Evidence of Musculoskeletal Dysfunction and Growing Rate of Injuries
According to the National Academy of Sports Medicine (NASM) musculoskeletal injuries are at all-time high than it was 40 years ago.
More than 600,000 knee replacements are performed each year in the United States. With an aging population demand for total knee replacement surgery is expected to exceed 3 million by the year 2030. The average cost of a knee replacement is approximately $20,000 totaling to 12B annually.
According to the U.S. National Center for Health Statistics (NCHS) the number of hip replacement procedures more than doubled in the United States, from 138,700 in 2000 to 310,800 in 2010. A total hip replacement usually will cost between $31,839 and $44,816, with an average cost of $39,299 with the annual cost approximately 1.2B, according to Blue Cross Blue Shield of North Carolina.
Neurosurgeons performed 2,296,331 total procedures in 2011 in the United States, 1,448,400 of which were spine surgeries, according to AANS National Neurosurgical Procedural Statistics. The average cost of a spine surgery is about $35,000. Estimated annual spine surgeries cost is 5B. These statistics clearly indicate that traditional orthopedic care and physical therapy treatments are failing to produce successful outcomes.
Conventional Injury Treatment and Exercise Protocols Gaps
Major Components of Human Movement System (HMS) are Overlooked
Basic human movement science defines the structure and components of the HMS and movement is carried out by three main systems within the human body, the nervous system, the muscular system, and the skeletal system . However, conventional injury treatment and exercise protocols only focus on the muscular system but the alignment of the skeletal and a proper functioning of the nervous system are not assessed. When the joints are misaligned and the nerves are not transmitting signals to the muscles attempts to restore the muscle strength cannot succeed and might lead to aggravating the problem further.
Interconnected Body Segments are not Evaluated
Typical injury treatments address only isolated body segments and neglect coordinated movement that must take place between the body segments. As a result, the areas outside of the location of pain are not evaluated . If a patient has a shoulder pain the conventional orthopedic care and physical therapy will treat the shoulder.
When human movement is carried out the HMS forms a functional movement chain between interconnected body segments that must work together to produce movement . It is very likely that the cause of a problem is a body segment located outside of the area of pain.
The Lumbo-Pelvic-Hip Joint Complex
The Lumbo-Pelvic-Hip Joint Complex (LPHC) is responsible for the overall neuromuscular control of the entire human movement system and LPHC is the link between the upper and lower body. It controls all functional chains movement between the interconnected body segments and it is designed to coordinate their movements.
At this point, Levin’s research identified main elements of proper functional chain movement as follows: multi-planar movements, skeletal alignment, the center of body weight, range of motion, the base of support, muscular control, bilateral and unilateral movement. It should be noted that the functional movement research is ongoing and new elements might be discovered.
The skeletal component of the LPHC consists of the lumbar spine, pelvis, and hip joints, and this complex is the base of support for the lower and upper body. All movements incorporate the transfer of energy from one segment to the next and proper skeletal alignment is required to allow the muscles to efficiently work together. If LPHC is not properly aligned it will cause certain body segments to compensate which can contribute to injury.
Current literature describes the assessment of functional chain movement and offers the checkpoints related to major body regions . However, this approach is incomplete because movement actions take place only as a result of a series of neuromuscular commands from the brain to activate the individual muscles responsible for moving specific joints and bones.
For example, a leg movement is comprised of interconnected segments such as pelvis, hip joint, knee joint and ankle joint that must work together to perform movement. Neuromuscular and skeletal imbalances may contribute to altered movement patterns and these dysfunctions can lead to increasing the risk of injury.
Skeletal System Alignment
One of the basic functions of the skeletal system is to serve as an internal support for the body and provide interaction with the muscular system and nervous system to produce movement. A muscle group for a specific movement is designed to provide actions to stabilize, neutralize and move joints and bones.
When the muscles contract, usually one of the bones attached at the joint moves. Ligaments connect the bones to each other and are designed to provide a structural stability for the bones.
Existing exercise programs do not take into consideration the interaction of the skeletal and muscular systems and focus on muscular movement actions only. All joints in the human body are interconnected and if one the joints is not functioning properly, it will it will compromise movement and place undue stress on the soft tissues, cartilages and muscles.The functional requirements of the joints are to provide proper interconnected stabilization and motion it is not addressed in the current exercise and injury treatments protocols.
A Science-Based Functional Therapy Alternative
Lenny Levin’s research efforts have developed comprehensive injury assessment and exercise protocols to produce successful outcomes. Functional chain movement assessment (FCMA) is a science-based approach to identify the root cause of an injury, remove pain, restore functional movement and bring the injured area to a normal function. Functional Therapy allows to eliminate major gaps in conventional orthopedic care, physical therapy and exercise methodology.
FCMA is an integrated approach to access human movement and provide exercise protocols, and it has proven to produce successful outcomes to treat injuries and improve performance. It is based on evaluating a coordinated effort of three main systems within the human body, to assess functional chain movements including the key components such as LPHC, skeletal system alignment, interconnected body segments that are overlooked by conventional medical care and fitness industry.
1. NASM Essentials Personal Training, Michael C. Clark, Scott C. Lucett, BrianG. Sutton, 4th edition, 2012.
2. ACSM’s Health-Related Fitness, Assessment Manual, 5th Edition, Gary Liguori, 2017
3. AFAA Fitness: Theory and Practice, Laura A. Gladwin, 5th Edition, 2011.
4. National Physical Therapy Examination, Study Guide, Mometrix Media LLC, 2013