The best pal a guy ever had

One of the worst days of my life; put my buddy down yesterday. 14+ years old, out living his breed by about a year and a half. A testament to his healthy lifestyle. This picture was taken a few years back on one of our typical winter Sunday mornings. A nice 3 mile run around Sandy Hook NJ, followed by a little stick fetching in the icy north Atlantic.

But it was much more than that. I first met him while running in the park when he was just a puppy. A beautiful woman was taking him for a stroll, and I used the excuse of petting him to say hello to her. She's now my wife.

Adios perro, ti amo.

Dissociation?

Journal of Bodywork & Movement Therapies, Oct. 09:

"The neutral spine principle, M. Wallden DO".
"The migratory fascia hypothesis, P. Lelean."

From page 351, "being able to dissociate the spine from the hips is a foundational movement skill".

?

First of all, Dr. Wallden did a great job of articulating his view on the topic. However, I'm still not buying into this. Yes, the neutral spine is something to be desired, but is it something that needs to be taught? Or, is the neutral spine a chain reaction of everything that went before it? On page 358 he gives a chart of pathological findings, and corrective exercises to ameliorate them. The problem is every one of the exercises focuses in on the spine itself.

At GAIN '09 I spent about 3 hours going over 2 case studies of athletes I worked with personally with low back back pain. In both cases, there were upper & lower extremity reasons why the athletes could not maintain a neutral spine. Not one isolated "spine" exercise was performed.

I think the second article I referenced kind of backs me up. The author discovered abnormal fascial folds throughout the pelvis & hips in patients , which produced facial strain patterns , which could contribute to iliolumbar strain patterns. The concept of rather than a weak spine, a spine that is biomechanically fed erroneous neural input.

I'm not sure if there is one size fits all here. I'll continue to rehab it as I see it.

Your opinion please

Occasionally I get snail mail, email looking for A.T.'s for clinical work. Not that I'm looking to leave my job, but I notice they all say, "clinical experience necessary". What are we traditional A.T.'s, chopped liver!? Don't we attack difficult issues week after week on this blog? We work with a challenging population, large volumes of patients, with limited resources, under difficult circumstances. Who wouldn't want a traditional A.T. on their staff?

JH and others who work in the clinic please give us your input of the mind set. If any readers have made the switch over, or switched over & come back to traditional, I would really enjoy your input.

On Ground Function: Hip to Shoulder

This is an exercise I'm using for an athlete rehabbing a L GH joint dislocation.

Pretty simple, it's I guess what you would call a modified scorpion.

Lying prone, shoulders & elbows @ 90-90.

The athlete reaches posterior left with their RLE & returns. This creates a chain reaction through the shoulder that challenges GH stability safely in what we used to call "closed chain". You may increase/decrease difficulty by raising/lowering the arm/elbow angle. You may also choose to do some self mobilization to the GH joint by placing a rolled up face towel beneath the proximal humerus. This provides a gentle posterior glide to the humerus in the glenoid as the leg comes around.

Ankle Sprains & Footware

Some great stuff out of the '09 International Ankle Symposium from this past summer:

"CLAIM AND COUNTERCLAIM: FOOTWEAR AND FOOT AND ANKLE MECHANICS DURING PHYSICAL ACTIVITY"
RICHARD SMITH, Discipline of Exercise and Sport Science, University of Sydney, Sydney, Australia.

Compared lower leg & foot mechanics during barefoot running to running with so called "neutral" & "dual-density" shoes. Their conclusion was, "The change is not always that which was intended by the shoe maker. The ground/shoe/rearfoot interface with the shank can be the
promoter or recipient of the motion drivers." Across the board there was more ankle motion/less mid-tarsal joint motion with the shoes. In the "stability" shoes, they noted tibial external rotation began much earlier than in barefoot-even while the knee was still flexing at ground contact. What do you think? Can this make one more susceptible to ankle sprains?

More on Concussions

High School ATC's who work with collision sports stay vigilant. Remember we get paid to watch the athletes, not the game. Athletes (some coaches too) think it's macho to ignore head injuries & will hide it from you. Here is an interview from the NY Times with an ex-Gators linebacker. He's only a year older than me yet has paid all his life from injuries 30+ years ago. He talks about how much has changed from those days, but has it really?

http://www.nytimes.com/2009/10/09/sports/ncaafootball/09concussions.html

Pete/Sarah Comments

Pete and Sarah had some great comments asking why I choose to not reduce GH dislocations on the football (American) field, which I thought deserved a post.

1. It's difficult to overcome heavily developed biceps/pecs/subscapularis without a forceful technique.
2. Even if you un-hook the shoulder pads, you still have the tight jersey to contend with.
3. Considering #2, it's very difficult to get enough ROM to do a Milch.
4. Along with Sarah's comment about the "audience", I've seen practitioners (including orthopedists), fail to reduce, get frustrated & embarrased, and use more & more forceful techniques.
5. The extra 1 minute walk or so to your A.T. table behind the bench is worth it compared to an ambulance ride & ER wait (remember I'm a hs ATC, no team orthopedist!)
6. Finally, in the spirit of this blog, it's only my opinion on what works best for me.