Memorial Day 2011

To most people they are only faces you see on the news.  This is Pedro Millet, my 3rd student athlete killed in action.

Integrated Isolation...Right Subscapularis On Ground Function.

"Subscapularis Strain from Swinging a Baseball Bat in an Adolescent with Closed Physis"- Higgins et al, Sports Health 6-11.

The top picture represents a "traditional" exercise for the subscapularis.  Sounds practical, right?  I mean the subscapularis IS an internal rotator of the shoulder, no?  Not as simple as you think.  Especially in batting, yes the shoulder is going through external rotation, which is loading this muscle.  The conundrum is the muscle originates anteriorly on the scapula...which is moving on the rib cage...which is also moving in the same direction, but at different speeds.  BTW, just like my previous post, the injury occurs no where near end range.

Here's an exercise that simulates the function of the subscapularis in batting.  Begin in the traditional pushup position.  As you begin the descent, sneak your right leg under the left, enough so that you feel the pelvis rotate, without it touching the ground.  Return to the starting position and repeat.  The bottom picture represents a "tweaked down" version of the same exercise, that might be used earlier in the rehabilitation process.

Please don't give me that "it's dangerous" or "my kids can't do that stuff". Remember I just lost a book contract because they said the guy in the pictures was too fat & old.  The alternative is to go bore your athletes to death like that spine guy.

You can get with this...or you can get with that!

A nationally renowned spine specialist criticized one of my blog posts because I had an athlete doing the exercise in this post: http://joestrainingroom.blogspot.com/2010/05/hips-in-hips-out.html

Described me as, " a strict follower of Gary Gray who goes overboard especially when he gets his hands on a med ball &s; working the spine in full flexion under load."

First of all, while it is true I have been heavily influenced by G2 & Dave Tiberio, I'm also influenced by Vern Gambetta, Warren Hammer and others. But I would hate to think anyone thinks of me a wannabe clone.  I'm not even sure what qualifies that as "A Gary Gray exercise".  And are we not supposed to do capoeira (pictured)  because the spine is in full flexion under load?  Or is that OK because they are upside down, or not holding a medicine ball?  I understand the theory about soft tissue creep, the stress on the intervertebral disks etc.  But Stuart McGill himself, in his book (Low Back Disorders p.105) described a vertebral subluxation (documented under fluoroscope) occurring while a guy was doing a deadlift- with his spine in good posture; not even close to end range!

Fortunately for me, another one of my influences is the great orthopedist Dr. Stephen Levin (on the right of this page is a link to his website).  Here is his take on this topic:

"Never believe a ''spine specialist', particularly if they are surgeons. If this 'specialist' is a surgeon, he does more harm in one day than you will have done in your lifetime. It is nonsense to consider the spine as 'weak' or 'strong' based on posture. A person instantly knows when their posture is appropriate for a task at the moment they begin to institute the task. Think of lifting a box of an unknown weight. Weightlifters start a 'clean and jerk' from a crouch because it is the strongest position.  As soon as there is an attempt to lift, the body recognizes the load, and the posture adjusts. Weightlifters start a 'clean and jerk' from a crouch because it is the strongest position. Nowadays, I rarely think of any muscle, or muscle group performing a particular task. I think in closed chain activities, with all muscle involved, all the time. It is impossible to contract only one muscle, you must always involve all muscles".

You can get with that- but Se baila así, se goza más.

Phil Donley weighs in on Long Tossing

Thanks to my buddy & ATSNJ president Eric Nussbaum for getting Phil Donley's
 (http://joestrainingroom.blogspot.com/2010/02/phil-donley-real-deal.html) response to my recent long toss post( http://joestrainingroom.blogspot.com/2011/05/long-toss-for-pitchers-is-questioned.html)...

"I am on the long toss side, also weighted  balls.  Just need to introduce them in the proper sequencing of the total program.  It is amazing how many professional pitchers find a place to long toss,over 250ft) when they are out of sight of those organizations that limit pitchers to 120 ft.   there is a time and place for all sorts of overload training."

Well said.

Integrated Isolation, R TFL, Trail leg in Gait

RLE Balance, LLE L anterolateral reach @ ankle height/BUE posterior @ overhead reach & return.

New Joe P. Ankle Rehab E-book

"Functional, Integrated Rehabilitation of the Sprained Ankle: A Practitioners Manual"

After I signed a contract with a publisher, I figured I was good to go.  But one obsticle after an other forced it to be abandoned.  But I'm sticking to my promise of keeping it under $20.  Its available on Amazon and Barnes & Noble for 9.99 as a Kindle & EPub respectively.  I resisted doing this for a while becaues of the risk of it being labled as what we used to call a "vanity press".  But, Dan Cipriani P.T., PHD, associate biomechanics professor at Chapman University, did the technical review for the book which gives it ligitimacy.  I had Ray Fowler (http://www.rayfowler.org/digital-services/) do the e-book coversion, and he really did a great job.  In my opinion, it is better than a hard copy because its easily searchable and navigated.  It definately does not look like your typical e-book, with lines disappearing and what not.

