are pushed forward and away from the body by the triceps until the elbows reach full extension. The anterior deltoids contract along with the coracobrachialis

and biceps, and the upper arms raise slightly as they pass over the extended knees. The abdominals flex the torso, and once the hands have cleared the extended knees, the slide begins its forward motion through ankle dorsiflexion

and hip and knee flexion.Slide15

Rowing injuries

low back, mainly due to excessive hyperflexion and twisting, and can include specific injuries such as spondylolysis

, sacroiliac joint dysfunction and disc herniationRib stress fractures account for the most time lost from on-water training and competition.

costochondritis

,

costovertebral

joint

subluxation

and

intercostal

muscle strains

Shoulder pain is quite common in rowers and can be the result of overuse, poor technique, or tension in the upper body.

Injuries concerning the forearm and wrist are also common, and can include

exertional

compartment syndrome, lateral

epicondylitis

,

deQuervain's

and intersection syndrome, and

tenosynovitis

of the wrist extensors

Am J Sports Med

.

2009 Jun;37(6):1193-9.

Epub

2009 Mar 19.Slide16

generalised

patellofemoral pain due to abnormal patellar trackingiliotibial band friction syndrome

Bilateral atraumatic medial meniscal tears

blisters and abrasions

BMJ Case Rep

.

2009;2009.

pii

: bcr11.2008.1258.

Epub

2009 May 17.Slide17

Case records of the Massachusetts General Hospital. Case 10-2007. A 55-year-old man impaled in a rowing accident.

N Engl J Med. 2007 Mar 29;356(13):1353-60Slide18

Caused by

overuse, poor technique, or tension in the upper bodySlide19

12 month study prospective cohort of injuries in international rowers

20 rowersGreatest numbers of injuries was to lumber spine

Half of the injuriesFollowed by kneesFollowed by cervical spineBr J Sports Med. 2010 Feb;44(3):207-14. Epub 2008 Aug 21.Slide20

RIB OMTSlide21

Pump handle motion = upper ribs

Bucket handle motion= lower ribs Slide22

Ribs 1-5Slide23

Ribs 6-10Slide24

Caliper motion ribs 11-12Slide25

Rib Evaulation

Place the fingertips of the anterior hand against the costochondral

junction, and those of the posterior hand at the rib head of the same rib.

Palpate along the region for tissue texture changes and somatic dysfunction in the individual ribs based on respiratory motion.Slide26

Terminology – For Board Review

Think “somatic dysfunction does” and name the dysfunction for what it likes to do:Exhalation dysfunction: the ribs do not rise with inhalation but move easily with exhalationInhalation dysfunction: the ribs rise easily with inhalation but do not lower with exhalationSlide27

More Terminology – For Board Review

Exhalation dysfunction:Pump handle: ribs are stuck down in the front and up in the back

Bucket handle: ribs are stuck down and inCaliper: ribs are stuck pincing in

Inhalation dysfunction:

Pump handle: ribs are stuck up in the front and down in the back

Bucket handle: ribs are stuck up and out

Caliper: ribs are stuck pincing out Slide28

Which is the ‘key rib’?

When Treating Groups of Ribs:Exhalation dysfunction: treat the upper rib in the group (frees up all ribs below it)

Inhalation dysfunction: treat the lower rib of the group (this rib is holding all ribs above it in an inhaled position)Using Functional Methods Diagnosis: This approach will lead to the key rib because you are comparing each rib with the one above and the one below. You are finding the one that doesn’t move.Slide29

Treatments

Techniques:Muscle EnergyRib raisingRespiratory diaphragm facilitation/releaseSoft tissue techniques

HVLA (consider patient’s age and history)With all techniques used, one must determine the patient’s condition/medical stability and to which techniques their body will best respondSlide30

Muscle Energy

Easy to do for your hospitalized patient on bed rest/limited activityKnow which muscle groups you want to activate depending on the dysfunctional ribs involved

Pectoralis minor muscle for upper ribs (3-5)Serratus anterior muscle for middle ribs (4-9) Latissimus dorsi muscle for lower ribs (7-12) Slide31
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Rib-RaisingSlide35

