Dedicated to the High School Athletic Trainer

Flexion & the Spine

2011-08-09T16:30:00.000-04:00

"To Crunch or not to Crunch: An Evidence Based Examination of Spinal Flexion Exercises, Their Potential Risks, and Their Applicability to Program Design"- Contreras, Schoenfeld JSCR 8-11.

I probably have disagreed with every article these two guys published. Which is why its important never to throw the baby out with the bath water sort of speak. I have to admire this work, they really took on some sacred cows regarding spinal flexion exercise in general. They make a lot of great points...

"The studies in question attempted to mimic the loading patterns of occupational workers by subjecting spinal segments to thousands of continuous bending cycles, which is far beyond what is normally performed in the course of a normal exercise program".

They also note research by Battie & Videman which indicates much of disk injury to be related to genetic factors and not exercise.

They note that many of the en vitro spine studies involve porcine models (which have very different mechanics than the human spine), or human cadaveric spines with most of the supportive structures removed.

They conclude by saying that based on current research its premature to conclude that the human spine has a limited # of bending cycles...and variety in spinal loading is associated with a lower risk of spinal pathology. And you want to do a good warm up before doing spinal flexion exercises early in the morning, or after prolonged periods of sitting; or save them for later on in the day.

Great work guys.

It's whats between the notes that counts!

2011-08-04T19:02:00.001-04:00

"Anatomical Structure determines Function, this determines Exercise Selection & Prescription- Richard Lieber

I'll agree with that...but I'll follow that with a quote by anatomist Jaap Van Der Wall...

"typically researchers "dissect what they have in their mind and lose
the continuity of the tissue." He goes on to say, "Muscle spindles
and GTOs are mostly concentrated in areas of muscular tissue directly
intermediating distal and proximal regular dense collagenous
connective tissue structures. These mechanoreceptors occur often in
muscle/connective tissue transition."

Let's use the hamstring musculature as an example. We've known for a long time that strains occur NEAR, but not actually AT the musculotendinous junction. Recent MR imaging has also demonstrated tears at the epimysial boundries between muscles.

The anatomy of the hamstring muscles are complex, and even vary between individuals. They not only have osseous attachments, but also numerous fascial expansions that attach muscle to bone, AND to other muscles. They are innervated by 2 different nerve branches; the long head of the bicep femoris, semimenbranosus & the semitendinosus by the tibial, the short head by the peroneal. Some anatomists consider the adductor magnus muscle a 5th hamstring muscle, as it shares a common nerve and thick fascial expansions.

When we attempt to understand the function of the hamstrings, like music, we need to understand what's going on proximal to distal, but also in between. Not only in the sagittal plane, but in the frontal, and especially in the transverse. The plane that a muscle is the most powerful in is not always the most important. What the opposite side of the body is doing during a particular task; and whether it's setting the hamstrings up for success. Now we have MR images documenting morphological improvements in an individual muscle from specific exercises. Yes that's useful in indicating the degree of healing, but not the whole picture:

"Movement is not an isolated event that occurs in one plane of motion. Rather it is a complex event that involves synergists, stabilizers, neutralizers and antagonists all working together to produce efficient triplanar movement"- Vern Gambetta.

The current trend of prescribing exercise by muscle architecture is subjective, and can be misleading. Rehab the athlete, not the injury...and let them leave you a little more athletic then when they came in. And never feel like you have to squeeze any muscle injury or prevention program into a traditional weight room exercise just because its there.

Yoga & Rotator Cuff Rehab

2011-08-02T21:56:00.000-04:00

Thank you Tracy Fober PT (www.ironmaven.blogspot.com) for the heads up on this article:

http://www.nytimes.com/2011/08/02/health/02brody.html?_r=2&src=me&ref=health

This variation of a traditional Yoga posture was found to be more effective than traditional physical therapy in treating rotator cuff tears. I don't think there is anything magic about the technique. It is very similar to the wall slides I have described previously in this blog. The concept of shortening lever arms, unloading the shoulder by way of the hand resting on a wall, and changing the limbs orientation to gravity gets the shoulder back into its envelope of function & helps normalize muscle recruitment patterns. I'll often add lower extremity drivers to the hand motion to enhance the exercise. I tried linking some of my old posts on the topic but the search command doesn't seem to work very well.

Sorry by the way about my lack of posting, they will probably be scarce for the next few weeks as we get the fall sports rolling here at EHS.

2011-07-21T10:47:00.000-04:00

Haven't missed a tour since high school, but this one will be tough. Two nights in NY on nights I have soccer games.

Video of Dr. Luigi Stecco performing Fascial Manipulation

2011-07-18T14:23:00.003-04:00

For those who want a look at the Fascial Manipulation technique...he doesn't begin actually performing the technique till about 9m into the video. In FM, you treat AWAY from the injury site, which is a bit different from other myofasical techniques.
http://youtu.be/dPgzwNEbcMU

2nd Annual ATSNJ Concussion Summit

2011-07-17T12:10:00.001-04:00

Some great points made by Dr. Robert Cantu,
...you will not know the true severity of a concussion until the athlete returns to their baseline.
...concussions are not created equal. One may be too many, while three may not necessarily prevent an athlete from future competition.
...the football helmet will never be the end all in concussion prevention.
...the most sever concussions involve blows directly to the head.

Neuropsychologist Reuben Echemndia presented research indicating post concussion neurocognitive testing (Impact et al) is beneficial even in the absence of baseline testing.

At the roundtable discussion I asked the possibility, based on the research by Sandra Black and David Viano, of neck strengthening playing a role in concussion prevention. The consensus was, at least from a theoretical standpoint, yes. But what kind??

Makes ya go hummmm...

2011-07-15T09:24:00.001-04:00

"Motor Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain"- Klykken et al, JAT 6-11.

I'm really impressed at the quality of the research in the Journal of Athletic Training in the last decade or so. This was a good one. The researchers took 10 athletes with recently sprained ankles, placed them in a relaxed prone position, then measured the motor neuron pool excitability of the soleus, anterior tib, & peroneus longus. The soleus was facilitated, the anterior tibialis inhibited, & no difference in the peroneus longus.

The authors go on to explain the reasons for the results. Included was the possibility the CNS was re-organizing to compensate for the loss of posterior talar glide, ie loss of dorsiflexion in the ankle. In running & gait, remember the soleus is a knee extensor. So in this scenario it is helping to limit the degree of knee excursion to control the degree of ankle dorsiflexion at the ankle joint.

A thought: What if this loss of dorsiflexion is not restored? Could the facilitated soleus persist? Could the articular complications resulting from an unresolved ankle sprain(s) be a culprit in chronic calf cramping in middle age runners?

Return to Play Concepts

2011-07-14T08:41:00.004-04:00

2011-07-14T08:38:00.000-04:00

Everything is Everything

2011-06-28T22:34:00.000-04:00

...an old Donny Hathaway song, and the topic of today's blog post.

"Can Balance Training Promote Balance & Strength in Prepubertal Children?"- Granacher et al, JSCR 6-11.

"Is There an Association Between Variables of Postural Control & Strength in Adolescents?"- Granacher et all, JSCR 6-11.

No & No.
These are two studies that measured balance as the ability to control pertubation- that incuded tests for static as well as dynamic. The first test had 6&7 year olds trying to keep still on air cushions & wobble boards for 45 minutes 3x per week for 4 weeks. Funny, but predictable if you were ever an elementary school teacher, the testors had problems with the subjects "attentional focus". Another words, as soon as the teacher had their back turned, the students were off task. The protocol failed to produce impovements in "postural sway"- the traditional method balance is measured.

In the 2nd study, the researchers tested a group of 16 year olds on their horizontal leg press performance, a counter movement vertical jump, & the ability to keep still on a stationary/moving surface balance testing device. No correlation between static & "dynamic" balance, and muscle strength.

Both studies began with stating the importance of adequate balance in preventing injurious falls in the respective age groups. The problem, as I see it, is the definition of balance. That concept of "stillness". Very different than what goes on the athletic field, or real life for that matter. The eyes looking one way, legs moving the opposite, with the arms maybe moving in another.