If you don't have a Kindle or Nook, no problem!  The book can be easily read on any PC or Mac by downloading the free software below:

Download Kindle Reader for PC:
http://www.amazon.com/gp/kindle/pc/download/ref=amb_link_151449822_1?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-1&pf_rd_r=0GA1PY8MZHJ175E8QP1W&pf_rd_t=1401&pf_rd_p=1289134842&pf_rd_i=1000426311

Download Kindle Reader for Mac:
http://www.amazon.com/gp/kindle/mac/download

Download Epub Reader for Mac or PC:
http://www.adobe.com/products/digitaleditions/

To purchase my book:
Amazon:
http://www.amazon.com/Functional-Integrated-Rehabilitation-Practitioners-ebook/dp/B0051BOA1S/ref=sr_1_1?s=books&ie=UTF8&qid=1305724069&sr=1-1

Barnes and Noble:
http://search.barnesandnoble.com/Functional-Integrated-Rehabilitation-of-the-Sprained-Ankle-A-Practitioners-Manual/Joseph-Przytula/e/2940012415851/?itm=1&USRI=ankle+sprain

Both sites give allow you to add your comments of your opinion on the book; and I encourage you to do so.  There are not many books on the topic.  The best selling one is written by a personal trainer.

Flexion/Rotation Test for C0-C1 ROM

With the C-spine in axial extension (aka retraction, posterior chin glide), the athlete's chin is passively flexed, then rotated.  Normal ROM would be between 30-35 degrees.  At that point you'll feel an abrupt change in the quality of movement.  That's where the motion reaches C2.  If you look at the athlete's eye brows you can see there is a restriction.  This is fairly common in combative & collision sports.

"Bailing Out", better known as compensation

According to Fryette's laws of spinal motion, if motion is lost in one plane, it will steal it from the other two planes.  Here I'm affording the thoracic spine increasing degrees of rotation by way of positioning the lower extremity.  In throwing, the eyes are a powerful and important driver of motion, so its important for them to focus on the target.  Take a look at the position of the head in relation to the shoulders.  The increasing degrees of thoracic spine rotation require greater degrees of cervical counter rotation as so the eyes can remain on the target.  The cervical spine is compensating into left side bending. What do you think?  Where do I go from here?

Long toss for pitchers is questioned.

"Biomechanical Comparison of Baseball Pitching and Long-Toss: Implications for Training and Rehabilitation", Flesig et al JOSPT 5-11.

Basically the authors are saying that you get to a point where kinematics are changed too much to have any transfer value to pitching.  That point is well taken.  What I'm wondering though is if it will be beneficial in producing the soft tissue adaptations to the shoulder & elbow that might carry over to the sport.  And, will adding in a little long toss a few times a week be enough to interfere with the motor learning process of pitching.  Is long toss something we need to throw out all together?

Remember Frans Bosch's definition of strength training; "coordination training with resistance", which states, "an ideal form of training should be able to provide a greater workload than an athlete's current stress handling capacity can deal with, while also complying with the criteria that must be met for an optimum transfer of training.  However, overload and specificity are not mutually compatible.  If one wants to include a large overload in training, then one must always deviate from some of the characteristics of goal or competition oriented forms of training" (Bosch '05).

Does (long distance) long toss meet this criteria...provided it is done in the right context?

"Fascilitation"?

From the May '11 JOSPT:  Effects of Kinesio Tape Compared With Nonelastic Sports Tape and the Untaped Ankle During a Sudden Inversion Perturbation in Male Athletes, Briem et al.


" Kinesio Tape had no significant effect on mean or maximum muscle activity compared to the no-tape condition. Neither stability level nor taping condition had a significant effect on the amount of time from perturbation to maximum activity of the fibularis longus muscle"

Fascia practitioners are crazy about this stuff, but I don't know.

Don't nitpick.

If you go looking for ghosts you will find them.  A prominent therapist stated this pistol squat was dysfunctional because of  "compensatory lumbar flexion due to insufficient posterior capsule hip mobility."  An athlete with TRUE hip capsule insufficiency would NEVER be able to squat that deep in the first place.  The deeper you squat the closer the thigh comes to the torso & reduces sagittal lumbosacral flexion.  Sure there are a few coaching points here put overall its a pretty damn good pistol squat that does not require remedial work.

Postural Fascism

The painting above is on display at the Museum of Modern Art in NYC.  Its called, "Woman Ironing, by Pablo Picasso.  Its a painting from Picasso's "blue period", in which his work was defined by the disparity between the rich & poor.  In this one you can see how the skeleton almost serves as a close hanger for the flesh. You've heard me say many times in this blog, "asymmetry is the norm". Its not my phrase.  I borrowed it from Norwegian physiotherapist Freddy Kaltenborn.  Posture is very much influenced by environmental, morphologic, cultural, and emotional issues.  Of course there are many interventional methods of influencing structure through function.  Do you really think structural work is what this 19th century French woman needed?  Probably just as much as your athletes do in the 21st.