"The Goal Posts move as your playing the game"

"The race in science is not for a predetermined end, and once you're there the story's over, the curtain comes down. That's not at all what it's like. Rather, it turns out, you find things you didn't expect."- Simon Schaffer, physicist.

These are quotes from the Nova special "Absolute Zero".

It documents the story of three scientists attempting to achieve the lowest theoretical temperature, -273 degrees C. Scientists Michael Faraday, James Dewar, & Kamerlingh Onnes all in competition in the late 1800's. Dewar insisted his experiments be conducted in absolute secrecy. The other two freely exchanged information, even published their results in scientific journals. By isolating himself, Dewar had boxed himself into a corner in an attempt to eliminate his competition. Onnes had one the race.

I couldn't help but compare Schaffer's quote to this blog's "learning through sharing" theme. I've gone to workshops given by a few of our own gurus. I'm always amazed at how the faithful mechanically blurt out the mantras that are the jargon of their particular "system". Multi level marketing schemes that are reminiscent of Scientology. The thought process being once you've achieved all the certifications with this particular individual you have reached the pinnical of your art. Practitioners who believe that if what they're doing is not working it is because they are performing it incorrectly, & they need to go to a refresher course. They are boxed into a corner.

A true professional will tell you right off the bat that some of their athlete's injuries do not get better. But they will never stop trying.

Puerco Asado!

Tracy, I'm sorry- just don't look.

Christmas dinner, in the Cuban tradition. I have to admit, for a gringo I am pretty good at it. I begin with a prayer thanking God for the lechon, then quickly summon the ancient Cuban spirit Chango & ask him to oversee this gringo's sazon de puerco. I prepare my own mojo dressing, then carefully massage it into the pig with my own hands. Then it's into the caja china for 5 hours of roasting. Finally, my father in law Maximo & I proudly flash the #1 sign.

Somos un buen equipo.

The path of least resistance

Being on the spot when injuries happen expedites healing time and is cost effective. This is one of our football lineman who, in the transition to indoor shot put, developed achilles tendinitis. The etiology is a planus foot structure aggravated by some lower extremity force reduction issues.

ATC's love to tape, and I'm no exception. With some Coverroll & Leukotape, simply pull the calcaneus firmly in a varus direction with the tape beginning & ending with the lateral & medial malleoli respectively. Then, another strip directly across the achillis tendon pulling medial to lateral in the same fashion. The subtalar joint will have a medial bias when you are done, but this will self correct when the foot hits the floor.

This is not a wait and see procedure. It should bring immediate relief of symptoms. I will repeat it for about 2 weeks. This is without any modalities or remedial exercise or any further intervention. The trick is catching the injury in it's infancy, with a few pennies worth of tape.

THIS IS WRONG!

...but funny. Sorry, I had to throw the yellow flag & delete this comment from one of my "friends".

"Joe P. is a great athletic trainer, but when he stands behind one of those orange cones, you can't see him".

When will they give me peace.

Rotation Part 3

Thank you all for your comments, you guys are right on. Jeramiah brings up a good point, that is the importance of "stiffness" in the transmission of force from one link to another. Porterfield, McGill & Sahrmann always allude to the importance of this in the prevention/rehab of back pain. In this vein, Vern always mentions the importance of throwing med balls, but also catching them. It's important to remember that one segment is slowing down as another is speeding up, and that requires proper stiffness about a joint(s). Vern also makes the statement that no more than 15% of your core training should be on the floor, and I think that is accurate and is consistent with the Japanese research. I agree with the group, that even if the rotation is taking place air born like a volleyball strike or a dive, the momentum is still initiated off the ground.

Many of the injuries attributed to rotation (disk injury, pars fx, et al) have a multifactoral etiology beyond the scope of this blog. It doesn't change the formula for a healthy back: Push, pull, squat, rotate, reach in a sound progression.

Rotation Part 2

Excellent research from last year's American Society of Biomechanics meeting from a few Japanese researchers, "A MECHANICAL CAUSE OF BODY ROTATION ABOUT THE VERTICAL AXIS IN BASEBALL BATTING". The authors concluding, "Such a rotation of the entire body could only be generated by the external forces acting eccentric to the center of mass and by the free moments acting on the body. The results clearly indicate that the rotation of the body during baseball batting is generated primarily by the moment of the ground reaction forces acting on the legs around the center of mass".

This drives home what we high school A.T.'s have always known, that is the transverse plane (rotation) is primarily driven by momentum, whether it's swinging a bat or throwing a baseball.

Yet, at last year's combined sections meeting of the APTA, a statement was made that "what is causing the torso to rotate is the muscles, so we have to work on the obliques, the core itself, and hip stability".

Now go back & read Vern's "Rotation is bad?" post from December 13 and decide for yourself who is right.

Rotation, part 1

It's amazing how people could read the same books & come to different conclusions. A lot of this anti-rotation stuff is extrapolated from Shirley Sahrmann's & Porterfield/DeRosa's work. I have much respect for these researchers/practitioners. In fact, P&D were pioneers in the role of fascia in the kinetic link principal.

OK, the reasoning goes something like this: The average range of motion of any one lumbar functional spinal unit is around 10 degrees flexion and 5 degrees extension, 5 degrees lateral bending and around 3 degrees rotation. Total rotation is approx. 13 degrees more or less. True Dat, as the kids say.

The T-spine, having 12 segments as opposed to 5, theoretically has a lot more rotation, approx. 35 degrees total. Word up on that too.

So, based on these anatomical configurations, exercises that are designed to ask more than 13 degrees from the lumbar spine bad. Isolating rotation in the T-spine good. Get it?

Well, that's an over simplification. Pure motion in any one cardinal plane doesn't really exist in the spine. Motions are coupled, or even troupled depending on how you look at it. If motion is not available in one plane, the spine will borrow it from another. Osteopaths, chiropractors, and P.T.'s use this concept all the time when they do their manipulations. No damage is done. In fact, these rotary manipulations that gap the facets have been proven clinically efficacious in reducing pain & muscle spasm after an injury.

A good illustration is a test John Perry, PT did at GAIN '08. He did a ROM test on Vern's feet by using upper extremity drivers! When Vern did a right trunk rotation for instance, his left foot pronated & his right foot supinated. He didn't ask Vern to do that-chain reaction biomechanics did it subconsciously. Once ROM was used up in the shoulders, the body transferred it to the ribs, T-spine, lumbar spine, hips, knees, then finally foot & ankle.

If this phenomenon does not take place, go be a detective Columbo & find out why. A particular segment could be mechanically stuck or out of sequence. Or, remember muscles are highly adaptable. They can be trained to do just about anything. Like the "proper form" enthusiasts who micro manage movement and inhibit this chain reaction.

Now, lets get to the exercises they say are absolutely contraindicated-certified back wreckers. Scorpians, seated trunk rotations et al. The proponents claim, "significant decrease in the complaints of low back pain since eliminating these exercises".

