Functional approach

The term Locomotor Dysfunction describes an abnormal condition of tissues involved in body’s mobility, posture and balance, including muscles, joints, discs and, most importantly, neural wiring’ in the central motor regulation centers of the central nervous system. This situation can be reversed by a variety of manual techniques and remedial exercises, which affect the nervous system as a whole. Manual techniques used to treat locomotor function consist of joint and soft tissue manipulation, reflex stimulation, various neuromuscular techniques. These release trigger points, strengthen, and most importantly, improve coordination by influencing the motor control of the central nervous system. Exercise program includesspinal stability and postural training, body awareness exercises, breathing retraining and neuromuscular reducation excercises.

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Rooted in developmental kinesiology, our therapeutic program is based on evoking the ideal movement patterns through the reflex stimulation of the motor regulation centers, and then conditioning the patients through exercise to be able to activate these patterns automatically without any conscious effort. All soft tissue techniques and gentle non-forceful manipulations are conducted in basic primal positions of an infant and follow the rules of Development Kinesiology. Different challenges are applied using therabands, gym balls and therapist cues.

Our therapeutic program puts a special emphasis on the importance of spinal stability and proprioception. Deep muscles of the spine are the first ones to be affected when pain is present. The deep spinal muscules never produce pain, but their inability to properly contract together overloads more superficial muscles. This creates trigger points, spinal joint dysfunctions, bulging and herniated discs whichresult in excruciating pain so familiar to to back pain sufferers. Our primary goal in this respect is to teach our patients to feel and control these muscles. We further aim to train our patients in how to activate these muscles at will evoking appropriate movement patterns and eventually to condition the brain to activate the associated locomotor programs automatically without the patient’s voluntary control. In our experience this is the best way to release muscular tension, establish proper movement patterns, improve posture and dramatically improve and strengthen spinal stability.

This approach not only alleviates suffering but also prevents relapses and recurrences which are so common with the back pain. For patients with increased work demands or athletes whether recreational or professional we progress spinal stability training into a functional training. The functional training is goal-oriented and involves various movements like: lunges, squats, pulling and twisting all of which are performed in challenging positions and are enhanced by different labile surfaces.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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