The other problem is the idea of trying to isolate balance. Good balance is more than just the vestibular system. It requires a certain degree of single leg power, core strength, agility, and even flexibility. I don't believe its possible to effectively train it independent of other neuromotor skills. Did those elementary school kids really have attentional focus deficits? Or did they want to do REALbalance training- skipping, hopping, jumping, stopping & just plain having fun.

GAIN 2011, Rice University- Houston TX USA

2011-06-27T09:04:00.000-04:00

I apologize for the lack of posting, I've been decompressing a bit.

It comes every year right at the end of my school year when I'm wiped & need uplifting. And it didn't disappoint. It is a jam packed schedule beginning at 6am "movement madness" sessions with the faculty- no passive learning here. Just short breaks for meals, and we're on the go till 9pm for 6 full days! Diving into function with the likes of Blatherwick, Gambetta, Fober, Giles, Radcliffe, Ryan, Winkler...Carl Valle getting us up to speed with technology...with Greg Thompson giving us the latest updates on motor learning & control. EVERYTHING from the individual exercises to year round performance planning. What a ride!!

But GAIN is only as good as it's "delegates". That is, the people who are hand picked by Vern to attend every year so NOTHING gets watered down. I mean come on, how many times have we paid good money to attend stuff that winds up looking like high school biology?

EVERYONE there had something to bring to the table. Performance coaches, Sport Scientists & physiotherapists from college & professional sports, high school ATCs & physical educators, physiotherapists from European Rugby...phew! Just imagine what it was like to have to get up in front of them & present!

Please consider joining us in '12.

Off to GAIN '11!

2011-06-10T09:58:00.000-04:00

Sorry I haven't been posting. I've been preparing for my presentations at the GAIN APPRENTORSHIP 2011
http://www.gambetta.com/Merchant5/merchant.mvc?Screen=CTGY&Store_Code=gambetta&Category_Code=Aprentorship
at Rice U in Houston next week. I'll be doing Return to Play, Functional Anatomy, as well as assisting Kelvin Giles with his PCA presentation.
http://movementdynamics.com/products/view/physical-competence-assessment-manual%202011
In addition, I'll be running the AM workout sessions on functional balance progressions & functional flexibility. It is a very cool experience...really diving into function. As usual I'll be over my head, but I wouldn't have it any other way. Think about joining us in '12.

In the end, it all comes down to Physical Competency

2011-06-02T08:45:00.000-04:00

"The Effects of Exercise for the Prevention of Overuse Anterior Knee Pain : A Randomized Controlled Trial"- Coppack et all, AJSM 6-11.

Pretty simple, 4 PRE's & 4 static stretches caused a 75% reduction in anterior knee pain among military recruits. Some of the exercises were "functional", & some were not. What I found interesting was 3 of Kelvin Giles' PCA assessments (although not referred to by name) were used as exercises. As budgets tighten & P.E. programs begin to disappear we see the decline of physical competency & literacy. You cannot have a decent athletic development program without it. Depending on the task at hand, it could be a knee injury, a shoulder, back etc. Let's not get so nit picky with our assessments that we lose site of the big picture. Do they have the right stuff or don't they? And if they don't, weave it in to their return to play repertoire. Believe me, the greatest gift you can give an injured athlete is to let them leave you a little more athletic then when they came in.

Memorial Day 2011

2011-05-29T19:31:00.000-04:00

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.

2011-05-28T11:20:00.000-04:00

"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!

2011-05-24T21:23:00.001-04:00

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

2011-05-21T22:06:00.000-04:00

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

2011-05-21T14:50:00.000-04:00

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

New Joe P. Ankle Rehab E-book

2011-05-18T09:11:00.002-04:00

"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

2011-05-16T17:47:00.000-04:00

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

2011-05-15T19:57:00.000-04:00

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.

2011-05-08T09:39:00.000-04:00

"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"?

2011-05-04T18:48:00.000-04:00

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.

2011-05-02T08:55:00.001-04:00

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

2011-05-01T17:46:00.000-04:00

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.

Take a look and let me know what you think

2011-04-23T09:08:00.000-04:00

Thanks to Vern on the heads up on this. It is a free kinematic analysis tool. This could be very useful. The only problem is, the way I understand, you would first need to build a calibration structure. And, that structure would need to be placed where you plan to do the filming. So, it would be best for those who have a dedicated area put aside for this purpose. What do you think of the idea of building a portable one that you could take apart and put back together? Would it be worth the effort? Otherwise, I wouldn't even have the room to store something like that. Oh, one annoying thing. You have to convert your video into .avi before you can download it. Weird but do-able.

http://video4coach.com/index.php?option=com_content&view=article&id=13&Itemid=4

What is pathological and what is adaptive?

2011-04-20T11:51:00.001-04:00

Two studies in the 4-11 edition of the AJSM provoke this question:

"High Prevalence of Pelvic and Hip Magnetic Resonance Imaging Findings in Asymptomatic Collegiate and Professional Hockey Players"- Silvis et al.

"Magnetic Resonance Imaging of the Throwing Elbow in the Uninjured, High School–Aged Baseball Pitcher"-Hurd et al.

In a previous post I spoke of this issue regarding the finding of osteophytes in athletic knees. Some researchers felt this was a pathological change, others felt is was a strategic reinforcement that the body does. The same was discovered in the elbows of healthy high school pitchers and the hips of healthy collegiate and professional hockey players. What was really interesting was the presence of asymptomatic adductor–abdominal rectus enthesopathy in hockey players. The body self organizing?

Does anyone know why all of a sudden my images started distorting?

2011-04-14T05:13:00.002-04:00

PBS Frontline: Football High

2011-04-14T05:12:00.000-04:00

This edition prominently features one of Joe's Training Room frequent contributors-BJ Maack, president of the Arkansas Athletic Trainers Association.

http://www.pbs.org/wgbh/pages/frontline/football-high/

Enhancing play low with pelvic drivers.

2011-04-13T12:39:00.000-04:00

Play low. A lost, necessary part of blocking, tackling, fielding. It requires good T-spine, hip, knee, and ankle flexibility. The first picture is typical, with the ankles splayed because of poor dorsflexion. Permit no more than a 30 degree ER. Have the athlete squat as low as possible while maintaining good posture. Once there, instruct them to move the pelvis as described in the images. 4 to 5 sets of 30 seconds is good.

A great research journal that bridges the gap...

2011-04-12T13:58:00.000-04:00

"Human Movement Science". This month's edition is a little off topic as far as A.T., but do a journal search on "knee" or "ankle". Outstanding.

http://www.sciencedirect.com/science/journal/01679457

Ramblings on the "Isolate before Integrate" Philosophy

2011-04-11T12:29:00.000-04:00

"Effects of muscle strengthening on vertical jump height: a simulation study." Bobbert et al, MSSE '94.

In this study, isolation training caused a 20% increase in knee extensor force, BUT caused a 9cm DECREASE in vertical jump height.

Orchard, J., Walt, S., McIntosh, A. and Garlick, D. (2002) Muscle activity during the drop punt kick. In: Science and Football IV. Eds: Sprinks, W., Reilly, T. and Murphy, A. London: Taylor and Francis. 32-43.

Australian footballers have been having a real tough go of it with hamstring strains. But its a lot more than a strength/flexibility thing. This study shows they (hamstrings) are not particularly active in the follow through of a kick, as you would think. They seem to have more of a timing sort of purpose.

I don't mean to beat this topic to death, just saying how tough it is to rock a rhyme thats right on time.

...but, compared to what?

2011-04-08T13:17:00.001-04:00

I was just reading a research article on the use of electrical stimulation to enhance vertical jump height. There was a lot of this stuff back in the 80s. There were two control groups, one that did no training, and another that practiced jumping without the electrical stimulation. The electrical stimulation showed an advantage over both groups over a 6 week training period. But what if they compared it to a group that went though a functional leg strength progression. One that included progressive loading. Would it still show an advantage? And would that technique be practical in the context of a team setting? Don't just read the abstracts, they can be misleading.

