IASTM

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

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

Mi Muchacha Y Yo!

Intellectual Isolation

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

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

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

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

Boyle on Squats

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

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

Enough already!

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

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

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

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

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

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

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

Doctor Coughlan's comment

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

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

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

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

A little comic relief

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

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