Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch18 p.3 TK INSTRUCTOR MANUAL: CHAPTER 18 Body Mechanics and Self-Care To be successful, this course needs to be taught in a primarily body-centered, experiential fashion. To that end, this instructor’s manual is organized a little differently from the other 17 TK chapters because teaching body mechanics and self-care requires a different educational approach from teaching kinesiology. Here are a few of the primary differences you’ll notice in this course’s curriculum to help keep the focus on experiential rather than cognitive learning: The instructor’s manual has its own “Teaching Tips” component to address the different instructional approach that is needed. Lecture time is relegated to just a few minutes at the beginning and end of classes so that most of class time can be devoted to exercises and practice labs. Numerous exercises are suggested for specific classroom uses. Paperwork reduction is encouraged through the use of simple, single-page assessment charts and grading rubrics. Students are required to use the TK textbook outside of class for homework assignments and review but are asked not to bring the book to class. No PowerPoint presentation is provided. The only uses of electronics suggested for this course are short segments of the TK video related directly to body mechanics and self-care. Of course, the curriculum is based on the strong kinesiology foundation of the entire textbook, and the experiential teaching approach used here has been developed directly out of a five-step research-based teaching model that cultivates self-directed learning.1 But in this body-based course, these cognitive foundational materials should remain in the background as helpful anchors that won’t be addressed directly in class. Note to Instructors: Each of you will bring your own great ideas to this class and are encouraged to do so. The various self-assessment charts for students, grading rubrics, and grading criteria percentages that I offer here are based on my own teaching of this material for many years and are designed to make student assessments and your grading as simple as possible. All of these materials, including the printable student packet at the end of this instructor’s manual, are presented in Word document format as a template that can be easily changed to best fit your curriculum. 1 Ambrose et al., How Learning Works: 7 Research-Based Principles for Smart Teaching (San Francisco: Jossey-Bass, 2010). TK INSTRUCTOR MANUAL FOR CHAPTER 18 Table of Contents OBJECTIVES 3 BODY MECHANICS AND SELF-CARE TEACHING TIPS Preparation and Setup Instructional Approach Addressing Students’ Varying Motor Skill Levels Feedback Grading 3 3 3 5 5 6 COURSE NOTES: LECTURE POINTS AND EXERCISES Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 Class 8 Class 9 Class 10 8 8 9 10 11 12 13 14 15 15 16 ADDITIONAL EXERCISES 17 Exercise 1: Inhibiting a holding pattern where it starts 17 Exercise 2: Spinal flexion and hyperextension assessment with partner 17 Exercise 3: Movement observation of head, neck, and spine in OA rock 18 Exercise 4: Progressive muscular relaxation 18 Exercise 5: Yielding while moving with the sand-bag body 19 STUDENT HANDOUTS 20 Chart 1: Roadmap to Student Success in This Class Class 1 Review 20 21 Chart 2: Student Self-Assessment of Strengths and Weaknesses Class 2 Review 22 23 Chart 3: A Study Plan Approach Class 3 Review 24 25 Chart 4: Strategies and Performance Class 4 Review 26 27 Chart 5: Reflecting on and Adjusting Strategies 28 Chart 6: Table of Contents (TOC) Review 29 Chart 7: Body Mechanics Lab 1 Self-Assessment 31 FINAL INSTRUCTOR EVALUATION FOR LAB 2 32 FINAL PROJECT INSTRUCTIONS 33 Final Project Grading Rubric 34 OBJECTIVES Explain the benefits of beginning a massage in a neutral, upright stance. Describe effective lower limb alignment for body mechanics in massage. Explain how core muscle engagement will improve body mechanics. Describe the effect of hyperextended or flexed postures on body mechanics. Discuss how keeping the sternum lifted supports the shoulder girdle. Identify two guidelines for elbow and arm positioning while giving massage. Describe how to actively relax muscles of the head and neck. Describe how postural sway can be used to maintain a natural, fluid stance. Explain how and why diaphragmatic breathing can support the shoulders and arms. Discuss how and why to use complete movement sequences while giving massage. Discuss how and why to face the direction of a stroke while giving massage. Describe how and why to use a rocker base when making weight shifts. Explain how to synchronize upper and lower body movements while giving massage. Describe how to optimally align joints in the hands and forearms when applying force. Describe two guidelines for maximizing leverage when applying force. Discuss how and why to use optimal lines of force when pushing and pulling. Discuss how and why varying hand positions when giving massage prevents injuries. Describe optimal table height, chair and stool use, and client padding in massage. BODY MECHANICS AND SELF-CARE TEACHING TIPS2 PREPARATION AND SETUP Practice exercises ahead of time to determine how long they’ll take during class. Suggested exercises are listed in the syllabus and the class outline in italics. See the many exercises provided in the "Body Mechanics and Self-Care" course syllabus. Make copies of any images from the book you want to use in class. This will help you minimize books and electronics to keep the classroom open for movement and labs. Set up the chairs in a circle so that they can easily be pushed to the sides to practice exercises in the middle of the room. About the student handouts: Handouts are meant to be introduced during the last 1015 minutes of class so that students can start working on them with a partner. Notice that the handouts for classes 15 match the self-directed learning cycle steps. Although these handouts may look like a lot of paperwork at first, they're designed to minimize paperwork for instructors as well as students and focus the students on body awareness and motor development. INSTRUCTIONAL APPROACH Emphasize the body awareness and exercise activities. Present general concepts of kinesiology and the learning cycle as background material only. The concepts behind exercises are referenced by textbook page number but shouldn’t be taught during class time. There is plenty of material in the textbook and online for students to delve into concepts, and the final presentation brings concepts into focus. Plan classes so that students only take notes for a few minutes at the beginning of class and perhaps at the end of class. The course is designed so that the ratio of lecture to experiential exercises is 1:5. Keep