Getting back inside the envelope

2011-04-06T12:32:00.000-04:00

This athlete is returning to softball from a sprained right knee. I didn't like the way her single leg hop looked- too much valgus. I could get that knee back into the envelope of function by removing the exercise or doing mini jumps on two feet. What I chose was to continue single leg training, but modify the same exercise. The athlete is doing the single leg hop up a 30 degree incline, with no more knee valgus. Handicap ramps typically found around schools are perfect for this purpose.

Do your work at the edge of the envelope of function

2011-04-02T12:30:00.000-04:00

This athlete is in the early stages of rehab for a right groin strain. To be specific, a right rectus femoris origin strain. Here we are using integrated integration as Gary Gray calls it; using top down drivers to influence the groin & enhance the healing process on both a myofascial & neural level. In the first picture, the athlete is in a right stride stance, swinging 6 lb. powerballs from the hip to posterior @ overhead. In the 2nd, he's doing alternating frontal plane swings, the emphasis on creating frontal plane pelvic movement. In the 3rd he's again in a right stride stance doing R/L rotational swings @ shoulder height. By selecting my stance & arm swing pattern I'm protecting the lesion from injury. The athlete can be pretty aggressive with these without any pain what so ever.

The lower extremity exercises I'm choosing are lateral lunges, right stagger squats, and right/left posterior lunges with a bilateral upper extremity reach anterior to knee height. No need to be concerned with "proper firing patterns" here, the body is self selecting according to the task. Because the exercises I chose are within the envelope of function, there is no need to be concerned with compensatory movement patterns. Those who choose an isolated, open chain approach are a lot smarter than me. Remember in function, an individual muscle may have to work isometrically, concentrically, and eccentrically all at the same time. Not only at each particular joint, but in each individual plane at that joint. My hats off to them.

Neuromuscular exercise for Patellofemoral Stress Syndrome- Bosch Overhead Reach Drill

2011-03-31T18:22:00.000-04:00

The boys like to watch the pelvis wiggle, but the knees don't like it very much. Upon foot contact in running/jumping, the pelvis goes too deep into the frontal plane, presenting in contralateral rotation. Ideally, the ilia should be at least level, or optimally the fee pelvis a bit higher. When the ipsilateral ilium is higher, it contributes to excessive knee abduction/internal rotation at ground contact.

This is one of the exercises I use to enhance pelvic stiffness in athletes presenting with patellofemoral stress syndrome. I do it a bit different than Frans does. BTW, Frans does not use this as a rehabilitation exercise, he uses it as a neuromuscular drill to enhance sprint mechanics. I'll have the athlete take a big step forward onto the affected leg, punch the non weight bearing ilium and hand to the ceiling, then step backwards with that same leg and return to the starting position for 3 sets of 10 reps. I begin with the athlete holding a crutch overhead, then build up to a weighted bar.

I know horizontal training ("clam shell" exercise etc) is popular for developing pelvic & core stability, but as I've articulated many times on this blog, it has little carryover to upright function.

Sahrmann vs. Lederman

2011-03-27T21:26:00.000-04:00

I listened to a recent webcast from Dr. Shirley Sahrmann in which she says a if you can't recruit a specific muscle under a controlled condition, there is little chance it will be beneficial in an integrated manner. If you read her "movement impairment syndromes" book, a lot of open chain strengthening done on-table with alot of grooving movement patterns to get that muscle working in the real world sort of speak.
Dr. Eyal Lederman, on page 10 of his "Neuromuscular Rehabilitation in Manual & Physical Therapies" he says, "There are several misconceptions about motor control which are likely to make rehabilitation unnecessarily long and complex. They all originate from the principle of "isolate in order to integrate". The muscle is NEVER the goal of the movement. Focusing on tensing, clenching, bracing, or holding specific muscles during movement turns them into the goal of the movement. Muscles work in complex synergies- they never work alone. All muscles are equally important, even muscles that are silent. Muscles which are slow or at low EMG activity are part of the whole control pattern."

Sahrmann's approach is very much, "isolate to integrate".

In her excellent text, "Diagnosis & Treatment of Movement Impairment Syndromes", for the most part she uses very isolated corrective muscle work. On page 32 she says, "the desired muscle action should be practiced under the specific conditions in which it is to be used."

Comments?

3 weeks out, from 1 to 5

2011-03-25T12:18:00.010-04:00

Not a single ROM exercise. I focused in where the PCA led me. Its interesting how symptoms resolve before the the SICK scapula totally corrects.

PFSS Rehab

2011-03-24T06:01:00.001-04:00

Hip hikes, stagger squats with double arm reaches at ankle height, and lateral mini band walks. Here I'm unloading the quads a bit to minimize patellofemoral compression. Focusing on the pelvic engine.

Fire Puxatony Phil

2011-03-23T11:06:00.001-04:00

Ahhhh, springtime in New Jersey.

On ground function carryover to upright

2011-03-22T18:35:00.000-04:00

Don't be afraid to go to the ground if you think you can get something out of it that can facilitate upright function. This athlete is using a traditional bridge with a L/R bilateral upper extremity, in sync (arms moving in the same direction) rotational reach. Real important to keep the elbows locked straight and hands together. He's using it as a remedial exercise to improve his ability to rack the olympic bar to his shoulders (ie front squat position). His glenohumeral flexibility is actually not bad, its his thoracic spine and rib cage that have the motion restrictions. Restrictions of the costovertebral/costosternal joints are commonly created when heavy bench press exercise is overused. These restrictions are often overlooked as a culprit in shoulder dysfunction.

It has nothing to do with lactic acid

2011-03-21T21:29:00.000-04:00

"Unraveling the neurophysiology of muscle fatigue", Enoka et al; JEK 3-11.

The authors don't have all the answers, but basically fatigue is the brain's way of protecting the body from injury.

Hodge's new Pain & Motor Control Theory

2011-03-20T11:43:00.001-04:00

He's not ready to give up his abdominal hollowing and multifidus exercises yet, but I think its a bold step for him pointing more to what we talk about it this blog. A few excerpts:

"One example is work in low back pain that has investigated temporal and spatial aspects of activation of the deep abdominal muscle, transversus abdominis, in trials of motor rehabilitation. The implication is not that this change constitutes the entirety of the adaptation, but that it is a common component that can be used as a ‘‘marker’’ of adaptation."

"each individual develops a protective strategy (from injury) that is unique based on experience, anthropometrics, posture, task, etc."

"it would seem reasonable to conclude that it is necessary find the right balance between restoration of control to some baseline and the maintenance or retention of elements of the adaptation in order to meet the demands of function."

There are VERY popular fee based sports medicine websites out there that flop from one idea to the other with no rhyme or reason looking for the latest panacea. I would like to think I've stayed pretty consistent here with my approach, and not because of stubborness...I hope.

The body is self organizing-get used to it- part deux

2011-03-20T10:45:00.000-04:00

If this doesn't stop all the BS I don't know what will.
http://aol.sportingnews.com/sport/story/2011-03-20/one-legged-wrestler-anthony-robles-wins-collegiate-championship

Books/Journals vs. the Web

2011-03-20T10:23:00.000-04:00

Thanks Vern for this-Seth Godin sums it up just perfectly:

"Books, used properly, immerse us in a single idea. Books bring a voice into our head, create a different brain chemistry, open doors to a more powerful lever, a learning that can yes, change us. Dozens (perhaps hundreds) of times in my life, a book has changed my mind. So have some powerful lectures or direct engagements with teachers or mentors. These are the moments of true change, times when we are entrained with the message, when we feel the learning happening in real time. Yes, tweet. Yes, stay in sync. Yes, absorb the lessons that come from many inputs, over time. The quiet enjoyment that books (and great teachers) bring, the uncomfortable place they bring us when we’re open enough to let them in and to be honest with ourselves… this is precious."