Jeez, how often were they doing these exercises? Why were they a staple of their repertoire to the point that they were causing back ache? The only application I can see to the scorpion or lying trunk rotations is maybe a wrestler. I'm not a big fan of the contraindicated exercises either, but not for the reasons they give. I'm not done yet. Stay tuned for part 2. Your input please, pro or con.

Rotation is Bad?

Be sure to read Vern Gambetta's post for December 13. I will expand on this.

NJ High School Soccer Coach of the Year!

http://blog.nj.com/hssportshonors/2008/12/boys_soccer_coach_of_the_year.html

Congratulations to Elizabeth High Soccer Coach Joe Cortico. This was no easy task-3 of the top ten teams in the state are in our conference. Joe created a battle hardened team that physically & mentally wore even the best teams down. If you have never coached in an urban environment like this, it's difficult to understand the unique challenges that it presents.

One side note that I can't understand. In an obvious attempt to bore us to death, our impromptu "soccer band" was squelched by the grinch who stole soccer. I'm not sure who was responsible. What a show! High school students singing & playing Spanish tunes & dancing salsa in the stands waving the EHS banner. It definitely added to the experience.

Aquatic Therapy 2

Vern's post today, "the evidence gap" got me thinking. If it walks & quacks like a duck...

This athlete is doing a single leg water dumbbell high pull in chest deep water. He is a middle distance runner of ours I suspect has a stress fracture. I chose this exercise in an attempt to preserve power output without gravity beating up on the injury. He has no MRI, no x-ray, no bone scan to confirm my suspicions. 3X per week are aquatic workouts, 2 days on land with 1 competition day. He is improving. I've used this protocol probably a hundred times in my career, with athletes even winning county championships in the process.

The hardest part is getting the cooperation from coaches & parents. It requires patience & trust. It helps that I've been around here 27 years and many of these athlete's parents have been my students.

Muscle Energy Technique

M.E.T. is an osteopathic joint mobilization technique developed by Fred Mitchell & Phillip Greenman from Michigan U.S.A. It is a gentle, safe technique that uses a series of muscle contractions/relaxations to restore motion & reduce pain/spasticity. Most techniques are designed for the spine.

As the years go by, I find myself using it less & less. Not because it's ineffective. It's just that the more I understand function, the more I see the lumbar & cervical spines being hit takers for some other joint(s). I mainly use it for sprains directly to the spine from a sports injury. It's particularly soothing to cervical sprains from wrestling & football. MET fits in well with the functional approach. With manipulation, the practitioner is driving through a dysfunction. MET is a triplanar approach. That is, when resistance is felt in one plane, the A.T. backs off & goes to another plane.

I'm not sure if M.E.T. has any advantage over manipulation. I don't do manipulation- it's rare that I have roentenograms/bone scans to rule out a fx. One thing the A.T. must always be cautious of is being hell bent on increasing passive ROM. Measurable improvements do not always coincide with measurable pain improvements. I am always more concerned with the pain free ROM I have assisted the athlete with.

My suggestion to A.T.'s is to be a good detective & look for the trouble makers. Jimmy Cyriax told us decades ago that the cause of a dysfunction can be 1" or 1 yard away from the pain. We have the advantage of sitting and watching the athlete compete- other health care practitioners don't get that, and that is a HUGE advantage. Joint dysfunction magnifies itself under fatigue, making the compensations more visible.

"Hit takers & trouble makers"- a good topic for GAIN '09?

The sacrum is the lower extremity scapula

What do you think of this idea? It came to mind as I was working with my hip impingement/lumbar spine pain athlete. He has iliosacral/sacroiliac issues. I'm doing MET to correct them, but knowing damn well it is only temporary.

Ben Kibler MD came up with the "scapular funnel" concept of the upper extemity. That is, the scapula transmits forces coming through the lower extremity & torso to the ipsilateral arm. But, it's reactions are only as good as the information coming in. In the computer industry they call it "garbage in/garbage out".

I think the same might be said of the sacrum. As in the scapula, dysfunctions in the IS/SI joint doesn't always manifest itself in pain directly on the joint. I've seen in the literature stress fx's of the sacrum in distance runners, which might back up my hypothesis.

The big researchers on this joint are Kaltenborn, Vleeming, and Schneiders. It's interesting stuff.

10,000 hits!

Thanks to all my readers, especially Tracy, Pat, Juan, Jonathon, the two Kevins, and all of my international enthusiasts. I hope I'm keeping to the spirit of this blog- applying the scientific to the practical to address injuries the high school ATC sees every day. With a diversion now & then.

Don't be afraid to ask questions, or to disagree with me when you see fit. I'm approaching 50 & my cerebral cortex needs plenty of stimulation.

I found it amusing when a university clinical director depicted me on their web site as the Will Farell character in "old school". They have since removed it. I don't know if this person still follows my blog, but I hope they do. I thought the premise was pretty funny.

Anyway, thanks for stopping in my A.T. room- even it's just to take a peek at what the old man is up to. I am truly humbled.

All your problems behind you

All right, stop giggling. So you opened up my blog today and got a backside in your face. BUTT, this is serious stuff. OK, no more jokes, I promise. This is what Shirley Sahrmann describes as the "Muslim prayer position". We see the hips have translated to the left, and (is a little less obvious in the pic) rotated to the right.

The athlete suffers from chronic L lower lumbar back pain; and bilateral anterior hip impingement. We're looking at bilateral posterior iliofemoral joint capsule tightness. He got through football ok, but running indoors on a hard dusty floor is unbearable. Fortunately, his P.E. period is kind of slow so I'll have plenty of 1 on 1 manual therapy time.

In the past, these type of dysfunctions were seen in more sedentary peeps 40+. They have entered the high school A.T. realm. Why do you think? Are we getting better at diagnosis? Too much sports specialization? Are computers & video games creating too much sitting time?

My home state

Every day driving home from work I have to go over the Victory Bridge. It is a nice looking bridge as bridges go, dedicated to our WW2 vets. The problem is it has become a hot spot for suicide attempts. Occasionally I am stuck in traffic jams while police try to coax someone off the railing. In this down economy, putting up a barb wire fence to prevent jumping was deemed too expensive. Plus, I guess it would interfere with the aesthetics. As an alternative, signs were put up every 100 feet persuading potential leapers not to jump.

http://www.1010wins.com/Signs-Aim-to-Deter-Suicides-on-New-Jersey-Bridge/3426615

Nordic Hamstring Curl question

Rob asks:
"I am strength coach who uses this exercises, and dont fully understand why you are saying this is not a good exercise.
Also, what do you use/recommend to use instead of this exercise?
Are you also against Glute/Ham Raises, Physioball Leg Curls, and Slide Board Leg Curls."

******************************************************************************
- Thanks for the great question Rob. In upright function, the hamstrings work as the reins on a horse. With assistance from the soleus, they EXTEND the knee, not flex it; they work DYNAMICALLY at the hip, not isometically; they accelerate or decelerate rotation about the knee (depending on what phase of gait you are in). In the nordic leg curl, half the knee (tibia) is fixed to the ground.

