GAIN '10 Dates Released!

http://www.thegainnetwork.com/

Dive into the stuff we talk about on this blog. Don't worry, we'll all be in the deep end over our heads! Believe me when I tell you not a minute of the 6 days from the 18th to the 23rd of June is wasted. Our Australian mate Kelvin Giles makes sure of that- "if you're on time you're 5 minutes late!" No passive learning here; we're all learning, working out, eating, and just hanging out together.

Besides all the great presenters from last year, Frans Bosch will be joining us. If you haven't read his running biomechanics book you are really missing out.

In addition to the meeting, you join our community of learning & sharing. We've got a website where we continuously send documents & videos back & forth to re-enforce & apply what we've learned in Florida. We hope you can join the revolution.

Pec Minor Stretch, Joey Style.

This is my idea of a pec minor stretch. In front of the edge of a wall, in a right stride stance, do a RUE L45 reach @ thigh height. From there do a thumb down R120 reach @ shoulder height. As you do the reach, attempt to tap the R AC joint to the wall the best you can. Hold for 2 seconds @ return to the starting position for 3 sets of 10.

The right stride stance will block rib rotation so that the origin of the pec minor is being lengthened in all 3 planes. The AC joint tap on the wall requires the lower traps to glide the scap caudally. The pronated hand reach shortens the pec major, lengthening the insertion of the pec minor in all 3 planes.

Any thoughts?

Traditional Pec Minor Stretch

A hypertonic pec minor muscle was identified as a big trouble maker at this years Scapular Summit in Kentucky. This is the recommended stretch for the muscle, the "doorway" method.

Here's the problem the way I see it. We're assuming the scap is staying put while the ribcage rotates away. We're also assuming we're stretching the pec minor & not the major. We're assuming the athlete has no anterior GH laxity. My thought is if the pec minor is tight, what's to stop it from dragging the scap with it? In this scenario all you would be stretching are the muscles that insert on the proximal humerus (pec major, ant. deltoid, biceps etc), no?

The Elizabeth Lambert Saga

I usually don't comment on this stuff, but the hair pulling incident brought up some issues I am seeing in high school girl's sports. I do see officials making calls they would NEVER make in a boy's game. And it seems parents, coaches, and athletes are OK with that for the most part. But there is the occasional official who works both girls & boys games and doesn't differentiate between the two genders.

We had girl's rugby game this past spring where a lot of player's from the other team were getting hurt. Some of our girl's tackles looked like NFL highlight films. They're really I nice bunch of kids- they just like to hit and they're good at it. The best is this little Puerto Rican girl, all 5'2" of her! The coach came out onto the field and admonished the ref for "letting the game get out of control" and threatened to pull his team off the field. To keep the game going our coach actually had to tell our players to bring them down a little easier, and took our 5'2" assassin off the field. It was a playoff game to boot.

Kibler's '09 Scapular Summit

Dr. Ben Kibler is an orthopedist from Lexington Kentucky USA. Would love to meet him someday. There are not many orthopedists who understand function more than him. This is his third international summit on the scapulothoracic joint.

In the coming weeks I'll be commenting on some of the highlights. Several of the presentations focused on the neuromuscular issue of the upper trap overpowering the mid/lower & the scapular dyskinesis that goes with it. I was a little disappointed all the solutions appeared to be isolated ones. Most of the exercises look like manual muscle testing positions.

I'm not sure what percentage of my functional approach has been scientifically driven, and how much comes from the population I work with. Remember I work with the adolescent population who by nature just cannot sit still; with a wide variety of learning disabilities mixed in. Getting them to lie down, put their elbow here, shoulder over there etc is just not going to happen.

At GAIN '10 I presented some of my ideas of how I approach the trap issue. It sure looked a lot different than what was presented at the scap summit. It's kind of paradoxical how my almost 30 years of experience in one job has enriched me in so many ways, yet boxed me in so many others.

Be careful with this stuff

I know quad atrophy following acl tears is frustrating, but don't rob Peter to pay Paul:

Patellofemoral joint force and stress during the wall squat and one-leg squat.
Escamilla RF, Fleisig GS, Wilk KE, Andrews et al, Med Sci Sport.EX 4/09

Doesn't make a difference how close you position the feet to the wall, they beat up the osteochondral surface of the patella.

Rachel's question

"I am an HS in So. IL and just getting into the S&C scene and just wanted to make sure I am understanding you correctly w/ how I approach this:Most HS athletes don't even know what core is and have done nothing to address it - so I look at doing the neutral positions first then adding movement when they are able to perform w/o help and w/ little-no difficulty."

First of all, welcome to the blog Rachel- Glad you found us!
2nd- Your athletes don't even know what the core is? GREAT!!! You are one step ahead of the game because they haven't been corrupted yet!