The "N" Word

2011-03-15T12:37:00.002-04:00

"Neuromuscular Training Improves Knee Kinematics, in Particular in Valgus Aligned Adolescent Team Handball Players of Both Sexes- Barendrecht et al, JSCR 3-11."

I am guilty of using it. No I'm not speaking of the term that you hear rappers use. I talking about the word, "neuromuscular". It has become as ambiguous as the word "core". Nordic hamstring curls are considered neuromuscular in this study. The authors achieved their goals of improving knee valgus on a drop jump test...but the control group was "usual handball training", whatever that was. Was it no strength training at all? It wasn't clear. And that's the problem with these ACL prevention protocols- they always compare to no intervention at all.

Is this the way the A.T. would do it? Would we take athletes which we had no idea of their conditioning history and have them bounding? Triple jumping? ...As part of a 10 week ACL prevention protocol? I doubt it because we know what would happen. Patellar tendinosis, patellafemoral syndrome up the wazoo. If not in 10 weeks, soon after. Since we spend years, and not weeks with our athletes (as opposed to other practitioners) we know there is no such thing as a quick fix. We think LTAD= long term athletic development= functional leg progressions. Rather than a 2X per week, it would be interwoven seamlessly into the daily warmup and conditioning modules. No P90X, no "Instanity workout"- no guru, no method, no teacher.

Wisdom from Brian Green

2011-03-14T05:08:00.000-04:00

"10 years years from now we might find out that leaving it alone is the best treatment".

Absolutely Brian, and you have Dr. Lederman to back you up! Page 170 of "Neuromuscular Rehabilitation in Manual & Physical Therapies,( 2010)":

"The injury response is a positive healty response and not a motor dysfunction or pathology. Acute musculoskeletal injuries should be left alone- the body knows best. The patient should be encouraged to keep active".

That sounds a lot like when I speak of "training around the injury", or "training at the periphery of function", no? That does NOT mean throw out all your manual therapies, but it does mean keep it puroposeful and functional and keep the athlete actively involved whenever possible (e.g. FMR, Mulligans). That was the basis of my (now defunct) ankle rehab book. But a simple example- let's say an athlete sprained their ankle and dorsiflexion is painful. But you want to preserve function. You ask them to squat and they lean to the contralateral side because it hurts. Simply move the involved foot forward and have them stagger squat, as it requires less dorsiflexion.

Joe's A.T. room gets legitimized

2011-03-13T13:11:00.000-04:00

Thank you Paul Grace A.T.C., NATA hall of famer for your kudos!:

"I think you've got something going on that is worth reading and helping get people talking about athletic training".

Go to resources for the functional ATC

2011-03-13T12:57:00.000-04:00

Shame on me if I make this stuff seem more complex than it is, because its not my intention. Please call me out on it when I do, so thank you for your comment SLS. I want to keep things simple, inexpensive, and EFFECTIVE as possible for the high school ATC. After I punish myself in the time out corner for 5 minutes.

1. Pedagogical resources (Free). These guys have marketing in mind, but after you read you'll see what I mean:

http://sethgodin.typepad.com/
http://bobsutton.typepad.com/

2. Books:
about $20 bucks a piece:
A. Athletic Development: the Art & Science of Functional Sports Conditioning- Gambetta
This is the scaffolding for your rehab programs.

B. Functional Training for Athletes at all levels- Radcliffe.
Provides a great menu to plug into the scaffolding.

Now a little more expensive:

Books:

1. Physical Education for Children: Building the Foundation- Gabbard, LeBlanc, Lowy
I would have placed this book at #1, but its out of print and can only be purchased from re-sellers for top $. The authors never intended it for rehab purposes, but it is one of my favorites.

2. Functional soft tissue examination and treatment by manual methods, 3rd edition- Hammer. Expensive, about $150. But, an extremely valuable resource that should be in every A.T. room.

DVD: Ankle Sprain, Chain Reaction Rehab- FVD 2.10, Gary Gray.
It is selling for $80 on Perform Better, but you might be able to find it cheaper. You'll see Gary's functional approach in action and get an idea what it looks like.

...and think about joining us at the Gambetta Athletic Improvement Network (GAIN). Yeah its expensive, but once your in your in.

http://www.thegainnetwork.com/Merchant2/4.12/merchant.mv?Screen=CTGY&Store_Code=Gain&Category_Code=Apprentorship
**************************************************************************************
Remember, SLS and others, that functional training=purposeful training. Otherwise you are just wasting the precious little time that you have to work with your athletes. Did I articulate myself better here? Let me know.

Great question from JM

2011-03-12T10:21:00.000-05:00

"Joe, what are your thoughts on this recent shift focused on the respirtory/neurological system by regulating breathing? System integration makes sense rehabbing the athlete and not just an injury. Keep up your great thought provoking posts! We are all thankful."
****************************************************************************

Excellent question JM that lets me get up on my soapbox & bore with my pontification. The local hip hop stations all seem to have the "old school" at noon where they play music from the 80s. Most just change the station. So you can too but it goes like this...

Back in the day, A.T. education was unique, because we all graduated with a dual A.T./P.E./Health certification. There was no such thing as an A.T. degree. Because of that, those of us coming out of that era had a strong base in motor control/learning. That was something that separated us from other professions like the physical therapy and chiropractic. This whole "functional" movement evolved from US, not the before metioned. They just re-named what we did (e.g. plyometics became "stretch cycle shortening training"). Somewhere around the time actual A.T. degree programs were created, we lost that background in pedagogy, motor control, and movement education. We seemed to borrow from physical therapy, causing the lines between the two professions to blur, leading to unnecessary conflict between the two.
In the last 5 years, the plethora of information supporting complex systems & motor control theory have exploded! And, they are pointing to the "old school" way WE used to do it. Yet we are mindlessly led from one marketing innovation to another rather than taking the lead.
So finally, to answer your question...to us old schoolers this breathing movement is not "system integration" at all. In function, you can do the same task a thousand times, breathing differently each time, using different muscle firing patterns each time... and be doing it absolutely correct. If a breathing pattern does appear aberrant, that particular task is simply outside the athlete's envelope of function. Modify it until you get the results you desire. The catch 22 is, you would have no idea how to do that without a strong background in pedagogy, motor learning/control, and movement education. Running out and getting some personal trainer certification won't fix it.

Brilliant!!!

2011-03-11T19:22:00.000-05:00

Does anyone know who Jason Silvernail D.P.T. is?

http://www.somasimple.com/forums/showthread.php?p=95314&posted=1#post95314

http://www.somasimple.com/forums/showpost.php?p=96406&postcount=7

Training Stages (Gambetta, Giles)

2011-03-11T08:10:00.002-05:00

1. Fundamentals (age 6-9) focus on physical literacy, gross motor skills
2. Learn to Train (age8-12) learn overall sport skills
3. Train to Train (age 11-16) consolidate sport skills + tactics with physical abilities
4. Train to Compete (age 15-23) sport specialization, increase training intensity
5. Train to Win (age 18+) focused, dedicated, competitive

If you really want to reduce ACL injuries, "Tommy John" surgeries et al follow these guidelines. Quick fix protocols later on only have limited success.

Youth + the right kind of remedial work

2011-03-10T12:31:00.000-05:00

10 days out...from a "1" on both tests; to a 4 on the shoulder internal rotation test & a 3 on the shoulder lift off. 12 minutes out of his lunch period 5 days per week + some work on his own. The shoulder throwing pain he was having is already gone, but I explained to him that is only because volume is very low right now. Once the season moves on to back-to-back games his remedial work will take on an even greater roll.

Exercise is GOOD for your knees!

2011-03-07T14:00:00.000-05:00

These Australian researchers see knee osteophytes as a protective mechanism, not part of the degenerative process:
http://journals.lww.com/acsm-msse/Fulltext/2011/03000/What_Is_the_Effect_of_Physical_Activity_on_the.8.aspx

The human body is self organizing-get used to it.

2011-03-04T12:50:00.000-05:00

"Individuals With Low Back Pain Breathe Differently Than Healthy Individuals During a Lifting Task"- Hagins et al JOSPT 3-11.

