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12/6/2016
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Janda to Vojta with Exercises and Fascial Release
Vojta Philosophy
Dr. Kamil Henner- 1895-1967- was Vojta’s instructor and mentor. He headed Charles’ Univ neurological clinic and was considered to be the founder of modern neurology in Czechoslovakia.
Stated- “Motor activity (function) is the expression of the activity of the CNS,” thus posture can be a test of the CNS.
Janda’s Upper Crossed Syndrome
Hypertonic or Tight Muscles Suboccipitals
SCM
Upper trapezius
Levator Scapula
Pectoralis major
Janda’s Upper Crossed Syndrome
Hypotonic, Weak or Inhibited muscles Middle Trapezius
Lower Trapezius
Serratus Anterior
Longus Colli
Longus Capitus
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Postural signs of LCS
FHP
Suboccipital extension
Elevated rounded shoulders
Scapular winging
Increased thoracic kyphosis
Janda’s Lower Crossed Syndrome
Hypertonic, Tight Muscles Quadratus Lumborum
Erector Spinae
Psoas
Adductors
Hamstrings
TFL
Rectus Femoris
Janda’s Lower Crossed Syndrome
Hypotonic, Weak, Inhibited Muscles Abdominals
Gluteals
Quadriceps- Single joint muscles
Postural Signs of LCS
Lumbar hyperlordosis=anterior pelvic tilt Tight ES
Weak Gluts
Protruding abdomen Weak abs
Tight ES
Hypertonic/kyphotic TL spine Unstable shoulder
McGills Orchestra Theory
Muscles cannot and should not be classified into separate categories based on their function. This is a didactic exercise and does not reflect what occurs in life and in function. Muscles work synergistically like an orchestra. We have to broaden our understanding.
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Fetal Movement Development
Heinz Prechtl- Professor Emeritus of Developmental Neurology, University of Groningen, the Netherlands, and Honorary Professor, Medical Univ of Graz, Austria
Fetal Movement Development
During the first trimester in the uterus fetuses demonstrate regular exercise patterns including rolling, turning, leg kicks, flexing and waving arms.
Movements suggest behavior of the fetus is not solely reflexive because observed movements (yawning, stretching, limb movements) are spontaneous and not reflexive.
Fetal Development
Fetal Movement is known to begin well before quickening (13-16) at about 7-8.5 wks of gestational life.
Movements become more pronounced in the 10th, 11th week of life to allow for change of position.
Fetuses change positions constantly in reaction to the intra-uterine environment
Fetal Movement Development
De Vreis and Prechtl- by 15 wks, 16 distinct movement patterns that resemble those in pre and full term infants are clearly distinguishable.
“Changing ends in the uterus requires propulsion by means of arms and legs”
Walking movements are seen in the womb around 19-20 weeks of life. “Berenyi” July 2011
Fetal Movement Development
Liley reports that around 26 weeks of gestation the fetus turns first by extending its head and rotating it, next its shoulders rotate and finally LS and legs.
This suggests use of long spinal reflexes
Extra uterine use of long spinal reflexes to roll over occurs betw 4.5 and 6 mos. of life.
Fetal Movement Development
Therefore: Liley writes- the reason we do not see this behavior in the neonate is not that he lacks the neural co-ordination, but that “a trick that is simple in a state of buoyancy becomes difficult under the newfound tyranny of gravity.”
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Fetal Movement Development
Heinz Prechtl- “there is a continuity of many neural functions from prenatal to postnatal life. Only at 3 months does the nervous system become adapted to the requirements of extra-uterine life.” This holds true for non-vital functions only.
Neurodevelopment of Posture
When an infant is born, the tonic system is dominant and the postural system is undeveloped.
Flexion dominates Posture develops in stages as co-
contraction patterns allow for stability Posture in essence is the development
of the extensor part of the program and proper co-contraction patterns.
• Janda
Neurodevelopment of Posture
In 30% of children, the normal co-contraction patterns that allow for stability do not develop normally.