No, I don't use the other exercises very much either. Maybe after an ART session. Remember, the hamstrings- like other muscles, are stimulated by ground, gravity, and momentum. You don't get that with those exercises.
Not to say YOU are wrong. As a matter of fact, Bosch & Klomp use the nordic leg curl in their running book. I don't get it though, I don't feel it fits in with their model of running physiology. One thing I was critical of in the book was the disconnect between theory & conditioning.

Nordic Hamstring Curls: Not a Fan

I can't believe P.T.'s/A.T.'s working with elite teams are still prescribing this exercise as a method of reducing hamstring strains & preventing ACL trauma. It's tunnel vision focusing on the sarcomeres of the four muscles themselves. What about improving neural drive? Isn't that part of strength & power output too? Who ever strained one with the leg posterior to the torso? There is no carry over what so ever of this exercise to upright function.

My opinion is the resurgance of this exercise has something to do with the resurgance of isokinetics in the literature. Trying to find an "on field" way to replicate it. I'm seeing a lot of "quad-to-hamstring strength ratio" and "bilateral discrepency" terminology that I heard back in the early 80's.

There's some talk of the pelvis' role in the injury process, but they feel the the hamstrings are influencing the pelvis, rather than the other way around, as I see it on the high school level.

Envelope of Load Acceptance

This is a term used by Scott Dye, MD used to describe the etiology behind patellofemoral pain/injury. It describes why the same load may lead to patellofemoral pain in one person and not in another, or even lead to pain in the same person at one time but not at another. A loss of patellar and peripatellar tissue homeostasis if you will.

This concept can be applied to any joint in the body, no? Every athlete begins a sports season with a personal envelope due to their anatomy, level of sport specific fitness, previous injury, and what Janda described as "pattern overload". In other words, too much of the same thing; whether it be running in straight lines, or playing video games.

With all the scientific stuff I talk about, the manual therapy, functional exercise et al, never forget program design. In my opinion, I've never met anyone better at it than Vern Gambetta. I think all A.T.'s should own his book, "Athletic Development: The art & science of functional Sports Conditioning". I really think this is the scaffolding that builds a great rehab program. Without it, all you are doing is throwing pancake batter at a wall and hoping it sticks. I'm trying to convince him to get a weekend course going that will focus on just this.

I believe there is too much cook booking going on with strength coaches, and with athletic trainers (by way of treatment protocols). Working with a team or teams is a lot tougher than working in a private clinic. We deal with multiple athletes all at once in the concept of a team or teams- all with different envelopes of function. If we are not expanding those envelopes, we may be heaving pancake batter.

FMR Certification

This past weekend I was in Chicago as part of the Functional Manual Reaction certification process. It is a mobilization with movement approach similar to Mulligan, but is consistent with chain reaction biomechanics. It was good to see and work with Pat Donovan, an ATC at U. Illinois @ Chicago. Like myself, he is a "traditional" ATC. I was constantly running back to him asking, "hey Pat, what do you think of this", or "hey Pat, do you think that would work with this?" I must have sounded like Louie the lizard from the old budwiser commercials. It becomes clear that the ATC has a window of opportunity to prevent future movement dysfunction that other professions are not privy to. While the two professions are similar, they are definately not redundent.

Tina

A few readers asked me how to get in touch with Christina Christie, P.T. Christina specializes in the functional approach to female issues resulting from child birth. You can contact her at:

http://www.pelvicsolutions.com/

Her Clinic is:

Accelerated rehabilitaiton Center

6759 Dempster Street

Morton Grove, Il.60053

Ph# 847-470-9995

Grade 2 R ACL sprain c/ 2 degree knee ext. deficit

Here is a functional alternative to your posterior tibia glides on the plynth. This athlete cannot walk without an antalgic gait. The athlete performs a LLE pivot lunge while partial weight bearing with the crutches. The R heel must remain on the ground at all times. Frequently check to make sure the R foot does not externally rotate. If it does, it means the athlete is stepping too far. You can easy get down on one knee and use your hands to slow the tibia down/speed up the femur as the L leg comes forward. It is also a great way to re-train gait. Another example of the athlete correcting his own dysfunction using proper appliction of ground, gravity, and momentum.

The Agony of Defeat

The Minutemen lost in overtime yesterday to defending state champs Clifton, 2-1. This athlete got elbowed in the opening minutes of the game. It was a 1mm laceration that required 17 sutures. It was fun trying to clean & dress it in a 29 degree, 15 mph wind. He did return to play.

Proximal Acceleration thoughts

JH picked up on the segweigh from "proximal acceleration" to "anyspacewhatever", and asked why I chose that particular foot/hand movement. The rotational step cause the L shoulder to go through something that looked like flexion, horizontal abduction, then maybe abduction (sagittal, transverse, frontal). "Troupling" if you will. What I was going after was the pelvis & shoulder moving out of sync. If you remember, I used a similar movement in the "reactive abs" post last August. I could also choose to have the pelvis/shoulder moving in sync, with the shoulder moving a little faster (kind of what goes on in the cocking phase of throwing, or swimming).

From the AP news wire:

http://apnews.excite.com/article/20081117/D94GTED80.html
As you read on, will see yet another nod for "regional interdependance" (the kinetic link principle). High school A.T.'s- this is something we can help prevent. Repeat the mantra here: there is no such thing as "just a sprained ankle". Resist the urge to slap some tape on them and send them back to the field.

I just had a former athlete visit me last night with chronic knee pain. I worked with him early last year for a wicked deltoid/spring ligament tear on the opposite ankle. I had to give myself a pat on the back when I saw how good that ankle looked. His history revealed an injury to the ipsilateral ankle this past August. His rehab consisted of ice, seated band exercises, and tape. Upon evaluation, his mid tarsal joint was all locked up. The ankle was not painful however. It simply borrowed transverse & frontal plane motion from the knee.

Protocols are helpful, but rehab it as you see it. Every ankle sprain is a little different.

Anyspacewhatever

This past Sunday my wife & I took a ride across the bridge to NYC to see an exhibition at the Guggenheim museum. The building itself is cool, designed by Frank Lloyd Wright. Besides the timeless paintings by Picasso, Degas, and Van Gough etc, the entire building was transformed into an exhibit:

http://www.guggenheim.org/exhibitions/exhibition_pages/anyspace/index.html

The exhibit was inspired by French philosopher Gilles Deleuze's concept of "anyspacewhatever- a cinematic moment linking one scene to another...which in isolation makes no sense...free from constraints...a free floating moment of pure possibility."

In other words, every wall, floor, ceiling, railing etc. was transformed. All flowed together. I couldn't help but comparing it to the wall-less training room concept and the kinetic link principle. After all, athletic training is both science & art, is it not? One of my favorite parts of the exhibit (if there were parts at all) was "cinema liberte". It involved a banned film from the 1930's. Why? "Circus freaks" were part of the cast. It re-enforced what I have always believed- that your plan must be adaptable to include everyone from the elite athlete, to the kid in the wheel chair with muscular dystrophy...at the same point in time. In a P.E. class a few years back, in the same class I had the high school football offensive player of the year & classified students at the same time.

Life imitates art, art imitates life, and oh yeah, the apple doesn't fall far from the tree...Vern Gambetta's son is an architect.