This teaching proper breathing stuff has taken on a life of its own. These authors demonstrate breathing patterns could be a subconscious stabilizing strategy.

Using the PCA to save time

2011-03-02T23:20:00.000-05:00

This athlete is a pitcher who came to me complaining of posterior shoulder pain during the early acceleration phase of his delivery. Evaluation revealed a forwardly rotated scapula, a tender coracoid process, and GIRD. I used the gauge to This scapular malposition is usually associated with weak same side lower trapezius muscles and a tight pec. minor; the GIRD a tight posterior shoulder capsule.

The tests I used were:

1. Shoulder Liftoff
2. Shoulder IR (note: NOT an official PCA test)
3. Standing shoulder ER
4. Thomas Test 1.

The whole process only took me less than 5 minutes and gave me good information. The shoulder liftoff was expected- the athlete scored a "1", which would be consistent with weak lower traps. This is problematic, indicating this athlete cannot really get "hip to shoulder". What I didn't expect was the good performance on the standing shoulder ER, meaning the pec. minor was probably not a culprit. The Thomas Test 1 revealed a slightly tight same side iliopsoas (this would grade a "3", which normally isn't bad, but in throwers your really want a "5", meaning the thigh should drop below the table) which could theoretically prevent a good low trap load via poor torso extension. The internal rotation shoulder test will provide the athlete with a visible indication of their progress. This would grade a "1", which is undesirable for a thrower. This score indicates the possibility of shoulder & elbow injuries as per Donnelly.

My next step was to confirm my suspicions further by inspecting some of the myofascial centers of coordination about the scapula. Interesting the pec minor myofascial cc was indeed negative.

http://www.amazon.com/Fascial-Manipulation-Practical-Luigi-Stecco/dp/8829919780

I'll only get to see this athlete a half of his lunch period 5 days a week. But with the help of a streamlined remedial program he should have a great season.

Good article from the NY Times on Tendinosis

2011-03-01T11:35:00.000-05:00

http://www.nytimes.com/2011/03/01/health/01brody.html?_r=1&src=me&ref=health

Interesting the thing that gave the author his greatest pain relief was his change in swimming mechanics. Frans Bosch believes if you fix mechanics, the body will fix itself. Much of GAIN is spent in this realm.

"If they give you ruled paper, write the other way"-Juan Ramon Jiminez

2011-03-01T11:14:00.000-05:00

The epigraph on the first page of one of my favorite books of all time, Farenheit 451 by Ray Bradbury.

How does it pertain to athletic training?
Never be afraid to question what you have learned...even if it is coming out of a prestigious university. As the health care dollar shrinks, marketing becomes more intense & protocols which have very little merit are presented as the next best thing. You can be fooled into thinking you are falling behind if you don't jump on the bandwagon. Remember that's just part of the marketing strategy. Do your research-and don't just read the abstracts and make up your own mind.

I heard others refer to this blog site as "outside the box" thinking. Its really not at all. It's about the high school A.Ts lack of time and needing to get the most bang for your buck. Getting it right the first time so the athlete isn't returning time and time again for that chronic ankle soreness or concussion. Or better yet, preventing it in the first place.

ATSNJ Pubalgia workshop 2-27-11

2011-02-28T13:05:00.000-05:00

The talk started off with Dr. Andrew Boyarski, a general sugeon from New Brunswick, NJ. I really enjoyed this one:

http://www.rwjuh.edu/physicians/physician_profile.aspx?physicianid=147

Dr. Boyarski is skeptical of the US trend of using mesh to do these repairs, especially in young athletes. He put it quite simply, that this technique destroys the continuity of the fascia and may promote nerve entrapments. He described what he calls the normal "scissor down" effect of the fascia on the inguinal canal, which protects the area from injury.

He says although MRIs are beneficial in the differential diagnosis, they are too uni-dimensional to be of benefit in the diagnosis of an athletic hernia. He prefers diagnostic ultrasound for this purpose. He simply asks the athlete to cough, and looks for the "scissor down" effect on the ultrasound. (Note: on the A.T. side of the evaluation, he says with a little practice this effect is palpable externally. He says adductor tenderness varies, and is not a good indicator).

He chooses to a version of the repair technique he learned from Dr. Ulrike Muschaweck, an orthopedist from Germany. The surgery is done with a local anasthetic. He asks the athlete to cough while he is staring directly at the canal to be sure the "scissor down" effect has been restored. In this technique, the floor of the canal is reinforced with sutures and the athlete is usually back to competition in 6 weeks. He was quick to emphasise the importance of the therapist on the prevention and rehabilitation side of the equation by way of a good "core" strengthening program.

Next up was orthopedist Charles Gatt
http://www.rwjuh.edu/physicians/physician_profile.aspx?physicianid=1668

Dr. Gatt spoke of evaluation & treatment of pelvis/hip injuries in general. Again the topic of diagnostic ultrasound came up. He uses a portable one to guide cortisone injections in the inflammatory phase, especially in hamstring injuries. He cites research from Bergfeld to support this (readers take a look at this and let me know what you think) :

http://ajsm.highwire.org/content/28/3/297.abstract

I asked him about FAI, as to whether he felt it was a nature or nurture thing. He agreed with most researchers, that its the latter.

Russel Steves, PT, ATC spoke on the rehabilitation of athletic hernia:
http://uhs.princeton.edu/staff/detail.php?NetID=rgsteves

Those with Dr. Boyarski's repair are up and doing light walking immediately, doing light stretching and exercise weeks 3 & 4, and are segueing back to competition the 5th & 6th! While most of he protocol was pretty traditional, it was interesting he proposed the possibility of a functional protocol as being effective also. He spoke of the need of the "muscles to be powerful in a lengthened position". Sounds like Dr. Tiberio's "transformational zone" concept, no? He also mentioned ART and Graston by name as being beneficial.
Finally Jennifer Lister A.T.C. spoke on using a Pilates based approach to pelvis/groin injury rehabilitation and prevention:
http://uhs.princeton.edu/staff/detail.php?NetID=jlister

The Inflence of Children's Shoes on Gait and Running

2011-02-25T11:43:00.000-05:00

This is a great article that is free and you may want to save to your hard drive:

http://www.jfootankleres.com/content/pdf/1757-1146-4-3.pdf

Take a look and let me know what you think.

Good Quote from Winston Churchill

2011-02-23T13:21:00.000-05:00

"Continuous effort - not strength or intelligence - is the key to unlocking our potential."

The barbell...what a great tool!

2011-02-22T12:13:00.002-05:00

Here I am doing a transverse plane power snatch; something you can't do with a olympic bar. The bar is shorter, thinner, and the plates are welded on. Of course you could do the same exercise with dumbbells, but the barbell adds a bit of horizontal drag to it that enhances the movement. Because the hands are fixed, it really challanges the rib cage, scapulae, and core. Instead of just letting the bar drop, I'm pulling it back to the starting position to increase the speed of the bar and get as many reps as possible in 10s.

Your Thoughts

2011-02-17T02:04:00.000-05:00

A rotational plank with light force applied downward to the head by a partner. It's from the neck strengthening video I just did for the ATSNJ. Of course it's just not about coming up with dopey looking exercises, but I think this could have some value. It could be done on a field with no special equipment.

Websites

2011-02-15T12:38:00.000-05:00

Colleagues contact me all the time and ask me what they think about this or that website. Don't have an opinion. I'm not really a website kind of guy. It's like a hunter aiming for where the rabbits already been. I read a few blogs by people who inspire me like Vern and Tracy. My blog is a reflexion of me. The TR is my lab, and I use whats in my toolbox to enhance athletic development from my end as an A.T. I never profess to have all the answers. Things arise that I don't have answers for, and I look to the journals not for answers, but to see if there are others who are seeing the same that I am, and what their approach is.

I will say this- the functional approach does not work with everyone. Those who seem to be the most resistant are those with an external locas of control and don't believe the power to heal is already inside them.