the notes brief. You might even put a short outline of concepts and exercises on the board for them to refer to during class, then have them copy this at the end of class. For students who want more information, there is plenty of support material in the textbook around each exercise that students can study outside of class. Prepare the students for motor learning. Integrate theory with practice by presenting informal short lectures with simple exercises that can be done sitting or standing in place, with or without partners. Instruct students to wear comfortable clothes for moving and stretching and be prepared for physical activity. Even consider grading them on the appropriateness of their clothes for a movement class. Inform students what they need to bring to class. Instruct students that they only need to bring a writing utensil and a three-ring binder with writing paper to keep notes and hold student handouts. Encourage students to leave books at home or in their lockers so the classroom is as open as possible for moving. They will need to use TK outside of class for readings and homework. Begin the body mechanics and self-care course with basic skills and gradually combine them into more complex sequences and applications. Body mechanics is a motor skill. Like any physical education, it involves a gradual repatterning of the neuromuscular system in a progressive learning process. Basic skills to begin with include body awareness, breathing, aligning the spine, making smooth weight shifts, and massaging with whole-body movements. Provide a conceptual rationale for each body mechanics or self-care principle or suggestion that you offer. This encourages the students to use logic when trying to figure out a better way to use their bodies while giving massage. It helps them develop a primary skill that they can use after they have graduated—the ability to use concepts from kinesiology to solve body mechanics issues that arise while giving massage. Contrast old and new patterns to help students learn how to move out of faulty patterns as they work. When using contrast, ask the student on the table receiving touch for comparative feedback about the quality of touch. For example, have a student contrast leaning and pushing with the whole body to apply pressure with applying pressure from a bent-knee stance. Then ask the student receiving massage which one feels more effective. Provide numerous opportunities for assessment. This is probably the most important body mechanics and self-care tool students will take from this class because assessment activities develop the body awareness and self-monitoring skills students will need to work safely and avoid injury. There are numerous assessment charts provided in this chapter so that assessment skills can be graded. Relate body mechanics to quality of touch. Have the student receiving massage in the labs provide the other student with feedback about the quality of touch. Since the quality of movement usually translates through the quality of touch, this type of feedback will help students learn to recognize how using good body mechanics not only prevents injury but it also improves technique. To develop pattern-recognition skills, have students work together in pairs for 10 minutes at the end class to start filling out the charts and reviews. Encourage students to discuss elements on each chart and/or review to compare answers and patterns. Have students finish the charts and reviews as homework. ADDRESSING STUDENTS’ VARYING MOTOR SKILL LEVELS Be prepared for highly trained movers such as athletes to have difficulty with body mechanics instruction. Athletes or dancers might learn body mechanics skills faster than less-experienced students, or they might struggle to adopt new patterns because deeply engrained motor habits cause them to be rigid and overwork. This type of student can benefit from body awareness exercises that promote relaxation, stretching, and subtle, intrinsic movement. Set up exercises that allow students to observe and assess as many other students as possible. Have students of varying skill levels observe and assess each other to help them recognize and differentiate effective body mechanics from faulty mechanics. One simple way to do this when the group is going through an exercise is to have half the group stop and observe the other half of the class doing the exercise, then reverse the roles. As they observe, point out key elements in the exercise such as what to look for and common mistakes. FEEDBACK Offer suggestions rather than dictating what is right or wrong body mechanics. By using this open tone, it allows students to be more open to receive feedback. It keeps students from feeling like they are being criticized, which can lead some students to shut down and be incapable of taking in feedback. "May I make a suggestion?" allows students to be more receptive to input. Provide feedback in bite-sized chunks that can be easily assimilated. Too much new information can lead to a state of sensory confusion, which results in resistance. Be sensitive to the timing of your feedback or suggestion. Students practicing a massage technique often find that feedback breaks their concentration, which creates frustration. Ideally, set up lab time in which students can focus primarily on their body mechanics skills. Give students positive feedback about their body-use patterns before giving them constructive feedback. This builds students’ confidence and receptivity to subsequent corrections. When they hear comments that they are using their bodies effectively, they will take pause to sense the ease and efficiency with which they are moving and can later recreate that sensation. Once students feel confident in their motor abilities, they’ll be more open to receiving corrections to improve problem patterns. Ask individual students what kinds of feedback will be the most useful. Most students are pretty sensitive about their bodies and will tense up when faulty body patterns are pointed out. When approaching individuals to provide feedback, be sensitive to differences in learning styles, what each student is working on, and individual body problems and emotional issues. To help students relax and be more receptive, empower them to direct your feedback by asking, "What kinds of feedback would be most helpful for you?" Offer a short menu, such as "Do you prefer to get feedback while you're working or afterward?" "Do you prefer tactile or verbal feedback?" Give students plenty of time to process feedback. When students receive corrections from an instructor, a number of internal processes occur: They register the feedback, sense what they are doing, and then make a choice about whether or not the feedback is helpful. If students