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The L.A. Sports & Spine Philosophy
Craig Liebenson, D.C.
www.lasportsandspine.com
(310) 470-2909
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OUR PHILOSOPHY
• Finding the Source of Your Pain
• Functional Goals of Care
• Modern Approach to Fitness
• Functional Approach - Biomechanics
• What You Can Expect at L.A.S.S.
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FINDING THE SOURCE OF YOUR PAIN
Injury
Repetitive Strain
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Genetics/Anatomy
Injuries/TraumaRepetitive Strain/
Overuse
What leads to pain?
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Repetitive Strain/Overuse
• If your ACTIVITY DEMANDS exceed your FUNCTIONAL CAPACITY this will cause repetitive strain
• Any GAP between your DEMANDS & CAPACITY must be erased by postural advice & core-stability training in order to address your “weak link”
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Site vs Source of Pain
Site• Pain Generator• Structure
Source• Factors responsible for
pain• Overactivity• Poor posture• “Weak link”
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Guarding after an injury is normal
• “after an injury tissues heal, but muscles learn, they readily develop habits of guarding that outlast the injury”
Janet Travell, MD
White House Physician,
President John F Kennedy
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Hardware vs Software
Hardware• Orthopedic problem• Structural problem• Injury or Degeneration• Inflammatory
Software• Rehabilitation problem• Functional problem• Postural • Mechanical
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Corrupted Motor Program
Pain/Injury orRepetitive Strain
Corrupted Program“emergency brake”
Disability -Activity Tolerance
The Corrupted Program:
• Faulty movement patterns
• Poor biomechanics
• Is a protective reaction to pain or injury
• Is memorized as a new motor program & becomes a habit!
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Corrupted Motor Program - altered biomechanics
•
• Poor posture • Faulty movement patterns
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GOALS OF CARE
Improve your biomechanics!• Postural Correction• Core Activation• Breathing Re-education & Flexibility Training• Independent Functioning
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Goal: Correct your Posture• Poor posture strains your
joints and overloads your muscles
• Correcting your posture re-aligns you
• Correcting your posture is the first step in injury prevention, recovery & performance enhancement
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Goal: Correct your PostureA Posture Test
• Can you reach your arms overhead so that the back of your hands touch the wall?
• Can you do this without your back arching away from the wall?
• Can you flatten your back?
• Is it painful?
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Goal: Activate your core
• Your core muscles give you support & stability
• They help you prevent injury
• They aid your recovery & rehab
• And, they enhance your performance
Your core provides you with a 360º ring of support
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Goal: Activate your core
A Core Test• Perform a plank• With only your toes &
forearms on the floor• Can you hold this position for
60 seconds?• Try a front plank• Try side planks• Is it painful?
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Husk vs Core
Husk/Shell• Outer Superficial Muscles
(e.g. shoulder shruggers, chin pokers, jaw clenchers)
• Compensate• Guard/Protect• Emergency Brake• Limit Mobility• Increase
Stress/Tension/Pain
Deep Core• Inner Muscles (e.g.
shoulder depressors, pelvic floor, gluteals)
• Stabilize you• Guide movement
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Goal: Re-educate Breathing
• Breathing with your chest & shoulders in a vertical direction is a common error ’es shoulder/neck
tension– Disables the core
Standing or Sitting Breathing Test
• When you breathe in do your shoulders rise up
• Ideally you would breathe horizontally not vertically
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Goal: Re-educate Breathing
A Breathing Test:• Lie on your back &
see if when you breathe in your abdomen or chest rises more
• Ideally, your abdomen would rise more
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Goal: Flexibility training• Tight muscles lead to muscle
imbalances & poorly compensated movement patterns
• If you have good flexibility then you can maintain an upright posture during normal activities such as:– Standing– Squats– Lunges
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Goal: Flexibility trainingA Flexibility Test:
• Perform a squat
• Can you keep your chest arched up in front?
• Can you keep your head over your knees?
• Can you prevent your knees from passing in front of your toes?