On the Shoulders of Giants!

2011-02-13T18:35:00.001-05:00

Spent the weekend with Dr.'s Antonio Stecco & Warren Hammer studying the myofascial system. The Steccos take a more global, integrated approach to treating the fasica system than I have been exposed to in the past. I'll be hooking up with them again next month after I spend some time on the application side of it with my athletes. The Steccos are the only fascial practitioners who do their own research, and aren't afraid to stick their neck out in the professional journals. His father Luigi and his sister Carla's many works can be found in a Medline search. Carla has the first anatomical book on the myofascial system (not illustrations) due out this fall.

Every ATC should have a copy of Dr. Hammer's text, "Functional Soft-Tissue Examination and Treatment by Manual Methods, Third Edition". Very detailed, and well illustrated. It is expensive ($155), but it's the low budget, high tech stuff that works:

http://www.jblearning.com/catalog/9780763752873/

Resisted running- Where does it fit (or does it)?

2011-02-11T08:46:00.001-05:00

"THE LONGITUDINAL EFFECTS OF RESISTED SPRINT TRAINING USING WEIGHTED SLEDS vS. WEIGHTED VESTS"- JSCR, 12-10.

Granted it was a small study-only 20 participants, and they were lacrosse-not track athletes, and the study only lasted 7 weeks.

The results showed sprint training with a weighted vest or sled pulls did not improve performance in the short sprints. Our old track coach, the great Dave Costello claimed all resisted running, including parachute running, had limited value. He would use it sparingly- only on his regional/national caliber sprinters. He said while it looked like running, the mechanics were different and had little carry over.

Not to say it doesn't have a benefit. If you play a sport like football or Rugby where people are hanging on you or pushing you I could see it being purposeful. Would you use it to compliment shot put, discus, javelin, hammer throw?

Everybody wants a "System"

2011-02-09T11:42:00.001-05:00

"Effects of Pilates Based Exercises on Pain & Disability in Individuals with Persistent Non Specific Low Back Pain: A systematic review with meta analysis" Lim et al, JOSPT 2-11.

I'm glad to see this. There are P.T. practices popping up all over that use Pilates exclusively as a panacea. Nothing against Pilates, but it's one of those, "If all you have is a hammer, everything is a nail" things. The conclusion was, " Existing evidence does not establish superiority of Pilates-based exercise to other forms of exercise to reduce pain and disability for patients with persistent nonspecific low back pain."

Don't feel bad if you don't have thousands of $ of equipment in your A.T. room. You can still get it done. Successful athletic training is A.T. directed, but athlete- not equipment- centered.

Fascial Stretch Therapy Certification? Fascial Fitness Certification?

2011-02-09T08:24:00.000-05:00

Ay carumba.
Don't get confused, stay the course on the functional path.
Doing some course work with the Steccos and Warren Hammer this weekend and I'll report back.

http://www.fasciacongress.org/other-events/Stecco%20Workshop%20Full%20Text.pdf

"Posterior Chain" Weakness? Think again.

2011-02-08T06:08:00.001-05:00

"Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement"- Bell et al ', Archives of Physical Medicine and Rehabilitation '07.

Pretty cool. The authors took subjects who's knees exhibited medial knee displacement during a squat. They then gave them heel lifts to see if it corrected. If it did, they studied their lower extremity strength and compared it to those who did not display medial knee displacement. They had GREATER hip extension and external rotation strength than those with normal squat kinematics! They went on to make recommendations for ankle strength/ROM.

So much for "training the glutes and hamstrings to fire better". Just teach them to squat and land better period- don't try to 2nd guess the body as to what muscle is firing how much and when. And it always amazes me how quickly adolescents adapt with a minimal amount of intervention. Just take the time.

The Gastocnemius is an upside down hamstring- more evidence.

2011-02-06T17:58:00.000-05:00

Ankle Dorsiflexion Range of Motion and Landing Biomechanics- Fong et al, JAT Jan '11.

On page 8 speaks of the importance of the gastroc in force attentuation at the knee during landing. Greater dorsiflexion was associated with smaller ground reaction forces.

Synesthesia

2011-02-03T08:43:00.000-05:00

http://en.wikipedia.org/wiki/Synesthesia

Numbers have specific colors! Musical notes float through space in specific patterns! No it's not a psychedelic drug experience. This is how synesthesiasts perceive the world. Watched the PBS Nova program on the brain last night which had a segment on this neurologic condition. It's not just limited to music & math, and research is already going on as to how it may be beneficial to non synesthesiasts in learning.

There has to be athletes that experience this on the playing field.

Another good reason to stay active!

2011-02-01T10:53:00.000-05:00

http://www.webmd.boots.com/healthy-ageing/news/20110201/exercise-reverses-memory-loss

We can do better.

2011-02-01T05:17:00.001-05:00

"Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players"- Junge et all, AJSM '1-11.
In the U.S. we have the "Santa Monica program". In Europe you have "The "11".

In Switzerland, football (soccer) teams performing ‘‘The 11’’ had an 11.5% lower incidence of match injuries and a 25.3% lower incidence of training injuries than other teams; noncontact injuries in particular were prevented by the program. In the U.S., the Santa Monica protocol ACL prevention program dropped female collegiate soccer injury rates an overall 41%, and non contact injuries 70%. The program is free online at:
http://www.aclprevent.com/pepprogram.htm

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

While I admire the effort, and the results, both are really not programs but exercises slapped together. Why isn't a good lower extremity performance & prevention program weaved seamlessly into the athletic development model, if there is a model at all?!

If we have already identified the problem, then why wait till the high school or club years? Why not begin in elementary school?

http://joestrainingroom.blogspot.com/2009/07/from-spark-into-bonfire.html

Never forget sports medicine is a discipline that has always been driven by the field practitioners.

http://joestrainingroom.blogspot.com/2009/02/kitchen-chemistry.html

Can the human body handle this?

2011-01-30T12:00:00.000-05:00

When I was a kid the NFL regular season was 11 games. Now 18 games, plus another 11 if you make it to the super bowl? Thanks to my buddy Lou Argondizza for bringing this to my attention:

http://sports.espn.go.com/espn/eticket/story?page=110128/PainkillersCurrentUse

Working at the periphery of the envelope of function

2011-01-30T07:02:00.002-05:00

This athlete is a wrestler re-abilitating a grade 2 L knee MCL sprain.

He needs to move from a four point stance to a stand up position. The transfer from kneel to standup right now is outside his envelope- the knee perturbates in the process. So I have his R knee elevated to reduce the depth of the stand up. I keep folding the mat and have him single leg stand up until the perturbation resolves.

By the way, the single leg stand up is a great remedial tool to improve the single leg squat. By moving the knee of the trail leg ahead of the forward leg heel, it reduces the ability of the trail leg to assist in the movement.

Now this is a functional movement screen

2011-01-28T07:44:00.001-05:00

Simply asked this athlete to 2 step, hop, return, and repeat 10x.

Sagittal plane task, we should expect stability in the other two planes.

Frontal plane: Elevated R ilium, knee valgus.
Transverse: R shoulder, pelvis L rotation, knee, foot IR.

Why don't we see the foot collapsing also?

Something I want to drive home...

2011-01-27T12:57:00.001-05:00

It's all about athletic development, planned performance training designed by you so that your athletes thrive, not just survive your protocols.

http://sports.espn.go.com/ncf/news/story?id=6061650

Thanks fellow GAINer Randy Ballard for bringing this to my attention.

Seats?! We don't need no stinking seats!

2011-01-26T20:45:00.000-05:00

Knee Rehab, Treasure of Sierre Madre Style.

When is a squat no longer functional?

2011-01-25T08:57:00.000-05:00

The heavy load, combined with the long lever arm created by the olympic bar forces the athlete to place the feet outside of hip width and externally rotate the legs for more stability. Does it have a carryover to jumping, landing, running, & ACL prevention anymore?

