Introduction to Active Care

Why is active care considered a complementary addition to chiropractic care? 

Helps create a long term effect and increase confidence and ability to perform ADLs in the patient 

What is active care?

The patient is taking an active role in their treatment, typically in the form of exercise

What are the benefits active care is intended to provide?

reduce pain, restore biomechanics and function, improve mobility and flexibility

improve proprioception and balance, improve strength, stability and coordination

Active care defining characteristics

1.) increase knowledge through education, addresses underlying dysfunction and causative factors (long-term solutions)

2.) pain confrontation and exposure to painful movements/activities 

3.) person-centered care focused on function and BPS approach 

4.) promotes self-efficacy and independent patients 

Passive care defining characteristics

1.) minimal verbal education

2.) patch job on relief (short-term fixes)

3.) pain avoidance and passive coping strategies

4.) labeled with diagnosis/disease, promotes reliance on others to “Fix” them and creates dependent patients

What are the 3 roles movement plays in patient care?

1.) general health and wellness → wellness as medicine

2.) Assessment → static assessment doesn’t help diagnose a movement problem

3.) treatment and management

What effect does cardio training and overall cardiovascular fitness have on health disease? All-cause mortality? what specific diseases may benefit most?

1.) achieving 150 minutes a week of at least moderate physical activity helps prevent and manage over 20 chronic conditions → coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health, msk conditions 

2.) muscular strength is inversely associated with protective against all-cause mortality 

How many minutes of aerobic exercise are recommended each week?

150 minutes

What effect does resistance training and overall strength have on health and disease? all-cause mortality? what specific disease may benefit the most?

1.) achieving at least 2 non-consecutive days of resistance training each week helps prevent and manage over 20 chronic conditions

2.) coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health, msk conditions 

How much resistance training is recommended each week?

2 non-consecutive days each week

What is the correlation between strength and all-cause mortality 

1.) grip strength is a independent predictor of all-cause mortality and CVD

2.) single best predictor of senior citizen falling is toe strength (Most important) and leg strength

3.) lower body and upper body strength have been demonstrated in numerous studies using various measures of strength to be strongly correlated with all-cause mortality and CVD risk

Why does movement assessment lead to better diagnosis and improved outcomes?

Find the cause → explain the source → determine effective treatment → shorten treatment time

Source

refers to location the individual is feeling pain

Cause 

refers to what is causing pain in the individual’s system → may or may not be the same location as the source 

What is the #1 predictor of injury?

previous injury

What is motor control? What does altered motor control involve? 

necessary input, sufficiently processed with an acceptable output 

-altered motor control involves poor timing, sequencing, coordination and synergy of the neuromuscular system which manifests in dysfunctional movement 

What is a mobility dysfunction? What is the general rule for determining a MD?

1.) limitation in an individual’s ability to move independently and purposefully through their environment and control their body position

2.) general rule = active movement and passive movement dysfunctional

What is Stability/motor control dysfunction? what is the general rule?

1.) motor control dysfunction, mechanical breathing dysfunction, high threshold strategy, prime mover/global muscle compensation behavioral asymmetry

2.) General rule = active dysfunctional and passive functional

Should we incorporate movement assessment as part of our standard operating procedure to look at patterns or parts?

movement patterns

When do you have justification to go look at the parts and make sure that anatomy is supporting function?

when a pattern is dysfunctional 

When should functional movement assessment be performed?

1.) 1st baseline assessment

2.) post intervention check

3.) ongoing assessment 

Why perform a functional movement assessment?

Find the cause, explain the source, determine effective treatment and shorten treatment time 

improved outcomes and reduced to plan errors 

How does our locomotor system develop

1.) occurs in a predictable manner → if balanced muscular co-activation is lost, dysfunction in what would be otherwise normal muscular synergies 

2.) same muscular synergies which evolve to enable infant to support itself, turn over, crawl, verticalize, and eventually develop gait 

3.) manifests as characteristic postures and dysfunctional movement patterns 

What happens to mobilizers and stabilizers when compensatory movement patterns occur?

1.) the deficit of the locomotor system stability triggers a compensatory mechanism → stabilizing function is overtaken by the mobilizing muscles

2.) compensation leads to mobilizers increased activity, and subsequently their decreased flexibility→ may lead to a pathological chain of reactions w/in the msk system

Why do functional muscle imbalances occur?

1.) disuse and lack of stimulation 

2.) adaption to highly repetitive movement and stabilization patterns 

3.) dysfunction, pain, injury 

Upper crossed syndrome: Commonly weak muscles

1.) deep neck flexors

2.) lower traps

3.) serratus anterior

4.) rhomboids

Upper crossed syndrome: commonly tight muscles 

1.) pectoralis major/minor 

2.) upper traps 

3.) levator scapulae 

4.) suboccipital 

Lower crossed syndrome: commonly weak muscles 

1.) abdominals 

2.) gluteus maximus 

Lower crosse syndrome: Commonly tight muscles 

1.) hip flexors 

2.) thoracolumbar extensors 

Kinetic chain

how the human body can be considered in terms of interrelated links or segment

-only tissue that can mediate such responsiveness is the connective tissue

Regional interdependence

concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with the patient’s primary complaint 

Stable joints

joints that move primarily in 1 plane

Mobile joints

Joints that move in primarily 3 planes

Which joints/regions are meant to be mobile and therefore most prone to mobility restrictions?

1.) ankle

2.) hip

3.) thoracic

4.) glenohumeral

5.) upper cervical

6.) wrist

Which joints are meant to be stable and therefore most prone to stability limitations?

1.) knee 

2.) lumbar

3.) scapula 

4.) lower cervical 

5.) elbow 

According to the hierarchy of movement, should management and treatment of dysfunctional movement begin by addressing mobility, motor control or functional patterning?

Mobility → Motor control → functional patterning 

Movement evaluation

Functional patterning → motor control → mobilty

Should active care treatment plans be based on generalized guidelines or individualized to the person/patient 

individualized to the person/patient 

What should be the primary focus of treatment based on dysfunctional movement findings?

1.) identify relevant dysfunctional movement patterns and improve them → post check to know if you improved them

2.) focus should be restoring and ensuring adequate/proper amount of mobility and stability (and capacity) for the movement/physical demands

What techniques can help restore optimal length-tension relationship within the muscular system 

stretching, manual therapies, motor control, strengthening 

What techniques can help restore optimal force-couple relationship within the nervous system?

motor control, exercise/loading stabilization, regular movement

What techniques can help restore optimal arthrokinematics within the skeletal system?

Chiropractic, repeated ERL, regular movement, exercise/loading 

How do you know if a treatment was effective?

Check and Re-check 

What are the goals of evidence-inspired active care?

1.) education and empowerment, reduce pain and sensitivity

2.) determine cause, treat the source, address dysfunctional movement patterns, restore function