ignore you, question your feedback, or become argumentative, frustrated, or irritable, the correction might too difficult for them to make. When internalizing body-based feedback, a transition phase occurs in which a student experiences an unfamiliar body feeling. This can cause proprioceptive confusion and disorientation. Given this complexity of internal processes in changing body patterns, it’s important to give students plenty of time to process your feedback and undergo these internal shifts. Set clear guidelines for students to follow when giving each other feedback about body mechanics. Students tend to be hard on each other when giving body mechanics feedback, including being overly critical, giving too much input that overwhelms the recipient, or giving faulty feedback based on their own misconceptions. Given this tendency, make sure to provide clear guidelines to help your students learn to give each other constructive and objective feedback. Use mirrors, photos, and videos for feedback. Having students practice body mechanics assessments with videos or photos helps them to develop problem-solving skills. Digital cameras can give them information about alignment right on the spot. Mirrors in the classroom are ideal, but students should be warned to take only an occasional sideways glance lest they become obsessed with self-correction. Share your own body mechanics self-correction processes with your students as a form of feedback. Seeing our faulty body habits show up in a student’s working style is a humbling experience. Capitalize on this process by using it as a teaching opportunity. Demonstrate how you monitor and adjust your body when you're giving massage to work more effectively and prevent injury. By demonstrating self-corrections, you'll show your students that teachers are human and no one is perfect. This can help students recognize that using body mechanics is an ongoing process, which helps them grow out of a dualistic, right-or-wrong way of thinking. 5. GRADING a. Base the grade for this course on individuals' effort, progress, and level of improvement during a term rather than on their actual body patterns. Some instructors even make improving posture a part of a student’s grade. This can be a double-edged sword because the pressure to change the posture can increase muscular holding, actually making the student more rigid. On the other hand, it can help students develop body awareness skills, allowing them to improve body mechanics and avoid injury from faulty patterns. Generally, grading in body mechanics and self-care courses is most effective if it is based primarily on performance, grasp of concepts, and ability to become a self-learner.  b. Using rubrics for grading. The simple grading rubrics presented here are designed to make grading faster, easier, and more objective. When introducing assignments such as a graded lab or the final project, give students the rubric to help them prepare for the assignment or test and understand the specific performance expectations and grading criteria you’ll use. Hint: Always make a copy of the completed grading rubric forms before returning them to students in case a student contests her or his grade.  c. Grading the charts and reviews. In most cases, you'll be able to glance over a student's charts and reviews and make general assessments of the amount of effort she or he has put into self-reflection. There are six charts and four reviews. Each chart in the grading criteria presented here is worth 3 points. You'll need to let the students know that the charts will be generally graded (on a 3-2-1 scale) to give them credit for their effort level. 2 Adapted from learning resources for the forthcoming Somatic Patterning Series (Longmont, CO: EMS Press). COURSE NOTES: LECTURE POINTS AND EXERCISES CLASS 1 Introductions Names and stretching warm-up: *Have each student introduce him- or herself, then show the class his or her favorite stretch, tell us why he or she likes it, then lead the class through that stretch. Go over class requirements, labs, and grading. Present requirements with emphasize on self-directed learning and how to get the most out of this course. Lead a group discussion about posture and body mechanics. This will activate prior knowledge and flush out beliefs or misconceptions that limit learning. "What is good posture?" "How does posture relate to body mechanics and self-care?" "What are the benefits of paying attention to posture and movement?" Suggested concepts and exercises (exercises in italics) Overview of the elements of effective body mechanics Optimal posture and neutral spine Provides foundation for healthy body mechanics Are key to injury prevention Require optimal joint alignment Three body masses align vertically COGs align along LOG Centering and leveling pelvis while seated * Seated pelvic rock - p. 379 Standing alignment assessment * Axial compression test - p. 43 Postural muscle support key in neutral spine and core stability * Low back protection with the transversus abdominis - p. 165 Diaphragmatic breathing * Coordinating diaphragmatic breathing with IAP - p. 246 Centering thorax over pelvis with postural sway * Postural sway for fluid body mechanics - p. 155 Importance of beginning massage in a neutral spine, upright stance * Exercises for grounding and countersupport - p. 136 * Centering body over feet - p. 177 Maintain neutral spine for an optimal line of force and tension during push and pull * Pushing and pulling with partner - p. 146 Pattern-recognition assessments Introduce Chart 1 to review overall requirements for class Have students work in pairs on charts and/or reviews for about 10 minutes at the end of class Homework Read Chapter 18: From Intro on p. 672 through 18.1.3 Practice exercises Finish Chart 1 and Review 1 CLASS 2 Review Stretching warm-up to wake up spinal muscles and reset resting length Optimal posture and centering over base of support * Center spine while seated with pelvic rock * Center thorax over pelvis while standing with postural sway * Center knees while standing on one leg Postural muscle activation * Low back protection with the transversus abdominis - p. 165 e. Finding breath support for upper body * Diaphragmatic breathing f. Reviewing lines of force and tension in push and pull * Pushing and pulling with partner Suggested concepts and exercises (exercises in italics) Continuity of muscular tone and joint motion in neutral spine Muscular balance: The relative equality of muscle strength and length between opposing muscles Between flexor and extensor chains, between tonic and phasic muscles * Arcing for spinal movement - p. 451 Discuss how holding patterns affect posture and movement * Inhibiting a holding pattern where it starts? (see Exercise 1 on