When you need some inspiration, check out Stacy Smith ATC's art:

http://stacy-art.com/

(p.s.- in the spirit of anyspacewhatever, the run on sentences in this post were deliberate).

Whoohoo!

Congratulations to EHS Boys Varsity Soccer- State Sectional Champs! Two more games to go!

http://www.nj.com/hssports/results/boyssoccer/index.ssf/2008/11/elizabeth_1_columbia_0_high_sc.html

Proximal Acceleration

In Vern's recent post on working with his volleyball players, he mentioned exercises designed to "emphasise shoulder lag & hip lead".

Good.

There's too much of this "keeping the humerus in the scapular plane" stuff going on. In certain shoulder conditions it may be helpful to start there, I understand. However, the shoulder capsule is not a passive structure. It is rich in proprioceptors- Pacinian Corpuscles, Golgi-Mazzoni Corpuscles, Ruffini Endings, Golgi Endings- to name a few. They communicate by way of fascia with the rest of the body.

Dave Tiberio of UConn coined the term "proximal acceleration" to describe the phenomenon that feeds these proprioceptors. That is, the proximal segment moving faster than the distal. This places a specific stress on the capsule that lets it know what it needs to tell the shoulder musculature. Which muscles to contract, when to contract, at what speed, in what sequence.

In my work with my dislocated shoulder athlete, I'm using this concept. And I can do it safely, provided I sequence it properly. The picture shows me with a 3lb. implement with wheels on it so it can roll on the wall. I begin with the implement in my left hand at shoulder height, feet shoulder width apart, L foot forward, R externally rotated. I am leaning onto my left foot. Then I take a R rotational step with my L foot to meet my R. My LUE is rolling straight up the wall. I quickly return to the starting position.

This exercise looks like it may be containdicated for this shoulder condition, but look closer. Although the shoulder is abducted, it is also internally rotated. In addition, stability is afforded to the shoulder in the sagittal & frontal planes by way of the wall. I can increase or decrease the athlete's threshold by controlling how far he moves the hand up the wall in relation to the quantity & amplitude of foot movement. Heck, I can even do my posterior GH glides as he's exercising. It's all in the sequencing.

I'm feeding the core, I feeding the capsule, I'm feeding the shoulder- I'm getting hip to shoulder.

Good functional listening

Tracy Fober's Ironmaven post for today was a good example of when a kinetic link does the unexpected and zigs instead of zags. A lateral lunge caused right knee pain. Sometimes hip or ankle stiffness or a genu varum or valgum gives unexpected results. It doesn't mean you give up doing lateral lunges. Tracy's solution was to put him in a stride stance and use pelvic drivers to get from point A to B. In other words, she set her athlete up for success. Simply put, she saw the frontal plane was gunked up, so she used the sagittal & transverse planes to get to the frontal. It would be interesting to see what would happen if the athlete went back to lateral lunges after Tracy's intervention. I'm sure that knee would feel a little better.

A-C Joint Unloading

A.T.'s love to tape, & I'm no exception. This athlete has a grade 1 acromioclavicular sprain. The technique often provides pain relief in the acute stages of the injury. In addition, an athlete with this injury finds it difficult to run because of the bouncing that goes along with it. With this technique, conditioning can usually be continued while the shoulder is healing. It also provides some resistance to horizontal adduction, the most painful arm movement with this injury.

It's easy:

1. Liberally spray the area with an adherent.

2. Apply 2" wide coverroll stretch tape (or similar) (9" is usually good) from the mid lateral delt to just higher than mid trap.

3. Apply a second piece (8" is usually good) bisecting the joint anterior to posterior.

4. Have the athlete bend the elbow of the affected side 90 degrees, and get an assistant to hold it so the arm is weightless.

5. Apply leukotape (or similar) caudal to cephalad, firmly pulling so that the skin wrinkles.

6. Apply a second piece to directly over the AC joint, depressing the distal clavicle.

The tape will usually stay on 2 days, as long as they don't spend too long in the shower. Instruct them to blot it with some paper towel or toilet paper after they get get out.

Veteran's Day 2008- Luigi

The horrors of war have always been close to home for me. In my home town of Rahway, N.J., nearly every street is named after a fallen WW2 vet. My dad was a D-Day vet himself. As an 8 year old boy I remember my neighbor across the street crying when his 18 year old friend was KIA in Vietnam.

This past spring, Elizabeth NJ had to rename another street. On September 20 2007, we lost one of our former football players-Luigi Marciante. He was KIA in Iraq. He left a wife and a newborn son. If it never happened to you, you will never understand how you can never let this go. Luigi was not some gung-ho wannabe bad ass. He wanted to be a cop like his dad, but figured some military experience as an MP would also serve his country. A true citizen soldier.

I am very proud of his sister Enza, a former student athletic trainer of mine. She has turned this in to something positive- raising funds for the thousands of Vets who will return from Iraq & Afganistan disabled. Whether you are for or against the war, we have to support these men & women all we can. I will do future posts on this topic at a later date.

Dislocated Shoulder comments

JH asks, "I would be curious to see how his dislocations have effected his scapular positioning and movement. Speaking of which, have you developed or seen a post op principle based shoulder program that starts at the scapula and thoracic spine instead of at the glenohumerous?"

JH, your questions are always more than meets the eye. He does have scapular mal-position (depressed), but it doesn't seem to transfer over to dyskinesis. The long thoracic nerve seems to have been spared in the injury.

I'm sure one can find protocols on the internet that meet those requirements. However, I feel you should treat it like you see it. With my swimmer with instability, I'm doing more "peltrunkula" work. But in this case it will not be my primary focus. I will aggressively go after his GH capsule, as it is biting down already. A tight capsule sounds like it might add stability to the joint, but nothing can be further from the truth. Usually (not always) a GH positional fault occurs, where the humeral head sits anterior in glenoid. This sets you up for your next dislocation or labrum tear. Will I use traditional mobes? Mulligans? FMR? ART? Not sure yet.

Simultaneously, I'll work on restoring his neuromuscular control. Stay tuned. This is a challange.

My work is cut out for me.

When Vern said we all would have to work harder, & transferring dreams into reality, he wasn't kidding. Here is my latest challange. This athlete had 2 traumatic left shoulder dislocations last month that required closed reductions. Take a look. Brachial plexus injury is obvious. He has active & passive IR/EX ROM deficits. Oh yeah- he is a wrestler.

No outside help here. Typical, the only P.T. who accepts his health inurance is too far away to be logistically practical for him or his parents. This is the trenches. But I wouldn't have it any other way.

Getting Political

No matter how you feel about the latest U.S. election, there is one thing you can't deny: The high school athletic trainer as part of the solution to the health care crisis. If my Sportsware injury tracking query is correct, last year I treated over 700 injuries myself. Not to mention the thousands of rehab sessions, or the injuries that I helped to prevent. I encourage every high school A.T. to do an end of the year report and present it to your school A.D., principal, and school board. The tax payers need to be aware of the quality, low cost health care we provide to our athletes every day. Whether you voted for McCain or Obama, you have to appreciate that.

