Active Relaxation in Water Training of coordination, balance and fascial health Anne Bommer & Johan Lambeck Senior Lecturers Association IATF www.clinicalaichi.org History § Originated by Jun Konno since 1995 § Designed as an individual preparation for Watsu, progressing to Ai Chi Ne § Based on Zen-Shiatsu by Masunaga (stretch meridians) § Combines posture, breathe and relaxation o Shizuto Masunaga (1977). Zen-Shiatsu: how to harmonize yin and yang for better health. 1 Conceptual map of High intensity aquatic activities strengthening Cardio fitness slow fast Ai Chi Open loop coordination Relaxation Ballistic movements stretching Low intensity 2 Urine Bladder Sacrum movement, centre of balance Also liver Gal bladder 3 Also Heart Small intestine/ duodenum Stretch 1: Lung and large intestines / cabeon Adapted for water >> balancing 4 QiGong: Qi sinks in Dantian with large circles, regulation of the central and the peripheral Qi Push a balloon under water Weizhong Sun, german centre for chinese medicine 5 Concepts § Continuity and slowness § Movements must flow, without force § Movement and breath belong together § Repetition: affects energy flow and connective tissue § Pelvic mechanics and alignment are important How to breathe § Breath mechanics • Exhale slowly • Inhale deeply • Hold for a moment • Slow exhalation with pursed lips • Long exhalation pause § Think of the abdomen, should be heavy § Feel your body long and large § Not for ATrelax, more for Ai Chi § > at some moment a disconnection between breathing and movement § > but deep breathing is important to activate activity of the n.vagus (Pranayama) 6 General information § Water depth at shoulder level § Temperature at 30 – 35 degrees § Work to the point of tension, no pain § Benefits for: • Equilibrium, coordination ,ROM, muscle tension, respiration, and trophotropic effects, mental effects Contemplating, Floating, Uplifting, Enclosing and Folding (1-5) § A symmetrical trunk position with a wide symmetrical stance and a visual fixation point. There is no movement of the center of gravity (COG.) The arms move symmetrically. 7 Soothing and Gathering § Soothing (6) • A symmetrical trunk position with a wide symmetrical stance and a visual fixation point. There is no movement of the COG. The arms move asymmetrically. § Gathering (7) • A trunk position as symmetrical as possible in a tandem stance, with a visual fixation point. There is no movement of the COG during the repetitive asymmetrical arm movements. Freeing and Shifting § Freeing (8) • Trunk rotations in tandem stance, with the eyes following the moving hand. The COG changes because of the continuous change of side. The arms move asymmetrically. § Shifting (9) • Rotations between thorax and pelvis with a wide symmetrical stance, while continuously shifting the COG in the coronal plane. The arms move asymmetrically and the eyes follow the moving hand. 8 Accepting, Accepting with grace, Rounding and Balancing (10-13) § Accepting • A symmetrical trunk activity in a tandem stance, with continuous shifts of the COG in the sagittal plane. There is a visual fixation point § Accepting with grace and Rounding: • Symmetrical arm movements in unipedal stance where either the front leg or the hind leg is lifted during one breath cycle. There is a visual fixation point. § Balancing: • Symmetrical arm movements in unipedal stance during 3 breath cycles. There is no real visual fixation point. Halfcircling, Encircling, Surrounding, Nurturing (14-17) § Symmetrical arm movements, in accordance with T’ai Chi, in a symmetrical stance with continuous movements of the COG. The eyes follow the hands 9 Flowing, Reflecting, Suspending (18-20) § Flowing and Reflecting • Symmetrical arm movements occur while walking laterally, making cross-steps and pivots. A visual fixation point is possible. § Suspending • Symmetrical arm movements with a body turn and a floating phase. There are no visual fixation points. Regulatory conditions: § Increase of difficulty from: § a symmetrical trunk position to (rotatory) trunk movements. § a static to a dynamic COG. § small hand movements to large reaching movements. § wide support to narrow bases of support. § visual control to non-visual / vestibular control. § symmetrical to asymmetrical arm movements. 