CJW "Stop it Before it Starts" Symposium

2011-01-23T10:15:00.000-05:00

Sorry I haven't been posting. Been preparing and presenting down in Richmond Va. Great, smart enthusiastic, friendly people. The P.T. clinic is so cool! Think of a good high school or Collegiate A.T. room, not the typical assembly line style that is so popular. Minimal machines, with everyone up and moving. I got that warm fuzzy feeling as soon as I walked in and felt right at home. Interesting many of the patients pay cash to continue their conditioning and fitness beyond the rehab. I also found out why they laugh at what we call barbeque up here.

I took some hits on the NJ accent. I didn't think I sounded like Snooki and Tony Soprano but I guess it needs some work.

Very Timely

2011-01-16T12:40:00.000-05:00

Thanks for fellow GAINer Sal Marinello (http://www.salmarinello.com/) for bringing this to my attention:

"Relationship Betwen Core Stability, Functional Movement, and Performance"- Okada et al, JSCR Jan. 11.

A lot of great research is coming out of Indiana State lately. Stuart McGill's trunk muscle endurance tests along with the functional movement screen were used to determine the relationship between core stability, functional movement, and performance on the overhead medicine ball throw, T test, and single leg squat. Found a moderate to weak correlation. The authors go on to say that although core stability (as interpreted by McGill) is important, it should not be a primary emphasis of any training program.

If I understand what the authors are saying correctly is the "bracing" type exercises should be included as a general physical competency movement, but not used ad nauseum as a "corrective" exercise. The test exercises described require a "reactive core". The "trunk stability exercises" have stillness as their goal.

Vern Gambetta has some very good reactive core tests. One is to repeatedly laterally hop onto one foot while a teammate tosses a medicine ball to opposite sides of the torso.

"It ain't me babe"- Bob Dylan

2011-01-11T21:02:00.001-05:00

"The best trainers and coaches of all time find and fix weaknessess. The rest simply focus on strengths".

That's a quote from a well known physical therapist.

And I imagine I'll never be the best because it's the athlete's strengths I focus on first during rehabilitation & return to play. Set them up for success by finding that athlete's comfort zone & using it as my starting point. Gradually expanding their envelope of function by monitoring them both intra and inter workout; and making adjustments.

Great post by the Iron Maven

2011-01-10T21:03:00.000-05:00

http://ironmaven.blogspot.com/2010/11/nothing-by-slice.html

In this blog I am very guilty of serving it up by the slice. But at least I serve it up Jersey style with lots of sausage and anchovies. In my mindset the nature of blogging or tweating is serving up soundbites. Here we're only dipping our big toe into the lake of function. Please think about joining us at GAIN this June at Rice University in Houston Texas. Having the faculty of Vern Gambetta, Kelvin Giles, James Radcliffe, Tracy Fober, and Greg Thompson as rescouces is invaluable no matter what level of athletic development you're on. But what really sets GAIN apart is its members, which are presonally selected by Vern each year and return to join us.

Inverted Winshield Wipers

2011-01-10T20:24:00.000-05:00

This is an early phase neuromuscular exercise I am using for an athlete with a right shoulder subluxation. Think of the Oregon sway drill with the hands gliding in an upside down windshield wiper pattern on the wall. The glenohumeral jonint capsule remains protected throughout the exercise because the humerus remains in the scapular plane, and does not abduct above chest height. The closed chain pressure on the hands combined with the total body movement challenges this athlete's shoulder stability within his zone of function. No need to be concerned here about what muscle is firing when; the nervous system is conducting the concert. I got the idea of these exercises from Mabel Todd's (Dance instructor @ Princeton U.) book, "The Thinking Body" published in 1937. Doing the exercise with a partner, rather than the wall enhances it.

Joe P. speaking appearance

2011-01-09T14:03:00.000-05:00

I'll be speaking at the 3rd annual CJW "Stop it before it starts" Seminar in Richmond, Virginia this January 22 with Vern Gambetta.

http://cjwmedical.com/custompage.asp?PageName=sportseducation

The topic will be "Return to play considerations for the Elite Athlete", and teaching the PCA (Physical Competancy Assessment).

http://www.movementdynamics.com/

If you're in the area stop by and say hello!

Enough with the Turkish Get Up

2011-01-03T08:55:00.000-05:00

Teaching & learning it is very time intensive, and I'm not sure if what the athlete gets out of it is worth it. Compared to other things they could be doing with that time.

My last post of the year.

2010-12-31T08:23:00.001-05:00

Great comment on Fascia from British Osteopath Leon Chaitow:

"in therapeutic terms, as well as anatomically, there is little logic in trying to consider muscles and
joints as separate structures from fascia, because they are so intimately related. Remove connective tissue from the scene and any muscle left would be a jelly-like structure without form or functional ability, and joints would quite simply fall apart. We also now know that there exists a tensegrity-like state of structural and functional continuity between all of the body’s hard and soft tissues, with fascia being the ubiquitous elastic- plastic, gluey, component that invests, supports and separates, connects and divides, wraps and gives cohesion, to the rest of the body- the fascial, connective tissue network.

Any tendency to think of a local dysfunction, as existing in isolation should be discouraged as we try to visualize a complex, interrelated, symbiotically functioning assortment of tissues, comprising skin, muscles, ligaments, tendons and bone, as well as the neural structures, blood and lymph channels, and vessels that bisect and invest these tissues e all given shape, form and functional ability by the fascia."- JBMT 1-11 (pre-print)

As the pelvis goes so goes the rest of the body

2010-12-29T23:22:00.000-05:00

"Pelvic Control Of Professional Baseball Pitchers And Its Correlation To Pitching Performance"- McKenzie, ACSM '09 annual meeting.

"Pelvis & Torso Kinematics & Their Relationship to Shoulder Kinematics in High School Baseball Pitchers"- Oliver et al JSCR 12-10.

The first showed pitchers who tilted seven degrees or fewer during their stance transition had lower opponent batting averages (.244 vs. .290) and fewer walks and hits allowed per inning. Interesting, they did not have fewer injuries.

In the 2nd, the authors found a correlation between torso axial rotation speed and shoulder elevation angle (in other words, shoulder drag) in high school baseball pitchers.

Interesting, both recommended "core" training in the same or subsequent articles or lectures.

Couldn't this same concept of pelvic control be applied to other activities like running & jumping; or low back pain? The question is, is core training and pelvis stability exercise the answer. Or, is the unstable pelvis a manifestation of a generalized lack of strength & power in body? What would their PCA look like?

2010-12-26T18:39:00.000-05:00

Did I pervert the research here?

2010-12-26T17:28:00.000-05:00

"Scapular Muscle Recruitment Patterns: Trapezius Muscle Latency with and without Impingement Syndrome- Cools et al, AJSM '03".

Last month I got hammered pretty good on a discussion thread on the GAIN forum on this topic. The topic had to do with the use of traditional olympic bar pulling movements (shrugs, high pulls et al) in the training of throwing athletes. I made the point that these types of pulling movements create upper trapezius hypertrophy which can cause impingement syndromes in throwers and swimmers. This is one study, of several, which shows trap shrugging preceding middle/lower trap activity in subjects with impingement syndrome. Of course one could say this is an adaptive pattern that people with impingement syndrome take on subconsciously to avoid the portion of the arc that is painful.

My take on the matter is that this muscle firing sequence CREATES impingement syndromes/tendinitis. I first came up with the idea years ago when I was fortunate enough to take a course with Australia's Lyn Watson, a manual P.T. who specializes in shoulders. Lyn felt it had to do with the traditional shrug being more levator scapulae dominant than trapezius. The upper trapezius came more into play when the arms were pushing overhead.

I don't want anyone to be afraid to shrug or pull! In sports like volleyball, the shrug is an important part of the jumping/striking sequence. The same could be said for the javelin thrower, where the implement creates a long lever arm that the shoulder must contend with. But I still think they must be applied prudently in swimmers, baseball players and cricket bowlers.