p. 17 of this manual) Exercise for releasing ligamentous restrictions to segmental mobility * Stretching posterior spinal ligaments - p. 457 Exercise for increasing segmental stability in lumbar spine * Sway correction with lumbar multifidus - p. 469 Checking segmental mobility and continuity of tone * Spinal flexion and hyperextension assessment with partner (see Exercise 2 on p. 17 of this manual) Checking initiation, sequence, and organization of spinal movement with arcing * Arcing - p. 451 Exercises to balance spinal flexors and extensors * Stretch/strengthen spinal extensors - p. 470 * Balancing your body with reverse actions - p. 133 Pattern-recognition assessments Introduce Chart 2 Have students work in pairs on charts and/or reviews for about 10 minutes at the end of class. Homework Read sections 18.1.418.1.6 Practice exercises Complete Chart 2 and Review 2 CLASS 3 Review Shoulder stretching and ROM warm-up Improving continuity of tone with postural support and segmental mobility Muscular balance, effect of stress on muscles, holding patterns Muscular balance between flexor and extensor muscles Core muscle training to establish neutral spine Finding neutral spine with arcing motion Improving muscle balance with stretching and strengthening exercises Suggested concepts and exercises (exercises in italics) Dimensional cross between shoulder girdle and upper spine Importance of postural support and lift in head to balance shoulder girdle Shoulders suspended from neck and cranium by tensional pulls of muscles Upper trapezius needs to be working eccentrically Balance of girdle highly calibrated to allow passage of blood vessels and nerves Neuromuscular patterning in neck starts with movement at the uppermost joints * Movement observation of head, neck, and spine in OA rock (see Exercise 3 on p. 18 of this manual) * Neuromuscular patterning to engage the neck stabilizers - p. 541 Breath support for shoulder yoke balance * Breath support for arms and upper body - p. 240 Efficient abduction occurs in plane of scaption * Slow abduction with arms in frontal plane, then in plane of scaption (see Figures 16.28 and 16.31) Scapulohumeral rhythm: Ratio of movement between GH joint and scapula * Neuromuscular patterning for scapulohumeral rhythm - p. 572 Maintaining scapula neutral in posture and movement * Finding scapula neutral - p. 602 Pattern-recognition assessments Introduce Chart 3 Have students work in pairs on charts and/or reviews for about 10 minutes at the end of class Homework Read sections 18.1.618.1.7 Practice exercises Complete Chart 3 and Review 3 CLASS 4 Review Spinal movement at OA Lifts head and elongates neck Activates intrinsic muscular support Suspends shoulder yoke along eccentric muscular tensions Creates upper spinal support for shoulder girdle Breath support for shoulders, head, and neck Scaption, scapulohumeral rhythm, scapula neutral Suggested concepts and exercises (exercises in italics) Relaxation response Progressive muscular relaxation * Breathing to release tension - p. 258 * Progressive muscular relaxation? (see Exercise 4 on p. 18 of this manual) Active relaxation during movement * Slow movement to relax head and neck muscles - p. 110 * Sand-bag body? (see Exercise 5 on p. 19 of this manual) Contact touch: Since the postural tone at the initiation of a massage stroke carries through the entire stroke, which affects body mechanics, it is helpful to start a massage with contact touch. It helps the practitioner center the body and the touch. For better results, practice this exercise right after a relaxation exercise before they stand up by having students practice contact touch with a student sitting nearby. * Static contact - p. 218 Breathing patterns and diaphragmatic breathing * Locating, tracking, stretching diaphragm - p. 242 * Review diaphragmatic breathing - p. 246 * Muscle patterns in upper chest breath - p. 259 Pattern-recognition assessments Introduce Chart 4 Have students work in pairs on assessment charts and/or reviews for about 10 minutes at the end of class Homework Readings: 18.218.2.3 Practice exercises Complete Chart 4 and Review 4 Complete online Holmes/Rahe stress inventory at www.mindtools.com/pages/article/newTCS_82.htm CLASS 5 Body mechanics lab 1 (First round) Review Collect stress inventories Concepts Relaxation response Active relaxation Fluid movement and postural sway Finding breath support for upper body and arms Collect and briefly discuss Holmes/Rahe stress inventory What were your results? Were you surprised at your results? How many of you feel like you need to reduce your stress? What are a few ways to reduce stress? What exercises have you been practicing? Suggested concepts and exercises (exercises in italics) Rocker base of support * Using a rocker base in massage - p. 86 Tai chi warm-up Introduce concepts for moving around table during warm-up Instructions for applying concepts to movement in Chart 7, sections 18.118.3 Body mechanics lab suggested activities The objective of this checklist is to read it to students before they start the massage to help the students center into their bodies. Begin with practitioner standing ready to give massage to class partner (partner should be on the table ready to receive). Go over the "Self-Care" checklist * Checklist for body mechanics in massage - p. 697 *TK video segments "Intro to Palpation" and "Tissue Layering": To begin the massage, have students massage along with 15-minute video. This exercise is designed to help students center their touch in an awareness of direction of forces and tissue layers. This exercise usually improves quality of touch, which tends to improve body mechanics. The inverse is also true, as body mechanics improve, quality of touch improves due to increased focus, leverage, and economy of effort. Homework Readings: 18.2.418.2.6 and 18.3 (entire section) "Moving around the Massage Table," pp. 681684 Students who gave massage in lab complete Body Mechanics Self-Assessment Chart 7 Students who received massage in lab complete TOC Chart 6 Introduce and assign Chart 5 CLASS 6 Body mechanics lab 1 (Second round) Review Return stress inventories Discuss reading and principles for moving around the table Pace Direction of movement Rocker base Upper-/lower-body synchronization Direction of force and tissue layering (if applicable) Suggested concepts and exercises To move efficiently around the table Move slowly and with awareness Face the direction of the massage stroke Use a rocker base to shift body weight when stepping Stay over the base of support to remain lifted over the hands and the client Match and synchronize upper-body movement with lower-body movement Take a step when you come to the end of a reach Move into a lunge rather than assuming a fixed lunge