Range Tweaks

If an exercise causes pain, it doesn't mean you need to abandon that exercise. In this month's JOSPT, researcher's measured patellofemoral joint forces in short vs. long lunges. In this case, more WAS better- if you have PFSS that is. The longer lunge reduced knee flexion, therefore reduced retro patellar stress. You could use the same stategy for your step ups & squats. However, it is only one strategy. If you understand the kinetic link concept, there are ways to INCREASE joint flexion while DECREASING retro patellar stress. Stay tuned...

Speed & the Brain

Here is some interesting research explaining why reaction time & speed declines as we age, especially after the magic age of 40.

http://apnews.excite.com/article/20081103/D947M52G0.html

County Champs!

Congratulations to Coaches Joe Cortico & Jack Gonzalez for a tough victory in chilly 38 degree weather last night. What a great bunch of kids- I really feel happy for them. We have 3 of the top 20 teams in the state in our conference- and you have to play each team twice, so it was no easy task. On to the state tournament!

http://www.nj.com/hssports/results/boyssoccer/index.ssf/2008/11/elizabeth_1_summit_0_high_scho.html

Annoying

Why do the spray buttons on those Cramer Tougskin cans break off so easy? I can't tell you how many full cans I've waisted when they were accidentally dropped on the floor.

The same thing with Cramer Shark tape cutters. One drop on the floor and the tip breaks off and they are finished.

SM,TA,Pelvic Floor-my turn.

I'm going to let JH's comment answer this one for me:

"Working in an industrial setting we see a lot of back issues. Once pain is controlled we find that they are very strong in the movements they perform daily but very weak in any number of given exercises they do not perform on a daily basis. It is really as simple as giving them a variety of movements that are "new" to the body and the appropriate muscles learn how to respond resulting in a more versatile spine."

YES!!!

If you read the studies on this topic, the subjects are almost entirely involved in repetitive tasks, such as factory workers & cricket batsmen. The same movement patterns are performed sometimes hours at a time. My ART recert classes always begin with a lecture on repetitive stress syndrome, and it's effect on the fascial structures of the body. "Grooving movement patterns" is a popular buzz word in sports and physical therapy today. However, remember Wolf's law from your college AT classes- that is, form follows function. That means you are also molding bone, soft tissue, and the nervous system- for a specific task. There are consequences. Vern Gambetta cautions us not to develop "adapted athletes" over "adaptable" athletes.

There is an interesting topic in Dr. McGill's book regarding an athlete doing a deadlift under a fluoroscope. One vertebral segment appeared to buckle under the stress of the load. What caused an abhorrent movement pattern at one particular level, and no where else? Fatigue from a previous workout? Maybe a sore knee that caused the athlete to push harder with one leg than the other? A rib dysfunction that caused an abnormal rotation? An undiagnosed spondylolysis or pars fracture? The reader is left to wonder. However, we must not jump to the conclusion that a weak multifidus at a specific level, on a specific side, or the TA is the culprit, and the solution is to isolate them with biofeedback.

How can we take JH's clinical work in the industrial setting & apply it to athletics? I think the easiest place to get this started is with recovery/restoration. How about some bat swings from the contralateral side...throwing with the contralateral arm...running backwards, sideways, carioca? If your job requires stooping/lifting to the right, how about standing in a stride stance, alternate over-the-shoulder punches to the left...if you are a cyclist, how about lateral lunges with rotational over-the-shoulder-punches?

There are exceptions. Christina Christie, a P.T. from California, works with women who have bladder control issues resulting from child birth. She describes the pelvic floor as a "trampoline". She points out that beginning the rehab process in the vertical overloads this system. Therefore, her protocols are initiated from the floor. Similar concept as to my idea on wall slides for GH instability.

Magic Muscles?

Effect of Stabilization Training on Multifidus Muscle Cross-sectional Area Among Young Elite Cricketers With Low Back Pain- JOSPT: 2008;38(3):101:108
Julie A. Hides, Warren R. Stanton, Shaun McMahon, Kevin Sims, Carolyn A. Richardson

Free magazines such as Biomechanics & Training & Conditioning Magazine are considered "throw aways". However, they are not that at all. They give you a "reader's digest" version of a variety of interesting topics, then give you references at the end so you can dig in further if you wish. I like them because they give me an indication of which way the wind is blowing, sort of speak.

In one of these journals, a physical therapist interpreted the above article as "It would be wise to evaluate & retrain the multifidus in athletes involved in sports requiring repeated trunk rotation, such as baseball, golf, & hockey."

Me, being the skeptic, says:

1. Even the authors admit there was no control group used in this study.

2. These athletes cardiovascular training consisted of "cycle type ergometers".

3. Resistance Training was described as "Weight Training exercise 3x per week.

4. The authors make the statement, "subjects with LBP who received the intervention commented that their ability to squat with weights was improved after intervention, as they could “feel” where their backs were in space as they added load." This kind of gives you the idea of the type of resistance training that was going on. In addition, "Techniques of squatting and lunging were examined, and subjects were instructed to maintain their lumbar lordosis and thoracic kyphosis throughout the movement." Does this really happen in real life?

5. The authors continuously refer to the proprioceptive role of the multifidus, transversus abdominus, and pelvic floor muscles, but yet choose to train them in a "bodybuilding" type isolation style using ultasound to make sure they are isolating enough.

Ok, I buy into the fact that those 3 muscles atrophy after a localized injury to a spinal structure. Paul Hodges has documented that in vitro & vivo extensively. But allow me to refer to the 2nd edition of Dr. Stuart McGill's "Low Back Disorders". On page 110 he makes the statement, "the reason for the clinical emphasis on the multifidus may well be that the bulk of research has been performed on this muscle." He goes on to mention researchers who have found similar unilateral atrophy in other lumbar muscles. On page 120, he makes another key statement, "conceiving spine stabilizers as intrinsic or extrinsic my offer no benefit for clinical decision making. The relative contribution from every muscle source is dynamically changing depending on it's need to contract for other purposes."

Shirley Sahrmann, in her excellent book "Diagnosis & treatment of movement impairment syndromes" says on page 35, "these patients have motor control problems. The lack of extensive discussion reflects the limited information available, NOT the importance of this factor in movement impairment syndromes." In an article in SPINE in '96, Julie Hides herself suggests "impaired reflexes" being responsible for the failure of the multifidus.

What I'm getting at is, don't these muscles get stimulated the same way others do- that is by ground, gravity, and momentum? If that is true, what could be blocking this?

A preamble to my next series of posts.

In my next few posts, I'll be referring to the work of Hodges, Jull, & Richardson on core training & spine stability. If it sounds like I'm being critical, nothing can be further from the truth. I'm not in same league as these people. The truth is I'm a 49 year old man who watches cartoons at night to help him relax before bed time.

However, this blog is dedicated to the high school A.T.; and the care & prevention of injuries to adolescent athletes. So, I must interpret research and apply it in a manner that suits my setting.