These pictures are of one of my favorite thrower/swimmer exercises, the see-saw. It can be done with the bands attached to a fixed object, or better yet in opposition with a partner. It creates joint stability/power where you need it the most- where the arms are at the extremes of motion and switching directions. The "transformational zone" as Gary Gray calls it. The goal is to get straight arms behind the ears without arching the back. Many of your atheltes won't be able to do this with moderate resistance. And if they can't, they're really not getting hip to shoulder.

My point is that it's not only about hip to shoulder; but rather how you get hip to shoulder. My example has resistance applied with a horizontal vector bias. The middle/lower traps are integrated quite nicely. And so are the upper traps, but as opposed to a shrug, through a long lever arm. As the arms would during swimming and throwing, no? Think about it a bit, and let me know if I'm on target or just making some wild metaphysical leap with the research.

New Jersey: The Soprano State

2010-12-22T08:27:00.001-05:00

Corruption at every level:

http://www.nj.com/news/index.ssf/2010/12/nj_taxpayers_fund_millions_in.html

Poor, good for nothing quads

2010-12-21T05:06:00.000-05:00

I was just reading Vern's leg circuit post, followed by an article by a noted ACL injury researcher. The ACL article spoke of girls using a faulty quadricep dominent movement pattern, with the need to "teach them to activate their glutes & hamstrings more. Interesting, the recent strength coach roundtable I recently mentioned pointed to the same, but in all athletes. I wonder what running, cutting, and landing mechanics would like if the researchers injected a nerve block into the femoral nerve? Do these athletes need to be taught to fire their "posterior chain" better, or is this pattern a result of a poor leg strength foundation/progression?

Listen, do yourself a favor and save Vern's post to your hard drive:

http://www.functionalpathtrainingblog.com/2010/12/the-gambetta-leg-circuit.html

Can we have our food now?

2010-12-17T09:28:00.001-05:00

At 51 years old I still relax the same way I did as a kid, watching cartoons before I go to bed. There is a new episode of South Park where one of the parents decides to become a gourmet chef, quits his job as a geologist, and begins preparing his neuvo cuisine in the school cafeteria. The students are left standing there with their empty trays saying, "can we have our food now?" as the dad becomes totally immersed in his culinary skills and totally forgets he has hundreds of mouths to feed.

I had an email discussion with my buddy Pat Donahue, ATC at U.Illinois @ Chicago. I was inquiring about a new school of rehab he had experience with, and I asked him how it was working out. He brought up a very good point- that while its practitioners were claiming outstanding results, it just didn't fit into the A.T. concept. Very practitioner driven, one-on-one protocols. In the A.T. environment, our time is very precious to us. When we tie up our hands with manual techniques we must be sure we are getting the most bang for our buck. For instance, I do myofascial release. I choose ART and Graston because I feel they are very effective and extremely time efficient. However, it appears the Italian School of MF release (Carla Stecco) is really showing an edge. But it's just too time intensive for the typical A.T. setting.

I feel this philosophy goes well beyond the A.T. room as the health care dollar shrinks. We don't want to feed our athletes fish sticks and pizza, but we don't want them standing there with empty trays either.

Good question from Kev...

2010-12-16T09:17:00.000-05:00

"Could you define pelvic drop since I am unable to view the article please? Is it in the frontal plane? Would farmer and waiter carries be an appropriate exercise to address the QL and GM in order to encourage stabilization of the pelvis and reduce lumbar shear?"

pelvic drop=non weight bearing pelvis dropping in frontal plane= Trendelenburg sign.

In these subjects, in was occurring in Treadmill walking.
The point I'm getting out of this article, and others like it, is don't piece meal muscles (of course occasionally you need to, but not in this case). If we look at this issue from that point of individual muscle then we would also have to look at the same side erector spinae, the same side internal oblique, opposite ext. oblique- the list goes on and on.
As far as remedial exercise, Frans has a few that address the issue.
Others I can think of are SLS on the leg opposite the drop, while keeping the non weight bearing illum as high as possible...double time skips doing the same...extended walking/running in other planes & retro sagittal.

However, in my opinion it may be more of a physical competency thing. Not enough of a lower extremity strength & power base. Pelvic drop means the body is lollygagging in the force reduction phase, maybe as a protective measure. Opinions?

No Magic Muscles

2010-12-14T20:44:00.000-05:00

"The Relationship Between Hip-Abductor Strength and the Magnitude of Pelvic Drop in Patients With Low Back Pain- Kendall et al, JSR 12-10."

Pelvic drop in walking or running is not a good thing. It creates shear at the lumbar spine, is implicated in patellofemoral stress syndrome & medial tibial stress syndrome ("shin splints") et al.

These researchers wanted to know if strengthening the glut medius/minimus would improve the Trendelenburg sign (pelvic drop) during treadmill walking. This type of study has already been done studying floor exercise, but this one used, well, somewhat functional exercises. Interesting that while these two muscles did get stronger, it did not carry over to functional pelvic stability- the same result as the floor based strengthening exercises. But if you are a regular reader of my blog you'll understand why it didn't work. Remember Bosch's definition of strength training, "Coordination Training with resistance" and the outcome is no surprise.

GIRD of the hip?

2010-12-10T09:20:00.000-05:00

"Velocity in Professional Baseball Pitchers Passive Ranges of Motion of the Hips and Their Relationship With Pitching Biomechanics and Ball- Robb et al, AJSM 12-`10."

Not me saying that, it's the authors! Femoroacetabular dysfunction of the lead hip in baseball pitchers; causing loss of ball velocity and shoulder injury. And, it was the first article that I've seen that suggested a correlation between GIRD and hip dysfunction. The authors used fluid goniometry to assess passive AB/ADD, IR/ER of both hips (in prone by the way). Interesting they didn't assess Flex/Ext; it would have been interesting to see how they influenced the previous. A similar test was done recently by Todd Ellenbecker involving active ROM that didn't show as much of a deviation between R/L hips as passive ROM did. The authors chose passive because they felt it also measured accessory motion.

Be sure to evaluate lead hip active/passive IR on the whenever you see GIRD of the shoulder and/or elbow injury in throwers.

This is definately a case of "pattern overload" that could benefit from retro training, like doing some throwing with the opposite arm.

After Sid Viscious, the Ebonettes

2010-12-05T09:54:00.001-05:00

After coming to my neck of the woods we can see why Malcolm Mclaren got bored with the Sex Pistols. I always liked the Ramones better anyway.

Just think of the ACL injuries we could prevent Tracy!

High Ankle Sprain-Day 3

2010-12-05T09:33:00.001-05:00

Do your athletes still get advice to soak a sprained ankle in a bucket of hot water and epsom salts?
That's what happened here, but we survived it. If you can exudate the substrate out of the ankle mortise with good acute care and early minimal weight bearing exercise, the injury should look something like this. Aquatic therapy is particularly useful because of the hydrostatic pressure and weightless environment, so if you have access to a pool use it! With the tape job described in a previous post, this athlete is already ambulating without an antalgic gait! Ahhhh youth.

Functional Training= Purposeful training

2010-12-02T20:43:00.000-05:00

This is part of the on ground sequence I used today for my left "high" ankle sprain re-abilitation program. Whenever you choose to go to the ground you have to keep in mind you are in a gravity confused environment. So, the therapist needs to be certain they are getting something from the ground they can't get from upright function. In this case I'm using contralateral lower extremity drivers to mobilize the affected ankle; because the athlete is not ready for full weight bearing. I'm doing something that will enhance upright function and prevent soft tissue dysfunction.

Be wary of the mindless application of on ground function- it is rampant.

High Ankle Sprain

2010-11-30T21:19:00.000-05:00

I took a snapshot of this because you don't see this too often. An "isolated" high ankle sprain of the distal anterior tibiofibular joint. The deltoid, ATF, CF, and PTF ligs, and posterior tibiofibular ligs were spared. The transverse draw tests were negative for aberrant motion, but were minimally painful.

In this scenario the traditional Mulligan style taping for a positional fault of the distal fibula will give you good results; because it also provides good stabilization to the distal anterior tibiofibular joint. I'm expecting this athlete to make a fairly quick recovery.