Monday Medical: Healing injuries with proper movement patterns
November 6, 2017
Want to build back strength after an injury or surgery? Then first, you should make sure you're moving properly.
That's where Davor Vasiljevic's work comes in. Vasiljevic is a physical therapist at UCHealth SportsMed Clinic and certified strength and conditioning coach, as well as a board-certified orthopedic clinical specialist.
His approach to musculoskeletal pain and rehabilitation is based on Shirley Sahrmann's work of isolating issues and imbalances in a patient's movement patterns and then correcting them. Eventually, proper movements are reinforced with strength training.
"If one muscle is tighter or stronger than the muscle on the opposing side of a joint, that could create problematic posturing, leading to imprecise movements and then pain," Vasiljevic said. "If you strength train with a problematic movement pattern, you're potentially creating a worse problem, because you're strengthening those postures."
Most people don't start with dysfunctional movement patterns; as children, natural movement patterns can be near perfect. But then life comes into play. Long hours sitting at a desk can create stress, while some professionals, such as surgeons and hairdressers, face work-specific postural stresses. Past injuries and surgeries can impact someone's natural movement patterns as well.
Additionally, sports that are rotational or one-sided in nature, such as tennis or snowboarding, may create muscle imbalances, while sports such as dance and gymnastics, which require extreme ranges of motion, can alter joint structure, and thus, muscle performance.
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Vasiljevic begins by assessing a patient's fundamental movements, such as squatting or raising the arms overhead, and correlates pain with each motion.
"You will notice segments that move too much, segments that move too little, segments that may be rotating in different ways," Vasiljevic said. "Then, you can infer which muscles may be tight and which muscles may be long."
Next, a patient's movements are corrected to retrain muscles. If a patient's trunk rotates in one direction while they squat, Vasiljevic helps stop that rotation through verbal and physical cues.
Then the patient progresses to more complex movements, such as jumping or picking a box up off the floor. Eventually, weights are added to reinforce the proper movement.
"It can take weeks," Vasiljevic said. "The older and more ingrained these patterns are, the more mental work it's going to take to change."
Manual therapy and other traditional physical therapy treatments are often used in conjunction with the movement training.
"This is an ongoing process," Vasiljevic said. "Once we fix the problem manually, we should continue to maintain appropriate muscle balances or we may revert back to old habits."
The strategy is helpful for anyone, from young athletes to older patients struggling with chronic pain. And it can help with various conditions, from treating shoulder impingements to preventing ACL injuries.
Vasiljevic has worked with a range of athletes. He has traveled with the USA Judo National Team, helping competitors at national and international training camps, and at the world championships. He also recently assisted a top-eight finisher in the Tahoe 200 Endurance Run.
"The movement approach is novel in the way it allows the patient to learn proper movement strategies and essentially correct muscle imbalances by themselves," Vasiljevic said. "It creates a level of independence. They don't have to rely on coming back to therapy constantly."
The work isn't always easy for patients, especially at first. But it is rewarding.
"In the beginning, there can be some confusion. There's a learning curve," Vasiljevic said. "But ultimately, the level of independence to fix their own issue or essentially help themselves is what the reward is."
For more information, contact UCHealth SportsMed Clinic at 970-871-2370.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.