If you only have a hammer...

If you only have a hammer, then everything becomes a nail= you cannot address shoulder MDI with manual therapy alone! It is primarily a neuromuscular dysfunction that requires an athlete centered, long term plan- with plenty of cooperation from the coach. Google "the volume trap" and a great article will come up from Vern Gambetta that every coach should read. If your coach has fallen head first into it, then the best thought out plans will not work. Changing length tension relationships with some laser, MET and MF release only temporarily make the shoulder look and feel better.

Don't assume because you've taken an NASM or NSCA course you are prepared for this. Hint: Sticking an exercise band or a dumbbell in their hand is the worst place to start.

There are no quick fixes here- repeat the mantra.

ACL Rehab, Minuteman Style

My GAIN compadre Bill Knowles uses the term, “Rehab the athlete, not the injury”. In that vein, I begin by mobilizing the hips & ankle. Why? I suspect an old unresolved ankle sprain & a hypomobile hip (usually go hand in hand) left the knee with no where to go but injury city. Notice I use the L hip to influence the R hip flexors (I’ll explain why in a later blog). Warmup next: med ball chop series in a narrow R/L stride stance followed by Oregon sway drill. Then, I begin my rehab circuit. The theme for this session is improving his movement quality & developing position specific strength & work capacity.

-3 minutes rockfit trainer
-20 R/L SLS
-dot drill hop/stick/hold
-hurdle over/under/crawl
-10 scissor burpees.

3M rest between each lap
5X around the circuit.

Broken hurdles I got from the track coach, $0.

Rockfit Trainer I purchased off the discount rack 10 years ago, $8.

7lb. medball, $25.

Roll of tape, $.75.

Portable table I got for free at a speaking engagement, $0.

Building & executing the best ACL rehab program money can't buy , priceless.

Joe Columbo & the case of the weak lower trap

Vern Gambetta, weary from traveling the globe; spreading the gospel of athletic development. Steps off the stage & gets hit in the gut with, "What's your favorite lower trap exercise?!". Dazed, he reaches into his holster and fires back with, "what difference does it make?!"

Great answer, but what did he mean? Hold on, let me go find a phone booth, put my old stinky overcoat on, and stick that foul stogy in my mouth. OK, now I'm ready.

Why did that person ask that question? My intuition tells me he probably already knows good lower trap exercises that hypertrophy, yet don't work. How does a weak lower trap manifest itself? Scapular malposition. An elevated (sagittal plane) inferior scapular angle and probably a subacromial impingement.

What do we know so far? ""What difference does it make"= "A muscle's maximum force production is insignificant in relation to the timing and rate of force development"-Thein & Body '98"". Let's dig deeper.

What would block the neural drive to the muscle? I go back into my Datsun for my musculoskeletal screen toolbox.

-a hypomobile T-spine?

-tight lats?

-tight levator scaps?

- a hypertonic ipsilateral pec minor?

I interrogate yet deeper. What about the athlete's exercise regimen? Does it include exercises that interfere with the LT's length tension relationships? Does it include heavy shrugs? Isolated ab floor work? Are his "lower trap" exercises making the problem worse? Remember, traditional remedial one's such as the superman and the wall slide lack an eccentric component. Muscles are highly adaptable- you can train them to do anything. But is it the right thing?

Well, got to go. The wife is making meat loaf tonight (walk into the sunset with bad 70's wa-wa guitar and synthesizers).

Defining the Profession

I have had a huge response to this blog so far, most of it negative. The reason? The title. I chose the title to give it a homey, unpretentious feel.

Is a name going to be what differentiates us from personal trainers, physical therapists, & chiropractors? Why should someone choose to see an athletic trainer if we are all the same? For that matter, why should an employer choose to hire an athletic trainer over another health care professional? I feel that what defines us is our education.

Unlike the other 3, I have a physical education/teaching background. I've taken motor learning, movement education, adaptive P.E., and coaching courses. This gives me a unique approach to the care & prevention of athletic injuries.

Let's use my previous post on the MCL as an example. I did not get one response that the valgus position of the knee in the 2nd picture was dangerous. I'm sure there are health care professionals who would cringe if they saw it. They would say things like, "You have to keep the knee over the foot! You have to squeeze a ball between the knees to protect the MCL and turn on the VMO!" However, we are certified athletic trainers, and we know better.

We know that in real life, the knee must go there there (look at the soccer player's knee). We know that to strengthen the MCL, we must progressively load it. We know by looking at the picture that my VMO was turned on subconsciously by the lunge & my arm drivers. I don't need a ball- we know the Golgi receptors in my knee communicate with my CNS and tell my L VMO & glute to fire to protect the knee.

Very different from the traditional approach, yes? No "grooving of movement patterns". The ATC wants a knee that is adaptable to all movement patterns, rather than adapted to one.

...and this is how I sell myself, and the profession that I love. For those my fellow ATC's who write me to remind me how unprofessional I am- I refuse to get involved in any name calling. By the work I do, my students are well aware what separates me from the guy down the street.

Tweak out/Tweak in- L Knee MCL

The pictures to the left are two examples of using chain reaction biomechanics to unload or load the left knee MCL. I am choosing top down drivers- I could have chosen bottom up depending on the goals of my rehab session. Both movements involve a LLE lunge. On the top, I'm using a BUE reach to my left lateral ankle. You can see the net effect is a varus load. I'm recruiting plenty of the knee's friends, including the glutes, hamstrings, erector spinae et al. I am unloading the MCL. So, this is an exercise which may be included in the early phases of rehab. On the bottom, I am using a LUE R rotational reach underneath my armpit; and a RUE overhead L lateral reach. The net effect is a valgus load, loading the MCL. Now I've reduced the contribution of the muscles mentioned above and forced the knee muscles to do more work. This is an exercise which might be included in the later phases of rehab. An example of high tech/low budget rehab using ground, gravity, momentum, and the wisdom of the body.

Welcome to Joe's Training Room

An experience from my first year out of college in the fall of '82 still sticks with me. I had just completed a tough 3 week R2play on one of my footballers with a grade 2 ankle sprain. After his first game back, his father approached me to thank me. He said, "you do good work...so what do you want to do with your life...you certainly don't want to stay here". Well, here I am 3 decades out. I've always felt we HS ATC's work in the most challenging setting. The largest student athlete population, with little resources and manpower. Working with the young, developing athlete. Injuries occurring in this stage of physical development may manifest in permanent disabilities in adulthood. Yet, we're isolated from the intellectual stimulation of the college setting. Very few of the colleagues I started out with way back in '82 are still around. Unfortunately, they've long since burnt out and moved on to other professions. This stinks- it means never having the chance to mature as a professional, not to mention the effect on the athletic training profession as a whole.

If you're looking for info on the latest electrotherapy device, you probably won't find it here. Those of you that have heard me speak at the EATA, ATSNJ, or NEA meetings know I use the kinetic link concept of rehabilitation. The ground, gravity, and momentum are my main modalities of choice; my hands being the second. I wish you to embrace the "wall-less" training room concept.

Does what works on the college or professional athlete work for the high school age athlete? I'm going to be challenging you to think about it. Hopefully you're going to learn from my mistakes, and I'm going to learn from yours. Maybe we can re-define the high school setting into something to aspire to, rather than just another step on the ladder.