I often work with classified athletes. For example, emotionally disturbed, ADHD, neurologically impaired et al. Yes, they are athletes too, and they have spines that get injured. In addition, I work with the "teenage" population. I know what would happen if I left them alone 5 minutes with one of those pressure gauge bags & an ultrasound unit. They would probably be text messaging their boyfriends, while talking to their friends, with an I Pod in their ear. A few would probably be beating each other over the head with the pressure bags.

I don't pretend to have all the answers, but since this is my blog I get to be selfish & tell you how I approach the issue.

High Tech?

I understand this athlete had a CT scan to his brain 3 weeks prior to his death. As with other sports injuries, we cannot rely on technology alone in addressing brain injury issues in sports. Athletic Training is both an art & a science. However, the more an ATC moves away from high tech (head injuries & other wise), the more we are second guessed (I am by no means saying that this went on in the Montclair case). Yeah, it still happens to me three decades into the game-and I'm sure I'm not the only one. If you would like to anonymously share your "MD coach" stories, feel free to do so. Oh, come on, we all them. I've even had coaches who could read X-rays!

Every athletic trainer's heartbreak

http://www.montclairtimes.com/NC/0/813.html

EHS Coaches Comments...

"Muscles" asked what our coaches do differently-

Good question. I spoke with the coaches about this, and they feel it has to do more with the style of play than conditioning. (I find it interesting that they don't think they do much conditioning. I think that's because a lot of what they do involves the ball). They said the South American/European players are trained to avoid direct confrontation, and it is "instinct" to jump out of the way to avoid a slide tackle or collision. My interpretation of this is it is that it involves both outstanding agility, and an intense knowledge of the game. Like Vern always says, personal training is not coaching.

Conversation with Coach Gambetta

Just got off the phone with Vern. He asked, "Hey Joe- great post on the ACL protocol. I'm curious- how many girls soccer ACL injuries have you had in the 26+ years at YOUR school."

Feeling pretty stupid, I said, "0". And only 1 in boys soccer.

In all fairness, I don't think I have very much to do with that though. Our coaches are Portugese & Columbian. Most of our players are Portugese, Columbian, and Brazilian. They bring a lot of their cultural idiology to the sport.

Antonio, Joe, Jack, Gustavo- may you never be brainwashed.

In simplicity there is beauty, redux

A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players- Am. J. Sports Med. 2008; 36; 1476

Thanks Tracy Fober for bringing this to my attention. 70 hr. work weeks are turning my brain to mush.

This knee ACL prevention program dropped female collegiate soccer injury rates an overall 41%, and non contact injuries 70%. Very impressive. The program is free online at:

http://www.aclprevent.com/pepprogram.htm

http://www.aclprevent.com/pep_replacement.htm

I found it interesting that the study used the replacement exercises to "alleviate boredom". Take a look at both protocols, and see if you came to the same conclusion I did.

Closing the Chain

You don't hear of the term "closed chain" much any more. It was first proposed in Steindler's 1955 text, "Kinesiology of the human body". His definition is, "a condition or environment in which the distal segment meets considerable resistance that restrains free motion". It got too confusing as to what defines "considerable resistance" or "restrains". But, here are two of my favorites. The first is a closed chain "mountain climber". The athlete has a pair of football girdles wrapped around his feet for glide on a painted concrete floor. On a traditional gymnasium floor, a pair of socks will do just fine. The exercise is appropriate for just about any LE rehab. The nature of the injury, and the stage of healing will determine whether the legs move in sync or out of sync, the plane, and the direction. I hate to use the term, but it's a great "core" & cardiovascular exercise.

In the 2nd picture, the athlete is in a narrow stride stance, holding two powerballs over his head and shaking them right to left, in sync, as quickly as possible for 30 seconds. I also have them go sagittal plane hip to overhead, then rotational @ shoulder. Beginning proprioception training for a LE injury from the top down is sometimes a good way to set your athletes up for success.

In simplicity there is beauty

This is a typical afternoon scene at my high school. I set up a rehab circuit on the corner of the field turf. A soccer game is going on in the distance. The athlete pictured is working on a 3 day old grade 1 hyperextended R knee. As you can see, the athlete came in her street clothes, unaware cocktail hour was over. Ay Dios mio! Que gente! She soon regretted it.

-45 second sprint @ 120 RPM's on the stationary bike

-miniband carioca step R/L 30 yards.

-Rockfit, 1 minute

-5" R leg close chain stepup & return (Rockfit upside down), 10 reps each leg

-In R stride stance, BUE rotational reach to R lateral ankle/overhead press with 3lb. dumbbells, 10 reps.

-10 pushups, pivoting off distal thighs.

-3 minute rest

5X around the circuit.

By the way, don't think I'm getting fancy. The stationary bike I found in the trash in back of the junior high. I purchased about 30 bucks worth of parts out of my pocket and moved it over to our field house.

Hip Dislocation!

This past Friday night was a bittersweet victory for Minuteman football. One athlete with a possible medial meniscus tear, and a first for me- a posterior hip dislocation. Special thanks goes to Danielle Coppola, the ATC at Eastside Newark H.S., their team orthopedist, Dr. Robin Gehrmann, the City of Newark ambulance EMT's and the staff at University Hospital. Top notch care through the whole process.

ITBFS

Iliotibial Band Friction Syndrome. A runner that has Genu Varum (bow legged); and who's sport requires them to run in straight lines will be prone to this type of tendinitis. The stretch pictured above should be a regular part of this athlete's program. The athlete stands in a slight stride stance, with the involved leg behind, toes of both feet pointed straight ahead . The back knee is kept in full extension. The foot is supinated by way of a slant board (just prop a T shirt underneath the medial border of the foot if you don't have one). The right arm is relaxed at the side, then does a maximal left lateral overhead reach, then returns to the starting position. 3 sets of 20 reps are performed. Note: Watch for the athlete "bailing out" in the the transverse plane. If this occurs, you may need to place the athlete's lead foot more medially, and/or move closer to the wall.

Performing myofascial release with this stretch is easy!:

1. Position either hand midway down the athlete's lateral thigh, with the heel cephalid & the fingers caudal.

2. Press firmly into the thigh, then direct your tension distally.

3. On subsequent sets, place the hand proximally and distally along the path of the ITB.

4. It may also be helpful to place your hand on the anterior border (VL), or the posterior border (BF).

The athlete is actually doing the release himself, with minimal intervention by the ATC.

Healing Psychology

Marras WS, Davis KG, Heaney CA, Maronitis BS, Allread WG. The influence of psychosocial Stress, gender, and personality on mechanical loading of the lumbar spine. Spine. 2000;25:3045–3054.

It was a coincidence when I had just finished reading this journal article when I received an email from an A.T. student doing a master's thesis on healing psychology. I found it interesting the questions seemed to focus on verbal counseling. That's one way of approaching the problem.

Those of you who read my blog on a regular basis know I believe in empowering the athlete. Tradition tells us to "focus on the weak points, the weak links". Vern Gambetta taught me years ago that this may not be a good strategy for short, or long term success. Rather, teach the athlete to exploit their strengths.