stance Occasionally pause in a neutral, upright posture to recenter the body and mind Pattern-recognition assessments Introduce Chart 6 Introduce Chart 7 Homework Students who gave massage in lab complete Body Mechanics Self-Assessment Chart 7 Students who received massage in lab complete TOC chart 6 Study for Key Terms Quiz Compile Charts 17 to turn in for grade next week CLASS 7 Review Return Key Terms Quizzes Collect Charts 17 Review direction of force and tissue layering (if applicable) Lead review discussion What helped you the most in the labs? What came up that we need to do troubleshooting around in this class? Suggested concepts and exercises (exercises in italics) Administer Key Term Quiz (20 minutes) Stretching warm-up for arms and hands Stretching the neck - p. 512 Stretching the levator scapula - p. 588 Stretching the pectoralis muscles - p. 597 Stretching the wrists and thumbs - p. 668 Stretching chest muscles and the thoracic spine - p. 678 Arm stretch for neural tension (see Figure 5.7 on p. 103) Discuss and practice principles for effective hand use (have students practice with whoever is next to them, giving their partner a spot massage on the arm, the thigh, or the shoulders). Position the body for optimal lines of force when pushing and pulling When applying pressure, align the fingers, wrist, and forearm To apply pressure, lean the whole body into the hands and push from the feet * Efficient use of force in pressure applications - p. 139 Make every stroke a full-body movement Vary massage strokes to avoid overusing any one hand position Balance the body by alternating opposing strokes Review hand positions and grips (see p. 686) * Grip strength and joint alignment for massage - p. 631 Homework Introduce final project paper and presentation assignment. Offer suggestions for choosing a topic, such as: Identify the body part with which you're having issues. Look over the exercises for that part and pick three that work for you. Research the content around that exercise to meet the criteria on the rubric. To study for labs, review TOC, look over charts to see what you need to focus on to improve your body mechanics, and practice the exercises that help you the most. CLASS 8 Graded body mechanics lab 2 (First round) Review Discuss reading and principles for moving around the table Review reading and basic ergonomic principles Table height Chair height Use of pads and pillows Suggested activities exercises Go over testing protocol Have students get the room ready Start graded lab Time working time (1 hour is recommended); let students know when they have 15 minutes left to work Observe students working and fill out testing rubrics Homework To study for labs, review TOC, look over charts to see what you need to focus on to improve your body mechanics, and practice the exercises that help you the most. Work on final project paper and presentation. Compile Charts 17 and Reviews 14 to turn in next class. CLASS 9 Graded body mechanics lab 2 (Second round) Review Collect charts and reviews Discuss final project parameters Have students sign up to set order Take questions Discuss how to use charts to identify topic of final project Suggested activities exercises Go over testing protocol Let students get the room ready Start test and time (1 hour is recommended) Observe students working and fill out testing rubrics Homework Work on final project paper and presentation CLASS 10 Final project presentations Return graded lab rubrics: Make sure you have copies in case a student contests the grade Return graded charts and reviews Collect final project papers Coordinate presentations: It helps to use a timer or give the students a "1 minute left" hand signal to keep them moving along ADDITIONAL EXERCISES Exercise 1 * Inhibiting a holding patterns where it starts ? Holding patterns: Talking points Places mechanical stress on soft tissues and joints Displaces body mass and center of weight off line of gravity Causes muscles to become stretch-weakened and adaptively shortened Interrupts continuity of movement along kinetic chains Limits segmental mobility in spine or exacerbates spinal instability Every holding pattern has a point of initiation, a place where the neuromuscular chain of tension begins. This is akin to the seed of a holding pattern. By sensing where the pattern begins, you begin to regain control over it. Sense your entire body, then tune into your holding pattern. See if you can sense the center of the pattern. Where does it initiate in your body? What muscles contract to maintain it? Once you are able to locate the place where you feel it begins, tighten that area even more. This will help you feel more clearly exactly how the pattern starts. Also, by actively tightening into your holding pattern, you take conscious control over the pattern. Contract and relax the pattern several times. Once able to control how your pattern begins, relax and gently breathe into that area. Visualize your breath melting the area. Then broaden your focus and relax the surrounding tissues. If you are unable to relax, sense the pattern as deeply as you can with a healing intention. Exercise 2 *Spinal flexion and hyperextension assessment with partner (from Instructor Manual for Chapter 14) Begin this exercise by discussing the markers of normal spinal flexion and hyperextension (see page 447). Demonstrate this assessment first on a volunteer. Assess the following elements: Where the spine is rigid and lacks flexion or hyperextension. Where the spine is hyperflexible and tends to bend and seemingly hinge. When hiked or protracted shoulders cause hyperflexibility in the thoracic spine. When students retract the shoulders or drop the head behind the body in hyperextension. Where the spinal muscles are adaptively shortened. Where the spinal muscles are stretch-weakened. When hip inflexibility causes hyperflexion in the lumbar spine. Have students work in pairs, with one student observing while the other student gets into a position of spinal flexion (see Figure 14.13a). Instruct the observer to give the student in flexion both verbal and tactile feedback about the position of flexion. Repeat the same process with one student in the cobra pose of hyperextension (see Figure 14.13b). Switch roles and repeat step b. Bring the students back into a large group and discuss the findings. Also discuss what kind of body would restore a continuity of tone and movement to the spine, identifying where it needs more motion, where it needs stabilized. Exercise 3 *Movement observation of head, neck, and spine in OA rock (from Instructor Manual for Chapter 15) Flexion and extension With the volunteer still standing sideways, have them nod their heads, rocking in a "yes" motion. Notice where the axis of motion is