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Goal: Flexibility trainingA Flexibility Test (cont’d):
• Can you prevent your knees from collapsing inwards?
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Goal: Flexibility trainingA Flexibility Test:
• Perform a kneeling lunge• Can you reach overhead with
your arms so they are vertical?
• Can you lean forward in your hip without your knee pressing forward of your knee?
• Can you feel the stretch in the front of your hip on the back leg?
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INDEPENDENT
SEMI-SUPERVISED
SUPERVISED
Goal: Independent Functioning
• Our goal is to help you return to your activities as soon as possible
• We will guide you through this process
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FITNESS FACTORS
Traditional• Strength• Flexibility• Cardio-vascular
Functional• Agility• Balance• Coordination• Speed• Endurance• Relaxation
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Which is the athlete?
Bodybuilding (cosmetics) vs. Athletics
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Big & Strong Quick & Powerful
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COORDINATION
BALANCE
AGILITY
FUNdamental ABC’s of Fitness
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Aristotle
• “Practice doesn’t make perfect, it makes permanent”
• Quality NOT Quantity is our goal
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YOGA
TAI CHIPILATES
Core Fitness Philosophies
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Functional Approach - Biomechanics
• Holistic approach
• Patient-centered care
• Return you to your recreational, home & work activities as soon & safely as possible
• Identify & train your “weak link”
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Functional Approach - Biomechanics
Legs and FeetLegs and Feet
ScapulaScapula
Arm and ShoulderArm and Shoulder
Thoracic and LumbarThoracic and LumbarSpineSpine
Hips and PelvisHips and Pelvis
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Faulty Biomechanical Movement Pattern - Running
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Faulty Biomechanical Movement Pattern - Stepping
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Faulty Biomechanical Movement Pattern - Reaching
• Ideal arm raising w/ shoulder relaxed
• Poor pattern due to shrugging the shoulder up
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You will learn the ATHLETIC POSTURE
• Chin in• Chest up• Shoulders relaxed• Knees over toes• This posture protects
you against injury & enhances athletic performance
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WHAT YOU CAN EXPECT
• Orthopedic & Functional Evaluation
• Individualized Self-Care Prescription
• Collaberation with MDs, Trainers, etc.
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Evaluation
Orthopedic• Initial• Rule out Serious or
Sinister problem requiring medical/surgical intervention
Functional• After Ortho
assessment• Biomechanical
Predisposing or Perpetuating factors
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Roadmap of Care - Your 1st Visit
• Orthopedic Dx – site of pain
• Functional Dx – source of pain
• Map of Problem – What makes you hurt
• Goal: find the Compass – Customize your program.
• Simple, light exercise to nourish tissue
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Phase One of Care• PHASE 1 – Approx 1 month - 3X/week• GOAL: Increase Function/Reduce Pain/Increase
Activities
• SUCCESS: 80% of people are 50-80% improved
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Phase Two of Care
• 1:1 Preventive & Functional Training
• Soft Tissue Work
• Diminishing frequency
• More self-care
• Return to activities
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Synergy• MD – Medication/Tests• ORTHO – Medication/Tests/Injections/Surgery• ACUPUNCTURE• PSYCHOLOGICAL COUNSELING - Relaxation• OTHER – Massage/Personal Training• LASS – Physical therapy, manual therapy, fitness
training, soft tissue work, nutrition-supplements
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What You Will Learn on Day 1
• Site of pain– Where it is coming from
• Source or cause of your problem– Why it happened
• What will we do
• What you should avoid
• What you can do• Prognosis/forecast
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Dr Liebenson works with premier elite athletes
• Kobe Bryant, Sam Cassell, Corey Magette - NBA• Jayson Werth, Troy Glaus, Eric Byrnes - MLB• Christian van de Velde - Tour de France• Nathan Ramsey - Motocross• Julia Mancuso - Olympic Gold Medal Skier • Tara Dakidas - Snowboarder• Scott Walchek - Triathlete• Team Chiropractor - NBA, L.A. Clippers• Consultant - MLB, Arizona Diamondbacks• Chiropractor - Athlete’s Performance International
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