Adam’s Background
• Adam’s professional credentials include Licensure in Physical Therapy (IL) and Massage Therapy (IL) and Fellow of Applied Functional Science (Gray Institute)(’09). Some of his certifications include Enhance Running Technician, Functional Range Conditioning (FRC), Dry Needling Certified, Neurokinetic Therapy level 3(NKT), Functional-Neuro-Orthopedic Rehab (FNOR) provider, and he has his certificate of competency in vestibular rehabilitation. As a Physical Therapist of over 16 years in Chicago, he is the owner of REAL Physical Therapy and founder of The Movement Guild. He is the author of two books, including the most recently published Foundations of Movement: A Brain-Based Musculoskeletal Approach. Adam is a Master Instructor on the Rocktape Education Team for the past seven years, and also teaches a host of his own material Adam’s father owned a health club growing up giving him an early introduction to movement and a different perspective on how the human body functions.• Adam does not see his material and what he does as “his approach”, but has gathered and brought people and information together. Through the vast amount of influential people he has met, including his father, and the courses he has taken, to bring together what he calls “integrated Movement”.• Before attending PT school, Adam was already engulfed in the world of human movement, as his father was in the industry. He had watched the functional movement digest series by the Gray Institute back in the 90s which gave him a functional understanding of movement as opposed to the “Biomechanical/Orthopedic” understanding of just muscles and actions, which got him into trouble. • His understanding, from watching these series, was that the body worked to control the forces that were presented to it including, as Gary Grey says, mass, momentum, gravity and ground reaction forces. • After PT, he went and took as many courses as he could to continue to layer onto his understanding, and fill gaps as he understood them.• He was fascinated by the stories of his patients about their injury and pain, why they thought some things worked and others didn’t. This inspired him to learn more about applied neurology to gain a better view of what his patients were experiencing. • Through meeting new people like Nick Studholme, Adam then came to a more “Brain Based” approach of motor control which started with muscle testing and then progressed to higher level reflex testing and sensory integration. He learned of the Carrick Institute where he learned more about the brain and central nervous system. • Adam has written 2 books, his first “Real Movement: Perspective on Integrated Motion & Motor Control” and his most recent “Foundations of Movement: A Brain Based Musculoskeletal Approach”. In his second book he involved a “Neuro-Editor” Dr. Michael Drzewiecki who offers a second clinical perspective on the topics in his book. Dr. Drzewiecki worked with Dr. Carrick of the Carrick Institute directly and has a very good understanding of application of neurology clinically.
What Makes a Good Course? How Should Courses be Approached? • Someone who takes a big textbook and teaches about it and their clinical experience in using it.• Be the person in a course who goes to the instructor and asks where they learned that, find the source of the information so that you understand it and don't get seduced by the techniques taught. This will allow you to better understand the limitations or gaps of the information that will later need to be filled.• Find a person who is good at applying the information and ask them to become your mentor. You need to see the information in practice. The Brain • From Dr. David Trouster “The brain is the ultimate virtual reality machine.”• It gets information from three sensory systems; o Proprioception: what your skin, muscles and joints tell your brain about where you are in space. They respond to movement, and most often lengthening. o Visual system: different then just eyesight, there are many complex reflexes involved that happen subconsciously.o Vestibular system: the inner ear telling your brain where your head is in space.• These three systems should tell your brain the same information. Often there can be a discrepancy between these systems. A lot of the time one system is compensating for the other two. Then sub-clinical issues or clinical pathologies can arise.• Cognition is what is used to balance out these systems if there are discrepancies or weaknesses. You can see this by getting someone to do a cerebellar rapid tests or use cognition during a movement task, if they cannot complete it you know there is compensation occurring.  Pain • Chronic pain, bilateral pain, pain on one side of the body, this may all be from these systems not integrating properly.• If the treatment you use requires constant consistency of application it may not be dealing with the root of the problem. Adam generally assumes the pain individuals have in his office is really peripheral nerve, sensory nerve irritation that's mimicking muscle or joint pain. Dave George talks alot about this.• You really have 2 types of nerves. You have sensory nerves that go from your skin, floss through the skin, through the muscle and joint, up to the spinal cord and then the brain. Then you have motor nerves which elicit a response to the tissue based on the sensory information provided. • The immobile skin creates irritation through the sensory nerves resulting in dysfunctional afferent messages. Adam often starts by making sensory changes by mobilizing the skin (superficial) tissues through pinching and rolling it in the right spot followed by rechecking the movement.
Adam’s Assessment Process
• You first have to realize that you can't isolate a system, it all works together. You can only emphasize systems.• Many tests can emphasize different areas of the brain through variations in posture (bilateral/unilateral stance, heel to toe), tasks (arm movement, cognitive demands, turning head), or sensory feedback (eyes open closed, head tilts) Some common test used are Romberg variations, rapid alternating movements at many joints of the body (thinking about the neural anatomy), typical bedside neurological exam, visual reflexes (pursuits, cicad, optokinetics, convergence/divergence), cranial nerves (facial sensations, smell, eyes), sensory maps (spinothalamic tracts, decreased sensation, point discrimination), musculoskeletal exams (strength testing, reactivity).• With all these tests he follows the results based on what he found as it pertains to the areas of the brain that are meant to coordinate the various tests.• Some tools he uses to collect information;o Balance tracking system (B-tracks); modified CTSIB test, weight distribution, single leg balance, cervical challengeo Far infrared goggles (Vestibular first); movement of eyes in the darko Dynamometer; toe and hip strengtho Pulse Oximeter with perfusion index; blood oxygen levels o Moxy (near infrared spectrometry); blood oxygenation and hemoglobin measurements in real timeo Blood pressure on both sides; mesocephalic wind up, blood pressure will be higher on one side • Staying as objective with his tests as possible. This gives him a solid foundation to come back to when utilizing different treatment methods to insure progression with each patient. Some methods may lack substantiating research because it can be difficult to conduct but at the end of the day his responsibility is to find what works for his patients.• This also helps Adam mentor his practitioners. Having this objective data allows for consistency for his patients and for him to better assist the practitioners working with him.