Set the athlete up for success. If you have evaluated the athlete and determined a certain motion or plane is painful, then don't go there. Work around the injury. Find a plane, direction, speed, range etc. that's not painful and let that be your starting point. Think of my previous post with the hamstring strain athlete. Although he had a grade 2 BF strain, he moved very well in the frontal & transverse planes. I put my thinking cap on and came up with as many exercises & drills I could think of that integrated the hamstring in these planes. Forget about endless ice, stim, stretching. Let their own nervous system quiet the pain & muscle spasm. If there are team drills the athlete can safely participate in, let them do it.

In my 26+ years of athletic training, I have never healed anyone. That is a skill I will never have.

Chiropractors

I'm often asked what I think about chiropractors. Well, I definitely don't buy into the Palmer theory (most chiropractors don't either). However, I am a big believer in manual therapy. Although I have certificates in many manual therapy techniques, I am the first to point out that I am not a manual therapist. Meaning, I don't have a traditional degree from an academic institution in manual therapy. A chiropractor does. During my soft tissue courses, I had the pleasure of being instructed by and training with chiropractors. I was amazed at how much better their palpation skills & sense of touch was then my own. They really raised the bar for me, and I am grateful.

Much like athletic training, the chiropractic also suffers from credibility issues. They get paid much less by insurance companies for doing the same thing a P.T. does. The internet is loaded with information accusing them of medical quackery and insurance fraud. To be honest, I started out as a skeptic myself. Then I began to read some of their research in The Journal of Bodywork & movement Therapies. I quickly realized they were on to something and I had better get on board before I got left behind. Ken Cieslack, who works in Teaneck High School here in NJ, is an ATC & chiropractor. I am jealous.

The credibility issue is over, as far as I'm concerned. The efficacy of spinal manipulation has been documented in the research journals ad nauseum. Most of the complaints I've heard from A.T.'s have to do with chiro's being "too pushy", getting involved in gray area's like pre season physicals or nutrition. Stick to the manual therapy you guys. You were the first, as far as I know, to have a degree program in manual therapy & manipulation- and you are the best at it.

Lumbopelvic Manipulation for the Treatment of Patients With Patellofemoral Pain Syndrome: Development of a Clinical Prediction Rule/ JOSPT June '08

Isolated Knee Pain: A case report highlighting regional interdependence/JOSPT Oct. '08

Utility of the frontal plane projection angle in Females with Patellofemoral Pain/JOSPT Oct. '08

Diagnosis & Treatment of Movement Impairment Syndromes, Shirley Sahrmann '02/pp107-108

The physical therapy profession has embraced the Australian school, and manipulation articles are abundant. There is a plethora of research supporting manipulation as a treatment for PFSS. So, I thought I would throw my 2 cents in.

"Global Interdependence"= The kinetic link principle, just like "stretch-shortening cycle training"= plyometrics.

The concept is that the lumbopelvic orientation to the lower extremity is causing abnormal forces at the knee. By correcting it, normal alignment is restored and pain is spontaneously removed.

Me, being the pragmatist, would like to know what caused these dysfunctions in the first place. What came first, the chicken or the egg? Are the lumbopelvic structures simply reacting to abnormal forces coming from the feet, ankles, tibia, femur? I'm not the only one who thinks so. Here's an excerpt from Shirley Sahrmann:

"Extensive information is available from practitioners who ascribe to dysfunction of the SI joint as a common cause of back pain. However, I do not support this premise. Although many individuals have pain in the SI region, I propose that the pain does not arise from the motion of the joint. Rather, pain in the SI region is a result of the tissues that attach to this area (with the exception of pregnancy)."

It is common with athletes who have PFSS to exhibit excessive femoral IR at ground contact. In the 3rd article above, the authors found that as a coping strategy, some of the athletes were subconsciously posteriorly rotating their contralateral pelvis during functional tests to create more external rotation of the ipsilateral femur. Now picture that happening a few million times during running or jumping sports. Would not the pelvis adjust? Maybe an upslip of the R SP? An outflare of the L ilium? A sacral torsion?

As far as I've seen, the longest follow up has been 4 months pain free. What would be the treatment if they returned with pain? More manipulation?...would all that manipulation in the long term create hypermobility? (I've heard this anecdotally, but I've seen no research supporting it).

Anyway, I know some of my fellow ATC's are also chiropractors/manipulative P.T.'s. I would really enjoy your input.

Sandals & Existentialism

Your comments always get me thinking. A reader asked what I thought of the current trend of sandals as everyday footware on foot health.

Sandals are leisure wear, period. It drives me nuts when kids show up for rehab in them. What did they think was going to happen? I would be serving them cocktails on the veranda?

The deeper issue is the external locus of control. The healing is going to come from some pill, or some cream, or some machine, or somebody. A friend of mine used to have a poster hanging in his A.T. room that said, "if you want treatment, talk to an ATC, if you want to heal your injury, talk to God". The religious theme aside, the point is the power to heal is already inside all of us. The creator, or nature-whatever fits, designed our body in a way that requires movement to keep it healthy. The solution to healing lies in that fact.

Sandals belong on the boardwalk, pool or beach. How many of us have seen the idiots who get them stuck in escalators, or who trip over a crack in the sidewalk, or get them stuck in a revolving door etc? I'm not sure of the effect they have on the foot arch or everyday walking mechanics. However, it appears you need more of a shuffling action to walk with them. So, if you have an athlete returning from an ankle sprain, I could see it inhibiting dorsiflexion.

I wish it were that easy too.

Be sure to read Vern Gambetta's blog for today, Oct. 3 '08.

The same could be said about planning a good rehab or remedial exercise program.

Don't cook book your approach.

For instance, let's use my hamstring post as an example. Listen to what the body is showing you. The hamstring has 4 different muscles- which muscles were injured may be significant. Where is the lesion on the muscle? Closer to the hip? The knee? All this gives you clues where to begin your program.

Wall Slides

A Comparison of Serratus Anterior Muscle Activation During a Wall Slide Exercise and Other Traditional Exercises- JOSPT, December '06.

This article documented EMG studies showing serratus anterior activity in the traditional wall slide exercise was not that much different than the traditional push up plus exercise.

The top photo is similar to the exercise version the article spoke of.

The bottom one is my version.

The athlete is a freestyle swimmer of ours with R shoulder MDI. As I alluded to in an earlier post, the worst thing to do with these athletes is put an exercise band or dumbbell in their hand in the early stages of rehab. Think of the arm as a back hoe, with the scapula being the cab. If the cab of the back hoe is not stable, the whole machine becomes unstable, and loses stability.

But, wall slides are boring, and not very functional. In the bottom picture I'm using the opposite arm & hips to create a load/explode to the scapula in the directions I want. The mini band on the ankles enhances the hip load. Meanwhile, the R hand is gliding from the 1 o'clock to 8 o'clock position while it goes from neutral to pronation. I probably have about a hundred versions of this exercise depending on the dysfunction I see. Someday when I have time I should write it down and organize it. Right now I barely have time to take a dump.