Learning to recognize the signs of the lack of development can drive your treatment away from focusing on the area of complaint to a more global approach.
▪ Janda
Neurodevelopment of Posture
Faulty co-contraction patterns can be recognized as: Chronically flexed/internally rotated posture Faulty movement patterns, or the inability to
establish stability thru extremities Trigger point chains develop Difficulty finding neutral, seen as lack of core
stability Decreased ability to extend T4- or lack of
spinal elongation• Janda
Philosophy
The development of automatic body posture is: Genetically determined
Founded in spontaneous motor development
Foundation for every motor behavior/expression○ Confidence, fear, happiness, depression
Philosophy
Postural information is encrypted in the nervous system and it is passed on by support from performance and the level of excitement thru additional experiences
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Philosophy
Characteristics of movement Balance- which automatically steers body
posture
Center of Gravity changes- changes occur with development as body rises against gravity○ Supine- COG shift is caudal to cranial
○ Prone- COG shift is cranial to caudal
Angular movement- phasic muscles work in certain angles between segments of the extremity and the trunk- ideal angles idealize movement
Philosophy Foundation for the
undisturbed development of movement is individual and depends on: Motivation (Greed and
Desire)-neugierde/beigierde
Sensory orientation Automatic steering of
posture
Janda’s motivation concept
Posture and the limbic system are intimately linked The co-contraction patterns are limbically
driven and linked with the infants desire to see his or her mother
Limbic is emotion, behavior, memory, motivation
Motivation Study
Atun-Einy et al, 2013, “INFANT BEHAV DEV,” Israel
Assessed motivation to move and its relationship to motor dev in infants 27 infants assessed every 3 wks
Documented 4 landmarks of development, sitting, hoch ziehen, crawling, and cruising
2 distinct motivation profiles were seen
Motivation Study
The strongly motivated infants had earlier onset of all 4 milestones
Findings suggest empirical evidence for motivational cascade whereby motivation to move and motor development enjoy a reciprocal relationship.
Philosophy
Non ideal movement Motor disturbed children do not
demonstrate the ability to: Develop balance Change COG Establish ideal joint angles for movement,
○ Respect the patterns
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Philosophy
Motor disturbed children may develop deficits due to: Lack of motivation- greed and desire
And experience: Alternative movements Creation of substitute patterns
Philosophy
Goal of movement development
Communication and Orientation
“a means to a purpose”
Philosophy
Communication needs a whole body global reaction
Automatic postural control is the basis for: Every movement
Every intentional motor behavioral expression
Every intentional emotion
Philosophy
Evolution of Locomotion Spine is the generator of locomotion.
Angle of the spine affects the angle of the legs and the ability to walk.
We can step but spine needs to pull our body over our hips. Movement while upright or crawling requires the same spinal function. What is different is the angle of the extremities.
Philosophy Evolution of Locomotion
Snake>fish>amphibian>
tetrapod
Movement comes from the spine
Angular changes in joints create sudden changes in the CNS which affects its output, “afferenceaffects efference.”
Philosophy
Vojta- movement development begins in horizontal position and is the basis for raising function to the vertical posture.
Evaluation of the spine is viewed in its raising to the vertical posture
Beginning- from both stomach and back lying
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Philosophy
Spinal muscles are the raising muscles
Deformed function of spinal mm is seen in all motor hinderances, from light postural disturbances to the worst neurological sickness.
Normal developmental function gives a synergistic relationship to remaining skeletal mm, therefore influences extremities
Philosophy
Spinal muscles steer the posture. If deficient, postural collapse, which is seen as an inelastic axis organ, develops as a crookedness of kyphosis or scoliosis.
Key joints, hips and shoulders, won’t ER w/o elasticity and stretch of the vertebrae.
Philosophy
The synergistic relationship between spinal mm and remaining skeletal mm correspond to ripening of CNS.
Deformity in function of deep spinal mm widens to other skeletal mm
The global negative effect in development is seen as a substitute pattern
Philosophy
The raising of the body axis steers aglobal reciprocal course through the periphery of each extremity.