Demonstrate the procedure on patient in front of directorSlide36

Thumb PressureSlide37

Demonstrate the procedure on patient in front of directorSlide38

Thoracic myofacialSlide39

Demonstrate the procedure on patient in front of directorSlide40

Lateral Recumbent under the shoulderSlide41

Demonstrate the procedure on patient in front of directorSlide42

OMT Lumbar SpineSlide43

Myofascial Stretching

Patient is prone. Place thumb onto paraspinal muscles adjacent to the vertebral spinous process. In a bowing like motion stretch the muscles away from you and release. Perform slowly.Slide44
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Demonstrate the procedure on patient in front of directorSlide46

Lumbar rotation technique

Patient is supine. Have the patient lace fingers behind head. Standing to the side of the patient grab the patient’s contra lateral upper arm and pull toward you and caudally.Slide47
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Demonstrate the procedure on patient in front of directorSlide49

Lumbar Mobilization

The patient is in the lateral recumbent position. The side that the dysfunctional vertebra is rotated towards is up (eg, for a left rotated lumbar, the patient is lying on their RIGHT side). The patients upper most leg is dropped over the side of the table. The patients upper elbow is flexed. The lower elbow is also flexed and the arm is tucked under the head. Stand to the side of the patient with his/her face to you. Your one arm should be placed onto the upper elbow and the other arm placed on the upper hip. A twisting motion is performed by moving the patients elbow backward and the patient’s upper hip forwards, carrying the dysfunctional vertebra into correct positionSlide50
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Demonstrate the procedure on patient in front of directorSlide52

Innervation Table

Organ/System

Parasympathetic

Sympathetic

Ant. Chapman's

Post. Chapman's

EENT

Cr Nerves (III, VII, IX, X)

T1-T4

T1-4,

2

nd

ICS

Suboccipital

Heart

Vagus (CN X)

T1-T4

T1-4 on L,

T2-3

T3 sp process

Respiratory

Vagus (CN X)

T2-T7

3

rd

& 4

th

ICS

T3-5 sp process

Esophagus

Vagus (CN X)

T2-T8

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Foregut

Vagus (CN X)

T5-T9 (Greater Splanchnic)

---

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Stomach

Vagus (CN X)

T5-T9 (Greater Splanchnic)

5

th

-6

th

ICS on L

T6-7 on L

Liver

Vagus (CN X)

T5-T9 (Greater Splanchnic)

Rib 5 on R

T5-6

Gallbladder

Vagus (CN X)

T5-T9 (Greater Splanchnic)

Rib 6 on R

T6

Spleen

Vagus (CN X)

T5-T9 (Greater Splanchnic)

Rib 7 on L

T7

Pancreas

Vagus (CN X)

T5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic)

Rib 7 on R

T7

Midgut

Vagus (CN X)

Thoracic Splanchnics (Lesser)

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Small Intestine

Vagus (CN X)

T9-T11 (Lesser Splanchnic)

Ribs 9-11

T8-10

Appendix

 T12

Tip of 12

th

Rib

T11-12 on R

Hindgut

Pelvic Splanchnics (S2-4)

Lumbar (Least) Splanchnics

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Ascending Colon

 Vagus (CN X)

T9-T11 (Lesser Splanchnic)

R Femur @ hip

T10-11

Transverse Colon

 Vagus (CN X)

T9-T11 (Lesser Splanchnic)

Near Knees

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Descending Colon

Pelvic Splanchnic (S2-4)

Least Splanchnic

L Femur @ hip

T12-L2

Colon & Rectum

Pelvic Splanchnics (S2-4)

T8-L2

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Questions

1. The most common injury that rowers experience occurs to what structure:A. KneesB. NeckC. Lumbar spine

D. ElbowsE. Thoracic spineSlide54

Questions

2. The bucket handle motion occurs in what rib set:A. rib 1-5B. rib 6-10C. rib 11-12

D. floating ribsE. cervical ribsSlide55

Questions

3. Shoulder pain in a rower is usually from all of the above except:A. poor techniqueB. overuseC. tension in the upper body

D. idiot for a coxman Slide56
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Ready…Row