in the neck. At what vertebral level does the flexion and extension of the neck occur? Does the head rock directly on top of the neck? Or does the head look like its falling behind the body? It does when the axis of motion is in the mid- or lower cervical segments. In this pattern, the neck bends in the middle like a hinge. Flexion and extension should occur at the atlanto-occipital (AO) joints. The axis of movement can be approximated between the transverse processes of C-1, in the hollow spot behind the ears (see Figure 15.66c). NM patterning of the head and neck The trick in NM patterning for the neck is to isolate movement in the upper cervical unit while maximizing support and stability in the lower cervical unit (see exercise *Neuromuscular patterning to engage the neck stabilizers, p. 541). If the head is falling behind the body, encourage the volunteer to find the axis of lift and motion at the AO joints. To help them engage the intrinsic support, use these prompts: "Lift your occiput without dropping your chin. Then slowly nod your head at the uppermost part of your neck. Keep the middle and lower part of your neck stable." Exercise 4 * Progressive muscular relaxation? Learner Objectives: This exercise will help students: To increase muscular awareness of holding patterns. To develop awareness and control over muscular tone with contractrelax. To relax as deeply as possible and release muscular tension. Getting Ready: Have the students lie down in a comfortable position on the floor mats or massage tables. Tell them to use blankets and pillows so that they can stay warm and comfortable. Put on soft, relaxing music. Then talk them through progressive muscular relaxation with the following script: "During this exercise, let yourself relax as deeply as possible. It's common to drift off as you relax, so don't worry about following my instructions should you drift off. Now let's begin." "Close your eyes and relax . . . allow your eyelids to become heavier and smooth." "Sense your whole body . . . scanning your muscles from head to toes." "Feel the overall muscular tone of your body . . . noticing places where your attention is drawn . . . noticing where you are tight or uncomfortable . . . and noticing areas that you are the least aware of. " "Notice how what parts of your spine rest on the floor and what parts are held up by muscular tension. Sense the back of your head . . . shoulders . . . pelvis . . . legs . . . feet . . . and arms." "Take a few easy breaths. On each exhalation, allow your body to become heavier and heavier." "Now slowly and lightly contract the muscles on your face, around your eyes and nose, and hold. Feel the holding . . . take a slow, easy breath and as you exhale . . . slowly release and relax these muscles." Repeat step 6, filling in the blanks with different body parts each time you say it (neck, shoulders, arms, hands, chest, abdomen, waist, spine, lower back, hips, thighs, knees, feet) "Now slowly and lightly contract the muscles on your _______, around/ over/between/near (pick one) your _____________, and hold. Feel the holding . . . take a slow, easy breath . . . and as you exhale . . . slowly release the contraction . . . letting your body sink, settle, and relax . . ." "Scan your entire body for anyplace you still feel muscular tension. Contract that area slowly, using half the effort you used before . . . hold . . . then relax the area twice as much as before . . . let your body sink, settle, and relax . . ." "Take the next 10 minutes in silence to relax as deeply as possible . . . " "Come back slowly . . . notice your body . . . take several deep breaths to bring yourself back to the room and the class . . . stretch and yawn . . . wake your muscles up . . . then slowly roll to your side and sit up . . . bring whatever relaxation you feel back with you . . . " After the exercise: Discuss the experience with your students. Assign progressive relaxation as homework to practice at night before bedtime. Exercise 5 * Yielding while moving with the sand-bag body? Learn Objective: To learn how to relax during movement Lie on your back with your knees bent and relax. With each exhalation, let your body sink into the floor. Slowly roll to your side, let your head and neck be really heavy. Imagine your body as a sand bag with liquid sand slowly pouring into the side you are rolling toward. Continue slowly rolling from one side to the other. Use the image of liquid sand to help you sink and relax into sensations of slow, heavy movement. Sense the weight of your organs sinking toward the ground. Sense the weight of your heart and lungs sinking into your ribs. If you feel stuck in any area of your body, stop and rest there until you feel that area relax, then start rolling again. ? These patterning exercises are adapted from Somatic Patterning: How to Improve Posture and Movement and Ease Pain (Longmont, CO: EMS Press, 2007). STUDENT HANDOUTS TK BODY MECHANICS AND SELF-CARE: Chart 1 Roadmap to Student Success in This Class Name:___________________________ Partner:_______________________ Date: __________ Instructions: Fill out four "Goals Identification" boxes in far right column Prerequisite Knowledge Joint/muscle structure and function NM mechanisms Biomechanics concepts Posture/gait concepts For Each Class Wear loose, warm clothes Bring three-ring binder with paper and writing utensil, water in closed container, and hair ties if needed Come prepared to move Goals Identification What do you want to learn in this class? Professionalism Preparedness and attitude Attendance and punctuality Appropriate dress Full participation Homework Readings Class exercises Charts Pattern-recognition skills What body patterns do you want to change? Grading Criterion Professionalism - 20% Six assessment charts and four reviews - 30% Key terms quiz - 10% Graded lab - 20% Final project - 20% Skills for Daily Practice Body awareness Centering and relaxation Neutral joint positioning Core muscle engagement Diaphragmatic breathing What body mechanics and self-care challenges do you want to address? Class Activities Reviews and discussions Exercises/NM patterning skills Assessment charts 4 body mechanics labs Final project presentations Applications Students need to demonstrate the transfer of skills to: Body use during massage Daily activities Client education Do you plan on teaching client self-care skills? ______ Is so, which kinds? Stretching exercises Body awareness Breathing Posture Relaxation skills Muscle activation Range of motion Other______________ TK BODY MECHANICS AND SELF-CARE Class 1 Review Instructions: List all the major concepts that were introduced in class today. Instructions: List exercises that go with concepts below. Instructions: Identify which concepts above relate to each of the exercises below. Practice the exercises during the week. Practice Log: Mark the day and month __ /__ each time you practice this exercise. Seated pelvic rock Axial compression test with a supine client Low back protection with transversus abdominis Coordinating diaphragmatic breathing with intra-abdominal pressure (IAP) Postural sway for fluid body mechanics Exercises for grounding and countersupport Centering body over feet Pushing and pulling with partner TK BODY MECHANICS AND SELF-CARE: Chart 2 Student Self-Assessment of Strengths and Weaknesses Name:___________________________Partner:_______________________ Date: __________ How would you describe your body-awareness skills? How do you notice your body during the course of a day? How often do you sense your body during the day? What causes you to be self-aware (position, comfort or discomfort, pain, self-consciousness, breathing, emotions, etc.)