The raising of the polysegmental area is the highest differentiation of muscle function and it occurs intentionally, and proceeds spontaneously and instinctively.
Key Developmental Concept
Roswitha Brunkow referred to muscle function as primitive and differentiated.
Primitive is the muscle function from distal to proximal as is seen in the womb
Differentiated function is that which is necessary to develop antigravity function and occurs from proximal to distal
Muscle differentiation evokes spinal rotation which is necessary for spinal elongation
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Philosophy
ICP is result of blocked development and lack of muscle differentiation. Just as is seen in scoliosis.
The origin of the deformity is the lack of postural steering by the deep spinal mm, lack of elasticity and stretch, and therefore stiffness occurs and curves result
Key Developmental concept Errors in development
occur when the muscles don’t differentiate and substitute patterns of movement occur as is seen in all postural deficits of which cerebral palsy has its greatest expression.
Philosophy
Principles Muscle function is from the body to the
support points○ Proximal to distal and distal to proximal
The proprioceptive density thru the stimulation will be maximized and utilized at the key joints (hips and shoulders)
Stimulation zones and start positions are useful through whole of life
Philosophy
The description of muscles and their function in the anatomy books are not right regarding man’s development.
Vojta Origin is broad, insertion is narrow, this
necessitates a co-contractive reaction for muscles to differentiate.
Philosophy
The brain knows no muscle, but only the global natural law of movement patterns, which we use from birth to death.
If the function of one muscle in the pattern is disturbed, it is only a matter of time that the whole muscle chain weakens.
If a disturbance persists for more than 6 weeks a substitute pattern develops
Janda
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Theory
“With every central at risk motor disturbance the muscle function differentiation is impaired and it is not possible for the muscles to work in a distal direction.”
Vaclav Vojta
Theory“With every motor disturbance of a central or a
peripheral nature, the outer rotation of key joints is the first to be missing.”
Vaclav Vojta
Muscle Play
Chains can be functional and/or anatomic. Anatomic chains have fibers that run in same direction.
Chains are made of links. If one link is deficient the whole chain is deficient.
Muscular Chains 1st abdominal chain
Develops by 3 mos. Differentiates during rolling so that pull is from
the overlying hip to the support shoulder 2nd abdominal chain
Develop by 3 months Differentiates with rolling Between 4 ½ and 5 mos. Pull is from the overlying shoulder to the support
hip Posterior chain- diagonal sit- triceps, teres
major, SA, Lat, QL etc
Muscular Chains Abdominal chains
Develop by 3 mos
Pull is from overlying hip to support elbow
Pull is support elbow to the underlying hip
IAO to TA, to EAO, to SA, scapula, and rhomboid
Muscular Chains
1st abdominal chain Differentiates with
rolling at 5 mos. Pull is from overlying
hip to the support shoulder
Pull continues to the support elbow
Internal oblique is the tour guide followed thru to TA, to EAO, to SA, scapula, and rhomboid
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Muscular Chains 2nd Abdominal Chain
Differentiates between 4 ½ and 5 months
Differentiates with rolling
Pull is from the overlying shoulder to the support hip
SA to EAO to TA to IAO to the hip and knee
Muscular Chains
Posterior chain
Develops during diagonal sit with exploration of 3rd
dimension at 7 to 8 ½ mos. Triceps, teres major,
serratus anterior, lat, QL., hip abductors, ERs
Muscular Chains 1st and 2nd abdominal
chains have a posterior component
Posterior abdominal muscles- Ql and SPI
Muscular Chains 1st chain involves
underlying Ql, SPI
2nd chain involves overlying QL, SPI
Muscular Chains The first chain
continues to the elbow and includes glenohumeral muscles acting with antagonistic synergism
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Muscular Chains 2nd chain reaches to
the knee with an antagonistic synergism of the femoroacetabular joint
Muscle chains
Flank connection between the shoulder and the pelvis Latissimus Dorsi TA has different tension on each side.
