The L.A. Sports & Spine Philosophy

Craig Liebenson, D.C.

www.lasportsandspine.com

(310) 470-2909

craigliebensondc@gmail.com

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.

FINDING THE SOURCE OF YOUR PAIN

Injury

Repetitive Strain

Genetics/Anatomy

Injuries/TraumaRepetitive Strain/

Overuse

What leads to pain?

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”

Site vs Source of Pain

Site• Pain Generator• Structure

Source• Factors responsible for

pain• Overactivity• Poor posture• “Weak link”

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

Hardware vs Software

Hardware• Orthopedic problem• Structural problem• Injury or Degeneration• Inflammatory

Software• Rehabilitation problem• Functional problem• Postural • Mechanical

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!

Corrupted Motor Program - altered biomechanics

•

• Poor posture • Faulty movement patterns

GOALS OF CARE

Improve your biomechanics!• Postural Correction• Core Activation• Breathing Re-education & Flexibility Training• Independent Functioning

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

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?

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

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?

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

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

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

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

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?

Goal: Flexibility trainingA Flexibility Test (cont’d):

• Can you prevent your knees from collapsing inwards?

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?

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

FITNESS FACTORS

Traditional• Strength• Flexibility• Cardio-vascular

Functional• Agility• Balance• Coordination• Speed• Endurance• Relaxation

Which is the athlete?

Bodybuilding (cosmetics) vs. Athletics

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Big & Strong Quick & Powerful

COORDINATION

BALANCE

AGILITY

FUNdamental ABC’s of Fitness

Aristotle

• “Practice doesn’t make perfect, it makes permanent”

• Quality NOT Quantity is our goal

YOGA

TAI CHIPILATES

Core Fitness Philosophies

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”

Functional Approach - Biomechanics

Legs and FeetLegs and Feet

ScapulaScapula

Arm and ShoulderArm and Shoulder

Thoracic and LumbarThoracic and LumbarSpineSpine

Hips and PelvisHips and Pelvis

Faulty Biomechanical Movement Pattern - Running

Faulty Biomechanical Movement Pattern - Stepping

Faulty Biomechanical Movement Pattern - Reaching

• Ideal arm raising w/ shoulder relaxed

• Poor pattern due to shrugging the shoulder up

You will learn the ATHLETIC POSTURE

• Chin in• Chest up• Shoulders relaxed• Knees over toes• This posture protects

you against injury & enhances athletic performance

WHAT YOU CAN EXPECT

• Orthopedic & Functional Evaluation

• Individualized Self-Care Prescription

• Collaberation with MDs, Trainers, etc.

Evaluation

Orthopedic• Initial• Rule out Serious or

Sinister problem requiring medical/surgical intervention

Functional• After Ortho

assessment• Biomechanical

Predisposing or Perpetuating factors

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

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

Phase Two of Care

• 1:1 Preventive & Functional Training

• Soft Tissue Work

• Diminishing frequency

• More self-care

• Return to activities

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

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

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