He is an expert in psychosocial aspects of back and neck pain patients, and has pioneered the identification of risk factors of chronicity and preemptive reactivation treatments with a cognitive-behavioral emphasis. This article will summarize the impact of psychosocial factors on prediction of patient prognosis, and how patients with such factors can be appropriately managed. The Role of Reactivation December 1, Musculoskeletal pain patients in general, and LBP patients in particular, require an approach that addresses the physical biological and psychosocial dimensions of their problems. This modern approach is called "biopsychosocial" BPS , in that the total patient is our subject. Rather than focusing on structural causes and cures, this new paradigm emphasizes the goal of maintaining or restoring function.

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All Rights Reserved. F or e w or d his is an exciting chapter in the history of pro- are looking at the problem and helping to solve it. I T active health through performance.

We have arrived at this point in history through a pro- encourage you to utilize FTH as an applied workbook. Take time after each chapter to summarize three take- gression that is true of nearly any space. First, there is aways that directly apply to your situation and clients. Next comes sharing FTH. As you do this, you will probably come to the through educational mediums in the various disciplines, realization, regardless of your educational background or market awareness, applied career pathways, outcome data, practicing discipline, that the information confirms many and leaders emerging in each area of expertise.

A struggle of your beliefs. If your key takeaway from FTH is redun- ensues to determine which career discipline is most pow- dant commonalities between the diverse disciplines and erful, followed by stagnation through isolation, until the practitioners, one would argue we have just taken a giant next-generation questions why we are doing this in the first step forward in upgrading population health and care.

With world- health and performance? And arent all these class partners, facilities, technologies, and specialists span- systems working in concert within each of us? This is our tioned as the breakthrough book which bridges the gap responsibility, and it has given us the honor to learn and between rehab and prehab through performance, acting as work side by side so many of the special people and pro- the foundation to the next generation of care and under- fessionals who made time within their demanding sched- standing.

FTH covers a broad spectrum of populations, ules for this book. Their actions should be celebrated. As from the developing child learning basic movement literacy leaders, they show how we must work together in the best to elite athletes, weekend warriors, and the aging popula- interest of both our clients and the field at all times.

Rather tion. When you look at the All-Star team of contributors, than let ego or politics consume energy, we must integrate two things will strike you. First, this is a multi-disciplinary and apply our knowledge and skills for the needs of each group of internationally respected expert practitioners who individual client.

The second thing athletic development training approaches, off-season sys- you will notice is an impressive performance by the FTH tems, and rehabilitation considerations.

On behalf of all of Editor, Dr. Craig Liebenson, who was able to bring this us who will benefit from the FTH, I send our deepest grati- team of experts together and organize their vast knowledge tude to the editor, Dr.

Craig Liebenson, and to all of those into one integrated and functional approach for the readers who contributed to this work for the passion they put into benefit. FTH demonstrates the power of collaboration for it. I look forward to witnessing the teamwork and precision the greater good of our respective fields. F or e w or d unctional training and rehabilitation present a are dysfunctional at bodyweight, then loads and complex F popular way to describe approaches to exercise at all levels.

Functional stuff, in a word, is simply tasks are really not actionable in an efficient and effective manner. The identification of dysfunction justifies more more holistic than the current common alternative. To grossly oversimplify, if functional movement pat- Really?

Agreement followed by action is easy to cific environment. If functional movement patterns are track, measure, modify, and improve.

Agreement without not acceptable, then we must find out why and take action action actually has the same outcome as non-agreement. The popularity of functional insert your modality Engineering a functional approach requires a blend here might imply that conventional methods of rehabili- of science and art.

The true functional approach requires tation and training fall short in two distinct ways. No engineer will incomplete in the resolution or management of dysfunc- rush the foundation to construct a better building; instead tion movement patterns. My journey toward a functional isolation for in-depth evaluation, treatment, and training. At the beginning of Moreover, it also does not address activity and sports speci- that journey, I had to make a decision. I had to trust ficity or elite performance methods.

A functional approach the functional material and programming presented to is simply the most efficient and effective entry point. Call me or I had to have a responsible professional way to itgeneral physical preparedness or a state of uncompli- test the theories and ideas that were proposed under the cated adaptability.

The strength impair- them efficiently and effectively. I also looked at train- ment has been adequately addressed and yet ambulation ing methods that produced the unfortunate side effect efficiency is not restored.

Likewise, specialization may com- of gross asymmetry, compromised mobility, or limited promise general functional movement patterns even though motor control. In other words, a loss of the foundation a general functional base is the time-tested starting point while focussing on a better top floor, if you can appreciate for greatness.

You might find exceptions to this statement, another construction parallel. Staying close to the against the map, compass, and clockin modern travel, functional base might also provide great benefit in physical the GPS does it for us. A single gauge points as an indica- durability, but we will have to be a little smarter to prove it.

The Functional Train- Those of us who have dedicated a big part of our prac- ing Handbook will offer you many ideas about grooving tice, teaching, and publishing in defense of function come motor patterns, functional restoration, as well as main- together on the big ideas even though we may embrace taining function in performance situations. Please make slightly different side paths of the well-traveled road.

How- sure you have gauges to watch and that you have time ever, we will reach very close to the common destination. Your observations are extremely We believe that basic functional movements provide the valuable when they come from experience in the tech- general base for more advanced physical loads and complex niques demonstrated in this text, probably a little less movement tasks.