Adam’s Treatment Process
• The assessments become the tests as Gary Grey says.• It just may be regressed.
Adams Advice For New Clinicians
• Get really good at one thought process, rather than being okay at a number of thought processes.• There are many many different thought processes out there and all of them work but all of them have holes. • Decide what you want your foundation to be in and learn as much in that course as possible while improving your proficiency with it as best you can. • Once you do that, you have a foundation to branch off to fill in any gaps you experience.• Attending courses is more beneficial than just reading the material, as you get to see how the individual puts their thought process together. • At every course Adam has taken, he has gone up to the instructor and said “Thank you, is there anywhere you can point me to learn more, any person, book or material that can help be influential in this thought process”. He also gets any material references in the course. • Take the course. read the books and get a mentor in the field of the thought process Posture
• Garbage bucket term like plantar fasciitis or piriformis syndrome.• It means different things to different people.• Adam has got away from the term posture and uses position sense. Posture is dynamic and there is no neutral as Gary Grey would say, there are zones of neutrality that you pass through.• As David George would talk about in FNOR, Adam thinks about assessing and treating capacities rather than anatomy. Where is your head at in space relative to your shoulder? Where's your shoulders relative to your pelvis?• Posture is dynamic and reflexive. Far more of what the brain does is reflexive than volitional. Adam thinks a lot about reflexive stability and looking for where the dysfunction or discrepancy lies within in.• Adam likes to use cues like standing up tall, head up to the ceiling or using rock tape as a cue throughout the day so that the patient has more information on where they are in space. Treating Different Populations • Movement is a spectrum. The approach doesn't change.• Motion at the joints are the same, just speed, velocity and amplitude change as Gary Grey would say.• Professional athletes just tend to be better compensators most of the time. A lot of the time they are not better movers just good compensators and are also athletic. A large factor with this population is where they are in season, have they had an injury or are they injured currently, or is this prehab. Adam adds the ocular exercises in active recovery or layers them into movement tasks. He uses isometric holds so that they can either move the body on a fixed joint or the joint on a fixed body while implementing eye or rapid alternating movements, etc. • He doesn't just do this with athletes, he does this with everybody. There's only variances in thresholds and tolerances with regressions and progressions.• There are movement thresholds and nervous system thresholds that allow you to dictate when to progress or that you've progressed too far. Movement threshold is looking at simply the quality of the movement task. In regards to the nervous system threshold, you can look at a number of things. An increase in heart rate, a drop in blood oxygenation (pulse oximeter), eyes will constrict, unconscious breath holding, etc.• The same can be said in an older population. Even though their sensory systems are starting to decline functionally, there is always an area of opportunity for improvement within those systems or their ability to compensate. The approach remains the same, the results may just come on a little slower but if you drive the right system, it will change.
Central Nervous System Wind Up
• Top of brain step is mesencephalon, which acts as the gas in the ANS, and specifically the sympathetic nervous system. The parasympathetic gets its innervation from the pons and medulla.• Test for mesocephalic wind up by looking at blood pressure on both sides, the side that is higher can be wound up (both systole and diastole). These patients may have a lot of anxiety, chronic pain on one side of the body, or convergence spasm of the eye on that side among other symptoms.• You then stimulate the parasympathetic nervous system on the affected side. Deep breathing, gargling, and humming all work because of the neuro-anatomical relationships via the tenth cranial nerve (vagus) which comes from the lower part of the brain stem travelling down the neck and through the diaphragm. The abducens nerve is also lower in the brain stem and can be stimulated with lateral eye exercises which can bias activity of the parasympathetic areas of the brain causing the blood pressure to even out from side to side. • The blood pressure check also gives you something objective to show to the patient when they come in and leave, showing them changes that can benefit the psychological aspect of their healing.
Where to Find Adam Instagram: @adamwolfpt @themovementguildchicagoWebsite: www.movementguild.comBooks: 1. "Real Movement: Perspective on Integrated Motion & Motor Control” 2. "Foundations of Movement: A Brain-Based Musculoskeletal Approach”.
Resources From the Show:
• Applied functional science by Gary grey• Functional Movement Digest series by Grey institute• Nick Studholme disciplined in applied Kinesiology, Functional Neuro-Orthopedic Rehab (Dave George and Stuart Fife)• Mike Drzewiecki (wrote book with and treated Adam) worked directly with Dr Carrick• The Carrick Institute• Lenny Parracino from the Grey Institute body work in California• Dr. David Traster from The Neurologic Wellness Institute• Dr. Eric Cob from Zhealth• Human Locomotion written by Thomas Michaud