Research Roundup: August 2020

 

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Diaphragmatic Breathing for Posture

Menon, Vivek V., Mudasir R. Baba, Pavankumar, and Sneha Suresh. "Effects of Diaphragmatic Training on Posture and Stability in Asymptomatic Subjects: A Randomized Clinical Trial." Indian Journal of Physiotherapy and Occupational Therapy 14, no. 2 (April-June 2020), 221-225.

By no means a thorough or robust study, we are including this one because of our belief in evidence-informed practice, and this paper does serve as a reminder of the importance of the diaphragm for postural control. (Better references included below.)

 

Anatomical Review: The Diaphragm
  • The throacic diaphragm separates the thoracic and abdominal cavities.
  • Comprised of central and peripheral parts, that converge at the central tendon.
  • The central tendon fuses with the inferior surface of the pericardium.

  • On either side of the central tendon, the diaphragm ascends to the left and right domes.
  • The peripheral, muscular portion  of the diaphragm is divided into three parts: sternal, costal, and lumbar.
  • Sternal fibres arise from the posterior surface of the xiphoid process.
  • Costal fibres arise from the posterior surface of costal cartilage of ribs 7-10, and directly to the posterior surface of ribs 11-12.
  • Lumbar fibres arise from the anterior surface of L1-L3, via the left and right crura, and the arcuate ligaments.

  • The left crura arises from the bodies and intevertebral discs of L1-L2.
  • The right crura arises from the bodies and intevertebral discs of L1-L3, with some fibres surrounding the oesophageal opening.
  • The crura also blend with the anterior longitudinal ligament of the vertebral column.
  • The medial arcuate ligament is a thickened sheet of fascia that arises from the upper portion of the psoas major, attaching to the lateral aspect of L1 or L2, and the anterior aspect of the transverse process of L1 and/or L2. 
  • The lateral arcuate ligament is a thickened sheet of fascia that arises from the anterior surface of quadratus lumborum, extending to the lower margin of the 12th rib and attaching to the anterior aspect of the transverse process of L1, and sometimes L2 and L3. 
  • The median arcuate ligament is formed by the medial margins of the left and right crura.

  • Diapragmatic ligaments also attach the diaphragm to the viscera.

www.kenhub.com/en/library/anatomy/diaphragm

 

Key Points
  • Diaphragm training has previously been shown to increase the cross-sectional area of the deep spinal stabilisers, such as the transverse abdominals and lumbar multifidus.1
  • Improving diaphragmatic "strength" can improve balance, through deeper core control mechanisms and proprioceptive feedback.
  • Diaphragmatic breath training decreases load through accessory breathing muscles of the neck, thereby supporting cervical posture.

  

Clinically: Pilates in Practice
  • Breathing is the most fundamental and foundational work for Pilates (and rehab)!
  • Spend time teaching diaphragmatic breathing techniques, including lateral and posterior diaphragm expansion; use props to set up for success!
  • When cueing through thoracic extension, diaphragmatic breathing can unload the lumbar spine.
  • Diaphragmatic breath cues can release the scalenes and other accessory breathing muscles to encourage fluid upper body movements; chest expansion and other upright arm series; mermaid; upstretch.
  • All of the pre-Pilates preparatory mat work will be supported with appropriate diaphragmatic breathing to support a deep abdominal and cylindrical core connections.

 

1. Kocjan, Janusz, Mariusz Adamek, Bożena Gzik-Zroska, Damian Czyżewski, and Mateusz Rydel. "Network of breathing. Multifunctional role of the diaphragm: a review." Advances in Respiratory Medicine 85, no. 4 (2017), 224-232. doi:10.5603/arm.2017.0037.

2. Moore, Keith L., Arthur F. Dalley, and A. M. Agur. Clinically Oriented Anatomy. Philadelphia: Lippincott Williams & Wilkins, 2013.

3. Finta, Regina, Edit Nagy, and Tamás Bender. "The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain." Journal of Pain Research Volume 11 (2018), 3031-3045. doi:10.2147/jpr.s181610

4. Gormanc, Niamh. "Diaphragm." Kenhub. Last modified April 15, 2014. https://www.kenhub.com/en/library/anatomy/diaphragm.

  

 

The Learning Styles Neuromyth

Papadatou-Pastou, Marietta, Anna K. Touloumakos, Christina Koutouveli, and Alexia Barrable. "The learning styles neuromyth: when the same term means different things to different teachers." European Journal of Psychology of Education, 2020. doi:10.1007/s10212-020-00485-2.

The concept of learning styles has long been debunked, and yet they persist in all educational communities. This paper outlines why it is difficult to use theories of learning styles in practice: "the same term means different things to different teachers."

 

 Key Points
  • There are many models of learning styles, and therefore little consensus on what different learning styles connote.
  • The Visual-Auditory-(Reading)-Kinaesthetic (VARK/VAK) is the most common understanding of learning styles.
  • Theories of learning and learning styles are often confused.
  • Learning styles are also often confused with learning approaches and/or motivation theories.
  • There are many differences in learning, which do need to be considered and accommodated, but they cannot be summarised neatly into learning styles.
  • Encouraging learners  to reflect upon their own ways of learning supporting them to develop their own learning strategies is more effective.1

 

Clinically: Teaching Pilates in Practice
  • This may seem abstract for movement practitioners, but opens up discussions regarding our "tried-and-true" teaching methods and encourages a more holistic and collaborative approach to education and rehabilitation with our clients.
  • Focus on "learning to learn" and motor skill learning. 
  • Communicate with students: encourage learning reflection and strategies to help support their education. 

 

 1. Dinsmore, D. L., Alexander, P. A., & Loughlin, S. M. (2008). Focusing the conceptual lens on metacognition, self-regulation, and self-regulated learning. Educational Psychology Review, 20(4), 391–409. https://doi.org/10.1007/s10648-008-9083-6.

 

 

Passive Movement for Motor Memories

Tays, Grant, Shancheng Bao, Mousa Javidialsaadi, and Jinsung Wang. "Consolidation of use-dependent motor memories induced by passive movement training." Neuroscience Letters 732 (2020), 135080. doi:10.1016/j.neulet.2020.135080

A previous body of literature exists that shows that visuomotor adaptation can be facilitated with passive movements, and that use-dependent learning can occur when movements are performed passively. This small study included healthy, neurologically-intact individuals, and shows that the learning that occurs with passive movements only, persists after time delays; further studies that look into this effect with injured populations are required to ascertain if the findings can be extrapolated.

 

 Key Points
  • These participants performed no active movement, and had no visual feedback to training.
  • Visuomotor adaptation that occurs with passive movement training can persist for up to 24 hours after training.
  • These learning adaptations are not demonstrated at a five-minute interval after training, suggesting that it takes some time for motor memories to be consolidated. 
  • Proprioceptive inputs, via passive movement training, support optimal motor control and performance.
  • Observational learning + active movements in addition to passive movements will lead to faster adaptations; passive movements/proprioceptive inputs alone cannot facilitate optimal learning.

 

Clinically: Pilates in Practice
  • Clients who are immobilised/unable to actively move their limbs, will benefit from passive movements for motor patterning. 
  • Very weak limbs can be facilitated through passive movements; double leg lowers at the Tower with assistance; side lying arm series with spring/sling support on the Cadillac. 
  • If a client has pain with active movement, but pain-free passive movement, facilitate their passive movement range through supported techniques; manual handling; slings/springs.
  • Closed kinetic chain exercises where the injured body part passively flexes/extends; throwing pearls on the Cadillac; Reformer footwork with activation through one side only.
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