○ Face side- contraction of lat and QL cause the TA to stretch. This triggers or releases thru the diagonal pelvis and has a lateral vector.
○ Occiput side- stretched in the direction of the spinal convexity- also occurs due to face side lat and QL
○ Both cause a TA contraction that is directed towards the middle.
Fascial Release
Pin and stretch Active Passive Reciprocal inhibition
Evaluation Movement screens
○ Single leg stand○ Shoulder Flexion
Palpation○ Shoulder- scapular mobility○ Hip- QL/SPI- TL/S
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UCS/ Shoulder Chain Muscles
Latissimus Dorsi Lower trapezius Rhomboid minor/major Serratus posterior Serratus anterior Subscapularis Pect minor Subclavius SCM Suboccipitals
LCS/Hip Chain Muscles
Gluteals
TFL
Piriformis/hip rotators
Psoas
Rectus Femoris
Adductors
Hamstrings
Abdominals
Roll II Position Exercises
Side lying with load on shoulder and hip joint
Support arm and leg get massive ER contraction.
Liebenson/Sato, Hildebrand
Exercises
Sidelying- Roll 2- assisted
Activate by resisting on the shoulder as patient rises up
Facilitates the raising or anti-gravity mechanism of pectoralis, lateral rotators, and abductors of the shoulder
Exercises
Upper extremity support function- self generated
Useful for upper quarter issues including cervical disc issues, throwing and swimming injuries etc.
Position- same as Roll II- on side with shoulder at 90 degrees flexion with forearm pronating. On hip with underlying leg at 45 degrees in hip and knee, overlying leg at 90 degrees hip and knee
Action- slight raise with fulcrum point at the elbow
Exercises
Peel back on this exercise for those patients with difficulty- load underlying elbow with overlying hand.
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ExercisesUpper extremity support function- advancedUpper extremity Reflex Roll Shoulder 90
degreesLie on shoulder of occiput arm at 90 degrees
with forearm pronatedFace arm held over reaching up and forwardOcciput leg on floor with hip and knee at 45
degreesFace leg held above floor with hip and knee 90
degreesAction- Small raise from support elbow
activated with pronation and acetabular loading
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Roll Exercises
Forward Verticalization
Exercises
Upper extremity support function
Self generated
Side bridge Diagonal sit with both hips 45 and both
knees 45
Key- centrate support shoulder as raise up from support points of elbow and knees. Attempt to maintain centrated shoulder.
Exercises
Side bridge variations= Diagonal sit position Both knees at 45 degrees
Overleg 90- underleg 45
Underleg 90- overleg 45
Roll up and forward. Centrate the shoulder by rotating the trunk forward.
Exercises
Upper quarter support function Partner exercise Diagonal sit-
Diagonal sit w/ support on elbow Support leg 90/90 Over leg 45/45 Head looks to support arm hand
Action- Partner draws back on support GH joint to centrate
shoulder. Observe activation of lower trap. Resist head movement toward upward gaze of eyes
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Exercises
Lower Extremity support function Closed Chain Hip External Rotation
Diagonal sit with lower leg at 90/90
Arm support at elbow
Centrate support shoulder
Raise the hip approximately 2-3 inches off surface
Exercises
Progression 1. Lower leg 45/45 with upper leg held
above the surface
2. Lower leg 90/90 with upper leg held above the surface below 90 degrees
○ Stemmen- bracing
Exercises Prone shoulder
support function
Position- Prone on elbows with shoulder at 110-120 flexion.
Action reach with support function
Peelback- contralateral knee support
Exercises
Fourth position- useful for activation of tibialis anterior which when it fires it activates the rest of the chain. The chain is part of the gait cycle.
Push foot into floor
Push hands into floor
Staccato breath
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Thank You
Richard Cohen, D.C.
417 Market St
Kingston, PA 18704
570-283-1011 Cell- 570-262-9374
Cohenhayduchiro.com