When you get a chance, be sure to visit my archives. YOU will be corrupted (in a good way) to my version of "the reactive core". A core that can brace the body to take a punch or handle a collision with another athlete; as well as blasting a soccer ball into a net. Like any other muscles of the body, the core is loaded by ground, gravity, and momentum. The core muscles are loaded with proprioceptors; and fascia which links it with the rest of the body. It loves when the hips are moving one way & the shoulders another; or in the same direction but different speeds.

There are some exercises which I consider core-ready, give your athletes a good dose of this stuff Rachel:

-3D jumping jacks
-3D skipping
-3D mountain climbers
-3D "burpees"
-3D pushups

Got to go. A weekend off, the first since July!

Neuromuscular vs. Muscular

This month's Journal of Strength & Conditoning research:

Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate Ligament Injury and Prevention
Imwalle, Lauren E; Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

Journal of Strength and Conditioning Research:
November 2009 - Volume 23 - Issue 8 - pp 2223-2230

placed biomechanical markers liberally on the upper & lower extremities & had them do 45 & 90 degree cutting maneuvers. At least in this study, frontal plane adduction moments at the hip were the biggest predictors of how much the knees abducted. They site Brent's research from a study published 3 years ago in "medicine & science in sport & exercise" that showed steady increases in hip abduction strength in adolescent boys; with no such similarity in girls. The authors recommend strategies that increase hip abduction control, & include protocols that include plyometrics, dynamic stabilization, & trunk neuromuscular training.


Much like in Hodge's work on spine stability, we have to be careful on the application side of this. Resist the temptation to run to those 4 way hip machines. Neuromuscular is a lot different & complicated than muscular. Neuromuscular adaptation takes longer. Neuromuscular integrates myofascial slings throughout the body that contribute to hip & knee stability. Neuromuscular understands the foot is on the ground dealing with artificial turf, or wet grass, or improper footwear; that the eyes are driving movement from above with the head & shoulders reacting.

Dave Tiberio, P.T. uses the term "resonent frequency" to describe tendon & ligaments (that includes the ACL) ability to react to changes in load intensity & velocity. Re-setting that resonent frequency is the key. We forget the ACL is living tissue & loaded with proprioceptors! It will tell the rest of the body what to do, provided the body has been trained to work in what G2 calls, "the transformational zone".

Neuromuscular takes planned performance training-muscular does not.

More Squatology

Thought I would give an A.T. perspective on Vern's post for today:

http://www.functionalpathtrainingblog.com/2009/11/more-than-an-exercise.html

Vern states he would not use the Bulgarian squat for football, soccer, or hockey. He is correct, groin strains & athletic hernia are prevelent in these sports, and alludes to this squat contributing to it.

While it might be appropriate as a lead up to a SLS (single leg squat), it's important to move on. The problem begins when you load the movement. The trail leg is used to stabilize, creating isometric contractions about the hips & pelvis that are not conducive to rythmic, flowing movement. Of course you can argue that isometric contraction happens naturally in a traditional SLS, and you would be correct. But, in the Bulgarian Squat, that stabilization is initiated top down since it is traveling through the pelvis first- "neural confusion" if you will.

IASTM

Acronym for Instrument Assisted Soft Tissue Mobilization. Here I am doing Graston Technique (only one type of IASTM) with the #3 tool ("tongue depressor") on this athlete's patellar tendon. Sort of like an instrument assisted deep transverse friction massage. Only it's a lot easier on the hands & treatment times are a lot shorter; about 2 minutes max. It is immediately followed by active ROM, then functional exercise. Dr. Warren Hammer introduced Graston at this year's Fascial Congress last month in Belgium. There are several types, including SASTM & ASTYM. They definitely have a place in the A.T.'s toolbox.

Graston is an NATA sponsor. However, we don't get a price break on learning the technique or purchasing the tools. Again, this keeps a valuable modality out of the hands of a typical high school ATC. I have seen collegiate programs send out entire A.T. staffs to be certified in Graston or ART at premium $$$. ALL of my continuing ed (almost 30 years worth now) has come out of my own pocket. Not fair NATA- help us.

Mi Muchacha Y Yo!

Intellectual Isolation

Trying to push my way through the last few weeks of the fall season. 6, occasionally 7 day-70hr weeks for the last 3 months have taken their toll. Not getting enough sleep or exercise, eating crappy food. But I'm certain I'm in good company! This months "Strength & Conditioning" mag had a good Q&A with a high school ATC from Pa., USA.