There is no such thing as shin splints

I had an incident occur at my school recently that is all too common. A visiting team coach calls me over to look at an athlete with "shin splints". The athlete was wearing two ankle stirrups to help alleviate bilateral medial tibia pain. I watched the player jump and land a few times, and it became obvious there were serious force reduction issues going on. It was particularly troubling because the fall season has just begun.

I wonder if that coach ever saw an athlete land from a routine jump and completely shatter their entire lower leg?

I have.

If you are a coach, don't think it can't happen to you. Get the blinders off- a shin splint is a stress reaction in the tibia. In other words, either a precursor to a stress fx, or a stress fx itself. Asking your ATC to tape the shin is a waste of time. If the athlete has a planus or cavus foot structure, an orthotic may help. But more often than not, it's a training progression issue. Don't think this is the A.T.'s responsibility alone. Sport appropriate axial loading exercises that increase bone density must be integrated into your workouts. If you're working with female athletes, it's even more important.

If your athlete presents with these symptoms, listen to your ATC. Rest accompanied by non weight bearing exercise (ie stationary bike, pool) is crucial to prevent further damage. Just because these symptoms appear does not mean the end of the season. Manipulation of work/rest and weight bearing/non weight bearing exercise can allow bone remodeling to take place. I will post more on this topic in the future.

Hamstring Rehab

This is an athlete with a grade 2 strain of the L bicep femoris muscle. Although the injury is only a few days old, I'm already doing agility work in the transverse & frontal planes. The ahthlete cannot jog without limping, but looks sound in these two planes. I will avoid going directly into the sagittal plane at this time, understanding it's beyond this athlete's threshold. This way I am producing neural drive to the muscle in an integrated manner, meaning there are plenty of other muscles around to assist the BF. In addition, I'm minimizing scar formation. An article in the March '04 JOSPT by Sherry & Best supports this approach.

Mike Mussina on pitching

Ray Korn, our baseball coach sent me this link. In an era of anabolic steroid/GH abuse, this erudite approach to pitching is refreshing:

http://www.nytimes.com/interactive/2007/08/17/sports/playmagazine/20070817_MUSSINA_GRAPHIC.html#

HexLite

Occasionally I'll give my opinion on a product, although I accept no monetary compensation for it. This one is for Tracie Fober's HexLite bars. It's fresh on my mind because I used it for the first time for ACL rehab.

If you've been reading my blog, you know I like to keep learning movement on an subconscious level when ever possible. If you're trying to teach an athlete to squat properly, this is a great tool. Because of the way the weight is distributed, the body has no choice but to do it by driving though the hips & legs. Even if you consciously attempt a torso dominant strategy, the body will self correct.

The HexLite is small & convenient enough that you're not married to the anterior sagittal plane. I included it in my rehab circuit and had the athlete monster walking forward, back, laterally, etc. It can handle over 200 lbs of plates and stores easily in the corner of your A.T. room. Even if you're like me and don't have one. The website is http://www.ironmaven.net/hexlite.html

This is what it's all about

The Minutemen won big Friday night, shutting out it's opponent once again. Even more special to me was my ACL reconstruction player cementing his starting job. He was 2nd string JV last year when he suffered the injury. It is particularly rewarding to see the physical transformation that took place with his whole body during the rehab process. He is leaner, stronger, & faster. We played the game in the rain on a wet, slippery field. I knew this situation would arise, so I tried to design a drill in rehab that would safely proprioceptively prepare him for this. What I came up with was walking, then agility drills on a grass hill in front of our gym with his sneakers on. There was plenty of slipping & sliding, but not so much that he couldn't regain his balance.

It's important to remember that proprioception deficits after ACL reconstruction have been documented up to 2 years post surgery (Corrigan, '92). This drives home the need for a remedial component in every strength & conditioning regimen.

Don't be passive

A reader comments, "at $14400 for the GIFT program and $3600 for the GAIN program I think I'll have to rely on Joe to educate me!".

This blog is not an infomercial for any program. Don't imitate-innovate! I'm not smart enough to be Vern or Gary. Early in my career, I made the mistake of monkey-see-monkey -do. Athletic development should be athlete centered, not protocol centered.

What I'm getting at is it's not about money. Ask your school librarian if she could get Athletic Therapy Today or the Journal of the American College of Sports Medicine etc. added to the periodical list. But never stop learning. Don't become one of those people Tracie Fober spoke of in her blog. The type that like to place the name of their school that they graduated from 30 years ago after their signature. In the real world, nobody cares. It's "what have you done for me lately"- the quality of your work. If college & professional athletes that you had in high school are coming back to you for something their ATC or P.T. can't do for them, you know you are on to something.

Don't be passive- life is competitive and the stakes are too high.

A quick, great read...

Below is a link to an article in this month's Biomechanics magazine. While you are reading it, keep in the back of your mind my "Who's zooming who?" post. Is it a compensation, or a bonafide dysfunction?

http://www.biomech.com/current_full_article/?ArticleID=157

The myofascial puzzle

This is me working on our ex baseball short stop, Roberto Ramos. He was drafted by the Boston Red Sox this past summer. I'm doing ART (active release technique) on his cervical muscles.

Fascia is the framework that connects all soft tissue and organs continuously throughout the human body. Muscle, tendon, and fascia are anatomically inseparable. A good book on the subject is Schultz's "The Endless Web". In the past, we have looked at it as a passive structure, but recent studies have proved it has contractile properties of it's own. In 2006 a group of German researchers presented research documenting this phenomenon at the World Congress of Biomechanics.

Thomas Myer's book "Anatomy Trains" describes the functional links between the upper and lower extremities by way of fascia. Take a look at it, and you will understand how a myofascial dysfunction in the neck can cause a plantar fasciitis.

There are many types of myofasical release. My favorite happens to be ART because it is fast, and there are no gadgets to loose. I didn't do MF release for a long time because some of the other techniques required you to hold static positions for up to 10 minutes! It killed my wrists and hands, & the time requirement was totally inappropriate for my setting. In addition, ART involves active movement by the athlete. I believe rehab modalities that involve the athlete fixing his own dysfunction are the best. By the way, the new neural flossing protocols are really cool!

However, learning ART is very expensive, and requires a yearly re-credentialing process. That being said, I am seeing more & more collegiate ATC's when I re-cert. Many chiropractors & some P.T.'s are certified, and the ART website has a provider locator's service. It's not a bad idea to develop a relationship with a practitioner.

Lenny Paraccino, a soft tissue therapist out in California, is working on some real exciting stuff. He is using MF release in a more global, integrated way. I think he is really on to something. Check out his website at http://www.kineticconditioning.net/

Iron Maven's last blog

Be sure to check out Tracy Fober's blog for Sunday, Sept. 21, '08. Coach Fober had the pleasure of speaking to Paul Hodges and Shirley Sahrmann! Add that to the fact that she snatches more than me and is just plain smarter than me, and I am thoroughly intimidated. She is a P.T. with an olympic lifting background, and applies hybrids of weight lifting movements to athletic development and rehab. Take note of her comments on the hubris of some of the faculty and students. It's funny because I see it in the A.T. profession too, and experienced it when I was first starting this blog.