? What do you do for exercise? Physical work? Sports? Recreation? Do you have any physical limitations that will prevent you from doing certain movements or exercises in this class? If so, please identify your limitations. What are the biggest physical challenges or stresses in your life? What are your coping skills? How do you best manage stress? Describe your ability to relax. What helps you relax? How often do you consciously relax? Describe your sleep pattern (sound sleeper, insomniac, how many hours per night, activities before retiring, etc.). TK BODY MECHANICS AND SELF-CARE Class 2 Review Name: ________________________________ Instructions: List all the major concepts that were introduced in class today. Instructions: List exercises that go with concepts below. Instructions: Identify which concepts above relate to each of the exercises below. Practice the exercises during the week. Practice Log: Mark the day and month __ /__ each time you practice this exercise. Partner observation exercise: Rolling down and up the spine Arcing for spinal movement Inhibiting a holding pattern where it starts Stretching posterior spinal ligaments Sway correction with the lumbar multifidus Spinal flexion and hyperextension assessment with partner Arcing for spinal movement Stretch/strengthen spinal extensors Stretching posterior spinal ligaments TK BODY MECHANICS AND SELF-CARE: Chart 3 A Study Plan Approach Name:___________________________ Partner:_______________________ Date: __________ What time and how long do you plan to do the following? Mon Tues Wed Thurs Fri Set up a study and test schedule on a calendar Read class assignments slowly and carefully Take notes while reading Review readings on a regular basis Spend 1 hour each day to practice exercises Practice observation exercises Practice class exercises Study with a partner or in small group Apply exercises to clinic, daily activities, other classes Self-test to recall exercises and concepts Write down questions I have about class content How often do you do this? Always Usually Sometimes Seldom Never Arrive to class prepared, punctual, rested, alert Pay full attention in class Formulate intelligent questions for class Ask questions when you are confused in class Answer the teacher's questions in class Make sure I understand homework assignments TK BODY MECHANICS AND SELF-CARE Class 3 Review Name: ________________________________ Instructions: List all the major concepts that were introduced in class today. Instructions: List exercises that go with concepts below. Instructions: Identify which concepts above relate to each of the exercises below. Practice the exercises during the week. Practice Log: Mark the day and month __ /__ each time you practice this exercise. Movement observation of head, neck, and spine in OA rock Neuromuscular patterning to engage the neck stabilizers Breath support for arms and upper body Contrast abduction with arms in frontal plane and plane of scaption Neuromuscular patterning for scapulohumeral rhythm Finding scapula neutral TK BODY MECHANICS AND SELF-CARE: Chart 4 Strategies and Performance Name:___________________________Partner:_______________________ Date: __________ Applying strategies Most of the time Sometimes Never Describe what you mean I am more aware of my own body and how I move I pay attention to my posture and movement during the course of daily activities I do the exercises I apply what I've learned in class to my body mechanics in other classes and clinics I observe people's posture and movement all the time I understand and see whole body patterns more now Monitoring performance Paying attention to how you use your body I'm aware of this part of my body and it feels good. I'm aware of this part of my body and it bothers me. I have little awareness of this part of my body. It needs attention. Describe what you mean Thorax and breathing Feet Knees Hips and pelvis Spine Head and neck Shoulders Arms and hands TK BODY MECHANICS AND SELF-CARE Class 4 Review Name: ________________________________ Instructions: List all the major concepts that were introduced in class today. Instructions: List exercises that go with concepts below. Instructions: Identify which concepts above relate to each of the exercises below. Practice the exercises during the week. Practice Log: Mark the day and month __ /__ each time you practice this exercise. Slow movement to relax head and neck muscles Sand-bag body Breathing to release tension Progressive muscular relaxation Static contact Locating, tracking, stretching diaphragm Review diaphragmatic breathing Muscle patterns in upper chest breath TK BODY MECHANICS AND SELF-CARE: CHART 5 Reflecting on and Adjusting Strategies Name:__________________________ Partner:_______________________ Date: __________ Reflecting on strategies: Assessing which parts of your body need help. Describe how this part of your body feels while you work. Identify massage techniques or strokes that cause discomfort in this area of your body. Describe how you deal with this discomfort. Does the way you deal with discomfort in this area work? Thorax and breathing Feet and support Knees and lines of force Hips/pelvis and core power Spine, head, and neck Shoulders Arms and hands Adjusting strategies: Choosing the right exercises for each part of your body. Engaging what muscles for postural stability with which exercise(s)? Repositioning what joints for optimal lines of force with which exercise(s)? Stretching what muscles with which exercise(s)? Strengthening what muscles with which exercise(s)? Thorax and breathing Feet and support Knees and lines of force Hips/pelvis and core power Spine, head, and neck Shoulders Arms and hands Thorax and breathing BODY MECHANICS AND SELF-CARE: CHART 6 Table of Contents (TOC) Review Name: _______________________Partner: __________________________Date: ____________ INSTRUCTIONS: Carefully read the following list. Highlight what you understand and feel you can do. Underline what you don't understand and have trouble with. Make sure to do both pages. 