10 ICF subcategories Function level: domain b7 Actvity level: domain d4 Neuromusculoskeletal and movement Mobility related functions 710 mobility of joint functions 4106 shifting the body’s the center of 715 stability of joint functions gravity 720 mobility of bone functions (scapula) 4154 maintaining a standing position 730 muscle power 4452 use of arms: reaching 755 involuntary movement reaction functions 7602 coordination of voluntary movement 7603 supportive functions of the legs 7800 sensation of muscular stiffness 7801 sensation of muscle spasm In order to use muscle activity for joint function, one needs (to train) functional and structural integrity of connective tissue Ai Chi: balance strategies non-intentional movements § Predictive/preparation § Reactive/correction expected prevention, static unexpected loss mechanisms. Ø Ankle/hip strategies - static mechanisms: Ø Insecurity strategy - stiffening joints Ø Stumble strategies - increase base of sup. Ø Sideways § Counter-weight, dynamic = Supporting and balance reactions reactions that accompany intentional movements Guccione cs 2001, Bronstein cs 2004, Pijnappels 2005, Rose 2010 11 Ankle strategy Hip strategy Stumble strategy Bronstein A, et al (2004) Clinical disorders of balance, posture and gait 12 Intentional movements and specific balance - initiation (go/stop) - maintain weight-bearing during a task - limits of reaching with concentric and eccentric activity - unipedal weight (= stance on 1 leg) Ai Chi and Halliwick § Resemblances • Breath control • Balance control • Relaxation • Progression / disengagement o Small > large ROM o Symmetry > asymmetry o Decrease base of support • ICF: function, activity and participation 13 Sagittal Rotation Control Transversal Rotation Control 14 Longitudinal Rotation Control Therapy § Anecdotal cases (+ indirect evidence since 2004) • Lymph drainage after mamma-amputation o `10 years of various therapies, also 4 years of weekly hydrotherapy: no effects – Thixotropic effects of connective tissue – Sympathetic effects through (rotational) movements (T2-L3) • Neurodynamic stretch effects § Cohorts • Increase of ventilation parameters in COPD patients (Mooneyham 2000, unpublished) • Increase of balance (BBS) in FMS patients: hungarian physiotherapy thesis 2005) 15 Breast cancer related lymph edema § On the basis of clinical experience and early clinical data, practitioners indicate that moderate aerobic exercise that involves trunk and extremity muscle contraction actually assists in breast-cancer related lymph edema (BCRL) volume control. o P.Richley Geigle at the APTA congress 2010 § Aquatic exercise utilizes hydrostatic pressure to reduce residual arm volumes. In addition to the constant hydrostatic pressure, buoyancy allows women to move more freely than on land, creating more muscle pump activity to mobilize lymph fluid Programme by Richley-Geigle § See next slide § In an unpublished cross-over design with a rate of 2/ wk: • Some effects on decreasing volume were found • No adverse effects were registered • Arms felt ‘soft” o Ambroza 2010 o Confirmed by Jamison, 2005 16 Exerciseprotocol for lymphedema Activity Intensity Time Materials Remarks - Warming-up: 1 set, all 7 – 10 min Gradually Core stability, walking directions more expanded materials to chest - Legs increase - Cardio resistance - Arms - Cardio - Functional - Cooling- down Waterdepth: clavicula. Watertemp = 32C. Always diaphrafmatic respiration. Continuous activity of 30 to 40 minutes Uit: Ambroza & Richley Geigle 2010 Aqua lymphatic therapy 1 § N=3, 14 months, 1 to 2 times / wk § Postmastectomy with dissection of the glands § Breath ex., slow and rhythmic movements. First the proximal and then the distal joints were involved. Standing till the shoulders in water of 32C0. § Included was a self lymphatic massage in water § Volume of the arm decreased with 249, 326, 116 ml § Wellbeing and strength increased o Tidar, 2004 17 Aqua lymphatic therapy 2 § RCT, n = 48: self-management (n=32) vs self- management + ALT: 3 months, 1/wk (n=16) + follow up. § Conclusion : ALT is a safe intervention with high compliance in women with a mild to moderate lymph edema. A sign. direct and an insign. long-term effect on arm volume could be recorded. • > the authors relate this to a low frequency or low adherence to self- management o Tidar, 2010 18 Relation with Clinical Ai Chi § Based on the limited evidence, elements of a programme seem to be: • A moderate aerobic programme • Slow and rhythmic movements of trunk and upper extremities • Breathing exercises • This coincides with some of the basic elements of Clinical Ai Chi Sympathetic system 19 Neurotension/dynamics § Stretching the neuromeningeal tissues: • Nerve roots, dura/pia mater, meningea, neuraxis, nerve sheaths, arachnoidea § Procedures: • ULNT1 – Median nerve • ULNT2 – Median and Radial nerve • ULNT3 – Ulnar nerve • SLR, slump, PKF (passive knee flexion) § “Sliders” would fit in Ai Chi 20 21 Tai Chi § Tai Chi emphasizes total body movement, particularly in rotational planes, with gradual narrowing of basis of support o Partly in Ai Chi § Tai Chi emphasizes the management of energy, feeling it’s centre (Dantian) with different breathing techniques o Not specifically in Ai Chi 22 Tai Chi § Tai Chi