I am jealous of the fact he is able to get away & work with the Pittsburgh Steelers (american football), and travel to the U.K. to work with Welsh Rugby. I doubt I would be able to swing that here at EHS. This past weekend was typical for me, flying out on a Sunday morning to recert a soft tissue technique, flying back that same night to be back at EHS monday morning.

It made me cognisant of the intellectual isolation we high school A.T.'s experience. School funding for our continuing ed is slim or none, plus we deal with more teams than a typical collegiate A.T. does. The annual GAIN meeting means a lot to me. It takes place just as school gets out in June and gives me a chance to recharge my batteries. SHARING (actively) with professionals from all over the globe. Much smarter, & just as passionate as I am about the profession. Guys just as nuts as I am- Jim Radcliffe from Oregon flying in on the AM to give a workshop, then flying back that afternoon to work with his volleyball team.

I hope you guys enjoy my posts as much as I enjoy your comments. Although I don't always respond, I read every one of them. I hope it helps bridge the intellectual isolation gap.

Boyle on Squats

I’ve received a lot of questions on Mike Boyle’s recent statements condemning “traditional squats”, and promoting the single leg squat.

There are hundreds of ways to squat, both good or bad depending on the context in which they are used. If you are working with a football lineman , there are situations where a traditional squat could be a good thing. On the other hand, single leg squats may be contraindicated for an athlete with a patellar osteochondral defect. Once you consider foot placement & angle, what the opposite leg is doing, what the arms are doing, the implements you are using to load (or unload), the combinations are endless. If you’re looking for a great, inexpensive video on the subject, consider Vern Gambetta’s, “Legs, Legs, Legs”. It will not only demonstrate 3D squats, but as with all Vern’s stuff will provide you with great ideas to build on.

Enough already!

Look, I don't want to beat this core stabilizaton thing to death, but Hodges work in 90's was misinterpreted! Thats not me saying it- it's Doctor Hodges himself!!:

The lumbar multifidus: Does the evidence support clinical beliefs? Manual Therapy, Volume 11, Issue 4, Pages 254-263D. MacDonald, G. Lorimer Moseley, P. Hodges 2007

“Although there is support for the importance of the lumbar multifidus and the specific contribution of this muscle to intervertebral control, several of the clinical beliefs have little or no support “.

Feedforward Responses of Transversus Abdominis Are Directionally Specific
and Act Asymmetrically: Implications for Core Stability Theories, JOSPT 5/08

"bilateral activation of the TrA in isolation does not reflect the normal
motor pattern for rapid unilateral ballistic patterns of movement and, therefore, future research may examine if such training may detrain individuals who require such fast actions (eg, elite athletes).”

There is an article in the NSCA's "journal of strength & conditioning" this month that makes the statement, "development of the core is accomplished first through ISOMETRIC STABILITY with progression to multi joint movements involving the hip, torso, and scapular region". Readers of my blog know I believe in the concept of a "reactive core". One that emphasises training in the "zones of transformation"; that is when the body is switching directions and injuries occur. There is nothing wrong with doing isometric bracing movements (planks et al). As long as it is understood they occur in a neutral zone. A truly strong core is one that can take a direct blow, protect us from falls, as well as coordiate the upper & lower extremities in a fluid, coordinated manner.

The article makes references to Hodges original work in the 90's. I think that's where this "rigid pillar" isometric-style core gets it's origin. I know Doctor Eyal Lederman of London's Center for Professional Development in Osteopathy (www.cpdo.net/myth_of_core_stability.doc) occasionally tunes into this blog. If you're out there doctor, I'd really appreciate your opinion on this.

Doctor Coughlan's comment

Hey Garrett-never connected the dots that it was you! But I know great research when I see it. Thanks for attacking a complex issue the way only a Celt can. You say:

"we need to focus not only on the ankle but also huge emphasis on the proximal musculature/joints and the coordination of movement between the shank and rearfoot."

Which was what I was getting at with rotational squat/glute inhibition question. That squat would unlock the foot & load the soft tissue. If it was compromised by trauma, then I think it's safe to conclude we're not getting the proprioceptive input up the chain. The answer lies somewhere in a combination of both- restoring soft tissue integrity/mobility at the ankle, and addressing the proximal issues.

I think what you're alluding to suggests a shift to the more functional styles of joint mobes that integrate U-LE, ie Mulligan & FMR. Then the next step; what do we do about the soft tissue integrity? I've just begun using Graston. I know Stacy Walker, A.T. professor at Ball State is a reader of my blog. They do a lot of Graston research. If you're out there Stacy I would really appreciate your comments.

A little comic relief

I thought Sal Marinello (http://www.healthandfitnessadvice.com/)
was playing a practical joke when he sent me this until my step son said he had seen the infomercial on TV the night before. Use your imagination on this one.

https://www.shakeweight.com/ver5/index.asp