18.1 SKELETAL ALIGNMENT 18.1.1 Begin massage with optimal posture in a neutral, upright stance 18.1.2 Center the body over the base of support 18.1.3 Straighten the knees but avoid locking or bending them 18.1.4 Engage the core muscles to lengthen and stabilize the spine and torso 18.1.5 Avoid the tendency to stand up straight by hyperextending the spine 18.1.6 Keep the sternum lifted and the shoulders symmetrical 18.1.7 Engage and maintain the scapula neutral position 18.1.8 Allow elbows to be weighted and keep the arms forward of the body 18.2 RELAXATION, BREATHING, AND FLUIDITY 18.2.1 Actively relax the muscles in the head and neck 18.2.2 Practice postural sway to cultivate a natural, fluid stance 18.2.3 Establish breath support for the shoulders and arms with diaphragmatic breathing 18.2.4 Move slowly and with awareness 18.2.5 Make every stroke a complete movement sequence 18.2.6 Occasionally pause in a neutral, upright posture to recenter the body and mind 18.3 MOVING AROUND THE MASSAGE TABLE 18.3.1 Face the direction of the massage stroke 18.3.2 Use a rocker base to shift body weight when stepping 18.3.3 Stay over base of support to remain lifted over the hands and the client 18.3.4 Match and synchronize upper body movement with lower body movement 18.3.5 Take a step when you come to the end of a reach 18.3.6 Move into a lunge rather than assuming a fixed lunge stance 18.4 FORCE APPLICATIONS AND HAND USE 18.4.1 Make every stroke a full-body movement 18.4.2 When applying pressure, align the fingers, wrist, and forearm 18.4.3 To apply pressure, lean the whole body into hands and push from feet 18.4.4 Use optimal lines of force when pushing and pulling 18.4.5 Vary massage strokes to avoid overusing any one hand position 18.4.6 Balance the body by alternating opposing strokes 18.5 ERGONOMICS AND EQUIPMENT 18.5.1 Table Height 18.5.2 Foot Stools and Folding Stools 18.5.3 Chairs and Seated Techniques 18.5.4 Table Pads, Bolsters, and Face Cradles 18.5.5 Mirrors for Feedback BODY MECHANICS AND SELF-CARE LAB 1: CHART 7 Body Mechanics Lab 1 Self-Assessment Name: _______________________Partner: __________________________Date: ____________ Concept Exceptional Good Adequate, needs attention Describe how you will improve this pattern. Began massage by standing in a neutral stance. Aligned and grounded your legs under your body. Engaged your core muscles. Breathed into the width of your lower ribs to more effectively engage your diaphragm. Swayed a little to relax and feel fluid, intrinsic motion. Stood next to the table and placed your hands on your partner to make a connection. Slightly leaned into your hands to begin the massage. Found an easy rhythm that works for both you and your partner. Let your body follow your hands and faced the direction of your strokes. Moved your whole body to move your hands. Stepped forward into each stroke. Staggered your feet in the direction of your stroke, working over a rocker base. TK BODY MECHANICS AND SELF-CARE Final Instructor Evaluation for Lab 2 Name: _________________________________ Date:__________ Final score: _______________ 5 Student made exceptional improvement in this category. 4 Student improved in this category. 3 Student did not improve in this category. Notes Demonstrates optimal posture, make corrections as needed Maintains core muscle engagement Maintains shoulder symmetry and scapula neutral; maintains weighted elbows Looks relaxed; induces relaxation; recenters in neutral between strokes Demonstrates breath support Moves fluidly with full-body motion; completes stroke sequences Faces direction of stroke Moves upper/lower body in sync; uses a rocker base to shift weight Moves through lunges rather than holds position Stacks joints in arms when applying force; leans whole body into pressure; pushes from feet Total points Final score (total pts. 2) TK BODY MECHANICS AND SELF-CARE Final Project Instructions Write a two-page paper (double-spaced, 12-point font). In the paper, discuss the following three points: Pick a part of your body where you have experienced new awareness or change. Discuss the changes by describing and contrasting your old patterns with your new patterns. Make sure to use anatomical terms (such as muscles and joints) and kinesiological terms (such as actions and range of motion). Describe within the context of whole-body patterns of posture and movement. Name three exercises that helped you the most to change your pattern. Explain what the exercises are and how they helped you to improve the pattern. Identify one major concept (which are outlined in the key terms), describing ideal movement in the area of the body where you feel the change. For instance, the concept of the lumbarpelvic rhythm describes lumbar and hip motion in forward bending. The final presentation will be based on the paper you wrote. Present your paper to the class with a 5-minute reading and demonstration. You will be graded using the grading rubric criteria on the next page. TK BODY MECHANICS AND SELF-CARE Final Project Grading Rubric Name:____________________________________ Date: ___________________ Final score:__________ Presentation Student demonstrates exceptional thought/ incentive/self-reflection Student demonstrates above-average thought /incentive/self-reflection Student demonstrates adequate thought /incentive/self-reflection Student does not demonstrate thought/ incentive/self-reflection Describe a part of your body where you have experienced new awareness or change. Describe muscle patterns and how they affect the resting position of weight-bearing joints. Name three exercises that helped you the most to change this pattern and describe how they helped you. Define one major concept of movement in the area of the body you are presenting on and relate it to your pattern. Content Superb grasp of concepts, logical flow and great development of ideas Good grasp of concepts, logical flow and reasonable development of ideas Partial grasp of concepts, partially logical flow and development of ideas Poor grasp of concepts, illogical flow, insufficient development of ideas Written paper Exceptional writing with excellent sentence structure, spelling, grammar, and punctuation Good writing with a few minor mistakes in sentence structure, spelling, grammar, and punctuation Adequate writing with many mistakes in sentence structure, spelling, grammar, and punctuation Inadequate writing with serious mistakes in sentence structure, spelling, grammar, and punctuation Total: © 2013 by Education, Inc. Foster, Instructor Manual for Therapeutic Kinesiology