If, however, basic functional movements valuable without practical experience. I think we would xiii c Wolters Kluwer. Please be of one with practice and reflection. My wise mentorsstarting with my This foreword is both a professional and personal Dadall articulated that I should hold onto my words, thank-you to Craig for his commitment to a better func- until I had the calluses to back them up. I offer the same tional model. Welcome to the movement Movement! Craig Liebenson and his contributors Gray Cook, P.

T Handbook came about as a result of the renais- sance occurring in rehabilitation and training. For a weight lifter it may focus on control of the sagittal plane see Chapter Meanwhile for a mixed martial arts We are recognizing the overlapping roles and interdepen- fighter training will focus on building their rate of force dence of clinicians, trainers, and coaches see Chapter 3.

The book aims to distinguish what is sprinting, weight lifting, etc. In contrast, an endurance ath- functional about functional training from what is merely lete such as a marathon runner, Iron Man competitor, or popular.

With the Internet and social media falsely granting triathlete will focus on such traits as running economy see instant expert status on anyone with a loud bullhorn, this Chapter Let us start with what functional training is not.

It is Rehab specialists have learned to successfully help patients not sport-specific training which through mimicry trains resume activity and athletes to return to sport. Trainers movement patterns that are replicas of sports maneuvers. What is functional training? It is training with a pur- If trainers successfully build capacity strength, endurance, pose or goal.

By having a clear objective it is inherently and power on a foundation of high-quality movement client-, athlete-, or patient-centered. Because func- patterns, then skill coaches can focus on biomechanical tional training is designed to help people achieve their goals optimization of the craft of sprinting, kicking, throwing, safely and efficiently.

Most importantly the head coach is now in a If we think about or try to define function, the answer position to macro- instead of micro-manage the overall per- becomes it depends. What is functional depends on an formance aspects of the athlete and team. When the coach individuals age, sport, injury history, stage of rehabilita- can focus on motivating and inspiring each individual on tion, goals, etc. To many saying it depends is a cop-out, the team to maximize their potential, the most efficient but to assume that everyone needs the same tests or exer- development of the athlete can occur.

In fact, we are all unique so what is is its underlying emphasis on durability. If training is func- functional truly depends. Thus, residual adaptation will occur and results will balance assessment and training would be a functional pri- be achieved in the fastest, safest manner possible to develop ority.

Women are at risk post-menopausally for osteoporo- athleticism throughout the lifespan, during the off-season, sis; therefore, spinal posture is a key. Young girls and female and even maintain it in-season see Chapter This athletes in sports such as soccer, basketball, or volleyball process is always guided by a results-oriented approach with sudden starting and stopping and change of direction see Chapter 5 called the clinical audit process CAP.

Low Dr. Karel Lewit says the methods should serve the goals. This is the ity, or poor motor control of the core; thus, assessing and painless dysfunction that is most greatly limiting function remediating these key functional deficits are crucial.

Indi- in the kinetic chain. Put in other words it is the source of viduality is the rule, not the exception. Once this is Clearly, populations have heterogenous rather than identified then a program can be designed that resets homogenous functional requirements.

Functional training function so that the painless dysfunction is remediated see for a basketball player may require an abundance of frontal Chapter 7 and performance enhanced in the most efficient xv c Wolters Kluwer. The Functional Train- rehabilitation, fitness, and athletic development specialists ing Handbook strives to free clinicians and trainers from more than just craftsman, but true artists.

Results or outcomes should always trump an output-based approach that blindly fol- Learn the rules like a pro, so you can break them like an lows methods i. In this way, it is artistPablo Picasso my hope that this book will serve as a guide to making c Wolters Kluwer. A C K N O W L ED G e M E N T S t has been a privilege to take this journey from importance not only of utilizing exercises which challenged I my chiropractic roots to a more broad-based soft tissue injury and athletic development para- muscles while minimizing joint load, but also of spine spar- ing strategies such as the hip hinge.

Within a few years, a digm. As a chiropractor I was introduced to an alternative new leader emerged within the Prague School of Manual approach to treating the locomotor system, its particular MedicinePavel Kolar, P. His work based on focus being on role of joint dysfunction in musculoskeletal the Vojta approach to care for children with Cerebral Palsy health. I am indebted in particular to a few of the more quickly expanded to include the use of developmental revolutionary influences I had in the early s who early movement patterns to facilitate the emergence of improved, on took a more functional than structural approachDrs.

At the same time that I was studying this more modern Amazingly, while the clinical-rehabilitation world version of chiropractic, I was introduced to the role of soft was sharpening its principles and methods for improving tissue dysfunction in both pain and movement. I learned of the quality of movement patterns, a similar trend began to the Nimmo method from the wonderfully observant Chi- emerge in the Strength and Conditioning field in the late ropractor Richard Hamilton.

Then, a key turning point for s.


Functional Training - Craig Liebenson

This delayed activation was far away from the location of the original injury. It persisted afterward—it became programmed as a default. On the top is the EMG of the control group, and on the bottom is that of the injured group. Some of you might call it gluteal amnesia. This is a normal and expected response to an injury in the lower quarter. Protectively, we expect the brain will try to immobilize this area and that will get programmed.


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